Bill Text: IA SSB3126 | 2017-2018 | 87th 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.
Spectrum: Committee Bill
Status: (N/A - Dead) 2018-02-07 - Subcommittee recommends passage. [SSB3126 Detail]
Download: Iowa-2017-SSB3126-Introduced.html
Senate
Study
Bill
3126
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HUMAN
RESOURCES
BILL
BY
CHAIRPERSON
SEGEBART)
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
TLSB
6007XC
(4)
87
pf/rn
S.F.
_____
Section
1.
DUALLY
ELIGIBLE
MEDICARE
AND
MEDICAID
1
BENEFICIARIES
RECEIVING
HOSPICE
BENEFIT
IN
A
NURSING
FACILITY
2
——
OPTIONS
FOR
ELIMINATION
OF
PASS-THROUGH
PAYMENT.
The
3
department
of
human
services
shall
pursue
options
for
the
4
payment
of
the
nursing
facility
room
and
board
expenses
for
5
a
dually
eligible
Medicare
and
Medicaid
member
receiving
the
6
Medicare
hospice
benefit,
to
allow
Medicaid
managed
care
7
organizations
to
reimburse
the
nursing
facility
directly
8
for
the
room
and
board
expenses
rather
than
indirectly
as
9
a
pass-through
payment
from
the
hospice
services
provider.
10
The
department
of
human
services
shall
report
all
options
11
identified
to
the
chairpersons
and
ranking
members
of
the
joint
12
appropriations
subcommittee
on
health
and
human
services,
the
13
legislative
services
agency,
and
the
legislative
caucus
staffs
14
on
or
before
October
1,
2018.
15
EXPLANATION
16
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
17
the
explanation’s
substance
by
the
members
of
the
general
assembly.
18
This
bill
requires
the
department
of
human
services
(DHS)
19
to
pursue
options
for
the
payment
of
the
nursing
facility
room
20
and
board
expenses
for
a
dually
eligible
Medicare
and
Medicaid
21
member
receiving
the
Medicare
hospice
benefit,
to
allow
22
Medicaid
managed
care
organizations
to
reimburse
the
nursing
23
facility
directly
for
the
room
and
board
expenses
rather
24
than
indirectly
as
a
pass-through
payment
from
the
hospice
25
services
provider.
DHS
is
required
to
report
all
options
26
identified
to
the
chairpersons
and
ranking
members
of
the
joint
27
appropriations
subcommittee
on
health
and
human
services,
the
28
legislative
services
agency,
and
the
legislative
caucus
staffs
29
on
or
before
October
1,
2018.
30
Currently,
the
Medicare
hospice
benefit
covers
the
costs
of
31
palliative
care
for
an
individual
who
is
terminally
ill
in
the
32
individual’s
home
or
in
a
nursing
facility.
Medicare
does
not
33
have
a
long-term
custodial
nursing
facility
benefit,
so
that
if
34
an
individual
elects
the
Medicare
hospice
benefit
in
a
nursing
35
-1-
LSB
6007XC
(4)
87
pf/rn
1/
2
S.F.
_____
facility,
the
individual’s
room
and
board
are
not
covered
by
1
Medicare
and
the
individual
or
a
third-party
payor
must
pay
for
2
the
costs
of
the
room
and
board.
For
those
individuals
dually
3
eligible
for
Medicare
and
Medicaid
who
elect
the
Medicare
4
hospice
benefit,
Medicare
is
financially
responsible
for
the
5
hospice
care
and
the
Medicaid
program
is
the
third-party
payor
6
responsible
for
the
nursing
facility
room
and
board
expense.
7
For
the
nursing
facility
room
and
board
care,
the
Medicaid
8
program
must
provide
for
payment
in
an
amount
equal
to
at
9
least
95
percent
of
the
Medicaid
daily
nursing
facility
rate
10
(the
rate
the
state
Medicaid
program
pays
for
nursing
facility
11
services
furnished
to
an
individual
who
has
not
elected
to
12
receive
hospice
care).
Historically,
the
Medicaid
program
13
has
paid
the
hospice
provider
for
the
nursing
facility
room
14
and
board
expenses
of
dually
eligible
individuals
who
elect
15
the
hospice
benefit,
and
the
hospice
provider
has
then
passed
16
through
this
payment
to
the
nursing
facility.
The
bill
would
17
require
DHS
to
pursue
options
to
instead
allow
Medicaid
managed
18
care
organizations
to
pay
the
nursing
facility
directly
for
19
the
nursing
facility
room
and
board
costs,
and
eliminate
the
20
pass-through
payment
utilizing
the
hospice
provider.
21
-2-
LSB
6007XC
(4)
87
pf/rn
2/
2
