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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 provider" means a provider of services 2 34 through long-term care alternatives. 2 35 6. "Long-term care service development" means any of the 3 1 following: 3 2 a. The remodeling of existing space and, if necessary, the 3 3 construction of additional space required to accommodate 3 4 development of long-term care alternatives, excluding the 3 5 development of assisted-living programs or elder group home 3 6 alternatives. 3 7 b. New construction for long-term care alternatives, 3 8 excluding new construction of assisted-living programs or 3 9 elder group homes, if the senior living coordinating unit 3 10 determines that new construction is more cost-effective than 3 11 the conversion of existing space. 3 12 7. "Nursing facility" means a licensed nursing facility as 3 13 defined in section 135C.1 or a licensed hospital as defined in 3 14 section 135B.1, a distinct part of which provides long-term 3 15 care nursing facility beds. 3 16 8. "Nursing facility conversion" means any of the 3 17 following: 3 18 a. The remodeling of nursing facility space existing on 3 19 July 1, 1999, and certified for medical assistance nursing 3 20 facility reimbursement and, if necessary, the construction of 3 21 additional space required to accommodate an assisted-living 3 22 program. 3 23 b. New construction of an assisted-living program if 3 24 existing nursing facility beds are no longer licensed and the 3 25 senior living coordinating unit determines that new 3 26 construction is more cost-effective than the conversion of 3 27 existing space. 3 28 9. "PACE program" means a program of all-inclusive care 3 29 for the elderly established pursuant to 42 U.S.C. } 3 30 1396(u)(4) that provides delivery of comprehensive health and 3 31 social services to seniors by integrating acute and long-term 3 32 care services, and that is operated by a public, private, 3 33 nonprofit, or proprietary entity. "Pre-PACE program" means a 3 34 PACE program in the initial start-up phase that provides the 3 35 same scope of services as a PACE program. 4 1 10. "Persons with disabilities" means individuals eighteen 4 2 years of age or older with disabilities as disability is 4 3 defined in section 225B.2. 4 4 11. "Senior" means elder as defined in section 231.4 and 4 5 as defined under the PACE program pursuant to 42 U.S.C. } 4 6 1396(u)(4). 4 7 12. "Senior living coordinating unit" means the senior 4 8 living coordinating unit created within the department of 4 9 elder affairs pursuant to section 231.58, or its designee. 4 10 13. "Senior living program" means the senior living 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 senior living 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 eighty million dollars for the fiscal period beginning July 1, 5 30 2000, and ending on or before June 30, 2005, to be used for 5 31 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, using the percentile-based reimbursement 6 21 system, and to provide funding for the transition to a case- 6 22 mix reimbursement system. Funding shall be provided under 6 23 this section for the percentile-based reimbursement system, 6 24 until such time as the case-mix reimbursement system is fully 6 25 implemented. 6 26 e. To the department of human services an amount 6 27 necessary, annually, for additional expenses incurred relative 6 28 to implementation of the senior living program in assisting 6 29 home and community-based waiver consumers with rent expenses 6 30 pursuant to the state supplementary assistance program. 6 31 3. Any funds remaining after disbursement of moneys under 6 32 subsection 2 shall be invested with the interest earned to be 6 33 available in subsequent fiscal years for the purposes provided 6 34 in subsection 2, paragraph "b", and subsection 2, paragraph 6 35 "c", subparagraphs (1) and (2). 7 1 Sec. 6. NEW SECTION. 249H.6 NURSING FACILITY CONVERSION 7 2 AND LONG-TERM CARE SERVICES DEVELOPMENT GRANTS. 7 3 1. The department of human services, at the direction of 7 4 the senior living coordinating unit, may use moneys 7 5 appropriated to the department from the senior living trust 7 6 fund to award grants to any of the following: 7 7 a. A licensed nursing facility that has been an approved 7 8 provider under the medical assistance program for the three- 7 9 year period prior to application for the grant. The grant 7 10 awarded may be used to convert all or a portion of the 7 11 licensed nursing facility to a certified assisted-living 7 12 program and may be used for capital or one-time expenditures, 7 13 including but not limited to start-up expenses, training 7 14 expenses, and operating losses for the first year of operation 7 15 following conversion associated with the nursing facility 7 16 conversion. 7 17 b. A long-term care provider or a licensed nursing 7 18 facility that has been an approved provider under the medical 7 19 assistance program for the three-year period prior to 7 20 application for the grant or a provider that will meet 7 21 applicable medical assistance provider requirements as 7 22 specified in subsection 2, paragraph "c" or "d". The grant 7 23 awarded may be used for capital or one-time expenditures, 7 24 including but not limited to start-up expenses, training 7 25 expenses, and operating losses for the first year of operation 7 26 for long-term care service development. 