House Study Bill 124 HOUSE FILE BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON UPMEYER) 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 2005HC 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 shall assess licensed nursing facilities 1 6 a quality assurance assessment not to exceed six percent of 1 7 the total annual revenue of the nursing facility. The maximum 1 8 assessment shall be consistent with the guidelines established 1 9 by the centers for Medicare and Medicaid services of the 1 10 United States department of health and human services and the 1 11 corresponding waiver of the uniform tax requirement granted 1 12 pursuant to the waiver request submitted under this section. 1 13 2. The quality assurance assessment shall be collected by 1 14 the department in equal monthly amounts on or before the 1 15 fifteenth day of each month. The department may deduct the 1 16 monthly assessment amount from medical assistance payments to 1 17 a nursing facility. The amount deducted from payments shall 1 18 not exceed the total amount of the fee due. 1 19 3. Revenue generated from the quality assurance assessment 1 20 shall be deposited in the senior living trust fund created in 1 21 section 249H.4. The revenues shall only be used for services 1 22 for which federal financial participation under the medical 1 23 assistance program is available to match state funds. 1 24 4. The department of human services shall provide a 1 25 reimbursement to nursing facilities under this section. The 1 26 reimbursement amount shall be calculated as a per patient day 1 27 amount and shall be paid to nursing facilities in addition to 1 28 the reimbursement payment specified in 2001 Iowa Acts, chapter 1 29 192, section 4, subsection 2, paragraph "c". 1 30 5. If federal financial participation to match the 1 31 assessments made under subsection 1 becomes unavailable under 1 32 federal law, the department shall terminate the imposition of 1 33 the assessment beginning on the date that the federal 1 34 statutory, regulatory, or interpretive change takes effect. 1 35 6. The department may procure a sole source contract to 2 1 implement the provisions of this section. 2 2 7. For the purposes of this section, "nursing facility" 2 3 means nursing facility as defined in section 135C.1, excluding 2 4 residential care facilities and nursing facilities that are 2 5 operated by the state. 2 6 8. The department may adopt administrative rules under 2 7 section 17A.4, subsection 2, and section 17A.5, subsection 2, 2 8 paragraph "b", to implement this section. 2 9 Sec. 2. STATE PLAN AMENDMENT == QUALITY ASSURANCE 2 10 ASSESSMENT == WAIVER OF UNIFORM TAX. 2 11 1. The department of human services shall submit a medical 2 12 assistance state plan amendment to the centers for Medicare 2 13 and Medicaid services of the United States department of 2 14 health and human services to effectuate the nursing facility 2 15 quality assurance assessment. The department of human 2 16 services shall take any necessary steps to preserve the 2 17 original applicability date of October 1, 2003, established 2 18 pursuant to 2003 Iowa Acts, chapter 112, section 4, subsection 2 19 9, as amended by 2004 Iowa Acts, chapter 1085, sections 8 and 2 20 10. 2 21 2. The department of human services shall submit an 2 22 application to the secretary of the United States department 2 23 of health and human services to request a waiver of the 2 24 uniform tax requirement pursuant to 42 U.S.C. } 1396b(w)(3)(E) 2 25 and 42 C.F.R. } 433.68(e)(2). 2 26 Sec. 3. CONTINGENT EFFECTIVE DATE. 2 27 1. Section 1 of this Act, amending section 249A.20B, shall 2 28 not take effect unless the department of human services 2 29 receives approval of both the medical assistance state plan 2 30 amendment submitted pursuant to section 2 of this Act from the 2 31 centers for Medicare and Medicaid services of the United 2 32 States department of health and human services to effectuate 2 33 the nursing facility quality assurance assessment and of the 2 34 application to the secretary of the United States department 2 35 of health and human services for a waiver of the uniform tax 3 1 requirement pursuant to 42 U.S.C. } 1396b(w)(3)(E) and 42 3 2 C.F.R. } 433.68(e)(2) submitted pursuant to section 2 of this 3 3 Act. If both approvals are received, the amendment to section 3 4 249A.20B in this Act shall take effect upon the date that both 3 5 approvals have been received by the department, and the 3 6 department shall notify the Code editor of the date of receipt 3 7 of the approvals. 3 8 2. If both approvals described in subsection 1 are not 3 9 received by June 30, 2005, the section of this Act amending 3 10 section 249A.20B is repealed. 