2000 Summary of Legislation HUMAN SERVICES Published by the Iowa General Assembly -- Legislative Service Bureau

HUMAN SERVICES LEGISLATION

SENATE FILE 174 - Medical Assistance Advisory Council Membership (full text of act)

   BY COMMITTEE ON HUMAN RESOURCES. This Act changes Code references involving the membership of a council of health care provider organizations and other persons interested in the Medical Assistance (Medicaid) Program. The Director of Human Services is required to consult with the council at least semiannually and is to consider the advice and consultation offered by the council in the director's preparation of budget recommendations for the program. The Act strikes the membership position for the Community Mental Health Centers Association and replaces it with its successor organization, the Association of Community Providers. In addition, a membership position for the Iowa Psychiatric Nurse Managers Network is eliminated, as the network no longer exists.

   The Act takes effect March 31, 2000.

SENATE FILE 2193 - Senior Living Program (full text of act)

   BY COMMITTEE ON HUMAN RESOURCES. This Act creates new Code Chapter 249H, the "Iowa Senior Living Program Act."

   The Act provides the legislative findings related to the program. The goal of the program is to create a comprehensive long-term care system that is consumer-directed, provides balance between the options of institutional and noninstitutional care, and contributes to the quality of life.

   The Act creates the Senior Living Trust Fund and provides for ongoing appropriations from the trust fund. The trust fund is created in the State Treasury under the authority of the Department of Human Services (DHS). Moneys deposited in the fund include those received through intergovernmental agreements for the Senior Living Program, grants, contributions, participant payments, and a portion of the federal moneys received by the department from public nursing facilities. The trust fund is to be operated in accordance with the guidelines of the Health Care Financing Administration of the U.S. Department of Health and Human Services. Moneys in the fund are to be appropriated only for the purposes of the Senior Living Program and are not considered part of the General Fund of the State. Moneys in the fund at the end of a fiscal year do not revert to the General Fund of the State and cannot be transferred, used, obligated, appropriated, or otherwise encumbered, except for purposes of the Senior Living Program. Interest or earnings on moneys in the trust fund are credited to the trust fund. The Act directs DHS to adopt rules to administer the trust fund and to establish participation in the program for public nursing facilities. The Act directs the Treasurer of State to provide a quarterly report of the trust fund activities and balances to the long-term care coordinating unit.

   The Act provides for allocations from the trust fund, subject to appropriations by the General Assembly. Allocations include:

1. An allocation to DHS of a maximum of $80 million over a maximum five-year period to be used for the conversion of existing nursing facility space and development of long-term care alternatives.
2. An allocation to the Department of Elder Affairs, annually, in an amount necessary to cover expenses of implementation and administration of long-term care services programs and for delivery of long-term care services to low and moderate income seniors.
3. An allocation to DHS, annually, for administrative purposes and service delivery costs related to the Senior Living Program and Trust Fund and for implementation of a new reimbursement system under the Medical Assistance (MA) Program (Medicaid).
4. An allocation to DHS, in an amount necessary to continue providing nursing facility provider reimbursements using a percentile-based reimbursement system and to provide funding for the transition to a case-mix reimbursement system. Funding is to be provided for the percentile-based reimbursement system until such time as the case-mix reimbursement system is fully implemented.
5. An allocation to DHS, annually, for additional expenses, relative to the Senior Living Program, that are incurred due to rent expenses under the State Supplementary Assistance Program of consumers participating in an MA Program home and community-based services waiver.

   The remainder of the funds is to be invested with the interest and earnings to be used for administration of programs and delivery of long-term care services and for expenses related to implementation of the Senior Living Program and administration of the trust fund.

   The Act provides the procedures and criteria for the awarding of grants for conversion of nursing facilities to provide assisted-living programs and for long-term care services development. A nursing facility that receives a grant for nursing facility conversion shall enter into a contract with DHS pursuant to which the nursing facility agrees to be reimbursed for nursing facility costs at a fixed rate, with annual cost-of-living increases, for a period of four years. The Act also provides for separate grants to nursing facilities that are awarded nursing facility conversion grants, if the conversion includes provision of child care for children with special needs, safe shelter for victims of dependent adult abuse, or respite care. The Act does not create an entitlement to any funds available for grant purposes, but provides that DHS, in its discretion, may only award grants to the extent funds are available and applications are approved.

