Legislative Priorities

We work at the state and federal levels of government on legislative priorities to ensure that public policy decisions improve the lives of Iowans in need of care from nursing facilities, assisted living programs and home health agencies.

View our 2019 Legislative Session Report (requires member login)

Skilled Nursing Facilities
  • Nursing Home Rebasing – Nursing home rates are rebased by the Department of Human Services (DHS) per Iowa law. Rebasing essentially recalibrates providers rates based on their actual cost and other facility specifics compared to other providers in Iowa. This recalibration is done every two years. The legislature is tasked with appropriating funding to ensure Medicaid rates are adjusted as costs rise over time. Over the last several years, the system has not been adequately funded, which has created a significant shortfall in the rates nursing facility providers are receiving from Medicaid. The state share of this shortfall is $54.9 million. Because of the gap in funding, nursing facility providers are being reimbursed at 2012 rates. These low rates are causing private pay residents to pay more (cost shift), and several facilities across Iowa are facing closure. Iowa Health Care Association (IHCA) has asked the Iowa Legislature to appropriate $54.9 million in Medicaid nursing home rebasing to ensure providers can continue to provide services for Iowa’s most vulnerable.
  • Nursing Home Renovation Funding – The General Assembly has historically set aside Rebuilding Iowa Infrastructure Fund (RIIF) funding for the renovation of older nursing facilities and those caring for high numbers of Iowans on Medicaid. These facilities have limited access to capital. Renovation of aging facilities is vital to meeting regulatory and quality improvement requirements. Since its inception, this funding has helped average over $100 million in new nursing facility construction.
  • Case Mix Adjustment Period – DHS calculates nursing facilities’ case mix, which represents acuity of the patients a facility serves and affects the facility’s Medicaid rate. The calculation of rates is time-consuming and completed every quarter. IHCA supports changing the calculation of case-mix adjusted rates to two times a year, rather than every quarter. This modification would give DHS and the managed care organizations a lead time of six months to calculate rates and input the new rates in their systems prior to provider claim submission. The added lead time should allow for more accurate and timely rate implementation by the managed care organizations.
  • Hospice Billing Modernization – IHCA was involved in a DHS-led workgroup to study options on how to remove the hospice room and board pass-through. Those options will be given to the legislature through a report created by DHS. IHCA supports providers receiving 100% of the base rates (current rates are 95%) from the managed care companies and making hospice days subject to the quality assurance assessment fee.
  • Department of Public Safety Background Checks – Currently providers are required to utilize the Department of Public Safety’s (DPS) background check system for current and prospective employees. The DPS system only provides a background check for Iowa crimes, charges, etc., and is not expedient—requiring providers to wait to hire prospective new employees. IHCA supports modernizing the system to conduct a more thorough national background check, as well as utilizing a real-time system that is more expedient. IHCA would support a private third-party running the system.
  • Certificate of Need – Iowa’s Health Facilities Council (HFC), the five-member council that votes to approve or deny applications for expansion or new institutional health care facilities, has historically prevented over-construction of expensive health care facilities (hospitals and nursing homes) by applying an objective test to each application it reviews. This has helped keep health care cost increases in check by reducing duplication in services across the state. However, each year the legislature is presented with proposals that would weaken Iowa’s current Certificate of Need (CON) system. Weakening the requirements for a CON, especially a project cost threshold, would allow new classes of providers to “cherry-pick” patients/residents from higher reimbursement categories, and would tilt the playing field against providers that were required to seek CON approval.
Assisted Living Programs
  • Assisted Living Daily Rate Increase – Iowa Center for Assisted Living (ICAL) proposes to increase the assisted living (AL) service rate floor to $35 and corresponding 3% increase to the Home & Community-Based Services (HCBS) Elderly Waiver rate. The AL Service is unique to assisted living providers and would allow for additional reimbursement for assisted living providers only. The revised reimbursement would incentivize these providers offering Medicaid Elderly Waiver to no longer bill through the Consumer Directed Attendant Care (CDAC) program. CDAC requires Assisted Living Elderly Waiver providers to document care and services in 15-minute increments. This onerous reporting requirement is a needless administrative burden for providers and DHS.
  • More Prompt Approval of Assisted Living Services – ICAL supports legislation or rules that push DHS and/or the managed care companies to promptly approve assisted living services. These services include but are not limited to Personal Emergency Response System (PERs), Assisted Living Service (AL On-Call) and meals. Currently, Medicaid eligibles moving from nursing home or acute settings to home and community-based service settings (like assisted living) are hampered with lengthy approval times and processes.
  • Continuance of Assisted Living Social Model – ICAL supports allowing tenants to make their own choices of how to live and supports any state initiative that continues this practice. As Iowa’s elderly population begins transitioning to models like assisted living and/or nursing facility care, it is important that the care is provided in settings that yield good outcomes and high patient satisfaction. The social model foundation has been proven to improve outcomes and deliver high-quality care.
Home Health Agencies
  • Full Cost Coverage for Home Health – Iowa Center for Home Care (ICHC) has requested $4.17 million of state funds to increase the Medicaid funding for low-income elderly and disabled Iowans receiving care in their own home. This amount would reimburse Home Health Agency (HHA) providers at 100% of the low utilization payment adjustment (LUPA) rate, which is the rate calculated by Centers for Medicare and Medicaid Services (CMS). This funding request is vital to ensure that home care providers are able to continue to serve Iowa Medicaid patients. Additionally, home health care providers offer the most affordable service in Iowa’s Medicaid care continuum.
All Providers
  • Workforce – Support public policies or appropriations that support workforce development and retention to Iowa’s health care field. Providers are continually burdened by an inadequate pool of trained health care providers to meet the demands of the patients they serve every day.
  • CMS/DIA Survey & Certification – Continue to monitor and modify Centers for Medicare & Medicaid Services (CMS) and Department of Inspections and Appeals (DIA) survey and certification proposals.
  • Managed Care Reform – Exempt elderly/disabled Iowans who are approved for Nursing Facility Medicaid from mandatory Medicaid managed care enrollment. This does not include those individuals receiving rehabilitation and/or are expecting a change in care settings. These people would be offered the option to return to the regular state Medicaid program.
  • Any Willing Provider – Ensure that any provider who is an enrolled Iowa Medicaid provider is allowed to be a network provider with all of the managed care organizations (MCOs) the provider chooses to contract/credential with.
  • No Prior Authorization for Long-Term Services and Support (LTSS) – Statutorily prevent the installation of prior authorization requirements for LTSS patients. This would include nursing facility patients and assisted living/home health patients who are on the elderly waiver.

Legislative Session Report