Senate File 649 S-3158 Amend Senate File 649 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < DIVISION I 4 DEPARTMENT OF VETERANS AFFAIRS —— FY 2025-2026 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, 2025, and ending June 30, 2026, 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 30 of the United States or eligible service members pursuant to 31 section 16.54: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 33 DIVISION II 34 AGING AND DISABILITY SERVICES —— FY 2025-2026 35 -1- SF 649.1953 (2) 91 lh/ko 1/ 34 #1.

Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 1 AND DISABILITY SERVICES. There is appropriated from the 2 general fund of the state to the department of health and human 3 services for the fiscal year beginning July 1, 2025, and ending 4 June 30, 2026, the following amount, or so much thereof as is 5 necessary, to be used for the purposes designated: 6 For aging programs for the department of health and human 7 services and area agencies on aging to provide citizens of 8 Iowa who are 60 years of age and older with case management; 9 for Iowa’s aging and disabilities resource centers; for the 10 return to community program; for the purposes of chapter 231E; 11 to administer the prevention of elder abuse, neglect, and 12 exploitation program pursuant to section 231.56A, in accordance 13 with the requirements of the federal Older Americans Act of 14 1965, 42 U.S.C. §3001 et seq., as amended; for the operation 15 of the dependent adult abuse services program pursuant to 16 chapter 235B; for other services which may include but are not 17 limited to adult day care, respite care, chore, information 18 and assistance, and material aid; for information and options 19 counseling for persons with disabilities; and for salaries, 20 support, administration, maintenance, and miscellaneous 21 purposes, and for not more than the following full-time 22 equivalent positions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,208,180 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 88.00 25 1. Moneys appropriated in this section may be used to 26 supplement federal moneys received under federal regulations. 27 To receive moneys appropriated in this section, a local area 28 agency on aging shall match the moneys with moneys from other 29 sources according to rules adopted by the department. Moneys 30 appropriated in this section may be used for services not 31 specifically enumerated in this section only if approved by the 32 department as part of an area agency on aging’s area plan. 33 2. Of the moneys appropriated in this section, $949,282 34 shall be used for the family support center component of the 35 -2- SF 649.1953 (2) 91 lh/ko 2/ 34

comprehensive family support program under section 225C.47. 1 3. Of the moneys appropriated in this section, $33,632 shall 2 be used to build community capacity through the coordination 3 and provision of training opportunities in accordance with the 4 consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 5 Iowa, July 15, 1994). 6 DIVISION III 7 BEHAVIORAL HEALTH —— FY 2025-2026 8 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 9 BEHAVIORAL HEALTH. There is appropriated from the general fund 10 of the state to the department of health and human services for 11 the fiscal year beginning July 1, 2025, and ending June 30, 12 2026, the following amount, or so much thereof as is necessary, 13 to be used for the purposes designated: 14 For behavioral health prevention, treatment, and recovery 15 efforts to reduce the prevalence of the use of, provide 16 treatment for, and support recovery from alcohol, tobacco, and 17 substance use and misuse, problem gambling, and other addictive 18 behaviors. Activities shall align with accepted best practice 19 guidance standards for behavioral health including those 20 published by the centers for disease control and prevention of 21 the United States department of health and human services, and 22 the substance abuse and mental health services administration 23 of the United States department of health and human services, 24 for health promotion; universal, selective, and indicated 25 prevention; treatment; and recovery services and supports; and 26 shall include a 24-hour helpline, public information resources, 27 professional training, youth prevention, program evaluation, 28 and efforts at the state and local levels, and for not more 29 than the following full-time equivalent positions: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,442,121 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 71.00 32 1. Of the moneys appropriated in this section, $300,000 33 shall be used to support the work of the children’s behavioral 34 health system including evidence-based behavioral health 35 -3- SF 649.1953 (2) 91 lh/ko 3/ 34