7 27 2. A grant shall be awarded only to an applicant who meets 7 28 all of the following criteria, as applicable to the type of 7 29 grant: 7 30 a. The applicant is a long-term care provider or a nursing 7 31 facility that is located in an area determined by the senior 7 32 living coordinating unit to be underserved with respect to a 7 33 particular long-term care alternative service, and that has 7 34 demonstrated the ability or potential to provide quality long- 7 35 term care alternative services. 8 1 b. The applicant is able to provide a minimum matching 8 2 contribution of twenty percent of the total cost of any 8 3 conversion, remodeling, or construction. 8 4 c. The applicant is applying for a nursing facility 8 5 conversion grant and is able to demonstrate all of the 8 6 following: 8 7 (1) Conversion of the nursing facility or a distinct 8 8 portion of the nursing facility to an assisted-living program 8 9 is projected to offer efficient and economical care to 8 10 individuals requiring long-term care services in the service 8 11 area. 8 12 (2) Assisted-living services are otherwise not likely to 8 13 be available in the area for individuals eligible for services 8 14 under the medical assistance program. 8 15 (3) The resulting reduction in the availability of nursing 8 16 facility services is not projected to cause undue hardship on 8 17 those individuals requiring nursing facility services for a 8 18 period of at least ten years. 8 19 (4) Public support following a community-based assessment. 8 20 (5) Conversion of the nursing facility is projected to 8 21 result in a lower per client reimbursement cost to the grant 8 22 applicant under the medical assistance program. 8 23 d. The applicant is applying for a long-term care service 8 24 development grant and is able to demonstrate all of the 8 25 following: 8 26 (1) Long-term care service development is projected to 8 27 offer efficient and economical care to individuals requiring 8 28 long-term care services in the service area. 8 29 (2) The proposed long-term care alternative is otherwise 8 30 not likely to be available in the area for individuals 8 31 eligible for services under the medical assistance program. 8 32 (3) Public support following a community-based assessment. 8 33 e. The applicant agrees to do all of the following as 8 34 applicable to the type of grant: 8 35 (1) Participate and maintain a minimum medical assistance 9 1 client base participation rate of forty percent, subject to 9 2 the demand for participation by individuals eligible for 9 3 medical assistance. 9 4 (2) Provide a service delivery package that is affordable 9 5 for those individuals eligible for services under the medical 9 6 assistance home and community-based services waiver program. 9 7 (3) Provide a refund to the senior living trust fund, on 9 8 an amortized basis, in the amount of the grant, if the 9 9 applicant or the applicant's successor in interest ceases to 9 10 operate an affordable long-term care alternative within the 9 11 first ten-year period of operation following the awarding of 9 12 the grant or if the applicant or the applicant's successor in 9 13 interest fails to maintain a participation rate of forty 9 14 percent in accordance with subparagraph (1). 9 15 3. The department of human services shall adopt rules in 9 16 consultation with the senior living coordinating unit, 9 17 pursuant to chapter 17A, to provide all of the following: 9 18 a. An application process and eligibility criteria for the 9 19 awarding of grants. The eligibility criteria shall include 9 20 but are not limited to the applicant's demonstration of an 9 21 affordable service package, the applicant's use of the funds 9 22 for allowable costs, and the applicant's ability to refund the 9 23 funds if required under subsection 2, paragraph "e", 9 24 subparagraph (3). The primary eligibility criterion used 9 25 shall be the applicant's potential impact on the overall goal 9 26 of moving toward a balanced, comprehensive, affordable, high- 9 27 quality, long-term care system. 9 28 b. Criteria to be utilized in determining the amount of 9 29 the grant awarded. 9 30 c. Weighted criteria to be utilized in prioritizing the 9 31 awarding of grants to individual grantees during a grant 9 32 cycle. Greater weight shall be given to the applicant's 9 33 demonstration of potential reduction of nursing facility beds, 9 34 the applicant's ability to meet demonstrated community need, 9 35 and the established history of the applicant in providing 10 1 quality long-term care services. 10 2 d. Policies and procedures for certification of the 10 3 matching funds required of applicants under subsection 2, 10 4 paragraph "b". 10 5 e. Other procedures the department of human services deems 10 6 necessary for the proper administration of this section, 10 7 including but not limited to the submission of progress 10 8 reports on a bimonthly basis to the senior living coordinating 10 9 unit. 10 10 4. The department of human services shall adopt rules to 10 11 ensure that a nursing facility that receives a nursing 10 12 facility conversion grant allocates costs in an equitable 10 13 manner. 10 14 5. In addition to the types of grants described in 10 15 subsection 1, the department of human services, at the 10 16 direction of the senior living coordinating unit, may also use 10 17 moneys appropriated to the department from the senior living 10 18 trust fund to award grants, of not more than one hundred 10 19 thousand dollars per grant, to licensed nursing facilities 10 20 that are awarded nursing facility conversion grants and agree, 10 21 as part of the nursing facility conversion, to also provide 10 22 adult day care, child care for children with special needs, 10 23 safe shelter for victims of dependent adult abuse, or respite 10 24 care. 10 25 6. The department of human services shall establish a 10 26 calendar for receiving and evaluating applications and for 10 27 awarding of grants. 