House File 2643 H-8295 Amend the amendment, H-8294, to House File 2643 as follows: 1 1. Page 1, after line 7 by inserting: 2 < ___. Page 6, line 12, by striking < 24 > and inserting < 20 > 3 ___. Page 7, line 14, after < designated > by inserting 4 < , including for liability amounts associated with the 5 supplemental nutrition assistance program payment error rate, > 6 ___. Page 10, after line 15 by inserting: 7 < DIVISION ___ 8 HEALTH AND HUMAN SERVICES —— PRIOR APPROPRIATIONS AND OTHER 9 PROVISIONS 10 RURAL PSYCHIATRIC RESIDENCIES 11 Sec. ___. 2019 Iowa Acts, chapter 85, section 3, subsection 12 4, paragraph j, is amended to read as follows: 13 j. Of the funds appropriated in this subsection, $400,000 14 shall be used for rural psychiatric residencies to support the 15 annual creation and training of four psychiatric residents who 16 will provide mental health services in underserved areas of 17 the state. Notwithstanding section 8.33, moneys that remain 18 unencumbered or unobligated at the close of the fiscal year 19 shall not revert but shall remain available for expenditure for 20 the purposes designated for subsequent fiscal years. 21 FAMILY INVESTMENT PROGRAM ACCOUNT 22 Sec. ___. 2019 Iowa Acts, chapter 85, section 9, is amended 23 by adding the following new subsection: 24 NEW SUBSECTION . 7. Notwithstanding section 8.33, moneys 25 appropriated in this section that remain unencumbered or 26 unobligated at the close of the fiscal year shall not revert 27 but shall remain available for expenditure for the purposes 28 designated, and may be transferred to the appropriations made 29 in this division of this Act for general administration and 30 field operations for technology needs including the eligibility 31 integrated applications solutions (ELIAS) project, until the 32 close of the succeeding fiscal year. 33 STATE SUPPLEMENTARY ASSISTANCE 34 Sec. ___. 2019 Iowa Acts, chapter 85, section 15, subsection 35 -1- H8294.4427 (3) 88 pf/rn 1/ 19 #1.

4, is amended to read as follows: 1 4. Notwithstanding section 8.33 , moneys appropriated 2 in this section that remain unencumbered or unobligated 3 at the close of the fiscal year shall not revert but 4 shall remain available for expenditure for the purposes 5 designated , including for liability amounts associated with the 6 supplemental nutrition assistance program payment error rate, 7 until the close of the succeeding fiscal year. 8 CHILD AND FAMILY SERVICES 9 Sec. ___. 2019 Iowa Acts, chapter 85, section 19, subsection 10 18, is amended to read as follows: 11 18. Of the funds appropriated in this section, at least 12 $147,000 shall be used for the continuation of the child 13 welfare provider training academy, a collaboration between the 14 coalition for family and children’s services in Iowa and the 15 department. Notwithstanding section 8.33, moneys allocated 16 under this subsection that remain unencumbered or unobligated 17 at the close of the fiscal year shall not revert but shall 18 remain available for expenditure for the purposes designated 19 until the close of the succeeding fiscal year. 20 Sec. ___. 2019 Iowa Acts, chapter 85, section 19, is amended 21 by adding the following new subsection: 22 NEW SUBSECTION . 24. Notwithstanding section 8.33, moneys 23 appropriated in this section that remain unencumbered or 24 unobligated at the close of the fiscal year shall not revert 25 but shall remain available for expenditure for the purposes 26 designated, and including services implemented to meet the 27 requirements of the federal Family First Prevention Services 28 Act, until the close of the succeeding fiscal year. 29 MENTAL HEALTH INSTITUTES 30 Sec. ___. 2019 Iowa Acts, chapter 85, section 24, subsection 31 2, is amended to read as follows: 32 2. a. Notwithstanding sections 218.78 and 249A.11 , any 33 revenue received from the state mental health institute at 34 Cherokee or the state mental health institute at Independence 35 -2- H8294.4427 (3) 88 pf/rn 2/ 19

