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1 1 Section 1. NEW SECTION. 249H.1 TITLE.
1 2 This chapter shall be known and may be cited as the "Iowa
1 3 Long-Term Care Program Act".
1 4 Sec. 2. NEW SECTION. 249H.2 LEGISLATIVE FINDINGS –
1 5 GOAL.
1 6 1. The general assembly finds that:
1 7 a. The preservation, improvement, and coordination of the
1 8 health care infrastructure of Iowa is critical to the health
1 9 and safety of Iowans.
1 10 b. An increasing number of elders and persons with
1 11 disabilities in the state require long-term care services
1 12 provided outside of a medical institution.
1 13 c. A full array of long-term care services is necessary to
1 14 provide cost-effective and appropriate services to the varied
1 15 population of health care consumers.
1 16 d. The supported development of long-term care
1 17 alternatives, including assisted-living facility services,
1 18 adult day care, and home and community-based services, is
1 19 critical in areas of the state where such alternatives
1 20 otherwise are not likely to be developed.
1 21 e. Cost containment in the delivery of health care is
1 22 necessary to improve services and access for all Iowans.
1 23 f. Grants are necessary to cover the expenditures related
1 24 to the development of alternative health care services.
1 25 Development of these alternatives will improve access to and
1 26 delivery of long-term care services to underserved individuals
1 27 or in underserved areas, which will in turn contain or reduce
1 28 the cost and improve the quality of health care services.
1 29 g. A continuing source of funding is necessary to enhance
1 30 the state's ability to meet the rising demand of elders with
1 31 low and moderate incomes in obtaining an appropriate variety
1 32 of long-term care services.
1 33 2. The goal of this program is to create a comprehensive
1 34 long-term care system that is consumer-directed, provides a
1 35 balance between the alternatives of institutionally and
2 1 noninstitutionally provided services, and contributes to the
2 2 quality of the lives of Iowans.
2 3 Sec. 3. NEW SECTION. 249H.3 DEFINITIONS.
2 4 As used in this chapter, unless the context otherwise
2 5 provides:
2 6 1. "Affordable" means rates for payment of services which
2 7 do not exceed the rates established for providers of medical
2 8 and health services under the medical assistance program. In
2 9 relation to services provided by a provider of services under
2 10 a home and community based waiver, "affordable" means that the
2 11 total monthly cost of the home and community-based waiver
2 12 services provided do not exceed the cost for that level of
2 13 care as established by rule by the department of human
2 14 services, pursuant to chapter 17A, in consultation with the
2 15 department of elder affairs.
2 16 2. "Case mix reimbursement" means a reimbursement
2 17 methodology that recognizes the acuity and need level of the
2 18 residents of a nursing facility.
2 19 3. "Elder" means elder as defined in section 231.4 and as
2 20 defined under the PACE program pursuant to 42 U.S.C. }
2 21 1396(u)(4).
2 22 4. "Long-term care alternatives" means those services
2 23 specified under the medical assistance program as home and
2 24 community-based waiver services for elder persons or adults
2 25 with disabilities, elder group homes certified under chapter
2 26 231B, assisted-living programs certified under chapter 231C,
2 27 and the PACE program.
2 28 5. "Long-term care coordinating unit" means the long-term
2 29 care coordinating unit created within the department of elder
2 30 affairs pursuant to section 231.58, or its designee.
2 31 6. "Long-term care program" means the long-term care
2 32 program created in this chapter to provide for long-term care
2 33 alternatives, long-term care service development, and nursing
2 34 facility conversion.
2 35 7. "Long-term care provider" means a provider of services
3 1 through long-term care alternatives.
3 2 8. "Long-term care service development" means any of the
3 3 following:
3 4 a. The remodeling of existing space and, if necessary, the
3 5 construction of additional space required to accommodate
3 6 development of long-term care alternatives, excluding the
3 7 development of assisted-living programs or elder group home
3 8 alternatives.
