Supporters urge insurance coverage for Fast Forward wraparound; insurers warn of administrative burden

CONCORD, N.H. — At a Jan. 20 hearing, the Senate Health and Human Services Committee considered Senate Bill 128, which would require a public‑private funding structure so children with private insurance could access the state’s Fast Forward youth and family wraparound program without relying on state general funds.

Senator Regina Birdsall, sponsor of SB 128, said the bill responds to a study committee’s recommendation and aims to braid federal, state and private funds so families with commercial coverage receive the same Fast Forward wraparound services now paid for with state dollars when private insurers do not cover them. “Treating children in their communities results in long term savings to the state and to insurers,” Birdsall said.

Fast Forward is a bundled, family‑driven wraparound program operated by two care management entities in New Hampshire. DHHS staff and the care management entities said roughly 20 percent of Fast Forward families currently have private insurance; DHHS estimated the incremental cost to cover commercially insured children who receive Fast Forward services at about $2 million to $3 million annually, once reserves and administrative planning amounts in the draft legislation are included.

Advocates and parents urged passage. Holly Stevens of NAMI New Hampshire said wraparound services are evidence‑based and that family peer support components are “not covered by commercial insurance in any way.” A parent, Katie Lyon Pingree, described repeated emergency department visits and an eventual out‑of‑state residential placement for her son; she urged lawmakers to make Fast Forward available to families regardless of their insurance.

Dennis Calcutt of Connected Families and Luke Renard of NFI North (the two state care management entities) described Fast Forward as a bundled program whose clinical and “functional support” elements — family peer support, care coordination and community‑based supports — are designed to work together. Renard said 602 Fast Forward referrals were handled in his fiscal year, 67 of them commercially insured, and that the program lost money serving commercially insured children because the care management entities do not receive private reimbursement for those bundled services.

Insurance industry witnesses urged caution or opposed the bill as drafted. Andrew Hosmer of Harvard Pilgrim Health Care said carriers already cover many services in the wraparound model and that the bill would impose substantial new administrative requirements — including age‑segmented parity reporting that he said exceeds federal parity (MHPAEA) requirements. Sabrina Dunlap of Anthem urged continued stakeholder work, saying carriers and care managers had not reached contracts and some coding questions remain. AHIP (insurer trade association) representatives asked lawmakers to consider whether coding, contracting and alternative payment models could close gaps short of establishing an assessment mechanism.

Commissioner D.J. Betancourt said the Department of Insurance can work with the sponsors and noted that if the bill becomes an assessment, the department’s preference is to limit scope and add guardrails. He said his staff had prepared a fiscal worksheet and that the $2 million to $3 million range reflected the commercial share of existing program costs plus reserve and operating considerations. The commissioner cautioned that assessments are rare and can set precedents for future requests if not tightly scoped.

Supporters asked the committee to advance the bill so children with private insurance could access the Fast Forward model without relying on state general revenues; insurers and the insurance department urged tighter definitions, clearer coding and a negotiated approach to contracting before an assessment mechanism is adopted.