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The Fiscal Committee conducted a Special Meeting today on key budget and healthcare issues:

Posted: May 23, 2014

The Fiscal Committee conducted a Special Meeting today on key budget and healthcare issues:

Governor Hassan Executive Order 

The Governor appeared before the Fiscal Committee to request approval of an Executive order that would freeze hiring, equipment purchases and out of state travel for all state agencies. The Governor reported that the Judicial Branch has agreed to similar freezes and the Governor asked the Legislative Branch to do the same.

Currently the state is actually $4 million AHEAD of revenue estimates for the current budget. The problem is that during the month of April, business tax receipts dropped so significantly that the Governor actually said today that if the trends do not change by June, there would have to be a special session of the Legislature to cut the state budget even further than this Executive Order.

It is unclear at this time but it appears that business tax law changes (made by the previous Legislature) are a major cause of the recent revenue decline as April was the first month the new business tax laws were effective

The Governor cited some examples of affected cuts such as computers and software. There will be a waiver process in place for state agencies to make these expenditures.

MET Update 

The Governor said she has been meeting with NH hospitals to negotiate on MET alternatives. Hassan said there are alternatives to the current MET situation i.e. other states have similar MET taxes implemented in different ways. The Governor indicated she wants to preserve the MET in some form and not eliminate the tax completely.

State Agency Lapses 

The Governor said that budgeted lapses will be met across State Government. DHHS will likely not meet its full lapse but other state agencies will pitch in to help  For example, the department of Education has excess dollars because of declining school enrollment.

The Executive Order was approved 10-0.

Medicaid Expansion Update 

Jeff Meyers of DHHS presented various State Plan Amendments to the Fiscal Committee for approval. These included 4 SPA’s (State Plan Amendments) Alternative Benefit, Cost Sharing, Payment and FMAP Drawdown. The Fiscal Committee approved all 4 of these SPA’s today.

One key item contained in this first step of Medicaid expansion (SPA’s) is co-payments for Emergency Department usage. The main issue is relative to “inappropriate use of the Emergency Department.” DHHS will be bringing forward new language relative to ED coverage. The original proposal included a $8 co-pay for inappropriate use of the ED. However, this was removed after it was met with opposition from the NH Hospital Association. In addition, DHHS believes that CMS would frown upon a copay. DHHS will be working on a strong/good definition of non-essential use of the emergency department. The current proposal on this issue will be changed within the next 60 days. In addition, there will be adjustments to co-payments for RX drugs aimed at individuals under 100% of the federal poverty level.

You can view the SPA’s here: http://www.gencourt.state.nh.us/LBA/budget/FiscalItems/52214%20Agenda%20Items.pdf

1115 Waiver 

Finally, Jim Hardy of Deloitte Consulting conduced the attached presentation on the 1115 Waiver. This includes an update on the public input process. The 1115 waiver is expected to “save” the state of NH almost $47 million over 5 years. The attached presentation recaps the waivers’

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