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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