NH CARES

Network for Responsible Budgeting

NHCares@tds.net

March 30, 2007 update

Division III Completed Its DHHS Budget Today and Made Several Major Changes from Monday

IT’S A WRAP and a PRETTY GOOD WRAP at THAT

Division III wrapped up its work on the DHHS budget today (Friday the 30th) at 1:30 PM. Short of serious problems surfacing in the next few days, this will likely be the budget that will: (1) Be adopted by the Full Finance Committee next week, and (2) Adopted by the Full House on April 12th.

Overall, this is the ONE of the BEST DHHS BASIC SAFETY NET-CITIZEN OPPORTUNITY BUDGETS that has come out of the House in years. There are holes (especially with too low or nonexistent rate increases that risk access, quality, and effectiveness), but Division III worked diligently to fix the biggest ones. And in large part, they succeeded. Further, in many areas where they fell short, they recognized the issues, and made a commitment to keep working on them. And following a time honored and pragmatic tradition, they put some off until FY 09 and passed some off to the Senate.

As important, the Ways and Means Committee did not take the lowest revenue estimates (they took mid-range ones) as they have in the recent past and rationally increased the cigarette tax by $.17 per pack to provide clearly needed revenue the Finance Committee requested. This gave Division III the ability to fix the many technical problems that were uncovered (with the help of the Governor’s Budget team who for the first time in years attended all the sessions!) and to add funds where it was clearly necessary for the DHHS budget to provide the basic opportunities, care, and support NH people need to lead better lives and to better themselves.

To summarize, Division III’s DHHS budget is very similar to the biennial “Hager-Wallner Budget Amendments” that CARES has supported to fix the biggest safety net holes in the DHHS House Budget that usually comes out of Division III. It is good news and a tribute to their work that Divisions III’s House Budget has made these fixes. We still have work to do in the Senate, but the biggest fixes have been made.

MAJOR CHANGES MADE SINCE MONDAY
(See “Wednesday Update” for Division III Changes through Monday the 26th and please note that the page numbers refer to the Governor’s Budget)

OMBP Page 759, PAU 5-1-2-1-3 - 90 & 91 – Healthy Kids Silver and Gold Insurance $536,000 in General Funds was added in FY 08 (60% to Gold in Class 90 and 40% to Silver in Class 91) and $637,000 in FY 09 to provide enough funds to meet projected enrollment increases.

OMBP Page 759, PAU 5-1-2-1-3-90 – Direct and Indirect Medical Education Payments for Teaching Hospitals These were suspended in the Governor’s budget and restored by adding $2.2m in General Funds ($4.4m total with Medicaid match) in both FY 08 and FY 09. (Most go to Dartmouth-Hitchcock.)

DPH Page 790, PAU 5-1-5-3-4-93 – Rural Health & Primary Care Loan Repayments for Medical Staff in Short Supply $279,371 in General Funds was added in FY 08 and $273,627 in FY 09 to help recruit key medical staff by helping repay their college loans.

DPH Page 808, PAU 5-1-5-4-4-90 – Antiviral Medications for Bird Flu and Other Pandemics This was reduced by $3.9m in General Funds to purchase the federal allotment only and to spread purchases over time to deal with the limited shelf life. $1m was added in FY 09 to build up the inventory with a staggered shelf life.

DCYF HB 2 Section 6 Covering Page 825, PAU 5-1-6-7-2-90 – HB 2 Section Requiring $40k per County of DCYF 5% Diversion Funds Be Provided to Child Advocacy and Family Support Center - This section was deleted. Note: A proposed section in HB 2 to suspend DCYF residential rate setting was also rejected.

BEAS Page 862, PAU 5-1-8-4-1-88 (new PAU) – Crotched Mountain Rehab Center Rate Adjustment $100,000 in General Funds in FY 08 and in FY 09 were added to be available for a rate agreement.

BEAS Page 862, PAU 5-1-8-4-1-90 & 91 – BEAS Medicaid Elder Nursing Homes (90) and HCBC Community & Home Nursing (91) After analyzing a number of differing DHHS caseload histories, the committee concluded that the DHHS projected decreases in nursing home residents in the Governor’s budget were unrealistically high. As a result, they increased the projected number of people to be served in nursing homes by 129 for FY08 and by 298 for FY09. Correspondingly, they reduced the number projected to be served by home and community nursing services by 135 in FY08 and by 298 in FY09.

Division III then changed the budgets to incorporate these new projections. Nursing Home (90) General Funds were increased by $2m in FY08 ($8m total) and by $3.8m ($15.1m total) in FY09. “Home Nursing” (91) was reduced by $.5m in General Funds ($2m total) in FY08 and by $1.1m ($4.4m total) in FY 09.
(Note: Section 11 of HB 2 that keeps the county share of nursing homes at 25% was unchanged.)

BEAS Page 862, PAU 5-1-8-4-1-90 & 91 & 95 – Footnotes for Nursing Homes (90), Home Care (91), and Mid Level Assisted Living Care (95) A footnote was added to the budget page to make the funds in 90, 91, and 95 non-lapsing for FY08. This means if they are not spent by the end of FY08, they stay in these budget lines and are not transferred (i.e. “lapsed”) back to the State’s General Funds The committee also agreed to add a section in HB 2 (the Budget Trailer Bill) to make sure funds in the nursing home are used for nursing homes.

BEAS Page 862, PAU 5-1-8-4-1-91 – Elder Case Management Rates in Home Nursing Services (91) $178,000 total in General Funds was added for FY08 – FY09 to provide a 3% rate increase for contracted case management services for elders in community care.

BEAS Page 862, PAU 5-1-8-4-1-91 – A New PAU for Nursing Services Only in the “Home Nursing Services” Line (91) which Now Includes 10 Other Elder Services The 10 other non-nursing services for elders in the “Home Nursing Services” line (including Personal and Adult Medical Day, Case Management, and some home delivered meals and Assisted Living 1) has created confusion over the years about what services and what rate increases were funded. To help eliminate this confusion, the committee agreed to separate the nursing services into a separate line. (CARES has suggested taking a similar approach with Medicaid OMBP Provider Payments by separating these by groups served and medical care provided.)

BBH Page 872, PAU 5-1-9-4-1 – Community Mental Health Residential Care - $188,484 was added in FY09 to make the rate increase effective 7-1-08 (rather than 1-1-09) to help providers stay in business.

BBH Page 872, PAU 5-1-9-4-1-98 – Footnote for the RFP for Family Mutual Support Services (98) A footnote was added to involve the NH Council on Developmental Disabilities in the process of DHHS developing an RFP for family support for both adults and children with mental illness.

BDS Page 886, PAU 5-1-10-1-93 – Community Developmental Services Funds to Eliminate the Waitlist $2m in General Funds ($4m in total) was added for FY 08 and $3m ($6m total) for FY 09.

Note: Division III reviewed the 17 proposals for implementing cost savings, making cuts, and increasing revenues to come up with $7m in General Funds to add to the developmental services Wait List. Division III adopted 5 of these totally about $1.8m in General Funds, but did not specifically target those to the DD Waitlist.

NEXT NH CARES STEPS

Once the House Finance Committee adopts the DHHS Budget and it is published, we will update all our comparison sheets to prepare for the Senate stage.

See you Friday, April 6th for our weekly meeting (9 am at the NH Center for Nonprofits) to recap all of the above – and prepare for the Senate.