House File 811 - Enrolled




                                             HOUSE FILE 811

                             AN ACT
 RELATING TO AND MAKING APPROPRIATIONS FOR HEALTH AND HUMAN
    SERVICES AND INCLUDING OTHER RELATED PROVISIONS AND APPRO-
    PRIATIONS, PROVIDING PENALTIES, MAKING PENALTIES APPLICABLE
    AND PROVIDING EFFECTIVE, RETROACTIVE, AND APPLICABILITY DATE
    PROVISIONS.

 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

                           DIVISION I
           GENERAL FUND AND BLOCK GRANT APPROPRIATIONS
                          ELDER AFFAIRS
    Section 1.  DEPARTMENT OF ELDER AFFAIRS.  There is
 appropriated from the general fund of the state to the
 department of elder affairs for the fiscal year beginning July
 1, 2009, and ending June 30, 2010, the following amount, or so
 much thereof as is necessary, to be used for the purposes
 designated:
    For aging programs for the department of elder affairs and
 area agencies on aging to provide citizens of Iowa who are 60
 years of age and older with case management for the frail
 elderly only if the monthly cost per client for case
 management for the frail elderly services provided does not
 exceed the amount specified in this section, resident advocate
 committee coordination, employment, and other services which
 may include but are not limited to adult day services, respite
 care, chore services, telephone reassurance, information and
 assistance, and home repair services, and for the construction
 of entrance ramps which make residences accessible to the
 physically handicapped, and for salaries, support,
 administration, maintenance, and miscellaneous purposes, and
 for not more than the following full=time equivalent
 positions:
 .................................................. $  4,958,230
 ............................................... FTEs      37.50
    1.  Funds appropriated in this section may be used to
 supplement federal funds under federal regulations.  To
 receive funds appropriated in this section, a local area
 agency on aging shall match the funds with moneys from other
 sources according to rules adopted by the department.  Funds
 appropriated in this section may be used for elderly services
 not specifically enumerated in this section only if approved
 by an area agency on aging for provision of the service within
 the area.
    2.  a.  Of the funds appropriated in this section,
 $1,385,015 shall be transferred to the department of human
 services in equal amounts on a quarterly basis for
 reimbursement of case management services provided under the
 medical assistance elderly waiver.  The department of human
 services shall adopt rules for case management services
 provided under the medical assistance elderly waiver in
 consultation with the department of elder affairs.
    b.  The monthly cost per client for case management for the
 frail elderly services provided shall not exceed an average of
 $70.  However, if the department of human services adopts
 administrative rules revising the reimbursement methodology to
 include 15 minute units, 24=hour on=call, and other
 requirements consistent with federal regulations, the $70
 monthly cap shall be eliminated and replaced with a quarterly
 projection of expenditures and reimbursement revisions
 necessary to maintain expenditures within the amounts budgeted
 under the appropriations made for the fiscal year for the
 medical assistance program.
    c.  The department of human services shall review
 projections for state funding expenditures for reimbursement
 of case management services under the medical assistance
 elderly waiver on a quarterly basis and shall determine if an
 adjustment to the medical assistance reimbursement rates are
 necessary to provide reimbursement within the state funding
 amounts budgeted under the appropriations made for the fiscal
 year for the medical assistance program.  Any temporary
 enhanced federal financial participation that may become
 available for the medical assistance program during the fiscal
 year shall not be used in projecting the medical assistance
 elderly waiver case management budget.  The department of
 human services shall revise such reimbursement rates as
 necessary to maintain expenditures for medical assistance
 elderly waiver case management services within the state
 funding amounts budgeted under the appropriations made for the
 fiscal year for the medical assistance program.
    3.  Of the funds appropriated in this section, $179,961
 shall be transferred to the department of economic development
 for the Iowa commission on volunteer services to be used for
 the retired and senior volunteer program.
    4.  The department shall continue the elder abuse
 initiative program established pursuant to section 231.56A.
    5.  In addition to any other funds appropriated in this
 section for these purposes, $220,000 shall be used to provide
 for elder unmet home and community=based services needs as
 identified in reports submitted by the area agencies on aging.
    6.  During the fiscal year beginning July 1, 2009,
 notwithstanding section 231.33, subsection 19, relating to
 departmental training of area agency on aging boards of
 directors and section 231.63 relating to the development of
 end=of=life care information, the department is not required
 to comply with these requirements if funding is not available.
                             HEALTH
    Sec. 2.  DEPARTMENT OF PUBLIC HEALTH.  The allocations made
 in this section may include amounts carried forward from
 appropriations and allocations made for the same purposes in
 the previous fiscal year.  There is appropriated from the
 general fund of the state to the department of public health
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amounts, or so much thereof as is
 necessary, to be used for the purposes designated:
    1.  ADDICTIVE DISORDERS
    For reducing the prevalence of use of tobacco, alcohol, and
 other drugs, and treating individuals affected by addictive
 behaviors, including gambling, and for not more than the
 following full=time equivalent positions:
 .................................................. $ 28,652,500
 ............................................... FTEs      18.00
    a.  Of the funds appropriated in this subsection,
 $8,028,214 shall be used for the tobacco use prevention and
 control initiative, including efforts at the state and local
 levels, as provided in chapter 142A.
    (1)  The director of public health shall dedicate
 sufficient resources to promote and ensure retailer compliance
 with tobacco laws and ordinances relating to persons under 18
 years of age, and shall prioritize the state's compliance in
 the allocation of available funds to comply with 42 U.S.C. }
 300x=26 and section 453A.2.
    (2)  Of the full=time equivalent positions authorized in
 this subsection, 2.00 full=time equivalent positions shall be
 utilized to provide for enforcement of tobacco laws,
 regulations, and ordinances under a chapter 28D agreement
 entered into between the Iowa department of public health and
 the alcoholic beverages division of the department of
 commerce.
    b.  Of the funds appropriated in this subsection,
 $17,546,252 shall be used for substance abuse treatment and
 prevention.
    (1)  Of the funds allocated in this lettered paragraph,
 $993,487 shall be used for the public purpose of a grant
 program to provide substance abuse prevention programming for
 children.
    (a)  Of the funds allocated in this subparagraph, $473,100
 shall be utilized for the public purpose of providing grant
 funding for organizations that provide programming for
 children by utilizing mentors.  Programs approved for such
 grants shall be certified or will be certified within six
 months of receiving the grant award by the Iowa commission on
 volunteer services as utilizing the standards for effective
 practice for mentoring programs.
    (b)  Of the funds allocated in this subparagraph, $473,100
 shall be utilized for the public purpose of providing grant
 funding for organizations that provide programming that
 includes youth development and leadership.  The programs shall
 also be recognized as being programs that are scientifically
 based with evidence of their effectiveness in reducing
 substance abuse in children.
    (c)  The Iowa department of public health shall utilize a
 request for proposals process to implement the grant program.
    (d)  All grant recipients shall participate in a program
 evaluation as a requirement for receiving grant funds.
    (e)  Of the funds allocated for the grant program, $47,287
 shall be used to administer substance abuse prevention grants
 and for program evaluations.
    (2)  It is the intent of the general assembly that from the
 moneys allocated in this lettered paragraph persons with a
 dual diagnosis of substance abuse and gambling addictions
 shall be given priority in treatment services.
    c.  (1)  Of the funds appropriated in this subsection,
 $4,078,035 shall be used for funding of gambling treatment,
 including administrative costs and to provide programs which
 may include but are not limited to outpatient and follow=up
 treatment for persons affected by problem gambling,
 rehabilitation and residential treatment programs, information
 and referral services, education and preventive services, and
 financial management services.  Of the amount allocated in
 this lettered paragraph, up to $100,000 may be used for the
 licensing of gambling treatment programs as provided in
 section 135.150.
    (2)  (a)  Notwithstanding any provision to the contrary, to
 standardize the availability, delivery, cost of delivery, and
 accountability of gambling and substance abuse treatment
 services statewide, the department shall continue
 implementation of a process to create a system for delivery of
 the treatment services in accordance with the requirements
 specified in 2008 Iowa Acts, chapter 1187, section 3,
 subsection 4.  To ensure the system provides a continuum of
 treatment services that best meets the needs of Iowans, the
 gambling and substance abuse treatment services in an area may
 be provided either by a single agency or by separate agencies
 submitting a joint proposal.  The process shall be completed
 by July 1, 2010.
    (b)  From the amounts designated for gambling and substance
 abuse treatment, the department may use up to $100,000 for
 administrative costs to continue developing and implementing
 the process in accordance with subparagraph division (a).
    (3)  The requirement of section 123.53, subsection 3, is
 met by the appropriations and allocations made in this Act for
 purposes of substance abuse treatment and addictive disorders
 for the fiscal year beginning July 1, 2009.
    d.  The bureau of substance abuse prevention and treatment,
 the division of tobacco use prevention and control, and the
 office of gambling treatment and prevention shall develop a
 strategy to coordinate prevention activities across the
 spectrum of addictive disorders in order to maximize
 efficiencies and reduce expenditures while meeting the needs
 of Iowans.  The strategy shall be presented to the individuals
 specified in this Act for submission of reports by December
 15, 2009.
    2.  HEALTHY CHILDREN AND FAMILIES
    For promoting the optimum health status for children,
 adolescents from birth through 21 years of age, and families,
 and for not more than the following full=time equivalent
 positions:
 .................................................. $  2,249,167
 ............................................... FTEs      14.00
    a.  Of the funds appropriated in this subsection, not more
 than $570,226 shall be used for the healthy opportunities to
 experience success (HOPES)=healthy families Iowa (HFI) program
 established pursuant to section 135.106.  The department shall
 transfer the funding allocated for the HOPES=HFI program to
 the Iowa empowerment board for distribution and shall assist
 the board in managing the contracting for the funding.  The
 funding shall be distributed to renew the grants that were
 provided to the grantees that operated the program during the
 fiscal year ending June 30, 2009.
    b.  Of the funds appropriated in this subsection, $292,791
 shall be used to continue to address the healthy mental
 development of children from birth through five years of age
 through local evidence=based strategies that engage both the
 public and private sectors in promoting healthy development,
 prevention, and treatment for children.
    c.  Of the funds appropriated in this subsection, $35,108
 shall be distributed to a statewide dental carrier to provide
 funds to continue the donated dental services program
 patterned after the projects developed by the national
 foundation of dentistry for the handicapped to provide dental
 services to indigent elderly and disabled individuals.
    3.  CHRONIC CONDITIONS
    For serving individuals identified as having chronic
 conditions or special health care needs, and for not more than
 the following full=time equivalent positions:
 .................................................. $  2,756,236
 ............................................... FTEs       3.00
    a.  Of the funds appropriated in this subsection, $176,542
 shall be used for grants to individual patients who have
 phenylketonuria (PKU) to assist with the costs of necessary
 special foods.
    b.  Of the funds appropriated in this subsection, $438,018
 is allocated for continuation of the contracts for resource
 facilitator services in accordance with section 135.22B,
 subsection 9, and for brain injury training services and
 recruiting of service providers to increase the capacity
 within this state to address the needs of individuals with
 brain injuries and such individuals' families.
    c.  Of the funds appropriated in this subsection, $244,579
 shall be used as additional funding to leverage federal
 funding through the federal Ryan White Care Act, Title II,
 AIDS drug assistance program supplemental drug treatment
 grants.
    d.  Of the funds appropriated in this subsection, $88,938
 shall be used for the public purpose of providing a grant to
 an existing national=affiliated organization to provide
 education, client=centered programs, and client and family
 support for people living with epilepsy and their families.
    4.  COMMUNITY CAPACITY
    For strengthening the health care delivery system at the
 local level, and for not more than the following full=time
 equivalent positions:
 .................................................. $  4,116,847
 ............................................... FTEs      21.00
    a.  Of the funds appropriated in this subsection, $90,000
 is allocated for a child vision screening program implemented
 through the university of Iowa hospitals and clinics in
 collaboration with community empowerment areas.
    b.  Of the funds appropriated in this subsection, $143,254
 is allocated for continuation of an initiative implemented at
 the university of Iowa and $125,802 is allocated for
 continuation of an initiative at the state mental health
 institute at Cherokee to expand and improve the workforce
 engaged in mental health treatment and services.  The
 initiatives shall receive input from the university of Iowa,
 the department of human services, the department of public
 health, and the mental health, mental retardation,
 developmental disabilities, and brain injury commission to
 address the focus of the initiatives.
    c.  Of the funds appropriated in this subsection,
 $1,054,060 shall be used for essential public health services
 that promote healthy aging throughout the lifespan, contracted
 through a formula for local boards of health, to enhance
 health promotion and disease prevention services.
    d.  Of the funds appropriated in this section, $100,000
 shall be deposited in the governmental public health system
 fund created by this Act to be used to further develop the
 Iowa public health standards and to begin implementation of
 public health modernization in accordance with chapter 135A,
 as enacted by this Act, to the extent funding is available.
    5.  ELDERLY WELLNESS
    For promotion of healthy aging and optimization of the
 health of older adults:
 .................................................. $  8,345,779
    a.  Of the funds appropriated in this subsection,
 $2,292,076 shall be used for local public health nursing
 services.
    b.  Of the funds appropriated in this subsection,
 $6,053,703 shall be used for home care aide services.
    6.  ENVIRONMENTAL HAZARDS
    For reducing the public's exposure to hazards in the
 environment, primarily chemical hazards, and for not more than
 the following full=time equivalent positions:
 .................................................. $  1,000,391
 ............................................... FTEs       4.50
    a.  Of the funds appropriated in this subsection, $601,631
 shall be used for childhood lead poisoning provisions.
    b.  Of the funds appropriated in this subsection, not more
 than $262,153 shall be used for the development of scientific
 and medical expertise in environmental epidemiology.
    7.  INFECTIOUS DISEASES
    For reducing the incidence and prevalence of communicable
 diseases, and for not more than the following full=time
 equivalent positions:
 .................................................. $  1,630,661
 ............................................... FTEs       5.00
    8.  PUBLIC PROTECTION
    For protecting the health and safety of the public through
 establishing standards and enforcing regulations, and for not
 more than the following full=time equivalent positions:
 .................................................. $  3,569,986
 ............................................... FTEs     130.00
    a.  Of the funds appropriated in this subsection, not more
 than $549,240 shall be credited to the emergency medical
 services fund created in section 135.25.  Moneys in the
 emergency medical services fund are appropriated to the
 department to be used for the purposes of the fund.
    b.  Of the funds appropriated in this subsection, $232,477
 shall be used for sexual violence prevention programming
 through a statewide organization representing programs serving
 victims of sexual violence through the department's sexual
 violence prevention program.  The amount allocated in this
 lettered paragraph shall not be used to supplant funding
 administered for other sexual violence prevention or victims
 assistance programs.
    c.  Of the funds appropriated in this subsection, not more
 than $348,244 shall be used for the continuation and support
 of a coordinated system of delivery of trauma and emergency
 medical services.
    d.  Of the funds appropriated in this subsection, not more
 than $539,467 shall be used for the state poison control
 center.
    9.  RESOURCE MANAGEMENT
    For establishing and sustaining the overall ability of the
 department to deliver services to the public, and for not more
 than the following full=time equivalent positions:
 .................................................. $  1,062,517
 ............................................... FTEs      10.00
    The university of Iowa hospitals and clinics under the
 control of the state board of regents shall not receive
 indirect costs from the funds appropriated in this section.
 The university of Iowa hospitals and clinics billings to the
 department shall be on at least a quarterly basis.
                 DEPARTMENT OF VETERANS AFFAIRS
    Sec. 3.  DEPARTMENT OF VETERANS AFFAIRS.  There is
 appropriated from the general fund of the state to the
 department of veterans affairs for the fiscal year beginning
 July 1, 2009, and ending June 30, 2010, the following amounts,
 or so much thereof as is necessary, to be used for the
 purposes designated:
    1.  DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
    For salaries, support, maintenance, and miscellaneous
 purposes, including the war orphans educational assistance
 fund created in section 35.8, and for not more than the
 following full=time equivalent positions:
 .................................................. $  1,067,170
 ............................................... FTEs      17.20
    2.  IOWA VETERANS HOME
    For salaries, support, maintenance, and miscellaneous
 purposes:
 .................................................. $ 11,326,650
    a.  The Iowa veterans home billings involving the
 department of human services shall be submitted to the
 department on at least a monthly basis.
    b.  If there is a change in the employer of employees
 providing services at the Iowa veterans home under a
 collective bargaining agreement, such employees and the
 agreement shall be continued by the successor employer as
 though there had not been a change in employer.
    c.  Commencing with the fiscal year beginning July 1, 2009,
 the Iowa veterans home shall revise the payment and exemption
 amounts for residents participating in the incentive therapy
 program in accordance with all of the following:
    (1)  The incentive therapy payment amount for domiciliary
 level of care residents shall not exceed $150 per month and
 for nursing level of care residents shall not exceed $75 per
 month.
    (2)  The amounts paid under the program that are exempt
 from computation of resident support shall be increased to
 reflect the increases in the incentive therapy payments in
 accordance with subparagraph (1).
    3.  STATE EDUCATIONAL ASSISTANCE == CHILDREN OF DECEASED
 VETERANS
    For provision of educational assistance pursuant to section
 35.9:
 .................................................. $     22,944
    Sec. 4.  LIMITATION OF COUNTY COMMISSION OF VETERANS
 AFFAIRS FUND STANDING APPROPRIATIONS.  Notwithstanding the
 standing appropriation in the following designated section for
 the fiscal year beginning July 1, 2009, and ending June 30,
 2010, the amounts appropriated from the general fund of the
 state pursuant to that section for the following designated
 purposes shall not exceed the following amount:
    For the county commissions of veterans affairs fund under
 section 35A.16:
 .................................................. $  1,000,000
                         HUMAN SERVICES
    Sec. 5.  TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
 GRANT.  There is appropriated from the fund created in section
 8.41 to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, from moneys
 received under the federal temporary assistance for needy
 families (TANF) block grant pursuant to the federal Personal
 Responsibility and Work Opportunity Reconciliation Act of
 1996, Pub. L. No. 104=193, and successor legislation, which
 are federally appropriated for the federal fiscal years
 beginning October 1, 2008, and ending September 30, 2009, and
 beginning October 1, 2009, and ending September 30, 2010, the
 following amounts, or so much thereof as is necessary, to be
 used for the purposes designated:
    1.  To be credited to the family investment program account
 and used for assistance under the family investment program
 under chapter 239B:
 .................................................. $ 28,606,513
    2.  To be credited to the family investment program account
 and used for the job opportunities and basic skills (JOBS)
 program and implementing family investment agreements in
 accordance with chapter 239B:
 .................................................. $ 13,084,528
    Notwithstanding section 8.33, not more than 5 percent of
 the moneys designated in this subsection that are allocated by
 the department for contracted services, other than family
 self=sufficiency grant services allocated under this
 subsection, that remain unencumbered or unobligated at the
 close of the fiscal year shall not revert but shall remain
 available for expenditure for the purposes designated until
 the close of the succeeding fiscal year.  However, unless such
 moneys are encumbered or obligated on or before September 30,
 2010, the moneys shall revert.
    3.  To be used for the family development and
 self=sufficiency grant program in accordance with section
 216A.107:
 .................................................. $  2,998,675
    Notwithstanding section 8.33, moneys appropriated in this
 subsection that remain unencumbered or unobligated at the
 close of the fiscal year shall not revert but shall remain
 available for expenditure for the purposes designated until
 the close of the succeeding fiscal year.  However, unless such
 moneys are encumbered or obligated on or before September 30,
 2010, the moneys shall revert.
    4.  For field operations:
 .................................................. $ 18,507,495
    5.  For general administration:
 .................................................. $  3,744,000
    6.  For local administrative costs:
 .................................................. $  2,189,830
    7.  For state child care assistance:
 .................................................. $ 25,831,177
    a.  Of the funds appropriated in this subsection,
 $18,986,177 shall be transferred to the child care and
 development block grant appropriation made by the Eighty=third
 General Assembly, 2009 Session, for the federal fiscal year
 beginning October 1, 2009, and ending September 30, 2010.  Of
 this amount, $200,000 shall be used for provision of
 educational opportunities to registered child care home
 providers in order to improve services and programs offered by
 this category of providers and to increase the number of
 providers.  The department may contract with institutions of
 higher education or child care resource and referral centers
 to provide the educational opportunities.  Allowable
 administrative costs under the contracts shall not exceed 5
 percent.  The application for a grant shall not exceed two
 pages in length.
    b.  Any funds appropriated in this subsection remaining
 unallocated shall be used for state child care assistance
 payments for individuals enrolled in the family investment
 program who are employed.
    8.  For mental health and developmental disabilities
 community services:
 .................................................. $  4,894,052
    9.  For child and family services:
 .................................................. $ 32,084,430
    10.  For child abuse prevention grants:
 .................................................. $    250,000
    11.  For pregnancy prevention grants on the condition that
 family planning services are funded:
 .................................................. $  1,930,067
    Pregnancy prevention grants shall be awarded to programs in
 existence on or before July 1, 2009, if the programs are
 comprehensive in scope and have demonstrated positive
 outcomes.  Grants shall be awarded to pregnancy prevention
 programs which are developed after July 1, 2009, if the
 programs are comprehensive in scope and are based on existing
 models that have demonstrated positive outcomes.  Grants shall
 comply with the requirements provided in 1997 Iowa Acts,
 chapter 208, section 14, subsections 1 and 2, including the
 requirement that grant programs must emphasize sexual
 abstinence.  Priority in the awarding of grants shall be given
 to programs that serve areas of the state which demonstrate
 the highest percentage of unplanned pregnancies of females of
 childbearing age within the geographic area to be served by
 the grant.
    12.  For technology needs and other resources necessary to
 meet federal welfare reform reporting, tracking, and case
 management requirements:
 .................................................. $  1,037,186
    13.  For the healthy opportunities for parents to
 experience success (HOPES) program administered by the
 department of public health to target child abuse prevention:
 .................................................. $    200,000
    14.  To be credited to the state child care assistance
 appropriation made in this section to be used for funding of
 community=based early childhood programs targeted to children
 from birth through five years of age developed by community
 empowerment areas as provided in section 28.9:
 .................................................. $  7,350,000
    a.  The department shall transfer TANF block grant funding
 appropriated and allocated in this subsection to the child
 care and development block grant appropriation in accordance
 with federal law as necessary to comply with the provisions of
 this subsection.
    b.  Of the amounts appropriated in this section,
 $12,962,008 for the fiscal year beginning July 1, 2009, shall
 be transferred to the appropriation of the federal social
 services block grant made for that fiscal year.
    c.  The department may transfer funds allocated in this
 section to the appropriations made in this Act for general
 administration and field operations for resources necessary to
 implement and operate the services referred to in this section
 and those funded in the appropriation made in this division of
 this Act for the family investment program from the general
 fund of the state.
    Sec. 6.  FAMILY INVESTMENT PROGRAM ACCOUNT.
    1.  Moneys credited to the family investment program (FIP)
 account for the fiscal year beginning July 1, 2009, and ending
 June 30, 2010, shall be used to provide assistance in
 accordance with chapter 239B.
    2.  The department may use a portion of the moneys credited
 to the FIP account under this section as necessary for
 salaries, support, maintenance, and miscellaneous purposes.
    3.  The department may transfer funds allocated in this
 section to the appropriations in this Act for general
 administration and field operations for resources necessary to
 implement and operate the services referred to in this section
 and those funded in the appropriation made in this division of
 this Act for the family investment program from the general
 fund of the state.
