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Clarification sought on care for the disabled

A group of people with developmental disabilities and the nine area agencies that provide services to those with disabilities or acquired brain damage filed a complaint last week in Hillsborough County Superior Court, arguing that long-term services to those with developmental disabilities should not be part of the N.H. Department of Health and Human Services’s effort to develop a managed-care program for Medicaid services.

In the complaint, attorneys from the Manchester law firm Devine, Millimet & Branch argue that Senate bill 147, adopted in 2011, required DHHS to seek proposals from private for-profit vendors who would provide managed-care services for programs that are mandatory for Medicaid coverage. The long-term care programs for the developmentally disabled are not mandatory, the lawyers wrote, and were never discussed during hearings on the bill.

“The area agency system in New Hampshire is a leader in cost-effectiveness in the provision of services,” attorneys Thomas Quarles Jr. and John D. MacIntosh wrote. “Other states spend an average of $220,119 per person per year for institutional services. New Hampshire, with no institutional services, averages $42,959 per person, per year. Spending by the state of New Hampshire for supported living, personal assistance, supported employment and family support services is the lowest in New England, ranks 43rd nationally, and is only 38 percent of the national average... At the same time, area agencies lead New England and rank second nationally in the percent of children and adults that are living in their own family home. Cost-effectiveness and quality outcomes are the hallmark of the Area Agency system.”

“We’re looking for clarification in the intent of the law,” said Alan Greene, executive director of Monadnock Developmental Services — the area agency that serves the Monadnock region from offices in Keene and Peterborough — on Wednesday. “It is our position that DHHS has overstepped the intent of the legislation. It was to create managed-care Medicaid for mandatory services. We are not mandatory. Proof of that is that we were forced to have waiting lists by the state.”

The state was planning to select managed-care organizations to provide services to many Medicaid eligible residents by July 1, 2012, but that date has been pushed back, and no managed-care organizations have yet been approved by the federal Center for Medicare and Medicaid Services. Expansion of the program to cover developmentally disabled clients is to be in a second stage of the state’s plan. As a result of the delay, the earliest possible date that managed care could be put into place for the developmentally disabled is 2014. The complaint is seeking a declaratory judgement that SB 147 does not allow the DHHS to plan to use a Medicaid managed-care program to provide long-term services to those who are developmentally disabled or have acquired brain disorders.

Greene said the managed-care model is not appropriate for dealing with the needs of the developmentally disabled.

“I believe the state will be courting disaster,” he said. “Only four states use managed care for the developmentally disabled. None of them are using private companies.”

He said managed-care providers have to operate as a business and would need to find a way to make a profit on care for the developmentally disabled.

“They’re either going to eliminate services for some people or dilute the quality,” he said. “We don’t know what the result will be. We’re courting danger.”

Officials from the Department of Health and Human Services did not return calls from the Ledger-Transcript seeking comment on the complaint.

Dave Anderson can be reached at 924-7172, ext. 233 or danderson@ledgertranscript.com. He’s on Twitter at @DaveAndersonMLT.

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