SENATE FILE _____

BY  (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON RAGAN)

A BILL FOR

An Act relating to allowing financial supplementation to a nursing facility for provision of a private room to a recipient of medical assistance.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 249A.4, Code 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  9A.
  a.  Recommend to the council on human services the adoption of rules allowing supplementation of the combination of client participation and payment made through the medical assistance program, by the resident of a nursing facility or the resident’s family, for provision of a private room not otherwise covered under the medical assistance program unless:
   (1)  The private room is therapeutically required pursuant to 42 C.F.R. § 483.10(c)(8)(ii).
   (2)  No room other than the private room is available.
   b.  The rules shall require all of the following if a nursing facility provides for such supplementation:
   (1)  The nursing facility shall inform all current and prospective residents and residents’ legal representatives of the following:
   (a)  If the resident desires a private room, the resident or resident’s family may provide supplementation by directly paying the facility the amount of supplementation.
   (b)  The nursing facility’s policy if a resident residing in a private room converts from private pay to payment under the medical assistance program, but the resident or resident’s family is not willing or able to pay supplementation for the private room.
   (c)  The private rooms for which supplementation is required.
   (d)  The process for an individual to take legal responsibility for providing supplementation, including identification of the individual and the extent of the legal responsibility.
   (2)  For residents for whom the nursing facility receives supplementation, the nursing facility shall indicate in the resident’s record all of the following:
   (a)  Identification of the private room for which the nursing facility is receiving supplementation.
   (b)  The identity of the individual making the supplemental payments. 
   (c)  The amount of the supplemental payment.
   (d)  The private pay charge for the private room for which the nursing facility is receiving the supplemental payment.
   (3)  If the nursing facility only provides one type of room or all private rooms, the nursing facility shall not be eligible to request supplementation.
   (4)  A nursing facility may base the supplementation amount on the difference between the amount paid for a room covered under the medical assistance program and the private pay rate for the private room identified for supplementation. However, the total payment for the private room from all sources shall be the lesser of the private room rate or not more than two times the rate for the room covered under the medical assistance program for which the resident would be eligible. 
EXPLANATION
   This bill directs the director of human services to recommend to the council on human services the adoption of rules allowing supplementation under the medical assistance program, by the resident of a nursing facility or the resident’s family, for provision of a private room not otherwise covered under the medical assistance program. Supplementation is not available if the private room is therapeutically required under federal regulations or no room other than the private room is available. The bill specifies what the rules are to require if a nursing facility provides for supplementation and the information to be included in the resident’s record if supplementation is received by the nursing facility. The rules are to provide that if the nursing facility only provides one type of room or all private rooms, the nursing facility shall not be eligible to request supplementation and also provides for limitation of the amount of supplementation that a nursing facility may accept.