   The Act provides for appropriation of funds beginning October 1, 2000, to the Department of Elder Affairs for activities related to home and community-based services for seniors. Moneys appropriated are to be disbursed through the area agencies on aging. The Act provides that the Act does not create an entitlement, but that the department, in its discretion, may only disburse funds to the extent funds are available and requests for funding are approved.

   The Act describes provisions relating to the Program for All-Inclusive Care for the Elderly (PACE) Program and the Pre-PACE Program, which is defined in the Act as a program that provides delivery of comprehensive health and social services to seniors by integrating acute and long-term care services, and is operated by an entity as permitted under federal regulation. A Pre-PACE Program is defined as a PACE Program in its initial stages that provides the same scope of services as a PACE Program.

   The Act directs the Department of Elder Affairs and the area agencies on aging, in consultation with the Senior Living Coordinating Unit, to create a database directory of all health care and support services available to seniors. The database is to be made available electronically to the public. The Act directs the department to seek foundation funding to provide an educational program to individuals age 21 and older to assist them in planning for financing health care services and other supports in their senior years.

   The Act also directs DHS to develop and distribute an informational packet to the public that explains the MA Program relative to health care services options for seniors. The Act provides that the Director of Human Services, Director of the Department of Elder Affairs, Director of Public Health, Director of the Department of Inspections and Appeals, Director of Revenue and Finance, and Commissioner of Insurance are to constitute a Senior Advisory Council to provide oversight in the development and operation of all informational aspects of the Senior Living Program.

   The Act provides for the establishment of a Caregiver Support Access and Education Program to provide access to respite care and education to caregivers, through the area agencies on aging or other appropriate agencies.

   The Act provides a sunset provision for new Code Section 249H.6, which is the section that provides grants for nursing facility conversion and long-term care services development, effective June 30, 2005.

   The Act requires nursing facilities, regardless of the individual's source of payment for care, to complete a resident assessment for all prospective and current residents.

   The Act changes the name of the Long-term Care Coordinating Unit of the Department of Elder Affairs to the Senior Living Coordinating Unit; adds four members of the General Assembly to the membership of the unit as ex officio, nonvoting members; and adds to the duties of the unit the provision of direction and oversight for disbursement of moneys from the Senior Living Trust Fund and the required consultation with state universities and other institutions with expertise in senior issues and long-term care.

   The Act requests that the Legislative Council authorize a Senior Living Insurance and Incentives Study Committee to review current long-term care insurance laws, current long-term care insurance options available in the state, the types of services covered under a long-term care insurance option, and incentives for the purchase of long-term care insurance including, but not limited to, tax credits.

   The Act directs DHS to convene a task force to develop a case-mix reimbursement methodology. The Act directs the task force to submit a report to the Governor and the General Assembly by December 15, 2000, regarding the reimbursement methodology developed and including a summary of any expenditures for nursing facility conversion and for long-term care service development.

   The Act directs DHS to review and make recommendations to the General Assembly on or before October 1, 2000, regarding the feasibility of applying the Senior Living Program to residential care facilities and in applying any reimbursement methodology changes to these facilities.

   The Act states that the General Assembly is to maintain the fiscal effort in funding long-term care services existing on June 30, 2000, and is not to make reductions in appropriations for this purpose as a result of the Act.

   The Act provides for FY 2000-2001 appropriations to DHS and the Department of Elder Affairs relating to the Senior Living Program.

   The Act provides for emergency rulemaking authority for DHS and the Department of Elder Affairs in implementing the Act.

   The Act takes effect March 1, 2000. The portion of the Act relating to the receipt of federal funds on or after October 1, 1999, is retroactively applicable to October 1, 1999.

