House File 295 - IntroducedA Bill ForAn Act 1relating to reimbursement for dually eligible Medicare
2and Medicaid beneficiaries receiving the Medicare hospice
3benefit in a nursing facility.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1   Section 1.  DUALLY ELIGIBLE MEDICARE AND MEDICAID
2BENEFICIARIES RECEIVING HOSPICE BENEFIT IN A NURSING FACILITY
3— ELIMINATION OF PASS-THROUGH PAYMENT.
   41.  The department of human services shall request federal
5approval from the centers for Medicare and Medicaid services of
6the United States department of health and human services for
7a section 1115 demonstration waiver to allow for the payment
8of the nursing facility room and board expenses for a dually
9eligible Medicare and Medicaid member receiving the Medicare
10hospice benefit, to allow Medicaid managed care organizations
11and the Medicaid fee-for-service payment system to reimburse
12the nursing facility directly for the room and board expenses
13at ninety-five percent of the base rate rather than indirectly
14as a pass-through payment from the hospice services provider.
15The department of human services shall report receipt of
16such approval to the chairpersons and ranking members of
17the appropriations committees of the house and senate, the
18co-chairpersons and ranking members of the joint appropriations
19subcommittee on health and human services, and the legislative
20services agency.
   212.  The department of human services shall adopt rules
22pursuant to chapter 17A to administer this section and
23specifically to allow Medicaid managed care organizations and
24the department’s fee-for-service Medicaid payment system to
25reimburse a nursing facility directly for the room and board
26expenses at ninety-five percent of the base rate as provided in
27this section.
28EXPLANATION
29The inclusion of this explanation does not constitute agreement with
30the explanation’s substance by the members of the general assembly.
   31This bill requires the department of human services (DHS)
32to request federal approval from the centers for Medicare and
33Medicaid services of the United States department of health and
34human services for a section 1115 demonstration waiver to allow
35for the payment of the nursing facility room and board expenses
-1-1for a dually eligible Medicare and Medicaid member receiving
2the Medicare hospice benefit, to allow Medicaid managed care
3organizations (MCOs) and the Medicaid fee-for-service (FFS)
4payment system to reimburse the nursing facility directly for
5the room and board expenses at 95 percent of the base rate
6rather than indirectly as a pass-through payment from the
7hospice services provider. The bill requires DHS to report
8receipt of such approval to the chairpersons and ranking
9members of the appropriations committees of the house and
10senate, the co-chairpersons and ranking members of the joint
11appropriations subcommittee on health and human services,
12and the legislative services agency. The bill requires DHS
13to adopt administrative rules to administer the bill and
14specifically to allow Medicaid MCOs and the department’s
15FFS Medicaid payment system to reimburse a nursing facility
16directly for the room and board expenses at 95 percent of the
17base rate as provided in the bill.
   18Currently, the Medicare hospice benefit covers the costs of
19palliative care for an individual who is terminally ill in the
20individual’s home or in a nursing facility. Medicare does not
21have a long-term custodial nursing facility benefit, so if an
22individual elects the Medicare hospice benefit in a nursing
23facility, the individual’s room and board are not covered by
24Medicare and the individual or a third-party payor must pay for
25the costs of the room and board. For those individuals dually
26eligible for Medicare and Medicaid who elect the Medicare
27hospice benefit, Medicare is financially responsible for the
28hospice care and the Medicaid program is the third-party payor
29responsible for the nursing facility room and board expense.
30For the nursing facility room and board care, the Medicaid
31program must provide for payment in an amount equal to at least
3295 percent of the Medicaid daily nursing facility base rate
33(the rate the state Medicaid program pays for nursing facility
34services furnished to an individual who has not elected to
35receive hospice care). Historically, the Medicaid program
-2-1has paid the hospice provider for the nursing facility room
2and board expenses of dually eligible individuals who elect
3the hospice benefit, and the hospice provider has then passed
4this payment on to the nursing facility under a contract with
5the nursing facility. Current practice is for most hospice
6providers to pay 100 percent of the nursing facility base rate
7to the nursing facility.
   8Pursuant to 2018 Iowa Acts, chapter 1038, DHS was directed to
9review the hospice benefit for dually eligible individuals in
10a nursing facility and report options for elimination of the
11pass-through payments to the chairperson and ranking members
12of the joint appropriations subcommittee on health and human
13services, the legislative service agency, and the legislative
14caucus staffs on or before October 1, 2018. DHS submitted the
15report that included four options. The bill reflects option
161 of the report which is budget neutral and would require DHS
17to request federal approval to allow Medicaid managed care
18organizations and the Medicaid fee-for-service payment system
19to pay the nursing facility directly for the nursing facility
20room and board costs, and eliminate the pass-through payment
21utilizing the hospice provider.
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