Amendment H-1315 to HF 685

Filed April 27, 2023 in the House by

What it changes

1. Page 20, after line 2 by inserting: “DIVISION ___ NURSING FACILITY AND HOSPITAL CAPACITY AND FINANCING Sec. ___. NEW SECTION . 135C.7A Nursing facility license application for change of ownership —— required information.
2. In addition to the requirements of section 135C.7, the change of ownership of a previously licensed nursing facility shall be subject to approval by the department through application for a license. An applicant for a nursing facility license under this section shall submit all of the following information to the department with the license application: a. Information about the applicant’s organizational and ownership structures. The applicant shall provide information regarding all related parties with a five percent or greater controlling interest in the applicant organization, including the related party’s relationship to the applicant organization. The information provided shall be updated at least thirty days prior to issuance of the license if any changes in the information occur. b. Information regarding any related party transactions and associated reimbursement structures. c. Information related to the applicant’s financial suitability to operate a nursing facility as verified by the applicant, which shall include but is not limited to all of the following: (1) Financial projections for operational expenses and revenues, including realistic occupancy and reimbursement rates and the disclosure of any related party transactions, projected for the first three years of operation. (2) Projected initial cash and liquid assets relative to the acquisition or start-up of the applicant’s organization. (3) If the applicant is a component of a corporate chain organization, no less than three years of historical financial and operating information. -1- HF 685.2037.S (1) 90 mb 1/ 6 d. Information related to the applicant’s regulatory history with any other state or licensing jurisdiction as verified by the applicant, which shall include but is not limited to all of the following: (1) Information related to any complaint, allegation, or investigation concerning the applicant in any other state or licensing jurisdiction. (2) Affirmation that the applicant has not voluntarily surrendered a license while under investigation in any other state or licensing jurisdiction. (3) Supporting documentation regarding the resolution of any disciplinary action or complaint, allegation, or investigation against the applicant in any other state or licensing jurisdiction. (4) Affirmation that no other nursing facility owned or operated by the applicant has been subject to operation by a court-appointed receiver or temporary manager.
3. Information required under subsection 1 shall not be limited to information relating to nursing facility operations but shall also include information relative to any other health care operations under the control and management of the applicant or related parties which may include but is not limited to assisted living programs, hospice services, home health agencies, or other long-term care related health services.
4. The department may request that an applicant provide additional or supplemental information with the application which may include verification of cash or liquid resources to maintain nursing facility operations for a period of not less than two months.
5. The department may require an applicant to create an escrow account sufficient to sustain financial operations of the applicant’s nursing facility for a period of not less than two months upon consideration of the timing of projected deposits and disbursements during the nursing facility’s -2- HF 685.2037.S (1) 90 mb 2/ 6 initial operating period. a. The escrow account shall be sufficiently funded by the applicant prior to the issuance of the nursing facility license under this section. b. The department, in consultation with the applicant, may reduce or return the amounts held in escrow two years from the date of initial commencement of operation of the nursing facility. c. The escrow requirement shall be terminated no later than five years from the date of initial commencement of operation of the nursing facility. d. The department may utilize funds held in escrow if the applicant’s nursing facility is subject to operation under receivership pursuant to section 135C.30.
6. The department shall verify the accuracy and completeness of the information provided under this section.
7. The information or documents provided to the department under this section detailing the applicant’s financial condition or the terms of the applicant’s contractual business relationships shall be confidential and not considered a public record under chapter
9. For the purposes of this section: a. “Applicant” means a person required to obtain a nursing facility license under this section due to change of ownership of a previously licensed nursing facility. b. “Related party” means a related party or organization described by rule of the department of health and human services relating to nursing facility financial and statistical reporting and determination of payment rates pursuant to 441 lAC 81.6(11)(1). Sec. ___. NEW SECTION . 135C.35A Moratorium —— new construction or increase in bed capacity —— nursing facilities.
10. Beginning July 1, 2023, and ending no later than June 30, 2026, the department shall impose for an initial period of twelve months a temporary moratorium on submission of -3- HF 685.2037.S (1) 90 mb 3/ 6 applications for new construction of a nursing facility or a permanent change in bed capacity of a nursing facility that increases the bed capacity of the nursing facility. The department, in consultation with the department of health and human services, may extend the moratorium in six-month increments following the conclusion of the initial twelve-month period, but for no longer than a total of thirty-six months.
11. The department, in consultation with the department of health and human services, may waive the moratorium as specified in this section if any of the following applies: a. The departments jointly determine there is a specialized need for the nursing facility beds requested. b. The average occupancy of all licensed nursing facility beds located within the county and contiguous counties of the location of the proposed increase in nursing facility bed capacity exceeded eighty-five percent during the three most recent calendar quarters as published by the centers for Medicare and Medicaid services of the United States department of health and human services at the time of the filing of the application.
12. The department shall publish any request for a waiver of the moratorium as well as an explanation for the decision to either grant or deny the waiver request.
13. For the purposes of this section, “occupancy” means the average number of residents of the nursing facility during the applicable time period divided by the licensed bed capacity of the nursing facility. Sec. ___. NEW SECTION . 135C.35B Availability of nursing facility bed data. No later than January 1, 2024, the department of health and human services shall develop a publicly available dashboard detailing the number of nursing facility beds available in the state, the overall quality rating of the available nursing facility beds as specified by the centers for Medicare and Medicaid services of the United States department of health -4- HF 685.2037.S (1) 90 mb 4/ 6 and human services star ratings, any increase in the number of available nursing facility beds in each county during the state fiscal year, any decrease in the number of available nursing facility beds in each county during the state fiscal year, and an explanation of the causes of such increase or decrease in available nursing facility beds. Sec. ___. NEW SECTION . 249A.28 Hospital directed payment —— prohibition of pass-through on non-Medicaid payors. A hospital participating in the hospital directed payment program pursuant to 42 C.F.R. §438.6 shall not knowingly pass on the directed payment increase for health care services provided to non-Medicaid payors, including as a fee or rate increase. If a hospital violates this section, the hospital shall not receive the directed payment but shall instead only be reimbursed the hospital base reimbursement rate for health care services provided under the medical assistance program for one year from the date the violation is discovered. Sec. ___. Section 249L.3, Code 2023, is amended by adding the following new subsection: NEW SUBSECTION . 6A. A nursing facility shall not knowingly pass on the quality assurance assessment to non-Medicaid payors, including as a rate increase or service charge. If a nursing facility violates this section, the department shall not reimburse the nursing facility the quality assurance assessment due the nursing facility under the medical assistance program, but shall instead only reimburse the nursing facility at the nursing facility base reimbursement rate under the medical assistance program for one year from the date the violation is discovered. Sec. ___. NURSING FACILITY BED NEED FORMULA —— STUDY AND RECOMMENDATIONS. The department of health and human services shall convene a workgroup including representatives of nursing facilities, managed care organizations, the department of inspections, appeals, and licensing, and other appropriate stakeholders to review the existing nursing facility bed need -5- HF 685.2037.S (1) 90 mb 5/ 6 formula. The department of health and human services shall submit a report of the recommendations of the workgroup for improvement to the nursing facility bed need formula, including recommendations related to the process for establishing a projection of future nursing facility bed use taking into consideration the state’s changing demographics and the need to ensure an adequate number of nursing facility beds, to the governor and the general assembly by December 2,
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15. Title page, line 1, after “relating to” by inserting “health care services and financing, including nursing facility licensing and financing and”
16. By renumbering, redesignating, and correcting internal references as necessary. -6- HF 685.2037.S (1) 90 mb 6/ 6

Official amendment (PDF) · In the Bill Book