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PAG LIN 1 1 SENATE FILE 2193 1 2 1 3 AN ACT 1 4 RELATING TO THE ESTABLISHMENT OF A SENIOR LIVING PROGRAM, 1 5 INCLUDING THE CREATION OF A SENIOR LIVING TRUST FUND, 1 6 PROVIDING FOR THE DEVELOPMENT AND PROVISION OF SENIOR 1 7 LIVING PROGRAM INFORMATION AND ELECTRONIC ACCESS, 1 8 PROVIDING FOR A CAREGIVER SUPPORT AND EDUCATION PROGRAM, 1 9 PROVIDING FOR A SENIOR LIVING INSURANCE POLICY AND 1 10 INCENTIVES STUDY, PROVIDING FOR ALLOCATION OF THE MONEYS 1 11 IN THE SENIOR LIVING TRUST FUND, MAKING APPROPRIATIONS, 1 12 AND PROVIDING AN EFFECTIVE DATE, AND PROVIDING FOR 1 13 RETROACTIVE APPLICABILITY. 1 14 1 15 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 1 16 1 17 DIVISION I 1 18 TITLE AND FINDINGS 1 19 Section 1. NEW SECTION. 249H.1 TITLE. 1 20 This chapter shall be known and may be cited as the "Iowa 1 21 Senior Living Program Act". 1 22 Sec. 2. NEW SECTION. 249H.2 LEGISLATIVE FINDINGS – 1 23 GOAL. 1 24 1. The general assembly finds that: 1 25 a. The preservation, improvement, and coordination of the 1 26 health care infrastructure of Iowa is critical to the health 1 27 and safety of Iowans. 1 28 b. An increasing number of seniors and persons with 1 29 disabilities in the state require long-term care services 1 30 provided outside of a medical institution. 1 31 c. A full array of long-term care services is necessary to 1 32 provide cost-effective and appropriate services to the varied 1 33 population of health care consumers. 1 34 d. The supported development of long-term care 1 35 alternatives, including assisted-living facility services, 2 1 adult day care, and home and community-based services, is 2 2 critical in areas of the state where such alternatives 2 3 otherwise are not likely to be developed. 2 4 e. Cost containment in the delivery of health care is 2 5 necessary to improve services and access for all Iowans. 2 6 f. Grants are necessary to cover the expenditures related 2 7 to the development of alternative health care services. 2 8 Development of these alternatives will improve access to and 2 9 delivery of long-term care services to underserved individuals 2 10 or in underserved areas, which will in turn contain or reduce 2 11 the cost and improve the quality of health care services. 2 12 g. A continuing source of funding is necessary to enhance 2 13 the state's ability to meet the rising demand of seniors with 2 14 low and moderate incomes in obtaining an appropriate variety 2 15 of long-term care services. 2 16 2. The goal of this program is to create a comprehensive 2 17 long-term care system that is consumer-directed, provides a 2 18 balance between the alternatives of institutionally and 2 19 noninstitutionally provided services, and contributes to the 2 20 quality of the lives of Iowans. 2 21 DIVISION II 2 22 IOWA SENIOR LIVING PROGRAM 2 23 Sec. 3. NEW SECTION. 249H.3 DEFINITIONS. 2 24 As used in this chapter, unless the context otherwise 2 25 provides: 2 26 1. "Affordable" means rates for payment of services which 2 27 do not exceed the rates established for providers of medical 2 28 and health services under the medical assistance program with 2 29 eligibility for an individual equal to the eligibility for 2 30 medical assistance pursuant to section 249A.3. In relation to 2 31 services provided by a provider of services under a home and 2 32 community-based waiver, "affordable" means that the total 2 33 monthly cost of the home and community-based waiver services 2 34 provided do not exceed the cost for that level of care as 2 35 established by rule by the department of human services, 3 1 pursuant to chapter 17A, in consultation with the department 3 2 of elder affairs. 3 3 2. "Assisted living" means assisted living as defined in 3 4 section 231C.2. 3 5 3. "Case mix reimbursement" means a reimbursement 3 6 methodology that recognizes the acuity and need level of the 3 7 residents of a nursing facility. 3 8 4. "Long-term care alternatives" means those services 3 9 specified under the medical assistance program as home and 3 10 community-based waiver services for elder persons or adults 3 11 with disabilities, elder group homes certified under chapter 3 12 231B, assisted-living programs certified under chapter 231C, 3 13 and the PACE program. 3 14 5. "Long-term care provider" means a provider of services 3 15 through long-term care alternatives. 3 16 6. "Long-term care service development" means any of the 3 17 following: 3 18 a. The remodeling of existing space and, if necessary, the 3 19 construction of additional space required to accommodate 3 20 development of long-term care alternatives, excluding the 3 21 development of assisted-living programs or elder group home 3 22 alternatives. 3 23 b. New construction for long-term care alternatives, 3 24 excluding new construction of assisted-living programs or 3 25 elder group homes, if the senior living coordinating unit 3 26 determines that new construction is more cost-effective than 3 27 the conversion of existing space. 