3 9 b. New construction for long-term care alternatives,
3 10 excluding new construction of assisted-living programs or
3 11 elder group homes, if the long-term care coordinating unit
3 12 determines that new construction is more cost-effective than
3 13 the conversion of existing space.
3 14 9. "Nursing facility" means a licensed nursing facility as
3 15 defined in section 135C.1 or a licensed hospital as defined in
3 16 section 135B.1, a distinct part of which provides long-term
3 17 care nursing facility beds.
3 18 10. "Nursing facility conversion" means any of the
3 19 following:
3 20 a. The remodeling of nursing facility space existing on
3 21 July 1, 1999, and certified for medical assistance nursing
3 22 facility reimbursement and, if necessary, the construction of
3 23 additional space required to accommodate an assisted-living
3 24 program.
3 25 b. New construction of an assisted-living program if
3 26 existing nursing facility beds are no longer licensed and the
3 27 long-term care coordinating unit determines that new
3 28 construction is more cost-effective than the conversion of
3 29 existing space.
3 30 11. "PACE program" means a program of all-inclusive care
3 31 for the elderly established pursuant to 42 U.S.C. } 1396(u)(4)
3 32 that provides delivery of comprehensive health and social
3 33 services to elders by integrating acute and long-term care
3 34 services, and that is operated by a public, private,
3 35 nonprofit, or proprietary entity. "Pre-PACE program" means a
4 1 PACE program in the initial start-up phase that provides the
4 2 same scope of services as a PACE program.
4 3 12. "Persons with disabilities" means individuals with
4 4 disabilities as disability is defined in section 225B.2.
4 5 Sec. 4. NEW SECTION. 249H.4 LONG-TERM CARE TRUST FUND –
4 6 CREATED – APPROPRIATIONS.
4 7 1. A long-term care trust fund is created in the state
4 8 treasury under the authority of the department of human
4 9 services. Moneys received through intergovernmental
4 10 agreements for the long-term care program and moneys received
4 11 from sources, including grants, contributions, and participant
4 12 payments, shall be deposited in the fund.
4 13 2. The department of human services, upon receipt of
4 14 federal revenue on or after July 1, 1999, from public nursing
4 15 facilities, participating in the medical assistance program,
4 16 shall deposit the federal revenue received in the trust fund,
4 17 less a sum of five thousand dollars per participating public
4 18 nursing facility.
4 19 3. Moneys deposited in the trust fund shall be used only
4 20 for the purposes of the long-term care program as specified in
4 21 this chapter.
4 22 4. The trust fund shall be operated in accordance with the
4 23 guidelines of the health care financing administration of the
4 24 United States department of health and human services. The
4 25 trust fund shall be separate from the general fund of the
4 26 state and shall not be considered part of the general fund of
4 27 the state. The moneys in the trust fund shall not be
4 28 considered revenue of the state, but rather shall be funds of
4 29 the long-term care program. The moneys in the trust fund are
4 30 not subject to section 8.33 and shall not be transferred,
4 31 used, obligated, appropriated, or otherwise encumbered, except
4 32 to provide for the purposes of this chapter. Notwithstanding
4 33 section 12C.7, subsection 2, interest or earnings on moneys
4 34 deposited in the trust fund shall be credited to the trust
4 35 fund.
5 1 5. The department of human services shall adopt rules
5 2 pursuant to chapter 17A to administer the trust fund and to
5 3 establish procedures for participation by public nursing
5 4 facilities in the intergovernmental transfer of funds to the
5 5 long-term care trust fund.
5 6 6. The treasurer of state shall provide a quarterly report
5 7 of long-term care trust fund activities and balances to the
5 8 long-term care coordinating unit.
5 9 Sec. 5. NEW SECTION. 249H.5 APPROPRIATIONS – LONG-TERM
5 10 CARE TRUST FUND.
