Senate File 2117 H-8012 Amend Senate File 2117, as amended, passed, and reprinted by 1 the Senate, as follows: 2 1. By striking everything after the enacting clause and 3 inserting: 4 < DIVISION I 5 APPROPRIATION REDUCTIONS 6 Section 1. EXECUTIVE BRANCH APPROPRIATION REDUCTIONS. 7 1. For the period beginning on the effective date of this 8 section and ending on June 30, 2018, the following departments 9 and agencies and the judicial branch are subject to a reduction 10 in expenditures made from appropriations from the general fund 11 in the following amounts: 12 a. Department of administrative services 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 62,560 14 b. Auditor of state 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,062 16 c. Department of commerce 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,433 18 d. Executive council 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 777 20 e. Governor’s office 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 20,888 22 f. Governor’s office of drug control policy 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,058 24 g. Department of human rights 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 21,228 26 h. Department of inspections and appeals 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 102,374 28 In identifying and implementing the reduction pursuant 29 to this paragraph, the director of the department shall be 30 authorized to make allocations between department divisions 31 in the manner and to the extent as the director determines 32 appropriate, in consultation with the department of management. 33 i. State public defender 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 236,041 35 -1- SF2117.3319 (5) 87 tm/rn 1/ 9 #1.

j. Department of management 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,629 2 k. Department of revenue 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 528,271 4 l. Secretary of state 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 31,525 6 m. Treasurer of state 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 9,256 8 n. Department of agriculture and land stewardship 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 188,688 10 o. Department of natural resources 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 123,373 12 p. Department of economic development 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 157,960 14 q. Iowa workforce development 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 166,960 16 r. Department for the blind 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,720 18 s. College aid commission 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 94,172 20 t. Department of education 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 784,830 22 In identifying and implementing the reduction pursuant to 23 this paragraph, the department shall not reduce the standing 24 appropriation under section 285.2, subsection 1, paragraph “b”, 25 for purposes of nonpublic school transportation. 26 u. Community colleges 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 500,000 28 v. Vocational rehabilitation 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 54,472 30 w. Iowa public television 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,421 32 x. Board of regents 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,133,070 34 In identifying and implementing the reduction pursuant to 35 -2- SF2117.3319 (5) 87 tm/rn 2/ 9

this paragraph, the board shall not reduce expenditures made 1 from appropriations for the university of northern Iowa, the 2 state school for the deaf, and the Iowa braille and sight 3 saving school. 4 y. Department on aging 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 110,012 6 z. Department of public health 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 662,871 8 aa. Department of human services 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,316,042 10 In identifying and implementing the reduction pursuant 11 to this paragraph, the department shall not reduce benefits 12 available under the Medicaid state plan and approved waivers. 13 ab. Department of veterans affairs 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 36,877 15 ac. Iowa veterans home 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 65,164 17 ad. Department of Justice 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 378,471 19 In identifying and implementing the reduction pursuant to 20 this paragraph, the department shall not reduce expenditures 21 made from appropriations for victim assistance grants. 22 ae. Iowa civil rights commission 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,431 24 af. Department of corrections 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,405,688 26 ag. Law enforcement academy 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,607 28 ah. Department of public defense 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 59,193 30 ai. Department of homeland security and emergency 31 management 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,130 33 aj. Department of public safety 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 200,000 35 -3- SF2117.3319 (5) 87 tm/rn 3/ 9

The department shall not apply any reduction to expenditures 1 made from appropriations to the division of the state patrol. 2 ak. Judicial branch 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,611,815 4 2. The department of management, in consultation with 5 the departments and agencies and the judicial branch listed 6 in subsection 1, shall identify and implement the reductions 7 in subsection 1 with respect to the appropriate general fund 8 appropriations. Within fifteen days of the effective date of 9 this section, the department of management shall transmit a 10 report to the general assembly and legislative services agency 11 listing the appropriation reductions applied. 12 3. In order to implement the reductions in subsection 1, 13 the departments and agencies and the judicial branch may adjust 14 allocations made from appropriations that are being reduced. 15 4. In order to implement the reductions in subsection 1, the 16 department of management may reduce a standing appropriation to 17 a department or agency required to reduce expenditures pursuant 18 to subsection 1. 19 Sec. 2. TRANSFER —— IOWA SKILLED WORKER AND JOB CREATION 20 FUND. There is transferred from the Iowa skilled worker and 21 job creation fund created in section 8.75 to the general fund 22 of the state for the fiscal year beginning July 1, 2017, and 23 ending June 30, 2018, the following amount: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,000,000 25 Sec. 3. SUPPLEMENTAL REIMBURSEMENT FOR GROUND EMERGENCY 26 MEDICAL TRANSPORTATION PROVIDED TO MEDICAID BENEFICIARIES. The 27 department of human services shall submit a Medicaid state 28 plan amendment to the centers for Medicare and Medicaid 29 services of the United States department of health and human 30 services to request authorization to establish and administer a 31 methodology to provide supplemental reimbursement to eligible 32 ground emergency medical transportation providers that provide 33 ground emergency medical transportation services to Medicaid 34 beneficiaries. For purposes of this section, “eligible ground 35 -4- SF2117.3319 (5) 87 tm/rn 4/ 9

