House File 2698 H-8348 Amend House File 2698 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < DIVISION I 4 DEPARTMENT OF VETERANS AFFAIRS —— FY 2024-2025 5 Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is 6 appropriated from the general fund of the state to the 7 department of veterans affairs for the fiscal year beginning 8 July 1, 2024, and ending June 30, 2025, the following amounts, 9 or so much thereof as is necessary, to be used for the purposes 10 designated: 11 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 12 For salaries, support, maintenance, and miscellaneous 13 purposes, and for not more than the following full-time 14 equivalent positions: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 17 2. IOWA VETERANS HOME 18 For salaries, support, maintenance, and miscellaneous 19 purposes: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 21 a. The Iowa veterans home billings involving the department 22 of health and human services shall be submitted to the 23 department on at least a monthly basis. 24 b. The Iowa veterans home expenditure report shall be 25 submitted monthly to the general assembly. 26 3. HOME OWNERSHIP ASSISTANCE PROGRAM 27 For transfer to the Iowa finance authority for the 28 continuation of the home ownership assistance program for 29 persons who are or were eligible members of the armed forces of 30 the United States, pursuant to section 16.54: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 32 DIVISION II 33 AGING AND DISABILITY SERVICES —— FY 2024-2025 34 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 35 -1- HF 2698.4378 (2) 90 pf/ko 1/ 59 #1.

AND DISABILITY SERVICES. There is appropriated from the 1 general fund of the state to the department of health and human 2 services for the fiscal year beginning July 1, 2024, and ending 3 June 30, 2025, the following amount, or so much thereof as is 4 necessary, to be used for the purposes designated: 5 For aging programs for the department of health and human 6 services and area agencies on aging to provide citizens of 7 Iowa who are 60 years of age and older with case management; 8 Iowa’s aging and disabilities resource centers; for the 9 return to community program; for the purposes of chapter 231E, 10 to administer the prevention of elder abuse, neglect, and 11 exploitation program pursuant to section 231.56A, in accordance 12 with the requirements of the federal Older Americans Act of 13 1965, 42 U.S.C. §3001 et seq., as amended; for the reporting 14 and evaluation of cases of dependant adult abuse pursuant to 15 chapter 235B; and for other services which may include but are 16 not limited to adult day, respite care, chore, information 17 and assistance, and material aid, for information and options 18 counseling for persons with disabilities, and for salaries, 19 support, administration, maintenance, and miscellaneous 20 purposes: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,088,714 22 1. Funds appropriated in this section may be used to 23 supplement federal funds under federal regulations. To 24 receive funds appropriated in this section, a local area 25 agency on aging shall match the funds with moneys from other 26 sources according to rules adopted by the department. Funds 27 appropriated in this section may be used for services not 28 specifically enumerated in this section only if approved by the 29 department as part of an area agency on aging’s area plan. 30 2. Of the funds appropriated in this section, $949,282 31 shall be used for the family support center component of the 32 comprehensive family support program under chapter 225C, 33 subchapter V. 34 3. Of the funds appropriated in this section, $33,632 shall 35 -2- HF 2698.4378 (2) 90 pf/ko 2/ 59

be used to build community capacity through the coordination 1 and provision of training opportunities in accordance with the 2 consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 3 Iowa, July 14, 1994). 4 DIVISION III 5 BEHAVIORAL HEALTH —— FY 2024-2025 6 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 7 BEHAVIORAL HEALTH. There is appropriated from the general fund 8 of the state to the department of health and human services for 9 the fiscal year beginning July 1, 2024, and ending June 30, 10 2025, the following amount, or so much thereof as is necessary, 11 to be used for the purposes designated: 12 For behavioral health prevention, treatment, and recovery 13 efforts to reduce the prevalence of the use of, provide 14 treatment for, and support recovery from tobacco and substance 15 use and misuse pursuant to the applicable policy, purpose, 16 and intent described in sections 125.1 and 142A.1, alcohol, 17 problem gambling, and other addictive behaviors. Activities 18 shall align with accepted best practice guidance standards for 19 behavioral health including those published by the centers for 20 disease control and prevention and the substance abuse and 21 mental health services administration of the United States 22 department of health and human services for health promotion; 23 universal, selective, and indicated prevention; treatment; and 24 recovery services and supports; and shall include a 24-hour 25 helpline, public information resources, professional training, 26 youth prevention, program evaluation, and efforts at the state 27 and local levels: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,400,114 29 1. Of the funds appropriated in this section, $300,000 shall 30 be used to support the work of the children’s behavioral health 31 system including evidence-based behavioral health prevention, 32 treatment, and recovery services and supports for children and 33 their families pursuant to the intent specified in section 34 225C.6B, subsection 1. 35 -3- HF 2698.4378 (2) 90 pf/ko 3/ 59

