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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. } 1396(u)(4) 3 30 that provides delivery of comprehensive health and social 3 31 services to seniors by integrating acute and long-term care 3 32 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 sixty-five million dollars for the fiscal period beginning 5 30 July 1, 2000, and ending on or before June 30, 2005, to be 5 31 used for the conversion of existing nursing facility space and 5 32 development of long-term care alternatives. 5 33 b. To the department of elder affairs, an amount 5 34 necessary, annually, for expenses incurred in implementation 5 35 and administration of the long-term care alternatives programs 6 1 and for delivery of long-term care services to seniors with 6 2 low or moderate incomes. 6 3 c. To the department of human services, an amount 6 4 necessary, annually, for all of the following: 6 5 (1) Expenses incurred in implementation of the senior 6 6 living program. 6 7 (2) Expenses incurred in administration of medical 6 8 assistance home and community-based waivers and the PACE 6 9 program due to implementation of the senior living trust fund. 6 10 (3) Expenses incurred due to increased service delivery 6 11 provided under medical assistance home and community-based 6 12 waivers as a result of nursing facility conversions and long- 6 13 term care service development, for the fiscal period beginning 6 14 July 1, 2000, and ending on or before June 30, 2005. 6 15 (4) Expenses incurred in program administration related to 6 16 implementation of nursing facility case mix reimbursement 6 17 under the medical assistance program. 6 18 d. To the department of human services, an amount 6 19 necessary to provide funding for nursing facility provider 6 20 reimbursements, 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 long- 7 32 term care coordinating unit to be underserved with respect to 7 33 a 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 establish a 10 11 calendar for receiving and evaluating applications and for 10 12 awarding of grants. 10 13 5. a. The department of human services shall develop a 10 14 cost report to be completed by a grantee which includes, but 10 15 is not limited to, revenue, costs, loans undertaken by the 10 16 grantee, fixed assets of the grantee, a balance sheet, and a 10 17 profit and loss statement. 10 18 b. Grantees shall submit, annually, completed cost reports 10 19 to the department of human services regarding the project for 10 20 a period of ten years following the date of initial operation 10 21 of the grantee's long-term care alternative. 10 22 6. The department of human services, in consultation with 10 23 the department of elder affairs, shall provide annual reports 10 24 to the governor and the general assembly concerning grants 10 25 awarded. The annual report shall include the total number of 10 26 applicants and approved applicants, an overview of the various 10 27 grants awarded, and detailed reports of the cost of each 10 28 project funded by a grant and information submitted by the 10 29 approved applicant. 10 30 7. For the purpose of this section, "underserved" means 10 31 areas in which four and four-tenths percent of the number of 10 32 individuals sixty-five years of age and older is not greater 10 33 than the number of currently licensed nursing facility bids 10 34 and certified assisted-living units. In addition, the 10 35 department, in determining if an area is underserved, may 11 1 consider additional information gathered through the 11 2 department's own research or submitted by an applicant, 11 3 including but not limited to any of the following: 11 4 a. Availability of and access to long-term care 11 5 alternatives relative to individuals eligible for medical 11 6 assistance. 11 7 b. The current number of seniors and persons with 11 8 disabilities and the projected number of these individuals. 11 9 c. The current number of seniors and persons with 11 10 disabilities requiring professional nursing care and the 11 11 projected number of these individuals. 11 12 d. The current availability of long-term care alternatives 11 13 and any known changes in the availability of such 11 14 alternatives. 11 15 8. This section does not create an entitlement to any 11 16 funds available for grants under this section, and the 11 17 department of human services may only award grants to the 11 18 extent funds are available and within its discretion, to the 11 19 extent applications are approved. 11 20 9. In addition to any other remedies provided by law, the 11 21 department of human services may recoup any grant funding 11 22 previously awarded and disbursed to a grantee or the grantee's 11 23 successor in interest and may reduce the amount of any grant 11 24 awarded, but not yet disbursed, to a grantee or the grantee's 11 25 successor in interest, by the amount of any refund owed by a 11 26 grantee or the grantee's successor in interest pursuant to 11 27 subsection 2, paragraph "e", subparagraph (3). 