House
File
649
S-3293
Amend
House
File
649,
as
amended,
passed,
and
1
reprinted
by
the
House,
as
follows:
2
1.
Page
1,
line
19,
by
striking
<
9,852,577
>
and
3
inserting
<
10,302,577
>
4
2.
Page
1,
after
line
29
by
inserting:
5
<
1A.
The
amount
appropriated
in
this
section
6
includes
additional
funding
of
$450,000
for
delivery
of
7
long-term
care
services
to
seniors
with
low
or
moderate
8
incomes.
>
9
3.
Page
2,
line
35,
by
striking
<
20,703,190
>
and
10
inserting
<
25,703,190
>
11
4.
Page
3,
by
striking
lines
2
through
11
and
12
inserting:
13
<
a.
(1)
Of
the
funds
appropriated
in
this
14
subsection,
$5,453,830
shall
be
used
for
the
tobacco
15
use
prevention
and
control
initiative,
including
16
efforts
at
the
state
and
local
levels,
as
provided
in
17
chapter
142A.
18
(2)
Of
the
funds
allocated
in
this
paragraph
19
“a”,
$453,830
shall
be
transferred
to
the
alcoholic
20
beverages
division
of
the
department
of
commerce
21
for
enforcement
of
tobacco
laws,
regulations,
and
22
ordinances
in
accordance
with
2011
Iowa
Acts,
House
23
File
467,
as
enacted.
>
24
5.
Page
6,
line
16,
by
striking
<
2,601,905
>
and
25
inserting
<
2,549,270
>
26
6.
Page
6,
line
17,
by
striking
<
10.00
>
and
27
inserting
<
11.00
>
28
7.
Page
6,
line
25,
by
striking
<
287,520
>
and
29
inserting
<
329,885
>
30
8.
Page
6,
line
30,
after
<
children.
>
by
inserting
31
<
A
portion
of
the
funds
allocated
in
this
lettered
32
paragraph
may
be
used
for
a
full-time
equivalent
33
position
to
coordinate
the
activities
under
this
34
paragraph.
>
35
9.
Page
7,
by
striking
lines
8
through
14.
36
10.
Page
7,
line
19,
by
striking
<
3,262,256
>
and
37
inserting
<
3,369,156
>
38
11.
Page
7,
line
20,
by
striking
<
4.00
>
and
39
inserting
<
5.00
>
40
12.
Page
7,
line
21,
by
striking
<
136,808
>
and
41
inserting
<
160,582
>
42
13.
Page
7,
line
25,
by
striking
<
383,600
>
and
43
inserting
<
483,600
>
44
14.
Page
8,
line
6,
by
striking
<
755,791
>
and
45
inserting
<
788,303
>
46
15.
Page
8,
line
8,
by
striking
<
711,052
>
and
47
inserting
<
547,065
>
48
16.
Page
8,
line
12,
by
striking
<
363,987
>
and
49
inserting
<
200,000
>
50
-1-
HF649.2839
(1)
84
pf/jp
1/
52
#1.
#2.
#3.
#4.
#5.
#6.
#7.
#8.
#9.
#10.
#11.
#12.
#13.
#14.
#15.
17.
Page
8,
line
18,
by
striking
<
421,782
>
and
1
inserting
<
528,834
>
2
18.
Page
8,
line
20,
after
<
disorders.
>
by
3
inserting
<
A
portion
of
the
funds
allocated
in
this
4
paragraph
may
be
used
for
one
full-time
equivalent
5
position
for
administration
of
the
center.
>
6
19.
Page
8,
line
28,
by
striking
<
3,677,659
>
and
7
inserting
<
4,813,872
>
8
20.
Page
9,
line
33,
by
striking
<
Iowa-Nebraska
>
9
and
inserting
<
Iowa
>
10
21.
Page
10,
line
1,
by
striking
<
116,597
>
and
11
inserting
<
132,580
>
12
22.
Page
10,
after
line
1
by
inserting:
13
<
(1A)
For
distribution
to
the
Iowa
family
planning
14
network
agencies
for
necessary
infrastructure,
15
statewide
coordination,
provider
recruitment,
service
16
delivery,
and
provision
of
assistance
to
patients
in
17
determining
an
appropriate
medical
home:
18
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
74,517
>
19
23.
Page
10,
line
5,
by
striking
<
68,332
>
and
20
inserting
<
74,517
>
21
24.
Page
10,
line
9,
by
striking
<
68,332
>
and
22
inserting
<
74,517
>
23
25.
Page
10,
line
14,
by
striking
<
113,754
>
and
24
inserting
<
124,050
>
25
26.
Page
10,
line
19,
by
striking
<
101,264
>
and
26
inserting
<
110,430
>
27
27.
Page
10,
line
23,
by
striking
<
238,420
>
and
28
inserting
<
260,000
>
29
28.
Page
10,
line
27,
by
striking
<
247,590
>
and
30
inserting
<
270,000
>
31
29.
By
striking
page
10,
line
32,
through
page
11,
32
line
5,
and
inserting:
33
<
h.
(1)
Of
the
funds
appropriated
in
this
34
subsection,
$149,000
shall
be
used
for
continued
35
implementation
of
the
recommendations
of
the
direct
36
care
worker
task
force
established
pursuant
to
2005
37
Iowa
Acts,
chapter
88,
based
upon
the
report
submitted
38
to
the
governor
and
the
general
assembly
in
December
39
2006.
The
department
may
use
a
portion
of
the
funds
40
allocated
in
this
lettered
paragraph
for
an
additional
41
position
to
assist
in
the
continued
implementation.
42
(2)
It
is
the
intent
of
the
general
assembly
that
43
a
board
of
direct
care
workers
shall
be
established
44
within
the
department
of
public
health
by
July
1,
2014,
45
contingent
upon
the
availability
of
funds
to
establish
46
and
maintain
the
board.
47
(3)
The
direct
care
worker
advisory
council
48
shall
submit
a
final
report
no
later
than
March
1,
49
2012,
to
the
governor
and
the
general
assembly,
in
50
-2-
HF649.2839
(1)
84
pf/jp
2/
52
#17.
#18.
#19.
#20.
#21.
#22.
#23.
#24.
#25.
#26.
#27.
#28.
#29.
accordance
with
2010
Iowa
Acts,
chapter
1192,
section
1
2,
subsection
4,
paragraph
“h”,
subparagraph
(3).
2
(4)
The
department
of
public
health
shall
report
to
3
the
persons
designated
in
this
Act
for
submission
of
4
reports
regarding
use
of
the
funds
allocated
in
this
5
lettered
paragraph,
on
or
before
January
15,
2012.
6
i.
(1)
Of
the
funds
appropriated
in
this
7
subsection,
$130,100
shall
be
used
for
allocation
to
an
8
independent
statewide
direct
care
worker
association
9
for
education,
outreach,
leadership
development,
10
mentoring,
and
other
initiatives
intended
to
enhance
11
the
recruitment
and
retention
of
direct
care
workers
in
12
health
care
and
long-term
care
settings.
13
(2)
Of
the
funds
appropriated
in
this
subsection,
14
$45,173
shall
be
used
to
provide
scholarships
or
15
other
forms
of
subsidization
for
direct
care
worker
16
educational
conferences,
training,
or
outreach
17
activities.
>
18
30.
Page
11,
after
line
13
by
inserting:
19
<
k.
Of
the
funds
appropriated
in
this
subsection,
20
$50,000
shall
be
used
for
a
matching
dental
education
21
loan
repayment
program
to
be
allocated
to
a
dental
22
nonprofit
health
service
corporation
to
develop
the
23
criteria
and
implement
the
loan
repayment
program.
24
l.
Of
the
funds
appropriated
in
this
subsection,
up
25
to
$134,214
shall
be
used
to
support
the
department’s
26
activities
relating
to
health
and
long-term
care
access
27
as
specified
pursuant
to
chapter
135,
division
XXIV.
28
m.
Of
the
funds
appropriated
in
this
subsection,
29
$363,987
shall
be
used
as
state
matching
funds
for
the
30
health
information
network
as
enacted
by
this
Act.
31
n.
Of
the
funds
appropriated
in
this
subsection,
32
$25,000
shall
be
used
for
a
pilot
program
established
33
as
a
collaborative
effort
between
the
department
34
of
public
health
and
the
department
of
education
35
to
provide
vision
screening
to
elementary
school
36
children
in
one
urban
and
one
rural
school
district
37
in
the
state,
on
a
voluntary
basis,
over
a
multiyear
38
period.
The
departments
shall
develop
protocol
for
39
participating
schools
including
the
grade
level
of
the
40
children
to
be
screened,
the
training
and
certification
41
necessary
for
individuals
conducting
the
vision
42
screening,
vision
screening
equipment
requirements,
and
43
documentation
and
tracking
requirements.
Following
44
the
conclusion
of
the
pilot
program,
the
participating
45
schools
shall
report
findings
and
recommendations
46
for
statewide
implementation
of
the
vision
screening
47
program
to
the
departments.
>
48
31.
Page
11,
line
19,
by
striking
<
7,297,142
>
and
49
inserting
<
7,336,142
>
50
-3-
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(1)
84
pf/jp
3/
52
#30.
32.
Page
11,
line
22,
by
striking
<
5,287,955
>
and
1
inserting
<
5,326,955
>
2
33.
Page
12,
line
7,
by
striking
<
2,906,532
>
and
3
inserting
<
2,778,688
>
4
34.
Page
12,
after
line
24
by
inserting:
5
<
d.
Of
the
funds
appropriated
in
this
subsection,
6
$50,000
shall
be
used
for
education,
testing,
training,
7
and
other
costs
to
conform
the
requirements
for
8
certification
of
emergency
medical
care
providers
with
9
national
standards.
>
10
35.
Page
12,
by
striking
lines
25
through
30.
11
36.
Page
23,
line
27,
by
striking
<
897,237,190
>
and
12
inserting
<
878,216,915
>
13
37.
Page
23,
by
striking
lines
28
through
34
and
14
inserting:
15
<
1.
Medically
necessary
abortions
are
those
16
performed
under
any
of
the
following
conditions:
17
a.
The
attending
physician
certifies
that
18
continuing
the
pregnancy
would
endanger
the
life
of
the
19
pregnant
woman.
20
b.
The
attending
physician
certifies
that
the
21
fetus
is
physically
deformed,
mentally
deficient,
or
22
afflicted
with
a
congenital
illness.
23
c.
The
pregnancy
is
the
result
of
a
rape
which
24
is
reported
within
45
days
of
the
incident
to
a
law
25
enforcement
agency
or
public
or
private
health
agency
26
which
may
include
a
family
physician.
27
d.
The
pregnancy
is
the
result
of
incest
which
28
is
reported
within
150
days
of
the
incident
to
a
law
29
enforcement
agency
or
public
or
private
health
agency
30
which
may
include
a
family
physician.
31
e.
Any
spontaneous
abortion,
commonly
known
as
a
32
miscarriage,
if
not
all
of
the
products
of
conception
33
are
expelled.
>
34
38.
By
striking
page
28,
line
17,
through
page
29,
35
line
8,
and
inserting:
36
<
___.
a.
The
department
may
implement
cost
37
containment
strategies
recommended
by
the
governor,
and
38
may
adopt
emergency
rules
for
such
implementation.
39
b.
The
department
shall
not
implement
the
cost
40
containment
strategy
to
require
a
primary
care
referral
41
for
the
provision
of
chiropractic
services.
42
c.
The
department
may
increase
the
amounts
43
allocated
for
salaries,
support,
maintenance,
and
44
miscellaneous
purposes
associated
with
the
medical
45
assistance
program,
as
necessary,
to
implement
the
cost
46
containment
strategies.
The
department
shall
report
47
any
such
increase
to
the
legislative
services
agency
48
and
the
department
of
management.
49
d.
If
the
savings
to
the
medical
assistance
50
-4-
HF649.2839
(1)
84
pf/jp
4/
52
#32.
#33.
#34.
#35.
#36.
#37.
#38.
program
exceed
the
cost,
the
department
may
transfer
1
any
savings
generated
for
the
fiscal
year
due
to
2
medical
assistance
program
cost
containment
efforts
3
initiated
pursuant
to
2010
Iowa
Acts,
chapter
1031,
4
Executive
Order
No.
20,
issued
December
16,
2009,
or
5
cost
containment
strategies
initiated
pursuant
to
6
this
subsection,
to
the
appropriation
made
in
this
7
division
of
this
Act
for
medical
contracts
or
general
8
administration
to
defray
the
increased
contract
costs
9
associated
with
implementing
such
efforts.
10
e.
The
department
shall
report
the
implementation
11
of
any
cost
containment
strategies
under
this
12
subsection
to
the
individuals
specified
in
this
13
division
of
this
Act
for
submission
of
reports
on
a
14
quarterly
basis.
>
15
39.
Page
29,
after
line
12
by
inserting:
16
<
___.
Of
the
funds
appropriated
in
this
section,
17
$6,100,000
shall
be
used
to
reduce
the
waiting
lists
18
of
the
medical
assistance
home
and
community-based
19
services
waivers,
including
the
waiver
for
persons
with
20
intellectual
disabilities
for
which
the
nonfederal
21
share
is
paid
as
state
case
services
and
other
support
22
pursuant
to
section
331.440.
The
department
shall
23
distribute
the
funding
allocated
under
this
subsection
24
proportionately
among
all
home
and
community-based
25
services
waivers.
26
___.
a.
The
department
may
submit
medical
27
assistance
program
state
plan
amendments
to
the
centers
28
for
Medicare
and
Medicaid
services
of
the
United
29
States
department
of
health
and
human
services,
and
may
30
adopt
administrative
rules
pursuant
to
chapter
17A
to
31
implement
any
of
the
following
if
the
respective
state
32
plan
amendment
is
approved:
33
(1)
Health
homes
pursuant
to
section
2703
of
the
34
federal
Patient
Protection
and
Affordable
Care
Act,
35
Pub.
L.
No.
111-148.
The
department
shall
collaborate
36
with
the
medical
home
system
advisory
council
created
37
pursuant
to
section
135.159
in
developing
such
health
38
homes.
39
(2)
Accountable
care
organization
pilot
programs,
40
if
such
programs
are
advantageous
to
the
medical
41
assistance
program.
42
b.
Any
health
home
or
accountable
care
organization
43
pilot
program
implemented
pursuant
to
this
subsection
44
shall
demonstrate
value
to
the
state
with
a
45
positive
return
on
investment
within
two
years
of
46
implementation,
and
may
utilize
care
coordination
fees,
47
pay-for-performance
fees,
or
shared
saving
strategies
48
if
approved
as
part
of
the
state
plan
amendment.
>
49
40.
Page
29,
line
19,
by
striking
<
5,773,844
>
and
50
-5-
HF649.2839
(1)
84
pf/jp
5/
52
#39.
inserting
<
9,893,844
>
1
41.
Page
29,
line
20,
before
<
The
>
by
inserting
2
<
1.
>
3
42.
Page
29,
after
line
24
by
inserting:
4
<
2.
Of
the
funds
appropriated
in
this
section,
5
$150,000
shall
be
used
for
implementation
of
a
6
uniform
cost
report
to
be
used
in
the
development
7
of
specified
Medicaid
reimbursement
rates
over
a
8
multiyear
timeframe.
The
department
of
human
services,
9
in
collaboration
with
affected
providers,
shall
10
finalize
a
uniform
cost
report
that
includes
provider
11
type-specific
cost
schedules
by
December
15,
2011.
12
The
uniform
cost
report
shall
be
applied
to
providers
13
of
home
and
community-based
services
waiver
services,
14
habilitation
services,
case
management
services
15
and
community
mental
health
centers,
residential
16
care
facilities,
psychiatric
medical
institutions
17
for
children,
and
intermediate
care
facilities
18
for
the
mentally
retarded
in
the
development
of
19
Medicaid
reimbursement
rates.
The
department
shall
20
collaborate
with
affected
Medicaid
providers
to
test
21
the
effectiveness
of
the
cost
report
and
determine
22
the
fiscal
impact
of
implementing
the
uniform
cost
23
report
during
the
fiscal
year
beginning
July
1,
2012.
24
A
report
of
the
findings
and
fiscal
impact
shall
be
25
submitted
to
the
governor
and
the
general
assembly
by
26
December
31,
2013.
The
rates
paid
in
the
fiscal
year
27
beginning
July
1,
2014,
shall
be
established
using
28
uniform
cost
reports
submitted
in
the
fiscal
year
29
beginning
July
1,
2012.
Implementation
of
the
uniform
30
cost
report
shall
be
limited
to
the
extent
of
the
31
funding
available.
32
3.
a.
Of
the
funds
appropriated
in
this
section,
33
$100,000
shall
be
used
for
implementation
of
an
34
electronic
medical
record
system,
including
system
35
purchase
or
development,
for
home
and
community-based
36
services
providers
and
mental
health
services
providers
37
that
comply
with
the
requirements
of
federal
and
state
38
laws
and
regulation
by
the
fiscal
year
beginning
July
39
1,
2013.
40
b.
The
department
shall
analyze
the
costs
and
41
benefits
of
providing
an
electronic
medical
record
and
42
billing
system
for
home
and
community-based
services
43
providers
and
mental
health
services
providers
that
44
comply
with
the
requirements
of
federal
and
state
laws
45
and
regulation.
The
analysis
shall
include
a
review
46
of
all
of
the
following:
including
the
capability
for
47
an
electronic
medical
record
and
billing
system
within
48
the
procurement
for
the
Medicaid
management
information
49
system,
developing
the
system,
and
utilizing
capacity
50
-6-
HF649.2839
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84
pf/jp
6/
52
#41.
#42.
within
the
health
information
network
established
by
1
the
department
of
public
health
as
enacted
in
this
2
Act.
If
the
analysis
demonstrates
that
a
program
3
may
be
implemented
in
a
cost-effective
manner
and
4
within
available
funds,
the
department
may
take
steps
5
to
implement
such
a
system.
The
department
shall
6
report
the
results
of
the
analysis,
activities,
and
7
recommendations
to
the
persons
designated
in
this
8
division
of
this
Act
for
submission
of
reports
by
9
December
15,
2011.