3 28 7. "Nursing facility" means a licensed nursing facility as 3 29 defined in section 135C.1 or a licensed hospital as defined in 3 30 section 135B.1, a distinct part of which provides long-term 3 31 care nursing facility beds. 3 32 8. "Nursing facility conversion" means any of the 3 33 following: 3 34 a. The remodeling of nursing facility space existing on 3 35 July 1, 1999, and certified for medical assistance nursing 4 1 facility reimbursement and, if necessary, the construction of 4 2 additional space required to accommodate an assisted-living 4 3 program. 4 4 b. New construction of an assisted-living program if 4 5 existing nursing facility beds are no longer licensed and the 4 6 senior living coordinating unit determines that new 4 7 construction is more cost-effective than the conversion of 4 8 existing space. 4 9 9. "PACE program" means a program of all-inclusive care 4 10 for the elderly established pursuant to 42 U.S.C. } 1396(u)(4) 4 11 that provides delivery of comprehensive health and social 4 12 services to seniors by integrating acute and long-term care 4 13 services, and that is operated by a public, private, 4 14 nonprofit, or proprietary entity. "Pre-PACE program" means a 4 15 PACE program in the initial start-up phase that provides the 4 16 same scope of services as a PACE program. 4 17 10. "Persons with disabilities" means individuals eighteen 4 18 years of age or older with disabilities as disability is 4 19 defined in section 225B.2. 4 20 11. "Senior" means elder as defined in section 231.4 and 4 21 as defined under the PACE program pursuant to 42 U.S.C. } 4 22 1396(u)(4). 4 23 12. "Senior living coordinating unit" means the senior 4 24 living coordinating unit created within the department of 4 25 elder affairs pursuant to section 231.58, or its designee. 4 26 13. "Senior living program" means the senior living 4 27 program created in this chapter to provide for long-term care 4 28 alternatives, long-term care service development, and nursing 4 29 facility conversion. 4 30 Sec. 4. NEW SECTION. 249H.4 SENIOR LIVING TRUST FUND – 4 31 CREATED – APPROPRIATIONS. 4 32 1. A senior living trust fund is created in the state 4 33 treasury under the authority of the department of human 4 34 services. Moneys received through intergovernmental 4 35 agreements for the senior living program and moneys received 5 1 from sources, including grants, contributions, and participant 5 2 payments, shall be deposited in the fund. 5 3 2. The department of human services, upon receipt of 5 4 federal revenue on or after October 1, 1999, from public 5 5 nursing facilities participating in the medical assistance 5 6 program, shall deposit the federal revenue received in the 5 7 trust fund, less a sum of five thousand dollars as an 5 8 administration fee per participating public nursing facility. 5 9 3. Moneys deposited in the trust fund shall be used only 5 10 for the purposes of the senior living program as specified in 5 11 this chapter. 5 12 4. The trust fund shall be operated in accordance with the 5 13 guidelines of the health care financing administration of the 5 14 United States department of health and human services. The 5 15 trust fund shall be separate from the general fund of the 5 16 state and shall not be considered part of the general fund of 5 17 the state. The moneys in the trust fund shall not be 5 18 considered revenue of the state, but rather shall be funds of 5 19 the senior living program. The moneys in the trust fund are 5 20 not subject to section 8.33 and shall not be transferred, 5 21 used, obligated, appropriated, or otherwise encumbered, except 5 22 to provide for the purposes of this chapter. Notwithstanding 5 23 section 12C.7, subsection 2, interest or earnings on moneys 5 24 deposited in the trust fund shall be credited to the trust 5 25 fund. 5 26 5. The department of human services shall adopt rules 5 27 pursuant to chapter 17A to administer the trust fund and to 5 28 establish procedures for participation by public nursing 5 29 facilities in the intergovernmental transfer of funds to the 5 30 senior living trust fund. 5 31 6. The treasurer of state shall provide a quarterly report 5 32 of trust fund activities and balances to the senior living 5 33 coordinating unit. 5 34 Sec. 5. NEW SECTION. 249H.5 ALLOCATIONS – SENIOR LIVING 5 35 TRUST FUND. 6 1 1. Moneys deposited in the senior living trust fund 6 2 created in section 249H.4 shall be used only as provided in 6 3 appropriations from the trust fund to the department of human 6 4 services and the department of elder affairs, and for 6 5 purposes, including the awarding of grants, as specified in 6 6 this chapter. 6 7 2. Moneys in the trust fund are allocated, subject to 6 8 their appropriation by the general assembly, as follows: 6 9 a. To the department of human services, a maximum of 6 10 eighty million dollars for the fiscal period beginning July 1, 6 11 2000, and ending on or before June 30, 2005, to be used for 6 12 the conversion of existing nursing facility space and 6 13 development of long-term care alternatives. 6 14 b. To the department of elder affairs, an amount 6 15 necessary, annually, for expenses incurred in implementation 6 16 and administration of the long-term care alternatives programs 6 17 and for delivery of long-term care services to seniors with 6 18 low or moderate incomes. 6 19 c. To the department of human services, an amount 6 20 necessary, annually, for all of the following: 6 21 (1) Expenses incurred in implementation of the senior 6 22 living program. 