Revision: March 8, 2023, 12:32 p.m.
Health and Human Services
March 8, 2023
2023-0861s
05/07
Amendment to SB 36-FN
Amend the bill by replacing all after the enacting clause with the following:
1 Department of Health and Human Services; Eligibility for Assistance. Amend RSA 167:4, I(b) to read as follows:
(b) To the extent permissible under federal law, in the case of an applicant for public assistance or medical assistance who has made an assignment or transfer of assets to an individual for less than fair market value within [60] 36 months, or for up to 60 months if deemed necessary by the department based upon case specific information or extenuating circumstances, or in the case of transfers of real estate, or transfers of assets to a trust or portions of a trust that are treated as assets disposed of by the individual within [60] 36 months, or for up to 60 months if deemed necessary by the department based upon case specific information or extenuating circumstances, immediately preceding the date of application or while the application is pending, or in the case of a recipient of public assistance or medical assistance who makes such an assignment or transfer while in receipt of the assistance, the assistance sought shall only be granted or continue to be granted in accordance with rules establishing restrictions and eligibility criteria for such cases as adopted by the commissioner of the department of health and human services under RSA 541-A, subject to applicable federal regulations and waiver approval, if any, and review by the oversight committee on health and human services, established in RSA 126-A:13. The oversight committee on health and human services shall make a report to the legislative fiscal committee which shall have final approval authority.
2 Department of Health and Human Services; Medicaid Program; Medicaid Long-Term Care Eligibility Pilot. The commissioner of the department of health and human services shall, if necessary, seek approval from the federal Centers for Medicare and Medicaid Services (CMS) to implement a pilot to expedite Medicaid long-term care eligibility. The purpose of the pilot shall be to promote timely access to home and community based services (HCBS) by refining and improving the application process for financial and clinical eligibility so that access to HCBS services is more accessible to the individual, caregiver, and family. The department of health and human services shall implement the pilot at state designated access points. Notwithstanding RSA 14:30-a, the department may accept and expend any federal funds available for the purposes of this section without prior approval of the fiscal committee of the general court. The department shall begin the pilot on January 1, 2024. The department shall provide a report to the house health, human services and elderly affairs committee and the senate health and human services committee by January 1, 2025 regarding the pilot.
3 Personal Care Services; Definition of Personal Care Services Provider. Amend RSA 161-I:2, XII to read as follows:
XII. "Personal care services provider" means a person who:
(a) Is selected by:
(1) The eligible consumer;
(2) The eligible consumer's legal guardian;
(3) The eligible consumer's representative; or
(4) A person granted power of attorney by the eligible consumer; and
(b) Is employed by a home health agency or other qualified agency to provide personal care services; and
(c) Is not:
(1) The eligible consumer's legally responsible relative, except as authorized pursuant to RSA 161-I:3-a;
(2) The eligible consumer's legal guardian, except as authorized pursuant to RSA 161-I:3-a;
(3) The eligible consumer's representative; or
(4) A person granted power of attorney by the eligible consumer, except as authorized pursuant to RSA 161-I:3-a.
4 Personal Care Services; Authorization of Legally Responsible Relative. Amend RSA 161-I:3-a to read as follows:
161-I:3-a Authorization of Legally Responsible Relative, Guardian, or Person Granted Power of Attorney. The department may authorize reimbursement to a legally responsible relative, a guardian, or a person granted power of attorney by the eligible consumer, who provides personal care to an eligible consumer with special health care needs residing at home. Such reimbursement shall occur only when the department determines that the needs of the eligible consumer, the unavailability of appropriate providers or suitable alternative care services, and cost efficiencies make utilization of a legally responsible relative, guardian, or person granted power of attorney by the eligible consumer, for the provision of such services necessary and appropriate. Reimbursement shall be limited to care that is medically necessary due to specific health needs and shall not be made for care generally expected and provided by a legally responsible relative, guardian, or person granted power of attorney by the eligible consumer. The department shall not authorize reimbursement to a legally responsible relative, guardian, or person granted power of attorney by the eligible consumer, until a plan and rules adopted pursuant to RSA 541-A, are reviewed and approved by the oversight committee on health and human services, established in RSA 126-A:13.
5 Long-Term Care; Information and Referral. Amend RSA 151-E:5 to read as follows:
151-E:5 Information and Referral. The department shall establish a system of community-based [information and referral] aging and disability resource centers that provide information and referral services to [elderly and chronically ill adults] older adults and adults with disabilities. The [information and referral] aging and disability resource center network established under this section shall not be used for the purpose of political advocacy, but may inform and educate the general court regarding the extent of services available as well as the unmet needs in the community.