10
c.
Notwithstanding
section
8.33,
funds
allocated
in
11
this
subsection
that
remain
unencumbered
or
unobligated
12
at
the
close
of
the
fiscal
year
shall
not
revert
but
13
shall
remain
available
in
succeeding
fiscal
years
to
be
14
used
for
the
purposes
designated.
15
4.
Of
the
amount
appropriated
in
this
section,
16
$3,500,000
shall
be
used
for
technology
upgrades
17
necessary
to
support
Medicaid
claims
and
other
health
18
operations,
worldwide
federal
Health
Insurance
19
Portability
and
Accountability
Act
of
1996
(HIPAA)
20
claims,
transactions,
and
coding
requirements,
and
21
the
Iowa
automated
benefits
calculation
system.
22
Notwithstanding
section
8.33,
funds
allocated
in
this
23
subsection
that
remain
unencumbered
or
unobligated
at
24
the
close
of
the
fiscal
year
shall
not
revert
but
shall
25
remain
available
in
succeeding
fiscal
years
to
be
used
26
for
the
purposes
designated.
27
5.
Of
the
funds
appropriated
in
this
section,
28
$100,000
shall
be
used
for
an
accountable
care
29
organization
pilot
project
as
specified
in
the
division
30
of
this
Act
relating
to
prior
appropriations
and
31
related
changes.
32
6.
Of
the
funds
appropriated
in
this
section,
33
$200,000
shall
be
used
for
the
development
of
a
34
provider
payment
system
plan
to
provide
recommendations
35
to
reform
the
health
care
provider
payment
system
as
an
36
effective
way
to
promote
coordination
of
care,
lower
37
costs,
and
improve
quality
as
specified
in
the
division
38
of
this
Act
relating
to
cost
containment.
39
7.
Of
the
funds
appropriated
in
this
section,
40
$20,000
shall
be
used
for
the
development
of
a
plan
41
to
establish
an
all-payer
claims
database
to
provide
42
for
the
collection
and
analysis
of
claims
data
from
43
multiple
payers
of
health
care
as
specified
in
the
44
division
of
this
Act
relating
to
cost
containment.
45
8.
The
department
shall
amend
the
state
Medicaid
46
health
information
technology
plan
to
include
costs
47
related
to
the
one-time
development
costs
of
the
health
48
information
network
as
enacted
in
this
Act.
49
9.
Of
the
amount
appropriated
in
this
section,
up
50
-7-
HF649.2839
(1)
84
pf/jp
7/
52
to
$250,000
may
be
transferred
to
the
appropriation
for
1
general
administration
in
this
division
of
this
Act
to
2
be
used
for
additional
full-time
equivalent
positions
3
in
the
development
of
key
health
initiatives
such
as
4
cost
containment,
development
and
oversight
of
managed
5
care
programs,
and
development
of
health
strategies
6
targeted
toward
improved
quality
and
reduced
costs
in
7
the
Medicaid
program.
8
10.
Of
the
funds
appropriated
in
this
section,
9
$50,000
shall
be
used
for
home
and
community-based
10
services
waiver
quality
assurance
programs,
including
11
the
review
and
streamlining
of
processes
and
policies
12
related
to
oversight
and
quality
management
to
meet
13
state
and
federal
requirements.
The
department
shall
14
submit
a
report
to
the
persons
designated
by
this
15
division
of
this
Act
for
submission
of
reports
by
16
December
15,
2011,
regarding
the
modifications
to
the
17
quality
assurance
programs.
>
18
43.
Page
30,
line
22,
by
striking
<
There
>
and
19
inserting
<
1.
There
>
20
44.
Page
30,
line
32,
by
striking
<
32,927,152
>
and
21
inserting
<
33,056,102
>
22
45.
Page
30,
after
line
32
by
inserting:
23
<
2.
Of
the
funds
appropriated
in
this
section,
24
$128,950
is
allocated
for
continuation
of
the
contract
25
for
advertising
and
outreach
with
the
department
of
26
public
health.
>
27
46.
Page
31,
line
4,
by
striking
<
51,237,662
>
and
28
inserting
<
55,265,509
>
29
47.
Page
31,
line
5,
by
striking
<
49,868,235
>
and
30
inserting
<
51,896,082
>
31
48.
Page
31,
by
striking
lines
25
through
30
and
32
inserting
<
system
in
accordance
with
section
237A.30.
>
33
49.
Page
33,
after
line
32
by
inserting:
34
<
4.
For
the
fiscal
year
beginning
July
1,
2011,
35
notwithstanding
section
232.52,
subsection
2,
and
36
section
907.3A,
subsection
1,
the
court
shall
not
order
37
the
placement
of
a
child
at
the
Iowa
juvenile
home
38
or
the
state
training
school
under
section
232.52,
if
39
that
placement
is
not
in
accordance
with
the
population
40
guidelines
for
the
respective
juvenile
institution
41
established
pursuant
to
section
233A.1
or
233B.1.
>
42
50.
Page
34,
line
5,
by
striking
<
82,020,163
>
and
43
inserting
<
83,420,163
>
44
51.
Page
35,
line
29,
by
striking
<
7,170,116
>
and
45
inserting
<
7,670,116
>
46
52.
Page
37,
line
32,
by
striking
<
4,522,602
>
and
47
inserting
<
6,022,602
>
48
53.
Page
39,
after
line
35
by
inserting:
49
<
___.
Of
the
funds
appropriated
in
this
section,
50
-8-
HF649.2839
(1)
84
pf/jp
8/
52
#43.
#44.
#45.
#46.
#47.
#48.
#49.
#50.
#51.
#52.
#53.
$300,000
shall
be
used
for
continuation
of
the
central
1
Iowa
system
of
care
program
grant
through
June
30,
2
2012.
>
3
54.
Page
40,
line
8,
by
striking
<
34,897,591
>
and
4
inserting
<
34,466,591
>
5
55.
Page
41,
line
8,
by
striking
<
department
of
6
human
services
>
and
inserting
<
division
of
criminal
and
7
juvenile
justice
planning
of
the
department
of
human
8
rights
>
9
56.
Page
41,
by
striking
lines
14
and
15
and
10
inserting
<
submission
of
reports
and
to
the
department
11
of
human
services
by
>
12
57.
Page
47,
after
line
35
by
inserting:
13
<
Notwithstanding
section
8.33,
moneys
appropriated
14
in
this
section
that
remain
unencumbered
or
unobligated
15
at
the
close
of
the
fiscal
year
shall
not
revert
but
16
shall
remain
available
for
expenditure
for
the
purposes
17
designated
until
the
close
of
the
succeeding
fiscal
18
year.
>
19
58.
Page
48,
line
10,
by
striking
<
285.00
>
and
20
inserting
<
290.00
>
21
59.
Page
48,
by
striking
lines
17
through
25
and
22
inserting:
23
<
3.
Of
the
funds
appropriated
in
this
section,
24
$132,300
shall
be
used
to
contract
with
a
statewide
25
association
representing
community
providers
of
mental
26
health,
mental
retardation
and
brain
injury
services
27
programs
to
provide
technical
assistance,
support,
and
28
consultation
to
providers
of
habilitation
services
and
29
home
and
community-based
waiver
services
for
adults
30
with
disabilities
under
the
medical
assistance
program.
31
Notwithstanding
section
8.47
or
any
other
provision
of
32
law
to
the
contrary,
the
department
may
utilize
a
sole
33
source
approach
to
contract
with
the
association.
34
4.
Of
the
funds
appropriated
in
this
section,
35
$176,400
shall
be
used
to
contract
with
an
appropriate
36
entity
to
expand
the
provision
of
nationally
accredited
37
and
recognized
internet-based
training
to
include
38
mental
health
and
disability
services
providers.
39
Notwithstanding
section
8.47
or
any
other
provision
of
40
law
to
the
contrary,
the
department
may
utilize
a
sole
41
site
source
approach
to
enter
into
such
contract.
>
42
60.
Page
48,
before
line
30
by
inserting:
43
<
___.
Notwithstanding
section
8.33,
moneys
44
appropriated
in
this
section
that
remain
unencumbered
45
or
unobligated
at
the
close
of
the
fiscal
year
shall
46
not
revert
but
shall
remain
available
for
expenditure
47
for
the
purposes
designated
until
the
close
of
the
48
succeeding
fiscal
year.
>
49
61.
Page
49,
line
7,
by
striking
<
225,502,551
>
and
50
-9-
HF649.2839
(1)
84
pf/jp
9/
52
#54.
#55.
#56.
#57.
#58.
#59.
#60.
inserting
<
235,493,065
>
1
62.
Page
50,
line
6,
after
<
lower.
>
by
inserting
2
<
The
reimbursement
specified
under
this
paragraph
shall
3
be
adjusted
in
accordance
with
chapter
249N,
as
enacted
4
in
this
Act.
>
5
63.
Page
50,
line
19,
after
<
2011
>
by
inserting
6
<
,
except
that
the
portion
of
the
fund
attributable
7
to
graduate
medical
education
shall
be
reduced
in
8
an
amount
that
reflects
the
elimination
of
graduate
9
medical
education
payments
made
to
out-of-state
10
hospitals.
>
11
64.
Page
51,
line
10,
by
striking
<
For
>
and
12
inserting
<
(1)
For
>
13
65.
Page
51,
by
striking
lines
14
through
16
and
14
inserting:
<
medical
assistance.
15
(2)
For
nonstate-owned
psychiatric
medical
16
institutions
for
children,
reimbursement
rates
shall
17
remain
at
the
rates
in
effect
on
June
30,
2011,
except
18
that
the
reimbursement
rates
shall
be
adjusted
to
19
include
all
ancillary
costs
and
any
other
changes
20
required
for
federal
compliance.
To
the
extent
21
possible,
such
adjustments
shall
be
budget
neutral
22
to
the
institutions.
The
nonstate-owned
psychiatric
23
medical
institutions
for
children
shall
contract
with
24
other
health
care
providers
as
necessary
to
ensure
25
that
prescription
drug
and
other
ancillary
medical
26
services
are
provided
to
a
child
while
residing
27
in
the
institution.
The
department
shall
commence
28
implementation
activities
for
this
subparagraph
on
29
the
effective
date
of
this
subparagraph
in
order
to
30
facilitate
implementation
beginning
July
1,
2011.
>
31
66.
Page
56,
line
32,
by
striking
<
The
>
and
32
inserting
<
1.
The
>
33
67.
Page
57,
after
line
1
by
inserting:
34
<
2.
The
provision
under
the
section
of
the
division
35
of
this
Act
providing
for
reimbursement
of
medical
36
assistance,
state
supplementary
assistance,
and
social
37
service
providers
by
the
department
of
human
services
38
relating
to
reimbursement
of
nonstate-owned
psychiatric
39
medical
institutions
for
children.
>
40
68.
Page
57,
line
4,
after
<
ACCOUNT,
>
by
inserting
41
<
NONPARTICIPATING
PROVIDER
REIMBURSEMENT
FUND,
>
42
69.
Page
57,
by
striking
line
7
and
inserting:
43
<
HOSPITAL
HEALTH
CARE
ACCESS
TRUST
FUND,
AND
PHARMACY
44
ASSESSMENT
TRUST
FUND
>
45
70.
By
striking
page
57,
line
35,
through
page
46
58,
line
7,
and
inserting
<
necessary
abortions.
For
47
the
purpose
of
this
subsection,
an
abortion
is
the
48
purposeful
interruption
of
pregnancy
with
the
intention
49
other
than
to
produce
a
live-born
infant
or
to
remove
a
50
-10-
HF649.2839
(1)
84
pf/jp
10/
52
#62.
#63.
#64.
#65.
#66.
#67.
#68.
#69.
dead
fetus,
and
a
medically
necessary
abortion
is
one
1
performed
under
one
of
the
following
conditions:
2
(1)
The
attending
physician
certifies
that
3
continuing
the
pregnancy
would
endanger
the
life
of
the
4
pregnant
woman.
5
(2)
The
attending
physician
certifies
that
the
6
fetus
is
physically
deformed,
mentally
deficient,
or
7
afflicted
with
a
congenital
illness.
8
(3)
The
pregnancy
is
the
result
of
a
rape
which
9
is
reported
within
45
days
of
the
incident
to
a
law
10
enforcement
agency
or
public
or
private
health
agency
11
which
may
include
a
family
physician.
12
(4)
The
pregnancy
is
the
result
of
incest
which
13
is
reported
within
150
days
of
the
incident
to
a
law
14
enforcement
agency
or
public
or
private
health
agency
15
which
may
include
a
family
physician.
16
(5)
The
abortion
is
a
spontaneous
abortion,
17
commonly
known
as
a
miscarriage,
wherein
not
all
of
the
18
products
of
conception
are
expelled.
>
19
71.
Page
58,
line
27,
by
striking
<
54,226,279
>
and
20
inserting
<
44,226,279
>
21
72.
Page
59,
line
8,
by
striking
<
14,000,000
>
and
22
inserting
<
16,277,753
>
23
73.
Page
59,
line
26,
by
striking
<
51,500,000
>
and
24
inserting
<
65,000,000
>
25
74.
Page
59,
line
32,
by
striking
<
48,500,000
>
and
26
inserting
<
60,000,000
>
27
75.
Page
59,
line
35,
by
striking
<
48,500,00
>
and
28
inserting
<
60,000,000
>
29
76.
Page
60,
line
1,
by
striking
<
48,500,000
>
and
30
inserting
<
60,000,000
>
31
77.
Page
60,
line
5,
by
striking
<
48,500,000
>
and
32
inserting
<
60,000,000
>
33
78.
Page
60,
line
7,
after
<
allocated.
>
by
34
inserting
<
Pursuant
to
paragraph
“b”,
of
the
amount
35
appropriated
in
this
subsection,
not
more
than
36
$4,000,000
shall
be
distributed
for
prescription
drugs
37
and
podiatry
services.
>
38
79.
Page
60,
after
line
7
by
inserting:
39
<
b.
Notwithstanding
any
provision
of
law
to
the
40
contrary,
the
hospital
identified
in
this
subsection,
41
shall
be
reimbursed
for
outpatient
prescription
drugs
42
and
podiatry
services
provided
to
members
of
the
43
expansion
population
pursuant
to
all
applicable
medical
44
assistance
program
rules,
in
an
amount
not
to
exceed
45
$4,000,000.
>
46
80.
Page
60,
line
8,
by
striking
<
b.
>
and
inserting
47
<
c.
>
48
81.
Page
60,
line
9,
by
striking
<
6
>
and
inserting
49
<
4
>
50
-11-
HF649.2839
(1)
84
pf/jp
11/
52
#71.
#72.
#73.
#74.
#75.
#76.
#77.
#78.
#79.
#80.
82.
Page
60,
line
26,
after
<
subsection.
>
by
1
inserting
<
Of
the
collections
in
excess
of
the
2
$19,000,000
received
by
the
acute
care
teaching
3
hospital
under
this
subparagraph
(1),
$2,000,000
shall
4
be
distributed
by
the
acute
care
teaching
hospital
to
5
the
treasurer
of
state
for
deposit
in
the
IowaCare
6
account
in
the
month
of
January
2012,
following
the
7
July
1
through
December
31,
2011,
period.
>
8
83.
Page
60,
line
35,
after
<
subsection.
>
by
9
inserting
<
Of
the
collections
in
excess
of
the
10
$19,000,000
received
by
the
acute
care
teaching
11
hospital
under
this
subparagraph
(2),
$2,000,000
shall
12
be
distributed
by
the
acute
care
teaching
hospital
to
13
the
treasurer
of
state
for
deposit
in
the
IowaCare
14
account
in
the
month
of
July
2012,
following
the
15
January
1
through
June
30,
2012,
period.
>
16
84.
Page
61,
line
10,
by
striking
<
6,000,000
>
and
17
inserting
<
3,472,176
>
18
85.
Page
61,
line
11,
by
striking
<
Notwithstanding
>
19
and
inserting
<
a.
Notwithstanding
>
20
86.
Page
61,
after
line
17
by
inserting:
21
<
b.
The
department
shall
consult
with
providers
22
of
primary
care
services
in
established
regional
23
provider
network
areas
to
determine
if
the
option
24
of
establishing
an
alternative
provider
location
is
25
feasible.
The
department
may
implement
a
pilot
program
26
establishing
an
alternative
provider
location
in
an
27
established
regional
provider
network
area
experiencing
28
capacity
issues,
if
the
department
determines
that
this
29
option
would
most
appropriately
address
such
capacity
30
issues
and
provide
better
access
to
care
for
expansion
31
population
members
in
the
area.
Any
such
pilot
32
program
shall
be
implemented
within
funds
available
33
under
the
existing
appropriation
and
any
alternative
34
provider
location
shall
be
subject
to
the
requirements
35
applicable
to
an
expansion
population
provider
pursuant
36
to
chapter
249J.
>
37
87.
Page
61,
by
striking
lines
18
through
25
and
38
inserting:
39
<
6.
There
is
appropriated
from
the
IowaCare
account
40
created
in
section
249J.24
to
the
department
of
human
41
services
for
the
fiscal
year
beginning
July
1,
2011,
42
and
ending
June
30,
2012,
the
following
amount,
or
43
so
much
thereof
as
is
necessary
to
be
used
for
the
44
purposes
designated:
45
For
a
care
coordination
pool
to
pay
the
expansion
46
population
providers
consisting
of
the
university
of
47
Iowa
hospitals
and
clinics,
the
publicly
owned
acute
48
care
teaching
hospital
as
specified
in
section
249J.7,
49
and
nonparticipating
providers
as
specified
in
section
50
-12-
HF649.2839
(1)
84
pf/jp
12/
52
#82.
#83.
#84.
#85.
#86.
#87.
249J.24A
that
are
current
medical
assistance
program
1
providers,
for
services
covered
by
the
full
benefit
2
medical
assistance
program
but
not
under
the
IowaCare
3
program
pursuant
to
section
249J.6,
that
are
provided
4
to
expansion
population
members:
5
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
1,500,000
6
a.
