CSNI takes an active interest in Legislation (Federal and State) that could positively or detrimentally impact the developmental disability community. This is accomplished through monitoring proposed Legislation at the Federal and State level to ensure it advances the system, and responding to changing needs of those individuals with developmental disabilities and their families. CSNI has a dedicated group of Legislative Liaisons who educate through testimony, and actively informs self-advocates and parents of children who have developmental disabilities of pending legislation and proposed policy changes. CSNI tracks many bills on issues relative to developmental disabilities, acquired brain disorders and other health care issues.
CSNI News and Notes
May 24, 2016
SB 553 – VERSION ADOPTED BY BOTH BODIES
SENATE BILL 553
AN ACT relative to implementation of the Medicaid managed care program.
SPONSORS: Sen. Forrester, Dist 2; Sen. Carson, Dist 14; Sen. Feltes, Dist 15; Sen. Little, Dist 8; Sen. Reagan, Dist 17; Sen. Sanborn, Dist 9; Rep. Kotowski, Merr. 24; Rep. Ladd, Graf. 4; Rep. D. Brown, Graf. 16; Rep. Wallner, Merr. 10; Rep. Rosenwald, Hills. 30
COMMITTEE: Health and Human Services
This bill establishes procedures for the implementation of phase 2 of the Medicaid managed care plan.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
11May2016… 1745h 16-2745
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT relative to implementation of the Medicaid managed care program.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Medicaid Managed Care Program; Implementation. Notwithstanding any other provision of law to the contrary, the remaining unimplemented phases of the Medicaid managed care program, established in RSA 126-A:5, XIX, specifically nursing services; services provided under the choices for independence waiver; and services provided under the developmental disability, acquired brain disorder and in-home support waivers issued by the Centers for Medicare and Medicaid Services (CMS) under 42 USC section 1915(c), shall not be implemented until after:
I. The department of health and human services has prepared and adopted a comprehensive plan for the services to be incorporated into managed care.
II. The department has obtained approval by CMS of any waivers and state plan amendments necessary for the incorporation of such services into managed care.
III. The plan has been presented to the fiscal committee of the general court, the oversight committee on health and human services, established in RSA 126-A:13, and the county-state finance commission, established in RSA 28-B:1.
IV. The department has presented a report by the department’s actuary on the per member/per month cost of providing services within managed care under each plan to the general court. The report shall also identify all applicable rate cell information and include medical loss ratio information on managed care organization performance in the New Hampshire Medicaid care management program. The report shall be subject to the provisions of RSA 91-A.
V. The governor and executive council have approved any contract or contract amendment for the implementation of such services into managed care.
2 Development of Plan. The department of health and human services shall develop the plan for the incorporation of nursing and waiver services into managed care, as follows:
I. No later than 30 days after the effective date of this section, the department shall convene a working group consisting, at a minimum, of representatives of the following stakeholders: each managed care plan under contract with the state, the New Hampshire Association of Counties, the New Hampshire Health Care Association, Community Support Network, Inc., Granite State Independent Living, the Brain Injury Association of New Hampshire, Granite State Home Health Association, a member of the house of representatives appointed by the speaker of the house of representatives, a member of the senate appointed by the senate president, an independent case management organization industry representative, a member of the governor’s commission on managed care designated by the commission, and a member of the medical care advisory committee designated by the committee.
II. The working group shall be convened by the commissioner of health and human services and shall be subject to RSA 91-A. The department, in consultation with the working group, shall prepare a plan for the implementation of nursing and waiver services into managed care. Each plan shall include, at a minimum, a detailed description of the following: eligibility and enrollment, covered services, transition planning, prior authorization, transportation, pharmacy, case management, network adequacy, credentialing, quality metrics and outcome measurements, patient safety, utilization management, finance and reimbursement, rates and payment, grievance and appeals, and office of ombudsman. Each plan shall also address how the incorporation of the services into managed care shall achieve the legislative intent of providing value, quality, efficiency, innovation, and savings.
III. The plans for implementation of nursing and home care services provided under the choices for independence waiver into managed care shall be prepared prior to the plan for any other waiver services. The preparation of any plan by the working group for the incorporation of services provided under the developmental disability, acquired brain syndrome, and in-home supports waivers shall commence only after the completion of implementation of nursing and home care services under the choices for independence waiver into managed care.
3 Hearing; Public Comment. Each plan prepared by the department under section 2 of this act shall be subject to notice and public comment for 60 days and a public hearing.
I. The department of health and human services shall present an update on the status of the plan preparation each month to the fiscal committee of the general court and the oversight committee on health and human services until the plan has been implemented. The department’s updates shall also include managed care organization and department readiness for implementation.
II. No later than August 1, 2016, the department shall submit to the speaker of the house of representatives, the president of the senate, and the county-state finance commission, all proposed changes to state law the department believes may be necessary for the incorporation of nursing and waiver services into managed care.
5 Effective Date. This act shall take effect upon its passage.
April 20, 2016
LEGISLATIVE ALERT – HB 1680 NEEDS YOUR HELP!
EXTENDING THE MORATORIUM ON PRIOR AUTHORIZATIONS FOR DRUGS TO TREAT MENTAL ILLNESS
The major legislative priority of the NH Community Behavioral Health Association in 2016 was reauthorizing the NH Health Protection Program. We are happy to report that HB 1696 was signed into law two weeks ago by Governor Hassan. The community mental health centers are immensely grateful to legislators on both sides of the aisle who supported the bill, particularly Senators Jeb Bradley and Chuck Morse, and Speaker Shawn Jasper. We also want to thank our fellow healthcare advocates and providers for their hard work getting this legislation across the finish line!
But our other 2016 priority needs your help now: HB 1680, extending the suspension of prior authorization requirements for a community mental health program on drugs used to treat mental illness, which is pending in the Senate Health and Human Services Committee. Passage of HB 1680 will ensure that the most severely mentally ill individuals in our state do not experience delays or denials in getting the medications they need. In addition to NHCBHA, HB 1680 is strongly supported by NAMI-NH, the NH Medical Society, and the NH Hospital Association.
Since the State’s Medicaid program went to a managed care model in late 2013, two managed care organizations (MCOs) have made decisions about prescriptions using their own formularies and their own staff. They and the Department of Health and Human Services strongly oppose HB 1680, primarily for financial reasons. In spite of that opposition, HB 1680 passed the House Health and Human Services Committee and the full House unanimously last month.
Last year, the House and Senate passed a law creating a one-year moratorium on the use of prior authorizations for drugs used for severe mental illness. The hope was that consensus could be reached by the CMHCs, the MCOs, and the Department on changes to the prior authorization process before June 2016. However, medical directors at the CMHCs have reported continued problems with prior authorizations, and we have numerous examples of how our consumers have suffered. We need HB 1680 passed to continue the moratorium.
We know that the State has a financial interest in seeing that Medicaid managed care works, and we have worked hard with the State and the MCOs to make that system work as well. But we seriously question the figure of $3 million that the Department of Health and Human Services has used as the fiscal impact of the moratorium on prior authorizations; and we have yet to see specifics about which drugs are included in that figure. We have also pointed out to legislators that the MCOs are not responsible for the costs of NH Hospital, hospital emergency rooms, or jail, when patients are denied their prescriptions and end up there.
The community mental health system is one that has experienced many challenges over the years. In addition to inadequate fiscal resources, we continue to face significant workforce shortages due to an inability to offer competitive salaries compared to other healthcare providers; fewer medical students choosing psychiatry as their specialty; and the burden of paperwork that comes with being a designated community mental health provider. The additional workload resulting from an overzealous prior authorization process has only served to delay or deny necessary medications for patients and further reduce our capacity to provide timely access to care because prescribers need to spend more time and effort into advocating for necessary medications for their patients.
Our prescribers have no financial interest in the medications that are prescribed. They are trying to do what they believe is clinically and ethically best for their patients. The excess hurdles they are being required to jump over significantly decrease their availability to provide access to care in a system that is already under-resourced. Passage of HB 1680 will allow prescribers to focus on the provision of quality care to some of our most vulnerable and sickest citizens.
Please contact your Senators and ask them to vote YES on this critical legislation!
Members of the Senate Health & Human Services Committee representing this region are:
Chairman Sanborn, Sen. Avard, and Sen. Carson
Andy Sanborn Chairman
Molly Kelly V Chairman
Martha Fuller Clark
Contact information for all 24 Senators can be found at: http://www.gencourt.state.nh.us/Senate/members/senate_roster.aspx
April 15, 2015
SB 553 Had A Hearing in the House
The hearing on SB 553 was well attended today. Everyone from NH who spoke supported this bill. The MCO’s were allowed to speak, and were lukewarm in their support. Families spoke about the fact that the system for Step 1 is not working well, and their frustration with continually having to do prior authorizations on the same medications.
Thank you to those who wrote and provided testimony. The Health and Human Services and Elderly Affairs Committee chair said that they had heard the message loud and clear. They will vote in Executive Session and report to the full House in a week or so.
April 13, 2016
SB 553 Has A Hearing in the House
For those of you who may be planning to make the trip Concord on Thursday morning, a few tips that may make the experience an easier one.
1. Getting there– Take Rt. 93 to Exit 14 in Concord. Stay in the left lane as you come to the lights at the end of the ramp. Turn left, and go through several lights, passing through Main St. until you reach State St.where you take a left. You are now on the road that passes behind the State House. The Legislative Office Building (LOB) is directly behind the State House. Many of the parking meters will be covered and reserved for Legislators. Be sure that you bring quarters to feed the meter where you do park. The streets on either side of the State House are limited to 2 hours. My advice is to proceed past the large church on your right to the parking garage. Remember to get the number of the space you are in. You pay at the machines at the entrance.
2 We will be meeting in the lobby of the LOB at 9:40. You will be able to get your pink sticker there.The hearing is scheduled for 10 am in room 205. There may be another hearing that is still in progress, so be prepared to wait. If you have brought a sign, you cannot take it into the hearing room. If you have testimony, bring 20 copies, 1 for each of the committee members.