5 11 1. Moneys deposited in the long-term care trust fund
5 12 created in section 249H.4 shall be used only as provided in
5 13 appropriations from the trust fund to the department of human
5 14 services and the department of elder affairs, and for
5 15 purposes, including the awarding of grants, as specified in
5 16 this chapter.
5 17 2. Moneys in trust fund are appropriated as follows:
5 18 a. To the department of human services, a maximum of
5 19 sixty-five million dollars for the fiscal period beginning
5 20 July 1, 2000, and ending on or before June 30, 2005, to be
5 21 used for the conversion of existing nursing facility space and
5 22 development of long-term care alternatives.
5 23 b. To the department of elder affairs, an amount
5 24 necessary, annually, for expenses incurred in implementation
5 25 and administration of long-term care service programs and for
5 26 delivery of long-term care services to elders with low or
5 27 moderate incomes.
5 28 c. To the department of human services, an amount
5 29 necessary, annually, for all of the following:
5 30 (1) Expenses incurred in implementation of the long-term
5 31 care program.
5 32 (2) Expenses incurred in administration of medical
5 33 assistance home and community-based waivers and the PACE
5 34 program due to implementation of the long-term care trust
5 35 fund.
6 1 (3) Expenses incurred due to increased service delivery
6 2 provided under medical assistance home and community-based
6 3 waivers as a result of nursing facility conversions and long-
6 4 term care service development, for the fiscal period beginning
6 5 July 1, 2000, and ending on or before June 30, 2005.
6 6 (4) Expenses incurred in program administration related to
6 7 implementation of nursing facility case mix reimbursement
6 8 under the medical assistance program.
6 9 d. To the department of human services, an amount
6 10 necessary to provide funding for nursing facility provider
6 11 reimbursements, which supports transition to a case mix
6 12 reimbursement system.
6 13 e. To the department of human services an amount
6 14 necessary, annually, for additional expenses incurred relative
6 15 to implementation of the long-term care program in assisting
6 16 home and community-based waiver consumers with rent expenses
6 17 pursuant to the state supplementary assistance program.
6 18 3. Any funds remaining after disbursement of moneys under
6 19 subsection 2 shall be invested with the interest earned to be
6 20 available in subsequent fiscal years for the purposes provided
6 21 in subsection 2, paragraph "b", and subsection 2, paragraph
6 22 "c", subparagraphs (1) and (2).
6 23 Sec. 6. NEW SECTION. 249H.6 NURSING FACILITY CONVERSION
6 24 AND LONG-TERM CARE SERVICES DEVELOPMENT GRANTS.
6 25 1. The department of human services, at the direction of
6 26 the long-term care coordinating unit, may use moneys
6 27 appropriated to the department from the long-term care trust
6 28 fund to award grants to any of the following:
6 29 a. A licensed nursing facility that has been an approved
6 30 provider under the medical assistance program for the three-
6 31 year period prior to application for the grant. The grant
6 32 awarded may be used to convert all or a portion of the
6 33 licensed nursing facility to a certified assisted-living
6 34 program and may be used for capital or one-time expenditures,
6 35 including but not limited to start-up expenses, training
7 1 expenses, and operating losses for the first year of operation
7 2 following conversion associated with the nursing facility
7 3 conversion.
7 4 b. A long-term care provider or a licensed nursing
7 5 facility that has been an approved provider under the medical
7 6 assistance program for the three-year period prior to
7 7 application for the grant or a provider that will meet
7 8 applicable medical assistance provider requirements as
7 9 specified in subsection 2, paragraph "c" or "d". The grant
7 10 awarded may be used for capital or one-time expenditures,
7 11 including but not limited to start-up expenses, training
7 12 expenses, and operating losses for the first year of operation
7 13 for long-term care service development.
7 14 2. A grant shall be awarded only to an applicant who meets
7 15 all of the following criteria, as applicable to the type of
7 16 grant:
7 17 a. The applicant is a long-term care provider or a nursing
7 18 facility that is located in an area determined by the long-
7 19 term care coordinating unit to be underserved with respect to
7 20 a particular long-term care alternative service, and that has
7 21 demonstrated the ability or potential to provide quality long-
7 22 term care alternative services.
