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Restraint and Seclusion bill & Fiscal Committee Update

Posted: 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:


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:

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:

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

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