prevention, treatment, and recovery services and supports for 1 children and their families pursuant to the intent specified in 2 section 225C.6B, subsection 1. 3 2. Of the moneys appropriated in this section, $950,000 4 shall be used for an integrated substance use disorder managed 5 care system. The department shall maintain the level of mental 6 health and substance use disorder treatment services provided 7 by the managed care contractors, and shall take the steps 8 necessary to continue the federal waivers as needed to maintain 9 the level of services. 10 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 11 WAGERING RECEIPTS FUND. There is appropriated from the 12 sports wagering receipts fund created in section 8.57I, to the 13 department of health and human services for the fiscal year 14 beginning July 1, 2025, and ending June 30, 2026, the following 15 amount, or so much thereof as is necessary, to be used for 16 behavioral health prevention, treatment, and recovery efforts 17 to reduce the prevalence of the use of, provide treatment for, 18 and support recovery from alcohol, tobacco, and substance use 19 and misuse, problem gambling, and other addictive behaviors: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 21 DIVISION IV 22 PUBLIC HEALTH —— FY 2025-2026 23 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 24 HEALTH. There is appropriated from the general fund of the 25 state to the department of health and human services for the 26 fiscal year beginning July 1, 2025, and ending June 30, 2026, 27 the following amount, or so much thereof as is necessary, to be 28 used for the purposes designated: 29 For programs that support health promotion, protect the 30 health and safety of the public, conduct disease surveillance 31 and investigation to reduce the incidence of morbidity and 32 mortality, serve individuals with chronic conditions including 33 but not limited to cancer, support the Iowa donor registry as 34 specified in section 142C.18, and strengthen the health care 35 -4- SF 649.1953 (2) 91 lh/ko 4/ 34

delivery system and workforce to improve health outcomes for 1 all Iowans, and for not more than the following full-time 2 equivalent positions: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,433,369 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 348.60 5 1. Of the moneys appropriated in this section, the following 6 amounts are allocated to the department of health and human 7 services to be used as follows to support the goals of 8 increased access, health system integration, and engagement: 9 a. $600,000 for distribution to a nonprofit organization 10 that established the first statewide drug donation repository 11 for continuation of the pharmaceutical infrastructure for 12 safety net providers established as described in 2007 Iowa 13 Acts, chapter 218, section 108, and for the prescription drug 14 donation repository program established in chapter 135M. 15 Moneys under this paragraph shall be distributed in their 16 entirety on July 1, 2025, for the purpose specified. 17 b. $374,000 for distribution to free clinics, as defined in 18 section 135.24, and a nonprofit organization that facilitates 19 the initiation, operation, and collaboration of free clinics 20 for necessary infrastructure, statewide coordination, provider 21 recruitment, service delivery, and provision of assistance to 22 patients in securing a medical home inclusive of oral health 23 care. Of the moneys allocated, $40,000 shall be used to lower 24 fees associated with using an electronic prescribing system. 25 Moneys under this paragraph shall be distributed in their 26 entirety on July 1, 2025, for the purpose specified. 27 c. $25,000 for distribution to an organization that raises 28 awareness about issues related to rural health clinics for 29 necessary infrastructure and service delivery transformation. 30 Moneys under this paragraph shall be distributed in their 31 entirety on July 1, 2025, for the purpose specified. 32 d. $225,000 for distribution to an organization that is 33 the oldest continuously operating medical society in the most 34 populous county in the state according to the most recently 35 -5- SF 649.1953 (2) 91 lh/ko 5/ 34