11 28 10. The senior living coordinating unit shall review 11 29 projects that receive grants under this section to ensure that 11 30 the goal to provide alternatives to nursing facility care is 11 31 being met and that an adequate number of nursing facility 11 32 services remain to meet the needs of Iowans. 11 33 Sec. 7. NEW SECTION. 249H.7 HOME AND COMMUNITY-BASED 11 34 SERVICES FOR SENIORS. 11 35 1. Beginning October 1, 2000, the department of elder 12 1 affairs, in consultation with the senior living coordinating 12 2 unit, shall use funds appropriated from the senior living 12 3 trust fund for activities related to the design, maintenance, 12 4 or expansion of home and community-based services for seniors, 12 5 including but not limited to adult day care, personal care, 12 6 respite, homemaker, chore, and transportation services 12 7 designed to promote the independence of and to delay the use 12 8 of institutional care by seniors with low and moderate 12 9 incomes. At any time that moneys are appropriated, the 12 10 department of elder affairs, in consultation with the senior 12 11 living coordinating unit, shall disburse the funds to the area 12 12 agencies on aging. 12 13 2. The department of elder affairs shall adopt rules, in 12 14 consultation with the senior living coordinating unit and the 12 15 area agencies on aging, pursuant to chapter 17A, to provide 12 16 all of the following: 12 17 a. (1) The criteria and process for disbursement of 12 18 funds, appropriated in accordance with subsection 1, to area 12 19 agencies on aging. 12 20 (2) The criteria shall include, at a minimum, all of the 12 21 following: 12 22 (a) A distribution formula that triple weights all of the 12 23 following: 12 24 (i) Individuals seventy-five years of age and older. 12 25 (ii) Individuals aged sixty and older who are members of a 12 26 racial minority. 12 27 (iii) Individuals sixty years of age and older who reside 12 28 in rural areas as defined in the federal Older Americans Act. 12 29 (iv) Individuals who are sixty years of age and older who 12 30 have incomes at or below the poverty level as defined in the 12 31 federal Older Americans Act. 12 32 (b) A distribution formula that single weights individuals 12 33 sixty years of age and older who do not meet the criteria 12 34 specified in subparagraph subdivision (a). 12 35 b. The criteria for long-term care providers to receive 13 1 funding as subcontractors of the area agencies on aging. 13 2 c. Other procedures the department of elder affairs deems 13 3 necessary for the proper administration of this section, 13 4 including but not limited to the submission of progress 13 5 reports, on a bimonthly basis, to the senior living 13 6 coordinating unit. 13 7 3. This section does not create an entitlement to any 13 8 funds available for disbursement under this section and the 13 9 department of elder affairs may only disburse moneys to the 13 10 extent funds are available and, within its discretion, to the 13 11 extent requests for funding are approved. 13 12 4. Long-term care providers that receive funding under 13 13 this section shall submit annual reports to the appropriate 13 14 area agency on aging. The department of elder affairs shall 13 15 develop the report to be submitted, which shall include, but 13 16 is not limited to, units of service provided, the number of 13 17 service recipients, costs, and the number of units of service 13 18 identified as necessitated but not provided. 13 19 5. The department of elder affairs, in cooperation with 13 20 the department of human services, shall provide annual reports 13 21 to the governor and the general assembly concerning the impact 13 22 of moneys disbursed under this section on the availability of 13 23 long-term care services in Iowa. The reports shall include 13 24 the types of services funded, the outcome of those services, 13 25 and the number of individuals receiving those services. 13 26 Sec. 8. NEW SECTION. 249H.8 PACE PROGRAM. 13 27 For the purposes of this chapter, all of the following 13 28 apply to a PACE program: 13 29 1. A person operating a PACE program shall have a PACE 13 30 program agreement with the health care financing 13 31 administration of the United States department of health and 13 32 human services, shall enter a contract with the department of 13 33 human services and shall comply with 42 U.S.C. } 1396(u)(4) 13 34 and all regulations promulgated pursuant to that section. 13 35 2. Services provided under a PACE or pre-PACE program 14 1 shall be provided on a capitated basis. 14 2 3. A pre-PACE program may contract with the department of 14 3 human services to provide services to individuals eligible for 14 4 medical assistance, on a capitated basis, for a limited scope 14 5 of the PACE service package through a prepaid health plan 14 6 agreement, with the remaining services reimbursed directly to 14 7 the service providers by the medical assistance or federal 14 8 Medicare programs. 