2018 Legislative Wrap Up

The 2018 Legislative Session finished in late May, with completed bills sent to Governor Sununu for his approval or veto in June and July. This was second year of 2-year biennium. Since the state budget was finalized last year, policy matters dominated this session.

The Granite State Home Health Association — the 501(c)6 advocacy affiliate of the newly-named Home Care, Hospice & Palliative Care Alliance of New Hampshire — tracked over 50 bills that could impact our members and the people they serve. Below is an update of key bills.


Bills Enacted in 2018 Session



HB 1816, re: Medicaid Managed Care, stopped implementation of commercially-based managed care for Medicaid long-term services and supports, including nursing home services, Choices for Independence, and services provided under the Development Disability Waiver and Acquired Brain Injury Waiver. The bill authorizes NH DHHS to develop voluntary county or local PACE or ACO models for nursing home and CFI clients. GSHHA supported this bill. Signed by the Governor; effective on June 25, 2018

SB 313, reforming New Hampshire’s Medicaid and Premium Assistance Program, establishing the Granite Workforce Pilot Program, and relative to certain liquor funds. This bill reauthorized NH’s Medicaid expansion program through December 31, 2023. Enrollees in the new Granite Advantage expansion program will transition into Medicaid managed care. The bill also creates certain work requirements for the expansion population. It increases revenue deposited into the drug and alcohol use prevention fund and transfers money to the Granite Advantage program for substance use disorder prevention, treatment and recovery. Signed by the Governor; effective December 31, 2018.


Human Resources & Professional Licensure


HB 1530, requiring criminal background checks for applicants for allied health professional licensure or certification. This bill impacts the following professionals: athletic trainers; physical therapists and PT assistants; occupational therapists and OT assistants; speech-language pathologists; respiratory therapists; recreational therapists and genetic counselors. They must submit a criminal records report upon 1) initial licensure or certification; 2) reinstatement of a license or certificate; or 3) for conditional licensure or certification. The report may be from each state where the applicant worked in the past 6 years, or a NH State Police background check and FBI check. An applicant may work in the profession for up to 90 days while the Board of Allied Health Professionals awaits the criminal records report. During this time, the applicant may be employed in the profession as long as they work under direct supervision of a licensee, attest in writing that no disqualifying criminal activity exists and their allied health board is not part of an interstate licensure compact. Signed by the Governor; effective August 11, 2018


SB 334, re: temporary licensure of allied health professionals from nearby states and reciprocal and temporary licensure for occupations and professions for persons from other states. This bill allows occupational therapists and OT assistants, physical therapists and PT assistants, speech pathologists, respiratory therapists and recreational therapists from CT, RI, MA, ME, NY and VT who are currently licensed to be eligible for temporary licensure for 120 days while applying for a NH license. GSHHA supported this portion of the bill. We did not take a position on a more controversial, non-health related section of SB 334 which affects all other regulatory boards and commissions. It allows anyone to apply for a temporary license, unless the respective NH Board has determined the other state’s licensure is not comparable, the Board is a member of an interstate licensing compact, or the Board has an existing procedure for reciprocity. Signed by the Governor: allied health section took effect on August 20, 2018. The other section takes effect on January 1, 2019.


Medical Issues


SB 332, re: medication synchronization requires health insurers with prescription drug coverage to allow covered persons to synchronize the dispensing dates of their maintenance prescription drugs. GSHHA supported this bill. Signed by the Governor, effective January 1, 2019.


SB 581, re: compounding of drugs and establishing a committee to study rulemaking authority for reconstituted drugs. This was a controversial bill that was introduced when the Board of Pharmacy issued cease and desist rulings to certain providers administering Remicade. It pitted the Board of Pharmacy against home infusion and outpatient infusion providers. SB 581 clarifies that “compounding” shall not include the simple addition of flavoring, nor shall it include the preparation of a single dose of nonhazardous commercially-available drug or licensed biologic for administration within 2 hours of preparation to an individual patient, when done in accordance with the manufacturer’s approved labeling and instructions. GSHHA monitored this bill closely to assure that any changes to the pharmacy statute didn’t interfere with administration of certain routine medications in the home. We supported the final version. Signed by the Governor, effective June 12, 2018


HB 1471, re: telemedicine and establishing a committee to study health care reimbursement for telemedicine and telehealth. This bill, which applies mainly to primary care and specialty services, clarifies that telemedicane can be provided to a patient in a non-medical environment such as the patient’s home. It also establishes a committee to study appropriate reimbursement rates for telemedicine services. The committee must file its report by November 1. Signed by the Governor. The committee establishment was effective on June 18, while the site clarification took effect on August 17, 2018.

Legal Issues


HB 1807, re: exploitation of elderly, disabled or impaired adults, clarifies the current law regarding exploitation of these vulnerable individuals. Currently, the law defines the state of mind of the individual committing the crime as someone who knowingly or recklessly, through the use of undue influence, harassment, duress, force, compulsion or coercion. exploits a person. HB 1807 adds that it is also a crime in any circumstances where the person knew that the elderly, disabled or impaired adult lacked the capacity to consent, or consciously disregarded a substantial and unjustifiable risk that the individual lacked capacity to consent. Signed by the Governor; effective January 1, 2019



Bills Sent to Interim Study

These bills will be examined in greater detail by the legislative committee and recommended for future action.


HB 628, re: a family and medical leave insurance program, would have set up a program to deduct .67% from participating employee wages, enabling the participants to apply for up to 6 weeks of paid leave. This bill will likely return in 2019.


HB 656, re: the legalization of marijuana, would have allowed for possession and cultivation of small amounts of marijuana


Bills Killed in the Legislature


SB 576, re: home health rate-setting. This bill was introduced by Senator Jeb Bradley at GSHHA’s request to restore a suspended law that required DHHS to annually adopt rules and set rates for Medicaid home health services. The Senate amended the bill to require an informal rate analysis, and a House Finance Committee sought to amend it further by weakening the existing statute. Faced with the prospect of a statute with no teeth, GSHHA opposed the amendment and suggested the bill be killed if the House was unwilling to adopt the Senate version. The House Finance Committee Democrats filed a Minority Report to recommend passing the Senate version. The Majority Report of “inexpedient to legislate” passed by a vote of 180-154 on party lines.


SB 378 re: an exemption from the board of registration of medical technicians would have exempted personal care workers and hospice volunteers in settings such as assisted living, home care and community residences from the having to register as a medical technician. GSHHA supported this bill. While the bill was defeated, the Board of Registration of Medical Technicians issued a clarification that it would not require health care workers outside of a hospital or ambulatory surgical center to be registered.


SB 490, re: establishing a commission to study end-of-life choices


SB 554, re: the minimum wage, would have increased the minimum hourly wage to $15.00 if an employer does not offer health benefits, and to $12.00 by July 1, 2021 if an employer offers health benefits.


HB 1201 re: an employee’s earned but unused vacation time would have required an employer to pay its employees for earned but unused vacation time.


SB 422, re: advance notice of work schedules would have required employers to give at least 14 days’ advance notice of work schedules to employees. GSHHA opposed this bill.



It’s Election Season!


In case you haven’t noticed the yard signs, there are elections coming up. The NH Primary Election Day is September 11th, and the General Election Day is November 6th. Candidates are running for Congress, the NH Senate and the NH House of Representatives. Click here to see who is running in your area.


Now is a great time to inform candidates about home health and hospice issues — whether it’s talking with a Congressional candidate about federal issues, taking them on a home health visit, or briefing a State Senate candidate about inadequate funding in Medicaid and the Choices for Independence program. Candidates are eager to meet during election season — and much too busy once their in office!