Bill Text: NH HB461 | 2014 | Regular Session | Amended
Bill Title: Relative to long-term care services.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Passed) 2014-05-28 - Signed by the Governor on 5/27/2014; Chapter 0033; Effective 5/27/2014 [HB461 Detail]
Download: New_Hampshire-2014-HB461-Amended.html
HB 461-FN – AS AMENDED BY THE HOUSE
22Jan2014… 2337h
2013 SESSION
01/10
HOUSE BILL 461-FN
AN ACT relative to long-term care services.
SPONSORS: Rep. Donovan, Sull 4
COMMITTEE: Health, Human Services and Elderly Affairs
This bill clarifies long-term care eligibility for the purpose of receiving Medicaid-funded nursing home services.
This bill also places a time limit for the required assessment or reassessment for such services unless there are unusual circumstances.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
22Jan2014… 2337h
13-0756
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Thirteen
AN ACT relative to long-term care services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Long-Term Care; Eligibility. Amend RSA 151-E:3 by inserting after paragraph II the following new paragraph:
II-a. Subject to written approval by the Center for Medicare and Medicaid Services, financial eligibility rules in paragraph II shall include eligibility as medically needy if the person’s countable income is at or below the general Medicaid program medically needy income limit or the person incurs allowable medical expenses each month, including the anticipated cost of waiver services, which exceed the amount of the person’s monthly income which is over the medically needy income limit for the waiver. For the purpose of the waiver, the medically needy income limit shall be the general Medicaid program medically needy income limit plus the difference between that limit and the special income limit for the waiver. The department shall submit a request for such approval within 30 days of the effective date of this paragraph.
2 Assessment or Reassessment at Time of Eligibility. Amend RSA 151-E:8 to read as follows:
151-E:8 Assessment or Reassessment at Time of Eligibility. The department shall perform an assessment or reassessment of the person’s clinical eligibility when the person becomes financially eligible for Medicaid benefits pursuant to RSA 151-E:3, I(b) but no later than 45 days from application for long-term care services, unless there are unusual circumstances which impede such a determination within 45 days. Unusual circumstances means when an agency cannot reach a decision because the applicant or examining physician delays or fails to take a required action, or when there is an administrative or other emergency beyond the agency’s control. The department shall notify the applicant relative to the nature of the delay within 5 days following the expiration of the 45-day requirement.
3 Effective Date. This act shall take effect 60 days after its passage.
LBAO
13-0756
Amended 01/29/14
HB 461-FN FISCAL NOTE
AN ACT relative to long-term care services.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as amended by the House (Amendment #2013-2337h), will increase state revenue and expenditures by indeterminable amounts in FY 2015 and each year thereafter. There will be no fiscal impact on county or local revenues and expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill would alter the financial eligibility rules for individuals applying for or receiving Choices for Independence (CFI) services subject to written approval from the Centers for Medicare and Medicaid Services (CMS). The Department states individuals must be clinically and financially eligible for CFI services. Financial eligibility is determined first. Currently, eligibility for these services is determined at the beginning of the each month as follows:
• Individuals with monthly gross income no higher than $2,163 are eligible as categorically needy. ($2,163 is the monthly special income limit for long term care programs.)
• If an individual’s gross income exceeds $2,163:
• The individual’s net income is determined.
• The $591 medically needy income limit is subtracted from the individual’s net income. The excess income is equal to the amount the individual must “spend down” in medical costs, including the cost of room and board for residential care, in order to become or remain eligible for services.
• If an individual’s medical costs exceed the excess income, the person is determined to be eligible.
• After an individual is determined to be financially eligibility, clinical eligibility is determined.
CFI program participants are required to notify the Department within 10 days of any change in income or resources. The Department indicates under the proposed bill, financial eligibility would be determined on an annual basis. The Department assumes the bill would not increase the number of CFI recipients or result in additional costs since there would be no change in clinical or financial eligibility standards. Absent the time required to do a more detailed analysis of the remaining 17 cases, the Department randomly selected and reviewed a sample of 17 of the total of 34 case files for medically needy CFI recipients. In each case, the recipients consistently met their required spend down amount on the first day of each month. The Department assumes the remaining 17 medically needy CFI recipients also satisfy their required spend down each month. Individuals would still be required to notify the department within 10 days of any change in income or resources.
