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PAG LIN 1 1 DIVISION I 1 2 TITLE AND FINDINGS 1 3 Section 1. NEW SECTION. 249H.1 TITLE. 1 4 This chapter shall be known and may be cited as the "Iowa 1 5 Senior Living Program Act". 1 6 Sec. 2. NEW SECTION. 249H.2 LEGISLATIVE FINDINGS – 1 7 GOAL. 1 8 1. The general assembly finds that: 1 9 a. The preservation, improvement, and coordination of the 1 10 health care infrastructure of Iowa is critical to the health 1 11 and safety of Iowans. 1 12 b. An increasing number of seniors and persons with 1 13 disabilities in the state require long-term care services 1 14 provided outside of a medical institution. 1 15 c. A full array of long-term care services is necessary to 1 16 provide cost-effective and appropriate services to the varied 1 17 population of health care consumers. 1 18 d. The supported development of long-term care 1 19 alternatives, including assisted-living facility services, 1 20 adult day care, and home and community-based services, is 1 21 critical in areas of the state where such alternatives 1 22 otherwise are not likely to be developed. 1 23 e. Cost containment in the delivery of health care is 1 24 necessary to improve services and access for all Iowans. 1 25 f. Grants are necessary to cover the expenditures related 1 26 to the development of alternative health care services. 1 27 Development of these alternatives will improve access to and 1 28 delivery of long-term care services to underserved individuals 1 29 or in underserved areas, which will in turn contain or reduce 1 30 the cost and improve the quality of health care services. 1 31 g. A continuing source of funding is necessary to enhance 1 32 the state's ability to meet the rising demand of seniors with 1 33 low and moderate incomes in obtaining an appropriate variety 1 34 of long-term care services. 1 35 2. The goal of this program is to create a comprehensive 2 1 long-term care system that is consumer-directed, provides a 2 2 balance between the alternatives of institutionally and 2 3 noninstitutionally provided services, and contributes to the 2 4 quality of the lives of Iowans. 2 5 DIVISION II 2 6 IOWA SENIOR LIVING PROGRAM 2 7 Sec. 3. NEW SECTION. 249H.3 DEFINITIONS. 2 8 As used in this chapter, unless the context otherwise 2 9 provides: 2 10 1. "Affordable" means rates for payment of services which 2 11 do not exceed the rates established for providers of medical 2 12 and health services under the medical assistance program with 2 13 eligibility for an individual equal to the eligibility for 2 14 medical assistance pursuant to section 249A.3. In relation to 2 15 services provided by a provider of services under a home and 2 16 community based waiver, "affordable" means that the total 2 17 monthly cost of the home and community-based waiver services 2 18 provided do not exceed the cost for that level of care as 2 19 established by rule by the department of human services, 2 20 pursuant to chapter 17A, in consultation with the department 2 21 of elder affairs. 2 22 2. "Assisted living" means assisted living as defined in 2 23 section 231C.2. 2 24 3. "Case mix reimbursement" means a reimbursement 2 25 methodology that recognizes the acuity and need level of the 2 26 residents of a nursing facility. 2 27 4. "Long-term care alternatives" means those services 2 28 specified under the medical assistance program as home and 2 29 community-based waiver services for elder persons or adults 2 30 with disabilities, elder group homes certified under chapter 2 31 231B, assisted-living programs certified under chapter 231C, 2 32 and the PACE program. 2 33 5. "Long-term care coordinating unit" means the long-term 2 34 care coordinating unit created within the department of elder 2 35 affairs pursuant to section 231.58, or its designee. 3 1 6. "Long-term care provider" means a provider of services 3 2 through long-term care alternatives. 3 3 7. "Long-term care service development" means any of the 3 4 following: 3 5 a. The remodeling of existing space and, if necessary, the 3 6 construction of additional space required to accommodate 3 7 development of long-term care alternatives, excluding the 3 8 development of assisted-living programs or elder group home 3 9 alternatives. 3 10 b. New construction for long-term care alternatives, 3 11 excluding new construction of assisted-living programs or 3 12 elder group homes, if the long-term care coordinating unit 3 13 determines that new construction is more cost-effective than 3 14 the conversion of existing space. 3 15 8. "Nursing facility" means a licensed nursing facility as 3 16 defined in section 135C.1 or a licensed hospital as defined in 3 17 section 135B.1, a distinct part of which provides long-term 3 18 care nursing facility beds. 3 19 9. "Nursing facility conversion" means any of the 3 20 following: 3 21 a. The remodeling of nursing facility space existing on 3 22 July 1, 1999, and certified for medical assistance nursing 3 23 facility reimbursement and, if necessary, the construction of 3 24 additional space required to accommodate an assisted-living 3 25 program. 3 26 b. New construction of an assisted-living program if 3 27 existing nursing facility beds are no longer licensed and the 3 28 long-term care coordinating unit determines that new 3 29 construction is more cost-effective than the conversion of 3 30 existing space. 3 31 10. "PACE program" means a program of all-inclusive care 3 32 for the elderly established pursuant to 42 U.S.C. } 1396(u)(4) 3 33 that provides delivery of comprehensive health and social 3 34 services to seniors by integrating acute and long-term care 3 35 services, and that is operated by a public, private, 4 1 nonprofit, or proprietary entity. "Pre-PACE program" means a 4 2 PACE program in the initial start-up phase that provides the 4 3 same scope of services as a PACE program. 4 4 11. "Persons with disabilities" means individuals eighteen 4 5 years of age or older with disabilities as disability is 4 6 defined in section 225B.2. 4 7 12. "Senior" means elder as defined in section 231.4 and 4 8 as defined under the PACE program pursuant to 42 U.S.C. } 4 9 1396(u)(4). 