House File 788 - Introduced
HOUSE FILE
BY COMMITTEE ON HUMAN RESOURCES
(SUCCESSOR TO HSB 124)
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to a nursing facility quality assurance
2 assessment, providing a contingent effective date, providing
3 for retroactive applicability, and providing an effective
4 date.
5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
6 TLSB 2005HV 81
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PAG LIN
1 1 Section 1. Section 249A.20B, Code 2005, is amended by
1 2 striking the section and inserting in lieu thereof the
1 3 following:
1 4 249A.20B NURSING FACILITY QUALITY ASSURANCE ASSESSMENT.
1 5 1. The department may assess licensed nursing facilities a
1 6 quality assurance assessment not to exceed six percent of the
1 7 total annual revenue of all nursing facilities, in the
1 8 aggregate. The maximum assessment shall be consistent with
1 9 the guidelines established by the centers for Medicare and
1 10 Medicaid services of the United States department of health
1 11 and human services and the corresponding waiver request
1 12 submitted in accordance with this section.
1 13 2. The department may require that the quality assurance
1 14 assessment be paid to the department by a nursing facility in
1 15 equal monthly amounts on or before the fifteenth day of the
1 16 month, or the department may deduct the monthly assessment
1 17 amount from the medical assistance payments to a nursing
1 18 facility. The amount deducted from medical assistance
1 19 payments shall not exceed the total amount of the fee due.
1 20 The department shall assess interest on any assessment amount
1 21 not paid or on any assessment amount paid after the date the
1 22 assessment is due to be paid.
1 23 3. The department of human services shall provide a
1 24 reimbursement to nursing facilities under this section. The
1 25 reimbursement amount shall be calculated as a per patient day
1 26 amount and shall be paid to nursing facilities in addition to
1 27 the reimbursement payment specified in 2001 Iowa Acts, chapter
1 28 192, section 4, subsection 2, paragraph "c".
1 29 4. In addition to the reimbursement amount paid pursuant
1 30 to subsection 3, and the reimbursement payment specified in
1 31 2001 Iowa Acts, chapter 192, section 4, subsection 2,
1 32 paragraph "c", the department may pay nursing facilities an
1 33 additional amount during the period in which the quality
1 34 assurance assessment is provided under this section as a per
1 35 patient day amount.
2 1 5. Revenue generated from the quality assurance assessment
2 2 less any amount paid to nursing facilities under subsections 3
2 3 and 4, shall be deposited in the senior living trust fund
2 4 created in section 249H.4.
2 5 6. If federal financial participation to match the
2 6 assessment made under subsection 1 becomes unavailable under
2 7 federal law or if federal approval of the assessment is
2 8 otherwise terminated following approval:
2 9 a. The department shall terminate the imposition of the
2 10 assessment beginning on the date that the federal statutory,
2 11 regulatory, or interpretive changes take effect.
2 12 b. The department shall terminate payment of the
2 13 reimbursement amount pursuant to subsection 3 and the
2 14 additional amount pursuant to subsection 4.
2 15 c. The department is not required to continue payment or
2 16 to replace payment of the reimbursement amount or any
2 17 additional payment with state=only funds.
2 18 7. The department may procure a sole source contract to
2 19 implement the provisions of this section.
2 20 8. This section shall not be interpreted to authorize the
2 21 department to seek federal approval to implement any other
2 22 quality assurance assessment unless specifically authorized by
2 23 the general assembly.
2 24 9. For the purposes of this section, "nursing facility"
2 25 means nursing facility as defined in section 135C.1, excluding
2 26 residential care facilities and nursing facilities that are
2 27 operated by the state.
2 28 10. The department of human services may adopt
2 29 administrative rules under section 17A.4, subsection 2, and
2 30 section 17A.5, subsection 2, paragraph "b", to implement this
2 31 section.
2 32 Sec. 2. STATE PLAN AMENDMENT == QUALITY ASSURANCE
2 33 ASSESSMENT == WAIVER OF UNIFORM TAX. If the department of
2 34 human services determines that the opportunities for the state
2 35 to receive additional federal funding under the medical
3 1 assistance program will not be jeopardized by implementation
3 2 of a quality assurance assessment on licensed nursing
3 3 facilities, the department shall do both of the following:
3 4 1. Submit a medical assistance state plan amendment to the
3 5 centers for Medicare and Medicaid services of the United
3 6 States department of health and human services to effectuate
3 7 the nursing facility quality assurance assessment. The
3 8 department of human services may take any necessary steps to
3 9 preserve the original applicability date of October 1, 2003,
3 10 established pursuant to 2003 Iowa Acts, chapter 112, section
3 11 4, subsection 9, as amended by 2004 Iowa Acts, chapter 1085,
3 12 sections 8 and 10.
3 13 2. Submit an application to the secretary of the United
3 14 States department of health and human services to request a
3 15 waiver of the uniform tax requirement pursuant to 42 U.S.C. }
3 16 1396b(w)(3)(E) and 42 C.F.R. } 433.68(e)(2).
3 17 Sec. 3. CONTINGENT EFFECTIVE DATE.
3 18 1. Section 1 of this Act, amending section 249A.20B, shall
3 19 not take effect unless all of the following conditions are
3 20 met:
3 21 a. The department of human services receives approval of
3 22 both the medical assistance state plan amendment submitted
3 23 pursuant to section 2 of this Act from the centers for
3 24 Medicare and Medicaid services of the United States department
3 25 of health and human services to effectuate the nursing
3 26 facility quality assurance assessment and of the application
3 27 to the secretary of the United States department of health and
3 28 human services for a waiver of the uniform tax requirement
3 29 pursuant to 42 U.S.C. } 1396(w)(3)(E) and 42 C.F.R. }
3 30 433.68(e)(2) submitted pursuant to section 2 of this Act.
