House Study Bill 739 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON HARRIS) A BILL FOR An Act relating to the Medicaid home and community-based 1 services elderly waiver program, including transition 2 planning and assisted living services. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 6062YC (11) 91 ak/ko

H.F. _____ Section 1. NEW SECTION . 249A.32C Medicaid home and 1 community-based services elderly waiver program —— transition 2 planning, case management, and assisted living services. 3 The department of health and human services shall adopt 4 rules pursuant to chapter 17A that do all of the following: 5 1. Allow case managers and care coordination team members 6 to work with a resident of a skilled nursing facility, family 7 members of the resident, and other skilled nursing facility 8 staff to initiate transition planning from the skilled 9 nursing facility to the Medicaid home and community-based 10 services elderly waiver program prior to the discharge of 11 the resident. Transition planning may include but is not 12 limited to needs assessments, care coordination, and service 13 planning. Transition planning may be initiated for any 14 resident of a skilled nursing facility who is determined by the 15 skilled nursing facility’s discharge planner to be capable of 16 successfully transitioning to a lower level of care, and who is 17 otherwise eligible for the Medicaid home and community-based 18 services elderly waiver program. Provision of Medicaid home 19 and community-based elderly waiver services shall commence 20 after the resident is discharged to a lower level of care. 21 2. a. Define “targeted population” , for purposes of 22 case management services furnished to Medicaid home and 23 community-based services elderly waiver program participants, 24 as an individual who meets one of the following criteria: 25 (1) An adult who is identified with a primary diagnosis 26 of intellectual disability, chronic mental illness, or 27 developmental disability. 28 (2) A child who is eligible to receive home and 29 community-based intellectual disability waiver services or home 30 and community-based children’s mental health waiver services. 31 (3) An adult aged sixty-five or older who is a resident of 32 a nursing facility, as that term is defined in section 135C.1, 33 approved by Medicaid to provide services under the Medicaid 34 home and community-based services elderly waiver program. 35 -1- LSB 6062YC (11) 91 ak/ko 1/ 3

H.F. _____ b. A member enrolled with a managed care organization or 1 integrated health home shall not be included in the definition 2 of targeted population. 3 Sec. 2. MEDICAID ELDERLY WAIVER —— ASSISTED LIVING 4 SERVICES. The department of health and human services shall 5 adopt rules pursuant to chapter 17A that do all of the 6 following: 7 1. Define “assisted living service” to mean personal care 8 and supportive services that are furnished to Medicaid home and 9 community-based services elderly waiver program participants 10 who reside in a homelike, noninstitutional setting. The 11 assisted living service must include twenty-four-hour on-site 12 response capability to meet participant needs, as well as 13 member safety and security, through incidental supervision. 14 Assisted living service is not reimbursable if performed 15 at the same time as any service included in an approved 16 consumer-directed attendant care agreement. 17 2. Specify that a unit of assisted living service is one 18 day. 19 3. Specify that a unit of assisted living service is 20 billable only if both of the following requirements are met: 21 a. The member was present in the facility during that day’s 22 bed census. 23 b. The assisted living provider has documented at least 24 one assisted living service encounter for that day. The 25 documentation must include the participant’s response to 26 the assisted living service encounter. The documented 27 assisted living service encounter cannot also be an authorized 28 consumer-directed attendant care service. 29 EXPLANATION 30 The inclusion of this explanation does not constitute agreement with 31 the explanation’s substance by the members of the general assembly. 32 This bill relates to the Medicaid home and community-based 33 services elderly waiver program (elderly waiver), including 34 transition planning and assisted living services. 35 -2- LSB 6062YC (11) 91 ak/ko 2/ 3

H.F. _____ The bill directs the department of health and human 1 services (HHS) to adopt rules to allow case managers and care 2 coordination team members to work with a resident of a skilled 3 nursing facility, family members of the resident, and other 4 skilled nursing facility staff to initiate transition planning 5 from the skilled nursing facility to the elderly waiver program 6 prior to the discharge of the resident. 7 HHS must also adopt rules to include adults aged 65 or older 8 who are residents of a nursing facility in the definition of 9 targeted population for purposes of case management services 10 furnished to elderly waiver participants. 11 The bill directs HHS to adopt rules to define “assisted 12 living service” to mean personal care and supportive services 13 that are furnished to waiver participants who reside in a 14 homelike, noninstitutional setting. The service must include 15 24-hour on-site response capability to meet member needs 16 as well as member safety and security through incidental 17 supervision. Assisted living service is not reimbursable 18 if performed at the same time as any service included in an 19 approved consumer-directed attendant care agreement. The rules 20 must also specify certain billing requirements. 21 -3- LSB 6062YC (11) 91 ak/ko 3/ 3