6 23 (2) Expenses incurred in administration of medical 6 24 assistance home and community-based waivers and the PACE 6 25 program due to implementation of the senior living trust fund. 6 26 (3) Expenses incurred due to increased service delivery 6 27 provided under medical assistance home and community-based 6 28 waivers as a result of nursing facility conversions and long- 6 29 term care service development, for the fiscal period beginning 6 30 July 1, 2000, and ending on or before June 30, 2005. 6 31 (4) Expenses incurred in program administration related to 6 32 implementation of nursing facility case mix reimbursement 6 33 under the medical assistance program. 6 34 d. To the department of human services, an amount 6 35 necessary to provide funding for nursing facility provider 7 1 reimbursements, using the percentile-based reimbursement 7 2 system, and to provide funding for the transition to a case- 7 3 mix reimbursement system. Funding shall be provided under 7 4 this section for the percentile-based reimbursement system, 7 5 until such time as the case-mix reimbursement system is fully 7 6 implemented. 7 7 e. To the department of human services an amount 7 8 necessary, annually, for additional expenses incurred relative 7 9 to implementation of the senior living program in assisting 7 10 home and community-based waiver consumers with rent expenses 7 11 pursuant to the state supplementary assistance program. 7 12 3. Any funds remaining after disbursement of moneys under 7 13 subsection 2 shall be invested with the interest earned to be 7 14 available in subsequent fiscal years for the purposes provided 7 15 in subsection 2, paragraph "b", and subsection 2, paragraph 7 16 "c", subparagraphs (1) and (2). 7 17 Sec. 6. NEW SECTION. 249H.6 NURSING FACILITY CONVERSION 7 18 AND LONG-TERM CARE SERVICES DEVELOPMENT GRANTS. 7 19 1. The department of human services, at the direction of 7 20 the senior living coordinating unit, may use moneys 7 21 appropriated to the department from the senior living trust 7 22 fund to award grants to any of the following: 7 23 a. A licensed nursing facility that has been an approved 7 24 provider under the medical assistance program for the three- 7 25 year period prior to application for the grant. The grant 7 26 awarded may be used to convert all or a portion of the 7 27 licensed nursing facility to a certified assisted-living 7 28 program and may be used for capital or one-time expenditures, 7 29 including but not limited to start-up expenses, training 7 30 expenses, and operating losses for the first year of operation 7 31 following conversion associated with the nursing facility 7 32 conversion. 7 33 b. A long-term care provider or a licensed nursing 7 34 facility that has been an approved provider under the medical 7 35 assistance program for the three-year period prior to 8 1 application for the grant or a provider that will meet 8 2 applicable medical assistance provider requirements as 8 3 specified in subsection 2, paragraph "c" or "d". The grant 8 4 awarded may be used for capital or one-time expenditures, 8 5 including but not limited to start-up expenses, training 8 6 expenses, and operating losses for the first year of operation 8 7 for long-term care service development. 8 8 2. A grant shall be awarded only to an applicant who meets 8 9 all of the following criteria, as applicable to the type of 8 10 grant: 8 11 a. The applicant is a long-term care provider or a nursing 8 12 facility that is located in an area determined by the senior 8 13 living coordinating unit to be underserved with respect to a 8 14 particular long-term care alternative service, and that has 8 15 demonstrated the ability or potential to provide quality long- 8 16 term care alternative services. 8 17 b. The applicant is able to provide a minimum matching 8 18 contribution of twenty percent of the total cost of any 8 19 conversion, remodeling, or construction. 8 20 c. The applicant is applying for a nursing facility 8 21 conversion grant and is able to demonstrate all of the 8 22 following: 8 23 (1) Conversion of the nursing facility or a distinct 8 24 portion of the nursing facility to an assisted-living program 8 25 is projected to offer efficient and economical care to 8 26 individuals requiring long-term care services in the service 8 27 area. 8 28 (2) Assisted-living services are otherwise not likely to 8 29 be available in the area for individuals eligible for services 8 30 under the medical assistance program. 8 31 (3) The resulting reduction in the availability of nursing 8 32 facility services is not projected to cause undue hardship on 8 33 those individuals requiring nursing facility services for a 8 34 period of at least ten years. 8 35 (4) Public support following a community-based assessment. 9 1 (5) Conversion of the nursing facility is projected to 9 2 result in a lower per client reimbursement cost to the grant 9 3 applicant under the medical assistance program. 9 4 d. The applicant is applying for a long-term care service 9 5 development grant and is able to demonstrate all of the 9 6 following: 9 7 (1) Long-term care service development is projected to 9 8 offer efficient and economical care to individuals requiring 9 9 long-term care services in the service area. 9 10 (2) The proposed long-term care alternative is otherwise 9 11 not likely to be available in the area for individuals 9 12 eligible for services under the medical assistance program. 