House File 653 H-1399 Amend House File 653 as follows: 1 1. Page 6, line 21, by striking < program > and inserting 2 < initiative > 3 2. Page 10, line 6, by striking < 2,807,776 > and inserting 4 < 2,907,776 > 5 3. Page 11, after line 24 by inserting: 6 < (4) Not less than $100,000 is allocated to the Polk county 7 medical society for continuation of the safety net provider 8 patient access to a specialty health care initiative as 9 described in 2007 Iowa Acts, chapter 218, section 109. > 10 4. Page 11, by striking lines 25 through 29 and inserting: 11 < f. Of the funds appropriated in this subsection, 12 $76,231 shall be used by the department in implementing the 13 recommendations in the final report submitted by the direct 14 care worker advisory council to the > 15 5. Page 12, line 5, by striking < 104,019 > and inserting 16 < 191,188 > 17 6. Page 17, line 31, by striking < 2017 > and inserting < 2018 > 18 7. Page 19, by striking lines 27 through 31 and inserting 19 < 1 for assistance under the family investment program, in 20 subsection 6 for child care assistance, or in subsection 10 for 21 technology costs related to the family investment program, as 22 applicable, have been expended. For > 23 8. Page 27, line 22, by striking < 1,284,605,740 > and 24 inserting < 1,284,405,740 > 25 9. By striking page 34, line 29, through page 35, line 4. 26 10. Page 41, line 16, by striking < 87,329,375 > and inserting 27 < 87,279,375 > 28 11. Page 46, line 9, by striking < 1,186,595 > and inserting 29 < 1,136,595 > 30 12. Page 47, after line 25 by inserting: 31 < c. Notwithstanding section 8.33, moneys corresponding to 32 the state savings resulting from implementation of the federal 33 Fostering Connections to Success and Increasing Adoptions Act 34 of 2008, Pub. L. No. 110-351, and successor legislation, as 35 -1- HF653.2484 (2) 87 pf/rn 1/ 11 #1. #2. #3. #4. #5. #6. #7. #8. #9. #10. #11. #12.

determined in accordance with 42 U.S.C. §673(a)(8), that remain 1 unencumbered or unobligated at the close of the fiscal year, 2 shall not revert to any fund but shall remain available for the 3 purposes designated in this subsection until expended. The 4 amount of such savings and any corresponding funds remaining 5 at the close of the fiscal year shall be determined separately 6 and any changes in either amount between fiscal years shall not 7 result in an unfunded need. > 8 13. Page 48, line 14, by striking < 2015 > and inserting 9 < 2016 > 10 14. Page 53, line 1, by striking < 13,883,040 > and inserting 11 < 14,033,040 > 12 15. Page 53, line 17, by striking < 250,000 > and inserting 13 < 200,000 > 14 16. Page 53, line 26, by striking < Code > 15 17. Page 54, after line 2 by inserting: 16 < ___. Of the funds appropriated in this section, $200,000 17 shall be used to continue to expand the provision of nationally 18 accredited and recognized internet-based training to include 19 mental health and disability services providers. > 20 18. Page 54, line 31, after < funding > by inserting < , 21 including the $2,500,000, > 22 19. Page 55, line 5, after < with > by inserting < subparagraph 23 division (a) and > 24 20. Page 55, after line 12 by inserting: 25 < (d) For the fiscal year beginning July 1, 2017, Medicaid 26 managed care long-term services and supports capitation 27 rates shall be adjusted to reflect the rebasing pursuant to 28 subparagraph division (a) for the patient populations residing 29 in Medicaid-certified nursing facilities. > 30 21. Page 55, after line 23 by inserting: 31 < (3) Medicaid managed care organizations shall adjust 32 facility-specific rates based upon payment rate listings issued 33 by the department. The rate adjustments shall be applied 34 retroactively based upon the effective date of the rate letter 35 -2- HF653.2484 (2) 87 pf/rn 2/ 11 #13. #14. #15. #16. #17. #18. #19. #20. #21.

