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Implementation of Medicaid Managed Care for N.H. nursing homes likely to be delayed until sometime in 2015

LACONIA — Interim Belknap County Nursing Home Administrator Charlotte Flanagan told county commissioners yesterday that it is likely that the state implementation of Medicaid Managed Care for nursing homes will be delayed for as much as a year.
She said that nursing homes around the state are lobbying for a delay and are concerned that critical questions posed to the two managed care organizations which are under contract with the state — such as how per diem rates will be calculated and what the contracts with nursing homes will cover — have not been answered.
In a letter written to the commissioners last month, Flanagan said that so many questions remain unanswered that she thinks the state should delay its proposed implementation date of April 1, 2015 by a least a year.
She said that the managed care regulations she has seen create additional regulations for nursing homes and will require more pre-authorizations in the patient care area.
County Commissioner Steven Nedeau said he had discussed the issue with other county officials at a statewide meeting held recently in Concord and had he had been told that implementation will ''probably not even happen until late next year.''
Commissioners, who convened nearly half an hour after their scheduled starting time yesterday due to a "non-meeting" they held, approved a five-year service agreement with Cintas corporation for a desk-top shredding service for the Belknap County Nursing Home.
They also received a schedule of fees from Lakes Region Public Access TV and decided to ask for a further explanation of the fees, which range up to $300 flat rate for video taping county and delegation meetings.
Attending the meeting was Paula Child of Gilford, whose husband Ken is a resident of the county home, and who had spoken at Monday night's meeting of the County Convention's Executive Committee about her disappointment with the committee's discussion of funding the wages of nurses at the county home.
She said that she planned to attend meetings of the convention along with her husband. ''Bringing Ken along will make it a lot more real,'' she said.
County Commissioner Ed Philpot said that an ideal situation would be for commissioners and the convention ''to concentrate on ways to make Belknap County better. But it doesn't seem to me that we're doing that in a cooperative way."

Last Updated on Thursday, 02 October 2014 12:59

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Belmont Mill masonry to be evaluated

BELMONT — Selectmen and members of the public who attended yesterday's meeting with contractors hired to repair the Belmont Mill, with a goal of turning it into town hall, said they want to make sure the masonry is sound before the town sinks any more money into it.

Contractor Bonnette, Page and Stone representative Keith McBey agreed and said that they have a masonry expert available to them.

After learning two years ago that the fourth floor of the mill was sagging and then learning the work done to repair it was partially faulty, selectmen got some estimates from BP&S to fix it to the point that it could be used and a second estimate for using it as a town hall.

The total estimates to repair came to just about $1.4 million and included site work, mechanical repairs to things like the heating ventilation and air conditioning system and the elevator, the sprinkler system, and the electrical system.

The estimates on the conversion to town hall use is about $2.3 million.

At a recent meeting, Budget Committee Chair Ron Mitchell urged them to trim their mill repair budget but yesterday selectmen said they want a true estimate.

"If we're going to do it, we're going to do it right," Selectboard Chair Ruth Mooney told McBey, meaning that as BP&S continues with their cost estimating and should it determine additional things need repairing and replacing, the company should let the selectmen know so the taxpayers can have a complete picture before they vote in March.

The Belmont Mill burned in 1992 and restoration on it began about four years later, ending in 1998. Since that time, taxpayers have repaired the roof, fixed some drainage problems, and have done some environmental testing that led to asbestos, mold and lead paint remediation.

Town Administrator Jeanne Beaudin said yesterday that she was still putting together a detailed record from 2000 to 2006 of other repairs done to the mill.

The other immediate obstacle to using the mill as a town hall is the potential repayment of a portion of the Community Development Block Grant Loan Program used to restore it. The loan has five years left and using the building as a town hall is not an accepted use under the terms that limit it to uses that serve middle- to low-income families.

Selectman Jon Pike said there is also a cost for not doing anything about moving town hall over the next five years. He noted that construction costs will only get higher and it may be better for the town to repay the interest on the CDBG loan now and move on with the project.

Beaudin said she was working with one of U.S. Senator Kelly Ayotte's aids about the loan repayment should the town decide to move forward with the town hall use.

Pike noted that the mill wasn't going anywhere and that it was now the center of town and should be used as the town hall.

"The million spent saving the mill was historically correct but economically incorrect," Pike said. "But now that it's ours, why don't we use it."

"It is the epicenter," he said.

Pike also noted that the top floor of the existing town hall building was condemned in 1965 and there is not enough space for town government.

"It's overcrowded and has moisture problems," he said, adding there is no privacy for people who are conducting business there.

Mooney added that there is limited handicap parking at the current town hall. "It would make a better parking lot than a town hall," she said.

Selectmen will meet again with BP&S on October 15 at 3:30 p.m.

Last Updated on Thursday, 02 October 2014 12:55

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South Down Shores residents now bringing recyclables (and trash) to their own dumpsters

LACONIA — Residents of South Down Shores have joined the city in its recycling effort by entering an arrangement with Waste Management, Inc. to collect both trash and recyclables from nearly 500 units in 21 villages at a remote location.

David Barth, who heads the trash committee of the South Down Council, said that the community has been beset with trash and recycling issues for years. Although homeowners pay property taxes, the city does not collect either trash or recyclables at the curbside in the gated community. Instead, South Down is served by multiple private contractors who collect trash for a negotiated monthly fee, which may be as much as $40.

