Text: H01763                            Text: H01765
Text: H01700 - H01799                   Text: H Index
Bills and Amendments: General Index     Bill History: General Index



House Amendment 1764

Amendment Text

PAG LIN
  1  1    Amend House File 740 as follows:
  1  2    #1.  By striking page 2, line 18, through page 10,
  1  3 line 28, and inserting the following:
  1  4    "Sec.    .  MODIFIED PRICE-BASED CASE-MIX
  1  5 REIMBURSEMENT – NURSING FACILITIES.
  1  6    1.  Beginning July 1, 2001, the department of human
  1  7 services shall reimburse nursing facilities under the
  1  8 medical assistance program in accordance with a
  1  9 phased-in, modified price-based case-mix reimbursement
  1 10 system that includes a case-mix adjusted component and
  1 11 a non-case-mix adjusted component.
  1 12    2.  The modified price-based case-mix reimbursement
  1 13 rate shall be phased in over a three-year period.
  1 14    a.  For the fiscal year beginning July 1, 2001, and
  1 15 ending June 30, 2002, 66.67 percent of a facility's
  1 16 reimbursement rate shall be computed based on the
  1 17 current rate effective June 30, 2001, and 33.33
  1 18 percent shall be computed based on the modified price-
  1 19 based case-mix reimbursement rate.  The current rate
  1 20 portion shall be increased by an inflation allowance
  1 21 of 6.21 percent, with a maximum reimbursement rate of
  1 22 $94.00.
  1 23    b.  For the fiscal year beginning July 1, 2002, and
  1 24 ending June 30, 2003, 33.33 percent of a facility's
  1 25 reimbursement rate shall be computed based on the
  1 26 current rate effective June 30, 2001, and 66.67
  1 27 percent shall be computed based on the modified price-
  1 28 based case-mix reimbursement rate.  The current rate
  1 29 portion shall be increased by an inflation allowance
  1 30 of 9.21 percent with a maximum reimbursement rate of
  1 31 $97.47.
  1 32    c.  For the fiscal year beginning July 1, 2003, and
  1 33 ending June 30, 2004, and thereafter, 100 percent of a
  1 34 facility's reimbursement rate shall be computed based
  1 35 on the modified price-based case-mix reimbursement
  1 36 rate.
  1 37    3.  Modified price-based case-mix reimbursement
  1 38 rate calculation.
  1 39    a.  The department of human services shall
  1 40 determine the statewide median of nursing facility
  1 41 costs as follows:
  1 42    (1)  For the fiscal period beginning July 1, 2001,
  1 43 and ending June 30, 2003, the department shall
  1 44 determine the statewide median of nursing facility
  1 45 costs based upon each facility's actual costs taken
  1 46 from the most recent cost reports, submitted by the
  1 47 nursing facility for the period ending on or before
  1 48 December 31, 2000, subject to certain existing
  1 49 limitations and adjustments.  These costs shall be
  1 50 inflated forward to July 1, 2001, by using the
  2  1 midpoint of each cost report and applying the HCFA/SNF
  2  2 index.
  2  3    (2)  Beginning July 1, 2003, and every second state
  2  4 fiscal year thereafter beginning on July 1 of the
  2  5 respective state fiscal year, the department shall
  2  6 recalculate the statewide median of nursing facility
  2  7 costs based upon the most recent cost reports
  2  8 submitted by the nursing facility for the period
  2  9 ending on or before December 31 of the previous
  2 10 calendar year and shall inflate these costs forward to
  2 11 the beginning of the state fiscal year, by using the
  2 12 midpoint of each cost report and applying the HCFA/SNF
  2 13 index.
  2 14    b.  Beginning July 1, 2002, and thereafter, the
  2 15 occupancy factor shall be increased to 85 percent when
  2 16 calculating the nondirect care cost component of the
  2 17 modified price-based case-mix reimbursement rate.  The
  2 18 occupancy factor shall not apply to support care
  2 19 costs.
  2 20    c.  The modified price-based case-mix reimbursement
  2 21 rate paid to nursing facilities shall be calculated
  2 22 using the statewide median cost as adjusted to reflect
  2 23 the case mix of the medical assistance residents in
  2 24 the nursing facility.