pursuant to 42 C.F.R §438.6(e) may be retained and expended by 1 the mental health institute. 2 b. Notwithstanding sections 218.78 and 249A.11, any 3 COVID-19 related funding received through federal funding 4 sources by the state mental health institute at Cherokee or the 5 state mental health institute at Independence may be retained 6 and expended by the mental health institute. 7 FIELD OPERATIONS 8 Sec. ___. 2019 Iowa Acts, chapter 85, section 27, is amended 9 by adding the following new subsection: 10 NEW SUBSECTION . 4. Notwithstanding section 8.33, moneys 11 appropriated in this section that remain unencumbered or 12 unobligated at the close of the fiscal year shall not revert 13 but shall remain available for expenditure for the purposes 14 designated until the close of the succeeding fiscal year. 15 GENERAL ADMINISTRATION 16 Sec. ___. 2019 Iowa Acts, chapter 85, section 28, is amended 17 by adding the following new subsection: 18 NEW SUBSECTION . 7. Notwithstanding section 8.33, moneys 19 appropriated in this section that remain unencumbered or 20 unobligated at the close of the fiscal year shall not revert 21 but shall remain available for expenditure for the purposes 22 designated until the close of the succeeding fiscal year. 23 DECATEGORIZATION FY 2018 CARRYOVER FUNDING 24 Sec. ___. DECATEGORIZATION CARRYOVER FUNDING FY 2018 —— 25 TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188, 26 subsection 5, paragraph “b”, any state-appropriated moneys in 27 the funding pool that remained unencumbered or unobligated 28 at the close of the fiscal year beginning July 1, 2017, and 29 were deemed carryover funding to remain available for the two 30 succeeding fiscal years that still remain unencumbered or 31 unobligated at the close of the fiscal year beginning July 1, 32 2019, shall not revert but shall be transferred to the medical 33 assistance program for the fiscal year beginning July 1, 2020. 34 Sec. ___. LIMITATION NOT APPLICABLE TO FY 2020-2021. All 35 -3- H8294.4427 (3) 88 pf/rn 3/ 19

of the following amendments to 2019 Iowa Acts, chapter 85, are 1 not applicable to the associated appropriations made for the 2 fiscal year beginning July 1, 2020, and ending June 30, 2021, 3 notwithstanding section 1 of this Act: 4 1. 2019 Iowa Acts, chapter 85, section 9, as amended in this 5 division of this Act. 6 2. 2019 Iowa Acts, chapter 85, section 19, subsection 18, as 7 amended in this division of this Act. 8 3. 2019 Iowa Acts, chapter 85, section 19, subsection 24, if 9 enacted by this division of this Act. 10 4. 2019 Iowa Acts, chapter 85, section 27, as amended in 11 this division of this Act. 12 5. 2019 Iowa Acts, chapter 85, section 28, as amended in 13 this division of this Act. 14 Sec. ___. LIMITATION APPLICABLE TO FY 2020-2021. All of 15 the following amendments to 2019 Iowa Acts, chapter 85, are 16 applicable to the associated appropriations made for the fiscal 17 year beginning July 1, 2020, and ending June 30, 2021, pursuant 18 to section 1 of this Act: 19 1. 2019 Iowa Acts, chapter 85, section 3, subsection 4, 20 paragraph “j”. 21 2. 2019 Iowa Acts, chapter 85, section 15, subsection 4. 22 3. 2019 Iowa Acts, chapter 85, section 24, subsection 2, as 23 amended in this division of this Act. 24 Sec. ___. EFFECTIVE DATE. This division of this Act, being 25 deemed of immediate importance, takes effect upon enactment. 26 Sec. ___. RETROACTIVE APPLICABILITY. This division of this 27 Act applies retroactively to July 1, 2019. 28 DIVISION ___ 29 HEALTH AND HUMAN SERVICES —— FY 2019-2020 PROVISIONS NOT 30 APPLICABLE FOR FY 2020-2021 31 Sec. ___. HEALTH AND HUMAN SERVICES PROVISIONS NOT 32 APPLICABLE TO FY 2020-2021. The following provisions of 2019 33 Iowa Acts, chapter 85, are not applicable to the associated 34 appropriations made for the fiscal year beginning July 1, 2020, 35 -4- H8294.4427 (3) 88 pf/rn 4/ 19

