Senate
File
542
-
Introduced
SENATE
FILE
542
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
SSB
1232)
A
BILL
FOR
An
Act
relating
to
reimbursement
for
dually
eligible
Medicare
1
and
Medicaid
members
receiving
the
Medicare
hospice
benefit
2
and
Medicaid-only
members
electing
the
hospice
benefit
in
a
3
nursing
facility.
4
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
5
TLSB
2055SV
(1)
88
pf/rh
S.F.
542
Section
1.
DUALLY
ELIGIBLE
MEDICARE
AND
MEDICAID
MEMBERS
1
AND
MEDICAID-ONLY
MEMBERS
RECEIVING
HOSPICE
BENEFIT
IN
A
2
NURSING
FACILITY
——
ELIMINATION
OF
PASS-THROUGH
PAYMENT.
3
1.
The
department
of
human
services
shall
request
federal
4
approval
from
the
centers
for
Medicare
and
Medicaid
services
of
5
the
United
States
department
of
health
and
human
services
for
6
a
section
1115
demonstration
waiver
to
allow
for
the
payment
7
of
the
nursing
facility
room
and
board
expenses
for
a
dually
8
eligible
Medicare
and
Medicaid
member
receiving
the
Medicare
9
hospice
benefit
or
a
Medicaid-only
member
electing
the
member’s
10
hospice
benefit,
to
allow
Medicaid
managed
care
organizations
11
and
the
Medicaid
fee-for-service
payment
system
to
reimburse
12
the
nursing
facility
directly
for
the
room
and
board
expenses
13
at
no
less
than
ninety-five
percent
of
the
nursing
facility’s
14
Medicaid
fee-for-service
rate
rather
than
indirectly
as
a
15
pass-through
payment
from
the
hospice
services
provider.
16
The
department
of
human
services
shall
report
receipt
of
17
such
approval
to
the
chairpersons
and
ranking
members
of
18
the
appropriations
committees
of
the
house
and
senate,
the
19
co-chairpersons
and
ranking
members
of
the
joint
appropriations
20
subcommittee
on
health
and
human
services,
and
the
legislative
21
services
agency.
22
2.
The
department
of
human
services
shall
adopt
rules
23
pursuant
to
chapter
17A
to
administer
this
section
and
24
specifically
to
allow
Medicaid
managed
care
organizations
and
25
the
department’s
fee-for-service
Medicaid
payment
system
to
26
reimburse
a
nursing
facility
directly
for
the
room
and
board
27
expenses
at
no
less
than
ninety-five
percent
of
the
nursing
28
facility’s
Medicaid
fee-for-service
rate
as
provided
in
this
29
section.
30
EXPLANATION
31
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
32
the
explanation’s
substance
by
the
members
of
the
general
assembly.
33
This
bill
requires
the
department
of
human
services
(DHS)
34
to
request
federal
approval
from
the
centers
for
Medicare
and
35
-1-
LSB
2055SV
(1)
88
pf/rh
1/
3
S.F.
542
Medicaid
services
of
the
United
States
department
of
health
and
1
human
services
for
a
section
1115
demonstration
waiver
to
allow
2
for
the
payment
of
the
nursing
facility
room
and
board
expenses
3
for
a
dually
eligible
Medicare
and
Medicaid
member
receiving
4
the
Medicare
hospice
benefit
or
a
Medicaid-only
member
electing
5
the
member’s
hospice
benefit,
to
allow
Medicaid
managed
care
6
organizations
(MCOs)
and
the
Medicaid
fee-for-service
(FFS)
7
payment
system
to
reimburse
the
nursing
facility
directly
for
8
the
room
and
board
expenses
at
no
less
than
95
percent
of
the
9
nursing
facility’s
Medicaid
FFS
rate
rather
than
indirectly
10
as
a
pass-through
payment
from
the
hospice
services
provider.
11
The
bill
requires
DHS
to
report
receipt
of
such
approval
to
12
the
chairpersons
and
ranking
members
of
the
appropriations
13
committees
of
the
house
and
senate,
the
co-chairpersons
and
14
ranking
members
of
the
joint
appropriations
subcommittee
15
on
health
and
human
services,
and
the
legislative
services
16
agency.
The
bill
requires
DHS
to
adopt
administrative
rules
17
to
administer
the
bill
and
specifically
to
allow
Medicaid
MCOs
18
and
the
department’s
FFS
Medicaid
payment
system
to
reimburse
a
19
nursing
facility
directly
for
the
room
and
board
expenses
at
20
no
less
than
95
percent
of
the
nursing
facility’s
Medicaid
FFS
21
rate
as
provided
in
the
bill.
22
Currently,
the
Medicare
hospice
benefit
covers
the
costs
of
23
palliative
care
for
an
individual
who
is
terminally
ill
in
the
24
individual’s
home
or
in
a
nursing
facility.
Medicare
does
not
25
have
a
long-term
custodial
nursing
facility
benefit,
so
if
an
26
individual
elects
the
Medicare
hospice
benefit
in
a
nursing
27
facility,
the
individual’s
room
and
board
are
not
covered
by
28
Medicare
and
the
individual
or
a
third-party
payor
must
pay
for
29
the
costs
of
the
room
and
board.
For
those
individuals
dually
30
eligible
for
Medicare
and
Medicaid
who
elect
the
Medicare
31
hospice
benefit,
Medicare
is
financially
responsible
for
the
32
hospice
care
and
the
Medicaid
program
is
the
third-party
payor
33
responsible
for
the
nursing
facility
room
and
board
expense.
34
For
the
nursing
facility
room
and
board
care,
the
Medicaid
35
-2-
LSB
2055SV
(1)
88
pf/rh
2/
3
S.F.
542
program
must
provide
for
payment
in
an
amount
equal
to
at
least
1
95
percent
of
the
Medicaid
daily
nursing
facility
base
rate
2
(the
rate
the
state
Medicaid
program
pays
for
nursing
facility
3
services
furnished
to
an
individual
who
has
not
elected
to
4
receive
hospice
care).
Historically,
the
Medicaid
program
5
has
paid
the
hospice
provider
for
the
nursing
facility
room
6
and
board
expenses
of
dually
eligible
individuals
who
elect
7
the
hospice
benefit,
and
the
hospice
provider
has
then
passed
8
this
payment
on
to
the
nursing
facility
under
a
contract
with
9
the
nursing
facility.
Current
practice
is
for
most
hospice
10
providers
to
pay
100
percent
of
the
nursing
facility
base
rate
11
to
the
nursing
facility.
12
Pursuant
to
2018
Iowa
Acts,
chapter
1038,
DHS
was
directed
to
13
review
the
hospice
benefit
for
dually
eligible
individuals
in
14
a
nursing
facility
and
report
options
for
elimination
of
the
15
pass-through
payments
to
the
chairperson
and
ranking
members
16
of
the
joint
appropriations
subcommittee
on
health
and
human
17
services,
the
legislative
service
agency,
and
the
legislative
18
caucus
staffs
on
or
before
October
1,
2018.
DHS
submitted
19
the
report
that
included
four
options.
The
bill
reflects
20
option
1
of
the
report
which
is
budget
neutral
with
regard
to
21
the
dually
eligible
members
and
would
require
DHS
to
request
22
federal
approval
to
allow
Medicaid
managed
care
organizations
23
and
the
Medicaid
fee-for-service
payment
system
to
pay
the
24
nursing
facility
directly
for
the
nursing
facility
room
and
25
board
costs,
and
eliminate
the
pass-through
payment
utilizing
26
the
hospice
provider.
27
-3-
LSB
2055SV
(1)
88
pf/rh
3/
3