14 9 4. PACE and pre-PACE programs are not subject to 14 10 regulation under chapter 514B. 14 11 5. A PACE or pre-PACE program shall, at the time of 14 12 entering into the initial contract and of renewal of a 14 13 contract with the department of human services, demonstrate 14 14 cash reserves in an amount established by rule of the 14 15 department to cover expenses in the event of insolvency. 14 16 Sec. 9. NEW SECTION. 249H.9 SENIOR LIVING PROGRAM 14 17 INFORMATION ELECTRONIC ACCESS EDUCATION ADVISORY 14 18 COUNCIL. 14 19 1. The department of elder affairs and the area agencies 14 20 on aging, in consultation with the senior living coordinating 14 21 unit, shall create, on a county basis, a database directory of 14 22 all health care and support services available to seniors. 14 23 The department of elder affairs shall make the database 14 24 electronically available to the public, and shall update the 14 25 database on at least a monthly basis. 14 26 2. The department of elder affairs shall seek foundation 14 27 funding to develop and provide an educational program for 14 28 individuals aged twenty-one and older which assists 14 29 participants in planning for and financing health care 14 30 services and other supports in their senior years. 14 31 3. The department of human services shall develop and 14 32 distribute an informational packet to the public that 14 33 explains, in layperson terms, the law, regulations, and rules 14 34 under the medical assistance program relative to health care 14 35 services options for seniors, including but not limited to 15 1 those relating to transfer of assets, prepaid funeral 15 2 expenses, and life insurance policies. 15 3 4. The director of human services, the director of the 15 4 department of elder affairs, the director of public health, 15 5 the director of the department of inspections and appeals, the 15 6 director of revenue and finance, and the commissioner of 15 7 insurance shall constitute a senior advisory council to 15 8 provide oversight in the development and operation of all 15 9 informational aspects of the senior living program under this 15 10 section. 15 11 Sec. 10. NEW SECTION. 249H.10 CAREGIVER SUPPORT 15 12 ACCESS AND EDUCATION PROGRAMS. 15 13 The department of human services and the department of 15 14 elder affairs, in consultation with the senior living 15 15 coordinating unit, shall implement a caregiver support program 15 16 to provide access to respite care and to provide education to 15 17 caregivers in providing appropriate care to seniors and 15 18 persons with disabilities. The program shall be provided 15 19 through the area agencies on aging or other appropriate 15 20 agencies. 15 21 Sec. 11. NEW SECTION. 249H.11 FUTURE REPEAL. 15 22 Section 249H.6 is repealed on June 30, 2005. However, 15 23 grants awarded and moneys appropriated for grants on or before 15 24 June 30, 2005, shall be disbursed to eligible applicants after 15 25 that date if necessary. 15 26 DIVISION III 15 27 MISCELLANEOUS PROVISIONS 15 28 Sec. 12. NEW SECTION. 135C.23A RESIDENT ASSESSMENT. 15 29 A nursing facility shall complete a resident assessment 15 30 prior to initial admission of a resident and periodically 15 31 during the resident's stay in the facility. The assessment 15 32 shall be completed for each prospective resident and current 15 33 resident regardless of payor source. The nursing facility may 15 34 utilize the same resident assessment tool required for 15 35 certification of the facility under the medical assistance and 16 1 federal Medicare programs to comply with this section. 16 2 Sec. 13. Section 231.58, Code 1999, is amended to read as 16 3 follows: 16 4 231.58LONG-TERM CARESENIOR LIVING COORDINATING UNIT. 16 5 1. Along-term caresenior living coordinating unit is 16 6 created within the department of elder affairs. The 16 7 membership of the coordinating unit consists of: 16 8 a. The director of human services. 16 9 b. The director of the department of elder affairs. 16 10 c. The director of public health. 16 11 d. The director of the department of inspections and 16 12 appeals. 16 13 e. Two members appointed by the governor. 16 14 f. Four members of the general assembly, as ex officio, 16 15 nonvoting members. 16 16 2. The legislative members of the unit shall be appointed 16 17 by the majority leader of the senate, after consultation with 16 18 the president of the senate and the minority leader of the 16 19 senate, and by the speaker of the house, after consultation 16 20 with the majority leader and the minority leader of the house 16 21 of representatives. 16 22 3. Nonlegislative members shall receive actual expenses 16 23 incurred while serving in their official capacity and may also 16 24 be eligible to receive compensation as provided in section 16 25 7E.6. Legislative members shall receive compensation pursuant 16 26 to section 2.12. 