issued by the department. A Medicaid managed care organization 1 shall honor all retroactive rate adjustments including when 2 specific provider rates are delayed or amended. > 3 22. Page 62, by striking lines 24 and 25 and inserting 4 < affected providers or services shall be reimbursed as > 5 23. Page 64, after line 35 by inserting: 6 < Sec. ___. EFFECTIVE UPON ENACTMENT. The following 7 provisions of this division of this Act, being deemed of 8 immediate importance, take effect upon enactment: 9 1. The provision relating to section 232.141 and directing 10 the state court administrator and the division administrator of 11 the department of human services division of child and family 12 services to make the determination, by June 15, 2017, of the 13 distribution of funds allocated for the payment of the expenses 14 of court-ordered services provided to juveniles which are a 15 charge upon the state. > 16 24. Page 71, line 35, by striking < program > and inserting 17 < initiative > 18 25. Page 75, line 20, by striking < 1,403,888 > and inserting 19 < 1,453,888 > 20 26. Page 77, after line 3 by inserting: 21 < (4) Not less than $50,000 is allocated to the Polk county 22 medical society for continuation of the safety net provider 23 patient access to a specialty health care initiative as 24 described in 2007 Iowa Acts, chapter 218, section 109. > 25 27. Page 77, by striking lines 4 through 8 and inserting: 26 < f. Of the funds appropriated in this subsection, 27 $38,115 shall be used by the department in implementing the 28 recommendations in the final report submitted by the direct 29 care worker advisory council to the > 30 28. Page 77, line 19, by striking < 52,009 > and inserting 31 < 95,594 > 32 29. Page 83, line 17, by striking < 2018 > and inserting 33 < 2019 > 34 30. Page 85, by striking lines 13 through 17 and inserting 35 -3- HF653.2484 (2) 87 pf/rn 3/ 11 #22. #23. #24. #25. #26. #27. #28. #29.

< 1 for assistance under the family investment program, in 1 subsection 6 for child care assistance, or in subsection 10 for 2 technology costs related to the family investment program, as 3 applicable, have been expended. For > 4 31. Page 93, line 7, by striking < 642,302,870 > and inserting 5 < 642,202,870 > 6 32. Page 104, line 33, by striking < 43,664,687 > and 7 inserting < 43,639,687 > 8 33. Page 109, line 26, by striking < 593,297 > and inserting 9 < 568,297 > 10 34. Page 111, after line 7 by inserting: 11 < c. Notwithstanding section 8.33, moneys corresponding to 12 the state savings resulting from implementation of the federal 13 Fostering Connections to Success and Increasing Adoptions Act 14 of 2008, Pub. L. No. 110-351, and successor legislation, as 15 determined in accordance with 42 U.S.C. §673(a)(8), that remain 16 unencumbered or unobligated at the close of the fiscal year, 17 shall not revert to any fund but shall remain available for the 18 purposes designated in this subsection until expended. The 19 amount of such savings and any corresponding funds remaining 20 at the close of the fiscal year shall be determined separately 21 and any changes in either amount between fiscal years shall not 22 result in an unfunded need. > 23 35. Page 111, line 31, by striking < 2015 > and inserting 24 < 2017 > 25 36. Page 116, line 18, by striking < 6,941,520 > and inserting 26 < 7,016,520 > 27 37. Page 116, line 34, by striking < 125,000 > and inserting 28 < 100,000 > 29 38. Page 117, line 8, by striking < Code > 30 39. Page 117, after line 12 by inserting: 31 < ___. Of the funds appropriated in this section, $100,000 32 shall be used to continue to expand the provision of nationally 33 accredited and recognized internet-based training to include 34 mental health and disability services providers. > 35 -4- HF653.2484 (2) 87 pf/rn 4/ 11 #31. #32. #33. #34. #35. #36. #37. #38. #39.

40. Page 122, by striking lines 2 and 3 and inserting 1 < provided at hospitals shall be rebased effective October 1, 2 2018, subject to Medicaid program upper payment limit > 3 41. Page 125, by striking lines 30 and 31 and inserting 4 < affected providers or services shall be reimbursed as: > 5 42. Page 128, after line 6 by inserting: 6 < Sec. ___. EFFECTIVE UPON ENACTMENT. The following 7 provisions of this division of this Act, being deemed of 8 immediate importance, take effect upon enactment: 9 1. The provision relating to section 232.141 and directing 10 the state court administrator and the division administrator of 11 the department of human services division of child and family 12 services to make the determination, by June 15, 2018, of the 13 distribution of funds allocated for the payment of the expenses 14 of court-ordered services provided to juveniles which are a 15 charge upon the state. > 16 43. Page 130, line 15, after < diseases > by inserting < , as 17 defined in the federal Orphan Drug Act of 1983, Pub. L. No. 18 97-414, > 19 44. Page 130, line 33, after < diseases > by inserting < , as 20 defined in the federal Orphan Drug Act of 1983, Pub. L. No. 21 97-414, > 22 45. Page 136, line 8, by striking < COST-REPORTING > and 23 inserting < TIERED RATES AND DOCUMENTATION CHANGES > 24 46. Page 138, line 27, by striking < healthcare > and 25 inserting < health care > 26 47. Page 140, line 22, after < section 139, > by inserting 27 < subsection 1, > 28 48. Page 140, lines 23 and 24, by striking < subsection 1, > 29 49. Page 142, by striking lines 13 and 14. 30 50. Page 143, by striking lines 12 and 13 and inserting 31 < beds beginning July 1, 2017 . > 32 51. Page 144, after line 22 by inserting: 33 < DIVISION ___ 34 NON-STATE GOVERNMENT-OWNED NURSING FACILITY UPPER PAYMENT LIMIT 35 -5- HF653.2484 (2) 87 pf/rn 5/ 11 #40. #41. #42. #43. #44. #45. #46. #47. #48. #49. #50. #51.

