N.H. Rev. Stat. § 126-A:5

Current through Chapter 381 of the 2024 Legislative Session

Section 126-A:5 - [See Note] Commissioner of Health and Human Services

I. Administrative and executive direction of the department of health and human services shall be under the direction of a commissioner of health and human services who shall be appointed by the governor and council. The commissioner shall hold office for a term of 4 years from the date of the appointment.

II. The commissioner may enter into such contracts as the commissioner deems necessary for the provision of services to clients of the department and for the operation of facilities of the department, subject to the approval of the governor and council. The commissioner further may receive, expend, control, convey, hold in trust, or invest any funds or real or personal property given or devised to or owned by any facility as the commissioner deems appropriate or expedient. At the discretion of the commissioner, the department may directly operate and administer any program or facility which provides, or which may be established to provide, services to clients of the department, or the commissioner may contract with any individual, partnership, association, agency, or corporation, either public or private, profit, or nonprofit, as, in the discretion of the commissioner, may be necessary and appropriate for the operation and administration of any program or facility which provides services to clients of the department.

II-a. [Repealed.]

III. The commissioner may designate any member of the department to act on behalf of the commissioner or the department. The commissioner further may delegate any duty or authority of the commissioner or the department to any member of the department or to any sub-unit or component of the department.

IV. Pursuant to RSA 541-A, the commissioner shall have the authority to establish fees, copayments or any other charges for services or assistance provided by or on behalf of the department.

V. The commissioner shall have the authority to direct an autopsy be made upon the death of any person admitted to, a resident of, or receiving care from the New Hampshire hospital, Glencliff home, or any other residential facility operated by the department or a contract service provider, if the commissioner deems it necessary for the purpose of determining the existence of infection or disease, cause of death, or for other good reason. The findings of any such autopsy shall be treated by the department in accordance with the quality assurance program under RSA 126-A:4, IV and by the medical examiner in accordance with the provisions of RSA 611-B:21, IV.

VI. The commissioner shall have the authority to make arrangements for the funeral and burial of any person who has not made other arrangements and dies while admitted to, a resident of, or receiving care from New Hampshire hospital, Glencliff home, or any other residential facility operated by the department or a contract service provider. If an autopsy is ordered pursuant to RSA 126-A:5, V, then following the autopsy, the medical examiner shall deliver the body to any person authorized pursuant to RSA 611:14. In the event that a dead body is unclaimed for a period of not less than 48 hours following completion of any autopsy ordered pursuant to this section, then the medical examiner shall deliver the body to a funeral home as directed by the commissioner, who shall decently bury or cremate the body at department expense, or, with consent of the commissioner, it may be sent at department expense to the medical department of a medical school or university, to be used for the advancement of the science of anatomy or surgery, as provided for by law.

VII. The commissioner shall establish advisory groups or other mechanisms to solicit input from clients and providers of the department and their families regarding the services provided by the department and its contract providers.

VIII. The commissioner shall establish an appeals process for any individual applying for or receiving services from the department or its contract service providers, any providers, programs, services, or facilities which are licensed or certified by the department, or with regard to actions related to employees of the department or any other matter within the jurisdiction of the department. Notwithstanding any other provision of law, the appeals process shall include:

(a) A jurisdictional review by the commissioner, or a hearings examiner designated by the commissioner, to determine whether a denial or change in services, benefits, or a license is automatic due entirely to a change in state or federal law. In the event the department's action is due entirely to such a change in state or federal law, the department shall provide adequate notice and provide the applicant, recipient, or licensee the opportunity to state the reasons he or she believes issues of fact or interpretation of law should be heard, prior to the commissioner or hearings examiner designated by the commissioner conducting a jurisdictional review.

(1) If the commissioner, or hearings examiner designated by the commissioner determines that sole issue on appeal is the result of the state or federal law that caused a denial or change in services, benefits, or a license, and the appeal does not require resolution of a factual disagreement or legal issue, then an order dismissing the appeal shall be issued by the commissioner, or a hearings examiner designated by the commissioner, after such jurisdictional review and without an administrative hearing.

(2) In all other cases, if the automatic result of the new state or federal law is not the only issue on appeal, then an administrative hearing shall be conducted by the commissioner, or a hearings examiner designated by the commissioner, to address the other issues in accordance with rules established by the commissioner.

(b) For appeals of all other matters, the commissioner, or a hearings examiner designated by the commissioner, shall conduct an administrative hearing in accordance with the rules established by the commissioner.

(c) Unless the commissioner has delegated to the hearings examiner authority to issue a decision on behalf of the department, following the hearing, the hearings examiner shall submit to the commissioner a proposed decision which shall include:

(1) A statement of the issues presented in the appeal;

(2) A summary of the evidence received;

(3) Proposed findings of fact and rulings of law; and

(4) A proposed order.

(d) If following a hearing the proposed decision is adverse to the individual applying for or receiving services, facility or employee who made the appeal, or if the commissioner proposes to make an adverse finding, ruling, or order which the hearings examiner has not recommended, the commissioner shall provide the appealing party with a copy of the commissioner's proposed decision and offer an opportunity to submit a brief and make an oral argument regarding the contested findings of fact, rulings of law, or proposed order.

