Bill Text: IA SF2142 | 2017-2018 | 87th General Assembly | Introduced

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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.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced - Dead) 2018-02-01 - Subcommittee: Segebart, Chelgren, and Ragan. S.J. 215. [SF2142 Detail]

Download: Iowa-2017-SF2142-Introduced.html

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Senate File 2142 - Introduced




                                 SENATE FILE       
                                 BY  RAGAN, JOCHUM, MATHIS,
                                     and PETERSEN

                                      A BILL FOR

  1 An Act relating to reimbursement for dually eligible Medicare
  2    and Medicaid beneficiaries receiving the Medicare hospice
  3    benefit in a nursing facility.
  4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    TLSB 5864XS (5) 87
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PAG LIN



  1  1    Section 1.  DUALLY ELIGIBLE MEDICARE AND MEDICAID
  1  2 BENEFICIARIES RECEIVING HOSPICE BENEFIT IN A NURSING FACILITY
  1  3 ==== OPTIONS FOR ELIMINATION OF PASS=THROUGH PAYMENT.  The
  1  4 department of human services shall pursue options for the
  1  5 payment of the nursing facility room and board expenses for
  1  6 a dually eligible Medicare and Medicaid member receiving the
  1  7 Medicare hospice benefit, to allow Medicaid managed care
  1  8 organizations to reimburse the nursing facility directly
  1  9 for the room and board expenses rather than indirectly as
  1 10 a pass=through payment from the hospice services provider.
  1 11 The department of human services shall report all options
  1 12 identified to the chairpersons and ranking members of the joint
  1 13 appropriations subcommittee on health and human services, the
  1 14 legislative services agency, and the legislative caucus staffs
  1 15 on or before October 1, 2018.
  1 16                           EXPLANATION
  1 17 The inclusion of this explanation does not constitute agreement with
  1 18 the explanation's substance by the members of the general assembly.
  1 19    This bill requires the department of human services (DHS)
  1 20 to pursue options for the payment of the nursing facility room
  1 21 and board expenses for a dually eligible Medicare and Medicaid
  1 22 member receiving the Medicare hospice benefit, to allow
  1 23 Medicaid managed care organizations to reimburse the nursing
  1 24 facility directly for the room and board expenses rather
  1 25 than indirectly as a pass=through payment from the hospice
  1 26 services provider. DHS is required to report all options
  1 27 identified to the chairpersons and ranking members of the joint
  1 28 appropriations subcommittee on health and human services, the
  1 29 legislative services agency, and the legislative caucus staffs
  1 30 on or before October 1, 2018.
  1 31    Currently, the Medicare hospice benefit covers the costs of
  1 32 palliative care for an individual who is terminally ill in the
  1 33 individual's home or in a nursing facility.  Medicare does not
  1 34 have a long=term custodial nursing facility benefit, so that if
  1 35 an individual elects the Medicare hospice benefit in a nursing
  2  1 facility, the individual's room and board are not covered by
  2  2 Medicare and the individual or a third=party payor must pay for
  2  3 the costs of the room and board.  For those individuals dually
  2  4 eligible for Medicare and Medicaid who elect the Medicare
  2  5 hospice benefit, Medicare is financially responsible for the
  2  6 hospice care and the Medicaid program is the third=party payor
  2  7 responsible for the nursing facility room and board expense.
  2  8 For the nursing facility room and board care, the Medicaid
  2  9 program must provide for payment in an amount equal to at
  2 10 least 95 percent of the Medicaid daily nursing facility rate
  2 11 (the rate the state Medicaid program pays for nursing facility
  2 12 services furnished to an individual who has not elected to
  2 13 receive hospice care). Historically, the Medicaid program
  2 14 has paid the hospice provider for the nursing facility room
  2 15 and board expenses of dually eligible individuals who elect
  2 16 the hospice benefit, and the hospice provider has then passed
  2 17 through this payment to the nursing facility.  The bill would
  2 18 require DHS to pursue options to instead allow Medicaid managed
  2 19 care organizations to pay the nursing facility directly for
  2 20 the nursing facility room and board costs, and eliminate the
  2 21 pass=through payment utilizing the hospice provider.
       LSB 5864XS (5) 87
       pf/rn