Text: HF00739 Text: HF00741 Text: HF00700 - HF00799 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 HOUSE FILE 740 1 2 1 3 AN ACT 1 4 RELATING TO THE SENIOR LIVING PROGRAM INCLUDING PROVISIONS 1 5 RELATING TO AND MAKING APPROPRIATIONS FROM THE SENIOR LIVING 1 6 TRUST FUND TO THE DEPARTMENT OF ELDER AFFAIRS AND THE 1 7 DEPARTMENT OF HUMAN SERVICES. 1 8 1 9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 1 10 1 11 Section 1. DEPARTMENT OF ELDER AFFAIRS APPROPRIATION. 1 12 There is appropriated from the senior living trust fund 1 13 created in section 249H.4 to the department of elder affairs 1 14 for the fiscal year beginning July 1, 2001, and ending June 1 15 30, 2002, the following amount, or so much thereof as is 1 16 necessary, to be used for the purpose designated: 1 17 For the development of a comprehensive senior living 1 18 program, including program administration and costs associated 1 19 with implementation, salaries, support, maintenance, and 1 20 miscellaneous purposes, and for not more than the following 1 21 full-time equivalent positions: 1 22 .................................................. $ 5,285,426 1 23 ............................................... FTEs 8.00 1 24 1. Of the funds appropriated in this section, $100,000 1 25 shall be used by the department to fund recruitment and 1 26 retention strategies to provide additional training and 1 27 support for certified nurse aides, employed by nursing 1 28 facilities, as a means of reducing staff turnover. The 1 29 department shall contract with an agency or organization whose 1 30 primary purpose is the improvement of the nurse aide 1 31 profession through the provision of continuing education, 1 32 support and empowerment programs, and career opportunities 1 33 within the field of nurse assisting, with the goal of the 1 34 further stabilization of the nurse aide workforce and the 1 35 reduction of nurse aide turnover. 2 1 2. Of the funds appropriated in this section, $255,800 2 2 shall be used by the department to fund strategies for 2 3 dependent adult abuse detection, training, and services. 2 4 3. The funds appropriated under this section shall be used 2 5 in accordance with any regulations, requirements, or 2 6 guidelines of the health care financing administration of the 2 7 United States department of health and human services 2 8 applicable to the senior living program. 2 9 Sec. 2. DEPARTMENT OF HUMAN SERVICES APPROPRIATION. There 2 10 is appropriated from the senior living trust fund created in 2 11 section 249H.4 to the department of human services for the 2 12 fiscal year beginning July 1, 2001, and ending June 30, 2002, 2 13 the following amounts, or so much thereof as is necessary, to 2 14 be used for the purposes designated: 2 15 1. To provide grants to nursing facilities for conversion 2 16 to assisted living programs or to provide long-term care 2 17 alternatives and to provide grants to long-term care providers 2 18 for development of long-term care alternatives: 2 19 .................................................. $ 20,000,000 2 20 2. To supplement the medical assistance appropriation and 2 21 to provide reimbursement for health care services and rent 2 22 expenses to eligible persons through the home and community- 2 23 based services waiver and the state supplementary assistance 2 24 program, including program administration and data system 2 25 costs associated with implementation, salaries, support, 2 26 maintenance, and miscellaneous purposes, and for not more than 2 27 the following full-time equivalent positions: 2 28 .................................................. $ 1,733,406 2 29 ............................................... FTEs 5.00 2 30 3. To implement nursing facility provider reimbursement 2 31 based upon a case-mix reimbursement methodology: 2 32 .................................................. $ 24,750,000 2 33 a. In order to carry out the purposes of this subsection, 2 34 the department shall transfer funds appropriated in this 2 35 section to supplement other appropriations to the department 3 1 of human services. 3 2 b. Notwithstanding section 8.33, moneys appropriated under 3 3 this subsection that remain unencumbered or unobligated at the 3 4 close of the fiscal year shall be retained in the senior 3 5 living trust fund. 3 6 Sec. 3. CONVERSION GRANT PROJECTS – RULES – INTENT. 