2. Of the funds appropriated in this section, $950,000 1 shall be used for an integrated substance use disorder managed 2 care system. The department shall maintain the level of mental 3 health and substance use disorder treatment services provided 4 by the managed care contractors. The department shall take the 5 steps necessary to continue the federal waivers as needed to 6 maintain the level of services. 7 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 8 WAGERING RECEIPTS FUND. There is appropriated from the sports 9 wagering receipts fund created in section 8.57, subsection 6, 10 to the department of health and human services for the fiscal 11 year beginning July 1, 2024, and ending June 30, 2025, the 12 following amount, or so much thereof as is necessary, to be 13 used for behavioral health prevention, treatment, and recovery 14 efforts to reduce the prevalence of the use of, provide 15 treatment for, and support recovery from tobacco and substance 16 use and misuse pursuant to the applicable policy, purpose, and 17 intent described in sections 125.1 and 142A.1, alcohol, problem 18 gambling, and other addictive behaviors: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 20 DIVISION IV 21 PUBLIC HEALTH —— FY 2024-2025 22 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 23 HEALTH. There is appropriated from the general fund of the 24 state to the department of health and human services for the 25 fiscal year beginning July 1, 2024, and ending June 30, 2025, 26 the following amount, or so much thereof as is necessary, to be 27 used for the purposes designated: 28 For programs that support health promotion, protect the 29 health and safety of the public, conduct disease surveillance 30 and investigation to reduce the incidence of morbidity and 31 mortality, serve individuals with chronic conditions including 32 but not limited to cancer, support the Iowa donor registry as 33 specified in section 142C.18, and strengthen the health care 34 delivery system and workforce to improve health outcomes for 35 -4- HF 2698.4378 (2) 90 pf/ko 4/ 59

all Iowans: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,531,821 2 1. Of the funds appropriated in this section, $2,100,000 3 shall be deposited in the medical residency training account 4 created in section 135.175, subsection 5, paragraph “a”, and is 5 appropriated from the account to the department to be used for 6 the purposes of the medical residency training state matching 7 grants program as specified in section 135.176. 8 2. Of the funds appropriated in this section, the following 9 amounts are allocated to be used as follows to support the 10 goals of increased access, health system integration, and 11 engagement: 12 a. $600,000 is allocated to the Iowa prescription 13 drug corporation for continuation of the pharmaceutical 14 infrastructure for safety net providers originally established 15 as described in 2007 Iowa Acts, chapter 218, section 108, and 16 for the prescription drug donation repository program created 17 in chapter 135M. Funds allocated under this paragraph shall 18 be distributed in their entirety for the purpose specified on 19 July 1, 2024. 20 b. $374,000 is allocated to free clinics and free clinics 21 of Iowa for necessary infrastructure, statewide coordination, 22 provider recruitment, service delivery, and provision of 23 assistance to patients in securing a medical home inclusive 24 of oral health care. Of the funds allocated, $40,000 shall 25 be used to cover fees associated with using an electronic 26 prescribing system. Funds allocated under this paragraph shall 27 be distributed in their entirety for the purpose specified on 28 July 1, 2024. 29 c. $25,000 is allocated to the Iowa association of rural 30 health clinics for necessary infrastructure and service 31 delivery transformation. Funds allocated under this paragraph 32 shall be distributed in their entirety for the purpose 33 specified on July 1, 2024. 34 d. $225,000 is allocated to the Polk county medical society 35 -5- HF 2698.4378 (2) 90 pf/ko 5/ 59