7 23 b. The applicant is able to provide a minimum matching
7 24 contribution of twenty percent of the total cost of any
7 25 conversion, remodeling, or construction.
7 26 c. The applicant is applying for a nursing facility
7 27 conversion grant and is able to demonstrate all of the
7 28 following:
7 29 (1) Conversion of the nursing facility or a distinct
7 30 portion of the nursing facility to an assisted-living program
7 31 is projected to offer efficient and economical care to
7 32 individuals requiring long-term care services in the service
7 33 area.
7 34 (2) Assisted-living services are otherwise not likely to
7 35 be available in the area for individuals eligible for services
8 1 under the medical assistance program.
8 2 (3) The resulting reduction in the availability of nursing
8 3 facility services is not projected to cause undue hardship on
8 4 those individuals requiring nursing facility services for a
8 5 period of at least ten years.
8 6 (4) Public support following a community-based assessment.
8 7 (5) Conversion of the nursing facility is projected to
8 8 result in a lower per client reimbursement cost to the grant
8 9 applicant under the medical assistance program.
8 10 d. The applicant is applying for a long-term care service
8 11 development grant and is able to demonstrate all of the
8 12 following:
8 13 (1) Long-term care service development is projected to
8 14 offer efficient and economical care to individuals requiring
8 15 long-term care services in the service area.
8 16 (2) The proposed long-term care alternative is otherwise
8 17 not likely to be available in the area for individuals
8 18 eligible for services under the medical assistance program.
8 19 (3) Public support following a community-based assessment.
8 20 e. The applicant agrees to do all of the following as
8 21 applicable to the type of grant:
8 22 (1) Participate and maintain a minimum medical assistance
8 23 client base participation rate of forty percent, subject to
8 24 the demand for participation by individuals eligible for
8 25 medical assistance.
8 26 (2) Provide a service delivery package that is affordable
8 27 for those individuals eligible for services under the medical
8 28 assistance home and community-based services waiver program.
8 29 (3) Provide a refund to the long-term care trust fund, on
8 30 an amortized basis, in the amount of the grant, if the
8 31 applicant or the applicant's successor in interest ceases to
8 32 operate an affordable long-term care alternative within the
8 33 first ten-year period of operation following the awarding of
8 34 the grant.
8 35 3. The department of human services shall adopt rules in
9 1 cooperation with the long-term care coordinating unit,
9 2 pursuant to chapter 17A, to provide all of the following:
9 3 a. An application process and eligibility criteria for the
9 4 awarding of grants. The eligibility criteria shall include
9 5 but are not limited to the applicant's demonstration of an
9 6 affordable service package, the applicant's use of the funds
9 7 for allowable costs, and the applicant's ability to refund the
9 8 funds if required under subsection 2, paragraph "e",
9 9 subparagraph (3). The primary eligibility criterion used
9 10 shall be the applicant's potential impact on the overall goal
9 11 of moving toward a balanced, comprehensive, affordable, high-
9 12 quality, long-term care system.
9 13 b. Criteria to be utilized in determining the amount of
9 14 the grant awarded.
9 15 c. Weighted criteria to be utilized in prioritizing the
9 16 awarding of grants to individual grantees during a grant
9 17 cycle. Greater weight shall be given to the applicant's
9 18 demonstration of potential reduction of nursing facility beds,
9 19 the applicant's ability to meet demonstrated community need,
9 20 and the established history of the applicant in providing
9 21 quality long-term care services.
9 22 d. Policies and procedures for certification of the
9 23 matching funds required of applicants under subsection 2,
9 24 paragraph "b".
9 25 e. Other procedures the department of human services deems
9 26 necessary for the proper administration of this section,
9 27 including but not limited to the submission of progress
9 28 reports on a bimonthly basis to the long-term care
9 29 coordinating unit.