published census for continuation of safety net provider 1 patients access to specialty care as described in 2007 Iowa 2 Acts, chapter 218, section 109. Moneys under this paragraph 3 shall be distributed in their entirety on July 1, 2025, for the 4 purpose specified. 5 2. Of the moneys appropriated in this section, $600,000 6 shall be used for rural psychiatric residencies for residents 7 selected on or before June 30, 2025. 8 3. Of the moneys appropriated in this section, $20,000 shall 9 be used to make radon test kits available, free of charge, to 10 homeowners and renters in the state. The department shall 11 provide a link on the department’s internet site for homeowners 12 and renters in the state to order radon test kits. 13 4. Of the moneys appropriated in this section, $2,300,000 14 shall be used for Medicaid graduate medical education efforts 15 and consistent with the purpose of the department’s request for 16 approval to the centers of Medicare and Medicaid services of 17 the United States department of health and human services for 18 a Medicaid supplemental enhanced payment for the purposes of 19 maximizing federal funding opportunities for graduate medical 20 education as described in 2025 Iowa Acts, House File 972, or 21 successor legislation. 22 5. The university of Iowa hospitals and clinics under 23 the control of the state board of regents shall not receive 24 indirect costs from the moneys appropriated in this section. 25 The university of Iowa hospitals and clinics billings to the 26 department shall be, at a minimum, on a quarterly basis. 27 DIVISION V 28 COMMUNITY ACCESS AND ELIGIBILITY —— FY 2025-2026 29 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 30 ACCESS AND ELIGIBILITY. There is appropriated from the 31 general fund of the state to the department of health and human 32 services for the fiscal year beginning July 1, 2025, and ending 33 June 30, 2026, the following amount, or so much thereof as is 34 necessary, to be used for the purposes designated: 35 -6- SF 649.1953 (2) 91 lh/ko 6/ 34

To be used for salaries, support, maintenance, and 1 miscellaneous purposes and for family investment program (FIP) 2 assistance in accordance with chapter 239B, and for other costs 3 associated with providing needs-based benefits or assistance 4 including but not limited to maternal and child health, oral 5 health, obesity prevention, the promoting independence and 6 self-sufficiency through employment, job opportunities and the 7 basic skills (PROMISE JOBS) program, supplemental nutrition 8 assistance program (SNAP) employment and training, the FIP 9 diversion program, family planning, rent reimbursement, 10 and eligibility determinations for medical assistance, food 11 assistance, and the children’s health insurance program, and 12 for not more than the following full-time equivalent positions: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,542,456 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 870.40 15 1. Of the child support collections assigned under FIP, 16 the federal share of the child support collections shall be 17 credited to the child support services appropriation made in 18 this division of this Act. Of the remainder of the child 19 support collections assigned under FIP, a portion shall be 20 credited to community access and eligibility, and the remaining 21 moneys may be used to increase recoveries, to sustain cash flow 22 in the collection services center refund account as provided in 23 section 252B.13A, or for technology needs. If child support 24 collections assigned under FIP are greater than estimated or 25 are otherwise determined not to be required for maintenance of 26 efforts, the state share of either amount is appropriated to 27 the department for child support services as described in this 28 Act, or may be transferred to or retained in the collection 29 services center refund account. 30 2. Of the moneys appropriated in this section, $3,075,000 31 shall be used for continuation of the department’s initiative 32 to provide for adequate developmental surveillance and 33 screening during a child’s first five years. The moneys shall 34 be used first to fully fund the current participating counties 35 -7- SF 649.1953 (2) 91 lh/ko 7/ 34

to ensure that those counties are fully operational, with 1 the remaining moneys to be used for expanding participation 2 to additional counties. Full implementation and expansion 3 shall include enhancing the scope of the initiative through 4 collaboration with child health specialty clinics to promote 5 the use of developmental surveillance and screening to 6 support healthy child development through early identification 7 and response to both biomedical and social determinants of 8 healthy development by providing practitioner consultation 9 and continuous improvement through training and education, 10 particularly for children with behavioral conditions and 11 needs. The department shall also collaborate with the Medicaid 12 program and child health specialty clinics to assist in 13 coordinating the activities of the first five initiative into 14 the establishment of patient-centered medical homes developed 15 to improve health quality and population health while reducing 16 health care costs. To the maximum extent possible, moneys 17 allocated in this subsection shall be utilized as matching 18 moneys for Medicaid program reimbursement. 19 3. Of the moneys appropriated in this section, $1,145,102 20 is allocated to the Iowa commission on volunteer service for 21 programs and grants. 22 4. The university of Iowa hospitals and clinics under 23 the control of the state board of regents shall not receive 24 indirect costs from the moneys appropriated in this section. 25 The university of Iowa hospitals and clinics billings to the 26 department shall be, at a minimum, on a quarterly basis. 27 CHILD SUPPORT SERVICES 28 Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from 29 the general fund of the state to the department of health and 30 human services for the fiscal year beginning July 1, 2025, and 31 ending June 30, 2026, the following amount, or so much thereof 32 as is necessary, to be used for the purposes designated: 33 For child support services, including salaries, support, 34 maintenance, and miscellaneous purposes, and for not more than 35 -8- SF 649.1953 (2) 91 lh/ko 8/ 34

