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PAG LIN 1 1 Section 1. FAMILY INVESTMENT PROGRAM. There is 1 2 appropriated from the general fund of the state to the 1 3 department of human services for the fiscal year beginning 1 4 July 1, 1995, and ending June 30, 1996, the following amount, 1 5 or so much thereof as is necessary, to be used for the purpose 1 6 designated: 1 7 For assistance under the family investment program under 1 8 chapter 239: 1 9 .................................................. $ 32,820,032 1 10 1. The department shall continue the special needs program 1 11 under the family investment program. 1 12 2. Notwithstanding section 239.6, the department is not 1 13 required to reconsider eligibility of family investment 1 14 program recipients every six months if a federal waiver is 1 15 granted. 1 16 3. The department may adopt administrative rules for the 1 17 family investment, food stamp, and medical assistance programs 1 18 to change or delete welfare reform initiatives that threaten 1 19 the integrity or continuation of the program or that are not 1 20 cost-effective. Prior to the adoption of rules, the 1 21 department shall consult with the welfare reform council, 1 22 members of the public involved in development of the policy 1 23 established in the 1993 session of the Seventy-fifth General 1 24 Assembly, and the chairpersons and ranking members of the 1 25 human resources committees of the senate and the house of 1 26 representatives. 1 27 4. The department shall consolidate the individual 1 28 planning and agreement provisions of the family investment 1 29 program and the family development and self-sufficiency grant 1 30 program to ensure service coordination by providing that if a 1 31 recipient is participating in the grant program, the 1 32 recipient's family investment agreement shall be developed or 1 33 revised in consultation with the family development and self- 1 34 sufficiency grant program worker. 1 35 5. The department shall research the feasibility of 2 1 establishing a program of developing community-based 2 2 residential facilities or "second chance homes" for young 2 3 mothers and children. The research shall consider potential 2 4 benefits of second chance homes including the potential 2 5 effects of deterring child abuse by use of the homes. The 2 6 research is subject to all of the following provisions: 2 7 a. The department shall consider developing the home in a 2 8 manner to provide supervision by mature adult couples. The 2 9 program should coordinate comprehensive services for pregnant 2 10 or parenting teens, including but not limited to educational 2 11 services, vocational services, personal and family counseling, 2 12 parent education classes, and assistance in developing 2 13 independent living and homemaking skills. 2 14 b. The department shall consider various options for 2 15 designing second chance homes so that the homes will not 2 16 necessarily be government-operated institutions. The options 2 17 considered shall include operation by churches and community 2 18 groups with state guidance through administrative rules. If 2 19 the program is implemented, administrative rules will 2 20 delineate how the homes will be structured and specify the 2 21 combination of support, services, and participant obligations 2 22 to help teenage mothers to become good mothers, finish school, 2 23 and gain adequate skills to support their children. 2 24 c. The department shall consider a design which provides 2 25 incentive grants to communities that pledge private funding 2 26 and in-kind services equal to at least one-half of the cost of 2 27 operating a second chance home. In addition, operating 2 28 expenses could be supported in part by participants' welfare 2 29 payments, food stamps, housing assistance, and other forms of 2 30 public assistance for which participants are eligible, as well 2 31 as a commitment from communities. 2 32 d. The department shall submit a report to the general 2 33 assembly on or before January 8, 1996, concerning the research 2 34 conducted pursuant to this subsection. 2 35 Sec. 2. EMERGENCY ASSISTANCE. There is appropriated from 3 1 the general fund of the state to the department of human 3 2 services for the fiscal year beginning July 1, 1995, and 3 3 ending June 30, 1996, the following amount, or so much thereof 3 4 as is necessary, to be used for the purpose designated: 3 5 For emergency assistance to families with dependent 3 6 children for homeless prevention programs: 3 7 .................................................. $ 1,767,500 3 8 1. The emergency assistance provided for in this section 3 9 shall be available beginning October 1 of the fiscal year and 3 10 shall be provided only if all other publicly funded resources 3 11 have been exhausted. Specifically, emergency assistance is 3 12 the program of last resort and shall not supplant assistance 3 13 provided by the low-income home energy assistance program 3 14 (LIHEAP), county general relief, and veterans affairs 3 15 programs. The department shall establish a $500 maximum 3 16 payment, per family, in a twelve-month period. The emergency 3 17 assistance includes, but is not limited to, assisting people 3 18 who face eviction, potential eviction, or foreclosure, utility 3 19 shutoff or fuel shortage, loss of heating energy supply or 3 20 equipment, homelessness, utility or rental deposits, or other 3 21 specified crisis which threatens family or living 3 22 arrangements. The emergency assistance shall be available to 3 23 migrant families who would otherwise meet eligibility 3 24 criteria. The department may contract for the administration 3 25 and delivery of the program. The program shall be terminated 3 26 when funds are exhausted. 3 27 2. For the fiscal year beginning July 1, 1995, the 3 28 department shall establish a process for the state to receive 3 29 refunds of rent deposits for emergency assistance recipients 3 30 which were paid by persons other than the state. The refunds 3 31 received by the department under this subsection shall be 3 32 deposited with the moneys of the appropriation made in this 3 33 section and used as additional funds for the emergency 3 34 assistance program. Notwithstanding section 8.33, moneys 3 35 received by the department under this subsection which remain 4 1 after the emergency assistance program is terminated and state 4 2 moneys in the emergency assistance account which remain 4 3 unobligated or unexpended at the close of the fiscal year 4 4 shall not revert to the general fund of the state but shall 4 5 remain available for expenditure when the program resumes 4 6 operation on October 1 in the succeeding fiscal year. 4 7 Sec. 3. MEDICAL ASSISTANCE. There is appropriated from 4 8 the general fund of the state to the department of human 4 9 services for the fiscal year beginning July 1, 1995, and 4 10 ending June 30, 1996, the following amount, or so much thereof 4 11 as is necessary, to be used for the purpose designated: 4 12 For medical assistance, including reimbursement for 4 13 abortion services, which shall be available under the medical 4 14 assistance program only for those abortions which are 4 15 medically necessary: 4 16 .................................................. $351,496,521 4 17 1. Medically necessary abortions are those performed under 4 18 any of the following conditions: 4 19 a. The attending physician certifies that continuing the 4 20 pregnancy would endanger the life of the pregnant woman. 4 21 b. The attending physician certifies that the fetus is 4 22 physically deformed, mentally deficient, or afflicted with a 4 23 congenital illness. 4 24 c. The pregnancy is the result of a rape which is reported 4 25 within 45 days of the incident to a law enforcement agency or 4 26 public or private health agency which may include a family 4 27 physician. 4 28 d. The pregnancy is the result of incest which is reported 4 29 within 150 days of the incident to a law enforcement agency or 4 30 public or private health agency which may include a family 4 31 physician. 4 32 e. Any spontaneous abortion, commonly known as a 4 33 miscarriage, if not all of the products of conception are 4 34 expelled. 4 35 2. Notwithstanding section 8.39, the department may 5 1 transfer funds appropriated in this section to a separate 5 2 account established in the department's case management unit 5 3 for expenditures required to provide case management services 5 4 for mental health, mental retardation, and developmental 5 5 disabilities services under medical assistance which are 5 6 jointly funded by the state and county, pending final 5 7 settlement of the expenditures. Funds received by the case 5 8 management unit in settlement of the expenditures shall be 5 9 used to replace the transferred funds and are available for 5 10 the purposes for which the funds were appropriated in this 5 11 section. 5 12 3. If a medical assistance recipient is more than 17 years 5 13 of age and is receiving care which is reimbursed under a 5 14 federally approved home and community-based services waiver 5 15 but would otherwise be approved for care in an intermediate 5 16 care facility for the mentally retarded, the recipient's 5 17 county of legal settlement shall reimburse the department on a 5 18 monthly basis for the portion of the recipient's cost of care 5 19 which is not paid from federal funds. 5 20 4. a. The county of legal settlement shall be billed for 5 21 50 percent of the nonfederal share of the cost of case 5 22 management provided for adults, day treatment, and partial 5 23 hospitalization in accordance with sections 249A.26 and 5 24 249A.27, and 100 percent of the nonfederal share of the cost 5 25 of care for adults which is reimbursed under a federally 5 26 approved home and community-based waiver that would otherwise 5 27 be approved for provision in an intermediate care facility for 5 28 the mentally retarded, provided under the medical assistance 5 29 program. The state shall have responsibility for the 5 30 remaining 50 percent of the nonfederal share of the cost of 5 31 case management provided for adults, day treatment, and 5 32 partial hospitalization. For persons without a county of 5 33 legal settlement, the state shall have responsibility for 100 5 34 percent of the nonfederal share of the cost of case management 5 35 provided for adults, day treatment, partial hospitalization, 6 1 and the home and community-based waiver services. The case 6 2 management services specified in this subsection shall be 6 3 billed to a county only if the services are provided outside 6 4 of a managed care contract. The department may adopt 6 5 emergency rules to implement the provisions of this 6 6 subsection. 6 7 b. The state shall pay the entire nonfederal share of the 6 8 costs for case management services provided to persons 17 6 9 years of age and younger who are served in a medical 6 10 assistance home and community-based waiver program for persons 6 11 with mental retardation. 6 12 c. Medical assistance funding for case management services 6 13 for eligible persons 17 years of age and younger shall also be 6 14 provided to persons residing in counties with child welfare 6 15 decategorization projects implemented in accordance with 6 16 section 232.188, provided these projects have included these 6 17 persons in their service plan and the decategorization project 6 18 county is willing to provide the nonfederal share of costs. 6 19 d. The state shall pay the entire nonfederal share of 6 20 intermediate care facilities for the mentally retarded (ICFMR) 6 21 costs for eligible persons 17 years of age and younger. 6 22 e. When paying the necessary and legal expenses of 6 23 intermediate care facilities for the mentally retarded 6 24 (ICFMR), the cost payment requirements of section 222.60 shall 6 25 be considered fulfilled when payment is made in accordance 6 26 with the medical assistance payment rates established for 6 27 ICFMRs by the department and the state or a county of legal 6 28 settlement is not obligated for any amount in excess of the 6 29 rates. 6 30 5. The department may adopt and implement administrative 6 31 rules regarding a prepaid mental health services plan for 6 32 medical assistance patients. The rules shall include but not 6 33 be limited to service provider standards, service 6 34 reimbursement, and funding mechanisms. Notwithstanding the 6 35 provisions of subsection 4, paragraph "a", of this section and 7 1 section 249A.26, requiring counties to pay all or part of the 7 2 nonfederal share of certain services provided to persons with 7 3 disabilities under the medical assistance program, the state 7 4 shall pay 100 percent of the nonfederal share of any services 7 5 included in the plan implemented pursuant to this subsection. 7 6 6. The department shall utilize not more than $60,000 of 7 7 the funds appropriated in this section to continue the 7 8 AIDS/HIV health insurance premium payment program as 7 9 established in 1992 Iowa Acts, Second Extraordinary Session, 7 10 Chapter 1001, section 409, subsection 6. Of the funds 7 11 allocated in this subsection, not more than $10,000 may be 7 12 expended for administrative purposes. 7 13 7. Contingent upon federal approval of a waiver, the 7 14 department shall adopt administrative rules to establish the 7 15 requirements for the alternative nursing home pilot project. 