4 10 13. "Senior living program" means the long-term care 4 11 program created in this chapter to provide for long-term care 4 12 alternatives, long-term care service development, and nursing 4 13 facility conversion. 4 14 Sec. 4. NEW SECTION. 249H.4 SENIOR LIVING TRUST FUND – 4 15 CREATED – APPROPRIATIONS. 4 16 1. A senior living trust fund is created in the state 4 17 treasury under the authority of the department of human 4 18 services. Moneys received through intergovernmental 4 19 agreements for the senior living program and moneys received 4 20 from sources, including grants, contributions, and participant 4 21 payments, shall be deposited in the fund. 4 22 2. The department of human services, upon receipt of 4 23 federal revenue on or after October 1, 1999, from public 4 24 nursing facilities participating in the medical assistance 4 25 program, shall deposit the federal revenue received in the 4 26 trust fund, less a sum of five thousand dollars as an 4 27 administration fee per participating public nursing facility. 4 28 3. Moneys deposited in the trust fund shall be used only 4 29 for the purposes of the senior living program as specified in 4 30 this chapter. 4 31 4. The trust fund shall be operated in accordance with the 4 32 guidelines of the health care financing administration of the 4 33 United States department of health and human services. The 4 34 trust fund shall be separate from the general fund of the 4 35 state and shall not be considered part of the general fund of 5 1 the state. The moneys in the trust fund shall not be 5 2 considered revenue of the state, but rather shall be funds of 5 3 the senior living program. The moneys in the trust fund are 5 4 not subject to section 8.33 and shall not be transferred, 5 5 used, obligated, appropriated, or otherwise encumbered, except 5 6 to provide for the purposes of this chapter. Notwithstanding 5 7 section 12C.7, subsection 2, interest or earnings on moneys 5 8 deposited in the trust fund shall be credited to the trust 5 9 fund. 5 10 5. The department of human services shall adopt rules 5 11 pursuant to chapter 17A to administer the trust fund and to 5 12 establish procedures for participation by public nursing 5 13 facilities in the intergovernmental transfer of funds to the 5 14 senior living trust fund. 5 15 6. The treasurer of state shall provide a quarterly report 5 16 of trust fund activities and balances to the long-term care 5 17 coordinating unit. 5 18 Sec. 5. NEW SECTION. 249H.5 ALLOCATIONS – SENIOR LIVING 5 19 TRUST FUND. 5 20 1. Moneys deposited in the senior living trust fund 5 21 created in section 249H.4 shall be used only as provided in 5 22 appropriations from the trust fund to the department of human 5 23 services and the department of elder affairs, and for 5 24 purposes, including the awarding of grants, as specified in 5 25 this chapter. 5 26 2. Moneys in the trust fund are allocated, subject to 5 27 their appropriation by the general assembly, as follows: 5 28 a. To the department of human services, a maximum of 5 29 sixty-five million dollars for the fiscal period beginning 5 30 July 1, 2000, and ending on or before June 30, 2005, to be 5 31 used for the conversion of existing nursing facility space and 5 32 development of long-term care alternatives. 5 33 b. To the department of elder affairs, an amount 5 34 necessary, annually, for expenses incurred in implementation 5 35 and administration of the long-term care alternatives programs 6 1 and for delivery of long-term care services to seniors with 6 2 low or moderate incomes. 6 3 c. To the department of human services, an amount 6 4 necessary, annually, for all of the following: 6 5 (1) Expenses incurred in implementation of the senior 6 6 living program. 6 7 (2) Expenses incurred in administration of medical 6 8 assistance home and community-based waivers and the PACE 6 9 program due to implementation of the senior living trust fund. 6 10 (3) Expenses incurred due to increased service delivery 6 11 provided under medical assistance home and community-based 6 12 waivers as a result of nursing facility conversions and long- 6 13 term care service development, for the fiscal period beginning 6 14 July 1, 2000, and ending on or before June 30, 2005. 6 15 (4) Expenses incurred in program administration related to 6 16 implementation of nursing facility case mix reimbursement 6 17 under the medical assistance program. 6 18 d. To the department of human services, an amount 6 19 necessary to provide funding for nursing facility provider 6 20 reimbursements, which supports transition to a case mix 6 21 reimbursement system. 6 22 e. To the department of human services an amount 6 23 necessary, annually, for additional expenses incurred relative 6 24 to implementation of the senior living program in assisting 6 25 home and community-based waiver consumers with rent expenses 6 26 pursuant to the state supplementary assistance program. 6 27 3. Any funds remaining after disbursement of moneys under 6 28 subsection 2 shall be invested with the interest earned to be 6 29 available in subsequent fiscal years for the purposes provided 6 30 in subsection 2, paragraph "b", and subsection 2, paragraph 6 31 "c", subparagraphs (1) and (2). 6 32 Sec. 6. NEW SECTION. 249H.6 NURSING FACILITY CONVERSION 6 33 AND LONG-TERM CARE SERVICES DEVELOPMENT GRANTS. 6 34 1. The department of human services, at the direction of 6 35 the long-term care coordinating unit, may use moneys 7 1 appropriated to the department from the senior living trust 7 2 fund to award grants to any of the following: 7 3 a. A licensed nursing facility that has been an approved 7 4 provider under the medical assistance program for the three- 7 5 year period prior to application for the grant. The grant 7 6 awarded may be used to convert all or a portion of the 7 7 licensed nursing facility to a certified assisted-living 7 8 program and may be used for capital or one-time expenditures, 7 9 including but not limited to start-up expenses, training 7 10 expenses, and operating losses for the first year of operation 7 11 following conversion associated with the nursing facility 7 12 conversion. 