Managed LTSS Program & State Initiative to Integrate Care for Dual Eligible Individuals
In March 2012, the state submitted a State Plan Amendment to CMS through the §1932(a) State Plan option for a statewide managed care delivery system known as the New Hampshire Medicaid Care Management Program. In May 2012, the state approved a $2.3 billion contract to establish a Medicaid managed care system. In August 2012, CMS approved New Hampshire’s State Plan Amendment. The state will launch its Medicaid managed care system in three phases over the course of three years. In Phase 1, all Medicaid recipients will be required to enroll in an MCO, with opt out for dual eligibles. Phase 2 will add LTSS and enrollment will be mandatory. Phase 3 will include individuals newly eligible for Medicaid by virtue of the Affordable Care Act. (Source: Care Management Program website; CMA & Truven Health Analytics, 7/2012; Managed Care Info Meeting Final Report, 8/2012; Update on Medicaid Care Management, 1/24/2013)
State Plan Amendment (3/30/2012)
CMS Approval Letter (8/24/2012)
On December 1, 2013, the state launched its transition to Medicaid managed care. (Source: HMA Weekly Roundup, 12/19/2013)
On April 3, 2014, New Hampshire Public Radio reported the planned December 1, 2014 transition to managed care for developmentally disabled Medicaid LTSS recipients will likely be delayed until January 2015 to focus on the Summer 2014 Medicaid expansion rollout. (Source: HMA Weekly Roundup, 4/9/14; New Hampshire Public Radio website)
On October 2, 2014, the state announced it is delaying the second phase of the state’s transition to managed care to allow more time to prepare for implementation. Originally scheduled to begin January 1, 2015, this second phase would have required LTSS recipients (including individuals with DD and people in nursing homes) to enroll in managed care plans. (Source: Concord Monitor, link no longer available 10/3/2014)
On November 6, 2014, the state Department of Health and Human Services announced that it would be reevaluating the nursing home carve-in. (Source: Concord Monitor, link no longer available 10/3/2014; NH Business Review, 11/5/2014)
On November 26, 2014, New Hampshire published an updated timeline for Step 2 of the state’s transition to managed care. Step 2 of the transition includes mandatory enrollment for medical care with one of the state’s MCOs for the following Medicaid recipients: children in foster care; Medicare dual eligibles; home care for children with severe disabilities; children with special health care needs enrolled in Special Medical Services/Partners in Health; and children with SSI. Step 2 also includes integration of LTSS such as Choices for Independence Waiver services and nursing facility services into the Medicaid Care Management program. According to the new timeline, stakeholder input on the Step 2 design considerations will continue through December 2014. Further, on July 1, 2015, all Step 2 mandatory populations will be required to select a health plan for medical services, Choices for Independence Waiver services and nursing facility stays. On September 1, 2015, health plan coverage will begin for medical services, Choices for Independence Waiver services, and nursing facility stays. (Source: New Hampshire DHHS Step 2 Update Slide Deck, 11/26/2014; State DHHS website)
State DHHS Stakeholder Engagement Summary for Step 2 of the Medicaid Care Management Program (11/5/2014)
On February 13, 2015, the Concord Monitor reported on the updated timeline for Step 2 of New Hampshire’s transition to managed care, as presented during the February 12 meeting of the Governor’s Commission on Medicaid Care Management. Under the updated timeline, mandatory enrollment for individuals currently eligible to opt out of managed care will begin on July 1, 2015; and medical coverage for most populations will begin in September 2015. However, managed care coverage for people receiving Choices for Independence HCBS waiver services is delayed until January 1, 2016; and managed care coverage for nursing facilities is delayed until July 1, 2016. The state has not yet determined when coverage will begin for individuals with DD and acquired brain disorders, as well as individuals who require in-home services and supports. (Source: Concord Monitor, link no longer available 2/13/2015)
On March 24, 2016, the New Hampshire Senate passed a bill that would delay implementation of the second phase of Medicaid managed care in the state, which would impact nursing homes, homecare services, and developmentally disabled and acquired brain disorder in-home supports. Implementation of Medicaid managed care will not be allowed before July 1, 2017, and upon approval by the joint legislative fiscal committee. (Source: Senate Bill 553 3/24/2016; NH Union Leader 3/24/2016)
