151-E:27 System of Care Implementation and Reporting Requirements. –
I. When preparing the biennial budget for the Choices for Independence program, the department shall prepare data showing the amount program provider rates would be increased to be in alignment with the rate plan as completed by the department.
II. The department shall review and propose rates for the Choices for Independence program in accordance with section 1902 (a)(30)(A) of the Social Security Act and requirements for Medicaid home and community based waiver programs under section 1915(c). The department shall provide a report to the house health, human services and elderly affairs committee and senate health and human services committee, the house finance committee, the senate finance committee and the joint legislative committee on health and human services established in RSA 126-A:13 on or before July 1, 2024. The focus of the rate study is to promote efficiency, economy, quality of care and access to services within New Hampshire's Choices for Independence program. The rate study shall establish reimbursement methodologies utilizing the U.S. Centers for Medicare and Medicaid Services Market Basket Index as an inflation benchmark for rate-setting purposes. The department shall seek input from Choices For Independence beneficiaries, providers, and other stakeholders in regard to access to Choices for Independence services in future rate setting processes. Information regarding access to services shall be publicly documented and shall be considered in the subsequent rate-setting process.
III. On a biennial basis, the department shall perform a financial review to determine whether ADRC offices are receiving sufficient funding to maintain their operations and make legislative budget requests if additional funding is warranted.
IV. Beginning November 1, 2023, and annually thereafter, the department shall report to the governor, the state commission on aging established in RSA 19-P:1 and the joint legislative committee on health and human services established in RSA 126-A:13. The report shall provide detailed information regarding the status of the implementation of this subdivision.
V. Beginning in 2024, the report shall address the following:
(a) The total cost of Medicaid long-term care services and Choices for Independence program services.
(b) The extent to which the state's long-term care support and services systems are consistent with a system of care.
(c) A description of any actual or planned changes in department policy or practice or developments external to the departments that will affect implementation of a system of care.
(d) Any other available information relevant to progress toward full implementation of a system of care.
(e) The result of pilots regarding access with the counties.
(f) A review of options to enhance the system of care.
(g) Presumptive eligibility findings and recommendations for next steps.
(h) The status of changes to the NH Easy application system and any additional enhancements needed.
(i) The status of reimbursement rates and rate study.
VI. Beginning in 2025, the report shall also address the following:
(a) Identification of those actions which will be required to maximize federal and private insurance funding participation in the system of care, along with target dates for completion.
(b) Identification of changes to statutes, administrative rules, policies, practices, and managed care and provider contracts which will be necessary to fully implement the system of care.
(c) Identification of significant gaps in the array of long-term care supports and services for older adults and adults with disabilities, along with a description of plans to close those gaps.
VII. Beginning in 2026, the report shall also address the following:
(a) Projections of future demand for services in the system of care.
(b) Identification of shortfalls in workforce sufficiency affecting full implementation of the system of care and plans for addressing those shortfalls.
(c) Identification of specific plan amendments and other changes to the Medicaid system required for full implementation of the system of care and plans for making those changes.
(d) Numbers of older adults and adults with disabilities waiting services in various categories.
VIII. Beginning in 2027, the report shall also address the following:
(a) Detailed statistical information regarding older adults and adults with disabilities serviced, along with demographic characteristics, service need and provision, involvement in service systems, service funding sources, and placement or other site of service provision.
(b) Financial information, including but not limited to measures of cost-effectiveness, comparisons with other states with regard to levels of funding from federal, state, local, and private sources, and cost savings resulting from service coordination and effectiveness.
(c) An assessment of any influences external to the department of health and human services, including configuration of the private long-term care health care system, which may be affecting establishment of the system of care.