TITLE XI
HOSPITALS AND SANITARIA

Chapter 151-E
LONG-TERM CARE

Section 151-E:1

    151-E:1 Purpose. –
I. The purpose of this chapter is to provide medicaid eligible elderly and chronically ill adults with a continuum of care appropriate to their needs and affordable to the state and its taxpayers.
II. To a great extent, the current system relies on nursing facilities to provide care for this group. While the quality of this care is high, an increasingly elderly and disabled population and a constrained public financial resource base require the state to reevaluate how long-term care services are provided. Moreover, many long-term care recipients and potential recipients prefer to be cared for at home or in other settings less acute than a nursing facility. Because far more may be spent on nursing facility care than on home and community-based care, there is an inherent difference between the state's present long-term care system and what recipients prefer.
III. This chapter is an essential step toward rebalancing the long-term care system and expanding choices available to recipients. It increases the continuum of care by adding mid-level care, including but not limited to, assisted living and residential care services. Through an acuity-based reimbursement system , a comprehensive needs assessment process, and an information and assistance process, it provides those eligible for Medicaid nursing facility services the opportunity to choose more appropriate, less costly mid-level services and home and community-based care. In this way, the state intends to serve this increasing Medicaid eligible population more appropriately and more economically.

Source. 1998, 388:1, eff. Nov. 25, 1998. 2007, 330:4, eff. Jan. 1, 2008.

Section 151-E:2

    151-E:2 Definitions. –
In this chapter:
I. "Assisted living facility" means a facility with individual living units where medical and social support services are provided on the basis of an individualized plan of care and which provides other common social support services.
II. "Congregate housing" means public housing providing congregate services as defined in RSA 161-F:36.
III. "Department" means the department of health and human services.
IV. "Home-based care" means a range of medical and supportive services provided under the medicaid waiver to persons in their own homes or in the home of a relative or other person.
V. "Nursing facility" means an institution or facility, or a distinct part of an institution or facility, whether proprietary or non-proprietary, which is primarily engaged in providing 24-hour care for residents needing:
(a) Skilled nursing care, medical monitoring, and related services;
(b) Rehabilitation services for the rehabilitation of injured chronically disabled or sick;
(c) Medication administration or instruction and supervision; or
(d) On a regular basis, health-related care and services (above the level of room and board) which can be made available to them only through institutional facilities which provide 24-hour care.
VI. "Medicaid waiver" means the medicaid home and community-based care waiver for the elderly and the chronically ill.
VII. "Mid-level care" means care provided in an assisted living facility, congregate housing, or residential care facility under the medicaid waiver.
VII-a. "Person-centered planning" means a planning process to develop an individual support plan that is directed by the person, his or her representative, or both, and which identifies his or her preferences, strengths, capacities, needs, and desired outcomes or goals.
VIII. "Residential care facility" means a facility, including a supported residential care facility, which provides services to 2 or more individuals, beyond room and board care, in a residential setting, as an alternative to nursing facility care, which offers residents home-like living arrangements, social, health, or medical services, including but not limited to, medical or nursing supervision, or medical care or treatment by appropriately trained or licensed individuals, assistance in daily living, or protective care. "Residential care facility" shall also include a facility certified in accordance with RSA 151:9, VIII.

Source. 1998, 388:1. 2002, 101:3, eff. Jan. 1, 2003. 2007, 330:5, eff. Jan. 1, 2008.

Section 151-E:3

    151-E:3 Eligibility. –
I. A person is medicaid eligible for nursing facility services or Medicaid home and community-based care waiver services if the person is:
(a) Clinically eligible for nursing facility care because the person requires 24-hour care for one or more of the following purposes:
(1) Medical monitoring and nursing care when the skills of a licensed medical professional are needed to provide safe and effective services;
(2) Restorative nursing or rehabilitative care with patient-specific goals;
(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
(4) Assistance with 2 or more activities of daily living involving eating, toileting, transferring, bathing, dressing, and continence; and
(b) Financially eligible as either:
(1) Categorically needy, as calculated pursuant to rules adopted by the department under RSA 541-A; or
(2) Medically needy, as calculated pursuant to rules adopted by the department under RSA 541-A.
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).
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.
III. [Repealed.]
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 shall obtain and give substantial weight to 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.

