Senate
Study
Bill
1133
-
Introduced
SENATE/HOUSE
FILE
_____
BY
(PROPOSED
DEPARTMENT
OF
HUMAN
SERVICES
BILL)
A
BILL
FOR
An
Act
relating
to
service
providers
under
Medicaid
home
and
1
community-based
services
waivers.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
1152XD
(5)
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S.F.
_____
H.F.
_____
Section
1.
Section
135C.6,
subsection
8,
paragraph
c,
1
unnumbered
paragraph
1,
Code
2013,
is
amended
to
read
as
2
follows:
3
A
residential
program
approved
by
the
department
of
human
4
services
pursuant
to
this
paragraph
“c”
to
receive
moneys
5
appropriated
to
the
department
of
human
services
under
6
provisions
of
a
federally
approved
home
and
community-based
7
services
habilitation
or
waiver
for
persons
with
intellectual
8
disabilities
program
may
provide
care
to
not
more
than
five
9
individuals.
The
department
shall
approve
a
residential
10
program
under
this
paragraph
that
complies
with
all
of
the
11
following
conditions:
12
Sec.
2.
2010
Iowa
Acts,
chapter
1031,
section
351,
is
13
amended
to
read
as
follows:
14
SEC.
351.
MEDICAID
HOME
AND
COMMUNITY-BASED
SERVICES
WAIVER
15
PAYMENTS
UTILIZATION
——
REVIEW.
The
Beginning
July
1,
2013,
16
the
department
of
human
services
shall
evaluate
payment
records
17
utilization
data
and
determine
the
proper
mechanism
to
trigger
18
a
review
of
payments
medical
necessity
for
services
provided
19
under
each
home
and
community-based
services
waiver
that
are
in
20
excess
of
the
median
amount
for
payments
through
the
applicable
21
waiver
.
Following
development
of
the
trigger
mechanism,
the
22
department
shall
require
advance
approval
for
services
for
23
which
payment
utilization
is
projected
to
exceed
the
median
24
trigger
mechanism
as
applicable
to
each
waiver
service
.
The
25
use
of
a
trigger
mechanism
and
the
approval
process
is
intended
26
to
preserve
necessary
services
while
preventing
overuse
of
27
services.
28
EXPLANATION
29
This
bill
involves
provisions
relating
to
Medicaid
home
and
30
community-based
services
(HCBS)
waivers.
31
The
bill
amends
a
provision
in
the
health
facilities
32
licensing
chapter
(Code
chapter
135C)
that
provides
an
33
exemption
from
licensing
as
a
health
care
facility
for
certain
34
residential
programs
to
which
the
department
of
human
services
35
-1-
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2
S.F.
_____
H.F.
_____
(DHS)
applies
accreditation,
certification,
or
standards
of
1
review.
The
bill
broadens
the
exemption
for
residential
2
programs
that
provide
care
to
not
more
than
five
individuals
3
that
are
approved
by
DHS
to
receive
moneys
under
an
HCBS
4
waiver,
by
removing
the
limitation
to
only
HCBS
waivers
for
5
persons
with
intellectual
disabilities
and
instead
providing
6
for
application
of
the
exemption
to
residential
programs
7
approved
by
DHS
to
receive
moneys
under
HCBS
habilitation
or
8
waiver
programs.
9
The
bill
also
amends
a
provision
in
2010
Iowa
Acts
relating
10
to
evaluation
of
Medicaid
HCBS
waiver
payments,
to
instead
11
require
that,
beginning
July
1,
2013,
DHS
evaluate
utilization
12
data
and
determine
the
proper
mechanism
to
trigger
a
review
of
13
medical
necessity
for
services
provided
under
each
home
and
14
community-based
services
waiver.
Following
development
of
the
15
trigger
mechanism,
DHS
is
required
to
provide
advance
approval
16
for
services
for
which
utilization
is
projected
to
exceed
the
17
trigger
mechanism
as
applicable
to
each
waiver
service.
18
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