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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, 1996, and ending June 30, 1997, 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 .................................................. $ 34,787,255 1 10 1. The department shall continue the special needs program 1 11 under the family investment program. 1 12 2. The department may adopt administrative rules for the 1 13 family investment, food stamp, and medical assistance programs 1 14 to change or delete welfare reform initiatives that threaten 1 15 the integrity or continuation of the program or that are not 1 16 cost-effective. Prior to the adoption of rules, the 1 17 department shall consult with the welfare reform council, 1 18 members of the public involved in development of the policy 1 19 established in the 1993 session of the Seventy-fifth General 1 20 Assembly, and the chairpersons and ranking members of the 1 21 human resources committees of the senate and the house of 1 22 representatives. 1 23 Sec. 2. EMERGENCY ASSISTANCE. There is appropriated from 1 24 the general fund of the state to the department of human 1 25 services for the fiscal year beginning July 1, 1996, and 1 26 ending June 30, 1997, the following amount, or so much thereof 1 27 as is necessary, to be used for the purpose designated: 1 28 For emergency assistance to families with dependent 1 29 children for homeless prevention programs: 1 30 .................................................. $ 1,967,500 1 31 1. The emergency assistance provided for in this section 1 32 shall be available beginning October 1 of the fiscal year and 1 33 shall be provided only if all other publicly funded resources 1 34 have been exhausted. Specifically, emergency assistance is 1 35 the program of last resort and shall not supplant assistance 2 1 provided by the low-income home energy assistance program 2 2 (LIHEAP), county general relief, and veterans affairs 2 3 programs. The department shall establish a $500 maximum 2 4 payment, per family, in a twelve-month period. The emergency 2 5 assistance includes, but is not limited to, assisting people 2 6 who face eviction, potential eviction, or foreclosure, utility 2 7 shutoff or fuel shortage, loss of heating energy supply or 2 8 equipment, homelessness, utility or rental deposits, or other 2 9 specified crisis which threatens family or living 2 10 arrangements. The emergency assistance shall be available to 2 11 migrant families who would otherwise meet eligibility 2 12 criteria. The department may contract for the administration 2 13 and delivery of the program. The program shall be terminated 2 14 when funds are exhausted. 2 15 2. For the fiscal year beginning July 1, 1996, the 2 16 department shall continue the process for the state to receive 2 17 refunds of rent deposits for emergency assistance recipients 2 18 which were paid by persons other than the state. The refunds 2 19 received by the department under this subsection shall be 2 20 deposited with the moneys of the appropriation made in this 2 21 section and used as additional funds for the emergency 2 22 assistance program. Notwithstanding section 8.33, moneys 2 23 received by the department under this subsection which remain 2 24 after the emergency assistance program is terminated and state 2 25 moneys in the emergency assistance account which remain 2 26 unobligated or unexpended at the close of the fiscal year 2 27 shall not revert to the general fund of the state but shall 2 28 remain available for expenditure when the program resumes 2 29 operation on October 1 in the succeeding fiscal year. 2 30 3. Of the funds appropriated in this section, $10,000 is 2 31 allocated to the community voice mail program to continue the 2 32 existing program. The funds shall be made available beginning 2 33 July 1, 1996. 2 34 Sec. 3. MEDICAL ASSISTANCE. There is appropriated from 2 35 the general fund of the state to the department of human 3 1 services for the fiscal year beginning July 1, 1996, and 3 2 ending June 30, 1997, the following amount, or so much thereof 3 3 as is necessary, to be used for the purpose designated: 3 4 For medical assistance, including reimbursement for 3 5 abortion services, which shall be available under the medical 3 6 assistance program only for those abortions which are 3 7 medically necessary: 3 8 .................................................. $366,687,988 3 9 1. Medically necessary abortions are those performed under 3 10 any of the following conditions: 3 11 a. The attending physician certifies that continuing the 3 12 pregnancy would endanger the life of the pregnant woman. 3 13 b. The attending physician certifies that the fetus is 3 14 physically deformed, mentally deficient, or afflicted with a 3 15 congenital illness. 3 16 c. The pregnancy is the result of a rape which is reported 3 17 within 45 days of the incident to a law enforcement agency or 3 18 public or private health agency which may include a family 3 19 physician. 3 20 d. The pregnancy is the result of incest which is reported 3 21 within 150 days of the incident to a law enforcement agency or 3 22 public or private health agency which may include a family 3 23 physician. 3 24 e. Any spontaneous abortion, commonly known as a 3 25 miscarriage, if not all of the products of conception are 3 26 expelled. 3 27 2. Notwithstanding section 8.39, the department may 3 28 transfer funds appropriated in this section to a separate 3 29 account established in the department's case management unit 3 30 for expenditures required to provide case management services 3 31 for mental health, mental retardation, and developmental 3 32 disabilities services under medical assistance which are 3 33 jointly funded by the state and county, pending final 3 34 settlement of the expenditures. Funds received by the case 3 35 management unit in settlement of the expenditures shall be 4 1 used to replace the transferred funds and are available for 4 2 the purposes for which the funds were appropriated in this 4 3 section. 4 4 3. If a medical assistance recipient is more than 17 years 4 5 of age and is receiving care which is reimbursed under a 4 6 federally approved home and community-based services waiver 4 7 but would otherwise be approved for care in an intermediate 4 8 care facility for the mentally retarded, the recipient's 4 9 county of legal settlement shall reimburse the department on a 4 10 monthly basis for the portion of the recipient's cost of care 4 11 which is not paid from federal funds. 4 12 4. a. The county of legal settlement shall be billed for 4 13 50 percent of the nonfederal share of the cost of case 4 14 management provided for adults, day treatment, and partial 4 15 hospitalization in accordance with sections 249A.26 and 4 16 249A.27, and 100 percent of the nonfederal share of the cost 4 17 of care for adults which is reimbursed under a federally 4 18 approved home and community-based waiver that would otherwise 4 19 be approved for provision in an intermediate care facility for 4 20 the mentally retarded, provided under the medical assistance 4 21 program. The state shall have responsibility for the 4 22 remaining 50 percent of the nonfederal share of the cost of 4 23 case management provided for adults, day treatment, and 4 24 partial hospitalization. For persons without a county of 4 25 legal settlement, the state shall have responsibility for 100 4 26 percent of the nonfederal share of the costs of case 4 27 management provided for adults, day treatment, partial 4 28 hospitalization, and the home and community-based waiver 4 29 services. The case management services specified in this 4 30 subsection shall be billed to a county only if the services 4 31 are provided outside of a managed care contract. 4 32 b. The state shall pay the entire nonfederal share of the 4 33 costs for case management services provided to persons 17 4 34 years of age and younger who are served in a medical 4 35 assistance home and community-based waiver program for persons 5 1 with mental retardation. 5 2 c. Medical assistance funding for case management services 5 3 for eligible persons 17 years of age and younger shall also be 5 4 provided to persons residing in counties with child welfare 5 5 decategorization projects implemented in accordance with 5 6 section 232.188, provided these projects have included these 5 7 persons in their service plan and the decategorization project 5 8 county is willing to provide the nonfederal share of costs. 5 9 d. When paying the necessary and legal expenses of 5 10 intermediate care facilities for the mentally retarded 5 11 (ICFMR), the cost payment requirements of section 222.60 shall 5 12 be considered fulfilled when payment is made in accordance 5 13 with the medical assistance payment rates established for 5 14 ICFMRs by the department and the state or a county of legal 5 15 settlement is not obligated for any amount in excess of the 5 16 rates. 5 17 5. The department may adopt and implement administrative 5 18 rules regarding a prepaid mental health services plan for 5 19 medical assistance patients. The rules shall include but not 5 20 be limited to service provider standards, service 5 21 reimbursement, and funding mechanisms. Notwithstanding the 5 22 provisions of subsection 4, paragraph "a", of this section and 5 23 section 249A.26, requiring counties to pay all or part of the 5 24 nonfederal share of certain services provided to persons with 5 25 disabilities under the medical assistance program, the state 5 26 shall pay 100 percent of the nonfederal share of any services 5 27 included in the plan implemented pursuant to this subsection. 5 28 6. The department shall utilize not more than $60,000 of 5 29 the funds appropriated in this section to continue the 5 30 AIDS/HIV health insurance premium payment program as 5 31 established in 1992 Iowa Acts, Second Extraordinary Session, 5 32 Chapter 1001, section 409, subsection 6. Of the funds 5 33 allocated in this subsection, not more than $5,000 may be 5 34 expended for administrative purposes. 5 35 7. Of the funds appropriated to the Iowa department of 6 1 health for substance abuse grants, $950,000 for the fiscal 6 2 year beginning July 1, 1996, shall be transferred to the 6 3 department of human services for an integrated substance abuse 6 4 managed care system. 6 5 8. The department shall implement a new medical assistance 6 6 home and community-based waiver for persons with physical 6 7 disabilities as a means to further develop the personal 6 8 assistance services program under section 225C.46. The waiver 6 9 shall not be implemented in a manner which would require 6 10 additional county or state funding for assistance provided to 6 11 an individual served under the waiver. 6 12 9. The department may expand the drug prior authorization 6 13 program to include the therapeutic class of gastrointestinal 6 14 drugs known as proton pump inhibitors. The department shall 6 15 not expand the requirement of drug prior authorization without 6 16 prior approval of the general assembly except to require prior 6 17 authorization of an equivalent of a prescription drug which is 6 18 subject to prior authorization as of June 30, 1996. The 6 19 department shall adopt administrative rules to implement this 6 20 provision. 6 21 10. The department of human services shall expand the 6 22 program to administratively pursue reimbursements for pharmacy 6 23 services to include all pharmacy claims for which a recipient 6 24 of medical assistance also has third-party coverage. 6 25 11. The department of human services, in consultation with 6 26 the Iowa department of public health and the department of 6 27 education, shall develop and implement a proposal to utilize 6 28 the early and periodic screening, diagnosis, and treatment 6 29 (EPSDT) funding under medical assistance, to the extent 6 30 possible, to implement the screening component of the EPSDT 6 31 program through the school system. The department may enter 6 32 into contracts to utilize maternal and child health centers, 6 33 the public health nursing program, or school nurses in 6 34 implementing this provision. 6 35 12. The department shall implement the case study for 7 1 outcome-based performance standards for programs serving 7 2 persons with mental retardation or other developmental 7 3 disabilities proposed pursuant to 1994 Iowa Acts, chapter 7 4 1170, section 56. The department shall adopt rules applicable 7 5 to the programs included in the case study, request a waiver 7 6 of applicable federal requirements, and take other actions 7 7 deemed necessary by the department to implement the case 7 8 study. 7 9 13. The department of human services shall submit a report 7 10 to the general assembly on or before January 1, 1997, 7 11 regarding reimbursement for teleconsultive services provided 7 12 by health care providers to recipients of medical assistance. 7 13 The report shall include but is not limited to recommendations 7 14 regarding the feasibility of implementation of a pilot 7 15 program, including the adoption and utilization of an 7 16 alternative reimbursement methodology, to determine the effect 7 17 of teleconsultive services on health care quality, access, and 7 18 cost. 7 19 14. A member of the joint appropriations subcommittee on 7 20 human services participating during the 1996 legislative 7 21 interim in a planning process for long-term care provided in 7 22 nursing facilities and through alternative types of care 7 23 involving a national foundation held by the department in the 7 24 state, is entitled to per diem and expenses payable as a joint 7 25 expense under section 2.12. 7 26 Sec. 4. MEDICAL CONTRACTS. There is appropriated from the 7 27 general fund of the state to the department of human services 7 28 for the fiscal year beginning July 1, 1996, and ending June 7 29 30, 1997, the following amount, or so much thereof as is 7 30 necessary, to be used for the purpose designated: 7 31 For medical contracts: 7 32 .................................................. $ 6,811,400 7 33 1. The department shall continue to contract for drug 7 34 utilization review under the medical assistance program. 7 35 2. The department shall negotiate with the department's 8 1 contractor for mental health managed care under the medical 8 2 assistance program to establish performance standards for 8 3 successful outcomes for persons receiving services under the 8 4 contract. The performance standards shall be incorporated 8 5 into the contract or shall be made an addendum to the contract 8 6 which is in effect as of the effective date of this 8 7 subsection. The contractor's attainment of these performance 8 8 standards shall be a factor in the department's decision to 8 9 extend the contract in effect for managed mental health care 8 10 or to initiate a new procurement process. Any future contract 8 11 shall contain sanctions for failure to attain the performance 8 12 standards. The provisions of section 228.5 as amended in this 8 13 Act are applicable to the requirements of this subsection. 8 14 3. Any future contract entered into by the department for 8 15 mental health managed care or for other services under the 8 16 medical assistance program shall include a provision which 8 17 requires the contractor to make public information the amount 8 18 of profit realized by the contractor and the amount of funds 8 19 expended by the contractor for administrative purposes under 8 20 the contract. 8 21 Sec. 5. STATE SUPPLEMENTARY ASSISTANCE. There is 8 22 appropriated from the general fund of the state to the 8 23 department of human services for the fiscal year beginning 8 24 July 1, 1996, and ending June 30, 1997, the following amount, 8 25 or so much thereof as is necessary, to be used for the purpose 8 26 designated: 8 27 For state supplementary assistance, funeral assistance, and 8 28 the mental retardation waiver rent subsidy program: 8 29 .................................................. $ 19,190,000 8 30 1. The department shall increase the personal needs 8 31 allowance for residents of residential care facilities by the 8 32 same percentage and at the same time as federal supplemental 8 33 security income and federal social security benefits are 8 34 increased due to a recognized increase in the cost of living. 8 35 The department may adopt emergency rules to implement this 9 1 subsection. 9 2 2. a. If during the fiscal year beginning July 1, 1996, 9 3 the department projects that state supplementary assistance 9 4 expenditures for a calendar year will not meet the federal 9 5 pass-along requirement specified in Title XVI of the federal 9 6 Social Security Act, section 1618, as codified in 42 U.S.C. } 9 7 1382g, the department may take actions including but not 9 8 limited to increasing the personal needs allowance for 9 9 residential care facility residents and making programmatic 9 10 adjustments or upward adjustments of the residential care 9 11 facility or in-home health-related care reimbursement rates 9 12 prescribed in this Act to ensure that federal requirements are 9 13 met. The department may adopt emergency rules to implement 9 14 the provisions of this subsection. 