and ending June 30, 2021, notwithstanding section 1 of this 1 Act: 2 1. 2019 Iowa Acts, chapter 85, section 3, subsection 2, 3 paragraph “a”. 4 2. 2019 Iowa Acts, chapter 85, section 3, subsection 7, 5 paragraph “b”. 6 3. 2019 Iowa Acts, chapter 85, section 3, subsection 9, 7 paragraph “b”. 8 4. 2019 Iowa Acts, chapter 85, section 4, subsection 1. 9 5. 2019 Iowa Acts, chapter 85, section 9, subsection 4. 10 6. 2019 Iowa Acts, chapter 85, section 13, subsections 21, 11 22, 23, and 24. 12 7. 2019 Iowa Acts, chapter 85, section 22, subsection 2. 13 8. 2019 Iowa Acts, chapter 85, section 24, subsection 1, 14 paragraph “a”, subparagraph (2). 15 9. 2019 Iowa Acts, chapter 85, section 24, subsection 1, 16 paragraph “b”, subparagraph (2). 17 10. 2019 Iowa Acts, chapter 85, section 26, subsection 1, 18 paragraph “b”. 19 11. 2019 Iowa Acts, chapter 85, section 27, subsection 2. 20 12. 2019 Iowa Acts, chapter 85, section 32, subsection 1. 21 13. 2019 Iowa Acts, chapter 85, section 33. 22 14. 2019 Iowa Acts, chapter 85, divisions VII, VIII, XI, 23 XII, XIV, XVI, XIX, and XXVII. 24 DIVISION ___ 25 HEALTH AND HUMAN SERVICES —— NEW PROVISIONS APPLICABLE FOR FY 26 2020-2021 27 STATE MEDICAL EXAMINER 28 Sec. ___. STATE MEDICAL EXAMINER —— USE OF MONEYS. For 29 the fiscal year beginning July 1, 2020, and ending June 30, 30 2021, a portion of the moneys appropriated from the general 31 fund of the state to the department of public health for 32 public protection shall be used to support the office of the 33 state medical examiner and to address the growth in demand 34 for services. The office of the state medical examiner shall 35 -5- H8294.4427 (3) 88 pf/rn 5/ 19

enter into a memorandum of understanding with the university 1 of Iowa hospitals and clinics to coordinate the completion of 2 forensic autopsies to address increased caseloads and prolonged 3 backlogs, and to promote regional efficiencies. 4 HOPES —— HFI 5 Sec. ___. HEALTHY OPPORTUNITIES FOR PARENTS TO EXPERIENCE 6 SUCCESS (HOPES) —— HEALTHY FAMILIES IOWA (HFI) PROGRAM. For 7 the fiscal year beginning July 1, 2020, and ending June 30, 8 2021, of the funds appropriated from the general fund of the 9 state to the department of public health for healthy children 10 and families, not more than $734,000 shall be used for the 11 healthy opportunities for parents to experience success (HOPES) 12 —— healthy families Iowa (HFI) program established pursuant to 13 section 135.106. 14 SEXUAL VIOLENCE PREVENTION PROGRAMMING 15 Sec. ___. SEXUAL VIOLENCE PREVENTION PROGRAMMING. For 16 the fiscal year beginning July 1, 2020, and ending June 17 30, 2021, of the moneys appropriated from the general fund 18 of the state to the department of public health for public 19 protection, up to $243,000 shall be used for sexual violence 20 prevention programming through a statewide organization 21 representing programs serving victims of sexual violence 22 through the department’s sexual violence prevention program, 23 and for continuation of a training program for sexual assault 24 response team (SART) members, including representatives of 25 law enforcement, victim advocates, prosecutors, and certified 26 medical personnel. The amount allocated in this section shall 27 not be used to supplant funding administered for other sexual 28 violence prevention or victims assistance programs. 29 TAX PREPARATION ASSISTANCE 30 Sec. ___. DEPARTMENT OF HUMAN SERVICES —— TAX PREPARATION 31 ASSISTANCE. For the fiscal year beginning July 1, 2020, and 32 ending June 30, 2021, of the moneys appropriated from the 33 general fund of the state to the department of human services 34 to be credited to the family investment program account and 35 -6- H8294.4427 (3) 88 pf/rn 6/ 19

