Committee Summary for Senate Health and Human Services (02/10/2025)

Bill/Time	Type	Title	Sponsor
SB129 00:02:22.200 - 9:16:43 AM	Public Hearing	relative to establishing an uncompensated health care fund to be administered by the department of insurance and assessed by a surcharge on commercial insurers, reinsurers, and trusts overseeing self-insured plans.	Innis, Daniel(R)[C+]2024
SB129 00:03:56.640 - 9:18:17 AM	Executive Session	relative to establishing an uncompensated health care fund to be administered by the department of insurance and assessed by a surcharge on commercial insurers, reinsurers, and trusts overseeing self-insured plans.	Innis, Daniel(R)[C+]2024
SB136 00:16:08.480 - 9:30:29 AM	Public Hearing	establishing an uncompensated care assessment, fund, and committee within the department of insurance.	Altschiller, Debra(D)[CT]2024
SB128 01:50:06.679 - 11:04:27 AM	Public Hearing	relative to children's mental health services for persons 18 years of age and younger.	Birdsell, Regina(R)[C+]2024

SB129: Grant Bossy, Deputy Chief of Staff of the New Hampshire Senate Information Only00:02:22.200 - 9:16:43 AM; Grant Bossy introduced Senate Bill 129 on behalf of Senator Dan Inis, the bill's prime sponsor. He explained that the bill aims to address the financial challenge of uncompensated care at New Hampshire hospitals and clinics, which increases costs for paying customers and health insurance rates. He noted that the bill was introduced at the request of Community Mental Health Centers in Senator Inis's district. However, the final version of the bill did not meet Senator Inis's expectations. An identical bill, Senate Bill 136, was proposed by Senator Al Schiller, and Senator Inis recommended that the committee consider that bill instead and vote to ITL (inexpedient to legislate) his bill.
SB129: Committee Information Only00:03:56.640 - 9:18:17 AM; The committee moved to executive session on Senate Bill 129. A motion to ITL (inexpedient to legislate) was made and seconded. There was no further discussion, and the motion passed with consent. The committee then moved to come out of the executive session.
SB136: Deborah Aler, Senator representing District 24 (Exeter, Stratham, Greenland, Rye, Hampton, North Hampton, and Hampton Falls) Support00:16:08.480 - 9:30:29 AM; Senator Deborah Aler introduced Senate Bill 136, which aims to establish an uncompensated care assessment fund and committee within the Department of Insurance. She explained that the bill is focused solely on mental health care costs, which were not clearly specified in the original text, and suggested an amendment to include the words 'mental health' in several places to clarify this focus. She highlighted the significant uncompensated care costs faced by New Hampshire's 10 nonprofit Community Mental Health Centers, which amounted to nearly $15 million in fiscal year 2024. She stressed the importance of these centers in providing care to the state's most vulnerable populations and the need for funding to sustain their operations. Senator Aler also mentioned the success of the Mission Zero project in reducing hospital emergency department psychiatric boarding and urged the committee to support the bill to help maintain these efforts.
SB136: Dr. Cynthia Whitaker, President and CEO of Greater Nashua Mental Health Support00:26:25.799 - 9:40:46 AM; Dr. Cynthia Whitaker, accompanied by Jay Coocher, President and CEO of Seacoast Mental Health Center, expressed strong support for Senate Bill 136. She explained that the 10 Community Mental Health Centers, which are part of the New Hampshire Community Behavioral Health Association, are the safety net for mental health care but do not receive safety net funding. She discussed the significant increase in uncompensated care costs, particularly at her center in Nashua, which saw costs rise from $1 million to $2.5 million in a recent year. Dr. Whitaker emphasized that these centers are legally required to provide care regardless of a patient's ability to pay, and the lack of funding threatens their ability to maintain and expand services, particularly in light of initiatives like Mission Zero. She deferred a question about potential federal funding to Roland Lamy, who was to speak next.
SB136: Roland Lamy, Executive Director of the New Hampshire Community Behavioral Health Association Support00:32:10.480 - 9:46:31 AM; Roland Lamy emphasized the growing concern of uncompensated care for the 10 Mental Health Centers in New Hampshire. He highlighted the centers' dependency on Medicaid revenue, which constitutes about 75% of their income, and discussed the inability to cost-shift as other providers might do. Lamy presented a spreadsheet to the committee detailing the uncompensated care data from fiscal year 21 to 24, showing a rise in uncompensated care across the centers. He explained different sources of uncompensated care, including the spend-down program, cost shares, and services for the chronically mentally ill. Lamy stressed that the bill aims to address this issue and ensure the sustainability of mental health services, noting that they are open to other solutions and have engaged with the Department of Insurance for feedback.
