House File 1049 - Enrolled House File 1049 AN ACT RELATING TO AND MAKING APPROPRIATIONS TO THE DEPARTMENT OF VETERANS AFFAIRS AND THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND RELATED PROVISIONS AND APPROPRIATIONS, INCLUDING AGING AND DISABILITY SERVICES; BEHAVIORAL HEALTH, PUBLIC HEALTH, COMMUNITY ACCESS AND ELIGIBILITY; THE MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY ASSISTANCE, HAWKI, AND OTHER HEALTH-RELATED PROGRAMS; SEX REASSIGNMENT SURGERIES OR ASSOCIATED PROCEDURES; FAMILY WELL-BEING AND PROTECTION; STATE-OPERATED SPECIALTY CARE, ADMINISTRATION AND COMPLIANCE; TRANSFERS, CASH FLOWS, AND NONREVERSIONS; PRIOR APPROPRIATIONS; THE BEER AND LIQUOR CONTROL FUND, AND THE BEHAVIORAL HEALTH FUND; REPORT ON NONREVERSION OF MONEYS; EMERGENCY RULES; AND A HOSPITAL DIRECTED PAYMENT PROGRAM; AND INCLUDING EFFECTIVE DATE AND RETROACTIVE APPLICABILITY PROVISIONS. BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: DIVISION I DEPARTMENT OF VETERANS AFFAIRS —— FY 2025-2026 Section 1. 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, 2025, and ending June 30, 2026, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:

House File 1049, p. 2 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION For salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 2. IOWA VETERANS HOME For salaries, support, maintenance, and miscellaneous purposes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 a. The Iowa veterans home billings involving the department of health and human services shall be submitted to the department on at least a monthly basis. b. The Iowa veterans home expenditure report shall be submitted monthly to the general assembly. 3. HOME OWNERSHIP ASSISTANCE PROGRAM For transfer to the Iowa finance authority for the continuation of the home ownership assistance program for persons who are or were eligible members of the armed forces of the United States or eligible service members pursuant to section 16.54: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 DIVISION II AGING AND DISABILITY SERVICES —— FY 2025-2026 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING AND DISABILITY SERVICES. There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: For aging programs for the department of health and human services and area agencies on aging to provide citizens of Iowa who are 60 years of age and older with case management; for Iowa’s aging and disabilities resource centers; for the return to community program; for the purposes of chapter 231E; to administer the prevention of elder abuse, neglect, and exploitation program pursuant to section 231.56A, in accordance with the requirements of the federal Older Americans Act of 1965, 42 U.S.C. §3001 et seq., as amended; for the operation

House File 1049, p. 3 of the dependent adult abuse services program pursuant to chapter 235B; for other services which may include but are not limited to adult day care, respite care, chore, information and assistance, and material aid; for information and options counseling for persons with disabilities; and for salaries, support, administration, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,208,180 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 88.00 1. Moneys appropriated in this section may be used to supplement federal moneys received under federal regulations. To receive moneys appropriated in this section, a local area agency on aging shall match the moneys with moneys from other sources according to rules adopted by the department. Moneys appropriated in this section may be used for services not specifically enumerated in this section only if approved by the department as part of an area agency on aging’s area plan. 2. Of the moneys appropriated in this section, $949,282 shall be used for the family support center component of the comprehensive family support program under section 225C.47. 3. Of the moneys appropriated in this section, $33,632 shall be used to build 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 15, 1994). DIVISION III BEHAVIORAL HEALTH —— FY 2025-2026 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— BEHAVIORAL HEALTH. There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: For behavioral health prevention, treatment, and recovery efforts to reduce the prevalence of the use of, provide treatment for, and support recovery from alcohol, tobacco, and substance use and misuse, problem gambling, and other addictive behaviors. Activities shall align with accepted best practice