for continuation of the safety net provider patients access 1 to specialty care initiative as described in 2007 Iowa Acts, 2 chapter 218, section 109. Funds allocated under this paragraph 3 shall be distributed in their entirety for the purpose 4 specified on July 1, 2024. 5 3. Of the funds appropriated in this section, $800,000 6 shall be used for rural psychiatric residencies to annually 7 fund eight psychiatric residents who will provide mental health 8 services in underserved areas of the state. 9 4. Of the funds appropriated in this section, $560,000 shall 10 be deposited in the state-funded family medicine obstetrics 11 fellowship program fund to be used for the state-funded family 12 medicine obstetrics fellowship program, in accordance with 13 section 135.193. 14 5. The department shall work with the board established 15 in chapter 135D to develop plans for program enhancements 16 in the Iowa health information network for the purpose of 17 empowering Iowa patients to access and direct their health 18 information utilizing the Iowa health information network. 19 Program enhancements shall protect data privacy, facilitate the 20 interchange of health data for the purpose of improving public 21 health outcomes, and increase participation by health care 22 providers. 23 6. The university of Iowa hospitals and clinics under 24 the control of the state board of regents shall not receive 25 indirect costs from the funds appropriated in this section. 26 The university of Iowa hospitals and clinics billings to the 27 department shall be on at least a quarterly basis. 28 DIVISION V 29 COMMUNITY ACCESS AND ELIGIBILITY —— FY 2024-2025 30 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 31 ACCESS AND ELIGIBILITY. There is appropriated from the 32 general fund of the state to the department of health and human 33 services for the fiscal year beginning July 1, 2024, and ending 34 June 30, 2025, the following amount, or so much thereof as is 35 -6- HF 2698.4378 (2) 90 pf/ko 6/ 59

necessary, to be used for the purposes designated: 1 To be used for salaries, support, maintenance, and 2 miscellaneous purposes and for family investment program (FIP) 3 assistance in accordance with chapter 239B, and for other costs 4 associated with providing needs-based benefits or assistance 5 including but not limited to maternal and child health, oral 6 health, obesity prevention, the promoting independence and 7 self-sufficiency through employment, job opportunities and 8 basic skills (PROMISE JOBS) program, supplemental nutrition 9 assistance program (SNAP) employment and training, the FIP 10 diversion program, family planning, rent reimbursement, 11 and eligibility determinations for medical assistance, food 12 assistance, and the children’s health insurance program: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,043,944 14 1. Of the child support collections assigned under FIP, 15 the federal share of support collections shall be credited to 16 the child support services appropriation made in this division 17 of this Act. Of the remainder of the assigned child support 18 collections received by child support services, a portion 19 shall be credited to community access and eligibility, and 20 the remaining funds may be used to increase recoveries, to 21 sustain cash flow in the child support payments account, or for 22 technology needs. If child support collections assigned under 23 FIP are greater than estimated or are otherwise determined not 24 to be required for maintenance of effort, the state share of 25 either amount may be transferred to or retained in the child 26 support payments account. 27 2. Of the funds appropriated in this section, $3,075,000 28 shall be used for continuation of the department’s initiative 29 to provide for adequate developmental surveillance and 30 screening during a child’s first five years. The funds shall 31 be used first to fully fund the current participating counties 32 to ensure that those counties are fully operational, with the 33 remaining funds to be used for expanding participation to 34 additional counties. The full implementation and expansion 35 -7- HF 2698.4378 (2) 90 pf/ko 7/ 59