    4.  Moneys appropriated in this division of this Act and
 credited to the FIP account for the fiscal year beginning July
 1, 2009, and ending June 30, 2010, are allocated as follows:
    a.  To be retained by the department of human services to
 be used for coordinating with the department of human rights
 to more effectively serve participants in the FIP program and
 other shared clients and to meet federal reporting
 requirements under the federal temporary assistance for needy
 families block grant:
 .................................................. $     20,000
    b.  To the department of human rights for staffing,
 administration, and implementation of the family development
 and self=sufficiency grant program in accordance with section
 216A.107:
 .................................................. $  5,496,946
    (1)  Of the funds allocated for the family development and
 self=sufficiency grant program in this lettered paragraph, not
 more than 5 percent of the funds shall be used for the
 administration of the grant program.
    (2)  The department of human rights may continue to
 implement the family development and self=sufficiency grant
 program statewide during fiscal year 2009=2010.
    c.  For the diversion subaccount of the FIP account:
 .................................................. $  1,814,000
    A portion of the moneys allocated for the subaccount may be
 used for field operations salaries, data management system
 development, and implementation costs and support deemed
 necessary by the director of human services in order to
 administer the FIP diversion program.
    d.  For the food stamp employment and training program:
 .................................................. $     68,059
    The department shall amend the food stamp employment and
 training state plan in order to maximize to the fullest extent
 permitted by federal law the use of the fifty=fifty match
 provisions for the claiming of allowable federal matching
 funds from the United States department of agriculture
 pursuant to the federal food stamp employment and training
 program for providing education, employment, and training
 services for eligible food assistance program participants,
 including but not limited to related dependent care and
 transportation expenses.
    e.  For the JOBS program:
 .................................................. $ 21,638,263
    5.  Of the child support collections assigned under FIP, an
 amount equal to the federal share of support collections shall
 be credited to the child support recovery appropriation made
 in this division of this Act.  Of the remainder of the
 assigned child support collections received by the child
 support recovery unit, a portion shall be credited to the FIP
 account, a portion may be used to increase recoveries, and a
 portion may be used to sustain cash flow in the child support
 payments account.  If as a consequence of the appropriations
 and allocations made in this section the resulting amounts are
 insufficient to sustain cash assistance payments and meet
 federal maintenance of effort requirements, the department
 shall seek supplemental funding.  If child support collections
 assigned under FIP are greater than estimated or are otherwise
 determined not to be required for maintenance of effort, the
 state share of either amount may be transferred to or retained
 in the child support payment account.
    6.  It is the intent of the general assembly that the
 department of human services review the feasibility of
 expanding categorical food assistance program eligibility in
 Iowa to at least 160 percent of the applicable federal poverty
 level and simplifying administrative requirements by
 eliminating current asset tests for food assistance program
 eligibility.  The department shall estimate the potential
 economic benefits and fiscal impact of making these changes on
 individual Iowa families and the state.  The department shall
 report on or before December 15, 2009, concerning the review,
 providing findings and recommendations, to the persons
 designated by this division of this Act for submission of
 reports.
    7.  The department may adopt emergency rules for the family
 investment, JOBS, food stamp, and medical assistance programs
 if necessary to comply with federal requirements.
    Sec. 7.  FAMILY INVESTMENT PROGRAM GENERAL FUND.  There is
 appropriated from the general fund of the state to the
 department of human services for the fiscal year beginning
 July 1, 2009, and ending June 30, 2010, the following amount,
 or so much thereof as is necessary, to be used for the purpose
 designated:
    To be credited to the family investment program (FIP)
 account and used for family investment program assistance
 under chapter 239B:
 .................................................. $ 34,592,700
    1.  Of the funds appropriated in this section, $8,553,735
 is allocated for the JOBS program.
    2.  Of the funds appropriated in this section, $2,518,271
 is allocated for the family development and self=sufficiency
 grant program.
    3.  a.  Of the funds appropriated in this section, $219,423
 shall be used for continuation of a grant to an Iowa=based
 nonprofit organization with a history of providing tax
 preparation assistance to low=income Iowans in order to expand
 the usage of the earned income tax credit.  The purpose of the
 grant is to supply this assistance to underserved areas of the
 state.  The grant shall be provided to an organization that
 has existing national foundation support for supplying such
 assistance that can also secure local charitable match
 funding.
    b.  The general assembly supports efforts by the
 organization receiving funding under this subsection to create
 a statewide earned income tax credit and asset=building
 coalition to achieve both of the following purposes:
    (1)  Expanding the usage of the tax credit through new and
 enhanced outreach and marketing strategies, as well as
 identifying new local sites and human and financial resources.
    (2)  Assessing and recommending various strategies for
 Iowans to develop assets through savings, individual
 development accounts, financial literacy, antipredatory
 lending initiatives, informed home ownership, use of various
 forms of support for work, and microenterprise business
 development targeted to persons who are self=employed or have
 fewer than five employees.
    4.  Notwithstanding section 8.39, for the fiscal year
 beginning July 1, 2009, if necessary to meet federal
 maintenance of effort requirements or to transfer federal
 temporary assistance for needy families block grant funding to
 be used for purposes of the federal social services block
 grant or to meet cash flow needs resulting from delays in
 receiving federal funding or to implement, in accordance with
 this division of this Act, activities currently funded with
 juvenile court services, county, or community moneys and state
 moneys used in combination with such moneys, the department of
 human services may transfer funds within or between any of the
 appropriations made in this division of this Act and
 appropriations in law for the federal social services block
 grant to the department for the following purposes, provided
 that the combined amount of state and federal temporary
 assistance for needy families block grant funding for each
 appropriation remains the same before and after the transfer:
    a.  For the family investment program.
    b.  For child care assistance.
    c.  For child and family services.
    d.  For field operations.
    e.  For general administration.
    f.  MH/MR/DD/BI community services (local purchase).
    This subsection shall not be construed to prohibit the use
 of existing state transfer authority for other purposes.  The
 department shall report any transfers made pursuant to this
 subsection to the legislative services agency.
    Sec. 8.  CHILD SUPPORT RECOVERY.  There is appropriated
 from the general fund of the state to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount, or so much thereof
 as is necessary, to be used for the purposes designated:
    For child support recovery, including salaries, support,
 maintenance, and miscellaneous purposes, and for not more than
 the following full=time equivalent positions:
 .................................................. $ 13,420,460
 ............................................... FTEs     520.00
    1.  The department shall expend up to $27,032, including
 federal financial participation, for the fiscal year beginning
 July 1, 2009, for a child support public awareness campaign.
 The department and the office of the attorney general shall
 cooperate in continuation of the campaign.  The public
 awareness campaign shall emphasize, through a variety of media
 activities, the importance of maximum involvement of both
 parents in the lives of their children as well as the
 importance of payment of child support obligations.
    2.  Federal access and visitation grant moneys shall be
 issued directly to private not=for=profit agencies that
 provide services designed to increase compliance with the
 child access provisions of court orders, including but not
 limited to neutral visitation sites and mediation services.
    3.  The appropriation made to the department for child
 support recovery may be used throughout the fiscal year in the
 manner necessary for purposes of cash flow management, and for
 cash flow management purposes the department may temporarily
 draw more than the amount appropriated, provided the amount
 appropriated is not exceeded at the close of the fiscal year.
    4.  For Iowa orders, notwithstanding section 598.22A and
 effective October 1, 2009, support arrearages for which all
 rights have been and remain assigned to the department for
 time periods prior to October 1, 1997, when a child did not
 receive assistance under Title IV=A of the federal Social
 Security Act or when a child received foster care services,
 are considered satisfied up to the amount of assistance
 received or foster care funds expended, and the child support
 recovery unit shall update court records accordingly.  The
 unit shall send information regarding the provisions of this
 subsection to the obligor and obligee by regular mail to the
 last known address, and any objection by an obligor or an
 obligee shall be heard by the district court.
    Sec. 9.  MEDICAL ASSISTANCE.  There is appropriated from
 the general fund of the state to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount, or so much thereof
 as is necessary, to be used for the purpose designated:
    For medical assistance reimbursement and associated costs
 as specifically provided in the reimbursement methodologies in
 effect on June 30, 2009, except as otherwise expressly
 authorized by law, including reimbursement for abortion
 services which shall be available under the medical assistance
 program only for those abortions which are medically
 necessary:
 .................................................. $677,613,847
    1.  Medically necessary abortions are those performed under
 any of the following conditions:
    a.  The attending physician certifies that continuing the
 pregnancy would endanger the life of the pregnant woman.
    b.  The attending physician certifies that the fetus is
 physically deformed, mentally deficient, or afflicted with a
 congenital illness.
    c.  The pregnancy is the result of a rape which is reported
 within 45 days of the incident to a law enforcement agency or
 public or private health agency which may include a family
 physician.
    d.  The pregnancy is the result of incest which is reported
 within 150 days of the incident to a law enforcement agency or
 public or private health agency which may include a family
 physician.
    e.  Any spontaneous abortion, commonly known as a
 miscarriage, if not all of the products of conception are
 expelled.
    2.  The department shall utilize not more than $60,000 of
 the funds appropriated in this section to continue the
 AIDS/HIV health insurance premium payment program as
 established in 1992 Iowa Acts, Second Extraordinary Session,
 chapter 1001, section 409, subsection 6.  Of the funds
 allocated in this subsection, not more than $5,000 may be
 expended for administrative purposes.
    3.  Of the funds appropriated in this Act to the department
 of public health for addictive disorders, $950,000 for the
 fiscal year beginning July 1, 2009, shall be transferred to
 the department of human services for an integrated substance
 abuse managed care system.  The department shall not assume
 management of the substance abuse system in place of the
 managed care contractor unless such a change in approach is
 specifically authorized in law.  The departments of human
 services and public health shall work together to maintain the
 level of mental health and substance abuse services provided
 by the managed care contractor through the Iowa plan for
 behavioral health.  Each department shall take the steps
 necessary to continue the federal waivers as necessary to
 maintain the level of services.
    4.  a.  The department shall aggressively pursue options
 for providing medical assistance or other assistance to
 individuals with special needs who become ineligible to
 continue receiving services under the early and periodic
 screening, diagnosis, and treatment program under the medical
 assistance program due to becoming 21 years of age who have
 been approved for additional assistance through the
 department's exception to policy provisions, but who have
 health care needs in excess of the funding available through
 the exception to policy provisions.
    b.  Of the funds appropriated in this section, $100,000
 shall be used for participation in one or more pilot projects
 operated by a private provider to allow the individual or
 individuals to receive service in the community in accordance
 with principles established in Olmstead v. L.C., 527 U.S. 581
 (1999), for the purpose of providing medical assistance or
 other assistance to individuals with special needs who become
 ineligible to continue receiving services under the early and
 periodic screening, diagnosis, and treatment program under the
 medical assistance program due to becoming 21 years of age who
 have been approved for additional assistance through the
 department's exception to policy provisions, but who have
 health care needs in excess of the funding available through
 the exception to the policy provisions.
    5.  Of the funds appropriated in this section, up to
 $3,050,082 may be transferred to the field operations or
 general administration appropriations in this Act for
 operational costs associated with Part D of the federal
 Medicare Prescription Drug, Improvement, and Modernization Act
 of 2003, Pub. L. No. 108=173.
    6.  Of the funds appropriated in this section, not more
 than $166,600 shall be used to enhance outreach efforts.  The
 department may transfer funds allocated in this subsection to
 the appropriations in this division of this Act for general
 administration, the state children's health insurance program,
 or medical contracts, as necessary, to implement the outreach
 efforts.
    7.  Of the funds appropriated in this section, up to
 $442,100 may be transferred to the appropriation in this Act
 for medical contracts to be used for clinical assessment
 services related to remedial services in accordance with
 federal law.
    8.  A portion of the funds appropriated in this section may
 be transferred to the appropriations in this division of this
 Act for general administration, medical contracts, the state
 children's health insurance program, or field operations to be
 used for the state match cost to comply with the payment error
 rate measurement (PERM) program for both the medical
 assistance and state children's health insurance programs as
 developed by the centers for Medicare and Medicaid services of
 the United States department of health and human services to
 comply with the federal Improper Payments Information Act of
 2002, Pub. L. No. 107=300.
    9.  It is the intent of the general assembly that the
 department continue to implement the recommendations of the
 assuring better child health and development initiative II
 (ABCDII) clinical panel to the Iowa early and periodic
 screening, diagnostic, and treatment services healthy mental
 development collaborative board regarding changes to billing
 procedures, codes, and eligible service providers.
    10.  Of the funds appropriated in this section, a
 sufficient amount is allocated to supplement the incomes of
 residents of nursing facilities, intermediate care facilities
 for persons with mental illness, and intermediate care
 facilities for persons with mental retardation, with incomes
 of less than $50 in the amount necessary for the residents to
 receive a personal needs allowance of $50 per month pursuant
 to section 249A.30A.
    11.  Of the funds appropriated in this section, the
 following amounts shall be transferred to appropriations made
 in this division of this Act to the state mental health
 institutes:
    a.  Cherokee mental health institute .......... $  9,098,425
    b.  Clarinda mental health institute .......... $  1,977,305
    c.  Independence mental health institute ...... $  9,045,894
    d.  Mount Pleasant mental health institute .... $  5,752,587
    12.  a.  Of the funds appropriated in this section,
 $2,687,889 is allocated for state match for disproportionate
 share hospital payment of $7,321,954 to hospitals that meet
 both of the following conditions:
    (1)  The hospital qualifies for disproportionate share and
 graduate medical education payments.
    (2)  The hospital is an Iowa state=owned hospital with more
 than 500 beds and eight or more distinct residency specialty
 or subspecialty programs recognized by the American college of
 graduate medical education.
    b.  Distribution of the disproportionate share payment
 shall be made on a monthly basis.  The total amount of
 disproportionate share payments including graduate medical
 education, enhanced disproportionate share, and Iowa
 state=owned teaching hospital payments shall not exceed the
 amount of the state's allotment under Pub. L. No. 102=234.  In
 addition, the total amount of all disproportionate share
 payments shall not exceed the hospital=specific
 disproportionate share limits under Pub. L. No. 103=66.
    13.  Of the funds appropriated in this section, up to
 $4,634,065 may be transferred to the IowaCare account created
 in section 249J.24.
    14.  Of the funds appropriated in this section, $200,000
 shall be used for the Iowa chronic care consortium pursuant to
 2003 Iowa Acts, chapter 112, section 12, as amended by 2003
 Iowa Acts, chapter 179, sections 166 and 167.
    15.  One hundred percent of the nonfederal share of
 payments to area education agencies that are medical
 assistance providers for medical assistance=covered services
 provided to medical assistance=covered children, shall be made
 from the appropriation made in this section.
    16.  a.  Any new or renewed contract entered into by the
 department with a third party to administer behavioral health
 services under the medical assistance program shall provide
 that any interest earned on payments from the state during the
 state fiscal year shall be remitted to the department for
 deposit in a separate account after the end of the fiscal
 year.
    b.  The department shall continue to maintain a separate
 account within the medical assistance budget for the deposit
 of all funds remitted pursuant to a contract with a third
 party to administer behavioral health services under the
 medical assistance program established pursuant to 2008 Iowa
 Acts, chapter 1187, section 9, subsection 20.  Notwithstanding
 section 8.33, funds remaining in the account that remain
 unencumbered or unobligated at the end of any fiscal year
 shall not revert but shall remain available in succeeding
 fiscal years and shall be used only in accordance with
 appropriations from the account for health and human
 services=related purposes.
    c.  For the fiscal year beginning July 1, 2009, funds in
 the separate account are appropriated to the department of
 human services as state matching funds for the medical
 assistance program.
    17.  The department shall continue to implement the
 provisions in 2007 Iowa Acts, chapter 218, section 124 and
 section 126, as amended by 2008 Iowa Acts, chapter 1188,
 section 55, relating to eligibility for certain persons with
 disabilities under the medical assistance program in
 accordance with the federal family opportunity Act.
    18.  The department shall add behavior programming, crisis
 intervention, and mental health outreach services to the home
 and community=based services mental retardation waiver in
 order to continue necessary home and community=based services
 for persons transitioning into the community under the money
 follows the person grant program.
    19.  It is the intent of the general assembly that the Iowa
 autism council established in section 256.35A shall work with
 the department of human services to review the option of
 implementing a home and community=based services waiver for
 individuals up to 21 years of age with autism under the
 medical assistance program.  The council shall present final
 recommendations to the general assembly by January 15, 2010.
    20.  The department shall issue a request for proposals to
 implement a correct coding initiative for the medical
 assistance program to promote correct coding of health care
 services by providers, to evaluate claims submissions, and to
 prevent improper payment.  The department may use a portion of
 any savings projected to result from the initiative for
 one=time implementation costs and for on=going costs of the
 contract to the extent that savings exceed costs of the
 initiative.
    21.  The department shall request a medical assistance
 state plan amendment to be effective July 1, 2010, that
 specifies the coverage criteria for applied behavioral
 analysis therapy in the remedial services program.  Such
 coverage criteria shall be based on the best practices in
 medical literature that have been documented to achieve
 results.
    22.  The department may issue a request for proposals to
 implement a transportation brokerage system for administering
 medical assistance program medical transportation payments and
 client referrals.  Any request for proposals shall be
 structured to be budget neutral to the state.
    Sec. 10.  HEALTH INSURANCE PREMIUM PAYMENT PROGRAM.  There
 is appropriated from the general fund of the state to the
 department of human services for the fiscal year beginning
 July 1, 2009, and ending June 30, 2010, the following amount,
 or so much thereof as is necessary, to be used for the purpose
 designated:
    For administration of the health insurance premium payment
 program, including salaries, support, maintenance, and
 miscellaneous purposes, and for not more than the following
 full=time equivalent positions:
 .................................................. $    508,011
 ............................................... FTEs      19.00
    Sec. 11.  MEDICAL CONTRACTS.  There is appropriated from
 the general fund of the state to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount, or so much thereof
 as is necessary, to be used for the purpose designated:
    For medical contracts, including salaries, support,
 maintenance, and miscellaneous purposes, and for not more than
 the following full=time equivalent positions:
 .................................................. $ 13,651,503
 ............................................... FTEs       6.00
    Sec. 12.  STATE SUPPLEMENTARY ASSISTANCE.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For the state supplementary assistance program:
 .................................................. $ 18,412,646
    2.  The department shall increase the personal needs
 allowance for residents of residential care facilities by the
 same percentage and at the same time as federal supplemental
 security income and federal social security benefits are
 increased due to a recognized increase in the cost of living.
 The department may adopt emergency rules to implement this
 subsection.
    3.  If during the fiscal year beginning July 1, 2009, the
 department projects that state supplementary assistance
 expenditures for a calendar year will not meet the federal
 pass=through requirement specified in Title XVI of the federal
 Social Security Act, section 1618, as codified in 42 U.S.C. }
 1382g, the department may take actions including but not
 limited to increasing the personal needs allowance for
 residential care facility residents and making programmatic
 adjustments or upward adjustments of the residential care
 facility or in=home health=related care reimbursement rates
 prescribed in this division of this Act to ensure that federal
 requirements are met.  In addition, the department may make
 other programmatic and rate adjustments necessary to remain
 within the amount appropriated in this section while ensuring
 compliance with federal requirements.  The department may
 adopt emergency rules to implement the provisions of this
 subsection.
    Sec. 13.  STATE CHILDREN'S HEALTH INSURANCE PROGRAM.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For maintenance of the healthy and well kids in Iowa (hawk=
 i) program pursuant to chapter 514I for receipt of federal
 financial participation under Title XXI of the federal Social
 Security Act, which creates the state children's health
 insurance program:
 .................................................. $ 14,629,830
    2.  Of the funds appropriated in this section, $128,950 is
 allocated for continuation of the contract for advertising and
 outreach with the department of public health and $90,050 is
 allocated for other advertising and outreach.
    Sec. 14.  CHILD CARE ASSISTANCE.  There is appropriated
 from the general fund of the state to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount, or so much thereof
 as is necessary, to be used for the purpose designated:
    For child care programs:
 .................................................. $ 37,974,472
    1.  Of the funds appropriated in this section, $34,417,754
 shall be used for state child care assistance in accordance
 with section 237A.13.  It is the intent of the general
 assembly to appropriate sufficient funding for the state child
 care assistance program for the fiscal year beginning July 1,
 2010, in order to avoid establishment of waiting list
 requirements by the department in the preceding fiscal year in
 anticipation that enhanced funding under the federal American
 Recovery and Reinvestment Act of 2009 will not be replaced for
 the fiscal year beginning July 1, 2010.
    2.  Nothing in this section shall be construed or is
 intended as or shall imply a grant of entitlement for services
 to persons who are eligible for assistance due to an income
 level consistent with the waiting list requirements of section
 237A.13.  Any state obligation to provide services pursuant to
 this section is limited to the extent of the funds
 appropriated in this section.
    3.  Of the funds appropriated in this section, $480,453 is
 allocated for the statewide program for child care resource
 and referral services under section 237A.26.  A list of the
 registered and licensed child care facilities operating in the
 area served by a child care resource and referral service
 shall be made available to the families receiving state child
 care assistance in that area.
    4.  a.  Of the funds appropriated in this section,
 $1,536,181 is allocated for child care quality improvement
 initiatives including but not limited to the voluntary quality
 rating system in accordance with section 237A.30.
    b.  The department shall revise the achievement bonus
 provisions under the voluntary quality rating system to
 provide that the bonus amount paid for a provider renewing a
 rating at levels 2 through 4 in years subsequent to the
 initial rating shall not be more than 50 percent of the amount
 of the initial bonus award.  For providers who renew at a
 lower rating level than previously awarded, the achievement
 bonus amount shall not be more than 50 percent of the award
 amount for the lower rating level.
    5.  The department may use any of the funds appropriated in
 this section as a match to obtain federal funds for use in
 expanding child care assistance and related programs.  For the
 purpose of expenditures of state and federal child care
 funding, funds shall be considered obligated at the time
 expenditures are projected or are allocated to the
 department's service areas.  Projections shall be based on
 current and projected caseload growth, current and projected
 provider rates, staffing requirements for eligibility
 determination and management of program requirements including
 data systems management, staffing requirements for
 administration of the program, contractual and grant
 obligations and any transfers to other state agencies, and
 obligations for decategorization or innovation projects.
    6.  A portion of the state match for the federal child care
 and development block grant shall be provided as necessary to
 meet federal matching funds requirements through the state
 general fund appropriation made for child development grants
 and other programs for at=risk children in section 279.51.
    7.  Of the funds appropriated in this section, $1,097,084
 is transferred to the Iowa empowerment fund from which it is
 appropriated to be used for professional development for the
 system of early care, health, and education.
    8.  Of the funds appropriated in this section, $350,000
 shall be allocated to a county with a population of more than
 300,000 to be used for continuation of a grant to support
 child care center services provided to children with mental,
 physical, or emotional challenges in order for the children to
 remain in a home or family setting.
    9.  Of the amount allocated in subsection 1, $93,000 shall
 be used for the public purpose of providing a grant to a
 neighborhood affordable housing and services organization
 established in a county with a population of more than
 350,000, that provides at least 300 apartment units to house
 more than 1,000 residents, of which more than 80 percent
 belong to a minority population and at least 95 percent are
 headed by a single parent and have an income below federal
 poverty guidelines, to be used for child development
 programming for children residing in the housing.
