HB 1468

This bill requires the department of health and human services to establish certain programs to increase access to prescription drugs for seniors. The bill grants rulemaking authority to the commissioner of health and human services for the purposes of the bill.

This bill requires the department of health and human services to encourage health plans and health care systems participating in the medicaid program to use case management incorporating evidence-based practice guidelines.

The bill also establishes a 3-year task force to study increasing access to prescription drug medicines for needy seniors.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

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

1 New Chapter; Access to Prescription Drugs. Amend RSA by inserting after chapter 161-I the following new chapter:

I. "Commissioner" means the commissioner of the department of health and human services.

III. "Division" means the division of elderly and adult services, department of health and human services.

161-J:2 Medicaid Outreach and Enrollment Program Established. The department shall establish the medicaid outreach and enrollment program. Such program shall be administered by the division through the development of outreach initiatives to identify medicaid-eligible medicare beneficiaries who are not participating in the medicaid program and to promote and encourage enrollment of such eligibles in the medicaid program. Initiatives may include, but are not limited to, mailings, advertisements, public service announcements, literature dissemination, and community outreach.

I. The department shall make an annual report to the general court beginning one year from the effective date of this chapter.

(a) The baseline number of medicare beneficiaries who were medicaid eligible at the beginning of the previous year.

(b) The number of medicaid-eligible medicare beneficiaries who were targeted via the medicaid outreach and enrollment program.

(c) The number of medicaid-eligible medicare beneficiaries who enrolled in medicaid in a given year and any information of enrollment via the medicaid outreach and enrollment program.

(d) A description of the outreach initiatives utilized by the medicaid outreach and enrollment program.

161-J:4 Rulemaking. The commissioner shall adopt rules, pursuant to RSA 541-A, necessary for the implementation of this chapter.

I. "Qualified medicare beneficiaries" means medicare beneficiaries with incomes equal to or below 100 percent of the federal poverty level who are eligible for medicaid assistance for the part A and part B medicare premiums and for medicare deductibles and co-insurance requirements as set forth in section 1905(p)(1) of Title XIX of the Social Security Act.

II. "Specified low-income medicare beneficiaries" means medicare beneficiaries who have incomes greater than 100 percent of the federal poverty level and less than and equal to 120 percent of the federal poverty level and meet the requirements set forth in section 1902(a)(10)(E)(iii) of Title 19 of the Social Security Act.

I. There is hereby established the medicaid Rx senior eligibility expansion program. To be eligible for the program, an individual shall:

(c) Be at least 65 years of age or an individual between the ages of 19 and 64 who is otherwise eligible for benefits under Title II of the Social Security Act (Federal Old Age, Survivors, and Disability Insurance);

(d) Meet the definition of a qualified medicare beneficiary or a specified low-income medicare beneficiary as set forth in subparagraph (c); and

(e) Be ineligible for and/or not receiving a prescription drug benefit through a medicare supplemental policy or any other third party payer prescription benefit.

II. Individuals eligible for the medicaid Rx senior eligibility expansion program shall be entitled to the medicaid prescription drug coverage as provided to medicaid recipients as set forth in Title XIX of the Social Security Act.

I. The medicaid Rx senior eligibility expansion program shall be administered by the division. The department shall apply for a federal medicare 1115 demonstration waiver from the Secretary of Health and Human Services to expand medicaid eligibility for the purposes of prescription drug coverage to qualified medicare beneficiaries and specified low-income medicare beneficiaries under the medicaid Rx senior eligibility expansion program.

II. The commissioner shall make an annual report beginning one year after the effective date of this chapter to the general court relative to the effectiveness of the medicaid Rx senior disability eligibility program.

2 New Subdivision; Medicaid Best Practices. Amend RSA 167 by inserting after section 97 the following new subdivision:

I. The department of health and human services shall identify medicaid patients who require ongoing and expensive care and develop interventions to improve their health, functional status and independence in an effort to promote adherence to best medical practices. The department shall encourage health plans and health care systems participating in the medicaid program to:

II. The department shall make an annual report beginning one year after the effective date of this section to the oversight committee established in RSA 126-A:13, relative to the effectiveness of this section.

