NHHA LEGISLATIVE UPDATE

JUNE 6, 2007
LEGISLATIVE HIGHLIGHTS


MEDICAID PROVIDER-BASED PAYMENT
Once again the Legislature acted in support of hospitals by prohibiting the New Hampshire Department of Health & Human Serivces from making changes to the current Medicaid provider-based payment system. HB 43 creates a study committee to examine Medicaid reimbursement for physician and outpatient hospital services. The bill goes one step further by prohibiting DHHS from submitting a Medicaid State Plan amendment to CMS prior to the completion of the study committee’s report.

On a related matter, in the ongoing dispute between hospitals and DHHS, the Joint Legislative Fiscal Committee refused to act on a request for approval to immediately eliminate Revenue Code 510 billing. In other actions, the Fiscal Committee approved the transfer of $1 million to fund outpatient hospital payments through June 30, 2007 while rejecting the Commissioner’s proposal to reduce payments from 81% to 55% of allowable costs.


MEDICAID – STATE BUDGET
The state budget will be voted on by the Senate this week and then move on to a House-Senate Committee of Conference to work out differences in the House and Senate versions of the budget. Good news for hospitals:
The Senate version includes:
= Full funding level for inpatient and outpatient hospital services proposed by the Governor (approved by the House)
= $4.4 million per year for Medicaid direct and indirect medical education (added by the House)
= Funding for Catastrophic payments proposed by the Governor (approved by the House)
= An additional $2.4 million in FY 2008 and $4 million in FY 2009 for neonatal and pediatric specialty hospital care. This was added in part due to Boston Children's Hospital's push for enhanced payments. We maintain that New Hampshire's hospitals are every bit as deserving of "enhanced" rates as Children's.

Senators responded by taking a systemwide approach to the problem of payment for children's "catastrophic" services to include:
= increased payments for pediatric specialty hospital services - an additional $6.4 million over 2 years. DHHS will be required to develop a new rate structure for intensive neonatal care, pediatric cardiac care, and other pediatric specialty care by Nov 1, 2007, subject to legislative approval to ensure that any proposed payment method carries out the legislature's intent. These rates would be paid to any facility that provides neonatal and pediatric specialty services.

= increased payments for children's services at Crotched Mountain Rehabilitation Center and Cedarcrest pediatric nursing facility. Raising payment rates for these two in-state children's specialty facilities will reduce unnecessarily longer (and more expensive) stays at Children's. This funding is in addition to the $6.4 million pediatric specialty hospital care appropriation.


MEDICAID SELECTIVE CONTRACTING
Earlier this week, the joint legislative Health & Human Services Oversight Committee strongly expressed its objections to the recent issuance of the RFP for Medicaid selective contracting. Prominent among the Committee’s concerns were the fact that this program has not been approved by CMS (the committee is unable to confirm whether a formal waiver request has even been submitted); that the Senate Finance Committee had already directed DHHS not to issue the RFP; that the mileage distances were too great for low-income patients and therefore affect access; that continuity of care would be compromised; and that the new system would be more difficult for Medicaid patients to navigate. In an unusual move, the Committee will meet in one week to take this up again to recommend a budget provision that would prohibit the Commissioner from moving forward with this program.


HEALTH INSURANCE
Medical Necessity Definition: The Governor has signed NHHA’s Medical Necessity bill. HB 228 standardizes New Hampshire’s statutory definition of medical necessity so that all health plans must adhere to a uniform standard. The new law goes into effect July 13, 2007.

Provider Credentialing: Our credentialing bill, HB 636, has passed both the House and Senate. It will require health plans to (1) complete review of physician credentialing applications within 30 days (for primary care) and 45 days (for specialists); and (2) pay physicians for on-call coverage under limited circumstances. This bill will go into effect 60 days after the Governor signs it.

Coverage for Dependent Young Adults: HB 790, extending family health coverage to dependents through age 25, has been passed by both the House and Senate. This bill should help reduce the level of uncompensated care attributable to the largest group of uninsured. It covers young people who are working part-time and going to school part-time, or who are living at home, starting their careers in low-wage jobs without insurance


CERTIFICATE OF NEED
ASC Exemption: The Senate is retaining SB 114 that would have exempted ASCs from CON regulatory oversight for further study. Senator Kathleen Sgambati will work with NHHA’s Ad Hoc CON Committee to develop an alternative proposal to deal with CON reforms.

CON Threshold/Expedited Review: The Senate tabled HB 597, a bill to raise the capital threshold for nursing homes, ASCs and specialty hospitals. Last week, this bill was amended on the floor of the Senate removing the threshold provision and replacing it with a requirement that the CON Board provide an expedited review of Elliot Hospital’s Londonderry facility.

CON and Construction: HB 727 would have required hospitals to assure in their CON applications that health insurance will be provided to construction workers by the general contractor. The bill was gutted and instead creates a commission to study the issue of health coverage offered by building contractors working for all types of non-profit organizations as well as municipalities. NHHA will have a seat on this committee.

CON Moratorium: HB 723 extends the moratorium on nursing home and rehabilitation beds through 6/30/09. Due to the expiration of the previous moratorium on 12/31/06, the CON Board issued both nursing home and rehab RFAs earlier in the year. Therefore, the Legislature decided to allow any applications received by the CON Board in response to
these RFAs to go forward.

MEDICAL LIABILITY
In a surprise move, the Senate tabled HB 143 last week. NHHA opposes HB 143, and if passed, it will upset the current balance in New Hampshire’s tort system with regard to settlements and payment of judgments. NHHA opposes HB 143 as it will unfairly punish defendants with "deep pockets", regardless of their degree of fault in a multi-defendant case.

HEALTHY KIDS PROGRAM
The House and Senate passed a bill that will increase outreach efforts to increase enrollment in the NH Healthy Kids Program. In addition to increased education to eligible families, the Department of HHS will pay partner agencies an enhanced application fee for outreach assistance they provide to enroll children in the program.



Go to http://www.nhha.org/nhha/state_law/bills.php to view the list of bills NHHA is tracking.

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