    10.  Notwithstanding section 8.33, moneys appropriated in
 this section or received from the federal appropriations made
 for the purposes of this section that remain unencumbered or
 unobligated at the close of the fiscal year shall not revert
 to any fund but shall remain available for expenditure for the
 purposes designated until the close of the succeeding fiscal
 year.
    Sec. 15.  JUVENILE INSTITUTIONS.  There is appropriated
 from the general fund of the state to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amounts, or so much
 thereof as is necessary, to be used for the purposes
 designated:
    1.  For operation of the Iowa juvenile home at Toledo and
 for salaries, support, and maintenance, and for not more than
 the following full=time equivalent positions:
 .................................................. $  6,754,759
 ............................................... FTEs     125.00
    2.  For operation of the state training school at Eldora
 and for salaries, support, and maintenance, and for not more
 than the following full=time equivalent positions:
 .................................................. $ 10,717,787
 ............................................... FTEs     202.70
    3.  A portion of the moneys appropriated in this section
 shall be used by the state training school and by the Iowa
 juvenile home for grants for adolescent pregnancy prevention
 activities at the institutions in the fiscal year beginning
 July 1, 2009.
    Sec. 16.  CHILD AND FAMILY SERVICES.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For child and family services:
 .................................................. $ 90,591,451
    2.  In order to address a reduction of $5,200,000 from the
 amount allocated under the appropriation made for the purposes
 of this section in prior years for purposes of juvenile
 delinquent graduated sanction services, up to $5,200,000 of
 the amount of federal temporary assistance for needy families
 block grant funding appropriated in this division of this Act
 for child and family services shall be made available for
 purposes of juvenile delinquent graduated sanction services.
    3.  The department may transfer funds appropriated in this
 section as necessary to pay the nonfederal costs of services
 reimbursed under the medical assistance program, state child
 care assistance program, or the family investment program
 which are provided to children who would otherwise receive
 services paid under the appropriation in this section.  The
 department may transfer funds appropriated in this section to
 the appropriations made in this division of this Act for
 general administration and for field operations for resources
 necessary to implement and operate the services funded in this
 section.
    4.  a.  Of the funds appropriated in this section, up to
 $34,200,400 is allocated as the statewide expenditure target
 under section 232.143 for group foster care maintenance and
 services.  If the department projects that such expenditures
 for the fiscal year will be less than the target amount
 allocated in this lettered paragraph, the department may
 reallocate the excess to provide additional funding for
 shelter care or the child welfare emergency services addressed
 with the allocation for shelter care.
    b.  If at any time after September 30, 2009, annualization
 of a service area's current expenditures indicates a service
 area is at risk of exceeding its group foster care expenditure
 target under section 232.143 by more than 5 percent, the
 department and juvenile court services shall examine all group
 foster care placements in that service area in order to
 identify those which might be appropriate for termination.  In
 addition, any aftercare services believed to be needed for the
 children whose placements may be terminated shall be
 identified.  The department and juvenile court services shall
 initiate action to set dispositional review hearings for the
 placements identified.  In such a dispositional review
 hearing, the juvenile court shall determine whether needed
 aftercare services are available and whether termination of
 the placement is in the best interest of the child and the
 community.
    5.  In accordance with the provisions of section 232.188,
 the department shall continue the child welfare and juvenile
 justice funding initiative during fiscal year 2009=2010.  Of
 the funds appropriated in this section, $1,717,753 is
 allocated specifically for expenditure for fiscal year
 2009=2010 through the decategorization service funding pools
 and governance boards established pursuant to section 232.188.
    6.  A portion of the funds appropriated in this section may
 be used for emergency family assistance to provide other
 resources required for a family participating in a family
 preservation or reunification project or successor project to
 stay together or to be reunified.
    7.  Notwithstanding section 234.35 or any other provision
 of law to the contrary, state funding for shelter care shall
 be limited to $7,686,460.  The department may continue or
 amend shelter care provider contracts to include the child
 welfare emergency services for children who might otherwise be
 served in shelter care that were implemented pursuant to 2008
 Iowa Acts, chapter 1187, section 16, subsection 7.
    8.  Except for federal funds provided by the federal
 American Recovery and Reinvestment Act of 2009, federal funds
 received by the state during the fiscal year beginning July 1,
 2009, as the result of the expenditure of state funds
 appropriated during a previous state fiscal year for a service
 or activity funded under this section are appropriated to the
 department to be used as additional funding for services and
 purposes provided for under this section.  Notwithstanding
 section 8.33, moneys received in accordance with this
 subsection that remain unencumbered or unobligated at the
 close of the fiscal year shall not revert to any fund but
 shall remain available for the purposes designated until the
 close of the succeeding fiscal year.
    9.  Of the funds appropriated in this section, at least
 $3,464,856 shall be used for protective child care assistance.
    10.  a.  Of the funds appropriated in this section, up to
 $2,257,277 is allocated for the payment of the expenses of
 court=ordered services provided to juveniles who are under the
 supervision of juvenile court services, which expenses are a
 charge upon the state pursuant to section 232.141, subsection
 4.  Of the amount allocated in this lettered paragraph, up to
 $1,556,287 shall be made available to provide school=based
 supervision of children adjudicated under chapter 232, of
 which not more than $15,000 may be used for the purpose of
 training.  A portion of the cost of each school=based liaison
 officer shall be paid by the school district or other funding
 source as approved by the chief juvenile court officer.
    b.  Of the funds appropriated in this section, up to
 $819,722 is allocated for the payment of the expenses of
 court=ordered services provided to children who are under the
 supervision of the department, which expenses are a charge
 upon the state pursuant to section 232.141, subsection 4.
    c.  Notwithstanding section 232.141 or any other provision
 of law to the contrary, the amounts allocated in this
 subsection shall be distributed to the judicial districts as
 determined by the state court administrator and to the
 department's service areas as determined by the administrator
 of the department's division of child and family services.
 The state court administrator and the division administrator
 shall make the determination of the distribution amounts on or
 before June 15, 2009.
    d.  Notwithstanding chapter 232 or any other provision of
 law to the contrary, a district or juvenile court shall not
 order any service which is a charge upon the state pursuant to
 section 232.141 if there are insufficient court=ordered
 services funds available in the district court or departmental
 service area distribution amounts to pay for the service.  The
 chief juvenile court officer and the departmental service area
 manager shall encourage use of the funds allocated in this
 subsection such that there are sufficient funds to pay for all
 court=related services during the entire year.  The chief
 juvenile court officers and departmental service area managers
 shall attempt to anticipate potential surpluses and shortfalls
 in the distribution amounts and shall cooperatively request
 the state court administrator or division administrator to
 transfer funds between the judicial districts' or departmental
 service areas' distribution amounts as prudent.
    e.  Notwithstanding any provision of law to the contrary, a
 district or juvenile court shall not order a county to pay for
 any service provided to a juvenile pursuant to an order
 entered under chapter 232 which is a charge upon the state
 under section 232.141, subsection 4.
    f.  Of the funds allocated in this subsection, not more
 than $100,000 may be used by the judicial branch for
 administration of the requirements under this subsection.
    11.  Of the funds appropriated in this section, $1,005,166
 shall be transferred to the department of public health to be
 used for the child protection center grant program in
 accordance with section 135.118.
    12.  If the department receives federal approval to
 implement a waiver under Title IV=E of the federal Social
 Security Act to enable providers to serve children who remain
 in the children's families and communities, for purposes of
 eligibility under the medical assistance program, children who
 participate in the waiver shall be considered to be placed in
 foster care.
    13.  Of the funds appropriated in this section, $2,695,256
 is allocated for the preparation for adult living program
 pursuant to section 234.46.
    14.  Of the funds appropriated in this section, $975,162
 shall be used for juvenile drug courts.  The amount allocated
 in this subsection shall be distributed as follows:
    a.  To the judicial branch for salaries to assist with the
 operation of juvenile drug court programs operated in the
 following jurisdictions:
    (1)  Marshall county:
 .................................................. $     58,509
    (2)  Woodbury county:
 .................................................. $    117,267
    (3)  Polk county:
 .................................................. $    182,779
    (4)  The third judicial district:
 .................................................. $     63,385
    (5)  The eighth judicial district:
 .................................................. $     63,385
    b.  For court=ordered services to support substance abuse
 services provided to the juveniles participating in the
 juvenile drug court programs listed in paragraph "a" and the
 juveniles' families:
 .................................................. $    489,837
    The state court administrator shall allocate the funding
 designated in this paragraph among the programs.
    15.  Of the funds appropriated in this section, $224,288
 shall be used for the public purpose of providing a grant to a
 nonprofit human services organization providing services to
 individuals and families in multiple locations in southwest
 Iowa and Nebraska for support of a project providing
 immediate, sensitive support and forensic interviews, medical
 exams, needs assessments, and referrals for victims of child
 abuse and their nonoffending family members.
    16.  Of the funds appropriated in this section, $123,923 is
 allocated for the elevate approach of providing a support
 network to children placed in foster care.
    17.  Of the funds appropriated in this section, $227,987 is
 allocated for use pursuant to section 235A.1 for continuation
 of the initiative to address child sexual abuse implemented
 pursuant to 2007 Iowa Acts, chapter 218, section 18,
 subsection 21.
    18.  Of the funds appropriated in this section, $75,741 is
 allocated for the public purpose of renewing of a grant to a
 county with a population between 189,000 and 196,000 in the
 latest preceding certified federal census for implementation
 of the county's runaway treatment plan under section 232.195.
    19.  Of the funds appropriated in this section, $590,780 is
 allocated for the community partnership for child protection
 sites.
    20.  Of the funds appropriated in this section, $355,036 is
 allocated for the department's minority youth and family
 projects under the redesign of the child welfare system.
    21.  Of the funds appropriated in this section, $281,217 is
 allocated for funding of the state match for the federal
 substance abuse and mental health services administration
 (SAMHSA) system of care grant.
    22.  Of the funds appropriated in this section, $23,792 is
 allocated for the public purpose of providing a grant to a
 child welfare services provider headquartered in a county with
 a population between 189,000 and 196,000 in the latest
 preceding certified federal census that provides multiple
 services including but not limited to a psychiatric medical
 institution for children, shelter, residential treatment,
 after school programs, school=based programming, and an
 Asperger's syndrome program, to be used for support services
 for children with autism spectrum disorder and their families.
    23.  Of the funds appropriated in this section, $125,000 is
 allocated for continuation of the contracts for the
 multidimensional treatment level foster care program
 established pursuant to 2006 Iowa Acts, chapter 1123, for an
 additional year.  The contractor shall provide a 25 percent
 match to receive the funds and shall submit a report on the
 program to the persons designated by this division of this Act
 for submission of reports.
    24.  Of the funds appropriated in this section, $80,000
 shall be transferred to the appropriation made in this
 division of this Act for the family support subsidy program to
 supplement that appropriation.
    Sec. 17.  The department of human services shall work
 jointly with the juvenile court and juvenile court services in
 studying the provision of child abuse information to juvenile
 court services concerning children under the supervision of
 juvenile court services, barriers to timely provision of the
 information, and how the provision of the information can be
 improved.  A final report with findings and recommendations
 shall be submitted to the governor, supreme court, and general
 assembly, on or before December 15, 2009.
    Sec. 18.  ADOPTION SUBSIDY.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For adoption subsidy payments and services:
 .................................................. $ 34,883,674
    2.  The department may transfer funds appropriated in this
 section to the appropriation made in this Act for general
 administration for costs paid from the appropriation relating
 to adoption subsidy.
    3.  Except for federal funds provided by the federal
 American Recovery and Reinvestment Act of 2009, federal funds
 received by the state during the fiscal year beginning July 1,
 2009, as the result of the expenditure of state funds during a
 previous state fiscal year for a service or activity funded
 under this section are appropriated to the department to be
 used as additional funding for the services and activities
 funded under this section.  Notwithstanding section 8.33,
 moneys received in accordance with this subsection that remain
 unencumbered or unobligated at the close of the fiscal year
 shall not revert to any fund but shall remain available for
 expenditure for the purposes designated until the close of the
 succeeding fiscal year.
    Sec. 19.  JUVENILE DETENTION HOME FUND.  Moneys deposited
 in the juvenile detention home fund created in section 232.142
 during the fiscal year beginning July 1, 2009, and ending June
 30, 2010, are appropriated to the department of human services
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, for distribution of an amount equal to a percentage
 of the costs of the establishment, improvement, operation, and
 maintenance of county or multicounty juvenile detention homes
 in the fiscal year beginning July 1, 2008.  Moneys
 appropriated for distribution in accordance with this section
 shall be allocated among eligible detention homes, prorated on
 the basis of an eligible detention home's proportion of the
 costs of all eligible detention homes in the fiscal year
 beginning July 1, 2008.  The percentage figure shall be
 determined by the department based on the amount available for
 distribution for the fund.  Notwithstanding section 232.142,
 subsection 3, the financial aid payable by the state under
 that provision for the fiscal year beginning July 1, 2009,
 shall be limited to the amount appropriated for the purposes
 of this section.
    Sec. 20.  FAMILY SUPPORT SUBSIDY PROGRAM.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For the family support subsidy program:
 .................................................. $  1,697,137
    2.  The department shall use at least $385,475 of the
 moneys appropriated in this section for the family support
 center component of the comprehensive family support program
 under section 225C.47.  Not more than $25,000 of the amount
 allocated in this subsection shall be used for administrative
 costs.
    3.  If at any time during the fiscal year, the amount of
 funding available for the family support subsidy program is
 reduced from the amount initially used to establish the figure
 for the number of family members for whom a subsidy is to be
 provided at any one time during the fiscal year,
 notwithstanding section 225C.38, subsection 2, the department
 shall revise the figure as necessary to conform to the amount
 of funding available.
    Sec. 21.  CONNER DECREE.  There is appropriated from the
 general fund of the state to the department of human services
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amount, or so much thereof as is
 necessary, to be used for the purpose designated:
    For building community capacity through the coordination
 and provision of training opportunities in accordance with the
 consent decree of Conner v. Branstad, No. 4=86=CV=30871(S.D.
 Iowa, July 14, 1994):
 .................................................. $     37,358
    Sec. 22.  MENTAL HEALTH INSTITUTES.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amounts, or so much thereof as is necessary, to be
 used for the purposes designated:
    a.  For the state mental health institute at Cherokee for
 salaries, support, maintenance, and miscellaneous purposes,
 and for not more than the following full=time equivalent
 positions:
 .................................................. $  5,436,076
 ............................................... FTEs     205.00
    b.  For the state mental health institute at Clarinda for
 salaries, support, maintenance, and miscellaneous purposes,
 and for not more than the following full=time equivalent
 positions:
 .................................................. $  6,227,335
 ............................................... FTEs     114.95
    c.  For the state mental health institute at Independence
 for salaries, support, maintenance, and miscellaneous
 purposes, and for not more than the following full=time
 equivalent positions:
 .................................................. $  9,503,567
 ............................................... FTEs     287.85
    d.  For the state mental health institute at Mount Pleasant
 for salaries, support, maintenance, and miscellaneous
 purposes, and for not more than the following full=time
 equivalent positions:
 .................................................. $  1,795,552
 ............................................... FTEs     116.44
    2.  The department shall submit a proposal for closing one
 state mental health institute and consolidating the services
 provided at the other state mental health institutes.  The
 proposal shall provide for maintaining the existing levels of
 beds and services after the consolidation.  The proposal shall
 be developed in coordination with the task force review of the
 four institutes performed under this section.  The department
 shall incorporate or address the findings and recommendations
 of the task force in such proposal.  The proposal shall be
 submitted to the persons designated by this division of this
 Act for submission of reports on or before December 15, 2009.
    3.  The department shall staff a task force to be appointed
 by the governor consisting of knowledgeable citizens to
 perform an in=depth review of the four state mental health
 institutes, services provided, public benefits of the services
 provided, economic effects connected to the presence of the
 institutes that are realized by the communities in the areas
 served and the families of personnel, and other public costs
 and benefits associated with the presence and availability of
 the four institutes.  The review shall be coordinated with the
 proposal to be developed by the department under this section
 and shall incorporate or address the proposal findings and
 recommendations.  The task force shall submit a report
 providing findings and recommendations to the governor and
 general assembly on or before December 15, 2009.
    Sec. 23.  STATE RESOURCE CENTERS.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amounts, or so much thereof as is necessary, to be
 used for the purposes designated:
    a.  For the state resource center at Glenwood for salaries,
 support, maintenance, and miscellaneous purposes:
 .................................................. $ 17,620,487
    b.  For the state resource center at Woodward for salaries,
 support, maintenance, and miscellaneous purposes:
 .................................................. $ 10,929,200
    2.  The department may continue to bill for state resource
 center services utilizing a scope of services approach used
 for private providers of ICFMR services, in a manner which
 does not shift costs between the medical assistance program,
 counties, or other sources of funding for the state resource
 centers.
    3.  The state resource centers may expand the time=limited
 assessment and respite services during the fiscal year.
    4.  If the department's administration and the department
 of management concur with a finding by a state resource
 center's superintendent that projected revenues can reasonably
 be expected to pay the salary and support costs for a new
 employee position, or that such costs for adding a particular
 number of new positions for the fiscal year would be less than
 the overtime costs if new positions would not be added, the
 superintendent may add the new position or positions.  If the
 vacant positions available to a resource center do not include
 the position classification desired to be filled, the state
 resource center's superintendent may reclassify any vacant
 position as necessary to fill the desired position.  The
 superintendents of the state resource centers may, by mutual
 agreement, pool vacant positions and position classifications
 during the course of the fiscal year in order to assist one
 another in filling necessary positions.
    5.  If existing capacity limitations are reached in
 operating units, a waiting list is in effect for a service or
 a special need for which a payment source or other funding is
 available for the service or to address the special need, and
 facilities for the service or to address the special need can
 be provided within the available payment source or other
 funding, the superintendent of a state resource center may
 authorize opening not more than two units or other facilities
 and begin implementing the service or addressing the special
 need during fiscal year 2009=2010.
    Sec. 24.  MI/MR/DD STATE CASES.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For distribution to counties for state case services for
 persons with mental illness, mental retardation, and
 developmental disabilities in accordance with section 331.440:
 .................................................. $ 11,446,288
    2.  For the fiscal year beginning July 1, 2009, and ending
 June 30, 2010, $200,000 is allocated for state case services
 from the amounts appropriated from the fund created in section
 8.41 to the department of human services from the funds
 received from the federal government under 42 U.S.C., ch. 6A,
 subch. XVII, relating to the community mental health center
 block grant, for the federal fiscal years beginning October 1,
 2007, and ending September 30, 2008, beginning October 1,
 2008, and ending September 30, 2009, and beginning October 1,
 2009, and ending September 30, 2010.  The allocation made in
 this subsection shall be made prior to any other distribution
 allocation of the appropriated federal funds.
    3.  For the fiscal year beginning July 1, 2009, to the
 extent the appropriation made in this section and other
 funding provided for state case services and other support, as
 defined in section 331.440, and the other funding available in
 the county's services fund under section 331.424A are
 insufficient to pay the costs of such services and other
 support, a county of residence may implement a waiting list or
 other measures to maintain expenditures within the available
 funding.
    4.  Notwithstanding section 8.33, moneys appropriated in
 this section that remain unencumbered or unobligated at the
 close of the fiscal year shall not revert but shall remain
 available for expenditure for the purposes designated until
 the close of the succeeding fiscal year.
    Sec. 25.  MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES ==
 COMMUNITY SERVICES FUND.  There is appropriated from the
 general fund of the state to the mental health and
 developmental disabilities community services fund created in
 section 225C.7 for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount, or so much thereof
 as is necessary, to be used for the purpose designated:
    For mental health and developmental disabilities community
 services in accordance with this division of this Act:
 ................................................. $ 15,790,111
    1.  Of the funds appropriated in this section, $15,763,951
 shall be allocated to counties for funding of community=based
 mental health and developmental disabilities services.  The
 moneys shall be allocated to a county as follows:
    a.  Fifty percent based upon the county's proportion of the
 state's population of persons with an annual income which is
 equal to or less than the poverty guideline established by the
 federal office of management and budget.
    b.  Fifty percent based upon the county's proportion of the
 state's general population.
    2.  a.  A county shall utilize the funding the county
 receives pursuant to subsection 1 for services provided to
 persons with a disability, as defined in section 225C.2.
 However, no more than 50 percent of the funding shall be used
 for services provided to any one of the service populations.
    b.  A county shall use at least 50 percent of the funding
 the county receives under subsection 1 for contemporary
 services provided to persons with a disability, as described
 in rules adopted by the department.
    3.  Of the funds appropriated in this section, $26,160
 shall be used to support the Iowa compass program providing
 computerized information and referral services for Iowans with
 disabilities and their families.
    4.  a.  Funding appropriated for purposes of the federal
 social services block grant is allocated for distribution to
 counties for local purchase of services for persons with
 mental illness or mental retardation or other developmental
 disability.
    b.  The funds allocated in this subsection shall be
 expended by counties in accordance with the county's county
 management plan approved by the board of supervisors.  A
 county without an approved county management plan shall not
 receive allocated funds until the county's management plan is
 approved.
    c.  The funds provided by this subsection shall be
 allocated to each county as follows:
    (1)  Fifty percent based upon the county's proportion of
 the state's population of persons with an annual income which
 is equal to or less than the poverty guideline established by
 the federal office of management and budget.
    (2)  Fifty percent based upon the amount provided to the
 county for local purchase of services in the preceding fiscal
 year.
    5.  A county is eligible for funds under this section if
 the county qualifies for a state payment as described in
 section 331.439.
    6.  The most recent population estimates issued by the
 United States bureau of the census shall be applied for the
 population factors utilized in this section.
    Sec. 26.  SEXUALLY VIOLENT PREDATORS.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For costs associated with the commitment and treatment of
 sexually violent predators in the unit located at the state
 mental health institute at Cherokee, including costs of legal
 services and other associated costs, including salaries,
 support, maintenance, and miscellaneous purposes, and for not
 more than the following full=time equivalent positions:
 .................................................. $  6,860,204
 ............................................... FTEs     105.50
    2.  Unless specifically prohibited by law, if the amount
 charged provides for recoupment of at least the entire amount
 of direct and indirect costs, the department of human services
 may contract with other states to provide care and treatment
 of persons placed by the other states at the unit for sexually
 violent predators at Cherokee.  The moneys received under such
 a contract shall be considered to be repayment receipts and
 used for the purposes of the appropriation made in this
 section.
    Sec. 27.  FIELD OPERATIONS.  There is appropriated from the
 general fund of the state to the department of human services
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amount, or so much thereof as is
 necessary, to be used for the purposes designated:
    For field operations, including salaries, support,
 maintenance, and miscellaneous purposes, and for not more than
 the following full=time equivalent positions:
 .................................................. $ 63,032,831
 ............................................... FTEs   2,000.13
    Priority in filling full=time equivalent positions shall be
 given to those positions related to child protection services
 and eligibility determination for low=income families.
    Sec. 28.  GENERAL ADMINISTRATION.  There is appropriated
 from the general fund of the state to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount, or so much thereof
 as is necessary, to be used for the purpose designated:
    For general administration, including salaries, support,
 maintenance, and miscellaneous purposes, and for not more than
 the following full=time equivalent positions:
 .................................................. $ 15,252,523
 ............................................... FTEs     354.33
    1.  Of the funds appropriated in this section, $48,556 is
 allocated for the prevention of disabilities policy council
 established in section 225B.3.