10 28 7. a. The department of human services shall develop a 10 29 cost report to be completed by a grantee which includes, but 10 30 is not limited to, revenue, costs, loans undertaken by the 10 31 grantee, fixed assets of the grantee, a balance sheet, and a 10 32 profit and loss statement. 10 33 b. Grantees shall submit, annually, completed cost reports 10 34 to the department of human services regarding the project for 10 35 a period of ten years following the date of initial operation 11 1 of the grantee's long-term care alternative. 11 2 8. The department of human services, in consultation with 11 3 the department of elder affairs, shall provide annual reports 11 4 to the governor and the general assembly concerning grants 11 5 awarded. The annual report shall include the total number of 11 6 applicants and approved applicants, an overview of the various 11 7 grants awarded, and detailed reports of the cost of each 11 8 project funded by a grant and information submitted by the 11 9 approved applicant. 11 10 9. For the purpose of this section, "underserved" means 11 11 areas in which four and four-tenths percent of the number of 11 12 individuals sixty-five years of age and older is not greater 11 13 than the number of currently licensed nursing facility beds 11 14 and certified assisted-living units. In addition, the 11 15 department, in determining if an area is underserved, may 11 16 consider additional information gathered through the 11 17 department's own research or submitted by an applicant, 11 18 including but not limited to any of the following: 11 19 a. Availability of and access to long-term care 11 20 alternatives relative to individuals eligible for medical 11 21 assistance. 11 22 b. The current number of seniors and persons with 11 23 disabilities and the projected number of these individuals. 11 24 c. The current number of seniors and persons with 11 25 disabilities requiring professional nursing care and the 11 26 projected number of these individuals. 11 27 d. The current availability of long-term care alternatives 11 28 and any known changes in the availability of such 11 29 alternatives. 11 30 10. This section does not create an entitlement to any 11 31 funds available for grants under this section, and the 11 32 department of human services may only award grants to the 11 33 extent funds are available and within its discretion, to the 11 34 extent applications are approved. 11 35 11. In addition to any other remedies provided by law, the 12 1 department of human services may recoup any grant funding 12 2 previously awarded and disbursed to a grantee or the grantee's 12 3 successor in interest and may reduce the amount of any grant 12 4 awarded, but not yet disbursed, to a grantee or the grantee's 12 5 successor in interest, by the amount of any refund owed by a 12 6 grantee or the grantee's successor in interest pursuant to 12 7 subsection 2, paragraph "e", subparagraph (3). 12 8 12. The senior living coordinating unit shall review 12 9 projects that receive grants under this section to ensure that 12 10 the goal to provide alternatives to nursing facility care is 12 11 being met and that an adequate number of nursing facility 12 12 services remain to meet the needs of Iowans. 12 13 Sec. 7. NEW SECTION. 249H.7 HOME AND COMMUNITY-BASED 12 14 SERVICES FOR SENIORS. 12 15 1. Beginning October 1, 2000, the department of elder 12 16 affairs, in consultation with the senior living coordinating 12 17 unit, shall use funds appropriated from the senior living 12 18 trust fund for activities related to the design, maintenance, 12 19 or expansion of home and community-based services for seniors, 12 20 including but not limited to adult day care, personal care, 12 21 respite, homemaker, chore, and transportation services 12 22 designed to promote the independence of and to delay the use 12 23 of institutional care by seniors with low and moderate 12 24 incomes. At any time that moneys are appropriated, the 12 25 department of elder affairs, in consultation with the senior 12 26 living coordinating unit, shall disburse the funds to the area 12 27 agencies on aging. 12 28 2. The department of elder affairs shall adopt rules, in 12 29 consultation with the senior living coordinating unit and the 12 30 area agencies on aging, pursuant to chapter 17A, to provide 12 31 all of the following: 12 32 a. (1) The criteria and process for disbursement of 12 33 funds, appropriated in accordance with subsection 1, to area 12 34 agencies on aging. 12 35 (2) The criteria shall include, at a minimum, all of the 13 1 following: 13 2 (a) A distribution formula that triple weights all of the 13 3 following: 13 4 (i) Individuals seventy-five years of age and older. 13 5 (ii) Individuals aged sixty and older who are members of a 13 6 racial minority. 13 7 (iii) Individuals sixty years of age and older who reside 13 8 in rural areas as defined in the federal Older Americans Act. 13 9 (iv) Individuals who are sixty years of age and older who 13 10 have incomes at or below the poverty level as defined in the 13 11 federal Older Americans Act. 13 12 (b) A distribution formula that single weights individuals 13 13 sixty years of age and older who do not meet the criteria 13 14 specified in subparagraph subdivision (a). 13 15 b. The criteria for long-term care providers to receive 13 16 funding as subcontractors of the area agencies on aging. 