ALTERNATIVE PAYMENT PROGRAM 1 Sec. ___. 2016 Iowa Acts, chapter 1139, section 81, is 2 amended by striking the section, and inserting in lieu thereof 3 the following: 4 SEC. 81. Section 249L.2, subsection 6, Code 2016, is amended 5 to read as follows: 6 6. “Nursing facility” means a licensed nursing facility as 7 defined in section 135C.1 that is a freestanding facility or 8 a nursing facility operated by a hospital licensed pursuant 9 to chapter 135B , but does not include a distinct-part skilled 10 nursing unit or a swing-bed unit operated by a hospital, or 11 a nursing facility owned by the state or federal government 12 or other governmental unit. “Nursing facility” includes a 13 non-state government-owned nursing facility if the nursing 14 facility participates in the non-state government-owned nursing 15 facility upper payment limit alternative payment program. 16 Sec. ___. 2016 Iowa Acts, chapter 1139, section 82, is 17 amended to read as follows: 18 SEC. 82. NON-STATE GOVERNMENT-OWNED NURSING FACILITY UPPER 19 PAYMENT LIMIT SUPPLEMENTAL ALTERNATIVE PAYMENT PROGRAM. 20 1. The department of human services shall submit, to the 21 centers for Medicare and Medicaid services (CMS) of the United 22 States department of health and human services no later than 23 September 29, 2017 , a Medicaid state plan amendment to allow 24 qualifying non-state government-owned nursing facilities to 25 receive a supplemental participate in an alternative payment 26 program in accordance with the upper payment limit requirements 27 pursuant to 42 C.F.R. §447.272 . The supplemental alternative 28 payment shall be in addition to the greater of the payment in 29 accordance with the upper payment limit requirements pursuant 30 to 42 C.F.R. §447.272 or the Medicaid fee-for-service per diem 31 reimbursement rate or the per diem payment established for the 32 nursing facility under a Medicaid managed care contract. 33 2. At a minimum, the Medicaid state plan amendment shall 34 provide for all of the following: 35 -6- HF653.2484 (2) 87 pf/rn 6/ 11

a. A non-state governmental entity shall provide the state 1 share of the difference between the expected supplemental 2 alternative payment and the Medicaid fee-for-service per diem 3 reimbursement rate in the form of an intergovernmental transfer 4 to the state. 5 b. The state shall claim federal matching funds and shall 6 make supplemental alternative payments to eligible non-state 7 governmental entities based on the supplemental alternative 8 payment amount as calculated by the state for each nursing 9 facility for which a non-state governmental entity owns the 10 nursing facility’s license. A managed care contractor shall 11 not retain any portion of the supplemental alternative payment, 12 but shall treat the supplemental difference between the 13 expected alternative payment and the Medicaid fee-for-service 14 per diem reimbursement rate as a pass through component of 15 the capitated payment calculation to the eligible non-state 16 governmental entity. 17 c. The supplemental alternative payment program shall 18 be budget neutral to the state. No general fund revenue 19 shall be expended under the program including for costs of 20 administration. If payments under the program result in 21 overpayment to a nursing facility, or if CMS disallows federal 22 participation related to a nursing facility’s receipt or 23 use of supplemental alternative payments authorized under 24 the program, the state may recoup an amount equivalent to 25 the amount of supplemental alternative payments overpaid or 26 disallowed. Supplemental Alternative payments shall be subject 27 to any adjustment for payments made in error, including but not 28 limited to adjustments made by state or federal law, and the 29 state may recoup an amount equivalent to any such adjustment. 30 d. A nursing facility participating in the program shall 31 notify the state of any changes in ownership that may affect 32 the nursing facility’s continued eligibility for the program 33 within thirty days of any such change. 34 e. No portion of the supplemental alternative payment 35 -7- HF653.2484 (2) 87 pf/rn 7/ 11

