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 7 pf/pj/5 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 6 24 pf:nh/pj/5