7 16 8. The department of human services shall use not more 7 17 than $47,368 to employ not more than 2 FTEs to develop and 7 18 implement a medical assistance home and community-based waiver 7 19 for persons with brain injury who currently reside in a 7 20 medical institution and who have been residents of a medical 7 21 institution for a minimum of thirty days. 7 22 9. Of the funds appropriated to the Iowa department of 7 23 health for substance abuse grants, $950,000 for the fiscal 7 24 year beginning July 1, 1995, shall be transferred to the 7 25 department of human services to implement an integrated 7 26 substance abuse managed care system. The department of human 7 27 services in conjunction with the Iowa department of health and 7 28 other appropriate state agencies may adopt and implement 7 29 emergency rules to establish a prepaid substance abuse 7 30 treatment plan for medical assistance recipients. The rules 7 31 shall include but are not limited to defining the structure of 7 32 the program, establishing the scope of services to be provided 7 33 in the program, including, but not limited to, establishing 7 34 client eligibility for prepaid substance abuse treatment 7 35 services, establishing the basis and the rate of reimbursement 8 1 for the program, defining the expected outcome measures of the 8 2 program, and defining a client appeals process. However, 8 3 nothing in the rules shall condition provider eligibility to 8 4 render services under this program upon the scope of services 8 5 rendered by a provider or upon provider licensure, 8 6 certification, or corporate structure. The department of 8 7 human services and the Iowa department of public health shall 8 8 evaluate methods for inclusion of court-ordered detoxification 8 9 services in the substance abuse managed care program and shall 8 10 provide recommendations regarding inclusion of the services in 8 11 the program to the general assembly on or before December 1, 8 12 1995. The department of human services shall submit a report 8 13 on a quarterly basis to the general assembly during the months 8 14 in which the general assembly is in session and to the fiscal 8 15 committee of the legislative council during the months in 8 16 which the general assembly is not in session, describing the 8 17 progress and activities of the integrated substance abuse 8 18 managed care program. 8 19 10. a. Beginning September 1, 1995, the department may 8 20 require prior authorization for any brand name prescription 8 21 drug which has an "A" rated generic bioequivalent as 8 22 determined by the federal food and drug administration and 8 23 which is recommended for prior authorization by the drug 8 24 utilization review commission. The department shall establish 8 25 an educational program through the drug utilization review 8 26 commission to review and encourage the use of these "A" rated 8 27 generic equivalents within the medical assistance program. 8 28 The department shall adopt administrative rules to implement 8 29 the prior authorization provisions of this paragraph. The 8 30 department shall not expand the requirement of prior 8 31 authorization for drugs other than the "A" rated generic 8 32 bioequivalents authorized under this paragraph, without prior 8 33 approval of the general assembly for such expansion. 8 34 Beginning January 1, 1996, prior authorization shall not be 8 35 required for clozapine. The department shall consider expert 9 1 medical opinion in revising administrative rules applicable to 9 2 clozapine. 9 3 b. The department shall amend the contract with the 9 4 department's fiscal agent regarding prior authorization of 9 5 prescription drugs to provide for review by the fiscal agent 9 6 of inquiries for prior authorization during pharmacy business 9 7 hours, evenings, Saturdays and during pharmacy peak business 9 8 hours on Sundays, and shall consider providing for review by 9 9 the fiscal agent of inquiries on a seven-day-per-week, 24- 9 10 hour-per-day basis. 9 11 c. (1) The department of human services shall conduct a 9 12 study of the prior authorization program based upon the 9 13 program data collected during fiscal year 1994-1995, including 9 14 a review of a sampling of specific drugs for which prior 9 15 authorization is required. The study shall be completed by 9 16 October 1, 1995, and a report of the findings of the study 9 17 shall be submitted to the chairpersons and ranking members of 9 18 the senate and house appropriations committees, to the 9 19 chairpersons and ranking members of the joint human services 9 20 appropriations committee, and to the legislative fiscal 9 21 bureau. The study shall address and include information and 9 22 recommendations regarding all of the following: 9 23 (a) A comparison of the costs associated with the 9 24 prescribing of generic drugs rather than brand name drugs, 9 25 taking into consideration any rebates or other cost reductions 9 26 associated with the use of brand name drugs. 9 27 (b) A review of the time associated with the prior 9 28 authorization process including telephone communications 9 29 between providers and the department's prior authorization 9 30 fiscal agent and with delays for either party. The review 9 31 shall include an analysis of the average time associated with 9 32 each inquiry by classification of drug. 9 33 (c) A review of the number of denials of authorization by 9 34 classification of drug by the fiscal agent and the rationale 9 35 for the denials. 10 1 (d) A review of the actual and projected cost savings and 10 2 workability of the prior authorization program. 10 3 (e) A review of the services provided by the fiscal agent 10 4 including a comparison of the services of the fiscal agent 10 5 with private pay insurers in providing a similar service, and 10 6 an evaluation of the current availability of the fiscal agent 10 7 and any improvements to the program which might result from 10 8 increased availability. 10 9 (f) A review of the volume of inquiries for prior 10 10 authorization during a weekly period including an analysis of 10 11 the days and times of peak volume as compared with the 10 12 availability of the fiscal agent for responding to inquiries. 10 13 (g) An analysis of the time which elapses between the 10 14 submission of a bill to the department for reimbursement and 10 15 actual reimbursement. 10 16 (2) Following receipt of the report from the department, 10 17 the legislative fiscal bureau shall review the study. The 10 18 review shall include all of the following: 10 19 (a) An evaluation of the cost and savings methodology 10 20 utilized by the department, including an analysis of whether 10 21 all governmental costs and savings were included or adequately 10 22 addressed in the savings methodology used during fiscal year 10 23 1994-1995. If the legislative fiscal bureau determines that 10 24 the cost and savings methodology utilized by the department or 10 25 the fiscal agent did not include or adequately address all 10 26 governmental costs, the legislative fiscal bureau shall 10 27 provide recommendations to the general assembly to improve the 10 28 cost and savings methodology for future application. 10 29 (b) An individualized assessment of the prior 10 30 authorization program based on a random sample of not more 10 31 than 50 individual prior authorization actions, of which one- 10 32 half shall be approval actions and one-half shall be denial 10 33 actions. The random sample shall be provided by the 10 34 department to the legislative fiscal bureau based upon a 10 35 random sampling methodology submitted by the legislative 11 1 fiscal bureau. All data deemed necessary by the legislative 11 2 fiscal bureau to conduct the assessment shall be provided by 11 3 the department including but not limited to the date and time 11 4 of the prior authorization contact between the fiscal agent 11 5 and the provider; the name, address, and telephone number of 11 6 the provider; and the classification of the drug for which 11 7 prior authorization was sought. If the action was an approval 11 8 action, the department shall provide a statement of the actual 11 9 cost associated with the substituted drug and the cost 11 10 associated with the alternative drug. If the action was a 11 11 denial action, the department shall provide the rationale for 11 12 the denial. 11 13 d. The department of human services shall, when it is 11 14 economically beneficial, implement maximum allowable costs for 11 15 multiple source drugs in accordance with federal guidelines. 11 16 e. The department shall develop a plan to administratively 11 17 pursue reimbursement for pharmacy services for which a 11 18 recipient of medical assistance also has third-party coverage. 11 19 The department shall develop the plan in cooperation with the 11 20 insurance division of the department of commerce and with 11 21 representatives of the Iowa pharmacists association. The 11 22 department shall submit the plan to the general assembly on or 11 23 before January 1, 1996, and shall implement the plan on or 11 24 before May 1, 1996. The department shall also include a 11 25 preliminary estimate of the costs of administratively pursuing 11 26 reimbursement for pharmacy services in the budget submitted to 11 27 the council of human services for fiscal year 1996-1997. 11 28 11. The department shall develop strategies to address 11 29 administrative and provider concerns associated with 11 30 discretionary medical assistance provided to individuals and 11 31 families pursuant to section 249A.3, subsection 4, and the 11 32 provisions relating to the expenditure of income to a level 11 33 which qualifies the individual or family as eligible for par- 11 34 ticipation in the medical assistance program. The department 11 35 shall submit a report regarding the strategies developed to 12 1 the general assembly on or before November 30, 1995. 12 2 12. The department may seek qualification of supervised 12 3 community treatment for children under the medical assistance 12 4 program. 12 5 13. The department shall amend the department's current 12 6 home and community-based waivers under medical assistance to 12 7 include "consumer directed attendant care" as allowed by 12 8 federal regulation. The department shall also develop and 12 9 implement a new home and community-based waiver for persons 12 10 with physical disabilities as a means to further develop the 12 11 personal assistance services program under section 225C.46. 12 12 The waiver shall not be implemented in a manner which would 12 13 require additional county or state costs for assistance 12 14 provided to an individual served under the waiver. A waiver 12 15 amended, developed, or implemented pursuant to this subsection 12 16 shall be consistent with the provisions of the appropriation 12 17 in this Act for a personal assistance services pilot project 12 18 and the provisions of chapter 255C relating to personal 12 19 assistance services. 12 20 14. The department of human services shall seek federal 12 21 approval on or before August 1, 1995, for the implementation 12 22 of a pilot program to allow medical assistance program 12 23 reimbursement for payment of services provided by persons who 12 24 provide a home and services to a total of seventy-five persons 12 25 who currently reside in nursing homes. The department, in 12 26 cooperation with the department of elder affairs, shall 12 27 develop a program which will result in a cost savings to the 12 28 state or in cost neutrality, and shall develop parameters for 12 29 the program which shall include but are not limited to all of 12 30 the following: 12 31 a. A maximum income eligibility level, established by the 12 32 department, which applies to persons providing a home and 12 33 services and seeking reimbursement through the medical 12 34 assistance program. 12 35 b. An evaluative component which enables the department to 13 1 measure the financial and quality of life aspects of the pilot 13 2 program in comparison with placement of a person in a nursing 13 3 home. 13 4 c. A maximum reimbursement rate of $15,000, annually, for 13 5 housing and services provided by the home provider under the 13 6 pilot program. 13 7 d. Any other criteria necessary to implement the pilot 13 8 program including but not limited to implementation in a 13 9 manner which targets current nursing home residents in both 13 10 rural and urban areas of the state. 13 11 15. The department of human services shall consult with 13 12 the department of inspections and appeals, the Iowa state 13 13 association of counties, and the Iowa association of 13 14 rehabilitation and residential facilities in adopting 13 15 administrative rules identifying optimum staffing ratios for 13 16 intermediate care facilities for the mentally retarded 13 17 (ICFMR). The administrative rules shall be implemented on or 13 18 before January 1, 1996. 13 19 Sec. 4. MEDICAL CONTRACTS. There is appropriated from the 13 20 general fund of the state to the department of human services 13 21 for the fiscal year beginning July 1, 1995, and ending June 13 22 30, 1996, the following amount, or so much thereof as is 13 23 necessary, to be used for the purpose designated: 13 24 For medical contracts: 13 25 .................................................. $ 6,226,400 13 26 1. The department shall continue to contract for drug 13 27 utilization review under the medical assistance program. 13 28 2. The department may use not more than $22,500 of the 13 29 funds appropriated in this section for contracting for the 13 30 rebasing-recalibration of the ambulatory patient grouping 13 31 system. 