9 15 b. If during the fiscal year beginning July 1, 1996, the 9 16 department projects that state supplementary assistance 9 17 expenditures will exceed the amount appropriated, the 9 18 department may transfer funds appropriated in this Act for 9 19 medical assistance for the purposes of the state supplementary 9 20 assistance program. However, funds shall only be transferred 9 21 from the medical assistance appropriation if the funds 9 22 transferred are projected to be in excess of the funds 9 23 necessary for the medical assistance program. 9 24 3. The department may use up to $75,000 of the funds 9 25 appropriated in this section for a rent subsidy program for 9 26 adult persons to whom all of the following apply: 9 27 a. Are receiving assistance under the medical assistance 9 28 home and community-based services for persons with mental 9 29 retardation (HCBS/MR) program. 9 30 b. Were discharged from an intermediate care facility for 9 31 the mentally retarded (ICFMR) immediately prior to receiving 9 32 HCBS/MR services. 9 33 The goal of the subsidy program shall be to encourage and 9 34 assist in enabling persons who currently reside in an ICFMR to 9 35 move to a community living arrangement. An eligible person 10 1 may receive assistance in meeting their rental expense and, in 10 2 the initial two months of eligibility, in purchasing necessary 10 3 household furnishings and supplies. The program shall be 10 4 implemented so that it does not meet the federal definition of 10 5 state supplementary assistance and will not impact the federal 10 6 pass-along requirement specified in Title XVI of the federal 10 7 Social Security Act, section 1618, as codified in 42 U.S.C. } 10 8 1382g. 10 9 Sec. 6. CHILD DAY CARE ASSISTANCE. There is appropriated 10 10 from the general fund of the state to the department of human 10 11 services for the fiscal year beginning July 1, 1996, and 10 12 ending June 30, 1997, the following amount, or so much thereof 10 13 as is necessary, to be used for the purposes designated: 10 14 For protective child day care assistance and state child 10 15 care assistance: 10 16 .................................................. $ 12,547,100 10 17 1. Of the funds appropriated in this section, $2,496,286 10 18 shall be used for protective child day care assistance. 10 19 2. Of the funds appropriated in this section, $8,180,889 10 20 shall be used for state child care assistance. 10 21 3. For the purposes of this subsection, the term "poverty 10 22 level" means the poverty level defined by the poverty income 10 23 guidelines published by the United States department of health 10 24 and human services. Based upon the availability of the 10 25 funding provided in subsection 2 the department shall 10 26 establish waiting lists for state child care assistance in 10 27 descending order of prioritization as follows: 10 28 a. Families with an income at or below 100 percent of the 10 29 federal poverty level whose members are employed at least 30 10 30 hours per week, and parents with a family income at or below 10 31 100 percent of the federal poverty level who are under the age 10 32 of 21 and are participating in an educational program leading 10 33 to a high school diploma or equivalent. 10 34 b. Parents with a family income at or below 100 percent of 10 35 the federal poverty level who are under the age of 21 and are 11 1 participating, at a satisfactory level, in an approved 11 2 training program or in an educational program. 11 3 c. Families with an income of more than 100 percent but 11 4 not more than 110 percent of the federal poverty level whose 11 5 members are employed at least 30 hours per week. Assistance 11 6 provided to families pursuant to this paragraph shall be 11 7 provided in accordance with a sliding fee scale developed by 11 8 the department. If, pursuant to an evaluation of expenditures 11 9 for state child care assistance it is determined that 11 10 sufficient funding is available, the department shall 11 11 implement the provisions of this paragraph on or before 11 12 January 2, 1997. 11 13 d. Families with an income at or below 155 percent of the 11 14 federal poverty level with a special needs child as a member 11 15 of the family. 11 16 e. Families with an income at or below 100 percent of the 11 17 federal poverty level whose members are employed part-time at 11 18 least 20 hours per week. 11 19 The department may adopt emergency rules to implement the 11 20 provisions of this subsection. 11 21 4. a. Migrant seasonal farm worker families whose family 11 22 income is equal to or less than 100 percent of the United 11 23 States office of management and budget poverty guidelines are 11 24 eligible for state child care assistance. The monthly family 11 25 income shall be determined by calculating the total amount of 11 26 family income earned during the 12-month period preceding the 11 27 date of application for the assistance and dividing the total 11 28 amount by 12. 11 29 b. Nothing in this section shall be construed or is 11 30 intended as, or shall imply, a grant of entitlement for 11 31 services to persons who are eligible for assistance due to an 11 32 income level consistent with the requirements of this section. 11 33 Any state obligation to provide services pursuant to this 11 34 section is limited to the extent of the funds appropriated in 11 35 this section. 12 1 5. If the department projects that funding for state child 12 2 care assistance is reasonably adequate to fund the provisions 12 3 of subsection 3, paragraphs "a", "b", and "c", the department 12 4 may transfer not more than $200,000 of the funding 12 5 appropriated in this section to the appropriation in this Act 12 6 for child and family services to provide additional funding 12 7 for family-centered services. 12 8 6. Of the funds appropriated in this section, $636,641 is 12 9 allocated for the statewide program for child day care 12 10 resource and referral services under section 237A.26. 12 11 7. The department may use any of the funds appropriated in 12 12 this section as a match to obtain federal funds for use in 12 13 expanding child day care assistance and related programs. 12 14 8. Of the funds appropriated in this section, $1,178,284 12 15 is allocated for transitional child care assistance. 12 16 9. During the 1996-1997 fiscal year, the department shall 12 17 utilize the moneys deposited in the child day care credit fund 12 18 created in section 237A.28 for state child care assistance, in 12 19 addition to the moneys allocated for that purpose in this 12 20 section. 12 21 10. Of the funds appropriated in this section, the 12 22 department shall expend not more than $20,000 to develop a 12 23 system in cooperation with child day care resource and 12 24 referral services under section 237A.26, in which volunteer 12 25 evaluation teams are utilized to review and inspect registered 12 26 family day care homes on behalf of the department. The 12 27 department shall also review requirements for payment of 12 28 publicly funded child day care, including but not limited to 12 29 the effects on providers and the state budget of paying for 12 30 child day care on a daily basis, block-of-hours basis, or 12 31 hourly basis. The department shall review the policy 12 32 implications of encouraging family day care home registration 12 33 by providing an enhanced reimbursement for family day care 12 34 homes that are registered. In addition, the department shall 12 35 develop a proposal for a disproportionate share reimbursement 13 1 adjustment for the child day care providers for which 75 13 2 percent or more of the children provided care receive public 13 3 funding for the cost of their care. The department shall 13 4 submit a report to the general assembly on or before January 13 5 15, 1997, which includes recommendations concerning the issues 13 6 required by this subsection. 13 7 11. Of the funds appropriated in this section, $35,000 is 13 8 allocated for use by the united Mexican-American center in Des 13 9 Moines for the center's child day care program. 13 10 12. A family who was eligible for and received state child 13 11 care assistance during the fiscal year beginning July 1, 1995, 13 12 shall continue to receive the assistance in the succeeding 13 13 fiscal year for as long as the family continues to meet the 13 14 eligibility requirements in effect for the fiscal year 13 15 beginning July 1, 1995. 13 16 13. Notwithstanding section 8.33, moneys appropriated to 13 17 the department of human services for state child care 13 18 assistance in 1996 Iowa Acts, House File 2114, section 2, 13 19 which remain unexpended or unobligated at the close of the 13 20 fiscal year shall not revert to the general fund of the state 13 21 but shall remain available for expenditure in the succeeding 13 22 fiscal year. 13 23 Sec. 7. JOBS PROGRAM. There is appropriated from the 13 24 general fund of the state to the department of human services 13 25 for the fiscal year beginning July 1, 1996, and ending June 13 26 30, 1997, the following amount, or so much thereof as is 13 27 necessary, to be used for the purposes designated: 13 28 For the federal-state job opportunities and basic skills 13 29 (JOBS) program, food stamp employment and training program, 13 30 family development and self-sufficiency grants, 13 31 entrepreneurial training, and implementing family investment 13 32 agreements, in accordance with this section: 13 33 .................................................. $ 12,601,592 13 34 1. Of the funds appropriated in this section, $11,692,292 13 35 is allocated for the JOBS program. For family investment 14 1 agreements developed in the fiscal year beginning July 1, 14 2 1996, the maximum time period for postsecondary education is 14 3 limited to two years. 14 4 2. The department shall continue to contract for services 14 5 in developing, delivering, and monitoring an entrepreneurial 14 6 training waiver program to provide technical assistance in 14 7 self-employment training to families which receive assistance 14 8 under the family investment program, contingent upon federal 14 9 approval of waiver renewal requests. 14 10 3. Of the funds appropriated in this section, $129,985 is 14 11 allocated for the food stamp employment and training program. 14 12 4. Of the funds appropriated in this section, $779,315 is 14 13 allocated to the family development and self-sufficiency grant 14 14 program as provided under section 217.12. 14 15 a. Not more than 5 percent of the funds allocated in this 14 16 subsection shall be used for the administration of the grant 14 17 program. 14 18 b. Federal funding matched by state, county, or other 14 19 funding which is not appropriated in this section shall be 14 20 deposited in the department's JOBS account. If the match 14 21 funding is generated by a family development and self- 14 22 sufficiency grantee, the federal funding received shall be 14 23 used to expand the family development and self-sufficiency 14 24 grant program. If the match funding is generated by another 14 25 source, the federal funding received shall be used to expand 14 26 the grant program or the JOBS program. The department may 14 27 adopt rules to implement the provisions of this paragraph. 14 28 c. Based upon the annual evaluation report concerning each 14 29 grantee funded by this allocation, the family development and 14 30 self-sufficiency council may use funds allocated to renew 14 31 grants. 14 32 Sec. 8. CHILD SUPPORT RECOVERY. There is appropriated 14 33 from the general fund of the state to the department of human 14 34 services for the fiscal year beginning July 1, 1996, and 14 35 ending June 30, 1997, the following amount, or so much thereof 15 1 as is necessary, to be used for the purposes designated: 15 2 For child support recovery, including salaries, support, 15 3 maintenance, and miscellaneous purposes and for not more than 15 4 the following full-time equivalent positions: 15 5 ................................................. $ 6,517,000 15 6 ............................................... FTEs 226.22 15 7 1. The director of human services, within the limitations 15 8 of the funds appropriated in this section, or funds 15 9 transferred from the family investment program appropriation 15 10 for this purpose, shall establish new positions and add 15 11 employees to the child support recovery unit if the director 15 12 determines that both the current and additional employees 15 13 together can reasonably be expected to maintain or increase 15 14 net state revenue at or beyond the budgeted level. If the 15 15 director adds employees, the department shall demonstrate the 15 16 cost-effectiveness of the current and additional employees by 15 17 reporting to the joint appropriations subcommittee on human 15 18 services the ratio of the total amount of administrative costs 15 19 for child support recoveries to the total amount of the child 15 20 support recovered. 15 21 2. Nonpublic assistance application fees and federal tax 15 22 refund offsets received by the child support recovery unit are 15 23 appropriated and shall be used for the purposes of the child 15 24 support recovery program. The director of human services may 15 25 add positions within the limitations of the amount 15 26 appropriated for salaries and support for the positions. The 15 27 director shall report any positions added pursuant to this 15 28 subsection to the chairpersons and ranking members of the 15 29 joint appropriations subcommittee on human services and the 15 30 legislative fiscal bureau. 15 31 3. The director of human services, in consultation with 15 32 the department of management and the legislative fiscal 15 33 committee, is authorized to receive and deposit state child 15 34 support incentive earnings in the manner specified under 15 35 applicable federal requirements. 16 1 4. The director of human services may establish new 16 2 positions and add state employees to the child support 16 3 recovery unit if the director determines the employees are 16 4 necessary to replace county-funded positions eliminated due to 16 5 termination, reduction, or nonrenewal of a chapter 28E 16 6 contract. However, the director must also determine that the 16 7 resulting increase in the state share of child support 16 8 recovery incentives exceeds the cost of the positions, the 16 9 positions are necessary to ensure continued federal funding of 16 10 the program, or the new positions can reasonably be expected 16 11 to recover at least twice the amount of money necessary to pay 16 12 the salaries and support for the new positions. 16 13 5. The child support recovery unit shall continue to work 16 14 with the judicial department to determine the feasibility of a 16 15 pilot project utilizing a court-appointed referee for judicial 16 16 determinations on child support matters. The extent and 16 17 location of any pilot project shall be jointly developed by 16 18 the judicial department and the child support recovery unit. 16 19 6. The department shall expend up to $50,000, including 16 20 federal financial participation, for the fiscal year beginning 16 21 July 1, 1996, for a child support public awareness campaign. 16 22 The department shall cooperate with the office of the attorney 16 23 general in continuation of the campaign. The public awareness 16 24 campaign shall emphasize, through a variety of media 16 25 activities and through continuation of the publication of 16 26 names of persons who are delinquent in payment of child 16 27 support obligations, the importance of maximum involvement of 16 28 both parents in the lives of their children as well as the 16 29 importance of payment of child support obligations. 16 30 7. The department shall continue the pilot program option 16 31 to provide and supervise a community service pilot project for 16 32 absent parents who are ordered by the court to perform 16 33 community service for failure to pay child support pursuant to 16 34 section 598.23A. 16 35 8. The director of human services may enter a contract 17 1 with private collection agencies to collect support payments 17 2 for cases which have been identified by the department as 17 3 difficult collection cases if the department determines that 17 4 this form of collection is more cost effective than 17 5 departmental collection methods. The director may use a 17 6 portion of the state share of funds collected through this 17 7 means to pay the costs of any contracts authorized under this 17 8 subsection. 17 9 9. The department shall employ on or before July 2, 1996, 17 10 at least 1.00 FTE to respond to telephone inquiries during all 17 11 weekly business hours. 17 12 10. The department shall develop guidelines to be used in 17 13 lieu of the child support guidelines prescribed under section 17 14 598.21, subsection 4, for establishing a support obligation 17 15 and the amount of the support debt accrued and accruing 17 16 pursuant to section 234.39 for the costs of foster care 17 17 services. The proposed guidelines shall reflect the public 17 18 purpose of establishing a support obligation without causing a 17 19 serious disruption of the family of the obligor. The 17 20 department shall submit the proposed guidelines to the general 17 21 assembly on or before January 15, 1997. 