UPDATE 3/28/2016
The NH Senate has passed an amended version of Senate Bill 553 which states that the remainder of Step 2 of Medicaid managed care be postponed from being implemented until after June 30, 2017.

SB 553 also requires Fiscal Committee approval for any further DHHS actions on implementing Step 2. The only change to the bill as originally introduced is that all Step 2 Phase 1 populations (Katie Beckett, Dual Eligibles) would remain in Medicaid managed care for their medical or state plan services. The bill is now with the House Health and Human Services committee, and will then go to the full House for vote.

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On Tuesday, March 15th the Senate Health and Human Services committee conducted a public hearing on whether the Department of Health and Human Services (DHHS) should be allowed to place long term supports and services into the hands of the commercial for-profit managed care organizations before June 30, 2017. This is what we have been referring to as Step 2 of Medicaid Managed Care.

The bill discussed at the public hearing is SB 553 relative to implementation of the Medicaid managed care program. This legislation was sponsored by Sen. Forrester (chair of the Senate Finance committee) and appears to have broad bipartisan support in its list of sponsors. SB 553 would do two things. First, it would prevent any further movement of Step 2 until July 1, 2017; and second, it provides legislative oversight of any such move by requiring the Joint Fiscal Committee to approve any future step 2 plans by DHHS.

This legislation was filed at the request of NH Health Care Association (NH’s Nursing Home lobby) and is supported by most of the stakeholders who would be impacted by proposed step 2 plans. This includes the public Nursing Homes (NH Counties) and independent case management companies. The Area Agencies through Community Support Network, Inc. are also supporting SB 553.

This public hearing in a legislative policy committee of the NH Legislature on Step 2 is long overdue. In 2011, during the initial legislative discussions on Medicaid managed care, Step 2 was not even part of the vocabulary of Medicaid managed care in NH. The plans of Step 2 were created after legislation was signed into law and right before RFP’s were issued to interested managed care organizations.

The current Medicaid managed care program may have resulted in some positive changes. However, it has also resulted in no less than 5 bills that were filed this legislative session. These bills aimed to fix problems with the program around transportation and prior authorization of medications/services. In addition, there is now over $50 million in new administrative costs. Finally, the two MCO’s have received constant (almost monthly) increases in their rates at the same time that many Medicaid recipients are being denied or delayed services that they are entitled to receive under the Medicaid program.

Senator Forrester introduced the bill and said that she believes step 2 is not ready for implementation and won’t be ready before June 30, 2017. Forrester believes that this bill will protect the families and all the providers impacted by step 2.

The DHHS Commissioner, Jeff Meyers, spoke against the bill because he said it would place the state in a position of violating contracts and the previous legislative intent of Medicaid managed care. Meyers did say that step 2 has a long way to go and that DHHS would not move forward until a lot more work is conducted. The current July and September 2016 dates for Nursing Home Care and CFI are no longer the target start dates for step 2 phases 2 and 3.

The committee heard from families in the DD and Area Agency system who expressed their concerns with how step 1 has negatively impacted their families. In addition, the families spoke about their concerns relative to how and why commercial insurance companies should be in charge of community supports in the state of NH.

In addition, dozens of families signed in to register support for the bill.

Finally, the NH Health Care Association (NH Nursing Homes) the NH Associations of Counties (Public Nursing Homes) Community Support Network, Inc. (Area Agencies), The NH Home Health Association (CFI/Home Care Providers) all spoke in favor of the bill.

No one spoke against the bill at the public hearing beyond Commissioner Meyers.

The committee, later in the evening, voted 3-0 to pass the bill.