7 13 b. A long-term care provider or a licensed nursing 7 14 facility that has been an approved provider under the medical 7 15 assistance program for the three-year period prior to 7 16 application for the grant or a provider that will meet 7 17 applicable medical assistance provider requirements as 7 18 specified in subsection 2, paragraph "c" or "d". The grant 7 19 awarded may be used for capital or one-time expenditures, 7 20 including but not limited to start-up expenses, training 7 21 expenses, and operating losses for the first year of operation 7 22 for long-term care service development. 7 23 2. A grant shall be awarded only to an applicant who meets 7 24 all of the following criteria, as applicable to the type of 7 25 grant: 7 26 a. The applicant is a long-term care provider or a nursing 7 27 facility that is located in an area determined by the long- 7 28 term care coordinating unit to be underserved with respect to 7 29 a particular long-term care alternative service, and that has 7 30 demonstrated the ability or potential to provide quality long- 7 31 term care alternative services. 7 32 b. The applicant is able to provide a minimum matching 7 33 contribution of twenty percent of the total cost of any 7 34 conversion, remodeling, or construction. 7 35 c. The applicant is applying for a nursing facility 8 1 conversion grant and is able to demonstrate all of the 8 2 following: 8 3 (1) Conversion of the nursing facility or a distinct 8 4 portion of the nursing facility to an assisted-living program 8 5 is projected to offer efficient and economical care to 8 6 individuals requiring long-term care services in the service 8 7 area. 8 8 (2) Assisted-living services are otherwise not likely to 8 9 be available in the area for individuals eligible for services 8 10 under the medical assistance program. 8 11 (3) The resulting reduction in the availability of nursing 8 12 facility services is not projected to cause undue hardship on 8 13 those individuals requiring nursing facility services for a 8 14 period of at least ten years. 8 15 (4) Public support following a community-based assessment. 8 16 (5) Conversion of the nursing facility is projected to 8 17 result in a lower per client reimbursement cost to the grant 8 18 applicant under the medical assistance program. 8 19 d. The applicant is applying for a long-term care service 8 20 development grant and is able to demonstrate all of the 8 21 following: 8 22 (1) Long-term care service development is projected to 8 23 offer efficient and economical care to individuals requiring 8 24 long-term care services in the service area. 8 25 (2) The proposed long-term care alternative is otherwise 8 26 not likely to be available in the area for individuals 8 27 eligible for services under the medical assistance program. 8 28 (3) Public support following a community-based assessment. 8 29 e. The applicant agrees to do all of the following as 8 30 applicable to the type of grant: 8 31 (1) Participate and maintain a minimum medical assistance 8 32 client base participation rate of forty percent, subject to 8 33 the demand for participation by individuals eligible for 8 34 medical assistance. 8 35 (2) Provide a service delivery package that is affordable 9 1 for those individuals eligible for services under the medical 9 2 assistance home and community-based services waiver program. 9 3 (3) Provide a refund to the senior living trust fund, on 9 4 an amortized basis, in the amount of the grant, if the 9 5 applicant or the applicant's successor in interest ceases to 9 6 operate an affordable long-term care alternative within the 9 7 first ten-year period of operation following the awarding of 9 8 the grant or if the applicant or the applicant's successor in 9 9 interest fails to maintain a participation rate of forty 9 10 percent in accordance with subparagraph (1). 9 11 3. The department of human services shall adopt rules in 9 12 consultation with the long-term care coordinating unit, 9 13 pursuant to chapter 17A, to provide all of the following: 9 14 a. An application process and eligibility criteria for the 9 15 awarding of grants. The eligibility criteria shall include 9 16 but are not limited to the applicant's demonstration of an 9 17 affordable service package, the applicant's use of the funds 9 18 for allowable costs, and the applicant's ability to refund the 9 19 funds if required under subsection 2, paragraph "e", 9 20 subparagraph (3). The primary eligibility criterion used 9 21 shall be the applicant's potential impact on the overall goal 9 22 of moving toward a balanced, comprehensive, affordable, high- 9 23 quality, long-term care system. 9 24 b. Criteria to be utilized in determining the amount of 9 25 the grant awarded. 9 26 c. Weighted criteria to be utilized in prioritizing the 9 27 awarding of grants to individual grantees during a grant 9 28 cycle. Greater weight shall be given to the applicant's 9 29 demonstration of potential reduction of nursing facility beds, 9 30 the applicant's ability to meet demonstrated community need, 9 31 and the established history of the applicant in providing 9 32 quality long-term care services. 9 33 d. Policies and procedures for certification of the 9 34 matching funds required of applicants under subsection 2, 9 35 paragraph "b". 10 1 e. Other procedures the department of human services deems 10 2 necessary for the proper administration of this section, 10 3 including but not limited to the submission of progress 10 4 reports on a bimonthly basis to the long-term care 10 5 coordinating unit. 10 6 4. The department of human services shall establish a 10 7 calendar for receiving and evaluating applications and for 10 8 awarding of grants. 10 9 5. a. The department of human services shall develop a 10 10 cost report to be completed by a grantee which includes, but 10 11 is not limited to, revenue, costs, loans undertaken by the 10 12 grantee, fixed assets of the grantee, a balance sheet, and a 10 13 profit and loss statement. 