17 22 Sec. 9. JUVENILE INSTITUTIONS. There is appropriated from 17 23 the general fund of the state to the department of human 17 24 services for the fiscal year beginning July 1, 1996, and 17 25 ending June 30, 1997, the following amount, or so much thereof 17 26 as is necessary, to be used for the purposes designated: 17 27 For the operation of the state training school and the Iowa 17 28 juvenile home, including salaries, support, maintenance, and 17 29 miscellaneous purposes and for not more than the following 17 30 full-time equivalent positions: 17 31 For the state juvenile institutions: 17 32 .................................................. $ 13,769,809 17 33 ............................................... FTEs 320.77 17 34 1. The following amounts of the funds appropriated and 17 35 full-time equivalent positions authorized in this section are 18 1 allocated for the Iowa juvenile home at Toledo: 18 2 .................................................. $ 5,130,863 18 3 ............................................... FTEs 118.54 18 4 2. The following amounts of the funds appropriated and 18 5 full-time equivalent positions authorized in this section are 18 6 allocated for the state training school at Eldora: 18 7 .................................................. $ 8,638,946 18 8 ............................................... FTEs 202.23 18 9 3. During the fiscal year beginning July 1, 1996, the 18 10 population levels at the state juvenile institutions shall not 18 11 exceed the population guidelines established under 1990 Iowa 18 12 Acts, chapter 1239, section 21. 18 13 4. Of the funds appropriated in this section, $10,000 18 14 shall be used by the state training school and $8,000 by the 18 15 Iowa juvenile home for grants for adolescent pregnancy 18 16 prevention activities at the institutions in the fiscal year 18 17 beginning July 1, 1996. 18 18 5. Within the funds appropriated in this section, the 18 19 department may reallocate funds as necessary to best fulfill 18 20 the needs of the institutions provided for in the 18 21 appropriation. 18 22 Sec. 10. CHILD AND FAMILY SERVICES. There is appropriated 18 23 from the general fund of the state to the department of human 18 24 services for the fiscal year beginning July 1, 1996, and 18 25 ending June 30, 1997, the following amount, or so much thereof 18 26 as is necessary, to be used for the purpose designated: 18 27 For child and family services: 18 28 ................................................. $ 85,460,607 18 29 1. The department may transfer moneys appropriated in this 18 30 section as necessary to pay the nonfederal costs of services 18 31 reimbursed under medical assistance or the family investment 18 32 program which are provided to children who would otherwise 18 33 receive services paid under the appropriation in this section. 18 34 The department may transfer funds appropriated in this section 18 35 to the appropriations in this Act for general administration 19 1 and for field operations for resources necessary to implement 19 2 and operate the services funded in this section. 19 3 2. a. Of the funds appropriated in this section, up to 19 4 $24,601,280 is allocated as the statewide expenditure target 19 5 under section 232.143 for group foster care maintenance and 19 6 services. 19 7 b. The department shall report quarterly to the 19 8 legislative fiscal bureau concerning the status of each 19 9 region's efforts to contain expenditures for group foster care 19 10 placements in accordance with the regional plan established 19 11 pursuant to section 232.143. 19 12 c. The department shall not certify any additional 19 13 enhanced residential treatment beds, unless the director of 19 14 human services approves the beds as necessary, based on the 19 15 type of children to be served and the location of the enhanced 19 16 residential treatment beds. 19 17 d. (1) Of the funds appropriated in this section, not 19 18 more than $6,538,215 is allocated as the state match funding 19 19 for psychiatric medical institutions for children. 19 20 (2) The department may transfer all or a portion of the 19 21 funds appropriated in this section for psychiatric medical 19 22 institutions for children (PMICs) to the appropriation in this 19 23 Act for medical assistance and may amend the managed mental 19 24 health care contract to include PMICs. 19 25 e. Of the funds allocated in this subsection, not more 19 26 than $1,077,995 is allocated as the state match funding for 50 19 27 highly structured juvenile program beds. 19 28 3. The department shall establish a goal that not more 19 29 than 15 percent of the children placed in foster care funded 19 30 under the federal Social Security Act, Title IV-E, may be 19 31 placed in foster care for a period of more than 24 months. 19 32 4. In accordance with the provisions of section 232.188, 19 33 the department shall continue the program to decategorize 19 34 child welfare services in additional counties or clusters of 19 35 counties. 20 1 5. Of the funds appropriated in this section, up to 20 2 $96,512 is allocated for continued foster care services to a 20 3 child who is 18 years of age or older in accordance with the 20 4 provisions of section 234.35, subsection 3, paragraph "c". 20 5 However, if funding in this appropriation would remain 20 6 unobligated at the end of the fiscal year, the allocation in 20 7 this subsection may be exceeded to the extent necessary to 20 8 provide the continued foster care services. The department 20 9 shall distribute the moneys allocated in this subsection to 20 10 the department's regions based on each region's proportion of 20 11 the total number of children placed in foster care on March 31 20 12 preceding the beginning of the fiscal year, who, during the 20 13 fiscal year would no longer be eligible for foster care due to 20 14 age. 20 15 6. Notwithstanding section 232.142, subsection 3, the 20 16 financial aid paid by the state for the establishment, 20 17 improvements, operation, and maintenance of county or 20 18 multicounty juvenile detention homes in the fiscal year 20 19 beginning July 1, 1996, shall be limited to $872,500. Funds 20 20 allocated in this subsection shall be prorated among eligible 20 21 detention homes. 20 22 7. The amount of the appropriation made in this section 20 23 available for foster care is based upon expansion of the 20 24 number of children in foster care who are eligible for federal 20 25 supplemental security income (SSI). The department may use up 20 26 to $300,000 of those funds to enter into a performance-based 20 27 contract to secure SSI benefits for children placed in foster 20 28 care. The contract shall include provisions for training of 20 29 department of human services and juvenile court staff, 20 30 completion of applications, tracking of application results, 20 31 and representation during the appeals process whenever an 20 32 appeal is necessary to secure SSI benefits. Notwithstanding 20 33 section 217.30 and section 232.2, subsection 11, and any other 20 34 provision of law to the contrary, the director or the 20 35 director's designee on behalf of a child in foster care may 21 1 release medical, mental health, substance abuse, or any other 21 2 information necessary only to determine the child's 21 3 eligibility for SSI benefits, and may sign releases for the 21 4 information. In any release of information made pursuant to 21 5 this subsection, confidentiality shall be maintained to the 21 6 maximum extent possible. 21 7 8. A portion of the funds appropriated in this section may 21 8 be used for emergency family assistance to provide other 21 9 resources required for a family participating in a family 21 10 preservation or reunification project to stay together or to 21 11 be reunified. 21 12 9. Notwithstanding section 234.35, subsection 1, for the 21 13 fiscal year beginning July 1, 1996, state funding for shelter 21 14 care paid pursuant to section 234.35, subsection 1, paragraph 21 15 "h", shall be limited to $3,223,732. The department shall 21 16 develop a formula in consultation with the shelter care 21 17 committee created by the department to allocate shelter care 21 18 funds to the department's regions. The formula shall be based 21 19 on the region's proportion of the state population of children 21 20 and historical usage. The department may adopt emergency 21 21 rules to implement the provisions of this subsection. 21 22 10. Of the funds appropriated in this section, not more 21 23 than $527,137 may be used to develop and maintain the state's 21 24 implementation of the national adoption and foster care 21 25 information system pursuant to the requirements of Pub. L. No. 21 26 99-509. The department may transfer funds as necessary from 21 27 the appropriations in this Act for field operations and 21 28 general administration to implement this subsection. Moneys 21 29 allocated in accordance with this subsection shall be 21 30 considered encumbered for the purposes of section 8.33. 21 31 11. Of the funds appropriated in this section, up to 21 32 $619,433 may be used as determined by the department for any 21 33 of the following purposes: 21 34 a. For general administration of the department to improve 21 35 staff training efforts. 22 1 b. For oversight of termination of parental rights and 22 2 permanency planning efforts on a statewide basis. 22 3 c. For personnel, assigned by the attorney general, to 22 4 provide additional services relating to termination of 22 5 parental rights and child in need of assistance cases. 22 6 d. For specialized permanency planning field operations 22 7 staff. 22 8 12. The department may adopt administrative rules 22 9 following consultation with child welfare services providers 22 10 to implement outcome-based child welfare services pilot 22 11 projects. The rules may include, but are not limited to, the 22 12 development of program descriptions, provider licensing and 22 13 certification standards, reimbursement and payment amounts, 22 14 contract requirements, assessment and service necessity 22 15 requirements, eligibility criteria, claims submission 22 16 procedures, and accountability standards. 22 17 13. Of the funds appropriated in this section, up to 22 18 $125,340 may be used to develop, in cooperation with providers 22 19 of children and family services, a performance-based 22 20 monitoring program to evaluate and improve outcomes for 22 21 children and families. The department may adopt 22 22 administrative rules to implement this subsection. 22 23 14. The department may develop, within the funds 22 24 available, a pilot kinship care project to enhance family 22 25 involvement in the development of the permanency plan required 22 26 under chapter 232 for children who are removed from their 22 27 homes. The project components may include family involvement 22 28 before and after removal of the child and shall stress safety 22 29 for the child. 22 30 15. Within the funds appropriated in this section, the 22 31 department may develop a subsidized guardianship program to 22 32 provide financial assistance to guardians of children who have 22 33 a permanency order under section 232.104, subsection 2, 22 34 paragraph "d", subparagraph (1), in cases in which all of the 22 35 following conditions exist: 23 1 a. The option of reunification has been eliminated and 23 2 termination of parental rights is not appropriate. 23 3 b. The child has lived with the potential guardian for at 23 4 least six months. 23 5 c. The child is either 14 years of age or older or, if 23 6 under 14 years of age, is part of a sibling group and cannot 23 7 be made available for adoption. 23 8 d. The placement does not require departmental 23 9 supervision. 23 10 The financial assistance provided shall be in the same 23 11 amount as provided for family foster care. For purposes of 23 12 medical assistance and child support recovery, these payments 23 13 shall be considered foster care payments. 23 14 16. The department shall continue to make adoption 23 15 presubsidy and adoption subsidy payments to adoptive parents 23 16 at the beginning of the month for the current month. 23 17 17. If Title XIX of the federal Social Security Act is 23 18 repealed prior to January 17, 1997, and the state is otherwise 23 19 authorized to establish requirements for providing health and 23 20 rehabilitative services to persons who would be eligible for 23 21 medical assistance under chapter 249A, the department shall 23 22 eliminate the clinical assessment and consultation teams 23 23 operating as part of the medical assistance children's 23 24 rehabilitative services initiative. The provisions of this 23 25 subsection shall apply through January 16, 1997. 23 26 18. Federal funds received by the state during the fiscal 23 27 years beginning July 1, 1995, and July 1, 1996, as the result 23 28 of the expenditure of state funds appropriated during a 23 29 previous state fiscal year for a service or activity funded 23 30 under this section shall be used as additional funding for 23 31 services provided under this section. Moneys received by the 23 32 department in accordance with the provisions of this section 23 33 shall remain available for the purposes designated until June 23 34 30, 1998. 23 35 19. The department may adopt emergency rules to revise 24 1 administrative rules relating to rehabilitative treatment 24 2 services under the child welfare program as necessary to 24 3 comply with federal requirements to maintain nonstate funding. 24 4 20. The department in cooperation with the department of 24 5 education shall collect data to determine the number of 24 6 children for whom sheltered workshops and supported employment 24 7 will be required during the period beginning July 1, 1997, 24 8 through June 30, 2002. The department shall report the 24 9 findings of the study to the general assembly by January 2, 24 10 1997. 24 11 21. Of the funds appropriated in this section, up to 24 12 $150,000 shall be transferred to the Iowa healthy kids trust 24 13 fund for use by the division of insurance of the department of 24 14 commerce for planning, administration, and implementation of 24 15 the Iowa healthy kids program as established in chapter 514I 24 16 as enacted in this Act. 24 17 Sec. 11. COMMUNITY-BASED PROGRAMS – ADOLESCENT PREGNANCY 24 18 PREVENTION. There is appropriated from the general fund of 24 19 the state to the department of human services for the fiscal 24 20 year beginning July 1, 1996, and ending June 30, 1997, the 24 21 following amount, or so much thereof as is necessary, to be 24 22 used for the purpose designated: 24 23 For community-based programs, on the condition that family 24 24 planning services are funded, including salaries, support, 24 25 maintenance, and miscellaneous purposes and for not more than 24 26 the following full-time equivalent positions: 24 27 .................................................. $ 2,635,146 24 28 ............................................... FTEs 1.00 24 29 1. Of the funds appropriated in this section, $736,146 24 30 shall be used for adolescent pregnancy prevention grants, 24 31 including not more than $156,048 for programs to prevent 24 32 pregnancies during the adolescent years and to provide support 24 33 services for pregnant or parenting adolescents. It is the 24 34 intent of the general assembly that by July 1, 1998, grants 24 35 awarded under this subsection be required to meet the criteria 25 1 under subsection 2 including the provision of community-wide 25 2 services within the proximity of the community or region. 25 3 2. Of the funds appropriated in this section, $298,000 25 4 shall be used for grants to community or regional groups which 25 5 demonstrate broad-based representation from community 25 6 representatives including but not limited to schools, 25 7 churches, human service-related organizations, and businesses. 25 8 Priority in the awarding of grants shall be given to groups 25 9 which provide services to both urban and rural areas within 25 10 the proximity of the community or region and which provide 25 11 age-appropriate programs adapted for both male and female 25 12 youth at the elementary, middle, and high school levels. A 25 13 program shall focus on the prevention of initial pregnancies 25 14 during the adolescent years by emphasizing sexual abstinence 25 15 as the only completely safe and effective means of avoiding 25 16 pregnancy and sexually transmitted diseases and by providing 25 17 information regarding the comparative failure rates of 25 18 contraceptives, and by emphasizing responsible decision making 25 19 in relationships, managing of peer and social pressures, 25 20 development of self-esteem, the costs and responsibilities of 25 21 parenting, and information regarding the alternative of 25 22 adoption for placement of a child. The program shall also 25 23 include an evaluation and assessment component which includes 25 24 evaluation of and recommendations for improvement of the 25 25 program by the youth and parents involved. Evaluation and 25 26 assessment reports shall be provided to the department of 25 27 human services, at a time determined by the department in the 25 28 grant award. Community or regional groups interested in 25 29 applying for a grant under this subsection may be issued a 25 30 planning grant or may utilize grant moneys for the costs of 25 31 technical assistance to analyze community needs, match service 25 32 providers to needs, negotiate service provision strategies, or 25 33 other assistance to focus grant services provided under this 25 34 subsection. The technical assistance may be provided by 25 35 organizations affiliated with institutions under the authority 26 1 of the state board of regents or other organizations 26 2 experienced in providing technical assistance concerning 26 3 similar services. 