Best Practices in Medicaid - New Hampshire

The Center for Health Transformation is inviting leaders from all 50 states to share their transforming solutions for the Medicaid program. In order that key decision-makers and industry leaders from around the country may learn from others’ successes, it is our intention to provide this interactive resource for showcasing the most innovative practices in the country. Please note that the following contributions have not been edited by CHT staff and will remain open indefinitely to future updates.

View New Hampshire's Official Medicaid website >> 

Consumer-directed care demonstrations (include number of beneficiaries served now and in any expansion plans)

The Home Care and Community Based Services (HCBS) In Home Supports (IHS) Waiver for Children with Severe Disabilities is an Independence Plus (first in the nation) waiver that is consumer/family driven. Current enrollment is approximately 200 individuals, and is expected to reach a total of 210 individuals within the year.

New Hampshire’s DD and ABD waivers have a service category called Consolidated (Developmental or Acquired Brain Disorder) Services. The definition of these services is: provision of assistance and resources to individuals with developmental disabilities and their families in order to improve and maintain the individuals’ opportunities and experiences in living, working socializing, recreating, and personal growth, safety and health. Consumers whose services are funded through this service category have full freedom and control in choosing their own provider(s) for each and every aspect of their services. These services are not provided to recipients by parents of minor children or spouses. In cases where services are provided by other relatives or friends these individuals must be fully qualified as providers. Currently 78 individuals utilize this option with a number slots still open/available.

Delivering high quality, coordinated, long term care for the disabled and/or the infirm

New Hampshire is a System Transition Grant (STG) recipient. The purpose of the grant is to focus on transforming the long-term care system to promote independence and community based services for the elderly and for adults with chronic conditions. The grant involves a 60-month planning and implementation effort. To date, New Hampshire has submitted and recently presented (5/17/06) its strategic plan for systems transformation to CMS. Pending CMS review and subsequent revisions, the plan will enter the implementation phase. Although the STG is not focusing on quality per se, New Hampshire is coordinating with the Real Choice Quality Improvement/Assurance Grant for Home and Community Based Care (HCBC) to develop ways of reviewing individual outcomes for the long-term care population across programs.

In addition to the STG grant, the Home and Community Based Program for the Elderly and Chronically Ill (HCBC-ECI) program provides a range of community based services for people who would otherwise require institutional care in a nursing facility, including consumer-directed personal care services.

Use of health information technology (electronic health records, e-prescribing, electronic billing, etc)

New Hampshire is not currently pursuing health information technology with respect to electronic health records, or e-prescribing. However, please refer to the response to question #5 (Transparent and publicly-accessible measurements of patient outcomes and/or quality improvements) for New Hampshire’s progress toward electronically capturing health data for the purpose of research and analysis.

Expanding coverage through private sector initiatives

New Hampshire is not currently expanding coverage through private sector initiatives.

Transparent and publicly-accessible measurements of patient outcomes and/or quality improvements

NH law RSA G-11,II(a) requires all health insurance carriers to report data on each and every medical bill they paid (includes hospital stays, surgical procedures, physician appointments, mental health services, prescription drugs, and other services that generate a bill.) This data will be analyzed by the New Hampshire Department of Health and Human Services (DHHS) and the New Hampshire Insurance Department and will be made available to outside parties for additional research and analysis. Because the data set is designed to track patients across insurance carriers and providers and providers across insurance carriers, the data will allow analysis of entire episodes of care in the private population and comparison of providers. The data will also be used by DHHS as a benchmark in the analysis of the NH Medicaid program. To our knowledge only Maine and New Hampshire collect private health care data in this comprehensive manner.

Efforts to combat fraud and abuse

The New Hampshire Department of Health and Human Services currently conducts the following procedures to combat fraud and abuse of the Medicaid program:

1. All concerns are referred to the New Hampshire Medicaid State Utilization Review (SURS) unit for review prior to approving provider enrollment. A monthly report is generated that is used to monitor any "unusual" activity and billing patterns of new, potentially abusive provider types. The claims of any new/suspect provider are pended to SURS for review prior to payment.
2. SURS assigns a specific point of contact person for each program area within the department to allow for "easier" referrals. This, effectively, allows the appropriate experts to monitor negative trends as it relates to their type of providers.
3. Monthly Recipient Explanation of Medicaid Benefits (REOMB's) can be either designated as random or focused. A focused REOMB survey can be done in junction with a specific area of interest for review in SURS (i.e., home health aides during a home health review).
4. Continuous education is provided to program area staff relative to SURS functions and why/when SURS should be notified of provider/recipient issues.

In addition to the above procedures, the Department also performs the following “Detective Controls” to combat Medicaid fraud and abuse:

1. The Department has established written guidelines for referrals to SURS from the fiscal agent (i.e., if a provider does not correct an error within 30 days, it is an automatic referral to SURS).
2. SURS is an active partner in the review/correction/enhancements with the fiscal agent of the claims processing system.
3. Enhanced Recovery is improving the approach to audits, utilizing more "data mining" techniques (rather than just statistical/random sampling techniques), identifying potential payment aberrations/outliers, which could in turn end up as identified cases of fraud / waste or abuse.
4. The knowledge of financial/operational/clinical/programmatic experts within the Department are utilized to enhance overall results of audits.

What changes would you make to the federal Title XIX so that you could provide better services to individuals and families on Medicaid in your state?

Suggested changes to Title XIX that would allow New Hampshire to provide better services to Medicaid recipients include:

• Enhancing the federal match for EPSDT services based upon provider performance thereby allowing states to offer incentives to providers and strengthen the provider network.
• Moving Medicaid from an entitlement program to one that fosters personal responsibility in order to participate in the program similar to the recent changes in TANF Re-authorization.

What are your future plans?

New Hampshire’s future plans include:

• Assessing opportunities for NH Medicaid provided by the Deficit Reduction Act of 2005.
• Exploring waiver options that would allow the state to move in parallel with changes in the health care delivery system and health care market.