Text: H01763 Text: H01765 Text: H01700 - H01799 Text: H Index Bills and Amendments: General Index Bill History: General Index
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
© 2001 Cornell College and League of Women Voters of Iowa
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