Senate File 236 - Enrolled




                                             SENATE FILE 236

                             AN ACT
 RELATING TO PSYCHIATRIC MEDICAL INSTITUTION FOR CHILDREN
    SERVICES AND PROVIDING AN EFFECTIVE DATE.

 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN
 == REIMBURSEMENT.
    1.  For the purposes of this section, unless the context
 otherwise requires, "psychiatric institution" means a
 psychiatric medical institution for children licensed under
 chapter 135H and receiving medical assistance program
 reimbursement.
    2.  The department of human services, in consultation with
 psychiatric institution providers, shall develop a cost=based
 rate setting methodology with levels of reimbursement based on
 acuity for psychiatric institution providers in accordance
 with this section.
    3.  a.  For the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, psychiatric institution providers may
 submit a projected cost report to be used to set a prospective
 rate for the rate period of July 1, 2009, through June 30,
 2010.  For that fiscal year, the maximum reimbursement rate
 for psychiatric institution providers shall be 103 percent of
 the patient=day weighted statewide average cost of psychiatric
 institution providers located within the state, based on the
 cost reports for the preceding fiscal year.  However, the
 average cost computation shall not include the psychiatric
 institution at the state mental health institute located at
 Independence, and upon receiving federal approval, the
 reimbursement rate for that psychiatric institution shall be
 as provided in the state plan amendment under subsection 5.
 The reimbursement payments made to psychiatric institution
 providers for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, shall be cost settled to actual cost,
 not to exceed the maximum reimbursement rate for the fiscal
 year.  Any overpayment amount shall be returned within 30 days
 of submission of a notice of overpayment to the provider.
    b.  Notwithstanding paragraph "a", on a case=by=case basis
 for psychiatric institution services provided to children with
 intensive needs who would otherwise require placement outside
 the state, the department may apply an exception to policy
 process to authorize provider reimbursement in excess of the
 maximum reimbursement rate under paragraph "a".
    4.  a.  By January 1, 2010, the department shall develop a
 methodology for cost=based reimbursement with an acuity
 adjustment based on the aggregate acuity level of each
 psychiatric institution's patient mix.  Under the methodology,
 each psychiatric institution's aggregate acuity level shall be
 recalculated periodically.  The department shall work with
 psychiatric institution provider representatives to develop
 the methodology.
    b.  The department shall implement the cost=based
 reimbursement with acuity adjustment methodology beginning on
 July 1, 2010.
    5.  The department shall submit a medical assistance state
 plan amendment to the centers for Medicare and Medicaid
 services of the United States department of health and human
 services requesting authorization to reimburse the psychiatric
 institution at the state mental health institute located at
 Independence at 100 percent of actual costs.  Upon receiving
 approval of the plan amendment, for the fiscal year beginning
 July 1, 2009, an amount equivalent to the resulting savings
 shall be transferred from the appropriation for the state
 mental health institute at Independence to the medical
 assistance appropriation to be used for the purposes described
 in this section.
    6.  The department shall track the number of admissions of
 Iowa children to out=of=state psychiatric medical institutions
 for children and the corresponding expenditures, and if
 necessary, shall adopt utilization control strategies to
 assure that utilization of such out=of=state admission is
 reduced, while maintaining access to treatment options that
 are in the best interests of the child and the child's family.
    7.  The department, in consultation with providers, shall
 develop and implement outcome measures for all psychiatric
 institution providers beginning on July 1, 2010.
    8.  The department of human services shall adopt rules
 pursuant to chapter 17A to implement this section.
    Sec. 2.  Section 249A.31, Code 2009, is amended by adding
 the following new unnumbered paragraph:
    NEW UNNUMBERED PARAGRAPH.  Effective July 1, 2010, the
 department shall apply a cost=based reimbursement methodology
 for reimbursement of psychiatric medical institution for
 children providers.
    Sec. 3.  EFFECTIVE DATE.  This Act, being deemed of
 immediate importance, takes effect upon enactment.


                                                             
                               JOHN P. KIBBIE
                               President of the Senate


                                                             
                               PATRICK J. MURPHY
                               Speaker of the House

    I hereby certify that this bill originated in the Senate and
 is known as Senate File 236, Eighty=third General Assembly.


                                                             
                               MICHAEL E. MARSHALL
                               Secretary of the Senate
 Approved                , 2009


                                
 CHESTER J. CULVER
 Governor

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