emergency medical transportation provider” means a provider who 1 provides ground emergency medical transportation services to 2 Medicaid beneficiaries and is enrolled as a Medicaid provider 3 during the period being claimed. 4 Sec. 4. 2017 Iowa Acts, chapter 169, section 17, subsection 5 1, paragraph a, subparagraph (1), is amended to read as 6 follows: 7 (1) For the purposes of providing assistance under the high 8 quality jobs program as described in section 15.335B : 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,900,000 10 5,900,000 11 Sec. 5. 2017 Iowa Acts, chapter 170, section 5, subsection 12 1, is amended to read as follows: 13 1. The appropriations made pursuant to section 2.12 for the 14 expenses of the general assembly and legislative agencies for 15 the fiscal year beginning July 1, 2017, and ending June 30, 16 2018, are reduced by the following amount: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 400,000 18 687,318 19 Sec. 6. 2017 Iowa Acts, chapter 174, section 31, subsection 20 1, paragraph c, subparagraph (3), is amended to read as 21 follows: 22 (3) (a) For the fiscal year beginning July 1, 2017, the 23 graduate medical education and disproportionate share hospital 24 fund shall remain at the amount in effect on June 30, 2017 , 25 except that the portion of the fund attributable to graduate 26 medical education shall be reduced in an amount that reflects 27 the elimination of graduate medical education payments made to 28 out-of-state hospitals . 29 (b) Effective May 1, 2018, a hospital that is located in 30 Iowa, is classified as state government-owned or nonstate 31 government-owned, and qualifies for graduate medical education 32 or disproportionate share hospital payments shall transfer 33 to the medical assistance program an amount equal to provide 34 the nonfederal share for a graduate medical education and 35 -5- SF2117.3319 (5) 87 tm/rn 5/ 9

disproportionate share hospital payment. Distribution of the 1 payments shall be made on a monthly basis. A hospital that 2 meets the specified conditions shall receive and retain one 3 hundred percent of the total graduate medical education and 4 disproportionate share hospital payments. 5 Sec. 7. REPEAL. 2017 Iowa Acts, chapter 170, section 18, 6 is repealed. 7 DIVISION II 8 SUPPLEMENTAL APPROPRIATIONS 9 Sec. 8. INDIGENT DEFENSE. There is appropriated from the 10 general fund of the state to the office of the state public 11 defender of the department of inspections and appeals for the 12 fiscal year beginning July 1, 2017, and ending June 30, 2018, 13 the following amount, or so much thereof as is necessary to 14 supplement appropriations made for the following designated 15 purpose: 16 For payments on behalf of eligible adults and juveniles from 17 the indigent defense fund in accordance with section 815.11: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,700,000 19 Sec. 9. UTILITY COSTS. There is appropriated from the 20 general fund of the state to the department of administrative 21 services for the fiscal year beginning July 1, 2017, and ending 22 June 30, 2018, the following amount, or so much thereof as is 23 necessary to supplement appropriations made for the following 24 designated purpose: 25 For payment of utility costs: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 451,871 27 Sec. 10. 2017 Iowa Acts, chapter 174, section 36, is amended 28 to read as follows: 29 SEC. 36. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is 30 appropriated from the pharmaceutical settlement account created 31 in section 249A.33 to the department of human services for the 32 fiscal year beginning July 1, 2017, and ending June 30, 2018, 33 the following amount, or so much thereof as is necessary, to be 34 used for the purpose designated: 35 -6- SF2117.3319 (5) 87 tm/rn 6/ 9