9 13 (3) Public support following a community-based assessment. 9 14 e. The applicant agrees to do all of the following as 9 15 applicable to the type of grant: 9 16 (1) Participate and maintain a minimum medical assistance 9 17 client base participation rate of forty percent, subject to 9 18 the demand for participation by individuals eligible for 9 19 medical assistance. 9 20 (2) Provide a service delivery package that is affordable 9 21 for those individuals eligible for services under the medical 9 22 assistance home and community-based services waiver program. 9 23 (3) Provide a refund to the senior living trust fund, on 9 24 an amortized basis, in the amount of the grant, if the 9 25 applicant or the applicant's successor in interest ceases to 9 26 operate an affordable long-term care alternative within the 9 27 first ten-year period of operation following the awarding of 9 28 the grant or if the applicant or the applicant's successor in 9 29 interest fails to maintain a participation rate of forty 9 30 percent in accordance with subparagraph (1). 9 31 3. The department of human services shall adopt rules in 9 32 consultation with the senior living coordinating unit, 9 33 pursuant to chapter 17A, to provide all of the following: 9 34 a. An application process and eligibility criteria for the 9 35 awarding of grants. The eligibility criteria shall include 10 1 but are not limited to the applicant's demonstration of an 10 2 affordable service package, the applicant's use of the funds 10 3 for allowable costs, and the applicant's ability to refund the 10 4 funds if required under subsection 2, paragraph "e", 10 5 subparagraph (3). The primary eligibility criterion used 10 6 shall be the applicant's potential impact on the overall goal 10 7 of moving toward a balanced, comprehensive, affordable, high- 10 8 quality, long-term care system. 10 9 b. Criteria to be utilized in determining the amount of 10 10 the grant awarded. 10 11 c. Weighted criteria to be utilized in prioritizing the 10 12 awarding of grants to individual grantees during a grant 10 13 cycle. Greater weight shall be given to the applicant's 10 14 demonstration of potential reduction of nursing facility beds, 10 15 the applicant's ability to meet demonstrated community need, 10 16 and the established history of the applicant in providing 10 17 quality long-term care services. 10 18 d. Policies and procedures for certification of the 10 19 matching funds required of applicants under subsection 2, 10 20 paragraph "b". 10 21 e. Other procedures the department of human services deems 10 22 necessary for the proper administration of this section, 10 23 including but not limited to the submission of progress 10 24 reports on a bimonthly basis to the senior living coordinating 10 25 unit. 10 26 4. The department of human services shall adopt rules to 10 27 ensure that a nursing facility that receives a nursing 10 28 facility conversion grant allocates costs in an equitable 10 29 manner. 10 30 5. In addition to the types of grants described in 10 31 subsection 1, the department of human services, at the 10 32 direction of the senior living coordinating unit, may also use 10 33 moneys appropriated to the department from the senior living 10 34 trust fund to award grants, of not more than one hundred 10 35 thousand dollars per grant, to licensed nursing facilities 11 1 that are awarded nursing facility conversion grants and agree, 11 2 as part of the nursing facility conversion, to also provide 11 3 adult day care, child care for children with special needs, 11 4 safe shelter for victims of dependent adult abuse, or respite 11 5 care. 11 6 6. The department of human services shall establish a 11 7 calendar for receiving and evaluating applications and for 11 8 awarding of grants. 11 9 7. a. The department of human services shall develop a 11 10 cost report to be completed by a grantee which includes, but 11 11 is not limited to, revenue, costs, loans undertaken by the 11 12 grantee, fixed assets of the grantee, a balance sheet, and a 11 13 profit and loss statement. 11 14 b. Grantees shall submit, annually, completed cost reports 11 15 to the department of human services regarding the project for 11 16 a period of ten years following the date of initial operation 11 17 of the grantee's long-term care alternative. 11 18 8. The department of human services, in consultation with 11 19 the department of elder affairs, shall provide annual reports 11 20 to the governor and the general assembly concerning grants 11 21 awarded. The annual report shall include the total number of 11 22 applicants and approved applicants, an overview of the various 11 23 grants awarded, and detailed reports of the cost of each 11 24 project funded by a grant and information submitted by the 11 25 approved applicant. 