13 32 3. The department may use not more than $75,000 of the 13 33 funds appropriated in this section for the independent 13 34 evaluation of the prepaid mental health services plan. The 13 35 department shall submit a report on a quarterly basis to the 14 1 general assembly during the months in which the general 14 2 assembly is in session and to the fiscal committee of the 14 3 legislative council during the months in which the general 14 4 assembly is not in session, describing the progress and 14 5 activities of the prepaid mental health services plan. 14 6 Sec. 5. STATE SUPPLEMENTARY ASSISTANCE. There is 14 7 appropriated from the general fund of the state to the 14 8 department of human services for the fiscal year beginning 14 9 July 1, 1995, and ending June 30, 1996, the following amount, 14 10 or so much thereof as is necessary, to be used for the purpose 14 11 designated: 14 12 For state supplementary assistance: 14 13 .................................................. $ 19,115,000 14 14 1. The department shall increase the personal needs 14 15 allowance for residents of residential care facilities by the 14 16 same percentage and at the same time as federal supplemental 14 17 security income and federal social security benefits are 14 18 increased due to a recognized increase in the cost of living. 14 19 The department may adopt emergency rules to implement this 14 20 subsection. 14 21 2. a. If during the fiscal year beginning July 1, 1995, 14 22 the department projects that state supplementary assistance 14 23 expenditures for a calendar year will not meet the federal 14 24 pass-along requirement specified in Title XVI of the federal 14 25 Social Security Act, section 1618, as codified in 42 U.S.C. } 14 26 1382g, the department may take actions including but not 14 27 limited to increasing the personal needs allowance for 14 28 residential care facility residents and making programmatic 14 29 adjustments or upward adjustments of the residential care 14 30 facility or in-home health-related care reimbursement rates 14 31 prescribed in this Act to ensure that federal requirements are 14 32 met. The department may adopt emergency rules to implement 14 33 the provisions of this subsection. 14 34 b. If during the fiscal year beginning July 1, 1995, the 14 35 department projects that state supplementary assistance 15 1 expenditures will exceed the amount appropriated, the 15 2 department may transfer funds appropriated in this Act for 15 3 medical assistance for the purposes of the state supplementary 15 4 assistance program. However, funds shall only be transferred 15 5 from the medical assistance appropriation if the funds 15 6 transferred are projected to be in excess of the funds 15 7 necessary for the medical assistance program. 15 8 Sec. 6. CHILD DAY CARE ASSISTANCE. There is appropriated 15 9 from the general fund of the state to the department of human 15 10 services for the fiscal year beginning July 1, 1995, and 15 11 ending June 30, 1996, the following amount, or so much thereof 15 12 as is necessary, to be used for the purposes designated: 15 13 For protective child day care assistance and state child 15 14 care assistance: 15 15 .................................................. $ 7,740,000 15 16 1. Of the funds appropriated in this section, $2,496,286 15 17 shall be used for protective child day care assistance. 15 18 2. Of the funds appropriated in this section, $2,895,934 15 19 shall be used for state child care assistance. 15 20 3. Based upon the availability of the funding provided in 15 21 subsection 2 the department shall establish waiting lists for 15 22 state child care assistance in descending order of 15 23 prioritization as follows: 15 24 a. Families who are at or below 100 percent of the federal 15 25 poverty level and are employed at least 30 hours a week. 15 26 b. Parents under the age of 21 who are employed full-time 15 27 or part-time or who are participating in an approved training 15 28 program or who are enrolled in an education program. 15 29 c. Families who are at or below 155 percent of the federal 15 30 poverty level who have a special needs child. 15 31 d. Families who are at or below 100 percent of the federal 15 32 poverty level who are employed part-time at least 20 hours per 15 33 week. 15 34 4. a. For state child care assistance, eligibility shall 15 35 be limited to children whose family income is equal to or less 16 1 than 100 percent of the United States office of management and 16 2 budget poverty guidelines. However, on or after October 1, 16 3 1995, the department may increase the income eligibility limit 16 4 to be equal to or less than 75 percent of the Iowa median 16 5 family income. 16 6 b. Migrant seasonal farm worker families whose family 16 7 income is equal to or less than 100 percent of the United 16 8 States office of management and budget poverty guidelines are 16 9 eligible for state child care assistance. The monthly family 16 10 income shall be determined by calculating the total amount of 16 11 family income earned during the 12-month period preceding the 16 12 date of application for the assistance and dividing the total 16 13 amount by 12. The department may adopt emergency rules to 16 14 implement the provisions of this lettered paragraph. For 16 15 purposes of eligibility for state child care assistance, a 16 16 migrant seasonal farm worker is an individual to which all of 16 17 the following conditions apply: 16 18 (1) The worker performs seasonal agricultural work which 16 19 requires travel so that the worker is unable to return to the 16 20 worker's permanent residence within the same day. 16 21 (2) Most of the worker's income is derived from seasonal 16 22 agricultural work performed during the months of July through 16 23 October. 16 24 (3) The worker generally performs seasonal agricultural 16 25 work in this state during the months of July through October. 16 26 c. The department may adopt administrative rules to comply 16 27 with the federal child care development block grant and 16 28 federal at-risk child care program; to streamline the existing 16 29 day care program; and to deliver the services within state and 16 30 federal funds appropriated. 16 31 d. Nothing in this section shall be construed or is 16 32 intended as, or shall imply, a grant of entitlement for 16 33 services to persons who are eligible for assistance due to an 16 34 income level consistent with the requirements of this section. 16 35 Any state obligation to provide services pursuant to this 17 1 section is limited to the extent of the funds appropriated in 17 2 this section. 17 3 5. The department shall develop, in cooperation with child 17 4 day care resource and referral services and with the state 17 5 child day care advisory council, incentives to encourage the 17 6 registration of child day care providers and shall report the 17 7 recommendations developed to the chairpersons and the ranking 17 8 members of the joint appropriations subcommittee on human 17 9 services on or before January 1, 1996. 17 10 6. Of the funds appropriated in this section, $636,641 is 17 11 allocated for the statewide program for child day care 17 12 resource and referral services under section 237A.26. 17 13 7. The department may use any of the funds appropriated in 17 14 this section as a match to obtain federal funds for use in 17 15 expanding child day care assistance and related programs. 17 16 8. Of the funds appropriated in this section, $1,676,139 17 17 shall be used for transitional child care assistance. 17 18 9. During the 1995-1996 fiscal year, the department shall 17 19 utilize the moneys deposited in the child day care credit fund 17 20 created in section 237A.28 for state child care assistance, in 17 21 addition to the moneys appropriated for that purpose in this 17 22 section. 17 23 10. Of the funds appropriated in this section, $35,000 is 17 24 allocated for use by the united Mexican-American center in Des 17 25 Moines for the center's child day care program. 17 26 Sec. 7. JOBS PROGRAM. There is appropriated from the 17 27 general fund of the state to the department of human services 17 28 for the fiscal year beginning July 1, 1995, and ending June 17 29 30, 1996, the following amount, or so much thereof as is 17 30 necessary, to be used for the purposes designated: 17 31 For the federal-state job opportunities and basic skills 17 32 (JOBS) program, food stamp employment and training program, 17 33 family development and self-sufficiency grants, 17 34 entrepreneurial training, and implementing family investment 17 35 agreements, in accordance with this section: 18 1 .................................................. $ 11,935,189 18 2 1. Of the funds appropriated in this section, $11,025,889 18 3 is allocated for the JOBS program. 18 4 2. The department shall continue to contract for services 18 5 in developing, delivering, and monitoring an entrepreneural 18 6 training waiver program to provide technical assistance in 18 7 self-employment training to families which receive assistance 18 8 under the family investment program, contingent upon federal 18 9 approval of waiver renewal requests. 18 10 3. Of the funds appropriated in this section, $129,985 is 18 11 allocated for the food stamp employment and training program. 18 12 4. Of the funds appropriated in this section, $779,315 is 18 13 allocated to the family development and self-sufficiency grant 18 14 program as provided under section 217.12. 18 15 a. Not more than 5 percent of the funds allocated in this 18 16 subsection shall be used for the administration of the grant 18 17 program. 18 18 b. Federal funding matched by state, county, or other 18 19 funding which is not appropriated in this section shall be 18 20 deposited in the department's JOBS account. If the match 18 21 funding is generated by a family development and self- 18 22 sufficiency grantee, the federal funding received shall be 18 23 used to expand the family development and self-sufficiency 18 24 grant program. If the match funding is generated by another 18 25 source, the federal funding received shall be used to expand 18 26 the grant program or the JOBS program. The department may 18 27 adopt emergency rules to implement the provisions of this 18 28 paragraph. 18 29 c. Based upon the annual evaluation report concerning each 18 30 grantee funded by this allocation, the family development and 18 31 self-sufficiency council may use funds allocated to renew 18 32 grants. 18 33 Sec. 8. CHILD SUPPORT RECOVERY. There is appropriated 18 34 from the general fund of the state to the department of human 18 35 services for the fiscal year beginning July 1, 1995, and 19 1 ending June 30, 1996, the following amount, or so much thereof 19 2 as is necessary, to be used for the purposes designated: 19 3 For child support recovery, including salaries, support, 19 4 maintenance, and miscellaneous purposes and for not more than 19 5 the following full-time equivalent positions: 19 6 .................................................. $ 6,390,000 19 7 ............................................... FTEs 226.22 19 8 1. The director of human services, within the limitations 19 9 of the funds appropriated in this section, or funds 19 10 transferred from the family investment program for this 19 11 purpose, shall establish new positions and add employees to 19 12 the child support recovery unit if the director determines 19 13 that both the current and additional employees together can 19 14 reasonably be expected to maintain or increase net state 19 15 revenue at or beyond the budgeted level. If the director adds 19 16 employees, the department shall demonstrate the cost- 19 17 effectiveness of the current and additional employees by 19 18 reporting to the joint appropriations subcommittee on human 19 19 services the ratio of the total amount of administrative costs 19 20 for child support recoveries to the total amount of the child 19 21 support recovered. 19 22 2. Nonpublic assistance application and user fees received 19 23 by the child support recovery program are appropriated and 19 24 shall be used for the purposes of the child support recovery 19 25 program. The director of human services may add positions if 19 26 fees collected relating to the new positions are sufficient to 19 27 pay the salaries and support for the positions. The director 19 28 shall report any positions added pursuant to this subsection 19 29 to the chairpersons and ranking members of the joint 19 30 appropriations subcommittee on human services and the 19 31 legislative fiscal bureau. 19 32 3. The director of human services, in consultation with 19 33 the department of management and the legislative fiscal 19 34 committee, is authorized to receive and deposit state child 19 35 support incentive earnings in the manner specified under 20 1 applicable federal requirements. 20 2 4. The director of human services may establish new 20 3 positions and add state employees to the child support 20 4 recovery unit if the director determines the employees are 20 5 necessary to replace county-funded positions eliminated due to 20 6 termination, reduction, or nonrenewal of a chapter 28E 20 7 contract. However, the director must also determine that the 20 8 resulting increase in the state share of child support 20 9 recovery incentives exceeds the cost of the positions, the 20 10 positions are necessary to ensure continued federal funding of 20 11 the program, or the new positions can reasonably be expected 20 12 to recover more than twice the amount of money to pay the 20 13 salaries and support for the new positions. 