Notwithstanding
section
249J.6,
the
amount
7
appropriated
in
this
subsection
is
intended
to
provide
8
payment
for
medically
necessary
services
provided
9
to
expansion
population
members
for
continuation
of
10
care
provided
by
the
university
of
Iowa
hospitals
and
11
clinics
or
the
publicly
owned
acute
care
teaching
12
hospital
as
specified
in
section
249J.7.
Payment
13
may
only
be
made
for
services
that
are
not
otherwise
14
covered
under
section
249J.6,
and
which
are
follow-up
15
services
to
covered
services
provided
by
the
hospitals
16
specified
in
this
paragraph
“a”.
17
b.
The
funds
appropriated
in
this
subsection
are
18
intended
to
provide
limited
payment
for
continuity
19
of
care
services
for
an
expansion
population
member,
20
and
are
intended
to
cover
the
costs
of
services
21
to
expansion
population
members,
regardless
of
22
the
member’s
county
of
residence
or
medical
home
23
assignment,
if
the
care
is
related
to
specialty
or
24
hospital
services
provided
by
the
hospitals
specified
25
in
paragraph
“a”.
26
c.
The
funds
appropriated
in
this
subsection
are
27
not
intended
to
provide
for
expanded
coverage
under
28
the
IowaCare
program,
and
shall
not
be
used
to
cover
29
emergency
transportation
services.
30
d.
The
department
shall
adopt
administrative
31
rules
pursuant
to
chapter
17A
to
establish
a
prior
32
authorization
process
and
to
identify
covered
services
33
for
reimbursement
under
this
subsection.
If
the
entire
34
amount
appropriated
under
this
subsection
is
expended,
35
the
responsibility
for
coordinating
noncovered
care
36
needs
of
expansion
population
members
shall
revert
to
37
the
medical
home
to
which
the
expansion
population
38
member
is
assigned.
39
7.
There
is
appropriated
from
the
IowaCare
account
40
created
in
section
249J.24
to
the
department
of
human
41
services
for
the
fiscal
year
beginning
July
1,
2011,
42
and
ending
June
30,
2012,
the
following
amount
or
43
so
much
thereof
as
is
necessary
to
be
used
for
the
44
purposes
designated:
45
For
a
laboratory
test
and
radiology
pool
for
46
services
authorized
by
a
federally
qualified
health
47
center
designated
by
the
department
as
part
of
the
48
IowaCare
regional
provider
network
that
does
not
have
49
the
capability
to
provide
these
services
on
site:
50
-13-
HF649.2839
(1)
84
pf/jp
13/
52
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
500,000
1
Notwithstanding
sections
249J.6
and
249J.7,
the
2
amount
appropriated
in
this
subsection
is
intended
3
to
provide
reimbursement
for
services
provided
to
4
expansion
population
members
that
have
previously
5
been
paid
for
through
expenditure
by
designated
6
regional
provider
network
providers
of
their
own
7
funds,
not
to
expand
coverage
under
the
IowaCare
8
program
or
to
expand
the
expansion
population
9
provider
network.
The
department
shall
designate
the
10
laboratory
and
radiology
provider
associated
with
11
each
designated
regional
provider
network
provider
12
that
may
receive
reimbursement.
The
department
shall
13
adopt
administrative
rules
pursuant
to
chapter
17A
14
to
establish
a
prior
authorization
process
and
to
15
identify
covered
services
for
reimbursement
under
this
16
subsection.
All
other
medical
assistance
program
17
payment
policies
and
rules
for
laboratory
and
radiology
18
services
shall
apply
to
services
provided
under
this
19
subsection.
If
the
entire
amount
appropriated
under
20
this
subsection
is
expended,
laboratory
tests
and
21
radiology
services
ordered
by
a
designated
regional
22
provider
network
provider
shall
be
the
financial
23
responsibility
of
the
regional
provider
network
24
provider.
Any
funds
remaining
at
the
end
of
the
25
fiscal
year
shall
be
used
to
pay
any
unpaid
claims
by
26
university
of
Iowa
physicians,
nurse
practitioners,
and
27
physician
assistants.
>
28
88.
Page
61,
before
line
26
by
inserting:
29
<
Sec.
___.
APPROPRIATIONS
FROM
NONPARTICIPATING
30
PROVIDER
REIMBURSEMENT
FUND
——
DEPARTMENT
OF
HUMAN
31
SERVICES.
Notwithstanding
any
provision
to
the
32
contrary,
and
subject
to
the
availability
of
funds,
33
there
is
appropriated
from
the
nonparticipating
34
provider
reimbursement
fund
created
in
section
249J.24A
35
to
the
department
of
human
services
for
the
fiscal
year
36
beginning
July
1,
2011,
and
ending
June
30,
2012,
the
37
following
amount
or
so
much
thereof
as
is
necessary
for
38
the
purposes
designated:
39
To
reimburse
nonparticipating
providers
in
40
accordance
with
section
249J.24A:
41
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
2,000,000
>
42
89.
By
striking
page
61,
line
34,
through
page
62,
43
line
1.
44
90.
Page
62,
by
striking
lines
33
through
35
and
45
inserting:
46
<
10.
For
transfer
to
the
department
of
public
47
health
to
be
used
for
the
costs
of
medical
home
48
system
advisory
council
established
pursuant
to
49
section
135.159,
including
for
the
incorporation
of
50
-14-
HF649.2839
(1)
84
pf/jp
14/
52
#88.
#89.
#90.
the
work
and
duties
of
the
prevention
and
chronic
1
care
management
advisory
council
pursuant
to
section
2
135.161,
as
amended
by
this
Act:
3
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
233,357
>
4
91.
Page
64,
line
3,
by
striking
<
To
>
and
inserting
5
<
1.
To
>
6
92.
Page
64,
line
6,
by
striking
<
29,000,000
>
and
7
inserting
<
60,496,712
>
8
93.
Page
64,
after
line
6
by
inserting:
9
<
2.
To
increase
the
monthly
upper
cost
limit
10
for
services
under
the
medical
assistance
home
and
11
community-based
services
waiver
for
the
elderly:
12
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
1,000,000
>
13
94.
Page
64,
after
line
22
by
inserting:
14
<
Sec.
___.
PHARMACY
ASSESSMENT
TRUST
FUND
——
15
DEPARTMENT
OF
HUMAN
SERVICES.
Notwithstanding
16
any
provision
to
the
contrary
and
subject
to
the
17
availability
of
funds,
there
is
appropriated
from
the
18
pharmacy
assessment
trust
fund
created
in
section
19
249N.4,
as
enacted
in
this
Act,
to
the
department
of
20
human
services
for
the
fiscal
year
beginning
July
1,
21
2011,
and
ending
June
30,
2012,
the
following
amounts,
22
or
so
much
thereof
as
is
necessary,
for
the
purposes
23
designated:
24
To
supplement
the
appropriation
made
in
this
Act
25
from
the
general
fund
of
the
state
to
the
department
of
26
human
services
for
medical
assistance:
27
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
17,377,252
>
28
95.
Page
65,
after
line
2
by
inserting:
29
<
Sec.
___.
CONTINUATION
OF
WORKGROUP
BY
JUDICIAL
30
BRANCH
AND
DEPARTMENT
OF
HUMAN
SERVICES.
The
judicial
31
branch
and
department
of
human
services
shall
continue
32
the
workgroup
implemented
pursuant
to
2010
Iowa
Acts,
33
chapter
1192,
section
24,
subsection
2,
to
improve
34
the
processes
for
involuntary
commitment
for
chronic
35
substance
abuse
under
chapter
125
and
serious
mental
36
illness
under
chapter
229.
The
recommendations
issued
37
by
the
workgroup
shall
address
alternatives
and
options
38
to
the
current
provision
of
transportation
by
the
39
county
sheriff;
to
the
role,
supervision,
and
funding
40
of
mental
health
patient
advocates;
and
for
civil
41
commitment
prescreening.
Additional
stakeholders
42
shall
be
added
as
necessary
to
facilitate
the
workgroup
43
efforts.
The
workgroup
shall
complete
deliberations
44
and
submit
a
final
report
providing
findings
and
45
recommendations
on
or
before
December
15,
2011.
>
46
96.
By
striking
page
70,
line
22,
through
page
72,
47
line
17.
48
97.
Page
72,
line
33,
after
<
Grenada,
>
by
inserting
49
<
Lebanon,
>
50
-15-
HF649.2839
(1)
84
pf/jp
15/
52
#91.
#92.
#93.
#94.
#95.
#96.
98.
Page
73,
line
28,
after
<
72,
>
by
inserting
1
<
shall
not
revert
but
shall
remain
available
in
2
succeeding
fiscal
years
to
be
used
for
the
purposes
3
designated
until
expended
and
any
other
>
4
99.
Page
74,
by
striking
lines
19
through
27
and
5
inserting:
6
<
Sec.
___.
2009
Iowa
Acts,
chapter
183,
section
62,
7
subsection
4,
is
amended
to
read
as
follows:
8
4.
The
financial
assistance
shall
be
for
any
of
the
9
following
purposes:
10
a.
For
making
temporary
payments
to
qualifying
11
families
whose
members
are
recently
unemployed
and
12
seeking
work
to
use
in
meeting
immediate
family
needs.
13
b.
For
providing
sliding
scale
subsidies
for
14
qualifying
families
for
child
care
provided
to
the
15
families’
infants
and
toddlers
by
providers
who
16
are
accredited
by
the
national
association
for
the
17
education
of
young
children
or
the
national
association
18
for
family
child
care,
or
who
have
a
rating
at
level
3
19
2
or
higher
under
the
child
care
quality
rating
system
20
implemented
pursuant
to
section
237A.30.
21
c.
For
expanding
training
and
other
support
for
22
infant
care
providers
in
the
community
and
this
state.
23
d.
For
ensuring
child
care
environments
are
healthy
24
and
safe.
25
e.
For
promoting
positive
relationships
between
26
parents
and
providers
in
their
mutual
efforts
to
care
27
for
very
young
children.
28
f.
For
ensuring
that
parents
have
the
information
29
and
resources
needed
to
choose
quality
child
care.
>
30
100.
By
striking
page
74,
line
28,
through
page
75,
31
line
7.
32
101.
Page
76,
after
line
31
by
inserting:
33
<
CHILD
WELFARE
TRAINING
ACADEMY
34
Sec.
___.
2010
Iowa
Acts,
chapter
1192,
section
19,
35
subsection
22,
is
amended
to
read
as
follows:
36
22.
Of
the
funds
appropriated
in
this
section,
37
at
least
$47,158
shall
be
used
for
the
child
welfare
38
training
academy.
Notwithstanding
section
8.33,
moneys
39
allocated
in
this
subsection
that
remain
unencumbered
40
or
unobligated
at
the
close
of
the
fiscal
year
shall
41
not
revert
but
shall
remain
available
for
expenditure
42
for
the
purposes
designated
until
the
close
of
the
43
succeeding
fiscal
year.
>
44
102.
Page
76,
line
32,
after
<
TRANSFER
>
by
45
inserting
<
AND
NONREVERSION
>
46
103.
Page
76,
line
34,
by
striking
<
subsection
>
and
47
inserting
<
subsections
>
48
104.
Page
77,
after
line
4
by
inserting:
49
<
NEW
SUBSECTION
.
5.
Notwithstanding
section
50
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#98.
#99.
#100.
#101.
#102.
#103.
#104.
8.33,
moneys
appropriated
in
this
section
that
remain
1
unencumbered
or
unobligated
at
the
close
of
the
fiscal
2
year
shall
not
revert
but
shall
remain
available
for
3
expenditure
for
the
purposes
designated
until
the
close
4
of
the
succeeding
fiscal
year.
>
5
105.
Page
77,
after
line
4
by
inserting:
6
<
DEPARTMENT
OF
HUMAN
SERVICES
——
FIELD
OPERATIONS
7
Sec.
___.
2010
Iowa
Acts,
chapter
1192,
section
8
29,
is
amended
by
adding
the
following
new
unnumbered
9
paragraph:
10
NEW
UNNUMBERED
PARAGRAPH
.
Notwithstanding
section
11
8.33,
moneys
appropriated
in
this
section
that
remain
12
unencumbered
or
unobligated
at
the
close
of
the
fiscal
13
year
shall
not
revert
but
shall
remain
available
for
14
expenditure
for
the
purposes
designated
until
the
close
15
of
the
succeeding
fiscal
year.
16
DEPARTMENT
OF
HUMAN
SERVICES
——
GENERAL
ADMINISTRATION
17
Sec.
___.
2010
Iowa
Acts,
chapter
1192,
section
30,
18
is
amended
by
adding
the
following
new
subsection:
19
NEW
SUBSECTION
.
5.
Notwithstanding
section
8.33,
20
moneys
appropriated
in
this
section
and
the
designated
21
allocations
that
remain
unencumbered
or
unobligated
22
at
the
close
of
the
fiscal
year
shall
not
revert
but
23
shall
remain
available
for
expenditure
for
the
purposes
24
designated
until
the
close
of
the
succeeding
fiscal
25
year.
>
26
106.
Page
77,
before
line
30
by
inserting:
27
<
QUALITY
ASSURANCE
TRUST
FUND
——
DEPARTMENT
OF
HUMAN
28
SERVICES
>
29
107.
Page
79,
after
line
3
by
inserting:
30
<
STATE
INSTITUTION
——
APPROPRIATION
TRANSFERS
31
Sec.
___.
DEPARTMENT
OF
HUMAN
SERVICES.
There
32
is
transferred
between
the
following
designated
33
appropriations
made
to
the
department
of
human
services
34
for
the
fiscal
year
beginning
July
1,
2010,
and
ending
35
June
30,
2011,
not
more
than
the
following
amounts:
36
1.
From
the
appropriation
made
for
purposes
of
the
37
state
resource
center
at
Glenwood
in
2010
Iowa
Acts,
38
chapter
1192,
section
25,
subsection
1,
paragraph
“a”,
39
to
the
appropriation
made
for
purposes
of
the
Iowa
40
juvenile
home
at
Toledo
in
2010
Iowa
Acts,
chapter
41
1192,
section
17,
subsection
1:
42
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
400,000
43
2.
From
the
appropriation
made
for
purposes
of
the
44
state
resource
center
at
Woodward
in
2010
Iowa
Acts,
45
chapter
1192,
section
25,
subsection
1,
paragraph
“b”,
46
to
the
appropriation
made
for
purposes
of
the
state
47
mental
health
institute
at
Independence
in
2010
Iowa
48
Acts,
chapter
1192,
section
24,
subsection
1,
paragraph
49
“c”:
50
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52
#105.
#106.
#107.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
400,000
>
1
108.
Page
79,
by
striking
lines
4
through
14.
2
109.
Page
81,
after
line
2
by
inserting:
3
<
Sec.
___.
RETROACTIVE
APPLICABILITY.
The
section
4
of
this
division
of
this
Act
making
transfers
between
5
appropriations
made
to
the
department
of
human
services
6
for
state
institutions
in
2010
Iowa
Acts,
chapter
1192,
7
applies
retroactively
to
January
1,
2011.
>
8
110.
Page
82,
after
line
3
by
inserting:
9
<
Sec.
___.
Section
29C.20B,
Code
2011,
is
amended
10
to
read
as
follows:
11
29C.20B
Disaster
case
management.
12
1.
The
rebuild
Iowa
office
homeland
security
13
and
emergency
management
division
shall
work
with
14
the
department
of
human
services
and
nonprofit,
15
voluntary,
and
faith-based
organizations
active
16
in
disaster
recovery
and
response
in
coordination
17
with
the
homeland
security
and
emergency
management
18
division
the
department
of
human
services
to
establish
19
a
statewide
system
of
disaster
case
management
to
be
20
activated
following
the
governor’s
proclamation
of
21
a
disaster
emergency
or
the
declaration
of
a
major
22
disaster
by
the
president
of
the
United
States
for
23
individual
assistance
purposes.
Under
the
system,
the
24
department
of
human
services
homeland
security
and
25
emergency
management
division
shall
coordinate
case
26
management
services
locally
through
local
committees
27
as
established
in
each
local
emergency
management
28
commission’s
emergency
plan.
Beginning
July
1,
29
2011,
the
department
of
human
services
shall
assume
30
the
duties
of
the
rebuild
Iowa
office
under
this
31
subsection
.
32
2.
The
department
of
human
services
homeland
33
security
and
emergency
management
division
,
in
34
conjunction
with
the
rebuild
Iowa
office,
the
homeland
35
security
and
emergency
management
division
department
36
of
human
services
,
and
an
Iowa
representative
to
37
the
national
voluntary
organizations
active
in
38
disaster,
shall
adopt
rules
pursuant
to
chapter
17A
to
39
create
coordination
mechanisms
and
standards
for
the
40
establishment
and
implementation
of
a
statewide
system
41
of
disaster
case
management
which
shall
include
at
42
least
all
of
the
following:
43
a.
Disaster
case
management
standards.
44
b.
Disaster
case
management
policies.
45
c.
Reporting
requirements.
46
d.
Eligibility
criteria.
47
e.
Coordination
mechanisms
necessary
to
carry
out
48
the
services
provided.
49
f.
Develop
formal
working
relationships
with
50
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#109.
#110.
agencies
and
create
interagency
agreements
for
1
those
considered
to
provide
disaster
case
management
2
services.
3
g.
Coordination
of
all
available
services
for
4
individuals
from
multiple
agencies.
>
5
111.
Page
82,
after
line
3
by
inserting:
6
<
Sec.
___.
Section
135.106,
Code
2011,
is
amended
7
by
adding
the
following
new
subsection:
8
NEW
SUBSECTION
.
4.
It
is
the
intent
of
the
general
9
assembly
that
priority
for
home
visitation
funding
be
10
given
to
approaches
using
evidence-based
or
promising
11
models
for
home
visitation.
>
12
112.
Page
82,
after
line
3
by
inserting:
13
<
Sec.
___.
Section
135H.6,
subsection
8,
Code
2011,
14
is
amended
to
read
as
follows:
15
8.
The
department
of
human
services
may
give
16
approval
to
conversion
of
beds
approved
under
17
subsection
6
,
to
beds
which
are
specialized
to
provide
18
substance
abuse
treatment.
However,
the
total
number
19
of
beds
approved
under
subsection
6
and
this
subsection
20
shall
not
exceed
four
hundred
thirty.