shall include enhancing the scope of the initiative through 1 collaboration with the child health specialty clinics to 2 promote the use of developmental surveillance and screening to 3 support healthy child development through early identification 4 and response to both biomedical and social determinants of 5 healthy development by providing practitioner consultation 6 and continuous improvement through training and education, 7 particularly for children with behavioral conditions and 8 needs. The department shall also collaborate with the Medicaid 9 program and the child health specialty clinics to assist in 10 coordinating the activities of the first five initiative into 11 the establishment of patient-centered medical homes developed 12 to improve health quality and population health while reducing 13 health care costs. To the maximum extent possible, funding 14 allocated in this subsection shall be utilized as matching 15 funds for Medicaid program reimbursement. 16 3. Of the funds appropriated in this section, $1,145,102 17 is allocated to the Iowa commission on volunteer service for 18 programs and grants. 19 4. The university of Iowa hospitals and clinics under 20 the control of the state board of regents shall not receive 21 indirect costs from the funds appropriated in this section. 22 The university of Iowa hospitals and clinics billings to the 23 department shall be on at least a quarterly basis. 24 CHILD SUPPORT SERVICES 25 Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from 26 the general fund of the state to the department of health and 27 human services for the fiscal year beginning July 1, 2024, and 28 ending June 30, 2025, the following amount, or so much thereof 29 as is necessary, to be used for the purposes designated: 30 For child support services, including salaries, support, 31 maintenance, and miscellaneous purposes: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,434,282 33 1. Federal access and visitation grant moneys shall be used 34 for services designed to increase compliance with the child 35 -8- HF 2698.4378 (2) 90 pf/ko 8/ 59

access provisions of court orders, including but not limited to 1 neutral visitation sites and mediation services. 2 2. The appropriation made to the department for child 3 support services may be used throughout the fiscal year in the 4 manner necessary for purposes of cash flow management, and for 5 cash flow management purposes the department may temporarily 6 draw more than the amount appropriated, provided the amount 7 appropriated is not exceeded at the close of the fiscal year. 8 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT 9 Sec. 8. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 10 GRANT. There is appropriated from the special fund created in 11 section 8.41 to the department of health and human services 12 for the fiscal year beginning July 1, 2024, and ending June 13 30, 2025, from moneys received under the federal temporary 14 assistance for needy families (TANF) block grant pursuant 15 to the federal Personal Responsibility and Work Opportunity 16 Reconciliation Act of 1996, Pub. L. No. 104-193, and successor 17 legislation, the following amounts, or so much thereof as is 18 necessary, to be used for the purposes designated: 19 1. For community access and eligibility, FIP, the PROMISE 20 JOBS program, implementing family investment agreements in 21 accordance with chapter 239B, and for continuation of the 22 program promoting awareness of the benefits of a healthy 23 marriage: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627 25 2. For community access and eligibility to provide 26 pregnancy prevention grants on the condition that family 27 planning services are funded: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 29 Pregnancy prevention grants shall be awarded to programs 30 in existence on or before July 1, 2024, if the programs have 31 demonstrated positive outcomes. Grants shall be awarded to 32 pregnancy prevention programs which are developed after July 33 1, 2024, if the programs are based on existing models that 34 have demonstrated positive outcomes. Grants shall comply with 35 -9- HF 2698.4378 (2) 90 pf/ko 9/ 59

the requirements provided in 1997 Iowa Acts, chapter 208, 1 section 14, subsections 1 and 2, including the requirement that 2 grant programs must emphasize sexual abstinence. Priority in 3 the awarding of grants shall be given to programs that serve 4 areas of the state which demonstrate the highest percentage of 5 unplanned pregnancies of females of childbearing age within the 6 geographic area to be served by the grant. 7 3. For community access and eligibility to meet one of the 8 four core purposes of TANF as specified in 45 C.F.R. §260.20, 9 including by modernizing the program to promote economic 10 mobility and self-sufficiency, ensuring that families are able 11 to overcome benefit cliffs, encouraging healthy families, and 12 streamlining service delivery to reduce duplication: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 14 4. For technology needs related to child support 15 modernization of the Iowa collections and reporting (ICAR) 16 system and for a closed loop referral system for the thrive 17 Iowa program: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 19 5. For early intervention and supports for the family 20 development and self-sufficiency (FaDSS) grant program in 21 accordance with section 216A.107: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,888,980 23 Of the funds allocated for the FaDSS grant program in this 24 subsection, not more than 5 percent of the funds shall be used 25 for administrative purposes. 26 6. For early intervention and supports for child abuse 27 prevention grants: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 125,000 29 7. For accountability, compliance, program integrity, 30 technology needs, and other resources necessary to meet federal 31 and state reporting, tracking, and case management requirements 32 and other departmental needs: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 34 8. For state child care assistance: 35 -10- HF 2698.4378 (2) 90 pf/ko 10/ 59