26 4 3. The department of human services, in cooperation with 26 5 the Iowa department of public health, shall determine the 26 6 criteria to be used in measuring the results of all pregnancy 26 7 prevention programs for which funds are allocated in this 26 8 section. The criteria to be used shall be made available to 26 9 the interim committee established in subsection 4. 26 10 4. The legislative council is requested to established a 26 11 legislative interim committee during the 1996 interim of the 26 12 general assembly to evaluate the effectiveness of current and 26 13 proposed adolescent pregnancy prevention programs. 26 14 5. Of the funds appropriated in this section, $846,014 26 15 shall be used by the department for child abuse prevention 26 16 grants. Of the funds allocated in this subsection, $115,000 26 17 shall be transferred to the Iowa department of public health 26 18 for the Iowa healthy family program under section 135.106, to 26 19 be expended in accordance with the provisions relating to this 26 20 program in 1996 Iowa Acts, Senate File 2448. 26 21 Sec. 12. COURT-ORDERED SERVICES PROVIDED TO JUVENILES. 26 22 There is appropriated from the general fund of the state to 26 23 the department of human services for the fiscal year beginning 26 24 July 1, 1996, and ending June 30, 1997, the following amount, 26 25 or so much thereof as is necessary, to be used for the purpose 26 26 designated: 26 27 Payment of the expenses of court-ordered services provided 26 28 to juveniles which are a charge upon the state pursuant to 26 29 section 232.141, subsection 4: 26 30 .................................................. $ 3,090,000 26 31 1. Notwithstanding section 232.141 or any other provision 26 32 of law, the funds appropriated in this section shall be 26 33 allocated to the judicial districts as determined by the state 26 34 court administrator. The state court administrator shall make 26 35 the determination on the allocations on or before June 15. 27 1 2. a. Each judicial district shall continue the planning 27 2 group for the court-ordered services for juveniles provided in 27 3 that district which was established pursuant to 1991 Iowa 27 4 Acts, chapter 267, section 119. A planning group shall 27 5 continue to perform its duties as specified in that law. 27 6 Reimbursement rates for providers of court-ordered evaluation 27 7 and treatment services paid under section 232.141, subsection 27 8 4, shall be negotiated with providers by each judicial 27 9 district's planning group. 27 10 b. Each district planning group shall submit an annual 27 11 report in January to the state court administrator and the 27 12 department of human services. The report shall cover the 27 13 preceding fiscal year and shall include a preliminary report 27 14 on the current fiscal year. The administrator and the 27 15 department shall compile these reports and submit the reports 27 16 to the chairpersons and ranking members of the joint 27 17 appropriations subcommittee on human services and the 27 18 legislative fiscal bureau. 27 19 3. The department of human services shall develop policies 27 20 and procedures to ensure that the funds appropriated in this 27 21 section are spent only after all other reasonable actions have 27 22 been taken to utilize other funding sources and community- 27 23 based services. The policies and procedures shall be designed 27 24 to achieve the following objectives relating to services 27 25 provided under chapter 232: 27 26 a. Maximize the utilization of funds which may be 27 27 available from the medical assistance program including usage 27 28 of the early and periodic screening, diagnosis, and treatment 27 29 (EPSDT) program. 27 30 b. Recover payments from any third-party insurance carrier 27 31 which is liable for coverage of the services, including health 27 32 insurance coverage. 27 33 c. Pursue development of agreements with regularly 27 34 utilized out-of-state service providers which are intended to 27 35 reduce per diem costs paid to those providers. 28 1 4. The department of human services, in consultation with 28 2 the state court administrator and the judicial district 28 3 planning groups, shall compile a monthly report describing 28 4 spending in the districts for court-ordered services for 28 5 juveniles, including the utilization of the medical assistance 28 6 program. The reports shall be submitted on or before the 28 7 twentieth day of each month to the chairpersons and ranking 28 8 members of the joint appropriations subcommittee on human 28 9 services and the legislative fiscal bureau. 28 10 5. Notwithstanding chapter 232 or any other provision of 28 11 law, a district or juvenile court in a department of human 28 12 services district shall not order any service which is a 28 13 charge upon the state pursuant to section 232.141 if there are 28 14 insufficient court-ordered services funds available in the 28 15 district allocation to pay for the service. The chief 28 16 juvenile court officer shall work with the judicial district 28 17 planning group to encourage use of the funds appropriated in 28 18 this section such that there are sufficient funds to pay for 28 19 all court-related services during the entire year. The eight 28 20 chief juvenile court officers shall attempt to anticipate 28 21 potential surpluses and shortfalls in the allocations and 28 22 shall cooperatively request the state court administrator to 28 23 transfer funds between the districts' allocations as prudent. 28 24 6. Notwithstanding any provision of law to the contrary, a 28 25 district or juvenile court shall not order a county to pay for 28 26 any service provided to a juvenile pursuant to an order 28 27 entered under chapter 232 which is a charge upon the state 28 28 under section 232.141, subsection 4. 28 29 7. Of the funds appropriated in this section, not more 28 30 than $100,000 may be used by the judicial department for 28 31 administration of the requirements under this section and for 28 32 travel associated with court-ordered placements which are a 28 33 charge upon the state pursuant to section 232.141, subsection 28 34 4. 28 35 8. Of the funds appropriated in this section, not more 29 1 than $400,000 may be transferred to the appropriation in this 29 2 Act for child and family services and used to provide school- 29 3 based supervision of children adjudicated under chapter 232. 29 4 Sec. 13. MENTAL HEALTH INSTITUTES. There is appropriated 29 5 from the general fund of the state to the department of human 29 6 services for the fiscal year beginning July 1, 1996, and 29 7 ending June 30, 1997, the following amount, or so much thereof 29 8 as is necessary, to be used for the purposes designated: 29 9 For the state mental health institutes for salaries, 29 10 support, maintenance, and miscellaneous purposes and for not 29 11 more than the following full-time equivalent positions: 29 12 .................................................. $ 41,537,333 29 13 ............................................... FTEs 927.16 29 14 1. The funds appropriated and full-time equivalent 29 15 positions authorized in this section are allocated as follows: 29 16 a. State mental health institute at Cherokee: 29 17 .................................................. $ 13,581,308 29 18 ............................................... FTEs 306.04 29 19 b. State mental health institute at Clarinda: 29 20 .................................................. $ 6,172,607 29 21 ............................................... FTEs 136.82 29 22 c. State mental health institute at Independence: 29 23 .................................................. $ 16,946,094 29 24 ............................................... FTEs 401.82 29 25 d. State mental health institute at Mount Pleasant: 29 26 .................................................. $ 4,837,324 29 27 ............................................... FTEs 82.48 29 28 2. Within the funds appropriated in this section, the 29 29 department may reallocate funds as necessary to best fulfill 29 30 the needs of the institutions provided for in the 29 31 appropriation. 29 32 3. As part of the discharge planning process at the state 29 33 mental health institutes, the department shall provide 29 34 assistance in obtaining eligibility for federal supplemental 29 35 security income (SSI) to those individuals whose care at a 30 1 state mental health institute is the financial responsibility 30 2 of the state. 30 3 Sec. 14. HOSPITAL-SCHOOLS. There is appropriated from the 30 4 general fund of the state to the department of human services 30 5 for the fiscal year beginning July 1, 1996, and ending June 30 6 30, 1997, the following amount, or so much thereof as is 30 7 necessary, to be used for the purposes designated: 30 8 For the state hospital-schools, for salaries, support, 30 9 maintenance, and miscellaneous purposes and for not more than 30 10 the following full-time equivalent positions: 30 11 .................................................. $ 62,029,824 30 12 ............................................... FTEs 1,516.00 30 13 1. The funds appropriated and full-time equivalent 30 14 positions authorized in this section are allocated as follows: 30 15 a. State hospital-school at Glenwood: 30 16 .................................................. $ 35,070,700 30 17 ............................................... FTEs 872.50 30 18 b. State hospital-school at Woodward: 30 19 .................................................. $ 26,959,124 30 20 ............................................... FTEs 643.50 30 21 2. Within the funds appropriated in this section, the 30 22 department may reallocate funds as necessary to best fulfill 30 23 the needs of the institutions provided for in the 30 24 appropriation. 30 25 Sec. 15. MENTAL ILLNESS SPECIAL SERVICES. There is 30 26 appropriated from the general fund of the state to the 30 27 department of human services for the fiscal year beginning 30 28 July 1, 1996, and ending June 30, 1997, the following amount, 30 29 or so much thereof as is necessary, to be used for the purpose 30 30 designated: 30 31 For mental illness special services: 30 32 .................................................. $ 121,220 30 33 1. The department and the Iowa finance authority shall 30 34 develop methods to implement the financing for existing 30 35 community-based facilities and to implement financing for the 31 1 development of affordable community-based housing facilities. 31 2 The department shall assure that clients are referred to the 31 3 housing as it is developed. 31 4 2. The funds appropriated in this section are to provide 31 5 funds for construction and start-up costs to develop community 31 6 living arrangements to provide for persons with mental illness 31 7 who are homeless. These funds may be used to match federal 31 8 Stewart B. McKinney Homeless Assistance Act grant funds. 31 9 Sec. 16. FAMILY SUPPORT SUBSIDY PROGRAM. There is 31 10 appropriated from the general fund of the state to the 31 11 department of human services for the fiscal year beginning 31 12 July 1, 1996, and ending June 30, 1997, the following amount, 31 13 or so much thereof as is necessary, to be used by the division 31 14 of children and family services for the purpose designated: 31 15 For the family support subsidy program: 31 16 .................................................. $ 1,344,000 31 17 The division of children and family services shall utilize 31 18 not more than $200,000 of the funds appropriated in this 31 19 section to implement a pilot project of the children-at-home 31 20 component under the comprehensive family support program in at 31 21 least one rural and one urban county. Not more than $50,000 31 22 of the funds allocated in this paragraph shall be used for 31 23 administrative costs. 31 24 Sec. 17. SPECIAL NEEDS GRANTS. There is appropriated from 31 25 the general fund of the state to the department of human 31 26 services for the fiscal year beginning July 1, 1996, and 31 27 ending June 30, 1997, the following amount, or so much thereof 31 28 as is necessary, to be used for the purpose designated: 31 29 To provide special needs grants to families with a family 31 30 member at home who has a developmental disability or to a 31 31 person with a developmental disability: 31 32 .................................................. $ 53,212 31 33 Grants must be used by a family to defray special costs of 31 34 caring for the family member to prevent out-of-home placement 31 35 of the family member or to provide for independent living 32 1 costs. The grants may be administered by a private nonprofit 32 2 agency which serves people statewide provided that no 32 3 administrative costs are received by the agency. Regular 32 4 reports regarding the special needs grants with the family 32 5 support subsidy program and an annual report concerning the 32 6 characteristics of the grantees shall be provided to the 32 7 legislative fiscal bureau. 32 8 Sec. 18. MI/MR/DD STATE CASES. There is appropriated from 32 9 the general fund of the state to the department of human 32 10 services for the fiscal year beginning July 1, 1996, and 32 11 ending June 30, 1997, the following amount, or so much thereof 32 12 as is necessary, to be used for the purposes designated: 32 13 For purchase of local services for persons with mental 32 14 illness, mental retardation, and developmental disabilities 32 15 where the client has no established county of legal 32 16 settlement: 32 17 .................................................. $ 5,454,000 32 18 If a county has a county management plan which is approved 32 19 by the director of human services pursuant to section 331.439, 32 20 the services paid for under this section are exempt from the 32 21 department's purchase of service system requirements. The 32 22 department shall adopt rules to implement the provisions of 32 23 this paragraph. 32 24 Sec. 19. MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES – 32 25 COMMUNITY SERVICES FUND. There is appropriated from the 32 26 general fund of the state to the mental health and 32 27 developmental disabilities community services fund created in 32 28 section 225C.7 for the fiscal year beginning July 1, 1996, and 32 29 ending June 30, 1997, the following amount, or so much thereof 32 30 as is necessary, to be used for the purpose designated: 32 31 For mental health and developmental disabilities community 32 32 services in accordance with this Act: 32 33 .................................................. $ 16,230,000 32 34 1. Of the funds appropriated in this section, $15,951,138 32 35 shall be allocated to counties for funding of community-based 33 1 mental health and developmental disabilities services. The 33 2 moneys shall be allocated to a county as follows: 33 3 a. Fifty percent based upon the county's proportion of the 33 4 state's population of persons with an annual income which is 33 5 equal to or less than the poverty guideline established by the 33 6 federal office of management and budget. 33 7 b. Fifty percent based upon the county's proportion of the 33 8 state's general population. 33 9 2. a. A county shall utilize the funding the county 33 10 receives pursuant to subsection 1 for services provided to 33 11 persons with a disability, as defined in section 225C.2. 33 12 However, no more than 50 percent of the funding shall be used 33 13 for services provided to any one of the service populations. 33 14 b. A county shall use at least 50 percent of the funding 33 15 the county receives under subsection 1 for contemporary 33 16 services provided to persons with a disability, as described 33 17 in rules adopted by the department. 33 18 3. Of the funds appropriated in this section, $30,000 33 19 shall be used to support the Iowa compass program providing 33 20 computerized information and referral services for Iowans with 33 21 disabilities and their families. 33 22 4. The department shall submit an annual report concerning 33 23 each population served and each service funded in this section 33 24 to the chairpersons and ranking members of the joint 33 25 appropriations subcommittee on human services and the 33 26 legislative fiscal bureau. 33 27 5. Of the funds appropriated in this section, not more 33 28 than $248,862 shall be provided to those counties having 33 29 supplemental per diem contracts in effect on June 30, 1994, 33 30 which were originally initiated under 1993 Iowa Acts, chapter 33 31 172, section 16, subsection 2. The amount provided to each 33 32 county shall be equal to the amount the county would be 33 33 eligible to receive under the supplemental per diem contracts 33 34 in effect on June 30, 1994, if the contracts were continued in 33 35 effect for the entire fiscal year beginning July 1, 1996. 