SENATE FILE 2254 - Child Support -- Medical Support -- Data Matching (full text of act)

   BY COMMITTEE ON HUMAN RESOURCES. This Act provides changes in child support law relating to medical support, to payment of financial institutions for the costs of quarterly data matches and automation program development, and to liability of financial institutions relating to data matches.

   The Act provides that an order under the "Medical Support" chapter (Code Chapter 252E) must include a notice of the order issued by the Child Support Recovery Unit to an employer. Additionally, the Act provides that an order of a foreign jurisdiction for medical support may be entered or filed with the clerk of the district court. However, such an entry or filing does not constitute registration of that foreign order, thereby requiring registration under the Uniform Interstate Family Support Act, Code Chapter 252K.

   The Act also changes the law allowing carryover of charges from the current fiscal year to the subsequent fiscal year for payment of fees to financial institutions for data matches and automation program development, to limit the carryover authorization only to costs incurred during the fiscal year beginning July 1, 1999, and carried over into the fiscal year beginning July 1, 2000.

   The Act expands the immunity provisions for financial institutions relating to disclosure of information in complying with the data match requirements. The Act defines "financial institution" for the purposes of the data match section to includes officers, directors, employees, contractors, and agents of a financial institution.

   The portion of the Act relating to liability of financial institutions is retroactively applicable to January 1, 2000.

SENATE FILE 2360 - Human Services -- Administration and Employment (full text of act)

   BY COMMITTEE ON HUMAN RESOURCES. This Act relates to various state and local administrative provisions involving human services.

Division I -- Administration of Human Services Institutions

   This division amends various Code provisions involving the administration of the institutions under the Department of Human Services. Under current law, the Director of Human Services is authorized to appoint a deputy director or other employee to have administrative authority over the state juvenile institutions. However, prior law specified that the Administrator of the Division of Mental Health and Developmental Disabilities had primary administrative authority over the four state mental health institutes and the two state hospital-schools (renamed as state resource centers by this Act). Under the Act, the director is authorized to assign the administrative authority over the institutes and the resource centers in the same way as for the state juvenile institutions. In addition, references to the superintendents and other administrative personnel assigned directly to institutions are made consistent. Conforming changes are made throughout the Code.

Division II -- Renaming State Hospital-Schools as State Resource Centers

   This division renames the Glenwood and Woodward State Hospital-Schools as the Glenwood and Woodward State Resource Centers. Conforming changes are made throughout the Code and the Code Editor is directed to make other conforming changes in law.

Division III -- County Cluster Employee and Volunteer Record Checks

   This division directs the department to conduct criminal and child and dependent adult abuse record checks of persons who are potential employees, employees, potential volunteers, and volunteers in the department's county cluster offices and who are in a position having direct contact with the department's clients. If it is determined that a person has committed a crime or has a record of founded child or dependent adult abuse, an evaluation is to be performed by the department to determine whether prohibition of employment or participation as a volunteer is warranted. If it is determined that the prohibition is warranted, the person is prohibited from employment or participation as a volunteer in county cluster offices in a position having direct contact with the department's clients.

Division IV -- County Mental Health and Developmental Disabilities Services Administration

   This division relates to mental health, mental retardation, and developmental disabilities (MH/MR/DD) services administered by the department and counties.

   Under current law, individual case management services funded under the Medical Assistance (Medicaid) Program for persons with certain disabilities are to be provided by the department except when a county or consortium of counties contracts with the department to be the provider. This division amends law that required a county or consortium to notify the department of any changes by a particular date by instead requiring the notification to be made at least 90 days before the change will take effect.

   Provisions requiring the department to work with Linn, Polk and Tama/Poweshiek Counties to establish a funding decategorization pilot project for adult MH/MR/DD services are expanded to include two additional counties, Washington and Webster.

   The department is directed to develop data that tracks the county of residence for all individuals who received MH/MR/DD services funded by the Medicaid Program and for which the nonfederal share was paid by the county or the state. Initially, the data is to be compiled for such individuals for fiscal years 1998-1999 and 1999-2000. The data is to be reported as soon as is practicable to the Governor, General Assembly, and any study committee created by the Legislative Council to study related issues. This division takes effect April 19, 2000.

