Committee adopts revised DHHS case-management rule with conditions on reporting and quarterly review

The Joint Legislative Committee on Administrative Rules approved the Department of Health and Human Services' revised amended conditional approval for rule 25-304, governing case management agencies (CFAs) under the Choices for Independence program. The debate focused on confidentiality of quality-management reports, the agency's authority under RSA 151-e, the process for annual sample reviews of CMA case records, and the timing of when a 'languishing' case clock should start (referral date vs. date of successful contact).

A provider, Carolyn Vertu of Granite Case Management, raised concerns that the department's quality-management requests are circular and may improperly treat provider materials as nonconfidential. Vertu also argued that reimbursement start dates should be tied to contact with the participant, not the referral, because providers currently decline to accept cases until contact is made to avoid fraud and payment risk.

DHHS bureau counsel and staff described annual review processes, quarterly reporting requirements that would identify major incidents, and operational steps taken to reduce long-term care application processing from an earlier average of about 120 days toward a shorter backlog average (agency reported improvement toward 45 days). The bureau emphasized the statutory authority (RSA 151-e) to adopt oversight and monitoring rules for Medicaid-funded CFI services.

The committee moved and adopted the revised amended conditional approval, noting agency clarifications on quality reporting, case-assignment processes, and the ability to use waivers or emergency rulemaking for closely related implementation questions.

Next steps: DHHS will continue quarterly reporting measures and work with providers on operational details; committee members asked for continued monitoring of application-processing timelines.