34 1 6. a. Funding from the federal social services block 34 2 grant in the amount of $13,038,763 is allocated for 34 3 distribution to counties for local purchase of services for 34 4 persons with mental illness or mental retardation or other 34 5 developmental disability. 34 6 b. The funds allocated in this subsection shall be 34 7 expended by counties in accordance with eligibility guidelines 34 8 established in the department's rules outlining general 34 9 provisions for service administration. Services eligible for 34 10 payment with funds allocated in this subsection are limited to 34 11 any of the following which are provided in accordance with the 34 12 department's administrative rules for the services: adult 34 13 support, adult day care, administrative support for 34 14 volunteers, community supervised apartment living 34 15 arrangements, residential services for adults, sheltered work, 34 16 supported employment, supported work training, transportation, 34 17 and work activity. 34 18 c. In purchasing services with funds allocated in this 34 19 subsection, a county shall designate a person to provide for 34 20 eligibility determination and development of a case plan for 34 21 individuals for whom the services are purchased. The 34 22 designated person shall be a medical assistance case manager 34 23 serving the person's county of residence. If an individual 34 24 does not have a case manager, the individual's eligibility 34 25 shall be determined by a social services caseworker of the 34 26 department serving the individual's county of residence. The 34 27 case plan shall be developed in accordance with the 34 28 department's rules outlining general provisions for service 34 29 administration. 34 30 d. Services purchased with funds allocated in this 34 31 subsection must be the result of a referral by the person who 34 32 identified the services in developing the individual's case 34 33 plan. 34 34 e. Services purchased with funds allocated in this 34 35 subsection must be under a purchase of service contract 35 1 established in accordance with the department's administrative 35 2 rules for purchase of service. 35 3 f. The funds provided by this subsection shall be 35 4 allocated to each county as follows: 35 5 (1) Fifty percent based upon the county's proportion of 35 6 the state's population of persons with an annual income which 35 7 is equal to or less than the poverty guideline established by 35 8 the federal office of management and budget. 35 9 (2) Fifty percent based upon the amount provided to the 35 10 county for local purchase of services in the preceding fiscal 35 11 year. 35 12 g. Each county shall submit to the department a plan for 35 13 funding of the services eligible for payment under this 35 14 subsection. The plan may provide for allocation of the funds 35 15 for one or more of the eligible services. The plan shall 35 16 identify the funding amount the county allocates for each 35 17 service and the time period for which the funding will be 35 18 available. Only those services which have funding allocated 35 19 in the plan are eligible for payment with funds provided in 35 20 this subsection. 35 21 h. A county shall provide advance notice to the individual 35 22 receiving services, the service provider, and the person 35 23 responsible for developing the case plan of the date the 35 24 county determines that funding will no longer be available for 35 25 a service. 35 26 i. The moneys provided under this subsection do not 35 27 establish an entitlement to the services funded under this 35 28 subsection. 35 29 7. If a county has a county management plan which is 35 30 approved by the director of human services pursuant to section 35 31 331.439, the county shall be considered to have met the 35 32 requirements of subsection 2, and subsection 6, paragraphs 35 33 "b", "c", "d", "e", and "g". The department shall adopt rules 35 34 to implement the provisions of this subsection. 35 35 Sec. 20. PERSONAL ASSISTANCE – FAMILY SUPPORT. There is 36 1 appropriated from the general fund of the state to the 36 2 department of human services for the fiscal year beginning 36 3 July 1, 1996, and ending June 30, 1997, the following amount 36 4 or so much thereof as is necessary, to be used for the purpose 36 5 designated: 36 6 For continuation of a pilot project for the personal 36 7 assistance services program in accordance with this section: 36 8 .................................................. $ 364,000 36 9 The funds appropriated in this section shall be used by the 36 10 division of children and family services to continue the pilot 36 11 project for the personal assistance services program under 36 12 section 225C.46 in an urban and a rural area. A portion of 36 13 the funds may be used for costs to develop a federal home and 36 14 community-based waiver under the medical assistance program 36 15 for persons with physical disabilities or other expenditures 36 16 necessary to develop the personal assistance program in the 36 17 most appropriate and cost-effective manner. However, not more 36 18 than $50,000 shall be used for administrative costs. The 36 19 pilot project and the waiver shall not be implemented in a 36 20 manner that would require additional county or state costs for 36 21 assistance provided to an individual served under the pilot 36 22 project or the waiver. 36 23 Sec. 21. FIELD OPERATIONS. There is appropriated from the 36 24 general fund of the state to the department of human services 36 25 for the fiscal year beginning July 1, 1996, and ending June 36 26 30, 1997, the following amount, or so much thereof as is 36 27 necessary, to be used for the purpose designated: 36 28 For field operations, including salaries, support, 36 29 maintenance, and miscellaneous purposes and for not more than 36 30 the following full-time equivalent positions: 36 31 ................................................. $ 38,483,998 36 32 ............................................... FTEs 2,019.00 36 33 Sec. 22. GENERAL ADMINISTRATION. There is appropriated 36 34 from the general fund of the state to the department of human 36 35 services for the fiscal year beginning July 1, 1996, and 37 1 ending June 30, 1997, the following amount, or so much thereof 37 2 as is necessary, to be used for the purpose designated: 37 3 For general administration, including salaries, support, 37 4 maintenance, and miscellaneous purposes and for not more than 37 5 the following full-time equivalent positions: 37 6 .................................................. $ 11,917,316 37 7 ............................................... FTEs 401.00 37 8 1. Of the funds appropriated in this section, $57,090 is 37 9 allocated for the prevention of disabilities policy council 37 10 established in section 225B.3. 37 11 2. a. Except as provided under this subsection and under 37 12 the appropriation in this Act to the legislative council, the 37 13 department shall not implement the options for service system 37 14 modification developed by the department's modification teams 37 15 in response to proposed federal action and shall not implement 37 16 other actions in response to enacted federal changes affecting 37 17 the programs administered by the department unless the 37 18 department is implementing a policy or action authorized in 37 19 law by the Seventy-sixth General Assembly, 1996 Session, or by 37 20 the Seventy-seventh General Assembly. 37 21 b. The department may make changes to the requirements for 37 22 periodic reporting by participants under the family investment 37 23 program, food stamp program, or medical assistance program if 37 24 the changes would result in a reduction in paperwork for the 37 25 participants and for department staff. If a federal waiver is 37 26 necessary to implement a change, the department may submit the 37 27 waiver request to the United States departments of health and 37 28 human services and agriculture, as applicable. If the 37 29 department elects to submit a waiver request or to adopt rules 37 30 to implement a change under this paragraph, the department 37 31 shall first consult with a group similar to the work group 37 32 that considered the state human investment policy proposal or 37 33 with a successor interagency task force which makes 37 34 recommendations concerning the family investment program, and 37 35 shall share the proposals with the chairpersons and ranking 38 1 members of the committees on human resources of the senate and 38 2 house of representatives. 38 3 c. If implementation of the request would result in 38 4 increased federal funding and would permit greater flexibility 38 5 in service funding, the department may submit a waiver request 38 6 to the United States department of health and human services 38 7 for Title IV-E funding to be provided to the state in a fixed 38 8 amount. Prior to submission of the request, the department 38 9 shall consult with representatives of the juvenile court and 38 10 service providers. 38 11 Sec. 23. DEPARTMENT OF HUMAN SERVICES RESTRUCTURING TASK 38 12 FORCE ON THE FUTURE OF HUMAN SERVICES. There is appropriated 38 13 from the general fund of the state to the legislative council 38 14 for the fiscal period beginning July 1, 1996, and ending June 38 15 30, 1998, the following amount, or so much thereof as is 38 16 necessary, to be used for the purpose designated: 38 17 For expenses associated with the activities of the task 38 18 force for assessing the structure and function of the 38 19 department of human services and human services programs in 38 20 accordance with this section: 38 21 .................................................. $ 75,000 38 22 1. The legislative council shall establish a task force to 38 23 develop a comprehensive proposal for changing the role and 38 24 function of the department of human services and its programs. 38 25 The purpose of the changes is to improve services to Iowans 38 26 through the creation of new federal, state, and local 38 27 partnerships. The task force shall make recommendations 38 28 regarding restructuring the department of human services in 38 29 order to achieve better human services results, to improve the 38 30 quality of service delivery, and to increase the quality of 38 31 the department's interaction with the public. The task force 38 32 may also assess program duplication and linkages with other 38 33 federal, state, or local programs or funding streams. 38 34 2. The task force shall be composed of not more than 21 38 35 members appointed by the legislative council and shall include 39 1 not more than five individuals recommended by the governor and 39 2 legislators who are members of the joint appropriations 39 3 subcommittee on human services and other knowledgeable 39 4 legislators designated by the legislative council. The task 39 5 force may use moneys appropriated in this section for 39 6 technical assistance. The task force shall consult with 39 7 service consumers, experts who are representative of 39 8 organizations such as nonprofit service organizations, health 39 9 insurers, and human services-oriented community organizations, 39 10 representatives of local governments, representatives of state 39 11 agencies, federal officials with expertise or responsibilities 39 12 regarding human services in Iowa, and others, as determined by 39 13 the task force. An interim report shall be completed prior to 39 14 the convening of the Seventy-seventh General Assembly. 39 15 The task force shall provide for public input concerning 39 16 the four modification proposals developed by the department in 39 17 response to proposed federal actions submitted to the joint 39 18 appropriations subcommittee on human services in February 39 19 1996. 39 20 The task force may establish work groups to assist in the 39 21 task force's consideration of the modification proposals which 39 22 may include the following: 39 23 a. A review of the child welfare modification proposal 39 24 which may include input from representatives of the juvenile 39 25 court, service providers, families receiving services, the 39 26 attorney general, representatives of local governments, 39 27 representatives of state agencies, and other citizens and 39 28 officials. 39 29 b. A review of the mental health and developmental 39 30 disabilities proposal which shall incorporate issues 39 31 associated with implementation of the funding reform enacted 39 32 in 1995 Iowa Acts, chapter 206; usage of service providers 39 33 such as intermediate care facilities for the mentally 39 34 retarded, state institutions, and other services for persons 39 35 with disabilities; distribution of services throughout the 40 1 state; and other issues. In addition, the review shall 40 2 consider a proposal to replace the single contract for managed 40 3 care under medical assistance with not more than four regional 40 4 plans utilizing collaborations between community mental health 40 5 centers as umbrella agencies. 40 6 c. A review of the family investment program proposal 40 7 which may include input from the work group which considered 40 8 the state human investment policy proposal or a successor 40 9 interagency task force which makes recommendations to the 40 10 department concerning the family investment program. 40 11 Consideration of issues associated with the proposal may 40 12 include review of the emergency assistance program, the family 40 13 development and self-sufficiency (FaDSS) program, and child 40 14 day care programs, and an assessment of the feasibility of 40 15 transferring all or part of the functions of the child support 40 16 recovery unit to other agencies of state government. 40 17 d. A review of the medical assistance proposal which may 40 18 include input from representatives of the medical assistance 40 19 advisory council, the long-term care resident's advocate, and 40 20 consumer groups such as the Iowa affiliate of the American 40 21 association of retired persons, Iowa citizens' action network, 40 22 the governor's DD council which was formerly referred to as 40 23 the governor's planning council for developmental 40 24 disabilities, and representatives of maternal and child health 40 25 centers. 40 26 3. If federal law requires the state to make changes in 40 27 the programs and services directed to the populations 40 28 addressed by the modification proposals and authorizes the 40 29 changes to be made without state legislation, the department 40 30 shall adopt rules to implement the changes. The rules shall 40 31 be submitted to the task force for review and recommendation 40 32 prior to their submission to the administrative rules review 40 33 committee. 40 34 Sec. 24. VOLUNTEERS. There is appropriated from the 40 35 general fund of the state to the department of human services 41 1 for the fiscal year beginning July 1, 1996, and ending June 41 2 30, 1997, the following amount, or so much thereof as is 41 3 necessary, to be used for the purpose designated: 41 4 For development and coordination of volunteer services: 41 5 .................................................. $ 98,900 41 6 Sec. 25. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY 41 7 ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE 41 8 DEPARTMENT OF HUMAN SERVICES. 41 9 1. a. The department of human services may allocate 41 10 increases among items and procedures for durable medical 41 11 products and supplies as deemed appropriate in cooperation 41 12 with durable medical equipment and supply dealers, 41 13 audiologists, and hearing aid dealers. 41 14 b. For the fiscal year beginning July 1, 1996, skilled 41 15 nursing facilities shall remain at the rates in effect on June 41 16 30, 1996. 41 17 c. The dispensing fee for pharmacists shall remain at the 41 18 rate in effect on June 30, 1996. The reimbursement policy for 41 19 drug product costs shall be in accordance with federal 41 20 requirements. 41 21 d. Reimbursement rates for inpatient and outpatient 41 22 hospital services shall remain at the rates in effect on June 41 23 30, 1996. The department shall continue the outpatient 41 24 hospital reimbursement system based upon ambulatory patient 41 25 groups implemented pursuant to 1994 Iowa Acts, chapter 1186, 41 26 section 25, subsection 1, paragraph "f". Reimbursements made 41 27 between July 1, 1996, and June 30, 1997, under the outpatient 41 28 hospital reimbursement system implemented pursuant to 1994 41 29 Iowa Acts, chapter 1186, section 25, subsection 1, paragraph 41 30 "f", shall be retrospectively adjusted so that the 41 31 reimbursement made is within a ten percent deviation of the 41 32 lower of the cost or the charges for the services provided 41 33 during the fiscal year ending June 30, 1996. In addition, the 41 34 department shall continue the revised medical assistance 41 35 payment policy implemented pursuant to that paragraph to 42 1 provide reimbursement for costs of screening and treatment 42 2 provided in the hospital emergency room if made pursuant to 42 3 the prospective payment methodology developed by the 42 4 department for the payment of outpatient services provided 42 5 under the medical assistance program. 42 6 e. Reimbursement rates for rural health clinics shall be 42 7 increased in accordance with increases under the federal 42 8 Medicare program. 