Source. 1998, 388:1. 2003, 223:10, eff. July 1, 2003. 2005, 175:2, eff. Jan. 1, 2006; 175:21, eff. Aug. 29, 2005. 2007, 330:6, 7, eff. Jan. 1, 2008; 330:11, eff. June 30, 2007. 2008, 168:1, eff. June 6, 2008. 2010, Sp. Sess., 1:86, eff. June 10, 2010. 2011, 224:30, eff. July 1, 2011. 2014, 33:1, eff. May 27, 2014. 2015, 145:1-3, eff. Aug. 11, 2015.

Section 151-E:4

    151-E:4 Consumer Choice. –
I. A person who has been determined to be Medicaid eligible for nursing facility services in accordance with RSA 151-E:3 shall have the right to receive nursing facility services; however, the person shall be offered and may choose to receive services in a less restrictive setting if such services are available. Such choice shall be offered in accordance with state laws and federal regulations. The person shall have the right to have his or her individual support plan developed through a person-centered planning process regardless of age, disability, or residential setting. The department shall take into consideration the family and community supports available to the person, the family's desire and ability to care for the person, and shall ensure that all consideration and support is offered to the family to maintain the person in home and community-based care. Nothing in this section is intended to require the provision of financial assistance or supports by a family member.
II. All individuals, entities, or organizations under contract to provide services in accordance with this chapter shall administer programs and services in accordance with 42 C.F.R. section 441.301, and any subsequent amendments thereto.

Source. 1998, 388:1, eff. Nov. 25, 1998. 2005, 175:3, eff. Aug. 29, 2005. 2007, 330:8, eff. Jan. 1, 2008. 2019, 287:8, eff. July 1, 2019. 2020, 32:6, eff. Jan. 1, 2021.

Section 151-E:5

    151-E:5 Information and Referral. – The department shall establish a system of community-based aging and disability resource centers that provide information and referral services to older adults and adults with disabilities. The aging and disability resource center network established under this section shall not be used for the purpose of political advocacy, but may inform and educate the general court regarding the extent of services available as well as the unmet needs in the community.

Source. 1998, 388:1, eff. Nov. 25, 1998. 2007, 330:9, eff. Jan. 1, 2008. 2023, 79:574, eff. July 1, 2023.

Section 151-E:6

    151-E:6 Acuity-Based Reimbursement System. –
I. The department shall pursue as expeditiously as possible the development and implementation of a reimbursement system for nursing facility services based primarily on the acuity level of patients consistent with state and federal law and all appropriate notice requirements. All nursing facilities shall use best efforts to provide all information and data requested by the department in the course of its development of such a system and to assist the department in any manner reasonably requested by the department.
II. Unless otherwise required by state or federal law, the acuity-based reimbursement system developed by the department shall not create separate classifications for county and non-county facilities and shall be based on the concept of the cost of operating an efficient facility rather than actual costs.
III. [Repealed.]

Source. 1998, 388:1, eff. Nov. 25, 1998. 2012, 264:2, II, eff. Aug. 17, 2012.

Section 151-E:6-a

    151-E:6-a Repealed by 2010, 368:1(15), eff. Dec. 31, 2010. –

Section 151-E:6-b

    151-E:6-b Memorandum of Agreement. – The department of health and human services shall establish, by means of a memorandum of agreement with the New Hampshire Association of Counties, a mechanism for the receipt of input from the Association of Counties regarding the type, cost, utilization, and procedures relative to payments which the counties are obligated to make pursuant to RSA 167:18-a. The memorandum of agreement shall be reviewed annually and amended as may be determined to be necessary by the parties.

Source. 2001, 198:2, eff. July 5, 2001. 2007, 263:15, eff. July 1, 2008.

Section 151-E:6-c

    151-E:6-c Payment System for Nursing Facilities. –
The payment system for nursing facility level of care shall be as follows:
I. Rate calculation worksheets for all providers will be provided at least 30 days prior to the effective date of any rate changes.
II. Acuity levels must be updated at least semi-annually, on a regular, predictable basis using the latest available data.
III. The commissioner of the department of health and human services shall continue to evaluate the effectiveness of the acuity-based payment system for medicaid payments for nursing facility care. The commissioner shall determine if any changes in the payment system are appropriate.
IV. [Repealed.]
V. Any rate changes due to the updating of acuity or cost data shall occur only with proper prior notification and explanation to affected providers and the affected beneficiary population.

Source. 2001, 198:2, eff. July 5, 2001. 2012, 264:2, III, eff. Aug. 17, 2012.