SENATE FILE 2368 - Family Investment Program -- Miscellaneous Provisions (full text of act)

   BY COMMITTEE ON HUMAN RESOURCES. This Act relates to the Family Investment Program (FIP) and associated provisions. The program receives federal funding under the federal Temporary Assistance for Needy Families (TANF) Block Grant that replaced the Aid to Families with Dependent Children (AFDC) Program.

   The Act eliminates a Code provision relating to confidentiality of records of persons receiving assistance through the Department of Human Services. The eliminated provision required the department to file a quarterly report in local and county offices showing the names and last known addresses of persons receiving assistance under Code Chapter 249, "State Supplementary Assistance"; Code Chapter 239B, "Family Investment Program"; and Code Chapter 249A, "Medical Assistance."

   The Act revises the conditions of eligibility for FIP by eliminating various restrictions and requirements regarding the unemployment status of parents in a two-parent family.

   The Act amends certain policy requirements for family investment agreements. The Act provides a new exemption to the requirements for participation in a family investment agreement for persons who are not U.S. citizens and are not qualified aliens as defined in federal law.

   The Act amends Code Section 239B.9, relating to limited benefit plans under FIP, by specifying that any limited benefit plan applied to a two-parent family more than once is to be treated as a subsequent limited benefit plan. A subsequent limited benefit plan is a defined term requiring a six-month period of eligibility for reduced assistance or ineligibility for cash assistance, followed by an indeterminate period until the individual participant completes significant contact with or action in regard to the JOBS Program (the employment-related training component of FIP).

   The Act amends Code Section 239B.11, "Family Investment Program Account," to expand the uses of the program diversion subaccount. Under the Act, the subaccount can be used to provide services and payments for persons whose FIP eligibility has ended, in order to help the persons to stabilize or improve their employment status. The Act provides a similar authorization in Code Section 239B.17, relating to activities required to be provided as part of the JOBS (or Promoting Independence and Self-sufficiency Job Opportunities and Basic Skills) Program under FIP.

   The Act amends Code Section 239B.14, relating to fraudulent practices under FIP, to direct the department to adopt rules for the recovery of overpayments. The rules are to include a provision for withholding of cash assistance or other FIP benefits.

   The Act amends Code Section 239B.18, relating to required participation in the JOBS Program for FIP participants. Under prior law, those exempt from the requirement to enter into a family investment agreement could choose to voluntarily participate in the JOBS Program. However, under the Act, this choice is not available to a participant who is not a U.S. citizen and is not a qualified alien as defined in federal law.

HOUSE FILE 2321 - Medical Assistance -- Eligibility -- Transfer of Assets (full text of act)

   BY COMMITTEE ON HUMAN RESOURCES. This Act amends portions of the Code relating to the Medical Assistance (MA) Program (Medicaid).

   The Act adds eligibility categories relating to coverage for certain Medicare beneficiaries. Coverage of these categories of individuals was mandated in the federal Balanced Budget Act of 1997, to be effective January 1998. To date, this required coverage has been implemented under administrative rules. The Act codifies existing practice.

   The first of the required coverage categories, additional specified low-income Medicare beneficiaries, includes individuals whose income is at least 120 percent but less than 135 percent of the federal poverty level. For these individuals, coverage would provide for payment of the full Medicare Part B premium. Part B covered services include physician and other medical services, outpatient hospital care, ambulatory surgical services, home health, clinical diagnostic laboratory services, and preventive services. The second of the required coverage categories, home health care for specified low-income Medicare beneficiaries, includes individuals whose income is at least 135 percent but not more than 175 percent of the federal poverty level. For these individuals, coverage would provide for payment of only the home health care portion of the Medicare Part B premium.

