House File 2772 - Introduced
HOUSE FILE
BY COMMITTEE ON APPROPRIATIONS
(SUCCESSOR TO HF 2561)
(SUCCESSOR TO HF 2325)
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act creating a brain injury services program and providing for
2 allocation of a previously enacted appropriation.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 6045HZ 81
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PAG LIN
1 1 Section 1. NEW SECTION. 135.22B BRAIN INJURY SERVICES
1 2 PROGRAM.
1 3 1. DEFINITIONS. For the purposes of this section:
1 4 a. "Brain injury services waiver" means the state's
1 5 medical assistance home and community=based services waiver
1 6 for persons with brain injury implemented under chapter 249A.
1 7 b. "Program administrator" means the division of the
1 8 department designated to administer the brain injury services
1 9 program in accordance with subsection 2.
1 10 2. PROGRAM CREATED.
1 11 a. A brain injury services program is created and shall be
1 12 administered by a division of the Iowa department of public
1 13 health in cooperation with counties and the department of
1 14 human services.
1 15 b. The division of the department assigned to administer
1 16 the advisory council on brain injuries under section 135.22A
1 17 shall be the program administrator. The division duties shall
1 18 include but are not limited to serving as the fiscal agent and
1 19 contract administrator for the program and providing program
1 20 oversight.
1 21 c. The division shall consult with the advisory council on
1 22 brain injuries, established pursuant to section 135.22A,
1 23 regarding the program and shall report to the council
1 24 concerning the program at least quarterly. The council shall
1 25 make recommendations to the department concerning the
1 26 program's operation.
1 27 3. PURPOSE. The purpose of the brain injury services
1 28 program is to provide services, service funding, or other
1 29 support for persons with a brain injury under one of the
1 30 program components established pursuant to this section.
1 31 4. GENERAL REQUIREMENTS == WAIVER ELIGIBLE COMPONENT.
1 32 a. The component of the brain injury services program for
1 33 persons eligible for the brain injury services waiver is
1 34 subject to the requirements provided in this subsection.
1 35 b. If a person is eligible for the brain injury services
2 1 waiver and is on the waiting list for the waiver but the
2 2 appropriation for the medical assistance program does not have
2 3 sufficient funding designated to pay the nonfederal share of
2 4 the costs to remove the person from the waiting list, the
2 5 brain injury services program may provide the funding for the
2 6 nonfederal share of the costs in order for the person to be
2 7 removed from the waiting list and receive services under the
2 8 waiver.
2 9 c. A person who receives support under the waiver eligible
2 10 component is not eligible to receive support under the cost=
2 11 share component of the program.
2 12 d. Provision of funding under the waiver eligible
2 13 component is not an entitlement. Subject to the department of
2 14 human services requirements for the brain injury services
2 15 waiver waiting list, the program administrator shall make the
2 16 final determination whether funding will be authorized under
2 17 this component.
2 18 5. GENERAL REQUIREMENTS == COST=SHARE COMPONENT. The
2 19 cost=share component of the brain injury services program
2 20 shall be directed to persons who have been determined to be
2 21 ineligible for the brain injury services waiver or persons who
2 22 are eligible for the waiver but funding was not authorized or
2 23 available to provide waiver eligibility for the persons under
2 24 the waiver eligible component. The cost=share component is
2 25 subject to general requirements which shall include but are
2 26 not limited to all of the following:
2 27 a. Services offered are consistent with the services
2 28 offered through the brain injury services waiver.
2 29 b. Each service consumer has a service plan developed
2 30 prior to service implementation and the service plan is
2 31 reviewed and updated at least quarterly.
2 32 c. All other funding sources for which the service
2 33 consumer is eligible are utilized to the greatest extent
2 34 possible. The funding sources potentially available include
2 35 but are not limited to community resources and public and
3 1 private benefit programs.
3 2 d. The maximum monthly cost of the services provided shall
3 3 be based on the maximum monthly amount authorized for the
3 4 brain injury services waiver.