16 272.4. Thelong-term caresenior living coordinating unit 16 28 shall: 16 29 a. Develop, for legislative review, the mechanisms and 16 30 procedures necessary to implement, utilizing current 16 31 personnel, a case-managed system of long-term care based on a 16 32 uniform comprehensive assessment tool. 16 33 b. Develop common intake and release procedures for the 16 34 purpose of determining eligibility at one point of intake and 16 35 determining eligibility for programs administered by the 17 1 departments of human services, public health, and elder 17 2 affairs, such as the medical assistance program, federal food 17 3 stamp program, and homemaker-home health aide programs. 17 4 c. Develop common definitions for long-term care services. 17 5 d. Develop procedures for coordination at the local and 17 6 state level among the providers of long-term care, including 17 7 when possible co-campusing of services. The director of the 17 8 department of general services shall give particular attention 17 9 to this section when arranging for office space pursuant to 17 10 section 18.12 for these three departments. 17 11 e. Prepare a long-range plan for the provision of long- 17 12 term care services within the state. 17 13 f. Propose rules and procedures for the development of a 17 14 comprehensive long-term care and community-based services 17 15 program. 17 16 g. Submit a report of its activities to the governor and 17 17 general assembly on January 15 of each year. 17 18 h. Provide direction and oversight for disbursement of 17 19 moneys from the senior living trust fund created in section 17 20 249H.4. 17 21 i. Consult with the state universities and other 17 22 institutions with expertise in the area of senior issues and 17 23 long-term care. 17 24 Sec. 14. Section 231C.2, subsection 1, Code 1999, is 17 25 amended to read as follows: 17 26 1. "Assisted living" means provision of housing with 17 27 services which may include but are not limited to health- 17 28 related care, personal care, and assistance with instrumental 17 29 activities of daily living to six or more tenants in a 17 30 physical structure which provides a homelike environment. 17 31 "Assisted living" also includes encouragement of family 17 32 involvement, tenant self-direction, and tenant participation 17 33 in decisions that emphasize choice, dignity, privacy, 17 34 individuality, shared risk, and independence. "Assisted 17 35 living"does not includeincludes the provision of housing and 18 1 assistance with instrumental activities of daily livingwhich18 2does not also include provision ofonly if personal care or 18 3 health-related care is also included. 18 4 Sec. 15. SENIOR LIVING INSURANCE AND INCENTIVES INTERIM 18 5 STUDY. The legislative council is requested to authorize a 18 6 senior living insurance and incentives study committee to 18 7 review current long-term care insurance laws, current long- 18 8 term care insurance options available in the state, the types 18 9 of services covered under a long-term care insurance option, 18 10 and incentives for the purchase of long-term care insurance 18 11 including, but not limited to, tax credits. The study 18 12 committee shall include input from consumers, consumer 18 13 advocates, the insurance industry, and the health care 18 14 industry. The study committee shall submit a report of 18 15 findings and recommendations to the governor and the general 18 16 assembly on or before December 15, 2000. 18 17 Sec. 16. REIMBURSEMENT METHODOLOGY EXPENDITURES 18 18 MEDICAL ASSISTANCE PROGRAM REPORT. The department of human 18 19 services shall submit a report, including any changes in the 18 20 reimbursement methodology used under the medical assistance 18 21 program and any expenditures for the development of 18 22 alternatives to health care facility care, including assisted 18 23 living and elder group homes, to the governor and the general 18 24 assembly on or before December 15, 2000. To the extent 18 25 possible, any change in the reimbursement methodology shall 18 26 provide for maintenance of the eighty percent occupancy rate 18 27 except as this requirement relates to direct care costs, shall 18 28 avoid rate reductions for nursing facilities, and shall 18 29 utilize the payment methods provided under the federal 18 30 Medicare program in order to simplify the multitude of payor 18 31 programs. 18 32 Sec. 17. RESIDENTIAL CARE FACILITIES APPLICATION OF 18 33 PROGRAM. The department of human services shall review and 18 34 shall make recommendations to the general assembly on or 18 35 before October 1, 2000, relating to the feasibility of 19 1 applying the senior living program and any changes in the 19 2 reimbursement methodology to residential care facilities. 