6 Long-Term Care; Person-Centered Counseling Program. Amend RSA 151-E by inserting after section 21 the following new section:
151-E:22 Person-Centered Counseling Program. The department shall:
I. Create a new person-centered counseling program in each contracted aging and disability resource centers (ADRC) to provide support and assistance to persons living at home or in short or long-term institutional settings, including hospitals, to transition into community-based settings. The program shall include referrals and support to access, at a minimum, but not limited to: assistance with completing Medicaid applications, referrals and access to Title III-B and Title XX services and programs, referrals and access to community-based services, housing, and other supports and services to meet the needs of the individual and their family.
II. Increase operational capacity in each ADRC to enable the provision of person-centered counseling services for adults, including but not limited to, educating consumers about available community-based resources for long-term services and supports, assistance with completing Medicaid applications, and assistance with the transition to access such services.
III. Establish performance metrics for each contracted information and referral resource center to assess each office’s ability to provide the services contained in this section.
7 Appropriation; Department of Health and Human Services; Person-Centered Counseling Program. The sum of $598,800 for the biennium ending June 30, 2025, is hereby appropriated to the department of health and human services for the purpose of funding the person-centered counseling program established in RSA 151-E:22. In addition to the appropriation and notwithstanding RSA 14:30-a, the department may accept and expend any federal funds available for the purposes of the counseling program without prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for the general fund portion of said sum out of any money in the treasury not otherwise appropriated.
8 Department of Health and Human Services; Classified Positions Established.
I. The following classified positions are established in the department of health and human services to support the person-centered counseling program established in RSA 151-E:22:
(a) Program Specialist III (Labor Grade 23, Step 5); and
(b) Program Specialist IV (Labor Grade 25, Step 5).
II. The sum of $190,000 for the biennium ending June 30, 2025, is hereby appropriated to the department of health and human services for the purpose of funding the positions as required in paragraph I of this section. In addition to the appropriation and notwithstanding RSA 14:30-a, the department may accept and expend matching federal funds without prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for the general fund portion of said sum out of any money in the treasury not otherwise appropriated.
9 Choices for Independence (CFI) Waiver; Rate Review. During the biennium ending June 30, 2025, the department of health and human services shall implement rate increases for the choices for independence (CFI) waiver in accordance with SB 86 of the 2023 regular legislative session. In addition, the department shall review and propose rates for the CFI program in accordance with section 1902 (a)(30)(A) of the Social Security Act and in accordance with the requirements under the 1915(c) Medicaid HCBS waiver program and provide a report to the house health, human services and elderly affairs committee and senate health and human services committee on or before July 1, 2024. The focus of the rate study is to promote efficiency, economy, and quality of care within New Hampshire’s CFI waiver program.
10 Department of Health and Human Services; Resource Disregard Enhancement Authority; Rulemaking. Pursuant to RSA 161:4-a, the department of health and human services shall enter into rulemaking, subject to the Centers for Medicare and Medicaid Services (CMS) approval as necessary, to increase the resource disregard to a maximum of $3,500 for individuals seeking nursing facility services or home and community based care under state waivers established under section 1915(c) of the Social Security Act.
11 Department of Health and Human Services; Report. The department of health and human services shall provide a status report to the house health, human services and elderly affairs and the senate health and human services committees by January 1, 2024, regarding the status of implementation of the changes outlined in this act. On January 1 of each year thereafter, the department shall provide an annual progress report to the committees regarding the ongoing impact of the changes outlined in this act.
12 Effective Date. This act shall take effect July 1, 2023.
2023-0861s
AMENDED ANALYSIS
This bill:
I. Revises the look-back period for medical assistance eligibility;
II. Establishes a pilot to expedite Medicaid long-term care eligibility;
III. Expands reimbursement eligibility for certain personal home care service providers;
IV. Renames the aging and disability resource center network for older adults and adults with disabilities;
V. Establishes a person-centered counseling program in the department of health and human services and makes an appropriation to the department this purpose;
VI. Directs the department of health and human services to conduct a rate review of the choices for independence program;
VII. Directs the department of health and human services to adopt rules increasing the resource disregard for purposes of determining eligibility for certain long-term care; and
VIII. Directs the department of health and human services to submit an annual report to the legislature regarding implementation the policies and programs outlined in the act.