(e) Following a review of a proposed decision after a hearing and of a brief and argument in a contested case, if any, the commissioner shall issue a final decision on the appeal.

IX. The commissioner shall adopt rules pursuant to RSA 541-A relative to the compensation of the members of the drug use review board.

X. The commissioner may assess and collect reasonable fees for the duplication of materials made pursuant to RSA 91-A:4 and for material generally available to the public upon request. Such fees shall be based on an amount necessary to recover the cost of producing such documents, regardless of the type of medium used. Local, state and federal agencies shall be exempted from these fees.

XI. The commissioner shall adopt rules, pursuant to RSA 541-A, implementing procedures for state registry and criminal background investigations of all new department staff who have regular contact with children, according to the provisions of RSA 170-G:8-c.

XII.

(a) Notwithstanding any other provision of law to the contrary, the commissioner shall, upon request, publicly disclose the information in subparagraphs (c)(3)-(c)(12) regarding the abuse or neglect of a child, as set forth in this paragraph, if there has been a fatality or near fatality resulting from abuse or neglect of a child. Information included in subparagraphs (c)(1) and (c)(2) shall also be disclosed if it is determined that such disclosure shall not be contrary to the best interests of the child, the child's siblings or other children in the household and there has been a fatality or near fatality resulting from abuse or neglect of a child. In addition, the same disclosure shall be made when there has been a fatality, to include suicide, or near fatality of a child under the legal supervision or legal custody of the department. In determining whether disclosure will be contrary to the best interests of the child, the child's siblings, or other children in the household, the commissioner shall consider the privacy interests of the child and the child's family and the effects which disclosure may have on efforts to reunite and provide services for the family. If the commissioner determines not to release the information, the commissioner shall provide written findings in support of the decision to the requestor. As used in this section, "near fatality" means an act or event that places a child in serious or critical condition as certified by a physician.

(b) Information may be disclosed as follows:

(1) Information released prior to the completion of the investigation of a report shall be limited to a statement that a report is "under investigation."

(2) When there has been a prior disclosure pursuant to subparagraph (b)(1) of this paragraph, information released in a case in which the report has been unfounded shall be limited to the statement that "the investigation has been completed, and the report has been determined unfounded."

(3) If the report has been founded, then information may be released pursuant to subparagraph (c) of this section.

(c) For the purposes of this paragraph, the following information shall be disclosed:

(1) The name of the abused or neglected child, provided that the name shall not be disclosed in a case of a near fatality unless the name has otherwise previously been disclosed.

(2) The name of the parent or other person legally responsible for the child or the foster family home, group home, child care institution, or child placing agency where the child is placed.

(3) The date of any report to the department of suspected abuse or neglect, to include any prior reports on file, provided that the identity of the person making the report shall not be made public.

(4) The statutory basis and supporting allegations of any such report, provided that the identity of the person making the report shall not be made public.

(5) Whether any such report was referred to a district office for assessment and, if so, the priority assigned by central intake.

(6) The date any such report was referred to the district office for assessment.

(7) For each report, the date and means by which the district office made contact with the family regarding the assessment.

(8) For each report, the date and means of any collateral contact made as part of the investigation provided that the identity of an individual so contacted shall not be made public.

(9) For each report, the date the assessment was completed.

(10) For each report, the fact that the department's investigation resulted in a finding of either abuse or neglect and the basis for the finding.

(11) Identification of services and actions taken, if any, by the department regarding the child named in the report and his or her family or substitute caregiver as a result of any such report or reports.

(12) Any extraordinary or pertinent information concerning the circumstances of the abuse or maltreatment of the child and the investigation of such abuse or maltreatment, where the commissioner determines such disclosure is consistent with the public interest.

(d) Any disclosure of information pursuant to this paragraph shall be consistent with the provisions of subparagraph (c). Such disclosure shall not identify or provide an identifying description of the source of the report, and shall not identify the name of the abused or neglected child's siblings, or any other members of the child's household, other than the subject of the report.

XIII. The commissioner shall adopt rules pursuant to RSA 541-A relative to approved headgear required by RSA 265:144, X.

XIV. [Repealed.]

XIV-a.

(a) The children's health insurance program shall include a public education and outreach component, the purpose of which shall be to increase enrollment by informing new parents of the program's availability and assisting families in the completion of the application process as necessary.

(b) The department shall allocate funds for the development of a volunteer program to promote the program to eligible families and to identify those families who may require assistance with the application or redetermination process, and provide training and supervision of volunteers.

(c) The department shall reimburse designated partner agencies, including health and home visiting providers, who had to provide additional follow-up with applicants an enhanced application fee for the outreach assistance to individuals requesting assistance in the application or redetermination process. Such fee shall be equal to twice the regular application fee.

XIV-b. A child's participation in any program that provides medical or dental treatment in any school setting shall require the explicit written consent of the child's parent or legal guardian.