3 7 1. The department of human services shall adopt rules that 3 8 provide that beginning with applications for conversion grants 3 9 received on or after July 1, 2001, the department shall give 3 10 greater weight in the scoring methodology to nursing facility 3 11 conversion projects that are primarily the renovation and 3 12 remodeling of the existing nursing facility structure and give 3 13 less weight to conversion projects that are primarily new 3 14 construction. The department of human services shall 3 15 encourage cooperative efforts between the department of 3 16 inspections and appeals, the state fire marshal and the grant 3 17 applicant to promote the acceptance of nursing facility 3 18 conversion projects that are primarily renovation and 3 19 remodeling of the existing nursing facility structure. 3 20 2. It is the intent of the general assembly that the 3 21 department of elder affairs certify all assisted living 3 22 programs established through nursing facility conversion 3 23 grants. The department of elder affairs shall consult with 3 24 conversion grant applicants and recipients to establish and 3 25 monitor occupancy agreements and assisted living program 3 26 residents shall be allowed access to third-party payors. The 3 27 department of elder affairs shall allow grant recipients to 3 28 revise and modify occupancy agreements to reflect rates that 3 29 are affordable, as defined in section 249H.3, during the ten- 3 30 year period of operation following the awarding of the grant 3 31 by the department of human services. 3 32 Sec. 4. MODIFIED PRICE-BASED CASE-MIX REIMBURSEMENT – 3 33 NURSING FACILITIES. 3 34 1. Beginning July 1, 2001, the department of human 3 35 services shall reimburse nursing facilities under the medical 4 1 assistance program in accordance with a phased-in, modified 4 2 price-based case-mix reimbursement system that includes a 4 3 case-mix adjusted component and a non-case-mix adjusted 4 4 component. 4 5 2. The modified price-based case-mix reimbursement rate 4 6 shall be phased in over a three-year period. 4 7 a. For the fiscal year beginning July 1, 2001, and ending 4 8 June 30, 2002, 66.67 percent of a facility's reimbursement 4 9 rate shall be computed based on the current rate and 33.33 4 10 percent shall be computed based on the modified price-based 4 11 case-mix reimbursement rate. The current rate portion shall 4 12 be calculated from the cost reports submitted by nursing 4 13 facilities for the period ending on or before December 31, 4 14 2000, plus an inflation factor of 6.21 percent, with a maximum 4 15 current rate portion of $94.00. A nursing facility shall not 4 16 receive a reimbursement rate under this paragraph that is less 4 17 than the rate received on June 30, 2001, plus an inflation 4 18 factor of 6.21 percent. For the purposes of this calculation, 4 19 any excess payment allowance received by the facility shall 4 20 not be considered part of the reimbursement rate. 4 21 b. For the fiscal year beginning July 1, 2002, and ending 4 22 June 30, 2003, 33.33 percent of a facility's reimbursement 4 23 rate shall be computed based on the current rate and 66.67 4 24 percent shall be computed based on the modified price-based 4 25 case-mix reimbursement rate. The current rate portion shall 4 26 be calculated from the current rate for the previous state 4 27 fiscal year, plus an additional inflation factor based on 4 28 HCFA/SNF index, with an estimated maximum current rate portion 4 29 of $97.47. A nursing facility shall not receive a 4 30 reimbursement rate under this paragraph that is less than the 4 31 rate received on June 30, 2002, plus an inflation factor based 4 32 on the HCFA/SNF index. For the purposes of this calculation, 4 33 any excess payment allowance received by the facility shall 4 34 not be considered part of the reimbursement rate. 4 35 c. For the fiscal year beginning July 1, 2003, and ending 5 1 June 30, 2004, and thereafter, 100 percent of a facility's 5 2 reimbursement rate shall be computed based on the modified 5 3 price-based case-mix reimbursement rate. 5 4 3. Modified price-based case-mix reimbursement rate 5 5 calculation. 