SB4181 - Tennessee - Finance And Administration, Dept. Of, Health Care, Tenncare
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Latest Update: Tuesday, May, 13th 2008 Companion Bill HB4144. Health Care - Requires that rules and regulations promulgated under the provisions governing nursing home administrators and health care facilities be in compliance with federal regulations issued by the centers for medicare and medicaid services; specifies that the rulemaking authority under the provisions governing long-term care services plan lies with the commissioner of finance and administration, instead of the commissioner of health. - Amends TCA Title 63 and Title 68 and 71. Fiscal Summary for SB4181 / *HB4144MINIMAL Bill Summary for SB4181 / *HB4144 ON MAY 1, 2008, THE SENATE ADOPTED AMENDMENTS #2, #3, #4 AND #5 AND PASSED SENATE BILL 4181, AS AMENDED. AMENDMENT #2 rewrites this bill, deletes the present law provisions governing the long-term care services plan, and enacts the Long Term Care Community Choices Act of 2008. LONG-TERM CARE This amendment retains the present law provisions for a long-term care client information, referral and assistance program. The amendment also retains the present law provision for the long-term care services planning council, in consultation with the long-term care advisory council, to develop an operational plan and budget projections for a program for home-based and community-based services (HBCS) to elderly and disabled individuals in need of assistance; however, it should be noted that the provisions for a long-term care services planning council are deleted by this bill. This amendment also retains the present law provision whereby, to the extent permitted by federal law, the value of federal veterans education benefits received by an applicant are not included as any form of income when making eligibility determinations for assistance for long-term care. This amendment requires the commissioner of finance and administration to: (1) Develop and implement a statewide fully integrated risk-based long-term care system that integrates Medicaid-reimbursed primary, acute and long-term care services. This amendment requires that the long term care system rebalance the overall allocation of funding for Medicaid-reimbursed long-term care services by expanding access to and utilization of cost-effective home and community based alternatives to institutional care for Medicaid-eligible individuals. Such system may include, subject to the availability of funding in each year's appropriations bill, expansion of PACE (Programs of All Inclusive Care for the Elderly) sites in additional major metropolitan areas of the state; (2) Ensure that comprehensive, person-centered care coordination across all Medicaid primary, acute and long-term care services is a central component of the integrated long term care system and the contractor risk agreement. This amendment provides that the cost of home and community-based services provided to a Medicaid-eligible individual, which includes the cost of home health services and/or private duty nursing to the extent covered under the Medicaid program, may not exceed the cost of institutional services for that individual in a nursing facility, except as permitted under the current Medicaid state plan or any federal waivers or amendments thereto; (3) Ensure that there is a single entry point into the long-term care system that is responsible for ensuring that persons seeking care and their families have access to readily available, easy-to understand information about long term care options. Medicaid eligible persons will not be required to go back through the single entry point in order to access long-term care services, but rather, will have a single entity that is responsible for coordinating all of the Medicaid benefits the member may need, including medical, behavioral, nursing facility, and home and community based services. The commissioner must also implement policies and processes that expedite the determination of Medicaid categorical and financial eligibility and medical eligibility for home and community based programs and services, either through contracted functions of the department of human services or within the bureau of TennCare; (4) Develop level of care criteria for new nursing facility admissions that ensure that the most intensive level of long-term care services is provided to persons with the highest level of need. Nursing facility residents who meet continued stay criteria and who remain financially eligible for Medicaid would continue to be eligible to receive nursing facility services or cost-effective home and community based waiver services, and would not be required to meet new nursing facility level of care criteria. Current enrollees in the statewide home and community based services waiver program for persons who are elderly and/or adults with physical disabilities who meet continued stay criteria and remain financially eligible for Medicaid would continue to be eligible to receive cost-effective home and community based waiver services and would not be required to meet new nursing facility level of care criteria except for admission to a nursing facility. The commissioner would develop and seek approval of a waiver application or amendment thereto that allows persons who meet a lesser level of care (i.e., who do not meet new nursing facility level of care criteria, but are "at risk" of institutional care) to qualify for a more moderate package of Medicaid-reimbursed home and community based waiver services up to a specified enrollment cap; (5) Develop and implement strategies to encourage the utilization of cost-effective home and community based services in lieu of institutional placement. The commissioner must specify in contractor risk agreements with integrated long term care contractors requirements related to nursing facility diversion; (6) Develop and implement a nursing facility transition initiative. The commissioner must specify in contractor risk agreements with contractors responsible for coordination of Medicaid primary, acute and long-term care services