XV. The commissioner shall establish a quality early learning opportunity initiative which shall be available on a first-come, first-served basis to families whose income is between 190 percent and 250 percent of the federal poverty guidelines, and whose children are enrolled in a child care program licensed under RSA 170-E, and who otherwise meet all other eligibility requirements for child care assistance. The amount of support provided to eligible families shall be calculated annually by the department and shall reflect the estimated average difference between the cost of licensed child care and unlicensed child care.

XVI. [Repealed.]

XVII. The commissioner or designee shall participate in the development of an evidence-based prescription drug education program designed to provide health care providers who are licensed to prescribe or dispense prescription drugs with information and education on the therapeutic and cost-effective utilization of prescription drugs. This program may be developed under the leadership of the New Hampshire Medical Society in partnership with area health education centers programs administered by Dartmouth Medical School and any organization in New Hampshire or other state the partnership shall see fit to consult. The commissioner or partners may seek grants and financial gifts from non-profit charitable foundations to cover planning and development of this program. The commissioner or partners shall present a progress report on the development of the program to the oversight committee on health and human services by November 1, 2008.

XVIII.

(a) The commissioner shall establish the state office of rural health (SORH) within the department. The SORH shall:

(1) Link rural health and human service providers with state and federal resources.

(2) Seek long-term solutions to the challenges of rural health.

(3) Increase access to health care in rural and underserved areas of the state.

(4) Improve recruitment and retention of health professionals in rural areas.

(5) Provide technical assistance and coordination to rural communities and health organizations.

(6) Maintain a clearing house for collecting and disseminating information on rural health care issues and innovative approaches to the delivery of health care in rural areas.

(7) Coordinate rural health interests and activities.

(8) Participate in strengthening state, local, and federal partnerships.

(b) The commissioner may adopt rules, pursuant to RSA 541-A, relative to accomplishing the goals under subparagraph (a).

(c) The commissioner shall submit a report beginning on November 1, 2025 and on every third year thereafter to the speaker of the house of representatives, the senate president, the governor, the oversight committee on health and human services established under RSA 126-A:13, the chairs of the house and senate executive departments and administration committees, the chairs of the house and senate committees having jurisdiction over health and human services, and the commission on primary care workforce issues established under RSA 126-T:1, on the health status of rural residents incorporating current data from the bureau of health statistics and data management and the SORH.

XVIII-a.

(a) The state office of rural health (SORH) established in paragraph XVIII shall receive and collect data regarding surveys completed by participating licensees pursuant to RSA 317-A:12-a, RSA 318:5-b, RSA 326-B:9-a, RSA 328-D:10-a, RSA 328-F:11-a, RSA 329:9-f, RSA 329-B:10-a, RSA 330-A:10-a, and RSA 330-C:9-a.

(b) The data collected shall be reviewed, evaluated, and analyzed by the SORH to provide policy decision makers and the commission on the interdisciplinary primary care workforce established under RSA 126-T:1, with critical information to develop and plan for New Hampshire's primary workforce current and future needs and to identify innovative ways for expanding primary care capacity and resources.

(c) Any personally identifiable information contained within the surveys collected by the SORH shall remain confidential and are exempt from disclosure pursuant to RSA 91-A. Any request for information maintained by and in the custody of the SORH under this paragraph shall require the redaction of any and all personally identifiable information by the SORH prior to the release of such information; provided, that the SORH shall be authorized to provide required data to the Health Resources and Services Administration (HRSA) pursuant to federal regulation and or directives governing receipt of federal resources by the SORH.

(d) The SORH shall be authorized to provide aggregate data and interval reports and such information shall be made available and published on the department of health and human services' Internet website. For purposes of quality assurance and validation of data including participation rates for survey completion, the SORH shall be authorized to provide the licensing boards identified in subparagraph (a) as follows:

(1) A list of National Provider Identification numbers of those licensees who have completed or appropriately opted-out of the survey; and

(2) Aggregate data results as it pertains to non-personal information listed on the survey.

(e) On or before December 1, 2019, and annually thereafter, the SORH shall make a written report to the speaker of the house of representatives, the senate president, the governor, the oversight committee on health and human services established under RSA 126-A:13, the chairs of the house and senate executive departments and administration committees, the chairs of the house and senate policy committee having jurisdiction over health and human services, and the commission on interdisciplinary primary care workforce established by RSA 126-T:1. The report shall include, but not be limited to, aggregate data and information on current and projected primary workforce needs and the participation rate on surveys completed pursuant to this paragraph.

(f) The commissioner may adopt rules, pursuant to RSA 541-A, relative to the administration of this paragraph.

XIX.