the following full-time equivalent positions: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 464.00 3 1. Federal access and visitation grant moneys shall be used 4 for services designed to increase compliance with the child 5 access provisions of court orders, including but not limited to 6 neutral visitation sites and mediation services. 7 2. The appropriation made to the department for child 8 support services may be used throughout the fiscal year in the 9 manner necessary for purposes of cash flow management, and for 10 cash flow management purposes the department may temporarily 11 draw more than the amount appropriated provided the amount 12 appropriated is not exceeded at the close of the fiscal year. 13 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT 14 Sec. 8. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 15 GRANT. There is appropriated from the special fund created in 16 section 8.41 to the department of health and human services 17 for the fiscal year beginning July 1, 2025, and ending June 18 30, 2026, from moneys received under the federal temporary 19 assistance for needy families (TANF) block grant pursuant 20 to the federal Personal Responsibility and Work Opportunity 21 Reconciliation Act of 1996, Pub. L. No. 104-193, and successor 22 legislation, including any TANF block grant moneys received in 23 any prior fiscal year that were deposited in the special fund 24 and remain unencumbered or unobligated on June 30, 2025, the 25 following amounts, or so much thereof as is necessary, to be 26 used for the purposes designated: 27 1. For community access and eligibility: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627 29 2. For community access and eligibility to provide 30 pregnancy prevention grants on the condition that family 31 planning services are funded: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 33 Pregnancy prevention grants shall be awarded to programs 34 in existence on or before July 1, 2025, if the programs have 35 -9- SF 649.1953 (2) 91 lh/ko 9/ 34

demonstrated positive outcomes. Grants shall be awarded 1 to pregnancy prevention programs developed after July 1, 2 2025, if the programs are based on existing models that have 3 demonstrated positive outcomes. Grants shall comply with the 4 requirements provided in 1997 Iowa Acts, chapter 208, section 5 14, subsections 1 and 2, including the requirement that a 6 program awarded a grant must emphasize sexual abstinence. 7 Priority in the awarding of grants shall be given to programs 8 that serve areas of the state which demonstrate the highest 9 percentage of unplanned pregnancies of females of childbearing 10 age within the geographic area to be served by the grant. 11 3. To meet one of the four purposes of TANF as specified 12 in 45 C.F.R. §260.20, including by modernizing the program 13 to promote economic mobility and self-sufficiency, ensuring 14 that families are able to overcome benefit cliffs, encouraging 15 healthy families, and streamlining service delivery to reduce 16 duplication: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 18 4. For early intervention and supports for child 19 abuse prevention grants and the family development and 20 self-sufficiency (FaDSS) grant program in accordance with 21 section 216A.107: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,013,980 23 5. For accountability, compliance, program integrity, 24 technology needs, and other resources necessary to meet 25 federal and state reporting, tracking, and case management 26 requirements, and other departmental needs: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 28 6. For state child care assistance: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 30 7. For child protective services: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 65,364,100 32 DIVISION VI 33 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 34 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 35 -10- SF 649.1953 (2) 91 lh/ko 10/ 34

