BillCam

HB 1604-FN - AS AMENDED BY THE SENATE

17Feb2022... 0554h

31Mar2022... 1160h

04/21/2022 1566s

2022 SESSION

22-2142

05/10

HOUSE BILL 1604-FN

AN ACT including state medical facilities in the statute providing medical freedom in immunizations.

SPONSORS: Rep. Cushman, Hills. 2; Rep. Blasek, Hills. 21; Rep. Roy, Rock. 32; Rep. Pauer, Hills. 26; Rep. Torosian, Rock. 14

COMMITTEE: Health, Human Services and Elderly Affairs

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AMENDED ANALYSIS

This bill requires state hospitals and medical facilities to grant religious and medical exemptions from vaccination requirements, provided that any request for a medical exemption shall include the supporting documentation required by federal regulation.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

17Feb2022... 0554h

31Mar2022... 1160h

04/21/2022 1566s 22-2142

05/10

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Twenty Two

AN ACT including state medical facilities in the statute providing medical freedom in immunizations.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Medical Freedom from Immunization; Exemption for State Medical Facilities. RSA 141-C:1-a, II(e) is repealed and reenacted to read as follows:

(e) Apply to a county nursing home, the New Hampshire state hospital, or any other medical facility or provider operated by the state of New Hampshire or any political subdivision identified in paragraph I, which is subject to a valid and enforceable Medicare or Medicaid condition of participation that imposes a vaccination requirement. Such facilities or providers shall, upon the request of an individual for whom vaccination is required under federal regulations promulgated by the Centers for Medicare and Medicaid Services, grant such exemption on medical or religious grounds, subject to the conditions established in subparagraphs (1) and (2).

(1) The written request for a religious exemption shall simply state: “I, (insert requestor's name), hereby attest that I sincerely hold religious beliefs and/or engage in religious practices or observances that dictate the refusal to accept the required vaccination(s). (Insert requestor’s signature and date.)” With the assistance of the employee, the employer shall document and evaluate the request to ensure that the individual submitting the request is covered under the organization's vaccine policy, that the request is submitted on the appropriate form, and that the requestor has properly signed and dated the form. The employer shall record the date upon which the request was received in accordance with company policy. The employer shall maintain the request in organization records for a period of not less than one year. The employer may deny the request for a religious exemption in cases in which there is a compelling rationale or evidence to believe the employee is acting fraudulently.

(2) The written request for a medical exemption shall include documentation as required under federal regulations promulgated by the Centers for Medicare and Medicare Services. The employer shall evaluate the request to ensure that the individual submitting the request is covered under the organization's vaccine policy, that the request is submitted on the appropriate form, and that the requestor has properly signed and dated the form. The employer shall record the date upon which the request was received in accordance with company policy. The employer shall maintain the request in organization records for a period of not less than one year.

2 Effective Date. This act shall take effect 60 days after its passage.

LBA

22-2142

Amended 3/11/22

HB 1604-FN- FISCAL NOTE

AS AMENDED BY THE HOUSE (AMENDMENT #2022-0554h)

AN ACT including state medical facilities in the statute providing medical freedom in immunizations.

FISCAL IMPACT: [ X ] State [ X ] County [ ] Local [ ] None

Estimated Increase / (Decrease)

STATE:

FY 2022

FY 2023

FY 2024

FY 2025

Appropriation

Revenue

Indeterminable impact on federal funds

Expenditures

Indeterminable impact on state general funds

Funding Source:

[ X ] General [ ] Education [ ] Highway [ X ] Other - Federal Medicaid Funds

COUNTY:

Revenue

Indeterminable Impact on federal funds

Indeterminable impact on federal funds

Expenditures

Indeterminable

METHODOLOGY:

This bill requires that state or political subdivision operated hospitals and medical facilities that institute a vaccination requirement grant exemptions on medical or religious grounds or as a matter of conscience. The Department of Health and Human Services states that, with respect to COVID-19 vaccinations, the proposed exemption is broader than that allowed for by the federal Centers for Medicare and Medicaid Services (CMS). Accordingly, the Department assumes the bill will result in CMS withholding Medicaid payments from the state due to noncompliance with the federal COVID-19 vaccine mandate for health care facilities. The timing and extent of any fiscal impact will depend on whether CMS ultimately interprets the state statute as noncompliant with federal regulations, as well as whether, when, and to what extent CMS implements a policy of withholding payments for noncompliant facilities. The Department notes that in FY21, NH Hospital and Glencliff Home received $38.4 million and $7.1 million in federal payments, respectively. In addition, although the PATH Center (a 16-bed transitional housing facility) was not fully operational during FY21, the program is expected to earn over $500,000 in Medicaid revenue in FY22. The total amount that may be lost is therefore estimated at $46 million per year.

In addition to state-operated facilities, the bill would apply to county nursing homes, which in FY22 and FY23 were budgeted to receive federal funds in the amounts of $111 million and $113.7 million, respectively.

In the event of lost federal funds, the state facilities identified above would either face budget reductions or require an increase in state general funds to make up the shortfall. The impact on state expenditures is therefore indeterminable. In the case of county nursing homes, any shortfall in FY24 and beyond could be made up for with either county funds or state general funds, depending on decisions made by future legislatures. It is assumed that in FY23, any shortfall would be funded by the state, as county payments for long-term care services in FY23 are statutorily limited by RSA 167:18-a.

It is assumed that any fiscal impact will begin in FY23.

AGENCIES CONTACTED:

Department of Health and Human Services