20 14 5. The child support recovery unit shall continue to work 20 15 with the judicial department to determine the feasibility of a 20 16 pilot project utilizing a court-appointed referee for judicial 20 17 determinations on child support matters. The extent and 20 18 location of any pilot project shall be jointly developed by 20 19 the judicial department and the child support recovery unit. 20 20 6. The department shall spend up to $50,000, including 20 21 federal financial participation, for the fiscal year beginning 20 22 July 1, 1995, for continuation of the child support public 20 23 awareness campaign. The department shall continue to 20 24 cooperate with the office of the attorney general in 20 25 continuation of the campaign. 20 26 7. The department shall continue the pilot program option 20 27 to provide and supervise a community service pilot project for 20 28 absent parents who are ordered by the court to perform 20 29 community service for failure to pay child support pursuant to 20 30 section 598.23A. 20 31 8. The director of human services may enter a contract 20 32 with private collection agencies to collect support payments 20 33 for cases which have been identified by the department as 20 34 difficult collection cases if the department determines that 20 35 this form of collection is more cost effective than 21 1 departmental collection methods. The director may use a 21 2 portion of the state share of funds collected through this 21 3 means to pay the costs of any contracts authorized under this 21 4 subsection. 21 5 9. The department shall employ at least one full-time 21 6 equivalent position to respond to telephone inquiries during 21 7 all weekly business hours. 21 8 Sec. 9. JUVENILE INSTITUTIONS. There is appropriated from 21 9 the general fund of the state to the department of human 21 10 services for the fiscal year beginning July 1, 1995, and 21 11 ending June 30, 1996, the following amount, or so much thereof 21 12 as is necessary, to be used for the purposes designated: 21 13 For the operation of the state training school and the Iowa 21 14 juvenile home, including salaries, support, maintenance, and 21 15 miscellaneous purposes and for not more than the following 21 16 full-time equivalent positions: 21 17 For the state juvenile institutions: 21 18 .................................................. $ 13,480,000 21 19 ............................................... FTEs 320.77 21 20 1. The following amounts of the funds appropriated and 21 21 full-time equivalent positions authorized in this section are 21 22 allocated for the Iowa juvenile home at Toledo: 21 23 .................................................. $ 4,980,000 21 24 ............................................... FTEs 118.54 21 25 2. The following amounts of the funds appropriated and 21 26 full-time equivalent positions authorized in this section are 21 27 allocated for the state training school at Eldora: 21 28 .................................................. $ 8,500,000 21 29 ............................................... FTEs 202.23 21 30 3. During the fiscal year beginning July 1, 1995, the 21 31 population levels at the state juvenile institutions shall not 21 32 exceed the population guidelines established under 1990 Iowa 21 33 Acts, chapter 1239, section 21. 21 34 4. Each state juvenile institution shall apply for 21 35 adolescent pregnancy prevention grants for the fiscal year 22 1 beginning July 1, 1995. 22 2 5. Within the funds appropriated in this section, the 22 3 department may reallocate funds as necessary to best fulfill 22 4 the needs of the institutions provided for in the 22 5 appropriation. 22 6 Sec. 10. CHILD AND FAMILY SERVICES. There is appropriated 22 7 from the general fund of the state to the department of human 22 8 services for the fiscal year beginning July 1, 1995, and 22 9 ending June 30, 1996, the following amount, or so much thereof 22 10 as is necessary, to be used for the purpose designated: 22 11 For child and family services: 22 12 .................................................. $ 83,380,000 22 13 1. The department may transfer moneys appropriated in this 22 14 section as necessary to pay the nonfederal costs of services 22 15 reimbursed under medical assistance or the family investment 22 16 program which are provided to children who would otherwise 22 17 receive services paid under the appropriation in this section. 22 18 The department may transfer funds appropriated in this section 22 19 to the appropriations in this Act for general administration 22 20 and for field operations for resources necessary to implement 22 21 and operate the services funded in this section. 22 22 2. a. Of the funds appropriated in this section, up to 22 23 $20,937,703 is allocated for group foster care maintenance and 22 24 services. For the fiscal year beginning July 1, 1995, the 22 25 statewide target, as provided in section 232.143, for the 22 26 daily average number of children placed in group foster care 22 27 services which are a charge upon or paid for by the state 22 28 shall be 1,220. Notwithstanding the statewide target 22 29 established in this subsection and sections 232.52, 232.102, 22 30 232.117, 232.127, and 232.182, a target established in a 22 31 region's group foster care plan developed pursuant to section 22 32 232.143 may be exceeded, a group foster care placement may be 22 33 ordered, and state payment may be made if a clinical 22 34 assessment and consultation team finds that the placement is 22 35 necessary to meet the child's needs. The department and the 23 1 courts shall work together to ensure that a region's group 23 2 foster care expenditures shall not exceed the funds allocated 23 3 to the region for group foster care placements in the 1995- 23 4 1996 fiscal year. However, regions may transfer bed days 23 5 between regions as necessary to meet group foster care needs. 23 6 The department may adopt emergency rules to implement the 23 7 provisions of this paragraph. 23 8 b. In each quarter of the fiscal year, the department 23 9 shall compare the actual number of group foster care 23 10 placements in a region and the targets allocated to the region 23 11 for that quarter. The department shall develop a methodology 23 12 to provide, within the funds allocated in this subsection, 23 13 fiscal incentives to regions which have reduced the number or 23 14 length of group foster care placements. 23 15 c. The department shall report quarterly to the 23 16 legislative fiscal bureau concerning the status of each 23 17 region's efforts to limit the number of group foster care 23 18 placements in accordance with the regional plan established 23 19 pursuant to section 232.143. 23 20 d. Notwithstanding the formula specified in section 23 21 232.143, subsection 1, the department and the judicial 23 22 department shall develop a formula for allocating a portion of 23 23 the statewide target to each of the department's regions based 23 24 on factors determined by the department and the judicial 23 25 department which may include but are not limited to historical 23 26 usage of group foster care beds and indicators of need for 23 27 group foster care placements. The formula shall be 23 28 established by May 1, 1995. The department may adopt 23 29 emergency rules to implement the provisions of this paragraph. 23 30 e. The department shall not certify any additional 23 31 enhanced residential treatment beds, unless the director of 23 32 human services approves the beds as necessary, based on the 23 33 type of children to be served and the location of the enhanced 23 34 residential treatment beds. 23 35 f. (1) Of the funds appropriated in this section, not 24 1 more than $6,439,398 is allocated as the state match funding 24 2 for psychiatric medical institutions for children. 24 3 (2) Based upon the director's decision pursuant to 1994 24 4 Iowa Acts, chapter 1186, section 10, subsection 19, regarding 24 5 the managed care approaches for determining service necessity 24 6 for children served by psychiatric medical institutions for 24 7 children (PMICs), the department may transfer all or a portion 24 8 of the moneys appropriated in this section for PMICs to the 24 9 appropriation in this Act for medical assistance and may amend 24 10 the managed mental health care contract to include PMICs, and 24 11 may increase the statewide target for group foster care 24 12 placements in paragraph "a" of this subsection, accordingly. 24 13 The department may adopt emergency rules to implement the 24 14 provisions of this paragraph. 24 15 g. Of the funds allocated in this subsection, not more 24 16 than $995,764 is allocated as the state match funding for 50 24 17 highly structured juvenile program beds. 24 18 3. The department shall establish a goal that not more 24 19 than 15 percent of the children placed in foster care funded 24 20 under the federal Social Security Act, Title IV-E, may be 24 21 placed in foster care for a period of more than 24 months. 24 22 4. In accordance with the provisions of section 232.188, 24 23 the department shall continue the program to decategorize 24 24 child welfare services in additional counties or clusters of 24 25 counties. 24 26 5. Of the funds appropriated in this section, up to 24 27 $96,512 is allocated for continued foster care services to a 24 28 child who is 18 years of age or older in accordance with the 24 29 provisions of section 234.35, subsection 3, paragraph "c". 24 30 However, if funding in this appropriation would remain 24 31 unobligated at the end of the fiscal year, the allocation in 24 32 this subsection may be exceeded to the extent necessary to 24 33 provide the continued foster care services. The department 24 34 shall distribute the moneys allocated in this subsection to 24 35 the department's regions based on each region's proportion of 25 1 the total number of children placed in foster care on March 31 25 2 preceding the beginning of the fiscal year, who, during the 25 3 fiscal year would no longer be eligible for foster care due to 25 4 age. 25 5 6. Notwithstanding section 232.142, subsection 3, the 25 6 financial aid paid by the state for the establishment, 25 7 improvements, operation, and maintenance of county or 25 8 multicounty juvenile detention homes in the fiscal year 25 9 beginning July 1, 1995, shall be limited to $872,500. Funds 25 10 allocated in this subsection shall be prorated among eligible 25 11 detention homes. 25 12 7. The amount of the appropriation made in this section 25 13 available for foster care is based upon expansion of the 25 14 number of children in foster care who are eligible for federal 25 15 supplemental security income (SSI). The department may use up 25 16 to $300,000 of those funds to enter into a performance-based 25 17 contract to secure SSI benefits for children placed in foster 25 18 care. The contract shall include provisions for training of 25 19 department of human services and juvenile court staff, 25 20 completion of applications, tracking of application results, 25 21 and representation during the appeals process whenever an 25 22 appeal is necessary to secure SSI benefits. Notwithstanding 25 23 section 217.30 and section 232.2, subsection 11, and any other 25 24 provision of law to the contrary, the director or the 25 25 director's designee on behalf of a child in foster care may 25 26 release medical, mental health, substance abuse, or any other 25 27 information necessary only to determine the child's 25 28 eligibility for SSI benefits, and may sign releases for the 25 29 information. In any release of information made pursuant to 25 30 this subsection, confidentiality shall be maintained to the 25 31 maximum extent possible. 25 32 8. A portion of the funds appropriated in this section may 25 33 be used for emergency family assistance to provide other 25 34 resources required for a family participating in a family 25 35 preservation or reunification project to stay together or to 26 1 be reunified. 26 2 9. Notwithstanding section 234.35, subsection 1, for the 26 3 fiscal year beginning July 1, 1995, state funding for shelter 26 4 care paid pursuant to section 234.35, subsection 1, paragraph 26 5 "h", shall be limited to $3,383,736. The department may adopt 26 6 emergency rules to implement the provisions of this 26 7 subsection. 26 8 10. Of the funds appropriated in this section, not more 26 9 than $512,862 may be used to develop and maintain the state's 26 10 implementation of the national adoption and foster care 26 11 information system pursuant to the requirements of Pub. L. No. 26 12 99-509. The department may transfer funds as necessary from 26 13 the appropriations in this Act for field operations and 26 14 general administration to implement this subsection. Moneys 26 15 allocated in accordance with this subsection shall be 26 16 considered encumbered for the purposes of section 8.33. 