used for family investment assistance under chapter 239B, 1 $195,000 shall be used for a contract executed in accordance 2 with 2019 Iowa Acts, chapter 85, section 9, subsection 4, 3 with an Iowa-based nonprofit organization with a history of 4 providing tax preparation assistance to low-income Iowans in 5 order to expand the usage of the earned income tax credit. 6 The purpose of the contract is to supply this assistance to 7 underserved areas of the state. 8 HEALTH PROGRAM OPERATIONS 9 Sec. ___. HEALTH PROGRAM OPERATIONS. There is appropriated 10 from the general fund of the state to the department of human 11 services for the fiscal year beginning July 1, 2020, and ending 12 June 30, 2021, the following amount or so much thereof as is 13 necessary, to be used for the purposes designated: 14 For health program operations: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 17,831,343 16 1. The department of inspections and appeals shall provide 17 all state matching moneys for survey and certification 18 activities performed by the department of inspections 19 and appeals. The department of human services is solely 20 responsible for distributing the federal matching moneys for 21 such activities. 22 2. Of the moneys appropriated in this section, $50,000 shall 23 be used for continuation of home and community-based services 24 waiver quality assurance programs, including the review and 25 streamlining of processes and policies related to oversight and 26 quality management to meet state and federal requirements. 27 3. Of the amount appropriated in this section, up to 28 $200,000 may be transferred to the appropriation for general 29 administration to be used for additional full-time equivalent 30 positions in the development of key health initiatives such 31 as development and oversight of managed care programs and 32 development of health strategies targeted toward improved 33 quality and reduced costs in the Medicaid program. 34 4. Of the moneys appropriated in this section, $1,000,000 35 -7- H8294.4427 (3) 88 pf/rn 7/ 19

shall be used for planning and development, in cooperation with 1 the department of public health, of a phased-in program to 2 provide a dental home for children. 3 5. a. Of the moneys appropriated in this section, $573,000 4 shall be credited to the autism support program fund created 5 in section 225D.2 to be used for the autism support program 6 created in chapter 225D, with the exception of the following 7 amount of this allocation which shall be used as follows: 8 b. Of the moneys allocated in this subsection, $25,000 shall 9 be used for the public purpose of continuation of a grant to a 10 nonprofit provider of child welfare services that has been in 11 existence for more than 115 years, is located in a county with 12 a population between 200,000 and 220,000 according to the most 13 recent federal decennial census, is licensed as a psychiatric 14 medical institution for children, and provides school-based 15 programming, to be used for support services for children with 16 autism spectrum disorder and their families. 17 Sec. ___. REFERENCES TO MEDICAL CONTRACTS —— REPLACED. For 18 the fiscal year beginning July 1, 2020, and ending June 30, 19 2021, all references in 2019 Iowa Acts, chapter 85, division V, 20 to “medical contracts” shall be replaced with the term “health 21 program operations” and all transfers of funds made to or from 22 the appropriation for medical contracts shall instead be made 23 to or from the appropriation for health program operations. 24 CHILD AND FAMILY SERVICES 25 Sec. ___. CHILD AND FAMILY SERVICES —— GROUP FOSTER 26 CARE. For the fiscal year beginning July 1, 2020, and ending 27 June 30, 2021, of the funds appropriated from the general fund 28 of the state to the department of human services for child and 29 family services, $26,025,000 is allocated as the statewide 30 expenditure target under section 232.143 for group foster care 31 maintenance and services. If the department projects that such 32 expenditures for the fiscal year will be less than the target 33 amount allocated in this paragraph “a”, the department may 34 reallocate the excess to provide additional funding for family 35 -8- H8294.4427 (3) 88 pf/rn 8/ 19

foster care, independent living, family-centered services, 1 shelter care, or the child welfare emergency services addressed 2 with the allocation for shelter care. 3 FAMILY SUPPORT SUBSIDY PROGRAM 4 Sec. ___. FAMILY SUPPORT SUBSIDY PROGRAM. For the fiscal 5 year beginning July 1, 2020, and ending June 30, 2021, of the 6 moneys appropriated from the general fund of the state to the 7 department of human services for the family support subsidy 8 program, at least $875,195 is transferred to the department 9 of public health for the family support center component of 10 the comprehensive family support program under chapter 225C, 11 subchapter V. 12 DEPARTMENT OF HUMAN SERVICES PROVIDER REIMBURSEMENTS 13 Sec. ___. PROVIDERS REIMBURSED UNDER THE DEPARTMENT OF 14 HUMAN SERVICES. 15 1. For the fiscal year beginning July 1, 2020, and 16 ending June 30, 2021, the following reimbursement rates and 17 methodologies shall apply: 18 a. (1) For the fiscal year beginning July 1, 2020, 19 case-mix, non-case-mix, and special population nursing 20 facilities shall be reimbursed in accordance with the 21 methodology in effect on June 30, 2020. 22 (2) For managed care claims, the department of human 23 services shall adjust the payment rate floor for nursing 24 facilities, annually, to maintain a rate floor that is no 25 lower than the Medicaid fee-for-service case-mix adjusted 26 rate calculated in accordance with subparagraph (1) and 27 441 IAC 81.6. The department shall then calculate adjusted 28 reimbursement rates, including but not limited to add-on 29 payments, annually, and shall notify Medicaid managed care 30 organizations of the adjusted reimbursement rates within 30 31 days of determining the adjusted reimbursement rates. Any 32 adjustment of reimbursement rates under this subparagraph shall 33 be budget neutral to the state budget. 34 (3) Medicaid managed care organizations shall adjust 35 -9- H8294.4427 (3) 88 pf/rn 9/ 19

