SB 0401

AN ACT relative to long-term care funding and making an appropriation therefor.

SPONSORS: Sen. Johnson, Dist 3; Sen. Flanders, Dist 7; Sen. Disnard, Dist 8; Sen. Burns, Dist 1; Sen. Gordon, Dist 2; Rep. Micklon, Rock 26; Rep. Rogers Johnson, Rock 25

This bill increases the funding for long-term care nursing services. The bill also requires the department of health and human services to recalculate the payments made to nursing facilities, and requires the department of health and human services to reimburse municipal and private emergency medical ambulance transport providers for the transportation of medicaid patients.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.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

I. Amend 2001, 130:1, PAU 05, 01, 10, 04, 01 by increasing Class 90, 91 and 95 and the estimated source of funds as follows:

II. The funds appropriated under paragraph I of this section shall be in addition to any other funds appropriated to the department of health and human services.

I. Within 30 days of the effective date of this act, the department of health and human services shall recalculate the payments made to nursing facilities retroactive to October 1, 2001. The department shall increase rates effective retroactive to October 1, 2001 to:

(a) Eliminate the across-the-board reductions calculated in setting rates effective October 1, 2001 and February 1, 2002;

(b) Synchronize acuity with the cost base year for the same historical period and realize changes in acuity to within 6 months of the effective date of the rate change; and

(c) Increase calculations and payments beyond the median calculations currently in the payment system to, as closely as possible, fully expend the total dollars appropriated in this line item for the state fiscal year ending June 30, 2002.

II. On or before October 1, 2002, the department of health and human services shall:

(a) Re-base cost using the previous year's cost reports inflated forward from the midpoint of the cost report period to the midpoint of the rate period using the DRI/McGraw-Hill-HCFA Nursing Home Without Capital Market Basket - Quarterly Forecast;

(b) Synchronize acuity with the cost base year for the same historical period and realize changes in acuity to within 6 months of the effective date of the rate change; and

(c) Increase calculations and payments beyond the median calculations to, as closely as possible, fully expend the total dollars appropriated in PAU 05, 01, 10, 04, 01, class 90 for the state fiscal year ending June 30, 2003.

III Within 30 days of the effective date of this act, the department of health and human services shall reculculate the payments made to home health facilities and nursing services mid level care facilities retroactive to July 1, 2001.

IV. On or before July 1, 2002, the department of health and human services shall increase calculations and payments to, as closely as possible, fully expend the total dollars appropriated in 2001, 130:1, PAU 05, 01, 10, 04, 01, class 91 and class 95 for the state fiscal year ending June 30, 2003.

3 Source of Funding. Notwithstanding any other provision of law, the "other funds" appropriated in section 1 of this act shall be transferred from the balance in the health care fund, established in RSA 167:70.

I. Amend 2001, 130:1, PAU 05, 01, 07, 06, 03 by increasing class 90 line for emergency medical transport services. The department of health and human services shall reimburse municipal and private emergency medical ambulance transport providers in the class 90 account of PAU 05, 01, 07, 06, 03 for the emergency and non-emergency transportation of New Hampshire Medicaid patients at the same transport and mileage rate as the Federal Health Care Financing Authority pays for the emergency and non-emergency transportation of Medicare patients. Payment of the new rate shall be retroactive to January 1, 2002 for all emergency and non-emergency ambulance transports of Medicaid patients.

II. Notwithstanding any other provision of law, the funds required to increase the payment to the new rate provided in this section shall be transferred from the balance in the health care fund established in RSA 167:70.

The Department of Health and Human Services indicates this bill, as amended by the Senate, (Senate Amendment #2002-2782s) will increase state restricted expenditures by $19,789,255 in FY 2002 and FY 2003. State restricted revenue will increase by $9,894,627 in FY 2002 and FY 2003. In addition, in FY 2002 and FY 2003 there will be an indeterminable increase in state revenue and expenditures and county expenditures due to administrative costs. There will be no fiscal impact on county and local revenue or local expenditures.

This bill appropriates $18,659,862 in FY 2002 and FY 2003 to the Department of Health and Human Services for nursing services, home nursing services and mid level care. For each year, $9,329,931 of the appropriation is from the Health Care Fund, and $9,329,931 is from federal funds. In addition, this bill makes a supplemental appropriation from the Health Care Fund to the Department in an amount necessary to provide a rate increase for emergency medical transport services provided for Medicaid recipients retroactive to January 1, 2002.

The Department states this bill will reduce the Health Care Fund principal by $9,894,627 and increase federal Medicaid revenue by the same amount in FY 2002 and again in FY 2003. The Department assumed the federal share of Medicaid nursing home reimbursements would be 50%. The principal balance in the Health Care Fund would be reduced from $45,811,896 to $26,022,641 over the biennium. The interest earned on the fund and corresponding amount available for the Community Grant Program would be reduced based on the interest rate earned on the principal balance. The Department indicated the cost to increase the transportation reimbursement paid to providers for emergency and non-emergency transportation of Medicaid patients would be $1,129,393, of which 50% would be reimbursed by federal funds and 50% from the Health Care Fund principal.

In addition to the appropriation of Health Care Fund principal, the Department would incur additional administrative costs in implementing this bill. These costs cannot be determined, but would be shared 50% federal Medicaid funds, 25% state funds and 25% county funds.