Section 151-E:7

    151-E:7 Needs Assessment for Applicants for Nursing Facility Services. –
I. In order to determine the most cost effective and appropriate level of long-term care services, the department shall assess the clinical eligibility of each applicant to a nursing facility in a uniform manner throughout the state. The assessment shall be voluntary for all applicants, except those who have applied for or have been determined to be eligible for medicaid benefits.
II. The assessment shall be completed prior to admission or, if necessary for reasons of the person's health or safety, as soon after admission as possible, in accordance with rules adopted by the department pursuant to RSA 541-A.
III. The department in a uniform manner throughout the state shall determine whether the person is clinically eligible for nursing facility services.
IV. The department shall inform both the applicant and the administrator of the nursing facility of the department's determination of the services needed by the applicant and shall provide information and assistance to the applicant in accordance with RSA 151-E:9.
V. If a nursing facility admits a person who at the time of admission was not determined to be clinically eligible for the level of services provided by a nursing facility and that person, within a 3-year period after admission, is determined to be financially eligible for medicaid benefits pursuant to RSA 151-E:3, I(b), the nursing facility shall be responsible for all costs of medicaid-funded long-term care services provided to the individual for the period of time, not to exceed one year, from the date of the determination of financial eligibility to the end of the third year of admission unless the individual is determined to be clinically eligible for nursing facility services.
VI. Any assessment of medical needs conducted under this section shall be conducted by a qualified medical professional.

Source. 1998, 388:1, eff. Nov. 25, 1998.

Section 151-E:8

    151-E:8 Assessment or Reassessment at Time of Eligibility. – The department shall perform an assessment or reassessment of the person's clinical eligibility when the person becomes financially eligible for medicaid benefits pursuant to RSA 151-E:3, I(b).

Source. 1998, 388:1, eff. Nov. 25, 1998.

Section 151-E:9

    151-E:9 Information and Assistance. –
The department shall provide information and assistance to each applicant to a nursing facility. Such information and assistance shall:
I. Be based upon the principle that services shall be provided in the setting that is least restrictive of the applicant's ability to live independently;
II. Take into consideration the applicant's choice of service location;
III. Include information regarding the degree to which the services sought are available at home or in some other community-based setting;
IV. Explain the relative costs to the applicant of choosing care in the home or other setting rather than nursing facility care; and
V. Include advice as to whether receiving services in a home or other community-based setting is clinically appropriate for the applicant.

Source. 1998, 388:1, eff. Nov. 25, 1998.

Section 151-E:10

    151-E:10 Notification by Hospitals. – Prior to the discharge or referral of any person to any nursing facility, a hospital shall notify the department that such person requires nursing facility services which necessitate an assessment under RSA 151-E:7 or the provision of information and assistance under RSA 151-E:9.

Source. 1998, 388:1, eff. Nov. 25, 1998.

Section 151-E:11

    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. [Repealed.]
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 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:
(a) Bases for the methodologies;
(b) Identification of services considered in determining costs;
(c) Average annual costs based on the annual average number of recipients in the setting;
(d) The requirement that nursing facility care include both the initial Medicaid rate and supplemental rates paid through the Medicaid Quality Incentive Program; and
(e) The requirement that the nursing facility will include the cost for transitional case management.

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. 2015, 259:16, eff. July 1, 2015. 2020, 32:7, 8, eff. Jan. 1, 2021. 2021, 122:41, eff. July 9, 2021.

Section 151-E:12

    151-E:12 Rulemaking. – The commissioner of the department of health and human services shall adopt rules, pursuant to RSA 541-A, relative to the administration of this chapter.

Source. 1998, 388:1, eff. Nov. 25, 1998.

Section 151-E:13

    151-E:13 Repealed by by 2004, 260:21, II, eff. June 16, 2004. –

Section 151-E:14

    151-E:14 Nursing Facility Trust Fund Established. – There is hereby established the nursing facility trust fund for the receipts from nursing facilities as defined in RSA 84-C:1, V(a), from the nursing facility quality assessment under RSA 84-C:3, any federal financial participation received by the state as a result of expenditures funded by these nursing facility quality assessments, and the interest thereon. All of these funds shall be credited to and for the purposes of the nursing facility trust fund and shall not be used for any other purposes.

Source. 2003, 223:11, eff. July 1, 2003. 2008, 253:6, eff. June 26, 2008.