42 9 f. Home health agencies certified for the federal Medicare 42 10 program, hospice services, and acute care mental hospitals 42 11 shall be reimbursed for their current federal Medicare audited 42 12 costs. 42 13 g. The basis for establishing the maximum medical 42 14 assistance reimbursement rate for nursing facilities shall be 42 15 the 70th percentile of facility costs as calculated from the 42 16 June 30, 1996, unaudited compilation of cost and statistical 42 17 data. However, to the extent funds are available within the 42 18 amount projected for reimbursement of nursing facilities 42 19 within the appropriation for medical assistance in this Act, 42 20 and within the appropriation for medical assistance as a 42 21 whole, the department shall adjust the maximum medical 42 22 assistance reimbursement for nursing facilities to the 70th 42 23 percentile, as calculated on December 31, 1996, unaudited 42 24 compilation of cost and statistical data and the adjustment 42 25 shall take effect January 1, 1997. 42 26 h. The department may modify the reimbursement methodology 42 27 for skilled nursing facilities which participated in the 42 28 medical assistance program on or before May 31, 1993, and 42 29 which met the departmental disproportionate share payment 42 30 provisions as of May 31, 1993, if it is possible to 42 31 demonstrate that the modification would result in a cost 42 32 savings to the medical assistance program. 42 33 i. The department may revise the fee schedule used for 42 34 physician reimbursement. 42 35 j. Federally qualified health centers shall be reimbursed 43 1 at 100 percent of reasonable costs as determined by the 43 2 department in accordance with federal requirements. 43 3 k. The department may allocate increases among items and 43 4 procedures for dental procedures as deemed appropriate in 43 5 cooperation with dentists. 43 6 2. For the fiscal year beginning July 1, 1996, the maximum 43 7 cost reimbursement rate for residential care facilities 43 8 reimbursed by the department shall be $21.54 per day. The 43 9 flat reimbursement rate for facilities electing not to file 43 10 semiannual cost reports shall be $15.41 per day. For the 43 11 fiscal year beginning July 1, 1996, the maximum reimbursement 43 12 rate for providers reimbursed under the in-home health-related 43 13 care program shall be $414.11 per month. 43 14 3. Unless otherwise directed in this section, when the 43 15 department's reimbursement methodology for any provider 43 16 reimbursed in accordance with this section includes an 43 17 inflation factor, this factor shall not exceed the amount by 43 18 which the consumer price index for all urban consumers 43 19 increased during the calendar year ending December 31, 1995. 43 20 4. Notwithstanding section 234.38, in the fiscal year 43 21 beginning July 1, 1996, the foster family basic daily 43 22 maintenance rate and the maximum adoption subsidy rate for 43 23 children ages 0 through 5 years shall be $12.34, the rate for 43 24 children ages 6 through 11 years shall be $13.06, the rate for 43 25 children ages 12 through 15 years shall be $14.23, and the 43 26 rate for children ages 16 and older shall be $15.12. 43 27 5. For the fiscal year beginning July 1, 1996, the maximum 43 28 reimbursement rates for social service providers shall be the 43 29 same as the rates in effect on June 30, 1996, except under any 43 30 of the following circumstances: 43 31 a. If a new service was added after June 30, 1996, the 43 32 initial reimbursement rate for the service shall be based upon 43 33 actual and allowable costs. 43 34 b. If a social service provider loses a source of income 43 35 used to determine the reimbursement rate for the provider, the 44 1 provider's reimbursement rate may be adjusted to reflect the 44 2 loss of income, provided that the lost income was used to 44 3 support actual and allowable costs of a service purchased 44 4 under a purchase of service contract. 44 5 c. The department revises the reimbursement rates as part 44 6 of the changes in the mental health and developmental 44 7 disabilities services system initiated pursuant to 1995 Iowa 44 8 Acts, chapter 206 (Senate File 69), and associated 44 9 legislation. 44 10 d. The reimbursement rate revision is necessary to 44 11 implement the change required by the appropriation in this Act 44 12 for an increase in the reimbursement for residential care 44 13 facilities. 44 14 6. The group foster care reimbursement rates paid for 44 15 placement of children out-of-state shall be calculated 44 16 according to the same rate-setting principles as those used 44 17 for in-state providers unless the director determines that 44 18 appropriate care cannot be provided within the state. The 44 19 payment of the daily rate shall be based on the number of days 44 20 in the calendar month in which service is provided. 44 21 7. For the fiscal year beginning July 1, 1996, the 44 22 combined service and maintenance components of the 44 23 reimbursement rate paid to a shelter care provider shall be 44 24 based on the cost report submitted to the department. The 44 25 maximum reimbursement rate shall be $76.61 per day. If the 44 26 department would reimburse the provider at less than the 44 27 maximum rate but the provider's cost report justifies a rate 44 28 of at least $76.61, the department shall readjust the 44 29 provider's reimbursement rate to the maximum reimbursement 44 30 rate. In January 1997, the department shall review the usage 44 31 of shelter care and the funding allocated for shelter care, if 44 32 the usage is less than anticipated and the existing contracts 44 33 for provision of shelter care do not obligate the total amount 44 34 of the funds allocated, the department may utilize moneys in 44 35 the allocation, which would otherwise be unexpended, for wrap- 45 1 around services or support to enable group foster care 45 2 placement to be prevented or the length of stay reduced. 45 3 8. The department, through the drug utilization review 45 4 commission, shall propose a pilot project for an alternative 45 5 payment system, recommended in the study completed by the drug 45 6 utilization review commission, for compensation of pharmacists 45 7 for pharmaceutical care services under medical assistance at 45 8 no cost to the state. The department shall submit the 45 9 proposal to the members of the joint appropriations 45 10 subcommittee on human services on or before November 30, 1996. 45 11 9. For the fiscal year beginning July 1, 1996, the 45 12 department shall calculate reimbursement rates for 45 13 intermediate care facilities for the mentally retarded at the 45 14 80th percentile. The department shall address any other 45 15 proposals for containment of intermediate care facilities for 45 16 the mentally retarded costs with the work group for 45 17 restructuring of the department of human services created 45 18 pursuant to this Act. 45 19 10. The department of human services shall adopt rules 45 20 applicable to agencies providing services under the 45 21 department's rehabilitative treatment program for children and 45 22 their families to eliminate reimbursement rate limits on 45 23 service components which are within a category of cost which 45 24 itself has a reimbursement rate limit. The change required by 45 25 this subsection shall be implemented in a manner which is cost 45 26 neutral. 45 27 11. The department shall negotiate with providers of 45 28 services under the department's medical assistance 45 29 rehabilitative treatment program for children and families, to 45 30 revise the department's rules providing reimbursement rates 45 31 under the program, including a review of cost principles. The 45 32 goals for the revision are to simplify the reimbursement 45 33 process, reduce paperwork for providers, and provide full 45 34 payment for necessary services provided under contract with 45 35 the department. Prior to adoption of the rules and no later 46 1 than October 1, 1996, the department shall provide a 46 2 description of the agreement to the chairpersons and ranking 46 3 members of the joint appropriations subcommittee on human 46 4 services. The provisions of this subsection shall be separate 46 5 from the provisions of subsection 10. 46 6 12. The department of human services, in consultation with 46 7 representatives of nursing facilities, consumers, legislators, 46 8 a representative of the department of management or the 46 9 governor's designee, and other interested entities, shall do 46 10 all of the following with the goals of improving the quality 46 11 of care and improving the recruitment and retention of 46 12 qualified direct health care providers in nursing facilities: 46 13 a. Establish definitions for the direct health care, 46 14 administrative, room and board, and property cost categories 46 15 for reimbursement of nursing facilities under the medical 46 16 assistance program. 46 17 b. Analyze and make recommendations for the distribution 46 18 of costs among the cost categories which may include 46 19 elimination or replacement of the cost categories. 46 20 c. Analyze and make recommendations to eliminate 46 21 reimbursement rate limits on components which are within a 46 22 category of cost which itself has a reimbursement rate limit. 46 23 d. Conduct a cost-benefit analysis of incentive payments, 46 24 evaluate their impact on quality of care and patient well- 46 25 being, and make recommendations based upon the analysis and 46 26 evaluation. 46 27 e. Analyze and make recommendations for clarification and 46 28 simplification of the cost report format, which may include 46 29 standardization with the county charts of accounts. 46 30 f. Analyze and make recommendations regarding the use of a 46 31 reimbursement allowance for those nursing facilities serving a 46 32 disproportionate share of medical assistance patients. 46 33 g. Analyze and make recommendations regarding effective 46 34 ways to mediate disputes between a nursing facility and the 46 35 department of inspections and appeals concerning significant 47 1 violations, prior to a formal appeal. 47 2 h. Submit a report of the definitions, analysis, and 47 3 recommendations to the general assembly on or before December 47 4 16, 1996. 47 5 13. The department may adopt emergency rules to implement 47 6 the provisions of this section. 47 7 Sec. 26. RESIDENTIAL SERVICES – PURCHASE OF SERVICES – 47 8 REIMBURSEMENT RATE INCREASE. There is appropriated from the 47 9 general fund of the state to the department of human services 47 10 for the fiscal year beginning July 1, 1996, and ending June 47 11 30, 1997, the following amount, or so much thereof as is 47 12 necessary, to be used for the purpose designated: 47 13 For an increase in the purchase of service reimbursement 47 14 rate for adult residential services provided to persons 47 15 residing in any category of licensed residential care 47 16 facility. Beginning July 1, 1996, provider service rates for 47 17 adult residential services shall be increased up to the amount 47 18 of actual and allowable costs plus inflation, based upon the 47 19 cost reports on which rates have been established as of April 47 20 1, 1996. However, a provider service rate shall not be 47 21 increased by more than $4.36 per day. If a provider service 47 22 rate in effect prior to July 1, 1996, is greater than the 47 23 actual and allowable costs plus inflation, based upon the cost 47 24 report, or if the difference between the provider service rate 47 25 and the actual and allowable costs is less than $.44 per day, 47 26 the provider service rate shall be increased by $.44 per day: 47 27 .................................................. $ 1,300,000 47 28 1. Funding appropriated in this section shall be allocated 47 29 to counties in accordance with the distribution guidelines for 47 30 local purchase of services in accordance with the 47 31 appropriation in this Act for the mental health and 47 32 developmental disabilities community services fund. Use of 47 33 the funding is restricted to reimbursement of a licensed 47 34 residential care facility provider of adult residential 47 35 services which had a purchase of service contract for those 48 1 services in effect on June 30, 1996, and for which the rate 48 2 negotiated for fiscal year 1996-1997 is greater than the rate 48 3 paid in fiscal year 1995-1996. 48 4 2. Of the moneys appropriated in this section, $130,000 48 5 shall be transferred to the appropriation in this Act for 48 6 MI/MR/DD state cases and shall be used for payment of the 48 7 increased reimbursement rate to residential care facilities 48 8 providing services through local purchase of services for 48 9 persons under the state cases program, and in accordance with 48 10 the guidelines in this Act for local purchase of services. 48 11 Sec. 27. APPROPRIATIONS REDUCTIONS. The following 48 12 appropriations in this Act for the fiscal year beginning July 48 13 1, 1996, and ending June 30, 1997, are reduced by a total of 48 14 $1,560,000: child support recovery, juvenile institutions, 48 15 community-based programs, mental health institutes, state 48 16 hospital-schools, field operations, and general 48 17 administration. The department shall use the following 48 18 guidelines in achieving these reductions: 48 19 1. As the highest priority, avoid disruptions of direct 48 20 client services. 48 21 2. To the extent possible, use attrition to reduce the 48 22 number of positions filled. 48 23 3. To the extent possible, not disproportionately affect a 48 24 single job classification. 48 25 4. Not include in the reduction, the elimination of the 48 26 3.00 FTEs for managed care specialists in the medical services 48 27 division. 48 28 5. Consider reductions in administration, overhead, and 48 29 program duplication. 48 30 The department shall submit the department's plan for 48 31 accomplishing the reductions to the chairpersons and ranking 48 32 members of the joint appropriations subcommittee on human 48 33 services, the department of management, and the legislative 48 34 fiscal bureau on or before June 15, 1996. 48 35 Sec. 28. STATE INSTITUTIONS – CLOSINGS, REDUCTIONS, AND 49 1 BILLING PRACTICES. 49 2 1. If a state institution administered by the department 49 3 of human services is to be closed or reduced in size, prior to 49 4 the closing or reduction the department shall initiate and 49 5 coordinate efforts in cooperation with the Iowa department of 49 6 economic development to develop new jobs in the area in which 49 7 the state institution is located. In addition, the department 49 8 may take other actions to utilize any closed unit or other 49 9 facilities and services of an institution, including but not 49 10 limited to assisting public or private organizations in 49 11 utilizing the services and facilities. The actions may also 49 12 include assisting an organization with remodeling and lease 49 13 costs by forgiving future rental or lease payments to the 49 14 extent necessary for a period not to exceed five years. The 49 15 department of human services and the department of economic 49 16 development shall submit a joint report to the chairpersons 49 17 and ranking members of the joint appropriations subcommittee 49 18 on human services on or before January 2, 1997, regarding any 49 19 efforts made pursuant to this subsection. 49 20 2. For purposes of this section, "state institution" means 49 21 a state mental health institute, a state hospital-school, the 49 22 state training school, and the Iowa juvenile home under the 49 23 authority of the department of human services listed in 49 24 section 218.1. If excess capacity exists at a state 49 25 institution beyond the capacity required for placements at the 49 26 institution under law, the department of human services may 49 27 enter into a contract with a managed care provider or an 49 28 organized delivery system for health care, to provide services 49 29 during the fiscal year beginning July 1, 1996, at the 49 30 institution for the plan or system. 49 31 3. The department shall work with administrators of state 49 32 institutions and the department of management and the 49 33 legislative fiscal bureau in reviewing revenues and 49 34 expenditures attributable to state institutions, applicable 49 35 fiscal procedures, and other information as necessary to 50 1 develop a proposal to revise the manner of making 50 2 appropriations to these state institutions and of accounting 50 3 for reimbursements and expenditures so that in future fiscal 50 4 years the amounts appropriated reflect the net amount of state 50 5 funds needed. The proposal shall be submitted to the general 50 6 assembly on or before December 16, 1996. If deemed feasible 50 7 by those performing the review, the department of human 50 8 services and the department of management shall incorporate 50 9 the proposed revisions in the budget documents for the fiscal 50 10 year beginning July 1, 1997. 