Bill Text: IA HF295 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to reimbursement for dually eligible Medicare and Medicaid beneficiaries receiving the Medicare hospice benefit in a nursing facility. (See HF 518.)
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2019-03-19 - Withdrawn. H.J. 582. [HF295 Detail]
Download: Iowa-2019-HF295-Introduced.html
House
File
295
-
Introduced
HOUSE
FILE
295
BY
FRY
and
HEDDENS
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
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Section
1.
DUALLY
ELIGIBLE
MEDICARE
AND
MEDICAID
1
BENEFICIARIES
RECEIVING
HOSPICE
BENEFIT
IN
A
NURSING
FACILITY
2
——
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,
to
allow
Medicaid
managed
care
organizations
10
and
the
Medicaid
fee-for-service
payment
system
to
reimburse
11
the
nursing
facility
directly
for
the
room
and
board
expenses
12
at
ninety-five
percent
of
the
base
rate
rather
than
indirectly
13
as
a
pass-through
payment
from
the
hospice
services
provider.
14
The
department
of
human
services
shall
report
receipt
of
15
such
approval
to
the
chairpersons
and
ranking
members
of
16
the
appropriations
committees
of
the
house
and
senate,
the
17
co-chairpersons
and
ranking
members
of
the
joint
appropriations
18
subcommittee
on
health
and
human
services,
and
the
legislative
19
services
agency.
20
2.
The
department
of
human
services
shall
adopt
rules
21
pursuant
to
chapter
17A
to
administer
this
section
and
22
specifically
to
allow
Medicaid
managed
care
organizations
and
23
the
department’s
fee-for-service
Medicaid
payment
system
to
24
reimburse
a
nursing
facility
directly
for
the
room
and
board
25
expenses
at
ninety-five
percent
of
the
base
rate
as
provided
in
26
this
section.
27
EXPLANATION
28
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
29
the
explanation’s
substance
by
the
members
of
the
general
assembly.
30
This
bill
requires
the
department
of
human
services
(DHS)
31
to
request
federal
approval
from
the
centers
for
Medicare
and
32
Medicaid
services
of
the
United
States
department
of
health
and
33
human
services
for
a
section
1115
demonstration
waiver
to
allow
34
for
the
payment
of
the
nursing
facility
room
and
board
expenses
35
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for
a
dually
eligible
Medicare
and
Medicaid
member
receiving
1
the
Medicare
hospice
benefit,
to
allow
Medicaid
managed
care
2
organizations
(MCOs)
and
the
Medicaid
fee-for-service
(FFS)
3
payment
system
to
reimburse
the
nursing
facility
directly
for
4
the
room
and
board
expenses
at
95
percent
of
the
base
rate
5
rather
than
indirectly
as
a
pass-through
payment
from
the
6
hospice
services
provider.
The
bill
requires
DHS
to
report
7
receipt
of
such
approval
to
the
chairpersons
and
ranking
8
members
of
the
appropriations
committees
of
the
house
and
9
senate,
the
co-chairpersons
and
ranking
members
of
the
joint
10
appropriations
subcommittee
on
health
and
human
services,
11
and
the
legislative
services
agency.
The
bill
requires
DHS
12
to
adopt
administrative
rules
to
administer
the
bill
and
13
specifically
to
allow
Medicaid
MCOs
and
the
department’s
14
FFS
Medicaid
payment
system
to
reimburse
a
nursing
facility
15
directly
for
the
room
and
board
expenses
at
95
percent
of
the
16
base
rate
as
provided
in
the
bill.
17
Currently,
the
Medicare
hospice
benefit
covers
the
costs
of
18
palliative
care
for
an
individual
who
is
terminally
ill
in
the
19
individual’s
home
or
in
a
nursing
facility.
Medicare
does
not
20
have
a
long-term
custodial
nursing
facility
benefit,
so
if
an
21
individual
elects
the
Medicare
hospice
benefit
in
a
nursing
22
facility,
the
individual’s
room
and
board
are
not
covered
by
23
Medicare
and
the
individual
or
a
third-party
payor
must
pay
for
24
the
costs
of
the
room
and
board.
For
those
individuals
dually
25
eligible
for
Medicare
and
Medicaid
who
elect
the
Medicare
26
hospice
benefit,
Medicare
is
financially
responsible
for
the
27
hospice
care
and
the
Medicaid
program
is
the
third-party
payor
28
responsible
for
the
nursing
facility
room
and
board
expense.
29
For
the
nursing
facility
room
and
board
care,
the
Medicaid
30
program
must
provide
for
payment
in
an
amount
equal
to
at
least
31
95
percent
of
the
Medicaid
daily
nursing
facility
base
rate
32
(the
rate
the
state
Medicaid
program
pays
for
nursing
facility
33
services
furnished
to
an
individual
who
has
not
elected
to
34
receive
hospice
care).
Historically,
the
Medicaid
program
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has
paid
the
hospice
provider
for
the
nursing
facility
room
1
and
board
expenses
of
dually
eligible
individuals
who
elect
2
the
hospice
benefit,
and
the
hospice
provider
has
then
passed
3
this
payment
on
to
the
nursing
facility
under
a
contract
with
4
the
nursing
facility.
Current
practice
is
for
most
hospice
5
providers
to
pay
100
percent
of
the
nursing
facility
base
rate
6
to
the
nursing
facility.
7
Pursuant
to
2018
Iowa
Acts,
chapter
1038,
DHS
was
directed
to
8
review
the
hospice
benefit
for
dually
eligible
individuals
in
9
a
nursing
facility
and
report
options
for
elimination
of
the
10
pass-through
payments
to
the
chairperson
and
ranking
members
11
of
the
joint
appropriations
subcommittee
on
health
and
human
12
services,
the
legislative
service
agency,
and
the
legislative
13
caucus
staffs
on
or
before
October
1,
2018.
DHS
submitted
the
14
report
that
included
four
options.
The
bill
reflects
option
15
1
of
the
report
which
is
budget
neutral
and
would
require
DHS
16
to
request
federal
approval
to
allow
Medicaid
managed
care
17
organizations
and
the
Medicaid
fee-for-service
payment
system
18
to
pay
the
nursing
facility
directly
for
the
nursing
facility
19
room
and
board
costs,
and
eliminate
the
pass-through
payment
20
utilizing
the
hospice
provider.
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