New Hampshire 2025 Regular Session

New Hampshire Senate Bill SB125 Compare Versions

The same version is selected twice. Please select two different versions to compare.

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	SB 125-FN - AS AMENDED BY THE SENATE
2	2
3	3
4	4
5	5	03/13/2025 0784s
6	6
7	7	2025 SESSION
8	8
9	9	25-1000
10	10
11	11	05/09
12	12
13	13
14	14
15	15	SENATE BILL125-FN
16	16
17	17
18	18
19	19	AN ACTrelative to clinical eligibility criteria for nursing facility and home and community based care.
20	20
21	21
22	22
23	23	SPONSORS:Sen. Avard, Dist 12
24	24
25	25
26	26
27	27	COMMITTEE:Health and Human Services
28	28
29	29
30	30
31	31	-----------------------------------------------------------------
32	32
33	33
34	34
35	35	ANALYSIS
36	36
37	37
38	38
39	39	This bill updates clinical eligibility criteria for nursing facility and home and community based care; adds mobility to the activities of daily living; corrects the federal reference for the definition of “skilled professional medical personnel”; requires information from the applicant’s primary care physician be considered; clarifies the medical eligibility determination is the responsibility of “skilled professional medical personnel”; and gives the department staff authority to obtain medical information for the eligibility decision making process.
40	40
41	41
42	42
43	43	- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
44	44
45	45
46	46
47	47	Explanation:Matter added to current law appears in bold italics.
48	48
49	49	Matter removed from current law appears [in brackets and struckthrough.]
50	50
51	51	Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
52	52
53	53	03/13/2025 0784s25-1000
54	54
55	55	05/09
56	56
57	57
58	58
59	59	STATE OF NEW HAMPSHIRE
60	60
61	61
62	62
63	63	In the Year of Our Lord Two Thousand Twenty Five
64	64
65	65
66	66
67	67	AN ACTrelative to clinical eligibility criteria for nursing facility and home and community based care.
68	68
69	69
70	70
71	71	Be it Enacted by the Senate and House of Representatives in General Court convened:
72	72
73	73
74	74
75	75	1 Long-Term Care; Eligibility. Amend RSA 151-E:3 to read as follows:
76	76
77	77	151-E:3 Eligibility.
78	78
79	79	I. A person is medicaid eligible for nursing facility services or Medicaid home and community-based care waiver services if the person is:
80	80
81	81	(a) Clinically eligible for nursing facility care because the person requires 24-hour care for one or more of the following purposes:
82	82
83	83	(1) Medical monitoring and nursing care when the skills of a licensed medical professional are needed to provide safe and effective services;
84	84
85	85	(2) Restorative nursing or rehabilitative care with patient-specific goals;
86	86
87	87	(3) Medication administration by oral, topical, intravenous, intramuscular, or subcutaneous injection, or intravenous feeding for treatment of recent or unstable conditions requiring medical or nursing intervention; or
88	88
89	89	(4) Assistance with 2 or more activities of daily living involving eating, toileting, transferring, mobility, bathing, dressing, and continence; and
90	90
91	91	(b) Financially eligible as either:
92	92
93	93	(1) Categorically needy, as calculated pursuant to rules adopted by the department under RSA 541-A; or
94	94
95	95	(2) Medically needy, as calculated pursuant to rules adopted by the department under RSA 541-A.
96	96
97	97	II. Skilled professional medical personnel employed by or designated to act on behalf of the department shall determine clinical eligibility in accordance with the criteria in subparagraph I(a). The clinical eligibility determination shall be based upon an assessment tool, approved by the department, performed by skilled professional medical personnel employed by the department, or by an individual with equivalent training designated by the department. The department shall train all persons performing the assessment to use the assessment tool. For the purposes of this section, "skilled professional medical personnel" shall have the same meaning as in 42 C.F.R. section [432.50(d)(1)(ii)] 432.2.
98	98
99	99	II-a. Subject to written approval by the Center for Medicare and Medicaid Services, financial eligibility rules in paragraph II shall include eligibility if the person's countable income is at or below the nursing facility special income standard, as defined in 42 C.F.R. 435.236, for the Medicaid program or the person incurs allowable medical expenses each month, including the anticipated cost of waiver services, which when deducted from the individual's income would reduce the individual's income to an amount that is no higher than the nursing facility special income standard. The department shall submit a request for such approval within 30 days of the effective date of this paragraph.
100	100
101	101	III. [Repealed.]
102	102
103	103	IV. If the skilled professional medical personnel employed by or designated to act on behalf of the department are unable to determine that an applicant is eligible following the clinical assessment tool pursuant to paragraph II, the [skilled professional medical personnel] department shall obtain a determination for the need for long term care from the applicant’s primary care physician or nurse practitioner. The department shall request information from and give substantial weight to other clinical information provided by the applicant's [physician or nurse practitioner, including, but not limited to diagnosis, prognosis, and plan of care recommendations, and consider information from other licensed practitioners, including occupational or physical therapists, if available. All clinical information obtained shall also be used in the preparation of the initial support plan] other known health care providers, including but not limited to specialty care physicians, case management providers, or occupational or physical therapists, including diagnosis, prognosis, and plan of care recommendations. All clinical information obtained by the department shall be reviewed by skilled professional medical personnel employed by or designated to act on behalf of the department for an eligibility decision.