PROGRAMS —— FY 2025-2026 1 Sec. 9. MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY 2 ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There 3 is appropriated from the general fund of the state to the 4 department of health and human services for the fiscal year 5 beginning July 1, 2025, and ending June 30, 2026, the following 6 amount, or so much thereof as is necessary, to be used for the 7 purposes designated: 8 For medical assistance program reimbursement and associated 9 costs as specifically provided in the reimbursement 10 methodologies in effect on June 30, 2025, except as otherwise 11 expressly authorized by law, consistent with options under 12 federal law and regulations, and contingent upon receipt of 13 approval from the office of the governor of reimbursement for 14 each abortion performed under the medical assistance program; 15 for the state supplementary assistance program; for the health 16 insurance premium payment program; and for maintenance of 17 the healthy and well kids in Iowa (Hawki) program pursuant 18 to chapter 514I, including supplemental dental services, 19 for receipt of federal financial participation under Tit. 20 XXI of the federal Social Security Act, which creates the 21 children’s health insurance program; and for other specified 22 health-related programs: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,903,550,706 24 1. Of the moneys appropriated in this section, 25 $1,837,804,073 is allocated for medical assistance program 26 reimbursement and associated costs. 27 a. Of the moneys allocated in this subsection, $3,383,880 28 shall be used for program administration, outreach, and 29 enrollment activities of the state family planning services 30 program pursuant to section 217.41B, and of this amount, the 31 department may use $200,000 for administrative expenses. 32 b. Of the moneys allocated in this subsection, $3,050,000 33 shall be used to expand the capacity of intermittent 34 community-based services that allow an individual to remain 35 -11- SF 649.1953 (2) 91 lh/ko 11/ 34

in the community and that provide support to the individual, 1 including employment services, hourly supported community 2 living services, respite services, and day habilitation 3 services. 4 2. Iowans support reducing the number of abortions 5 performed in our state. Moneys appropriated under this section 6 shall not be used for abortions, unless otherwise authorized 7 under this section. 8 3. The provisions of this section relating to abortions 9 shall also apply to the Iowa health and wellness plan created 10 pursuant to chapter 249N. 11 4. Of the moneys appropriated in this section, $4,479,762 is 12 allocated for the state supplementary assistance program. 13 5. Of the moneys appropriated in this section, $61,266,871 14 is allocated for maintenance of the Hawki program pursuant 15 to chapter 514I, including supplemental dental services, for 16 receipt of federal financial participation under Tit. XXI of 17 the federal Social Security Act, which creates the children’s 18 health insurance program. 19 HEALTH PROGRAM OPERATIONS 20 Sec. 10. HEALTH PROGRAM OPERATIONS. There is appropriated 21 from the general fund of the state to the department of health 22 and human services for the fiscal year beginning July 1, 23 2025, and ending June 30, 2026, the following amount, or so 24 much thereof as is necessary, to be used for the purposes 25 designated: 26 For health program operations, and the autism support 27 program under section 225D.2, and for not more than the 28 following full-time equivalent positions: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,672,433 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 82.00 31 1. The department of inspections, appeals, and licensing 32 shall provide all state matching moneys for survey and 33 certification activities performed by the department of 34 inspections, appeals, and licensing. The department of health 35 -12- SF 649.1953 (2) 91 lh/ko 12/ 34

