House File 2116
HOUSE FILE
BY HEATON
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act directing the department of human services to request
2 federal waivers related to transfers of assets provisions
3 under the medical assistance program, and providing an
4 effective date and contingent effective dates.
5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
6 TLSB 5404YH 80
7 pf/sh/8
PAG LIN
1 1 Section 1. Section 249A.3, subsection 11, paragraphs a and
1 2 b, Code Supplement 2003, are amended by striking the
1 3 paragraphs.
1 4 Sec. 2. MEDICAL ASSISTANCE PROGRAM == TRANSFER OF ASSETS
1 5 WAIVER.
1 6 1. The department of human services shall request a waiver
1 7 from the centers for Medicare and Medicaid services of the
1 8 United States department of health and human services relative
1 9 to the transfer of assets for less than fair market value for
1 10 individuals requesting participation in the medical assistance
1 11 program for long=term care services. The waiver shall request
1 12 all of the following:
1 13 a. A waiver of section 1902(a)(18) of the federal Social
1 14 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
1 15 extent that the section requires compliance with section
1 16 1917(c)(2) of that Act, as codified at 42 U.S.C. }
1 17 1396p(c)(2), excluding transfers of certain assets from
1 18 application of penalties. The state shall request a waiver of
1 19 this section to permit application of prohibitions to the
1 20 transfer of all assets, including excluded assets.
1 21 b. A waiver of section 1902(a)(18) of the federal Social
1 22 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
1 23 extent that the section requires compliance with section
1 24 1917(c)(1)(B) of that Act, as codified at 42 U.S.C. }
1 25 1396p(c)(1)(B), providing that a transfer of nonexcluded
1 26 assets or the homestead for less than fair market value,
1 27 within a thirty=six=month look=back period or within a sixty=
1 28 month look=back period for certain transfers involving trusts
1 29 prior to an individual's request for medical assistance while
1 30 receiving long=term care services results in a penalty for
1 31 medical assistance payment of long=term care services for a
1 32 calculated period of time. The state shall request a waiver
1 33 of this section to permit extension of the look=back period to
1 34 seventy=two months.
1 35 c. A waiver of section 1902(a)(18) of the federal Social
2 1 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
2 2 extent that the section requires compliance with section
2 3 1917(c)(1)(C) of that Act, as codified at 42 U.S.C. }
2 4 1396p(c)(1)(C), allowing payment of medical assistance for
2 5 long=term care services following a prohibited transfer of
2 6 assets. The state shall request a waiver of this section to
2 7 permit prohibited transfer penalties to result in complete
2 8 ineligibility for medical assistance for the calculated
2 9 period.
2 10 d. A waiver of section 1902(a)(18) of the federal Social
2 11 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
2 12 extent that the section requires compliance with section
2 13 1917(c)(1)(D) of that Act, as codified at 42 U.S.C. }
2 14 1396p(c)(1)(D), requiring that the penalty of nonpayment for
2 15 long=term care services begins generally in the month that
2 16 assets are transferred. The state shall request a waiver of
2 17 this section to permit delaying the start of the penalty
2 18 period until the first day of the first month of eligibility
2 19 for medical assistance=paid long=term care services.
2 20 e. A waiver of section 1902(a)(18) of the federal Social
2 21 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
2 22 extent that the section requires compliance with section
2 23 1917(c)(1)(E) of that Act, as codified at 42 U.S.C. }
2 24 1396p(c)(1)(E), requiring the divisor used to calculate a
2 25 penalty period to be the statewide average nursing facility
2 26 payment rate. The state shall request a waiver of this
2 27 section to permit use of the statewide average nursing
2 28 facility payment made by medical assistance as the divisor.
2 29 f. A waiver of section 1902(a)(18) of the federal Social
2 30 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
2 31 extent that the section requires compliance with section
2 32 1917(c)(2)(A) of that Act, as codified at 42 U.S.C. }
2 33 1396p(c)(2)(A), permitting transfers of homesteads for less
2 34 than fair market value to specified relatives without regard
2 35 to whether the relative is in need of housing or resides in
3 1 the homestead at the time of the transfer. The state shall
3 2 request a waiver of this section to permit such transfers only
3 3 to specified relatives who were living in the homestead at the
3 4 time of the transfer and who provided physician=certified care
3 5 in the person's own home that prevented the person from
3 6 entering a long=term care facility for at least two years.