facility-specific rates based upon payment rate listings issued 1 by the department. The rate adjustments shall be applied 2 prospectively from the effective date of the rate letter issued 3 by the department. 4 b. For the fiscal year beginning July 1, 2020, reimbursement 5 rates for inpatient hospital services shall be rebased 6 effective October 1, 2020, subject to Medicaid program upper 7 payment limit rules, and adjusted as necessary to maintain 8 expenditures within the amount appropriated to the department 9 for this purpose for the fiscal year. 10 c. For the fiscal year beginning July 1, 2020, under 11 both fee-for-service and managed care administration of 12 the Medicaid program, critical access hospitals shall be 13 reimbursed for inpatient and outpatient services based on the 14 hospital-specific critical access hospital cost adjustment 15 factor methodology utilizing the most recent and complete cost 16 reporting period as applied prospectively within the funds 17 appropriated for such purpose for the fiscal year. 18 d. For the fiscal year beginning July 1, 2020, assertive 19 community treatment per diem rates shall remain at the rates in 20 effect on June 30, 2020. 21 e. Notwithstanding section 234.38, for the fiscal 22 year beginning July 1, 2020, the foster family basic daily 23 maintenance rate and the maximum adoption subsidy rate for 24 children ages 0 through 5 years shall be $16.78, the rate for 25 children ages 6 through 11 years shall be $17.45, the rate for 26 children ages 12 through 15 years shall be $19.10, and the 27 rate for children and young adults ages 16 and older shall be 28 $19.35. For youth ages 18 through 23 who have exited foster 29 care, the preparation for adult living program maintenance rate 30 shall be $602.70 per month. The maximum payment for adoption 31 subsidy nonrecurring expenses shall be limited to $500 and the 32 disallowance of additional amounts for court costs and other 33 related legal expenses implemented pursuant to 2010 Iowa Acts, 34 chapter 1031, section 408, shall be continued. 35 -10- H8294.4427 (3) 88 pf/rn 10/ 19

f. For the fiscal year beginning July 1, 2020, the 1 reimbursement rate for family-centered services providers shall 2 be established by contract. 3 2. With the exception of the providers and services 4 specified in subsection 1, all other provider and service 5 reimbursement rates and methodologies specified in 2019 Iowa 6 Acts, chapter 85, section 31, shall continue to be applicable 7 for the fiscal year beginning July 1, 2020, and ending June 30, 8 2021. 9 EMERGENCY RULES 10 Sec. ___. EMERGENCY RULES. 11 1. If necessary to comply with federal requirements 12 including time frames, or if specifically authorized by a 13 provision of this division of this Act, the department of 14 human services or the mental health and disability services 15 commission may adopt administrative rules under section 17A.4, 16 subsection 3, and section 17A.5, subsection 2, paragraph “b”, 17 to implement the provisions of this division of this Act and 18 the rules shall become effective immediately upon filing or 19 on a later effective date specified in the rules, unless the 20 effective date of the rules is delayed or the applicability 21 of the rules is suspended by the administrative rules review 22 committee. Any rules adopted in accordance with this section 23 shall not take effect before the rules are reviewed by the 24 administrative rules review committee. The delay authority 25 provided to the administrative rules review committee under 26 section 17A.4, subsection 7, and section 17A.8, subsection 9, 27 shall be applicable to a delay imposed under this section, 28 notwithstanding a provision in those sections making them 29 inapplicable to section 17A.5, subsection 2, paragraph “b”. 30 Any rules adopted in accordance with the provisions of this 31 section shall also be published as a notice of intended action 32 as provided in section 17A.4. 33 2. If during a fiscal year, the department of human 34 services is adopting rules in accordance with this section 35 -11- H8294.4427 (3) 88 pf/rn 11/ 19