11 26 9. For the purpose of this section, "underserved" means 11 27 areas in which four and four-tenths percent of the number of 11 28 individuals sixty-five years of age and older is not greater 11 29 than the number of currently licensed nursing facility beds 11 30 and certified assisted-living units. In addition, the 11 31 department, in determining if an area is underserved, may 11 32 consider additional information gathered through the 11 33 department's own research or submitted by an applicant, 11 34 including but not limited to any of the following: 11 35 a. Availability of and access to long-term care 12 1 alternatives relative to individuals eligible for medical 12 2 assistance. 12 3 b. The current number of seniors and persons with 12 4 disabilities and the projected number of these individuals. 12 5 c. The current number of seniors and persons with 12 6 disabilities requiring professional nursing care and the 12 7 projected number of these individuals. 12 8 d. The current availability of long-term care alternatives 12 9 and any known changes in the availability of such 12 10 alternatives. 12 11 10. This section does not create an entitlement to any 12 12 funds available for grants under this section, and the 12 13 department of human services may only award grants to the 12 14 extent funds are available and within its discretion, to the 12 15 extent applications are approved. 12 16 11. In addition to any other remedies provided by law, the 12 17 department of human services may recoup any grant funding 12 18 previously awarded and disbursed to a grantee or the grantee's 12 19 successor in interest and may reduce the amount of any grant 12 20 awarded, but not yet disbursed, to a grantee or the grantee's 12 21 successor in interest, by the amount of any refund owed by a 12 22 grantee or the grantee's successor in interest pursuant to 12 23 subsection 2, paragraph "e", subparagraph (3). 12 24 12. The senior living coordinating unit shall review 12 25 projects that receive grants under this section to ensure that 12 26 the goal to provide alternatives to nursing facility care is 12 27 being met and that an adequate number of nursing facility 12 28 services remain to meet the needs of Iowans. 12 29 Sec. 7. NEW SECTION. 249H.7 HOME AND COMMUNITY-BASED 12 30 SERVICES FOR SENIORS. 12 31 1. Beginning October 1, 2000, the department of elder 12 32 affairs, in consultation with the senior living coordinating 12 33 unit, shall use funds appropriated from the senior living 12 34 trust fund for activities related to the design, maintenance, 12 35 or expansion of home and community-based services for seniors, 13 1 including but not limited to adult day care, personal care, 13 2 respite, homemaker, chore, and transportation services 13 3 designed to promote the independence of and to delay the use 13 4 of institutional care by seniors with low and moderate 13 5 incomes. At any time that moneys are appropriated, the 13 6 department of elder affairs, in consultation with the senior 13 7 living coordinating unit, shall disburse the funds to the area 13 8 agencies on aging. 13 9 2. The department of elder affairs shall adopt rules, in 13 10 consultation with the senior living coordinating unit and the 13 11 area agencies on aging, pursuant to chapter 17A, to provide 13 12 all of the following: 13 13 a. (1) The criteria and process for disbursement of 13 14 funds, appropriated in accordance with subsection 1, to area 13 15 agencies on aging. 13 16 (2) The criteria shall include, at a minimum, all of the 13 17 following: 13 18 (a) A distribution formula that triple weights all of the 13 19 following: 13 20 (i) Individuals seventy-five years of age and older. 13 21 (ii) Individuals aged sixty and older who are members of a 13 22 racial minority. 13 23 (iii) Individuals sixty years of age and older who reside 13 24 in rural areas as defined in the federal Older Americans Act. 13 25 (iv) Individuals who are sixty years of age and older who 13 26 have incomes at or below the poverty level as defined in the 13 27 federal Older Americans Act. 13 28 (b) A distribution formula that single weights individuals 13 29 sixty years of age and older who do not meet the criteria 13 30 specified in subparagraph subdivision (a). 13 31 b. The criteria for long-term care providers to receive 13 32 funding as subcontractors of the area agencies on aging. 13 33 c. Other procedures the department of elder affairs deems 13 34 necessary for the proper administration of this section, 13 35 including but not limited to the submission of progress 14 1 reports, on a bimonthly basis, to the senior living 14 2 coordinating unit. 14 3 3. This section does not create an entitlement to any 14 4 funds available for disbursement under this section and the 14 5 department of elder affairs may only disburse moneys to the 14 6 extent funds are available and, within its discretion, to the 14 7 extent requests for funding are approved. 14 8 4. Long-term care providers that receive funding under 14 9 this section shall submit annual reports to the appropriate 14 10 area agency on aging. The department of elder affairs shall 14 11 develop the report to be submitted, which shall include, but 14 12 is not limited to, units of service provided, the number of 14 13 service recipients, costs, and the number of units of service 14 14 identified as necessitated but not provided. 