DHHS has announced a Dec. 1, 2013 start date for MCM Step 1, the Acute Care portion of the Medicaid managed care program. Medicaid recipients should have received an informational letter from DHHS Commissioner Toumpas last week, alerting them that enrollment will begin soon, but that no action is yet required. (Please note this is Step 1 only, not Step 2 which covers DD services). Click here to read a copy of the DHHS letter.

We want to keep everyone as updated as possible. At this point, we don't have much detailed information for you, but we are keeping a close eye on things and will keep you posted. Here is what we do know:

1. Detailed information and instructions are not yet available on options and actions items. You should receive materials and instructions in the mail from DHHS. In coming weeks you will be required to choose from one of three plans to cover Primary Care and other healthcare costs. Please know that as soon as any information does become available (hopefully in the next few weeks), we will pass along what we know to you. We also plan to hold information sessions as needed. You should also visit the new DHHS Medicaid Care Management site to read their updates.

2. DHHS is heavily marketing their NH EASY online account system, and encouraging folks to create an account on line. These accounts are easily manageable and convenient, so you might want to consider using this option. Click here to read instructions on how to sign up for NH EASY. If you have any questions or need help to sign up for NH EASY, please call or email Sandra Metivier, MDS Benefits Specialist, who will be more than happy to assist you in this process.

3. Step 2 of the Managed Care program, which includes disabilities services and long-term care, will not start until at least December 1, 2014, with specific plans not yet determined. Meanwhile, a group of NH families and the Area Agencies have filed a complaint in the NH State Court asking for a ruling that could exclude all waivered services (which is what most DD services are) from the Managed Care program. Click here to learn more about this complaint filing.

As information becomes available, we will post to our website and pass it along to you. If you have any questions, contact your MDS Service Coordinator or Sandra Metivier at 352-1304, ext. 290 or This email address is being protected from spambots. You need JavaScript enabled to view it..

Devine Millimet, a law firm in Concord NH, announced that it has filed a declaratory judgment action in the Hillsborough County Superior Court seeking a ruling that the State’s Department of Health and Human Services (DHHS) current efforts to develop a managed care program for Medicaid services should not include long term care services for people with developmental disabilities or acquired brain disorders served by New Hampshire’s developmental services system.

Deborah Fournier, an analyst at the NH Fiscal Policy Institute, explains:

“The primary argument in the complaint is that the state law underlying the managed care initiative only specifies that mandatory Medicaid services be required to be provided in a managed care context. Mandatory services are distinct from optional services and presumably from waivered services. In fact, some mandatory services are long-term care services (like skilled nursing facility care or home health care for people entitled to skilled nursing facility care).

“The argument in the complaint is that waivered services for those with developmental disabilities or acquired brain disorder are not mandatory services and therefore the State doesn’t have the authority to mandate those specific long-term care services be included in the managed care initiative. The complaint actually requests that the court rule on whether the law allows DHHS to mandate the inclusion of long-term care services for these two populations in the Medicaid managed care program.”

Fournier explains further: “The complaint is not so broad as to ask whether or not the State had the authority to mandate any waivered or optional service be included in the managed care initiative or to attempt to carve out waivered or optional services all together for any and all populations. The complaint does not seek any injunctive relief either; i.e., it doesn’t ask the court to stop the state from moving forward. It does ask the court to declare as a matter of law what the right answer is on this question.”

The case, captioned R. Stuart Wallace and Ethan Wallace et al., Plaintiffs, v. State of New Hampshire and the New Hampshire Department of Health and Human Services, Defendants, was filed by attorneys Thomas Quarles, Esq. and John D. MacIntosh, Esq. The plaintiffs are led by numerous individuals and family members served by the 10 Area Agencies that currently provide Medicaid-funded residential services and long term care for the developmentally disabled and individuals with acquired brain disorders.