10 14 b. Grantees shall submit, annually, completed cost reports 10 15 to the department of human services regarding the project for 10 16 a period of ten years following the date of initial operation 10 17 of the grantee's long-term care alternative. 10 18 6. The department of human services, in consultation with 10 19 the department of elder affairs, shall provide annual reports 10 20 to the governor and the general assembly concerning grants 10 21 awarded. The annual report shall include the total number of 10 22 applicants and approved applicants, an overview of the various 10 23 grants awarded, and detailed reports of the cost of each 10 24 project funded by a grant and information submitted by the 10 25 approved applicant. 10 26 7. For the purpose of this section, "underserved" means 10 27 areas in which four and four-tenths percent of the number of 10 28 individuals sixty-five years of age and older is not greater 10 29 than the number of currently licensed nursing facility bids 10 30 and certified assisted-living units. In addition, the 10 31 department, in determining if an area is underserved, may 10 32 consider additional information gathered through the 10 33 department's own research or submitted by an applicant, 10 34 including but not limited to any of the following: 10 35 a. Availability of and access to long-term care 11 1 alternatives relative to individuals eligible for medical 11 2 assistance. 11 3 b. The current number of seniors and persons with 11 4 disabilities and the projected number of these individuals. 11 5 c. The current number of seniors and persons with 11 6 disabilities requiring professional nursing care and the 11 7 projected number of these individuals. 11 8 d. The current availability of long-term care alternatives 11 9 and any known changes in the availability of such 11 10 alternatives. 11 11 8. This section does not create an entitlement to any 11 12 funds available for grants under this section, and the 11 13 department of human services may only award grants to the 11 14 extent funds are available and within its discretion, to the 11 15 extent applications are approved. 11 16 9. In addition to any other remedies provided by law, the 11 17 department of human services may recoup any grant funding 11 18 previously awarded and disbursed to a grantee or the grantee's 11 19 successor in interest and may reduce the amount of any grant 11 20 awarded, but not yet disbursed, to a grantee or the grantee's 11 21 successor in interest, by the amount of any refund owed by a 11 22 grantee or the grantee's successor in interest pursuant to 11 23 subsection 2, paragraph "e", subparagraph (3). 11 24 10. The long-term care coordinating unit shall review 11 25 projects that receive grants under this section to ensure that 11 26 the goal to provide alternatives to nursing facility care is 11 27 being met and that an adequate number of nursing facility 11 28 services remain to meet the needs of Iowans. 11 29 Sec. 7. NEW SECTION. 249H.7 HOME AND COMMUNITY-BASED 11 30 SERVICES FOR SENIORS. 11 31 1. Beginning October 1, 2000, the department of elder 11 32 affairs, in consultation with the long-term care coordinating 11 33 unit, shall use funds appropriated from the senior living 11 34 trust fund for activities related to the design, maintenance, 11 35 or expansion of home and community-based services for seniors, 12 1 including but not limited to adult day care, personal care, 12 2 respite, homemaker, chore, and transportation services 12 3 designed to promote the independence of and to delay the use 12 4 of institutional care by seniors with low and moderate 12 5 incomes. At any time that moneys are appropriated, the 12 6 department of elder affairs, in consultation with the long- 12 7 term care coordinating unit, shall disburse the funds to the 12 8 area agencies on aging. 12 9 2. The department of elder affairs shall adopt rules, in 12 10 consultation with the long-term care coordinating unit and the 12 11 area agencies on aging, pursuant to chapter 17A, to provide 12 12 all of the following: 12 13 a. (1) The criteria and process for disbursement of 12 14 funds, appropriated in accordance with subsection 1, to area 12 15 agencies on aging. 12 16 (2) The criteria shall include, at a minimum, all of the 12 17 following: 12 18 (a) A distribution formula that triple weights all of the 12 19 following: 12 20 (i) Individuals seventy-five years of age and older. 12 21 (ii) Individuals aged sixty and older who are members of a 12 22 racial minority. 12 23 (iii) Individuals sixty years of age and older who reside 12 24 in rural areas as defined in the federal Older Americans Act. 12 25 (iv) Individuals who are sixty years of age and older who 12 26 have incomes at or below the poverty level as defined in the 12 27 federal Older Americans Act. 12 28 (b) A distribution formula that single weights individuals 12 29 sixty years of age and older who do not meet the criteria 12 30 specified in subparagraph subdivision (a). 12 31 b. The criteria for long-term care providers to receive 12 32 funding as subcontractors of the area agencies on aging. 12 33 c. Other procedures the department of elder affairs deems 12 34 necessary for the proper administration of this section, 12 35 including but not limited to the submission of progress 13 1 reports, on a bimonthly basis, to the long-term care 13 2 coordinating unit. 13 3 3. This section does not create an entitlement to any 13 4 funds available for disbursement under this section and the 13 5 department of elder affairs may only disburse moneys to the 13 6 extent funds are available and, within its discretion, to the 13 7 extent requests for funding are approved. 13 8 4. Long-term care providers that receive funding under 13 9 this section shall submit annual reports to the appropriate 13 10 area agency on aging. The department of elder affairs shall 13 11 develop the report to be submitted, which shall include, but 13 12 is not limited to, units of service provided, the number of 13 13 service recipients, costs, and the number of units of service 13 14 identified as necessitated but not provided. 