(a) The commissioner shall employ a managed care model for administering the Medicaid program and its enrollees to provide for managed care services for all Medicaid populations throughout New Hampshire consistent with the provisions of 42 U.S.C. section 1396u-2. Models for managed care may include, but not be limited to, a traditional capitated managed care organization contract, an administrative services organization, an accountable care organization, or a primary care case management model, or a combination thereof, offering the best value, quality assurance, and efficiency, maximizing the potential for savings, and presenting the most innovative approach compared to other externally administered models. Services to be managed within the model shall include all mandatory Medicaid covered services and may include, but shall not be limited to, care coordination, utilization management, disease management, pharmacy benefit management, provider network management, quality management, and customer services. The model shall reimburse pharmacists for services described in RSA 126-A:3, III-a. The commissioner shall enter into contracts with the vendors that demonstrate the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, and savings. The commissioner shall establish rates based on the appropriate model for the contract that is full risk to the vendors. The rates shall be established in rate cells or other appropriate units for each population or service provided including, but not limited to, persons eligible for temporary assistance to needy families (TANF), aid for the permanently and totally disabled (APTD), breast and cervical cancer program (BCCP), home care for children with severe disabilities (HC-CSD), and those residing in nursing facilities. The rates and/or payment models for the program shall be presented to the fiscal committee of the general court on an annual basis. The managed care model or models' selected vendors providing the Medicaid services shall emphasize patient-centered, value-based care and include enhanced care management of high-risk populations as identified by the department. In contracting for the managed care program, the department shall ensure no reduction in the quality of care of services provided to enrollees in the managed care model and shall exercise all due diligence to maintain or increase the current level of quality of care provided. The commissioner may, in consultation with the fiscal committee, adopt rules, if necessary, to implement the provisions of this paragraph. The department shall seek, with the approval of the fiscal committee, all necessary and appropriate waivers to implement the provisions of this paragraph.

(b) [Repealed.]

(c) For the purposes of this paragraph:

(1) An "accountable care organization" means an entity or group which accepts responsibility for the cost and quality of care delivered to Medicaid patients cared for by its clinicians.

(2) "An administrative services organization" means an entity that contracts as an insurance company with a self-funded plan but where the insurance company performs administrative services only and the self-funded entity assumes all risk.

(3) A "managed care organization" means an entity that is authorized by law to provide covered health services on a capitated risk basis and arranges for the provision of medical assistance services and supplies and coordinates the care of Medicaid recipients residing in all areas of the state, including the elderly, those meeting federal supplemental security income and state standards for disability, and those who are also currently enrolled in Medicare.

(4) "A primary care case management" means a system under which a primary care case management contracts with the state to furnish case management services, which include the location, coordination, and monitoring of primary health care services, to Medicaid recipients.

(d) The vendors contracting with the department to carry out the Medicaid managed care program pursuant to this paragraph shall make quarterly reports to the commissioner regarding their efforts to implement New Hampshire's 10-year mental health plan issued in 2008. Such reports shall commence on November 1, 2013. The commissioner shall make an annual report summarizing the information in the vendors' reports to the oversight committee on health and human services, established in RSA 126-A:13, commencing on November 1, 2014.

(e) [Repealed.]

(f) The commissioner shall seek all necessary federal approvals, including, but not limited to, Medicaid state plan amendments and Medicaid care management contract approval, to allow the Medicaid managed care organizations to use their own drug formulary in providing pharmacy benefits and contracting with pharmacy providers. A managed care organization as defined in subparagraph (c)(3) that implements its own drug formulary shall comply with the provisions of the Federal Medicaid statute, 42 U.S.C. section 1396r-8, and RSA 420-J:7-b, II, II-a, and III.

(g)

(1) By July 15, 2017, the commissioner shall develop a universal online prior authorization form for drugs used to treat mental illness and require community mental health centers and managed care organizations to use such form by September 1, 2017. A reasonably completed prior authorization request submitted using the online form shall be approved or denied by the close of the next business day. Failure to meet this time frame shall be deemed automatic approval. If the prior authorization is denied, the prescribing provider may request a peer-to-peer review with a licensed psychiatric specialist with prescribing privileges by the close of the next business day. Failure by the managed care organization to provide such review by the close of the next business day shall be deemed automatic approval unless the prescribing provider fails to participate in the peer-to-peer review within that time period.

(2) Prior authorization for drugs prescribed by community mental health centers for treatment of severe mental illness shall be suspended if the deadlines under this subparagraph are not met, or if the commissioner determines there is a pattern of missed deadlines for peer-to-peer reviews following denials, or if at any time the commissioner determines such suspension is necessary to promote the behavioral health and well-being of New Hampshire's citizens being served under Medicaid managed care.

(3) The commissioner shall monitor compliance under this subparagraph and shall report quarterly through December 31, 2018 to the fiscal committee of the general court relative to adherence to all such requirements including the rate of denial.

(h) The commissioner shall develop and implement enhanced eligibility screening to stop per member/per month payments to managed care organizations in a timely manner for services for persons who are no longer eligible.