House File 1049, p. 4 guidance standards for behavioral health including those published by the centers for disease control and prevention of the United States department of health and human services, and the substance abuse and mental health services administration of the United States department of health and human services, for health promotion; universal, selective, and indicated prevention; treatment; and recovery services and supports; and shall include a 24-hour helpline, public information resources, professional training, youth prevention, program evaluation, and efforts at the state and local levels, and for not more than the following full-time equivalent positions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,442,121 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 71.00 1. Of the moneys appropriated in this section, $300,000 shall be used to support the work of the children’s behavioral health system including evidence-based behavioral health prevention, treatment, and recovery services and supports for children and their families pursuant to the intent specified in section 225C.6B, subsection 1. 2. Of the moneys appropriated in this section, $950,000 shall be used for an integrated substance use disorder managed care system. The department shall maintain the level of mental health and substance use disorder treatment services provided by the managed care contractors, and shall take the steps necessary to continue the federal waivers as needed to maintain the level of services. Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS WAGERING RECEIPTS FUND. There is appropriated from the sports wagering receipts fund created in section 8.57I, to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for behavioral health prevention, treatment, and recovery efforts to reduce the prevalence of the use of, provide treatment for, and support recovery from alcohol, tobacco, and substance use and misuse, problem gambling, and other addictive behaviors: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 DIVISION IV PUBLIC HEALTH —— FY 2025-2026

House File 1049, p. 5 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC HEALTH. There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: For programs that support health promotion, protect the health and safety of the public, conduct disease surveillance and investigation to reduce the incidence of morbidity and mortality, serve individuals with chronic conditions including but not limited to cancer, support the Iowa donor registry as specified in section 142C.18, and strengthen the health care delivery system and workforce to improve health outcomes for all Iowans, and for not more than the following full-time equivalent positions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,433,369 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 348.60 1. Of the moneys appropriated in this section, the following amounts are allocated to the department of health and human services to be used as follows to support the goals of increased access, health system integration, and engagement: a. $600,000 for distribution to a nonprofit organization that established the first statewide drug donation repository for continuation of the pharmaceutical infrastructure for safety net providers established as described in 2007 Iowa Acts, chapter 218, section 108, and for the prescription drug donation repository program established in chapter 135M. Moneys under this paragraph shall be distributed in their entirety on July 1, 2025, for the purpose specified. b. $374,000 for distribution to free clinics, as defined in section 135.24, and a nonprofit organization that facilitates the initiation, operation, and collaboration of free clinics for necessary infrastructure, statewide coordination, provider recruitment, service delivery, and provision of assistance to patients in securing a medical home inclusive of oral health care. Of the moneys allocated, $40,000 shall be used to lower fees associated with using an electronic prescribing system. Moneys under this paragraph shall be distributed in their entirety on July 1, 2025, for the purpose specified.

House File 1049, p. 6 c. $25,000 for distribution to an organization that raises awareness about issues related to rural health clinics for necessary infrastructure and service delivery transformation. Moneys under this paragraph shall be distributed in their entirety on July 1, 2025, for the purpose specified. d. $225,000 for distribution to an organization that is the oldest continuously operating medical society in the most populous county in the state according to the most recently published census for continuation of safety net provider patients access to specialty care as described in 2007 Iowa Acts, chapter 218, section 109. Moneys under this paragraph shall be distributed in their entirety on July 1, 2025, for the purpose specified. 2. Of the moneys appropriated in this section, $600,000 shall be used for rural psychiatric residencies for residents selected on or before June 30, 2025. 3. Of the moneys appropriated in this section, $20,000 shall be used to make radon test kits available, free of charge, to homeowners and renters in the state. The department shall provide a link on the department’s internet site for homeowners and renters in the state to order radon test kits. 4. Of the moneys appropriated in this section, $2,300,000 shall be used for Medicaid graduate medical education efforts and consistent with the purpose of the department’s request for approval to the centers of Medicare and Medicaid services of the United States department of health and human services for a Medicaid supplemental enhanced payment for the purposes of maximizing federal funding opportunities for graduate medical education as described in 2025 Iowa Acts, House File 972, or successor legislation. 5. The university of Iowa hospitals and clinics under the control of the state board of regents shall not receive indirect costs from the moneys appropriated in this section. The university of Iowa hospitals and clinics billings to the department shall be, at a minimum, on a quarterly basis. DIVISION V COMMUNITY ACCESS AND ELIGIBILITY —— FY 2025-2026 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY ACCESS AND ELIGIBILITY. There is appropriated from the

