DHHS pitches assessment‑informed rates, workforce grants and roadmap for developmental services

Chris Santanello, associate commissioner overseeing developmental services at the Department of Health and Human Services, told the House Finance Division II that department leaders have pursued compliance issues and then turned to system strengthening, workforce recruitment and a move toward assessment‑informed rates.

Santanello said the department completed a corrective‑action process required by federal oversight and on July 1, 2023 was found compliant in areas that previously limited reform work. After finishing compliance steps the department convened family forums, provider sessions and stakeholder surveys to establish shared values: choice for individuals, uniformity of access, program quality and long‑term sustainability.

The department has 10 area agencies designated to operate locally; these are nonprofit organizations that share governance of the system and determine eligibility for services under RSA 171‑A. Santanello emphasized the system characteristic that agencies and providers may not provide both service coordination and direct services for the same person—an operational control established in the current model.

Assessment‑informed rates and rate development

Santanello said DHHS contracted with Meijer & Stauffer to develop cost‑based rates and has engaged in roughly 39–40 stakeholder rate workgroups including providers, families and area agencies. The goal is to align an individual’s assessed needs with resource allocations to improve equity and budget predictability. Implementation would be phased and contingent on budget approval; Santanello said the department plans to prioritize rate changes that support home‑based services that help people remain independent and avoid higher‑cost residential placements.

"We have had significant stakeholder engagement," Santanello said, adding the intent to standardize how authorization levels map to funding.

Workforce investments and program scale

Santanello described a $15.6 million distribution of 100% federal Home and Community‑Based Services (HCBS) reinvestment funds to about 45 organizations for recruitment, retention and training initiatives for direct‑support professionals. He and other department staff said rate increases and workforce investments are intended to reduce provider vacancies and wait lists; department staff and two named providers (Waypoint and Accentria) told the committee last session that targeted rate increases helped recruit staff and expand service hours.

Waivers, caseloads and averages

Santanello reviewed the state’s home‑and‑community‑based waivers and population counts (fiscal‑year 2024 figures cited at the hearing):

- Children’s In‑Home Support waiver: about 460 children; average annual cost cited by DHHS ~$14,000 per person; the waiver cap is $35,000. - Developmental Disability (DD) waiver: about 5,939 individuals; average annual cost cited ~$73,000 (higher averages driven by residential services). - Acquired Brain Disorder waiver: about 235 participants. - Choices for Independence (CFI) waiver: about 3,900 participants; average annual cost cited ~$25,000.

Santanello and CFO Nathan White reminded the committee that the DD budget is large—earlier presenters described the biennial total for DD accounts as approaching $900 million—and that standardizing rates should improve budget accuracy by reducing year‑to‑year variability.

Public comment and provider concerns

Jeb Kurlop, a case‑management agency executive, told the committee that without standardized, assessment‑informed rates the system remains hard to predict and manage. "From a case‑management perspective… it’s very difficult without having standardized rates in our DD waiver to predict anything," he said, citing highly variable individual budgets and the difficulty providers have in forecasting costs and filling service plans. Carolyn Virtue of Granite Case Management asked the committee to note statutory distinctions in the system of care language and to ensure case management is treated according to its designation in the state plan and waivers.

Why it matters

Santanello framed the work as an effort to make services uniform across geographies, improve quality and create sustainability so taxpayer dollars better match assessed need. The department said it will prioritize rate phase‑in funding requests in upcoming budget materials and provide technical details about the proposed assessment methodology and phased implementation.

Provenance

topicintro: "I I've been with the department since 2016.... This is the operating structure of developmental services." (transcript excerpt)

topicfinish: "I would say individuals with disabilities are some of New Hampshire's most vulnerable citizens." (transcript excerpt)