Senate Study Bill 3054 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON RAGAN) A BILL FOR An Act relating to allowing financial supplementation to 1 a nursing facility for provision of a private room to a 2 recipient of medical assistance. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5481XC (3) 84 pf/nh

S.F. _____ Section 1. Section 249A.4, Code 2011, is amended by adding 1 the following new subsection: 2 NEW SUBSECTION . 9A. a. Recommend to the council on human 3 services the adoption of rules allowing supplementation of the 4 combination of client participation and payment made through 5 the medical assistance program, by the resident of a nursing 6 facility or the resident’s family, for provision of a private 7 room not otherwise covered under the medical assistance program 8 unless: 9 (1) The private room is therapeutically required pursuant 10 to 42 C.F.R. § 483.10(c)(8)(ii). 11 (2) No room other than the private room is available. 12 b. The rules shall require all of the following if a nursing 13 facility provides for such supplementation: 14 (1) The nursing facility shall inform all current and 15 prospective residents and residents’ legal representatives of 16 the following: 17 (a) If the resident desires a private room, the resident 18 or resident’s family may provide supplementation by directly 19 paying the facility the amount of supplementation. 20 (b) The nursing facility’s policy if a resident residing 21 in a private room converts from private pay to payment under 22 the medical assistance program, but the resident or resident’s 23 family is not willing or able to pay supplementation for the 24 private room. 25 (c) The private rooms for which supplementation is 26 required. 27 (d) The process for an individual to take legal 28 responsibility for providing supplementation, including 29 identification of the individual and the extent of the legal 30 responsibility. 31 (2) For residents for whom the nursing facility receives 32 supplementation, the nursing facility shall indicate in the 33 resident’s record all of the following: 34 (a) Identification of the private room for which the nursing 35 -1- LSB 5481XC (3) 84 pf/nh 1/ 2

S.F. _____ facility is receiving supplementation. 1 (b) The identity of the individual making the supplemental 2 payments. 3 (c) The amount of the supplemental payment. 4 (d) The private pay charge for the private room for which 5 the nursing facility is receiving the supplemental payment. 6 (3) If the nursing facility only provides one type of 7 room or all private rooms, the nursing facility shall not be 8 eligible to request supplementation. 9 (4) A nursing facility may base the supplementation amount 10 on the difference between the amount paid for a room covered 11 under the medical assistance program and the private pay rate 12 for the private room identified for supplementation. However, 13 the total payment for the private room from all sources 14 shall be the lesser of the private room rate or not more than 15 two times the rate for the room covered under the medical 16 assistance program for which the resident would be eligible. 17 EXPLANATION 18 This bill directs the director of human services to 19 recommend to the council on human services the adoption of 20 rules allowing supplementation under the medical assistance 21 program, by the resident of a nursing facility or the 22 resident’s family, for provision of a private room not 23 otherwise covered under the medical assistance program. 24 Supplementation is not available if the private room is 25 therapeutically required under federal regulations or no room 26 other than the private room is available. The bill specifies 27 what the rules are to require if a nursing facility provides 28 for supplementation and the information to be included in 29 the resident’s record if supplementation is received by 30 the nursing facility. The rules are to provide that if the 31 nursing facility only provides one type of room or all private 32 rooms, the nursing facility shall not be eligible to request 33 supplementation and also provides for limitation of the amount 34 of supplementation that a nursing facility may accept. 35 -2- LSB 5481XC (3) 84 pf/nh 2/ 2