Case 1:11-cv-00358-SM Document 50-43

Filed 09/23/11 Page 1 of 3

UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE **************************************** Dartmouth-Hitchcock Clinic and Mary * Hitchcock Memorial Hospital * d/b/a Dartmouth-Hitchcock, et al., * Plaintiff * * v. * Nicholas A. Toumpas, in his official capacity * as Commissioner of the New Hampshire * Department of Health and Human Services, * Defendant * * * ****************************************

11-cv-358-SM

AFFIDAVIT OF DIANE PETERSON IN SUPPORT OF THE DEFENDANTS OBJECTION TO MOTION FOR PRELIMINARY INJUNCTION I, Diane Peterson declare as follows: 1. I am currently employed by the New Hampshire Department of Health and Human

Services (DHHS), Office of Medicaid Business and Policy (OMBP), as an Administrator II. My responsibilities in this position include managing the NH Medicaid State Plan for OMBP. I have worked for DHHS for 32 years and, for a large part of that time, I have had these responsibilities. 2. I set up a system for maintaining the OMBP unit documents relating to Medicaid

state plan submittals, related public notices, and state plan correspondence for state plan amendments (SPA's) that are initiated in OMBP and submitted to the Centers for Medicare and Medicaid Services (CMS) for review and approval. This system has been used consistently by myself and by others who carried out the state plan function in the unit. The process is that if a state plan change needs to be made, a TN # is first obtained from the DHHS central SPA unit. The SPA includes only the page or pages on which changes are being made. The new TN #

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appears at the bottom of the page, as does the TN # of the page being superseded. The documents attached hereto are true and correct copies of the documents from my files. 3. The inpatient hospital reimbursement section of the NH Medicaid State Plan is in

Attachment 4.19-A. Attached hereto as Exh. DP-1 is a complete copy of all inpatient hospital reimbursement state plan pages, as amended and superseded, grouped by page, including all pending pages, as well as the CMS approved changes to Attachment 4.19-A since 1990. 4. The outpatient hospital reimbursement section of the NH Medicaid State Plan is in

Attachment 4.19-B, which also includes reimbursement details for other non-institutional Medicaid covered services. Attached hereto as Exh. DP-2 is a complete copy of all outpatient hospital and other non-institutional reimbursement state plan pages, as amended and superseded, grouped by page, including all pending pages, as well as the CMS approved changes to Attachment 4.19-B since 1990. In regard to TN 06-008, the SPA originally submitted to CMS did not include the reimbursement page from Attachment 4.19-B because no changes were being made to any reimbursement methodologies. However, in the CMS review process, CMS suggested through the CMS "Request for Additional Information (RAI)" process that DHHS make updates to page 1 of Attachment 4.19-B as language on the page was outdated. Therefore, OMBP submitted proposed, draft page 1 of Attachment 4.19-B in response to the RAI on this SPA. This page is now considered to be part of TN 06-008, and is included and referred to as "pending" in subsequent state plan amendments. This draft page is in a state of flux as it represents ongoing work between DHHS and CMS on DHHS' response to the outstanding CMS RAI on a pending SPA. 5. Attached hereto as Exh. DP-3 is a copy of the TN-08-017 SPA submitted to CMS.

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6.

Attached hereto as Exh. DP-4 are copies of the 2/26/2010 Public Notice related to a

number of items as it appeared in the Telegraph and the Union Leader. 7. Attached hereto as Exh. DP-5 is a copy of a Public Notice that was published on

June 25, 2011 in the Telegraph and June 27, 2011 in the Union Leader related to changes made in the recent legislative session. 8. 9. 10. Attached hereto as Exh. DP-6 is a copy of the TN 10-006 SPA submitted to CMS. Attached hereto as Exh. DP-7 is a copy of the TN 10-011 SPA submitted to CMS. Attached hereto as Exh. DP-8, is a copy of the TN 06-008 SPA submitted to CMS

and a subsequent OMBP draft update to page 1 of Attachment 4.19-B as requested by CMS. I declare under penalty of perjury that the foregoing is true and correct to the best of my personal knowledge and the information available to me.

Dated: 9/22/11

/S/ Diane Peterson Diane Peterson