SB136: Andre Mer, representing Harvard Pilgrim Healthcare Oppose00:42:54.559 - 9:57:15 AM; Andre Mer, representing Harvard Pilgrim Healthcare, opposed SB136. He argued that it is unreasonable to place the burden of uncompensated care on commercial carriers, as they already cover a broad range of clinical services. Mer pointed out the ambiguity in the bill's definition of uncompensated care, which could encompass a wide range of costs. He referenced the fiscal note from the insurance department, which highlighted potential unintended consequences such as disincentivizing insurance coverage. Mer expressed concerns about the financial burden the assessment would place on carriers, potentially destabilizing the health insurance market and leading to higher premiums and deductibles.
SB136: Sam Hawkins, Public Policy Assistant at NAMI New Hampshire Support00:48:33.480 - 10:02:54 AM; Sam Hawkins from NAMI New Hampshire supported SB136, emphasizing the importance of Community Mental Health Centers as the frontline in addressing the state's mental health crisis. He noted that these centers provide essential services to all Granite Staters regardless of their ability to pay, and highlighted the financial strain due to uncompensated care. Hawkins argued that services not covered by commercial insurers are often medically necessary for recovery. He urged the committee to vote OTP (Ought to Pass) on SB136 to fund these centers and maintain the quality of care.
SB136: DJ Beton Court, Commissioner of the New Hampshire Insurance Department, and Michelle Heaton, Director of Life at Health Division Information Only00:52:25.640 - 10:06:46 AM; Commissioner DJ Beton Court and Michelle Heaton provided detailed information on the fiscal implications of SB136. Beton Court emphasized the importance of substantive fiscal notes and the need to base analysis on the bill's written content. He expressed concerns about the impact of assessments on insurance costs and premiums, noting New Hampshire's low average monthly premium rate. Beton Court highlighted the potential for assessments to be passed onto consumers and the need for clear definitions and controls to manage costs. Heaton discussed technical issues with the bill's language and the challenges in defining uncompensated care, stressing the need for more parameters to assess its impact accurately.
SB136: Christine Stoddard, Senior Director of New Hampshire Public Policy at Bi-State Primary Care Association Support01:15:58.880 - 10:30:19 AM; Christine Stoddard supported the bill but suggested broadening its scope to include all safety net providers, not just mental health centers. She explained that community health centers are required to treat everyone regardless of their ability to pay and provide enabling services to increase access to care. Stoddard highlighted the significant amount of uncompensated care these centers incur, which was $14.5 million in 2023. She argued that addressing this issue is crucial to prevent the closure of health center sites and emphasized the cost savings community health centers bring to the Medicaid system. Stoddard also noted the economic impact of health centers on employment and urged the committee to solve the uncompensated care problem.
SB136: Erin Swier, Compliance Officer at Harbor Care in Nashua Information Only01:24:53.639 - 10:39:14 AM; Erin Swier from Harbor Care in Nashua discussed the organization's role in breaking the cycle of homelessness through healthcare, housing, and veteran services. Harbor Care serves over a thousand individuals and families across the state and provides medical, behavioral, and dental care to approximately 3,000 patients per year, as well as vital supports to over 500 veterans and their families. As a designated healthcare for the homeless program, Harbor Care is legally required to serve all community members regardless of their ability to pay, resulting in significant uncompensated care costs, totaling $3 million in 2023 and $2 million in 2024. This financial burden has led to difficult decisions, such as eliminating positions within the organization, which jeopardizes patient access and reduces time for providers to see patients. Swier emphasized the importance of preventative care and treatment for substance use disorders at Harbor Care, highlighting how it reduces downstream costs for emergency and urgent care. Supporting the uncompensated care pool for federally qualified health centers would not only improve the health and well-being of vulnerable community members but also makes financial sense for the healthcare system as a whole.