3 When you enter the room, look for the list to sign in, and indicate whether you wish to speak, and that you support the bill SB 553. There may be pink cards to sign in. If there are no seats left, you may stand along the back walls. When your name is called, go up, introduce yourself and where you are from and you have 3 minutes to make your points. When you are finished, if you are asked a question by one of the committee members, answer as best you can. If you don’t know the answer, say so. Keep an eye on the time, since the parking enforcement is quite busy. By the time noon arrives, the committee will end the hearing. Thank you for your efforts!
April 6, 2016
SB 553 Has A Hearing in the House
We know that is has been a little while since we have asked for you to engage in the goings on of the NH Legislature but we have some exciting news: Senate Bill (SB) 553 relative to implementation of the Medicaid managed care program is having a public hearing in the House Health and Human Services & Elderly Affairs committee and we need your help!
This bill (which has already passed the Senate on a vote of 23-0) would prevent DHHS from expanding the Medicaid managed care program before June 30, 2017. It would also require DHHS to receive legislative approval for any future expansions of Medicaid managed care via the Joint Fiscal committee.
As you know, for several years the Area Agencies and our families have been working hard to make sure that the Medicaid managed care program does not negatively impact people with developmental disabilities or acquired brain disorders NH. This public hearing is a great opportunity for our voices to be heard on this critical issue.
What: Public Hearing – this means you can testify or simply attend in person to show support. We need a lot of support!
When: Thursday, April 14th at 10am in LOB rooms 205-207
Where: The Legislative Office Building (LOB) is located at 33 N State St, Concord, NH 03301-Directly behind the State House. Bring quarters to feed the meters.
Why: The public hearing on SB 553 is an opportunity for our elected officials to discuss and ask tough questions about step 2 of Medicaid managed care. It is also a chance for families who have been negatively impacted by Medicaid managed care (step 1) to explain how the program has impacted their families medical services including prescriptions. The House members need to hear from their constituents that the Medicaid managed care program is not ready to be expanded at this time.
Who (should participate): All are invited to attend a public hearing especially those who receive services from the Area Agencies. It is also important to community members, school professionals, DPS’s and families/friends of those who receive supports.
How (can I help?): It’s easy really. There are many levels of support that you can offer! Choose one or a few
Come to the hearing wearing black. The color choice is simply because most people, even kids, own a black shirt, suit, sweater or dress-it has no other meaning. You will be given a large pink sticker to show your support for the bill.
Call your representative on the committee-Those from our region are Rep.Donald Lebrun, Vice Chair of the Health and Human Services Committee at 886-1725 or Donald.firstname.lastname@example.org and Rep.Stephen Stepanek at 673-7658 or email@example.com. We will organize calls to general members of the House later on when the full House votes on this bill- and ask them to support SB 553.
Write an email to a member of the committee See addresses above. Keep it short and polite. Include your name and city/town, ask them to support the bill as it was sent over from the Senate, tell them about how the delay would be helpful to you or your family and thank them. Also add a way to contact you, email or phone.
Testify at the hearing. If you choose to testify at the hearing please contact Dave Hackett at Dhackett@gatewayscs.org or Sarah Aiken at firstname.lastname@example.org to coordinate your message. While EVERYONE has the right to testify we want to respect the needs of the individuals and families time so a more coordinated effort helps that! You can also make posters to line the committee halls with. (Posters cannot be brought into the committee room.)
Your voice makes a difference. Stay involved!
March 23, 2016
This afternoon the State Senate passed an amended version of SB 553 relative to implementation of the Medicaid managed care program.
The only change to the bill as introduced is that all Step 2 Phase 1 populations (Katie Beckett, Dual Eligibles) would remain in Medicaid managed care for their medical or state plan services.
SB 553 states that the remainder of step 2 of Medicaid managed care shall not be implemented before June 30, 2017. It also requires Fiscal Committee approval for any further DHHS actions on implementing Step 2.
The bill passed on a roll call (recorded) vote of 23-0.
SB 553 now moves to the House Health and Human Services committee.
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.
September 15, 2015
Breaking News: NH state budget deal reached
By GARRY RAYNO
State House Bureau
CONCORD – A budget compromise will be announced at noon today in a press conference according to sources.
The deal would come one before the House and Senate return to Concord to vote on Gov. Maggie Hassan’s veto of the $11.35 billion, two-year budget that passed with only Republican votes.
The final sticking point between Hassan and Senate President Chuck Morse, R-Salem, and House Speaker Shawn Jasper, R-Hudson, were business tax cuts and how they would be implemented.
Most other issues such as a pay raise for state employees and additional money for drug treatment, prevention and recovery programs were already agreed to by both sides.
The key to a compromise’s approval are the House members of the conservative Republican Majority Caucus, led by former Speaker Bill O’Brien, who is expected to tell his caucus to vote for the override, but not to suspend the rules to introduce a new bill that would contain the compromise agreement at a caucus this morning.
April 3, 2015
Media Reports from April 1, 2015 vote at NH Statehouse
March 30, 2015
Learn More About the Budget on WMUR’s Close Up click on below
Support restoring developmental services funds by coming to the State House this
Wed, nesday, April 1, at 9 am!
March 27, 2015
The attached “Floor Amendment” will be offered on the House floor on Wednesday, April 1. It is amendment #1168h and sponsored by Reps. Wallner, Nordgren and Rogers.
The amendment restores the Developmental Services system to the Governor’s funding level, reversing a $52 million total fund cut by the House Finance committee.
The amendment will restore the AOA and SSBG funding to the Governor’s levels under the BEAS budget.
In addition, the amendment restores state funding funding for ServiceLink.
Finally, at the bottom of the amendment there is a restoration of funding for emergency shelters for the homeless population.
March 23, 2015
Good budget news from House Finance Committee at 2:15 today! Please know that the House Finance Committee just restored the Optional Medicaid Services for adults of 21 years of age. You will recall that these services are inclusive of ambulance services, audiology, speech therapy, OT, personal care, etc.
It is clear that advocacy and calls to House members expressing concern for such dramatic cuts are having an impact. Please continue to speak up – CALL YOU REP — in favor of a budget that provides adequate services for DD/ABD.
March 23, 2015
Proposed Health and Human Services cuts create uncertainty across N.H.
By CASEY McDERMOTT Monitor staff
Sunday, March 22, 2015
(Published in print: Monday, March 23, 2015)
Today, members the House Finance Committee – the ones tasked with reviewing Gov. Maggie Hassan’s budget proposal – will meet to go over the plans they’ve come up with for their own version of the state’s financial roadmap for the next two years.
For the last week, the division that oversees funding for the Department of Health and Human Services has whittled away at a number of programs – in some cases, eliminating state funding entirely and jeopardizing the accompanying possibility of federal funding along with it.
In votes that were mostly split along party lines, with Republican representatives supporting the cuts and Democratic representatives opposing them, committee members opted not to renew the state’s Medicaid expansion beyond the end of 2016 and not to extend substance abuse coverage to the state’s traditional Medicaid population. They also completely eliminated Medicaid coverage for so-called optional services such as wheelchair vans, private duty nursing and hearing aids for people older than 21, resulting in an estimated savings of $8.6 million in general funds.
They voted to take away all state funding for ServiceLink Resource Centers – used heavily by the state’s elderly population, veterans and people with disabilities – to the tune of about $2.6 million, which will also likely result in the loss of additional federal funding. They also cut state funding for “social services for non-Medicaid eligible elderly clients” – such as home meal delivery and transportation services, for example – by about $10.5 million, or about half.
They decided to delay by a year the opening of a 10-bed crisis unit at New Hampshire Hospital, which was supposed to open in July. This unit was meant to allow people experiencing a mental health crisis to be admitted more quickly and to alleviate the days, sometimes weeks, of waiting many are otherwise facing in hospital emergency rooms across the state.
They reduced funding for the Division of Developmental Services by an estimated $52 million, half in the form of general funds and half in the form of matched federal funds.
They decided to cut funding for the state’s emergency shelters – which provide help to people who are homeless and in other crisis situations, such as domestic violence – in half, taking away an estimated $4 million over the next biennium.
In explaining these and other proposed reductions, House finance officials have said the state simply cannot afford to spend at the levels proposed by Hassan in her version of the budget. Lawmakers also point to increased spending required by two recent settlements, one involving the state’s mental health system and another involving the Medicaid Enhancement Tax, as major cost drivers that need to be balanced out with reductions elsewhere.
“A budget is a balance,” House Finance Committee Chairman Neal Kurk said in an interview Friday morning, following a week of deliberation over these and other proposed reductions. “All of us would like to make sure our fellow citizens get every possible service from the state to the extent that their lives have been transformed by congenital or accidental injury or disability, but it’s not always possible for all needs of all people to be fulfilled all of the time.”
The proposed budget, Kurk said, “provides at least for basic needs.”
An estimate for the total, immediate cost savings achieved by these and other actions was still being finalized heading into this past weekend. An update on the reductions will likely be released today.
But already, many – from Nashua to the North Country – are worrying that some of these decisions, if carried through, would have devastating consequences for the state’s most vulnerable residents.
‘My life . . . would be over’
For Jeff Dickinson, the most troubling of the proposed cuts are the ones that would eliminate “optional” Medicaid services. As advocacy director for Granite State Independent Living, he knows hundreds of people who might be affected by the state’s decision to no longer pay for these services – but he’s also worried on a personal level.
Dickinson has muscular dystrophy, and he relies on personal care attendant services – one of the categories that would be eliminated under the House’s proposal. This, he said, allows him to “remain independent, continue working full time, pay my mortgage and live where I choose to live.”
“Without these (personal care attendant) services I am not sure how I would get out of bed, get dressed, fix meals, toilet, shower, and do all of those regular activities that most people usually take for granted,” Dickinson wrote in an email. “Truth be told, I wouldn’t be able to. I would be forced to live in a nursing home where I do not want to be. It is not an exaggeration to say that my life as I know it would be over.”