Conversion
of
21
beds
under
this
subsection
shall
not
require
a
revision
22
of
the
certificate
of
need
issued
for
the
psychiatric
23
institution
making
the
conversion.
Beds
for
children
24
who
do
not
reside
in
this
state
and
whose
service
costs
25
are
not
paid
by
public
funds
in
this
state
are
not
26
subject
to
the
limitations
on
the
number
of
beds
and
27
certificate
of
need
requirements
otherwise
applicable
28
under
this
section.
>
29
113.
Page
82,
after
line
31
by
inserting:
30
<
Sec.
___.
Section
154A.24,
subsection
3,
paragraph
31
s,
Code
2011,
is
amended
by
striking
the
paragraph.
>
32
114.
Page
82,
after
line
31
by
inserting:
33
<
Sec.
___.
NEW
SECTION
.
155A.43
Pharmaceutical
34
collection
and
disposal
program
——
annual
allocation.
35
Of
the
fees
collected
pursuant
to
sections
124.301
36
and
147.80
and
chapter
155A
by
the
board
of
pharmacy,
37
and
retained
by
the
board
pursuant
to
section
147.82,
38
not
more
than
one
hundred
twenty-five
thousand
39
dollars,
may
be
allocated
annually
by
the
board
for
40
administering
the
pharmaceutical
collection
and
41
disposal
program
originally
established
pursuant
to
42
2009
Iowa
Acts,
chapter
175,
section
9.
The
program
43
shall
provide
for
the
management
and
disposal
of
44
unused,
excess,
and
expired
pharmaceuticals.
The
45
board
of
pharmacy
may
cooperate
with
the
Iowa
pharmacy
46
association
and
may
consult
with
the
department
and
47
sanitary
landfill
operators
in
administering
the
48
program.
>
49
115.
Page
83,
after
line
9
by
inserting:
50
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(1)
84
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19/
52
#111.
#112.
#113.
#114.
#115.
<
Sec.
___.
Section
235B.19,
Code
2011,
is
amended
1
by
adding
the
following
new
subsection:
2
NEW
SUBSECTION
.
2A.
a.
The
department
shall
3
serve
a
copy
of
the
petition
and
any
order
authorizing
4
protective
services,
if
issued,
on
the
dependent
adult
5
and
on
persons
who
are
competent
adults
and
reasonably
6
ascertainable
at
the
time
the
petition
is
filed
in
7
accordance
with
the
following
priority:
8
(1)
An
attorney
in
fact
named
by
the
dependent
9
adult
in
a
durable
power
of
attorney
for
health
care
10
pursuant
to
chapter
144B.
11
(2)
The
dependent
adult’s
spouse.
12
(3)
The
dependent
adult’s
children.
13
(4)
The
dependent
adult’s
grandchildren.
14
(5)
The
dependent
adult’s
siblings.
15
(6)
The
dependent
adult’s
aunts
and
uncles.
16
(7)
The
dependent
adult’s
nieces
and
nephews.
17
(8)
The
dependent
adult’s
cousins.
18
b.
When
the
department
has
served
a
person
in
one
19
of
the
categories
specified
in
paragraph
“a”
,
the
20
department
shall
not
be
required
to
serve
a
person
in
21
any
other
category.
22
c.
The
department
shall
serve
the
dependent
adult’s
23
copy
of
the
petition
and
order
personally
upon
the
24
dependent
adult.
Service
of
the
petition
and
all
other
25
orders
and
notices
shall
be
in
a
sealed
envelope
with
26
the
proper
postage
on
the
envelope,
addressed
to
the
27
person
being
served
at
the
person’s
last
known
post
28
office
address,
and
deposited
in
a
mail
receptacle
29
provided
by
the
United
States
postal
service.
The
30
department
shall
serve
such
copies
of
emergency
orders
31
authorizing
protective
services
and
notices
within
32
three
days
after
filing
the
petition
and
receiving
such
33
orders.
34
d.
The
department
and
all
persons
served
by
the
35
department
with
notices
under
this
subsection
shall
36
be
prohibited
from
all
of
the
following
without
prior
37
court
approval
after
the
department’s
petition
has
been
38
filed:
39
(1)
Selling,
removing,
or
otherwise
disposing
of
40
the
dependent
adult’s
personal
property.
41
(2)
Withdrawing
funds
from
any
bank,
savings
and
42
loan
association,
credit
union,
or
other
financial
43
institution,
or
from
an
account
containing
securities
44
in
which
the
dependent
adult
has
an
interest.
>
45
116.
Page
83,
after
line
9
by
inserting:
46
<
Sec.
___.
Section
237A.1,
subsection
3,
paragraph
47
n,
Code
2011,
is
amended
to
read
as
follows:
48
n.
A
program
offered
to
a
child
whose
parent,
49
guardian,
or
custodian
is
engaged
solely
in
a
50
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#116.
recreational
or
social
activity,
remains
immediately
1
available
and
accessible
on
the
physical
premises
on
2
which
the
child’s
care
is
provided,
and
does
not
engage
3
in
employment
while
the
care
is
provided.
However,
4
if
the
recreational
or
social
activity
is
provided
in
5
a
fitness
center
or
on
the
premises
of
a
nonprofit
6
organization
the
parent,
guardian,
or
custodian
of
the
7
child
may
be
employed
to
teach
or
lead
the
activity.
>
8
117.
Page
83,
after
line
9
by
inserting:
9
<
Sec.
___.
Section
249A.4B,
subsection
2,
paragraph
10
a,
subparagraph
(18),
Code
2011,
is
amended
to
read
as
11
follows:
12
(18)
The
Iowa/Nebraska
Iowa
primary
care
13
association.
>
14
118.
Page
83,
by
striking
lines
10
through
19.
15
119.
Page
83,
after
line
21
by
inserting:
16
<
DIVISION
___
17
IOWA
FALSE
CLAIMS
ACT
18
Sec.
___.
Section
685.1,
subsection
11,
Code
2011,
19
is
amended
to
read
as
follows:
20
11.
“Original
source”
means
an
individual
who
has
21
direct
and
independent
prior
to
a
public
disclosure
22
under
section
685.3,
subsection
5,
paragraph
“c”
,
has
23
voluntarily
disclosed
to
the
state
the
information
on
24
which
the
allegations
or
transactions
in
a
claim
are
25
based;
or
who
has
knowledge
of
the
information
on
which
26
the
allegations
are
based
that
is
independent
of
and
27
materially
adds
to
the
publicly
disclosed
allegations
28
or
transactions,
and
has
voluntarily
provided
the
29
information
to
the
state
before
filing
an
action
under
30
section
685.3
which
is
based
on
the
information
this
31
chapter
.
32
Sec.
___.
Section
685.1,
Code
2011,
is
amended
by
33
adding
the
following
new
subsection:
34
NEW
SUBSECTION
.
15.
“State”
means
the
state
of
35
Iowa.
36
Sec.
___.
Section
685.2,
subsection
1,
unnumbered
37
paragraph
1,
Code
2011,
is
amended
to
read
as
follows:
38
A
person
who
commits
any
of
the
following
acts
is
39
jointly
and
severally
liable
to
the
state
for
a
civil
40
penalty
of
not
less
than
five
thousand
dollars
and
41
not
more
than
ten
thousand
dollars
the
civil
penalty
42
allowed
under
the
federal
False
Claims
Act,
as
codified
43
in
31
U.S.C.
§
3729
et
seq.,
as
may
be
adjusted
in
44
accordance
with
the
inflation
adjustment
procedures
45
prescribed
in
the
federal
Civil
Penalties
Inflation
46
Adjustment
Act
of
1990,
Pub.
L.
No.
101-410,
for
each
47
false
or
fraudulent
claim
,
plus
three
times
the
amount
48
of
damages
which
the
state
sustains
because
of
the
act
49
of
that
person
:
50
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52
#117.
#118.
#119.
Sec.
___.
Section
685.3,
subsection
5,
paragraph
1
c,
Code
2011,
is
amended
by
striking
the
paragraph
and
2
inserting
in
lieu
thereof
the
following:
3
c.
A
court
shall
dismiss
an
action
or
claim
4
under
this
section,
unless
opposed
by
the
state,
if
5
substantially
the
same
allegations
or
transactions
as
6
alleged
in
the
action
or
claim
were
publicly
disclosed
7
in
a
state
criminal,
civil,
or
administrative
hearing
8
in
which
the
state
or
an
agent
of
the
state
is
a
9
party;
in
a
state
legislative,
state
auditor,
or
other
10
state
report,
hearing,
audit,
or
investigation;
or
11
by
the
news
media,
unless
the
action
is
brought
by
12
the
attorney
general
or
the
qui
tam
plaintiff
is
an
13
original
source
of
the
information.
14
Sec.
___.
Section
685.3,
subsection
6,
Code
2011,
15
is
amended
to
read
as
follows:
16
6.
a.
Any
employee,
contractor,
or
agent
who
17
shall
be
entitled
to
all
relief
necessary
to
make
18
that
employee,
contractor,
or
agent
whole,
if
that
19
employee,
contractor,
or
agent
is
discharged,
demoted,
20
suspended,
threatened,
harassed,
or
in
any
other
manner
21
discriminated
against
in
the
terms
and
conditions
of
22
employment
because
of
lawful
acts
performed
done
by
23
the
employee,
contractor,
or
agent
on
behalf
of
the
24
employee,
contractor,
or
agent
or
associated
others
in
25
furtherance
of
an
action
under
this
section
or
other
26
efforts
to
stop
a
violation
one
or
more
violations
of
27
this
chapter
,
shall
be
entitled
to
all
relief
necessary
28
to
make
the
employee,
contractor,
or
agent
whole
.
Such
29
relief
30
b.
Relief
under
paragraph
“a”
shall
include
31
reinstatement
with
the
same
seniority
status
such
32
that
employee,
contractor,
or
agent
would
have
had
33
but
for
the
discrimination,
two
times
the
amount
of
34
back
pay,
interest
on
the
back
pay,
and
compensation
35
for
any
special
damages
sustained
as
a
result
of
36
the
discrimination,
including
litigation
costs
and
37
reasonable
attorney
fees.
An
employee,
contractor,
or
38
agent
may
bring
an
action
under
this
subsection
may
be
39
brought
in
the
appropriate
district
court
of
the
state
40
for
the
relief
provided
in
this
subsection
.
41
c.
A
civil
action
under
this
subsection
shall
not
42
be
brought
more
than
three
years
after
the
date
when
43
the
retaliation
occurred.
44
DIVISION
___
45
IOWACARE
PROGRAM
46
Sec.
___.
Section
249J.6,
subsection
2,
paragraph
47
b,
Code
2011,
is
amended
to
read
as
follows:
48
b.
Refusal
of
an
expansion
population
member
to
49
participate
in
a
comprehensive
medical
examination
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or
any
health
risk
assessment
implemented
by
the
1
department
shall
not
be
a
basis
for
ineligibility
2
for
or
disenrollment
from
the
expansion
population.
3
Refusal
of
an
expansion
population
member
to
4
participate
in
a
comprehensive
medical
examination
or
5
other
preventative
health
service
shall
not
negatively
6
affect
the
calculation
of
performance
payments
for
an
7
expansion
population
network
provider
medical
home.
8
Sec.
___.
Section
249J.6,
subsection
3,
Code
2011,
9
is
amended
to
read
as
follows:
10
3.
Expansion
population
members
,
including
members
11
assigned
to
an
expansion
population
network
provider
12
medical
home,
shall
be
provided
access
to
an
IowaCare
13
nurse
helpline,
accessible
twenty-four
hours
per
day,
14
seven
days
per
week,
to
assist
expansion
population
15
members
in
making
appropriate
choices
about
the
use
of
16
emergency
room
and
other
health
care
services.
17
Sec.
___.
Section
249J.7,
subsection
1,
paragraph
18
c,
Code
2011,
is
amended
to
read
as
follows:
19
c.
(1)
Tertiary
care
shall
only
be
provided
to
20
eligible
expansion
population
members
residing
in
any
21
county
in
the
state
at
the
university
of
Iowa
hospitals
22
and
clinics.
23
(2)
Secondary
care
shall
be
provided
by
the
24
publicly
owned
acute
care
teaching
hospital
located
25
in
a
county
with
a
population
over
three
hundred
26
fifty
thousand
and
the
university
of
Iowa
hospitals
27
and
clinics,
based
on
county
of
residence,
only
to
28
the
extent
specified
in
the
phase-in
of
the
regional
29
provider
network
designated
by
the
department.
30
Sec.
___.
Section
249J.24A,
subsection
1,
Code
31
2011,
is
amended
to
read
as
follows:
32
1.
A
nonparticipating
provider
may
be
reimbursed
33
for
covered
expansion
population
services
provided
to
34
an
expansion
population
member
by
a
nonparticipating
35
provider
if
the
nonparticipating
provider
contacts
the
36
appropriate
participating
provider
prior
to
providing
37
covered
services
to
verify
consensus
regarding
one
of
38
the
following
courses
of
action
if
any
of
the
following
39
conditions
is
met
:
40
a.
If
the
nonparticipating
provider
and
the
41
participating
provider
agree
that
the
medical
status
42
of
the
expansion
population
member
indicates
it
43
is
medically
possible
to
postpone
provision
of
44
services,
the
nonparticipating
provider
shall
direct
45
the
expansion
population
member
to
the
appropriate
46
participating
provider
for
services.
47
b.
a.
If
the
nonparticipating
provider
and
the
48
participating
provider
agree
determines
that
the
49
medical
status
of
the
expansion
population
member
50
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indicates
it
is
not
medically
possible
advisable
to
1
postpone
provision
of
services,
the
nonparticipating
2
provider
shall
provide
medically
necessary
services.
3
c.
b.
If
the
nonparticipating
provider
and
the
4
participating
provider
agree
that
transfer
of
the
5
expansion
population
member
is
not
possible
due
to
lack
6
of
available
inpatient
capacity,
the
nonparticipating
7
provider
shall
provide
medically
necessary
services.
8
d.
c.
If
the
medical
status
of
the
expansion
9
population
member
indicates
a
medical
emergency
and
the
10
nonparticipating
provider
is
not
able
to
contact
the
11
appropriate
participating
provider
prior
to
providing
12
medically
necessary
services,
the
nonparticipating
13
provider
shall
document
the
medical
emergency
14
and
inform
the
appropriate
participating
provider
15
immediately
after
the
member
has
been
stabilized
of
any
16
covered
services
provided.
17
Sec.
___.
Section
249J.24A,
subsection
2,
paragraph
18
a,
Code
2011,
is
amended
to
read
as
follows:
19
a.
If
the
nonparticipating
provider
meets
20
the
requirements
specified
in
subsection
1
,
the
21
nonparticipating
provider
shall
be
reimbursed
for
22
covered
expansion
population
services
,
limited
to
23
emergency
and
other
inpatient
hospital
services
24
provided
to
the
expansion
population
member
up
to
the
25
point
of
transfer
to
another
provider,
discharge,
26
or
transfer
to
another
level
of
care,
through
the
27
nonparticipating
provider
reimbursement
fund
in
28
accordance
with
rules
adopted
by
the
department
of
29
human
services.
However,
any
funds
received
from
30
participating
providers,
appropriated
to
participating
31
providers,
or
deposited
in
the
IowaCare
account
32
pursuant
to
section
249J.24
,
shall
not
be
transferred
33
or
appropriated
to
the
nonparticipating
provider
34
reimbursement
fund
or
otherwise
used
to
reimburse
35
nonparticipating
providers.
36
DIVISION
___
37
VOLUNTEER
HEALTH
CARE
PROVIDER
PROGRAM
38
Sec.
___.
Section
135.24,
subsection
2,
paragraphs
39
b
and
c,
Code
2011,
are
amended
to
read
as
follows:
40
b.
Procedures
for
registration
of
hospitals,
free
41
clinics,
field
dental
clinics,
and
specialty
health
42
care
provider
offices.
43
c.
Criteria
for
and
identification
of
hospitals,
44
clinics,
free
clinics,
field
dental
clinics,
specialty
45
health
care
provider
offices,
or
other
health
care
46
facilities,
health
care
referral
programs,
or
47
charitable
organizations,
eligible
to
participate
in
48
the
provision
of
free
medical,
dental,
chiropractic,
49
pharmaceutical,
nursing,
optometric,
psychological,
50
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social
work,
behavioral
science,
podiatric,
physical
1
therapy,
occupational
therapy,
respiratory
therapy,
or
2
emergency
medical
care
services
through
the
volunteer
3
health
care
provider
program.
A
hospital,
a
clinic,
a
4
free
clinic,
a
field
dental
clinic,
a
specialty
health
5
care
provider
office,
a
health
care
facility,
a
health
6
care
referral
program,
a
charitable
organization,
or
7
a
health
care
provider
participating
in
the
program
8
shall
not
bill
or
charge
a
patient
for
any
health
care
9
provider
service
provided
under
the
volunteer
health
10
care
provider
program.
11
Sec.
___.
Section
135.24,
Code
2011,
is
amended
by
12
adding
the
following
new
subsection:
13
NEW
SUBSECTION
.
6A.
A
hospital
providing
free
care
14
under
this
section
shall
be
considered
a
state
agency
15
solely
for
the
purposes
of
this
section
and
chapter
669
16
and
shall
be
afforded
protection
under
chapter
669
as
a
17
state
agency
for
all
claims
arising
from
the
provision
18
of
free
care
by
a
health
care
provider
registered
under
19
subsection
3
who
is
providing
services
at
the
hospital
20
in
accordance
with
this
section,
if
the
hospital
has
21
registered
with
the
department
pursuant
to
subsection
22
1.
23
Sec.
___.
Section
135.24,
subsection
7,
Code
2011,
24
is
amended
by
adding
the
following
new
paragraph:
25
NEW
PARAGRAPH
.
0e.
“Hospital”
means
hospital
as
26
defined
in
section
135B.1.
27
DIVISION
___
28
HEALTH
CARE
COST
CONTAINMENT
29
Sec.
___.
ALL-PAYER
CLAIMS
DATABASE
PLAN.
