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Volume 16, Issue 3
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Spring 2004 |
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| published quarterly by: The New Hampshire Challenge, Inc. P.O. Box 579, Dover, NH 03821-0579 |
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| In This Issue |
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A group of concerned advocates have developed this draft of:
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In recognition that Congress declared:
The objectives of the Medicaid program are to furnish,
To families with dependent children and to individuals who are aged, blind or disabled,
whose income and resources are insufficient to meet the costs of necessary medical services,
Medical assistance
and
Rehabilitation and other services to help attain or retain capability for independence or self-care,
We propose that the New Hampshire Medicaid program has as its goals to: ensure access to acute and long-term care; prevent harm; promote restoration and recovery; promote and foster independence; and promote community inclusion. To achieve these goals, at a minimum, the New Hampshire Medicaid program should adhere to the following principles:
1. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (World Health Organization.) Health is a state characterized by anatomical, physiological, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological, and social stress; a feeling of well-being; and freedom from the risk of disease and untimely death. (Stedman's Medical Dictionary, 27th Ed.)
2. Every individual should have access to health care.
3. The Medicaid administration process, eligibility process, and service delivery must be family-centered, culturally competent, and community-based.
4. There must be full parity in coverage for mental health care and physical health care. (President Bush and the New Freedom Initiative.)
5. The Medicaid application and eligibility-determination processes must both serve consumers and utilize tax dollars effectively and efficiently through a process that employs:
- Simplicity of administration;
- Coordination with other public programs (including education programs, vocational rehabilitation, and more), both in eligibility standards and application;
- Outreach that informs individuals and health care providers of assistance and benefit availability in order to ensure early and timely address of medical and rehabilitation needs;
- Prompt and local opportunity and assistance in applying for benefits;
- State personnel trained in the application and eligibility requirements of Medicaid and related programs; and
- Eligibility criteria that are reasonable and consistent with the objectives of Title XIX of the Social Security Act and its related regulations; and
- Medical professionals with the appropriate expertise in chronic illness, physical disabilities, mental illness and/or developmental disabilities to make informed medical eligibility determinations.
6. Medicaid-covered services must:
- Be sufficient in amount, duration and scope to reasonably achieve their purpose;
- Promote prevention, early detection, and intervention in regards to illness or disability;
- Be sufficiently available so as to allow for consumer choice of providers within a reasonably accessible geographical area;
- Be delivered in a way that maximizes consumer control;
- Be delivered and authorized in accordance with best practices and national standards; and
- Monitored regularly for availability, sufficiency, and quality.
7. When authorizing service coverage, the Medicaid agency must utilize guidelines that reflect best practices and national standards.
8. Medically necessary services are services "reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life, cause pain, result in illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and no other equally effective course of treatment is available or suitable for the recipient requesting a medically necessary service." (Current NH Medicaid definition of "medically necessary.")
9. The New Hampshire Department of Health and Human Services, with consumers, providers, and advocates, must regularly seek to identify gaps in Medicaid-covered services and work towards identifying the cause of and eliminating gaps, including the investment of State and federal funds in infrastructure and system development or expansion.
10. Provider oversight includes establishing quality standards for providers and ensuring standards are met.
11. Medicaid providers must:
- Receive reimbursement that is sufficient to enlist enough providers so that care and services are available to the same extent as available to the general population in the geographic area;
- Receive reimbursement, the rates for which are set in a public process that allows for the review and comment of rates and rate setting methodologies; and
- Accept Medicaid reimbursement and allowable recipient cost-sharing as payment in full.
12. Medicaid applicants and recipients are entitled to the due process protections of the United States Constitution and the protections identified in Title XIX of the Social Security Act and it related regulations.
13. The numbers of individuals eligible and in need of benefits will fluctuate with the economy, demographic changes, changes in private insurance coverage, and advances in medical technology. To ensure that eligible individuals in need of services have access to services, the State commits to maintaining its Medicaid efforts by: tracking and preparing for predictable changes in enrollment; including in annual planning the risk of unpredictable changes in enrollment; prohibiting enrollment or overall spending caps; maintaining and not reducing service coverage; and, maintaining and not restricting eligibility options.
14. The State will discourage cost shifting to the Medicaid program by private health and long-term-care insurers, and when failing to do so will accept the cost burden into the Medicaid program.
15. In the matter of changes to the Medicaid program-
- There must be a compelling basis, with no other reasonable alternative, to any substantial changes in the Medicaid program.
- Changes in the Medicaid program must not result in shifting State and federal costs to the local taxpayer, community, school district, or county.
- Changes to the Medicaid program must be decided upon, structured, and implemented through an ongoing public process that includes consumers, providers, advocates and other stakeholders. The public process should be structured as an ongoing two-way conversation between the public and the Department of Health and Human Services.
- Substantial changes should be piloted in small but empirically significant areas of the state to ensure the value of the change, as well as to determine any unintended consequences.
16. Any and all federal Medicaid dollars must be used in the Medicaid program only.
Send comments and suggestions regarding this draft proposal to: nhchallenge@comcast.net |
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Related Stories:
Medicaid block grants and DHHS reorganization
Will New Hampshire apply for a Medicaid block grant?
Medicaid Comparison Chart
Commissioner Stephen to hold hearings on the future of Medicaid
Come to a Citizens' Hearing on the steps of the Capitol |
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