The private duty nursing services – which, in Dickinson’s case, are necessary to monitor his use of a ventilator overnight in case the device would malfunction – would also be eliminated.
“For people that receive these services,” Dickinson wrote, “there is nothing optional about them at all.”
Without the support from the state, HHS Deputy Commissioner Marilee Nihan said, many families will be left with few alternatives for maintaining the care they rely on. According to the most recent data, provided by Nihan: About 10,000 people are currently using ambulance services that would be eliminated; about 3,000 people are using speech and occupational therapies, each; and about 2,500 are using audiology benefits, such as hearing aids.
“We’re talking about families who make $15,000 a year, they don’t have a lot of options,” Nihan said. “They certainly don’t have the resources to be able to fund some of these services themselves.”
In some cases, Nihan said, if families choose to forgo these services because of a lack of money, that could ultimately create more problems for the state – resulting in worse health for those residents and more pressure, or “downshifting,” onto local welfare offices.
Families face uncertainty
Earlier this month, Darienne McGuinness of Stratham attended the finance committee’s public hearing on the budget in Concord. There, the mother of three urged lawmakers not to reduce funding for developmental disability support services. Her oldest son, 11, has autism and receives services through the in-home support waiver program.
Those services, along with others provided through the state’s network of 10 nonprofit agencies that provide support to families caring for loved ones with developmental disabilities, would likely be affected by the reductions proposed by lawmakers last week.
On Friday, McGuinness was one of several family members gathered in Concord for part of an advocacy training workshop through the New Hampshire Leadership Series. She and several other families there – caring for children between ages 6 and 25 – watched lawmakers’ actions with trepidation about the ramifications of the reductions to developmental disabilities funding.
Consistency is especially important when you’re caring for a child with a disability, they said, and the support services that fall within the realm of the proposed reductions provide just that.
“Kids who experience disabilities need consistent support in order to maintain safety and skills throughout their lives,” said Jill Prakop, a parent from Derry who is on the waiting list for support services for her two children, ages 7 and 9. “That’s after 3 o’clock, you know, what they get in school. They need that at 4, 5, 6, 7 o’clock when they’re out in their communities with their parents.”
Thanks to the availability of those kind of supports, Michael Poulin said his son Brandon, now 25, is able to live independently in his own apartment in Nashua. It was “a long road to get him there,” Poulin said, but it was worth it.
“He wants to be independent, he wants to have his own life, he does have a job – it’s working minimal hours a week,” Poulin said. “He just loves going out into the community, and he wouldn’t have it any other way.”
To help make that possible for Brandon, his family relies on help from personal care service professionals – which might be cut under the House budget proposal.
“Our biggest fear is that, with the loss of losing that, it would be a step backwards,” Poulin said. “Our goal is to reduce his budget over time, and we’re really doing good in getting there – if it takes a step backwards, when we’re dead and gone, we just fear what would happen to him when we’re not here anymore and he doesn’t have them anymore.”
Jennifer Pineo, whose 6- and 10-year-old children are both on the autism spectrum, said she wishes legislators realized that reducing access to family supports has not only a significant financial impact on the families affected – it also affects the community, even the state, as a whole.
“We’re doing a lot of work with a little bit of funds,” said Pineo, who lives in LIttleton and sits on the board of the advocacy group ABLE NH. “And I know when you look at it all together it seems like a lot of money, but when you look at what it would cost if they were in other places or not within the family, it’s going to cost a lot more – supporting us so we can stay as family units and work through that is going to be more cost-effective than, you know, decimating our system.”
ServiceLink acts as lifeline
Paul Robitaille, manager for the ServiceLink Resource Center of Coos County, is similarly worried about what the elimination of state funding would mean for the future of his center. Located in Berlin, the Coos County facility logged about 15,000 contacts with clients – some of which included multiple contacts by the same people – last year.
“It would leave a tremendous hole,” Robitaille said. “I don’t know what goes on in a lot of other counties, but here in Coos County, we’re used to partnering with a lot of other agencies.”
The ServiceLink centers, he explained, act as a kind of “front door” for other support services in the community and the state at large. Older adults come in for assistance with making sense of their Medicare options, he said, while veterans can get help applying for benefits through the U.S. Department of Veterans Affairs. Low-income residents can connect with job training programs, housing assistance and more.
Many of the clients who seek help through ServiceLink are not computer literate, Robitaille added. Navigating through cumbersome, confusing online applications, phone menus or paperwork can get in the way of connecting people to the benefits they need, he explained.
“If ServiceLink is not here,” Robitaille said, “those questions do not get answered, and those people fall through the cracks.”
Rep. William Hatch, a Democratic lawmaker from Gorham, used to sit on the board of the Coos County ServiceLink. Particularly in rural regions of the state, he said, these centers are lifelines for people in need.
The loss of this program, combined with the potential loss of programs like at-home meal delivery for seniors, could make it more difficult for the state’s older population to remain independent in their communities, he said.
“This is real stuff,” Hatch said. “They do so much more than drop off meals three times a week. . . . This service enables people to stay in their homes, to not have to go to assisted living, to not have to go to a nursing home, which in many cases costs a lot more than having meals delivered.”
Cuts create HHS challenges
As lawmakers debated these and other proposed cuts, top department officials spent much of the week responding to questions and attempting to convey the potential toll of reductions.
The cuts, according to Nihan and other officials who were at the center of the budget discussions, will result not only in wide-reaching changes for the people who rely on the department’s services, but will also create significant administrative work for the department.
In some cases, the state will need to seek federal approval for proposed changes to its Medicaid program – something it’s had to do repeatedly in recent years, Nihan said. This, in part, has led federal officials to approach New Hampshire with increasing scrutiny, she said.
The state is also in the process of renegotiating contracts with the companies involved in its Medicaid managed care program, and those negotiations will also be affected – perhaps prolonged, officials said – by some of the representatives’ actions.
While Nihan hesitated to pick out one action that will have the most significant impact on the state – “I think they’re all egregious, contentious” – she said the decision to end the state’s Medicaid expansion is particularly disappointing.
Not only did the department and the state invest significant energy and resources getting the program off the ground in the last several years, she said, but now the 37,000 people who signed up for coverage through the expansion could end up “right back where they started” without access to affordable health care coverage.
And while Nihan and other officials have come to expect lawmakers to put forward some reductions, the outcome of last week’s votes was far more drastic than the department was expecting.
“There is virtually nothing in the work that DHHS does that went untouched,” Nihan said, “and nearly every single client who seeks services with DHHS is going to be impacted in some way.”
March 20, 2015
The House Finance committee, Division III has nearly completed their work on the state budget. Division III was responsible for the Department of Health and Human Services’ budget. The following are changes (from the Governor’s proposed budget) the committee has recommended to the full Finance committee. The House Finance committee (as a whole) will vote on the entire budget on Monday, March 23. The NH House votes on the entire budget on April 1. Please note that there have been some changes from previous decisions of the Division.
The following reductions will mean that the waiting lists for DD, ABD and IHS will increase dramatically over the next two years. In addition, the 11,000 families who benefit from Family Support will see services such as respite care or environmental modification reduced or eliminated.
Medicaid and Family Support Funding: The Developmental Disability, Acquired Brain Disorder, In Home Support and Family Support budgets have been reduced by a total of $26 million in general funds (State funds) or $52 million in total funds (State and Federal). In addition, the 3 Medicaid Waiver programs or accounts will consolidated into a single account. The reduction to Family Support will be “proportional” to the $52 million reduction. The funds will be non-lapsing, meaning if any dollars are not used in the first year of the new budget they will automatically be transferred to the second year of the biennium.
Optional Medicaid Services (Medical Services): The budget includes language that eliminates many optional Medicaid services for adults over 21 years of age. Please see the attached amendment for the complete list of services that were eliminated.
Medicaid Managed Care: The Division adopted language allowing the two Medicaid Managed Care Organizations to use their own preferred prescription drug lists. The Division also adopted language that requires DHHS to realize about $7 million of savings in year two (FY ’17) by moving forward with Step 2 of Medicaid managed care. Finally, the Division adopted language that forbids DHHS from setting the reimbursement rates for Step 2 providers in year one of the program. DHHS had planned to set rates for Step 2 providers in year one of Step 2. This will no longer be the case under the Division’s budget. The specific language only references CFI and Nursing Services. Please note that the budget no longer assumes Area Agency Step 2 savings as an earlier proposal had contemplated.
Area Agency Consolidation: Thanks to the work of The Community Support Network, Inc. educating key lawmakers, the Division III recommended budget does not include language requiring savings from Area Agency consolidation. There is budget language requiring savings from DHHS District Office (DO) consolidation.
March 18, 2015
Media Reports on State Budget
Union Leader: House budget writers trim from Health and Human Services
WMUR: Veterans, police, university system could face budget cuts
NHPR: N.H. House Budget Writers Slash H.H.S. Funding
Today Governor Hassan Announces: 3.9% Unemployment Rate in NH
March 12, 2015
House Finance Committee Plans Extremist Budget Reductions
Since receiving the State Budget about a month ago, the House Finance committee has done very little public work on HB 1 and HB 2. This week the panel announced that they plan to slash hundreds of millions dollars from NH’s budget. The current proposal is that DHHS alone will be cut by $60 million in general funds or state funds from current spending levels in the ’16/’17 budget! In other words, if the House Finance committee has their way the next two years will spend less than the current budget.
Despite an improving economy, strong state revenues and low unemployment, the Finance committee has apparently made the determination that not only does the Governor’s proposed budget invest too much money, but also our current state budget needs to be slashed and burned. Yes, this is the current budget, which was nearly unanimously approved by a Republican State Senate and a Democratically controlled NH House in 2013.
Why is this happening? The GOP controlled House has no intention of adopting any proposal that would give the state any significant new revenues. In addition, the House is adopting revenue projections that current taxes will raise much less money than the Governor is predicting in her budget proposal.