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 1 9. For child protective services: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 62,364,100 3 10. For child protective services for the kinship stipend 4 program: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,000,000 6 DIVISION VI 7 MEDICAL ASSISTANCE —— STATE SUPPLEMENTARY ASSISTANCE —— HEALTHY 8 AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED PROGRAMS 9 —— FY 2024-2025 10 Sec. 9. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY 11 ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There 12 is appropriated from the general fund of the state to the 13 department of health and human services for the fiscal year 14 beginning July 1, 2024, and ending June 30, 2025, the following 15 amount, or so much thereof as is necessary, to be used for the 16 purposes designated: 17 For medical assistance program reimbursement and associated 18 costs as specifically provided in the reimbursement 19 methodologies in effect on June 30, 2024, except as otherwise 20 expressly authorized by law, consistent with options under 21 federal law and regulations, and contingent upon receipt of 22 approval from the office of the governor of reimbursement 23 for each abortion performed under the program; for the state 24 supplementary assistance program; for the health insurance 25 premium payment program; and for maintenance of the healthy and 26 well kids in Iowa (Hawki) program pursuant to chapter 514I, 27 including supplemental dental services, for receipt of federal 28 financial participation under Tit. XXI of the federal Social 29 Security Act, which creates the children’s health insurance 30 program; and for other specified health-related programs: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,650,866,536 32 1. Of the funds appropriated in this section, 33 $1,605,063,804 is allocated for medical assistance program 34 reimbursement and associated costs. 35 -11- HF 2698.4378 (2) 90 pf/ko 11/ 59

a. Of the funds allocated in this subsection, $800,000 shall 1 be used for the renovation and construction of certain nursing 2 facilities, consistent with the provisions of chapter 249K. 3 b. Of the funds allocated in this subsection, $3,383,880 4 shall be used for program administration, outreach, and 5 enrollment activities of the state family planning services 6 program pursuant to section 217.41B, and of this amount, the 7 department may use $200,000 for administrative expenses. 8 c. Of the funds allocated in this subsection, 9 $1,700,000 shall be used to provide for additional home and 10 community-based services waiver slots for individuals with an 11 intellectual disability. 12 2. Iowans support reducing the number of abortions 13 performed in our state. Funds appropriated under this section 14 shall not be used for abortions, unless otherwise authorized 15 under this section. 16 3. The provisions of this section relating to abortions 17 shall also apply to the Iowa health and wellness plan created 18 pursuant to chapter 249N. 19 4. Of the funds appropriated in this section, $4,479,762 is 20 allocated for the state supplementary assistance program. 21 5. Of the funds appropriated in this section, $41,322,970 22 is allocated for maintenance of the Hawki program pursuant 23 to chapter 514I, including supplemental dental services, for 24 receipt of federal financial participation under Tit. XXI of 25 the federal Social Security Act, which creates the children’s 26 health insurance program. 27 HEALTH PROGRAM OPERATIONS 28 Sec. 10. HEALTH PROGRAM OPERATIONS. There is appropriated 29 from the general fund of the state to the department of health 30 and human services for the fiscal year beginning July 1, 31 2024, and ending June 30, 2025, the following amount, or so 32 much thereof as is necessary, to be used for the purposes 33 designated: 34 For health program operations and the autism support 35 -12- HF 2698.4378 (2) 90 pf/ko 12/ 59