requirements related to nursing facility-to-community transitions. Contractor requirements would include identifying and assessing nursing facility residents appropriate for transition to home and community-based settings, and planning and facilitating such transitions timely. Contractors would be permitted to coordinate or subcontract with local community based organizations to assist in the identification, planning and facilitation processes, and may offer, as a cost-effective alternative to continued institutional care, a per person transition cost allowance not to exceed $2,000 for items such as, but not limited to, first month's rent, rent and/or utility deposits, kitchen appliances, furniture and basic household items; (7) Develop and implement strategies to assist nursing facilities in diversifying their lines of business, including provision of home and community based services and specialized nursing facility care to meet the targeted needs of chronic care populations; (8) Develop and implement a plan to expand cost-effective community-based residential alternatives to institutional care for persons who are elderly and/or adults with physical disabilities, which may include, but are not limited to, the development of multiple levels of assisted care living facility services, adult family care homes, adult foster care homes, companion care models, and other cost-effective residential alternatives to nursing facility care. The commissioner and the commissioner of health would work to develop and/or modify licensure requirements for such facilities to support a nursing facility substitute framework for members who want to age in place in residences that offer increasing levels of cost-effective home and community-based care as an alternative to institutionalization as member's needs change; (9) Develop and implement an acuity-based reimbursement methodology for nursing facility services, based on an individualized assessment of need, as an alternative to the current cost-based nursing facility reimbursement system. The acuity-based reimbursement methodology for nursing facility services would be implemented over a period not to exceed two years from the initial date of implementation of such system or three years from the effective date of this bill, pursuant to a methodology established in regulations promulgated by the commissioner; (10) Develop and make available consumer-directed options for persons receiving home and community-based long-term care services under the integrated long term care program. Members eligible to receive home and community-based long term care pursuant to this amendment may, subject to regulations promulgated by the commissioner, be permitted to use the budget allowance to direct payment, utilizing the services of a fiscal intermediary, for those home and community based services that are necessary to meet the member's long-term care needs and to prevent and/or delay institutionalization and which are a cost-effective use of long-term care funds. Such services would include only those services which are permitted under the Medicaid state plan or any federal waivers or amendments thereto. This amendment establishes provisions for a competent adult with a functional disability who is living in that person's own home choosing to direct and supervise a paid personal aide in the person's performance of a health care task. This authority to choose a personal aide would also extend to a caregiver action on behalf of a minor child or incompetent adult living in his or her own home. This amendment defines "personal aide" and details the activities that the aide may perform; (11) Develop and implement quality assurance and quality improvement strategies to ensure the quality of long-term care services provided pursuant to this amendment and specify in contractor risk agreements with contractors responsible for coordination of Medicaid primary, acute and long-term care services requirements related to the quality of long-term care services provided; (12) Subject to the availability of funding, designate in the each year's appropriations bill an amount of money that can be used to increase access to home and community based services in the state-funded Options program for persons who do not qualify for Medicaid long-term care services. This funding may be used to provide services such as home-delivered meals, homemaker services and personal care, and to reduce the waiting list for these services under the Options program, or to offer transportation services or assistance to non-Medicaid eligible individuals; and (13) Provide Medicaid long term care services subject to the availability of funding in each year's appropriations bill. Present law requires the department of health to establish rules and regulations for: (1) The determination of payment for hospitals, and other health care providers who contract with the department for the care of persons eligible for assistance under the Medical Assistance Act of 1968; (2) The determination of the per diem cost for those institutions or distinct parts of institutions defined as an "intermediate care facility" and as designated and certified by the department. The commissioner may establish the maximum amount to be paid to such institutions, consistent with the requirements of federal law; and (3) The determination of the per diem cost for those institutions or distinct parts of institutions defined as a "skilled nursing facility" by the rules and regulations of the department, and as designated and certified by the department. The per diem cost may conform to the principles of reimbursement for provider cost under federal law. The commissioner may establish the maximum amount to be paid to such institutions, consistent with the requirements of federal law. This amendment specifies that upon passage of any law authorizing the promulgation of rules establishing an acuity-based reimbursement methodology for nursing facility care, the per diem cost reimbursement methodology set forth above in (2) and (3) would be phased out would be inapplicable upon the full implementation of such acuity-based