13 15 5. The department of elder affairs, in cooperation with 13 16 the department of human services, shall provide annual reports 13 17 to the governor and the general assembly concerning the impact 13 18 of moneys disbursed under this section on the availability of 13 19 long-term care services in Iowa. The reports shall include 13 20 the types of services funded, the outcome of those services, 13 21 and the number of individuals receiving those services. 13 22 Sec. 8. NEW SECTION. 249H.8 PACE PROGRAM. 13 23 For the purposes of this chapter, all of the following 13 24 apply to a PACE program: 13 25 1. A person operating a PACE program shall have a PACE 13 26 program agreement with the health care financing 13 27 administration of the United States department of health and 13 28 human services, shall enter a contract with the department of 13 29 human services and shall comply with 42 U.S.C. } 1396(u)(4) 13 30 and all regulations promulgated pursuant to that section. 13 31 2. Services provided under a PACE or pre-PACE program 13 32 shall be provided on a capitated basis. 13 33 3. A pre-PACE program may contract with the department of 13 34 human services to provide services to individuals eligible for 13 35 medical assistance, on a capitated basis, for a limited scope 14 1 of the PACE service package through a prepaid health plan 14 2 agreement, with the remaining services reimbursed directly to 14 3 the service providers by the medical assistance or federal 14 4 Medicare programs. 14 5 4. PACE and pre-PACE programs are not subject to 14 6 regulation under chapter 514B. 14 7 5. A PACE or pre-PACE program shall, at the time of 14 8 entering into the initial contract and of renewal of a 14 9 contract with the department of human services, demonstrate 14 10 cash reserves in an amount established by rule of the 14 11 department to cover expenses in the event of insolvency. 14 12 Sec. 9. NEW SECTION. 249H.9 SENIOR LIVING PROGRAM 14 13 INFORMATION – ELECTRONIC ACCESS – EDUCATION – ADVISORY 14 14 COUNCIL. 14 15 1. The department of elder affairs and the area agencies 14 16 on aging, in consultation with the long-term care coordinating 14 17 unit, shall create, on a county basis, a database directory of 14 18 all health care and support services available to seniors. 14 19 The department of elder affairs shall make the database 14 20 electronically available to the public, and shall update the 14 21 database on at least a monthly basis. 14 22 2. The department of elder affairs shall seek foundation 14 23 funding to develop and provide an educational program for 14 24 individuals aged twenty-one and older which assists 14 25 participants in planning for and financing health care 14 26 services and other supports in their senior years. 14 27 3. The department of human services shall develop and 14 28 distribute an informational packet to the public that 14 29 explains, in layperson terms, the law, regulations, and rules 14 30 under the medical assistance program relative to health care 14 31 services options for seniors, including but not limited to 14 32 those relating to transfer of assets, prepaid funeral 14 33 expenses, and life insurance policies. 14 34 4. The director of human services, the director of the 14 35 department of elder affairs, the director of public health, 15 1 the director of the department of inspections and appeals, the 15 2 director of revenue and finance, and the commissioner of 15 3 insurance shall constitute a senior advisory council to 15 4 provide oversight in the development and operation of all 15 5 informational aspects of the senior living program under this 15 6 section. 15 7 Sec. 10. NEW SECTION. 249H.10 CAREGIVER SUPPORT – 15 8 ACCESS AND EDUCATION PROGRAMS. 15 9 The department of human services, in cooperation with the 15 10 department of elder affairs, shall implement a caregiver 15 11 support program to provide access to respite care and to 15 12 provide education to caregivers in providing appropriate care 15 13 to seniors and persons with disabilities. The program shall 15 14 be provided through the area agencies on aging or other 15 15 appropriate agency. 15 16 Sec. 11. NEW SECTION. 249H.11 FUTURE REPEAL. 15 17 Section 249H.6 is repealed on June 30, 2005. However, 15 18 grants awarded and moneys appropriated for grants on or before 15 19 June 30, 2005, shall be disbursed to eligible applicants after 15 20 that date if necessary. 15 21 DIVISION III 15 22 MISCELLANEOUS PROVISIONS 15 23 Sec. 12. NEW SECTION. 135C.23A RESIDENT ASSESSMENT. 15 24 A nursing facility shall complete a resident assessment 15 25 prior to initial admission of a resident and periodically 15 26 during the resident's stay in the facility. The assessment 15 27 shall be completed for each prospective resident and resident 15 28 regardless of payor source. The nursing facility may utilize 15 29 the same resident assessment tool required for certification 15 30 of the facility under the medical assistance and federal 15 31 Medicare programs to comply with this section. 15 32 Sec. 13. Section 231.58, subsection 1, Code 1999, is 15 33 amended by adding the following new paragraph: 15 34 NEW PARAGRAPH. f. Four members of the general assembly, 15 35 as ex officio, nonvoting members. 16 1 Sec. 14. Section 231.58, subsection 2, Code 1999, is 16 2 amended by adding the following new paragraph: 16 3 NEW PARAGRAPH. h. Provide direction and oversight for 16 4 disbursement of moneys from the senior living trust fund 16 5 created in section 249H.4. 16 6 Sec. 15. Section 231.58, Code 1999, is amended by adding 16 7 the following new subsections: 16 8 NEW SUBSECTION. 1A. The legislative members of the unit 16 9 shall be appointed by the majority leader of the senate, after 16 10 consultation with the president of the senate and the minority 16 11 leader of the senate, and by the speaker of the house, after 16 12 consultation with the majority leader and the minority leader 16 13 of the house of representatives. 16 14 NEW SUBSECTION. 