New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 553 - HOME HEALTH SERVICES
Section He-W 553.08 - Rate Setting Methodology

Universal Citation: NH Admin Rules He-W 553.08

Current through Register No. 40, October 3, 2024

The rate setting methodology for skilled nursing and home health aide services shall be as follows:

(a) The rate setting methodology shall comply with the provisions of RSA 126-A:18-a and 126-A:18-b;

(b) The rates determined in accordance with the rate setting methodology shall be reduced in accordance with He-W 553.08(h) , if such reduction is necessary in order to bring aggregated, estimated expenditures to the amount of the legislative appropriation;

(c) The payment rates for skilled nursing services and home health aide services shall be as shown in Table 553-1 for services performed on or after August 1, 2007 and prior to July 1, 2009;

Table 553-1 Payment Rates for Skilled Nursing and Home Health Aide Services

Service Time Period and Rate Time Period and Rate
Aug 1, 2007 - Dec 31, 2008 Jan 1, 2009 - June 30, 2009
Skilled Nursing $21.50/unit $22.18/unit
Home Health Aide visit of fewer than 8 units of direct care time $ 5.96/unit $ 6.14/unit
Home Health Aide visit of 8 or more units of direct care time $ 5.74/unit $ 5.74/unit

(d) On and after July 1, 2009, the per visit rates established for skilled nursing services, and for home health aide visits comprised of fewer than 8 units of direct care time, shall be calculated as follows:

(1) For each New England state, statewide Low Utilization Payment Adjustment (LUPA) rates for skilled nursing and home health aide visits shall be computed as follows:
a. The Medicare LUPA rates for the services in each county as of April 1 preceding the state fiscal year to which it applies shall be identified;

b. The county LUPA rates in (d) (1) a. above shall be multiplied by the percent of the population in the applicable county to arrive at weighted LUPA rates; and

c. The weighted LUPA rates for each county in (d) (1) b. above shall be added together to arrive at the statewide LUPA rates for each New England state;

(2) For each New England state, excluding New Hampshire, the state Medicaid rate for each service shall be identified by:
a. Taking the per visit payment rate in effect on April 1 of the preceding state fiscal year; or

b. Taking the per unit payment rate in effect on April 1 of the preceding state fiscal year and converting units to visits based on New Hampshire's use patterns of units per visit;

(3) For each New England state, excluding New Hampshire, the Medicaid rate in (d) (2) above shall be divided by the LUPA rate in (d) (1) above to arrive at the Medicaid rate as a percent of the LUPA rate for each service;

(4) The percents in (d) (3) above for each New England state, excluding New Hampshire, shall be used to calculate the following measures of central tendency:
a. Mean (average);

b. Median; and

c. Mean (average) excluding the states with the highest and lowest percents;

(5) The 3 measures calculated in (d) (4) above shall be averaged and multiplied by New Hampshire LUPA rates as determined in (d) (1) above to create benchmark rates for skilled nursing and home health aide visits;

(6) Payment for skilled nursing visits shall be made at 105 percent of the benchmark rate in (d) (5) above; and

(7) Payment for home health aide visits shall be made at 105 percent of the benchmark rate in (d) (5) above;

(e) In interim years, when payment rates are not established according to the methodology in He-W 553.08(d) , payment rates shall be established annually by increasing the base year payment rate by the most recent annual percentage increase in the home health market basket index published by the Centers for medicare and Medicaid Services, at http://www.cms.hhs.gov/MedicareProgramRatesStats/downloads/mktbskt-hha.pdf as of April 1 preceding the state fiscal year to which it will be applied;

(f) The base year in (e) above for each service shall be the most recent state fiscal year for which rates were established in accordance with He-W 553.08(d) ;

(g) On a biennial basis beginning with state fiscal year 2010, if the New Hampshire Legislature specifies payment rate increases for skilled nursing and home health aide services, those rates of increase, rather than the rates set in accordance with (d) or (e) above, or (i) below, shall be applied as directed by the Legislature;

(h) On a biennial basis beginning with state fiscal year 2010, if the Legislature does not specify a payment rate increase for skilled nursing and home health aide services, the department shall take the following steps:

(1) The department shall project the estimated visits and units of skilled nursing and all home health aide services to be provided to the Home and Community Based Care for the Elderly and Chronically Ill (HCBC-ECI) population;

(2) The ratesetting methodology in (d) above and (i) below shall be applied to the estimated visits and units in (h) (1) above to arrive at a total estimated expenditure for those services;

(3) The amount in (h) (2) above shall be added to the estimated expenditures for homemaker services to be provided to the HCBC-ECI population to arrive at a total estimated expenditure;

(4) If the amount in (h) (3) above exceeds the legislative appropriation in the HCBC-ECI home health budget line for the Bureau of Elderly and Adult Services, a proportionate discount factor shall be uniformly applied to skilled nursing and all home health aide services to bring the aggregate estimated expenditure to the amount of the appropriation;

(5) The rates calculated in accordance with (h) (4) above for each year of the biennium shall not be less than the rates in effect for the prior state fiscal year; and

(6) If the amount in (h) (3) above does not exceed the legislative appropriation in the HCBC-ECI home health budget line for the Bureau of Elderly and Adult Services, rates shall be those calculated in accordance with He-W 553.08(d) above and (i) below; and

(i) On and after July 1, 2009, the payment for home health aide visits of 8 or more units of direct care time shall be at rates set by the department in accordance with RSA 161:4, VI(a), RSA 126-A:18-a, and RSA 126-A:18-b.

#9105, eff 3-18-08

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