2010 New Hampshire Statutes
TITLE XI HOSPITALS AND SANITARIA
CHAPTER 151-E LONG-TERM CARE
Section 151-E:11 Program Management and Cost Controls.

151-E:11 Program Management and Cost Controls. –
    I. The department shall designate in its operating budget requests specific class lines for nursing facility, mid-level, and home-based care provided for in this chapter. These class lines shall reflect, and the requesting documentation shall include, the anticipated number of persons to receive services. The department shall not increase expenditures in approved budgets for these class lines or the number of persons to receive mid-level or home care services without the approval of the legislative fiscal committee, and the prior review of the county-state finance commission. The medicaid rates paid for nursing facility services, mid-level care services, and home and community-based care services shall not be reduced below those levels in effect on the last day of the previous biennium. No transfers may be made from the nursing facility medicaid quality incentive program and all funding derived from that program shall be paid to nursing facilities.
    II. For the fiscal year beginning July 1, 2003, and each fiscal year thereafter the average annual cost for the provision of services to persons in the mid-level of care shall not exceed 60 percent of the average annual cost for the provision of services in a nursing facility. The average annual cost for the provision of services in home-based care shall not exceed 50 percent of the average annual cost for the provision of services to persons in a nursing facility. No person whose costs would be in excess of 80 percent of the average annual cost for the provision of services to a person in a nursing facility shall be approved for home-based or mid-level services without the prior approval of the commissioner of health and human services. The prior approval shall include a comparison of the mid-level or home-based care costs of the person with the costs of a facility qualified to provide any specialized services necessary for the proper care and treatment of the individual. The department shall provide a report semi-annually on the utilization of non-nursing home services to the county-state finance commission and the legislative fiscal committee.
    III. (a) The methodology for determining the cost of care for recipients in the home and community-based care waiver program for the elderly and chronically ill shall include the cost of:
          (1) Waiver program services; and
          (2) Other medicaid long-term care services, including but not limited to personal care, home health services, physical therapy, occupational therapy, speech therapy, adult medical day program services, private duty nursing, and case management services.
       (b) Such methodology shall not include services rendered for the treatment of an acute illness or injury.
    IV. Pursuant to RSA 541-A, the commissioner of the department of health and human services, with prior reporting to the oversight committee on health and human services, shall adopt by rule:
       (a) Methodologies for determining the cost and average annual cost of home-based care, mid-level care, and intermediate, skilled, or specialized nursing facility care, including:
          (1) Bases for the methodologies;
          (2) Identification of services considered in determining costs;
          (3) Average annual costs based on the annual average number of recipients in the setting;
          (4) The requirement that nursing facility care include both the initial Medicaid rate and supplemental rates paid through the Medicaid Quality Incentive Program; and
          (5) The requirement that the nursing facility will include the cost for transitional case management.
       (b) A process to identify persons in home-based or mid-level care whose costs are expected to exceed 80 percent of the average annual cost for the provision of services to a person in a nursing facility.
       (c) A standard of review and process for prior approval by the commissioner, in accordance with paragraph II of this section, for the cases identified through the process in subparagraph (b).

Source. 1998, 388:1. 2003, 223:5, eff. July 1, 2003; 319:35, eff. July 1, 2003. 2005, 175:13, eff. Aug. 29, 2005. 2010, 112:1, 2, eff. Jan. 1, 2011.