program: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,597,231 2 1. The department of inspections, appeals, and licensing 3 shall provide all state matching funds for survey and 4 certification activities performed by the department of 5 inspections, appeals, and licensing. The department of health 6 and human services is solely responsible for distributing the 7 federal matching funds for such activities. 8 2. Of the funds appropriated in this section, a sufficient 9 amount shall be used for the administration of the health 10 insurance premium payment program, including salaries, support, 11 maintenance, and miscellaneous purposes. 12 3. Of the funds appropriated in this section, $750,000 shall 13 be used for the state poison control center. Pursuant to the 14 directive under 2014 Iowa Acts, chapter 1140, section 102, the 15 federal matching funds available to the state poison control 16 center from the department under the federal Children’s Health 17 Insurance Program Reauthorization Act of 2009 allotment shall 18 be subject to the federal administrative cap rule of 10 percent 19 applicable to funding provided under Tit. XXI of the federal 20 Social Security Act and included within the department’s 21 calculations of the cap. 22 4. Unless otherwise provided, annual increases for services 23 provided through contracts funded under this section shall 24 not exceed the amount by which the consumer price index for 25 all urban consumers increased during the most recently ended 26 calendar year. 27 HEALTH CARE ACCOUNTS AND FUNDS 28 Sec. 11. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT 29 OF HEALTH AND HUMAN SERVICES. There is appropriated from the 30 pharmaceutical settlement account created in section 249A.33 to 31 the department of health and human services for the fiscal year 32 beginning July 1, 2024, and ending June 30, 2025, the following 33 amount, or so much thereof as is necessary, to be used for the 34 purposes designated: 35 -13- HF 2698.4378 (2) 90 pf/ko 13/ 59

Notwithstanding any provision of law to the contrary, to 1 supplement the appropriation made in this Act for health 2 program operations under the medical assistance program for the 3 same fiscal year: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 5 Sec. 12. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF 6 HEALTH AND HUMAN SERVICES. Notwithstanding any provision to 7 the contrary and subject to the availability of funds, there is 8 appropriated from the quality assurance trust fund created in 9 section 249L.4 to the department of health and human services 10 for the fiscal year beginning July 1, 2024, and ending June 30, 11 2025, the following amount, or so much thereof as is necessary, 12 for the purposes designated: 13 To supplement the appropriation made in this Act from the 14 general fund of the state to the department of health and human 15 services for medical assistance for the same fiscal year: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 17 Sec. 13. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 18 DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding any 19 provision to the contrary and subject to the availability of 20 funds, there is appropriated from the hospital health care 21 access trust fund created in section 249M.4 to the department 22 of health and human services for the fiscal year beginning July 23 1, 2024, and ending June 30, 2025, the following amount, or so 24 much thereof as is necessary, for the purposes designated: 25 To supplement the appropriation made in this Act from the 26 general fund of the state to the department of health and human 27 services for medical assistance for the same fiscal year: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 29 REIMBURSEMENT RATES 30 Sec. 14. REIMBURSEMENT RATES. 31 1. Reimbursement for medical assistance, state 32 supplementary assistance, and social service providers and 33 services reimbursed under the purview of the department of 34 health and human services shall remain at the reimbursement 35 -14- HF 2698.4378 (2) 90 pf/ko 14/ 59

rate or shall be determined pursuant to the reimbursement 1 methodology in effect on June 30, 2024, with the exception of 2 the following: 3 a. If reimbursement is otherwise negotiated by contract or 4 pursuant to an updated fee schedule. 5 b. As otherwise provided in this section. 6 2. a. Notwithstanding any provision of law to the contrary, 7 for the fiscal year beginning July 1, 2024, and ending June 8 30, 2025, the department of health and human services shall 9 reimburse case-mix nursing facility rates at the amounts in 10 effect on June 30, 2024. 11 b. The department of health and human services shall 12 calculate each nursing facility’s case-mix index for the period 13 beginning July 1, 2023, using weighting based on the current 14 patient driven payment model (PDPM) schedule. Rosters shall be 15 made to show a separate calculation to determine the average 16 case-mix index for a nursing-facility-wide case mix index, and 17 a case-mix index for the residents of a nursing facility who 18 are Medicaid recipients using all minimum data set reports by 19 the nursing facility for the previous semi-annual period using 20 a day weighted calculation. 21 3. For the fiscal year beginning July 1, 2024, Medicaid 22 provider rates shall be adjusted to 85 percent of the benchmark 23 rates based on the department’s 2023 Medicaid rate review for 24 all of the following Medicaid providers: 25 a. Medical supply providers. 26 b. Physician assistants. 27 c. Physical therapists. 28 d. Occupational therapists. 29 e. Certified nurse midwives. 30 4. For the fiscal year beginning July 1, 2024, reimbursement 31 rates for home and community-based services providers shall be 32 increased compared to the rates in effect on June 30, 2024, to 33 the extent possible within the state funding, including the 34 $14,600,000 provided for this purpose. 35 -15- HF 2698.4378 (2) 90 pf/ko 15/ 59