  2 25    d.  (1)  The department of human services shall use
  2 26 the resource utilization groups-III (RUG-III), version
  2 27 5.12b, 34 group, index maximizer model as the resident
  2 28 classification system to determine a nursing
  2 29 facility's case-mix index, based on data from the
  2 30 minimum data set (MDS) submitted by each facility.
  2 31 Standard version 5.12b, 34 group case-mix indices,
  2 32 developed by HCFA, shall be the basis for calculating
  2 33 the average case-mix index and shall be used to adjust
  2 34 the direct-care component in the determination of the
  2 35 modified price-based case-mix reimbursement rate.
  2 36    (2)  The department of human services shall
  2 37 determine and adjust each facility's case-mix index on
  2 38 a quarterly basis.  A separate calculation shall be
  2 39 made to determine the average case-mix index for a
  2 40 facilitywide case-mix index, and a case-mix index for
  2 41 the medical assistance residents of the nursing
  2 42 facility using the minimum data set (MDS) report
  2 43 submitted by the facility for the previous quarter,
  2 44 which reflects the residents in the facility on the
  2 45 last day of the previous calendar quarter.
  2 46    e.  The department shall calculate the rate ceiling
  2 47 for the direct-care cost component at 110 percent of
  2 48 the median of case-mix adjusted costs.  Nursing
  2 49 facilities with direct care case-mix adjusted costs at
  2 50 100 percent of the median or greater, shall receive an
  3  1 amount equal to their costs not to exceed 110 percent
  3  2 of the median.  Nursing facilities with case-mix
  3  3 adjusted costs below 100 percent of the median shall
  3  4 receive a profit add-on payment by having their
  3  5 payment rate for the direct-care cost component
  3  6 calculated as their allowable case-mix adjusted cost
  3  7 plus 50 percent of the difference between 100 percent
  3  8 of the median and their allowable case-mix adjusted
  3  9 cost, not to exceed 10 percent of the median of case-
  3 10 mix adjusted costs.
  3 11    f.  The department shall calculate the rate ceiling
  3 12 for the nondirect care cost component at 100 percent
  3 13 of the median of non-case-mix adjusted costs.  Nursing
  3 14 facilities with non-case-mix adjusted costs at 95
  3 15 percent of the median or greater shall receive an
  3 16 amount equal to their costs not to exceed 100 percent
  3 17 of the median.  Nursing facilities with non-case-mix
  3 18 adjusted costs below 95 percent of the median shall
  3 19 receive a profit add-on payment that is their costs
  3 20 plus 50 percent of the difference between 95 percent
  3 21 of the median and their non-case-mix adjusted costs,
  3 22 not to exceed 15 percent of the median of non-case-mix
  3 23 adjusted costs.
  3 24    g.  The department shall apply the geographic wage
  3 25 index adjustment annually to the case-mix adjusted
  3 26 component of the modified price-based case-mix
  3 27 reimbursement rate for the nursing facilities located
  3 28 in standard metropolitan statistical area counties in
  3 29 Iowa identified by HCFA.  This rate shall be
  3 30 calculated using the case-mix adjusted costs of the
  3 31 nursing facility, not to exceed $8 per patient day.  A
  3 32 nursing facility may request an exception to
  3 33 application of the geographic wage index based upon a
  3 34 reasonable demonstration of wages, location, and total
  3 35 cost.  A request for an exception shall be submitted
  3 36 to the department of human services within 30 days of
  3 37 receipt of notification by the nursing facility of the
  3 38 new reimbursement rate.  The exception request shall
  3 39 include an explanation of the circumstances and
  3 40 supporting data.
  3 41    h.  For the purpose of determining the median
  3 42 applicable to Medicare-certified hospital-based
  3 43 skilled nursing facilities, the department shall treat
  3 44 such facilities as a separate peer group.