5 6 a. The department of human services shall determine the 5 7 statewide median of nursing facility costs as follows: 5 8 (1) For the fiscal period beginning July 1, 2001, and 5 9 ending June 30, 2003, the department shall determine the 5 10 statewide median of nursing facility costs based upon each 5 11 facility's actual costs taken from the most recent cost 5 12 reports, submitted by the nursing facility for the period 5 13 ending on or before December 31, 2000, subject to certain 5 14 existing limitations and adjustments. These costs shall be 5 15 inflated forward to July 1, 2001, by using the midpoint of 5 16 each cost report and applying the HCFA/SNF index. 5 17 (2) Beginning July 1, 2003, and every other fiscal year 5 18 thereafter beginning on July 1 of the respective state fiscal 5 19 year, the department shall recalculate the statewide median of 5 20 nursing facility costs based upon the most recent cost reports 5 21 submitted by the nursing facility for the period ending on or 5 22 before December 31 of the previous calendar year and shall 5 23 inflate these costs forward to the beginning of the state 5 24 fiscal year by using the midpoint of each cost report and 5 25 applying the HCFA/SNF index. 5 26 b. Beginning July 1, 2003, and thereafter, an occupancy 5 27 factor of 85 percent shall be applied when calculating the 5 28 nondirect care cost component of the modified price-based 5 29 case-mix reimbursement rate. The occupancy factor shall not 5 30 apply to support care costs. 5 31 c. The modified price-based case-mix reimbursement rate 5 32 paid to nursing facilities shall be calculated using the 5 33 statewide median cost as adjusted to reflect the case mix of 5 34 the medical assistance residents in the nursing facility. 5 35 d. (1) The department of human services shall use the 6 1 resource utilization groups-III (RUG-III), version 5.12b, 34 6 2 group, index maximizer model as the resident classification 6 3 system to determine a nursing facility's case-mix index, based 6 4 on data from the minimum data set (MDS) submitted by each 6 5 facility. Standard version 5.12b, 34 group case-mix indices, 6 6 developed by HCFA, shall be the basis for calculating the 6 7 average case-mix index and shall be used to adjust the direct- 6 8 care component in the determination of the rate ceiling and 6 9 the modified price-based case-mix reimbursement rate. 6 10 (2) The department of human services shall determine and 6 11 adjust each facility's case-mix index on a quarterly basis. A 6 12 separate calculation shall be made to determine the average 6 13 case-mix index for a facilitywide case-mix index, and a case- 6 14 mix index for the medical assistance residents of the nursing 6 15 facility using the minimum data set (MDS) report submitted by 6 16 the facility for the previous quarter, which reflects the 6 17 residents in the facility on the last day of the previous 6 18 calendar quarter. 6 19 e. The department shall calculate the rate ceiling for the 6 20 direct-care cost component at 120 percent of the median of 6 21 case-mix adjusted costs. Nursing facilities with case-mix 6 22 adjusted costs at 95 percent of the median or greater, shall 6 23 receive an amount equal to their costs not to exceed 120 6 24 percent of the median. Nursing facilities with case-mix 6 25 adjusted costs below 95 percent of the median shall receive an 6 26 excess payment allowance by having their payment rate for the 6 27 direct-care cost component calculated as their case-mix 6 28 adjusted cost plus 100 percent of the difference between 95 6 29 percent of the median and their case-mix adjusted cost, not to 6 30 exceed 10 percent of the median of case-mix adjusted costs. 6 31 Any excess payment allowance realized from the direct care 6 32 cost component of the modified price-based case-mix 6 33 reimbursement shall be expended to increase the compensation 6 34 of direct care workers or to increase the ratio of direct care 6 35 workers to residents. The department of human services shall 7 1 implement a new monitoring and reporting system to assess 7 2 compliance with the provisions of this paragraph. 