Section 151-E:15

    151-E:15 Expenditure of Funds From Nursing Facility Trust Fund. –
Notwithstanding any other provision of law, moneys in the nursing facility trust fund shall be expended in the following manner:
I. All moneys in the fund shall be paid out no less frequently than on a quarterly basis and shall be disbursed as follows:
(a) The moneys in the fund shall be used to eliminate or reduce to the maximum extent possible the difference between the allowable medicaid costs, derived from the nursing facility medicaid acuity rate setting system, which nursing facilities incur in providing care to medicaid residents, and the amount which the state has budgeted in order to fund that care.
(b) If after the disbursement required in subparagraph (a) there are still any moneys remaining in the fund, the nursing facility rate setting system shall be adjusted to insure that all moneys in the fund are expended for nursing facility care.
II. The state treasurer shall transfer from the nursing facility trust fund to the general fund on the first business day of each quarter the amount necessary to fund the payments under paragraph I.
III. The state treasurer shall transfer, and the commissioner of health and human services shall fund the full amount of the nursing facility trust fund in each quarter.
IV. Notwithstanding the provisions of RSA 167:18-a, no county shall be required to make any contribution to the distribution under this section.

Source. 2003, 223:11. 2004, 260:18, eff. June 16, 2004. 2007, 263:16, eff. July 1, 2008.

Section 151-E:15-a

    151-E:15-a Repealed by 2019, 346:358, II, eff. July 1, 2019. –

Section 151-E:16

    151-E:16 Accurate Cost Estimates. –
I. The department shall estimate and report the full cost to the state of adequately funding long-term care services at a level which ensures all eligible individuals the quality services which they need and for which they are eligible. The cost estimates shall include the cost to fund home and community-based, mid-level, and nursing facility care at a reimbursement level necessary to ensure that individuals who are eligible for Medicaid-funded long-term care services have access to quality services in all 3 settings, are able to live with dignity in a safe environment, and are able to exercise choice in their care setting. The department estimate shall be based on provider reimbursement rates that ensure a provider workforce that is sufficient to fully meet the needs of eligible consumers.
II. The department shall include the estimate required by paragraph I as an informational addendum to its budget submission.

Source. 2007, 330:10, eff. Jan. 1, 2008.

Section 151-E:17

    151-E:17 Availability of Targeted Management Services. – The department shall make available to and advise all Medicaid recipients who require a nursing facility level of care or are at risk of needing such care and who are patients in hospitals, rehabilitation hospitals, or nursing facilities of the availability of targeted case management services provided by independent case managers, to explore the feasibility of transitioning to home and community-based care.

Source. 2007, 330:10, eff. Jan. 1, 2008.

Section 151-E:18

    151-E:18 Presumptive Eligibility. –
I. The commissioner of the department shall establish a presumptive eligibility program to prevent unnecessary and costly institutionalization of individuals who are Medicaid eligible for nursing facility services and choose to receive services in less restrictive settings.
II. Pending verification of application information, the department shall authorize medical assistance in the interval between application and the final Medicaid eligibility determination if the department determines the applicant is likely to be eligible. Presumptive eligibility shall be made available at department district offices, information and referral resource centers, and other qualified providers. The presumptive eligibility period shall not include coverage of home or environmental modifications.
III. Presumptive eligibility authorizations shall be dependent upon a face-to-face clinical assessment of each applicant and review of a completed Medicaid application. The department shall perform the face-to-face clinical assessment within 20 business days of a request for medical assistance. The department shall review the application for presumptive eligibility within 5 business days of completion of the Medicaid application and clinical assessment.
IV. The presumptive eligibility period begins on the date the department determines the applicant likely meets the eligibility criteria and ends on the date eligibility is verified or the individual is determined ineligible.
V. The Medicaid applicant shall acknowledge in writing the uncertainty of continuing service coverage beyond the presumptive eligibility period and the potential for financial responsibility for costs incurred in the event of a determination of Medicaid ineligibility.
VI. If an applicant is determined ineligible for Medicaid, the department shall promptly notify the applicant and the applicant's providers of the finding and the immediate termination of service coverage authorization. In such a case, the department shall use non-Medicaid funds to pay for any waiver services which the applicant has already received. In the event an application was filed with fraudulent intent, the department shall be entitled to reimbursement of funds expended on behalf of the applicant.
VII. The commissioner of the department shall adopt rules, pursuant to RSA 541-A, relative to:
(a) A process to determine presumptive eligibility.
(b) A definition of a qualified provider.
(c) Content and format of forms required under this section.