paid to a participating nursing facility may be used for 1 contingent fees. Expenditures for development fees, legal 2 fees, or consulting fees shall not exceed five percent of 3 the supplemental alternative funds received, annually, and 4 any such expenditures shall be reported to the department of 5 human services, and included in the department’s annual report 6 pursuant to subsection 3. 7 f. The supplemental alternative payment paid to a 8 participating nursing facility shall only be used as specified 9 in state and federal law. Supplemental Alternative payments 10 paid to a participating nursing facility shall only be used as 11 follows: 12 (1) A portion of the amount received may be used for nursing 13 facility quality improvement initiatives including but not 14 limited to educational scholarships and nonmandatory training. 15 Priority in the awarding of contracts for such training shall 16 be for Iowa-based organizations. 17 (2) A portion of the amount received may be used for nursing 18 facility remodeling or renovation. Priority in the awarding 19 of contracts for such remodeling or renovations shall be for 20 Iowa-based organizations and skilled laborers. 21 (3) A portion of the amount received may be used for health 22 information technology infrastructure and software. Priority 23 in the awarding of contracts for such health information 24 technology infrastructure and software shall be for Iowa-based 25 organizations. 26 (4) A portion of the amount received may be used for 27 endowments to offset costs associated with maintenance of 28 hospitals licensed under chapter 135B and nursing facilities 29 licensed under chapter 135C . 30 g. A non-state governmental entity shall only be eligible 31 for supplemental alternative payments attributable to up to 10 32 percent of the potential non-state government-owned nursing 33 facilities licensed in the state. 34 3. Following receipt of approval and implementation of the 35 -8- HF653.2484 (2) 87 pf/rn 8/ 11

program, the department shall submit a report to the governor 1 and the general assembly, annually, on or before December 15, 2 regarding the program. The report shall include, at a minimum, 3 the name and location of participating non-state governmental 4 entities and the non-state government-owned nursing facilities 5 with which the non-state governmental entities have partnered 6 to participate in the program; the amount of the matching 7 funds provided by each non-state governmental entity; the 8 net supplemental payment amount difference between the 9 expected alternative payment and the Medicaid fee-for-service 10 per diem reimbursement rate received by each participating 11 non-governmental entity and non-state government-owned nursing 12 facility; and the amount expended for each of the specified 13 categories of approved expenditure. 14 4. The department of human services shall work 15 collaboratively with representatives of nursing facilities, 16 hospitals, and other affected stakeholders in adopting 17 administrative rules, and in implementing and administering 18 this program. 19 5. As used in this section: 20 a. “Non-state governmental entity” means a hospital 21 authority, hospital district, health care district, city, or 22 county. 23 b. “Non-state government-owned nursing facility” means a 24 nursing facility owned or operated by a non-state governmental 25 entity for which a non-state governmental entity holds 26 the nursing facility’s license and is party to the nursing 27 facility’s Medicaid contract. 28 Sec. ___. 2016 Iowa Acts, chapter 1139, section 84, 29 subsection 1, is amended to read as follows: 30 1. The section of this division of this Act directing the 31 department of human services to submit a Medicaid state plan 32 amendment to CMS no later than September 29, 2017, shall be 33 implemented as soon as possible following enactment, consistent 34 with all applicable federal requirements. 35 -9- HF653.2484 (2) 87 pf/rn 9/ 11

Sec. ___. EFFECTIVE UPON ENACTMENT. This division of this 1 Act, being deemed of immediate importance, takes effect upon 2 enactment. 3 Sec. ___. RETROACTIVE APPLICABILITY. This division of this 4 Act applies retroactively to May 27, 2016. 5 DIVISION ___ 6 LEGISLATIVE INTERIM —— OPIOID EPIDEMIC EVALUATION 7 Sec. ___. LEGISLATIVE INTERIM STUDY COMMITTEE —— OPIOID 8 EPIDEMIC EVALUATION. 9 1. The legislative council is requested to establish an 10 interim study committee to comprehensively evaluate the state’s 11 response to the opioid epidemic in the state. 12 2. The committee shall receive input from agencies and 13 entities including but not limited to all of the following: 14 a. Representatives of the professional licensing boards for 15 professionals authorized to prescribe controlled substances. 16 b. Representatives of public safety and public health 17 including but not limited to the office of the state medical 18 examiner, the division of criminal investigation of the 19 department of public safety, the department of corrections and 20 community-based corrections, law enforcement agencies, the 21 governor’s office of drug control policy, and the department 22 of public health. 23 c. Representatives of the medical community and health 24 insurance payers including but not limited to the Iowa hospital 25 association, the Iowa medical society, the Iowa osteopathic 26 medical society, the Iowa pharmacy association, and America’s 27 health insurance plans. 28 d. Consumers and representatives of consumers including but 29 not limited to the Iowa substance abuse information center, the 30 Iowa prescription abuse reduction task force, and addiction 31 treatment centers in the state. 32 3. The interim committee’s evaluation shall include but is 33 not limited to a review of the protocols and practices relating 34 to the prescribing of opioid medications and the treatment 35 -10- HF653.2484 (2) 87 pf/rn 10/ 11