Amendment to HB 480 - Page 2 - II.

HB 480 - VERSION ADOPTED BY BOTH BODIES - Page 3 - (k) Performing any other appropriate duties as assigned by the department.

The defendant shall provide authorization for the FL to obtain all Amendment to HB 480 - Page 3 - necessary mental health records.

Amendment to HB 480 - Page 4 Effective- Date.2025-0061h AMENDED ANALYSIS This bill directs the committee to study restoration of competency to submit any additional proposals on or before July 1, 2025 and requires, once adequate funding is received, the department of health and human services to establish a 2-year pilot program to create the position of one or more forensic liaisons, who will assist in competency proceedings of criminal defendants.

This act shall take effect upon its passage.

HB 480 - VERSION ADOPTED BY BOTH BODIES LBA 25-0779 5/14/25 HB 480- FISCAL NOTE AS AMENDED BY THE HOUSE (AMENDMENT #2025-0061h) AN ACT relative to restoration of competency to stand trial for criminal defendants.

FISCAL IMPACT:

This bill does not provide funding, nor does it authorize new positions.

Estimated State Impact FY 2025 FY 2026 FY 2027 FY 2028 Revenue $0 $0 $0 $0 Revenue Fund(s) None $1.02 to $1.22 $1.05 to $1.25 Expenditures* $0 million million $0 Funding Source(s) General Fund Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill METHODOLOGY:

This bill directs the committee to study restoration of competency to submit any additional proposals on or before July 1, 2025 and requires, once adequate funding is received, the department of health and human services to establish a 2-year pilot program to create the position of one or more forensic liaisons, who will assist in competency proceedings of criminal defendants.

The Department of Health and Human Services (DHHS) indicates New Hampshire currently does not have a competency restoration program.

The Office of the Forensic Examiner is tasked with performing competency evaluations.

DHHS states the bill would have a significant fiscal impact.

DHHS would be required to establish a two-year pilot restoration of competency program in a county in New Hampshire.

The bill requires DHHS to add “one or more” Forensic Liaison positions and to hire, train, and supervise of these positions.

Since the DHHS has never been involved in the adult criminal justice system or with restoration of competency for individuals in the criminal system, it does not know how many staff would be needed.

DHHS has no information on the number of individuals or their needs.

Establishing a pilot program to service those in the criminal justice system would take significant time and resources and would involve establishing the proper number of positions and their supervisory responsibilities, hiring and training such staff, and implementing the program.

The bill also requires contracting for services necessary for competency restoration not otherwise covered by a third-party payer.

DHHS states there is no way to estimate the need for contracted services currently.

DHHS provided the following additional information:

· Competency restoration within NH has never been formally studied from a health plan coverage perspective.

Whether Medicare, Medicaid, commercial insurance, and other health plan providers are willing to pay for restorative services is unknown and may differ by plan.

It is not likely that federal dollars would be available for the State’s restoration program.

The Insurance Department will need to be engaged to identify coverage concerns and issues related to such a program from a health plan perspective.

· DHHS would need to renegotiate the Managed Care Organization contracts to ensure the coverage of such services for the Medicaid expansion population, commercial insurance contracts would need to be renegotiated for New Hampshire Hospital, and community mental health centers, and others that may provide these services.

These costs are indeterminable but are expected to be significant.

· Certain mental health services provided by licensed practitioners may be covered by insurance.

Restoration of competency is not solely mental health treatment and requires additional expertise and skills.

Aside from the Office of the Forensic Examiner, DHHS does not know if such expertise exists within the state.

The Office of Professional Licensure and Certification does not have administrative rules within their boards relative to the proper treatment and provision of these services.

To meet some of the program objectives in the bill, such as assisting the defendant in obtaining and receiving services, the State will need to spend money to develop standards for clinicians to provide proper restorative services from NH licensed clinicians or engage out-of-state contracts for provision of certain services.

· DHHS does not receive information from the criminal justice system currently.

The Office of the Forensic Examiner performs competency evaluations.

DHHS would need to coordinate with the Judicial Branch and the Office of the Forensic Examiner regarding individuals found incompetent to stand trial.

DHHS is unable to determine if an existing system is available or if a system would be necessary to facilitate this coordination.

DHHS provided a cost estimate assuming the workload would require four new positions:

a Forensic Case Manager, a Forensic Liaison and two Psychologists.

The estimated salary and benefit costs for these positions is $616,194 in FY 2026 and $646,994 in FY 2027.

In addition to salaries and benefits there would be administrative costs including transportation, documentation, courier, postage, contracting for services, supervisory responsibilities, and administrative rule changes.

These costs are indeterminable at this time but estimated to be between $400,000 and $600,000.

It is assumed that any fiscal impact would occur after FY 2025.

AGENCIES CONTACTED:

Department of Health and Human Services