    2.  The department shall report at least monthly to the
 legislative services agency concerning the department's
 operational and program expenditures.
    3.  Notwithstanding provisions to the contrary in chapter
 217, if necessary to address funding reductions in general
 administration and field operations, the department may
 propose and implement reorganization of the departmental
 administration and field operations during the fiscal year
 beginning July 1, 2009.  At least 30 calendar days prior to
 implementation of any reorganization, the department shall
 submit a detailed proposal for the reorganization to the
 chairpersons and ranking members of the joint appropriations
 subcommittee on health and human services, the department of
 management, and the persons designated by this division of
 this Act for submission of reports, to provide an opportunity
 for review, and comment, and possible revision of the
 proposal.
    4.  The department shall adopt rules pursuant to chapter
 17A establishing standards for childrens centers under section
 237B.1, as amended by this Act.
    Sec. 29.  VOLUNTEERS.  There is appropriated from the
 general fund of the state to the department of human services
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amount, or so much thereof as is
 necessary, to be used for the purpose designated:
    For development and coordination of volunteer services:
 .................................................. $     94,067
    Sec. 30.  FAMILY PLANNING SERVICES.  There is appropriated
 from the general fund of the state to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount or so much thereof
 as is necessary, to be used for the purpose designated:
    For family planning services to individuals with incomes
 not to exceed 200 percent of the federal poverty level as
 defined by the most recently revised income guidelines
 published by the United States department of health and human
 services, who are not currently receiving the specific benefit
 under the medical assistance program:
 .................................................. $     10,000
    Moneys appropriated under this section shall not be used to
 provide abortions.  The department shall work with appropriate
 stakeholders to implement and administer the program.
    Sec. 31.  PREGNANCY COUNSELING AND SUPPORT SERVICES PROGRAM
 == APPROPRIATION.  There is appropriated from the general fund
 of the state to the department of human services for the
 fiscal year beginning July 1, 2009, and ending June 30, 2010,
 the following amount or so much thereof as is necessary for
 the purpose designated:
    For a pregnancy counseling and support services program as
 specified in this section:
 .................................................. $    100,000
    The department of human services shall continue the
 pregnancy counseling and support services program to provide
 core services consisting of information, education,
 counseling, and support services to women who experience
 unplanned pregnancies by supporting childbirth, assisting
 pregnant women in remaining healthy and maintaining a healthy
 pregnancy while deciding whether to keep the child or place
 the child for adoption, and assisting women after the birth of
 a child that was implemented pursuant to 2008 Iowa Acts,
 chapter 1187, section 30.
    Sec. 32.  MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
 ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
 DEPARTMENT OF HUMAN SERVICES.
    1.  a.  (1)  For the fiscal year beginning July 1, 2009,
 the total state funding amount for the nursing facility budget
 shall not exceed $146,803,575.
    (2)  For the fiscal year beginning July 1, 2009, the
 department shall rebase case=mix nursing facility rates.
 However, total nursing facility budget expenditures, including
 both case=mix and noncase=mix shall not exceed the amount
 specified in subparagraph (1).  When calculating case=mix per
 diem cost and the patient=day=weighted medians used in
 rate=setting for nursing facilities effective July 1, 2009,
 the inflation factor applied from the midpoint of the cost
 report period to the first day of the state fiscal year rate
 period shall be adjusted to maintain state funding within the
 amount specified in subparagraph (1).
    (3)  The department, in cooperation with nursing facility
 representatives, shall review projections for state funding
 expenditures for reimbursement of nursing facilities on a
 quarterly basis and the department shall determine if an
 adjustment to the medical assistance reimbursement rate is
 necessary in order to provide reimbursement within the state
 funding amount.  Any temporary enhanced federal financial
 participation that may become available to the Iowa medical
 assistance program during the fiscal year shall not be used in
 projecting the nursing facility budget.  Notwithstanding 2001
 Iowa Acts, chapter 192, section 4, subsection 2, paragraph
 "c", and subsection 3, paragraph "a", subparagraph (2), if the
 state funding expenditures for the nursing facility budget for
 the fiscal year beginning July 1, 2009, are projected to
 exceed the amount specified in subparagraph (1), the
 department shall adjust the reimbursement for nursing
 facilities reimbursed under the case=mix reimbursement system
 to maintain expenditures of the nursing facility budget within
 the specified amount.  The department shall revise such
 reimbursement as necessary to adjust the annual accountability
 measures payment in accordance with 2001 Iowa Acts, chapter
 192, section 4, subsection 4, as amended by 2008 Iowa Acts,
 chapter 1187, section 33, and as amended by this Act.
    b.  For the fiscal year beginning July 1, 2009, the
 department shall reimburse pharmacy dispensing fees using a
 single rate of $4.57 per prescription or the pharmacy's usual
 and customary fee, whichever is lower.
    c.  (1)  For the fiscal year beginning July 1, 2009,
 reimbursement rates for outpatient hospital services shall
 remain at the rates in effect on June 30, 2009.
    (2)  For the fiscal year beginning July 1, 2009,
 reimbursement rates for inpatient hospital services shall
 remain at the rates in effect on June 30, 2009.  The Iowa
 hospital association shall submit information to the general
 assembly's standing committees on government oversight during
 the 2010 session of the general assembly regarding actions
 taken to increase compensation and other costs of employment
 for hospital staff who provide direct care to patients.
    (3)  For the fiscal year beginning July 1, 2009, the
 graduate medical education and disproportionate share hospital
 fund shall remain at the amount in effect on June 30, 2009.
    (4)  In order to ensure the efficient use of limited state
 funds in procuring health care services for low=income Iowans,
 funds appropriated in this Act for hospital services shall not
 be used for activities which would be excluded from a
 determination of reasonable costs under the federal Medicare
 program pursuant to 42 U.S.C. } 1395X(v)(1)(N).
    d.  For the fiscal year beginning July 1, 2009,
 reimbursement rates for rural health clinics, hospices,
 independent laboratories, rehabilitation agencies, and acute
 mental hospitals shall be increased in accordance with
 increases under the federal Medicare program or as supported
 by their Medicare audited costs.
    e.  For the fiscal year beginning July 1, 2009,
 reimbursement rates for home health agencies shall remain at
 the rates in effect on June 30, 2009, not to exceed a home
 health agency's actual allowable cost.
    f.  For the fiscal year beginning July 1, 2009, federally
 qualified health centers shall receive cost=based
 reimbursement for 100 percent of the reasonable costs for the
 provision of services to recipients of medical assistance.
    g.  For the fiscal year beginning July 1, 2009, the
 reimbursement rates for dental services shall remain at the
 rates in effect on June 30, 2009.
    h.  Unless legislation is enacted by the Eighty=third
 General Assembly, 2009 Session, adjusting such rates, for the
 fiscal year beginning July 1, 2009, the maximum reimbursement
 rate for psychiatric medical institutions for children shall
 be $167.19 per day.
    i.  For the fiscal year beginning July 1, 2009, unless
 otherwise specified in this Act, all noninstitutional medical
 assistance provider reimbursement rates shall remain at the
 rates in effect on June 30, 2009, except for area education
 agencies, local education agencies, infant and toddler
 services providers, and those providers whose rates are
 required to be determined pursuant to section 249A.20.
    j.  Notwithstanding any provision to the contrary, for the
 fiscal year beginning July 1, 2009, the reimbursement rate for
 anesthesiologists shall remain at the rate in effect on June
 30, 2009.
    k.  Notwithstanding section 249A.20, for the fiscal year
 beginning July 1, 2009, the average reimbursement rate for
 health care providers eligible for use of the federal Medicare
 resource=based relative value scale reimbursement methodology
 under that section shall remain at the rate in effect on June
 30, 2009; however, this rate shall not exceed the maximum
 level authorized by the federal government.
    l.  For the fiscal year beginning July 1, 2009, the
 reimbursement rate for residential care facilities shall not
 be less than the minimum payment level as established by the
 federal government to meet the federally mandated maintenance
 of effort requirement.  The flat reimbursement rate for
 facilities electing not to file semiannual cost reports shall
 not be less than the minimum payment level as established by
 the federal government to meet the federally mandated
 maintenance of effort requirement.
    m.  For the fiscal year beginning July 1, 2009, inpatient
 mental health services provided at hospitals shall be
 reimbursed at the cost of the services, subject to Medicaid
 program upper payment limit rules; community mental health
 centers and providers of mental health services to county
 residents pursuant to a waiver approved under section 225C.7,
 subsection 3, shall be reimbursed at 100 percent of the
 reasonable costs for the provision of services to recipients
 of medical assistance; and psychiatrists shall be reimbursed
 at the medical assistance program fee for service rate.
    n.  For the fiscal year beginning July 1, 2009, the
 reimbursement rate for consumer=directed attendant care shall
 remain at the rates in effect on June 30, 2009.
    o.  For the fiscal year beginning July 1, 2009, the
 reimbursement rate for providers of family planning services
 that are eligible to receive a 90 percent federal match shall
 be increased by 5 percent above the rates in effect on June
 30, 2009.
    2.  For the fiscal year beginning July 1, 2009, the
 reimbursement rate for providers reimbursed under the in=
 home=related care program shall not be less than the minimum
 payment level as established by the federal government to meet
 the federally mandated maintenance of effort requirement.
    3.  Unless otherwise directed in this section, when the
 department's reimbursement methodology for any provider
 reimbursed in accordance with this section includes an
 inflation factor, this factor shall not exceed the amount by
 which the consumer price index for all urban consumers
 increased during the calendar year ending December 31, 2002.
    4.  For the fiscal year beginning July 1, 2009,
 notwithstanding section 234.38, the foster family basic daily
 maintenance rate, the maximum adoption subsidy rate, and the
 maximum supervised apartment living foster care rate, and the
 preparation for adult living program maintenance rate for
 children ages 0 through 5 years shall be $16.36, the rate for
 children ages 6 through 11 years shall be $17.01, the rate for
 children ages 12 through 15 years shall be $18.62, and the
 rate for children and young adults ages 16 and older shall be
 $18.87.
    5.  For the fiscal year beginning July 1, 2009, the maximum
 reimbursement rates for social services providers reimbursed
 under a purchase of social services contract shall remain at
 the rates in effect on June 30, 2009, or the provider's actual
 and allowable cost plus inflation for each service, whichever
 is less.  However, the rates may be adjusted under any of the
 following circumstances:
    a.  If a new service was added after June 30, 2009, the
 initial reimbursement rate for the service shall be based upon
 actual and allowable costs.
    b.  If a social service provider loses a source of income
 used to determine the reimbursement rate for the provider, the
 provider's reimbursement rate may be adjusted to reflect the
 loss of income, provided that the lost income was used to
 support actual and allowable costs of a service purchased
 under a purchase of service contract.
    6.  For the fiscal year beginning July 1, 2009, the
 reimbursement rates for family=centered service providers,
 family foster care service providers, group foster care
 service providers, and the resource family recruitment and
 retention contractor shall remain at the rates in effect on
 June 30, 2009.
    7.  The group foster care reimbursement rates paid for
 placement of children out of state shall be calculated
 according to the same rate=setting principles as those used
 for in=state providers, unless the director of human services
 or the director's designee determines that appropriate care
 cannot be provided within the state.  The payment of the daily
 rate shall be based on the number of days in the calendar
 month in which service is provided.
    8.  For the fiscal year beginning July 1, 2009, remedial
 service providers shall receive the same level of
 reimbursement under the same methodology in effect on June 30,
 2009.
    9.  a.  For the fiscal year beginning July 1, 2009, the
 combined service and maintenance components of the
 reimbursement rate paid for shelter care services and
 alternative child welfare emergency services purchased under a
 contract shall be based on the financial and statistical
 report submitted to the department.  The maximum reimbursement
 rate shall be $92.36 per day.  The department shall reimburse
 a shelter care provider at the provider's actual and allowable
 unit cost, plus inflation, not to exceed the maximum
 reimbursement rate.
    b.  Notwithstanding section 232.141, subsection 8, for the
 fiscal year beginning July 1, 2009, the amount of the
 statewide average of the actual and allowable rates for
 reimbursement of juvenile shelter care homes that is utilized
 for the limitation on recovery of unpaid costs shall remain at
 the amount in effect for this purpose in the preceding fiscal
 year.
    10.  For the fiscal year beginning July 1, 2009, the
 department shall calculate reimbursement rates for
 intermediate care facilities for persons with mental
 retardation at the 80th percentile.  For the fiscal year
 beginning July 1, 2009, notwithstanding any provision to the
 contrary, the rate calculation methodology shall utilize a 3
 percent consumer price index inflation factor.  However,
 beginning July 1, 2010, the rate calculation methodology shall
 utilize the consumer price index inflation factor applicable
 to the fiscal year beginning July 1, 2010.
    11.  For the fiscal year beginning July 1, 2009, for child
 care providers reimbursed under the state child care
 assistance program, the department shall set provider
 reimbursement rates based on the rate reimbursement survey
 completed in December 2004.  Effective July 1, 2009, the child
 care provider reimbursement rates shall remain at the rates in
 effect on June 30, 2009.  The department shall set rates in a
 manner so as to provide incentives for a nonregistered
 provider to become registered by applying the increase only to
 registered and licensed providers.
    12.  For the fiscal year beginning July 1, 2009,
 reimbursements for providers reimbursed by the department of
 human services may be modified if appropriated funding is
 allocated for that purpose from the senior living trust fund
 created in section 249H.4.
    13.  The department may adopt emergency rules to implement
 this section.
    Sec. 33.  2001 Iowa Acts, chapter 192, section 4,
 subsection 4, as amended by 2008 Iowa Acts, chapter 1187,
 section 33, is amended by striking the subsection, and
 inserting in lieu thereof the following:
    4.  NURSING FACILITY PAY=FOR=PERFORMANCE.
    a.  It is the intent of the general assembly that the
 department of human services initiate a system to recognize
 nursing facilities that provide quality of life and
 appropriate access to medical assistance program beneficiaries
 in a cost=effective manner.
    b.  The department shall design and implement a program to
 establish benchmarks and to collect data for these benchmarks
 to evaluate nursing facility performance and to adjust the
 program and benchmarks, accordingly, to recognize improvement.
 The program shall include procedures to provide a
 pay=for=performance payment based upon a nursing facility's
 achievement of multiple favorable outcomes as determined by
 these benchmarks.  Any increased reimbursement shall not
 exceed 5 percent of the sum of the direct and nondirect care
 medians.  The increased reimbursement shall be included in the
 calculation of nursing facility modified price=based payment
 rates with the exception of Medicare=certified hospital=based
 nursing facilities, state=operated nursing facilities, and
 special population nursing facilities.  The increased
 reimbursement shall be applicable to the payment periods
 beginning July 1, 2009.
    c.  It is the intent of the general assembly that any
 pay=for=performance payments to nursing facilities be used to
 support direct care staff through increased wages, enhanced
 benefits, and expanded training opportunities and that all
 pay=for=performance payments be used in a manner that improves
 and enhances quality of care for residents.
    d.  The program shall include various levels of compliance
 in order for a nursing facility to be considered eligible for
 a pay=for=performance payment including:
    (1)  The initial meeting of prerequisites including all of
 the following:
    (a)  A nursing facility shall not be eligible to
 participate if during the payment period the nursing facility
 receives a deficiency resulting in actual harm or immediate
 jeopardy, pursuant to the federal certification guidelines at
 an H level scope and severity or higher, regardless of the
 amount of fines assessed.
    (b)  The pay=for=performance payment component shall be
 suspended for any month the nursing facility is in denial of
 payment for new admissions status.
    (2)  Monitoring for nursing facility compliance with
 program requirements including:
    (a)  Survey compliance during the payment period.  If a
 nursing facility receives a deficiency resulting in actual
 harm pursuant to the federal certification guidelines at a G
 level scope and severity or higher, the payment shall be
 reduced by 25 percent for each such deficiency received during
 the state fiscal year.  Additionally, if the nursing facility
 fails to cure any deficiency cited within the time required by
 the department of inspections and appeals, the payment shall
 be forfeited and the nursing facility shall not receive any
 payment for that payment period.
    (b)  Compliance with the use of the pay=for=performance
 payment received.
    (c)  Establishing and utilizing a tracking and reporting
 system to document the use of the pay=for=performance payments
 by the nursing facility.
    (3)  Use of measures based on the four domains of quality
 of life, quality of care, access, and efficiency.
    e.  (1)  The department shall utilize cost reports or other
 means to document nursing facility eligibility for and
 compliance with the pay=for=performance payments.
    (2)  The department shall publish the results of the
 measures for which a nursing facility qualifies and the amount
 of any pay=for=performance payment received.  The department
 shall also publish information regarding the use of the
 pay=for=performance payments by any nursing facility receiving
 such payment.
    f.  The department may adopt emergency rules to implement
 this subsection.
    g.  The department shall request any medical assistance
 state plan amendment necessary to implement the
 pay=for=performance payment methodology.
    h.  It is the intent of the general assembly that the
 department of human services continue to convene the workgroup
 established pursuant to 2008 Iowa Acts, chapter 1187, section
 33, to develop recommendations to design a quality improvement
 process for targeted nursing facilities for implementation in
 the fiscal year beginning July 1, 2010.  Recommendations shall
 include a process that identifies the best practices used in
 facilities receiving pay=for=performance payment and creates a
 system to assist other nursing facilities in the
 implementation of those best practices.
    Sec. 34.  EMERGENCY RULES.
    1.  If specifically authorized by a provision of this
 division of this Act, the department of human services or the
 mental health, mental retardation, developmental disabilities,
 and brain injury commission may adopt administrative rules
 under section 17A.4, subsection 2, and section 17A.5,
 subsection 2, paragraph "b", to implement the provisions and
 the rules shall become effective immediately upon filing or on
 a later effective date specified in the rules, unless the
 effective date is delayed by the administrative rules review
 committee.  Any rules adopted in accordance with this section
 shall not take effect before the rules are reviewed by the
 administrative rules review committee.  The delay authority
 provided to the administrative rules review committee under
 section 17A.4, subsection 5, and section 17A.8, subsection 9,
 shall be applicable to a delay imposed under this section,
 notwithstanding a provision in those sections making them
 inapplicable to section 17A.5, subsection 2, paragraph "b".
 Any rules adopted in accordance with the provisions of this
 section shall also be published as notice of intended action
 as provided in section 17A.4.
    2.  If during the fiscal year beginning July 1, 2009, the
 department of human services is adopting rules in accordance
 with this section or as otherwise directed or authorized by
 state law, and the rules will result in an expenditure
 increase beyond the amount anticipated in the budget process
 or if the expenditure was not addressed in the budget process
 for the fiscal year, the department shall notify the persons
 designated by this division of this Act for submission of
 reports, the chairpersons and ranking members of the
 committees on appropriations, and the department of management
 concerning the rules and the expenditure increase.  The
 notification shall be provided at least 30 calendar days prior
 to the date notice of the rules is submitted to the
 administrative rules coordinator and the administrative code
 editor.
    Sec. 35.  DEPARTMENTAL EFFICIENCIES == BUDGET REDUCTIONS.
 The departments of elder affairs, public health, human
 services, and veterans affairs shall develop a plan to
 maximize efficiencies to reduce their respective FY 2009=2010
 budgets by five percent beginning in FY 2010=2011.  The
 departments shall collaborate to the extent appropriate to
 accomplish such reductions.  The departments shall report
 their plans for maximizing efficiencies and reducing their
 budgets to the individuals specified in this Act to receive
 reports by December 15, 2009.
    Sec. 36.  FULL=TIME EQUIVALENT POSITIONS == REDUCTIONS.
 The director of the department or state agency to which
 appropriations are made pursuant to this division of this Act,
 in making any reductions in full=time equivalent positions,
 shall, to the greatest extent possible, retain those positions
 providing direct services to the public.
    Sec. 37.  EXPENSE REIMBURSEMENT == REQUIREMENTS.
 Notwithstanding any provision to the contrary, for the fiscal
 year beginning July 1, 2009, and ending June 30, 2010, the
 director of a department or state agency to which
 appropriations are made pursuant to the provisions of this Act
 shall require employees, in order to receive reimbursement for
 expense, to submit actual receipts for meals and other costs.
 Reimbursement up to the maximum amount shall only be allowed
 in an amount equal to the sum of the actual receipts
 submitted.
    Sec. 38.  OUT=OF=STATE TRAVEL == RESTRICTIONS.
 Notwithstanding any provision to the contrary, for the fiscal
 year beginning July 1, 2009, and ending June 30, 2010,
 out=of=state travel by an employee of a department or state
 agency to which appropriations are made pursuant to this Act
 shall not be authorized unless the executive council
 authorizes the travel as necessary for the performance of
 official state business.
    Sec. 39.  LEAN GOVERNMENT EXCHANGE.  Beginning July 1,
 2009, the department of human services shall participate in
 the lean government exchange through consultation with the
 department of management, office of lean enterprise, to
 improve the speed and efficiency of departmental and program
 processes by eliminating waste.  The department shall
 initially apply this methodology to general administration.
 The department shall submit periodic progress reports
 regarding such implementation to the persons designated by
 this division of this Act for submission of reports.
    Sec. 40.  PHARMACY=RELATED ISSUES == INTERIM.
    1.  The legislative council is requested to establish a
 legislative study committee for the 2009 interim to identify
 strategies and solutions to address problems arising from
 inappropriate medication use in the health care system.
    2.  The study committee shall consist of members of the
 general assembly, and representatives of the department of
 public health, the Iowa pharmacy association, the Iowa medical
 society, the Iowa nurses association, wellmark blue cross blue
 shield, the principal financial group, the university of Iowa
 college of public health, the Iowa retail federation, the
 prevention and chronic care management advisory council
 established in section 135.161, the medical home system
 advisory council established in section 135.159, the Iowa
 healthcare collaborative, as defined in section 135.40, the
 health policy corporation of Iowa, and the Iowa foundation for
 medical care.
    3.  The study committee shall document the extent and
 causes of medication use problems and examine potential
 solutions including medication therapy management programs,
 evidence=based prescriber education programs, clinical
 pharmacy services in the primary medical home, collaborative
 practice models of care, and quality and performance=based
 payment systems.
    4.  The study committee shall submit a report of its
 findings and recommendations to the general assembly for
 consideration during the 2010 legislative session.
    Sec. 41.  REPORTS.  Any reports or information required to
 be compiled and submitted under this Act shall be submitted to
 the chairpersons and ranking members of the joint
 appropriations subcommittee on health and human services, the
 legislative services agency, and the legislative caucus staffs
 on or before the dates specified for submission of the reports
 or information.
    Sec. 42.  EFFECTIVE DATE.  The following provisions of this
 division of this Act, being deemed of immediate importance,
 take effect upon enactment:
    The provision under the appropriation for child and family
 services, relating to requirements of section 232.143 for
 representatives of the department of human services and
 juvenile court services to establish a plan for continuing
 group foster care expenditures for fiscal year 2009=2010.
