SB715 (2020) Detail

Relative to cost controls in long-term care.


SB 715-FN - AS AMENDED BY THE SENATE

 

03/05/2020   0773s

2020 SESSION

20-2799

01/03

 

SENATE BILL 715-FN

 

AN ACT relative to cost controls in long-term care.

 

SPONSORS: Sen. Rosenwald, Dist 13; Sen. Sherman, Dist 24; Sen. Giuda, Dist 2; Sen. Bradley, Dist 3; Rep. Campion, Graf. 12; Rep. Marsh, Carr. 8; Rep. McMahon, Rock. 7; Rep. Nordgren, Graf. 12

 

COMMITTEE: Health and Human Services

 

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ANALYSIS

 

This bill clarifies the cost controls for long-term care services.

 

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/05/2020   0773s 20-2799

01/03

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty

 

AN ACT relative to cost controls in long-term care.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  Hospitals and Sanitaria; Consumer Choice.  Amend RSA 151-E:4, I to read as follows:

I.  A person who has been determined to be Medicaid eligible for nursing facility services in accordance with RSA 151-E:3 shall have the right to receive nursing facility services; however, the person shall be offered and may choose to receive services in a less restrictive setting if such services are available[ and do not result in costs to the state and counties in excess of the limitations set forth in RSA 151-E:11, II].  Such choice shall be offered in accordance with state laws and federal regulations.  The person shall have the right to have his or her individual support plan developed through a person-centered planning process regardless of age, disability, or residential setting.  The department shall take into consideration the family and community supports available to the person, the family's desire and ability to care for the person, and shall ensure that all consideration and support is offered to the family to maintain the person in home and community-based care.  Nothing in this section is intended to require the provision of financial assistance or supports by a family member.

2  Long-Term Care; Program Management and Cost Controls.  Amend RSA 151-E:11, II to read as follows:

II.  [For the fiscal year beginning July 1, 2003, and each fiscal year thereafter the average annual cost for the provision of services to persons in the mid-level of care shall not exceed 60 percent of the average annual cost for the provision of services in a nursing facility.  The average annual cost for the provision of services in home-based care shall not exceed 50 percent of the average annual cost for the provision of services to persons in a nursing facility.  No person whose costs would be in excess of 80 percent of the average annual cost for the provision of services to a person in a nursing facility shall be approved for home-based or mid-level services without the prior approval of the commissioner of health and human services.  The prior approval shall include a comparison of the mid-level or home-based care costs of the person with the costs of a facility qualified to provide any specialized services necessary for the proper care and treatment of the individual.]  The department shall provide a report annually no later than January 1 on the utilization of non-nursing home services to the county-state finance commission and the legislative fiscal committee.  The department may report to the county-state finance commission and the legislative fiscal committee more frequently if new information is provided by the Centers for Medicare and Medicaid Services.

3  Long-Term Care; Program Management and Cost Controls.  Amend RSA 151-E:11, IV to read as follows:

IV.  Pursuant to RSA 541-A, the commissioner of the department of health and human services, with prior reporting to the oversight committee on health and human services, shall adopt by rule[:

(a)] methodologies for determining the cost and average annual cost of home-based care, mid-level care, and intermediate, skilled, or specialized nursing facility care, including:

[(1)] (a)  Bases for the methodologies;

[(2)] (b)  Identification of services considered in determining costs;

[(3)] (c)  Average annual costs based on the annual average number of recipients in the setting;

[(4)] (d)  The requirement that nursing facility care include both the initial Medicaid rate and supplemental rates paid through the Medicaid Quality Incentive Program; and

[(5)] (e)  The requirement that the nursing facility will include the cost for transitional case management.

[(b)  A process to identify persons in home-based or mid-level care whose costs are expected to exceed 80 percent of the average annual cost for the provision of services to a person in a nursing facility.

(c) A standard of review and process for prior approval by the commissioner, in accordance with paragraph II of this section, for the cases identified through the process in subparagraph (b).]

4  Effective Date.  This act shall take effect January 1, 2021.

 

LBAO

20-2799

Amended 3/9/20

 

SB 715-FN- FISCAL NOTE

AS AMENDED BY THE SENATE (AMENDMENT #2020-0773s)

 

AN ACT relative to cost controls in long-term care.

 

FISCAL IMPACT:      [ X ] State              [ X ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

$0

$0

$0

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable Increase

Indeterminable Increase

Indeterminable Increase

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [ X ] Other - Federal matching funds.

 

COUNTY:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

$0

Indeterminable

Indeterminable

 

METHODOLOGY:

This bill removes language pertaining to cost controls on home- and community-based care services.  Current RSA 151-E:11 establishes that the average annual cost for mid-level care shall not exceed 60 percent, and the average annual cost for home-based care shall not exceed 50 percent, of the average annual cost for nursing home services.  In addition, current statute states that the prior approval of the commissioner of the Department of Health and Human Services is needed for any individual case in which the cost for home- or community-based services exceeds 80 percent of the average annual cost for nursing home services.  The Department states that while the fiscal impact of the removal of cost controls is indeterminable, the bill is unlikely to impact the majority of participants in the Choices for Independence (CFI) program.  Of the 5,316 individual program participants served by the program from July 1, 2018 through October 31, 2019, the Department states that it met the needs of 5,262 (98.98 percent) at 69 percent or less of the cost of nursing facility care.  The remaining 54 participants received services at 70 percent or more of the cost of nursing home care, including 17 over the 80 percent threshold.  For informational purposes, the Department notes that if every program participant currently receiving services at 70 percent or more of the nursing facility cost received services at 100 percent of the nursing facility cost, the additional annual cost would be approximately $1.3 million.  Of this, 50 percent would be paid for with state general funds and 50 percent with matching federal funds.  It is assumed that county funds will be unaffected, at least for the duration of the FY 2020/21 biennium, as the statutory cap on county expenditures will likely be met regardless of the passage of this bill.  The impact, if any, on county expenditures in FY 2022 and beyond is indeterminable and would depend on the specific dollar amount of the county cap established in RSA 167:18-a, II(a).

    

AGENCIES CONTACTED:

Department of Health and Human Services

 

Links

SB715 at GenCourtMobile
SB715 Discussion

Action Dates

Date Body Type
Feb. 4, 2020 Senate Hearing
March 5, 2020 Senate Floor Vote
March 19, 2020 Senate Floor Vote

Bill Text Revisions

SB715 Revision: 8224 Date: March 9, 2020, 2:30 p.m.
SB715 Revision: 8046 Date: Jan. 16, 2020, 9:08 a.m.

Docket

Date Status
Jan. 8, 2020 Introduced 01/08/2020 and Referred to Health and Human Services; SJ 2
Feb. 4, 2020 Hearing: 02/04/2020, Room 100, SH, 01:30 pm; SC 5
March 5, 2020 Committee Report: Ought to Pass with Amendment # 2020-0773s, 03/05/2020; Vote 5-0; CC; SC 9
March 5, 2020 Committee Amendment # 2020-0773s, AA, VV; 03/05/2020; SJ 5
March 5, 2020 Ought to Pass with Amendment 2020-0773s, MA, VV; Refer to Finance Rule 4-5; 03/05/2020; SJ 5
March 19, 2020 Committee Report: Ought to Pass SC 11