Barth said that for an estimated cost of $15,000 Waste Management has placed four dumpsters, each of 10-cubic-yards, one for trash and another for recyclables. During June, July and August all four dumpsters were emptied twice a week, but he expected they would be emptied less frequently after seasonal residents left.

"We can't make them use the facility," Barth said, "but so far it has been overwhelmingly successful." He pointed out that many second homeowners are accustomed to recycling at their primary residence and welcomed the opportunity to do so at South Down. Likewise, both a number of year-round and seasonal residents have been taking recyclables to one of the four remote locations in the city.

Barth said that the arrangement offers residents, particularly those for whom South Down is not their primary residence, an opportunity to spare themselves the cost of private haulers. "We anticipate there will be significant savings throughout the community," he remarked. "We're saving money by doing the right thing."

Barth said that the ultimate cost of the program will depend on the results of the one-year trial period, explaining that estimating the volume of trash and recyclables in a community with a significant number of seasonal and weekend residents is challenging.

Barth credited Ann Saltmarsh of the Department of Public Works for providing sound advice and chaperoning the committee's relationship with waste contractors, particularly Waste Management. "We've been encouraging recycling at South Down for years," Saltmarsh said. "This is a very exciting and promising start."

 

CAPTION: Ann Saltmarsh of the Department of Public Works joined the trash committee of the South Down Council to mark the beginnings of the recycling program at the 21 villages of South Down Shores. From left Roger Legendre, Warren Murphy, Ann Saltmarsh, David Barth, Ed Balboni Dave Shea and Rick Robert. (Courtesy photo)

Last Updated on Thursday, 02 October 2014 01:12

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To avoid layoffs, county administrator sent insurance refund check back

LACONIA — A healthy refund from its health insurance carrier appears to have spared the Belknap County Commission from breaching its collective bargaining agreements with county employees — or laying off a significant number of them, but promises to spark another confrontation with the Belknap County Convention.

The refund from HealthTrust, the successor to the Local Government Center (LGC), represents a settlement following an investigation by the New Hampshire Bureau of Securities Regulation and an order by the New Hampshire Supreme Court. The bureau found that the LGC, which insured political subdivisions, had improperly withheld funds from municipalities, counties and school districts to maintain excessive reserves and transferred funds among risk pools with different memberships.

Although the LGC was ordered to distribute cash, municipalities, counties and school districts were given the option of taking the refunds due as a credit against their future premium payments.

Meanwhile, when the county convention adopted the 2014 county budget it declined to fund the annual increase in the employer's contribution to health insurance premiums.

The three commissioners, on the other hand, held that although the county's collective bargaining agreement with the State Employees Association (SEA), which represents county employees, had expired, the county was obliged to fund the increase. Commissioners transferred sufficient funds within the budget to do so.

The convention brought suit in Belknap County Superior Court challenging the authority of the commission to transfer funds without the approval of its executive committee. In August Justice James D. O'Neill, III issued a preliminary injunction prohibiting the commission from either spending in excess of any line-item appropriation of the budget adopted by the convention or transferring more than $300 from one line item to another without the approval of the executive committee.

County Administrator Debra Shackett said yesterday that county officials realized if the the court ruled in favor of the convention they could be compelled to lay off a significant number of employees to ensure that expenditures for health insurance matched what the convention appropriated for 2014. At the same time, she realized that if the refund could be taken as a credit against health insurance premiums, the county could fund the increase in the employer's contribution without exceeding the amount the convention appropriated.

Shackett explained that the health insurance contract tracks a fiscal year from July 1 to June 30 and the county is billed monthly. She said that she has yet to calculate the total value of the credit over the course of the fiscal year, but is confident that, with the credit, expenditures for health insurance will be less than the $2,594,925 appropriated by the convention in the 2014 budget.

Shackett said that when the refund arrived in the form of a check she asked officials at HealthTrust if instead it could be taken as a credit against the county's invoice and, assured that it could, chose that option. The commissioners, she said, approved her decision.

However, when the executive committee met earlier this week Representative Colette Worsman (R-Meredith), who chairs the convention, insisted that what she called a "rebate" should be treated as an unanticipated revenue, which could not be expended without an appropriation authorized by the convention.

Yesterday Worsman reaffirmed her position. "It is clearly a revenue," she insisted. The refund, she explained, is "money that was paid by the taxpayers and the taxpayers should receive the benefit." Noting that the funds were paid prior to 2014, she said the refund should be rolled in the fund balance at the end of the current fiscal year.

Worsman said that if the credit is used to fund health insurance in 2014, including the increase in the employer's contribution, the budget adopted by the convention would not only be undone but "undone in a manner that is not transparent to the taxpayers. "it would be to the detriment of the taxpayers to hide the expense and not use the revenue to benefit the taxpayers. Whether or not its a credit it's still real, hard money that taxpayers paid," she continued. "How it is used should be a decision left to the convention."

"It doesn't solve the issue," Worsman said, explaining that the convention sought to reduce the cost of health insurance to avoid liability for a 40 percent tax, which, starting in 2018, will be imposed on so-called "Cadillac plans" under the Affordable Care Act.

Worsman said that she has requested information on the amount of the credit, the actual expenses on health insurance for each department and how much of the credit would be applied against the expenses of each department. She expected to raise the issue at the next meeting of the executive committee, which is expected to be held later this month.

Last Updated on Thursday, 02 October 2014 12:32

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