The
30
department
of
human
services
shall
develop
a
plan
to
31
establish
an
all-payer
claims
database
to
provide
32
for
the
collection
and
analysis
of
claims
data
from
33
multiple
payers
of
health
care.
The
plan
shall
34
establish
the
goals
of
the
database
which
may
include
35
but
are
not
limited
to
determining
health
care
36
utilization
patterns
and
rates;
identifying
gaps
in
37
prevention
and
health
promotion
services;
evaluating
38
access
to
care;
assisting
with
benefit
design
and
39
planning;
analyzing
statewide
and
local
health
care
40
expenditures
by
provider,
employer,
and
geography;
41
informing
the
development
of
payment
systems
for
42
providers;
and
establishing
clinical
guidelines
related
43
to
quality,
safety,
and
continuity
of
care.
The
plan
44
shall
identify
a
standard
means
of
data
collection,
45
statutory
changes
necessary
to
the
collection
and
46
use
of
the
data,
and
the
types
of
claims
for
which
47
collection
of
data
is
required
which
may
include
48
but
are
not
limited
to
eligibility
data;
provider
49
information;
medical
data;
private
and
public
medical,
50
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pharmacy,
and
dental
claims
data;
and
other
appropriate
1
data.
The
plan
shall
also
include
an
implementation
2
and
maintenance
schedule
including
a
proposed
budget
3
and
funding
plan
and
vision
for
the
future.
4
Sec.
___.
PROVIDER
PAYMENT
SYSTEM
PLAN
——
PILOT
5
PROJECT.
The
department
of
human
services
shall
6
develop
a
provider
payment
system
plan
to
provide
7
recommendations
to
reform
the
health
care
provider
8
payment
system
as
an
effective
way
to
promote
9
coordination
of
care,
lower
costs,
and
improve
quality.
10
The
plan
shall
provide
analysis
and
recommendations
11
regarding
but
not
limited
to
accountable
care
12
organizations,
a
global
payment
system,
or
an
episode
13
of
care
payment
system.
14
Sec.
___.
EFFECTIVE
UPON
ENACTMENT.
This
division
15
of
this
Act,
being
deemed
of
immediate
importance,
16
takes
effect
upon
enactment.
>
17
120.
Page
83,
after
line
21
by
inserting:
18
<
DIVISION
___
19
NURSING
FACILITY
QUALITY
ASSURANCE
ASSESSMENT
PROGRAM
20
Sec.
___.
Section
249L.2,
Code
2011,
is
amended
by
21
adding
the
following
new
subsection:
22
NEW
SUBSECTION
.
8A.
“Patient
service
revenue”
means
23
the
total
Medicaid,
Medicare,
and
private
pay
revenues
24
as
they
correlate
with
the
Medicaid
cost
reports.
25
Sec.
___.
Section
249L.3,
subsection
1,
paragraph
26
d,
Code
2011,
is
amended
to
read
as
follows:
27
d.
The
aggregate
quality
assurance
assessments
28
imposed
under
this
chapter
shall
not
exceed
the
lower
29
of
three
five
percent
of
the
aggregate
non-Medicare
30
patient
service
revenues
of
a
nursing
facility
or
the
31
maximum
amount
that
may
be
assessed
pursuant
to
the
32
indirect
guarantee
threshold
as
established
pursuant
to
33
42
C.F.R.
§
433.68(f)(3)(i),
and
shall
be
stated
on
a
34
per-patient-day
basis.
35
Sec.
___.
Section
249L.4,
subsection
2,
Code
2011,
36
is
amended
to
read
as
follows:
37
2.
a.
Moneys
in
the
trust
fund
shall
be
used,
38
subject
to
their
appropriation
by
the
general
assembly,
39
by
the
department
only
for
reimbursement
of
services
40
for
which
federal
financial
participation
under
the
41
medical
assistance
program
is
available
to
match
state
42
funds.
43
b.
Any
moneys
appropriated
from
the
trust
fund
for
44
reimbursement
of
nursing
facilities,
in
addition
to
45
the
quality
assurance
assessment
pass-through
and
the
46
quality
assurance
assessment
rate
add-on
which
shall
be
47
used
as
specified
in
subsection
5
,
paragraph
“b”
,
shall
48
be
used
in
a
manner
such
that
no
less
than
thirty-five
49
percent
of
the
amount
received
by
a
nursing
facility
50
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#120.
is
used
for
increases
in
compensation
and
costs
1
of
employment
for
direct
care
workers,
and
no
less
2
than
sixty
percent
of
the
total
is
used
to
increase
3
compensation
and
costs
of
employment
for
all
nursing
4
facility
staff.
For
the
purposes
of
use
of
such
5
funds,
“direct
care
worker”
,
“nursing
facility
staff”
,
6
“increases
in
compensation”
,
and
“costs
of
employment”
7
mean
as
defined
or
specified
in
this
chapter
.
8
c.
One
million
dollars
of
the
moneys
in
the
trust
9
fund
shall
be
used
to
increase
the
monthly
upper
cost
10
limit
for
services
under
the
medical
assistance
home
11
and
community-based
services
waiver
for
the
elderly.
12
Sec.
___.
Section
249L.4,
subsection
5,
paragraph
13
a,
subparagraph
(2),
Code
2011,
is
amended
to
read
as
14
follows:
15
(2)
A
quality
assurance
assessment
rate
16
add-on.
This
rate
add-on
shall
be
calculated
on
a
17
per-patient-day
basis
for
medically
indigent
residents.
18
The
amount
paid
to
a
nursing
facility
as
a
quality
19
assurance
assessment
rate
add-on
shall
be
ten
not
20
exceed
fifteen
dollars
per
patient
day.
21
Sec.
___.
DIRECTIVE
TO
DEPARTMENT
OF
HUMAN
22
SERVICES.
Upon
enactment
of
this
division
of
this
Act,
23
the
department
of
human
services
shall
request
any
24
medical
assistance
state
plan
amendment
necessary
to
25
implement
the
revisions
to
the
nursing
facility
quality
26
assurance
assessment
program
specified
in
this
division
27
of
this
Act
from
the
centers
for
Medicare
and
Medicaid
28
services
of
the
United
States
department
of
health
and
29
human
services.
30
Sec.
___.
CONTINGENCY
PROVISION.
The
revised
31
quality
assurance
assessment
specified
in
this
Act
32
shall
accrue
beginning
July
1,
2011.
However,
accrued
33
quality
assurance
assessments
shall
not
be
collected
34
prior
to
completion
of
both
of
the
following:
35
1.
The
approval
of
the
medical
assistance
state
36
plan
amendment
necessary
to
implement
the
revisions
37
specified
in
this
division
of
this
Act
by
the
centers
38
for
Medicare
and
Medicaid
services
of
the
United
States
39
department
of
health
and
human
services.
40
2.
An
appropriation
enacted
by
the
general
assembly
41
to
implement
the
revised
nursing
facility
provider
42
reimbursements
as
provided
in
this
Act.
43
Sec.
___.
EFFECTIVE
UPON
ENACTMENT
AND
44
APPLICABILITY.
This
division
of
this
Act,
being
deemed
45
of
immediate
importance,
takes
effect
upon
enactment.
46
However,
the
department
of
human
services
shall
only
47
implement
this
division
of
this
Act
if
the
department
48
receives
approval
of
the
state
plan
amendment
necessary
49
to
implement
the
revisions
to
the
nursing
facility
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quality
assurance
assessment
program
as
specified
in
1
this
division
of
this
Act.
>
2
121.
Page
83,
after
line
21
by
inserting:
3
<
DIVISION
___
4
PHARMACY
ASSESSMENT
5
Sec.
___.
NEW
SECTION
.
249N.1
Title.
6
This
chapter
shall
be
known
and
may
be
cited
as
the
7
“Pharmacy
Assessment
Program”
.
8
Sec.
___.
NEW
SECTION
.
249N.2
Definitions.
9
As
used
in
this
chapter,
unless
the
context
10
otherwise
requires:
11
1.
“Department”
means
the
department
of
human
12
services.
13
2.
“Pharmacy”
means
pharmacy
as
defined
in
section
14
155A.3.
15
Sec.
___.
NEW
SECTION
.
249N.3
Pharmacy
assessment
16
program.
17
1.
Beginning
July
1,
2011,
or
the
implementation
18
date
of
the
pharmacy
assessment
program
as
determined
19
by
receipt
of
approval
from
the
centers
for
Medicare
20
and
Medicaid
services
of
the
United
States
department
21
of
health
and
human
services,
whichever
is
later,
a
22
pharmacy
in
this
state
shall
be
assessed
a
fee
based
23
on
a
methodology
determined
by
the
department
in
24
consultation
with
pharmacy
representatives.
Pharmacies
25
domiciled
or
headquartered
outside
the
state
that
are
26
engaged
in
prescription
drug
sales
that
are
delivered
27
directly
to
patients
within
the
state
via
common
28
carrier,
mail,
or
a
carrier
service
are
not
subject
to
29
the
provisions
of
this
chapter.
30
2.
The
aggregate
assessment
imposed
under
this
31
section
shall
not
exceed
the
maximum
amount
that
may
be
32
assessed
pursuant
to
the
indirect
guarantee
threshold
33
as
established
pursuant
to
42
C.F.R.
§
433.68(f)(3)(i),
34
and
shall
be
stated
on
a
per
prescription
basis.
35
3.
The
assessment
shall
be
paid
by
each
pharmacy
to
36
the
department
on
a
quarterly
basis.
The
department
37
shall
prepare
and
distribute
a
form
upon
which
38
pharmacies
shall
calculate
and
report
the
assessment.
39
A
pharmacy
shall
submit
the
completed
form
with
the
40
assessment
amount
no
later
than
the
last
day
of
the
41
month
following
the
end
of
each
calendar
quarter.
The
42
department
may
deduct
the
monthly
amount
from
medical
43
assistance
payments
to
a
pharmacy.
The
amount
deducted
44
from
the
payments
shall
not
exceed
the
total
amount
of
45
the
assessment
due.
46
4.
A
pharmacy
shall
retain
and
preserve
for
a
47
period
of
three
years
such
books
and
records
as
may
be
48
necessary
to
determine
the
amount
of
the
assessment
49
for
which
the
pharmacy
is
liable
under
this
chapter.
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#121.
The
department
may
inspect
and
copy
the
books
and
1
records
of
a
pharmacy
for
the
purpose
of
auditing
2
the
calculation
of
the
assessment.
All
information
3
obtained
by
the
department
under
this
subsection
is
4
confidential
and
does
not
constitute
a
public
record.
5
5.
The
department
shall
collect
the
assessment
6
imposed
and
shall
deposit
all
revenues
collected
in
7
the
pharmacy
assessment
trust
fund
created
in
section
8
249N.4.
9
6.
a.
A
pharmacy
that
fails
to
pay
the
assessment
10
within
the
time
frame
specified
in
this
section
11
shall
pay,
in
addition
to
the
outstanding
assessment,
12
a
penalty
of
one
and
five-tenths
percent
of
the
13
assessment
amount
owed
for
each
month
or
portion
of
14
each
month
that
the
payment
is
overdue.
15
b.
If
the
assessment
has
not
been
received
by
the
16
department
by
seven
days
after
the
last
day
of
the
17
month
in
which
the
payment
is
due,
the
department
shall
18
withhold
an
amount
equal
to
the
assessment
and
penalty
19
owed
from
any
payment
due
such
pharmacy
under
the
20
medical
assistance
program.
21
c.
The
assessment
imposed
under
this
section
22
constitutes
a
debt
due
the
state
and
may
be
collected
23
by
civil
action,
including
but
not
limited
to
the
24
filing
of
tax
liens,
and
any
other
method
provided
for
25
by
law.
26
d.
Any
penalty
collected
pursuant
to
this
27
subsection
shall
be
credited
to
the
pharmacy
assessment
28
trust
fund.
29
7.
a.
If
pharmacies
are
not
reimbursed
at
the
30
reimbursement
rates
established
pursuant
to
this
31
chapter,
the
department
shall
terminate
the
imposition
32
of
the
assessment
under
this
section
no
later
than
33
ninety
days
from
the
date
such
reimbursement
takes
34
effect.
35
b.
If
federal
financial
participation
to
match
the
36
assessments
made
under
this
section
becomes
unavailable
37
under
federal
law,
the
department
shall
terminate
the
38
imposition
of
the
assessments
beginning
on
the
date
the
39
federal
statutory,
regulatory,
or
interpretive
change
40
takes
effect.
41
Sec.
___.
NEW
SECTION
.
249N.4
Pharmacy
assessment
42
trust
fund.
43
1.
A
pharmacy
assessment
trust
fund
is
created
44
in
the
state
treasury
under
the
authority
of
the
45
department.
Moneys
received
through
the
collection
of
46
the
pharmacy
assessment
imposed
under
this
chapter
and
47
any
other
moneys
specified
for
deposit
in
the
trust
48
fund
shall
be
deposited
in
the
trust
fund.
49
2.
Moneys
in
the
trust
fund
shall
be
used,
subject
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to
their
appropriation
by
the
general
assembly,
by
1
the
department
only
for
reimbursement
of
services
for
2
which
federal
financial
participation
under
the
medical
3
assistance
program
is
available
to
match
state
funds.
4
3.
Beginning
July
1,
2011,
or
the
implementation
5
date
of
the
pharmacy
assessment
program
as
determined
6
by
receipt
of
approval
from
the
centers
for
Medicare
7
and
Medicaid
services
of
the
United
States
department
8
of
health
and
human
services,
whichever
is
later,
9
moneys
that
are
appropriated
from
the
trust
fund
for
10
reimbursement
to
pharmacies
shall
be
used
to
provide
11
the
following
pharmacy
reimbursement
adjustment
12
increases
within
the
parameters
specified:
13
a.
Enhanced
generic
prescription
drug
dispensing
14
fee.
The
department
shall
reimburse
pharmacy
15
dispensing
fees
using
a
rate
of
four
dollars
and
16
thirty-four
cents
per
prescription
plus
the
enhanced
17
generic
prescription
drug
dispensing
fee
per
generic
18
prescription.
19
b.
Enhanced
brand
name
prescription
drug
dispensing
20
fee.
The
department
shall
reimburse
pharmacy
21
dispensing
fees
using
a
rate
of
four
dollars
and
22
thirty-four
cents
per
prescription
plus
the
enhanced
23
brand
name
prescription
drug
dispensing
fee
per
brand
24
name
prescription.
25
4.
Appropriations
from
the
trust
fund
shall
be
26
based
on
the
following:
27
a.
For
the
fiscal
year
beginning
July
1,
2011,
28
fifty-one
percent
of
the
moneys
in
the
trust
fund
shall
29
be
appropriated
for
reimbursement
to
pharmacies.
30
b.
For
the
fiscal
year
beginning
July
1,
2012,
31
seventy-five
percent
of
the
moneys
in
the
trust
fund
32
shall
be
appropriated
for
reimbursement
to
pharmacies.
33
5.
Any
payments
made
to
pharmacies
under
this
34
section
shall
result
in
budget
neutrality
to
the
35
general
fund
of
the
state.
36
6.
The
trust
fund
shall
be
separate
from
the
37
general
fund
of
the
state
and
shall
not
be
considered
38
part
of
the
general
fund
of
the
state.
The
moneys
39
in
the
trust
fund
shall
not
be
considered
revenue
of
40
the
state,
but
rather
shall
be
funds
of
the
pharmacy
41
assessment
program.
The
moneys
deposited
in
the
42
trust
fund
are
not
subject
to
section
8.33
and
shall
43
not
be
transferred,
used,
obligated,
appropriated,
44
or
otherwise
encumbered,
except
to
provide
for
the
45
purposes
of
this
chapter.
Notwithstanding
section
46
12C.7,
subsection
2,
interest
or
earnings
on
moneys
47
deposited
in
the
trust
fund
shall
be
credited
to
the
48
trust
fund.
49
7.
The
department
shall
adopt
rules
pursuant
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to
chapter
17A
to
administer
the
trust
fund
and
1
reimbursements
made
from
the
trust
fund.
2
8.
The
department
shall
report
annually
to
the
3
general
assembly
regarding
the
use
of
moneys
deposited
4
in
the
trust
fund
and
appropriated
to
the
department.
5
Sec.
___.
NEW
SECTION
.
249N.5
REPEAL.
6
This
chapter
is
repealed
June
30,
2013.
7
Sec.
___.
DIRECTIVE
TO
DEPARTMENT
OF
HUMAN
8
SERVICES.
Upon
enactment
of
this
division
of
this
Act,
9
the
department
of
human
services
shall
request
any
10
medical
assistance
state
plan
amendment
necessary
to
11
implement
this
division
of
this
Act
from
the
centers
12
for
Medicare
and
Medicaid
services
of
the
United
States
13
department
of
health
and
human
services.
14
Sec.
___.
CONTINGENCY
PROVISIONS.
15
1.
The
pharmacy
assessment
imposed
pursuant
to
this
16
division
of
this
Act
shall
not
be
imposed
retroactively
17
prior
to
July
1,
2011.
18
2.
The
pharmacy
assessment
shall
not
be
collected
19
until
the
department
of
human
services
has
received
20
approval
of
the
assessment
from
the
centers
for
21
Medicare
and
Medicaid
services
of
the
United
States
22
department
of
health
and
human
services.
23
Sec.
___.
EFFECTIVE
UPON
ENACTMENT
AND
24
APPLICABILITY.
This
division
of
this
Act,
being
deemed
25
of
immediate
importance,
takes
effect
upon
enactment.
26
However,
the
department
of
human
services
shall
only
27
implement
this
division
of
this
Act
if
the
department
28
receives
federal
approval
of
the
requests
relating
to
29
the
medical
assistance
state
plan
amendment
necessary
30
to
implement
this
division
of
this
Act.
>
31
122.
Page
83,
after
line
21
by
inserting:
32
<
DIVISION
___
33
BISPHENOL
A
PROHIBITION
34
Sec.
___.
NEW
SECTION
.
135.181
Bisphenol
A
35
prohibition.
36
1.
As
used
in
this
section,
unless
the
context
37
otherwise
requires:
38
a.