1B. Nonlegislative members shall receive 16 15 actual expenses incurred while serving in their official 16 16 capacity and may also be eligible to receive compensation as 16 17 provided in section 7E.6. Legislative members shall receive 16 18 compensation pursuant to section 2.12. 16 19 Sec. 16. Section 231C.2, subsection 1, Code 1999, is 16 20 amended to read as follows: 16 21 1. "Assisted living" means provision of housing with 16 22 services which may include but are not limited to health- 16 23 related care, personal care, and assistance with instrumental 16 24 activities of daily living to six or more tenants in a 16 25 physical structure which provides a homelike environment. 16 26 "Assisted living" also includes encouragement of family 16 27 involvement, tenant self-direction, and tenant participation 16 28 in decisions that emphasize choice, dignity, privacy, 16 29 individuality, shared risk, and independence. "Assisted 16 30 living"does not includeincludes the provision of housing and 16 31 assistance with instrumental activities of daily livingwhich16 32does not also include provision ofonly if personal care or 16 33 health-related care is also included. 16 34 Sec. 17. SENIOR LIVING INSURANCE AND INCENTIVES INTERIM 16 35 STUDY. The legislative council is requested to authorize a 17 1 senior living insurance and incentives study committee to 17 2 review current long-term care insurance laws, current long- 17 3 term care insurance options available in the state, the types 17 4 of services covered under a long-term care insurance option, 17 5 and incentives for the purchase of long-term care insurance 17 6 including, but not limited to, tax credits. The study 17 7 committee shall include input from consumers, consumer 17 8 advocates, the insurance industry, and the health care 17 9 industry. The study committee shall submit a report of 17 10 findings and recommendations to the governor and the general 17 11 assembly on or before December 15, 2000. 17 12 Sec. 18. REIMBURSEMENT METHODOLOGY – EXPENDITURES – 17 13 MEDICAL ASSISTANCE PROGRAM – REPORT. The department of human 17 14 services shall submit a report, including any changes in the 17 15 reimbursement methodology used under the medical assistance 17 16 program and any expenditures for the development of 17 17 alternatives to health care facility care, including assisted 17 18 living and elder group homes, to the governor and the general 17 19 assembly on or before December 15, 2000. To the extent 17 20 possible, any change in the reimbursement methodology shall 17 21 provide for maintenance of the eighty percent occupancy rate 17 22 except as this requirement relates to direct care costs, shall 17 23 avoid rate reductions for nursing facilities, and shall 17 24 utilize the payment methods provided under the federal 17 25 Medicare program in order to simplify the multitude of payor 17 26 programs. 17 27 Sec. 19. RESIDENTIAL CARE FACILITIES – APPLICATION OF 17 28 PROGRAM. The department of human services shall review and 17 29 shall make recommendations to the general assembly on or 17 30 before October 1, 2000, relating to the feasibility of 17 31 applying the senior living program and any changes in the 17 32 reimbursement methodology to residential care facilities. 17 33 Sec. 20. MAINTENANCE OF FISCAL EFFORT. The fiscal effort, 17 34 existing on June 30, 2000, represented by appropriations made 17 35 for long-term care services by the general assembly, shall be 18 1 maintained and a reduction shall not be made in such 18 2 appropriations to the department of human services or the 18 3 department of elder affairs for those services as a result of 18 4 this Act. 18 5 Sec. 21. DEPARTMENT OF ELDER AFFAIRS APPROPRIATION. There 18 6 is appropriated from the senior living trust fund created in 18 7 section 249H.4 in this Act to the department of elder affairs 18 8 for the fiscal year beginning July 1, 2000, and ending June 18 9 30, 2001, the following amount, or so much thereof as is 18 10 necessary, to be used for the purposes designated: 18 11 For the development of a comprehensive senior living 18 12 program, including program administration and costs associated 18 13 with implementation, salaries, support, maintenance, 18 14 miscellaneous purposes, and for not more than the following 18 15 full-time equivalent positions: 18 16 .................................................. $ 4,188,123 18 17 ............................................... FTEs 7.00 18 18 The department of elder affairs may adopt emergency rules 18 19 to carry out the provisions of this section. 18 20 Sec. 22. DEPARTMENT OF HUMAN SERVICES APPROPRIATION. 18 21 There is appropriated from the senior living trust fund 18 22 created in section 249H.4 in this Act to the department of 18 23 human services for the fiscal year beginning July 1, 2000, and 18 24 ending June 30, 2001, the following amounts, or so much 18 25 thereof as is necessary, to be used for the purposes 18 26 designated: 18 27 1. To provide grants to nursing facilities for conversion 18 28 to assisted living programs or to provide long-term care 18 29 alternatives and to provide grants to long-term care providers 18 30 for development of long-term care alternatives: 18 31 .................................................. $ 15,000,000 18 32 2. To supplement the medical assistance appropriation and 18 33 to provide reimbursement for health care services and rent 18 34 expenses to eligible persons through the home and community- 18 35 based services waiver and the state supplementary assistance 19 1 program, including program administration and data system 19 2 costs associated with implementation, salaries, support, 19 3 maintenance, miscellaneous purposes, and for not more than the 19 4 following full-time equivalent positions: 19 5 .................................................. $ 2,189,569 19 6 ............................................... FTEs 5.00 19 7 3. To implement nursing facility provider reimbursement 19 8 increases or reimbursement methodology changes: 19 9 .................................................. $ 17,750,000 19 10 The department shall transfer these funds to supplement 19 11 other appropriations to the department of human services to 19 12 carry out the purposes of this subsection. 