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 pf/rn 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