26 17 11. Of the funds appropriated in this section, $1,000,000 26 18 is allocated for respite services to families of children with 26 19 mental retardation or other developmental disabilities, who 26 20 would otherwise enter or continue group care or foster family 26 21 home placement. On or before January 4, 1996, the department 26 22 shall review the use of the funding allocated in this 26 23 subsection and project whether an amount of the funding will 26 24 be unused by the close of the fiscal year. If an amount is 26 25 projected, the department shall transfer the projected amount 26 26 to the appropriation in this Act for family support subsidy 26 27 for use to provide assistance to additional families who would 26 28 otherwise remain on the waiting list for that program. The 26 29 department shall work with the Iowa governor's planning 26 30 council for developmental disabilities, the arc of Iowa, the 26 31 Iowa respite coalition, and the Iowa family support initiative 26 32 to review use of the program funded in this section and 26 33 develop recommendations for consideration in the 1996 26 34 legislative session. The recommendations shall address how 26 35 much of the funding should be directed to families trying to 27 1 keep their children with disabilities in the family home, 27 2 potential administrative rule revisions to improve the 27 3 program, and actions for the department to take to inform 27 4 families about the program. The department may adopt 27 5 administrative rules to implement the provisions of this 27 6 subsection. 27 7 12. Of the funds appropriated in this section, up to 27 8 $673,217 may be used as determined by the department for any 27 9 of the following purposes: 27 10 a. For general administration of the department to improve 27 11 staff training efforts. 27 12 b. For oversight of termination of parental rights and 27 13 permanency planning efforts on a statewide basis. 27 14 c. For personnel, assigned by the attorney general, to 27 15 provide additional services relating to termination of 27 16 parental rights and child in need of assistance cases. 27 17 d. For specialized permanency planning field operations 27 18 staff. 27 19 13. The department may adopt administrative rules to 27 20 implement outcome-based child welfare services pilot projects. 27 21 The rules may include, but are not limited to, the development 27 22 of program descriptions, provider licensing and certification 27 23 standards, reimbursement and payment amounts, contract 27 24 requirements, assessment and service necessity requirements, 27 25 eligibility criteria, claims submission procedures, and 27 26 accountability standards. 27 27 14. Of the funds appropriated in this section, up to 27 28 $133,230 may be used to develop a performance-based monitoring 27 29 program to evaluate and improve outcomes for children and 27 30 families. The department may adopt administrative rules to 27 31 implement this subsection. 27 32 15. The department may develop, within the funds 27 33 available, a pilot kinship care project to enhance family 27 34 involvement in the development of the permanency plan required 27 35 under chapter 232 for children who are removed from their 28 1 homes. The project components may include family involvement 28 2 before and after removal of the child and shall stress safety 28 3 for the child. 28 4 16. Within the funds appropriated in this section, the 28 5 department may develop a subsidized guardianship program to 28 6 provide financial assistance to guardians of children who have 28 7 a permanency order under section 232.104, subsection 2, 28 8 paragraph "d", subparagraph (1), in cases in which all of the 28 9 following conditions exist: 28 10 a. The option of reunification has been eliminated and 28 11 termination of parental rights is not appropriate. 28 12 b. The child has lived with the potential guardian for at 28 13 least six months. 28 14 c. The child is either 14 years of age or older or, if 28 15 under 14 years of age, is part of a sibling group and cannot 28 16 be made available for adoption. 28 17 d. The placement does not require departmental 28 18 supervision. 28 19 The financial assistance provided shall be in the same 28 20 amount as provided for family foster care. For purposes of 28 21 medical assistance and child support recovery, these payments 28 22 shall be considered foster care payments. 28 23 17. Of the funds appropriated in this section, up to 28 24 $175,000 may be used to establish and maintain a truancy pilot 28 25 initiative in the fifth judicial district which shall be 28 26 directed to keeping targeted youth in school by providing 28 27 noneducational supportive and therapy services both inside and 28 28 outside the school setting. The department may adopt 28 29 administrative rules to implement supportive and therapy 28 30 services in the truancy pilot initiative. The rules may 28 31 include, but are not limited to, the development of program 28 32 descriptions, certification standards, reimbursement, contract 28 33 requirements, and eligibility and accountability standards. 28 34 18. The department, in cooperation with interested social 28 35 service providers, shall study the feasibility of expanding 29 1 existing confidentiality provisions to allow social service 29 2 providers to form local teams to discuss provision of the most 29 3 appropriate services in individual cases. The department 29 4 shall submit a report of the findings of the study to the 29 5 chairpersons and ranking members of the joint appropriations 29 6 subcommittee on human services on or before January 1, 1996. 29 7 19. Notwithstanding section 234.39, if a child was removed 29 8 from the child's home and placed in foster care during the 29 9 fiscal year beginning July 1, 1994, based upon an allegation 29 10 of child abuse that was subsequently determined to be 29 11 unfounded, a support obligation shall not be established for 29 12 the child's parent or guardian for the cost of the foster 29 13 care. 29 14 20. The department shall continue to make adoption 29 15 presubsidy and adoption subsidy payments to adoptive parents 29 16 at the beginning of the month for the current month. 29 17 Sec. 11. COMMUNITY-BASED PROGRAMS. There is appropriated 29 18 from the general fund of the state to the department of human 29 19 services for the fiscal year beginning July 1, 1995, and 29 20 ending June 30, 1996, the following amount, or so much thereof 29 21 as is necessary, to be used for the purpose designated: 29 22 For community-based programs, on the condition that family 29 23 planning services are funded, including salaries, support, 29 24 maintenance, and miscellaneous purposes and for not more than 29 25 the following full-time equivalent positions: 29 26 .................................................. $ 2,620,000 29 27 ............................................... FTEs 1.0 29 28 1. Of the funds appropriated in this section, $754,000 29 29 shall be used for adolescent pregnancy prevention grants, 29 30 including not more than $156,048 for programs to prevent 29 31 second or subsequent pregnancies during the adolescent years 29 32 and to provide support services for pregnant or parenting 29 33 adolescents. Rules adopted by the department may allow for 29 34 revision of existing grant categories and the addition of 29 35 grant categories which allow for the development and 30 1 initiation of a statewide adolescent pregnancy prevention 30 2 campaign and of a statewide assessment or evaluation grant. 30 3 2. Of the funds appropriated in this section, $298,000 30 4 shall be used for grants to community or regional groups which 30 5 demonstrate broad-based representation from community 30 6 representatives including but not limited to schools, 30 7 churches, human service-related organizations, and businesses. 30 8 Priority in the awarding of grants shall be given to groups 30 9 which provide services to both urban and rural areas within 30 10 the proximity of the community or region and which provide 30 11 age-appropriate programs adapted for both male and female 30 12 youth at the elementary, middle, and high school levels. A 30 13 program shall focus on the prevention of initial pregnancies 30 14 during the adolescent years by emphasizing sexual abstinence 30 15 as the only completely safe and effective means of avoiding 30 16 pregnancy and sexually transmitted diseases and by providing 30 17 information regarding the comparative failure rates of 30 18 contraceptives, and by emphasizing responsible decision making 30 19 in relationships, managing of peer and social pressures, 30 20 development of self-esteem, the costs and responsibilities of 30 21 parenting, and information regarding the alternative of 30 22 adoption for placement of a child. The program shall also 30 23 include an evaluation and assessment component which includes 30 24 evaluation of and recommendations for improvement of the 30 25 program by the youth and parents involved. Evaluation and 30 26 assessment reports shall be provided to the department of 30 27 human services, at a time determined by the department in the 30 28 grant award. Community or regional groups interested in 30 29 applying for a grant under this subsection may be issued a 30 30 planning grant or may utilize grant moneys for the costs of 30 31 technical assistance to analyze community needs, match service 30 32 providers to needs, negotiate service provision strategies, or 30 33 other assistance to focus grant services provided under this 30 34 subsection. The technical assistance may be provided by 30 35 organizations affiliated with institutions under the authority 31 1 of the state board of regents or other organizations 31 2 experienced in providing technical assistance concerning 31 3 similar services. 31 4 3. Of the funds appropriated in this section, $731,014 31 5 shall be used by the department for child abuse prevention 31 6 grants. 31 7 4. Of the funds appropriated in this section, an 31 8 additional $100,000, based upon the amount allocated in the 31 9 previous fiscal year, shall be used for family planning 31 10 services. 31 11 Sec. 12. COURT-ORDERED SERVICES PROVIDED TO JUVENILES. 31 12 There is appropriated from the general fund of the state to 31 13 the department of human services for the fiscal year beginning 31 14 July 1, 1995, and ending June 30, 1996, the following amount, 31 15 or so much thereof as is necessary, to be used for the purpose 31 16 designated: 31 17 Payment of the expenses of court-ordered services provided 31 18 to juveniles which are a charge upon the state pursuant to 31 19 section 232.141, subsection 4: 31 20 .................................................. $ 3,090,000 31 21 1. Notwithstanding section 232.141 or any other provision 31 22 of law, the funds appropriated in this section shall be 31 23 allocated to the judicial districts as determined by the state 31 24 court administrator. The state court administrator shall make 31 25 the determination on the allocations on or before June 15. 31 26 2. a. Each judicial district shall continue the planning 31 27 group for the court-ordered services for juveniles provided in 31 28 that district which was established pursuant to 1991 Iowa 31 29 Acts, chapter 267, section 119. A planning group shall 31 30 continue to perform its duties as specified in that law. 31 31 Reimbursement rates for providers of court-ordered evaluation 31 32 and treatment services paid under section 232.141, subsection 31 33 4, shall be negotiated with providers by each judicial 31 34 district's planning group. 31 35 b. Each district planning group shall submit an annual 32 1 report in January to the state court administrator and the 32 2 department of human services. The report shall cover the 32 3 preceding fiscal year and shall include a preliminary report 32 4 on the current fiscal year. The administrator and the 32 5 department shall compile these reports and submit the reports 32 6 to the chairpersons and ranking members of the joint 32 7 appropriations subcommittee on human services and the 32 8 legislative fiscal bureau. 32 9 3. The department of human services shall develop policies 32 10 and procedures to ensure that the funds appropriated in this 32 11 section are spent only after all other reasonable actions have 32 12 been taken to utilize other funding sources and community- 32 13 based services. The policies and procedures shall be designed 32 14 to achieve the following objectives relating to services 32 15 provided under chapter 232: 32 16 a. Maximize the utilization of funds which may be 32 17 available from the medical assistance program including usage 32 18 of the early and periodic screening, diagnosis, and treatment 32 19 (EPSDT) program. 32 20 b. Recover payments from any third-party insurance carrier 32 21 which is liable for coverage of the services, including health 32 22 insurance coverage. 32 23 c. Pursue development of agreements with regularly 32 24 utilized out-of-state service providers which are intended to 32 25 reduce per diem costs paid to those providers. 32 26 4. The department of human services, in consultation with 32 27 the state court administrator and the judicial district 32 28 planning groups, shall compile a monthly report describing 32 29 spending in the districts for court-ordered services for 32 30 juveniles, including the utilization of the medical assistance 32 31 program. The reports shall be submitted on or before the 32 32 twentieth day of each month to the chairpersons and ranking 32 33 members of the joint appropriations subcommittee on human 32 34 services and the legislative fiscal bureau. 32 35 5. Notwithstanding chapter 232 or any other provision of 33 1 law, a district or juvenile court in a department of human 33 2 services district shall not order any service which is a 33 3 charge upon the state pursuant to section 232.141 if there are 33 4 insufficient court-ordered services funds available in the 33 5 district allocation to pay for the service. The chief 33 6 juvenile court officer shall work with the judicial district 33 7 planning group to encourage use of the funds appropriated in 33 8 this section such that there are sufficient funds to pay for 33 9 all court-related services during the entire year. The eight 33 10 chief juvenile court officers shall attempt to anticipate 33 11 potential surpluses and shortfalls in the allocations and 33 12 shall cooperatively request the state court administrator to 33 13 transfer funds between the districts' allocations as prudent. 