Source. 2007, 330:10, eff. Jan. 1, 2008.

Section 151-E:19

    151-E:19 Support for Certain Residents of Nursing Homes and Assisted Living Facilities. –
I. In this section:
(a) "Asset transfer disqualification" means a transfer of assets for less than fair market value by a Medicaid applicant or recipient as set forth in 42 U.S.C. 1396p(c)(1)(A) and 42 U.S.C. 1396p(c)(1)(B).
(b) "Costs of care" means all costs of health care and lodging and all related costs, including transportation, medical, and personal care and any other costs, charges, and expenses incurred by the facility in rendering care to the resident.
(c) "Department" means the department of health and human services.
(d) "Fiduciary" means a person to whom power or property has been formally entrusted for the benefit of another such as an attorney-in-fact, legal guardian, trustee, or representative payee.
(e) "Long-term care facility" means a facility licensed by the department pursuant to He-P 803, 804, or 805.
(f) "Patient liability amount" means the amount of income that a resident is liable to contribute toward the cost of his or her nursing facility care.
(g) "Period of asset transfer disqualification" means the period of ineligibility for Medicaid required under 42 U.S.C. 1396p(c)(1)(E).
(h) "Person" includes persons both natural and otherwise, including, without limitation, any corporation, partnership, limited liability company, trust or other entity.
(i) "Resident" refers to any person who inhabits or inhabited a long-term care facility for any period of time.
II. (a) Except as provided in subparagraph (b), when an asset transfer made on or after the effective date of this section results in a final determination of a Medicaid asset transfer disqualification, the person who received the assets from a resident which resulted in the Medicaid asset transfer disqualification shall be liable under this section to the long-term care facility for all costs of care up to the amount transferred to the person. The person shall be liable at the facility's Medicaid rate for services for the period of asset transfer disqualification.
(b) It shall be an affirmative defense in any action instituted under subparagraph (a), that the transfer of the asset which resulted in a final determination of a Medicaid asset transfer disqualification was not a disqualifying transfer under 42 U.S.C. 1396p. The court's decision regarding such affirmative defense shall be made independently of the determination made by the department. If that affirmative defense is proven, the person shall not be liable under subparagraph (a).
(c) At least 45 days before filing an action pursuant to this paragraph, the facility shall send a written notice of its intent to file the action to any person whom it intends to name as a defendant in the action.
III. (a) A fiduciary who possesses or controls the income or assets of a resident of a long-term care facility and has the authority and duty to file an application for Medicaid on behalf of a resident shall be liable under this section to the long-term care facility for all costs of care which are not covered by Medicaid due to the fiduciary's negligence in failing to promptly and fully complete and pursue an application for Medicaid benefits for the resident. Upon a finding of negligence, the fiduciary shall be liable to the facility for the costs of care at the facility's Medicaid rate for services for the period of resulting noncoverage. At least 30 days before filing an action pursuant to this paragraph, the facility shall send a written notice of its intent to file the action to any person whom it intends to name as a defendant in the action. In any claim of negligence against a legal guardian, notice of intent to file the action shall simultaneously be provided to the probate court having jurisdiction over the guardianship. The probate court shall have jurisdiction over any action alleging negligence of a legal guardian, and shall, in any such action, consider whether removal of the guardian is in the ward's best interests in accordance with RSA 464-A:39, I(c) and shall have the authority to assess liability and award damages under this section.
(b) Within 10 days of admission of the resident to the facility, such facility shall provide written notice to the resident, and to any fiduciary of the resident whose identity and mailing address are disclosed to the facility at the time of admission. The notice shall be deemed to have been completed when delivered in hand or when placed in first class United States mail to the disclosed mailing address. The notice shall contain the following information:
(1) A summary of the fiduciary's potential responsibility to apply for Medicaid under this paragraph.
(2) An explicit reference to this section of the statute.
(3) Address and telephone number of the local Medicaid office.
(4) Name, address, and telephone number of any contact person at the facility who is responsible for assisting the resident in applying for Medicaid, if the facility has such a contact person.
(c) Any action under this paragraph shall be subject to the following affirmative defenses:
(1) The facility failed to provide notice to the fiduciary as described in subparagraph (b).
(2) The fiduciary was unable to fulfill his or her duties under this paragraph due to infirmity of body or mind.
IV. Any fiduciary or person who has received authority over the income of a resident such as a person who has been given or otherwise obtained authority over a resident's bank account, has been named as or has rights as a joint account holder, or otherwise has obtained or received any control over a resident's bank account or any other income of a resident, shall be liable under this section to the long-term care facility to the extent that any such person or fiduciary refuses to pay the patient liability amount due under Medicaid, provided that the person or fiduciary is in receipt of written notice from the department of the patient liability amount at the time such income is received by the fiduciary or person, and provided further that the liability of the person or fiduciary shall be for amounts going forward from the receipt of the notice. At least 30 days before filing an action pursuant to this paragraph, the facility shall send a written notice of its intent to file the action to any person or fiduciary whom it intends to name as a defendant in the action.
V. No judgment obtained in any proceeding under this chapter shall be acted upon through execution, levy, or otherwise during the pendency of any actually completed and filed application for Medicaid. Attachments and trustee process to secure any judgment or potential judgment shall be permitted subject to the discretion of the court to protect facilities from non-payment or from the failure of the resident, or that resident's fiduciary, to cooperate in obtaining Medicaid.
VI. Nothing contained in this section shall prohibit or otherwise diminish any other causes of action possessed by any such long-term care facility. The death of the resident shall not nullify or otherwise affect the liability of the person or persons charged with the cost of care rendered or the patient liability amount as referenced in this section.
VII. A fiduciary under this section shall not be personally liable for the acts or omissions of the fiduciary's predecessor, if any, solely by reason of his or her role as successor fiduciary.

