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HHS Oversight Committee

Posted: March 14, 2016

The Health and Human Services Oversight committee conducted its month meeting this morning.
Of interest, Commissioner Meyers spoke about the budget and dashboard statistics. The department currently has a Medicaid deficit of about $22 million. There are about 138,000 people on Medicaid in NH. The deficit is a result of the state budget, which projected a slight decrease in caseloads, while the reality had been flat or slight increased caseloads. There are no plans to implement any budget reductions at this time.
Developmental Services Update:
The Commissioner said that he has spent a lot of time working with the Area Agencies since he became Commissioner. Both sides have made a lot of progress on all of the issues around the LBA audit and the DD waitlist. He reinterred that all parties want to fix these issues.
The Commissioner reported the following: data, by the end of June 30th all but about $700,000 of the 2016 waitlist funding is going to be spent. This will result in 291 people receiving services.
In addition, FYE June 30, 2017 “looks extremely promising.” By the end of the biennium about 477 people will be served with waitlist dollars. The total spend will be about $18 million. The Commissioner said we don’t need any legislative changes to solve the problem.
In addition, the Commissioner said that Step 2 of Medicaid managed, phase 1 (mandatory enrollment) has been going well. He is pleased with the progress thus far.
However, in terms of Nursing Homes and CFI Services, Meyers said we have a lot more work to do before we can move forward with placing those services into Medicaid managed care. We need a written plan that explains exactly how the program will be implemented. The program needs to be fully mapped out and understood by the public. Then we can move forward. There will be no waiver on CFI and managed care until the plan is complete. The same is true for nursing home services. The Department will meet with the MCO’s to discuss the ground rules and the time frame in the coming week. The Area Agency services will be looked at for managed care after CFI and Nursing services are work out. There is no time frame and there will not be a time frame on that piece for the foreseeable future.
Finally- A Public Hearing on Step 2
On Tuesday, March 15th at 2:30pm the Senate Health and Human Services committee will conduct a public hearing on whether the Department of Health and Human Services (DHHS) should be allowed to place long term supports and services into the hands of the commercial for-profit managed care organizations before June 30, 2017.
The bill to be discussed at the public hearing is SB 553 relative to implementation of the Medicaid managed care program. The legislation is sponsored by Sen. Forrester (chair of the Senate Finance committee) and has broad bipartisan support in its list of sponsors. Including 3 leading democrats in the Legislature. SB 553 would do two things, first it would prevent any further movement of Step 2 until July 1, 2017 and second it provides legislative oversight of any such move by requiring the Joint Fiscal Committee to approve any future step 2 plans by DHHS.
This legislation was filed at the request of NH Health Care Association (NH’s Nursing Home lobby) and it is expected to be supported by most of the stakeholders who would be impacted by proposed step 2 plans. This includes the public Nursing Homes (NH Counties) and independent case management companies. The Area Agencies through Community Support Network, Inc. are also supporting SB 553.
A public hearing in a legislative policy committee of the NH Legislature on Step 2 is long, over due. In 2011, during the initial legislative discussions on Medicaid managed care, Step 2 was not even part of the vocabulary of Medicaid managed care in NH. The plans of Step 2 were created after legislation was signed into law and right before RFP’s were issued to interested managed care organizations.
The current Medicaid managed care program may have resulted in some positive changes, however, it has also resulted in no less than 5 bills that were filed this legislative session. These bills aimed to fix problems with the program around transportation and prior authorization of medications/services. In addition, there are now over $50 million in new administrative costs as a result of the two MCO’s that didn’t exists before NH made the leap in Medicaid managed care. Finally, the two MCO’s have received constant (almost monthly) increases in their rates at the same time, many Medicaid recipients are being denied or delayed services that they are entitled to receive under the Medicaid program.
It’s time for our elected officials to ask tough questions about the Medicaid managed care program in NH and specifically step 2: What is it? Why is it proposed? How will it work? What does it mean for the people who depend on these supports? The SB 553 public hearing will provide an excellent opportunity for this discussion to happen.
HB 1394 relative to the appropriation for developmental services
On Wednesday, the NH House passed legislation (HB 1394) that will allow unused budget appropriations within the Bureau of Developmental Services to be carried over from the FYE June 30, 2016 to the FYE, June 30, 2017. This will allow DHHS and the Area Agencies more time and flexibility in getting budgeted dollars to the people that depend on Area Agency community supports. This current flexibility exists with waitlist funds, but not with other funds. The bill now moves to the Senate for further examination.

This week Governor Hassan gave her final address to the Legislature with her 2016 State of the State. Of interest, the governor spoke about the need for NH to address the healthcare workforce shortage in fields from direct care workers to pediatric nurses to psychologists. Hassan plans to set up a Task Force to work with the department of Health and Human Services on that effort and to bring forward creative solutions. She said “From those who experience disabilities to New Hampshire’s seniors, addressing this shortage will allow more Granite Staters to stay at home and live independently.”

House Panel Adopts Reauthorization of Medicaid Expansion and Kills HB 1550
This week the House Health and Human Services and Elderly Affairs (HHS&EA) committee voted 17-1 to reauthorize Medicaid expansion for two more years by passing HB 1696. This bill would largely keep the program intact as its currently working for over 40,000 NH residents. The bill does implement a modest co-pay in certain circumstances for emergency department visits. The program will continue to be largely funded by the federal government with NH Hospitals and Insurance companies paying for the remainder of the costs. The bill is on the House floor next Wednesday for a vote.

On another issue this week, the House HHS&EA committee killed HB 1550 which would have set up a confusing and parrell process for complaint investigations in the developmental services system. The bill was opposed by CSNI and DHHS.

Senate Health and Human Services Committee Adopts Positive Bill
This week the Senate HHS Committee voted to pass SB 491. Senator Hosmer filed this bill on behalf of his constituents who want more flexibility in where services are provided by Licensed Nursing Assistants (LNA’s) can be conducted. People on Medicaid who receive LNA services often want these supports provided in a variety of community settings and not simply in the home. This bill will encourage DHHS to seek federal approval for this to happen. As a companion piece to this issue, CMS has very recently issued a clarification that these services may indeed be provided outside the home. NH and other states were given time to change their regulations to help comply with the new federal requirements. This new CMS rule and SB 491 will help allow medically-necessary health care services to be provided to older adults and persons with disabilities in their residences and the community!

Want More? You can view all the legislation CSNI is tracking this session in the CSNI BILLS 2016 spreadsheet.

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