Bill Text: IA SF2309 | 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. (Formerly SSB 3126.)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2018-03-21 - Withdrawn. S.J. 732. [SF2309 Detail]

Download: Iowa-2017-SF2309-Introduced.html

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Senate File 2309 - Introduced




                                 SENATE FILE       
                                 BY  COMMITTEE ON HUMAN
                                     RESOURCES

                                 (SUCCESSOR TO SSB
                                     3126)

                                 (COMPANION TO HF 2309
                                     BY COMMITTEE ON HUMAN
                                     RESOURCES)

                                      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 6007SV (2) 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, after consulting with affected
  1  5 providers and stakeholders, shall pursue options for the
  1  6 payment of the nursing facility room and board expenses for
  1  7 a dually eligible Medicare and Medicaid member receiving the
  1  8 Medicare hospice benefit, to allow Medicaid managed care
  1  9 organizations and the department's fee=for=service Medicaid
  1 10 payment system to reimburse the nursing facility directly
  1 11 for the room and board expenses rather than indirectly as
  1 12 a pass=through payment from the hospice services provider.
  1 13 The department of human services shall report all options
  1 14 identified to the chairpersons and ranking members of the joint
  1 15 appropriations subcommittee on health and human services, the
  1 16 legislative services agency, and the legislative caucus staffs
  1 17 on or before October 1, 2018.
  1 18                           EXPLANATION
  1 19 The inclusion of this explanation does not constitute agreement with
  1 20 the explanation's substance by the members of the general assembly.
  1 21    This bill requires the department of human services (DHS),
  1 22 after consulting with affected providers and stakeholders, to
  1 23 pursue options for the payment of the nursing facility room
  1 24 and board expenses for a dually eligible Medicare and Medicaid
  1 25 member receiving the Medicare hospice benefit, to allow
  1 26 Medicaid managed care organizations and the DHS fee=for=service
  1 27 payment system to reimburse the nursing facility directly
  1 28 for the room and board expenses rather than indirectly as
  1 29 a pass=through payment from the hospice services provider.
  1 30 DHS is required to report all options identified to the
  1 31 chairpersons and ranking members of the joint appropriations
  1 32 subcommittee on health and human services, the legislative
  1 33 services agency, and the legislative caucus staffs on or before
  1 34 October 1, 2018.
  1 35    Currently, the Medicare hospice benefit covers the costs of
  2  1 palliative care for an individual who is terminally ill in the
  2  2 individual's home or in a nursing facility.  Medicare does not
  2  3 have a long=term custodial nursing facility benefit, so that if
  2  4 an individual elects the Medicare hospice benefit in a nursing
  2  5 facility, the individual's room and board are not covered by
  2  6 Medicare and the individual or a third=party payor must pay for
  2  7 the costs of the room and board.  For those individuals dually
  2  8 eligible for Medicare and Medicaid who elect the Medicare
  2  9 hospice benefit, Medicare is financially responsible for the
  2 10 hospice care and the Medicaid program is the third=party payor
  2 11 responsible for the nursing facility room and board expense.
  2 12 For the nursing facility room and board care, the Medicaid
  2 13 program must provide for payment in an amount equal to at
  2 14 least 95 percent of the Medicaid daily nursing facility rate
  2 15 (the rate the state Medicaid program pays for nursing facility
  2 16 services furnished to an individual who has not elected to
  2 17 receive hospice care). Historically, the Medicaid program
  2 18 has paid the hospice provider for the nursing facility room
  2 19 and board expenses of dually eligible individuals who elect
  2 20 the hospice benefit, and the hospice provider has then passed
  2 21 through this payment to the nursing facility.  The bill would
  2 22 require DHS to pursue options to instead allow Medicaid managed
  2 23 care organizations to pay the nursing facility directly for
  2 24 the nursing facility room and board costs, and eliminate the
  2 25 pass=through payment utilizing the hospice provider.
       LSB 6007SV (2) 87
       pf/rn