New Hampshire wins GraniteCare waiver

Granite Staters eligible for Medicaid are one step closer to being part of a program that proponents say will offer lower prices on their outpatient procedures — and may also mean less money out of taxpayers’ pockets.

The state Department of Health and Human Services announced last month that it has received federal approval through the Centers for Medicare and Medicaid for a waiver for its GraniteCare Select program to allow competitive bidding for non-emergency outpatient procedures under Medicaid, effective July 1.

Medicaid is the state-federal health plan for those who meet certain income and disability guidelines.

GraniteCare Select is a process in which certain non-emergency outpatient procedures, such as colonoscopies or hernia surgeries, will be bid regionally, and the low bidder or bidders for that region will be authorized to perform the selected procedures.

Medicaid beneficiaries currently may receive care from any health-care facility, which is then reimbursed by Medicaid based on a percentage of the procedure’s cost.

“When we looked at claims for non-emergency outpatient operations, we saw a huge disparity in cost,” said HHS Commissioner John Stephen. “For example, in one part of the state, a tonsillectomy cost $2,500; in another, it was $500. Having this waiver approved by CMS is a huge step forward in bringing competition to the state where there has been none, and reduce taxpayer costs.”

HHS also is including quality standards in the bidding process to ensure the safety and efficacy of the procedures, such as requiring bidders to have reporting programs for medical errors, to have electronic information exchange capabilities, and to show adequate staffing for the services provided.

The commissioner also said the waiver covers transportation costs.

“Access to care is just as important as the quality,” said Stephen. “Access will not be impacted by having competition.”

The state budget, passed late last month by the Legislature, included savings of $7.8 million to the Medicaid program for GraniteCare Select.

GraniteCare Select still has one more hurdle to pass – and it could be a big one — before implementation. It must be approved by the Legislative Fiscal Committee, which has been at best lukewarm to Stephen’s proposal.

If approved, said Stephen, patients could begin receiving care under the program as early as December.

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