The bill would allow current and future CFI medically needy recipients with gross monthly income in excess of the special income limit for long term care programs, and with medical costs above their excess income to remain eligible for Medicaid without the monthly verification and without having their cases opened and closed each month. The Department indicates bill would also simplify administration of the eligibility determination process as staff would no longer need to process each CFI medically needy recipient on a monthly basis. The administrative savings related to this change cannot be determined. There would be additional one-time costs to modify the New HEIGHTS eligibility system. The Department is not able to estimate this cost but expects it will be minimal.
In addition, bill requires the Department to perform an assessment or reassessment of clinical eligibility no later than 45 days from application for long-term care services unless there are unusual circumstances, beyond the Department’s control, that would prevent the determination from being made. If unable to make the determination within 45 days, the Department would be required to notify the applicant within 5 days after expiration of the 45 day period. The Department states it would require two additional Medical Services Consultant II positions to adhere to the 45-day deadline. The Department assumes not receiving funding for the positions, or inability to find suitable candidates to fill the positions would constitute an administrative or other emergency beyond its control. In the event the Department is not able to meet the 45-day timeline the Department would need an additional Case Technician I position to provide the required notification within 5 days after the 45-day deadline. Finally, because the bill creates an additional requirement for the eligibility determination process, there is a strong likelihood the number of fair hearings at the Administrative Appeals Unit would increase. This would increase the working hours for Hearing Examiners and staff devoted to hearing preparation, attendance at hearings and completing post-hearing duties. The Department indicates a significant increase in demand for fair hearings would likely increase state general fund expenditures for staff.
The Department has estimated the following potential costs to meet the 45 day requirement assuming an effective date of July 1, 2014:
FY 2015
FY 2016
FY 2017
FY 2018
Salary - 2 Medical Services Consultants II, LG 24
$ 88,927
$ 93,960
$ 99,164
$ 103,526
Full-time Benefits
Social Security (6.2% of Salary)
5,513
5,826
6,148
6,419
Medicare (1.45% of Salary)
1,289
1,362
1,438
1,501
Retirement (12.13% of Salary)
10,787
11,397
12,029
12,558
Health Insurance
32,866
35,002
37,278
39,700
Dental Insurance
1,882
2,006
2,136
2,274
Life Insurance
40
40
40
40
Total Benefits
52,377
55,633
59,069
62,492
Equipment (One-time cost)
500
-
-
-
Total Costs
$ 141,804
$ 149,593
$ 158,233
$ 166,018
Federal Funds
$ 106,353
$ 112,195
$ 118,675
$ 124,514
General Funds
$ 35,451
$ 37,398
$ 39,558
$ 41,504
Salary - Case Technician I, LG 14 (If necessary)
$ 29,094
$ 31,192
$ 32,783
$ 34,067
Full-time Benefits
Social Security (6.2% of Salary)
1,804
1,934
2,033
2,112
Medicare (1.45% of Salary)
422
452
475
494
Retirement (12.13% of Salary)
3,529
3,784
3,977
4,132
Health Insurance
16,433
17,501
18,639
19,850
Dental Insurance
941
1,003
1,068
1,137
Life Insurance
20
20
20
20
Total Benefits
23,149
24,694
26,212
27,745
Equipment (One-time cost)
500
-
-
-
Total Costs
$ 52,743
$ 55,886
$ 58,995
$ 61,812
Federal Funds
$ 39,557
$ 41,915
$ 44,246
$ 46,360
General Funds
$ 13,186
$ 13,971
$ 14,749
$ 15,452
The New Hampshire Association of Counties states this bill will have no determinable fiscal impact on county revenue and expenditures.
This bill does not include an appropriation or establish new positions.