(i) Notwithstanding RSA 126-A:5, XIX(a) and 2017, 258:1, long-term supports and services, including, specifically nursing facility services and services provided under the choices for independence waiver, the developmental disabilities waiver, the in-home supports waiver, and the acquired brain disorder waiver, as those waivers are issued by the Centers for Medicare and Medicaid Services under 42 U.S.C. section 1396(c), shall not be incorporated into the department's care management program for delivery by a managed care organization, as defined in RSA 126-A:5, XIX(c)(3), under contract with the state. The department may develop a plan to offer on a voluntary basis only county or other locally-based Programs of the All Inclusive Care for the Elderly (PACE) or similar accountable care organization (ACO) models to provide on a non-fee-for-service basis nursing facility and choices for independence home care services for beneficiaries who voluntarily elect to participate. Any such plan for voluntary PACE and/or ACO models shall be approved by the oversight committee on health and human services, established in RSA 126-A:13, and the fiscal committee of the general court prior to implementation.

(j)

(1) Managed care organizations shall process credentialing applications from all types of providers within the following prescribed time frames:

(A) For primary care physicians, within 30 calendar days of receipt of clean and complete credentialing applications.

(B) For specialty care providers, within 45 calendar days of receipt of clean and complete credentialing applications.

(2) For the purposes of subparagraph (1), the start time begins when the managed care organization has received a provider's clean and complete application, and ends on the date of the provider's written notice of network status.

(3) For the purposes of this subparagraph, a "clean and complete" application is a claim that is signed and appropriately dated by the provider, and includes:

(A) Evidence of the provider's New Hampshire Medicaid identification; and

(B) Other applicable information to support the provider application, including provider explanations related to quality and clinical competence satisfactory to the managed care organization.

(4) If the managed care organization does not process a provider's credentialing application within the time frames set forth in this subparagraph, the managed care organization shall pay the provider retroactive to 30 calendar days or 45 calendar days after receipt of the provider's clean and complete application, depending on the prescribed time frame for the appropriate provider.

(5) Nothing in this subparagraph shall preclude the commissioner from administering the applicable contract requirements with the managed care organization as necessary to allow for exceptions to credentialing standards under this subparagraph.

(k)

(1) For the purposes of this subparagraph regarding claims quality assurance standards, the commissioner shall adopt the claims definitions established by the Centers for Medicare and Medicaid Services under the Medicaid program which are as follows:

(A) "Clean claim" means a claim that does not have any defect, impropriety, lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment.

(B) "Incomplete claim" means a claim that is denied for the purpose of obtaining additional information from the provider. The managed care organization shall pay or deny 95 percent of clean claims within 30 days of receipt, or receipt of additional information. The managed care organization shall pay 99 percent of clean claims within 90 days of receipt.

(2) Nothing in this subparagraph shall preclude the commissioner from administering the applicable contract requirements with the managed care organization as necessary to allow for exceptions to claims quality assurance standards under this subparagraph.

XIX-a.

(a)

(1) The commissioner shall pursue contracting options to administer the state's Medicaid dental program with the goals of improving access to dental care for Medicaid populations, improving health outcomes for Medicaid enrollees, expanding the provider network, increasing provider capacity, fostering individual behaviors that promote good oral health, and retaining innovative programs that improve access and care through a value-based care model.

(2) The commissioner shall issue a request for information to assist in determining whether the state's Medicaid dental program would be best administered by a dental managed care organization or, alternatively, by the state's current medical managed care organizations. The commissioner shall obtain the requested information from both the current medical managed care organizations and any interested dental managed care organization. The approach selected shall be that which demonstrates the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, patient education, and savings. The request for information shall be released no later than August 1, 2022. The request for information shall address improving health outcomes, expanding the provider network, increasing capacity of providers, integrating a value-based care model, and exploring innovative programs for children and adults.

(3) If the commissioner determines that the program would be best administered by a dental managed care organization, the commissioner shall issue a 3-year request for proposals, with 2 optional one-year extensions, to enter into contracts with the vendor that demonstrates the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, patient education, and savings. The state plan amendment shall be submitted to the Centers for Medicare and Medicaid Services (CMS) within the quarter of implementation (by June 30, 2023). Implementation of a procured contract shall begin April 1, 2023. The commissioner shall establish a capitated rate for the contract that is full risk to the vendor. In contracting with a dental managed care organization and the various rate cells, the department shall ensure no reduction in the quality of care of services provided to enrollees in the managed care model and shall exercise all due diligence to maintain or increase the quality of care provided. Following approval by the joint health care reform oversight committee, pursuant to RSA 420-N:3, the department shall seek, with the review of the fiscal committee of the general court, all necessary and appropriate state plan amendments and waivers to implement the provisions of this paragraph. The program shall not commence operation until such state plan amendments or waivers have been approved by CMS. All necessary state plan amendments shall be submitted within the quarter of implementation (by June 30, 2023) and waivers shall be submitted by October 1, 2022.

(4) The commissioner shall adopt rules, pursuant to RSA 541-A, if necessary, to implement the provisions of this paragraph and shall first obtain approval of proposed rules by the joint health care reform oversight committee, pursuant to RSA 420-N:3.

(b) Any vendor awarded a contract pursuant to this paragraph shall provide the following dental services to individuals 21 years of age and over, reimbursed under the United States Social Security Act, Title XIX, or successors to it:

(1) Diagnostic and preventive dental services including an annual comprehensive oral examination, necessary x-rays or other imaging, prophylaxis, topical fluoride, oral hygiene instruction, behavior management and smoking cessation counseling, and other services as determined by the annual update of Current Dental Terminology (CDT) codes D0100-D0999 and D1000-D1999 for diagnostic and preventive services. Annual updates to the CDT shall be made available on the department of health and human services' website.

