Lawmakers form nursing home rate study group

Summary#

SB 663 is enacted New Hampshire law creating a Medicaid methodology working group within the Department of Health and Human Services (DHHS). The group’s stated task is to study nursing home Medicaid rates and make recommendations; the law does not itself change rates.

  • The DHHS commissioner or a designee must convene a seven-member group: two legislators, the commissioner or designee, representatives appointed by three named associations, and a nursing-home cost-reporting accountant appointed by the governor.
  • The group must consider access and waiting lists, hospital discharge barriers, whether rates capture residents’ care needs, capital needs, workforce needs, and the nursing home sector’s solvency.
  • It must also consider a fair way to address changes in nursing home ownership while protecting Medicaid program integrity.
  • The commissioner or designee must submit proposed law or regulation changes by December 31, 2026, if DHHS intends to modify the rate method and believes changes are necessary after consulting the group.
  • The group is subject to New Hampshire’s public-meeting and records law, RSA 91-A.

What it means for you#

  • Nursing homes and their associations: Their associations appoint three group members. The group will study how Medicaid rates relate to nursing home care and finances, but the law does not require DHHS to change rates.
  • Medicaid nursing home residents and families: The group must consider access, waiting lists, hospital discharges, and whether residents’ care needs are reflected in rates. The law does not guarantee more beds, faster discharges, or different care.
  • DHHS: The department must convene the group and, if it intends to change the rate method, submit any proposed legal or regulatory changes it believes necessary by the deadline.
  • The public: The group is subject to RSA 91-A. The law does not create an application, appeal, or individual review process.

Money#

The official fiscal note says the bill has no fiscal impact on state, county, or local spending or revenue.

  • The bill gives no separate appropriation, staffing level, or payment amount for the group.
  • It does not directly raise or lower nursing home Medicaid rates.

What is unclear#

  • The bill sets no meeting schedule, duration, decision process, or requirement to publish the group’s recommendations.
  • DHHS is not required to adopt the group’s recommendations or change the rate method.
  • The bill does not define what counts as a “fair” approach to ownership changes or how the group should weigh its listed concerns.
  • Residents and direct-care workers have no specifically named seats on the group.
  • The supplied material does not include the existing rate rules, so their details and how this group’s work would interact with them could not be verified.

Case for#

  • The bill brings together DHHS, legislators, counties, health care associations, and a nursing-home cost-reporting accountant to examine the rate method.
  • Considering access, discharge barriers, resident care needs, infrastructure, workforce, and sector solvency together could help identify competing pressures before DHHS proposes changes.
  • The report deadline sets a date for DHHS to submit proposed changes if it decides changes are needed.

Case against#

  • The group makes recommendations, but the law does not require DHHS to act on them or change rates.
  • Residents and direct-care workers have no designated seats, even though access and care needs are among the required topics.
  • The law does not set criteria for balancing the group’s concerns or for deciding what ownership-related changes would protect Medicaid program integrity.