SB136: Chris McCracken, Manchester Information Only01:27:28.719 - 10:41:49 AM; Chris McCracken from Manchester discussed the structure of federally qualified health centers, noting that they serve about 177,000 patients in the Manchester area, with mental health and substance use disorder services being a significant part of their work. McCracken explained that 89% of their patients live at or below 200% of the poverty line, and many qualify for a sliding scale fee structure, which helps those with limited resources, such as the elderly on fixed incomes, to access care more affordably. Over the past 28 years at Amoskeag Health, the percentage of uninsured patients has fluctuated between 16% to 27%. The ability to maintain consistent care regardless of insurance status is crucial, but funding has been flat or decreasing, leading to a $3.9 million loss last year. To manage this, they closed administrative and clinical sites, reduced staff by over 40 FTEs, and relied on GOFER funds to prevent further reductions. McCracken emphasized the importance of establishing mechanisms to close these cost gaps to prevent further program reductions and increased costs passed on to the community.
SB136: Ken Gordon, CEO of Coos County Family Health Services Support01:34:32.600 - 10:48:53 AM; Ken Gordon, CEO of Coos County Family Health Services, serving approximately 12,500 residents of Coos and Northern Grafton Counties, spoke in support of SB136 and the establishment of an uncompensated healthcare fund. He highlighted the difficulty in distinguishing between community health centers and community mental health centers, noting their integration and the necessity to consider a broad definition of safety net providers. Gordon discussed the financial crisis in the safety net provider network, with his organization facing $1.8 million in uncompensated care and a $1.2 million loss last year. Required by law to serve everyone, they have had to cut back staff by about 10% and look for other efficiencies. He emphasized the importance of addressing these deficits to prevent costs from being transferred to higher-cost settings and encouraged the committee to clearly define uncompensated care.
SB136: Bob McLoud, CEO of Midstate Health Center in Bristol Support01:38:10.159 - 10:52:31 AM; Bob McLoud, CEO of Midstate Health Center in Bristol, expressed support for SB136, noting the struggles of safety net providers to make ends meet. He highlighted the difficulty in separating various services like mental health, primary care, and oral health, and mentioned that safety net providers cannot shift costs as hospitals might. Last year, Midstate Health Center lost $720,000, and even in good years, margins are very small. McLoud warned that without addressing uncompensated care, many safety net providers could disappear or limit services, which once gone, would not return. He urged the committee to work on the legislation and consider all safety net providers who are doing a great job with minimal resources.
SB136: Sabrina Dunlap, Senior Director of Government Relations for Anthem Information Only01:40:30.800 - 10:54:51 AM; Sabrina Dunlap from Anthem expressed confusion about the scope of SB136, whether it applies solely to mental health or extends to safety net providers as mentioned by Christine Stoddard. She acknowledged the crucial role of CMHCs and FQHCs and Anthem's willingness to continue discussions on improving access to mental health care outside of the legislative process. Dunlap questioned the approach of assessing commercial insurance to address the situation and suggested a broader discussion was needed to find a better route.
SB136: Jed O'Higgins, Legislative Liaison and Policy Analyst for Behavioral Health at DHHS Information Only01:42:09.000 - 10:56:30 AM; Jed O'Higgins from DHHS discussed the impact of the Medicaid unwind on community mental health centers, which continued to serve uninsured individuals despite staffing struggles and lower operating costs. These challenges contribute to waitlists and reduced revenue. O'Higgins connected this to the state's ten-year mental health plan and mission zero work, emphasizing the need for CMHCs to provide quality care to reduce unnecessary costs. In August 2024, G&C approved a $5 million award to address losses, used as a basis for a prioritized needs request. However, uncompensated care exceeds this amount. The funding supports integrated physical and behavioral health care by state-certified community behavioral health clinics to improve health outcomes and reduce the need for costly inpatient care. O'Higgins clarified that CMHCs offer medically necessary rehabilitative services and anticipate an increase in uncompensated care burdens moving forward.
SB136: Roland Lamy Information Only01:46:54.719 - 11:01:15 AM; Roland Lamy provided data on uncompensated care at his clinic, stating that out of a total of $15 million in uncompensated care, approximately $8.5 million was related to commercial and Medicare bad debt and write-offs for services not covered. This information was in response to a question about the percentage of uncompensated care from patients covered by commercial plans that do not cover the services provided.