50 11 4. The superintendents of the state hospital-schools shall 50 12 work with the department's administrative staff in studying 50 13 the manner in which services and costs are combined for 50 14 purposes of billing for medical assistance reimbursement at 50 15 the state hospital-schools. Following the study, the 50 16 superintendents shall submit a report which may include a 50 17 proposal for revising the state hospital-schools' manner of 50 18 billing for medical assistance reimbursement to be more 50 19 comparable to other intermediate care facilities for the 50 20 mentally retarded. The report shall be submitted to the 50 21 general assembly on or before December 16, 1996. 50 22 5. The superintendent of the state hospital-schools shall 50 23 work with the department's administrative staff in developing 50 24 methodologies to bill services, consultation, and other 50 25 assistance provided by the state hospital-schools in support 50 26 of community-based services. The department may implement the 50 27 methodologies in the fiscal year beginning July 1, 1996. 50 28 6. In addition to existing planning efforts for community- 50 29 based alternatives to placements at a state hospital-school, 50 30 if the department's budget planning for fiscal year 1997-1998 50 31 includes a proposal for reduction of capacity at a state 50 32 hospital-school or mental health institute, the department 50 33 shall work with counties, service providers, advocates, and 50 34 the department's contractor for managed mental health care 50 35 under medical assistance, in developing a plan for community- 51 1 based placements in place of the capacity proposed to be 51 2 reduced. The plan shall be submitted for review to the task 51 3 force on the future of human services created in this Act and 51 4 to the state-county management committee. It is the intent of 51 5 the general assembly that any authorization for any reduction 51 6 of capacity at a state hospital-school or state mental health 51 7 institute in fiscal year 1997-1998 is contingent upon 51 8 development of sufficient community-based placements to 51 9 replace the reduced capacity. 51 10 7. To the extent possible, the department shall consult 51 11 with the applicable workgroups of the task force on the future 51 12 of the department of human services created in this Act 51 13 concerning the activities required of the department pursuant 51 14 to this section. 51 15 Sec. 29. STANDARDS FOR CASELOADS. The department of human 51 16 services shall develop a plan for meeting national standards 51 17 on caseloads for the department's social workers. 51 18 The department shall submit the planning provisions 51 19 required by this section to the members of the joint 51 20 appropriations subcommittee on human services of the senate 51 21 and house of representatives on or before January 8, 1997. 51 22 Sec. 30. REPORTS. Any reports or information required to 51 23 be compiled and submitted under this Act shall be submitted to 51 24 the chairpersons and ranking members of the joint 51 25 appropriations subcommittee on human services, the legislative 51 26 fiscal bureau, the legislative service bureau, and to the 51 27 caucus staffs on or before the dates specified for submission 51 28 of the reports or information. 51 29 Sec. 31. REPORTS BY PROVIDERS OF FOSTER CARE SERVICES – 51 30 REVIEW – PROCESS SIMPLIFICATION. The department of human 51 31 services shall consult with providers of rehabilitation 51 32 treatment services relating to the medical assistance child 51 33 services initiative in reviewing provider requirements 51 34 relating to financial and statistical accountability reporting 51 35 and the process for submission of the reports relating to 52 1 these requirements. Following this review, and no later than 52 2 January 1, 1997, the department of human services shall 52 3 implement a process which provides, at a minimum, for a 52 4 simplified means of documenting compliance with provider 52 5 accountability requirements which shall, at a minimum, include 52 6 consolidation of the reports required and which may provide a 52 7 means for submission of the reports in an electronic format. 52 8 Sec. 32. Section 135H.6, Code 1995, is amended by adding 52 9 the following new subsections: 52 10 NEW SUBSECTION. 5A. The department of human services may 52 11 give approval to conversion of beds specializing in substance 52 12 abuse treatment previously approved under subsection 5, 52 13 paragraph "b", to beds which are not specialized as referenced 52 14 in subsection 5, paragraph "a". Beds converted under this 52 15 subsection shall be in addition to the number of beds 52 16 authorized under subsection 5, paragraph "a". However, the 52 17 total number of beds approved under subsection 5 shall not 52 18 exceed four hundred thirty. Conversion of beds under this 52 19 subsection shall not require a revision of the certificate of 52 20 need issued for the psychiatric institution making the 52 21 conversion. 52 22 NEW SUBSECTION. 7. A psychiatric institution licensed 52 23 prior to January 1, 1996, may exceed the number of beds 52 24 authorized under subsections 5 and 5A if the excess beds are 52 25 used to provide services funded from a source other than the 52 26 medical assistance program under chapter 249A. 52 27 Notwithstanding subsections 4, 5, and 5A, the provision of 52 28 services using such excess beds does not require a certificate 52 29 of need or a review by the department of human services. 52 30 Sec. 33. Section 228.5, subsection 1, Code 1995, is 52 31 amended to read as follows: 52 32 1. An individual or an individual's legal representative 52 33 shall be informed that mental health information relating to 52 34 the individual may be disclosed to employees or agents of or 52 35 for the same mental health facility or to other providers of 53 1 professional services or their employees or agents if and to 53 2 the extent necessary to facilitate the provision of 53 3 administrative and professional services to the individual. 53 4 Sec. 34. Section 228.5, Code 1995, is amended by adding 53 5 the following new subsection: 53 6 NEW SUBSECTION. 4. Mental health information relating to 53 7 an individual may be disclosed to other providers of 53 8 professional services or their employees or agents if and to 53 9 the extent necessary to facilitate the provision of 53 10 administrative and professional services to the individual. 53 11 Sec. 35. Section 232.143, Code Supplement 1995, is amended 53 12 to read as follows: 53 13 232.143 REGIONAL GROUP FOSTER CARETARGETBUDGET TARGETS. 53 14 1. A statewide expenditure targetfor the average number53 15offor children in group foster care placementson any day of53 16 in a fiscal year, which placements are a charge upon or are 53 17 paid for by the state, shall be established annually in an 53 18 appropriation bill by the general assembly. The department 53 19 and the judicial department shall jointly develop a formula 53 20 for allocating a portion of the statewide expenditure target 53 21 established by the general assembly to each of the 53 22 department's regions. The formula shall be based upon the 53 23 region's proportion of the state population of children and of 53 24 the statewidenumber of children placed inusage of group 53 25 foster care in the previous five completed fiscal years and 53 26 other indicators of need. Thenumberexpenditure amount 53 27 determined in accordance with the formula shall be the group 53 28 foster careplacementbudget target for that region. A region 53 29 may exceed its budget target for group foster care by not more 53 30 than five percent in a fiscal year, provided the overall 53 31 funding allocated by the department for all child welfare 53 32 services in the region is not exceeded. 53 33 2. For each of the department's regions, representatives 53 34 appointed by the department and the juvenile court shall 53 35 establish a plan for containing thenumber ofexpenditures for 54 1 children placed in group foster care ordered by the court 54 2 within the budget target allocated to that region pursuant to 54 3 subsection 1. The plan shall include monthly targets and 54 4 strategies for developing alternatives to group foster care 54 5 placements in order to contain expenditures for child welfare 54 6 servicesprovided to childrenwithin the amount appropriated 54 7 by the general assembly for that purpose. Each regional plan 54 8 shall be established in advance of the fiscal year to which 54 9 the regional plan applies. To the extent possible, the 54 10 department and the juvenile court shall coordinate the 54 11 planning required under this subsection with planning for 54 12 services paid under section 232.141, subsection 4. The 54 13 department's regional administrator shall communicate 54 14 regularly, as specified in the regional plan, with the 54 15 juvenile courts within that region concerning the current 54 16 status of the regional plan's implementation. 54 17 3. State payment for group foster care placements shall be 54 18 limited to those placements which are in accordance with the 54 19 regional plans developed pursuant to subsection 2. If a 54 20 proposed group foster care placement in a region would meet 54 21 the region's plan requirements except that the placement would 54 22 cause a monthly or overall budget target to be exceeded and 54 23 the child is eligible for an alternative service which is 54 24 costlier and more restrictive than the proposed placement, the 54 25 director of human services, after consultation with 54 26 appropriate juvenile court officials, may allow an exception 54 27 to policy and authorize the placement. At the close of the 54 28 fiscal year, moneys for specific placements authorized by the 54 29 director under this subsection shall be transferred from the 54 30 state appropriation for the alternative placement to the 54 31 appropriation for group foster care placements, as necessary 54 32 to prevent a deficit in the appropriation for group foster 54 33 care. 54 34 Sec. 36. Section 234.39, unnumbered paragraph 1, Code 54 35 Supplement 1995, is amended to read as follows: 55 1 It is the intent of this chapter that an individual 55 2 receiving foster care services and the individual's parents or 55 3 guardians, shall have primary responsibility for paying the 55 4 cost of the care and services. The support obligation 55 5 established and adopted under this section shall be consistent 55 6 with the limitations on legal liability established under 55 7 sections 222.78 and 230.15, and by any other statute limiting 55 8 legal responsibility for support which may be imposed on a 55 9 person for the cost of care and services provided by the 55 10 department. The department shall notify an individual's 55 11 parents or guardians at the time of the placement of an 55 12 individual in foster care, of the responsibility for paying 55 13 the cost of care and services. Support obligations shall be 55 14 established as follows: 55 15 Sec. 37. Section 234.39, Code Supplement 1995, is amended 55 16 by adding the following new subsection: 55 17 NEW SUBSECTION. 4. The support debt for the costs of 55 18 services, for which a support obligation is established 55 19 pursuant to this section, which accrues prior to the 55 20 establishment of the support debt, shall be collected, at a 55 21 maximum, in the amount which is the amount of accrued support 55 22 debt for the three months preceding the earlier of the 55 23 following: 55 24 a. The provision by the child support recovery unit of the 55 25 initial notice to the parent or guardian of the amount of the 55 26 support obligation. 55 27 b. The date that the written request for a court hearing 55 28 is received by the child support recovery unit as provided in 55 29 section 252C.3 or 252F.3. 55 30 Sec. 38. NEW SECTION. 239.23 FAMILY INVESTMENT PROGRAM 55 31 HOST HOMES. 55 32 1. As used in this section, unless the context otherwise 55 33 requires: 55 34 a. "Host home" means a host home authorized in accordance 55 35 with the provisions of this section and licensed by the 56 1 department to provide a living arrangement and related 56 2 services to minor parents and pregnant minors or an 56 3 alternative adult supervised placement approved by the 56 4 department. 56 5 b. "Minor parent" means a recipient of or applicant for 56 6 assistance who is less than eighteen years of age and has 56 7 never been married. 56 8 2. The department shall perform a home assessment of a 56 9 minor parent who applies for assistance to assess the minor 56 10 parent's living arrangement prior to the granting of 56 11 assistance. If a minor parent is receiving assistance at the 56 12 time the provisions of this section are implemented, the 56 13 department shall perform a home assessment as a condition of 56 14 continued assistance. 56 15 3. If the department determines, based upon the home 56 16 assessment, that the minor parent is living in an environment 56 17 which is conducive to the positive upbringing of the minor 56 18 parent's child, the department may allow the minor parent to 56 19 continue living in the home with the parent or the legal 56 20 guardian of the minor parent or in another current living 56 21 arrangement which is approved by the department. 56 22 4. If the department determines, based upon the home 56 23 assessment, that good cause exists for the minor parent to not 56 24 live with their parent or legal guardian or in the other 56 25 current living arrangement because the home environment is not 56 26 conducive to the minor parent's physical, emotional, or mental 56 27 well-being, the department shall require the minor parent to 56 28 relocate to a host home, as a condition of assistance under 56 29 this chapter. If the minor parent does not live in a host 56 30 home and the department determines the resulting level of risk 56 31 to the minor parent warrants the filing of a child in need of 56 32 assistance petition, the department shall file the petition. 56 33 5. If the department determines, based upon the home 56 34 assessment, that remaining in the current living arrangement 56 35 is not in the best interest of the minor parent or a child of 57 1 the minor parent and the minor parent is placed in a host 57 2 home, the parent or legal guardian shall be referred to the 57 3 department's child support recovery unit to establish a child 57 4 support obligation in accordance with the child support 57 5 guidelines prescribed pursuant to section 598.21, subsection 57 6 4, not to exceed the cost of the host home placement. 57 7 However, if a child in need of assistance petition is filed 57 8 and the child is placed in a foster care setting, the child 57 9 support obligation shall be determined as provided in section 57 10 234.39. 57 11 6. a. The department shall issue a request for proposals 57 12 for grants for nonprofit organizations to establish host homes 57 13 to provide adult supervision to minor parents and pregnant 57 14 minors presumed to be eligible for assistance. A proposal 57 15 shall demonstrate the organization's ability to provide 57 16 supervision, services, and other support to enable a minor 57 17 parent or pregnant minor to develop self-sufficiency. 57 18 b. Funding for a host home shall be obtained through 57 19 assignment of the minor parent's assistance under this 57 20 chapter, as permitted under federal law or waiver, through 57 21 child support recovered from the parent or legal guardian of 57 22 the minor parent, and through appropriations made for the 57 23 purposes of reimbursing host homes. 57 24 c. The department shall adopt rules for licensing of host 57 25 homes which are distinct from foster care licensure 57 26 requirements. 57 27 d. Host home services shall include but are not limited to 57 28 training in family development, parenting and self-sufficiency 57 29 skills, and assistance in completing an education. 57 30 e. A host home shall not be considered to be a group 57 31 foster care facility or to be another licensed facility which 57 32 provides care for children. The placement of a minor parent 57 33 or pregnant minor and the children of a minor parent shall not 57 34 be considered a placement which is subject to the statewide 57 35 target for the number of group foster care placements under 58 1 section 232.143 and associated provisions. 58 2 7. This section shall not be implemented prior to July 1, 58 3 1997, and implementation is contingent upon federal approval 58 4 of a waiver authorizing the implementation. 58 5 Sec. 39. Section 252B.4, Code 1995, is amended to read as 58 6 follows: 58 7 252B.4 NONASSISTANCE CASES. 58 8 The child support and paternity determination services 58 9 established by the department pursuant to this chapter and 58 10 other appropriate services provided by law including but not 58 11 limited to the provisions of chapters 239, 252A, 252C, 252D, 58 12 252E, 252F, 598, and 600B shall be made available by the unit 58 13 to an individual not otherwise eligible as a public assistance 58 14 recipient upon application by the individual for the services. 58 15 The application shall be filed with the department. 58 16 1. The director shall require an application fee of five 58 17 dollars. 58 18 2. The director mayrequire an additionalcollect a fee to 58 19 cover the costs incurred by the departmentin providing the58 20support collection and paternity determination servicesfor 58 21 service of process, genetic testing and court costs if the 58 22 entity providing the service charges a fee for the services. 