33 14 6. Notwithstanding any provision of law to the contrary, a 33 15 district or juvenile court shall not order a county to pay for 33 16 any service provided to a juvenile pursuant to an order 33 17 entered under chapter 232 which is a charge upon the state 33 18 under section 232.141, subsection 4. 33 19 7. Of the funds appropriated in this section, not more 33 20 than $200,000 may be used by the judicial department for 33 21 administration of the requirements under this section and for 33 22 travel associated with court-ordered placements which are a 33 23 charge upon the state pursuant to section 232.141, subsection 33 24 4. 33 25 8. Of the funds appropriated in this section, not more 33 26 than $400,000 may be transferred to the appropriation in this 33 27 Act for child and family services and used to provide school- 33 28 based supervision of children adjudicated under chapter 232. 33 29 Sec. 13. MENTAL HEALTH INSTITUTES. There is appropriated 33 30 from the general fund of the state to the department of human 33 31 services for the fiscal year beginning July 1, 1995, and 33 32 ending June 30, 1996, the following amount, or so much thereof 33 33 as is necessary, to be used for the purposes designated: 33 34 For the state mental health institutes for salaries, 33 35 support, maintenance, and miscellaneous purposes and for not 34 1 more than the following full-time equivalent positions: 34 2 .................................................. $ 43,190,000 34 3 ............................................... FTEs 954.75 34 4 1. The funds appropriated and full-time equivalent 34 5 positions authorized in this section are allocated as follows: 34 6 a. State mental health institute at Cherokee: 34 7 .................................................. $ 14,840,000 34 8 ............................................... FTEs 331.13 34 9 b. State mental health institute at Clarinda: 34 10 .................................................. $ 6,000,000 34 11 ............................................... FTEs 136.82 34 12 c. State mental health institute at Independence: 34 13 .................................................. $ 17,590,000 34 14 ............................................... FTEs 401.82 34 15 d. State mental health institute at Mount Pleasant: 34 16 .................................................. $ 4,760,000 34 17 ............................................... FTEs 84.98 34 18 2. Within the funds appropriated in this section, the 34 19 department may reallocate funds as necessary to best fulfill 34 20 the needs of the institutions provided for in the 34 21 appropriation. 34 22 3. As part of the discharge planning process at the state 34 23 mental health institutes, the department shall provide 34 24 assistance in obtaining eligibility for federal supplemental 34 25 security income (SSI) to those individuals whose care at a 34 26 state mental health institute is the financial responsibility 34 27 of the state. 34 28 Sec. 14. HOSPITAL-SCHOOLS. There is appropriated from the 34 29 general fund of the state to the department of human services 34 30 for the fiscal year beginning July 1, 1995, and ending June 34 31 30, 1996, the following amount, or so much thereof as is 34 32 necessary, to be used for the purposes designated: 34 33 For the state hospital-schools, for salaries, support, 34 34 maintenance, and miscellaneous purposes and for not more than 34 35 the following full-time equivalent positions: 35 1 .................................................. $ 66,260,000 35 2 ............................................... FTEs 1,666.00 35 3 1. The funds appropriated and full-time equivalent 35 4 positions authorized in this section are allocated as follows: 35 5 a. State hospital-school at Glenwood: 35 6 .................................................. $ 35,830,000 35 7 ............................................... FTEs 910.00 35 8 b. State hospital-school at Woodward: 35 9 .................................................. $ 30,430,000 35 10 ............................................... FTEs 756.00 35 11 2. Within the funds appropriated in this section, the 35 12 department may reallocate funds as necessary to best fulfill 35 13 the needs of the institutions provided for in the 35 14 appropriation. 35 15 Sec. 15. MENTAL ILLNESS SPECIAL SERVICES. There is 35 16 appropriated from the general fund of the state to the 35 17 department of human services for the fiscal year beginning 35 18 July 1, 1995, and ending June 30, 1996, the following amount, 35 19 or so much thereof as is necessary, to be used for the purpose 35 20 designated: 35 21 For mental illness special services: 35 22 .................................................. $ 121,220 35 23 1. The department and the Iowa finance authority shall 35 24 develop methods to implement the financing for existing 35 25 community-based facilities and to implement financing for the 35 26 development of affordable community-based housing facilities. 35 27 The department shall assure that clients are referred to the 35 28 housing as it is developed. 35 29 2. The funds appropriated in this section are to provide 35 30 funds for construction and start-up costs to develop community 35 31 living arrangements to provide for persons with mental illness 35 32 who are homeless. These funds may be used to match federal 35 33 Stewart B. McKinney Homeless Assistance Act grant funds. 35 34 Sec. 16. FAMILY SUPPORT SUBSIDY PROGRAM. There is 35 35 appropriated from the general fund of the state to the 36 1 department of human services for the fiscal year beginning 36 2 July 1, 1995, and ending June 30, 1996, the following amount, 36 3 or so much thereof as is necessary, to be used for the purpose 36 4 designated: 36 5 For the family support subsidy program: 36 6 .................................................. $ 1,110,000 36 7 Sec. 17. SPECIAL NEEDS GRANTS. There is appropriated from 36 8 the general fund of the state to the department of human 36 9 services for the fiscal year beginning July 1, 1995, and 36 10 ending June 30, 1996, the following amount, or so much thereof 36 11 as is necessary, to be used for the purpose designated: 36 12 To provide special needs grants to families with a family 36 13 member at home who has a developmental disability or to a 36 14 person with a developmental disability: 36 15 .................................................. $ 53,212 36 16 Grants must be used by a family to defray special costs of 36 17 caring for the family member to prevent out-of-home placement 36 18 of the family member or to provide for independent living 36 19 costs. A grant may provide up to $5,000 per person for costs 36 20 associated with an assistive animal. The grants may be 36 21 administered by a private nonprofit agency which serves people 36 22 statewide provided that no administrative costs are received 36 23 by the agency. Regular reports regarding the special needs 36 24 grants with the family support subsidy program and an annual 36 25 report concerning the characteristics of the grantees shall be 36 26 provided to the legislative fiscal bureau. 36 27 Sec. 18. MI/MR/DD STATE CASES. There is appropriated from 36 28 the general fund of the state to the department of human 36 29 services for the fiscal year beginning July 1, 1995, and 36 30 ending June 30, 1996, the following amount, or so much thereof 36 31 as is necessary, to be used for the purposes designated: 36 32 For purchase of local services for persons with mental 36 33 illness, mental retardation, and developmental disabilities 36 34 where the client has no established county of legal 36 35 settlement: 37 1 .................................................. $ 5,470,000 37 2 Sec. 19. MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES &endash; 37 3 COMMUNITY SERVICES FUND. There is appropriated from the 37 4 general fund of the state to the mental health and 37 5 developmental disabilities community services fund created in 37 6 section 225C.7 for the fiscal year beginning July 1, 1995, and 37 7 ending June 30, 1996, the following amount, or so much thereof 37 8 as is necessary, to be used for the purpose designated: 37 9 For mental health and developmental disabilities community 37 10 services in accordance with this Act: 37 11 ................................................. $ 16,230,000 37 12 1. Of the funds appropriated in this section, $15,951,138 37 13 shall be allocated to counties for funding of community-based 37 14 mental health and developmental disabilities services. The 37 15 moneys shall be allocated to a county as follows: 37 16 a. Fifty percent based upon the county's proportion of the 37 17 state's population of persons with an annual income which is 37 18 equal to or less than the poverty guideline established by the 37 19 federal office of management and budget. 37 20 b. Fifty percent based upon the county's proportion of the 37 21 state's general population. 37 22 2. a. A county shall utilize the funding the county 37 23 receives pursuant to subsection 1 for services provided to 37 24 persons with a disability, as defined in section 225C.2. 37 25 However, no more than 50 percent of the funding shall be used 37 26 for services provided to any one of the service populations. 37 27 b. A county shall use at least 50 percent of the funding 37 28 the county receives under subsection 1 for contemporary 37 29 services provided to persons with a disability. 37 30 c. The mental health and developmental disabilities 37 31 commission shall adopt rules pursuant to chapter 17A 37 32 describing the contemporary services. The commission may 37 33 adopt administrative rules to implement this subsection. 37 34 3. Of the funds appropriated in this section, $30,000 37 35 shall be used to support the Iowa compass program providing 38 1 computerized information and referral services for Iowans with 38 2 disabilities and their families. 38 3 4. The department shall submit an annual report concerning 38 4 each population served and each service funded in this section 38 5 to the chairpersons and ranking members of the joint 38 6 appropriations subcommittee on human services and the 38 7 legislative fiscal bureau. 38 8 5. a. A mental health and developmental disabilities 38 9 regional planning council established pursuant to section 38 10 225C.18 shall develop plans for the provision of services for 38 11 the fiscal year beginning July 1, 1995, for persons with a 38 12 disability in the county or counties comprising the planning 38 13 council. 38 14 b. County expenditure reports for services provided to 38 15 persons with a disability for the prior fiscal year are due to 38 16 the department on or before October 15, 1995. The county 38 17 MI/MR/DD/BI plan for the fiscal year beginning July 1, 1995, 38 18 is due to the department on or before April 1, 1995. 38 19 6. Of the funds appropriated in this section, not more 38 20 than $248,862 shall be provided to those counties having 38 21 supplemental per diem contracts in effect on June 30, 1994, 38 22 which were originally initiated under 1993 Iowa Acts, chapter 38 23 172, section 16, subsection 2. The amount provided to each 38 24 county shall be equal to the amount the county would be 38 25 eligible to receive under the supplemental per diem contracts 38 26 in effect on June 30, 1994, if the contracts were continued in 38 27 effect for the entire fiscal year beginning July 1, 1995. 38 28 7. a. Funding from the federal social services block 38 29 grant in the amount of $13,038,763 is allocated for 38 30 distribution to counties for local purchase of services for 38 31 persons with mental illness or mental retardation or other 38 32 developmental disability. 38 33 b. The funds allocated in this subsection shall be 38 34 expended by counties in accordance with eligibility guidelines 38 35 established in the department's rules outlining general 39 1 provisions for service administration. Services eligible for 39 2 payment with funds allocated in this subsection are limited to 39 3 any of the following which are provided in accordance with the 39 4 department's administrative rules for the services: adult 39 5 support, adult day care, administrative support for 39 6 volunteers, community supervised apartment living 39 7 arrangements, residential services for adults, sheltered work, 39 8 supported employment, supported work training, transportation, 39 9 and work activity. 39 10 c. In purchasing services with funds allocated in this 39 11 subsection, a county shall designate a person to provide for 39 12 eligibility determination and development of a case plan for 39 13 individuals for whom the services are purchased. The 39 14 designated person shall be a medical assistance case manager 39 15 serving the person's county of residence. If an individual 39 16 does not have a case manager, the individual's eligibility 39 17 shall be determined by a social services caseworker of the 39 18 department serving the individual's county of residence. The 39 19 case plan shall be developed in accordance with the 39 20 department's rules outlining general provisions for service 39 21 administration. 