13 17 c. Other procedures the department of elder affairs deems 13 18 necessary for the proper administration of this section, 13 19 including but not limited to the submission of progress 13 20 reports, on a bimonthly basis, to the senior living 13 21 coordinating unit. 13 22 3. This section does not create an entitlement to any 13 23 funds available for disbursement under this section and the 13 24 department of elder affairs may only disburse moneys to the 13 25 extent funds are available and, within its discretion, to the 13 26 extent requests for funding are approved. 13 27 4. Long-term care providers that receive funding under 13 28 this section shall submit annual reports to the appropriate 13 29 area agency on aging. The department of elder affairs shall 13 30 develop the report to be submitted, which shall include, but 13 31 is not limited to, units of service provided, the number of 13 32 service recipients, costs, and the number of units of service 13 33 identified as necessitated but not provided. 13 34 5. The department of elder affairs, in cooperation with 13 35 the department of human services, shall provide annual reports 14 1 to the governor and the general assembly concerning the impact 14 2 of moneys disbursed under this section on the availability of 14 3 long-term care services in Iowa. The reports shall include 14 4 the types of services funded, the outcome of those services, 14 5 and the number of individuals receiving those services. 14 6 Sec. 8. NEW SECTION. 249H.8 PACE PROGRAM. 14 7 For the purposes of this chapter, all of the following 14 8 apply to a PACE program: 14 9 1. A person operating a PACE program shall have a PACE 14 10 program agreement with the health care financing 14 11 administration of the United States department of health and 14 12 human services, shall enter a contract with the department of 14 13 human services and shall comply with 42 U.S.C. } 1396(u)(4) 14 14 and all regulations promulgated pursuant to that section. 14 15 2. Services provided under a PACE or pre-PACE program 14 16 shall be provided on a capitated basis. 14 17 3. A pre-PACE program may contract with the department of 14 18 human services to provide services to individuals eligible for 14 19 medical assistance, on a capitated basis, for a limited scope 14 20 of the PACE service package through a prepaid health plan 14 21 agreement, with the remaining services reimbursed directly to 14 22 the service providers by the medical assistance or federal 14 23 Medicare programs. 14 24 4. PACE and pre-PACE programs are not subject to 14 25 regulation under chapter 514B. 14 26 5. A PACE or pre-PACE program shall, at the time of 14 27 entering into the initial contract and of renewal of a 14 28 contract with the department of human services, demonstrate 14 29 cash reserves in an amount established by rule of the 14 30 department to cover expenses in the event of insolvency. 14 31 Sec. 9. NEW SECTION. 249H.9 SENIOR LIVING PROGRAM 14 32 INFORMATION – ELECTRONIC ACCESS – EDUCATION – ADVISORY 14 33 COUNCIL. 14 34 1. The department of elder affairs and the area agencies 14 35 on aging, in consultation with the senior living coordinating 15 1 unit, shall create, on a county basis, a database directory of 15 2 all health care and support services available to seniors. 15 3 The department of elder affairs shall make the database 15 4 electronically available to the public, and shall update the 15 5 database on at least a monthly basis. 15 6 2. The department of elder affairs shall seek foundation 15 7 funding to develop and provide an educational program for 15 8 individuals aged twenty-one and older which assists 15 9 participants in planning for and financing health care 15 10 services and other supports in their senior years. 15 11 3. The department of human services shall develop and 15 12 distribute an informational packet to the public that 15 13 explains, in layperson terms, the law, regulations, and rules 15 14 under the medical assistance program relative to health care 15 15 services options for seniors, including but not limited to 15 16 those relating to transfer of assets, prepaid funeral 15 17 expenses, and life insurance policies. 15 18 4. The director of human services, the director of the 15 19 department of elder affairs, the director of public health, 15 20 the director of the department of inspections and appeals, the 15 21 director of revenue and finance, and the commissioner of 15 22 insurance shall constitute a senior advisory council to 15 23 provide oversight in the development and operation of all 15 24 informational aspects of the senior living program under this 15 25 section. 15 26 Sec. 10. NEW SECTION. 249H.10 CAREGIVER SUPPORT – 15 27 ACCESS AND EDUCATION PROGRAMS. 15 28 The department of human services and the department of 15 29 elder affairs, in consultation with the senior living 15 30 coordinating unit, shall implement a caregiver support program 15 31 to provide access to respite care and to provide education to 15 32 caregivers in providing appropriate care to seniors and 15 33 persons with disabilities. The program shall be provided 15 34 through the area agencies on aging or other appropriate 15 35 agencies. 16 1 Sec. 11. NEW SECTION. 249H.11 FUTURE REPEAL. 16 2 Section 249H.6 is repealed on June 30, 2005. However, 16 3 grants awarded and moneys appropriated for grants on or before 16 4 June 30, 2005, shall be disbursed to eligible applicants after 16 5 that date if necessary. 16 6 DIVISION III 16 7 MISCELLANEOUS PROVISIONS 16 8 Sec. 12. NEW SECTION. 135C.23A RESIDENT ASSESSMENT. 