SF 2142 (LSB 5864XS (5) 87)

SENATE FILE 2142

BY  RAGAN, JOCHUM, MATHIS, and PETERSEN

A BILL FOR

An Act relating to reimbursement for dually eligible Medicare and Medicaid beneficiaries receiving the Medicare hospice benefit in a nursing facility.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  DUALLY ELIGIBLE MEDICARE AND MEDICAID BENEFICIARIES RECEIVING HOSPICE BENEFIT IN A NURSING FACILITY —— OPTIONS FOR ELIMINATION OF PASS-THROUGH PAYMENT.  The department of human services shall pursue options for the payment of the nursing facility room and board expenses for a dually eligible Medicare and Medicaid member receiving the Medicare hospice benefit, to allow Medicaid managed care organizations to reimburse the nursing facility directly for the room and board expenses rather than indirectly as a pass-through payment from the hospice services provider. The department of human services shall report all options identified to the chairpersons and ranking members of the joint appropriations subcommittee on health and human services, the legislative services agency, and the legislative caucus staffs on or before October 1, 2018.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill requires the department of human services (DHS) to pursue options for the payment of the nursing facility room and board expenses for a dually eligible Medicare and Medicaid member receiving the Medicare hospice benefit, to allow Medicaid managed care organizations to reimburse the nursing facility directly for the room and board expenses rather than indirectly as a pass-through payment from the hospice services provider. DHS is required to report all options identified to the chairpersons and ranking members of the joint appropriations subcommittee on health and human services, the legislative services agency, and the legislative caucus staffs on or before October 1, 2018.
   Currently, the Medicare hospice benefit covers the costs of palliative care for an individual who is terminally ill in the individual’s home or in a nursing facility. Medicare does not have a long-term custodial nursing facility benefit, so that if an individual elects the Medicare hospice benefit in a nursing facility, the individual’s room and board are not covered by Medicare and the individual or a third-party payor must pay for the costs of the room and board. For those individuals dually eligible for Medicare and Medicaid who elect the Medicare hospice benefit, Medicare is financially responsible for the hospice care and the Medicaid program is the third-party payor responsible for the nursing facility room and board expense. For the nursing facility room and board care, the Medicaid program must provide for payment in an amount equal to at least 95 percent of the Medicaid daily nursing facility rate (the rate the state Medicaid program pays for nursing facility services furnished to an individual who has not elected to receive hospice care). Historically, the Medicaid program has paid the hospice provider for the nursing facility room and board expenses of dually eligible individuals who elect the hospice benefit, and the hospice provider has then passed through this payment to the nursing facility. The bill would require DHS to pursue options to instead allow Medicaid managed care organizations to pay the nursing facility directly for the nursing facility room and board costs, and eliminate the pass-through payment utilizing the hospice provider.