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DHHS Releases Plan for New Delivery and Payment Models for Nursing Facility and CFI Services
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Office of Medicaid Services
Publish Date:
March 6, 2018

Concord, NH — The New Hampshire Department of Health and Human Services (DHHS) today released a detailed plan Adobe Acrobat Reader Symbol for new models of delivery and payment of nursing facility and home and community based long term supports and services. The plan will offer a choice between managed care and locally based and operated programs for all-inclusive care for the elderly, or PACE Centers.

The plan is issued in accordance with Senate Bill 553, enacted in June 2016, which required the Department to engage stakeholders and to develop a plan to move nursing facility and home care long term supports and services away from a fee-for-service delivery and payment model. Home and community based services are provided in New Hampshire under a program entitled Choices for Independence (CFI), which strives to allow persons with long term support needs to remain in their homes rather than in nursing home facilities.

The total budget for nursing facility and CFI services in state fiscal year 2019 will exceed $400 million for the first time. The cost of nursing facility services has risen steadily over the past several years. Since 2010, nursing home payments by the state have risen by $18 million, from $180 million to $198 million in SFY 2019. The average cost of CFI services in the community is only a third of the cost of nursing facility care for a year. All of these services are currently paid on a fee-for-service basis that rewards volume, not value.

In order to re-balance long term supports and services away from unnecessary institutionalization in nursing facilities, to improve care coordination and quality, and to implement a payment system that emphasizes value and not volume, the Department is proposing a hybrid model for the delivery of these long-term supports and services in New Hampshire: a managed care model that will be delivered through health plans contracted by the state and locally established PACE centers.

From July 2016 to August 2017, the Department convened 9 meetings of the full SB 533 stakeholder group and an additional 6 meetings of various subgroups. Experts on long term supports offered presentations on a variety of aspects of managed care and other potential models of delivery. The presentations and meeting minutes can all be accessed at

The Department also met on a number of occasions with representatives of the NH Association of Counties. Under current law, the state’s counties pay the majority of the non-federal share of long term services.

The proposed plan describes how nursing facility and CFI services will be provided in managed care and PACE Centers. The plan will be presented informally to the SB 553 stakeholder group on March 13, 2018 at 10:30 a.m.- 12 noon in the Division of Public Health Services Auditorium, 29 Hazen Drive, Concord. The plan will also be presented to the Fiscal Committee of the General Court, the Health & Human Services Oversight Committee and the State-County Finance Committee.

A public hearing will be held on March 20, 2018, at 5:00-7:00 p.m. in the Division of Public Health Services Auditorium, 29 Hazen Drive, Concord. All interested parties may also comment in writing about the plan through a new website:

Under the terms of Senate Bill 155 enacted in June 2017, the Department is required to deliver and pay for long term supports and services in some form of managed care beginning on July 1, 2019.

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New Hampshire Department of Health and Human Services
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