16 9 A nursing facility shall complete a resident assessment 16 10 prior to initial admission of a resident and periodically 16 11 during the resident's stay in the facility. The assessment 16 12 shall be completed for each prospective resident and current 16 13 resident regardless of payor source. The nursing facility may 16 14 utilize the same resident assessment tool required for 16 15 certification of the facility under the medical assistance and 16 16 federal Medicare programs to comply with this section. 16 17 Sec. 13. Section 231.58, Code 1999, is amended to read as 16 18 follows: 16 19 231.58LONG-TERM CARESENIOR LIVING COORDINATING UNIT. 16 20 1. Along-term caresenior living coordinating unit is 16 21 created within the department of elder affairs. The 16 22 membership of the coordinating unit consists of: 16 23 a. The director of human services. 16 24 b. The director of the department of elder affairs. 16 25 c. The director of public health. 16 26 d. The director of the department of inspections and 16 27 appeals. 16 28 e. Two members appointed by the governor. 16 29 f. Four members of the general assembly, as ex officio, 16 30 nonvoting members. 16 31 2. The legislative members of the unit shall be appointed 16 32 by the majority leader of the senate, after consultation with 16 33 the president of the senate and the minority leader of the 16 34 senate, and by the speaker of the house, after consultation 16 35 with the majority leader and the minority leader of the house 17 1 of representatives. 17 2 3. Nonlegislative members shall receive actual expenses 17 3 incurred while serving in their official capacity and may also 17 4 be eligible to receive compensation as provided in section 17 5 7E.6. Legislative members shall receive compensation pursuant 17 6 to section 2.12. 17 72.4. Thelong-term caresenior living coordinating unit 17 8 shall: 17 9 a. Develop, for legislative review, the mechanisms and 17 10 procedures necessary to implement, utilizing current 17 11 personnel, a case-managed system of long-term care based on a 17 12 uniform comprehensive assessment tool. 17 13 b. Develop common intake and release procedures for the 17 14 purpose of determining eligibility at one point of intake and 17 15 determining eligibility for programs administered by the 17 16 departments of human services, public health, and elder 17 17 affairs, such as the medical assistance program, federal food 17 18 stamp program, and homemaker-home health aide programs. 17 19 c. Develop common definitions for long-term care services. 17 20 d. Develop procedures for coordination at the local and 17 21 state level among the providers of long-term care, including 17 22 when possible co-campusing of services. The director of the 17 23 department of general services shall give particular attention 17 24 to this section when arranging for office space pursuant to 17 25 section 18.12 for these three departments. 17 26 e. Prepare a long-range plan for the provision of long- 17 27 term care services within the state. 17 28 f. Propose rules and procedures for the development of a 17 29 comprehensive long-term care and community-based services 17 30 program. 17 31 g. Submit a report of its activities to the governor and 17 32 general assembly on January 15 of each year. 17 33 h. Provide direction and oversight for disbursement of 17 34 moneys from the senior living trust fund created in section 17 35 249H.4. 18 1 i. Consult with the state universities and other 18 2 institutions with expertise in the area of senior issues and 18 3 long-term care. 18 4 Sec. 14. Section 231C.2, subsection 1, Code 1999, is 18 5 amended to read as follows: 18 6 1. "Assisted living" means provision of housing with 18 7 services which may include but are not limited to health- 18 8 related care, personal care, and assistance with instrumental 18 9 activities of daily living to six or more tenants in a 18 10 physical structure which provides a homelike environment. 18 11 "Assisted living" also includes encouragement of family 18 12 involvement, tenant self-direction, and tenant participation 18 13 in decisions that emphasize choice, dignity, privacy, 18 14 individuality, shared risk, and independence. "Assisted 18 15 living"does not includeincludes the provision of housing and 18 16 assistance with instrumental activities of daily livingwhich18 17does not also include provision ofonly if personal care or 18 18 health-related care is also included. 18 19 Sec. 15. SENIOR LIVING INSURANCE AND INCENTIVES INTERIM 18 20 STUDY. The legislative council is requested to authorize a 18 21 senior living insurance and incentives study committee to 18 22 review current long-term care insurance laws, current long- 18 23 term care insurance options available in the state, the types 18 24 of services covered under a long-term care insurance option, 18 25 and incentives for the purchase of long-term care insurance 18 26 including, but not limited to, tax credits. The study 18 27 committee shall include input from consumers, consumer 18 28 advocates, the insurance industry, and the health care 18 29 industry. The study committee shall submit a report of 18 30 findings and recommendations to the governor and the general 18 31 assembly on or before December 15, 2000. 18 32 Sec. 16. REIMBURSEMENT METHODOLOGY TASK FORCE – REPORT. 18 33 The department of human services shall convene a task force 18 34 consisting of the members of the senior living coordinating 18 35 unit, representatives of the nursing facility industry, 19 1 consumers and consumer advocates to develop a case-mix 19 2 reimbursement methodology. The methodology developed shall 19 3 include a limited number of levels of reimbursement. The task 19 4 force shall submit a report of the reimbursement methodology 19 5 developed to the governor and the general assembly on or 19 6 before December 15, 2000. The department of human services 19 7 shall also include in the report a summary of the expenditures 19 8 for nursing facility development and of long-term care service 19 9 development. 