Governor Sununu is correct: “… fiscally responsible and sustainable rate increases” is what New Hampshire needs.
An across-the-board increase of 3.1% for all providers will not address the very serious problems we are facing in our healthcare system. Rate increases should be targeted to address access to care issues our citizens are experiencing, to bring NH into compliance with federal rate parity requirements and to allow for consideration of the adequacy of the current provider rate.
The rates in question are drastically different, ranging from $1.74 to thousands of dollars. Comparatively, this math does not work for the providers reimbursed on the lower end of this scale, while it is beneficial or excessive to the most costly providers. There is a great disparity in the history of these: some have been adjusted only once in twenty years while others are adjusted annually or more frequently.
NH DHHS adjusts hospital rates annually, the rates are increased or decreased through the DRG methodology. The Center for Medicare and Medicaid Services (CMS) publishes the rates and NH DHHS adopts the rates annually. There are many factors which are considered in the development of the rate, including application of a wage index.
For the Home and Community-based Care Waivers, CMS has directed states to develop “a fee schedule rate that is consistent with efficiency, economy, and quality of care, and is sufficient to enlist enough providers so that care and services are available under the plan at least to the same extent that such care and services are available to the general population” as required by §1902(a)(30)(A) of the Social Security Act. NH DHHS is not in compliance with this requirement and the mandate cannot be met with a 3.1% increase. The legislature needs to appropriately fund the waiver services to afford access to care and avoid other more costly care.
Governor Sununu and Commissioner Meyers have given consideration to the across-the-board increase and identified serious flaws with this method. I would ask our legislators to consider the downsides to this one-size-fits-all policy. One size never fits all and we can do better. The provider funding should be targeted to ensure the funding will best serve the citizens of NH by ensuring access to needed care.
Hon. Robert E Clegg
Hudson, NH