3 7 g. A waiver of section 1902(a)(18) of the federal Social
3 8 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
3 9 extent that the section requires compliance with section
3 10 1917(c)(2)(B)(i) and (ii) of that Act, as codified at 42
3 11 U.S.C. } 1396p(c)(2)(B)(i) and (ii), permitting transfers for
3 12 less than fair market value to or on the sole behalf of
3 13 spouses of clients without further limitation. The state
3 14 shall request a waiver of this section to limit such transfers
3 15 only to an amount allowed under spousal impoverishment asset
3 16 provisions.
3 17 h. A waiver of section 1902(a)(18) of the federal Social
3 18 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
3 19 extent that the section requires compliance with section
3 20 1917(c)(2)(B)(iii) and (iv) of that Act, as codified at 42
3 21 U.S.C. } 1396p(c)(2)(B)(iii) and (iv), permitting transfers
3 22 for less than fair market value to trusts for the sole benefit
3 23 of children disabled according to federal social security
3 24 income criteria without a requirement that the trust principal
3 25 revert to the state after the disabled child's death to repay
3 26 any medical assistance payments made. Transfers for less than
3 27 fair market value are also permitted to be transferred to
3 28 trusts for the sole benefit of people under age sixty=five who
3 29 are disabled according to supplemental security income
3 30 criteria. The state shall request a waiver of this section to
3 31 limit such transfers to trusts that revert to the state after
3 32 the death of the disabled child, and to prohibit transfers
3 33 without penalty to trusts for people with a disability who are
3 34 under age sixty=five and who are not the children of the
3 35 transferor.
4 1 i. A waiver of section 1902(a)(18) of the federal Social
4 2 Security Act, as codified at 42 U.S.C. } 1396(a)(18), to the
4 3 extent that the section requires compliance with section
4 4 1917(d)(2)(C) of that Act, as codified at 42 U.S.C. }
4 5 1396p(d)(2)(C), specifying that trusts may be established
4 6 without regard to their purpose. The state shall request a
4 7 waiver of this section to permit discretion as to allowable
4 8 purposes for a trust.
4 9 2. The department of human services shall adopt rules
4 10 pursuant to chapter 17A to administer this section.
4 11 Sec. 3. CONTINGENT EFFECTIVE DATE. The amendment to
4 12 section 249A.3, subsection 11, paragraphs a and b, Code
4 13 Supplement 2003, in this Act, shall not take effect unless the
4 14 department of human services receives approval of all waivers
4 15 requested pursuant to section 2 of this Act from the centers
4 16 for Medicare and Medicaid services of the United States
4 17 department of health and human services. If approval is
4 18 received by June 30, 2004, the amendment shall take effect
4 19 July 1, 2004. If approval is received after June 30, 2004,
4 20 the amendment shall take effect on the date that the approval
4 21 is received by the department. The department shall notify
4 22 the Code editor of the date of receipt of any approval.
4 23 Sec. 4. EFFECTIVE DATES. The section of this Act
4 24 directing the department of human services to request waivers
4 25 from the United States department of health and human
4 26 services, being deemed of immediate importance, takes effect
4 27 upon enactment.
4 28 EXPLANATION
4 29 This bill directs the department of human services to
4 30 request waivers from the centers for Medicare and Medicaid
4 31 services of the United States department of health and human
4 32 services relating to transfer of assets provisions for persons
4 33 receiving long=term care services under the medical assistance
4 34 program. The bill repeals current law relating to transfer of
4 35 assets but the repeal of current law is contingent upon
5 1 receipt of approval of all waivers by the department. The
5 2 portion of the bill directing the department to request
5 3 federal waivers takes effect upon enactment.
5 4 LSB 5404YH 80
5 5 pf/sh/8