and human services shall be solely responsible for distributing 1 the federal matching moneys for such activities. 2 2. Of the moneys appropriated in this section, a sufficient 3 amount shall be allocated for the administration of the health 4 insurance premium payment program, including salaries, support, 5 maintenance, and miscellaneous purposes. 6 3. Of the moneys appropriated in this section, $750,000 7 shall be allocated for a nonprofit organization that provides 8 access to emergency poison information and treatment. Pursuant 9 to the directive under 2014 Iowa Acts, chapter 1140, section 10 102, the federal matching moneys available to the nonprofit 11 organization from the department under the federal Children’s 12 Health Insurance Program Reauthorization Act of 2009 shall be 13 subject to the federal administrative cap rule of 10 percent 14 applicable to moneys provided under Tit. XXI of the federal 15 Social Security Act and shall be included in the department’s 16 calculations of the cap. 17 4. Unless otherwise provided by law, if a contract for 18 services provided under this section initially entered into 19 during the fiscal year beginning July 1, 2025, and ending 20 June 30, 2026, provides for an annual increase of the cost of 21 services provided under the contract, the annual increase shall 22 not exceed the amount by which the consumer price index for 23 all urban consumers increased during the immediately preceding 24 calendar year. This subsection shall not affect a contract 25 entered into on or before June 30, 2025, that is for a term of 26 more than one 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, 2025, and ending June 30, 2026, the following 33 amount, or so much thereof as is necessary, to be used for the 34 purposes designated: 35 -13- SF 649.1953 (2) 91 lh/ko 13/ 34

Notwithstanding any provision of law to the contrary, to 1 supplement the appropriation made in this Act from the general 2 fund of the state for health program operations under the 3 medical assistance program for the same fiscal year: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 5 Sec. 12. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF 6 HEALTH AND HUMAN SERVICES. Notwithstanding any provision of 7 law to the contrary, and subject to the availability of moneys, 8 there is appropriated from the quality assurance trust fund 9 created in section 249L.4 to the department of health and human 10 services for the fiscal year beginning July 1, 2025, and ending 11 June 30, 2026, the following amount, or so much thereof as is 12 necessary, 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 19 any provision of law to the contrary, and subject to the 20 availability of moneys, there is appropriated from the hospital 21 health care access trust fund created in section 249M.4 to the 22 department of health and human services for the fiscal year 23 beginning July 1, 2025, and ending June 30, 2026, the following 24 amount, or so much thereof as is necessary, for the purposes 25 designated: 26 To supplement the appropriation made in this Act from the 27 general fund of the state to the department of health and human 28 services for medical assistance for the same fiscal year: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 30 SEX REASSIGNMENT SURGERIES OR ASSOCIATED PROCEDURES 31 Sec. 14. NEW SECTION . 249A.14 Sex reassignment surgeries or 32 associated procedures —— reimbursement prohibited. 33 1. Moneys appropriated from the general fund of the state 34 to the department for the medical assistance program shall 35 -14- SF 649.1953 (2) 91 lh/ko 14/ 34

not be used for reimbursement for sex reassignment surgery 1 or associated procedures, including hormone therapy or other 2 medical interventions intended to alter primary or secondary 3 sex characteristics related to an individual’s gender dysphoria 4 diagnosis. 5 2. This section shall not be construed to prohibit Medicaid 6 program reimbursement for services not described under 7 subsection 1 that are otherwise covered under the Medicaid 8 program. 9 3. The department of health and human services shall adopt 10 rules pursuant to chapter 17A to administer this section. 11 REIMBURSEMENT RATES 12 Sec. 15. REIMBURSEMENT RATES. 13 1. Reimbursement for medical assistance, state 14 supplementary assistance, and social service providers and 15 services reimbursed under the purview of the department of 16 health and human services shall remain at the reimbursement 17 rate in effect on June 30, 2025, or shall be determined 18 pursuant to the reimbursement methodology in effect on June 30, 19 2025, with the exception of the following: 20 a. If reimbursement is otherwise negotiated by contract or 21 pursuant to an updated fee schedule. 22 b. As otherwise provided in this section of this Act. 23 2. Of the moneys appropriated for medical assistance 24 program reimbursement and associated costs as specifically 25 provided in the reimbursement methodologies June 30, 2025, the 26 following amounts, or so much thereof as is necessary, are 27 allocated to the department of health and human services to be 28 used for the following purposes: 29 a. (1) Notwithstanding any provision of law to the 30 contrary, for the fiscal year beginning July 1, 2025, and 31 ending June 30, 2026, the department of health and human 32 services shall rebase case-mix nursing facility rates beginning 33 July 1, 2025, using the Medicaid cost reports on file for 34 the period ending December 31, 2024, to the extent possible 35 -15- SF 649.1953 (2) 91 lh/ko 15/ 34

