SF 2160 (LSB 5481SV (5) 84)

RELATING TO ALLOWING FINANCIAL SUPPLEMENTATION TO A NURSING FACILITY FOR PROVISION OF A PRIVATE ROOM TO A RECIPIENT OF MEDICAL ASSISTANCE.

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

    Section 1.  Section 249A.4, Code 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  9A.
  a.  Allow supplementation of the combination of client participation and payment made through the medical assistance program for those items and services identified in 42 C.F.R. § 483.10(c)(8)(ii), by the resident of a nursing facility or the resident’s family. Supplementation under this subsection may include supplementation for provision of a private room not otherwise covered under the medical assistance program unless either of the following applies:
   (1)  The private room is therapeutically required pursuant to 42 C.F.R. § 483.10(c)(8)(ii).
   (2)  No room other than the private room is available.
   b.  The rules adopted to administer this subsection shall require all of the following if a nursing facility provides for supplementation for provision of a private room:
   (1)  The nursing facility shall inform all current and prospective residents and residents’ legal representatives of the following:
   (a)  If the resident desires a private room, the resident or resident’s family may provide supplementation by directly paying the facility the amount of supplementation. Supplementation by a resident’s family shall not be treated as income of the resident for purposes of medical assistance program eligibility or client participation.
   (b)  The nursing facility’s policy if a resident residing in a private room converts from private pay to payment under the medical assistance program, but the resident or resident’s family is not willing or able to pay supplementation for the private room.
   (c)  A description and identification of the private rooms for which supplementation is available.
   (d)  The process for an individual to take legal responsibility for providing supplementation, including identification of the individual and the extent of the legal responsibility.
   (2)  For a resident for whom the nursing facility receives supplementation, the nursing facility shall indicate in the resident’s record all of the following:
   (a)  A description and identification of the private room for which the nursing facility is receiving supplementation.
   (b)  The identity of the individual making the supplemental payments.
   (c)  The private pay charge for the private room for which the nursing facility is receiving supplementation.
   (d)  The total charge to the resident for the private room for which the nursing facility is receiving supplementation, the portion of the total charge reimbursed under the medical assistance program, and the portion of the total charge reimbursed through supplementation.
   (3)  If the nursing facility only provides one type of room or all private rooms, the nursing facility shall not be eligible to request supplementation.
   (4)  A nursing facility may base the supplementation amount on the difference between the amount paid for a room covered under the medical assistance program and the private pay rate for the private room identified for supplementation. However, the total payment for the private room from all sources shall not be greater than the aggregate average private room rate for the type of rooms covered under the medical assistance program for which the resident would be eligible.
   (5)  Supplementation pursuant to this subsection shall not be required as a precondition of admission, expedited admission, or continued stay in a facility.
   (6)  Supplementation shall not be applicable if the facility’s occupancy rate is less than eighty percent.
   (7)  The nursing facility shall ensure that all appropriate care is provided to all residents notwithstanding the applicability or availability of supplementation.
   (8)  A private room for which supplementation is required shall be retained for the resident consistent with existing bed-hold policies.

______________________________
JOHN P. KIBBIE
President of the Senate

______________________________
KRAIG PAULSEN
Speaker of the House

   I hereby certify that this bill originated in the Senate and is known as Senate File 2160, Eighty-fourth General Assembly.

______________________________
MICHAEL E. MARSHALL
Secretary of the Senate
Approved _______________, 2012

______________________________
TERRY E. BRANSTAD
Governor