7 3 f. The department shall calculate the rate ceiling for the 7 4 nondirect care cost component at 110 percent of the median of 7 5 non-case-mix adjusted costs. Nursing facilities with non- 7 6 case-mix adjusted costs at 96 percent of the median or greater 7 7 shall receive an amount equal to their costs not to exceed 110 7 8 percent of the median. Nursing facilities with non-case-mix 7 9 adjusted costs below 96 percent of the median shall receive an 7 10 excess payment allowance that is their costs plus 65 percent 7 11 of the difference between 96 percent of the median and their 7 12 non-case-mix adjusted costs, not to exceed 8 percent of the 7 13 median of non-case-mix adjusted costs. Any excess payment 7 14 allowance realized from the nondirect care cost component of 7 15 the modified price-based case-mix reimbursement shall be used 7 16 to fund quality of life improvements. The department of human 7 17 services shall implement a new monitoring and reporting system 7 18 to assess compliance with the provisions of this paragraph. 7 19 g. The department shall apply the geographic wage index 7 20 adjustment annually to the case-mix adjusted component of the 7 21 modified price-based case-mix reimbursement rate for nursing 7 22 facilities located in standard metropolitan statistical area 7 23 counties in Iowa identified by HCFA. This rate shall be 7 24 calculated using the case-mix adjusted costs of the nursing 7 25 facility, not to exceed $8 per patient day. A nursing 7 26 facility may request an exception to application of the 7 27 geographic wage index based upon a reasonable demonstration of 7 28 wages, location, or total cost. A request for an exception 7 29 shall be submitted to the department of human services within 7 30 30 days of receipt of notification by the nursing facility of 7 31 the new reimbursement rate. The exception request shall 7 32 include an explanation of the circumstances and supporting 7 33 data. 7 34 h. For the purpose of determining the median applicable to 7 35 Medicare-certified hospital-based skilled nursing facilities, 8 1 the department shall treat such facilities as a separate peer 8 2 group. 8 3 i. The modified price-based case-mix reimbursement rate 8 4 for state-operated nursing facilities and special population 8 5 nursing facilities shall be the average allowable per diem 8 6 costs, adjusted for inflation, based on the most current 8 7 financial and statistical report. Special population nursing 8 8 facilities enrolled on or after June 1, 1993, shall have a 8 9 rate ceiling equal to the rate ceiling for Medicare-certified 8 10 hospital-based nursing facilities. 8 11 4. ACCOUNTABILITY MEASURES. 8 12 a. It is the intent of the general assembly that the 8 13 department of human services initiate a system to measure a 8 14 variety of elements to determine a nursing facility's capacity 8 15 to provide quality of life and appropriate access to medical 8 16 assistance program beneficiaries in a cost-effective manner. 8 17 Beginning July 1, 2001, the department shall implement a 8 18 process to collect data for these measurements and shall 8 19 develop procedures to increase nursing facility reimbursements 8 20 based upon a nursing facility's achievement of multiple 8 21 favorable outcomes as determined by these measurements. Any 8 22 increased reimbursement shall not exceed 3 percent of the 8 23 calculation of the modified price-based case-mix reimbursement 8 24 median. The increased reimbursement shall be included in the 8 25 calculation of nursing facility modified price-based payment 8 26 rates beginning July 1, 2002, with the exception of Medicare- 8 27 certified hospital-based nursing facilities, state-operated 8 28 nursing facilities, and special population nursing facilities. 8 29 b. It is the intent of the general assembly that increases 8 30 in payments to nursing facilities under the case-mix adjusted 8 31 component shall be used for the provision of direct care with 8 32 an emphasis on compensation to direct care workers. The 8 33 department shall compile and provide a detailed analysis to 8 34 demonstrate growth of direct care costs, increased acuity, and 8 35 care needs of residents. The department shall also provide 9 1 analysis of cost reports submitted by providers and the 9 2 resulting desk review and field audit adjustments to 9 3 reclassify and amend provider cost and statistical data. The 9 4 results of these analyses shall be submitted to the general 9 5 assembly for evaluation to determine payment levels following 9 6 the transition funding period. 9 7 5. As used in this section: 9 8 a. "Case-mix" means a measure of the intensity of care and 9 9 services used by similar residents in a facility. 9 10 b. "Case-mix adjusted costs" means specified costs 9 11 adjusted for acuity by the case-mix index. Costs subject to 9 12 adjustment are the salaries and benefits of registered nurses, 9 13 licensed practical nurses, certified nursing assistants, 9 14 rehabilitation nurses, and contracted nursing services. 