What this all means for specific DHHS services and programs is still completely unknown, however, at this point it is clear that the Governor and the House Finance committee are miles and miles apart in terms of the level of investment needed in NH’s state budget.
What can you do? The House Finance committee’s proposed actions are extreme and unwise. If you care about NH’s future I would encourage you to reach out to the House Finance committee and ask them to put together a reasonable budget that does not dismantle critical human services. There is some hope, the chair of Division 3 called the $60 million DHHS cut a “moving target.” Meaning there is an opening to lessen the amount of money currently being proposed to be reduced.
The Legislature’s website: http://www.gencourt.state.nh.us
February 11, 2015
At this point in the legislative session, CSNI has identified the attached 29 pieces of legislation that we will monitor and/or actively advocate for or against. This list could change at any time. Of interest are bills relative to the governance and taxation of 501 c 3 charitable organizations and the prohibition/elimination of the ability of NH employers to seek waivers from the Department of Labor to pay people with a disability less than the minimum wage for certain jobs. Special education and education in general are always hot topics in the Legislature and 2015 is no different. See attached for more information on those bills.
There are two bills this session that were of concern to CSNI that have already been dealt with in a favorable manner. The first is HB 569 this bill would subject many 501 c 3 organizations to the Business Enterprise Tax (all charitable organizations, like 501 c 3’s are currently exempted). The good news is that the House Ways and Means committee has voted to “retain” the legislation for one year of further study.
On another subject, the House Health and Human Services and Elderly Affairs committee has killed HB 687 relative to eligibility for Medicaid. This bill would have required DHHS to hire a technology vendor to conduct Medicaid eligibility on behalf of the state and DHHS. There was a concern that this bill could have many unintended consequences. The committee, seeing no need for the bill, promptly killed it.
Yesterday, the House and Senate held hearings on two bills that would prohibit the payment of sub-mimum wages to people with disabilities. This issue has gained traction following a fall study committee that recommended NH adopt the policy of removing the ability of the Executive Branch to grant employers the ability to apply for waivers to pay people with disabilities less than the minimum wage. The bill has received strong support from various stakeholders. The two bills are HB 411 and SB 47.
January 29, 2015
Please see attachment for 2015 Bills for CSNI
2015 Bills CSNI
Joint Fiscal Committee & Medicaid Expansion Update
This morning the Fiscal Committee met and voted to approve NH’s application for a Premium Assistance Medicaid Waiver.A copy of the full 125 page application can be seen here:http://www.dhhs.nh.gov/pap-1115-waiver/documents/final-waiver-app-11072014.pdfDHHS will soon be submitting the waiver to CMS and the Department hopes to have approval of the waiver by the end of March. Jeff Meyers, Assistant Commissioner reviewed the waiver’s Executive Summary (included in link above) with the Fiscal Committee members this morning.Health and Human Services Oversight Committee The Health and Human Services Oversight committee conducted their final meeting of the legislative term this morning. A new committee will likely reconvene sometime in January.A report on the DD/ABD Wait lists as of September 30, 2014 was distributed to the committee. Please see attachedCathy Spinney, representing the Developmental Services Quality Council, presented the attached information relative to Medicaid managed care and Developmental Services.Some other brief and new items of interest included:
- Commissioner Toumpas reported that 9 mental health centers recently entered into contracts with one MCO and those new contracts include a “new payment model.” The 9 Centers are “close to agreement” with the other MCO. It was noted that 1 mental health center has had a contact for several months with both MCO’s.
- DHHS presented a list of legislation that they will be seeking in 2015. Please see attached. The vast majority of these bills are non-controversial and technical in nature.
- The Commissioner stated that legislation will be required for nursing homes to move forward with Medicaid managed care. This is because of the uniqueness of two key funding streams: Proportionate Share Payments (ProShare) and Medicaid Quality Improvement Program (MQUIP).
- The Department will be taking real world examples of individuals who have has problems with Step 1 of Medicaid managed care and begin working with the MCOs’ to try and work through the issues in a type of role play scenario/training.
November 6, 2014
House-Senate 2015 Election Summary
October 27 2014
How to Contact Your Legislator
To locate your Senator or Representative: go to www.nh.gov/government/state.html, choose “Legislative Branch” and click on “Who’s My Legislator?”
- Be friendly – legislators are happy to hear from constituents
- Remember – quantity matters. If a legislator hears from 5, 10, or 50 people, that is a groundswell
- Introduce yourself – give your name and town
- State your reason for contact – “I am asking you to support/oppose (issue, bill, etc.)”
- Use Bill number, sponsor and title if your contact is about legislation
- Tell your story (briefly) – how this will impact you, your family, people you care about
- Thank your legislator for the time and attention, for the support, for the vote. Call/write/visit again. When you establish a record of reasonable, positive correspondence you develop clout on future issues.
- You are not imposing by calling – legislators appreciate learning more about the issues they face
- Leave a message – state the bill number, your position, and a phone number in case there are questions
- If you don’t know the answer to a question, say you will get the answer and call back, and then follow u
Write a Letter:
- If you use sample letters, add a personal touch if you can
- Do not use postcards
- Use personal stationery or letterhead if available
- Include your name and address on the letter â€“ envelopes may get discarded
- Typed letters are easier to read, but handwritten letters are more personal (if they are legible)
- Make an appointment
- Introduce yourself – even if you’ve met before
- Get down to business quickly
- Ask what you can do
- Leave written material
- If you are contacting your own legislator, put your name and town in the message
- Don’t use attachments; not everyone can open them
October 1, 2014
2014 GENERAL ELECTION CANDIDATES
Thursday, July 3, 2014
CONCORD, N.H. (AP) — Preliminary figures show the state ended its two-year budget cycle with a $5.8 million dollar surplus on the revenue side, lower than the $26 million that budget writers projected.
The Nashua Telegraph (http://bit.ly/1jMBUR1) reports that figures released Wednesday show a boost in business taxes, tourism and tobacco taxes helped produce the surplus. The state has a $10.7 billion two-year budget.
State officials were still cautious. Last month, Gov. Maggie Hassan got legislative approval to freeze non-essential hiring, travel and equipment purchases. Two other reasons for concern: Taxes on interest and dividends are down $16 million for the year and taxes on telecommunications sales fell $4 million.
Final numbers will come out in three weeks and the surplus could shrink if spending controls are not met
State ends fiscal 2014 with $5.8 million revenue surplus
Revenues are on target for fiscal year 2014, but business and interest and dividend taxes pose a problem in coming year.
GARRY RAYNO, Union Leader
State House Bureau
CONCORD — In a preliminary report, the state ended the 2014 fiscal year with a $5.8 million revenue surplus for the $2.17 billion general fund budget.
After several months of concern over sliding revenues, June produced more money than state budget writers estimated by $5 million, although $1 million is because of a Justice Department settlement.
Gov. Maggie Hassan noted June revenues are on target as a result of a strengthening economy that has boosted some state taxes, although others continue to lag.
“We continue to see shortfalls in business taxes and the interest and dividend tax, which appear to be related, at least in part, to a number of changes in the state tax code in recent years, as well as to businesses beginning to apply various tax credits and carry forwards accrued during the recession,” said Hassan, who last month imposed a freeze on hiring, out-of-state travel and equipment purchases that use general funds.
Senate President Chuck Morse, R-Salem, noted good business enterprise tax returns mean businesses are creating jobs, and good rooms and meals tax recipients show the summer tourist season is off to a good start.
“With revenues on plan, it is imperative that state agencies are meeting their spending and lapse figures to ensure the budget remains balanced and spending does not exceed the revenues we’ve collected,” Morse said. He called for Hassan’s office to update the Joint Legislative Fiscal Committee at its meeting near the end of the month so budget writers can evaluate the state’s financial picture heading into the second year of the biennium.
The biennial budget lawmakers passed a year ago, assumes a $26 million surplus for the 2014 fiscal year which ended June 30 to have a balanced budget at the end of the biennium June 30, 2015.
The state collected $2.175 billion during fiscal year 2014 in unaudited figures released by the Department of Administrative Services Wednesday, showing a $5.8 million revenue surplus. The state collected $2.27 billion in general fund revenue in 2013, but that includes $47 million from a tobacco company settlement and federal nursing home money that is no longer included in the state’s general fund.
June is one of the largest months for business taxes payments, and state budget officials were concerned about recent returns. Business taxes produced $90.6 million in June, which is $800,000 less than estimates.For the fiscal year, business taxes totaled $553.6 million, which is $7.5 million below estimates, but $1.6 million more than a year ago.
The interest and dividends tax continues to be a concern said Administrative Services Commissioner Linda Hodgdon as it produced $12.1 million for the month, which is $1.6 million below estimates.
For the fiscal year, interest and dividend taxes produced $80.1 million, which is $16 million below estimates and $13.1 million less than collected in 2013.Budget officials believe changes made in the interest and dividends tax in 2012 are also having a significant impact on the levy. Lawmakers changed the state’s trust laws so that trusts established by an entity or person who gives up the right to the principal or what are called non-grantor trusts would be exempt from the interest and dividends tax.
Former Gov. John Lynch vetoed the bill but the Republican-controlled House and Senate overrode his veto.
For the 2014 fiscal year, the communications tax was also problematic, producing $3.8 million less than anticipated at $58.7 million. Collections were down in June by $300,000.
However, rooms and meals, tobacco and real estate transfer taxes were all at least $3 million more than budget writers anticipated, as were liquor commission profits.
In June the tobacco tax was up $4.5 million at $23.7 million, while the rooms and meals tax was up $1.3 million at $22.2 million.
Along with business and the interest and dividends taxes, the insurance, communications, real estate transfer taxes and lottery revenue were all below estimates for the month.
Administrative Services will release another revenue report for June at the end of the month that adjusts collections between the 2014 and 2015 fiscal years.
May 6, 2014
State revenues down $22 million in April
Business and interest and dividend tax changes in 2012 reduce state revenue this fiscal year officials say.