58 23a. The director shall, by rule, establish and inform all58 24applicants for support enforcement and paternity determination58 25services of the fee schedule.58 26b. The additional fee for services may be deducted from58 27the amount of the support money recovered by the department or58 28may be collected from the recipient of the services following58 29recovery of support money by the department.58 30 3. When the unit intercepts a federal tax refund of an 58 31 obligor for payment of delinquent support and the funds are 58 32 due to a recipient of services who is not otherwise eligible 58 33 for public assistance, the unit shall deduct a twenty-five 58 34 dollar fee from the funds before forwarding the balance to the 58 35 recipient. 59 1 a. The unit shall inform the recipient of the fee under 59 2 this subsection prior to assessment. 59 3 b. The fee shall be assessed only to individuals who 59 4 receive support from the federal tax refund offset program. 59 5 If the tax refund due the recipient is less than fifty 59 6 dollars, the fee shall not be assessed. 59 74. The department may adopt rules to establish fees which59 8provide for recovery of administrative costs of the program in59 9addition to other fees identified.59 105.4. Fees collected pursuant to this section shall be 59 11 retained by the department for use by the unit. The director 59 12 or a designee shall keep an accurate record of funds so 59 13 retained. 59 146.5. An application fee paid by a recipient of services 59 15 pursuant to subsection 1 may be recovered by the unit from the 59 16 person responsible for payment of support and if recovered, 59 17 shall be used to reimburse the recipient of services. 59 18 a. The fee shall be an automatic judgment against the 59 19 person responsible to pay support. 59 20 b. This subsection shall serve as constructive notice that 59 21 the fee is a debt due and owing, is an automatic judgment 59 22 against the person responsible for support, and is assessed as 59 23 the fee is paid by a recipient of services. The fee may be 59 24 collected in addition to any support payments or support 59 25 judgment ordered, and no further notice or hearing is required 59 26 prior to collecting the fee. 59 27 c. Notwithstanding any provision to the contrary, the unit 59 28 may collect the fee through any legal means by which support 59 29 payments may be collected, including but not limited to income 59 30 withholding under chapter 252D or income tax refund offsets, 59 31 unless prohibited under federal law. 59 32 d. The unit is not required to file these judgments with 59 33 the clerk of the district court, but shall maintain an 59 34 accurate accounting of the fee assessed, the amount of the 59 35 fee, and the recovery of the fee. 60 1 e. Support payments collected shall not be applied to the 60 2 recovery of the fee until all other support obligations under 60 3 the support order being enforced, which have accrued through 60 4 the end of the current calendar month, have been paid or 60 5 satisfied in full. 60 6 f. This subsection applies to fees that become due on or 60 7 after July 1, 1992. 60 8 Sec. 40. Section 426B.2, subsection 5, Code Supplement 60 9 1995, is amended to read as follows: 60 10 5. The department of human services shall notify the 60 11 director of revenue and finance of the amounts due a county in 60 12 accordance with the provisions of this section. The director 60 13 of revenue and finance shall draw warrants on the property tax 60 14 relief fund, payable to the county treasurer in the amount due 60 15 to a county in accordance with subsections 1 and 3 andin Septemberon 60 17 July 1 andMarchJanuary 1 of each year. Warrants for the 60 18 state payment in accordance with subsection 2 shall bemailed60 19 distributed in January of each year. 60 20 Sec. 41. NEW SECTION. 514I.1 IOWA HEALTHY KIDS PROGRAM 60 21 – LEGISLATIVE INTENT. 60 22 1. The general assembly finds that increased access to 60 23 health care services could improve children's health and 60 24 reduce the incidence and costs of childhood illness and 60 25 disabilities among children in this state. Many children do 60 26 not have health care services available or funded, and for 60 27 those who do, lack of access is a restriction to obtaining 60 28 such services. It is the intent of the general assembly that 60 29 a program be implemented to provide health care services and 60 30 comprehensive health benefits or insurance coverage to 60 31 children. A goal for the program is to cooperate with any 60 32 existing programs with similar purposes funded by either the 60 33 public or private sector. 60 34 2. For the purposes of this chapter, unless the context 60 35 otherwise requires: 61 1 a. "Advisory council" means the advisory council created 61 2 by the division under section 514I.4. 61 3 b. "Division" means the insurance division of the 61 4 department of commerce. 61 5 c. "Program" means the program developed by the division 61 6 in accordance with section 514I.3. 61 7 Sec. 42. NEW SECTION. 514I.2 IOWA HEALTHY KIDS PROGRAM 61 8 AUTHORIZATION. 61 9 1. The general assembly authorizes the division to 61 10 implement the Iowa healthy kids program. The division shall 61 11 have all powers necessary to carry out the purposes of this 61 12 chapter, including, but not limited to, the power to receive 61 13 and accept grants, loans, or advances of funds from any person 61 14 and to receive and accept from any source contributions of 61 15 money, property, labor, or any other thing of value, to be 61 16 held, used, and applied for the purposes of the program. 61 17 2. The program shall operate initially on a pilot project 61 18 basis to include urban and rural areas. Expansion beyond the 61 19 initial pilot project is subject to authorization by law. 61 20 3. Implementation of the program shall be limited to the 61 21 extent of the funding appropriated for the purposes of the 61 22 program. 61 23 Sec. 43. NEW SECTION. 514I.3 IOWA HEALTHY KIDS PROGRAM 61 24 OBJECTIVES. 61 25 The division shall develop a program to attain all of the 61 26 following objectives: 61 27 1. Organize groupings of children for provision of 61 28 comprehensive health benefits or insurance coverage. 61 29 2. Arrange for the collection of any payment or premium, 61 30 in an amount to be determined by the division. The payment or 61 31 premium shall be collected from a family of a participating 61 32 child or other person to provide for payment for health care 61 33 services or premiums for comprehensive health benefits or 61 34 insurance coverage and for the actual or estimated 61 35 administrative expenses incurred during the period for which 62 1 the payments are made. The amount of payment or premium 62 2 charged shall be based on the ability of the family of a child 62 3 to pay. The division shall provide for adjustment of the 62 4 amount charged to reflect contributions, public subsidy, or 62 5 other means used to defray the amount charged. 62 6 3. Establish administrative and accounting procedures for 62 7 the operation of the program. 62 8 4. Establish, in consultation with appropriate 62 9 professional organizations, standards for health care 62 10 services, providers, and comprehensive health benefits or 62 11 insurance coverage appropriate for children and their family 62 12 members. 62 13 5. Establish eligibility criteria which children and their 62 14 family members must meet in order to participate in the 62 15 program. 62 16 6. Establish participation criteria for the program and, 62 17 if appropriate, contract with an authorized insurer, health 62 18 maintenance organization, or insurance or benefits 62 19 administrator to provide administrative services to the 62 20 program. 62 21 7. Contract with authorized insurers, benefits providers, 62 22 or any provider of health care services meeting standards 62 23 established by the division, for the provision of 62 24 comprehensive health benefits or insurance coverage and health 62 25 care services to participants. 62 26 8. Develop and implement a plan to publicize the program, 62 27 eligibility requirements of the program, and procedures for 62 28 enrollment in the program and to maintain public awareness of 62 29 the program. 62 30 9. Provide for administration of the program. 62 31 10. As appropriate, enter into contracts with local school 62 32 boards or other agencies to provide on-site information, 62 33 enrollment, and other services necessary to the operation of 62 34 the program. 62 35 11. Provide an interim report on or before March 1, 1997, 63 1 to the governor and general assembly, on the development of 63 2 the program to date and an annual report thereafter until the 63 3 program is terminated or extended statewide. 63 4 Sec. 44. NEW SECTION. 514I.4 ADVISORY COUNCIL. 63 5 1. The division may create an advisory council to assist 63 6 the division in implementing the program. The advisory 63 7 council membership may include, but is not limited to, the 63 8 following: 63 9 a. A school administrator. 63 10 b. A member of a school board. 63 11 c. An employee of the state or local government in public 63 12 health services. 63 13 d. A pediatrician who is a member of the American academy 63 14 of pediatrics, Iowa chapter. 63 15 e. The director of human services or the director's 63 16 designee. 63 17 f. A member of the association of Iowa hospitals and 63 18 health systems. 63 19 g. A representative of authorized health care insurers or 63 20 health maintenance organizations. 63 21 h. A representative of a university center for health 63 22 issues. 63 23 i. A family practice physician who is a member of the Iowa 63 24 academy of family physicians. 63 25 j. A school nurse who is a member of the Iowa nurses 63 26 association. 63 27 k. The director of public health or the director's 63 28 designee. 63 29 l. A citizen who is knowledgeable concerning health care 63 30 and children's issues. 63 31 m. A citizen who is a parent with children at home who is 63 32 active in a school-parent organization. 63 33 2. Advisory council members are entitled to receive, from 63 34 funds of the division, reimbursement for actual and necessary 63 35 expenses incurred in the performance of their official duties. 64 1 Sec. 45. NEW SECTION. 514I.5 LICENSING NOT REQUIRED – 64 2 FISCAL OPERATION. 64 3 1. Health benefits or insurance coverage obtained under 64 4 the program is secondary to any other available private or 64 5 public health benefits or insurance coverage held by the 64 6 participant child. The division may establish procedures for 64 7 coordinating benefits under this program with benefits under 64 8 other public and private coverage. 64 9 2. The program shall not be deemed to be insurance. 64 10 However, the insurance division may require that any marketing 64 11 representative utilized and compensated by the program be 64 12 appointed as a representative of the insurers or health 64 13 benefits services providers with which the program contracts. 64 14 Sec. 46. NEW SECTION. 514I.6 THE IOWA HEALTHY KIDS TRUST 64 15 FUND. 64 16 1. An Iowa healthy kids trust fund is created in the state 64 17 treasury under the authority of the commissioner of insurance, 64 18 to which all appropriations shall be deposited and used to 64 19 carry out the purposes of this chapter. Other revenues of the 64 20 program such as grants, contributions, matching funds, and 64 21 participant payments shall not be considered revenue of the 64 22 state, but rather shall be funds of the program. However, the 64 23 division may designate portions of grants, contributions, 64 24 matching funds, and participant payments as funds of the state 64 25 and deposit those funds in the trust fund. 64 26 2. The trust fund shall be separate from the general fund 64 27 of the state and shall not be considered part of the general 64 28 fund of the state. The moneys in the trust fund are not 64 29 subject to section 8.33 and shall not be transferred, used, 64 30 obligated, appropriated, or otherwise encumbered except as 64 31 provided in this section. Notwithstanding section 12C.7, 64 32 subsection 2, interest or earnings on moneys deposited in the 64 33 trust fund shall be credited to the trust fund. 64 34 Sec. 47. NEW SECTION. 514I.7 ACCESS TO RECORDS – 64 35 CONFIDENTIALITY – PENALTIES. 65 1 1. Notwithstanding any other law to the contrary, the 65 2 program shall have access to the medical records of a child 65 3 who is participating or applying to participate in the program 65 4 upon receipt of permission from a parent or guardian of the 65 5 child, including but not limited to the medical records 65 6 maintained by the state or a political subdivision of the 65 7 state. Notwithstanding chapter 22, any identifying 65 8 information, including medical records and family financial 65 9 information, obtained by the program pursuant to this 65 10 subsection is confidential. Except as provided in section 65 11 252B.9, chapter 252E, or any federal law or regulation to the 65 12 contrary, the program, the program's employees, and agents of 65 13 the program shall not release, without the written consent of 65 14 the participant or the parent or guardian of the participant, 65 15 to any state or federal agency, to any private business or 65 16 person, or to any other entity, any confidential information 65 17 received pursuant to this subsection. 65 18 2. A violation of the provisions of subsection 1 is a 65 19 serious misdemeanor. 65 20 Sec. 48. FEDERAL WAIVERS. 65 21 1. The department of human services shall submit a waiver 65 22 request or requests to the United States department of health 65 23 and human services as necessary to implement the changes in 65 24 the family investment program and host home provisions under 65 25 section 239.23 as enacted by this Act. In addition, the 65 26 department may submit additional waiver requests to the United 65 27 States department of health and human services to make changes 65 28 to the medical assistance program under chapter 249A, as 65 29 necessary to revise the program in accordance with any waiver 65 30 provision implemented pursuant to section 239.23. 65 31 2. The waiver request or requests submitted by the 65 32 department of human services to the United States department 65 33 of health and human services shall be to apply the provisions 65 34 of section 239.23 statewide. If federal waiver approval of 65 35 the provisions is granted, the department of human services 66 1 shall implement the provisions in accordance with the federal 66 2 approval. If an approved waiver is in conflict with a 66 3 provision of state law, the waiver provision shall apply and 66 4 the department shall propose an amendment to resolve the 66 5 conflict. The proposed amendment shall be submitted in 66 6 accordance with the provisions of section 2.16 to the Seventy- 66 7 seventh General Assembly. 66 8 3. The department of human services shall adopt 66 9 administrative rules pursuant to chapter 17A to implement the 66 10 provisions of an approved waiver. If necessary to conform 66 11 with federal waiver terms and conditions or to efficiently 66 12 administer the provisions, the rules may apply additional 66 13 policies and procedures which are consistent with the 66 14 provisions of the approved waiver. 66 15 4. The effective date of a waiver requested under this 66 16 section which is granted by the federal government shall be 66 17 established by rule but shall not be earlier than July 1, 66 18 1997. If federal law is enacted to permit the state to 66 19 implement a provision of section 239.23 without a federal 66 20 waiver, the department shall proceed to implement the 66 21 provisions within the time frame specified in this subsection. 66 22 Sec. 49. EMERGENCY RULES. If specifically authorized by a 66 23 provision of this Act, the department of human services or the 66 24 mental health and mental retardation commission may adopt 66 25 administrative rules under section 17A.4, subsection 2, and 66 26 section 17A.5, subsection 2, paragraph "b", to implement the 66 27 provisions and the rules shall become effective immediately 66 28 upon filing, unless the effective date is delayed by the 66 29 administrative rules review committee, notwithstanding section 66 30 17A.4, subsection 5, and section 17A.8, subsection 9, or a 66 31 later effective date is specified in the rules. Any rules 66 32 adopted in accordance with this section shall not take effect 66 33 before the rules are reviewed by the administrative rules 66 34 review committee. Any rules adopted in accordance with the 66 35 provisions of this section shall also be published as notice 67 1 of intended action as provided in section 17A.4. 67 2 Sec. 50. EFFECTIVE DATE. The following provisions of this 67 3 Act, being deemed of immediate importance, take effect upon 67 4 enactment: 67 5 1. Section 4, subsection 2, relating to the mental health 67 6 managed care program. 67 7 2. Section 6, subsection 13, relating to moneys 67 8 appropriated in 1996 Iowa Acts, House File 2114. 67 9 3. Section 10, subsection 18, relating to expenditure of 67 10 federal funds for child and family services. 67 11 4. Section 27, relating to appropriations reductions. 67 12 SF 2442 67 13 pf/cc/26
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