14 15 5. The department of elder affairs, in cooperation with 14 16 the department of human services, shall provide annual reports 14 17 to the governor and the general assembly concerning the impact 14 18 of moneys disbursed under this section on the availability of 14 19 long-term care services in Iowa. The reports shall include 14 20 the types of services funded, the outcome of those services, 14 21 and the number of individuals receiving those services. 14 22 Sec. 8. NEW SECTION. 249H.8 PACE PROGRAM. 14 23 For the purposes of this chapter, all of the following 14 24 apply to a PACE program: 14 25 1. A person operating a PACE program shall have a PACE 14 26 program agreement with the health care financing 14 27 administration of the United States department of health and 14 28 human services, shall enter a contract with the department of 14 29 human services and shall comply with 42 U.S.C. } 1396(u)(4) 14 30 and all regulations promulgated pursuant to that section. 14 31 2. Services provided under a PACE or pre-PACE program 14 32 shall be provided on a capitated basis. 14 33 3. A pre-PACE program may contract with the department of 14 34 human services to provide services to individuals eligible for 14 35 medical assistance, on a capitated basis, for a limited scope 15 1 of the PACE service package through a prepaid health plan 15 2 agreement, with the remaining services reimbursed directly to 15 3 the service providers by the medical assistance or federal 15 4 Medicare programs. 15 5 4. PACE and pre-PACE programs are not subject to 15 6 regulation under chapter 514B. 15 7 5. A PACE or pre-PACE program shall, at the time of 15 8 entering into the initial contract and of renewal of a 15 9 contract with the department of human services, demonstrate 15 10 cash reserves in an amount established by rule of the 15 11 department to cover expenses in the event of insolvency. 15 12 Sec. 9. NEW SECTION. 249H.9 SENIOR LIVING PROGRAM 15 13 INFORMATION – ELECTRONIC ACCESS – EDUCATION – ADVISORY 15 14 COUNCIL. 15 15 1. The department of elder affairs and the area agencies 15 16 on aging, in consultation with the senior living coordinating 15 17 unit, shall create, on a county basis, a database directory of 15 18 all health care and support services available to seniors. 15 19 The department of elder affairs shall make the database 15 20 electronically available to the public, and shall update the 15 21 database on at least a monthly basis. 15 22 2. The department of elder affairs shall seek foundation 15 23 funding to develop and provide an educational program for 15 24 individuals aged twenty-one and older which assists 15 25 participants in planning for and financing health care 15 26 services and other supports in their senior years. 15 27 3. The department of human services shall develop and 15 28 distribute an informational packet to the public that 15 29 explains, in layperson terms, the law, regulations, and rules 15 30 under the medical assistance program relative to health care 15 31 services options for seniors, including but not limited to 15 32 those relating to transfer of assets, prepaid funeral 15 33 expenses, and life insurance policies. 15 34 4. The director of human services, the director of the 15 35 department of elder affairs, the director of public health, 16 1 the director of the department of inspections and appeals, the 16 2 director of revenue and finance, and the commissioner of 16 3 insurance shall constitute a senior advisory council to 16 4 provide oversight in the development and operation of all 16 5 informational aspects of the senior living program under this 16 6 section. 16 7 Sec. 10. NEW SECTION. 249H.10 CAREGIVER SUPPORT – 16 8 ACCESS AND EDUCATION PROGRAMS. 16 9 The department of human services and the department of 16 10 elder affairs, in consultation with the senior living 16 11 coordinating unit, shall implement a caregiver support program 16 12 to provide access to respite care and to provide education to 16 13 caregivers in providing appropriate care to seniors and 16 14 persons with disabilities. The program shall be provided 16 15 through the area agencies on aging or other appropriate 16 16 agencies. 16 17 Sec. 11. NEW SECTION. 249H.11 FUTURE REPEAL. 16 18 Section 249H.6 is repealed on June 30, 2005. However, 16 19 grants awarded and moneys appropriated for grants on or before 16 20 June 30, 2005, shall be disbursed to eligible applicants after 16 21 that date if necessary. 16 22 DIVISION III 16 23 MISCELLANEOUS PROVISIONS 16 24 Sec. 12. NEW SECTION. 249A.18A RESIDENT ASSESSMENT. 16 25 A nursing facility as defined in section 135C.1 shall 16 26 complete a resident assessment prior to initial admission of a 16 27 resident and periodically during the resident's stay in the 16 28 facility. The assessment shall be completed for each 16 29 prospective resident and current resident regardless of payor 16 30 source. The nursing facility may utilize the same resident 16 31 assessment tool required for certification of the facility 16 32 under the medical assistance and federal Medicare programs to 16 33 comply with this section. 16 34 Sec. 13. Section 231.58, Code 1999, is amended to read as 16 35 follows: 17 1 231.58LONG-TERM CARESENIOR LIVING COORDINATING UNIT. 17 2 1. Along-term caresenior living coordinating unit is 17 3 created within the department of elder affairs. The 17 4 membership of the coordinating unit consists of: 17 5 a. The director of human services. 