3 5 e. Assistance under the cost=share component shall be made
3 6 available to a designated number of service consumers who are
3 7 eligible, as determined from the funding available for the
3 8 cost=share component, on a first=come, first=served basis.
3 9 f. Nothing in this section shall be construed or is
3 10 intended as, or shall imply, a grant of entitlement to
3 11 services to persons who are eligible for participation in the
3 12 cost=share component based upon the eligibility provisions
3 13 adopted consistent with the requirements of this section. Any
3 14 obligation to provide services pursuant to this section is
3 15 limited to the extent of the funds appropriated or provided
3 16 for the cost=share component.
3 17 6. COST=SHARE COMPONENT ELIGIBILITY. An individual must
3 18 meet all of the following requirements in order to be eligible
3 19 for the cost=share component of the brain injury services
3 20 program:
3 21 a. The individual is age one month through sixty=four
3 22 years.
3 23 b. The individual has a diagnosed brain injury as defined
3 24 in section 135.22.
3 25 c. The individual is a resident of this state and either a
3 26 United States citizen or a qualified alien as defined in 8
3 27 U.S.C. } 1641.
3 28 d. The cost=share component's financial eligibility
3 29 requirements shall be based on the requirements used for the
3 30 hawk=i program under chapter 514I. The individual must meet
3 31 the cost=share component's financial eligibility requirements
3 32 and be willing to pay a cost=share for the cost=share
3 33 component.
3 34 e. The individual does not receive services or funding
3 35 under any type of medical assistance home and community=based
4 1 services waiver.
4 2 7. COST=SHARE REQUIREMENTS.
4 3 a. An individual's cost=share responsibility for services
4 4 under the cost=share component shall be determined on a
4 5 sliding scale based upon the individual's family income. An
4 6 individual's cost=share shall be assessed as a copayment,
4 7 which shall not exceed thirty percent of the cost payable for
4 8 the service.
4 9 b. The service provider shall bill the department for the
4 10 portion of the cost payable for the service that is not
4 11 covered by the individual's copayment responsibility.
4 12 8. APPLICATION PROCESS.
4 13 a. The application materials for services under both the
4 14 waiver eligible and cost=share components of the brain injury
4 15 services program shall use the application form and other
4 16 materials of the brain injury services waiver. In order to
4 17 apply for the brain injury services program, the applicant
4 18 must authorize the department of human services to provide the
4 19 applicant's waiver application materials to the brain injury
4 20 services program. The application materials provided shall
4 21 include but are not limited to the waiver application, and any
4 22 denial letter, financial assessment, and functional assessment
4 23 regarding the person.
4 24 b. If a functional assessment for the waiver has not been
4 25 completed due to a person's financial ineligibility for the
4 26 waiver, the brain injury services program may provide for a
4 27 functional assessment to determine the person's needs by
4 28 reimbursing the department of human services for the
4 29 assessment.
4 30 c. The program administrator shall file copies of the
4 31 individual's application and needs assessment with the program
4 32 resource facilitator assigned to the individual's geographic
4 33 area.
4 34 d. The department's program administrator shall make a
4 35 final determination as to whether program funding will be
5 1 authorized under the cost=share component.
5 2 9. SERVICE PROVIDERS AND REIMBURSEMENT. All of the
5 3 following requirements apply to service providers and
5 4 reimbursement rates payable for services under the cost=share
5 5 component:
5 6 a. A service provider must either be certified to provide
5 7 services under the brain injury services waiver or have a
5 8 contract with a county to provide services and will become
5 9 certified to provide services under such waiver within a
5 10 reasonable period of time specified in rule.
5 11 b. The reimbursement rate payable for the cost of a
5 12 service provided under the cost=share component is the rate
5 13 payable under the medical assistance program. However, if the
5 14 service provided does not have a medical assistance program
5 15 reimbursement rate, the rate shall be the amount payable under
5 16 the county contract.