III. The commissioner of health and human services shall adopt rules, pursuant to RSA 541-A, necessary to implement this program.

3 Task Force Established. There is established a task force to study establishing a New Hampshire Rx senior patient assistance program.

(a) Three members of the house of representatives, appointed by the speaker of the house.

II. The members of the task force shall serve without compensation, however, legislative members of the task force shall receive mileage at the legislative rate when attending to the duties of the task force.

5 Duties. The task force shall study the feasibility of establishing a New Hampshire Rx senior patient assistance program. The committee shall consider eligibility guidelines and enrollment fees.

6 Chairperson; Quorum. The members of the task force shall elect a chairperson from among the members. The first meeting of the task force shall be called by the first-named house member. The first meeting of the task force shall be held within 45 days of the effective date of this section. Six members of the task force shall constitute a quorum.

7 Report. The task force shall report its findings and any recommendations for proposed legislation to the speaker of the house of representatives, the senate president, the house clerk, the senate clerk, the governor, and the state library on or before November 1, 2005.

The Department of Health and Human Services stated this bill will increase state expenditures by $15,870,351 in FY 2003, $18,756,017 in FY 2004, $21,137,666 in FY 2005 and $31,427,856 in FY 2006. State revenues will increase by $7,935,175 in FY 2003, $9,378,008 in FY 2004, $10,568,833 in FY 2005 and $15,713,928 in FY 2006. There will be no impact on county and local revenue or expenditures.

The Department indicated this bill requires the Commissioner to apply for a federal demonstration waiver to expand Medicaid eligibility for prescription drugs to qualified Medicare beneficiaries (QMB) and specified low-income Medicare beneficiaries (SLMB). This bill also requires the Department to implement a Chronic Disease Management Program. In estimating the fiscal impact of this bill, the Department made the following assumptions:

· This bill would be effective July 1, 2002 and outreach efforts would begin 60 days later.

· Outreach costs would provide funds for a full-time Case Technician and a Program Specialist to coordinate outreach, mail campaigns, public service announcements, literature and related activities.

· Chronic disease management savings would not be realized for 20 months based on industry standards.

· The Division of Family Assistance would be impacted by an increase in the number of applicants for the drug benefit. Six new Case Technicians would be required.

· Drug costs used are those typical for the QMB and SLMB population and drug rebates of 19% are assumed.

· Additional costs will include payment of Medicare B and Coinsurance/Deductible for QMB and Medicare B for SLMB enrollees.

· The estimated total population is 21,225, and 46% will enroll in the program by FY 2006.

Based on these assumptions, the Department assumed the following costs:

FY 2003 FY 2004 FY 2005 FY 2006

Projected Enrollment 5,050 6,312 7,890 9,863

Prescription Cost Per

Recipient Per Month $ 182 $ 215 $ 253 $ 299

Annual Total Cost for

Prescriptions 11,029,200 16,284,960 23,954,040 35,388,444

Cost After Rebates 8,933,652 13,190,818 19,402,772 28,664,640

Additional QMB Costs 2,373,600 2,967,000 3,707,976 4,635,744

Additional SLMB Costs 1,782,000 2,227,176 2,784,456 3,480,408

Outreach Costs 142,553 147,542 152,706 158,051

New Heights

Modifications 250,000

Chronic Disease

Management Program

- Costs & (Savings) 2,153,360 (23,464) (5,169,537) (5,783,243)

Division of Family

Assistance

6 Case Technicians 235,186 246,945 259,293 272,256

Total Projected

Expenditures $15,870,351 $18,756,017 $21,137,666 $31,427,856

Federal Funds $ 7,935,175 $ 9,378,008 $10,568,833 $15,713,928

General Funds $ 7,935,175 $ 9,378,008 $10,568,833 $15,713,928