Source. 2013, 167:1, eff. July 2, 2013. 2014, 138:1-3, eff. June 16, 2014.

Commission on Medicaid Long-Term Care Financing and Costs

Section 151-E:20

    151-E:20 Repealed by 2013, 144:133, eff. Nov. 1, 2013. –

Commission to Evaluate the Direct Care Workforce and Preparedness of Long-Term Care and Support Services for Aging Adults with Dementia or Other Cognitive Brain Injuries

Section 151-E:21

    151-E:21 Repealed by 2017, 152:2, eff. Dec. 1, 2017. –

System of Care for Healthy Aging

Section 151-E:22

    151-E:22 Purposes. –
The purposes of this subdivision are to:
I. Build upon existing infrastructure to establish a comprehensive and coordinated system of care to ensure that older adults and adults with disabilities have access to and timely delivery of supports and services and to ensure that they have a meaningful range of options.
II. Reduce the cost of providing long-term care by expanding the availability of less costly home and community-based services.
III. Require the department of health and human services to expand and improve access to home and community-based services for older adults and adults with disabilities in alignment with New Hampshire's state plan on aging, the federal Older Americans Act, Americans with Disabilities Act, and Medicaid law.
IV. The system of care referenced in this subdivision is meant to streamline access to long-term care supports and services and not intended to expand eligibility for any current Medicaid programs, including long-term care Medicaid or any home and community-based Medicaid waiver programs.

Source. 2023, 79:568, eff. July 1, 2023.

Section 151-E:23

    151-E:23 Statement of Policy. – It is the policy of New Hampshire to establish and implement a comprehensive and coordinated system of care that promotes healthy aging and enables older adults and adults with disabilities to have a meaningful choice in care options, including the ability to receive the care they need in their homes and communities.

Source. 2023, 79:568, eff. July 1, 2023.

Section 151-E:24

    151-E:24 Definitions. –
In this subdivision:
I. "Disability" means a physical or mental impairment that substantially limits one or more major life activities.
II. "Home and community-based services" means a range of medical and supportive services provided to persons in their own homes or other community-based settings including, but not limited to, adult day programs, and assisted living.
III. "Long-term services and supports"means a variety of services provided in both facilities and community-based settings designed to meet a person's health or personal care needs to help them live as independently and safely as possible when they can no longer perform everyday activities on their own.
IV. "Older adult" means an individual who is 60 years of age or older.
V. "System of care" means:
(a) A comprehensive and coordinated delivery system for the provision of long-term services and supports to New Hampshire's older adults and adults with disabilities.
(b) The system of care is intended to provide services to all older adults and adults with disabilities who require long-term services and supports.
(c) The system of care shall have the following characteristics:
(1) A comprehensive array of long-term services and supports including, but not limited to, personal care, homemaker services, transportation, meal delivery or preparation, emergency response systems, adult day care, and family caregiver support to enable older adults and adults with disabilities to remain independent and in the setting of their choice.
(2) An absence of significant gaps in services and barriers to services.
(3) Sufficient administrative capacity to ensure quality service delivery.
(4) Services that are consumer-driven, community-based, and culturally and linguistically competent.
(5) Transparent, with information made available and known to consumers, providers, and payers.
(6) A funding system that supports a full range of service options.
(7) A performance measurement system for accountability, monitoring and reporting of system quality, access and cost.