House File 1049, p. 7 general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: To be used for salaries, support, maintenance, and miscellaneous purposes and for family investment program (FIP) assistance in accordance with chapter 239B, and for other costs associated with providing needs-based benefits or assistance including but not limited to maternal and child health, oral health, obesity prevention, the promoting independence and self-sufficiency through employment, job opportunities and the basic skills (PROMISE JOBS) program, supplemental nutrition assistance program (SNAP) employment and training, the FIP diversion program, family planning, rent reimbursement, and eligibility determinations for medical assistance, food assistance, and the children’s health insurance program, and for not more than the following full-time equivalent positions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,542,456 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 870.40 1. Of the child support collections assigned under FIP, the federal share of the child support collections shall be credited to the child support services appropriation made in this division of this Act. Of the remainder of the child support collections assigned under FIP, a portion shall be credited to community access and eligibility, and the remaining moneys may be used to increase recoveries, to sustain cash flow in the collection services center refund account as provided in section 252B.13A, or for technology needs. If child support collections assigned under FIP are greater than estimated or are otherwise determined not to be required for maintenance of efforts, the state share of either amount is appropriated to the department for child support services as described in this Act, or may be transferred to or retained in the collection services center refund account. 2. Of the moneys appropriated in this section, $3,075,000 shall be used for continuation of the department’s initiative to provide for adequate developmental surveillance and screening during a child’s first five years. The moneys shall be used first to fully fund the current participating counties

House File 1049, p. 8 to ensure that those counties are fully operational, with the remaining moneys to be used for expanding participation to additional counties. Full implementation and expansion shall include enhancing the scope of the initiative through collaboration with child health specialty clinics to promote the use of developmental surveillance and screening to support healthy child development through early identification and response to both biomedical and social determinants of healthy development by providing practitioner consultation and continuous improvement through training and education, particularly for children with behavioral conditions and needs. The department shall also collaborate with the Medicaid program and child health specialty clinics to assist in coordinating the activities of the first five initiative into the establishment of patient-centered medical homes developed to improve health quality and population health while reducing health care costs. To the maximum extent possible, moneys allocated in this subsection shall be utilized as matching moneys for Medicaid program reimbursement. 3. Of the moneys appropriated in this section, $1,145,102 is allocated to the Iowa commission on volunteer service for programs and grants. 4. The university of Iowa hospitals and clinics under the control of the state board of regents shall not receive indirect costs from the moneys appropriated in this section. The university of Iowa hospitals and clinics billings to the department shall be, at a minimum, on a quarterly basis. CHILD SUPPORT SERVICES Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: For child support services, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 464.00 1. Federal access and visitation grant moneys shall be used

House File 1049, p. 9 for services designed to increase compliance with the child access provisions of court orders, including but not limited to neutral visitation sites and mediation services. 2. The appropriation made to the department for child support services 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. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT Sec. 8. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT. There is appropriated from the special fund created in section 8.41 to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, 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, including any TANF block grant moneys received in any prior fiscal year that were deposited in the special fund and remain unencumbered or unobligated on June 30, 2025, the following amounts, or so much thereof as is necessary, to be used for the purposes designated: 1. For community access and eligibility: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627 2. For community access and eligibility to provide pregnancy prevention grants on the condition that family planning services are funded: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 Pregnancy prevention grants shall be awarded to programs in existence on or before July 1, 2025, if the programs have demonstrated positive outcomes. Grants shall be awarded to pregnancy prevention programs developed after July 1, 2025, if the programs 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 a program awarded a grant must emphasize sexual abstinence. Priority in the awarding of grants shall be given to programs

House File 1049, p. 10 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. 3. To meet one of the four purposes of TANF as specified in 45 C.F.R. §260.20, including by modernizing the program to promote economic mobility and self-sufficiency, ensuring that families are able to overcome benefit cliffs, encouraging healthy families, and streamlining service delivery to reduce duplication: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 4. For early intervention and supports for child abuse prevention grants and the family development and self-sufficiency (FaDSS) grant program in accordance with section 216A.107: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,013,980 5. For accountability, compliance, program integrity, technology needs, and other resources necessary to meet federal and state reporting, tracking, and case management requirements, and other departmental needs: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 6. For state child care assistance: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 7. For child protective services: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 65,364,100 DIVISION VI MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED PROGRAMS —— FY 2025-2026 Sec. 9. MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: For medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies in effect on June 30, 2025, except as otherwise expressly authorized by law, consistent with options under