19 3 Sec. 18. MAINTENANCE OF FISCAL EFFORT. The fiscal effort, 19 4 existing on June 30, 2000, represented by appropriations made 19 5 for long-term care services by the general assembly, shall be 19 6 maintained and a reduction shall not be made in such 19 7 appropriations to the department of human services or the 19 8 department of elder affairs for those services as a result of 19 9 this Act. 19 10 Sec. 19. DEPARTMENT OF ELDER AFFAIRS APPROPRIATION. There 19 11 is appropriated from the senior living trust fund created in 19 12 section 249H.4 in this Act to the department of elder affairs 19 13 for the fiscal year beginning July 1, 2000, and ending June 19 14 30, 2001, the following amount, or so much thereof as is 19 15 necessary, to be used for the purposes designated: 19 16 For the development of a comprehensive senior living 19 17 program, including program administration and costs associated 19 18 with implementation, salaries, support, maintenance, 19 19 miscellaneous purposes, and for not more than the following 19 20 full-time equivalent positions: 19 21 .................................................. $ 4,188,123 19 22 ............................................... FTEs 7.00 19 23 The department of elder affairs may adopt emergency rules 19 24 to carry out the provisions of this section. 19 25 Sec. 20. DEPARTMENT OF HUMAN SERVICES APPROPRIATION. 19 26 There is appropriated from the senior living trust fund 19 27 created in section 249H.4 in this Act to the department of 19 28 human services for the fiscal year beginning July 1, 2000, and 19 29 ending June 30, 2001, the following amounts, or so much 19 30 thereof as is necessary, to be used for the purposes 19 31 designated: 19 32 1. To provide grants to nursing facilities for conversion 19 33 to assisted living programs or to provide long-term care 19 34 alternatives and to provide grants to long-term care providers 19 35 for development of long-term care alternatives: 20 1 .................................................. $ 15,000,000 20 2 2. To supplement the medical assistance appropriation and 20 3 to provide reimbursement for health care services and rent 20 4 expenses to eligible persons through the home and community- 20 5 based services waiver and the state supplementary assistance 20 6 program, including program administration and data system 20 7 costs associated with implementation, salaries, support, 20 8 maintenance, miscellaneous purposes, and for not more than the 20 9 following full-time equivalent positions: 20 10 .................................................. $ 2,189,569 20 11 ............................................... FTEs 5.00 20 12 3. To implement nursing facility provider reimbursement at 20 13 the seventieth percentile or reimbursement methodology 20 14 changes: 20 15 .................................................. $ 17,750,000 20 16 The department shall transfer these funds to supplement 20 17 other appropriations to the department of human services to 20 18 carry out the purposes of this subsection. 20 19 Sec. 21. EMERGENCY RULES. 20 20 1. The department of human services and the department of 20 21 elder affairs may adopt emergency rules to implement this Act. 20 22 2. If the department of human services or the department 20 23 of elder affairs adopts emergency rules under section 17A.4, 20 24 subsection 2, and section 17A.5, subsection 2, paragraph "b", 20 25 to implement this Act, the rules shall become effective 20 26 immediately upon filing, unless a later effective date is 20 27 specified in the rules. Any rules adopted in accordance with 20 28 the provisions of this section shall also be published as 20 29 notice of intended action as provided in section 17A.4. 20 30 Sec. 22. EFFECTIVE DATE. This Act, being deemed of 20 31 immediate importance, takes effect upon enactment. 20 32 Sec. 23. RETROACTIVE APPLICABILITY. The section in this 20 33 Act that creates section 249H.6 as it relates to receipt of 20 34 federal funding, is retroactively applicable to October 1, 20 35 1999. 21 1 EXPLANATION 21 2 This bill creates a new Code chapter 249H. Division I, 21 3 Code section 249H.1, establishes the "Iowa Senior Living 21 4 Program Act". 21 5 Division I, Code section 249H.2, provides the legislative 21 6 findings related to and the goal of the program. The goal of 21 7 the program is to create a comprehensive long-term care system 21 8 that is consumer-directed, provides balance between the 21 9 options of institutional and noninstitutional care, and 21 10 contributes to the quality of life. 21 11 Division II, Code section 249H.3, provides definitions used 21 12 in the chapter. 21 13 Division II, Code section 249H.4, creates the senior living 21 14 trust fund and provides for ongoing appropriations from the 21 15 trust fund. The trust fund is created in the state treasury 21 16 under the authority of the department of human services. 