Source. 2023, 79:568, eff. July 1, 2023.

Section 151-E:25

    151-E:25 Duties of Commissioner of the Department of Health and Human Services. –
The commissioner of the department of health and human services shall:
I. Modify the policies and practices of the department of health and human services necessary to implement this subdivision, to the extent possible within existing statutory and budget constraints.
II. Coordinate the plans and activities of the commissioner with the bureau of elderly and adult services, the bureau of family assistance and division of long-term supports and services to implement the system of care and reduce duplication of efforts across divisions and bureaus within the department.
III. Develop a plan for full establishment and maintenance of a system of care. Such plan shall be reviewed annually and amended or modified as needed. It shall include sufficient detail to allow compliance with the reporting requirements of RSA 151-E:27 as applicable and shall address at least the following elements:
(a) System capacity, including workforce sufficiency.
(b) Federal funding participation, including but not limited to, Medicaid waivers and plan amendments.
(c) Changes to statutes, administrative rules, and structure of appropriations, and department policy, practice and structure.
(d) Projections of cost savings from increased service effectiveness and reductions in costly forms of care and use of such savings to close existing gaps in long term care services.
(e) Recommended modifications to law, practice, and policy to prepare for and accommodate the participation of privately funded service providers in the system of care.
(f) Changes to 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).
IV. Beginning no later than January 1, 2025, begin adjusting rates for the Choices for Independence waiver consistent with the rate study, assuming funds are available. Any unspent funds allocated to the Choices for Independence program shall be non-lapsing and shall be used for service provision for the Choices for Independence program.
V. On or before September 30, 2024, submit a waiver request to the Centers for Medicare and Medicaid services or implement an alternative method to establish a robust presumptive eligibility process for Medicaid home and community-based waiver services, including a mechanism for third party participation.
VI. Improve functionality of the NH EASY system for individuals applying for services and provide additional trainings for professionals who frequently assist people applying for services and develop associated performance metrics.
VII. Ensure applications for Medicaid long-term services are user friendly and processed in a timely manner and develop performance metrics to measure these attributes.
VIII. On or before June 30, 2025, maintain an online portal for providers, case managers, navigators and other long-term care service providers to enable them to easily identify and access available long-term care services and supports for older adults and adults with disabilities. The portal functions required by this section may be assigned to an entity that has responsibilities in addition to those required by this section. The portal shall contain the following information:
(a) A current list of home and community-based care waiver service providers accepting new clients, including links to websites and contact telephone numbers, organized by region that is updated on a weekly basis.
(b) Non-Medicaid resources to support the cost of home and community-based services.
(c) Referral information for legal service organizations.
(d) Guidance regarding family navigation of hospital discharge protocols and options.
IX. On or before June 30, 2025, create a public facing online dashboard to track home and community-based waiver services data, including, but not limited to, results of any performance measurement assessments, waiver services authorized but not paid, current wait times for receiving waiver services and the number of people from institutionalized care into the community.

Source. 2023, 79:568, eff. July 1, 2023.

Section 151-E:26

    151-E:26 Person-Centered Counseling Program. –
The department shall:
I. Create a new person-centered counseling program in each contracted aging and disability resource center (ADRC) to provide support and assistance to persons living at home or in short or long-term institutional settings, including hospitals, to transition into community-based settings. The program shall include referrals and support to access, at a minimum, but not limited to: assistance with completing Medicaid applications, discharge planning, referrals and access to Title III-B and Title XX services and programs, referrals and access to community-based services, housing, and other supports and services to meet the needs of the individual and their family. These services shall not replace or duplicate targeted case management services described in RSA 151-E:17.
II. Increase operational capacity in each ADRC to enable the provision of person-centered counseling services for adults, including but not limited to, educating consumers about available community-based resources for long-term services and supports, assistance with completing Medicaid applications, and assistance with the transition to access such services.
III. Establish performance metrics for each contracted information and referral resource center to assess each office's ability to provide the services contained in this section.

Source. 2023, 79:568, eff. July 1, 2023.

Section 151-E:27

    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.

Source. 2023, 79:568, eff. July 1, 2023.