                           DIVISION II
                    SENIOR LIVING TRUST FUND,
               PHARMACEUTICAL SETTLEMENT ACCOUNT,
                IOWACARE ACCOUNT, AND HEALTH CARE
                     TRANSFORMATION ACCOUNT
    Sec. 43.  DEPARTMENT OF ELDER AFFAIRS.  There is
 appropriated from the senior living trust fund created in
 section 249H.4 to the department of elder affairs for the
 fiscal year beginning July 1, 2009, and ending June 30, 2010,
 the following amount, or so much thereof as is necessary, to
 be used for the purpose designated:
    For the development and implementation of a comprehensive
 senior living program, including case management only if the
 monthly cost per client for case management for the frail
 elderly services provided does not exceed the amount specified
 in this section, and including program administration and
 costs associated with implementation:
 .................................................. $  8,486,698
    1.  a.  Of the funds appropriated in this section,
 $1,010,000 shall be transferred to the department of human
 services in equal amounts on a quarterly basis for
 reimbursement of case management services provided under the
 medical assistance elderly waiver.
    b.  The monthly cost per client for case management for the
 frail elderly services provided shall not exceed an average of
 $70.  However, if the department of human services adopts
 administrative rules revising the reimbursement methodology to
 include 15 minute units, 24=hour on=call, and other
 requirements consistent with federal regulations, the $70
 monthly cap shall be eliminated and replaced with a quarterly
 projection of expenditures and reimbursement revisions
 necessary to maintain expenditures within the amounts budgeted
 under the appropriations made for the fiscal year for the
 medical assistance program.
    c.  The department of human services shall review
 projections for state funding expenditures for reimbursement
 of case management services under the medical assistance
 elderly waiver on a quarterly basis and shall determine if an
 adjustment to the medical assistance reimbursement rates are
 necessary to provide reimbursement within the state funding
 amounts budgeted under the appropriations made for the fiscal
 year for the medical assistance program.  Any temporary
 enhanced federal financial participation that may become
 available for the medical assistance program during the fiscal
 year shall not be used in projecting the medical assistance
 elderly waiver case management budget.  The department of
 human services shall revise such reimbursement rates as
 necessary to maintain expenditures for medical assistance
 elderly waiver case management services within the state
 funding amounts budgeted under the appropriations made for the
 fiscal year for the medical assistance program.
    2.  Notwithstanding section 249H.7, the department of elder
 affairs shall distribute funds appropriated in this section in
 a manner that will supplement and maximize federal funds under
 the federal Older Americans Act and shall not use the amount
 distributed for any administrative purposes of either the
 department of elder affairs or the area agencies on aging.
    3.  Of the funds appropriated in this section, $60,000
 shall be used to provide dementia=specific education to direct
 care workers and other providers of long=term care to enhance
 existing or scheduled efforts through the Iowa caregivers
 association, the Alzheimer's association, and other
 organizations identified as appropriate by the department.
    Sec. 44.  DEPARTMENT OF INSPECTIONS AND APPEALS.  There is
 appropriated from the senior living trust fund created in
 section 249H.4 to the department of inspections and appeals
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amount, or so much thereof as is
 necessary, to be used for the purpose designated:
    For the inspection and certification of assisted living
 facilities and adult day care services, including program
 administration and costs associated with implementation:
 .................................................. $  1,339,527
    Sec. 45.  IOWA FINANCE AUTHORITY.  There is appropriated
 from the senior living trust fund created in section 249H.4 to
 the Iowa finance authority for the fiscal year beginning July
 1, 2009, and ending June 30, 2010, the following amount, or so
 much thereof as is necessary, to be used for the purposes
 designated:
    For the rent subsidy program, to provide reimbursement for
 rent expenses to eligible persons:
 .................................................. $    700,000
    Participation in the rent subsidy program shall be limited
 to only those persons who meet the requirements for the
 nursing facility level of care for home and community=based
 services waiver services as in effect on July 1, 2009, and to
 those individuals who are eligible for the federal money
 follows the person grant program under the medical assistance
 program.  Of the funds appropriated in this section, not more
 than $35,000 may be used for administrative costs.
    Sec. 46.  DEPARTMENT OF HUMAN SERVICES.  Any funds
 remaining in the senior living trust fund created in section
 249H.4 following the appropriations from the senior living
 trust fund made in this division of this Act to the department
 of elder affairs, the department of inspections and appeals,
 and the Iowa finance authority, for the fiscal year beginning
 July 1, 2009, and ending June 30, 2010, are appropriated to
 the department of human services to supplement the medical
 assistance program appropriations made in this Act, including
 program administration and costs associated with
 implementation.  In order to carry out the purposes of this
 section, the department may transfer funds appropriated in
 this section to supplement other appropriations made to the
 department of human services.
    Sec. 47.  PHARMACEUTICAL SETTLEMENT ACCOUNT.  There is
 appropriated from the pharmaceutical settlement account
 created in section 249A.33 to the department of human services
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amount, or so much thereof as is
 necessary, to be used for the purpose designated:
    To supplement the appropriations made for medical contracts
 under the medical assistance program:
 .................................................. $  1,323,833
    Sec. 48.  APPROPRIATIONS FROM IOWACARE ACCOUNT.
    1.  There is appropriated from the IowaCare account created
 in section 249J.24 to the state board of regents for
 distribution to the university of Iowa hospitals and clinics
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amount, or so much thereof as is
 necessary, to be used for the purposes designated:
    For salaries, support, maintenance, equipment, and
 miscellaneous purposes, for the provision of medical and
 surgical treatment of indigent patients, for provision of
 services to members of the expansion population pursuant to
 chapter 249J, and for medical education:
 .................................................. $ 27,284,584
    a.  Funds appropriated in this subsection shall not be used
 to perform abortions except medically necessary abortions, and
 shall not be used to operate the early termination of
 pregnancy clinic except for the performance of medically
 necessary abortions.  For the purpose of this subsection, an
 abortion is the purposeful interruption of pregnancy with the
 intention other than to produce a live=born infant or to
 remove a dead fetus, and a medically necessary abortion is one
 performed under one of the following conditions:
    (1)  The attending physician certifies that continuing the
 pregnancy would endanger the life of the pregnant woman.
    (2)  The attending physician certifies that the fetus is
 physically deformed, mentally deficient, or afflicted with a
 congenital illness.
    (3)  The pregnancy is the result of a rape which is
 reported within 45 days of the incident to a law enforcement
 agency or public or private health agency which may include a
 family physician.
    (4)  The pregnancy is the result of incest which is
 reported within 150 days of the incident to a law enforcement
 agency or public or private health agency which may include a
 family physician.
    (5)  The abortion is a spontaneous abortion, commonly known
 as a miscarriage, wherein not all of the products of
 conception are expelled.
    b.  Notwithstanding any provision of law to the contrary,
 the amount appropriated in this subsection shall be allocated
 in twelve equal monthly payments as provided in section
 249J.24.
    2.  There is appropriated from the IowaCare account created
 in section 249J.24 to the state board of regents for
 distribution to the university of Iowa hospitals and clinics
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amount, or so much thereof as is
 necessary, to be used for the purposes designated:
    For salaries, support, maintenance, equipment, and
 miscellaneous purposes, for the provision of medical and
 surgical treatment of indigent patients, for provision of
 services to members of the expansion population pursuant to
 chapter 249J, and for medical education:
 .................................................. $ 47,020,131
    The amount appropriated in this subsection shall be
 distributed only if expansion population claims adjudicated
 and paid by the Iowa Medicaid enterprise exceed the
 appropriation to the state board of regents for distribution
 to the university of Iowa hospitals and clinics provided in
 subsection 1.  The amount appropriated in this subsection
 shall be distributed monthly for expansion population claims
 adjudicated and approved for payment by the Iowa Medicaid
 enterprise using medical assistance program reimbursement
 rates.
    3.  There is appropriated from the IowaCare account created
 in section 249J.24 to the department of human services for the
 fiscal year beginning July 1, 2009, and ending June 30, 2010,
 the following amount, or so much thereof as is necessary, to
 be used for the purposes designated:
    For distribution to a publicly owned acute care teaching
 hospital located in a county with a population over 350,000
 for the provision of medical and surgical treatment of
 indigent patients, for provision of services to members of the
 expansion population pursuant to chapter 249J, and for medical
 education:
 .................................................. $ 46,000,000
    a.  Notwithstanding any provision of law to the contrary,
 the amount appropriated in this subsection shall be allocated
 in twelve equal monthly payments as provided in section
 249J.24.  Any amount appropriated in this subsection in excess
 of $41,000,000 shall be allocated only if federal funds are
 available to match the amount allocated.
    b.  Notwithstanding the total amount of proceeds
 distributed pursuant to section 249J.24, subsection 6,
 paragraph "a", unnumbered paragraph 1, for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the county
 treasurer of a county with a population of over 350,000 in
 which a publicly owned acute care teaching hospital is located
 shall distribute the proceeds collected pursuant to section
 347.7 in a total amount of $38,000,000, which would otherwise
 be distributed to the county hospital, to the treasurer of
 state for deposit in the IowaCare account.
    c.  (1)  Notwithstanding the amount collected and
 distributed for deposit in the IowaCare account pursuant to
 section 249J.24, subsection 6, paragraph "a", subparagraph
 (1), the first $19,000,000 in proceeds collected pursuant to
 section 347.7 between July 1, 2009, and December 31, 2009,
 shall be distributed to the treasurer of state for deposit in
 the IowaCare account and collections during this time period
 in excess of $19,000,000 shall be distributed to the acute
 care teaching hospital identified in this subsection.
    (2)  Notwithstanding the amount collected and distributed
 for deposit in the IowaCare account pursuant to section
 249J.24, subsection 6, paragraph "a", subparagraph (2), the
 first $19,000,000 in collections pursuant to section 347.7
 between January 1, 2010, and June 30, 2010, shall be
 distributed to the treasurer of state for deposit in the
 IowaCare account and collections during this time period in
 excess of $19,000,000 shall be distributed to the acute care
 teaching hospital identified in this subsection.
    Sec. 49.  APPROPRIATIONS FROM ACCOUNT FOR HEALTH CARE
 TRANSFORMATION == DEPARTMENT OF HUMAN SERVICES.
 Notwithstanding any provision to the contrary, there is
 appropriated from the account for health care transformation
 created in section 249J.23 to the department of human services
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amounts, or so much thereof as is
 necessary, to be used for the purposes designated:
    1.  For the costs of medical examinations and development
 of personal health improvement plans for the expansion
 population pursuant to section 249J.6:
 .................................................. $    556,800
    2.  For the provision of a medical information hotline for
 the expansion population as provided in section 249J.6:
 .................................................. $    100,000
    3.  For other health promotion partnership activities
 pursuant to section 249J.14:
 .................................................. $    600,000
    4.  For the costs related to audits, performance
 evaluations, and studies required pursuant to chapter 249J:
 .................................................. $    125,000
    5.  For administrative costs associated with chapter 249J:
 .................................................. $  1,132,412
    6.  For planning and development, in cooperation with the
 department of public health, of a phased=in program to provide
 a dental home for children in accordance with section 249J.14,
 subsection 7:
 .................................................. $  1,000,000
    7.  For continuation of the establishment of the tuition
 assistance for individuals serving individuals with
 disabilities pilot program, as enacted in 2008 Iowa Acts,
 chapter 1187, section 130:
 .................................................. $     50,000
    8.  For medical contracts:
 .................................................. $  1,300,000
    9.  For payment to the publicly owned acute care teaching
 hospital located in a county with a population of over 350,000
 that is a participating provider pursuant to chapter 249J:
 .................................................. $    290,000
    Disbursements under this subsection shall be made monthly.
 The hospital shall submit a report following the close of the
 fiscal year regarding use of the funds appropriated in this
 subsection to the persons specified in this Act to receive
 reports.
    Notwithstanding section 8.39, subsection 1, without the
 prior written consent and approval of the governor and the
 director of the department of management, the director of
 human services may transfer funds among the appropriations
 made in this section as necessary to carry out the purposes of
 the account for health care transformation.  The department
 shall report any transfers made pursuant to this section to
 the legislative services agency.
    Sec. 50.  APPROPRIATION FROM ACCOUNT FOR HEALTH CARE
 TRANSFORMATION == DEPARTMENT OF ELDER AFFAIRS.
 Notwithstanding any provision to the contrary, there is
 appropriated from the account for health care transformation
 created in section 249J.23 to the department of elder affairs
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, the following amounts, or so much thereof as is
 necessary, to be used for the purpose designated:
    For re=programming of the SEAMLESS computer system for case
 management:
 .................................................. $    200,000
    Sec. 51.  IOWACARE RENEWAL OF WAIVER.  It is the intent of
 the general assembly that the department of human services
 apply for renewal of the IowaCare section 1115 demonstration
 waiver under the medical assistance program.  The department
 shall seek to renew the existing terms of the waiver for an
 additional five=year period and shall seek maximum expenditure
 authority for payments to the state's four mental health
 institutes.  The IowaCare section 1115 demonstration waiver
 renewal shall be amended to remove the limitation on new
 provider taxes and shall transfer the seriously emotionally
 disturbed children waiver to be approved as a section 1915(c)
 home and community=based services waiver.
    Sec. 52.  MEDICAL ASSISTANCE PROGRAM == NONREVERSION FOR FY
 2009=2010.  Notwithstanding section 8.33, if moneys
 appropriated for purposes of the medical assistance program
 for the fiscal year beginning July 1, 2009, and ending June
 30, 2010, from the general fund of the state, the senior
 living trust fund, the health care trust fund, and the
 property tax relief fund are in excess of actual expenditures
 for the medical assistance program and remain unencumbered or
 unobligated at the close of the fiscal year, the excess moneys
 shall not revert but shall remain available for expenditure
 for the purposes of the medical assistance program until the
 close of the succeeding fiscal year.
                          DIVISION III
                        MH/MR/DD SERVICES
                     ALLOWED GROWTH FUNDING
                          FY 2009=2010
    Sec. 53.  Section 426B.5, subsection 2, paragraph i,
 subparagraph (3), Code 2009, is amended to read as follows:
    (3)  Avoiding the need for reduction or elimination of a
 mobile crisis team or other critical emergency services when
 the reduction or elimination places the public's health or
 safety at risk.
    Sec. 54.  2008 Iowa Acts, chapter 1191, section 1, is
 amended to read as follows:
    SECTION 1.  COUNTY MENTAL HEALTH, MENTAL RETARDATION, AND
 DEVELOPMENTAL DISABILITIES ALLOWED GROWTH APPROPRIATION AND
 ALLOCATIONS == FISCAL YEAR 2009=2010.
    1.  There is appropriated from the general fund of the
 state to the department of human services for the fiscal year
 beginning July 1, 2009, and ending June 30, 2010, the
 following amount, or so much thereof as is necessary, to be
 used for the purpose designated:
    For distribution to counties of the county mental health,
 mental retardation, and developmental disabilities allowed
 growth factor adjustment for fiscal year 2009=2010 as provided
 in this section in lieu of the allowed growth factor
 provisions of section 331.438, subsection 2, and section
 331.439, subsection 3, and chapter 426B:
 .................................................. $ 69,949,069
                                                      54,108,770
    2.  The amount appropriated in this section shall be
 allocated as provided in a later enactment of the general
 assembly.
    Sec. 55.  2008 Iowa Acts, chapter 1191, section 1, as
 amended by this division of this Act, is amended by adding the
 following new subsections:
    NEW SUBSECTION.  1.  Of the amount appropriated in this
 section, $146,750 shall be used for assistance to the counties
 with limited county mental health, mental retardation, and
 developmental disabilities services fund balances which were
 selected in accordance with 2000 Iowa Acts, chapter 1221,
 section 3, to receive such assistance, in the same amount
 provided during the fiscal year beginning July 1, 2000, and
 ending June 30, 2001, to pay reimbursement increases in
 accordance with 2000 Iowa Acts, chapter 1221, section 3.
    NEW SUBSECTION.  2.  Of the amount appropriated in this
 section, $12,000,000 shall be distributed as provided in this
 subsection.
    a.  To be eligible to receive a distribution under this
 subsection, a county must meet the following requirements:
    (1)  The county is levying for the maximum amount allowed
 for the county's mental health, mental retardation, and
 developmental disabilities services fund under section
 331.424A for taxes due and payable in the fiscal year
 beginning July 1, 2009, or the county is levying for at least
 90 percent of the maximum amount allowed for the county's
 services fund and that levy rate is more than $2 per $1,000 of
 the assessed value of all taxable property in the county.
    (2)  In the fiscal year beginning July 1, 2007, the
 county's mental health, mental retardation, and developmental
 disabilities services fund ending balance under generally
 accepted accounting principles was equal to or less than 15
 percent of the county's actual gross expenditures for that
 fiscal year.
    b.  A county's allocation of the amount appropriated in
 this subsection shall be determined based upon the county's
 proportion of the general population of the counties eligible
 to receive an allocation under this subsection.  The most
 recent population estimates issued by the United States bureau
 of the census shall be applied in determining population for
 the purposes of this paragraph.
    c.  The allocations made pursuant to this subsection are
 subject to the distribution provisions and withholding
 requirements established in this section for the county mental
 health, mental retardation, and developmental disabilities
 allowed growth factor adjustment for the fiscal year beginning
 July 1, 2009.
    NEW SUBSECTION.  3.  The following amount of the funding
 appropriated in this section is the allowed growth factor
 adjustment for fiscal year 2009=2010, and shall be credited to
 the allowed growth funding pool created in the property tax
 relief fund and for distribution in accordance with section
 426B.5, subsection 1:
 .................................................. $ 41,962,020
    NEW SUBSECTION.  4.  The following formula amounts shall be
 utilized only to calculate preliminary distribution amounts
 for the allowed growth factor adjustment for fiscal year
 2009=2010 under this section by applying the indicated formula
 provisions to the formula amounts and producing a preliminary
 distribution total for each county:
    a.  For calculation of a distribution amount for eligible
 counties from the allowed growth funding pool created in the
 property tax relief fund in accordance with the requirements
 in section 426B.5, subsection 1:
 .................................................. $ 49,626,596
    b.  For calculation of a distribution amount for counties
 from the mental health and developmental disabilities (MH/DD)
 community services fund in accordance with the formula
 provided in the appropriation made for the MH/DD community
 services fund for the fiscal year beginning July 1, 2009:
 .................................................. $ 15,763,951
    NEW SUBSECTION.  5.  After applying the applicable
 statutory distribution formulas to the amounts indicated in
 subsection 4 for purposes of producing preliminary
 distribution totals, the department of human services shall
 apply a withholding factor to adjust an eligible individual
 county's preliminary distribution total.  In order to be
 eligible for a distribution under this section, a county must
 be levying 90 percent or more of the maximum amount allowed
 for the county's mental health, mental retardation, and
 developmental disabilities services fund under section
 331.424A for taxes due and payable in the fiscal year for
 which the distribution is payable.  An ending balance
 percentage for each county shall be determined by expressing
 the county's ending balance on a modified accrual basis under
 generally accepted accounting principles for the fiscal year
 beginning July 1, 2007, in the county's mental health, mental
 retardation, and developmental disabilities services fund
 created under section 331.424A, as a percentage of the
 county's gross expenditures from that fund for that fiscal
 year.  If a county borrowed moneys for purposes of providing
 services from the county's services fund on or before July 1,
 2007, and the county's services fund ending balance for that
 fiscal year includes the loan proceeds or an amount designated
 in the county budget to service the loan for the borrowed
 moneys, those amounts shall not be considered to be part of
 the county's ending balance for purposes of calculating an
 ending balance percentage under this subsection.  The
 withholding factor for a county shall be the following
 applicable percent:
    a.  For an ending balance percentage of less than 5
 percent, a withholding factor of 0 percent.  In addition, a
 county that is subject to this lettered paragraph shall
 receive an inflation adjustment equal to 3 percent of the
 gross expenditures reported for the county's services fund for
 the fiscal year.
    b.  For an ending balance percentage of 5 percent or more
 but less than 10 percent, a withholding factor of 0 percent.
 In addition, a county that is subject to this lettered
 paragraph shall receive an inflation adjustment equal to 2
 percent of the gross expenditures reported for the county's
 services fund for the fiscal year.
    c.  For an ending balance percentage of 10 percent or more
 but less than 25 percent, a withholding factor of 25 percent.
 However, for counties with an ending balance percentage of 10
 percent or more but less than 15 percent, the amount withheld
 shall be limited to the amount by which the county's ending
 balance was in excess of the ending balance percentage of 10
 percent.
    d.  For an ending balance percentage of 25 percent or more,
 a withholding percentage of 100 percent.
    NEW SUBSECTION.  6.  The total withholding amounts applied
 pursuant to subsection 5 shall be equal to a withholding
 target amount of $7,664,576.  If the department of human
 services determines that the amount to be withheld in
 accordance with subsection 6 is not equal to the target
 withholding amount, the department shall adjust the
 withholding factors listed in subsection 6 as necessary to
 achieve the target withholding amount.  However, in making
 such adjustments to the withholding factors, the department
 shall strive to minimize changes to the withholding factors
 for those ending balance percentage ranges that are lower than
 others and shall not adjust the zero withholding factor or the
 inflation adjustment percentage specified in subsection 5,
 paragraph "a".
    Sec. 56.  ADULT MENTAL HEALTH AND DEVELOPMENTAL
 DISABILITIES SERVICES SYSTEM TASK FORCE.  The co-chairpersons
 of the joint appropriations subcommittee on health and human
 services, in consultation with the ranking members of the
 subcommittee, shall appoint a task force of stakeholders for
 the 2009 legislative interim to address the service system
 administered by counties for adult mental health and
 developmental disabilities services.  The task force shall
 address both funding and service issues and may utilize a
 facilitator to assist the process.  The task force shall
 submit a final report with recommendations to the governor and
 general assembly for action during the 2010 legislative
 session.
    Sec. 57.  MENTAL HEALTH, MENTAL RETARDATION, DEVELOPMENTAL
 DISABILITIES, AND BRAIN INJURY COMMISSION AND MENTAL HEALTH
 PLANNING COUNCIL.  During the fiscal year beginning July 1,
 2009, the mental health, mental retardation, developmental
 disabilities, and brain injury commission and the Iowa mental
 health planning council established by the department of human
 services pursuant to federal requirements for the community
 mental health services block grant, or the officers of such
 bodies, shall meet at least quarterly to coordinate the
 efforts of the bodies.
    Sec. 58.  STATE RESOURCE CENTER BILLINGS == AMERICAN
 RECOVERY AND REINVESTMENT ACT.  For the period beginning
 October 1, 2008, and ending September 30, 2010, or the period
 for which funding from the federal American Recovery and
 Reinvestment Act of 2009 can be used for the cost of care for
 patients at a state resource center, whichever is longer, the
 per diem amounts billed to counties under section 222.73 for
 such care may be adjusted downward by an applicable percentage
 of the nonfederal portion of the billing amounts, as necessary
 to comply with the intent of the federal Act.
    Sec. 59.  EFFECTIVE DATE == RETROACTIVE APPLICABILITY.  The
 section of this division of this Act relating to state
 resource center billings, being deemed of immediate
 importance, takes effect upon enactment, is retroactively
 applicable to October 1, 2008, and is applicable on and after
 that date.
                           DIVISION IV
            HEALTH CARE TRUST FUND APPROPRIATIONS ==
                     HEALTH CARE ACTIVITIES
    Sec. 60.  DEPARTMENT OF PUBLIC HEALTH.  In addition to any
 other appropriation made in this Act for the purposes
 designated, there is appropriated from the health care trust
 fund created in section 453A.35A to the department of public
 health for the fiscal year beginning July 1, 2009, and ending
 June 30, 2010, the following amounts, or so much thereof as is
 necessary, for the purposes designated:
    1.  ADDICTIVE DISORDERS
 .................................................. $  2,748,692
    a.  Of the funds appropriated in this subsection, $357,870
 shall be used for culturally competent substance abuse
 treatment pilot projects.