21 17 Moneys deposited in the fund include those received through 21 18 intergovernmental agreements for the senior living program, 21 19 grants, contributions, participant payments, and a portion of 21 20 the federal moneys received by the department of human 21 21 services from public nursing facilities. Moneys in the fund 21 22 are to be appropriated only for the purposes of the senior 21 23 living program. The trust fund is to be operated in 21 24 accordance with the guidelines of the health care financing 21 25 administration of the United States department of health and 21 26 human services. Moneys in the fund are not considered part of 21 27 the general fund of the state. Moneys in the fund at the end 21 28 of a fiscal year do not revert to the state general fund and 21 29 cannot be transferred, used, obligated, appropriated, or 21 30 otherwise encumbered, except for purposes of the senior living 21 31 program. Interest or earnings on moneys in the trust fund are 21 32 credited to the trust fund. The department of human services 21 33 is directed to adopt rules to administer the trust fund and to 21 34 establish participation in the program for public nursing 21 35 facilities. The treasurer of state is directed to provide a 22 1 quarterly report of the trust fund activities and balances to 22 2 the long-term care coordinating unit. 22 3 Division II, Code section 249H.5, provides for allocations 22 4 from the trust fund. Allocations include: 22 5 1. An allocation to the department of human services of a 22 6 maximum of $65 million over a maximum five-year period to be 22 7 used for the conversion of existing nursing facility space and 22 8 development of long-term care alternatives. 22 9 2. An allocation to the department of elder affairs, 22 10 annually, in an amount necessary to cover expenses of 22 11 implementation and administration of long-term care services 22 12 programs and for delivery of long-term care services to low 22 13 and moderate income seniors. 22 14 3. An allocation to the department of human services, 22 15 annually, for administrative purposes and service delivery 22 16 related to the senior living program and trust fund and for 22 17 implementation of a new reimbursement system. 22 18 4. An allocation to the department of human services, in 22 19 an amount necessary to provide nursing facility provider 22 20 reimbursements using a percentile-based reimbursement system 22 21 and to provide funding for the transition to a case-mix 22 22 reimbursement system. Funding is to be provided for the 22 23 pecentile-based reimbursement system until such time as the 22 24 case-mix reimbursement system if fully implemented. 22 25 5. An allocation to the department of human services, 22 26 annually, for additional expenses, relative to the senior 22 27 living program, that are incurred due to rent expenses of 22 28 consumers participating in a home and community-based waiver 22 29 program under the state supplementary assistance program. 22 30 The remainder of the funds is to be invested with the 22 31 interest and earnings to be used for administration of 22 32 programs and delivery of long-term care services and for 22 33 expenses related to implementation of the senior living 22 34 program and administration of the trust fund. 22 35 Division II, Code section 249H.6, provides the procedures 23 1 and criteria for the awarding of grants for conversion of 23 2 nursing facilities to provide assisted-living programs and for 23 3 long-term care services development. The section provides 23 4 that the section does not create an entitlement to any funds 23 5 available for grant purposes, but that the department of human 23 6 services, in its discretion, may only award grants to the 23 7 extent funds are available and applications are approved. 23 8 Division II, Code section 249H.7, provides for 23 9 appropriation of funds beginning October 1, 2000, to the 23 10 department of elder affairs for activities related to home and 23 11 community-based services for seniors. Moneys appropriated to 23 12 the department of elder affairs are to be disbursed through 23 13 the area agencies on aging. The section provides that the 23 14 section does not create an entitlement, but that the 23 15 department of elder affairs, in its discretion, may only 23 16 disburse funds to the extent funds are available and requests 23 17 for funding are approved. 23 18 Division II, Code section 249H.8, describes provisions 23 19 relating to the PACE program and the pre-PACE program, which 23 20 is defined in the bill as a program that provides delivery of 23 21 comprehensive health and social services to seniors by 23 22 integrating acute and long-term care services, and is operated 23 23 by an entity as permitted under federal regulation. A pre- 23 24 PACE program is defined as a PACE program in its initial 23 25 stages that provides the same scope of services as a PACE 23 26 program. 