  3 45    i.  The modified price-based case-mix reimbursement
  3 46 rate for state-operated nursing facilities and special
  3 47 population nursing facilities shall be the average
  3 48 allowable per diem costs, adjusted for inflation,
  3 49 based on the most current financial and statistical
  3 50 report.  Special population nursing facilities
  4  1 enrolled on or after June 1, 1993, shall have a rate
  4  2 ceiling equal to the rate ceiling for Medicare-
  4  3 certified hospital-based nursing facilities.
  4  4    4.  a.  ACCOUNTABILITY MEASURES.
  4  5    It is the intent of the general assembly that the
  4  6 department of human services initiate a system to
  4  7 measure a variety of elements to determine a nursing
  4  8 facility's capacity to provide quality of life and
  4  9 appropriate access to medical assistance program
  4 10 beneficiaries in a cost-effective manner.  Beginning
  4 11 July 1, 2001, the department shall implement a process
  4 12 to collect data for these measurements and shall
  4 13 develop procedures to increase nursing facility
  4 14 reimbursements based upon a nursing facility's
  4 15 achievement of multiple favorable outcomes as
  4 16 determined by these measurements.  Any increased
  4 17 reimbursement shall not exceed 3 percent of the
  4 18 calculation of the modified price-based case-mix
  4 19 reimbursement median.  The increased reimbursement
  4 20 shall be included in the calculation of nursing
  4 21 facility modified price-based payment rates beginning
  4 22 July 1, 2002, with the exception of Medicare-certified
  4 23 hospital-based nursing facilities, state-operated
  4 24 nursing facilities, and special population nursing
  4 25 facilities.
  4 26    b.  It is the intent of the general assembly that
  4 27 increases in payments to nursing facilities under the
  4 28 case-mix adjusted component shall be used for the
  4 29 provision of direct care.  The department shall
  4 30 compile and provide a detailed analysis to demonstrate
  4 31 growth of direct care costs, increased acuity, and
  4 32 care needs of residents.  The department shall also
  4 33 provide analysis of cost reports submitted by
  4 34 providers and the resulting desk review and field
  4 35 audit adjustments to reclassify and amend provider
  4 36 cost and statistical data.  The results of these
  4 37 analyses shall be submitted to the general assembly
  4 38 for evaluation to determine payment levels following
  4 39 the transition funding period.
  4 40    5.  As used in this section:
  4 41    a.  "Case-mix" means a measure of the intensity of
  4 42 care and services used by similar residents in a
  4 43 facility.
  4 44    b.  "Case-mix adjusted costs" means specified costs
  4 45 adjusted for acuity by the case-mix index.  Costs
  4 46 subject to adjustment are the salaries and benefits of
  4 47 registered nurses, licensed practical nurses,
  4 48 certified nursing assistants, rehabilitation nurses,
  4 49 and contracted nursing services.
  4 50    c.  "Case-mix index" means a numeric score within a
  5  1 specific range that identifies the relative resources
  5  2 used by similar residents and represents the average
  5  3 resource consumption across a population or sample.
  5  4    d.  "Facilitywide average case-mix index" is a
  5  5 simple average, carried to four decimal places, of all
  5  6 resident case-mix indices based on the last day of
  5  7 each calendar quarter.
  5  8    e.  "Geographic wage index" means an annual
  5  9 calculation of the average difference between the Iowa
  5 10 hospital-based rural wage index and Iowa hospital-
  5 11 based standard metropolitan statistical area wage
  5 12 indices as published by HCFA each July.  The wage
  5 13 factor shall be revised when the skilled nursing
  5 14 facility wage indices are released by HCFA.
  5 15    f.  "HCFA" means the health care financing
  5 16 administration of the United States department of
  5 17 health and human services.
  5 18    g.  "HCFA/SNF index" means the HCFA total skilled
  5 19 nursing facility market basket index published by data
  5 20 resources, inc.  The HCFA/SNF index listed in the
  5 21 latest available quarterly publication prior to the
  5 22 July 1 rate setting shall be used to determine the
  5 23 inflation factor which shall be applied based upon the
  5 24 midpoint of the cost report period.
  5 25    h.  "Median" means the median cost calculated by
  5 26 using a weighting method based upon total patient days
  5 27 of each nursing facility.
  5 28    i.  "Medicaid" or "medical assistance" means
  5 29 medical assistance as defined in section 249A.2.