3 11 Sec. 4. RETROACTIVE APPLICABILITY. If the amendment to 3 12 section 249A.20B in this Act takes effect as provided in 3 13 section 3 of this Act, any assessment made under section 3 14 249A.20B, as amended, may be made retroactive to October 1, 3 15 2003, if preserved as provided in section 2 of this Act, or 3 16 the applicability date approved in the state plan amendment. 3 17 Sec. 5. EFFECTIVE DATES. Section 2 of this Act, relating 3 18 to directing the department of human services to submit a 3 19 medical assistance state plan amendment to the centers for 3 20 Medicare and Medicaid services of the United States department 3 21 of health and human services to effectuate the nursing 3 22 facility quality assurance assessment and directing the 3 23 department of human services to submit an application to the 3 24 secretary of the United States department of health and human 3 25 services for a waiver of the uniform tax requirement pursuant 3 26 to 42 U.S.C. } 1396b(w)(3)(E) and 42 C.F.R. } 433.68(e)(2), 3 27 being deemed of immediate importance, takes effect upon 3 28 enactment. 3 29 EXPLANATION 3 30 This bill provides for a quality assurance assessment not 3 31 to exceed 6 percent of the total annual revenue of a licensed 3 32 nursing facility. The maximum assessment on a nursing 3 33 facility is to be consistent with the guidelines established 3 34 by the centers for Medicare and Medicaid services of the 3 35 United States department of health and human services and the 4 1 corresponding waiver of uniformity of the assessment granted 4 2 by the federal government. This is similar to a provision 4 3 enacted in 2003 which did not take effect due to lack of 4 4 federal approval of the medical assistance state plan 4 5 amendment and the waiver of the uniform tax requirement. 4 6 The bill directs the department of human services (DHS) to 4 7 submit a medical assistance state plan amendment to the 4 8 centers for Medicare and Medicaid services of the United 4 9 States department of health and human services to effectuate 4 10 the assessment. The bill directs DHS to take any necessary 4 11 steps to preserve the original retroactive applicability date 4 12 of October 1, 2003, that was established pursuant to the 2003 4 13 enactment as amended by a 2004 enactment. 4 14 The bill also directs DHS to submit an application to the 4 15 secretary of the United States department of health and human 4 16 services to request a waiver of the uniform tax requirement on 4 17 nursing facilities. 4 18 The bill provides that the assessment is to be collected by 4 19 DHS in equal monthly amounts on or before the 15th day of each 4 20 month, and that DHS may deduct the monthly assessment amount 4 21 from medical assistance payments to a nursing facility. The 4 22 amount deducted from payments is not to exceed the total 4 23 amount of the fee due. 4 24 Revenue generated from the assessment is to be deposited in 4 25 the senior living trust fund, and the revenues are only to be 4 26 used for services for which federal financial participation 4 27 under the medical assistance program is available to match 4 28 state funds. 4 29 The bill provides that if federal financial participation 4 30 to match the assessments becomes unavailable under federal 4 31 law, DHS is to terminate the imposition of the assessment 4 32 beginning on the date that the federal statutory, regulatory, 4 33 or interpretive change takes effect. 4 34 DHS may procure a sole source contract and may adopt 4 35 administrative rules to implement the bill. 5 1 The portions of the bill relating to implementation of the 5 2 quality assurance assessment do not take effect until DHS 5 3 receives approval of both the medical assistance state plan 5 4 amendment and the waiver of the uniform tax requirement. If 5 5 both approvals are received, these portions of the bill take 5 6 effect upon the date that both approvals have been received by 5 7 the department, and DHS is to notify the Code editor of the 5 8 date of receipt of the approvals. If both approvals are not 5 9 received by June 30, 2005, the provision is repealed. The 5 10 bill also provides that if the bill takes effect, the 5 11 assessment may be made retroactive to October 1, 2003, if 5 12 preserved under the original state plan amendment submitted, 5 13 or the applicability date approved in the state plan 5 14 amendment. 5 15 The portions of the bill directing DHS to submit a medical 5 16 assistance state plan amendment and to request a waiver of the 5 17 uniform tax requirement take effect upon enactment. 5 18 LSB 2005HC 81 5 19 pf:nh/pj/5