23 27 Division II, Code section 249H.9, directs the department of 23 28 elder affairs and the area agencies on aging, in consultation 23 29 with the senior living coordinating unit, to create a database 23 30 directory of all health care and support services available, 23 31 to seniors. The database is to be made available, 23 32 electronically, to the public. The bill directs the 23 33 department of elder affairs to seek foundation funding to 23 34 provide an educational program to individuals ages 21 and 23 35 older to assist them in planning for financing health care 24 1 services and other supports in their senior years. The bill 24 2 also directs the department of human services to develop and 24 3 distribute an informational packet to the public that explains 24 4 the medical assistance program relative to health care 24 5 services options for seniors. The bill provides that the 24 6 director of human services, director of the department of 24 7 elder affairs, director of public health, director of the 24 8 department of inspections and appeals, the director of revenue 24 9 and finance, and the commissioner of insurance are to 24 10 constitute a senior advisory council to provide oversight in 24 11 the development and operation of all informational aspects of 24 12 the senior living program. 24 13 Division II, Code section 249H.10, provides for the 24 14 establishment of a caregiver support access and education 24 15 program to provide access to respite care and education to 24 16 caregivers, through the area agencies on aging or other 24 17 appropriate agencies. 24 18 Division II, Code section 249H.11, provides a sunset 24 19 provision for new Code section 249H.6, which is the section 24 20 that provides grants for nursing facility conversion and long- 24 21 term care services development. Under the bill, Code section 24 22 249H.6 would be repealed effective June 30, 2005. 24 23 Division III of the bill provides miscellaneous provisions. 24 24 Division III of the bill adds a provision to the health 24 25 care facilities chapter which requires nursing facilities, 24 26 regardless of the individual's source of payment for care, to 24 27 complete a resident assessment for all prospective and current 24 28 residents. 24 29 Division III of the bill changes the name of the long-term 24 30 care coordinating unit to the senior living coordinating unit; 24 31 adds four members of the general assembly to the membership of 24 32 the unit as ex officio, nonvoting members; and adds to the 24 33 duties of the unit the provision of direction and oversight 24 34 for disbursement of moneys from the senior living trust fund 24 35 and the required consultation with state universities and 25 1 other institutions with expertise in senior issues and long- 25 2 term care. 25 3 Division III of the bill requests that the legislative 25 4 council authorize a senior living insurance and incentives 25 5 study committee to review current long-term care insurance 25 6 laws, current long-term care insurance options available in 25 7 the state, the types of services covered under a long-term 25 8 care insurance option, and incentives for the purchase of 25 9 long-term care insurance including, but not limited to, tax 25 10 credits. The study committee is to include input from 25 11 consumers, consumer advocates, the health care industry, and 25 12 the insurance industry. The study committee is directed to 25 13 submit a report of the findings and recommendations to the 25 14 governor and the general assembly by December 15, 2000. 25 15 Division III of the bill directs the department of human 25 16 services to submit a report including any changes in the 25 17 reimbursement methodology under the medical assistance program 25 18 and any expenditures for the development of alternatives to 25 19 health care facility care to the general assembly by December 25 20 15, 2000. The bill provides that, to the extent possible, any 25 21 changes in the reimbursement methodology are to provide for 25 22 maintenance of the 80 percent occupancy rate, except as the 25 23 requirement relates to direct-care costs, shall avoid rate 25 24 reductions for nursing facilities, and shall utilize the 25 25 payment methods provided under the federal Medicare program in 25 26 order to simplify the multitude of payor programs. 25 27 Division III of the bill directs the department of human 25 28 services to review and make recommendations to the general 25 29 assembly on or before October 1, 2000, regarding the 25 30 feasibility of applying the senior living program to 25 31 residential care facilities and in applying any reimbursement 25 32 methodology changes to these facilities. 25 33 Division III of the bill establishes that the general 25 34 assembly is to maintain the fiscal effort in funding long-term 25 35 care services, existing on June 30, 2000, and is not to make 26 1 reductions in appropriations for this purpose as a result of 26 2 the bill. 26 3 Division III of the bill provides for fiscal year 2000-2001 26 4 appropriations to the department of human services and the 26 5 department of elder affairs relating to the senior living 26 6 program. 26 7 Division III of the bill provides for emergency rulemaking 26 8 authority for the department of human services and the 26 9 department of elder affairs in implementing the bill. 26 10 The bill takes effect upon enactment. The section of the 26 11 bill relating to the receipt of federal funds on or after 26 12 October 1, 1999, is retroactively applicable to October 1, 26 13 1999. 26 14 LSB 6131XC 78 26 15 pf/cf/24.3
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