9 30 4. The department of human services shall establish a
9 31 calendar for receiving and evaluating applications and for
9 32 awarding of grants.
9 33 5. a. The department of human services shall develop a
9 34 cost report to be completed by a grantee which includes, but
9 35 is not limited to, revenue, costs, loans undertaken by the
10 1 grantee, fixed assets of the grantee, a balance sheet, and a
10 2 profit and loss statement.
10 3 b. Grantees shall submit, annually, completed cost reports
10 4 to the department of human services regarding the project for
10 5 a period of ten years following the date of initial operation
10 6 of the grantee's long-term care alternative.
10 7 6. The department of human services, in consultation with
10 8 the department of elder affairs, shall provide annual reports
10 9 to the governor and the general assembly concerning grants
10 10 awarded. The annual report shall include the total number of
10 11 applicants and approved applicants, an overview of the various
10 12 grants awarded, and detailed reports of the cost of each
10 13 project funded by a grant and information submitted by the
10 14 approved applicant.
10 15 7. This section does not create an entitlement to any
10 16 funds available for grants under this section, and the
10 17 department of human services may only award grants to the
10 18 extent funds are available and within its discretion, to the
10 19 extent applications are approved.
10 20 8. In addition to any other remedies provided by law, the
10 21 department of human services may recoup any grant funding
10 22 previously awarded and disbursed to a grantee or the grantee's
10 23 successor in interest and may reduce the amount of any grant
10 24 awarded, but not yet disbursed, to a grantee or the grantee's
10 25 successor in interest, by the amount of any refund owed by a
10 26 grantee or the grantee's successor in interest pursuant to
10 27 subsection 2, paragraph "e", subparagraph (3).
10 28 9. The long-term care coordinating unit shall review
10 29 projects that receive grants under this section to ensure that
10 30 the goal to provide alternatives to nursing facility care is
10 31 being met and that an adequate number of nursing facility
10 32 services remain to meet the needs of Iowans.
10 33 Sec. 7. NEW SECTION. 249H.7 HOME AND COMMUNITY-BASED
10 34 SERVICES FOR ELDERS.
10 35 1. Beginning October 1, 2000, the department of elder
11 1 affairs, in consultation with the long-term care coordinating
11 2 unit, shall use funds appropriated from the long-term care
11 3 trust fund for activities related to the design, maintenance,
11 4 or expansion of home and community-based services for elders,
11 5 including but not limited to adult day care, personal care,
11 6 respite, homemaker, chore, and transportation services
11 7 designed to promote the independence of and to delay the use
11 8 of institutional care by elders with low and moderate incomes.
11 9 At any time that moneys are appropriated, the department of
11 10 elder affairs, in consultation with the long-term care
11 11 coordinating unit, shall disburse the funds to the area
11 12 agencies on aging.
11 13 2. The department of elder affairs shall adopt rules, in
11 14 consultation with the long-term care coordinating unit and the
11 15 area agencies on aging, pursuant to chapter 17A, to provide
11 16 all of the following:
11 17 a. The criteria and process for disbursement of funds,
11 18 appropriated in accordance with subsection 1, to area agencies
11 19 on aging.
11 20 b. The criteria for long-term care providers to receive
11 21 funding as subcontractors of the area agencies on aging.
11 22 c. Other procedures the department of elder affairs deems
11 23 necessary for the proper administration of this section,
11 24 including but not limited to the submission of progress
11 25 reports, on a bimonthly basis, to the long-term care
11 26 coordinating unit.
11 27 3. This section does not create an entitlement to any
11 28 funds available for disbursement under this section and the
11 29 department of elder affairs may only disburse moneys to the
11 30 extent funds are available and, within its discretion, to the
11 31 extent requests for funding are approved.