(2) Comprehensive restorative treatment necessary to prevent or treat oral health conditions, to reduce or eliminate the need for future acute oral health care, and to avoid more costly medical or dental care.

(3) Oral surgery and treatment necessary to relieve pain, eliminate infection or prevent imminent tooth loss.

(4) Removable prosthodontic coverage for individuals served on the developmental disability (DD), acquired brain disorder (ABD), and choices for independence (CFI) waivers, such waivers authorized under Section 1915(c) of the Social Security Act, and nursing facility resident populations only, subject to medical necessity.

(5) The individual benefit shall be capped at $1,500 per year, excluding preventive services, provided that this cap shall be subject to adjustment upon approval by the joint legislative fiscal committee and governor and council.

(c) With the exception of diagnostic and preventive services, cost sharing shall be implemented to the maximum extent allowed under CMS guidelines for Medicaid recipients with family incomes above 100 percent of the Federal Poverty Level (FPL).

(d) The department of health and human services shall present an annual report to the health and human services oversight committee that includes, but is not limited to, Medicaid recipient utilization, provider participation, and other indicators of program effectiveness.

(e) In this paragraph, "dental managed care organization" means any dental care organization, dental service organization, health insurer, or other entity licensed under Title XXXVII, that provides, directly or by contract, dental care services covered under this paragraph rendered by licensed providers and that meets the requirements of Title XIX or Title XI of the federal Social Security Act.

XX. The commissioner shall administer the grant for the New Hampshire Information Exchange Planning and Implementation Project.

XXI.

(a) The commissioners of the departments of health and human services and corrections, and the attorney general shall enter into a memorandum of understanding establishing an inter-departmental team, to address responsibilities associated with the most challenging cases of individuals 18 years of age or older with developmental disabilities or acquired brain disorders who present a substantial risk to community safety as determined by a comprehensive risk assessment appropriate to the individual. The memorandum of understanding shall include a requirement for participation by: the department of health and human services, including the bureau of developmental services, the bureau of behavioral health, the division for children, youth and families, the bureau of drug and alcohol services, the New Hampshire hospital, the department of justice, and the department of corrections. The purpose of the memorandum of understanding is to promote collaboration and cooperation across all services systems to determine and recommend system responsibility for providing and/or funding specific services and supports to effectively meet the needs of the individual and the public safety of the community in accordance with the rules of the respective departments.

(b) Nothing in this paragraph shall abrogate the rights of individuals or responsibilities of agencies under RSA 171-A, RSA 171-B, RSA 137-K, or any other applicable state or federal law.

(c) Any of the departments may refer a case to the team for consideration. In addition, a county house of corrections may refer a case to the team for consideration for individuals determined eligible under RSA 171-A.

(d) The commissioners and the attorney general shall submit an annual report beginning on November 1, 2011 to the president of the senate, the speaker of the house of representatives, and the governor relative to the outcomes and recommendations of the team.

XXII. The commissioner shall fully implement expanded coverage of Medicaid family planning services as required by RSA 126-A:4-c no later than July 1, 2013. At the time of implementation, the state's Medicaid plan shall be amended to enable the state to accept federal matching funds. As provided in RSA 126-A:4-c, the department shall ensure that the state realizes the 90 percent federal Medicaid match available for the family planning services. If the traditional claims payment systems are unavailable for implementation within the time frame indicated in this paragraph, the commissioner shall manually process the payment of claims or contract with a third party administrator to ensure timely provider payment capacity and uninterrupted access to eligible recipients. At least 30 days in advance of program implementation, the commissioner shall conduct an outreach effort to all participating Medicaid family planning providers to distribute guidance and technical assistance regarding patient enrollment procedures, eligibility criteria, and covered medical services and supplies. Within 60 days after program implementation as required under this paragraph and annually thereafter, the commissioner shall make a report relative to the Medicaid family planning services program to the joint legislative fiscal committee.

XXIII. [Repealed.]

XXIV. [Repealed.]

XXV. [Repealed.]

XXVI. [Repealed.]

XXVII. The commissioner, in collaboration with the commissioner of the department of safety, the director of the police standards and training council, and the local chapter of the Alzheimer's Association, shall develop an educational program on Alzheimer's disease and other related dementia, for both the general public and special interest groups, including law enforcement. Depending upon available resources, additional information and input may be sought from the fish and game department, the adjutant general's department, the board of medicine, the New Hampshire Medical Society, and other interested parties. The commissioner shall provide an interim report on or before January 1, 2015 with a final report on or before July 1, 2015 on the status of the implementation of the educational program to the oversight committee on health and human services established in RSA 126-A:13 and the subcommittee on Alzheimer's disease and other related dementia established in RSA 126-A:15-a. The commissioner shall post a link to the local chapter of the Alzheimer's Association on the department's website.