39 22 d. Services purchased with funds allocated in this 39 23 subsection must be the result of a referral by the person who 39 24 identified the services in developing the individual's case 39 25 plan. 39 26 e. Services purchased with funds allocated in this 39 27 subsection must be under a purchase of service contract 39 28 established in accordance with the department's administrative 39 29 rules for purchase of service. 39 30 f. The funds provided by this subsection shall be 39 31 allocated to each county as follows: 39 32 (1) Fifty percent based upon the county's proportion of 39 33 the state's population of persons with an annual income which 39 34 is equal to or less than the poverty guideline established by 39 35 the federal office of management and budget. 40 1 (2) Fifty percent based upon the amount provided to the 40 2 county for local purchase services in the preceding fiscal 40 3 year. 40 4 g. Each county shall submit to the department a plan for 40 5 funding of the services eligible for payment under this 40 6 subsection. The plan may provide for allocation of the funds 40 7 for one or more of the eligible services. The plan shall 40 8 identify the funding amount the county allocates for each 40 9 service and the time period for which the funding will be 40 10 available. Only those services which have funding allocated 40 11 in the plan are eligible for payment with funds provided in 40 12 this subsection. 40 13 h. A county shall provide advance notice to the individual 40 14 receiving services, the service provider, and the person 40 15 responsible for developing the case plan of the date the 40 16 county determines that funding will no longer be available for 40 17 a service. 40 18 i. Moneys allocated to a county pursuant to paragraph "f" 40 19 shall be provided to the county as claims are submitted to the 40 20 state. 40 21 j. The moneys provided under this subsection do not 40 22 establish an entitlement to the services funded under this 40 23 subsection. 40 24 Sec. 20. PERSONAL ASSISTANCE &endash; FAMILY SUPPORT. There is 40 25 appropriated from the general fund of the state to the 40 26 department of human services for the fiscal year beginning 40 27 July 1, 1995, and ending June 30, 1996, the following amount 40 28 or so much thereof as is necessary, to be used for the purpose 40 29 designated: 40 30 For implementing a pilot project for the personal 40 31 assistance services program in accordance with this section: 40 32 .................................................. $ 250,000 40 33 1. The funds appropriated in this section shall be used by 40 34 the division of mental health and developmental disabilities 40 35 to implement a pilot project for the personal assistance 41 1 services program under section 225C.46 in an urban and a rural 41 2 area. A portion of the funds may be used for costs to develop 41 3 a federal home and community-based waiver under the medical 41 4 assistance program for persons with physical disabilities or 41 5 other expenditures necessary to develop the personal 41 6 assistance program in the most appropriate and cost-effective 41 7 manner. However, not more than $50,000 shall be used for 41 8 administrative costs. The pilot project and the waiver shall 41 9 not be implemented in a manner that would require additional 41 10 county or state costs for assistance provided to an individual 41 11 served under the pilot project or the waiver. 41 12 2. In cooperation with the personal assistance and family 41 13 support services council, the Iowa family support initiative, 41 14 and the governor's planning council for developmental 41 15 disabilities, the department shall apply for any federal funds 41 16 made available through the federal Families of Children with 41 17 Disabilities Support Act of 1994, provided no new state or 41 18 county funds are needed to match the federal funds. The 41 19 department may use funds from existing programs as matching 41 20 funds, provided the program goals are consistent and 41 21 reductions in services for program recipients do not occur. 41 22 The department shall use the personal assistance and family 41 23 support services council to meet any federal requirements for 41 24 a state board policy group, or may use a subgroup of the 41 25 council if necessary for meeting federal specifications on 41 26 size, composition, configuration, or functioning relating to a 41 27 federal requirement for a policy group. The department's 41 28 planning for a comprehensive family support initiative under 41 29 section 225C.47 and this subsection shall address options for 41 30 a means test eligibility requirement and for local review of 41 31 eligibility by existing bodies such as the mental health and 41 32 developmental disabilities regional planning councils created 41 33 pursuant to section 225C.18. 41 34 Sec. 21. FIELD OPERATIONS. There is appropriated from the 41 35 general fund of the state to the department of human services 42 1 for the fiscal year beginning July 1, 1995, and ending June 42 2 30, 1996, the following amount, or so much thereof as is 42 3 necessary, to be used for the purpose designated: 42 4 For field operations, including salaries, support, 42 5 maintenance, and miscellaneous purposes and for not more than 42 6 the following full-time equivalent positions: 42 7 ................................................. $ 38,140,000 42 8 ............................................... FTEs 2009.50 42 9 The department may exceed the quantity of full-time 42 10 equivalent positions authorized in this section by up to 8.5 42 11 FTEs as necessary to increase services for the permanent 42 12 placement of children for whom parental rights have been 42 13 terminated and who are under the guardianship of the 42 14 department. 42 15 Sec. 22. GENERAL ADMINISTRATION. There is appropriated 42 16 from the general fund of the state to the department of human 42 17 services for the fiscal year beginning July 1, 1995, and 42 18 ending June 30, 1996, the following amount, or so much thereof 42 19 as is necessary, to be used for the purpose designated: 42 20 For general administration, including salaries, support, 42 21 maintenance, and miscellaneous purposes and for not more than 42 22 the following full-time equivalent positions: 42 23 .................................................. $ 10,907,951 42 24 ............................................... FTEs 375.50 42 25 Of the funds appropriated in this section, $57,090 is 42 26 allocated for the prevention of disabilities policy council 42 27 established in section 225B.3. 42 28 Sec. 23. VOLUNTEERS. There is appropriated from the 42 29 general fund of the state to the department of human services 42 30 for the fiscal year beginning July 1, 1995, and ending June 42 31 30, 1996, the following amount, or so much thereof as is 42 32 necessary, to be used for the purpose designated: 42 33 For development and coordination of volunteer services: 42 34 .................................................. $ 85,793 42 35 Sec. 24. "X-PERT" PUBLIC ASSISTANCE BENEFIT ELIGIBILITY 43 1 DETERMINATION SYSTEM. There is appropriated from the general 43 2 fund of the state to the department of human services for the 43 3 fiscal year beginning July 1, 1995, and ending June 30, 1996, 43 4 the following amount, or so much thereof as is necessary, to 43 5 be used for the purpose designated: 43 6 For the development costs of the "X-PERT" knowledge-based 43 7 computer software package for public assistance benefit 43 8 eligibility determination, including salaries, support, 43 9 maintenance, and miscellaneous purposes and for not more than 43 10 the following full-time equivalent positions: 43 11 .................................................. $ 919,000 43 12 ............................................... FTEs 17.00 43 13 Moneys appropriated in this section shall be considered 43 14 encumbered for the purposes of section 8.33. 43 15 Sec. 25. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY 43 16 ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE 43 17 DEPARTMENT OF HUMAN SERVICES. 43 18 1. a. For the fiscal year beginning July 1, 1995, the 43 19 department of human services may allocate any increases in 43 20 payments for durable medical products and supplies so that 43 21 equipment and supplies which have greater wholesale cost 43 22 increases may be reimbursed at a higher rate and those which 43 23 have a lower or no wholesale cost increase may be reimbursed 43 24 at a lower rate or have no increase. 43 25 b. For the fiscal year beginning July 1, 1995, providers 43 26 of obstetric services when provided by physicians or certified 43 27 nurse-midwives shall have their medical assistance 43 28 reimbursement rates increased by 5.0 percent over the rates in 43 29 effect on June 30, 1995. 43 30 c. For the fiscal year beginning July 1, 1995, skilled 43 31 nursing facilities shall have their medical assistance rates 43 32 increased by 4.6 percent over the rates in effect on June 30, 43 33 1995. 43 34 d. The dispensing fee for pharmacists shall remain at the 43 35 rate in effect on June 30, 1995. The reimbursement policy for 44 1 drug product costs shall be in accordance with federal 44 2 requirements. 44 3 e. Reimbursement rates for in-patient and outpatient 44 4 hospital services shall be increased by an average of 4.2 44 5 percent over the rates in effect on June 30, 1995. The 44 6 department shall continue the outpatient hospital 44 7 reimbursement system based upon ambulatory patient groups 44 8 implemented pursuant to 1994 Iowa Acts, chapter 1186, section 44 9 25, subsection 1, paragraph "f". In addition, the department 44 10 shall continue the revised medical assistance payment policy 44 11 implemented pursuant to that paragraph to provide 44 12 reimbursement for costs of screening and treatment provided in 44 13 the hospital emergency room is made pursuant to the 44 14 prospective payment methodology developed by the department 44 15 for the payment of outpatient services provided under the 44 16 medical assistance program. 44 17 f. Reimbursement rates for rural health clinics shall be 44 18 increased in accordance with increases under the federal 44 19 medicare program. 44 20 g. Home health agencies certified for the federal medicare 44 21 program, hospice services, and acute care mental hospitals 44 22 shall be reimbursed for their current federal medicare audited 44 23 costs. 44 24 h. The basis for establishing the maximum medical 44 25 assistance reimbursement rate for nursing facilities shall be 44 26 the 70th percentile of facility costs as calculated from the 44 27 June 30, 1995, unaudited compilation of cost and statistical 44 28 data. However, to the extent funds are available within the 44 29 amount projected for reimbursement of nursing facilities 44 30 within the appropriation for medical assistance in this Act, 44 31 and within the appropriation for medical assistance as a 44 32 whole, the department shall adjust the maximum medical 44 33 assistance reimbursement for nursing facilities to the 70th 44 34 percentile, as calculated on December 31, 1995, unaudited 44 35 compilation of cost and statistical data and the adjustment 45 1 shall take effect January 1, 1996. 45 2 i. The department may revise the fee schedule used for 45 3 physician reimbursement. 45 4 j. Federally qualified health centers shall be reimbursed 45 5 at 100 percent of reasonable costs as determined by the 45 6 department in accordance with federal requirements. 45 7 k. Reimbursement for air ambulance service shall be $7.50 45 8 per mile and the base rate is $200. 45 9 2. For the fiscal year beginning July 1, 1995, the maximum 45 10 cost reimbursement rate for residential care facilities 45 11 reimbursed by the department shall be $21.32 per day. The 45 12 flat reimbursement rate for facilities electing not to file 45 13 semiannual cost reports shall be $15.25 per day. For the 45 14 fiscal year beginning July 1, 1995, the maximum reimbursement 45 15 rate for providers reimbursed under the in-home health-related 45 16 care program shall be $409.89 per month. 45 17 3. Unless otherwise directed in this section, when the 45 18 department's reimbursement methodology for any provider 45 19 reimbursed in accordance with this section includes an 45 20 inflation factor, this factor shall not exceed the amount by 45 21 which the consumer price index for all urban consumers 45 22 increased during the calendar year ending December 31, 1994. 45 23 4. Notwithstanding section 234.38, in the fiscal year 45 24 beginning July 1, 1995, the foster family basic daily 45 25 maintenance rate and the maximum adoption subsidy rate for 45 26 children ages 0 through 5 years shall be $12.00, the rate for 45 27 children ages 6 through 11 years shall be $12.72, the rate for 45 28 children ages 12 through 15 years shall be $13.89, and the 45 29 rate for children ages 16 and older shall be $14.73. 45 30 Effective July 1, 1995, payments to foster and adoptive 45 31 families shall be calculated on a daily basis. Effective July 45 32 1, 1995, the special care allowance paid to adoptive families 45 33 who have adopted a child with special needs and are eligible 45 34 for an adoptive subsidy shall be the same as foster care. 45 35 5. For the fiscal year beginning July 1, 1995, the maximum 46 1 reimbursement rates for social service providers shall be the 46 2 same as the rates in effect on June 30, 1995, except under any 46 3 of the following circumstances: 46 4 a. If a new service was added after June 30, 1995, the 46 5 initial reimbursement rate for the service shall be based upon 46 6 actual and allowable costs. 