SB 715-FN - AS AMENDED BY THE SENATE
SENATE BILL 715-FN
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
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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.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
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty
Be it Enacted by the Senate and House of Representatives in General Court convened:
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.
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.
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).]
SB 715-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2020-0773s)
FISCAL IMPACT: [ X ] State [ X ] County [ ] Local [ ] None
Estimated Increase / (Decrease)
[ X ] General [ ] Education [ ] Highway [ X ] Other - Federal matching funds.
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).
Department of Health and Human Services
|Feb. 4, 2020||Senate||Hearing|
|March 5, 2020||Senate||Floor Vote|
|March 19, 2020||Senate||Floor Vote|
|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|