5 17 10. RESOURCE FACILITATION. The program shall utilize
5 18 resource facilitators to facilitate program services. The
5 19 resource facilitator shall be available to provide ongoing
5 20 support for individuals with brain injury in coping with the
5 21 issues of living with a brain injury and in assisting such
5 22 individuals in transitioning back to employment and living in
5 23 the community. The resource facilitator is intended to
5 24 provide a linkage to existing services and increase the
5 25 capacity of the state's providers of services to persons with
5 26 brain injury by doing all of the following:
5 27 a. Providing brain injury=specific information, support,
5 28 and resources.
5 29 b. Enhancing the usage of support commonly available to an
5 30 individual with brain injury from the community, family, and
5 31 personal contacts and linking such individuals to appropriate
5 32 services and community resources.
5 33 c. Training service providers to provide appropriate brain
5 34 injury services.
5 35 d. Accessing, securing, and maximizing the private and
6 1 public funding available to support an individual with a brain
6 2 injury.
6 3 Sec. 2. 2005 Iowa Acts, chapter 179, section 1, subsection
6 4 2, paragraph d, is amended to read as follows:
6 5 d. For distribution to counties as cost=share for county
6 6 coverage of services to adult persons with the Iowa department
6 7 of public health for the brain injury in accordance with the
6 8 law enacted as a result of the provisions of 2005 Iowa Acts,
6 9 House File 876, or other law providing for such coverage to
6 10 commence service program in the fiscal year beginning July 1,
6 11 2006, as provided in accordance with section 135.22B, if
6 12 enacted by the Eighty=first General Assembly, 2006 Session:
6 13 .................................................. $ 2,426,893
6 14 The amount allocated in this paragraph "d" shall be
6 15 allocated by the Iowa department of public health as follows:
6 16 (1) For state cost=share of services provided under
6 17 section 135.22B:
6 18 .................................................. $ 2,092,665
6 19 (2) For contract resource facilitator services:
6 20 .................................................. $ 173,125
6 21 (3) For a sole source contract with a statewide
6 22 association representing community providers of mental health,
6 23 mental retardation, and brain injury services to provide, in
6 24 collaboration with a statewide organization representing
6 25 individuals with a brain injury and their families, brain
6 26 injury training services and recruiting of service providers
6 27 to increase the capacity within this state to address the
6 28 needs of individuals with brain injuries and such individuals'
6 29 families:
6 30 .................................................. $ 40,000
6 31 (4) For reimbursement for needs assessments performed
6 32 under section 135.22B:
6 33 .................................................. $ 26,750
6 34 (5) For match of federal funding, administrative and
6 35 personnel costs including salaries, support, maintenance, and
7 1 miscellaneous purposes:
7 2 .................................................. $ 94,353
7 3 Notwithstanding section 8.33, the appropriated moneys
7 4 allocated in this paragraph "d" that remain unencumbered or
7 5 unobligated at the close of the fiscal year shall not revert
7 6 but shall remain available for expenditure for the purposes
7 7 designated until the close of the succeeding fiscal year.
7 8 Sec. 3. EMERGENCY RULES. The Iowa department of public
7 9 health may adopt administrative rules under section 17A.4,
7 10 subsection 2, and section 17A.5, subsection 2, paragraph "b",
7 11 to implement the provisions of this Act, and the rules shall
7 12 become effective immediately upon filing or on a later
7 13 effective date specified in the rules, unless the effective
7 14 date is delayed by the administrative rules review committee.
7 15 Any rules adopted in accordance with this section shall not
7 16 take effect before the rules are reviewed by the
7 17 administrative rules review committee. The delay authority
7 18 provided to the administrative rules review committee under
7 19 section 17A.4, subsection 5, and section 17A.8, subsection 9,
7 20 shall be applicable to a delay imposed under this section,
7 21 notwithstanding a provision in those sections making them
7 22 inapplicable to section 17A.5, subsection 2, paragraph "b".
7 23 Any rules adopted in accordance with the provisions of this
7 24 section shall also be published as notice of intended action
7 25 as provided in section 17A.4.
7 26 EXPLANATION
7 27 This bill creates a new brain injury services program and
7 28 provides for funding of the program through allocation of a
7 29 previously enacted appropriation.
