HB784: relative to long-term care services.

HB 784-FN-LOCAL - AS INTRODUCED

2003 SESSION

03-0604

01/10

HOUSE BILL 784-FN-LOCAL

AN ACT relative to long-term care services.

SPONSORS: Rep. MacKay, Merr 39; Rep. Pilliod, Belk 31; Rep. Batula, Hills 58; Sen. Larsen, Dist 15

COMMITTEE: Health, Human Services and Elderly Affairs

ANALYSIS

This bill authorizes individuals eligible to receive medicaid-funded nursing home services to choose appropriate, community-based services as an alternative, if such community services would cost the state no more than services in a nursing facility would cost the state.

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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03-0604

01/10

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Three

AN ACT relative to long-term care services.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Long-Term Care; Purpose. Amend RSA 151-E:1, III to read as follows:

III. This chapter is [an initial] a major step toward [incrementally] rebalancing the long-term care system and expanding choices available to recipients. It increases the continuum of care by adding mid-level care, including but not limited to, assisted living and residential care services. Through an acuity-based reimbursement system [and], a comprehensive needs assessment process, and an information and assistance process, it [encourages] provides those eligible for medicaid nursing facility services the right and ability to [consider] choose more appropriate, less costly mid-level services and home and community-based care. In this way, the state intends to serve this increasing medicaid eligible population more appropriately and more economically.

2 Long-Term Care; Consumer Choice. Amend RSA 151-E:4 to read as follows:

151-E:4 Consumer Choice. A person who has been determined to be medicaid eligible for nursing facility services in accordance with RSA 151-E:3 shall have the right to receive nursing facility services; however, the person [may choose] has the right to receive services in a less restrictive setting such as home-based care or mid-level care, if such services are available and do not result in greater costs to the state and counties [in excess of the limitations set forth in RSA 151-E:11, II] than if the individual chooses to receive services in a nursing facility. In order to facilitate that choice, the individual may utilize the medicaid funds allocated for his or her nursing facility care to pay for his or her home-based care or his or her mid-level care. Such choice shall be subject to limitations imposed by federal and state laws and regulations.

3 Long-Term Care; Information and Referral. Amend RSA 151-E:5 to read as follows:

151-E:5 Information and Referral.

I. The department shall establish a system of community-based focal points, known as Servicelink, that provide information and referral services to elderly and chronically ill adults. The information and referral network established under this section shall not be used for the purpose of political [or legislative] advocacy, but may inform and educate the general court regarding the extent of services available as well as the unmet needs in the community.

II. The department shall designate in its operating budget request a specific class line for the Servicelink system with sufficient funding to operate the system effectively.

4 New Paragraphs; Long-Term Care; Needs Assessment. Amend RSA 151-E:7 by inserting after paragraph VI the following new paragraphs:

VII. Any assessment of medical needs conducted under this section shall be conducted by the department, or its designee. If the department chooses to have a designee or sub-contractor perform these assessments, this individual performing the assessment shall not have a financial interest in the nursing facility or be employed by an entity that has a ownership or financial interest in a nursing facility.

VIII. The department shall implement the uniform assessment system, throughout the state, by December 1, 2003.

5 Long-Term Care; Information and Assistance. RSA 151-E:9 is repealed and reenacted to read as follows:

151-E:9 Information and Assistance.

I. The department shall provide information and assistance to each applicant to a nursing facility and shall also provide information and assistance to an individual when the person becomes financially eligible for medicaid benefits pursuant to RSA 151-E:3, I(b). Such information and assistance shall:

(a) Inform individuals of their right, pursuant to RSA 151-E:4, to choose to receive appropriate services in a less restrictive setting, such as home-based care or mid-level care, if such services are available and do not result in greater costs to the state and counties than if the individual chooses to receive services in a medical facility;

(b) Be based upon the principle that services shall be provided in the setting that is least restrictive of the applicant's ability to live independently;

(c) Take into consideration the applicant's choice of service location;

(d) Include information regarding the degree to which the services sought are available at home or in some other community-based setting;

(e) Explain the relative costs to the applicant of choosing care in the home or other setting rather than nursing facility care; and

(f) Include advice as to whether receiving services in a home or other community-based setting is clinically appropriate for the applicant.

II. The information and assistance under this section shall be provided by the department or its designee. If the department chooses to have a designee or sub-contractor provide the information and assistance, the individual providing such services shall not have a financial interest in the nursing facility or be employed by an entity that has a ownership or financial interest in a nursing facility.

III. The department shall implement the information and assistance system, throughout the state, by December 1, 2003.

6 Repeal. RSA 151-E:11, relative to program management and cost controls, is repealed.

7 Effective Date. This act shall take effect 60 days after its passage.

LBAO

03-0604

Revised 2/3/03

HB 784 FISCAL NOTE

AN ACT relative to long-term care services.

FISCAL IMPACT:

The NH Association of Counties indicated this bill may increase county expenditures by an indeterminable amount in FY 2004 and each year thereafter. The Department of Health and Human Services stated this bill will decrease state expenditures by $1,154,860 in FY 2004 and increase state expenditures by $158,070 in FY 2005 and each year thereafter. State revenue will decrease by $2,689,395 in FY 2004 and by $2,206,222 each year thereafter. County expenditures will decrease by $896,465 in FY 2004 and by $735,407 in FY 2005 and each year thereafter. There will be no fiscal impact on county revenue or local expenditures and revenue.

METHODOLOGY:

The Department indicated this bill continues the Service Link Network that provides information and referral services to elderly and chronically ill adults, and removes restrictions on less expensive mid-level residential or community-based services as an alternative to nursing home care. The Department stated this bill will not change eligibility requirements and would not effect the total number of people receiving long term care services. In its fiscal analysis of this bill the Department made the following assumptions:

· The number of Medicaid eligible nursing home residents will decrease by 10% or 492 beds in FY 2004 and 494 in FY 2005, 2006 and 2007.

· Of the reduction in nursing home beds, 50% of the individuals would receive home care and 50% would receive mid-level residential care.

· Calculations are based on amounts in the Department's FY 2004-2005 budget request and held constant for FY 2006 and 2007.

· Expenditures for all three types of service will be shared: 50% federal Medicaid funds, 25% state funds and 25% county funds. The county share of expenditures is reflected as revenue for nursing services in the state operating budget.

· Provider Payments for other Medicaid services for long term care residents will not be effected.

Nursing Services: FY 2004 FY 2005 FY 2006 FY 2007

Nursing Home Residents (492) (494) (494) (494)

Mid Level Care Residents 246 247 247 247

Recipients of Home Care 246 247 247 247

State Expenditures

(from change in services) ($3,585,860) ($2,941,630) ($2,941,630) ($2,941,630)

Service Link

(100% state) 2,431,000 3,099,700 3,099,700 3,099,700

Total State Expenditures ($1,154,860) $ 158,070 $ 158,070 $ 158,070

State Revenue

Federal 50% of Services ($1,792,930) ($1,470,815) ($1,470,815) ($1,470,815)

County 25% of Services (896,465) (735,407) (735,407) (735,407)

Total State Revenue ($2,689,395) ($2,206,222) ($2,206,222) ($2,206,222)

County Expenditures 25% ($896,465) ($735,407) ($735,407) ($735,407)

The New Hampshire Association of Counties stated this bill will restrict additional state expenditures for Medicaid long term care services in total, resulting in additional costs to the counties.