Notwithstanding any provision of law to the contrary, to 1 supplement the appropriations made in this Act for medical 2 contracts under the medical assistance program for the fiscal 3 year beginning July 1, 2017, and ending June 30, 2018: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 800,000 5 864,257 6 DIVISION III 7 IOWA ECONOMIC EMERGENCY FUND 8 Sec. 11. Section 8.55, subsection 3, paragraph c, Code 2018, 9 is amended by striking the paragraph and inserting in lieu 10 thereof the following: 11 c. There is appropriated from the Iowa economic emergency 12 fund to the general fund of the state for the fiscal year in 13 which moneys in the fund were used for cash flow purposes, 14 for the purposes of reducing or preventing any overdraft on 15 or deficit in the general fund of the state, the amount from 16 the Iowa economic emergency fund that was used for cash flow 17 purposes pursuant to paragraph “b” and that was not returned 18 to the Iowa economic emergency fund by June 30 of the fiscal 19 year. The appropriation in this paragraph shall not exceed one 20 percent of the adjusted revenue estimate for the fiscal year 21 for which the appropriation is made and is contingent upon all 22 of the following having occurred: 23 (1) Prior to an appropriation being made pursuant to this 24 paragraph, the balance of the general fund of the state at the 25 end of the fiscal year for which the appropriation is made is 26 negative. 27 (2) The governor issues an official proclamation and 28 notifies the legislative fiscal committee and the legislative 29 services agency that the balance of the general fund is 30 negative and that an appropriation made pursuant to this 31 paragraph brings the general fund of the state into balance. 32 Sec. 12. APPROPRIATION IN LIEU OF STANDING APPROPRIATION. 33 1. There is appropriated from the Iowa economic emergency 34 fund created in section 8.55 to the general fund of the state 35 -7- SF2117.3319 (5) 87 tm/rn 7/ 9

for the fiscal year beginning July 1, 2017, and ending June 30, 1 2018, the following amount: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13,000,000 3 2. The appropriation made pursuant to this section is in 4 lieu of the standing appropriation implemented under section 5 8.55 by the department of management pursuant to the official 6 proclamation issued by the governor on September 28, 2017. 7 Sec. 13. RETROACTIVE APPLICABILITY. The following 8 provision or provisions of this division of this Act apply 9 retroactively to September 28, 2017: 10 The section of this division of this Act appropriating 11 moneys from the Iowa economic emergency fund to the general 12 fund in lieu of a prior standing appropriation. 13 DIVISION IV 14 MEDICAID 15 Sec. 14. 2017 Iowa Acts, chapter 174, section 12, subsection 16 15, paragraph a, subparagraph (7), is amended to read as 17 follows: 18 (7) Elimination of the three-month retroactive Medicaid 19 coverage benefit for Medicaid applicants effective October 1, 20 2017 , with the exception of otherwise eligible individuals who 21 are residents of nursing facilities licensed under chapter 22 135C . The department shall seek a waiver from the centers for 23 Medicare and Medicaid services of the United States department 24 of health and human services to implement the strategy. 25 If federal approval is received, an applicant’s Medicaid 26 coverage shall be effective on the first day of the month of 27 application, as allowed under the Medicaid state plan. 28 Sec. 15. 2017 Iowa Acts, chapter 174, section 12, subsection 29 15, paragraph c, is amended to read as follows: 30 c. The department may adopt emergency rules , in 31 consultation with affected provider groups, to implement this 32 subsection. 33 Sec. 16. MEDICAID STATE PLAN AMENDMENT. Upon enactment 34 of the section of this division of this Act relating to 35 -8- SF2117.3319 (5) 87 tm/rn 8/ 9

the three-month retroactive Medicaid coverage benefit, the 1 department of human services shall request an amendment to the 2 Medicaid state plan from the centers for Medicare and Medicaid 3 services of the United States department of health and human 4 services to implement the provision. 5 DIVISION V 6 EFFECTIVE DATE 7 Sec. 17. EFFECTIVE DATE. This Act, being deemed of 8 immediate importance, takes effect upon enactment. > 9 ______________________________ COMMITTEE ON APPROPRIATIONS GRASSLEY of Butler, Chairperson -9- SF2117.3319 (5) 87 tm/rn 9/ 9