“Infant
pacifier”
means
a
device
designed
to
be
39
bitten
or
sucked
by
an
infant
for
the
sole
purpose
of
40
soothing
or
providing
comfort
to
the
infant,
including
41
soothing
discomfort
caused
by
teething.
42
b.
“Reusable
beverage
container”
means
a
baby
bottle
43
or
spill-proof
container
primarily
intended
by
the
44
manufacturer
for
use
by
a
child
three
years
of
age
or
45
younger.
46
1A.
For
purposes
of
this
section,
“reusable
beverage
47
container”
includes
disposable
baby
bottle
liners
48
designed
to
hold
liquids
in
a
baby
bottle.
49
2.
Beginning
January
1,
2013,
a
person
shall
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#122.
not
manufacture,
sell,
or
distribute
in
commerce
in
1
this
state
any
infant
pacifier
or
reusable
beverage
2
container
containing
bisphenol
A.
A
manufacturer
or
3
wholesaler
who
sells
or
offers
for
sale
in
this
state
a
4
reusable
beverage
container
that
is
intended
for
retail
5
sale
shall
do
all
of
the
following:
6
a.
Ensure
that
the
container
is
conspicuously
7
labeled
as
not
containing
bisphenol
A.
8
b.
Provide
the
retailer
with
affirmation
that
the
9
container
does
not
contain
bisphenol
A.
10
3.
A
manufacturer
shall
use
the
least
toxic
11
alternative
when
replacing
bisphenol
A
in
accordance
12
with
this
section.
13
4.
In
complying
with
this
section,
a
manufacturer
14
shall
not
replace
bisphenol
A
with
a
substance
rated
15
by
the
United
States
environmental
protection
agency
16
as
a
class
A,
B,
or
C
carcinogen
or
a
substance
listed
17
on
the
agency’s
list
of
chemicals
evaluated
for
18
carcinogenic
potential
as
known
or
likely
carcinogens,
19
known
to
be
human
carcinogens,
or
likely
to
be
human
20
carcinogens.
21
5.
In
complying
with
this
section,
a
manufacturer
22
shall
not
replace
bisphenol
A
with
a
reproductive
23
toxicant
that
has
been
identified
by
the
United
States
24
environmental
protection
agency
as
causing
birth
25
defects,
reproductive
harm,
or
developmental
harm.
26
6.
A
person
who
violates
this
section
is
subject
27
to
a
civil
penalty
of
five
hundred
dollars
for
each
28
violation.
29
Sec.
___.
EFFECTIVE
DATE.
This
division
of
this
30
Act
takes
effect
January
1,
2013.
>
31
123.
Page
83,
after
line
21
by
inserting:
32
<
DIVISION
___
33
HEALTH
INFORMATION
TECHNOLOGY
34
Sec.
___.
NEW
SECTION
.
135D.1
Findings
and
intent.
35
1.
The
general
assembly
finds
all
of
the
following:
36
a.
Technology
used
to
support
health-related
37
functions
is
widely
known
as
health
information
38
technology.
Electronic
health
records
are
used
to
39
collect
and
store
relevant
patient
health
information.
40
Electronic
health
records
serve
as
a
means
of
bringing
41
evidence-based
knowledge
resources
and
patient
42
information
to
the
point
of
care
to
support
better
43
decision
making
and
more
efficient
care
processes.
44
b.
Health
information
technology
allows
for
45
comprehensive
management
of
health
information
and
its
46
secure
electronic
exchange
between
providers,
public
47
health
agencies,
payers,
and
consumers.
Broad
use
of
48
health
information
technology
should
improve
health
49
care
quality
and
the
overall
health
of
the
population,
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#123.
increase
efficiencies
in
administrative
health
care,
1
reduce
unnecessary
health
care
costs,
and
help
prevent
2
medical
errors.
3
c.
Health
information
technology
provides
a
4
mechanism
to
transform
the
delivery
of
health
and
5
medical
care
in
Iowa
and
across
the
nation.
6
2.
It
is
the
intent
of
the
general
assembly
to
7
use
health
information
technology
as
a
catalyst
8
to
achieve
a
healthier
Iowa
through
the
electronic
9
sharing
of
health
information.
A
health
information
10
network
involves
sharing
health
information
across
the
11
boundaries
of
individual
practice
and
institutional
12
health
settings
and
with
consumers.
The
result
is
a
13
public
good
that
will
contribute
to
improved
clinical
14
outcomes
and
patient
safety,
population
health,
access
15
to
and
quality
of
health
care,
and
efficiency
in
health
16
care
delivery.
17
3.
It
is
the
intent
of
the
general
assembly
that
18
the
health
information
network
shall
not
constitute
a
19
health
benefit
exchange
or
a
health
insurance
exchange.
20
Sec.
___.
NEW
SECTION
.
135D.2
Definitions.
21
For
the
purposes
of
this
chapter,
unless
the
context
22
otherwise
requires:
23
1.
“Authorized”
means
having
met
the
requirements
24
as
a
participant
for
access
to
the
health
information
25
network.
26
2.
“Board”
means
the
board
of
directors
of
Iowa
27
e-health.
28
3.
“Consumers”
means
people
who
acquire
and
use
29
goods
and
services
for
personal
need.
30
4.
“Continuity
of
care
document”
means
a
summary
31
of
a
patient’s
health
information
for
each
visit
to
a
32
provider
to
be
delivered
through
the
health
information
33
network.
34
5.
“Department”
means
the
department
of
public
35
health.
36
6.
“Deputy
director”
means
the
deputy
director
of
37
public
health.
38
7.
“Director”
means
the
director
of
public
health.
39
8.
“Exchange”
means
the
authorized
electronic
40
sharing
of
health
information
between
providers,
41
payers,
consumers,
public
health
agencies,
the
42
department,
and
other
authorized
participants
utilizing
43
the
health
information
network
and
health
information
44
network
services.
45
9.
“Executive
director”
means
the
executive
director
46
of
the
office
of
health
information
technology.
47
10.
“Health
information”
means
any
information,
48
in
any
form
or
medium,
that
is
created,
transmitted,
49
or
received
by
a
provider,
payer,
consumer,
public
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health
agency,
the
department,
or
other
authorized
1
participant,
which
relates
to
the
past,
present,
2
or
future
physical
or
mental
health
or
condition
of
3
an
individual;
the
provision
of
health
care
to
an
4
individual;
or
the
past,
present,
or
future
payment
for
5
the
provision
of
health
care
to
an
individual.
6
11.
“Health
information
network”
means
the
exclusive
7
statewide
electronic
health
information
network.
8
12.
“Health
information
network
services”
means
9
the
exchanging
of
health
information
via
the
health
10
information
network;
education
and
outreach
to
11
support
connection
and
access
to
and
use
of
the
health
12
information
network;
and
all
other
activities
related
13
to
the
electronic
exchange
of
health
information.
14
13.
“Health
Insurance
Portability
and
Accountability
15
Act”
means
the
federal
Health
Insurance
Portability
16
and
Accountability
Act
of
1996,
Pub.
L.
No.
104-191,
17
including
amendments
thereto
and
regulations
18
promulgated
thereunder.
19
14.
“Infrastructure”
means
technology
including
20
architecture,
hardware,
software,
networks,
terminology
21
and
standards,
and
policies
and
procedures
governing
22
the
electronic
exchange
of
health
information.
23
15.
“Iowa
e-health”
means
the
collaboration
24
between
the
department
and
other
public
and
private
25
stakeholders
to
establish,
operate,
and
sustain
an
26
exclusive
statewide
health
information
network.
27
16.
“Iowa
Medicaid
enterprise”
means
Iowa
medicaid
28
enterprise
as
defined
in
section
249J.3.
29
17.
“Local
board
of
health”
means
a
city,
county,
or
30
district
board
of
health.
31
18.
“Office”
means
the
office
of
health
information
32
technology
within
the
department.
33
19.
“Participant”
means
an
authorized
provider,
34
payer,
patient,
public
health
agency,
the
department,
35
or
other
authorized
person
that
has
voluntarily
agreed
36
to
authorize,
submit,
access,
and
disclose
health
37
information
through
the
health
information
network
in
38
accordance
with
this
chapter
and
all
applicable
laws,
39
rules,
agreements,
policies,
and
procedures.
40
20.
“Participation
and
data
sharing
agreement”
means
41
the
agreement
outlining
the
terms
of
access
and
use
for
42
participation
in
the
health
information
network.
43
21.
“Patient”
means
a
person
who
has
received
or
is
44
receiving
health
services
from
a
provider.
45
22.
“Payer”
means
a
person
who
makes
payments
46
for
health
services,
including
but
not
limited
to
an
47
insurance
company,
self-insured
employer,
government
48
program,
individual,
or
other
purchaser
that
makes
such
49
payments.
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23.
“Protected
health
information”
means
1
individually
identifiable
patient
information,
2
including
demographic
information,
related
to
the
past,
3
present,
or
future
health
or
condition
of
a
person;
4
the
provision
of
health
care
to
a
person;
or
the
past,
5
present,
or
future
payment
for
such
health
care;
which
6
is
created,
transmitted,
or
received
by
a
participant.
7
“Protected
health
information”
does
not
include
8
education
and
other
records
that
are
covered
under
the
9
federal
Family
Educational
Rights
and
Privacy
Act
of
10
1974,
as
codified
at
20
U.S.C.
1232g,
as
amended;
or
11
any
employment
records
maintained
by
a
covered
entity,
12
as
defined
under
the
Health
Insurance
Portability
and
13
Accountability
Act,
in
its
role
as
an
employer.
14
24.
“Provider”
means
a
hospital,
physician
clinic,
15
pharmacy,
laboratory,
health
service
provider,
or
16
other
person
that
is
licensed,
certified,
or
otherwise
17
authorized
or
permitted
by
law
to
administer
health
18
care
in
the
ordinary
course
of
business
or
in
the
19
practice
of
a
profession,
or
any
other
person
or
20
organization
that
furnishes,
bills,
or
is
paid
for
21
health
care
in
the
normal
course
of
business.
22
25.
“Public
health
agency”
means
an
entity
that
is
23
governed
by
or
contractually
responsible
to
a
local
24
board
of
health
or
the
department
to
provide
services
25
focused
on
the
health
status
of
population
groups
and
26
their
environments.
27
26.
“Purchaser”
means
any
individual,
employer,
28
or
organization
that
purchases
health
insurance
or
29
services
and
includes
intermediaries.
30
27.
“Vendor”
means
a
person
or
organization
that
31
provides
or
proposes
to
provide
goods
or
services
to
32
the
department
pursuant
to
a
contract,
but
does
not
33
include
an
employee
of
the
state,
a
retailer,
or
a
34
state
agency
or
instrumentality.
35
Sec.
___.
NEW
SECTION
.
135D.3
Iowa
e-health
36
established
——
guiding
principles,
goals,
domains.
37
1.
Iowa
e-health
is
established
as
a
38
public-private,
multi-stakeholder
collaborative.
39
The
purpose
of
Iowa
e-health
is
to
develop,
administer,
40
and
sustain
the
health
information
network
to
improve
41
the
quality,
safety,
and
efficiency
of
health
care
42
available
to
Iowans.
43
2.
Iowa
e-health
shall
manage
and
operate
44
the
health
information
network.
Nothing
in
45
this
chapter
shall
be
interpreted
to
impede
or
46
preclude
the
formation
and
operation
of
regional,
47
population-specific,
or
local
health
information
48
networks
or
their
participation
in
the
health
49
information
network.
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3.
Iowa
e-health
shall
facilitate
the
exchange
1
of
health
information
for
prevention
and
treatment
2
purposes
to
help
providers
make
the
best
health
care
3
decisions
for
patients
and
to
provide
patients
with
4
continuity
of
care
regardless
of
the
provider
the
5
patient
visits.
6
4.
The
guiding
principles
of
Iowa
e-health
include
7
all
of
the
following:
8
a.
To
engage
in
a
collaborative,
public-private,
9
multi-stakeholder
effort
including
providers,
payers,
10
purchasers,
governmental
entities,
educational
11
institutions,
and
consumers.
12
b.
To
create
a
sustainable
health
information
13
network
which
makes
information
available
when
and
14
where
it
is
needed.
15
c.
To
ensure
the
health
information
network
16
incorporates
provider
priorities
and
appropriate
17
participant
education.
18
d.
To
instill
confidence
in
consumers
that
their
19
health
information
is
secure,
private,
and
accessed
20
appropriately.
21
e.
To
build
on
smart
practices
and
align
with
22
federal
standards
to
ensure
interoperability
within
and
23
beyond
the
state.
24
5.
The
goals
of
Iowa
e-health
include
all
of
the
25
following:
26
a.
To
build
awareness
and
trust
of
health
27
information
technology
through
communication
and
28
outreach
to
providers
and
consumers.
29
b.
To
safeguard
privacy
and
security
of
health
30
information
shared
electronically
between
participants
31
through
the
health
information
network
so
that
the
32
health
information
is
secure,
private,
and
accessed
33
only
by
authorized
individuals
and
entities.
34
c.
To
promote
statewide
deployment
and
use
of
35
electronic
health
records.
36
d.
To
enable
the
electronic
exchange
of
health
37
information.
38
e.
To
advance
coordination
of
activities
across
39
state
and
federal
governments.
40
f.
To
establish
a
governance
model
for
the
health
41
information
network.
42
g.
To
establish
sustainable
business
and
technical
43
operations
for
the
health
information
exchange.
44
h.
To
secure
financial
resources
to
develop
and
45
sustain
the
health
information
network.
46
i.
To
monitor
and
evaluate
health
information
47
technology
progress
and
outcomes.
48
6.
Iowa
e-health
shall
include
the
following
five
49
domains:
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a.
Governance.
Iowa
e-health
shall
be
governed
1
by
a
board
of
directors
whose
members
represent
2
stakeholders
such
as
provider
organizations
and
3
associations,
providers,
payers,
purchasers,
4
governmental
entities,
business,
and
consumers.
Iowa
5
e-health
shall
be
supported
by
the
department’s
office
6
of
health
information
technology.
The
board
shall
7
set
direction,
goals,
and
policies
for
Iowa
e-health
8
and
provide
oversight
of
the
business
and
technical
9
operations
of
the
health
information
network
and
health
10
information
network
services.
11
b.
Business
and
technical
operations.
The
office
of
12
health
information
technology
shall
perform
day-to-day
13
operations
to
support
and
advance
Iowa
e-health,
the
14
health
information
network,
and
health
information
15
network
services.
16
c.
Finance.
Iowa
e-health
shall
identify
and
17
manage
financial
resources
to
achieve
short-term
and
18
long-term
sustainability
of
the
health
information
19
network.
The
health
information
network
shall
be
20
financed
by
participants
based
on
a
business
model
and
21
financial
sustainability
plan
approved
by
the
board
22
no
later
than
December
31,
2011,
and
submitted
to
the
23
governor
and
the
general
assembly.
The
model
and
plan
24
may
contemplate
participant
fees
based
on
value-based
25
principles.
Fees
shall
not
be
assessed
to
participants
26
prior
to
approval
by
the
board
and
an
enactment
of
the
27
general
assembly
establishing
such
fees.
28
d.
Technical
infrastructure.
Iowa
e-health
shall
29
implement
and
manage
the
core
infrastructure
and
30
standards
to
enable
the
safe
and
secure
delivery
of
31
health
information
to
providers
and
consumers
through
32
the
health
information
network.
33
e.
Legal
and
policy.
Iowa
e-health
shall
establish
34
privacy
and
security
policies
and
guidelines,
and
35
participation
and
data
sharing
agreements,
to
protect
36
consumers
and
enforce
rules
for
utilization
of
the
37
health
information
network.
38
Sec.
___.
NEW
SECTION
.
135D.4
Governance
——
board
39
of
directors
——
advisory
council.
40
1.
Iowa
e-health
shall
be
governed
by
a
board
of
41
directors.
Board
members
shall
be
residents
of
the
42
state
of
Iowa.
The
membership
of
the
board
shall
43
comply
with
sections
69.16
and
69.16A.
44
2.
The
board
of
directors
shall
be
comprised
of
the
45
following
members:
46
a.
The
board
shall
include
all
of
the
following
as
47
voting
members:
48
(1)
Two
members
who
represent
the
Iowa
49
collaborative
safety
net
provider
network
created
in
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section
135.153,
designated
by
the
network.
1
(2)
Four
members
who
represent
hospitals,
two
of
2
whom
are
designated
by
the
two
largest
health
care
3
systems
in
the
state,
one
of
whom
is
designated
by
the
4
university
of
Iowa
hospitals
and
clinics,
and
one
of
5
whom
is
designated
by
the
Iowa
hospital
association
to
6
represent
critical
access
hospitals.
7
(3)
Two
members
who
represent
two
different
private
8
health
insurance
carriers,
designated
by
the
federation
9
of
Iowa
insurers,
one
of
which
has
the
largest
health
10
market
share
in
Iowa.
11
(4)
One
member
who
is
a
licensed
physician,
12
designated
by
the
Iowa
medical
society.
13
(5)
One
member
representing
the
department
who
is
14
designated
by
the
department.
15
(6)
One
member
representing
the
Iowa
Medicaid
16
enterprise
who
is
the
Iowa
Medicaid
director,
or
the
17
director’s
designee.
18
b.
The
board
shall
include
as
ex
officio,
19
nonvoting
members
four
members
of
the
general
20
assembly,
one
appointed
by
the
speaker
of
the
house
of
21
representatives,
one
appointed
by
the
minority
leader
22
of
the
house
of
representatives,
one
appointed
by
the
23
majority
leader
of
the
senate,
and
one
appointed
by
the
24
minority
leader
of
the
senate.
25
3.
A
person
shall
not
serve
on
the
board
in
any
26
capacity
if
the
person
is
required
to
register
as
a
27
lobbyist
under
section
68B.36
because
of
the
person’s
28
activities
for
compensation
on
behalf
of
a
profession
29
or
an
entity
that
is
engaged
in
providing
health
care,
30
reviewing
or
analyzing
health
care,
paying
for
health
31
care
services
or
procedures,
or
providing
health
32
information
technology
or
health
information
network
33
services.
34
4.
a.