11 32 4. Long-term care providers that receive funding under
11 33 this section shall submit annual reports to the appropriate
11 34 area agency on aging. The department of elder affairs shall
11 35 develop the report to be submitted, which shall include, but
12 1 is not limited to, units of service provided, the number of
12 2 service recipients, costs, and the number of units of service
12 3 identified as necessitated but not provided.
12 4 5. The department of elder affairs, in cooperation with
12 5 the department of human services, shall provide annual reports
12 6 to the governor and the general assembly concerning the impact
12 7 of moneys disbursed under this section on the availability of
12 8 long-term care services in Iowa. The reports shall include
12 9 the types of services funded, the outcome of those services,
12 10 and the number of individuals receiving those services.
12 11 Sec. 8. NEW SECTION. 249H.8 PACE PROGRAM.
12 12 For the purposes of this chapter, all of the following
12 13 apply to a PACE program:
12 14 1. A person operating a PACE program shall have a PACE
12 15 program agreement with the health care financing
12 16 administration of the United States department of health and
12 17 human services, shall enter a contract with the department of
12 18 human services and shall comply with 42 U.S.C. } 1396(u)(4)
12 19 and all regulations promulgated pursuant to that section.
12 20 2. Services provided under a PACE or pre-PACE program
12 21 shall be provided on a capitated basis.
12 22 3. A pre-PACE program may contract with the department of
12 23 human services to provide services to individuals eligible for
12 24 medical assistance, on a capitated basis, for a limited scope
12 25 of the PACE service package through a prepaid health plan
12 26 agreement, with the remaining services reimbursed directly to
12 27 the service providers by the medical assistance or federal
12 28 Medicare programs.
12 29 4. PACE and pre-PACE programs are not subject to
12 30 regulation under chapter 514B.
12 31 5. A PACE or pre-PACE program shall, at the time of
12 32 entering into the initial contract and of renewal of a
12 33 contract with the department of human services, demonstrate
12 34 cash reserves in an amount established by rule of the
12 35 department to cover expenses in the event of insolvency.
13 1 Sec. 9. NEW SECTION. 249H.9 FUTURE REPEAL.
13 2 Section 249H.6 is repealed on June 30, 2005. However,
13 3 grants awarded and moneys appropriated for grants on or before
13 4 June 30, 2005, shall be disbursed to eligible applicants after
13 5 that date if necessary.
13 6 Sec. 10. Section 231.58, subsection 2, Code 1999, is
13 7 amended by adding the following new paragraph:
13 8 NEW PARAGRAPH. h. Provide direction and oversight for
13 9 disbursement of moneys from the long-term care trust fund
13 10 created in section 249H.4.
13 11 Sec. 11. MAINTENANCE OF FISCAL EFFORT. The fiscal effort,
13 12 existing on June 30, 2000, represented by appropriations made
13 13 for long-term care services by the general assembly, shall be
13 14 maintained and a reduction shall not be made in such
13 15 appropriations to the department of human services or the
13 16 department of elder affairs for those services as a result of
13 17 this Act.
13 18 Sec. 12. DEPARTMENT OF ELDER AFFAIRS APPROPRIATION. There
13 19 is appropriated from the long-term care trust fund created in
13 20 section 249H.4 in this Act to the department of elder affairs
13 21 for the fiscal year beginning July 1, 2000, and ending June
13 22 30, 2001, the following amount, or so much thereof as is
13 23 necessary, to be used for the purposes designated:
13 24 For the development of a comprehensive long-term care
13 25 system, including program administration and costs associated
13 26 with implementation, salaries, support, maintenance,
13 27 miscellaneous purposes, and for not more than the following
13 28 full-time equivalent positions:
13 29 .................................................. $ 4,188,123
13 30 ............................................... FTEs 7.00
13 31 The department of elder affairs may adopt emergency rules
13 32 to carry out the provisions of this section.
13 33 Sec. 13. DEPARTMENT OF HUMAN SERVICES APPROPRIATION.