9 15 c. "Case-mix index" means a numeric score within a 9 16 specific range that identifies the relative resources used by 9 17 similar residents and represents the average resource 9 18 consumption across a population or sample. 9 19 d. "Excess payment allowance" means an amount stated as a 9 20 percentage that is calculated as a percent of the difference 9 21 between the excess payment ceiling and a nursing facility's 9 22 costs. 9 23 e. "Excess payment ceiling" or "profit ceiling" means an 9 24 amount stated in terms of per patient day that is calculated 9 25 as a percent of the median. 9 26 f. "Facilitywide average case-mix index" is a simple 9 27 average, carried to four decimal places, of all resident case- 9 28 mix indices based on the last day of each calendar quarter. 9 29 g. "Geographic wage index" means an annual calculation of 9 30 the average difference between the hospital-based rural wage 9 31 index for Iowa and Iowa hospital-based standard metropolitan 9 32 statistical area wage indices as published by HCFA each July. 9 33 The wage factor shall be revised when the skilled nursing 9 34 facility wage indices are released by HCFA. 9 35 h. "HCFA" means the health care financing administration 10 1 of the United States department of health and human services. 10 2 i. "HCFA/SNF index" means the HCFA total skilled nursing 10 3 facility market basket index published by data resources, inc. 10 4 The HCFA/SNF index listed in the latest available quarterly 10 5 publication prior to the July 1 rate setting shall be used to 10 6 determine the inflation factor which shall be applied based 10 7 upon the midpoint of the cost report period. 10 8 j. "Median" means the median cost calculated by using a 10 9 weighting method based upon total patient days of each nursing 10 10 facility. 10 11 k. "Medicaid" or "medical assistance" means medical 10 12 assistance as defined in section 249A.2. 10 13 l. "Medicaid average case-mix index" means the simple 10 14 average, carried to four decimal places, of all resident case- 10 15 mix indices where Medicaid is known to be the per diem payor 10 16 source on the last day of the calendar quarter. 10 17 m. "Medicare" means the federal Medicare program 10 18 established by Title XVIII of the federal Social Security Act. 10 19 n. "Minimum data set" or "MDS" means the federally 10 20 required resident assessment tool. Information from the MDS 10 21 is used by the department to determine the facility's case-mix 10 22 index. 10 23 o. "Non-case-mix adjusted costs" means an amount stated in 10 24 terms of per patient day that is calculated using allowable 10 25 costs from the cost reports of facilities, divided by the 10 26 allowable patient days for the cost report period, and 10 27 beginning July 1, 2003, patient days as modified pursuant to 10 28 subsection 3, paragraph "b". Non-case-mix adjusted costs 10 29 include all allowable costs less case-mix adjusted costs. 10 30 p. "Nursing facility" means a skilled nursing facility 10 31 certified under both the federal Medicaid program and the 10 32 federal Medicare program, and a nursing facility certified 10 33 under the federal Medicaid program. 10 34 q. "Rate ceiling" or "upper payment limit" means a maximum 10 35 rate amount stated in terms of per patient day that is 11 1 calculated as a percent of the median. 11 2 r. "Special population nursing facility" means a skilled 11 3 nursing facility the resident population of which is either of 11 4 the following: 11 5 (1) One hundred percent of the residents of the nursing 11 6 facility is under the age of 22 and require the skilled level 11 7 of care. 11 8 (2) Seventy percent of the residents served requires the 11 9 skilled level of care for neurological disorders. 11 10 6. The department of human services may adopt rules under 11 11 section 17A.4, subsection 2, and section 17A.5, subsection 2, 11 12 paragraph "b", to implement this section. The rules shall 11 13 become effective immediately upon filing, unless the effective 11 14 date is delayed by the administrative rules review committee, 11 15 notwithstanding section 17A.4, subsection 5, and section 11 16 17A.8, subsection 9, or a later effective date is specified in 11 17 the rules. Any rules adopted in accordance with this section 11 18 shall not take effect before the rules are reviewed by the 11 19 administrative rules review committee. Any rules adopted in 11 20 accordance with the provisions of this section shall also be 11 21 published as notice of intended action as provided in section 11 22 17A.4. 