19 13 Sec. 23. EMERGENCY RULES. 19 14 1. The department of human services and the department of 19 15 elder affairs may adopt emergency rules to implement this Act. 19 16 2. If the department of human services or the department 19 17 of elder affairs adopts emergency rules under section 17A.4, 19 18 subsection 2, and section 17A.5, subsection 2, paragraph "b", 19 19 to implement this Act, the rules shall become effective 19 20 immediately upon filing, unless a later effective date is 19 21 specified in the rules. Any rules adopted in accordance with 19 22 the provisions of this section shall also be published as 19 23 notice of intended action as provided in section 17A.4. 19 24 Sec. 24. EFFECTIVE DATE. This Act, being deemed of 19 25 immediate importance, takes effect upon enactment. 19 26 Sec. 25. RETROACTIVE APPLICABILITY. The section in this 19 27 Act that creates section 269H.4 as it relates to receipt of 19 28 federal funding, is retroactively applicable to October 1, 19 29 1999. 19 30 EXPLANATION 19 31 This bill creates a new Code chapter 249H. Division I, 19 32 Code section 249H.1, establishes the "Iowa Senior Living 19 33 Program Act". 19 34 Division I, Code section 249H.2, provides the legislative 19 35 findings related to and the goal of the program. The goal of 20 1 the program is to create a comprehensive long-term care system 20 2 that is consumer-directed, provides balance between the 20 3 options of institutional and noninstitutional care, and 20 4 contributes to the quality of life. 20 5 Division II, Code section 249H.3, provides definitions used 20 6 in the chapter. 20 7 Division II, Code section 249H.4, creates the senior living 20 8 trust fund and provides for ongoing appropriations from the 20 9 trust fund. The trust fund is created in the state treasury 20 10 under the authority of the department of human services. 20 11 Moneys deposited in the fund include those received through 20 12 intergovernmental agreements for the senior living program, 20 13 grants, contributions, participant payments, and a portion of 20 14 the federal moneys received by the department of human 20 15 services from public nursing facilities. Moneys in the fund 20 16 are to be appropriated only for the purposes of the senior 20 17 living program. The trust fund is to be operated in 20 18 accordance with the guidelines of the health care financing 20 19 administration of the United States department of health and 20 20 human services. Moneys in the fund are not considered part of 20 21 the general fund of the state. Moneys in the fund at the end 20 22 of a fiscal year do not revert to the state general fund and 20 23 cannot be transferred, used, obligated, appropriated, or 20 24 otherwise encumbered, except for purposes of the senior living 20 25 program. Interest or earnings on moneys in the trust fund are 20 26 credited to the trust fund. The department of human services 20 27 is directed to adopt rules to administer the trust fund and to 20 28 establish participation in the program for public nursing 20 29 facilities. The treasurer of state is directed to provide a 20 30 quarterly report of the trust fund activities and balances to 20 31 the long-term care coordinating unit. 20 32 Division II, Code section 249H.5, provides for allocations 20 33 from the trust fund. Allocations include: 20 34 1. An allocation to the department of human services of a 20 35 maximum of $65 million over a maximum five-year period to be 21 1 used for the conversion of existing nursing facility space and 21 2 development of long-term care alternatives. 21 3 2. An allocation to the department of elder affairs, 21 4 annually, in an amount necessary to cover expenses of 21 5 implementation and administration of long-term care services 21 6 programs and for delivery of long-term care services to low 21 7 and moderate income seniors. 21 8 3. An allocation to the department of human services, 21 9 annually, for administrative purposes and service delivery 21 10 related to the senior living program and trust fund and for 21 11 implementation of a new reimbursement system. 21 12 4. An allocation to the department of human services, in 21 13 an amount necessary to provide nursing facility provider 21 14 reimbursements which supports a case mix reimbursement system. 21 15 5. An allocation to the department of human services, 21 16 annually, for additional expenses, relative to the senior 21 17 living program, that are incurred due to rent expenses of 21 18 consumers participating in a home and community-based waiver 21 19 program under the state supplementary assistance program. 21 20 The remainder of the funds is to be invested with the 21 21 interest and earnings to be used for administration of 21 22 programs and delivery of long-term care services and for 21 23 expenses related to implementation of the senior living 21 24 program and administration of the trust fund. 21 25 Division II, Code section 249H.6, provides the procedures 21 26 and criteria for the awarding of grants for conversion of 21 27 nursing facilities to provide assisted-living programs and for 21 28 long-term care services development. The section provides 21 29 that the section does not create an entitlement to any funds 21 30 available for grant purposes, but that the department of human 21 31 services, in its discretion, may only award grants to the 21 32 extent funds are available and applications are approved. 21 33 Division II, Code section 249H.7, provides for 21 34 appropriation of funds beginning October 1, 2000, to the 21 35 department of elder affairs for activities related to home and 22 1 community-based services for seniors. Moneys appropriated to 22 2 the department of elder affairs are to be disbursed through 22 3 the area agencies on aging. The section provides that the 22 4 section does not create an entitlement, but that the 22 5 department of elder affairs, in its discretion, may only 22 6 disburse funds to the extent funds are available and requests 22 7 for funding are approved. 