Senate File 446 - Introduced SENATE FILE 446 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO SSB 1251) A BILL FOR An Act relating to appropriations for health and human services 1 and including other related provisions and appropriations, 2 providing penalties, and including effective, retroactive, 3 and applicability date provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1004SV (4) 85 pf/jp
S.F. 446 DIVISION I 1 DEPARTMENT ON AGING —— FY 2013-2014 2 Section 1. DEPARTMENT ON AGING. There is appropriated from 3 the general fund of the state to the department on aging for 4 the fiscal year beginning July 1, 2013, and ending June 30, 5 2014, the following amount, or so much thereof as is necessary, 6 to be used for the purposes designated: 7 For aging programs for the department on aging and area 8 agencies on aging to provide citizens of Iowa who are 60 years 9 of age and older with case management for frail elders, Iowa’s 10 aging and disabilities resource center, and other services 11 which may include but are not limited to adult day services, 12 respite care, chore services, information and assistance, 13 and material aid, for information and options counseling for 14 persons with disabilities who are 18 years of age or older, 15 and for salaries, support, administration, maintenance, and 16 miscellaneous purposes, and for not more than the following 17 full-time equivalent positions: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,831,025 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 28.00 20 1. Funds appropriated in this section may be used to 21 supplement federal funds under federal regulations. To 22 receive funds appropriated in this section, a local area 23 agency on aging shall match the funds with moneys from other 24 sources according to rules adopted by the department. Funds 25 appropriated in this section may be used for elderly services 26 not specifically enumerated in this section only if approved 27 by an area agency on aging for provision of the service within 28 the area. 29 2. Of the funds appropriated in this section, $279,946 30 shall be transferred to the economic development authority for 31 the Iowa commission on volunteer services to be used for the 32 retired and senior volunteer program. 33 3. a. The department on aging shall establish and enforce 34 procedures relating to expenditure of state and federal funds 35 -1- LSB 1004SV (4) 85 pf/jp 1/ 122
S.F. 446 by area agencies on aging that require compliance with both 1 state and federal laws, rules, and regulations, including but 2 not limited to all of the following: 3 (1) Requiring that expenditures are incurred only for goods 4 or services received or performed prior to the end of the 5 fiscal period designated for use of the funds. 6 (2) Prohibiting prepayment for goods or services not 7 received or performed prior to the end of the fiscal period 8 designated for use of the funds. 9 (3) Prohibiting the prepayment for goods or services 10 not defined specifically by good or service, time period, or 11 recipient. 12 (4) Prohibiting the establishment of accounts from which 13 future goods or services which are not defined specifically by 14 good or service, time period, or recipient, may be purchased. 15 b. The procedures shall provide that if any funds are 16 expended in a manner that is not in compliance with the 17 procedures and applicable federal and state laws, rules, and 18 regulations, and are subsequently subject to repayment, the 19 area agency on aging expending such funds in contravention of 20 such procedures, laws, rules and regulations, not the state, 21 shall be liable for such repayment. 22 4. Of the funds appropriated in this section, $250,000 23 shall be used to fund services to meet the unmet needs of older 24 individuals as identified in the annual compilation of unmet 25 service units by the area agencies on aging. 26 5. Of the funds appropriated in this section, $600,000 27 shall be used to fund home and community-based services through 28 the area agencies on aging that enable older individuals to 29 avoid more costly utilization of residential or institutional 30 services and remain in their own homes. 31 6. Of the funds appropriated in this section, $2,210,646 32 shall be used to administer the office of substitute decision 33 maker established pursuant to chapter 231E, on a statewide 34 basis. 35 -2- LSB 1004SV (4) 85 pf/jp 2/ 122