Senate Bill 147-FN (Chapter 125, Laws of 2011) set up a capitation-based managed care program for the provision of Medicaid services to certain parts of the Medicaid population in New Hampshire. The scope of this law was limited to specific Medicaid programs and populations, including all mandatory Medicaid programs. The long-term care services provided by the Area Agencies are not named in the law and are not mandatory Medicaid services. Therefore, the State’s new Medicaid managed care program does not apply to long term care services for the developmentally-disabled or those with acquired brain injuries. The Complaint also seeks a judicial determination that none of the individual plaintiffs are required to participate in managed care programs for these services and that none of the Area Agencies are required to enter into contracts for the provision of long-term managed care services to their Medicaid populations with the three separate managed care organizations that the State Department of Health and Human Services has contracted with to put the Medicaid managed care program into effect.

The first phase of the State’s Medicaid managed care program for acute care services was supposed to be operating by July 1, 2012. That phase is still in the planning stages and will not be operational until December 1, 2013 at the earliest. Medicaid managed care for long term care services is the second phase of the program and cannot start for at least one year after the start of the first phase. Because of this delay, the plaintiffs have sought a declaratory judgment rather than an injunction, which if successful, will have the same effect as an injunction against the State.

Click here to access a copy of Complaint Document filed.

Click here for updates and more information on Medicaid Managed Care.

Do you know a Direct Support Professional who goes above and beyond in providing services to the people he or she supports? Is there a Home Provider you know who embodies the mission of MDS? Deadline for DSP and Home Provider of the Year nominations has been extended to this Thursday, August 29th.

Now is the time to nominate a Direct Support Professional and/or Home Provider from our Monadnock region for consideration for the 2013 DSP/Home Provider of the Year Awards, given annually by the NH Council on Developmental Disabilities. Each region will submit two nominations – one for DSP of the Year, one for Home Provider of the Year – to the DD Council in late August. The 22 nominees will be recognized on the State House lawn on Yellow Flag Day in mid-September. The statewide honoree will be selected from these nominees and will be announced in late October at the annual DSP Conference at the Attitash Grand Summit Resort in Bartlett, N.H.

Click here for a nomination form or contact your MDS service coordinator. Extended deadline to submit nominations is Thursday, August 29th. Please send your letter of nomination to Priscilla Brisson at MDS: This email address is being protected from spambots. You need JavaScript enabled to view it. or by mail to MDS, 121 Railroad Street, Keene, N.H. 03431.

Click here to read about the 2012 winners...

tea-390Join us for an evening out at the Peterborough Players on Tuesday, September 17th. Reception starts at 7:00 p.m., with show at 8:00 p.m. Click here for ticket information and details.

New Hampshire ranks #2 overall in the nation in how well its state Medicaid program serves Americans with intellectual and developmental disabilities, according to the 2013 Case for Inclusion. This report, produced annually by United Cerebral Palsy (UCP), ranks all 50 states and the District of Columbia on outcomes for Americans with intellectual and developmental disabilities (ID/DD). Arizona came in at the top of the list, with Vermont at #4, Connecticut at #8, and Massachusetts at #10. New Hampshire’s high ranking can be linked to the fact that we have no state institution, and a well formed, family-supported community based service system. Highlights and a link to the report are at the end of this article.

How are rankings determined? This study measures outcomes by assessing how well each state does in five categories:

  • Promoting independence (community living)

  • Promoting productivity (employment)

  • Keeping families together

  • Reaching those in need (Wait List)

  • Tracking community involvement and safety

Here is how things play out on a national basis:

Ranking: All states still have room for improvement, but some states have consistently remained at the bottom since 2007, including Arkansas (#50), Illinois (#48), Mississippi (#51) and Texas (#49).

Community Based Services: 38 states now meet the 80/80 Community standard, which means that at least 80% of all individuals with ID/DD are served in the community, and 80% of all resources spent on those with ID/DD are for community support, nearly triple the 2007 number.

Institutions: As of 2011, 13 states have no state institutions to seclude those with ID/DD. Another 10 states have only one institution each. Since 1960, 209 of 354 state institutions have been closed, leaving just 149 remaining. The Laconia State School in NH was closed in 1991.