13 34 There is appropriated from the long-term care trust fund
13 35 created in section 249H.4 in this Act to the department of
14 1 human services for the fiscal year beginning July 1, 2000, and
14 2 ending June 30, 2001, the following amounts, or so much
14 3 thereof as is necessary, to be used for the purposes
14 4 designated:
14 5 1. To provide grants to nursing facilities for conversion
14 6 to assisted living programs or to provide long-term care
14 7 alternatives and to provide grants to long-term care providers
14 8 for development of long-term care alternatives:
14 9 .................................................. $ 15,000,000
14 10 2. To supplement the medical assistance appropriation and
14 11 to provide reimbursement for health care services and rent
14 12 expenses to eligible persons through the home and community-
14 13 based services waiver and the state supplementary assistance
14 14 program, including program administration and data system
14 15 costs associated with implementation, salaries, support,
14 16 maintenance, miscellaneous purposes, and for not more than the
14 17 following full-time equivalent positions:
14 18 .................................................. $ 2,189,569
14 19 ............................................... FTEs 5.00
14 20 3. To implement nursing facility provider reimbursement
14 21 increases or reimbursement methodology changes:
14 22 .................................................. $ 12,750,000
14 23 The department shall transfer these funds to supplement
14 24 other appropriations to the department of human services to
14 25 carry out the purposes of this subsection.
14 26 Sec. 14. EMERGENCY RULES.
14 27 1. The department of human services and the department of
14 28 elder affairs may adopt emergency rules to implement this Act.
14 29 2. If the department of human services or the department
14 30 of elder affairs adopts emergency rules under section 17A.4,
14 31 subsection 2, and section 17A.5, subsection 2, paragraph "b",
14 32 to implement this Act, the rules shall become effective
14 33 immediately upon filing, unless the effective date is delayed
14 34 by the administrative rules review committee, notwithstanding
14 35 section 17A.4, subsection 5, and section 17A.8, subsection 9,
15 1 or unless a later effective date is specified in the rules.
15 2 Any rules adopted in accordance with the provisions of this
15 3 section shall also be published as notice of intended action
15 4 as provided in section 17A.4.
15 5 EXPLANATION
15 6 This bill creates a new Code chapter, 249H, established in
15 7 Code section 249H.1 as the "Iowa Long-Term Care Program Act".
15 8 Code section 249H.2 provides the legislative findings
15 9 related to and the goal of the program. The goal of the
15 10 program is to create a comprehensive long-term care system
15 11 that is consumer-directed, provides balance between the
15 12 options of institutional and noninstitutional care, and
15 13 contributes to the quality of life.
15 14 Code section 249H.3 provides definitions used in the
15 15 chapter.
15 16 Code section 249H.4 creates the long-term care trust fund
15 17 and provides for ongoing appropriations from the trust fund.
15 18 The trust fund is created in the state treasury under the
15 19 authority of the department of human services. Moneys
15 20 deposited in the fund include those received through
15 21 intergovernmental agreements for the long-term care program,
15 22 grants, contributions, participant payments, and a portion of
15 23 the federal moneys received by the department of human
15 24 services from public nursing facilities. Moneys in the fund
15 25 are to be appropriated only for the purposes of the long-term
15 26 care program. The trust fund is to be operated in accordance
15 27 with the guidelines of the health care financing
15 28 administration of the United States department of health and
15 29 human services. Moneys in the fund are not considered part of
15 30 the general fund of the state. Moneys in the fund at the end
15 31 of a fiscal year do not revert to the state general fund and
15 32 cannot be transferred, used, obligated, appropriated, or
15 33 otherwise encumbered, except for purposes of the long-term
15 34 care program. Interest or earnings on moneys in the trust
15 35 fund are credited to the trust fund. The department of human
16 1 services is directed to adopt rules to administer the trust
16 2 fund and to establish participation in the program for public
16 3 nursing facilities. The treasurer of state is directed to
16 4 provide a quarterly report of the trust fund activities and
16 5 balances to the long-term care coordinating unit.