7 30 The new program is created in new Code section 135.22B to
7 31 be administered by the division of the Iowa department of
7 32 public health assigned to administer the advisory council on
7 33 brain injuries.
7 34 The bill provides definitions and states the program's
7 35 purpose. The bill addresses general requirements, including a
8 1 provision that the program is not an entitlement but is
8 2 limited to the extent of the funding provided.
8 3 The program has three primary components: a waiver eligible
8 4 component, a cost=share component, and a resource facilitation
8 5 component.
8 6 The waiver eligible component is for persons with a brain
8 7 injury that are eligible for the medical assistance (Medicaid)
8 8 program home and community=based services waiver for persons
8 9 with brain injury but are on a waiting list because funding is
8 10 not available to pay the nonfederal share of the costs to
8 11 remove the person from the waiting list. Under this
8 12 component, the brain injury services program may provide the
8 13 funding for the nonfederal share of the costs so that the
8 14 person may be removed from the waiting list. If a person
8 15 receives assistance under this component, the person is not
8 16 eligible for assistance under the cost=share component.
8 17 The cost=share component is directed to persons with a
8 18 brain injury who have either been determined to be ineligible
8 19 for the brain injury services waiver or who are eligible for
8 20 the waiver but are on a waiting list and funding was not
8 21 provided under the waiver eligible component. Eligibility for
8 22 this component is limited to individuals with a diagnosed
8 23 brain injury who are willing to pay cost=share under the
8 24 program, and are not receiving services under any Medicaid
8 25 home and community=based services waiver. The component's
8 26 financial eligibility requirements are required to be based on
8 27 those applicable under the hawk=i program for providing health
8 28 coverage for low=income children.
8 29 Various cost=share requirements are applicable to the cost=
8 30 share component, including a sliding scale for individual
8 31 cost=share and state cost=share for the portion not covered by
8 32 the individual cost=share.
8 33 The program's application provisions utilize the
8 34 application materials of the Medicaid program's home and
8 35 community=based brain injury services waiver. An applicant
9 1 for the brain injury services program must authorize the
9 2 department of human services to provide the applicant's waiver
9 3 application materials to the program. If there was not a
9 4 functional assessment performed under the waiver of the
9 5 applicant's needs because of the applicant's financial
9 6 eligibility, the brain injury services program may provide for
9 7 the assessment by reimbursing the department of human services
9 8 for the assessment. The program administrator has final
9 9 authority in determining whether program funding will be
9 10 authorized under the cost=share component.
9 11 Service provider and reimbursement provisions include
9 12 requirements that service providers must be certified to
9 13 provide services under the brain injury services waiver or
9 14 have a county contract to provide services and become
9 15 certified to provide services under the waiver. Reimbursement
9 16 rates payable under the program are the same as the Medicaid
9 17 rates. If there is not a Medicaid rate, the county contract
9 18 rate applies.
9 19 The program includes a resource facilitator component to
9 20 assist individuals with the program and to enhance the service
9 21 system available to individuals in the state with brain
9 22 injury. The bill addresses the duties of resource
9 23 facilitators.
9 24 The provisions of an appropriation made for MH/MR/DD
9 25 allowed growth for fiscal year 2006=2007 in a contingent
9 26 allocation made for brain injury services are amended. The
9 27 language is revised to refer to the program created in the
9 28 bill and to allocate the appropriation to the Iowa department
9 29 of public health for various purposes associated with the
9 30 brain injury services program created in the bill. Moneys in
9 31 the allocation that remain unencumbered or unobligated at the
9 32 close of the fiscal year do not revert but remain available
9 33 for expenditure for the brain injury program in the succeeding
9 34 fiscal year.
9 35 The Iowa department of public health is authorized to adopt
10 1 rules to implement the brain injury services program utilizing
10 2 emergency procedures that forego various public comment
10 3 periods, but the rules remain subject to review by the
10 4 administrative rules review committee before being adopted.
10 5 LSB 6045HZ 81
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