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Cindy Rosenwald and Dan Feltes: Sununu must do his job on substance misuse and mental health provider rates



For the Monitor
Tuesday, July 10, 2018

With the signing of Senate Bill 313, the Medicaid expansion reauthorization legislation, the health care of more than 50,000 Granite Staters is protected. It can be the single most effective way to combat our opioid public health epidemic, if implemented.

Recently, substance misuse treatment and recovery providers expressed concern about the possible implementation of SB 313. Specifically, they are worried the reimbursement rates for the critical services they provide will be too low on Jan. 1 when new rates go into effect. We’ve also heard concerns about mental health rates as well as the connection between those rates and our limited provider capacity, New Hampshire’s high suicide rate, and our ongoing crisis of mental health patients, including children, sitting in emergency rooms for days and weeks at a time just waiting for treatment. In response, some in the press have said the Legislature failed to address reimbursement rates for behavioral health care in SB 313. That’s incorrect.

Democrats insisted that a Medicaid expansion compromise include a requirement that behavioral health rates are “sufficient to ensure access to, and provider capacity for, all behavioral health services,” including substance use disorder services. Like any hard-fought compromise, some things were non-negotiable, and, for us, this provision was one of them. Now, after signing SB 313, Gov. Sununu needs to do his job. He needs to follow through on this legal requirement, ideally in this upcoming special session.

As you may have seen, Gov. Sununu asked for a special session of the Legislature on July 25 to deal with an internet sales tax issue created by a decision of the U.S. Supreme Court. In doing so, we can hopefully provide some measure of certainty to our business community. However, we must also provide some measure of certainty to our mental health and substance misuse service providers. To provide this certainty to providers, our Legislature can and should set aside a minimum amount necessary to enhance behavioral health rates, both for inpatient and outpatient providers. That’s just sound fiscal management. It is also consistent with a newly enacted legal requirement of SB 313 intended to help combat our opioid epidemic.

This Sununu administration has had – at best – a rocky record building and retaining provider capacity for our opioid public health epidemic, with story after story of providers struggling to stay afloat and some closing their doors. In terms of rankings, New Hampshire ranks as having one of the worst provider capacities to deal with one of the worst opioid public health epidemics. The Sununu administration’s potential failure to follow through on the legal requirement in SB 313 may send our already limited provider capability right over the edge.

As a consequence, we respectfully ask Gov. Sununu and the Executive Council to approve a special session for July 25 that involves not just the internet sales tax issue, but also mental health and substance misuse provider rates. The time to act is now. Granite Staters shouldn’t have to wait until the next governor and Legislature pass bills well into next spring in order to actually deal with mental health and substance misuse provider rates. That’s just too late. Our providers, our communities and our economy need and demand some measure of certainty right now.

(Cindy Rosenwald is state representative for Ward 3 of Nashua. Dan Feltes lives in Concord’s South End and is state senator for Concord, Hopkinton, Henniker, Penacook and Warner. They both served on the Medicaid expansion commission and were the lead Democratic negotiators on the reauthorization of Medicaid expansion.)