46 7 b. If a social service provider loses a source of income 46 8 used to determine the reimbursement rate for the provider, the 46 9 provider's reimbursement rate may be adjusted to reflect the 46 10 loss of income, provided that the lost income was used to 46 11 support actual and allowable costs of a service purchased 46 12 under a purchase of service contract. 46 13 c. The department revises the reimbursement rates due to 46 14 implementation of a redesigned purchase of services system. 46 15 6. The group foster care reimbursement rates paid for 46 16 placement of children out-of-state shall be calculated 46 17 according to the same rate-setting principles as those used 46 18 for in-state providers unless the director determines that 46 19 appropriate care cannot be provided within the state. The 46 20 payment of the daily rate shall be based on the number of days 46 21 in the calendar month in which service is provided. 46 22 7. For the fiscal year beginning July 1, 1995, the 46 23 combined service and maintenance components of the 46 24 reimbursement rate paid to a shelter care provider shall be 46 25 based on the cost report submitted to the department. The 46 26 maximum reimbursement rate shall be $76.61 per day. If the 46 27 department would reimburse the provider at less than the 46 28 maximum rate but the provider's cost report justifies a rate 46 29 of at least $76.61, the department shall readjust the 46 30 provider's reimbursement rate to the maximum reimbursement 46 31 rate. In January 1996, the department shall review the usage 46 32 of shelter care and the funding allocated for shelter care, if 46 33 the usage is less than anticipated and the existing contracts 46 34 for provision of shelter care do not obligate the total amount 46 35 of the funds allocated, the department may utilize moneys in 47 1 the allocation, which would otherwise be unexpended, for wrap- 47 2 around services or support to enable group foster care 47 3 placement to be prevented or the length of stay reduced. 47 4 8. The department shall continue the pilot project to 47 5 implement the alternative payment system, recommended in the 47 6 study completed by the drug utilization review commission, for 47 7 compensation of pharmacists for pharmaceutical care services 47 8 under medical assistance. A report of the findings and 47 9 recommendations resulting from an evaluation of the pilot 47 10 project regarding the payment system shall be submitted to the 47 11 legislative fiscal bureau and to the chairpersons and ranking 47 12 members of the joint appropriations subcommittee on human 47 13 services by January 15, 1997. 47 14 9. The department shall modify reimbursement provisions 47 15 applicable to agencies providing services under the 47 16 department's rehabilitative treatment program for children and 47 17 their families. The modification shall address the service 47 18 utilization reimbursement rates under the program to include 47 19 the time a child is away from the agency for good cause. 47 20 10. The department may adopt emergency rules to implement 47 21 the provisions of this section. 47 22 11. For the period beginning on the effective date of this 47 23 subsection and ending June 30, 1996, the department shall not 47 24 reduce the percentile amount used to calculate reimbursement 47 25 rates for intermediate care facilities for the mentally 47 26 retarded. 47 27 Sec. 26. STANDARDS FOR CASELOADS AND REIMBURSEMENT. 47 28 1. The department of human services shall develop a plan 47 29 for meeting national standards on caseloads for the 47 30 department's social workers. 47 31 2. The department shall also develop a plan for improving 47 32 the adequacy of reimbursement for family foster care. The 47 33 foster care reimbursement rate improvement provisions shall 47 34 provide for basing the reimbursement rates on at least 75 47 35 percent of the United States department of agriculture 48 1 estimate of the costs to raise a child in the calendar year 48 2 immediately preceding the fiscal year. In addition the family 48 3 foster care provisions of the plan shall address additional 48 4 reimbursement for respite care, including in-home respite 48 5 care, and adequate allowances for clothing and school 48 6 expenses. The clothing allowance upon a child's initial 48 7 placement shall be at least $250 and at least $50 per month 48 8 for the remainder of the placement. School expenses shall be 48 9 reimbursed for elementary and developmental preschool children 48 10 at not more than $50 per semester and for grades seven through 48 11 twelve at not more than $100 per semester. Driver's education 48 12 expenses shall be reimbursed in full. 48 13 3. The department shall submit the planning provisions 48 14 required by this section to the members of the joint 48 15 appropriations subcommittee on human services of the senate 48 16 and house of representatives on or before January 8, 1996. 48 17 Sec. 27. STATE INSTITUTIONS &endash; CLOSINGS AND REDUCTIONS. 48 18 If a state institution administered by the department of human 48 19 services is to be closed or reduced in size, prior to the 48 20 closing or reduction the department shall initiate and 48 21 coordinate efforts in cooperation with the Iowa department of 48 22 economic development to develop new jobs in the area in which 48 23 the state institution is located. In addition, the department 48 24 may take other actions to utilize the facilities of an 48 25 institution, including but not limited to assisting not-for- 48 26 profit users with remodeling and lease costs by forgiving 48 27 future rental or lease payments to the extent necessary for a 48 28 period not to exceed five years. 48 29 Sec. 28. 1994 Iowa Acts, chapter 1186, section 10, 48 30 unnumbered paragraph 2, is amended to read as follows: 48 31 For child and family services: 48 32 .................................................. $74,617,61248 33 81,264,807 48 34 Sec. 29. 1994 Iowa Acts, chapter 1186, section 18, 48 35 unnumbered paragraph 2, is amended to read as follows: 49 1 For purchase of local services for persons with mental 49 2 illness, mental retardation, and developmental disabilities 49 3 services where the client has no established county of legal 49 4 settlement: 49 5 .................................................. $5,973,49249 6 2,973,492 49 7 Sec. 30. 1994 Iowa Acts, chapter 1186, section 19, 49 8 unnumbered paragraph 2, is amended to read as follows: 49 9 For mental illness, mental retardation, developmental 49 10 disabilities, and brain injury community services in 49 11 accordance with the provisions of this Act: 49 12 ................................................. $29,277,95849 13 21,860,789 49 14 Sec. 31. 1994 Iowa Acts, chapter 1186, section 19, 49 15 subsection 6, paragraph a, as amended by 1994 Iowa Acts, 49 16 chapter 1199, section 70, is amended to read as follows: 49 17 a. Of the funds appropriated in this section,$13,038,76349 18 $5,621,594 is allocated for distribution to counties for local 49 19 purchase of services for persons with mental illness or mental 49 20 retardation or other developmental disability. 49 21 Sec. 32. 1994 Iowa Acts, chapter 1186, section 20, 49 22 unnumbered paragraph 2, is amended to read as follows: 49 23 For field operations, including salaries, support, 49 24 maintenance, and miscellaneous purposes: 49 25 .................................................. $37,567,63949 26 41,337,613 49 27 Sec. 33. 1994 Iowa Acts, chapter 1194, section 10, 49 28 subsections 2 and 3, are amended to read as follows: 49 29 2. Not more than $1,725,1482,078,730 of the funds 49 30 appropriated in subsection 1 shall be used by the department 49 31 of human services for general administration. From the funds 49 32 set aside by this subsection for general administration, the 49 33 department of human services shall pay to the auditor of state 49 34 an amount sufficient to pay the cost of auditing the use and 49 35 administration of the state's portion of the funds 50 1 appropriated in subsection 1. 50 2 3. In addition to the allocation for general 50 3 administration in subsection 2, the remaining funds 50 4 appropriated in subsection 1 shall be allocated in the 50 5 following amounts to supplement appropriations for the federal 50 6 fiscal year beginning October 1, 1994, for the following 50 7 programs within the department of human services: 50 8 a. Field operations: 50 9 .................................................. $12,124,29750 10 11,322,332 50 11 b. Child and family services: 50 12 .................................................. $14,101,01950 13 -0- 50 14 c. Child care assistance: 50 15 .................................................. $1,310,65250 16 1,581,230 50 17 d. Local administrative costs and other local services: 50 18 .................................................. $1,164,21050 19 1,462,851 50 20 e. Volunteers: 50 21 .................................................. $122,77850 22 148,259 50 23 f. Community-based services: 50 24 .................................................. $146,32150 25 183,855 50 26 g. Local purchase: 50 27 .................................................. $ 10,917,169 50 28 h. MI/MR state cases: 50 29 .................................................. $ 3,000,000 50 30 Sec. 34. Section 99D.7, Code 1995, is amended by adding 50 31 the following new subsection: 50 32 NEW SUBSECTION. 22. To cooperate with the gamblers 50 33 assistance program administered by the department of human 50 34 services to incorporate information regarding the gamblers 50 35 assistance program and its toll-free telephone number in 51 1 printed materials distributed by the commission. The 51 2 commission may require licensees to have the information 51 3 available in a conspicuous place as a condition of licensure. 51 4 Sec. 35. Section 99E.9, Code 1995, is amended by adding 51 5 the following new subsection: 51 6 NEW SUBSECTION. 8. The Iowa lottery board shall cooperate 51 7 with the gamblers assistance program administered by the 51 8 department of human services to incorporate information 51 9 regarding the gamblers assistance program and its toll-free 51 10 telephone number in printed materials distributed by the 51 11 board. 51 12 Sec. 36. Section 217.3, subsection 4, Code 1995, is 51 13 amended to read as follows: 51 14 4. Approve the budget of the department of human services 51 15 prior to submission to the governor.Within two weeks of the51 16datePrior to approval of the budgetis approved, the council 51 17 shall publicize and hold a public hearing to provide 51 18 explanations and hear questions, opinions, and suggestions 51 19 regarding the budget. Invitations to the hearing shall be 51 20 extended to the governor, the governor-elect, the director of 51 21 the department of management, and other persons deemed by the 51 22 council as integral to the budget process. 51 23 Sec. 37. Section 232.188, subsection 6, Code 1995, is 51 24 amended to read as follows: 51 25 6. Initially the department shall work with the five 51 26 counties previously authorized under law to enter into 51 27 decategorization agreements with the state. At a minimum, any 51 28 of those counties may elect to use funding for foster care, 51 29 family-centered services, subsidized adoption, child day care, 51 30 local purchase of service, state juvenile institution care, 51 31 state mental health institute care, state hospital-school 51 32 care, juvenile detention, department direct services, and 51 33 court-ordered services for juveniles in the child welfare fund 51 34 established for that county. A portion of the fund may also 51 35 be used for emergency family assistance to provide resources 52 1 for families to remain intact or to be reunified. The 52 2 department shall inform each county in advance of a fiscal 52 3 year of the amount of funding that is available on account for 52 4 the county at the state institutions for the fiscal year. 52 5 Sec. 38. EMERGENCY RULES. If specifically authorized by a 52 6 provision of this Act, the department of human services or the 52 7 mental health and mental retardation commission may adopt 52 8 administrative rules under section 17A.4, subsection 2, and 52 9 section 17A.5, subsection 2, paragraph "b", to implement the 52 10 provisions and the rules shall become effective immediately 52 11 upon filing, unless a later effective date is specified in the 52 12 rules. In addition, the department may adopt administrative 52 13 rules in accordance with the provisions of this section as 52 14 necessary to comply with federal requirements or to adjust to 52 15 a change in the level of federal funding during the fiscal 52 16 year beginning July 1, 1995, and ending June 30, 1996. Any 52 17 rules adopted in accordance with the provisions of this 52 18 section shall also be published as notice of intended action 52 19 as provided in section 17A.4. 52 20 Sec. 39. EFFECTIVE DATE. Section 3, subsection 10, of 52 21 this Act, relating to drug prior authorization, section 3, 52 22 subsection 14, relating to the nursing home waiver pilot 52 23 program, section 25, subsection 11, relating to reimbursement 52 24 rates for intermediate care facilities for the mentally 52 25 retarded, and sections 28 through 33, amending 1994 Iowa Acts, 52 26 being deemed of immediate importance, take effect upon 52 27 enactment. 52 28 SF 462 52 29 pf/cc/26
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