reimbursement methodology. This amendment revises various present law provisions governing assisted-care living facilities. This amendment includes a facility that provides hospice services within the definition of assisted-care living facilities, and provides that residents may receive such care at the assisted-care living facility so long as their needs can be appropriately met. Present law defines that services that may and may not be offered at an assisted-care living facility. This amendment extends the list of authorized services to include medical services that could be provided in a person's private residence, such as home health, to be provided in the facility. This amendment allows an assisted-care living facility to provide these services or have the services delivered by an outside source, so long as the services are delivered by licensed and qualified staff. This amendment also revises expands the types of medical conditions that may be treated at an assisted-care living facility. This amendment specifies what conditions may be treated in an assisted-care living facility on a short-term basis or for persons receiving hospice care. This amendment authorizes the board for licensing health care facilities to establish a system for assessing civil monetary penalties for assisted-care living facilities that are in serious violation of state laws and regulations and which violations result in endangerment to the health, safety and welfare of residents. This amendment requires the bureau of TennCare to: (1) Define the state's medical eligibility criteria for all long-term care services; (2) Develop the pre-admission evaluation (PAE) assessment tool and make the determination of medical eligibility for long-term care services; and (3) Require that any MCO contract with all current nursing facility providers for a transition period of at least three years following implementation of the managed long-term care service delivery system or four years from the effective date of this bill. MCOs may, but are not required to, contract with nursing facility providers that do not meet this amendment's requirements for "current nursing facility providers". This amendment specifies that MCOs providing long-term care services will be subject to the same requirements regarding prompt payment of claims, and the liability for bad faith failure to pay claims promptly, as are applicable under present law for HMOs. OVERSIGHT COMMITTEE This amendment creates the select oversight committee on long term care, to be composed of 10 members, with five members to be appointed by the speaker of the senate and five members to be appointed by the speaker of the house of representatives. Members of the committee would be entitled to be reimbursed for their expenses in attending meetings of the committee or any subcommittees thereof at the same rates and in the same manner as when attending the general assembly. The committee would report on its activities to each member of the general assembly. The committee would review proposed expenditures and program proposals for long term care and make its comments on proposed expenditures and program activities in a timely fashion according to the following: (1) Any proposed expenditure of funds to implement new programs or expand existing programs, and any administrative or management changes requiring additional expenditures, must be filed in writing by the commissioner of finance and administration with the committee and may be reviewed by the committee. After any such review, the committee may comment to the commissioner of finance and administration on the proposed expenditures. If such expenditures are made before the committee has made its comments, if any, or if expenditures are made which are inconsistent with the comments of the committee, the commissioner of finance and administration must explain in writing the reasons for making such expenditures to the committee and each other member of the general assembly. (2) Any proposed federal waivers or waiver amendments and for contracts and amendments involving risk based contractors or managed care organizations must be filed in writing by the commissioner of finance and administration with the committee at the least 30 days before it is filed or submitted to the federal government or entered into with a contractor. The committee has the authority to review such plans and proposals and, after such review, the committee may comment to the commissioner of finance and administration and the commissioner is encouraged to consider the committee's comments, if any, in making its decisions. At least 30 days before the commission submits a request for a new waiver, an amendment to the waiver, or a renewal of the waiver for the TennCare program to the department of health and human services, the commissioner must transmit the proposed waiver, renewal or amendment to the committee and the committee must have an opportunity to comment prior to the waiver, renewal or amendment being submitted or taking effect. (3) Any proposed rules for implementing this bill, except for emergency or public necessity rules, must be filed in writing by the commissioner with the committee at least 30 days before it is filed or goes into effect. No rules may be submitted to the secretary of state or take effect unless the committee has been afforded the opportunity to comment. The committee may review the rules and, after the review, may comment to the commissioner. This rule review would be separate from any rule review under the UAPA. When any bill is introduced in the general assembly that will impact or potentially impact upon any area within the scope of review of the committee, the committee staff would, at the direction of the committee chair, identify such bill for review. For purposes of participating in the discussions and comments of the committee, the chair or the chair's designee of the appropriate standing committee would be notified of the date, time, and location where the committee will meet to review legislation which has been assigned to the respective standing committee, and such chair or