16 6 Code section 249H.5 provides for appropriations from the
16 7 trust fund. Appropriations include:
16 8 1. An appropriation to the department of human services of
16 9 a maximum of $65 million over a maximum five-year period to be
16 10 used for the conversion of existing nursing facility space and
16 11 development of long-term care alternatives.
16 12 2. An appropriation to the department of elder affairs,
16 13 annually, in an amount necessary to cover expenses of
16 14 implementation and administration of long-term care services
16 15 programs and for delivery of long-term care services to low
16 16 and moderate income elders.
16 17 3. An appropriation to the department of human services,
16 18 annually, for administrative purposes and service delivery
16 19 related to the long-term care program and trust fund and to
16 20 implementation of a new reimbursement system.
16 21 4. An appropriation to the department of human services,
16 22 in an amount necessary to provide nursing facility provider
16 23 reimbursements which supports a case mix reimbursement system.
16 24 5. An appropriation to the department of human services,
16 25 annually, for additional expenses, relative to the long-term
16 26 care program, that are incurred due to rent expenses of
16 27 consumers participating in a home and community-based waiver
16 28 program under the state supplementary assistance program.
16 29 The remainder of the funds is to be invested with the
16 30 interest and earnings to be used for administration of
16 31 programs and delivery of long-term care services and for
16 32 expenses related to implementation of the long-term care
16 33 program and administration of the trust fund.
16 34 Code section 249H.6 provides the procedures and criteria
16 35 for the awarding of grants for conversion of nursing
17 1 facilities to provide assisted-living programs and for long-
17 2 term care services development. The section provides that the
17 3 section does not create an entitlement to any funds available
17 4 for grant purposes, but that the department of human services,
17 5 in its discretion, may only award grants to the extent funds
17 6 are available and applications are approved.
17 7 Code section 249H.7 provides for appropriation of funds
17 8 beginning October 1, 2000, to the department of elder affairs
17 9 for activities related to home and community-based services
17 10 for elders. Moneys appropriated to the department of elder
17 11 affairs are to be disbursed through the area agencies on
17 12 aging. The section provides that the section does not create
17 13 an entitlement, but that the department of elder affairs, in
17 14 its discretion, may only disburse funds to the extent funds
17 15 are available and requests for funding are approved.
17 16 Code section 249H.8 describes provisions relating to the
17 17 PACE program and the pre-PACE program, which is defined in the
17 18 bill as a program that provides delivery of comprehensive
17 19 health and social services to elders by integrating acute and
17 20 long-term care services, and is operated by an entity as
17 21 permitted under federal regulation. A pre-PACE program is
17 22 defined as a PACE program in its initial stages that provides
17 23 the same scope of services as a PACE program.
17 24 Code section 249H.9 provides a sunset provision for new
17 25 Code section 249H.6, which is the section that provides grants
17 26 for nursing facility conversion and long-term care services
17 27 development. Under the bill, Code section 249H.6 would be
17 28 repealed effective June 30, 2005.
17 29 The bill also provides for a conforming change in the Code
17 30 to include the duty of the provision of direction and
17 31 oversight for disbursement of moneys from the trust fund in
17 32 the duties of the long-term care coordinating unit.
17 33 The bill establishes that the general assembly is to
17 34 maintain the fiscal effort in funding long-term care services,
17 35 existing on June 30, 2000, and is not to make reductions in
18 1 appropriations for this purpose as a result of the bill.
18 2 The bill provides for fiscal year 2000-2001 appropriations
18 3 to the department of human services and the department of
18 4 elder affairs relating to the long-term care program.
18 5 The bill provides for emergency rulemaking authority for
18 6 the department of human services and the department of elder
18 7 affairs in implementing the bill.
18 8 LSB 5472YH 78
18 9 pf/cf/24.1
Text: HF02212 Text: HF02214 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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