By GARRY RAYNO
State House Bureau, Union Leader
CONCORD — Business and interest and dividends tax breaks approved two years ago are helping to paint a bleak state revenue picture.
State revenues are down $22 million in April when the state collects significant money from the business enterprise and business profits taxes, and from the interest and dividend tax.
“A rough month,” said Linda Hodgdon, Administrative Services Commission. “Concerning, yes, very much so.”
For April, state revenues totaled $262.7 million, down 7.6 percent from budget writer estimates, and down $42.3 million from last April. For the year to date, the state has raised $1.94 billion, which is $4 million more than estimates for the year, but $24 million less than a year ago.
Business taxes returned $87.4 million for April, down $11.4 million from estimates and $5.1 million from a year ago. For the year to date, business taxes are down $7.1 million. Business tax changes made during the 2012 session that increased the time business have to write off loses, changed the threshold for paying the business enterprise tax, and increased tax credits are having an impact on returns and are expected to impact June returns as well, Hodgdon said.
Changes made in the interest and dividends tax in 2012 is also having a significant impact on that levy, she noted. Lawmakers changed the state’s trust laws so that trusts established by an entity or person who gives up the right to the principal or what are called non-grantor trusts would be exempt from the interest and dividends tax.
Former Gov. John Lynch vetoed the bill saying, “I remain concerned about the potential fiscal impact and unintended consequences of the provisions amending our trust laws. The proposed tax policy changes lack clarity, have not been fully examined and may be unfair to some taxpayers.”
The interest and dividends tax produced $31.8 million in April, $9.2 million below estimates or 22 percent, which Hodgdon said has never happened before. For the year the tax has produced $68.2 million, which is $13.6 million below expectations.
Together the business and interest and dividends tax returns “are a huge hit,” Hodgdon said. She conceded the state may end the year below revenue estimates. The biennial budget assumes a $26 million surplus at the end of the 2014 fiscal year to have a balanced budget at the end of the biennium June 30, 2015.
On the positive side, the rooms and meals tax — the state’s second biggest revenue producer — and the securities tax are both above estimates for the year and for the month.
Although the number of real estate units sold is off 1 percent from March, the sale prices are up and the real estate transfer tax is slightly ahead for the month, and for the year.
Thursday, Senate President Chuck Morse, R-Salem, said, “This shortfall creates a further complication as the legislature works to address the Medicaid Enhancement Tax, our inadequate rainy day fund, and credit watches issued by Moody’s and Standard & Poor’s.” He called for state agency heads to reevaluate their budgets and take steps to meet their targets.
Gov. Maggie Hassan said the state must continue efforts to promote economic growth while managing the state budget.
“State agencies remain focused on meeting all budget targets and increasing efficiency in order to protect taxpayer dollars,” Hassan said.“By working together, I know that we can resolve these challenges, build on the bipartisan progress that we have made and keep New Hampshire’s economy moving forward.”
June is another large revenue collection month for state coffers.
April 25, 2014
Final Public Hearing on Key Bill:
Please note the Restraint and Seclusion Legislation has been sent to a second House Committee. SB 396 relative to child restraint practice will have a third legislative public hearing in the Executive Departments and Administration Committee on Tuesday, April 29 at 10:30 am in Room 306 of the LOB. Please contact Jennifer Bertrand for more information about this legislation, email: email@example.com
Fiscal Committee Today:
The Department of Health and Human Services presented to the Fiscal Committee this morning. The presenters were: Deloitte: Jim Hardy, DHHS: Jeff Meyers & Nick Toumpas. The attached packet was presented to the committee. The packet contains 3 items: Cover Letter, 7 page concept paper, 2 page copy of public notice for the 1115 Waiver, PowerPoint (presentation of 1115 waiver concept).
Of interest/key points:
CMS requires public notice and two public hearings to be conducted before a state may apply for an 1115 waiver. The department has already provided and will be providing further public notice. In addition, two public hearings are scheduled in May.
Deloitte Consulting is currently working on the waiver application; this application will come to the Fiscal committee before June 1 and the Fiscal committee must approve the full waiver application.
The public comment period is now open on the waiver concept paper (concept paper attached).
What is the purpose of the 1115 waiver?
Jeff Myers provided the following comments:
DHHS needs to address capacity issues in public health. The examples of recent illegal and RX abuse issues in the state were mentioned. The new substance use disorder benefit will be rolled out soon; there are capacity issues with these new benefits and in mental health system. The 1115 waiver is going to respond to these issues.
The waiver will address the issues of “Building Capacity” of substance abuse, public health and mental health services.
It was noted that NH has recently increased some DRF capacity in the city of Franklin.
The waiver is also expected to help reduce “Low birth weight babies,” and women who smoke while pregnant. These problems are currently very expensive for Medicaid.
The adult dental benefit for pregnant women and their children will be also be in the waiver.
It was noted that NH has a tendency to treat sickness; we need more wellness care and preventative care. We need a more robust mental health and substance use network.
Jeff Myers said that “Quality Outcome” would be looked at though the “Triple Aim.”
CMS believe in the goals of the Triple Aim. Those goals are:
- 1. Improving the patient experience of care
- 2. Improving the health of population
- 3. Reducing the per capita cost of healthcare
CMS is pushing the “Triple AIM” through their Center for Innovation and state programs like SIM.
It was stated that current enrollment in Medicaid managed care is 116,000 people. It was also stated that eventually, DHHS will mandate ALL services and populations into MMC “including waiver and nursing home services.”
The future goals in NH Medicaid are to “serve the whole person through enhanced, cross-systemic care coordination.”
Overall, NH Health Care Reform Consists of:
- · Medicaid Transformation
- · Expanded Health Coverage (SB 413)
- · Population Health
- · Mental Heath System Reform
The type of 1115 waiver NH is applying for will be a “Comprehensive Medicaid Waiver.” It will be a 5-year waiver with funding each year. DHHS has identified 5 specific programs that it will propose to receive Designated State Health Program funding through CMS from the “Building Capacity for Transformation” waiver. (Title NH has given the 1115 waiver)
The 5 programs are:
1. Mental Health (Focus on payment reform, wellness)
2. Community Mental Health (10-year plan/DOJ Settlement. NH wants all services to be federally matched)
3. Oral Health, (5 year pilot program for Pregnant women and their children, no other current Medicaid recipients will partipcate)
4. Substance Use Disorder
5. Population Health (InShape program) DHHS would like to include adults with DD/ABD in the program (among other groups). There was little information provided as to what exactly “InShape” will do specifically.
The Next Meeting is on May 22 It will be a special Fiscal Committee meeting to approve the Medicaid waiver application (final version) and the remaining 3 SPA’s that require approval.
Nick Toumpas on Medicaid caseloads: Between October- December of 2013, NH’s Medicaid caseloads were declining. In January, Medicaid caseloads jumped up by 9,000 people through March. Why? There is a change in the way eligibility is calculated. This is a result of changes through the ACA. These adjustments allow people to self-attest their income. In addition, there is no longer an asset test and there are other changes that have streamlined the process of becoming eligible for Medicaid. DHHS is now checking the financial information people have submitted and is currently removing individuals who are not eligible. During the first week of April, 1,000 (out of the 9,000) people were disenrolled from Medicaid. It’s unclear if more and more people will be disenrolled in the month of April. The new streamlined eligibility rules only apply to children, pregnant women, caregivers, and the newly eligible Medicaid population.
New Items adding to DHHS deficit: The new Step 2 delay will “cost” NH $700,000-$900,000 per month in the current budget. The additional caseloads (if maintained) will “cost” $800,000 per month. These new expenses are unbudgeted.
Fiscal Committee 4-25-14
March 28, 2014
Sub-minimum Wage Update
On Tuesday, the Senate Commerce committee conducted a public hearing on HB 1174. As introduced the legislation establishes a commission to identify and recommend changes to NH laws and rules on the payment of sub-minimum wages to persons with disabilities. However, as part of the bill’s introduction to the Senate, the prime sponsor urged the Senate panel to ditch the study and simply enact an amendment that would prohibit the payment sub-minimum wages with one narrow exception.
Sen. Homser has officially drafted (although it was never officially introduced at the hearing) an amendment that replaces the entire bill. The amendment deletes two sections of current law and preserves another. The first section the amendment proposes to delete is relative to powers held by the Commissioner of the department of labor to grant a waiver to any NH employer to pay sub-minimum wages to persons who are “impaired by age or by physical or mental deficiency.” This section of NH labor law dates back to 1949, although it was amended as recently as 1968. In addition, the amendment would delete a second section of labor law that grants nonprofits the ability to create sheltered workshops. The current law requires the Commissioner of labor to approve these workshops, which were authorized by the Legislature in the late 1960’s. Finally, the amendment preserves what HB 401 of the 2011 legislative session achieved. HB 401 created a program for high school and post secondary students who are seeking to gain practical experience to obtain job skills to seek gainful and paid employment once the training has been completed. That legislation was signed into law in 2011. As a reminder, HB 401 was introduced at the request of the bureau of developmental services (BDS) and was sponsored by Rep. Rosenwald. The Hosmer amendment would not impact Project SEARCH.
The following groups spoke in support of the legislation (with amendment) at the public hearing: BDS, NHDDC, DRC, Easter Seals & Granite State Independent Living. In addition, several NH citizens including families and people with disabilities who are employed spoke very powerfully in favor of eliminating sub-mimuim wages. The testimony provided at the hearing stated that only two people in the state of NH are currently being paid sub-minimum wages. In addition, all of the current department of labor waivers (for sub-minimum wages) will expire in April of 2015. The department does not expect any new applications for waivers in the future. The amendment has an effective date that coincides with the final waivers expiration date. The amendment has little direct impact on any citizens at the present time. However, the amendment will enshrine a public policy that all citizens regardless of their disability should be treated equally in terms of minimum wage laws.