House File 1049, p. 11 federal law and regulations, and contingent upon receipt of approval from the office of the governor of reimbursement for each abortion performed under the medical assistance program; for the state supplementary assistance program; for the health insurance premium payment program; and for maintenance of the healthy and well kids in Iowa (Hawki) program pursuant to chapter 514I, including supplemental dental services, for receipt of federal financial participation under Tit. XXI of the federal Social Security Act, which creates the children’s health insurance program; and for other specified health-related programs: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,903,550,706 1. Of the moneys appropriated in this section, $1,837,804,073 is allocated for medical assistance program reimbursement and associated costs. a. Of the moneys allocated in this subsection, $3,383,880 shall be used for program administration, outreach, and enrollment activities of the state family planning services program pursuant to section 217.41B, and of this amount, the department may use $200,000 for administrative expenses. b. Of the moneys allocated in this subsection, $3,050,000 shall be used to expand the capacity of intermittent community-based services that allow an individual to remain in the community and that provide support to the individual, including employment services, hourly supported community living services, respite services, and day habilitation services. 2. Iowans support reducing the number of abortions performed in our state. Moneys appropriated under this section shall not be used for abortions, unless otherwise authorized under this section. 3. The provisions of this section relating to abortions shall also apply to the Iowa health and wellness plan created pursuant to chapter 249N. 4. Of the moneys appropriated in this section, $4,479,762 is allocated for the state supplementary assistance program. 5. Of the moneys appropriated in this section, $61,266,871 is allocated for maintenance of the Hawki program pursuant to chapter 514I, including supplemental dental services, for

House File 1049, p. 12 receipt of federal financial participation under Tit. XXI of the federal Social Security Act, which creates the children’s health insurance program. HEALTH PROGRAM OPERATIONS Sec. 10. HEALTH PROGRAM OPERATIONS. There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: For health program operations, and the autism support program under section 225D.2, and for not more than the following full-time equivalent positions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,672,433 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 82.00 1. The department of inspections, appeals, and licensing shall provide all state matching moneys for survey and certification activities performed by the department of inspections, appeals, and licensing. The department of health and human services shall be solely responsible for distributing the federal matching moneys for such activities. 2. Of the moneys appropriated in this section, a sufficient amount shall be allocated for the administration of the health insurance premium payment program, including salaries, support, maintenance, and miscellaneous purposes. 3. Of the moneys appropriated in this section, $750,000 shall be allocated for a nonprofit organization that provides access to emergency poison information and treatment. Pursuant to the directive under 2014 Iowa Acts, chapter 1140, section 102, the federal matching moneys available to the nonprofit organization from the department under the federal Children’s Health Insurance Program Reauthorization Act of 2009 shall be subject to the federal administrative cap rule of 10 percent applicable to moneys provided under Tit. XXI of the federal Social Security Act and shall be included in the department’s calculations of the cap. 4. Unless otherwise provided by law, if a contract for services provided under this section initially entered into during the fiscal year beginning July 1, 2025, and ending

House File 1049, p. 13 June 30, 2026, provides for an annual increase of the cost of services provided under the contract, the annual increase shall not exceed the amount by which the consumer price index for all urban consumers increased during the immediately preceding calendar year. This subsection shall not affect a contract entered into on or before June 30, 2025, that is for a term of more than one year. HEALTH CARE ACCOUNTS AND FUNDS Sec. 11. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT OF HEALTH AND HUMAN SERVICES. There is appropriated from the pharmaceutical settlement account created in section 249A.33 to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated: Notwithstanding any provision of law to the contrary, to supplement the appropriation made in this Act from the general fund of the state for health program operations under the medical assistance program for the same fiscal year: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 Sec. 12. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding any provision of law to the contrary, and subject to the availability of moneys, there is appropriated from the quality assurance trust fund created in section 249L.4 to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, for the purposes designated: To supplement the appropriation made in this Act from the general fund of the state to the department of health and human services for medical assistance for the same fiscal year: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 Sec. 13. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding any provision of law to the contrary, and subject to the availability of moneys, there is appropriated from the hospital health care access trust fund created in section 249M.4 to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following