or as otherwise directed or authorized by state law, and the 1 rules will result in an expenditure increase beyond the amount 2 anticipated in the budget process or if the expenditure was 3 not addressed in the budget process for the fiscal year, the 4 department shall notify the persons designated by this division 5 of this Act for submission of reports, the chairpersons and 6 ranking members of the committees on appropriations, and 7 the department of management concerning the rules and the 8 expenditure increase. The notification shall be provided at 9 least 30 calendar days prior to the date notice of the rules 10 is submitted to the administrative rules coordinator and the 11 administrative code editor. 12 REPORT ON NONREVERSION OF FUNDS 13 Sec. ___. REPORT ON NONREVERSION OF FUNDS. The department 14 of human services shall report the expenditure of any moneys 15 for which nonreversion authorization was provided for the 16 fiscal year beginning July 1, 2019, and ending June 30, 2020, 17 for the family investment program account, state supplementary 18 assistance, child and family services, the mental health 19 institutes, field operations, or general administration to the 20 chairpersons and ranking members of the joint appropriations 21 subcommittee on health and human services, the legislative 22 services agency, and the four legislative caucus staffs on a 23 quarterly basis beginning October 1, 2020. 24 CHILD AND FAMILY SERVICES 25 Sec. ___. CHILD AND FAMILY SERVICES APPROPRIATION. For the 26 fiscal year beginning July 1, 2020, and ending June 30, 2021, a 27 portion of the funds appropriated from the general fund of the 28 state to the department of human services for child and family 29 services may be used for family-centered services for purposes 30 of complying with the federal Family First Prevention Services 31 Act of 2018, Pub. L. No. 115-123, and successor legislation. 32 DIVISION ___ 33 PUBLIC HEALTH EMERGENCY PROVISIONS 34 COVID-19 REGULATIONS 35 -12- H8294.4427 (3) 88 pf/rn 12/ 19

Sec. ___. COVID-19 FEDERAL REGULATION. For the time 1 period beginning on the effective date of this division of 2 this Act, and ending June 30, 2021, notwithstanding state 3 administrative rules to the contrary, to the extent federal 4 regulations relating to the COVID-19 pandemic differ from state 5 administrative rules, including applicable federal waivers, the 6 federal regulations are controlling during the pendency of the 7 federally declared state of emergency. 8 COUNTY HOSPITAL FUNDING 9 Sec. ___. COUNTY HOSPITAL FUNDING —— SUSTAINING OF HOSPITAL 10 OPERATIONS. For the time period beginning on the effective 11 date of this division of this Act, and ending June 30, 2021, 12 notwithstanding any provision of section 347.14, subsection 13 4, to the contrary, a board of trustees of a county hospital 14 may borrow moneys secured solely by hospital revenues for the 15 purpose of providing working capital or for general financing 16 needs to sustain hospital operations. 17 Sec. ___. COUNTY HOSPITAL FUNDING —— NONCURRENT DEBT 18 ISSUANCE. For the time period beginning on the effective 19 date of this division of this Act, and ending June 30, 2021, 20 notwithstanding any provision of section 331.478, subsections 21 2 and 3, to the contrary, a board of trustees of a county 22 hospital may authorize noncurrent debt for the purpose of 23 providing working capital or for general financing needs to 24 sustain a county hospital’s operations including in the form of 25 natural disaster loans from the state or federal government. 26 Sec. ___. EFFECTIVE DATE. This division of this Act, being 27 deemed of immediate importance, takes effect upon enactment. 28 DIVISION ___ 29 MENTAL HEALTH AND DISABILITY SERVICES 30 Sec. ___. Section 331.389, subsection 4, paragraph c, Code 31 2020, is amended to read as follows: 32 c. The department shall work with any county that has not 33 agreed to be part of a region in accordance with paragraph 34 “a” and with the regions forming around the county to resolve 35 -13- H8294.4427 (3) 88 pf/rn 13/ 19