104	104
105	105	V. No applicant who is being assessed for annual redetermination shall be denied eligibility under this section without the individual's primary care physician, physician assistant, or nurse practitioner’s agreement that the applicant no longer meets the level of care identified in paragraph I.
106	106
107	107	2 Effective Date. This act shall take effect 60 days after its passage.
108	108
109	109
110	110
111	111	LBA
112	112
113	113	25-1000
114	114
115	115	Revised 2/25/25
116	116
117	117
118	118
119	119	SB 125-FN- FISCAL NOTE
120	120
121	121	AS INTRODUCED
122	122
123	123
124	124
125	125	AN ACTrelative to clinical eligibility criteria for nursing facility and home and community based care.
126	126
127	127
128	128
129	129	FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
130	130
131	131
132	132	Estimated State Impact
133	133	FY 2025 FY 2026 FY 2027 FY 2028
134	134	Revenue $0 $0 $0 $0
135	135	Revenue Fund(s) None
136	136	Expenditures* $0 $5 million+ (half general funds, half federal funds) $5 million+ (half general funds, half federal funds) $5 million+ (half general funds, half federal funds)
137	137	Funding Source(s) General Fund, Federal Funds
138	138	Appropriations* $0 $0 $0 $0
139	139	Funding Source(s) None
140	140	Expenditure = Cost of bill Appropriation = Authorized funding to cover cost of bill
141	141
142	142
143	143
144	144
145	145
146	146	Estimated State Impact
147	147
148	148
149	149
150	150	FY 2025
151	151
152	152	FY 2026
153	153
154	154	FY 2027
155	155
156	156	FY 2028
157	157
158	158	Revenue
159	159
160	160	$0
161	161
162	162	$0
163	163
164	164	$0
165	165
166	166	$0
167	167
168	168	Revenue Fund(s)
169	169
170	170	None
171	171
172	172	Expenditures*
173	173
174	174	$0
175	175
176	176	$5 million+ (half general funds, half federal funds)
177	177
178	178	$5 million+ (half general funds, half federal funds)
179	179
180	180	$5 million+ (half general funds, half federal funds)
181	181
182	182	Funding Source(s)
183	183
184	184	General Fund, Federal Funds
185	185
186	186	Appropriations*
187	187
188	188	$0
189	189
190	190	$0
191	191
192	192	$0
193	193
194	194	$0
195	195
196	196	Funding Source(s)
197	197
198	198	None
199	199
200	200	Expenditure = Cost of bill Appropriation = Authorized funding to cover cost of bill
201	201
202	202
203	203
204	204	METHODOLOGY:
205	205
206	206	This bill modifies RSA 151-E:3, relative to long-term care eligibility, by:
207	207
208	208	(1) Adding mobility to the list of activities of daily living;
209	209
210	210	(2) Changing how eligibility for long-term care is determined and redetermined by requiring the Department of Health and Human Services to get a determination of an applicant’s need for long term care from the applicant or participant’s primary care physician or nurse practitioner; and
211	211
212	212	(3) Allowing the Department to deny clinical eligibility for long-term care at a redetermination only if the participant’s primary care provider agrees that the participant no longer meets the level of care.
213	213
214	214
215	215
216	216	The Department notes that, with respect to (1), the bill does not define mobility or provide guidance regarding determining eligibility for long-term care based on an individual needing assistance with mobility. Currently, individuals may be clinically eligible for long-term care if they need assistance with two or more activities of daily living, such as eating, toileting, transferring, bathing, dressing, or continence. Per the Department, adding mobility to this list without definition will result in a lack of clarity as to what would qualify an individual for eligibility. The Department does not have a way to determine the potential number of individuals who would be eligible for long-term care as a result of the bill, but expects a cost in excess of $2.5 million per year.
217	217
218	218
219	219
220	220	With respect to (2), the Department already seeks medical information from an applicant’s primary care provider if they have one. The Department notes that the bill may result in situations in which it is unable to issue a denial of clinical eligibility, either because a primary care provider has failed to respond or because the individual lacks a primary care provider. Failing to issue a denial of clinical eligibility will result in delays to processing applications, which may result in the Department failing to meet the federal requirement that determinations be made within 45 days of the application. The Department therefore contends that this requirement could potentially put federal financial participation for Medicaid in jeopardy. Since the Department does not otherwise expect this change to cost money to implement, this provision will have no cost as long as there is no federal penalty for failing to meet eligibility determination deadlines.
221	221
222	222
223	223
224	224	Finally, with respect to (3), the Department assumes that this requirement will render moot the requirement that individuals have clinical eligibility redetermined every year. The Department further contends that the requirement that primary care providers agree with a clinical determination of ineligibility is unlikely to be approved by CMS. Without approval federal financial participation for Medicaid may be jeopardized. Assuming CMS were to approve the change, the proposed legislation would result in indeterminable growth of the Choices for Independence (CFI) program. The Department expects the proposed change will cost in excess of $2.5 million per year.
225	225
226	226
227	227
228	228	The costs cited above would be paid for with 50 percent general funds and 50 percent matching federal funds.
229	229
230	230
231	231
232	232	AGENCIES CONTACTED:
233	233
234	234	Department of Health and Human Services