In other news: This week was “Crossover” for the NH Legislature. Thursday was the deadline for all bills, which passed to “cross over” from the chamber where they originated to the other one. All of the legislation CSNI is tracking this session has been updated in the attachment. Many bills have been killed, many have been amended and now have completely different titles and some have been sent to study. If a bill in the attachment is a House Bill with a public hearing scheduled that hearing will take place in the Senate and vice versa for a Senate Bill with a scheduled hearing.
- The Governor signed SB 413 (Medicaid Expansion) in a live signing ceremony at 12:30pm on Thursday in the Executive Council chambers. The bill became law upon passage.
- The Senate passed the restraint and seclusion protection bill (SB 396) on Thursday. The bill now heads to the House for a public hearing.
March 14, 2014
Medicaid Expansion Advances In House
This week “Division III” of the House Finance committee recommended passage of SB 413 relative to access to health insurance coverage (Medicaid/Healthcare Expansion). The NH Fiscal Policy Institute has created the attached timeline for SB 413 implementation. The next step is for the entire House Finance committee to debate and make a recommendation to the NH House. The Executive Session in the House Finance committee will take place on Tuesday, March 18.
Budget Floor Fight
Speaking of the House Finance committee, prepare for a battle this week when the House takes up legislation that would use surplus state funds to restore so called back of the budget cuts to the department of Health and Human Services. The bill is HB 1411 -FN-A (FN= Fiscal Note A=Appropriation). The committee report says the bill would provide DHHS with $7 million, with the remainder of the surplus going to the State’s Rainy Day Account. Under current law without legislative directive any surplus funds simply remain in the operation account. The House Finance committee recommends approval of HB 1411 on a party line vote. The House vote should be the same. The question is, how fast will the Senate vote to kill this legislation? They have already voted down a similar bill introduced by Sen. Larsen earlier in the season.
House Committee Votes to “Study” Medicaid Managed Care Concerns
Next week the House will vote on two bills that would have addressed the concerns that certain transportation providers have raised relative to the business practices of NH’s MCO’s. The department of Health and Human Services convinced the House Health and Human Services and Elderly Affairs committee that the bills would be too problematic to move forward at this time. (They even convinced the sponsor who wrote the recommendation of study.) The pair of bills sent to interim study may not be the solution at this time, however, this is just the latest example of the hand’s off approach the Legislative Branch has elected to take on the issue of the privatization of NH’s Medicaid program. Fortunately, the Governor’s Commission on Medicaid Managed Care is providing some oversight to the program.
Update on SB 414 relative to Medicaid-funded services provided as a part of a child’s individualized education program.
On Thursday, the State Senate passed and sent over to the House, SB 414 relative to Medicaid-funded services provided as a part of a child’s individualized education program. The bill was originally scheduled to be examined by the Senate Finance committee, however, that requirement was waived. This bill seeks to ensure that children obtain medically necessary services by designating medically necessary services provided outside a child’s individualized education program (IEP) as non-duplicative.
March 7, 2013
ACA Advances In NH
The State Senate passed a version of “Medicaid Expansion” on Thursday. The “New Hampshire health protection program” will provide access to more affordable healthcare for thousands of NH residents. This will be accomplished through both the public and private sectors. The legislation is going to be “fast tracked” in the House, so expect the Governor to sign the bill this month. This is great news for many in NH, most importantly those who will receive healthcare, but also the hospitals and providers who will benefit from a reduction in uncompensated care. In addition, the NH health protection program implementation demands will hopefully force DHHS to delay their proposed commercialization of NH’s nationally recognized DD/ABD community support system.
Also on the ACA front this week, the Joint Committee on Health Reform gave the okay for the NH Insurance Department to accept a federal grant from the U.S. Department of Health and Human Services for continued implementation of plan management partnership operations during 2014, and for exploring continuity of coverage options. It is expected that the Fiscal committee will also grant this request on Monday.
Business Enterprise Tax
This week the NH House killed HB 1509 which would have subjected hundreds of nonprofits to the Business Enterprise Tax (BET). The proponents of taxing nonprofits wanted to “study” the issue rather than defeat the bill outright. The House wisely disposed of the bill by voting to ITL on Wednesday. There is still one more anti nonprofit piece of legislation in the House: SB 186, which would place financial and administrative burdens on nonprofits by requiring onerous “training” for Board of Directors. No hearing has been scheduled on that bill at this point.
SB 414 relative to Medicaid-Funded Services Provided as a Part of a Child’s Individualized Education Program
On Tuesday, the Senate Education and Human Services passed this legislation that clarifies that if a child receives Medicaid-funded services as part of the child’s special education program (IEP) and also receives the same or similar medical services outside of his or her special education school program, the services that are provided outside of the child’s special education program shall not be considered to be duplicative provided that both services are medically necessary. This protection is to ensure services are not reduced or eliminated for children. Please stay tuned for more information on this bill as the process unfolds.
SB 396 relative to child restraint practices is scheduled for a public hearing on March 11th in the LOB Room 103 at 10:20AM. This bill would establish some critical basic requirements to protect children & school staff and keep parents informed.
Bipartisan agreement on Medicaid expansion bill
By NORMA LOVE / Associated Press / February 6, 2014
CONCORD, N.H. (AP) — State Senate leaders announced a bipartisan deal Thursday to expand Medicaid to an estimated 49,000 poor New Hampshire adults by using federal funds to pay for private insurance.
Senate President Chuck Morse, a Salem Republican, and Senate Democratic Leader Sylvia Larsen of Concord announced the agreement in a presentation before the chamber’s Rules Committee. The committee voted unanimously to allow their bill’s introduction.
Gov. Maggie Hassan praised the agreement in her State-of-the-State speech about an hour later.
‘‘With today’s positive step forward, it’s clear that we can work through this together and help working people access critical health coverage,’’ she said.
Morse agreed: ‘‘The bipartisan nature of this agreement shows what can happen when we work together to focus on the issues critical to the well-being of our state.’’
Larsen said the agreement is the culmination of private negotiations since efforts to expand Medicaid failed during a special session in November.
‘‘At the end of the day, this is about expanding coverage for tens of thousands of mostly working, low-income citizens, supporting our providers, helping our state budget, and helping our economy. Our bill will do all of these things,’’ said Larsen.
Morse and Larsen said the agreement’s framework, which will be put into legislation next week, would expand access to private health insurance by using an existing state program that subsidizes employer-based insurance and by buying private coverage through the federal marketplace.
Morse said the key was setting a deadline for federal approval of using Medicaid funds to fund private insurance by June 30, 2015.
If New Hampshire were to expand the program, the federal government would pick up the full cost for the first three years and 90 percent over the long haul. New Hampshire’s health care providers would share in an estimated $2.4 billion over seven years.
The bipartisan agreement would end when federal funding drops below 100 percent in three years unless the Legislature voted to continue it.
New Hampshire is one of a small group of states that has not decided whether to expand Medicaid.
The Republican-led Senate has insisted on using federal Medicaid funds to pay for private insurance, either through an existing state program or the federal insurance marketplace. The House passed a new plan last month similar to one the Senate rejected in November.
Hassan, a Democrat, and the Democratic-led House had argued last year that the Senate’s timeline to move adults into the marketplace and off the state’s new managed care system did not allow enough time for new insurers to offer plans through the exchange. The two also differed on whether enrollment in Medicaid should end when the federal subsidy is reduced starting in 2017.
Morse and Larsen did not go into details on how the agreement resolved those issues. Morse said the framework lays out firm deadlines and approval process.
New Hampshire’s current Medicaid program covers low-income children, parents with nondisabled children under 18, pregnant women, senior citizens and people with disabilities. The expansion would add anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,856 for a single adult.
© Copyright 2014 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten
Thursday, February 6, 2014
NH state revenues higher than last year, despite crummy January
By KEVIN LANDRIGAN
CONCORD – Seven months into the state’s budget year, New Hampshire revenues remain slightly higher than last year, despite a sluggish January in which taxes and fees dipped below expectations.
Administrative Services Commissioner Linda Hodgdon cautioned that broad themes can’t be drawn from returns in January, because it’s typically the fourth-smallest month of the year for government income.
“We’re still in reasonably solid shape, but March and April will tell us how good it really is,” Hodgdon said.
Those two months are when 40 percent of the money comes from the state’s two main taxes on business owners: the 8.5 percent levy on corporate profits and the 0.75 percent tax on all business activity.
Last month, the state received $100.7 million in revenue, which was 3.7 percent less than expected.
So far this year, the state has gotten $742.4 million, which is $13 million – or 1.4 percent – ahead of forecast.
“We’re still ahead of the game at this point, which is obviously a good thing,” Hodgdon said.
It’s also much improved from this time last year, when the state was facing a $30 million revenue shortfall. A slow economic recovery improved that picture and ultimately produced a $72 million budget surplus.
The biggest slump this past month was in an assortment of fees and taxes known as “other,” which was 25 percent below target. Hodgdon said much of that was awaiting federal approval of charges the state can assess against federal grants to cover the health care costs for federal workers in New Hampshire once they retired.
Here is how some of the other main state taxes look:
Business taxes: For the year, $257 million, which is $4.6 million more than forecast.
Room and meals: This hospitality and tourism-based tax on hotel room rentals and eating out is almost right on target, with $132 million thus far, compared to a $131 million estimate.
Real Estate Transfer Tax: The improving housing market has the tax up $2.8 million over estimate, or 4.4 percent for the year. Last month it sagged a bit; $9 million came in when $10.5 million had been expected.
Interest and Dividends Tax: This levy on investments is off $3 million, or 8.4 percent for the year. Hodgdon said this could improve once investors pay federal and state taxes in March and April, as returns to this point typically are based on last year’s investment profits.
Communications Tax: This tax on telephone and Internet use has been subpar, with $2 million, or 5.5 percent, off for the year. Some of this is due to a 2012 tax cut the Republican-led Legislature gave for cellular and cable companies eliminating the tax on Internet access business.