3 31 b. The reimbursement payments and any additional payments
3 32 proposed to be made are not deemed hold harmless payments by
3 33 the centers for Medicare and Medicaid services of the United
3 34 States department of health and human services, contrary to
3 35 federal rules regarding allowable health care provider taxes.
4 1 c. The department of human services submits a plan for
4 2 implementation of the quality assurance assessment to the
4 3 administrative rules review committee which includes an
4 4 evaluation of the projected effect of the assessment and the
4 5 specific effect of payment of an additional amount to nursing
4 6 facilities relative to all of the following:
4 7 (1) The impact on the nursing facility case=mix
4 8 reimbursement system.
4 9 (2) The interest of the state in rebalancing the long=
4 10 term care system.
4 11 (3) The potential that the centers for Medicare and
4 12 Medicaid services of the United States department of health
4 13 and human services will reduce the ability of the state to
4 14 effectively utilize the quality assurance assessment.
4 15 2. If the approvals described in subsection 1, paragraph
4 16 "a", are not received by December 31, 2005, the section of
4 17 this Act amending section 249A.20B is repealed.
4 18 Sec. 4. CONTINGENT REPEAL. If the amendment to section
4 19 249A.20B in this Act takes effect as provided in section 3 of
4 20 this Act, section 249A.20B, as amended, is repealed June 30,
4 21 2006.
4 22 Sec. 5. RETROACTIVE APPLICABILITY. If the amendment to
4 23 section 249A.20B in this Act takes effect as provided in
4 24 section 3 of this Act, any assessment made under section
4 25 249A.20B, as amended, may be made retroactive to October 1,
4 26 2003, if preserved as provided in section 2 of this Act, or
4 27 the applicability date approved in the state plan amendment.
4 28 Sec. 6. EFFECTIVE DATES. Section 2 of this Act, relating
4 29 to directing the department of human services to submit a
4 30 medical assistance state plan amendment to the centers for
4 31 Medicare and Medicaid services of the United States department
4 32 of health and human services to effectuate the nursing
4 33 facility quality assurance assessment and directing the
4 34 department of human services to submit an application to the
4 35 secretary of the United States department of health and human
5 1 services for a waiver of the uniform tax requirement pursuant
5 2 to 42 U.S.C. } 1396b(w)(3)(E) and 42 C.F.R. } 433.68(e)(2),
5 3 being deemed of immediate importance, takes effect upon
5 4 enactment.
5 5 EXPLANATION
5 6 This bill provides for the imposition of a quality
5 7 assurance assessment not to exceed 6 percent of the total
5 8 annual revenue of all licensed nursing facilities, in the
5 9 aggregate, under the medical assistance program. The maximum
5 10 assessment is to be consistent with the guidelines established
5 11 by the centers for Medicare and Medicaid services of the
5 12 United States department of health and human services and the
5 13 corresponding waiver of uniformity of the assessment granted
5 14 by the federal government. The bill provides for payment of
5 15 the assessment by nursing facilities and for reimbursement of
5 16 the nursing facilities by the department of human services
5 17 (DHS). The bill also provides for payment of an additional
5 18 amount to nursing facilities beyond any reimbursement amounts.
5 19 The bill provides that the net revenue generated by imposition
5 20 of the assessment is to be deposited in the senior living
5 21 trust fund.
5 22 The bill provides that if federal financial participation
5 23 to match the assessment becomes unavailable or if federal
5 24 approval of the assessment is otherwise terminated following
5 25 approval, DHS is to terminate the imposition of the assessment
5 26 and payment of the reimbursement amount and any additional
5 27 amount, and is not required to continue payment or to replace
5 28 payment of the reimbursement amount or any additional amount
5 29 with state=only funds.
5 30 The bill authorizes DHS to procure a sole source contract
5 31 to implement the bill and provides that the bill is not to be
5 32 interpreted as authorizing the department to seek federal
5 33 approval to implement any other quality assurance assessment
5 34 unless specifically authorized by the general assembly.
5 35 If DHS determines that the opportunities for the state to
6 1 receive additional federal funding under the medical
6 2 assistance program will not be jeopardized by implementation
6 3 of the assessment, the bill directs DHS to seek the necessary
6 4 waiver of the uniform tax requirement and submit a state plan
6 5 amendment to implement the assessment.
6 6 The quality assurance assessment does not take effect
6 7 unless DHS receives approval of the necessary waiver and state
6 8 plan amendment, the reimbursement payments and additional
6 9 payments are not deemed hold harmless payments by the federal
6 10 government, and the department submits an implementation plan
6 11 to the administrative rules review committee. Additionally,
6 12 if federal approval of the waiver and the state plan amendment
6 13 are not received by December 31, 2005, the assessment
6 14 provision is repealed.
6 15 If the assessment does take effect, the assessment
6 16 provision is repealed June 30, 2006. If the assessment does
6 17 take effect, the assessment may be retroactive to October 1,
6 18 2003, or is applicable from the date approved in the state
6 19 plan amendment.
6 20 The provision directing DHS to submit a medical assistance
6 21 state plan amendment and to request a waiver of the uniform
6 22 tax requirement takes effect upon enactment.
6 23 LSB 2005HV 81
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