19 10 Sec. 17. RESIDENTIAL CARE FACILITIES – APPLICATION OF 19 11 PROGRAM. The department of human services shall review and 19 12 shall make recommendations to the general assembly on or 19 13 before October 1, 2000, relating to the feasibility of 19 14 applying the senior living program and any changes in the 19 15 reimbursement methodology to residential care facilities. 19 16 Sec. 18. MAINTENANCE OF FISCAL EFFORT. The fiscal effort, 19 17 existing on June 30, 2000, represented by appropriations made 19 18 for long-term care services by the general assembly, shall be 19 19 maintained and a reduction shall not be made in such 19 20 appropriations to the department of human services or the 19 21 department of elder affairs for those services as a result of 19 22 this Act. 19 23 Sec. 19. DEPARTMENT OF ELDER AFFAIRS APPROPRIATION. There 19 24 is appropriated from the senior living trust fund created in 19 25 section 249H.4 in this Act to the department of elder affairs 19 26 for the fiscal year beginning July 1, 2000, and ending June 19 27 30, 2001, the following amount, or so much thereof as is 19 28 necessary, to be used for the purposes designated: 19 29 For the development of a comprehensive senior living 19 30 program, including program administration and costs associated 19 31 with implementation, salaries, support, maintenance, 19 32 miscellaneous purposes, and for not more than the following 19 33 full-time equivalent positions: 19 34 .................................................. $ 4,188,123 19 35 ............................................... FTEs 7.00 20 1 The department of elder affairs may adopt emergency rules 20 2 to carry out the provisions of this section. 20 3 Sec. 20. DEPARTMENT OF HUMAN SERVICES APPROPRIATION. 20 4 There is appropriated from the senior living trust fund 20 5 created in section 249H.4 in this Act to the department of 20 6 human services for the fiscal year beginning July 1, 2000, and 20 7 ending June 30, 2001, the following amounts, or so much 20 8 thereof as is necessary, to be used for the purposes 20 9 designated: 20 10 1. To provide grants to nursing facilities for conversion 20 11 to assisted living programs or to provide long-term care 20 12 alternatives and to provide grants to long-term care providers 20 13 for development of long-term care alternatives: 20 14 ................................................. $ 20,000,000 20 15 2. To supplement the medical assistance appropriation and 20 16 to provide reimbursement for health care services and rent 20 17 expenses to eligible persons through the home and community- 20 18 based services waiver and the state supplementary assistance 20 19 program, including program administration and data system 20 20 costs associated with implementation, salaries, support, 20 21 maintenance, miscellaneous purposes, and for not more than the 20 22 following full-time equivalent positions: 20 23 .................................................. $ 2,240,034 20 24 ............................................... FTEs 5.00 20 25 3. To implement nursing facility provider reimbursement at 20 26 the seventieth percentile and case-mix reimbursement 20 27 methodology changes: 20 28 .................................................. $ 17,750,000 20 29 The department shall transfer these funds to supplement 20 30 other appropriations to the department of human services to 20 31 carry out the purposes of this subsection. The total amount 20 32 expended by the department of human services in the fiscal 20 33 year beginning July 1, 2000, and ending June 30, 2001, for 20 34 nursing facility provider reimbursements under both the 20 35 seventieth percentile and the case-mix reimbursement 21 1 methodologies shall not exceed the amount appropriated in this 21 2 subsection. 21 3 Sec. 21. EMERGENCY RULES. 21 4 1. The department of human services and the department of 21 5 elder affairs may adopt emergency rules to implement this Act. 21 6 2. If the department of human services or the department 21 7 of elder affairs adopts emergency rules under section 17A.4, 21 8 subsection 2, and section 17A.5, subsection 2, paragraph "b", 21 9 to implement this Act, the rules shall become effective 21 10 immediately upon filing, unless a later effective date is 21 11 specified in the rules. Any rules adopted in accordance with 21 12 the provisions of this section shall also be published as 21 13 notice of intended action as provided in section 17A.4. 21 14 Sec. 22. EFFECTIVE DATE. This Act, being deemed of 21 15 immediate importance, takes effect upon enactment. 21 16 Sec. 23. RETROACTIVE APPLICABILITY. The section in this 21 17 Act that creates section 249H.6 as it relates to receipt of 21 18 federal funding, is retroactively applicable to October 1, 21 19 1999. 21 20 EXPLANATION 21 21 This bill creates a new Code chapter 249H. Division I, 21 22 Code section 249H.1, establishes the "Iowa Senior Living 21 23 Program Act". 21 24 Division I, Code section 249H.2, provides the legislative 21 25 findings related to and the goal of the program. The goal of 21 26 the program is to create a comprehensive long-term care system 21 27 that is consumer-directed, provides balance between the 21 28 options of institutional and noninstitutional care, and 21 29 contributes to the quality of life. 21 30 Division II, Code section 249H.3, provides definitions used 21 31 in the chapter. 