SB128: Regina Birdsell, State Senator for District 19 (Derry, Hampstead, Windham) Support01:50:06.679 - 11:04:27 AM; Senator Birdsell introduced Senate Bill 128, emphasizing its role in enhancing children's mental health services. The bill aims to increase access to behavioral health services while saving the state money. It addresses the disparity in insurance coverage by proposing a public-private partnership to fund the Fast Forward New Hampshire program, which provides youth and family-driven wraparound services. This program is currently only covered by Medicaid, not private insurance, leading to significant taxpayer expenses for privately insured children. The bill proposes an assessment on private insurers to fund the program equitably. It also includes updates to parity review requirements to analyze services for children aged 0-8, particularly 0-5, to ensure these populations have access to necessary services. The senator mentioned ongoing discussions with the Department of Insurance and requested a grace period for completing the fiscal note.
SB128: Andrew Hosmer, Harvard Pilgrim Healthcare Oppose01:54:53.239 - 11:09:14 AM; Andrew Hosmer, representing Harvard Pilgrim Healthcare, expressed opposition to Senate Bill 128. He highlighted concerns over the potential large assessment on commercial carriers for behavioral health services for children and adolescents. He noted that some services mentioned in the bill are already covered by Harvard Pilgrim, including in-home services, residential treatment, and structured outpatient programs. Hosmer pointed out that functional support services, which are not clinical and thus not covered under their commercial insurance, are a concern. Additionally, he criticized section three of the bill for creating an enormous administrative burden by requiring detailed data metrics and age-separated comparative analytics for mental health parity filings. He stated that these requirements go beyond federal rules under the Mental Health Parity and Addiction Equity Act (MHPAEA). Despite opposition, he expressed willingness to work with the bill's sponsor and other stakeholders to revisit the legislation.
SB128: DJ Bettencourt, New Hampshire Insurance Department Information Only01:57:58.960 - 11:12:19 AM; DJ Bettencourt, the Commissioner of the New Hampshire Insurance Department, provided an overview of the history and implications of the services under discussion. He noted that previous discussions about these services were often in the context of mandates, which posed significant challenges including federal defrayal requirements. He discussed the Fast Forward program, which is provided by two providers in New Hampshire, and highlighted the bundled nature of these services, making it difficult to separate them into clinical and non-clinical components. Bettencourt expressed reservations about assessments, particularly citing a potential cost of around $2 million, which he suggested should be contained with guardrails. He warned about the precedent that assessments might set, potentially leading to more providers seeking similar arrangements. He also mentioned the impact on the DHS's Medicaid budget and offered assistance in addressing those issues.
SB128: Sabrina Dunlap, Anthem Oppose02:04:05.159 - 11:18:26 AM; Sabrina Dunlap, Senior Director of Government Relations for Anthem, expressed opposition to the proposed assessment for covering Fast Forward services. She highlighted her involvement in discussions about mental health services and mandates, particularly referencing last year's bill SP411. Dunlap questioned the assertion that commercial carriers were a drain on the Fast Forward program, as the program is administered by DHHS through two care management entities not in network with commercial carriers like Anthem. She noted that the services covered by Fast Forward are largely covered by commercial insurance, suggesting that identifying gaps might be a more constructive approach than an assessment. She also expressed readiness to continue discussions with stakeholders.
SB128: Jenny Higgins, DHHS (representing Patricia Tilly) Information Only02:07:10.800 - 11:21:31 AM; Jenny Higgins, Legislative Liaison for Behavioral Health at DHHS, spoke on behalf of Patricia Tilly. She described the Fast Forward program as a youth and family-driven wraparound service aimed at keeping children and youth in their home communities with individualized care plans. She provided a fiscal analysis, noting that about 20% of families served by Fast Forward have private insurance, and 75-85% of those are connected to Medicaid through the Katie Beckett program. Higgins mentioned costs exceeding $2 million annually for commercially insured youth, with a fiscal note range of $2 to $3 million, which includes additional costs like reserves. She clarified that Fast Forward is covered for all youth but emphasized the costs for those with commercial insurance.
SB128: Holly Stevens, NAMI New Hampshire Support02:13:41.239 - 11:28:02 AM; Holly Stevens, Director of Public Policy at NAMI New Hampshire, spoke in favor of Senate Bill 128. She highlighted the crisis of youth mental health and the importance of community-based services like Fast Forward, which provides intensive family-focused services to prevent hospitalization. Stevens emphasized that the services provided by NAMI New Hampshire, such as family peer support, are not covered by commercial insurance, which burdens taxpayers. She argued that if commercial insurance covered these services, it could lead to earlier intervention and reallocation of funds to other areas of children's behavioral health.