the chair's designee would become an ex officio member of the committee when such legislation is considered by the committee. The committee would review all bills so identified and may attach committee comments to such bill prior to its consideration by the appropriate standing committee. The committee would make no recommendation concerning the passage of a bill it reviews nor would it have the authority to prevent the consideration of the bill by the standing committee to which it is referred. The committee would review regularly the following long term care services-related programs, functions and activities of the department of health, the commission on aging and disabilities and the TennCare program: (1) Eligibility and enrollment standards, including determinations of how long term services recipients are assigned to MCOs, or other matters related to eligibility and assignment of TennCare enrollees and participants in the Options program; (2) Provisions of services, facilities or programs by TennCare and Options providers, including benefit packages or other related matters; (3) Education programs for TennCare and Options enrollees, MCOs and providers, including eligibility, access to providers and MCOs, benefit package offered, deductibles and co-payments required or other related matters; (4) Review and evaluation of performance of MCOs, including their compliance with contracts entered into with the state, review of MCO contracts entered into with any long term care services provider or other related matters; (5) Compliance by the appropriate agencies with provisions of applicable federal waivers, including review of proposed amendments to the waiver for system changes, and evaluations or reports prepared for or by the federal government, or other related matters; (6) Staffing within the department, including recruitment, selection, training, compensation, discipline or other matters; (7) Management, including planning, budgeting, information systems, organizational structure, rules and regulations, department policies and procedures or other related matters; and (8) Any other matters considered material. The committee will terminate at the adjournment of the regular session of the general assembly convened in 2013. The general assembly may continue the committee for five years by appropriate action during such regular session. This amendment specifies that the select committee on TennCare would no longer have authority for oversight of long-term care in the TennCare program and all such oversight authority would be vested in the committee created by this amendment. EFFECTIVE DATE This bill as amended would take effect July 1, 2008, and would be repealed July 1, 2012. On July 1, 2012, the statutes that were in effect prior to this bill's effective date, would be revived and reinstated. AMENDMENT #3 clarifies that a qualified entity will conduct a comprehensive individualized assessment of needs in accordance with protocols developed by the commissioner and will develop a care plan with active participation of the member and family or other caregivers that addresses the needs and builds on and does not supplant family and other caregiving supports. The amendment further clarifies that the entity responsible for care coordination must cost-effectively implement the care plan, assure coordination and monitoring of all Medicaid primary, acute and long-term care services to assist individuals and family or other caregivers in providing care, and assure the availability of a qualified workforce to timely provide necessary services. This amendment specifies that the long-term care system must be implemented in a manner that affords access to the "appropriate level" of cost-effective home and community-based services for the greatest number of eligible persons, subject to funding. This amendment revises the provision whereby contractor requirements must include "identifying and assessing nursing facility residents appropriate for transition to home and community-based settings." This amendment instead provides that contract requirements must include "identification of nursing facility residents who may be appropriate for transition to home and community based settings, as well as assessment and care plan development by a qualified entity." This amendment requires the commissioner of finance and administration to work with the board for licensing health care facilities, instead of with the commissioner of health, to develop and/or modify licensure requirements for such facilities to support a nursing facility substitute framework for members who want to age in place in residences that offer increasing levels of cost-effective home and community-based care as an alternative to institutionalization as member's needs change. This amendment adds a requirement for the commissioner of finance and administration to ensure that recipients of long-term care services are notified how to contact the bureau of TennCare if they have concerns about the long-term care services they are or are not receiving and the process for resolving such issues. This amendment specifies that assisted care living facilities are not authorized to provide medical services to assisted care living facility residents if such services are reimbursable under Medicare. AMENDMENT #4 replaces authorization for the select oversight committee on long term care to hire staff with a requirement that the legislative staff of the select oversight committee on TennCare serve as legislative staff to the select oversight committee on long term care. This amendment changes the termination date of the select oversight committee on long term care from the adjournment of the regular session of the general assembly convened in 2013 to June 30, 2012. AMENDMENT #5 specifies that since a waiver, amendment, or renewal requests is legally enforceable when it takes effect, the committee must review such waivers, amendments or renewal requests in the same manner as proposed legislation, subject to the 30-day period required by this bill. Latest Actions
Fiscal Notes
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