within state funding, including no more than $20,000,000 1 from the allocation provided for medical assistance program 2 reimbursement and associated costs. 3 (2) The department of health and human services shall 4 calculate each nursing facility’s case-mix index for the period 5 beginning July 1, 2024, using weighting based on the current 6 patient-driven payment model schedule. Rosters shall be 7 made to show a separate calculation to determine the average 8 case-mix index for a nursing-facility-wide case-mix index, and 9 a case-mix index for the residents of a nursing facility who 10 are Medicaid recipients using all minimum data set reports by 11 the nursing facility for the previous semiannual period using a 12 day weighted calculation. 13 b. For the fiscal year beginning July 1, 2025, $2,136,304 14 shall be used to increase to the extent possible reimbursement 15 rates for dentists, excluding orthodontic services, compared to 16 rates in effect on June 30, 2025. 17 c. For the fiscal year beginning July 1, 2025, $420,000 18 shall be used to increase to the extent possible reimbursement 19 rates for maternal health providers compared to the rates in 20 effect on June 30, 2025. 21 d. For the fiscal year beginning July 1, 2025, $100,000 22 shall be used to increase to the extent possible reimbursement 23 rates for prosthetics compared to rates in effect on June 30, 24 2025. 25 3. For the fiscal year beginning July 1, 2025, reimbursement 26 rates for home health agencies shall continue to be based 27 on the Medicare low utilization payment adjustment (LUPA) 28 methodology with state geographic wage adjustments, and shall 29 be adjusted to increase the rates to the extent possible. 30 4. For the fiscal year beginning July 1, 2026, and for 31 each fiscal year thereafter, the department shall review the 32 reimbursement rates for home health agencies and pharmacy 33 dispensing fees. 34 5. On or before December 15, 2025, the department shall 35 -16- SF 649.1953 (2) 91 lh/ko 16/ 34

review the current rate limit calculation and application for 1 special population nursing facility rates. 2 NURSING FACILITIES —— MEDICAID REIMBURSEMENT METHODOLOGY 3 PROPOSAL 4 Sec. 16. NURSING FACILITIES —— MEDICAID REIMBURSEMENT 5 METHODOLOGY PROPOSAL. 6 1. By April 1, 2026, the department of health and human 7 services shall develop a reimbursement methodology proposal for 8 reimbursement of nursing facilities under the Medicaid program 9 that includes all of the following: 10 a. A base-rate payment component. 11 b. A quality assurance assessment pass-through component. 12 c. A quality assurance add-on component, which includes a 13 fixed fee payment and a quality-based payment. 14 2. The reimbursement methodology proposal shall include 15 recommendations developed by the department of health and human 16 services, in consultation with stakeholders including the Iowa 17 health care association and leadingage Iowa, for specific 18 metrics the department of health and human services will use 19 to determine whether a nursing facility is eligible to receive 20 all or a portion of the quality-based payment portion of the 21 reimbursement to the nursing facility. 22 3. The total state expenditures for reimbursement of 23 nursing facilities under the Medicaid program using the 24 reimbursement methodology proposed in this section shall 25 not exceed the amount appropriated for this purpose for the 26 applicable fiscal year. 27 NURSING FACILITY BED FORECASTING FORMULA 28 Sec. 17. NURSING FACILITY BED FORECASTING FORMULA. 29 1. On or before July 1, 2026, the department of health and 30 human services, in consultation with appropriate stakeholders, 31 shall develop and implement a nursing bed facility forecasting 32 formula utilizing the recommendations for improvement to the 33 nursing facility bed need formula developed by the workgroup 34 convened pursuant to 2023 Iowa Acts, chapter 158, section 11, 35 -17- SF 649.1953 (2) 91 lh/ko 17/ 34 #1.