Bill Text: IA HF554 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A bill for an act relating to service providers under Medicaid home and community-based services waivers. (Formerly HSB 119)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2013-12-31 - END OF 2013 ACTIONS [HF554 Detail]
Download: Iowa-2013-HF554-Introduced.html
House
File
554
-
Introduced
HOUSE
FILE
554
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
HSB
119)
(COMPANION
TO
SF
351)
A
BILL
FOR
An
Act
relating
to
service
providers
under
Medicaid
home
and
1
community-based
services
waivers.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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554
Section
1.
Section
135C.6,
subsection
8,
paragraph
c,
1
unnumbered
paragraph
1,
Code
2013,
is
amended
to
read
as
2
follows:
3
A
residential
program
approved
by
the
department
of
human
4
services
pursuant
to
this
paragraph
“c”
to
receive
moneys
5
appropriated
to
the
department
of
human
services
under
6
provisions
of
a
federally
approved
home
and
community-based
7
services
habilitation
or
waiver
for
persons
with
intellectual
8
disabilities
program
may
provide
care
to
not
more
than
five
9
individuals.
The
department
shall
approve
a
residential
10
program
under
this
paragraph
that
complies
with
all
of
the
11
following
conditions:
12
Sec.
2.
2010
Iowa
Acts,
chapter
1031,
section
351,
is
13
amended
to
read
as
follows:
14
SEC.
351.
MEDICAID
HOME
AND
COMMUNITY-BASED
SERVICES
WAIVER
15
PAYMENTS
UTILIZATION
——
REVIEW.
The
department
of
human
16
services
shall
evaluate
payment
records
utilization
data
and
17
determine
the
proper
mechanism
to
trigger
a
review
of
payments
18
medical
necessity
for
services
provided
under
each
home
and
19
community-based
services
waiver
that
are
in
excess
of
the
20
median
amount
for
payments
through
the
applicable
waiver
.
21
Following
evaluation
of
the
utilization
data
and
determination
22
of
the
trigger
mechanism,
the
department
shall
notify
the
23
affected
providers
of
the
results
of
the
evaluation
of
24
utilization
data,
the
determination
of
the
trigger
mechanism,
25
and
the
criteria
that
will
be
used
for
review
of
services
that
26
exceed
the
trigger
mechanism,
at
least
sixty
days
prior
to
27
applying
the
trigger
mechanism
to
assess
the
medical
necessity
28
of
the
services
requested.
Following
development
of
the
29
trigger
mechanism
provision
of
notice
to
affected
providers
30
as
required
under
this
section
,
the
department
shall
require
31
advance
approval
for
services
for
which
payment
utilization
is
32
projected
to
exceed
the
median
trigger
mechanism
as
applicable
33
to
each
waiver
service
.
The
use
of
a
trigger
mechanism
and
the
34
approval
process
is
intended
to
preserve
necessary
services
35
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554
while
preventing
overuse
of
services.
1
EXPLANATION
2
This
bill
involves
provisions
relating
to
Medicaid
home
and
3
community-based
services
(HCBS)
waivers.
4
The
bill
amends
a
provision
in
the
health
facilities
5
licensing
chapter
(Code
chapter
135C)
that
provides
an
6
exemption
from
licensing
as
a
health
care
facility
for
certain
7
residential
programs
to
which
the
department
of
human
services
8
(DHS)
applies
accreditation,
certification,
or
standards
of
9
review.
The
bill
broadens
the
exemption
for
residential
10
programs
that
provide
care
to
not
more
than
five
individuals
11
that
are
approved
by
DHS
to
receive
moneys
under
an
HCBS
12
waiver,
by
removing
the
limitation
to
only
HCBS
waivers
for
13
persons
with
intellectual
disabilities
and
instead
providing
14
for
application
of
the
exemption
to
residential
programs
15
approved
by
DHS
to
receive
moneys
under
HCBS
habilitation
or
16
waiver
programs.
17
The
bill
also
amends
a
provision
in
2010
Iowa
Acts
relating
18
to
evaluation
of
Medicaid
HCBS
waiver
payments,
to
instead
19
require
that
DHS
evaluate
utilization
data
and
determine
the
20
proper
mechanism
to
trigger
a
review
of
medical
necessity
for
21
services
provided
under
each
home
and
community-based
services
22
waiver.
Following
evaluation
of
the
utilization
data
and
23
determination
of
the
trigger
mechanism,
DHS
is
required
to
24
notify
affected
providers
at
least
60
days
prior
to
applying
25
the
trigger
mechanism.
Following
provision
of
the
notice,
26
DHS
is
to
require
advance
approval
for
services
for
which
27
utilization
is
projected
to
exceed
the
trigger
mechanism.
28
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