    (1)  The department shall utilize the amount allocated in
 this lettered paragraph for at least three pilot projects to
 provide culturally competent substance abuse treatment in
 various areas of the state.  Each pilot project shall target a
 particular ethnic minority population.  The populations
 targeted shall include but are not limited to
 African=American, Asian, and Latino.
    (2)  The pilot project requirements shall provide for
 documentation or other means to ensure access to the cultural
 competence approach used by a pilot project so that such
 approach can be replicated and improved upon in successor
 programs.
    b.  Of the funds appropriated in this subsection,
 $1,597,656 shall be used for tobacco use prevention,
 cessation, and treatment.  The department shall utilize the
 funds to provide for a variety of activities related to
 tobacco use prevention, cessation, and treatment including to
 support Quitline Iowa, QuitNet cessation counseling and
 education, grants to school districts and community
 organizations to support Just Eliminate Lies youth chapters
 and youth tobacco prevention activities, the Just Eliminate
 Lies tobacco prevention media campaign, nicotine replacement
 therapy, and other prevention and cessation materials and
 media promotion.  Of the funds allocated in this lettered
 paragraph, not more than $148,262 may be utilized by the
 department for administrative purposes.
    c.  Of the funds appropriated in this subsection, $793,166
 shall be used for substance abuse treatment activities.
    2.  HEALTHY CHILDREN AND FAMILIES
 .................................................. $    493,574
    a.  Of the funds appropriated in this subsection, $159,603
 shall be used to address the healthy mental development of
 children from birth through five years of age through local
 evidence=based strategies that engage both the public and
 private sectors in promoting healthy development, prevention,
 and treatment for children.
    b.  Of the funds appropriated in this subsection, $143,643
 shall be used for childhood obesity prevention.
    c.  Of the funds appropriated in this subsection, $190,328
 shall be used to provide audiological services and hearing
 aids for children.  The department may enter into a contract
 to administer this paragraph.
    d.  It is the intent of the general assembly that the
 department of public health shall implement the
 recommendations of the postnatal tissue and fluid bank task
 force created in 2007 Iowa Acts, chapter 147, based upon the
 report submitted to the general assembly in November 2007, as
 funding becomes available.  The department shall notify the
 Iowa Code editor and the persons specified in this Act to
 receive reports when such funding becomes available.
    3.  CHRONIC CONDITIONS
 .................................................. $    999,219
    a.  Of the funds appropriated in this subsection, $383,271
 shall be used for child health specialty clinics.
    b.  Of the funds appropriated in this subsection, $454,224
 shall be used for the comprehensive cancer control program to
 reduce the burden of cancer in Iowa through prevention, early
 detection, effective treatment, and ensuring quality of life.
 The department shall utilize one of the full=time equivalent
 positions authorized in this subsection for administration of
 the activities related to the comprehensive cancer control
 program.
    c.  Of the funds appropriated in this subsection, $161,724
 shall be used for cervical and colon cancer screening.
    4.  COMMUNITY CAPACITY
 .................................................. $  2,720,507
    a.  Of the funds appropriated in this subsection, $61,349
 shall be deposited in the governmental public health system
 fund created by this Act to be used to further develop the
 Iowa public health standards and to begin implementation of
 public health modernization in accordance with chapter 135A,
 as enacted in this Act, to the extent funding is available.
    b.  Of the funds appropriated in this subsection, $163,600
 shall be used for the mental health professional shortage area
 program implemented pursuant to section 135.80.
    c.  Of the funds appropriated in this subsection, $40,900
 shall be used for a grant to a statewide association of
 psychologists that is affiliated with the American
 psychological association to be used for continuation of a
 program to rotate intern psychologists in placements in urban
 and rural mental health professional shortage areas, as
 defined in section 135.80.
    d.  Of the funds appropriated in this subsection, the
 following amounts shall be allocated to the Iowa collaborative
 safety net provider network established pursuant to section
 135.153 to be used for the purposes designated:
    (1)  For distribution to the Iowa=Nebraska primary care
 association for statewide coordination of the Iowa
 collaborative safety net provider network:
 .................................................. $     81,800
    (2)  For distribution to the Iowa family planning network
 agencies for necessary infrastructure, statewide coordination,
 provider recruitment, service delivery, and provision of
 assistance to patients in determining an appropriate medical
 home:
 .................................................. $     82,796
    (3)  For distribution to the local boards of health that
 provide direct services for pilot programs in three counties
 to assist patients in determining an appropriate medical home:
 .................................................. $     82,796
    (4)  For distribution to maternal and child health centers
 for pilot programs in three counties to assist patients in
 determining an appropriate medical home:
 .................................................. $     82,796
    (5)  For distribution to free clinics for necessary
 infrastructure, statewide coordination, provider recruitment,
 service delivery, and provision of assistance to patients in
 determining an appropriate medical home:
 .................................................. $    204,500
    (6)  For distribution to rural health clinics for necessary
 infrastructure, statewide coordination, provider recruitment,
 service delivery, and provision of assistance to patients in
 determining an appropriate medical home:
 .................................................. $    122,700
    (7)  For continuation of the safety net provider patient
 access to specialty health care initiative as described in
 2007 Iowa Acts, ch. 218, section 109:
 .................................................. $    327,200
    (8)  For continuation of the pharmaceutical infrastructure
 for safety net providers as described in 2007 Iowa Acts, ch.
 218, section 108:
 .................................................. $    327,200
    The Iowa collaborative safety net provider network may
 continue to distribute funds allocated pursuant to this
 lettered paragraph through existing contracts or renewal of
 existing contracts.
    e.  Of the funds appropriated in this subsection, $500,000
 shall be used to continue funding for the community health
 center incubation grant program.  Funds shall be utilized by
 the recipient of the grant in the previous fiscal year to
 ensure continuation of affordable primary and preventive
 health care services to the uninsured and underserved in
 northwest Iowa.
    f.  Of the funds appropriated in this subsection, $200,000
 shall be used for continued implementation of the
 recommendations of the direct care worker task force
 established pursuant to 2005 Iowa Acts, chapter 88, based upon
 the report submitted to the governor and the general assembly
 in December 2006.  The department may use a portion of the
 funds allocated in this paragraph for an additional position
 to assist in the continued implementation including
 credentialing of direct care workers.  The department of
 public health shall report to the persons designated in
 division I of this Act for submission of reports regarding use
 of the funds allocated in this lettered paragraph, on or
 before January 10, 2010.
    g.  (1)  Of the funds appropriated in this subsection,
 $150,000 shall be used for allocation to an independent
 statewide direct care worker association for education,
 outreach, leadership development, mentoring, and other
 initiatives intended to enhance the recruitment and retention
 of direct care workers in health and long=term care.
    (2)  Of the funds appropriated in this subsection, $70,000
 shall be used to provide conference scholarships to direct
 care workers.
    (3)  The association specified in this lettered paragraph
 shall report to the persons designated in division I of this
 Act for submission of reports on or before January 1, 2010,
 the use of the funds allocated in this lettered paragraph, any
 progress made regarding the initiatives specified and in
 expanding the association statewide, and the number of
 scholarships provided, and shall include in the report a copy
 of the association's internal revenue service form 990.
    h.  The department may utilize one of the full=time
 equivalent positions authorized in this subsection for
 administration of the activities related to the Iowa
 collaborative safety net provider network.
    i.  The department may utilize one of the full=time
 equivalent positions authorized in this subsection for
 administration of the volunteer health care provider program
 pursuant to section 135.24.
    j.  Of the funds appropriated in this subsection, $222,870
 shall be transferred to the department of elder affairs to be
 used for unmet needs.
    Sec. 61.  DEPARTMENT OF HUMAN SERVICES.  In addition to any
 other appropriation made in this Act for the purposes
 designated, there is appropriated from the health care trust
 fund created in section 453A.35A to the department of human
 services for the fiscal year beginning July 1, 2009, and
 ending June 30, 2010, the following amount, or so much thereof
 as is necessary, for the purpose designated:
    MEDICAL ASSISTANCE
 .................................................. $111,834,156
    Sec. 62.  Section 453A.35, subsection 1, Code 2009, is
 amended to read as follows:
    1.  The proceeds derived from the sale of stamps and the
 payment of taxes, fees, and penalties provided for under this
 chapter, and the permit fees received from all permits issued
 by the department, shall be credited to the general fund of
 the state.  However, beginning July 1, 2007, of the revenues
 generated from the tax on cigarettes pursuant to section
 453A.6, subsection 1, and from the tax on tobacco products as
 specified in section 453A.43, subsections 1, 2, 3, and 4, and
 credited to the general fund of the state under this
 subsection, there is appropriated, annually, to the health
 care trust fund created in section 453A.35A, the first one
 hundred twenty=seven seventeen million six seven hundred
 ninety=six thousand dollars.
                           DIVISION V
                            IOWACARE
    Sec. 63.  2008 Iowa Acts, chapter 1187, section 44,
 subsection 3, is amended to read as follows:
    3.  There is appropriated from the IowaCare account created
 in section 249J.24 to the department of human services for the
 fiscal year beginning July 1, 2008, and ending June 30, 2009,
 the following amount, or so much thereof as is necessary, to
 be used for the purposes designated:
    For distribution to a publicly owned acute care teaching
 hospital located in a county with a population over three
 hundred fifty thousand for the provision of medical and
 surgical treatment of indigent patients, for provision of
 services to members of the expansion population pursuant to
 chapter 249J, and for medical education:
 .................................................. $ 40,000,000
                                                      46,000,000
    Notwithstanding any provision of law to the contrary, the
 amount appropriated in this subsection shall be allocated in
 twelve equal monthly payments as provided in section 249J.24.
 Any amount appropriated in this subsection in excess of
 $37,000,000 41,000,000 shall be allocated only if federal
 funds are available to match the amount allocated.
    Sec. 64.  IOWACARE ACCOUNT == DISTRIBUTION AND DEPOSIT OF
 PROCEEDS OF HOSPITAL TAX LEVY.
    1.  Notwithstanding the total amount of proceeds
 distributed pursuant to section 249J.24, subsection 6,
 paragraph "a", unnumbered paragraph 1, for the fiscal period
 beginning July 1, 2008, and ending June 30, 2009, the county
 treasurer of a county with a population over 350,000 in which
 a publicly owned acute care teaching hospital is located shall
 distribute the proceeds collected pursuant to section 347.7 in
 a total amount of $38,000,000, which would otherwise be
 distributed to the county hospital, to the treasurer of state
 for deposit in the IowaCare account.
    2.  Notwithstanding the amount collected and distributed
 for deposit in the IowaCare account pursuant to section
 249J.24, subsection 6, paragraph "a", subparagraph (2), a
 maximum of $21,000,000 in proceeds collected pursuant to
 section 347.7 between January 1, 2009, and June 30, 2009,
 shall be distributed to the treasurer of state for deposit in
 the IowaCare account and collections during this time in
 excess of a maximum of $21,000,000 shall be distributed to the
 acute care teaching hospital identified in section 249J.24,
 subsection 6.  However, if the collections for the period
 between January 1, 2009, and June 30, 2009, do not equal at
 least $21,000,000, the initial proceeds collected pursuant to
 section 347.7 between January 1, 2009, and June 30, 2009, that
 are in excess of $17,000,000 and which are distributed to the
 acute care teaching hospital identified in section 249J.24,
 subsection 6, shall be redistributed to the treasurer of state
 for deposit in the IowaCare account in a total amount not to
 exceed a maximum of $21,000,000.
    Sec. 65.  EFFECTIVE DATE == RETROACTIVITY.  This division
 of this Act, being deemed of immediate importance, takes
 effect upon enactment and is retroactively applicable to July
 1, 2008.
                           DIVISION VI
                APPROPRIATIONS == RELATED CHANGES
               TOBACCO USE PREVENTION AND CONTROL
           INITIATIVE == HEALTHY IOWANS TOBACCO TRUST
    Sec. 66.  2008 Iowa Acts, chapter 1186, section 1,
 subsection 2, paragraph a, is amended by adding the following
 new unnumbered paragraph:
    NEW UNNUMBERED PARAGRAPH.  Notwithstanding section 8.33,
 moneys appropriated in this lettered paragraph that remain
 unencumbered or unobligated at the close of the fiscal year
 shall not revert but shall remain available for expenditure
 for the purposes designated until the close of the succeeding
 fiscal year.
               ADDICTIVE DISORDERS == GENERAL FUND
    Sec. 67.  2008 Iowa Acts, chapter 1187, section 2,
 subsection 1, is amended by adding the following new
 paragraph:
    NEW PARAGRAPH.  c.  Notwithstanding section 8.33, moneys
 appropriated in this subsection that remain unencumbered or
 unobligated at the close of the fiscal year shall not revert
 but shall remain available for expenditure for the purposes
 designated until the close of the succeeding fiscal year.
                     IOWA VETERANS HOME FTES
    Sec. 68.  2008 Iowa Acts, chapter 1187, section 4,
 subsection 2, is amended to read as follows:
    2.  IOWA VETERANS HOME
    For salaries, support, maintenance, and miscellaneous
 purposes, and for not more than the following full=time
 equivalent positions:
 .................................................. $ 12,694,154
 ............................................... FTEs     951.95
    a.  The Iowa veterans home billings involving the
 department of human services shall be submitted to the
 department on at least a monthly basis.
    b.  If there is a change in the employer of employees
 providing services at the Iowa veterans home under a
 collective bargaining agreement, such employees and the
 agreement shall be continued by the successor employer as
 though there had not been a change in employer.
    c.  The funds appropriated in this section that remain
 available for expenditure for the succeeding fiscal year
 pursuant to section 35D.18, subsection 5, shall be distributed
 to be used in the succeeding fiscal year in accordance with
 this lettered paragraph.  The first $1,000,000 shall remain
 available to be used for the purposes of the Iowa veterans
 home.  On or before October 15, 2009, the department of
 management shall transfer $1,833,333 to the appropriation for
 the medical assistance program to be used for rebasing of
 hospital reimbursement under the medical assistance program.
 Any remaining funding shall be used for purposes of the Iowa
 veterans home.
         FEDERAL TEMPORARY ASSISTANCE FOR NEEDY FAMILIES
            BLOCK GRANT == FAMILY INVESTMENT PROGRAM
    Sec. 69.  2008 Iowa Acts, chapter 1187, section 5, is
 amended by adding the following new unnumbered paragraph:
    NEW UNNUMBERED PARAGRAPH.  Notwithstanding section 8.33,
 moneys appropriated in this section that remain unencumbered
 or unobligated at the close of the fiscal year shall not
 revert but shall remain available for expenditure for the
 family investment program until the close of the succeeding
 fiscal year.
                       MEDICAL ASSISTANCE
    Sec. 70.  2008 Iowa Acts, chapter 1187, section 9,
 unnumbered paragraph 2, is amended to read as follows:
    For medical assistance reimbursement and associated costs
 as specifically provided in the reimbursement methodologies in
 effect on June 30, 2008, except as otherwise expressly
 authorized by law, including reimbursement for abortion
 services which shall be available under the medical assistance
 program only for those abortions which are medically
 necessary:
 .................................................. $649,629,269
                                                     587,884,830
          TRAINING FOR CHILD WELFARE SERVICES PROVIDERS
    Sec. 71.  2008 Iowa Acts, chapter 1187, section 9,
 subsection 20, paragraph c, subparagraph (6), is amended to
 read as follows:
    (6)  For training for child welfare services providers,
 $250,000.  The training shall be developed by the department
 in collaboration with the coalition for children and family
 services in Iowa.  Notwithstanding section 8.33, moneys
 allocated in this subparagraph that remain unencumbered or
 unobligated at the close of the fiscal year shall not revert
 but shall remain available for expenditure for the purposes
 designated until the close of the succeeding fiscal year.
          EMERGENCY AND CHILDRENS MENTAL HEALTH SERVICE
    Sec. 72.  2008 Iowa Acts, chapter 1187, section 9,
 subsection 20, is amended by adding the following new
 paragraph:
    NEW PARAGRAPH.  cc.  The department shall revise the
 provisions for the projects to implement an emergency mental
 health crisis services system and a mental health services
 system for children and youth under paragraph "c",
 subparagraphs (1) and (2), in order for services to be
 provided under both of the projects for a period of at least
 24 months.  Notwithstanding section 8.33, moneys allocated for
 the projects in paragraph "c" of this subsection that remain
 unencumbered or unobligated at the close of the fiscal year
 shall not revert but shall remain available for expenditure
 for the purposes designated until the close of the fiscal year
 that begins July 1, 2010.
    Sec. 73.  2008 Iowa Acts, chapter 1187, section 9, is
 amended by adding the following new subsection:
    NEW SUBSECTION.  25.  The revised appropriation made in
 this section incorporates reductions made pursuant to
 executive order number 10 issued on December 22, 2008.
                 STATE SUPPLEMENTARY ASSISTANCE
    Sec. 74.  2008 Iowa Acts, chapter 1187, section 12, is
 amended by adding the following new subsection:
    NEW SUBSECTION.  4.  Notwithstanding section 8.33, moneys
 appropriated in this section that remain unencumbered or
 unobligated at the close of the fiscal year shall remain
 available for expenditure for the state supplementary
 assistance program until the close of the succeeding fiscal
 year.
                  FAMILY SUPPORT SUBSIDY SLOTS
    Sec. 75.  2008 Iowa Acts, chapter 1187, section 19, is
 amended by adding the following new subsection:
    NEW SUBSECTION.  3.  If at any time during the fiscal year,
 the amount of funding available for the family support subsidy
 program is reduced from the amount initially used to establish
 the figure for the number of family members for whom a subsidy
 is to be provided at any one time during the fiscal year,
 notwithstanding section 225C.38, subsection 2, the department
 shall revise the figure as necessary to conform to the amount
 of funding available.
                      PREGNANCY COUNSELING
    Sec. 76.  2008 Iowa Acts, chapter 1187, section 30, is
 amended by adding the following new unnumbered paragraph:
    NEW UNNUMBERED PARAGRAPH.  Notwithstanding section 8.33,
 moneys appropriated in this section that remain unencumbered
 or unobligated at the close of the fiscal year shall remain
 available for expenditure for the purpose designated until the
 close of the fiscal year beginning July 1, 2010.
                       NURSING FACILITIES
    Sec. 77.  2008 Iowa Acts, chapter 1187, section 32,
 subsection 1, paragraph a, subparagraph (1), is amended to
 read as follows:
    (1)  For the fiscal year beginning July 1, 2008, the total
 state funding amount for the nursing facility budget shall not
 exceed $183,367,323 $158,482,025.
          DEPARTMENT OF ELDER AFFAIRS == MATCHING FUNDS
    Sec. 78.  2008 Iowa Acts, chapter 1187, section 39, is
 amended by adding the following new subsection:
    NEW SUBSECTION.  4.  Notwithstanding section 8.33, of the
 funds appropriated in this section, $216,242 shall not revert
 at the close of the fiscal year, but shall remain available to
 provide matching funds for the senior nutrition programs and
 the senior internship program funded through the federal
 American Reinvestment and Recovery Act of 2009 for the period
 during which federal funding is available under the Act.
             ACCOUNT FOR HEALTH CARE TRANSFORMATION
    Sec. 79.  2008 Iowa Acts, chapter 1187, section 46, is
 amended to read as follows:
    Sec. 46.  TRANSFER FROM ACCOUNT FOR HEALTH CARE
 TRANSFORMATION.  There is transferred from the account for
 health care transformation created pursuant to section 249J.23
 to the IowaCare account created in section 249J.24 a total of
 $3,000,000 for the fiscal year beginning July 1, 2008, and
 ending June 30, 2009.
             MEDICAL ASSISTANCE PROGRAM NONREVERSION
    Sec. 80.  2008 Iowa Acts, chapter 1187, section 50, is
 amended to read as follows:
    SEC. 50.  MEDICAL ASSISTANCE PROGRAM == REVERSION TO SENIOR
 LIVING TRUST FUND NONREVERSION FOR FY 2008=2009.
 Notwithstanding section 8.33, if moneys appropriated for
 purposes of the medical assistance program for the fiscal year
 beginning July 1, 2008, and ending June 30, 2009, from the
 general fund of the state, the senior living trust fund, the
 healthy Iowans tobacco trust fund, the health care trust fund,
 and the property tax relief fund are in excess of actual
 expenditures for the medical assistance program and remain
 unencumbered or unobligated at the close of the fiscal year,
 the excess moneys shall not revert but shall be transferred to
 the senior living trust fund created in section 249H.4 remain
 available for expenditure for the purposes of the medical
 assistance program until the close of the fiscal year
 beginning July 1, 2009.
          ADDICTIVE DISORDERS == HEALTH CARE TRUST FUND
    Sec. 81.  2008 Iowa Acts, chapter 1187, section 62,
 subsection 1, is amended by adding the following new
 paragraph:
    NEW PARAGRAPH.  d.  Notwithstanding section 8.33, moneys
 appropriated in this subsection that remain unencumbered or
 unobligated at the close of the fiscal year shall not revert
 but shall remain available for expenditure for the purposes
 designated until the close of the succeeding fiscal year.
              VIETNAM CONFLICT VETERANS BONUS FUND
    Sec. 82.  2007 Iowa Acts, chapter 176, section 3,
 unnumbered paragraph 3, as enacted by 2008 Iowa Acts, chapter
 1187, section 68, is amended to read as follows:
    Notwithstanding section 8.33, moneys appropriated in this
 section that remain unencumbered or unobligated at the close
 of the fiscal year shall not revert but shall remain available
 for expenditure for the purposes designated until the close of
 the succeeding fiscal year beginning July 1, 2009.
                 INJURED VETERANS GRANT PROGRAM
    Sec. 83.  2006 Iowa Acts, chapter 1184, section 5, as
 enacted by 2007 Iowa Acts, chapter 203, section 1, subsection
 4, unnumbered paragraph 2, and amended by 2008 Iowa Acts,
 chapter 1187, section 69, is amended to read as follows:
    Notwithstanding section 8.33, moneys appropriated in this
 subsection that remain unencumbered or unobligated at the
 close of the fiscal year shall not revert but shall remain
 available for expenditure for the purposes designated until
 the close of the fiscal year beginning July 1, 2008 2009.
    Sec. 84.  2008 Iowa Acts, chapter 1188, section 16, is
 amended to read as follows:
    SEC. 16.  MEDICAL ASSISTANCE, HAWK=I, AND HAWK=I EXPANSION
 PROGRAMS == COVERING CHILDREN == APPROPRIATION.  There is
 appropriated from the general fund of the state to the
 department of human services for the designated fiscal years,
 the following amounts, or so much thereof as is necessary, for
 the purpose designated:
    To cover children as provided in this Act under the medical
 assistance, hawk=i, and hawk=i expansion programs and outreach
 under the current structure of the programs:
 FY 2008=2009 ..................................... $  4,800,000
 FY 2009=2010 ..................................... $ 14,800,000
                                                       4,207,001
 FY 2010=2011 ..................................... $ 24,800,000
    Sec. 85.  CHILD CARE CREDIT FUND BALANCE TRANSFERRED.
 Moneys in the child care credit fund that remain unencumbered
 or unobligated at the close of the fiscal year beginning July
 1, 2008, are transferred to the general fund of the state.
    Sec. 86.  ADDICTIVE DISORDERS NONREVERSION DIRECTIVE.  The
 authority provided in this division of this Act for
 nonreversion of the appropriations for addictive disorder
 conditions referenced in this section is limited to $1,000,000
 and shall be realized by applying the authority to such
 appropriations in the following order until the limitation
 amount is reached:
    1.  The appropriation made from the healthy Iowans tobacco
 trust in 2008 Iowa Acts, chapter 1186, section 1.
