By PAULA TRACY, InDepthNH.org
HOOKSETT – A new state prison for men in Concord might cost as much as $500 million.
That sticker shock settled in over the Executive Council table Wednesday as councillors talked about plans for the future on the current prison grounds off North State Street.
The discussion came the same day InDepthNH.org published a story about the ongoing rat problem at the prison.
The council also discussed Medicaid reimbursement rates to hospitals which are expected to go up under a new formula being criticized by hospitals, approved a contract that will allow student behavioral data to be shared to prevent substance abuse and accepted the resignation of a Fish and Game Commissioner.
NEW PRISON FOR MEN MIGHT COST $500M
What could be the state’s most expensive project ever is looming as the aging men’s prison structure in Concord is overdue for repairs and officials say fixing it is throwing good money away at a bad building.
The state is spending just under $10 million for plans for the prison which will be the same bed size as the present one, said Corrections Commissioner Helen Hanks.
She noted that the prison for women, which is much smaller, cost a fraction of that amount and was done at a time when building costs were much lower than they are now.
The plan is to build the new prison for men on land owned by the state behind the present prison in Concord.
PRICE RESIGNATION
The council accepted the resignation of Susan Price as Fish and Game Commissioner for Carroll County after the commission voted overwhelmingly to recommend that she be suspended for violating a state law that prohibits commissioners from involvement in department personnel issues.
Price denied any such action but said she could not properly defend herself against the charge at a hearing which had been scheduled before the council Wednesday. The hearing was cancelled after accepting her resignation and Gov. Chris Sununu said he urged Price to resign prior to receiving her letter.
‘ROAD SHOW’ VISIT TO HOOKSETT ROCKET LAUNCHERS
The council met at the new Army National Guard Field Maintenance Shop in Hooksett as the first stop on a summer “roadshow” which goes to all five Executive Council districts throughout the warm summer months, leaving the Executive Council chambers in Concord to return there in the fall.
This first location was selected by Executive Councilor Ted Gatsas, a Republican from Manchester who is not running for re-election.
The meetings are typically shorter in summer and provide an opportunity to connect with community leaders in parts of the state and see new things, including this facility which maintains equipment often used in overseas deployments.
Before the meeting, department heads of state government got to tour the facility and view some of the equipment that is being serviced which has come from missions abroad, including rocket launchers.
Both Sgt. Scout Germaine and Sgt. Jeremy Foote, a service maintenance mechanic, explained the equipment and the work being done at the state-of-the-art facility.
The vehicles in the hangar came back to New Hampshire from Kuwait in the winter. It is a preventative maintenance facility which provides an equipment “reset,” said state Adjutant General David J. Mikolaities. There are only 12 states in the country with these High Mobility Artillery Systems or HMARS, and they serve as a deterrent to adversaries, he said.
The building won an environmentally sustainable LEED Silver certification in 2020 and is located at 1227 Hooksett Road.
The next “Road Show” meeting will be in three weeks at the Rocks Estate in Bethlehem, which is the new north country headquarters for the Society for the Protection of NH Forests.
HOSPITAL RATES DISPUTE RAGES/GOVERNOR CHARGES MISLEADING INDEPTHNH HEADLINE
Hospitals will see the current daily inpatient base rate for a bed go up from $3,300 a day to $7,000, effective Sept. 1, Gov. Chris Sununu announced Wednesday, arguing that “misleading” media and headlines to the contrary are sending the wrong message to the public.
But Steve Ahnen, president of the New Hampshire Hospital Association, said the headline Sununu referred to was correct and said Sununu and his press release on the subject is “only half the story” and hospitals will be getting back less than they do now, a contention with which Sununu strongly disagrees.
Cinde Warmington, Executive Councilor from Concord who is running for governor as a Democrat, asked for a discussion about the “cuts” to hospitals as payments are being reduced from 91 to 80 percent and that it will result in $35 million less, and asked what would it mean if the governor’s plan to reduce payments is not approved by the federal government.
The council approved contracts with three managed care organizations Wednesday to begin covering preventive treatments in primary care for persons enrolled in Medicaid.
Henry Lipman, state Medicaid Director, said going forward under the new plan by Sununu, this is the first time the state has ever had Medicaid rates on the inpatient side comparable to Medicare and comparable on the outpatient side to commercial insurance.
He said he is confident the federal government will approve the amendment because the policy it has laid out is to head in this direction toward Medicare rates in general and directed payments as long as the state is not above the commercial rate.
He said if they don’t approve it, the state might have to make some adjustments which would have to come back to the table as a subsequent amendment.
The state issued the new financial data in the governor’s press release Wednesday which Ahnen said he has yet to review. But he remained skeptical.
The new data comes at a time when a deal with the legislature fell through and Sununu changed the formula. In this, most community hospitals will receive less by percentage the repayment from the Medicaid Enhancement Tax. It goes from 91 to 80 percent under the plan which the state wants the feds to agree to.
Sununu is redistributing it to community health, mental health and substance abuse care providers, who do not pay the tax but who provide needed services to care for that population.
Sununu said there will be significant enhancements to Medicaid to expand primary care services and preventive treatments to improve residents’ health, patient experience, and the financial outlook of the program.