11 23 Sec. 5. NURSING FACILITY CONVERSION GRANTS. The nursing 11 24 facility conversion grants awarded on or after July 1, 2001, 11 25 may be used to convert all or a portion of the licensed 11 26 nursing facility to a certified assisted-living program. The 11 27 conversion program shall provide a service delivery package 11 28 that is affordable for those individuals eligible for services 11 29 under the medical assistance home and community-based services 11 30 waiver program applicable to a minimum of 40 percent of the 11 31 units. The reimbursement rates for the costs paid under the 11 32 medical assistance program apply only to those clients 11 33 participating in the medical assistance program. The 11 34 department of human services shall adjust the criteria for 11 35 eligibility for conversion grants to allow a licensed nursing 12 1 facility that has been an approved provider under the medical 12 2 assistance program for a two-year period to apply for a 12 3 conversion grant beginning July 1, 2001. 12 4 Sec. 6. Section 249H.3, subsection 1, Code 2001, is 12 5 amended to read as follows: 12 6 1. "Affordable" means rates for payment of room, board, 12 7 amenities, and medical and health services whichdo not exceed12 8the rates established for providers of medical and health12 9services under the medical assistance program with eligibility12 10for an individual equal to the eligibility for medical12 11assistance pursuant to section 249A.3may be purchased, in 12 12 conjunction with third-party payors, by seniors with low and 12 13 moderate incomes in the market area of the providers of such 12 14 services.In relation to services provided by a provider of12 15services under a home and community-based waiver, "affordable"12 16means that the total monthly cost of the home and community-12 17based waiver services provided does not exceed the cost for12 18that level of care as established by rule by the department of12 19human services, pursuant to chapter 17A, in consultation with12 20the department of elder affairs.12 21 Sec. 7. Section 249H.6, subsection 1, paragraphs a and b, 12 22 Code 2001, are amended to read as follows: 12 23 a. A licensed nursing facility that has been an approved 12 24 provider under the medical assistance program for thethree-12 25yeartwo-year period prior to application for the grant. The 12 26 grant awarded may be used to convert all or a portion of the 12 27 licensed nursing facility to a certified assisted-living 12 28 program and may be used for capital or one-time expenditures, 12 29 including but not limited to start-up expenses, training 12 30 expenses, and operating losses for the first year of operation 12 31 following conversion associated with the nursing facility 12 32 conversion. 12 33 b. A long-term care provider or a licensed nursing 12 34 facility that has been an approved provider under the medical 12 35 assistance program for thethree-yeartwo-year period prior to 13 1 application for the grant or a provider that will meet 13 2 applicable medical assistance provider requirements as 13 3 specified in subsection 2, paragraph "c" or "d". The grant 13 4 awarded may be used for capital or one-time expenditures, 13 5 including but not limited to start-up expenses, training 13 6 expenses, and operating losses for the first year of operation 13 7 for long-term care service development. 13 8 13 9 13 10 13 11 BRENT SIEGRIST 13 12 Speaker of the House 13 13 13 14 13 15 13 16 MARY E. KRAMER 13 17 President of the Senate 13 18 13 19 I hereby certify that this bill originated in the House and 13 20 is known as House File 740, Seventy-ninth General Assembly. 13 21 13 22 13 23 13 24 MARGARET THOMSON 13 25 Chief Clerk of the House 13 26 Approved , 2001 13 27 13 28 13 29 13 30 THOMAS J. VILSACK 13 31 Governor
Text: HF00739 Text: HF00741 Text: HF00700 - HF00799 Text: HF Index Bills and Amendments: General Index Bill History: General Index
© 2001 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Wed Jun 20 13:35:24 CDT 2001
URL: /DOCS/GA/79GA/Legislation/HF/00700/HF00740/010508.html
jhf