   The Act addresses disclaimers of inheritance and failure of a spouse to take against a will rather than taking what is provided under the provisions of the will under the Probate Code, as these mechanisms relate to transfer of assets policies when establishing eligibility under the MA Program. Current use of these mechanisms could allow a person to avoid receiving assets resulting in the person being erroneously eligible for the program. The Act establishes that under the Probate Code, a disclaimer of property, interest or right constitutes a transfer of assets, in determining eligibility for the program, in the amount of the value of the property, interest or right. The Act also provides that failure of a spouse to take against a will constitutes a transfer of assets, in determining program eligibility, to the extent the value received by taking against the will would have exceeded the value of the inheritance received under the will. The Act provides conforming language in both the "Medical Assistance" chapter (Code Chapter 249A) and in the "Probate Code" chapter (Code Chapter 633).

   The Act also includes changes relating to transfer of assets relating to medical assistance debt. The Act corrects the exemption of transfers of assets of less than $2,000 per calendar year to instead provide for exemption of a transfer of assets of $2,000 over the five-year look back period, which is consistent with federal law. The Act also eliminates a provision that exempts the transfer of a homestead to any person rather than just to those persons exempt under federal law. Other existing provisions in the Code remain to allow for the federally required exemptions relating to transfer of a homestead. The Act also provides that actions initiated under the transfer of assets for "Transfer of Assets -- Medical Assistance Debt" chapter (Code Chapter 249F) are not subject to administrative contested case proceedings under Code Chapter 17A and that review by the district court would be an original hearing before the court.

RELATED LEGISLATION

SENATE FILE 228 -- School Employment or Volunteer Record Checks (Complete summary under EDUCATION.)

   This Act authorizes the administrators of a public school district or an accredited private school to have access, for purposes of a volunteer or employment record check, to founded child and dependent adult abuse information in the possession of the Department of Human Services.

SENATE FILE 2007 -- Guardians -- Procurement of Professional Services for Ward (Complete summary under CIVIL LAW, PROCEDURE & COURT ADMINISTRATION.)

   This Act provides that a guardian is not required to seek prior court approval in the instance in which, if necessitated by the physical or mental disability of the ward, anesthesia is used in providing the ward professional care, counseling, treatment, or services limited to the provision of routine physical and dental examinations, and the anesthesia is administered within the health care practitioner's scope of practice.

SENATE FILE 2144 -- Regulation and Inspection of Health Care Facilities (Complete summary under HEALTH & SAFETY.)

   This Act relates to regulation and inspection of health care facilities under the purview of the Department of Inspections and Appeals. Under Code Chapter 135C, health care facilities include nursing facilities, intermediate care facilities, intermediate care facilities for persons with mental illness and such facilities for persons with mental retardation, and various forms of residential care facilities.

SENATE FILE 2294 -- Juvenile Facility Education Costs (Complete summary under EDUCATION.)

   This Act authorizes an area education agency to provide educational services to a newly established approved or licensed shelter care or juvenile detention facility if the facility makes a request for the services 90 days prior to the beginning of the time for which the services are requested. The provision takes effect April 20, 2000, and is applicable to a facility approved or licensed after December 1, 1998.

SENATE FILE 2344 -- Child and Family Services (Complete summary under CHILDREN & YOUTH.)

   This Act relates to child and family services involving the Department of Human Services, including home condition investigations, child and dependent adult abuse registry access, case permanency plan requirements and other child welfare provisions, and the State Child Care Assistance Program.

SENATE FILE 2369 -- Interagency Sharing of Confidential Information (Complete summary under CHILDREN & YOUTH.)

   This Act permits the sharing of juvenile court social records pursuant to an interagency agreement. The Act also provides for the sharing of certain Department of Human Services records.

SENATE FILE 2435 -- Appropriations -- Human Services (Complete summary under APPROPRIATIONS.)

   This Act provides appropriations to the Department of Human Services for FY 2000-2001 and includes provisions related to human services and health care.

SENATE FILE 2452 -- Miscellaneous Appropriations and Other Provisions (Complete summary under APPROPRIATIONS.)

   Division I of this Act appropriates for FY 2001-2002 for county mental health, mental retardation, and developmental disabilities services growth factor adjustment and makes other related changes.

HOUSE FILE 683 -- Child Custody, Visitation, and Support -- Mediation (Complete summary under CIVIL LAW, PROCEDURE & COURT ADMINISTRATION.)

