History of the Home Care Association of New Hampshire

The Association was formed in 1974 as a result of the merger of two organizations, the New Hampshire Home Care Association and the Bi-State Community Health Project. The new organization, the Community Health Care Association, was comprised of agency CEOs, Board Members of member agencies, and funding sources.

In the early nineteen eighties, the Association reorganized and restricted the Board of Directors to CEOs of member agencies and exclude proprietary agencies from membership. The Association formed a second 501(c)(3) organization to engage in research and development activities in the area of home care. Known as Home Care Resource Development, Inc., this entity was ultimately dissolved in 1997.

During the 1980’s, the Association’s successes included influencing the New Hampshire Legislature to fund maternal/child health care benefits and to institute the licensure of home health care providers. During this period, the Medicare Fiscal Intermediary started to deny Medicare claims for reimbursement in large numbers. The Association worked successfully to protect access to Medicare home health services, and went on to lobby for and obtain an increase in Medicaid rates for home health care in the late 1980’s.

Between 1988 and the early 1990’s, the home care industry experienced major growth in service delivery, as well as some consolidation of agencies and diversification into related services. In 1992 Association members voted to extend membership to all licensed providers of in-home services including for-profits. Also during this period, the Association worked on the development of a concept which came to be called the “Network.” The idea behind the Network was to promote uniform standards of care and negotiate contracts with major funding sources on behalf of non-profit, full-service agencies. The complexity of the issues and controversy about its merit and feasibility caused the Association to abandon the project in 1992.

In 1993, the Association purchased an office building several blocks from the State House, where Board, committee and other small group meetings are held. This move also served to heighten the visibility of the Association in the capital.

Since the mid 1990’s, Association priorities have been in the areas of government relations, education, and public information. Initiatives since then have resulted in important Medicaid legislation, external communications and media relations, and collaborative ventures with other health care provider groups. In 1997 the Association created the Granite State Home Health Association (GSHHA) as an affiliated corporation under section 501(c)(6) of the Internal Revenue Code to handle its increased lobbying activities. In the late 1990s, the Association’s attention focused again on Medicaid rates, achieving significant increases in 1999, the first upgrade in 10 years. At the same time, GSHHA worked for changes in the Interim Payment System (IPS) for Medicare, while HCANH supported members’ transition to prospective payment (PPS) under Medicare.

In the first years of the new millennium, HCANH’s priorities included: workforce shortage, technology, long term care, emergency preparedness, and the image and visibility of home health care, along with the continuing challenges of adequate payments, particularly in Medicaid. After several years of unsuccessfully pursuing improved Medicaid rates, HCANH filed suit against the state in April of 2005 under state law passed in 1997 (at the behest of the Association) that requires the state to establish and maintain rates that “better reflect the average cost of care.” The Association entered into a settlement agreement with the state in July 2005, and ultimately negotiated a new rate structure and rate-setting methodology. New Medicaid rules including this methodology were adopted in March 2008. However, continuing state budget limitations led the legislature to suspend the rules and even reduce provider rates in 2010.

On the Medicare side, GSHHA has advocated to improve the application of the wage index, eliminate across-the-board payment reductions in favor of targeted reimbursement revisions, institute policies to address fraud and abuse, and ensure home care’s proper place under healthcare reform initiatives.