On November 18, 2016, the New Hampshire Office of Medicaid Services (OMS) released a request for proposals (RFP) for technical assistance with the implementation of MLTSS. Responses to the RFP must be received by December 21, 2016, and officials hope to award the contract by February 1, 2017. A second RFP was issued on November 22, 2016, seeking assistance for the state’s reprocurement of its Medicaid Care Management MCOs. Responses to that RFP must be received by January 11, 2017, and officials hope to award this contract as well by February 1, 2017. The MLTSS consultant is expected to work collaboratively with the reprocurement consultant on the MLTSS-specific aspects of the RFP and contract. (Source: MLTSS TA RFP 11/18/2016; Reprocurement RFP 11/22/16)
A bill was introduced in the New Hampshire State Senate that would affect implementation of Step 2 of the states’ Medicaid managed care program, which implements MLTSS. Senate Bill (SB) 155 would require that the nursing facility services and services included under the Choices for Independence waiver be carved into the state’s existing managed care program starting on January 1, 2019. Additionally, services provided under New Hampshire’s developmental disability waiver would not be carved in before July 1, 2019. (Source: SB 155 3/30/2017)
On July 22, 2017, the New Hampshire legislature passed Senate Bill 155, which postpones step 2 of the implementation of Medicaid managed care in the state. Step 2 would implement a MLTSS program. SB 155 requires that this step not be implemented before July 1, 2019. (Source: SB 155 7/22/2017)
The New Hampshire Department of Health and Human Services (DHHS) has released an implementation plan for a fully capitated MLTSS program that will integrate both nursing facility (NF) and HCBS LTSS into the state’s current Medicaid managed care program. DHHS indicates that it will solicit MCOs through a reprocurement that will be responsible for the management of the full suite of acute, behavioral, and LTSS services for older adults and individuals with physical disabilities receiving services either in a NF or through the state’s Choices for Independence (CFI) waiver. The CFI waiver currently serves approximately 4,000 individuals.
New Hampshire also intends to expand the capacity of its LTSS system by providing additional choice for beneficiaries by establishing local Program of All-Inclusive Care for the Elderly (PACE) sites throughout the state. Once up and running, eligible beneficiaries will be able to choose between an MCO and participation in a PACE program. New Hampshire does not currently operate any PACE sites.
DHHS notes that integrating NF and CFI payments into the state’s risk adjustment processes will enable the state to:
- Improve the current managed care infrastructure, including oversight, readiness, MMIS, and EQRO;
- Strengthen MCO contract language;
- Use the private market to implement a more integrated program with MCOs that best suit the state’s needs.
The states proposed implementation timeline is as follows
- Winter 2018 – Planning Design;
- Spring 2018 – RFP, Contract, Waiver development;
- Spring 2018 – RFP procurement and award;
- Summer 2018 – PACE application process initiation;
- July 2018-July 2019 – Readiness;
- July 2019 – MCOs at risk for acute care services;
- December 2019 – MCOs at risk for CFI and NF facilities; go-live for PACE.
DHHS anticipates releasing an RFP on or near May 30, 2018. MCOs selected will be responsible for acute care services beginning July 1, 2019. Six months later, in December 2019, CFI and NF services will be officially carved in. DHHS will be amending its current 1915(c) CFI and 1915(b) waivers to allow for it to implement MLTSS. DHHS will be hosting a public hearing on March 27, 2018. (Source: MLTSS Implementation Plan 3/2018; DHHS Website 3/14/2018)
On April 25, 2018, the New Hampshire State Senate passed a bill, HB 1816, that included an amendment that would exclude LTSS from the state’s managed care program, essentially ending the state’s years-long efforts to implement an MLTSS program. The state will continue to pursue implementation of voluntary PACE sites or a similar ACO model. The bill passed the Senate 24-0, and was also approved by the House. (Source: Bill 4/25/2018)
Balancing Incentive Program
In December 2011, the state submitted its BIP application to CMS. In March 2012, CMS awarded the state $26.5 million in enhanced Medicaid funds, making New Hampshire the first state to apply for and receive CMS approval under the Balancing Incentive Program. (Source: CMS Balancing Incentive Program website)
BIP application (12/30/2011)
BIP Award Letter (3/1/2012)
BIP Structural Change Work Plan, link no longer available (10/23/2012)
Health Homes
As of June 2014, the state has not officially submitted a Proposed Health Home State Plan Amendment to CMS, but the state plans to participate in the Health Home State Plan Option in FY 2014. (Source: CMS Health Home Proposal Status website, 6/2014; Kaiser Health Home website, 6/2014)