Bill Text: NH SB147 | 2011 | Regular Session | Introduced
Bill Title: Relative to Medicaid managed care.
Spectrum: Partisan Bill (Republican 15-0)
Status: (Passed) 2011-06-08 - Senate Signed by the Governor on 06/02/2011; Effective 06/02/2011; Chapter 0125 [SB147 Detail]
Download: New_Hampshire-2011-SB147-Introduced.html
SB 147-FN – AS INTRODUCED
2011 SESSION
01/10
SENATE BILL 147-FN
AN ACT relative to Medicaid managed care.
SPONSORS: Sen. Bradley, Dist 3; Sen. De Blois, Dist 18; Sen. Forrester, Dist 2; Sen. Forsythe, Dist 4; Sen. Gallus, Dist 1; Sen. Groen, Dist 6; Sen. Lambert, Dist 13; Sen. Luther, Dist 12; Sen. Morse, Dist 22; Sen. Odell, Dist 8; Sen. Sanborn, Dist 7; Sen. White, Dist 9; Sen. Barnes, Jr., Dist 17; Sen. Boutin, Dist 16; Sen. Carson, Dist 14
COMMITTEE: Health and Human Services
This bill requires the department of health and human services to establish a mandatory Medicaid managed care program for all Medicaid clients. Under this bill, the department shall develop a waiver to implement the program to present to the fiscal committee of the general court before seeking final approval from the federal Centers for Medicare and Medicaid Services to implement the program.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
11-0215
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eleven
AN ACT relative to Medicaid managed care.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Medicaid Managed Care Program.
I. The department of health and human services shall enter into a contractual agreement with one or more managed care organizations to provide managed care services for all Medicaid recipients, including the elderly, those meeting federal supplemental security income and state standards for disability, and those who are also currently enrolled in Medicare. Services provided pursuant to such contractual agreement may include, but not be limited to, care coordination, utilization management, disease management, pharmacy benefit management, provider network management, quality management, and customer services. To implement the requirements under this section, the department shall develop a Medicaid waiver to support the Medicaid managed care program for Medicaid clients. The department shall submit the appropriate waivers, state plan amendments and federal applications, including but not limited to, waiver requests authorized pursuant to sections 1115 and 1915 of the Federal Social Security Act, or successor provisions, as the department shall deem necessary to secure appropriate federal financial support for the cost of the program. The waivers, state plan amendments, and federal applications shall authorize mandatory managed care for Medicaid recipients residing in all areas of the state, including the elderly, those meeting federal supplemental security income and state standards for disability, and those who are also currently enrolled in Medicare. The department shall present the proposed waivers, state plan amendments and federal applications to the fiscal committee of the general court prior to submission for final approval of the federal Centers for Medicare and Medicaid Services (CMS). The department shall provide periodic reports to the fiscal committee of the general court throughout the waiver development, approval, and implementation processes. The department shall seek input from health care providers and the public in the course of developing the waiver.
II. For the purposes of this act, a “managed care organization” means an entity that is authorized by law to provide covered health services on a capitated risk basis and arranges for the provision of medical assistance services and supplies and coordinates the care of Medicaid recipients residing in all areas of the state, including the elderly, those meeting federal supplemental security income and state standards for disability, and those who are also currently enrolled in Medicare.
III. The department, in applying for a waiver, state plan amendment, or other federal authorization to implement the provisions of this act, shall request authority from the Secretary of Health and Human Services to combine Medicaid and Medicare funding for service delivery to eligible individuals who are also eligible for Medicare. Implementation of these programs may begin without authority to include Medicare funding.
IV. The following categories of individuals shall not be required to enroll in the managed care program established under this act:
(a) An individual dually eligible for medical assistance and benefits under the federal Medicare program and enrolled in a Medicare managed care plan offered by an entity that is also a managed care organization;
(b) HIV positive individuals;
(c) Persons with serious mental illness and abused children and adolescents with serious emotional disturbances, as defined in RSA 169-C; and
V. Individuals determined to be eligible for nursing home services and residing in a nursing facility.
2 Effective Date. This act shall take effect upon its passage.
LBAO
11-0215
01/25/11
SB 147-FN - FISCAL NOTE
AN ACT relative to Medicaid managed care.
FISCAL IMPACT:
The Department of Health and Human Services states this bill will have an indeterminable impact on state revenue and expenditures, and county expenditures in FY 2013 and in each year thereafter. There will be no fiscal impact on county and local revenues or local expenditures.
METHODOLOGY:
The Department of Health and Human Services states that, given the complexity and number of unknown variables, it is not able to determine the fiscal impact of this bill at this time. The Department stated that potential savings may be identified once a formal Request for Proposals is released, and the responses are received and evaluated.
The Department provided the following information:
• In 2009, a leading health care actuarial firm, Milliman, Inc., reviewed NH Medicaid claims and conducted actuarial analysis to determine the viability of Medicaid managed care in NH. Their report identified factors that impact the ability of the state to achieve savings utilizing managed care. The existing reimbursement rates, size of the Medicaid caseload, administrative costs, and wrap-around responsibility were factors.
• New Hampshire’s reimbursement rates and administrative costs are comparatively low.
• The federal law requiring states to offer choice to recipients would require at least two managed care organizations to serve Medicaid enrollees.
• States must provide wrap around services; all services required by federal law including services which may not be included in the managed care benefit package.
• The Department issued a Request for Information in July, 2010 to solicit ideas from the managed care industry. Twelve entities responded and none of the responses offered savings. Most of the respondents stated they would need 6 to 9 months from the date of contract approval to program start up. Therefore the Department assumed there could be no fiscal impact until FY 2013.
• The New Hampshire Medicaid program currently utilizes most of the tools used in managed care including prior authorization, care management, and pharmacy benefit management.
• Based on the experience of other states, an up front investment is necessary as two claims adjudication systems are needed for the first 6 months after the transition date. The old MMIS system would continue to operate for 6 months since providers have 6-12 months to submit claims for services provided and new the claims would be processed through the new managed care system.
• Federal approvals required at various points in the procurement process may increase the timeline for implementation.