    2.  The appropriation made from the health care trust fund
 in 2008 Iowa Acts, chapter 1187, section 62, subsection 1.
    3.  The appropriation made from the general fund of the
 state in 2008 Iowa Acts, chapter 1187, section 2, subsection
 1.
    Sec. 87.  EFFECTIVE DATE.  This division of this Act, being
 deemed of immediate importance, takes effect upon enactment.
                          DIVISION VII
                       HEPATITIS AWARENESS
    Sec. 88.  Section 135.19, Code 2009, is amended to read as
 follows:
    135.19  VIRAL HEPATITIS PROGRAM == AWARENESS, VACCINATIONS,
 AND TESTING == STUDY.
    1.  If sufficient funds are appropriated by the general
 assembly, the department shall establish and administer a
 viral hepatitis program.  The goal of the program shall be to
 distribute information to citizens of this state who are at an
 increased risk for exposure to viral hepatitis regarding the
 higher incidence of hepatitis C exposure and infection among
 these populations, the dangers presented by the disease, and
 contacts for additional information and referrals.  The
 program shall also make available hepatitis A and hepatitis B
 vaccinations, and hepatitis C testing.
    2.  The department shall establish by rule a list of
 individuals by category who are at increased risk for viral
 hepatitis exposure.  The list shall be consistent with
 recommendations developed by the centers for disease control,
 and shall be developed in consultation with the Iowa viral
 hepatitis task force and the Iowa department of veterans
 affairs.  The department shall also establish by rule what
 information is to be distributed and the form and manner of
 distribution.  The rules shall also establish a vaccination
 and testing program, to be coordinated by the department
 through local health departments and clinics and other
 appropriate locations.
    3.  The department shall conduct a study to provide an
 epidemiological profile of hepatitis C and to assess its
 current and future impact on the state.  The department shall
 submit a report to the members of the general assembly by
 January 1, 2008, regarding the results of the study, and shall
 include a status report regarding the development and
 distribution of viral hepatitis information, and the results
 of the vaccination and testing program.
    Sec. 89.  Section 135.20, Code 2009, is repealed.
                          DIVISION VIII
                 SENIOR LIVING COORDINATING UNIT
    Sec. 90.  Section 231.58, Code 2009, is amended by striking
 the section and inserting in lieu thereof the following:
    231.58  LONG=TERM LIVING COORDINATION.
    The director may convene meetings, as necessary, of the
 director and the directors of human services, public health,
 and inspections and appeals, to assist in the coordination of
 policy, service delivery, and long=range planning relating to
 the long=term living system and older Iowans in the state.
 The group may consult with individuals, institutions and
 entities with expertise in the area of the long=term living
 system and older Iowans, as necessary, to facilitate the
 group's efforts.
    Sec. 91.  Section 249H.3, subsection 6, paragraph b, Code
 2009, is amended to read as follows:
    b.  New construction for long=term care alternatives,
 excluding new construction of assisted=living programs or
 elder group homes, if the senior living coordinating unit
 determines that new construction is more cost=effective than
 the conversion of existing space.
    Sec. 92.  Section 249H.3, subsection 8, paragraph b, Code
 2009, is amended to read as follows:
    b.  New construction of an assisted=living program if
 existing nursing facility beds are no longer licensed and the
 senior living coordinating unit determines that new
 construction is more cost=effective than the conversion of
 existing space.
    Sec. 93.  Section 249H.3, subsection 12, Code 2009, is
 amended by striking the subsection.
    Sec. 94.  Section 249H.4, subsection 6, Code 2009, is
 amended by striking the subsection.
    Sec. 95.  Section 249H.7, subsection 1, Code 2009, is
 amended to read as follows:
    1.  Beginning October 1, 2000, the The department of elder
 affairs, in consultation with the senior living coordinating
 unit, shall use funds appropriated from the senior living
 trust fund for activities related to the design, maintenance,
 or expansion of home and community=based services for seniors,
 including but not limited to adult day services, personal
 care, respite, homemaker, chore, and transportation services
 designed to promote the independence of and to delay the use
 of institutional care by seniors with low and moderate
 incomes.  At any time that moneys are appropriated, the
 department of elder affairs, in consultation with the senior
 living coordinating unit, shall disburse the funds to the area
 agencies on aging.
    Sec. 96.  Section 249H.7, subsection 2, unnumbered
 paragraph 1, Code 2009, is amended to read as follows:
    The department of elder affairs shall adopt rules, in
 consultation with the senior living coordinating unit and the
 area agencies on aging, pursuant to chapter 17A, to provide
 all of the following:
    Sec. 97.  Section 249H.7, subsection 2, paragraph c, Code
 2009, is amended to read as follows:
    c.  Other procedures the department of elder affairs deems
 necessary for the proper administration of this section,
 including but not limited to the submission of progress
 reports, on a bimonthly basis, to the senior living
 coordinating unit.
    Sec. 98.  Section 249H.9, subsection 1, Code 2009, is
 amended to read as follows:
    1.  The department of elder affairs and the area agencies
 on aging, in consultation with the senior living coordinating
 unit, shall create, on a county basis, a database directory of
 all health care and support services available to seniors.
 The department of elder affairs shall make the database
 electronically available to the public, and shall update the
 database on at least a monthly basis.
    Sec. 99.  Section 249H.10, Code 2009, is amended to read as
 follows:
    249H.10  CAREGIVER SUPPORT == ACCESS AND EDUCATION
 PROGRAMS.
    The department of human services and the department of
 elder affairs, in consultation with the senior living
 coordinating unit, shall implement a caregiver support program
 to provide access to respite care and to provide education to
 caregivers in providing appropriate care to seniors and
 persons with disabilities.  The program shall be provided
 through the area agencies on aging or other appropriate
 agencies.
                           DIVISION IX
               GAMBLING TREATMENT FUND ELIMINATION
    Sec. 100.  Section 8.57, subsection 6, paragraph e,
 subparagraph (1), Code 2009, is amended to read as follows:
    (1)  Notwithstanding provisions to the contrary in sections
 99D.17 and 99F.11, for the fiscal year beginning July 1, 2000,
 and for each fiscal year thereafter, not more than a total of
 sixty sixty=six million dollars shall be deposited in the
 general fund of the state in any fiscal year pursuant to
 sections 99D.17 and 99F.11.  The next fifteen million dollars
 of the moneys directed to be deposited in the general fund of
 the state in a fiscal year pursuant to sections 99D.17 and
 99F.11 shall be deposited in the vision Iowa fund created in
 section 12.72 for the fiscal year beginning July 1, 2000, and
 for each fiscal year through the fiscal year beginning July 1,
 2019.  The next five million dollars of the moneys directed to
 be deposited in the general fund of the state in a fiscal year
 pursuant to sections 99D.17 and 99F.11 shall be deposited in
 the school infrastructure fund created in section 12.82 for
 the fiscal year beginning July 1, 2000, and for each fiscal
 year thereafter until the principal and interest on all bonds
 issued by the treasurer of state pursuant to section 12.81 are
 paid, as determined by the treasurer of state.  The total
 moneys in excess of the moneys deposited in the general fund
 of the state, the vision Iowa fund, and the school
 infrastructure fund in a fiscal year shall be deposited in the
 rebuild Iowa infrastructure fund and shall be used as provided
 in this section, notwithstanding section 8.60.
    Sec. 101.  Section 99D.7, subsection 22, Code 2009, is
 amended to read as follows:
    22.  To require licensees to establish a process to allow a
 person to be voluntarily excluded for life from a racetrack
 enclosure and all other licensed facilities under this chapter
 and chapter 99F.  The process established shall require that a
 licensee disseminate information regarding persons voluntarily
 excluded to all licensees under this chapter and chapter 99F.
 The state and any licensee under this chapter or chapter 99F
 shall not be liable to any person for any claim which may
 arise from this process.  In addition to any other penalty
 provided by law, any money or thing of value that has been
 obtained by, or is owed to, a voluntarily excluded person by a
 licensee as a result of wagers made by the person after the
 person has been voluntarily excluded shall not be paid to the
 person but shall be deposited into credited to the gambling
 treatment general fund created in section 135.150 of the
 state.
    Sec. 102.  Section 99D.15, subsection 5, Code 2009, is
 amended by striking the subsection.
    Sec. 103.  Section 99F.4, subsection 22, Code 2009, is
 amended to read as follows:
    22.  To require licensees to establish a process to allow a
 person to be voluntarily excluded for life from an excursion
 gambling boat and all other licensed facilities under this
 chapter and chapter 99D.  The process established shall
 require that a licensee disseminate information regarding
 persons voluntarily excluded to all licensees under this
 chapter and chapter 99D.  The state and any licensee under
 this chapter or chapter 99D shall not be liable to any person
 for any claim which may arise from this process.  In addition
 to any other penalty provided by law, any money or thing of
 value that has been obtained by, or is owed to, a voluntarily
 excluded person by a licensee as a result of wagers made by
 the person after the person has been voluntarily excluded
 shall not be paid to the person but shall be deposited into
 credited to the gambling treatment general fund created in
 section 135.150 of the state.
    Sec. 104.  Section 99F.11, subsection 3, paragraph c, Code
 2009, is amended by striking the paragraph.
    Sec. 105.  Section 99G.39, subsection 1, Code 2009, is
 amended to read as follows:
    1.  Upon receipt of any revenue, the chief executive
 officer shall deposit the moneys in the lottery fund created
 pursuant to section 99G.40.  At least fifty percent of the
 projected annual revenue accruing from the sale of tickets or
 shares shall be allocated for payment of prizes to the holders
 of winning tickets.  After the payment of prizes, the
 following shall be deducted from the authority's revenue prior
 to disbursement:
    a.  An amount equal to one=half of one percent of the gross
 lottery revenue for the year shall be deposited in the
 gambling treatment fund created in section 135.150.
    b.  The expenses of conducting the lottery shall be
 deducted from the authority's revenue prior to disbursement.
 Expenses for advertising production and media purchases shall
 not exceed four percent of the authority's gross revenue for
 the year.
    Sec. 106.  Section 135.150, Code 2009, is amended to read
 as follows:
    135.150  GAMBLING TREATMENT FUND == PROGRAM == STANDARDS
 AND LICENSING.
    1.  A gambling treatment fund is created in the state
 treasury under the control of the department.  The fund
 consists of all moneys appropriated to the fund.  However, if
 moneys appropriated to the fund in a fiscal year exceed six
 million dollars, the amount exceeding six million dollars
 shall be transferred to the rebuild Iowa infrastructure fund
 created in section 8.57.  Moneys in the fund are appropriated
 to the department for the purposes described in this section.
    2.  1.  a.  Moneys appropriated to the department under
 this section shall be for the purpose of operating The
 department shall operate a gambling treatment program and
 shall be used for funding of administrative costs and to
 provide programs which may include, but are not limited to,
 outpatient and follow=up treatment for persons affected by
 problem gambling, rehabilitation and residential treatment
 programs, information and referral services, crisis call
 access, education and preventive services, and financial
 management and credit counseling services.
    b.  A person shall not maintain or conduct a gambling
 treatment program funded under this section through the
 department unless the person has obtained a license for the
 program from the department.  The department shall adopt rules
 to establish standards for the licensing and operation of
 gambling treatment programs under this section.  The rules
 shall specify, but are not limited to specifying, the
 qualifications for persons providing gambling treatment
 services, standards for the organization and administration of
 gambling treatment programs, and a mechanism to monitor
 compliance with this section and the rules adopted under this
 section.
    3.  Notwithstanding section 12C.7, subsection 2, interest
 or earnings on moneys deposited in the gambling treatment fund
 shall be credited to the gambling treatment fund.
 Notwithstanding section 8.33, moneys credited to the gambling
 treatment fund shall not revert to the fund from which
 appropriated at the close of a fiscal year.
    4.  2.  The department shall report semiannually to the
 legislative government oversight committees regarding the
 operation of the gambling treatment fund and program.  The
 report shall include, but is not limited to, information on
 revenues and expenses related to the fund for the previous
 period, fund balances for the period, and the moneys expended
 and grants awarded for operation of the gambling treatment
 program.
    Sec. 107.  GAMBLING TREATMENT FUND BALANCE TRANSFERRED ==
 EFFECTIVE DATE.
    1.  Moneys in the gambling treatment fund that remain
 unencumbered or unobligated at the close of the fiscal year
 beginning July 1, 2008, are transferred to the general fund of
 the state.
    2.  This section of this Act, being deemed of immediate
 importance, takes effect upon enactment.
                           DIVISION X
                     CHILD DEATH REVIEW TEAM
    Sec. 108.  Section 135.43, subsection 1, Code 2009, is
 amended to read as follows:
    1.  An Iowa child death review team is established as an
 independent agency of state government part of the office of
 the state medical examiner.  The Iowa department of public
 health office of the state medical examiner shall provide
 staffing and administrative support to the team.
    Sec. 109.  Section 135.43, subsection 2, unnumbered
 paragraph 1, Code 2009, is amended to read as follows:
    The membership of the review team is subject to the
 provisions of sections 69.16 and 69.16A, relating to political
 affiliation and gender balance.  Review team members who are
 not designated by another appointing authority shall be
 appointed by the director of public health state medical
 examiner.  Membership terms shall be for three years.  A
 membership vacancy shall be filled in the same manner as the
 original appointment.  The review team shall elect a
 chairperson and other officers as deemed necessary by the
 review team.  The review team shall meet upon the call of the
 chairperson, upon the request of a state agency, state medical
 examiner or as determined by the review team.  The members of
 the team are eligible for reimbursement of actual and
 necessary expenses incurred in the performance of their
 official duties.  The review team shall include the following:
    Sec. 110.  Section 135.43, subsection 4, unnumbered
 paragraph 1, Code 2009, is amended to read as follows:
    The review team shall develop protocols for a child
 fatality review committee, to be appointed by the director
 state medical examiner on an ad hoc basis, to immediately
 review the child abuse assessments which involve the fatality
 of a child under age eighteen.  The director state medical
 examiner shall appoint a medical examiner, a pediatrician, and
 a person involved with law enforcement to the committee.
    Sec. 111.  Section 135.43, subsections 7 and 8, Code 2009,
 are amended to read as follows:
    7.  a.  The state medical examiner, the Iowa department of
 public health, and the department of human services shall
 adopt rules providing for disclosure of information which is
 confidential under chapter 22 or any other provision of state
 law, to the review team for purposes of performing its child
 death and child abuse review responsibilities.
    b.  A person in possession or control of medical,
 investigative, assessment, or other information pertaining to
 a child death and child abuse review shall allow the
 inspection and reproduction of the information by the
 department office of the state medical examiner upon the
 request of the department office, to be used only in the
 administration and for the duties of the Iowa child death
 review team.  Except as provided for a report on a child
 fatality by an ad hoc child fatality review committee under
 subsection 4, information and records produced under this
 section which are confidential under section 22.7 and chapter
 235A, and information or records received from the
 confidential records, remain confidential under this section.
 A person does not incur legal liability by reason of releasing
 information to the department as required under and in
 compliance with this section.
    8.  Review team members and their agents are immune from
 any liability, civil or criminal, which might otherwise be
 incurred or imposed as a result of any act, omission,
 proceeding, decision, or determination undertaken or
 performed, or recommendation made as a review team member or
 agent provided that the review team members or agents acted in
 good faith and without malice in carrying out their official
 duties in their official capacity.  The department state
 medical examiner shall adopt rules pursuant to chapter 17A to
 administer this subsection.  A complainant bears the burden of
 proof in establishing malice or lack of good faith in an
 action brought against review team members involving the
 performance of their duties and powers under this section.
    Sec. 112.  Section 691.6, Code 2009, is amended by adding
 the following new subsection:
    NEW SUBSECTION.  10.  To provide staffing and support for
 the child death review team and any child fatality review
 committee under section 135.43.
    Sec. 113.  CHILD DEATH REVIEW TEAM RULES.  The rules
 adopted by the department of public health for purposes of the
 child death review team under section 135.43 shall remain in
 effect until replaced by rules adopted for purposes of that
 section by the state medical examiner.  Until replacement
 rules are adopted, the office of the state medical examiner
 shall fulfill the duties assigned to the department of public
 health under the rules being replaced.
                           DIVISION XI
                   PUBLIC HEALTH MODERNIZATION
    Sec. 114.  LEGISLATIVE FINDINGS AND INTENT == PURPOSE.  The
 general assembly finds all of the following:
    1.  A sound public health system is vital to the good
 health of all Iowans.  Iowa's public health system reduces
 health care costs by promoting healthy behaviors, preventing
 disease and injury, and protecting the health of the
 population.
    2.  The current foundation and organizational capacity for
 the governmental public health system does not allow for the
 equitable delivery of public health services.  Governmental
 public health is provided by county boards of health, city
 boards of health, one district board of health, the state
 board of health, and the department.  Varying degrees of
 authority, administration, and organizational capacity for
 providing public health services exist from community to
 community.
    3.  The Iowa public health modernization Act will allow
 boards of health, designated local public health agencies, and
 the department to increase system capacity, improve the
 equitable delivery of public health services, address quality
 improvement, improve system performance, and provide a
 foundation to measure outcomes through a voluntary
 accreditation program.  The Iowa public health modernization
 Act will assure the public of the availability of a basic
 level of public health service in every community.
    4.  The Iowa public health modernization Act is the result
 of extensive collaboration among governmental public health
 entities, including local boards of health, local public
 health agencies, the department, and the state board of
 health; academia; and professional associations.
    Sec. 115.  NEW SECTION.  135A.1  SHORT TITLE.
    This chapter shall be known and may be cited as the "Iowa
 Public Health Modernization Act".
    Sec. 116.  NEW SECTION.  135A.2  DEFINITIONS.
    As used in this chapter, unless the context otherwise
 requires, the following definitions apply:
    1.  "Academic institution" means an institution of higher
 education in the state which grants undergraduate and
 postgraduate degrees and is accredited by a nationally
 recognized accrediting agency as determined by the United
 States secretary of education.  For purposes of this
 definition, "accredited" means a certification of the quality
 of an institution of higher education.
    2.  "Accrediting entity" means a legal, independent,
 nonprofit or governmental entity or entities approved by the
 state board of health for the purpose of accrediting
 designated local public health agencies and the department
 pursuant to the voluntary accreditation program developed
 under this chapter.
    3.  "Administration" means the operational procedures,
 personnel and fiscal management systems, and facility
 requirements that must be in place for the delivery and
 assurance of public health services.
    4.  "Committee" means the governmental public health
 evaluation committee as established in this chapter.
    5.  "Communication and information technology" means the
 processes, procedures, and equipment needed to provide public
 information and transmit and receive information among public
 health entities and community partners; and applies to the
 procedures, physical hardware, and software required to
 transmit, receive, and process electronic information.
    6.  "Council" means the governmental public health advisory
 council as established in this chapter.
    7.  "Department" means the department of public health.
    8.  "Designated local public health agency" means an entity
 that is either governed by or contractually responsible to a
 local board of health and designated by the local board to
 comply with the Iowa public health standards for a
 jurisdiction.
    9.  "Governance" means the functions and responsibilities
 of the local boards of health and the state board of health to
 oversee governmental public health matters.
    10.  "Governmental public health system" means the system
 described in section 135A.6.
    11.  "Iowa public health standards" means the governmental
 public health standards adopted by rule by the state board of
 health.
    12.  "Local board of health" means a county or district
 board of health.
    13.  "Organizational capacity" means the governmental
 public health infrastructure that must be in place in order to
 deliver public health services.
    14.  "Public health region" means, at a minimum, one of six
 geographical areas approved by the state board of health for
 the purposes of coordination, resource sharing, and planning
 and to improve delivery of public health services.
    15.  "Public health services" means the basic public health
 services that all Iowans should reasonably expect to be
 provided by designated local public health agencies and the
 department.
    16.  "Voluntary accreditation" means verification of a
 designated local public health agency or the department that
 demonstrates compliance with the Iowa public health standards
 by an accrediting entity.
    17.  "Workforce" means the necessary qualified and
 competent staff required to deliver public health services.
    Sec. 117.  NEW SECTION.  135A.3  GOVERNMENTAL PUBLIC HEALTH
 SYSTEM MODERNIZATION == LEAD AGENCY.
    1.  The department is designated as the lead agency in this
 state to administer this chapter.
    2.  The department, in collaboration with the governmental
 public health advisory council and the governmental public
 health evaluation committee, shall coordinate implementation
 of this chapter including but not limited to the voluntary
 accreditation of designated local public health agencies and
 the department in accordance with the Iowa public health
 standards.  Such implementation shall include evaluation of
 and quality improvement measures for the governmental public
 health system.
    Sec. 118.  NEW SECTION.  135A.4  GOVERNMENTAL PUBLIC HEALTH
 ADVISORY COUNCIL.
    1.  A governmental public health advisory council is
 established to advise the department and make policy
 recommendations to the director of the department concerning
 administration, implementation, and coordination of this
 chapter and to make recommendations to the department
 regarding the governmental public health system.  The council
 shall meet at a minimum of quarterly.  The council shall
 consist of no fewer than fifteen members and no greater than
 twenty=three members.  The members shall be appointed by the
 director.  The director may solicit and consider
 recommendations from professional organizations, associations,
 and academic institutions in making appointments to the
 council.
    2.  Council members shall not be members of the
 governmental public health evaluation committee.
    3.  Council members shall serve for a term of two years and
 may be reappointed for a maximum of three consecutive terms.
 Initial appointment shall be in staggered terms.  Vacancies
 shall be filled for the remainder of the original appointment.
    4.  The membership of the council shall satisfy all of the
 following requirements:
    a.  One member who has expertise in injury prevention.
    b.  One member who has expertise in environmental health.
    c.  One member who has expertise in emergency preparedness.
    d.  One member who has expertise in health promotion and
 chronic disease prevention.
    e.  One member who has epidemiological expertise in
 communicable and infectious disease prevention and control.
    f.  One member representing each of Iowa's six public
 health regions who is an employee of a designated local public
 health agency or member of a local board of health.  Such
 members shall include a minimum of one local public health
 administrator and one physician member of a local board of
 health.
    g.  Two members who are representatives of the department.
    h.  The director of the state hygienic laboratory at the
 university of Iowa, or the director's designee.
    i.  At least one representative from academic institutions
 which grant undergraduate and postgraduate degrees in public
 health or other related health field and are accredited by a
 nationally recognized accrediting agency as determined by the
 United States secretary of education.  For purposes of this
 paragraph, "accredited" means a certification of the quality
 of an institution of higher education.
    j.  Two members who serve on a county board of supervisors.
    k.  Four nonvoting, ex officio members who shall consist of
 four members of the general assembly, two from the senate and
 two from the house of representatives, with not more than one
 member from each chamber being from the same political party.
 The two senators shall be designated one member each by the
 majority leader of the senate after consultation with the
 president and by the minority leader of the senate.  The two
 representatives shall be designated one member each by the
 speaker of the house of representatives after consultation
 with the majority leader of the house of representatives and
 by the minority leader of the house of representatives.
    l.  A member of the state board of health who shall be a
 nonvoting, ex officio member.
    5.  The council may utilize other relevant public health
 expertise when necessary to carry out its roles and
 responsibilities.
