HB 1816-FN - AS AMENDED BY THE SENATE

21Mar2018... 0864h

05/03/2018   1770s

2018 SESSION

18-2646

01/03

HOUSE BILL 1816-FN

AN ACT relative to Medicaid managed care.

SPONSORS: Rep. Kurk, Hills. 2

COMMITTEE: Health, Human Services and Elderly Affairs

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AMENDED ANALYSIS

This bill declares that the remaining unimplemented phases of step 2 of the program shall not be incorporated into the department of health and human services' care management program for delivery by a managed care organization.  This bill also requires the commissioner of the department of health and human services to implement enhanced eligibility screening.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

21Mar2018... 0864h

05/03/2018   1770s 18-2646

01/03

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Eighteen

AN ACT relative to Medicaid managed care.

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

1  New Subparagraphs; Medicaid  Managed Care Program; Waiver; Eligibility; Medical Loss Ratio.  Amend RSA 126-A:5, XIX by inserting after subparagraph (g) the following new subparagraphs:

(h)  The commissioner shall develop and implement enhanced eligibility screening to stop per member/per month payments to managed care organizations in a timely manner for services for persons who are no longer eligible.

(i)  Notwithstanding  RSA 126-A:5, XIX(a) and 2017, 258:1, long-term supports and services, including, specifically nursing facility services and services provided under the choices for independence waiver, the developmental disabilities waiver, the in-home supports waiver, and the acquired brain disorder waiver, as those waivers are issued by the Centers for Medicare and Medicaid Services under 42 U.S.C. section 1396(c), shall not be incorporated into the department’s care management program for delivery by a managed care organization, as defined in RSA 126-A:5, XIX (c)(3), under contract with the state.  The department may develop a plan to offer on a voluntary basis only county or other locally-based Programs of the All Inclusive Care for the Elderly (PACE) or similar accountable care organization (ACO) models to provide on a non-fee-for-service basis nursing facility and choices for independence home care services for beneficiaries who voluntarily elect to participate.  Any such plan for voluntary PACE and/or ACO models shall be approved by the oversight committee on health and human services, established in RSA 126-A:13, and the fiscal committees of the general court prior to implementation.

2  Effective Date.

I.  RSA 126-A:5, XIX(j) as inserted by section 1 of this act shall take effect upon its passage.

II.  The remainder of this act shall take effect 60 days after its passage.

LBAO

18-2646

12/14/17

HB 1816-FN- FISCAL NOTE

AS INTRODUCED

AN ACT relative to Medicaid managed care.

FISCAL IMPACT:      [ X ] State              [ X ] County               [    ] Local              [    ] None

METHODOLOGY:

This bill makes a variety of changes to RSA 126-A:5, which governs the state's Medicaid managed care program.  In particular, the bill: (1) directs the Department of Health and Human Services to seek a federal waiver allowing the General Court instead of actuaries to determine the per-member-per-month (PMPM) rate paid to managed care organizations (MCO); (2) directs the Department to develop and implement an enhanced screening tool to quickly stop payments to those no longer eligible, (3) requires MCOs to meet the medical loss ratio, with any surplus funds deposited in the State General Fund; and (4) directs that unimplemented phases of the Medicaid managed care program, specifically nursing facility and Choices for Independence services, not be implemented.

With respect to (1), the Department of Health and Human Services states the federal Centers for Medicare and Medicaid Services (CMS) is unlikely to approve any waiver transferring authority to set capitated rates to the General Court.  With respect to (2), the Department projects an indeterminable cost increase related to the development and implementation of enhanced eligibility screening.  The Department is unable to predict the extent of any cost savings that might result from the development of such a system.  With respect to (3), the Department notes the following: the federal Medicaid managed care rule establishes a minimum medical loss ratio of 85% for MCOs, but permits states to mandate medical loss ratios higher than the 85%.  The loss ratio contained in the current MCO contracts is 89.3%.  Unlike this bill, the federal rule does not require remittances from MCOs that fail to meet the minimum standard, although states do have the authority to require such remittances.  The Department assumes the amount of remittance deposited in the General Fund as a result of this bill would be the State's share (50% in the case of the traditional Medicaid program) and not the entire amount remitted.  The Department is unable to determine the extent of any General Fund benefit due to this component of the bill.  Finally, with respect to (4), the Department states it is unable to determine the fiscal impact at the state/county/local level of not implementing the final phases of Medicaid managed care.

The New Hampshire Association of Counties states this bill will have no impact on county revenues or expenditures.

AGENCIES CONTACTED:

Department of Health and Human Services and New Hampshire Association of Counties