Family Support Services: Only 15 states support a large share of families through family support. This is important, because those support services provide assistance to families that are caring for children with disabilities at home, which helps keep families

together and people with disabilities living in a community setting.

Employment: Just 10 states have at least 33% of individuals with ID/DD working in competitive employment, a standard which recognizes and supports work as key to a meaningful life. This measure has plummeted in recent years. In 2007, 17 states were meeting this standard. This year NH weighs in at 45%.

Waiting Lists: More than a quarter of a million people are on a waiting list for Home and Community Based Services (HCBS). Since the 2007 ranking, the size of the waiting list nationally has almost doubled from 138,000 to 268,000. However, 20 states report no waiting list or a relatively small waiting list. NH is in this category.

What does all this mean? Even though we’re doing well here in New Hampshire, we not satisfied.

We’re not satisfied because we have a Wait List. It’s too high, even though on a national basis our numbers are considered relatively small. Employment remains a challenging issue to us. There are many people who want to work, but who aren’t. We are considered stellar on the inclusion front, but the reality is that many people we support don’t have friends, are lonely, want to fall in love, don’t feel connected.

The task of helping people have real lives has been so daunting for the last generation that, even with the progress that has been made, we’re nowhere near where we need to be. Much remains to be done.

Full details on this report are available on-line at http://www.ucp.org/the-case-for-inclusion/2013/

Highlights of the 2013 Case for Inclusion Report:

  • The number of states serving 80% of individuals with ID/IDD in the community, and dedicating 80% of spending to the community, (the 80/80 Community standard) has nearly tripled, from 14 to 38, since 2007 when these outcomes started being measured. NH has been in the top 10 on this particular front since 2007.

  • The number of states with at least one third of individuals with ID/IDD employed has dropped from 17 in 2007 to 10 in 2012. The employment rate in NH, as measured by this report, is reported at 45%. (The Bureau of Developmental Services shows the current NH rate at 37%.)

  • More than 265,000 Americans are on the wait list for services, double the number from 2007. NH’s numbers, which we think are too high, are considered in the relatively small range.

  • New Hampshire’s overall ranking has continued to improve over the years. We are making progress, as evidenced in our jump from #11 in 2007 to #2 today.

 

The latest edition of Clipboard, Summer 2013, is now available to download...click here!

This week the state of New Hampshire received confirmation that Center for Medicaid/Medicare Services (CMS) has approved the State Plan Amendment (SPA) re: the initiation of Medicaid Managed Care. It is important to note that this does not mean that CMS has approved the Managed Care contract itself. The above-mentioned reflects approval of the State Plan Amendment (SPA) only, not the contracts or the rates. This SPA is a relatively simple document, a small link in the transition chain. It informs the federal government that the state of NH intends to shift its Medicaid program from a fee-for-service reimbursement to a managed care program.

Again, approval of the SPA is not the same as review and approval of the contract. CMS still has to approve both this massive managed care contract and the capitated rates paid to the Managed Care Organizations (MCOs). These are not yet approved. In addition, the three MCOs are still trying to build robust provider networks, which will also require approval by CMS and the state.

According to CMS's letter, CMS is still reviewing the contracts and their associated rates, and has continuing questions for the Department about them. No federal financial participation (no federal dollars) will be available to NH for Managed Care until the contracts are approved by CMS.

This SPA (State Plan Amendment) has absolutely nothing to do with Step 2 (DD and long-term care) or Area Agency services. As of right now, Step 1 covering medical and acute care services is still scheduled to begin on January 1, 2013, but as that date approaches it appears less and less likely to be do-able. Step 2 is still scheduled to start one year after Step 1 is implemented.

FYI, a final report on this past summer’s meetings to discuss Managed Care can be found on the DHHS website. Details on how Managed Care might affect people served by MDS and their families can be found on our special Managed Care Info page.