    6.  The council shall do all of the following:
    a.  Advise the department and make policy recommendations
 to the director of the department concerning administration,
 implementation, and coordination of this chapter and the
 governmental public health system.
    b.  Propose to the director public health standards that
 should be utilized for voluntary accreditation of designated
 local public health agencies and the department that include
 but are not limited to the organizational capacity and public
 health service components described in section 135A.6,
 subsection 1, by October 1, 2009.
    c.  Recommend to the department an accrediting entity and
 identify the roles and responsibilities for the oversight and
 implementation of the voluntary accreditation of designated
 local public health agencies and the department by January 2,
 2010.  This shall include completion of a pilot accreditation
 process for one designated local public health agency and the
 department by July 1, 2011.
    d.  Recommend to the director strategies to implement
 voluntary accreditation of designated local public health
 agencies and the department effective January 2, 2012.
    e.  Periodically review and make recommendations to the
 department regarding revisions to the public health standards
 pursuant to paragraph "b", as needed and based on reports
 prepared by the governmental public health evaluation
 committee pursuant to section 135A.5.
    f.  Review rules developed and adopted by the state board
 of health under this chapter and make recommendations to the
 department for revisions to further promote implementation of
 this chapter and modernization of the governmental public
 health system.
    g.  Form and utilize subcommittees as necessary to carry
 out the duties of the council.
    Sec. 119.  NEW SECTION.  135A.5  GOVERNMENTAL PUBLIC HEALTH
 EVALUATION COMMITTEE.
    1.  A governmental public health evaluation committee is
 established to develop, implement, and evaluate the
 governmental public health system and voluntary accreditation
 program.  The committee shall meet at least quarterly.  The
 committee shall consist of no fewer than eleven members and no
 greater than thirteen members.  The members shall be appointed
 by the director of the department.  The director may solicit
 and consider recommendations from professional organizations,
 associations, and academic institutions in making appointments
 to the committee.
    2.  Committee members shall not be members of the
 governmental public health advisory council.
    3.  Committee members shall serve for a term of two years
 and may be reappointed for a maximum of three consecutive
 terms.  Initial appointment shall be in staggered terms.
 Vacancies shall be filled for the remainder of the original
 appointment.
    4.  The membership of the committee shall satisfy all of
 the following requirements:
    a.  At least one member representing each of Iowa's six
 public health regions.  Each representative shall be an
 employee or administrator of a designated local public health
 agency or a member of a local board of health.  Such members
 shall be appointed to ensure expertise in the areas of
 communicable and infectious diseases, environmental health,
 injury prevention, healthy behaviors, and emergency
 preparedness.
    b.  Two members who are representatives of the department.
    c.  A representative of the state hygienic laboratory at
 the university of Iowa.
    d.  At least two representatives from academic institutions
 which grant undergraduate and postgraduate degrees in public
 health or other health=related fields.
    e.  At least one economist who has demonstrated experience
 in public health, health care, or a health=related field.
    f.  At least one research analyst.
    5.  The committee may utilize other relevant public health
 expertise when necessary to carry out its roles and
 responsibilities.
    6.  The committee shall do all of the following:
    a.  Develop and implement processes for evaluation of the
 governmental public health system and the voluntary
 accreditation program.
    b.  Collect and report baseline information for
 organizational capacity and public health service delivery
 based on the Iowa public health standards prior to
 implementation of the voluntary accreditation program on
 January 2, 2012.
    c.  Evaluate the effectiveness of the accrediting entity
 and the voluntary accreditation process.
    d.  Evaluate the appropriateness of the Iowa public health
 standards and develop measures to determine reliability and
 validity.
    e.  Determine what process and outcome improvements in the
 governmental public health system are attributable to
 voluntary accreditation.
    f.  Assure that the evaluation process is capturing data to
 support key research in public health system effectiveness and
 health outcomes.
    g.  Annually submit a report to the department by July 1.
    h.  Form and utilize subcommittees as necessary to carry
 out the duties of the committee.
    Sec. 120.  NEW SECTION.  135A.6  GOVERNMENTAL PUBLIC HEALTH
 SYSTEM.
    1.  The governmental public health system, in accordance
 with the Iowa public health standards, shall include but not
 be limited to the following organizational capacity components
 and public health service components:
    a.  Organizational capacity components shall include all of
 the following:
    (1)  Governance.
    (2)  Administration.
    (3)  Communication and information technology.
    (4)  Workforce.
    (5)  Community assessment and planning.  This component
 consists of collaborative data collection and analysis for the
 completion of population=based community health assessments
 and community health profiles and the process of developing
 improvement plans to address the community health needs and
 identified gaps in public health services.
    (6)  Evaluation.
    b.  Public health service components shall include all of
 the following:
    (1)  Prevention of epidemics and the spread of disease.
 This component includes the surveillance, detection,
 investigation, and prevention and control measures that
 prevent, reduce, or eliminate the spread of infectious
 disease.
    (2)  Protection against environmental hazards.  This
 component includes activities that reduce or eliminate the
 risk factors detrimental to the public's health within the
 natural or man=made environment.
    (3)  Prevention of injuries.  This component includes
 activities that facilitate the prevention, reduction, or
 elimination of intentional and unintentional injuries.
    (4)  Promotion of healthy behaviors.  This component
 includes activities to assure services that promote healthy
 behaviors to prevent chronic disease and reduce illness.
    (5)  Preparation for, response to, and recovery from public
 health emergencies.  This component includes activities to
 prepare the public health system and community partners to
 respond to public health threats, emergencies, and disasters
 and to assist in the recovery process.
    2.  The governmental public health system shall include but
 not be limited to the following entities:
    a.  Local boards of health.
    b.  State board of health.
    c.  Designated local public health agencies.
    d.  The department.
    Sec. 121.  NEW SECTION.  135A.7  GOVERNMENTAL PUBLIC HEALTH
 SYSTEM AND ACCREDITATION DATA COLLECTION SYSTEM.
    1.  The department shall establish and maintain a
 governmental public health system and an accreditation data
 collection system by which the state board of health, the
 director, the department, the council, and the committee may
 monitor the implementation and effectiveness of the
 governmental public health system based on the Iowa public
 health standards.
    2.  Notwithstanding section 22.7 or any other provision of
 law, local boards of health shall provide to the department
 and the accrediting entity upon request all data and
 information necessary to determine the local board's capacity
 to comply with the Iowa public health standards, including but
 not limited to data and information regarding governance,
 administration, communication and information technology,
 workforce, personnel, staffing, budget, contracts, and other
 program and agency information.
    3.  The department may share any data or information
 collected pursuant to this section with the council or the
 committee as necessary to perform the duties of the council
 and committee.  Data and information provided to the
 department under this section which are confidential pursuant
 to section 22.7, subsection 2, 11, or 50, section 139A.3, or
 other provision of law, remain confidential and shall not be
 released by the department, the council, or the committee.
    4.  During the pendency of the accreditation process, all
 accreditation files and reports prepared for or maintained by
 the accrediting entity are confidential and are not subject to
 discovery, subpoena, or other means of legal compulsion for
 their release.  After the accrediting entity has issued its
 recommendation or report only the preliminary drafts of the
 recommendation or report, and records otherwise confidential
 pursuant to chapter 22 or other provision of state or federal
 law, shall remain confidential and are not subject to
 discovery, subpoena, or other means of legal compulsion for
 their release.
    5.  To the extent possible, activities under this section
 shall be coordinated with other health data collection systems
 including those maintained by the department.
    Sec. 122.  NEW SECTION.  135A.8  GOVERNMENTAL PUBLIC HEALTH
 SYSTEM FUND.
    1.  The department is responsible for the funding of the
 administrative costs for implementation of this chapter.  A
 governmental public health system fund is created as a
 separate fund in the state treasury under the control of the
 department.  The fund shall consist of moneys obtained from
 any source, including the federal government, unless otherwise
 prohibited by law or the entity providing the funding.  Moneys
 deposited in the fund are appropriated to the department for
 the public health purposes specified in this chapter.  Moneys
 in the fund shall not be transferred, used, obligated,
 appropriated, or otherwise encumbered except as provided in
 this section.  Notwithstanding section 8.33, moneys in the
 governmental public health system fund at the end of the
 fiscal year shall not revert to any other fund but shall
 remain in the fund for subsequent fiscal years.
    2.  The fund is established to assist local boards of
 health and the department with the provision of governmental
 public health system organizational capacity and public health
 service delivery and to achieve and maintain voluntary
 accreditation in accordance with the Iowa public health
 standards.  At least seventy percent of the funds shall be
 made available to local boards of health and up to thirty
 percent of the funds may be utilized by the department.
    3.  Moneys in the fund may be allocated by the department
 to a local board of health for organizational capacity and
 service delivery.  Such allocation may be made on a matching,
 dollar=for=dollar basis for the acquisition of equipment, or
 by providing grants to achieve and maintain voluntary
 accreditation in accordance with the Iowa public health
 standards.
    4.  A local board of health seeking matching funds or
 grants under this section shall apply to the department.  The
 state board of health shall adopt rules concerning the
 application and award process for the allocation of moneys in
 the fund and shall establish the criteria for the allocation
 of moneys in the fund if the moneys are insufficient to meet
 the needs of local boards of health.
    Sec. 123.  NEW SECTION.  135A.9  RULES.
    The state board of health shall adopt rules pursuant to
 chapter 17A to implement this chapter which shall include but
 are not limited to the following:
    1.  Incorporation of the Iowa public health standards
 recommended to the department pursuant to section 135A.5,
 subsection 6.
    2.  A voluntary accreditation process to begin no later
 than January 2, 2012, for designated local public health
 agencies and the department.
    3.  Rules relating to the operation of the governmental
 public health advisory council.
    4.  Rules relating to the operation of the governmental
 public health system evaluation committee.
    5.  The application and award process for governmental
 public health system fund moneys.
    6.  Rules relating to data collection for the governmental
 public health system and the voluntary accreditation program.
    7.  Rules otherwise necessary to implement the chapter.
    Sec. 124.  NEW SECTION.  135A.10  PROHIBITED ACTS ==
 FRAUDULENTLY CLAIMING ACCREDITATION == CIVIL PENALTY.
    A local board of health or local public health agency that
 imparts or conveys, or causes to be imparted or conveyed,
 information claiming that it is accredited pursuant to this
 chapter or that uses any other term to indicate or imply it is
 accredited without being accredited under this chapter is
 subject to a civil penalty not to exceed one thousand dollars
 per day for each offense.  However, nothing in this chapter
 shall be construed to restrict a local board of health or
 local public health agency from providing any services for
 which it is duly authorized.
    Sec. 125.  NEW SECTION.  135A.11  IMPLEMENTATION.
    The department shall implement this chapter only to the
 extent that funding is available.
    Sec. 126.  EFFECTIVE DATE.  This division of this Act,
 being deemed of immediate importance, takes effect upon
 enactment.
                          DIVISION XII
                  IOWACARE == NONPARTICIPATING
                    PROVIDER == REIMBURSEMENT
    Sec. 127.  NEW SECTION.  249J.24A  NONPARTICIPATING
 PROVIDER REIMBURSEMENT FOR COVERED SERVICES == REIMBURSEMENT
 FUND.
    1.  A nonparticipating provider may be reimbursed for
 covered expansion population services provided to an expansion
 population member by a nonparticipating provider, if the
 nonparticipating provider contacts the appropriate
 participating provider prior to providing covered services to
 verify consensus regarding one of the following courses of
 action:
    a.  If the nonparticipating provider and the participating
 provider agree that the medical status of the expansion
 population member indicates it is medically possible to
 postpone provision of services, the nonparticipating provider
 shall direct the expansion population member to the
 appropriate participating provider for services.
    b.  If the nonparticipating provider and the participating
 provider agree that the medical status of the expansion
 population member indicates it is not medically possible to
 postpone provision of services, the nonparticipating provider
 shall provide medically necessary services.
    c.  If the nonparticipating provider and the participating
 provider agree that transfer of the expansion population
 member is not possible due to lack of available inpatient
 capacity, the nonparticipating provider shall provide
 medically necessary services.
    d.  If the medical status of the expansion population
 member indicates a medical emergency and the nonparticipating
 provider is not able to contact the appropriate participating
 provider prior to providing medically necessary services, the
 nonparticipating provider shall document the medical emergency
 and inform the appropriate participating provider immediately
 after the member has been stabilized of any covered services
 provided.
    2.  a.  If the nonparticipating provider meets the
 requirements specified in subsection 1, the nonparticipating
 provider shall be reimbursed for covered expansion population
 services provided to the expansion population member through
 the nonparticipating provider reimbursement fund in accordance
 with rules adopted by the department of human services.
 However, any funds received from participating providers,
 appropriated to participating providers, or deposited in the
 IowaCare account pursuant to section 249J.24, shall not be
 transferred or appropriated to the nonparticipating provider
 reimbursement fund or otherwise used to reimburse
 nonparticipating providers.
    b.  Reimbursement of nonparticipating providers under this
 section shall be based on the reimbursement rates and policies
 applicable to the nonparticipating provider under the full
 benefit medical assistance program, subject to the
 availability of funds in the nonparticipating provider
 reimbursement fund and subject to the appropriation of moneys
 in the fund to the department.
    c.  The department shall reimburse the nonparticipating
 provider only if the recipient of the services is an expansion
 population member with active eligibility status at the time
 the services are provided.
    3.  a.  A nonparticipating provider reimbursement fund is
 created in the state treasury under the authority of the
 department.  Moneys designated for deposit in the fund that
 are received from sources including but not limited to
 appropriations from the general fund of the state, grants, and
 contributions, shall be deposited in the fund.  However, any
 funds received from participating providers, appropriated to
 participating providers, or deposited in the IowaCare account
 pursuant to section 249J.24 shall not be transferred or
 appropriated to the nonparticipating provider reimbursement
 fund or otherwise used to reimburse nonparticipating
 providers.
    b.  Moneys in the fund shall be separate from the general
 fund of the state and shall not be considered part of the
 general fund of the state.  The moneys deposited in the fund
 are not subject to section 8.33 and shall not be transferred,
 used, obligated, appropriated, or otherwise encumbered, except
 to provide for the purposes specified in this section.
 Notwithstanding section 12C.7, subsection 2, interest or
 earnings on moneys deposited in the fund shall be credited to
 the fund.
    c.  Moneys deposited in the fund shall be used only to
 reimburse nonparticipating providers who provide covered
 services to expansion population members if no other third
 party is liable for reimbursement and as specified in
 subsection 1.
    d.  The department shall attempt to maximize receipt of
 federal matching funds under the medical assistance program
 for covered services provided under this section if such
 attempt does not directly or indirectly limit the federal
 funds available to participating providers.
    4.  For the purposes of this section, "nonparticipating
 provider" means a hospital licensed pursuant to chapter 135B
 that is not a member of the expansion population provider
 network as specified in section 249J.7.
    Sec. 128.  NONPARTICIPATING PROVIDER REIMBURSEMENT FOR
 COVERED SERVICES == IOWACARE PROGRAM WAIVER RENEWAL.
    1.  Beginning July 1, 2010, the department of human
 services shall include in any medical assistance program
 waiver relating to the continuation of the IowaCare program
 pursuant to chapter 249J, provisions for reimbursement of
 covered expansion population services provided to an expansion
 population member by a nonparticipating provider subject to
 all of the following:
    a.  A nonparticipating provider may be reimbursed if the
 nonparticipating provider contacts the appropriate
 participating provider prior to providing covered services to
 verify consensus regarding one of the following courses of
 action:
    (1)  If the nonparticipating provider and the participating
 provider agree that the medical status of the expansion
 population member indicates it is medically possible to
 postpone provision of services, the nonparticipating provider
 shall direct the expansion population member to the
 appropriate participating provider for services.
    (2)  If the nonparticipating provider and the participating
 provider agree that the medical status of the expansion
 population member indicates it is not medically possible to
 postpone provision of services, the nonparticipating provider
 shall provide medically necessary services.
    (3)  If the nonparticipating provider and the participating
 provider agree that transfer of the expansion population
 member is not possible due to lack of available inpatient
 capacity, the nonparticipating provider shall provide
 medically necessary services.
    (4)  If the medical status of the expansion population
 member indicates a medical emergency and the nonparticipating
 provider is not able to contact the appropriate participating
 provider prior to providing medically necessary services, the
 nonparticipating provider shall document the medical emergency
 and inform the appropriate participating provider immediately
 after the member has been stabilized of any covered services
 provided.
    b.  Reimbursement of a nonparticipating provider shall be
 based on the reimbursement rates and policies applicable to
 the nonparticipating provider under the full benefit medical
 assistance program, subject to the availability and
 appropriation of funds to the department for such purpose.
    c.  Reimbursement shall be made to a nonparticipating
 provider only if the recipient of the services is an expansion
 population member with active eligibility status at the time
 the services are provided.
    d.  For the purposes of this section, "nonparticipating
 provider" means a hospital licensed pursuant to chapter 135B
 that is not a member of the expansion population provider
 network as specified in section 249J.7.
    2.  Notwithstanding the requirement of this section
 directing the department of human services to include
 provisions for reimbursement of covered services provided to
 an expansion population member by a nonparticipating provider
 under any medical assistance program waiver relating to the
 continuation of the IowaCare program beginning July 1, 2010,
 if the department of human services in consultation with the
 governor determines that such requirement would adversely
 affect continuation of or would reduce the amount of funding
 available for the IowaCare waiver, the department shall not
 include such provisions in the IowaCare waiver.
                          DIVISION XIII
                 MISCELLANEOUS STATUTORY CHANGES
    Sec. 129.  NEW SECTION.  157.3B  EXAMINATION INFORMATION.
    Notwithstanding section 147.21, individual pass or fail
 examination results made available from the authorized
 national testing agency to the board may be disclosed to the
 board=approved education program from which the applicant for
 licensure graduated for purposes of verifying accuracy of
 national data and reporting aggregate licensure examination
 results as required for a program's continued accreditation.
    Sec. 130.  Section 234.12A, subsection 1, Code 2009, is
 amended to read as follows:
    1.  The department of human services shall maintain an
 electronic benefits transfer program utilizing electronic
 funds transfer systems for the food assistance program.  The
 electronic benefits transfer program implemented under this
 section shall at a minimum provide for all of the following:
    a.  A retailer shall not be required require a retailer to
 make cash disbursements or to provide, purchase, or upgrade
 electronic funds transfer system equipment as a condition of
 participation in the program.
    b.  A retailer providing electronic funds transfer system
 equipment for transactions pursuant to the program shall be
 reimbursed seven cents for each approved transaction pursuant
 to the program utilizing the retailer's equipment.
    c.  A retailer that provides electronic funds transfer
 system equipment for transactions pursuant to the program and
 who makes cash disbursements pursuant to the program utilizing
 the retailer's equipment shall be paid a fee of seven cents by
 the department for each cash disbursement transaction by the
 retailer.
    Sec. 131.  Section 237B.1, subsection 3, Code 2009, is
 amended to read as follows:
    3.  In establishing the initial and subsequent standards,
 the department of human services shall review other
 certification and licensing standards applicable to the
 centers.  The standards established by the department shall be
 broad facility standards for the protection of children's
 safety.  The department shall also apply criminal and abuse
 registry background check requirements for the persons who
 own, operate, staff, participate in, or otherwise have contact
 with the children receiving services from a children's center.
 The background check requirements shall be substantially
 equivalent to those applied under chapter 237 for a child
 foster care facility provider.  The department of human
 services shall not establish program standards or other
 requirements under this section involving program development
 or oversight of the programs provided to the children served
 by children's centers.
    Sec. 132.  Section 249A.3, subsection 14, Code 2009, is
 amended to read as follows:
    14.  Once initial ongoing eligibility for the family
 medical assistance program=related medical assistance is
 determined for a child described under subsection 1, paragraph
 "b", "f", "g", "j", "k", "l", or "n" or under subsection 2,
 paragraph "e", "f", or "h" the age of nineteen, the department
 shall provide continuous eligibility for a period of up to
 twelve months regardless of changes in family circumstances,
 until the child's next annual review of eligibility under the
 medical assistance program, if the child would otherwise be
 determined ineligible due to excess countable income but
 otherwise remains eligible with the exception of the following
 children:
    a.  A newborn child of a medical assistance=eligible woman.
    b.  A child whose eligibility was determined under the
 medically needy program.
    c.  A child who is eligible under a state=only funded
 program.
    d.  A child who is no longer an Iowa resident.
    e.  A child who is incarcerated in a jail or other
 correctional institution.
    Sec. 133.  CHILD SUPPORT ENFORCEMENT INFORMATION.  The
 sections of 2009 Iowa Acts, Senate File 319, amending section
 252B.5, subsection 9, paragraph "b", unnumbered paragraph 1;
 section 252B.9, subsection 2, unnumbered paragraph 1; section
 252B.9, subsection 2, paragraph "a"; section 252B.9,
 subsection 2, paragraph "b", unnumbered paragraph 1; section
 252B.9, subsection 2, paragraph "b", subparagraph (1); section
 252B.9, subsection 3, paragraphs "e" and "g"; section 252B.9A,
 subsection 1; section 252G.5, subsections 2 and 3; section
 598.22, subsection 3; and section 598.26, subsection 1, Code
 2009, and providing for such amendments' effective date, are
 repealed.
    Sec. 134.  EFFECTIVE DATE == RETROACTIVE APPLICABILITY.
 The section of this division of this Act amending section
 249A.3, subsection 14, being deemed of immediate importance,
 takes effect upon enactment and is retroactively applicable to
 July 1, 2008.
    Sec. 135.  EXCHANGE OF ELECTRONIC INDIVIDUALLY IDENTIFIABLE
 HEALTH INFORMATION.  The executive committee of the electronic
 health information advisory council created in section
 135.156, with the technical assistance of the advisory council
 and the support of the department of public health, shall
 review the electronic exchange of individually identifiable
 health information by health care providers for the purpose of
 treatment with the goal of facilitating informed treatment
 decisions and providing higher quality and safer care, while
 protecting the privacy of patients and the security and
 confidentiality of patient information.  Following the review,
 the executive committee shall report the results of its review
 and recommendations, including any proposed changes in state
 law and rules relating to such information exchange, to the
 governor and the general assembly no later than December 15,
 2009.
    Sec. 136.  EFFECTIVE DATE == RETROACTIVE APPLICABILITY.
 The section of this division of this Act relating to child
 support enforcement information by repealing sections of 2009
 Iowa Acts, Senate File 319, as enacted, being deemed of
 immediate importance, takes effect upon enactment, and is
 retroactively applicable to March 23, 2009.
    Sec. 137.  CODE EDITOR DIRECTIVE == INTENT.
    1.  References in this Act to the department of elder
 affairs mean the department on aging in accordance with 2009
 Iowa Acts, Senate File 204, as enacted, unless a contrary
 intent is clearly evident.
    2.  The Iowa Code editor is directed to make conforming
 changes, as appropriate, to codified provisions of this Act to
 reflect the provisions of 2009 Iowa Acts, Senate File 204, as
 enacted, including but not limited to replacing the words
 "department of elder affairs" with the words "department on
 aging".
    Sec. 138.  Sections 237A.28 and 422.100, Code 2009, are
 repealed.


                                                             
                               PATRICK J. MURPHY
                               Speaker of the House


                                                             
                               JOHN P. KIBBIE
                               President of the Senate

    I hereby certify that this bill originated in the House and
 is known as House File 811, Eighty=third General Assembly.


                                                             
                               MARK BRANDSGARD
                               Chief Clerk of the House
 Approved                , 2009


                            
 CHESTER J. CULVER
 Governor

                             -1-