Board
members
shall
serve
four-year
terms
35
but
shall
not
serve
more
than
two
consecutive
four-year
36
terms.
However,
the
board
members
who
represent
state
37
agencies
are
not
subject
to
term
limits.
38
b.
At
the
end
of
any
term,
a
member
of
the
39
board
may
continue
to
serve
until
the
appointing
or
40
designating
authority
names
a
successor.
41
c.
A
vacancy
on
the
board
shall
be
filled
for
the
42
remainder
of
the
term
in
the
manner
of
the
original
43
appointment.
A
vacancy
in
the
membership
of
the
board
44
shall
not
impair
the
right
of
the
remaining
members
to
45
exercise
all
the
powers
and
perform
all
the
duties
of
46
the
board.
47
d.
A
board
member
may
be
removed
by
the
board
for
48
cause
including
but
not
limited
to
malfeasance
in
49
office,
failure
to
attend
board
meetings,
misconduct,
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or
violation
of
ethical
rules
and
standards.
1
Nonattendance
of
the
board
members
appointed
by
the
2
governor
shall
be
governed
by
the
provisions
of
section
3
69.15.
A
board
member
may
be
removed
by
a
vote
of
the
4
board
if,
based
on
the
criteria
provided
in
section
5
69.15,
subsection
1,
paragraphs
“a”
and
“b”
,
the
board
6
member
would
be
deemed
to
have
submitted
a
resignation
7
from
the
board.
8
e.
The
board
members
shall
elect
a
chairperson
from
9
their
membership.
The
department’s
designee
shall
10
serve
as
vice
chairperson.
11
5.
Meetings
of
the
board
shall
be
governed
by
the
12
provisions
of
chapter
21.
13
a.
The
board
shall
meet
upon
the
call
of
the
14
chairperson
or
the
vice
chairperson.
Notice
of
the
15
time
and
place
of
each
board
meeting
shall
be
given
16
to
each
member.
The
board
shall
keep
accurate
and
17
complete
records
of
all
of
its
meetings.
18
b.
A
simple
majority
of
the
members
shall
19
constitute
a
quorum
to
enable
the
transaction
of
any
20
business
and
for
the
exercise
of
any
power
or
function
21
of
the
board.
Action
may
be
taken
and
motions
and
22
resolutions
adopted
by
the
affirmative
vote
of
a
23
majority
of
the
members
attending
the
meeting
whether
24
in
person,
by
telephone,
web
conference,
or
other
25
means.
A
board
member
shall
not
vote
by
proxy
or
26
through
a
delegate.
27
c.
Public
members
of
the
board
shall
receive
28
reimbursement
for
actual
expenses
incurred
while
29
serving
in
their
official
capacity,
only
if
they
are
30
not
eligible
for
reimbursement
by
the
organization
that
31
they
represent.
A
person
who
serves
as
a
member
of
32
the
board
shall
not
by
reason
of
such
membership
be
33
entitled
to
membership
in
the
Iowa
public
employees’
34
retirement
system
or
service
credit
for
any
public
35
retirement
system.
36
6.
The
board
may
exercise
its
powers,
duties,
37
and
functions
as
provided
in
this
chapter
and
as
38
prescribed
by
law.
The
director
and
the
board
shall
39
ensure
that
matters
under
the
purview
of
the
board
40
are
carried
out
in
a
manner
that
does
not
violate
or
41
risk
violation
of
applicable
state
or
federal
laws
or
42
regulations,
and
that
supports
overriding
public
policy
43
and
public
safety
concerns,
fiscal
compliance,
and
44
compliance
with
the
office
of
the
national
coordinator
45
for
health
information
technology
state
health
46
information
exchange
cooperative
agreement
program
or
47
any
other
cooperative
agreement
programs
or
grants
48
supporting
Iowa
e-health.
The
board
shall
do
all
of
49
the
following:
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a.
Participate
in
the
selection
of
the
executive
1
director
and
assist
in
the
development
of
performance
2
standards
and
evaluations
of
the
executive
director.
3
b.
Establish
priorities
among
health
information
4
network
services
based
on
the
needs
of
the
population
5
of
this
state.
6
c.
Oversee
the
handling
and
accounting
of
assets
7
and
moneys
received
for
or
generated
by
the
health
8
information
network.
9
d.
Establish
committees
and
workgroups
as
needed.
10
e.
Review
and
approve
or
disapprove
all
of
the
11
following,
as
proposed
by
the
department:
12
(1)
Strategic,
operational,
and
financial
13
sustainability
plans
for
Iowa
e-health,
the
health
14
information
network,
and
health
information
network
15
services.
16
(2)
Standards,
requirements,
policies,
and
17
procedures
for
access,
use,
secondary
use,
and
privacy
18
and
security
of
health
information
network
through
the
19
health
information
exchange,
consistent
with
applicable
20
federal
and
state
standards
and
laws.
21
(3)
Policies
and
procedures
for
administering
the
22
infrastructure,
technology,
and
associated
professional
23
services
necessary
for
the
business
and
technical
24
operation
of
the
health
information
network
and
health
25
information
network
services.
26
(4)
Policies
and
procedures
for
evaluation
of
the
27
health
information
network
and
health
information
28
network
services.
29
(5)
Mechanisms
for
periodic
review
and
update
of
30
policies
and
procedures.
31
(6)
An
annual
budget
and
fiscal
report
for
the
32
operations
of
the
health
information
network
and
an
33
annual
report
for
Iowa
e-health
and
health
information
34
network
services.
35
(7)
Major
purchases
of
goods
and
services.
36
f.
Adopt
administrative
rules
pursuant
to
chapter
37
17A
to
implement
this
chapter
and
relating
to
the
38
management
and
operation
of
the
health
information
39
network
and
health
information
network
services.
40
g.
Adopt
rules
for
monitoring
access
to
and
use
41
of
the
health
information
network
and
enforcement
42
of
health
information
network
rules,
standards,
43
requirements,
policies,
and
procedures.
The
board
44
may
suspend,
limit,
or
terminate
a
participant’s
45
utilization
of
the
health
information
network
for
46
violation
of
such
rules,
standards,
requirements,
47
policies,
or
procedures,
and
shall
establish,
by
rule,
48
a
process
for
notification,
right
to
respond,
and
49
appeal
relative
to
such
violations.
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h.
Have
all
remedies
allowed
by
law
to
address
any
1
violation
of
the
terms
of
the
participation
and
data
2
sharing
agreement.
3
i.
Perform
any
and
all
other
activities
in
4
furtherance
of
its
purpose.
5
7.
a.
A
board
member
is
subject
to
chapter
68B,
6
the
rules
adopted
by
the
Iowa
ethics
and
campaign
7
disclosure
board,
and
the
ethics
rules
and
requirements
8
that
apply
to
the
executive
branch
of
state
government.
9
b.
A
board
member
shall
not
participate
in
any
10
matter
before
the
board
in
which
the
board
member
11
has
a
direct
or
indirect
interest
in
an
undertaking
12
that
places
the
board
member’s
personal
or
business
13
interests
in
conflict
with
those
of
Iowa
e-health,
14
including
but
not
limited
to
an
interest
in
a
15
procurement
contract,
or
that
may
create
the
appearance
16
of
impropriety.
17
8.
Advisory
council.
18
a.
An
advisory
council
to
the
board
is
established
19
to
provide
an
additional
mechanism
for
obtaining
20
broader
stakeholder
advice
and
input
regarding
health
21
information
technology,
the
health
information
network,
22
and
health
information
network
services.
23
b.
The
advisory
council
shall
be
comprised
of
the
24
following
members
who
shall
serve
two-year
staggered
25
terms:
26
(1)
The
following
members
designated
as
specified:
27
(a)
One
member
who
is
a
licensed
practicing
nurse
28
in
an
office
or
clinic
setting,
designated
by
the
Iowa
29
nurses
association.
30
(b)
One
member
representing
licensed
pharmacists,
31
designated
by
the
Iowa
pharmacy
association.
32
(c)
One
member
representing
the
Iowa
healthcare
33
collaborative,
designated
by
the
collaborative.
34
(d)
One
member
representing
substance
abuse
35
programs,
designated
by
the
Iowa
behavioral
health
36
association.
37
(e)
One
member
representing
community
mental
38
health
centers,
designated
by
the
Iowa
association
of
39
community
providers.
40
(f)
One
member
representing
long-term
care
41
providers,
designated
by
the
Iowa
health
care
42
association/Iowa
center
for
assisted
living
and
the
43
Iowa
association
of
homes
and
services
for
the
aging.
44
(g)
One
member
representing
licensed
physicians,
45
designated
by
the
Iowa
academy
of
family
physicians.
46
(h)
One
member
representing
chiropractors,
47
designated
by
the
Iowa
chiropractic
society.
48
(i)
One
member
who
is
a
practicing
physician
in
49
an
office
or
clinic
setting,
designated
by
the
Iowa
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52
osteopathic
medical
association.
1
(j)
One
member
representing
business
interests,
2
designated
by
the
Iowa
association
of
business
and
3
industry.
4
(2)
The
following
members
appointed
by
the
board:
5
(a)
One
member
representing
the
state
board
of
6
health.
7
(b)
One
member
representing
academics.
8
(c)
One
member
representing
the
Iowa
Medicare
9
quality
improvement
organization.
10
(d)
One
member
who
is
the
state
chief
information
11
officer.
12
(e)
One
member
representing
the
private
13
telecommunications
industry.
14
(f)
One
member
representing
Des
Moines
university.
15
(g)
One
member
representing
home
health
care
16
providers.
17
(h)
One
member
representing
the
department
of
18
veterans
affairs.
19
c.
The
board
may
change
the
membership
and
the
20
composition
of
the
advisory
council,
by
rule,
to
21
accommodate
changes
in
stakeholder
interests
and
the
22
evolution
of
health
information
technology,
the
health
23
information
network,
and
health
information
network
24
services.
An
advisory
council
member
may
be
removed
by
25
a
vote
of
the
board
if,
based
on
the
criteria
provided
26
in
section
69.15,
subsection
1,
paragraphs
“a”
and
“b”
,
27
the
advisory
council
member
would
be
deemed
to
have
28
submitted
a
resignation
from
the
advisory
council.
29
Sec.
___.
NEW
SECTION
.
135D.5
Business
and
30
technical
operations
——
office
of
health
information
31
technology.
32
1.
The
office
of
health
information
technology
33
is
established
within
the
department
and
shall
be
34
responsible
for
the
day-to-day
business
and
operations
35
of
Iowa
e-health,
the
health
information
network,
and
36
health
information
network
services.
The
office
shall
37
be
under
the
direction
of
the
director
and
under
the
38
supervision
of
the
deputy
director.
39
2.
a.
The
department
shall
employ
an
executive
40
director
to
manage
the
office
and
the
executive
41
director
shall
report
to
the
deputy
director.
42
b.
The
executive
director
shall
manage
the
planning
43
and
implementation
of
Iowa
e-health,
the
health
44
information
network,
and
health
information
network
45
services,
and
shall
provide
high-level
coordination
46
across
public
and
private
sector
stakeholders.
47
c.
The
executive
director
shall
serve
as
Iowa’s
48
health
information
technology
coordinator
and
primary
49
point
of
contact
for
the
office
of
the
national
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coordinator
for
health
information
technology,
1
other
federal
and
state
agencies
involved
in
health
2
information
technology,
and
state
health
information
3
technology
coordinators
from
other
states.
4
3.
a.
The
executive
director
and
all
other
5
employees
of
the
office
shall
be
employees
of
the
6
state,
classified
and
compensated
in
accordance
with
7
chapter
8A,
subchapter
IV,
and
chapter
20.
8
b.
Subject
to
approval
of
the
board,
the
director
9
shall
have
the
sole
power
to
determine
the
number
of
10
full-time
and
part-time
equivalent
positions
necessary
11
to
carry
out
the
provisions
of
this
chapter.
12
c.
An
employee
of
the
office
shall
not
have
a
13
financial
interest
in
any
vendor
doing
business
or
14
proposing
to
do
business
with
Iowa
e-health.
15
4.
The
department
shall
do
all
of
the
following:
16
a.
Develop,
implement,
and
enforce
the
following,
17
as
approved
by
the
board:
18
(1)
Strategic,
operational,
and
financial
19
sustainability
plans
for
the
health
information
20
network,
Iowa
e-health,
and
health
information
network
21
services.
22
(2)
Standards,
requirements,
policies,
and
23
procedures
for
access,
use,
secondary
use,
and
privacy
24
and
security
of
health
information
exchanged
through
25
the
health
information
network,
consistent
with
26
applicable
federal
and
state
standards
and
laws.
27
(3)
Policies
and
procedures
for
monitoring
28
participant
usage
of
the
health
information
network
29
and
health
information
network
services;
enforcing
30
noncompliance
with
health
information
network
31
standards,
requirements,
policies,
rules,
and
32
procedures.
33
(4)
Policies
and
procedures
for
administering
34
the
infrastructure,
technology,
and
associated
35
professional
services
required
for
operation
of
the
36
health
information
network
and
health
information
37
network
services.
38
(5)
Policies
and
procedures
for
evaluation
of
the
39
health
information
network
and
health
information
40
network
services.
41
(6)
A
mechanism
for
periodic
review
and
update
of
42
policies
and
procedures.
43
(7)
An
annual
budget
and
fiscal
report
for
the
44
business
and
technical
operations
of
the
health
45
information
network
and
an
annual
report
for
Iowa
46
e-health,
the
health
information
network,
and
health
47
information
network
services.
The
department
shall
48
submit
all
such
reports
to
the
general
assembly.
49
b.
Convene
and
facilitate
board,
advisory
council,
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workgroup,
committee,
and
other
stakeholder
meetings.
1
c.
Provide
technical
and
operational
assistance
for
2
planning
and
implementing
Iowa
e-health
activities,
3
the
health
information
network,
and
health
information
4
network
services.
5
d.
Provide
human
resource,
budgeting,
project
and
6
activity
coordination,
and
related
management
functions
7
to
Iowa
e-health,
the
health
information
network,
and
8
health
information
network
services.
9
e.
Develop
educational
materials
and
educate
the
10
general
public
on
the
benefits
of
electronic
health
11
records,
the
health
information
network,
and
the
12
safeguards
available
to
prevent
unauthorized
disclosure
13
of
health
information.
14
f.
Enter
into
participation
and
data
sharing
15
agreements
with
participants
of
the
health
information
16
network.
17
g.
Record
receipts
and
approval
of
payments,
and
18
file
required
financial
reports.
19
h.
Apply
for,
acquire
by
gift
or
purchase,
and
20
hold,
dispense,
or
dispose
of
funds
and
real
or
21
personal
property
from
any
person,
governmental
entity,
22
or
organization
in
the
exercise
of
its
powers
and
23
performance
of
its
duties
in
accordance
with
this
24
chapter.
25
i.
Administer
grant
funds
in
accordance
with
the
26
terms
of
the
grant
and
all
applicable
state
and
federal
27
laws,
rules,
and
regulations.
28
j.
Select
and
contract
with
vendors
in
compliance
29
with
applicable
state
and
federal
procurement
laws
and
30
regulations.
31
k.
Coordinate
with
other
health
information
32
technology
and
health
information
network
programs
and
33
activities.
34
l.
Work
to
align
interstate
and
intrastate
35
interoperability
and
standards
in
accordance
with
36
national
health
information
exchange
standards.
37
m.
Execute
all
instruments
necessary
or
incidental
38
to
the
performance
of
its
duties
and
the
execution
of
39
its
powers.
40
Sec.
___.
NEW
SECTION
.
135D.6
Iowa
e-health
41
finance
fund.
42
1.
The
Iowa
e-health
finance
fund
is
created
as
43
a
separate
fund
within
the
state
treasury
under
the
44
control
of
the
board.
Revenues,
donations,
gifts,
45
interest,
or
other
moneys
received
or
generated
46
relative
to
the
operation
and
administration
of
the
47
health
information
network
and
health
information
48
network
services,
shall
be
deposited
in
the
fund.
49
2.
Moneys
in
the
fund
shall
be
expended
by
50
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52
the
department
only
on
activities
and
operations
1
suitable
to
the
performance
of
the
department’s
2
duties
on
behalf
of
the
board
and
Iowa
e-health
as
3
specified
in
this
chapter,
subject
to
board
approval.
4
Disbursements
may
be
made
from
the
fund
for
purposes
5
related
to
the
administration,
management,
operations,
6
functions,
activities,
and
sustainability
of
the
health
7
information
network
and
health
information
network
8
services.
9
3.
Notwithstanding
section
12C.7,
subsection
2,
10
earnings
or
interest
on
moneys
deposited
in
the
fund
11
shall
be
credited
to
the
fund.
Notwithstanding
section
12
8.33,
any
unexpended
balance
in
the
fund
at
the
end
13
of
each
fiscal
year
shall
be
retained
in
the
fund
and
14
shall
not
be
transferred
to
the
general
fund
of
the
15
state.
16
4.
The
moneys
in
the
fund
shall
be
subject
to
17
financial
and
compliance
audits
by
the
auditor
of
18
state.
19
5.
The
general
assembly
may
appropriate
moneys
20
in
the
fund
to
the
department
on
behalf
of
Iowa
21
e-health
for
the
health
information
network
and
health
22
information
network
services.
23
Sec.
___.
NEW
SECTION
.
135D.7
Technical
24
infrastructure.
25
1.
The
health
information
network
shall
provide
26
a
mechanism
to
facilitate
and
support
the
secure
27
electronic
exchange
of
health
information
between
28
participants.
The
health
information
network
shall
29
not
function
as
a
central
repository
of
all
health
30
information.
31
2.
The
health
information
network
shall
provide
a
32
mechanism
for
participants
without
an
electronic
health
33
record
system
to
access
health
information
from
the
34
health
information
network.
35
3.
The
technical
infrastructure
of
the
health
36
information
network
shall
be
designed
to
facilitate
37
the
secure
electronic
exchange
of
health
information
38
using
functions
including
but
not
limited
to
all
of
the
39
following:
40
a.
A
master
patient
index,
in
the
absence
of
a
41
single,
standardized
patient
identifier,
to
exchange
42
secure
health
information
among
participants.
43
b.