Liquor revenue: The taxes on wine sold at private and state-run stores and liquor is holding up, $38 million thus far this year, which is only $400,000 off the forecast.
See 2014 bills for an updated tracking sheet on all legislation CSNI is watching in 2014.
State Senate: No Dental Reform
The Senate voted Thursday not to allow dental hygienists to provide some care now reserved to dentists under a dentist’s oversight. The Senate instead voted to create a commission to study oral health. Senator Gilmour, sponsored the bill to create a new type of dental provider called a dental hygiene practitioner. The bill’s supporters (including many in the DD community) said the idea was similar to the role a nurse practitioner plays in doctor’s offices. The bill could have allowed more dental care to be provided at a lower cost.
Update on Bills Affecting Nonprofits:
House Ways and Means Committee: End the Conversation on BET
Rep. David Hess of Hooksett, who sponsored legislation to subject 501(c)(3) organizations to the Business Enterprise Tax (BET) said he wanted to have a “conversation” about the issue of nonprofits and taxes. On Tuesday, the House Ways and Means committee voted 12-8 to kill HB 1509, which effectively ended this conversation. The 8 dissenting votes are actually not votes to pass the legislation, they are votes to “study” the issue. The full House will decide which path to take: kill or study on February 5th. Either way, there will be no changes to BET tax law in 2014.
SB 186 relative to training of certain board officers of nonprofit corporations.
This legislation would impact: transportation providers, domestic violence prevention, meals on wheels, mental health, community health centers, area agencies, hospitals, private colleges, public health agencies, substance abuse prevention agencies, nursing homes, CAP agencies, home health agencies, soup kitchens, case management agencies & many other non-profits.
The state government mandated “training” for non-profit organizations came back from the dead. After being recommended to be killed by the Public & Municipal Affairs committee, Sen. Odell (who sponsored a similar bill last biennium) offered a floor amendment (attached) that would require 4 hours of training for one Board member every other year. The bill applies to any non-profit that receives $250,000 or more in local, state or federal funding on an annual basis. This funding can come to the nonprofit by any means.
In addition, the bill requires all non-profits to report on an annual basis to the Attorney General’s office. The AG’s office is also given the power to levy fines for non-compliance of the annual reporting requirement or the actual training.
The training must to be conducted by an entity that is not connected to the non-profit so this means additional costs to not-for-profits in NH.
Back of the Budget Cuts in Front of House Finance Committee
HB 1411 -FN-A relative to restoring moneys to the department of health and human services.
The House Finance committee didn’t waste any time reexamining the state budget this week. The panel conducted a public hearing on HB 1411, opening up a disagreement from the budget committee of conference in June- removing the back-of the-budget cuts to DHHS. The bill is sponsored by House Finance Chair, Rep. Wallner . The legislation which was supported by CSNI though verbal testimony hopes to restore about $7 million in reductions to Health and Human Services contained in the back-of-the budget. The bill proposes that the $17 million surplus from the previous budget (FYE June 30, 2013) be used to eliminate the $7 million back-of the-budget cut while sending the remainder of the surplus to the state’s rainy day account.
Toumpas: Cuts Coming without Legislative Action
In what has become an annual event, the Commissioner presented to the House Finance committee division III on Thursday afternoon. The message presented was that the department continues to face a $37 million shortfall. This is due to a variety of reasons that have been well documented since July. On the flip side, caseloads including Medicaid caseloads continue to not only level off, but in most cases are being reduced. The Commissioner said he will be forced to make “program cuts” unless the legislature appropriates additional funds to the department.
HB 1509 -FN-A relative to including nonprofit charitable enterprises in the business enterprise tax and lowering the rate of the tax.
This week the public hearing on HB 1509 took place in the Ways & Means committee with Rep. Hess introducing his bill and obviously speaking in support. He presented a new amendment to the legislation. The amendment does slightly “improve” the bill. However, many not for profits would still be negatively affected. As has been well chronicled in the media, Rep. Hess attacked nonprofits for high salaries and high capital expenditures. He said the bill is about starting a conversation on these issues in the state of NH.
The new amendment (which replaces the entire original bill) states that if a nonprofit’s IRS form 990 – line 9 “program service revenues” exceeds $2 million then the BET does apply. The only additional exclusion was for educational institutions run by govt. (I.e. USNH/community colleges). The amendment also has a provision that would allow nonprofits to deduct certain charitable expenses from their new BET payments.
Following the sponsor a total of 11 groups testified against the legislation, an additional 20 or so registered written opposition (including CSNI).
No one spoke in favor of the bill beyond Rep. Hess.
Most Opposing Speakers:
- Palace Theater, Manchester
- LeadingAge Maine and New Hampshire
- New Hampshire College & University Council
- Massachusetts College of Pharmacy
Upcoming Floor Vote:
SB 193, relative to dental therapists and access to oral health care will be voted on January 30, this bill authorizes licensure of dental therapists who may perform dental services under the supervision of a currently licensed dentist.
Other bills that have caught our eye include:
- HB 1174 establishing a commission to study the payment of subminimum wages to persons with disabilities. (Prime) Chris Muns
- HB1143 relative to the New Hampshire Law Against Discrimination. This bill makes certain changes to the state Law Against Discrimination to conform to the federal Fair Housing Act, as amended in 1988, 42 U.S.C. section 3601 et seq. (Prime) Lynne Ober
- HB 1211 relative to the use of force by persons with special responsibilities (Prime) Rep. Gidge
- HB 1555 relative to the neglect of elderly, disabled or impaired adults and relative to financial exploitation. This bill establishes the crime of financial exploitation of an elderly, disabled, or impaired adult and imposes a mandatory sentence of imprisonment for a second or subsequent offense of criminal neglect or financial exploitation of such person. (Prime)Katherine Rogers
- 2014-S-2782-R relative to child restraint practices. (Prime) Nancy Stiles
September 16, 2013
The NH Legislature has returned to Concord after a quiet July & August. Over the next several weeks, various subcommittees on legislation from the 2013 Legislative Session are conducing meetings. In addition, various new and old study committees are examining many issues.
Health and Human Services Oversite Committee
On September 13, 2013 the Health and Human Services Oversight Committee conducted its September meeting. Please see attached for the official meeting notes from the group’s August meeting as well as the Agenda for the September meeting.
Mathew Ertas of BDS reviewed with the committee the Quarterly Placements for the DD and ABD waitlists. There are currently 96 individuals on the DD waitlist. There are 5 people on the ABD waitlist. BDS said that DHHS has “released 75% of the funding for the first year of the biennium.” This is approximately $10 out of the $13 million appropriated by the State budget. The ABD waitlist has also received 75% of its state budget funding. Please see attached.
Please see attached for an update on NH Hospital by Robert MacLeod, CEO.
In addition, BBH’s Erik Riera updated the committee on Franklin Regional Hospital’s 10-bed acute psychiatric care unit. This unit will open on October 1st. The unit will accept involuntary admissions.
There is also an update attached from BBH on mental health initiatives for 2014-2015 in the form a grid. Many are the Mental Health System’s “10 year plan” goals.
- Update from the Commissioner
Commissioner Toumpas updated the committee on department caseloads which continue to remain stable and in some instances slightly decrease. It was noted the state budget assumed flat caseloads for the state. The commissioner’s office estimates that the department has a shortfall of about $35 million in General Fund dollars. This is all inclusive and takes into account back of the budget cuts, a delay in Medicaid managed care and other items.
There was brief update on the staffing challenges the Commissioner says DHHS faces. Toumpas said that 470 positions have been abolished in DHHS, the vacancy rate also remains high.
The commissioner reported a few noteworthy items relative to Medicaid managed care:
The department and CMS recently conducted a readiness review of all 3 MCO’s. The result of this was that the MCO’s presented “no issues” to the State or Federal government as to why they should not be allowed to proceed with Step 1. The enrollment for Step 1 began on September 11th. Medicaid recipients who participate in the electronic “NH Easy” were the first to enroll. The commissioner said 370 people have now enrolled in MMC. The call center remain open.
The Commissioner also repeated the department’s position that so called step 2 must begin December 2014. According to the Commissioner, any delay in step 2 could delay “savings.” How this savings would be achieved continues to be unknown.
- Adverse Event Reporting in Hospitals
Two representatives from the Bureau of Licensing & Certification within DHHS presented the attached information, which is the 2012 final report of Adverse Event Reporting for Hospitals and Surgical Centers. DHHS reported that the Surgical Centers are now submitting reports on Adverse Events to the state. In the past, the Centers did not report to the state on this issue. DHHS believes this change is a result of a meeting of stakeholders recently organized by the department.
Key CSNI 2013 Bills Re-Referred to Committee or Retained in Committee
- HB 462-FN, relative to an independent review process under the medical assistance program.
- HB 461-FN, relative to long-term care services.
- HB 597-FN, relative to mandatory drug testing for certain health care workers.
- HB 657-FN, requiring state agencies to submit efficiency expenditure requests as part of the biennial budget process.
- HB 658 –FN relative to registration for medical technicians.
- SB 186, relative to training of certain board officers of nonprofit corporations.
- SB 193-FN, relative to dental therapists and access to oral health care
June 6, 2013
Senate Passes A Budget
On Thursday the State Senate approved the state budget (HB 1/HB 2). The full Senate made no changes from the Finance committee’s recommendations as reported by CSNI two weeks ago. The Bureau of Developmental Services remains unchanged as recommended by the Governor on February 15th. The budget was adopted on a party line vote of 13-11. The Senate democrats introduced 5 floor amendments designed to override the committee’s recommended spending levels. All 5 attempts failed. There were similar attempts with HB 2 (Trailer Bill).
Foster’s Daily Democrat has a great list showcasing the key differences between the House and Senate budgets. Both Mental Health and Developmental Disabilities are listed as key areas of AGREEMENT! Check it out here: http://www.fosters.com/apps/pbcs.dll/article?AID=/20130606/AP02/306069965
$40 Million Hole for DHHS?