17 6 b. The director of the department of elder affairs. 17 7 c. The director of public health. 17 8 d. The director of the department of inspections and 17 9 appeals. 17 10 e. Two members appointed by the governor. 17 11 f. Four members of the general assembly, as ex officio, 17 12 nonvoting members. 17 13 2. The legislative members of the unit shall be appointed 17 14 by the majority leader of the senate, after consultation with 17 15 the president of the senate and the minority leader of the 17 16 senate, and by the speaker of the house, after consultation 17 17 with the majority leader and the minority leader of the house 17 18 of representatives. 17 19 3. Nonlegislative members shall receive actual expenses 17 20 incurred while serving in their official capacity and may also 17 21 be eligible to receive compensation as provided in section 17 22 7E.6. Legislative members shall receive compensation pursuant 17 23 to section 2.12. 17 242.4. Thelong-term caresenior living coordinating unit 17 25 shall: 17 26 a. Develop, for legislative review, the mechanisms and 17 27 procedures necessary to implement, utilizing current 17 28 personnel, a case-managed system of long-term care based on a 17 29 uniform comprehensive assessment tool. 17 30 b. Develop common intake and release procedures for the 17 31 purpose of determining eligibility at one point of intake and 17 32 determining eligibility for programs administered by the 17 33 departments of human services, public health, and elder 17 34 affairs, such as the medical assistance program, federal food 17 35 stamp program, and homemaker-home health aide programs. 18 1 c. Develop common definitions for long-term care services. 18 2 d. Develop procedures for coordination at the local and 18 3 state level among the providers of long-term care, including 18 4 when possible co-campusing of services. The director of the 18 5 department of general services shall give particular attention 18 6 to this section when arranging for office space pursuant to 18 7 section 18.12 for these three departments. 18 8 e. Prepare a long-range plan for the provision of long- 18 9 term care services within the state. 18 10 f. Propose rules and procedures for the development of a 18 11 comprehensive long-term care and community-based services 18 12 program. 18 13 g. Submit a report of its activities to the governor and 18 14 general assembly on January 15 of each year. 18 15 h. Provide direction and oversight for disbursement of 18 16 moneys from the senior living trust fund created in section 18 17 249H.4. 18 18 i. Consult with the state universities and other 18 19 institutions with expertise in the area of senior issues and 18 20 long-term care. 18 21 Sec. 14. Section 231C.2, subsection 1, Code 1999, is 18 22 amended to read as follows: 18 23 1. "Assisted living" means provision of housing with 18 24 services which may include but are not limited to health- 18 25 related care, personal care, and assistance with instrumental 18 26 activities of daily living to six or more tenants in a 18 27 physical structure which provides a homelike environment. 18 28 "Assisted living" also includes encouragement of family 18 29 involvement, tenant self-direction, and tenant participation 18 30 in decisions that emphasize choice, dignity, privacy, 18 31 individuality, shared risk, and independence. "Assisted 18 32 living"does not includeincludes the provision of housing and 18 33 assistance with instrumental activities of daily livingwhich18 34does not also include provision ofonly if personal care or 18 35 health-related care is also included. 19 1 Sec. 15. SENIOR LIVING INSURANCE AND INCENTIVES INTERIM 19 2 STUDY. The legislative council is requested to authorize a 19 3 senior living insurance and incentives study committee to 19 4 review current long-term care insurance laws, current long- 19 5 term care insurance options available in the state, the types 19 6 of services covered under a long-term care insurance option, 19 7 and incentives for the purchase of long-term care insurance 19 8 including, but not limited to, tax credits. The study 19 9 committee shall include input from consumers, consumer 19 10 advocates, the insurance industry, and the health care 19 11 industry. The study committee shall submit a report of 19 12 findings and recommendations to the governor and the general 19 13 assembly on or before December 15, 2000. 19 14 Sec. 16. REIMBURSEMENT METHODOLOGY TASK FORCE – REPORT. 19 15 The department of human services shall convene a task force 19 16 consisting of the members of the senior living coordinating 19 17 unit, representatives of the nursing facility industry, 19 18 consumers and consumer advocates to develop a case-mix 19 19 reimbursement methodology. The methodology developed shall 19 20 include a limited number of levels of reimbursement. The task 19 21 force shall submit a report of the reimbursement methodology 19 22 developed to the governor and the general assembly on or 19 23 before December 15, 2000. The department of human services 19 24 shall also include in the report a summary of the expenditures 19 25 for nursing facility conversion and for long-term care service 19 26 development. 