In a statement issued after the unanimous vote, Sununu said “prevention is the best medicine…by significantly raising rates and expanding Medicaid coverage for preventative services – especially during the state and country’s ongoing mental health crisis – this new structure helps keep Granite Staters healthy while lowering costs across the health care system. Once again, New Hampshire is leading from the front.”
Under the new arrangement, he said hospitals will see Medicaid rate increases totaling $76 million – more than doubling the base rate for inpatient services, with a 120 percent increase to critical access hospitals and 133 percent increase to Prospective Payment System Hospitals.
Additionally, rates for outpatient services have been increased, inclusive of enhancing direct payments supporting such services.
New patient-first services reimbursable by the New Hampshire Medicaid Program include health risk assessments, preventive screenings, preventive mental health screening and counseling, comprehensive medication reviews, and coverage for care coordination performed in primary care offices.
He said this new arrangement is a massive financial win for those providing services that meet the needs of patients across the Granite State.
Under this structure, the hospital systems are projected to receive $363.2 million in inpatient and outpatient hospital service reimbursement and directed payments.
By increasing rates, this redesign takes advantage of improved federal matching funds, securing an additional $129.6 million increase to the system. This structure incentivizes and rewards hospitals that provide an array of comprehensive, critical services.
Ahnen said after the meeting and upon reading the press release that the governor is telling only half the story.
“The governor directed the commissioner of Health and Human Services to cut payments to hospitals by only returning 80 percent of the MET tax they pay back from what was 91 percent. The rate increases that are contemplated in the (other community health care) contracts, those increases are coming from the tax that is paid by the hospitals. That is only part of the story. All of the other payments are going to go down and as a result hospitals will lose money under this arrangement. So on the one hand they are paying us more with the one hand, they are taking away with the other. It is basic math and it doesn’t add up.
“The governor’s directive was to cut $35 million in funding from hospitals and he still does that. He will pay more in a rate, but in the end, he is taking money away in other ways. So at the end of the day, hospitals will receive less money,” Ahnen insisted.
Ahnen provided InDepthNH.org with an email spreadsheet given to him from DHHS which he said shows every single large hospital in the state about to lose significant revenue.
“This is comparing this new payment against what hospitals received in 2023, not what they received in 2024, and the reason I suspect they did that was because – when we were modeling all this a month ago when we were trying to come up with a compromise, both the hospitals and the state – when we modeled it and used 2024, the numbers looked much worse,” Ahnen said.
The older data, he said, made it look better.
Ahnen said he does not have enough detail from the information the governor released Wednesday to say exactly what the loss or benefit is, and said Lipman has assured he will sit down with the Hospital Association with the new, actuarial data to go over the new numbers.
“So I am certain that when we are able to run this model, because I don’t have enough detail…I assure you if they ran this model against 2024 it would look much worse than it does right here. And when we run that we will be able to say what that value is,” Ahnen said.
He said the Hospital Association has not made any decision on going to court over this new formula but it is important to remind people that two Superior Courts found the MET tax unconstitutional and it led the state to partner with the hospitals to build “a much stronger, more stable, predictable Medicaid program for the state, for the Medicaid program, for our beneficiaries and for hospitals. Hospitals continue to be willing to sit down to find reasonable solutions to this dilemma, but this is not it. It is neither fair nor reasonable and it will be something that has significant implications on hospitals all across the state in terms of their ability to provide all the services they currently do, access to care and other things and this is something that we simply should not be doing and frankly, the partnership that we built over the past decade has helped to secure a much stronger Medicaid program. This will take us in absolutely the wrong direction.”
Sununu said he did not see it that way and said this is an “amazing opportunity we are creating. This is the difference between management that focuses on results and opportunity and previous structures that focused on politics….”
There has been misinformation, he said, singling out a headline in an InDepthNH.org story July 1 which read Executive Councilor Cinde “Warmington Concerned about Sununu’s ‘Unilateral’ Action Reducing Hospital Medicaid Reimbursements” as false, misleading and “bad media” though he said the story was accurate, but not what people focus on.
He said given the “misinformation” out there on this issue he had staff pull together a press release which has a chart that can be seen here https://www.governor.nh.gov/news-and-media/patient-health-first-new-hampshire-increases-medicaid-rates-expands-coverage-primary
Ahnen said there was nothing wrong with the InDepthNH.org headline.
CONTROVERSIAL CONTRACT APPROVED FOR SCHOOL DATA TO BE RELEASED ON TRUANCY/DISCIPLINE
A half million dollar state contract to reduce risks of youth substance misuse was debated but passed before the state’s Executive Council Wednesday with councilors saying they were hearing from constituents about privacy concerns related to the contract.
The council approved the contract and learned that no data on discipline and truancy would be shared with the federal government.
The contract for the state Health and Human Services Division for Environmental Health to enter into a memorandum of understanding with the New Hampshire Department of Education in the amount of $562,000 was tabled at the last meeting to allow for more questions to be answered.
The money is coming from the Governor’s Commission on Alcohol and Other Drugs which will expand implementation of the current program.
DHHS will monitor mid-term and final reports provided by the Department of Education to ensure program progress and positive outcomes.