issues preventing the county from joining a region. In 1 addition to the regional governance agreement requirements 2 in section 331.392, the department may compel the county and 3 region to engage in mediation for resolution of a dispute. 4 The costs incurred for mediation shall be paid by the county 5 and the region in dispute according to their governance 6 agreement. A county that has not agreed to be part of a 7 region in accordance with paragraph “a” shall be assigned by 8 the department to a region, unless exempted prior to July 1, 9 2014. A county assigned by the department to a region shall 10 be included in that region’s amended governance agreement 11 pursuant to this section as of an effective date designated by 12 the department. The assigned county and region shall operate 13 according to the region’s existing governance agreement until 14 the regional governance agreement is amended. 15 Sec. ___. Section 331.389, subsection 5, Code 2020, is 16 amended to read as follows: 17 5. a. If the department determines that a region or an 18 exempted county is not adequately fulfilling the requirements 19 under this chapter for a regional service system, the 20 department shall address the region or county in the following 21 order: 22 a. (1) Require compliance with a corrective action plan. 23 b. (2) Reduce the amount of the annual state funding 24 provided for the regional service system, not to exceed fifteen 25 percent of the amount. 26 c. (3) Withdraw approval for the region or for the county 27 exemption, as applicable. 28 b. The department shall rely on all information available, 29 including annual audits submitted under section 331.391, 30 regional governance agreements submitted under section 331.392, 31 and annual service and budget plans submitted under section 32 331.393 in determining whether a region or an exempted county 33 is adequately fulfilling the requirements for a regional 34 service system. The department may request and review 35 -14- H8294.4427 (3) 88 pf/rn 14/ 19

financial documents, contracts, and other audits, and may 1 perform on-site reviews and interviews to gather information. 2 Sec. ___. Section 331.392, subsection 4, Code 2020, is 3 amended to read as follows: 4 4. The financial provisions of the agreement shall include 5 all of the following: 6 a. Methods for pooling, management, and expenditure of the 7 funding under the control of the regional administrator. If 8 the agreement does not provide for pooling of the participating 9 county moneys in a single fund, the agreement shall specify how 10 the participating county moneys will be subject to the control 11 of the regional administrator. 12 b. (1) Methods for allocating administrative funding and 13 resources. 14 (2) Methods for allocating a region’s cash flow amount in 15 the event a county leaves the region. A region’s cash flow 16 amount shall be divided by the percentage of each county’s 17 population according to the region’s population indicated 18 in the region’s annual service and budget plan and shall be 19 allocated to the counties. This subparagraph shall apply to 20 all agreements in existence or entered into on or after July 21 1, 2020. 22 c. Contributions and uses of initial funding or related 23 contributions made by the counties participating in the 24 region for purposes of commencing operations by the regional 25 administrator. 26 d. Methods for acquiring or disposing of real property. 27 e. A process for determining the use of savings for 28 reinvestment. 29 f. A process for performance of an annual independent audit 30 of the regional administrator. The annual independent audit 31 prepared by the regional administrator shall be submitted to 32 the department upon completion of the audit. 33 Sec. ___. Section 331.392, Code 2020, is amended by adding 34 the following new subsection: 35 -15- H8294.4427 (3) 88 pf/rn 15/ 19

NEW SUBSECTION . 6. All agreements shall be submitted to the 1 department. The department shall approve the agreement if the 2 agreement complies with the requirements of this section. 3 Sec. ___. MENTAL HEALTH AND DISABILITY SERVICES —— 4 REGIONALIZATION AUTHORIZATION. 5 1. The department of human services shall facilitate the 6 county social services mental health and disability services 7 region dividing into two separate regions. All member 8 counties shall participate in the planning as required by the 9 department. Counties in the western portion of the region may 10 form a new region if the counties meet the requirements of 11 this section. Counties in the eastern portion of the region 12 shall retain the name county social services if a new region is 13 formed by the counties in the western portion of the region. 14 2. County formation of a proposed new mental health and 15 disability services region pursuant to this section is subject 16 to all of the following: 17 a. The aggregate population of all counties forming 18 the region is at least 50,000 and includes at least one 19 incorporated city with a population of more than 24,000. For 20 purposes of this subparagraph, “population” means the same as 21 defined in section 331.388, subsection 4, Code 2020. 22 b. Notwithstanding section 331.389, subsection 4, on or 23 before February 1, 2021, the counties forming the region have 24 complied with section 331.389, subsection 3, and all of the 25 following additional requirements: 26 (1) The board of supervisors of each county forming the 27 region has voted to approve a chapter 28E agreement. 28 (2) The duly authorized representatives of all the counties 29 forming the region have signed a chapter 28E agreement that is 30 in compliance with section 331.392 and 441 IAC 25.14. 31 (3) The county board of supervisors’ or supervisors’ 32 designee members and other members of the region’s governing 33 board are appointed in accordance with section 331.390. 34 (4) Executive staff for the region’s regional administrator 35 -16- H8294.4427 (3) 88 pf/rn 16/ 19