S.F. 446 7. Of the funds appropriated in this subsection, $40,000 1 shall be used for implementation of a guardianship and 2 conservatorship monitoring and assistance pilot project as 3 specified in this Act. 4 DIVISION II 5 OFFICE OF LONG-TERM CARE RESIDENT’S ADVOCATE —— FY 2013-2014 6 Sec. 2. OFFICE OF LONG-TERM CARE RESIDENT’S ADVOCATE. There 7 is appropriated from the general fund of the state to the 8 office of long-term care resident’s advocate for the fiscal 9 year beginning July 1, 2013, and ending June 30, 2014, the 10 following amount, or so much thereof as is necessary, to be 11 used for the purposes designated: 12 For salaries, support, administration, maintenance, and 13 miscellaneous purposes, and for not more than the following 14 full-time equivalent positions: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,321,707 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 16.00 17 1. Of the funds appropriated in this section, $500,000 18 shall be used to provide five additional local long-term care 19 resident’s advocates to continue moving toward the national 20 recommendation of one full-time equivalent paid staff ombudsman 21 per 2,000 long-term care beds in the state. 22 2. Of the funds appropriated in this section, $210,000 23 shall be used to provide two local long-term care resident’s 24 advocates to administer the certified volunteer long-term 25 care resident’s advocate program pursuant to section 231.45, 26 including operational certification and training costs. 27 DIVISION III 28 DEPARTMENT OF PUBLIC HEALTH —— FY 2013-2014 29 Sec. 3. DEPARTMENT OF PUBLIC HEALTH. There is appropriated 30 from the general fund of the state to the department of public 31 health for the fiscal year beginning July 1, 2013, and ending 32 June 30, 2014, the following amounts, or so much thereof as is 33 necessary, to be used for the purposes designated: 34 1. ADDICTIVE DISORDERS 35 -3- LSB 1004SV (4) 85 pf/jp 3/ 122
S.F. 446 For reducing the prevalence of use of tobacco, alcohol, and 1 other drugs, and treating individuals affected by addictive 2 behaviors, including gambling, and for not more than the 3 following full-time equivalent positions: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 29,763,690 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 13.00 6 a. (1) Of the funds appropriated in this subsection, 7 $7,753,830 shall be used for the tobacco use prevention 8 and control initiative, including efforts at the state and 9 local levels, as provided in chapter 142A . The commission 10 on tobacco use prevention and control established pursuant 11 to section 142A.3 shall advise the director of public health 12 in prioritizing funding needs and the allocation of moneys 13 appropriated for the programs and activities of the initiative 14 under this subparagraph (1) and shall make recommendations to 15 the director in the development of budget requests relating to 16 the initiative. 17 (2) Of the funds allocated in this paragraph “a”, $50,000 18 shall be used for a social media campaign to address tobacco 19 use reduction. 20 (3) (a) Of the funds allocated in this paragraph “a”, 21 $453,830 shall be transferred to the alcoholic beverages 22 division of the department of commerce for enforcement of 23 tobacco laws, regulations, and ordinances and to engage in 24 tobacco control activities approved by the division of tobacco 25 use prevention and control as specified in the memorandum of 26 understanding entered into between the divisions. 27 (b) For the fiscal year beginning July 1, 2013, and ending 28 June 30, 2014, the terms of the memorandum of understanding, 29 entered into between the division of tobacco use prevention 30 and control of the department of public health and the 31 alcoholic beverages division of the department of commerce, 32 governing compliance checks conducted to ensure licensed retail 33 tobacco outlet conformity with tobacco laws, regulations, and 34 ordinances relating to persons under eighteen years of age, 35 -4- LSB 1004SV (4) 85 pf/jp 4/ 122
