House File 2309 - Introduced HOUSE FILE 2309 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HF 2156) A BILL FOR An Act relating to reimbursement for dually eligible Medicare 1 and Medicaid beneficiaries receiving the Medicare hospice 2 benefit in a nursing facility. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 6007HV (2) 87 pf/rn

H.F. 2309 Section 1. DUALLY ELIGIBLE MEDICARE AND MEDICAID 1 BENEFICIARIES RECEIVING HOSPICE BENEFIT IN A NURSING FACILITY 2 —— OPTIONS FOR ELIMINATION OF PASS-THROUGH PAYMENT. The 3 department of human services, after consulting with affected 4 providers and stakeholders, shall pursue options for the 5 payment of the nursing facility room and board expenses for 6 a dually eligible Medicare and Medicaid member receiving the 7 Medicare hospice benefit, to allow Medicaid managed care 8 organizations and the department’s fee-for-service Medicaid 9 payment system to reimburse the nursing facility directly 10 for the room and board expenses rather than indirectly as 11 a pass-through payment from the hospice services provider. 12 The department of human services shall report all options 13 identified to the chairpersons and ranking members of the joint 14 appropriations subcommittee on health and human services, the 15 legislative services agency, and the legislative caucus staffs 16 on or before October 1, 2018. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill requires the department of human services (DHS), 21 after consulting with affected providers and stakeholders, to 22 pursue options for the payment of the nursing facility room 23 and board expenses for a dually eligible Medicare and Medicaid 24 member receiving the Medicare hospice benefit, to allow 25 Medicaid managed care organizations and the DHS fee-for-service 26 payment system to reimburse the nursing facility directly 27 for the room and board expenses rather than indirectly as 28 a pass-through payment from the hospice services provider. 29 DHS is required to report all options identified to the 30 chairpersons and ranking members of the joint appropriations 31 subcommittee on health and human services, the legislative 32 services agency, and the legislative caucus staffs on or before 33 October 1, 2018. 34 Currently, the Medicare hospice benefit covers the costs of 35 -1- LSB 6007HV (2) 87 pf/rn 1/ 2

H.F. 2309 palliative care for an individual who is terminally ill in the 1 individual’s home or in a nursing facility. Medicare does not 2 have a long-term custodial nursing facility benefit, so that if 3 an individual elects the Medicare hospice benefit in a nursing 4 facility, the individual’s room and board are not covered by 5 Medicare and the individual or a third-party payor must pay for 6 the costs of the room and board. For those individuals dually 7 eligible for Medicare and Medicaid who elect the Medicare 8 hospice benefit, Medicare is financially responsible for the 9 hospice care and the Medicaid program is the third-party payor 10 responsible for the nursing facility room and board expense. 11 For the nursing facility room and board care, the Medicaid 12 program must provide for payment in an amount equal to at 13 least 95 percent of the Medicaid daily nursing facility rate 14 (the rate the state Medicaid program pays for nursing facility 15 services furnished to an individual who has not elected to 16 receive hospice care). Historically, the Medicaid program 17 has paid the hospice provider for the nursing facility room 18 and board expenses of dually eligible individuals who elect 19 the hospice benefit, and the hospice provider has then passed 20 through this payment to the nursing facility. The bill would 21 require DHS to pursue options to instead allow Medicaid managed 22 care organizations to pay the nursing facility directly for 23 the nursing facility room and board costs, and eliminate the 24 pass-through payment utilizing the hospice provider. 25 -2- LSB 6007HV (2) 87 pf/rn 2/ 2