are identified or engaged. 1 (5) The regional service management plan is developed in 2 accordance with section 331.393 and 441 IAC 25.18 and 441 IAC 3 25.21 and is submitted to the department. 4 (6) The initial regional service management plan shall 5 identify the service provider network for the region, identify 6 the information technology and data management capacity to be 7 employed to support regional functions, and establish business 8 functions, accounting procedures, and other administrative 9 processes. 10 c. Each county forming the region shall submit the 11 compliance information required in paragraph “b” to the 12 director of human services on or before February 1, 2021. 13 Within forty-five days of receipt of such information, the 14 director of human services shall determine if the region is in 15 full compliance and shall approve the region if the region has 16 met all of the requirements of this section. 17 d. The director of human services shall work with a county 18 making a request under this section that has not agreed or 19 is unable to join the proposed new region to resolve issues 20 preventing the county from joining the proposed new region. 21 e. By February 1, 2021, the director of human services 22 shall assign a county, making a request under this section 23 that has not reached an agreement to be part of the proposed 24 new region, to an existing region or to another new proposed 25 region, consistent with this section. 26 3. If approved by the department, the region shall commence 27 full operations no later than July 1, 2021. 28 Sec. ___. MENTAL HEALTH AND DISABILITY SERVICES —— TRANSFER 29 OF FUNDS. Notwithstanding section 331.432, a county with a 30 population of over 300,000 based on the most recent federal 31 decennial census may transfer funds from any other fund 32 of the county to the mental health and disability regional 33 services fund for the purposes of providing mental health and 34 disability services for the fiscal year beginning July 1, 35 -17- H8294.4427 (3) 88 pf/rn 17/ 19

2020, and ending June 30, 2021. The county shall submit a 1 report to the governor and the general assembly by September 2 1, 2021, including the source of any funds transferred, the 3 amount of the funds transferred, and the mental health and 4 disability services provided with the transferred funds. The 5 county shall work with the department to maximize the use of 6 the medical assistance program and other third-party payment 7 sources, including but not limited to identifying individuals 8 enrolled with or eligible for Medicaid whose Medicaid-covered 9 services are being paid by the county or could be converted to 10 Medicaid-covered services. 11 DIVISION ___ 12 FOSTER HOME INSURANCE FUND 13 Sec. ___. Section 237.13, Code 2020, is amended by striking 14 the section and inserting in lieu thereof the following: 15 237.13 Foster home insurance fund. 16 1. For the purposes of this section, “foster home” means an 17 individual, as defined in section 237.1, subsection 7, who is 18 licensed to provide child foster care and shall also be known 19 as a “licensed foster home” . 20 2. The foster home insurance fund shall be administered by 21 the department of human services. The fund shall consist of 22 all moneys appropriated by the general assembly for deposit 23 in the fund. The department shall use moneys in the fund to 24 reimburse foster parents for the cost of purchasing foster care 25 liability insurance and to perform the administrative functions 26 necessary to carry out this section. 27 3. The department of human services shall adopt rules, 28 pursuant to chapter 17A, to carry out the provisions of this 29 section. 30 DIVISION ___ 31 VETERANS HOME CARRYFORWARD 32 Sec. ___. Section 35D.18, subsection 5, Code 2020, is 33 amended to read as follows: 34 5. Notwithstanding section 8.33 , any up to eight hundred 35 -18- H8294.4427 (3) 88 pf/rn 18/ 19

thousand dollars of the balance in the Iowa veterans home 1 annual appropriation or revenues that remains unencumbered or 2 unobligated at the close of the fiscal year shall not revert 3 but shall remain available for expenditure for specified 4 purposes of the Iowa veterans home until the close of the 5 succeeding fiscal year. >> 6 2. By renumbering, redesignating, and correcting internal 7 references as necessary. 8 ______________________________ FRY of Clarke -19- H8294.4427 (3) 88 pf/rn 19/ 19 #2.