  5 30    j.  "Medicaid average case-mix index" means the
  5 31 simple average, carried to four decimal places, of all
  5 32 resident case-mix indices where Medicaid is known to
  5 33 be the per diem payor source on the last day of the
  5 34 calendar quarter.
  5 35    k.  "Medicare" means the federal Medicare program
  5 36 established by Title XVIII of the federal Social
  5 37 Security Act.
  5 38    l.  "Minimum data set" or "MDS" means the federally
  5 39 required resident assessment tool.  Information from
  5 40 the MDS is used by the department to determine the
  5 41 facility's case-mix index.
  5 42    m.  "Non-case-mix adjusted costs" means an amount
  5 43 stated in terms of per patient day that is calculated
  5 44 using allowable costs from the cost reports of
  5 45 facilities, divided by the allowable patient days for
  5 46 the cost report period, and beginning July 1, 2003,
  5 47 patient days as modified pursuant to subsection 3,
  5 48 paragraph "b".  Non-case-mix adjusted costs include
  5 49 all allowable costs less case-mix adjusted costs.
  5 50    n.  "Nursing facility" means a skilled nursing
  6  1 facility certified under both the federal Medicaid
  6  2 program and the federal Medicare program, and a
  6  3 nursing facility certified under the federal Medicaid
  6  4 program.
  6  5    o.  "Rate ceiling" or "upper payment limit" means a
  6  6 maximum rate amount stated in terms of per patient day
  6  7 that is calculated as a percent of the median.
  6  8    p.  "Special population nursing facility" means a
  6  9 skilled nursing facility the resident population of
  6 10 which is either of the following:
  6 11    (1)  One hundred percent of the residents of the
  6 12 nursing facility is under the age of 22 and require
  6 13 the skilled level of care.
  6 14    (2)  Seventy percent of the residents served
  6 15 require the skilled level of care for neurological
  6 16 disorders.
  6 17    6.  The department of human services may adopt
  6 18 rules under section 17A.4, subsection 2, and section
  6 19 17A.5, subsection 2, paragraph "b", to implement this
  6 20 section.  The rules shall become effective immediately
  6 21 upon filing, unless the effective date is delayed by
  6 22 the administrative rules review committee,
  6 23 notwithstanding section 17A.4, subsection 5, and
  6 24 section 17A.8, subsection 9, or a later effective date
  6 25 is specified in the rules.  Any rules adopted in
  6 26 accordance with this section shall not take effect
  6 27 before the rules are reviewed by the administrative
  6 28 rules review committee.  Any rules adopted in
  6 29 accordance with the provisions of this section shall
  6 30 also be published as notice of intended action as
  6 31 provided in section 17A.4.
  6 32    Sec.    .  NURSING FACILITY CONVERSION GRANTS.  The
  6 33 nursing facility conversion grants awarded on or after
  6 34 July 1, 2000, may be used to convert all or a portion
  6 35 of the licensed nursing facility to a certified
  6 36 assisted-living program.  All converted units of
  6 37 assisted living shall be affordable, as defined in
  6 38 section 249H.3, to persons with low or moderate
  6 39 incomes.  Grant recipients shall maintain a minimum
  6 40 medical assistance client base participation rate of
  6 41 40 percent, subject to demand for participation by
  6 42 individuals eligible for medical assistance.  The
  6 43 department of human services shall adjust the criteria
  6 44 for eligibility for conversion grants to allow a
  6 45 licensed nursing facility that has been an approved
  6 46 provider under the medical assistance program for a
  6 47 three-year period to apply for a conversion grant
  6 48 beginning July 1, 2001."
  6 49    #2.  Title page, by striking lines 4 and 5, and
  6 50 inserting the following:  "department of human
  7  1 services."
  7  2    #3.  By renumbering as necessary.  
  7  3 
  7  4 
  7  5                               
  7  6 OSTERHAUS of Jackson
  7  7 HF 740.707 79
  7  8 pf/cls
     

Text: H01763                            Text: H01765
Text: H01700 - H01799                   Text: H Index
Bills and Amendments: General Index     Bill History: General Index

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