   This Act provides for mediation services related to custody, visitation and support of a child.

HOUSE FILE 2039 -- Miscellaneous Appropriations, Reductions, Supplementals, Transfers, and Credits (Complete summary under APPROPRIATIONS.)

   This Act relates to state budgetary matters by providing for reductions and supplementation of appropriations for FY 1999-2000 and includes certain reductions in appropriations for certain programs administered by the Department of Human Services, required actions to fill employee vacancies at a state hospital-school, and a requirement for the University of Iowa Hospitals and Clinics contract to increase claiming of reimbursement under the Medical Assistance Program (Medicaid).

HOUSE FILE 2135 -- Child Support -- Liens -- Motor Vehicle Registration -- Income Withholding (Complete summary under CIVIL LAW, PROCEDURE & COURT ADMINISTRATION.)

   This Act relates to support obligations. The Act amends the section of the Code relating to development of a statewide support lien index. The Act also removes the date October 1, 1999, as the last date on which a payor of income (an employer, trustee or governmental entity) was required to include, in payment identification, the date income was withheld from a support obligor. The Act also instructs the Department of Human Services to rescind any administrative rules in conflict with the Act.

HOUSE FILE 2327 -- County Mental Health, Mental Retardation, and Developmental Disabilities Services Funding (Complete summary under LOCAL GOVERNMENT.)

   This Act relates to county levy and expenditure authority involving the county mental health, mental retardation, and developmental disability services fund.

HOUSE FILE 2377 -- Access to Child Abuse Information (Complete summary under CHILDREN & YOUTH.)

   This Act provides for access to child abuse information for purposes of review and public disclosure and addresses a number of areas involving responsibilities of the Department of Human Services.

HOUSE FILE 2388 -- Modification of Child Custody or Support Orders -- Pilot Project (Complete summary under CIVIL LAW, PROCEDURE & COURT ADMINISTRATION.)

   This Act provides for implementation of a pilot project relating to the concurrent jurisdiction of the juvenile court and the district court in modification of child custody and support orders when the juvenile court issues an order removing a child from the custody of a parent previously granted custody or support.

HOUSE FILE 2533 -- Federal Block Grant Appropriations (Complete summary under APPROPRIATIONS.)

   This Act appropriates federal block grant and other nonstate moneys to state agencies for the federal fiscal year beginning October 1, 2000, and ending September 30, 2001. The Act includes funding for maternal and child health, preventive health and health services, substance abuse programs, low-income energy assistance, mental health, child care, social services, and other health and human services-related programs.

HOUSE FILE 2555 -- Tobacco Settlement Fund Appropriations (Complete summary under APPROPRIATIONS.)

   This Act relates to and makes appropriations from the Tobacco Settlement Fund, including appropriations to the Iowa Department of Human Services (DHS) for providers of services under the Medical Assistance (MA) Program (Medicaid) and for other providers of services under the purview of DHS, for expansion of home health care services and habilitative day care for children with special needs under the MA Program, for expansion of respite care services provided through home and community-based waivers under the MA Program, for supplementation of the Children's Health Insurance Program, and for performance of an evaluation to study the effects of providing continuous eligibility for children under the MA Program; to the Iowa Department of Public Health for additional substance abuse treatment under the Substance Abuse Treatment Program, for development of a Healthy Iowans 2010 Plan, and for a Tobacco Use Prevention and Control Program; and for assistance to certain counties with limited county mental health, mental retardation, and developmental disabilities services fund balances to pay reimbursement increases.

   The Act codifies provisions for eligibility under the MA Program for an infant whose family income is not more than 200 percent of the federal poverty level, and provides for eligibility under the Healthy and Well Kids in Iowa Program for a child whose family income does not exceed 200 percent of the federal poverty level. The Act also codifies provisions for the methodology to be used, beginning November 1, 2000, for all applicable noninstitutional health providers, excluding anesthesia and dental services, under the MA Program.

© 1998 Cornell College and League of Women Voters of Iowa

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