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DHHS opposes bill to let non‑designated providers claim community mental health program rates, warns of oversight and fiscal risks
Summary
Department testimony and behavioral‑health advocates told the committee HB636 would expand access to higher Medicaid reimbursement for providers that currently are not subject to the program‑level oversight and quality controls required of New Hampshire’s 10 designated community mental health programs.
The committee heard competing views on House Bill 636, a proposal that would allow community mental health providers — a broader provider category — to receive the same enhanced reimbursement rates now set for designated community mental health programs.
Rob Berry, general counsel for the Medicaid division at the Department of Health and Human Services, described the current statutory scheme and the reason for separate rate schedules.
"There are currently 10 community mental health centers who meet the term of community mental health program," Berry told the committee. "These are reviewed through a designation process every 5 years and are monitored through ongoing, contract oversight."
Why it matters: The department says the higher, program‑specific rates are calibrated to cover unbillable services, community‑based outreach and intensive supports required for people diagnosed with severe and persistent mental illness (SPMI) and severe emotional disturbance. Industry witnesses warned the bill could destabilize existing centers, create perverse incentives and increase costs for managed‑care capitation.
DHHS concerns and fiscal impact: Department witnesses said the bill would let entities that do not face the same regulatory designation, quality monitoring and mandatory services claim the program rate. That, DHHS argued, could dilute the funding stream intended to cover wraparound and community‑based services and would require the agency to rewrite administrative rules, evaluate statutory authority and reprice Medicaid capitation contracts. DHHS legal testimony also forecast a material effect on Managed Care Organization capitation rates.
Provider and advocate response: Representatives of the New Hampshire Community Behavioral Health Association, clinicians and mental‑health advocates said they were concerned that the proposed change would lower care quality for individuals with SPMI. Dr. Melinda Asbury, chair of psychiatry at a regional hospital and a practicing psychiatrist, said three of four core components of effective community‑based care — team‑based care, psychiatric rehabilitation and physician‑level medical oversight — require medical staff on site and oversight. "The amendments proposed by house bill 636 would not require these programs or providers to have on staff a medical personnel. Therefore rendering it impossible to deliver 3 of the 4 critical components," Asbury said.
NAMI and others added that community mental health centers already provide uncompensated care and serve people regardless of ability to pay; shifting higher rates to other providers could leave centers with uncompensated, high‑need caseloads.
Next steps: Committee members asked technical questions about workforce shortages and the relationship between provider designation, oversight and payment. DHHS requested additional time to map rule and fiscal implications. No final committee vote was recorded in the hearing record.
Ending: The hearing framed a tension between expanding provider capacity and preserving a regulated program structure designed specifically for high‑need patients. The department and community mental‑health leaders urged caution, saying rate parity should follow programmatic designation and oversight rather than be granted through statute without the safeguards that accompany the community mental health program designation.