A
record
locator
service
to
locate
and
exchange
44
secure
health
information
among
participants.
45
c.
Authorization,
authentication,
access,
and
46
auditing
processes
for
security
controls
to
protect
47
the
privacy
of
consumers
and
participants
and
the
48
confidentiality
of
health
information
by
limiting
49
access
to
the
health
information
network
and
health
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information
to
participants
whose
identity
has
been
1
authenticated,
and
whose
access
to
health
information
2
is
limited
by
their
role
and
recorded
through
an
audit
3
trail.
4
d.
Electronic
transmission
procedures
and
software
5
necessary
to
facilitate
the
electronic
exchange
of
6
various
types
of
health
information
through
the
health
7
information
network.
8
e.
Telecommunications
through
coordination
of
9
public
and
private
networks
to
provide
the
backbone
10
infrastructure
to
connect
participants
exchanging
11
health
information.
The
networks
may
include
but
12
are
not
limited
to
the
state-owned
communications
13
network,
other
fiber
optic
networks,
and
private
14
telecommunications
service
providers.
15
4.
The
state
shall
own
or
possess
the
rights
16
to
use
all
processes
and
software
developed,
and
17
hardware
installed,
leased,
designed,
or
purchased
18
for
the
health
information
network,
and
shall
permit
19
participants
to
use
the
health
information
network
20
and
health
information
network
services
in
accordance
21
with
the
standards,
policies,
procedures,
rules,
and
22
regulations
approved
by
the
board,
and
the
terms
of
the
23
participation
and
data
sharing
agreement.
24
Sec.
___.
NEW
SECTION
.
135D.8
Legal
and
policy.
25
1.
Upon
approval
from
the
board,
the
office
26
of
health
information
technology
shall
establish
27
appropriate
security
standards,
policies,
and
28
procedures
to
protect
the
transmission
and
receipt
of
29
individually
identifiable
health
information
exchanged
30
through
the
health
information
network.
The
security
31
standards,
policies,
and
procedures
shall,
at
a
32
minimum,
comply
with
the
Health
Insurance
Portability
33
and
Accountability
Act
security
rule
pursuant
to
45
34
C.F.R.
pt.
164,
subpt.
C,
and
shall
reflect
all
of
the
35
following:
36
a.
Include
authorization
controls,
including
the
37
responsibility
to
authorize,
maintain,
and
terminate
a
38
participant’s
use
of
the
health
information
network.
39
b.
Require
authentication
controls
to
verify
the
40
identity
and
role
of
the
participant
using
the
health
41
information
network.
42
c.
Include
role-based
access
controls
to
restrict
43
functionality
and
information
available
through
the
44
health
information
network.
45
d.
Include
a
secure
and
traceable
electronic
audit
46
system
to
document
and
monitor
the
sender
and
the
47
recipient
of
health
information
exchanged
through
the
48
health
information
network.
49
e.
Require
standard
participation
and
data
sharing
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agreements
which
define
the
minimum
privacy
and
1
security
obligations
of
all
participants
using
the
2
health
information
network
and
health
information
3
network
services.
4
f.
Include
controls
over
access
to
and
the
5
collection,
organization,
and
maintenance
of
records
6
and
data
for
purposes
of
research
or
population
health
7
that
protect
the
confidentiality
of
consumers
who
are
8
the
subject
of
the
health
information.
9
2.
a.
A
patient
shall
have
the
opportunity
to
10
decline
exchange
of
their
health
information
through
11
the
health
information
network.
The
board
shall
12
provide
by
rule
the
means
and
process
by
which
patients
13
may
decline
participation.
A
patient
shall
not
be
14
denied
care
or
treatment
for
declining
to
exchange
15
their
health
information,
in
whole
or
in
part,
through
16
the
health
information
network.
The
means
and
process
17
utilized
under
the
rules
shall
minimize
the
burden
on
18
patients
and
providers.
19
b.
Unless
otherwise
authorized
by
law
or
rule,
20
a
patient’s
decision
to
decline
participation
means
21
that
none
of
the
patient’s
health
information
shall
be
22
exchanged
through
the
health
information
network.
If
a
23
patient
does
not
decline
participation,
the
patient’s
24
health
information
may
be
exchanged
through
the
health
25
information
network
except
as
follows:
26
(1)
If
health
information
associated
with
a
patient
27
visit
with
a
provider
is
protected
by
state
law
that
is
28
more
restrictive
than
the
Health
Insurance
Portability
29
and
Accountability
Act,
a
patient
shall
have
the
right
30
to
decline
sharing
of
health
information
through
the
31
health
information
network
from
such
visit
as
provided
32
by
rule.
33
(2)
With
the
consent
of
the
patient,
a
provider
34
may
limit
health
information
associated
with
a
patient
35
visit
from
being
shared
through
the
health
information
36
network
if
such
limitation
is
reasonably
determined
37
by
the
provider,
in
consultation
with
the
patient,
to
38
be
in
the
best
interest
of
the
patient
as
provided
by
39
rule.
40
c.
A
patient
who
declines
participation
in
the
41
health
information
network
may
later
decide
to
42
have
health
information
shared
through
the
health
43
information
network.
A
patient
who
is
participating
44
in
the
health
information
network
may
later
decline
45
participation
in
the
health
information
network.
46
3.
The
office
shall
develop
and
distribute
47
educational
tools
and
information
for
consumers,
48
patients,
and
providers
to
inform
them
about
the
health
49
information
network,
including
but
not
limited
to
the
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safeguards
available
to
prevent
unauthorized
disclosure
1
of
health
information
and
a
patient’s
right
to
decline
2
participation
in
the
health
information
network.
3
4.
a.
A
participant
shall
not
release
or
use
4
protected
health
information
exchanged
through
the
5
health
information
network
for
purposes
unrelated
6
to
prevention,
treatment,
payment,
or
health
care
7
operations
unless
otherwise
authorized
or
required
by
8
law.
Participants
shall
limit
the
use
and
disclosure
9
of
protected
health
information
to
the
minimum
amount
10
required
to
accomplish
the
intended
purpose
of
the
use
11
or
request,
in
compliance
with
the
Health
Insurance
12
Portability
and
Accountability
Act
and
other
applicable
13
federal
law.
Use
or
distribution
of
the
information
14
for
a
marketing
purpose,
as
defined
by
the
Health
15
Insurance
Portability
and
Accountability
Act,
is
16
strictly
prohibited.
17
b.
The
department,
the
office,
and
all
persons
18
using
the
health
information
network
shall
be
19
individually
responsible
for
following
breach
20
notification
policies
as
provided
by
the
Health
21
Insurance
Portability
and
Accountability
Act.
22
c.
A
participant
shall
not
be
compelled
by
23
subpoena,
court
order,
or
other
process
of
law
24
to
access
health
information
through
the
health
25
information
network
in
order
to
gather
records
or
26
information
not
created
by
the
participant.
27
5.
a.
If
a
patient
has
declined
participation
in
28
the
health
information
network,
the
patient’s
health
29
information
may
be
released
to
a
provider
through
the
30
health
information
network
if
all
of
the
following
31
circumstances
exist:
32
(1)
The
patient
is
unable
to
provide
consent
due
to
33
incapacitation.
34
(2)
The
requesting
provider
believes,
in
good
35
faith,
that
the
information
is
necessary
to
prevent
36
imminent
serious
injury
to
the
patient.
Imminent
37
serious
injury
includes
but
it
not
limited
to
death,
38
injury
or
disease
that
creates
a
substantial
risk
of
39
death,
or
injury
or
disease
that
causes
protracted
loss
40
or
impairment
of
any
organ
or
body
system.
41
(3)
Such
information
cannot
otherwise
be
readily
42
obtained.
43
b.
The
department
shall
provide
by
rule
for
the
44
reporting
of
emergency
access
and
use
by
a
provider.
45
6.
All
participants
exchanging
health
information
46
and
data
through
the
health
information
network
47
shall
grant
to
participants
of
the
health
information
48
network
a
nonexclusive
license
to
retrieve
and
use
that
49
information
or
data
in
accordance
with
applicable
state
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and
federal
laws,
and
the
policies,
procedures,
and
1
rules
established
by
the
board.
2
7.
The
department
shall
establish
by
rule
the
3
procedures
for
a
patient
who
is
the
subject
of
health
4
information
to
do
all
of
the
following:
5
a.
Receive
notice
of
a
violation
of
the
6
confidentiality
provisions
required
under
this
chapter.
7
b.
Upon
request
to
the
department,
view
an
audit
8
report
created
under
this
chapter
for
the
purpose
of
9
monitoring
access
to
the
patient’s
records.
10
8.
a.
A
provider
who
relies
reasonably
and
in
11
good
faith
upon
any
health
information
provided
12
through
the
health
information
network
in
treatment
13
of
a
patient
shall
be
immune
from
criminal
or
civil
14
liability
arising
from
any
damages
caused
by
such
15
reasonable,
good
faith
reliance.
Such
immunity
shall
16
not
apply
to
acts
or
omissions
constituting
negligence,
17
recklessness,
or
intentional
misconduct.
18
b.
A
participant
that
has
disclosed
health
19
information
through
the
health
information
network
20
in
compliance
with
applicable
law
and
the
standards,
21
requirements,
policies,
procedures,
and
agreements
of
22
the
health
information
network
shall
not
be
subject
to
23
criminal
or
civil
liability
for
the
use
or
disclosure
24
of
the
health
information
by
another
participant.
25
9.
a.
Notwithstanding
chapter
22,
the
following
26
records
shall
be
kept
confidential,
unless
otherwise
27
ordered
by
a
court
or
consented
to
by
the
patient
or
by
28
a
person
duly
authorized
to
release
such
information:
29
(1)
The
protected
health
information
contained
in,
30
stored
in,
submitted
to,
transferred
or
exchanged
by,
31
or
released
from
the
health
information
network.
32
(2)
Any
protected
health
information
in
the
33
possession
of
Iowa
e-health
or
the
department
due
to
34
its
administration
of
the
health
information
network.
35
b.
Unless
otherwise
provided
in
this
chapter,
when
36
using
the
health
information
network
for
the
purpose
of
37
patient
treatment,
a
provider
is
exempt
from
any
other
38
state
law
that
is
more
restrictive
than
the
Health
39
Insurance
Portability
and
Accountability
Act
that
would
40
otherwise
prevent
or
hinder
the
exchange
of
patient
41
information
by
the
patient’s
providers.
42
Sec.
___.
NEW
SECTION
.
135D.9
Iowa
e-health
——
43
health
information
network
services.
44
Iowa
e-health
shall
facilitate
services
through
45
the
health
information
network
or
through
other
46
marketplace
mechanisms
to
improve
the
quality,
safety,
47
and
efficiency
of
health
care
available
to
consumers.
48
These
services
shall
include
but
are
not
limited
to
all
49
of
the
following:
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1.
Patient
summary
records
such
as
continuity
of
1
care
documents.
2
2.
A
provider
directory
and
provider
messaging.
3
3.
Clinical
orders
and
results.
4
4.
Public
health
reporting
such
as
electronic
5
reporting
to
the
statewide
immunization
registry
and
6
reportable
diseases.
7
5.
Medication
history.
8
Sec.
___.
NEW
SECTION
.
135D.10
Governance
review
9
and
transition.
10
1.
a.
The
Iowa
e-health
governance
structure
11
shall
continue
during
the
first
two
years
of
the
term
12
of
the
state
health
information
exchange
cooperative
13
agreement
with
the
office
of
the
national
coordinator
14
for
health
information
technology
to
address
the
15
development
of
policies
and
procedures;
dissemination
16
of
interoperability
standards;
the
initiation,
testing,
17
and
operation
of
the
health
information
network
18
infrastructure;
and
the
evolution
of
health
information
19
network
services
to
improve
patient
care
for
the
20
population.
21
b.
Following
the
end
of
the
first
two
years
of
the
22
term
of
the
cooperative
agreement,
the
board
and
the
23
department
shall
review
the
Iowa
e-health
governance
24
structure,
operations
of
the
health
information
25
network,
and
the
business
and
sustainability
plan
to
26
determine
if
the
existing
Iowa
e-health
governance
27
structure
should
continue
or
should
be
replaced
by
any
28
of
the
following:
29
(1)
A
public
authority
or
similar
body
with
broad
30
stakeholder
representation
on
its
governing
board.
31
(2)
A
not-for-profit
entity
with
broad
stakeholder
32
representation
on
its
governing
board.
33
2.
If
the
board
and
department
determine
that
the
34
governance
structure
should
be
replaced,
Iowa
e-health
35
shall
develop
a
transition
plan
to
transfer
the
36
responsibilities
for
the
domains
specified
in
section
37
135D.3.
38
Sec.
___.
Section
136.3,
subsection
14,
Code
2011,
39
is
amended
to
read
as
follows:
40
14.
Perform
those
duties
authorized
pursuant
to
41
sections
135.156
,
135.159
,
and
135.161
,
and
other
42
provisions
of
law.
43
Sec.
___.
Section
249J.14,
subsection
2,
paragraphs
44
a
and
b,
Code
2011,
are
amended
to
read
as
follows:
45
a.
Design
and
implement
a
program
for
distribution
46
and
monitoring
of
provider
incentive
payments,
47
including
development
of
a
definition
of
“meaningful
48
use”
for
purposes
of
promoting
the
use
of
electronic
49
medical
recordkeeping
by
providers.
The
department
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shall
develop
this
program
in
collaboration
with
the
1
department
of
public
health
and
the
electronic
health
2
information
advisory
council
and
executive
committee
3
board
of
directors
and
the
advisory
council
to
the
4
board
of
Iowa
e-health
created
pursuant
to
section
5
135.156
135D.4
.
6
b.
Develop
the
medical
assistance
health
7
information
technology
plan
as
required
by
the
centers
8
for
Medicare
and
Medicaid
services
of
the
United
9
States
department
of
health
and
human
services.
The
10
plan
shall
provide
detailed
implementation
plans
for
11
the
medical
assistance
program
for
promotion
of
the
12
adoption
and
meaningful
use
of
health
information
13
technology
by
medical
assistance
providers
and
the
14
Iowa
Medicaid
enterprise.
The
plan
shall
include
the
15
integration
of
health
information
technology
and
the
16
health
information
exchange
network
with
the
medical
17
assistance
management
information
system.
The
plan
18
shall
be
developed
in
collaboration
with
the
department
19
of
public
health
and
the
electronic
health
information
20
advisory
council
and
executive
committee
board
of
21
directors
and
the
advisory
council
to
the
board
of
Iowa
22
e-health
created
pursuant
to
section
135.156
135D.4
.
23
Sec.
___.
INITIAL
APPOINTMENTS
——
BOARD.
24
1.
The
initial
appointments
of
board
member
25
positions
described
in
section
135D.4,
as
enacted
by
26
this
division
of
this
Act,
shall
have
staggered
terms
27
as
follows:
28
a.
The
board
members
appointed
by
the
governor
29
shall
have
initial
terms
of
two
years,
after
which
the
30
members
shall
serve
four-year
terms,
subject
to
the
31
following:
32
(1)
The
terms
shall
begin
and
end
as
provided
in
33
section
69.19.
34
(2)
Any
board
member
appointed
by
the
governor
when
35
the
senate
is
not
in
session
shall
serve
only
until
36
the
end
of
the
next
regular
session
of
the
general
37
assembly,
unless
and
until
confirmed
by
the
senate.
38
b.
The
board
member
designated
by
the
Iowa
medical
39
society
shall
have
an
initial
term
of
two
years,
after
40
which
the
member
shall
serve
a
four-year
term.
41
c.
The
board
members
designated
by
the
university
42
of
Iowa
hospitals
and
clinics
and
the
Iowa
hospital
43
association
shall
have
initial
terms
of
four
years,
44
after
which
the
members
shall
serve
four-year
terms.
45
d.
The
board
members
designated
by
the
federation
46
of
Iowa
insurers
shall
serve
initial
terms
of
six
47
years,
after
which
the
members
shall
serve
four-year
48
terms.
49
2.
With
the
exception
of
board
members
who
are
50
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representative
of
state
agencies
and
not
subject
1
to
term
limits
as
provided
in
section
135D.4,
board
2
members
may
serve
an
additional
four-year
term,
3
with
the
exception
of
those
board
members
initially
4
serving
a
two-year
term,
who
may
serve
two
consecutive
5
four-year
terms
following
the
initial
two-year
term.
6
Sec.
___.
REPEAL.
Sections
135.154,
135.155,
and
7
135.156,
Code
2011,
are
repealed.
8
Sec.
___.
TRANSITION
PROVISIONS.
Notwithstanding
9
any
other
provision
of
this
division
of
this
Act,
10
the
department
of
public
health,
and
the
executive
11
committee
and
the
advisory
council
created
pursuant
to
12
section
135.156,
shall
continue
to
exercise
the
powers
13
and
duties
specified
under
that
section
until
such
time
14
as
all
board
members
have
been
appointed
as
provided
15
in
section
135D.4,
as
enacted
by
this
division
of
this
16
Act.
17
Sec.
___.
EFFECTIVE
DATE.
The
sections
of
this
18
division
of
this
Act
repealing
sections
135.154,
19
135.155,
and
135.156,
and
amending
sections
136.3
and
20
249J.14,
take
effect
on
the
date
all
board
members
are
21
appointed
as
provided
in
section
135D.4,
as
enacted
by
22
this
division
of
this
Act.
The
department
of
public
23
health
shall
notify
the
Code
editor
of
such
date.
24
Sec.
___.
EFFECTIVE
UPON
ENACTMENT.
Except
as
25
otherwise
provided
in
this
division
of
this
Act,
26
this
division
of
this
Act,
being
deemed
of
immediate
27
importance,
takes
effect
upon
enactment.
>
28
124.
By
striking
page
83,
line
22,
through
page
29
150,
line
23.
30
125.
Title
page,
line
3,
after
<
appropriations
>
by
31
inserting
<
,
providing
penalties,
>
32
126.
By
renumbering
as
necessary.
33
______________________________
COMMITTEE
ON
APPROPRIATIONS
ROBERT
E.
DVORSKY,
CHAIRPERSON
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52
#124.
#125.
#126.