21 32 Division II, Code section 249H.4, creates the senior living 21 33 trust fund and provides for ongoing appropriations from the 21 34 trust fund. The trust fund is created in the state treasury 21 35 under the authority of the department of human services. 22 1 Moneys deposited in the fund include those received through 22 2 intergovernmental agreements for the senior living program, 22 3 grants, contributions, participant payments, and a portion of 22 4 the federal moneys received by the department of human 22 5 services from public nursing facilities. Moneys in the fund 22 6 are to be appropriated only for the purposes of the senior 22 7 living program. The trust fund is to be operated in 22 8 accordance with the guidelines of the health care financing 22 9 administration of the United States department of health and 22 10 human services. Moneys in the fund are not considered part of 22 11 the general fund of the state. Moneys in the fund at the end 22 12 of a fiscal year do not revert to the state general fund and 22 13 cannot be transferred, used, obligated, appropriated, or 22 14 otherwise encumbered, except for purposes of the senior living 22 15 program. Interest or earnings on moneys in the trust fund are 22 16 credited to the trust fund. The department of human services 22 17 is directed to adopt rules to administer the trust fund and to 22 18 establish participation in the program for public nursing 22 19 facilities. The treasurer of state is directed to provide a 22 20 quarterly report of the trust fund activities and balances to 22 21 the long-term care coordinating unit. 22 22 Division II, Code section 249H.5, provides for allocations 22 23 from the trust fund. Allocations include: 22 24 1. An allocation to the department of human services of a 22 25 maximum of $80 million over a maximum five-year period to be 22 26 used for the conversion of existing nursing facility space and 22 27 development of long-term care alternatives. 22 28 2. An allocation to the department of elder affairs, 22 29 annually, in an amount necessary to cover expenses of 22 30 implementation and administration of long-term care services 22 31 programs and for delivery of long-term care services to low 22 32 and moderate income seniors. 22 33 3. An allocation to the department of human services, 22 34 annually, for administrative purposes and service delivery 22 35 related to the senior living program and trust fund and for 23 1 implementation of a new reimbursement system. 23 2 4. An allocation to the department of human services, in 23 3 an amount necessary to provide nursing facility provider 23 4 reimbursements using a percentile-based reimbursement system 23 5 and to provide funding for the transition to a case-mix 23 6 reimbursement system. Funding is to be provided for the 23 7 percentile-based reimbursement system until such time as the 23 8 case-mix reimbursement system is fully implemented. 23 9 5. An allocation to the department of human services, 23 10 annually, for additional expenses, relative to the senior 23 11 living program, that are incurred due to rent expenses of 23 12 consumers participating in a home and community-based waiver 23 13 program under the state supplementary assistance program. 23 14 The remainder of the funds is to be invested with the 23 15 interest and earnings to be used for administration of 23 16 programs and delivery of long-term care services and for 23 17 expenses related to implementation of the senior living 23 18 program and administration of the trust fund. 23 19 Division II, Code section 249H.6, provides the procedures 23 20 and criteria for the awarding of grants for conversion of 23 21 nursing facilities to provide assisted-living programs and for 23 22 long-term care services development. The section provides 23 23 that the department of human services is to adopt rules to 23 24 ensure that a nursing facility that receives a grant for 23 25 nursing facility conversion and divides costs in an equitable 23 26 manner. The section also provides for separate grants to 23 27 nursing facilities that are awarded nursing facility 23 28 conversion grants, if the conversion also includes provision 23 29 for adult day care, child care for children with special 23 30 needs, safe shelter for victims of dependent adult abuse, or 23 31 respite care. The section provides that the section does not 23 32 create an entitlement to any funds available for grant 23 33 purposes, but that the department of human services, in its 23 34 discretion, may only award grants to the extent funds are 23 35 available and applications are approved. 24 1 Division II, Code section 249H.7, provides for 24 2 appropriation of funds beginning October 1, 2000, to the 24 3 department of elder affairs for activities related to home and 24 4 community-based services for seniors. Moneys appropriated to 24 5 the department of elder affairs are to be disbursed through 24 6 the area agencies on aging. The section provides that the 24 7 section does not create an entitlement, but that the 24 8 department of elder affairs, in its discretion, may only 24 9 disburse funds to the extent funds are available and requests 24 10 for funding are approved. 24 11 Division II, Code section 249H.8, describes provisions 24 12 relating to the PACE program and the pre-PACE program, which 24 13 is defined in the bill as a program that provides delivery of 24 14 comprehensive health and social services to seniors by 24 15 integrating acute and long-term care services, and is operated 24 16 by an entity as permitted under federal regulation. A pre- 24 17 PACE program is defined as a PACE program in its initial 24 18 stages that provides the same scope of services as a PACE 24 19 program. 