5. For the fiscal year beginning July 1, 2024, reimbursement 1 rates for community mental health centers shall be increased 2 compared to the rates in effect on June 30, 2024, to the extent 3 possible within the state funding, including the $276,947 4 provided for this purpose. 5 6. For the fiscal year beginning July 1, 2024, enhanced 6 reimbursement shall be provided within the additional $369,000 7 appropriated for this purpose for a psychiatric medical 8 institution for children that meets the selection criteria 9 specified in 2024 Iowa Acts, House File 2402, or successor 10 legislation, if enacted. 11 7. For the fiscal year beginning July 1, 2024, the pharmacy 12 dispensing fee shall be adjusted within the additional $500,000 13 appropriated for this purpose. 14 8. For the fiscal year beginning July 1, 2024, the 15 reimbursement rates for mental health providers shall be 16 increased within the additional $2,104,186 appropriated for 17 this purpose. 18 9. For the fiscal year beginning July 1, 2024, 19 residential-based supported community living provider 20 rates shall be increased within the additional $1,352,750 21 appropriated for this purpose. 22 10. For the fiscal year beginning July 1, 2024, 23 reimbursement rates for home heath agencies shall continue to 24 be based on the Medicare low utilization payment adjustment 25 (LUPA) methodology with state geographic wage adjustments and 26 shall be adjusted to increase the rates to the extent possible 27 within the state funding appropriated. The department shall 28 continue to update the rates every two years to reflect the 29 most recent Medicare LUPA rates. 30 11. For the fiscal year beginning July 1, 2024, 31 reimbursement rates for air medical services provided by an 32 entity that has over 40 years of experience and is the largest 33 community-based provider of air medical services shall be 34 increased within the additional $250,000 appropriated for this 35 -16- HF 2698.4378 (2) 90 pf/ko 16/ 59

purpose. 1 DIVISION VII 2 FAMILY WELL-BEING AND PROTECTION —— FY 2024-2025 3 STATE CHILD CARE ASSISTANCE 4 Sec. 15. STATE CHILD CARE ASSISTANCE. There is appropriated 5 from the general fund of the state to the department of health 6 and human services for the fiscal year beginning July 1, 7 2024, and ending June 30, 2025, the following amount, or so 8 much thereof as is necessary, to be used for the purposes 9 designated: 10 For state child care assistance in accordance with section 11 237A.13: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34,966,931 13 1. If the appropriations made for purposes of the state 14 child care assistance program for the fiscal year are 15 determined to be insufficient, it is the intent of the general 16 assembly to appropriate sufficient funding for the fiscal year 17 in order to avoid establishment of waiting list requirements. 18 2. A portion of the state match for the federal child care 19 and development block grant shall be provided as necessary to 20 meet federal matching funds requirements through the state 21 general fund appropriation made for child development grants 22 and other programs for at-risk children in section 279.51. 23 EARLY INTERVENTION AND SUPPORTS 24 Sec. 16. EARLY INTERVENTION AND SUPPORTS. There is 25 appropriated from the general fund of the state to the 26 department of health and human services for the fiscal year 27 beginning July 1, 2024, and ending June 30, 2025, the following 28 amount, or so much thereof as is necessary, to be used for the 29 purposes designated: 30 For promoting the optimum health status for children 31 and adolescents from birth through 21 years of age, and for 32 families: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35,277,739 34 1. Of the funds appropriated in this section, not more 35 -17- HF 2698.4378 (2) 90 pf/ko 17/ 59