House File 1049, p. 14 amount, or so much thereof as is necessary, for the purposes designated: To supplement the appropriation made in this Act from the general fund of the state to the department of health and human services for medical assistance for the same fiscal year: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 SEX REASSIGNMENT SURGERIES OR ASSOCIATED PROCEDURES Sec. 14. NEW SECTION . 249A.14 Sex reassignment surgeries or associated procedures —— reimbursement prohibited. 1. Moneys appropriated from the general fund of the state to the department for the medical assistance program shall not be used for reimbursement for sex reassignment surgery or associated procedures, including hormone therapy or other medical interventions intended to alter primary or secondary sex characteristics related to an individual’s gender dysphoria diagnosis. 2. This section shall not be construed to prohibit Medicaid program reimbursement for services not described under subsection 1 that are otherwise covered under the Medicaid program. 3. The department of health and human services shall adopt rules pursuant to chapter 17A to administer this section. REIMBURSEMENT RATES Sec. 15. REIMBURSEMENT RATES. 1. Reimbursement for medical assistance, state supplementary assistance, and social service providers and services reimbursed under the purview of the department of health and human services shall remain at the reimbursement rate in effect on June 30, 2025, or shall be determined pursuant to the reimbursement methodology in effect on June 30, 2025, with the exception of the following: a. If reimbursement is otherwise negotiated by contract or pursuant to an updated fee schedule. b. As otherwise provided in this section of this Act. 2. Of the moneys appropriated for medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies June 30, 2025, the following amounts, or so much thereof as is necessary, are allocated to the department of health and human services to be

House File 1049, p. 15 used for the following purposes: a. (1) Notwithstanding any provision of law to the contrary, for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the department of health and human services shall rebase case-mix nursing facility rates beginning July 1, 2025, using the Medicaid cost reports on file for the period ending December 31, 2024, to the extent possible within state funding, including no more than $20,000,000 from the allocation provided for medical assistance program reimbursement and associated costs. (2) The department of health and human services shall calculate each nursing facility’s case-mix index for the period beginning July 1, 2024, using weighting based on the current patient-driven payment model schedule. Rosters shall be made to show a separate calculation to determine the average case-mix index for a nursing-facility-wide case-mix index, and a case-mix index for the residents of a nursing facility who are Medicaid recipients using all minimum data set reports by the nursing facility for the previous semiannual period using a day weighted calculation. b. For the fiscal year beginning July 1, 2025, $2,136,304 shall be used to increase to the extent possible reimbursement rates for dentists, excluding orthodontic services, compared to rates in effect on June 30, 2025. c. For the fiscal year beginning July 1, 2025, $420,000 shall be used to increase to the extent possible reimbursement rates for maternal health providers compared to the rates in effect on June 30, 2025. d. For the fiscal year beginning July 1, 2025, $100,000 shall be used to increase to the extent possible reimbursement rates for prosthetics compared to rates in effect on June 30, 2025. 3. For the fiscal year beginning July 1, 2025, reimbursement rates for home health agencies shall continue to be based on the Medicare low utilization payment adjustment (LUPA) methodology with state geographic wage adjustments, and shall be adjusted to increase the rates to the extent possible. 4. For the fiscal year beginning July 1, 2026, and for each fiscal year thereafter, the department shall review the

House File 1049, p. 16 reimbursement rates for home health agencies and pharmacy dispensing fees. 5. On or before December 15, 2025, the department shall review the current rate limit calculation and application for special population nursing facility rates. NURSING FACILITIES —— MEDICAID REIMBURSEMENT METHODOLOGY PROPOSAL Sec. 16. NURSING FACILITIES —— MEDICAID REIMBURSEMENT METHODOLOGY PROPOSAL. 1. By April 1, 2026, the department of health and human services shall develop a reimbursement methodology proposal for reimbursement of nursing facilities under the Medicaid program that includes all of the following: a. A base-rate payment component. b. A quality assurance assessment pass-through component. c. A quality assurance add-on component, which includes a fixed fee payment and a quality-based payment. 2. The reimbursement methodology proposal shall include recommendations developed by the department of health and human services, in consultation with stakeholders including the Iowa health care association and leadingage Iowa, for specific metrics the department of health and human services will use to determine whether a nursing facility is eligible to receive all or a portion of the quality-based payment portion of the reimbursement to the nursing facility. 3. The total state expenditures for reimbursement of nursing facilities under the Medicaid program using the reimbursement methodology proposed in this section shall not exceed the amount appropriated for this purpose for the applicable fiscal year. NURSING FACILITY BED FORECASTING FORMULA Sec. 17. NURSING FACILITY BED FORECASTING FORMULA. 1. On or before July 1, 2026, the department of health and human services, in consultation with appropriate stakeholders, shall develop and implement a nursing bed facility forecasting formula utilizing the recommendations for improvement to the nursing facility bed need formula developed by the workgroup convened pursuant to 2023 Iowa Acts, chapter 158, section 11, to ensure the availability of sufficient nursing facility beds