XXVIII. The commissioner shall include a link to the International Lyme and Associated Diseases Society (www.ILADS.org) on its Internet website and may include a disclaimer that the department of health and human services neither endorses nor supports the position of the International Lyme and Associated Diseases Society.

XXIX. The commissioner shall submit a state plan amendment to the Center for Medicare and Medicaid Services to provide substance use disorder services to Title XIX and Title XXI beneficiaries. The commissioner shall design the benefit consistent with Substance Abuse and Mental Health Service Administration (SAMHSA) treatment guidelines. The commissioner shall also determine the process and timeline for implementing services and, if necessary, phase in the benefit.

XXX. [Repealed.]

XXXI. The commissioner may enter into a contract or contracts with one or more physicians who are certified by an accredited addiction medicine or addiction psychiatry certifying body. The physician or physicians shall provide consultation and guidance to the department related to designing, updating, and monitoring practices and policies regarding medication assisted treatment and related treatments for substance use disorders in New Hampshire.

XXXII. The department of health and human services shall comply with the provisions of RSA 541-A:29 for the timely processing of completed applications, petitions, or other administrative requests made of the agency. However, the provisions of RSA 541-A:29-a shall not apply to any federally funded program administered by the department to the extent such default approval conflicts with federal law.

XXXIII.

(a) On or before September 1, 2019, the commissioner shall submit a report on the New Hampshire 10-year mental health plan of 2018 containing the priorities for implementation of the plan to the oversight committee on health and human services, established under RSA 126-A:13, the chairpersons of the house and senate policy committees with jurisdiction over health and human services matters, the president of the senate, the speaker of the house of representatives, the governor, and the office of the child advocate established in RSA 21-V. The commissioner shall submit a report on or before September 1, 2020 and annually thereafter on the status of the implementation of the 10-year mental health plan including, but not limited to, unmet benchmarks and recommendations for any necessary barrier resolution or necessary adjustments or modifications to the plan to better serve New Hampshire citizens, to the oversight committee on health and human services and the chairpersons of the house and senate policy committees with jurisdiction over health and human services matters. The annual report shall include any recommendations by the commissioner for legislation as needed or appropriate in achieving important benchmarks in fully implementing the 10-year mental health plan.

(b) As part of the annual report required by this paragraph, the commissioner of the department of health and human services, in conjunction with the commissioner of the department of education, shall issue a joint report on the implementation of 2019, 44 (SB 14), relative to child welfare. This portion of the report shall address in detail the implementation status of each section of 2019, 44 (SB 14) and include all information related to progress toward full implementation of a system of care under RSA 135-F. The report shall also address the following:

(1) The total cost of children's behavioral health services.

(2) The identification of barriers and service gaps in the array of children's behavioral health services, along with a description of efforts and plans to fill those gaps.

(3) The availability of mobile crisis and stabilization services in each part of the state and plans to fill any gaps.

(4) Changes to statutes, administrative rules, policies, practices, and managed care and provider contracts which will be necessary to fully implement the system of care.

(5) Shortfalls in workforce sufficiency affecting full implementation of the system of care as well as efforts and plans for addressing those shortfalls.

(6) Numbers of children and youth awaiting services in various categories.

(7) Plans to coordinate the system of care with existing efforts addressing early childhood interventions, primary prevention, and primary care integration.

(8) Plans to develop and/or coordinate a cross-system assessment tool and data collection system to measure outcomes, including but not limited to status upon exit from the system of care, measured treatment results, recidivism, and other returns to the service system.

XXXIV. The department of health and human services shall operate and manage the state's forensic psychiatric hospital. The department may contract with a private medical organization for the provision of clinical services.

XXXV. Notwithstanding any other provisions in the law, the department of health and human services may participate in a data match process with the office of professional licensure and certification to ensure that Medicaid providers have current valid licensure by matching the provider's first and last name and the provider's social security number or other taxpayer identification number.

XXXVI. The commissioner shall submit to the Centers for Medicare and Medicaid Services (CMS) an amendment to the state Medicaid plan to provide reimbursement for ambulance services when care is provided in response to an emergency call to a member's home or on a scene, when an ambulance is dispatched, and treatment is provided to the patient without the patient being transported to another site.

(a) Providers shall be eligible for Medicaid reimbursement when the provider has documented that:

(1) The response originated through an emergency call; and

(2) The patient consents to evaluation and treatment, and one of the following outcomes has occurred:

(A) After the evaluation, and when indicated, treatment, the licensed paramedic or emergency medical technician (EMT) and the patient agree there is no need for transportation by ambulance;

(B) The patient does not request and actively refuses transport to an emergency department for evaluation; or

(C) The patient is stable for referral to the patient's physician, other community resource, and the patient has the ability, including mental capacity and transportation resources, to obtain assistance and medically indicated follow-up.

(b) Providers shall also be eligible for Medicaid reimbursement when the provider has documented that the response originated through an emergency call, resuscitation efforts were terminated, and the patient is deceased.

