SF 2082 (LSB 5142ST (2) 85)

SENATE FILE 2082

BY  RAGAN, BEALL, HART, JOCHUM, BLACK, PETERSEN, BRASE, SCHOENJAHN, MATHIS, McCOY, GRONSTAL, COURTNEY, DEARDEN, HORN, WILHELM, BOWMAN, SENG, DANIELSON, DOTZLER, BOLKCOM, HOGG, HATCH, and SODDERS

A BILL FOR

An Act relating to the submission of a Medicaid state plan amendment for the provision of home and community-based services to elders.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  MEDICAID —— SECTION 1915(i) STATE PLAN AMENDMENT —— HOME AND COMMUNITY-BASED SERVICES FOR ELDERS.  The department of human services shall convene a workgroup of stakeholders with interest or expertise in issues relating to elders to develop a section 1915(i) medical assistance program state plan amendment in accordance with section 2402 of the federal Patient Protection and Affordable Care Act to cover home and community-based services for eligible elders 65 years of age or older. The workgroup shall make recommendations on or before September 1, 2014, relating to financial eligibility; benefits, including whether individuals receiving 1915(i) services should be eligible for full Medicaid benefits; available services; and the needs-based level of care criteria for determination of eligibility under the state plan amendment. The recommendations of the workgroup shall be incorporated into a 1915(i) state plan amendment and submitted by the department of human services to the centers for Medicare and Medicaid services of the United States department of health and human services for approval.
EXPLANATION
The inclusion of this explanation does not constitute agreement with

the explanation’s substance by the members of the general assembly.
   This bill directs the department of human services (DHS) to convene a workgroup of stakeholders with interest or expertise in issues relating to elders to develop a section 1915(i) Medicaid state plan amendment to provide home and community-based services (HCBS) to eligible elders. The workgroup is directed to make recommendations on or before September 1, 2014, relating to financial eligibility; benefits, including whether individuals receiving 1915(i) services should be eligible for full Medicaid benefits; available services; and the needs-based level of care criteria for determination of eligibility under the state plan amendment. The bill directs DHS to incorporate the recommendations of the workgroup into a state plan amendment to be submitted to the centers for Medicare and Medicaid services of the United States department of health and human services for approval.
   The 1915(i) state plan amendment option under the federal Patient Protection and Affordable Care Act (ACA) allows states to provide HCBS to eligible individuals without requiring the individuals to meet the institutional level of care criteria. Rather, an individual must meet a needs-based criteria specified by the state that is less restrictive than the state’s institutional level of care criteria. The ACA provision also allows states to expand the scope of allowable services; allows states to provide a specific set of HCBS benefits to a targeted population group; allows the use of increased income eligibility up to 300 percent of the supplemental security income (SSI) federal benefit level; and allows states to provide full Medicaid state plan benefits to those eligible for the 1915(i) HCBS option. Because the HCBS option is based on a state plan amendment rather than a waiver, the HCBS must be offered to all eligible individuals on a statewide basis. The state cannot limit the number of eligible individuals, establish a waiting list for these individuals, or limit services to only specified areas of the state.