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Dave Solomon's State House Dome: Pharmacy board could lose control of drug monitoring program

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January 20. 2018 5:28PM

SEN. BOB GIUDA (gencourt.state.nh.us)

CONCORD -- Fallout continues from the critical performance audit of the state’s Prescription Drug Monitoring Program, with state Sen. Bob Giuda, R-Warren, pushing for a big change.

He plans to introduce legislation that would remove the program from the Board of Pharmacy and place it under the control of the state’s biggest department, Health and Human Services.

“After four years and the expenditure of $630,000 …. the program is not working,” he writes in a letter to Gov. Chris Sununu, legislative leaders and DHHS Commissioner Jeffrey Meyers.

“And the recent statement by the Board of Pharmacy that the PDMP has contributed in some way to the slight decline in opioid-related deaths over the last year lacks any statistical basis whatsoever.”

The reduction in opioid-related deaths is much more likely attributable to the huge increase in EMS on-site administration of Narcan than to any effects of the PDMP, Giuda states.

He believes the failures detailed in the recent performance audit by the office of Legislative Budget Assistant are “abject and potentially life-threatening.”

“Just as the pilot who flies an aircraft is not qualified to design and build that aircraft, pharmacists who certify applicants and facilities and oversee continuing education of professionals are not trained or qualified to design and oversee a real-time, dynamic management information system tasked with statewide data collection, analysis and reporting,” according to the retired airline captain and Marine Corps veteran.

Watch for his proposal to be attached as an amendment to a DHHS-related bill of some sort in the week ahead.

No middle on Medicaid, yet

Both extremes in the debate over continuing Medicaid expansion in New Hampshire staked out their positions last week, leaving open the question of how the path to compromise will be found.

A group of leading Democratic senators and representatives on Wednesday released a letter they sent to Gov. Chris Sununu and Republican legislative leaders outlining the Democratic position, which is “reauthorize Medicaid expansion so that nobody loses their health insurance. Every single one of those more than 50,000 New Hampshire residents … must be able to continue to rely on this program after reauthorization.”

On the same day, a caucus of conservative House members issued a statement with the opposite point of view, stating, “The New Hampshire House Freedom Caucus stands strongly opposed to legislation that would make Obamacare Medicaid expansion permanent in New Hampshire.”

The dueling statements came out as legislation to keep Medicaid expansion in place (HB 1811) was the topic of a public hearing before the House Health, Human Services and Elderly Affairs Committee.

HB 1811, sponsored by a group of top Democrats in the House and Senate, extends Medicaid expansion, known as the New Hampshire Health Protection Program.

More importantly, it allows the use of money from the state budget to pay the state share, which up to now has been paid by hospitals and insurers in an opaque process recently deemed illegal by the feds.

That state share is scheduled to go up to 10 percent in 2020, and Republican leadership has yet to articulate a solution for raising that money.

Sources say one idea being considered is a tax on hospitals and insurers, who have been willing to close the gap up to now in order to keep the Medicaid payments flowing.

On the money

The state last week closed the books on fiscal year 2017, which ended on June 30, with the publication of the Comprehensive Annual Financial Report.

The audited tally shows that budget-writers were pretty conservative in predicting state revenues for the year.

Money from all taxes and fees into the General and Education Trust funds was supposed to total $2.3 billion for the year, and it came in at $2.4 billion, about a $90 million positive difference.

That’s about the same amount of money the state took in through taxes and fees in 2016, and well over 2015 receipts of $2.2 billion.

But it looks like revenues for fiscal year 2018 could be much closer to estimates.

According to a report provided by the Department of Administrative Services on Wednesday, fiscal year 2018 ending in June will show revenue over budget by only $1.7 million, before dipping $300,000 below budget for fiscal year 2019.

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