To The Daily Sun,
At a recent meeting chaired by the commissioner of state Health and Human Services, federal and state revisions to Belknap County's services were revealed.
As part of a statewide agreement to accept $150 million from the federal government over a five-year period, we are expected to build our service delivery capacity through the first year of the five-year cycle and to change the way services are delivered, and for how they are compensated, in the remainder of the five-year period.
An Integrated Delivery Network will form the administration vehicle in geographical consonance with the health delivery networks and not by county. In the case of Belknap County, we are in IDN 5, which stretches from just north of Concord up to Thornton. Thornton may be described as remote and at the foothills of the White Mountains.
In exchange for accepting our share of the $19.5 million in statewide funding to build infrastructure, Belknap County agrees to perform according to standards set by state Department of Health and Human Services and by the federal Center for Medicaid and Medicare Services.
Reading from the Community Driven Project Menu, this will mean (unspecified) county nursing home transitions and enhanced care coordination for high risk, high utilizing, and chronic condition populations. Words, as we know, mean whatever we choose for them to mean. These particular words should strike fear into the hearts of those who are the most vulnerable in our society — the aged and infirm.
It was suggested by a county commissioner of long experience that the only ways to achieve meaningful cuts to nursing home expense is to reduce the daily rate and/or the number of allowable beds. A reduction in nursing home beds was last achieved some 20 years ago under Commissioner Morton.
In the instance of Belknap County, capacity shrank from 65 beds per elderly population of 1,000 to 40 beds per 1,000. Thus, it is at least plausible that a further reduction could be made, which suggestion did not draw a denial from either Commissioner Meyers or his deputy.
There is a lot more to this project than what can be presented here, including many missed deadlines for implementation of Medicaid Phase 2. When this second phase is complete, Belknap will be compensated for elder care, not by the state nor the federal government directly, but by some managed-care organization who will receive funds, and, it is hoped, disburse them to the county. We enter this brave, new world not kicking and screaming but instead with the willing compliance of two of the three member Board of Belknap County Commissioners.
Having received notice of the Delivery Service Reform Incentive Program waiver program late in the day on April 3; they proceeded to approve county participation the very next morning at a regularly scheduled commission meeting. What could possibly go wrong?
Belknap County Commissioner
Gilmanton Iron Works
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