24 20 Division II, Code section 249H.9, directs the department of 24 21 elder affairs and the area agencies on aging, in consultation 24 22 with the senior living coordinating unit, to create a database 24 23 directory of all health care and support services available, 24 24 to seniors. The database is to be made available, 24 25 electronically, to the public. The bill directs the 24 26 department of elder affairs to seek foundation funding to 24 27 provide an educational program to individuals ages 21 and 24 28 older to assist them in planning for financing health care 24 29 services and other supports in their senior years. The bill 24 30 also directs the department of human services to develop and 24 31 distribute an informational packet to the public that explains 24 32 the medical assistance program relative to health care 24 33 services options for seniors. The bill provides that the 24 34 director of human services, director of the department of 24 35 elder affairs, director of public health, director of the 25 1 department of inspections and appeals, the director of revenue 25 2 and finance, and the commissioner of insurance are to 25 3 constitute a senior advisory council to provide oversight in 25 4 the development and operation of all informational aspects of 25 5 the senior living program. 25 6 Division II, Code section 249H.10, provides for the 25 7 establishment of a caregiver support access and education 25 8 program to provide access to respite care and education to 25 9 caregivers, through the area agencies on aging or other 25 10 appropriate agencies. 25 11 Division II, Code section 249H.11, provides a sunset 25 12 provision for new Code section 249H.6, which is the section 25 13 that provides grants for nursing facility conversion and long- 25 14 term care services development. Under the bill, Code section 25 15 249H.6 would be repealed effective June 30, 2005. 25 16 Division III of the bill provides miscellaneous provisions. 25 17 Division III of the bill adds a provision to the health 25 18 care facilities chapter which requires nursing facilities, 25 19 regardless of the individual's source of payment for care, to 25 20 complete a resident assessment for all prospective and current 25 21 residents. 25 22 Division III of the bill changes the name of the long-term 25 23 care coordinating unit to the senior living coordinating unit; 25 24 adds four members of the general assembly to the membership of 25 25 the unit as ex officio, nonvoting members; and adds to the 25 26 duties of the unit the provision of direction and oversight 25 27 for disbursement of moneys from the senior living trust fund 25 28 and the required consultation with state universities and 25 29 other institutions with expertise in senior issues and long- 25 30 term care. 25 31 Division III of the bill requests that the legislative 25 32 council authorize a senior living insurance and incentives 25 33 study committee to review current long-term care insurance 25 34 laws, current long-term care insurance options available in 25 35 the state, the types of services covered under a long-term 26 1 care insurance option, and incentives for the purchase of 26 2 long-term care insurance including, but not limited to, tax 26 3 credits. The study committee is to include input from 26 4 consumers, consumer advocates, the health care industry, and 26 5 the insurance industry. The study committee is directed to 26 6 submit a report of the findings and recommendations to the 26 7 governor and the general assembly by December 15, 2000. 26 8 Division III of the bill directs the department of human 26 9 services to convene a task force of members of the senior 26 10 living coordinating unit, representatives of the nursing 26 11 facility industry, consumers, and consumer advocates to 26 12 develop a case-mix reimbursement methodology. The task force 26 13 is directed to submit a report including any changes in the 26 14 reimbursement methodology under the medical assistance program 26 15 and any expenditures for the development of alternatives to 26 16 health care facility care to the general assembly by December 26 17 15, 2000. 26 18 Division III of the bill directs the department of human 26 19 services to review and make recommendations to the general 26 20 assembly on or before October 1, 2000, regarding the 26 21 feasibility of applying the senior living program to 26 22 residential care facilities and in applying any reimbursement 26 23 methodology changes to these facilities. 26 24 Division III of the bill establishes that the general 26 25 assembly is to maintain the fiscal effort in funding long-term 26 26 care services, existing on June 30, 2000, and is not to make 26 27 reductions in appropriations for this purpose as a result of 26 28 the bill. 26 29 Division III of the bill provides for fiscal year 2000-2001 26 30 appropriations to the department of human services and the 26 31 department of elder affairs relating to the senior living 26 32 program. 26 33 Division III of the bill provides for emergency rulemaking 26 34 authority for the department of human services and the 26 35 department of elder affairs in implementing the bill. 27 1 The bill takes effect upon enactment. The section of the 27 2 bill relating to the receipt of federal funds on or after 27 3 October 1, 1999, is retroactively applicable to October 1, 27 4 1999. 27 5 LSB 5616HV 78 27 6 pf/cf/24
Text: HF02407 Text: HF02409 Text: HF02400 - HF02499 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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