S.F. 446 shall restrict the number of such checks to one check per 1 retail outlet, and one additional check for any retail outlet 2 found to be in violation during the first check. 3 b. Of the funds appropriated in this subsection, 4 $22,049,360 shall be used for problem gambling and 5 substance-related disorder prevention, treatment, and recovery 6 services, including a 24-hour helpline, public information 7 resources, professional training, and program evaluation. 8 (1) Of the funds allocated in this paragraph “b”, 9 $18,932,508 shall be used for substance-related disorder 10 prevention and treatment. 11 (a) Of the funds allocated in this subparagraph (1), 12 $899,300 shall be used for the public purpose of a grant 13 program to provide substance-related disorder prevention 14 programming for children. 15 (i) Of the funds allocated in this subparagraph division 16 (a), $427,539 shall be used for grant funding for organizations 17 that provide programming for children by utilizing mentors. 18 Programs approved for such grants shall be certified or will 19 be certified within six months of receiving the grant award 20 by the Iowa commission on volunteer services as utilizing the 21 standards for effective practice for mentoring programs. 22 (ii) Of the funds allocated in this subparagraph division 23 (a), $426,839 shall be used for grant funding for organizations 24 that provide programming that includes youth development and 25 leadership. The programs shall also be recognized as being 26 programs that are scientifically based with evidence of their 27 effectiveness in reducing substance-related disorders in 28 children. 29 (iii) The department of public health shall utilize a 30 request for proposals process to implement the grant program. 31 (iv) All grant recipients shall participate in a program 32 evaluation as a requirement for receiving grant funds. 33 (v) Of the funds allocated in this subparagraph division 34 (a), up to $44,922 may be used to administer substance-related 35 -5- LSB 1004SV (4) 85 pf/jp 5/ 122
S.F. 446 disorder prevention grants and for program evaluations. 1 (b) Of the funds allocated in this subparagraph 2 (1), $273,062 shall be used for culturally competent 3 substance-related disorder treatment pilot projects. 4 (i) The department shall utilize the amount allocated 5 in this subparagraph division (b) for at least three pilot 6 projects to provide culturally competent substance-related 7 disorder treatment in various areas of the state. Each pilot 8 project shall target a particular ethnic minority population. 9 The populations targeted shall include but are not limited to 10 African American, Asian, and Latino. 11 (ii) The pilot project requirements shall provide for 12 documentation or other means to ensure access to the cultural 13 competence approach used by a pilot project so that such 14 approach can be replicated and improved upon in successor 15 programs. 16 (2) Of the funds allocated in this paragraph “b”, up 17 to $3,116,852 may be used for problem gambling prevention, 18 treatment, and recovery services. 19 (a) Of the funds allocated in this subparagraph (2), 20 $2,579,000 shall be used for problem gambling prevention and 21 treatment. 22 (b) Of the funds allocated in this subparagraph (2), up to 23 $437,852 may be used for a 24-hour helpline, public information 24 resources, professional training, and program evaluation. 25 (c) Of the funds allocated in this subparagraph (2), up 26 to $100,000 may be used for the licensing of problem gambling 27 treatment programs. 28 (3) It is the intent of the general assembly that from the 29 moneys allocated in this paragraph “b”, persons with a dual 30 diagnosis of substance-related disorder and gambling addiction 31 shall be given priority in treatment services. 32 c. Notwithstanding any provision of law to the contrary, 33 to standardize the availability, delivery, cost of delivery, 34 and accountability of problem gambling and substance-related 35 -6- LSB 1004SV (4) 85 pf/jp 6/ 122
S.F. 446 disorder treatment services statewide, the department shall 1 continue implementation of a process to create a system 2 for delivery of treatment services in accordance with the 3 requirements specified in 2008 Iowa Acts, chapter 1187, section 4 3, subsection 4. To ensure the system provides a continuum 5 of treatment services that best meets the needs of Iowans, 6 the problem gambling and substance-related disorder treatment 7 services in any area may be provided either by a single agency 8 or by separate agencies submitting a joint proposal. 9 (1) The system for delivery of substance-related disorder 10 and problem gambling treatment shall include problem gambling 11 prevention. 12 (2) The system for delivery of substance-related disorder 13 and problem gambling treatment shall include substance-related 14 disorder prevention by July 1, 2014. 15 (3) Of the funds allocated in paragraph “b”, the department 16 may use up to $100,000 for administrative costs to continue 17 developing and implementing the process in accordance with this 18 paragraph “c”. 