SB128: Emma Savini, New Futures Support02:17:16.959 - 11:31:37 AM; Emma Savini, Children's Behavioral Health Policy Coordinator at New Futures, expressed strong support for Senate Bill 128, which she said creates a reliable funding structure for the Fast Forward program. She emphasized the importance of the bundled system in Fast Forward, which covers both clinical and non-clinical services, crucial for the program's success. Savini compared these services to cancer navigators and peer supports in other health areas, pointing out potential parity issues. She also discussed the background of the bill, noting that an assessment would equitably distribute costs among carriers and mentioned the challenges with coding and billing for these services.
SB128: Kristen Shepard, Derry, New Hampshire Support02:21:21.479 - 11:35:42 AM; Kristen Shepard, a resident of Derry, New Hampshire, spoke in support of SB 128, sharing her personal experience with her son's mental health crisis. She described how Fast Forward, which was accessible only because her son had Medicaid, provided essential support to her family. Shepard emphasized the importance of Fast Forward in navigating the mental health system and argued that all families, regardless of insurance type, should have access to such services. She challenged the notion that functional services are not clinical, asserting their critical role in mental health care.
SB128: Katie Lyon, Pingree Support02:25:06.760 - 11:39:27 AM; Katie Lyon from Pingree urged support for Senate Bill 128, emphasizing the need for children and families with private insurance to have access to critical mental health services. She shared her personal story about her son Matthew, who began struggling with mental health issues following a concussion at age 14. She detailed the challenges her family faced navigating the mental health system, including ineffective therapy, Matthew's suicide attempt, and involuntary hospitalizations. She highlighted the lack of suitable treatment options in New Hampshire, which forced her family to send Matthew to a treatment facility in Utah. Despite some progress, reintegration into his community was challenging, and he ultimately lost his battle with mental illness at age 18. Katie expressed grief over not having access to programs like Fast Forward, which could have provided crucial support and guidance through the system. She urged the committee to pass SB 128 to ensure other families have access to such programs.
SB128: Dennis Calcut, Director for Connected Families Support02:31:43.960 - 11:46:04 AM; Dennis Calcut, the Director for Connected Families, expressed appreciation for the committee's interest in the work related to Senate Bill 128. He emphasized the importance of collaboration in addressing mental health issues and highlighted the role of Connected Families as one of the Care Management entities in New Hampshire. He discussed the funding from the Substance Abuse and Mental Health Services Administration and the values of a system of care, including being family-driven and community-based. He acknowledged the challenges in working with insurance companies and stressed the need for equitable solutions to ensure care coordination for all children, regardless of insurance status. He concluded by thanking the committee and urging continued collaboration to solve these issues.
SB128: Luke Rard, Executive Director of NFI North Support02:37:38.040 - 11:51:59 AM; Luke Rard, the Executive Director of NFI North, supported Senate Bill 128, focusing on the issue of equity in care management services. He mentioned that NFI North received 602 referrals for the Fast Forward program in fiscal year 24, with 28% of those being non-Medicaid. He highlighted the financial losses incurred by providing services to non-Medicaid patients and emphasized the success and positive outcomes of the program in the community. He discussed the challenges with coding and coverage by private insurers, particularly the lack of coverage for functional support services, which are essential components of the evidence-based model. He concluded by stressing the importance of fair coverage to ensure continued access to these services for all children.
SB128: Representative from America's Health Insurance Plans (AHIP) Information Only02:40:25.760 - 11:54:46 AM; A representative from America's Health Insurance Plans (AHIP) provided information on the role of Care Management entities and their function as outlined in state law. They distributed a document to the committee to clarify the roles of Connected New Hampshire and NFI. The representative highlighted the distinction between functional supports and medically necessary insurance-covered care, which has been a topic of discussion with the Department of Health and Human Services. They mentioned ongoing efforts to address coding issues to simplify billing practices for these entities. The representative also discussed the assessment mechanism proposed in the bill, comparing it to other existing assessments like the Medicaid expansion program and the vaccine fund. They emphasized the need for continued discussion and collaboration to find alternatives to assessments and ensure coverage for necessary services.

Rochefort, David(Chairman)(R)	Avard, Kevin(V Chairman)(R)[C+]2024	Birdsell, Regina(R)[C+]2024
Prentiss, Suzanne(D)[F]2024	Long, Pat(D)