If you are interested in reading more about the battle over the $40 million in “Back of the budget cuts for DHHS” you might want to check out a recent piece by Grant Bosse of NH Watch Dog. In the piece, Grant makes some valid points and breaks the issue down succinctly. There clearly is a back of the budget cut for DHHS, the issue is the exact size of that cut. Read more here: http://newhampshire.watchdog.org/11980/back-of-budget-cuts-at-heart-of-current-dispute/
Back to the Future
After most elections in NH one political party seizes control of both the House and the Senate, this did not happen in the 2012 election. For the first time since the 1920’s (perhaps in history!) there will be a spilt party controlled State Budget Committee of Conference. The republican controlled Senate and the democratically controlled House will have to agree on a state budget by June 30th.
- By Thursday, June 13th, a Committee of Conference (C of C) on HB 1 and 2 will be appointed by the House Speaker and Senate President.
- By Thursday, June 20th – at Noon – the C of C will vote on / report out and sign off on its HB 1 and 2 recommendation to the full House and Senate.
- And by Thursday, June 27th, the full House and Senate will vote on the C of C’s recommendation.
MAY 24, 2013
Toumpas: $40 Million Hole for DHHS
Late this morning, Commissioner Toumpas told the Senate Finance committee that the way the Senate has structured the DHHS budget additional cuts and reductions will likely be required over the next two years beginning July, 2013. One reason for shortfall is the Senate’s decision to continue with the House’s recommendation that APTD caseloads will continue to decrease over the next two years. The department predicts a slight uptick in caseloads. In addition, the Senate has added “back of the budget” cuts and other requirements that Toumpas says result in millions of dollars in a DHHS shortfall. Toumpas says another $40 million is necessary to ensure that to cuts to personnel and possibly to the DD/ABD Waitlists, Mental Health, CHINS and others are avoided. There were no dollar amounts assigned to the specific programs the Commissioner mentioned today.
Senate Finance committee rejects Medicaid expansion
Members of the Senate Finance Committee voted 4-2 Wednesday night to reject New Hampshire’s participation in the Medicaid expansion, as called for under the Affordable Care Act. The Senate Finance Committee replaced language in the budget with a study commission that would examine the impact of the expansion on the state, specifically whether it will lower costs and improve health outcomes. Senate President Peter Bragdon, said he had cost concerns should the federal government not follow through on its promise to cover most of the cost of the expansion and that no information provided thus far has answered those questions about cost and health outcomes. The study commission would have $200,000 to do its analysis and report out by Dec. 1, 2014.
Senate Finance Committee to Hospitals: Sign up for Medicaid Managed Care Or No Charity Reimbursement
There is now an amendment to HB 2 to require hospitals to participate in a managed care network by July 1, 2013 if they want state compensation for charity care.
Key Changes Senate has Made to the House’s Budget
Most of the cuts and reductions the Senate may impose and some potential additions/restorations continue to be on hold in the Finance committee, although the Senate has voted to cut the Family Resources Centers by $240,000 over the biennium as recommended by the House.
The committee is expected to vote on its proposed budget next Tuesday and the full Senate would vote June 6.
MAY 10, 2013
State Budget (Final) Public Hearing
On Thursday afternoon and evening the Senate Finance committee conducted a 6 hour public hearing on HB 1 and HB 2 (State budget). Developmental Services was the again the most advocated program, followed by Domestic Violence Prevention and Substance Abuse Treatment. Many others spoke about various human services programs for children, the elderly and those with mental illness.
Following additional committee work, the Senate votes on its budget on June 6. Commissioner Toumpas will back again before Senate Finance next week on Monday May 13th at 10:00am.
Step 1 Medicaid managed care gaining speed?
At the May Health and Human Services Oversight committee this morning Commissioner Toumpas provided some new information relative to Step 1 Medicaid managed care. First, there is one MCO that claims to have achieved providers in 80% of the state. It was unclear if this was network adequacy in 80% of the state or simply a presence in 80% of the state. The department continues to suggest that two MCO’s are moving ahead with network progress with the third seemingly behind the first two. DHHS has said they will proceed when two are ready.
The department has created new capitated rates for year 2 of Step 1 (It appears that, the current year 1 Step 1 rates have not and will never be used). These new rates are higher paying than the current rates and seem to be acceptable to Step 1 providers, including Hospitals and Community Mental Health Centers. The new rates would incorporated into a contract amendment.
In addition, there is a new supplemental rate for 3 categories of individuals with severe mental health diagnosis. These supplemental rates will allow the MCO’s to send additional money to not only the Community Mental Health Centers, but also other Step 1 providers such as RX.
Step 3 rates are being planned and worked on with the department’s vendor.
In terms of Step 2, next week, Commissioner Tomas, Nancy Rollins and Jose Montero are traveling to CMS in Baltimore to discuss the SIM program with other states and CMS.
Finally, the Commissioner reported that he has made phone personal phone calls to CEOs of hospitals, especially the “suing hospitals” to encourage them to sign on to Medicaid managed care. Toumpas said that he was very encouraged by most of the responses from the CEO’s and he said many of the hospitals are close to signing agreements with MCO’s.
The Commissioner strongly indicated that he envisions Step 1 commencing toward the end of calendar year 2013.
April 30, 2013
Senate Takes A Look At $2 Billion Budget For DHHS
By Todd Bookman
Senate budget writers turned their attention Monday to the state’s biggest agency, the Department of Health and Human Services.
The proposed budget for DHHS comes in at just more than $2 billion. It seeks to restore the CHINS program and increase payments to hospitals for uncompensated care.
The budget also lays out $24.5 million over the next two years to shore up the state’s troubled mental health system.
Senator Lou D’Allesandro questioned if the state can wait that long for a fix.
Commissioner Nick Toumpas replied there really is no choice.
“I’m not going to sit here and say there isn’t an issue. But I will also say, Senator, it wasn’t overnight that this issue was created. It’s not going to be overnight that it is going to be resolved.”
The Senate Finance Committee also questioned the agency’s $46 million in estimated savings for a transition to Medicaid managed care.
Already months behind schedule, Toumpas admitted that the full extent of those savings likely isn’t realistic.
April 1, 2013
Governor Hassan to Nominate Joseph Foster of Nashua to Serve as Attorney General
Foster is Respected Attorney, Former State Senate Leader
CONCORD – Focusing on ensuring safety and justice for the people of New Hampshire, Governor Maggie Hassan announced today that she will nominate Joseph Foster of Nashua, a respected attorney and former state Senate leader, to serve as New Hampshire’s next Attorney General.
Foster, of Nashua, has served as the chair of the management committee for one of New Hampshire’s largest law firms, McLane Law Firm, where he currently chairs the bankruptcy practice. In addition, Foster served as State Senator for New Hampshire’s 13th District from 2002-2008, rising to Majority Leader in 2007. During his tenure as chair of the Senate Judiciary Committee from 2004 to 2008 under both Democratic and Republican majorities, Foster led efforts to enact measures ensuring justice for the people of New Hampshire, including the Sexual Predators Act, one of the toughest laws in the nation protecting New Hampshire’s children from child predators.
“The role of Attorney General in protecting and ensuring justice for the people of New Hampshire is one of the highest responsibilities in our state,” Governor Hassan said. “I am confident that Joe’s judgment and experience make him the ideal candidate to serve as New Hampshire’s chief legal and law enforcement officer.
“Throughout his career as an attorney and public servant, Joe Foster has stood up and defended the cause of justice at every opportunity. As Senate Judiciary chair, he brought people together to pass tough laws to protect our children from predators and to improve our justice system,” Governor Hassan said. “His extensive legal experience will be invaluable in addressing the complex civil litigation facing the state, and in our ongoing efforts to improve protections for consumers.”
“I am profoundly honored by the trust Governor Hassan has placed in me to lead the New Hampshire Department of Justice as Attorney General,” Foster said. “If I am confirmed, I will work hard every day to protect public safety and ensure justice for all of our citizens.”
Prior to serving as State Senator, Foster served in the House of Representatives from 1995-1998. Foster received his J.D. from George Washington University in 1984 and his B.A. from Tufts University in 1981.
Foster’s nomination is subject to confirmation by the Executive Council. Governor Hassan will formally nominate Foster to the Council at Wednesday’s meeting.
March 29, 2013
Highlights This Week In Concord:
Please find the current list of CSNI priority legislation. (Sarah Aiken)
2013 CSNI Priority Bills
Full House Finance Committee Approves Governor Hassan’s BDS Budget Recommendations
HB 1 (Budget) and HB 2 (Trailer Bill) have received final approval by the House Finance Committee. On Wednesday evening, the committee voted 14-8 to pass a state budget recommendation to the entire NH House for debate and further action.
The Bureau of Developmental Services was one of only 5 programs that was left completely intact (as recommended by the Governor) in the department of Health and Human Services. The others were: Glencliff Home, NH Hospital, & Veterans Home/Services. In fact, the DD waitlist is the first item listed in the Chairman’s committee report of HB 1.
Some other DHHS highlights included in the budget:
- Full support of Medicaid expansion
- The budget begins to restore funding to larger hospitals to help make up for the uncompensated care they provide
- CHINS program is restored
- The Institute on Disability (IOD) received a restoration of lost funding
The House will vote on the budget on Wednesday, April 3rd. The debate will likely take an entire day, perhaps 2 days. There will be many “floor amendments” to make changes to the budget. The vast majority will be to cut spending and eliminate new revenue. Most, if not all of the floor amendments will fail.
Speaking of revenue, beyond “deferring” several business tax breaks scheduled to go into effect in the next fiscal year, the new budget raises 4 taxes/fees: Gas Tax, Tobacco Tax, Salt Water fishing license and the Marriage license. The tobacco tax recommendation in the budget is in line with the Governor’s recommendation of 30 cents above the current level. However, this is in conflict with HB 659 which is legislation already passed by the House. HB 659 raises the tax by only 20 cents from the current level. The new House “position” will become 30 cents once the budget is passed next week.