19 d. The requirement of section 123.53, subsection 5 , is met 20 by the appropriations and allocations made in this Act for 21 purposes of substance-related disorder treatment and addictive 22 disorders for the fiscal year beginning July 1, 2013. 23 e. The department of public health shall work with all 24 other departments that fund substance-related disorder 25 prevention and treatment services and all such departments 26 shall, to the extent necessary, collectively meet the state 27 maintenance of effort requirements for expenditures for 28 substance-related disorder services as required under the 29 federal substance-related disorder prevention and treatment 30 block grant. 31 2. HEALTHY CHILDREN AND FAMILIES 32 For promoting the optimum health status for children, 33 adolescents from birth through 21 years of age, and families, 34 and for not more than the following full-time equivalent 35 -7- LSB 1004SV (4) 85 pf/jp 7/ 122
S.F. 446 positions: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,996,099 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 10.00 3 a. Of the funds appropriated in this subsection, not more 4 than $739,318 shall be used for the healthy opportunities to 5 experience success (HOPES)-healthy families Iowa (HFI) program 6 established pursuant to section 135.106 . The funding shall 7 be distributed to renew the grants that were provided to the 8 grantees that operated the program during the fiscal year 9 ending June 30, 2013. 10 b. In order to implement the legislative intent stated in 11 sections 135.106 and 256I.9, that priority for home visitation 12 program funding be given to programs using evidence-based or 13 promising models for home visitation, it is the intent of the 14 general assembly to phase-in the funding priority in accordance 15 with 2012 Iowa Acts, chapter 1133, section 2, subsection 2, 16 paragraph 0b. 17 c. Of the funds appropriated in this subsection, $2,672,425 18 shall be used to expand the department’s initiative to 19 provide for adequate developmental surveillance and screening 20 during a child’s first five years statewide. The expansion 21 shall include enhancing the scope of the program through 22 collaboration with the child health specialty clinics to 23 promote healthy child development through early identification 24 and response to both biomedical and social determinants 25 of healthy development; by developing child health metrics 26 to inform practice, document long-term health impacts and 27 savings, and provide for continuous improvement through 28 training, education, and evaluation; and by providing for 29 practitioner consultation particularly for children with 30 behavioral conditions and needs. The department of public 31 health shall also collaborate with the Iowa Medicaid enterprise 32 and the child health specialty clinics to integrate the 33 activities of the first five initiative into the establishment 34 of patient-centered medical homes, community utilities, 35 -8- LSB 1004SV (4) 85 pf/jp 8/ 122
S.F. 446 accountable care organizations, and other integrated care 1 models developed to improve health quality and population 2 health while reducing health care costs. To the maximum extent 3 possible, funding allocated in this paragraph shall be utilized 4 as matching funds for medical assistance program reimbursement. 5 d. Of the funds appropriated in this subsection, $31,597 6 shall be distributed to a statewide dental carrier to provide 7 funds to continue the donated dental services program patterned 8 after the projects developed by the lifeline network to provide 9 dental services to indigent elderly and disabled individuals. 10 e. Of the funds appropriated in this subsection, $112,677 11 shall be used for childhood obesity prevention. 12 f. Of the funds appropriated in this subsection, $163,760 13 shall be used to provide audiological services and hearing 14 aids for children. The department may enter into a contract 15 to administer this paragraph. 16 g. Of the funds appropriated in this subsection, $25,000 17 shall be transferred to the university of Iowa college of 18 dentistry for provision of primary dental services to children. 19 State funds shall be matched on a dollar-for-dollar basis. 20 The university of Iowa college of dentistry shall coordinate 21 efforts with the department of public health, bureau of 22 oral and health delivery systems, to provide dental care to 23 underserved populations throughout the state. 