House File 2309 - Introduced
HOUSE FILE
BY COMMITTEE ON HUMAN
RESOURCES
(SUCCESSOR TO HF 2156)
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:
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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.
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