19 27 Sec. 17. RESIDENTIAL CARE FACILITIES – APPLICATION OF 19 28 PROGRAM. The department of human services shall review and 19 29 shall make recommendations to the general assembly on or 19 30 before October 1, 2000, relating to the feasibility of 19 31 applying the senior living program and any changes in the 19 32 reimbursement methodology to residential care facilities. 19 33 Sec. 18. MAINTENANCE OF FISCAL EFFORT. The fiscal effort, 19 34 existing on June 30, 2000, represented by appropriations made 19 35 for long-term care services by the general assembly, shall be 20 1 maintained and a reduction shall not be made in such 20 2 appropriations to the department of human services or the 20 3 department of elder affairs for those services as a result of 20 4 this Act. 20 5 Sec. 19. DEPARTMENT OF ELDER AFFAIRS APPROPRIATION. There 20 6 is appropriated from the senior living trust fund created in 20 7 section 249H.4 in this Act to the department of elder affairs 20 8 for the fiscal year beginning July 1, 2000, and ending June 20 9 30, 2001, the following amount, or so much thereof as is 20 10 necessary, to be used for the purposes designated: 20 11 For the development of a comprehensive senior living 20 12 program, including program administration and costs associated 20 13 with implementation, salaries, support, maintenance, 20 14 miscellaneous purposes, and for not more than the following 20 15 full-time equivalent positions: 20 16 .................................................. $ 4,188,123 20 17 ............................................... FTEs 7.00 20 18 The department of elder affairs may adopt emergency rules 20 19 to carry out the provisions of this section. 20 20 Sec. 20. DEPARTMENT OF HUMAN SERVICES APPROPRIATION. 20 21 There is appropriated from the senior living trust fund 20 22 created in section 249H.4 in this Act to the department of 20 23 human services for the fiscal year beginning July 1, 2000, and 20 24 ending June 30, 2001, the following amounts, or so much 20 25 thereof as is necessary, to be used for the purposes 20 26 designated: 20 27 1. To provide grants to nursing facilities for conversion 20 28 to assisted living programs or to provide long-term care 20 29 alternatives and to provide grants to long-term care providers 20 30 for development of long-term care alternatives: 20 31 ................................................. $ 20,000,000 20 32 2. To supplement the medical assistance appropriation and 20 33 to provide reimbursement for health care services and rent 20 34 expenses to eligible persons through the home and community- 20 35 based services waiver and the state supplementary assistance 21 1 program, including program administration and data system 21 2 costs associated with implementation, salaries, support, 21 3 maintenance, miscellaneous purposes, and for not more than the 21 4 following full-time equivalent positions: 21 5 .................................................. $ 2,240,034 21 6 ............................................... FTEs 5.00 21 7 3. To implement nursing facility provider reimbursement at 21 8 the seventieth percentile and case-mix reimbursement 21 9 methodology changes: 21 10 .................................................. $ 17,750,000 21 11 The department shall transfer these funds to supplement 21 12 other appropriations to the department of human services to 21 13 carry out the purposes of this subsection. The total amount 21 14 expended by the department of human services in the fiscal 21 15 year beginning July 1, 2000, and ending June 30, 2001, for 21 16 nursing facility provider reimbursements under both the 21 17 seventieth percentile and the case-mix reimbursement 21 18 methodologies shall not exceed the amount appropriated in this 21 19 subsection. 21 20 Sec. 21. EMERGENCY RULES. 21 21 1. The department of human services and the department of 21 22 elder affairs may adopt emergency rules to implement this Act. 21 23 2. If the department of human services or the department 21 24 of elder affairs adopts emergency rules under section 17A.4, 21 25 subsection 2, and section 17A.5, subsection 2, paragraph "b", 21 26 to implement this Act, the rules shall become effective 21 27 immediately upon filing, unless a later effective date is 21 28 specified in the rules. Any rules adopted in accordance with 21 29 the provisions of this section shall also be published as 21 30 notice of intended action as provided in section 17A.4. 21 31 Sec. 22. EFFECTIVE DATE. This Act, being deemed of 21 32 immediate importance, takes effect upon enactment. 21 33 Sec. 23. RETROACTIVE APPLICABILITY. The section in this 21 34 Act that creates section 249H.6 as it relates to receipt of 21 35 federal funding, is retroactively applicable to October 1, 22 1 1999. 22 2 22 3 22 4 22 5 MARY E. KRAMER 22 6 President of the Senate 22 7 22 8 22 9 22 10 BRENT SIEGRIST 22 11 Speaker of the House 22 12 22 13 I hereby certify that this bill originated in the Senate and 22 14 is known as Senate File 2193, Seventy-eighth General Assembly. 22 15 22 16 22 17 22 18 MICHAEL E. MARSHALL 22 19 Secretary of the Senate 22 20 Approved , 2000 22 21 22 22 22 23 22 24 THOMAS J. VILSACK 22 25 Governor
Text: SF02192 Text: SF02194 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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