22 8 Division II, Code section 249H.8, describes provisions 22 9 relating to the PACE program and the pre-PACE program, which 22 10 is defined in the bill as a program that provides delivery of 22 11 comprehensive health and social services to seniors by 22 12 integrating acute and long-term care services, and is operated 22 13 by an entity as permitted under federal regulation. A pre- 22 14 PACE program is defined as a PACE program in its initial 22 15 stages that provides the same scope of services as a PACE 22 16 program. 22 17 Division II, Code section 249H.9, directs the department of 22 18 elder affairs and the area agencies on aging, in consultation 22 19 with the long-term care coordinating unit, to create a 22 20 database directory of all health care and support services 22 21 available, to seniors. The database is to be made available, 22 22 electronically, to the public. The bill directs the 22 23 department of elder affairs to seek foundation funding to 22 24 provide an educational program to individuals ages 21 and 22 25 older to assist them in planning for financing health care 22 26 services and other supports in their senior years. The bill 22 27 also directs the department of human services to develop and 22 28 distribute an informational packet to the public that explains 22 29 the medical assistance program relative to health care 22 30 services options for seniors. The bill provides that the 22 31 director of human services, director of the department of 22 32 elder affairs, director of public health, director of the 22 33 department of inspections and appeals, the director of revenue 22 34 and finance, and the commissioner of insurance are to 22 35 constitute a senior advisory council to provide oversight in 23 1 the development and operation of all informational aspects of 23 2 the senior living program. 23 3 Division II, Code section 249H.10, provides for the 23 4 establishment of a caregiver support access and education 23 5 program to provide access to respite care and education to 23 6 caregivers, through the area agencies on aging. 23 7 Division II, Code section 249H.11, provides a sunset 23 8 provision for new Code section 249H.6, which is the section 23 9 that provides grants for nursing facility conversion and long- 23 10 term care services development. Under the bill, Code section 23 11 249H.6 would be repealed effective June 30, 2005. 23 12 Division III of the bill provides miscellaneous provisions. 23 13 Division III of the bill adds a provision to the health 23 14 care facilities chapter which requires, regardless of the 23 15 individual's source of payment for care, nursing facilities to 23 16 complete a resident assessment for all prospective and current 23 17 residents. 23 18 Division III of the bill adds four members of the general 23 19 assembly to the membership of the long-term care coordinating 23 20 unit as ex officio, nonvoting members. 23 21 Division III of the bill also provides for a conforming 23 22 change in the Code to include the duty of the provision of 23 23 direction and oversight for disbursement of moneys from the 23 24 trust fund in the duties of the long-term care coordinating 23 25 unit. 23 26 Division III of the bill requests that the legislative 23 27 council authorize a senior living insurance and incentives 23 28 study committee to review current long-term care insurance 23 29 laws, current long-term care insurance options available in 23 30 the state, the types of services covered under a long-term 23 31 care insurance option, and incentives for the purchase of 23 32 long-term care insurance including, but not limited to, tax 23 33 credits. The study committee is to include input from 23 34 consumers, consumer advocates, the health care industry, and 23 35 the insurance industry. The study committee is directed to 24 1 submit a report of the findings and recommendations to the 24 2 governor and the general assembly by December 15, 2000. 24 3 Division III of the bill directs the department of human 24 4 services to submit a report including any changes in the 24 5 reimbursement methodology under the medical assistance program 24 6 and any expenditures for the development of alternatives to 24 7 health care facility care to the general assembly by December 24 8 15, 2000. The bill provides that, to the extent possible, any 24 9 changes in the reimbursement methodology are to provide for 24 10 maintenance of the 80 percent occupancy rate, except as the 24 11 requirement relates to direct-care costs, shall avoid rate 24 12 reductions for nursing facilities, and shall utilize the 24 13 payment methods provided under the federal Medicare program in 24 14 order to simplify the multitude of payor programs. 24 15 Division III of the bill directs the department of human 24 16 services to review and make recommendations to the general 24 17 assembly on or before October 1, 2000, regarding the 24 18 feasibility of applying the senior living program to 24 19 residential care facilities and in applying any reimbursement 24 20 methodology changes to these facilities. 24 21 Division III of the bill establishes that the general 24 22 assembly is to maintain the fiscal effort in funding long-term 24 23 care services, existing on June 30, 2000, and is not to make 24 24 reductions in appropriations for this purpose as a result of 24 25 the bill. 24 26 Division III of the bill provides for fiscal year 2000-2001 24 27 appropriations to the department of human services and the 24 28 department of elder affairs relating to the senior living 24 29 program. 24 30 Division III of the bill provides for emergency rulemaking 24 31 authority for the department of human services and the 24 32 department of elder affairs in implementing the bill. 24 33 The bill takes effect upon enactment. The section of the 24 34 bill relating to the receipt of federal funds on or after 24 35 October 1, 1999, is retroactively applicable to October 1, 25 1 1999. 25 2 LSB 5616YH 78 25 3 pf/cf/24.2
Text: HF02275 Text: HF02277 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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