RSA 126-A:5

Amended by 2024, 376:5, eff. 8/23/2024.

Amended by 2024, 376:1, eff. on the date the Centers for Medicare and Medicaid Services certifies the approval of the amendment to the state Medicaid plan to the director of legislative services and the secretary of state.

Amended by 2024, 342:4, eff. 8/2/2024 .

Amended by 2024, 342:1, eff. on the date the Centers for Medicare and Medicaid Services certifies the approval of the amendment to the state Medicaid plan to the director of legislative services and the secretary of state.

Amended by 2024, 170:1, eff. 7/1/2024.

Amended by 2023, 145: 14, eff. 6/30/2023.

Amended by 2023, 145: 13, eff. 6/30/2023.

Amended by 2022, 110: 1, eff. 7/26/2022.

Amended by 2022, 96: 1, eff. 7/19/2022.

Amended by 2022, 319: 2, eff. 7/1/2022.

Amended by 2022, 285: 2, eff. 7/1/2022.

Amended by 2021, 189: 2, eff. 1/1/2022.

Amended by 2021, 122: 9, eff. 7/9/2021.

Amended by 2021, 91: 395, eff. 7/1/2021.

Amended by 2020 , 37: 20, eff. 7/29/2020.

Amended by 2020 , 37: 9, eff. 7/29/2020.

Amended by 2020 , 17: 6, eff. 7/17/2020.

Amended by 2020 , 17: 5, eff. 7/17/2020.

Amended by 2019 , 346: 227, eff. 7/1/2019.

Amended by 2019 , 346: 224, eff. 7/1/2019.

Amended by 2019 , 182: 1, eff. 9/8/2019.

Amended by 2019 , 268: 1, eff. 7/1/2019.

Amended by 2019 , 254: 4, eff. 7/1/2019.

Amended by 2019 , 254: 3, eff. 7/1/2019.

Amended by 2019 , 248: 1, eff. 7/12/2019.

Amended by 2018 , 342: 24, eff. 12/31/2018.

Amended by 2018 , 279: 16, eff. 1/1/2019.

Amended by 2018 , 278: 1, eff. 8/20/2018.

Amended by 2018 , 309: 1, eff. 6/25/2018 for subsection XIX(i) and 8/24/2018 for subsection XIX(h).

Amended by 2018 , 8: 2, eff. 4/18/2018.

Amended by 2017 , 195: 5, eff. 9/3/2017.

Amended by 2017 , 156: 219, eff. 7/1/2017.

Amended by 2017 , 156: 178, eff. 7/1/2017.

Amended by 2017 , 131: 2, eff. 6/16/2017.

Amended by 2017 , 131: 1, eff. 6/16/2017.

Amended by 2016 , 211: 1, eff. 6/6/2016.

Amended by 2016 , 13: 14, eff. 4/5/2016.

Amended by 2016 , 13: 4, eff. 4/5/2016.

Amended by 2016 , 13: 3, eff. 4/5/2016.

Amended by 2016 , 13: 1, eff. 4/5/2016.

Amended by 2015 , 199: 3, eff. 6/30/2016 - later changed to 6/30/2017.

Amended by 2015 , 276: 262, eff. 7/1/2015.

Amended by 2015 , 276: 261, eff. 7/1/2015.

Amended by 2015 , 276: 260, eff. 7/1/2015.

Amended by 2015 , 276: 231, eff. 7/1/2015.

Amended by 2015 , 276: 209, eff. 7/1/2015.

Amended by 2015 , 199: 1, eff. 7/6/2015.

Amended by 2015 , 42: 3, eff. 5/14/2015.

Amended by 2014 , 67: 2, eff. 5/27/2014.

Amended by 2014 , 3: 12, eff. 12/31/2016 - later changed to 12/31/2018.

Amended by 2014 , 3: 2, eff. 3/27/2014.

Amended by 2013 , 41: 1, eff. 8/3/2013.

Amended by 2013 , 92: 1, eff. 6/20/2013.

Amended by 2012 , 156: 1, eff. 6/7/2012.

Amended by 2011 , 232: 7, eff. 7/5/2011.

Amended by 2011 , 235: 2, eff. 9/3/2011.

Amended by 2011 , 235: 1, eff. 9/3/2011.

Amended by 2011 , 125: 1, eff. 6/2/2011.

1995, 310:1, 199. 1998, 354:1. 1999, 110:2; 223:2. 2003, 206:2, 3. 2004, 98:2, eff. May 11, 2004. 2005, 100:1, eff. Jan. 1, 2006. 2006, 258:18, eff. July 1, 2006; 299:3, eff. June 15, 2006. 2007, 156:4, eff. Aug. 17, 2007; 167:2, eff. Aug. 17, 2007; 263:12, 126, eff. July 1, 2007; 324:11, eff. Sept. 14, 2007; 345:1, eff. Sept. 14, 2007. 2008, 119:1, eff. June 3, 2008; 367:2, eff. Jan. 1, 2009. 2009, 144:41, eff. July 1, 2009.

This section is set out more than once due to postponed, multiple, or conflicting amendments.