24 h. Of the funds appropriated in this subsection, $50,000 25 shall be used to address youth suicide prevention. 26 i. Of the funds appropriated in this subsection, $2,000,000 27 shall be used to expand the I-smile oral health program to 28 at-risk adults with a priority to serve individuals 60 years 29 of age or older to improve systemic health and quality of 30 life, including to individuals with disabilities and older 31 individuals with physical, cognitive, or behavioral limitations 32 or chronic or complex conditions that adversely affect oral 33 self-care, result in greater susceptibility to oral disease, or 34 limit accessibility to professional oral care. 35 -9- LSB 1004SV (4) 85 pf/jp 9/ 122
S.F. 446 3. CHRONIC CONDITIONS 1 For serving individuals identified as having chronic 2 conditions or special health care needs, and for not more than 3 the following full-time equivalent positions: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,220,411 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 4.00 6 a. Of the funds appropriated in this subsection, $160,582 7 shall be used for grants to individual patients who have 8 phenylketonuria (PKU) to assist with the costs of necessary 9 special foods. 10 b. Of the funds appropriated in this subsection, $893,600 11 shall be used for the brain injury services program pursuant to 12 section 135.22B, including for continuation of the contracts 13 for resource facilitator services in accordance with section 14 135.22B, subsection 9, and to enhance brain injury training and 15 recruitment of service providers on a statewide basis. Of the 16 amount allocated in this paragraph, $95,000 shall be used to 17 fund one full-time equivalent position to serve as the state 18 brain injury service program manager. 19 c. Of the funds appropriated in this subsection, $550,000 20 shall be used as additional funding to leverage federal funding 21 through the federal Ryan White Care Act, Tit. II, AIDS drug 22 assistance program supplemental drug treatment grants. 23 d. Of the funds appropriated in this subsection, $100,000 24 shall be used for the public purpose of continuing a grant 25 with an existing national-affiliated organization to provide 26 education, client-centered programs, and client and family 27 support for people living with epilepsy and their families. 28 e. Of the funds appropriated in this subsection, $788,303 29 shall be used for child health specialty clinics. 30 f. Of the funds appropriated in this subsection, $400,000 31 shall be used by the regional autism assistance program 32 established pursuant to section 256.35, and administered by 33 the child health specialty clinic located at the university of 34 Iowa hospitals and clinics. The funds shall be used to enhance 35 -10- LSB 1004SV (4) 85 pf/jp 10/ 122
S.F. 446 interagency collaboration and coordination of educational, 1 medical, and other human services for persons with autism, 2 their families, and providers of services, including delivering 3 regionalized services of care coordination, family navigation, 4 and integration of services through the statewide system of 5 regional child health specialty clinics and fulfilling other 6 requirements as specified in chapter 225D, creating the autism 7 support program, as enacted in this Act. The university of 8 Iowa shall not receive funds allocated under this paragraph for 9 indirect costs associated with the regional autism assistance 10 program. 11 g. Of the funds appropriated in this subsection, $597,065 12 shall be used for the comprehensive cancer control program to 13 reduce the burden of cancer in Iowa through prevention, early 14 detection, effective treatment, and ensuring quality of life. 15 Of the funds allocated in this lettered paragraph, $150,000 16 shall be used to support a melanoma research symposium, a 17 melanoma biorepository and registry, basic and translational 18 melanoma research, and clinical trials. 19 h. Of the funds appropriated in this subsection, $126,450 20 shall be used for colon cancer screening, and $500,000 shall 21 be used to enhance the capacity of the breast and cervical 22 cancer screening program to include provision of recommended 23 prevention and early detection measures to a broader range of 24 low-income women. 25 i. Of the funds appropriated in this subsection, $528,834 26 shall be used for the center for congenital and inherited 27 disorders. 28 j. Of the funds appropriated in this subsection, $129,937 29 shall be used for the prescription drug donation repository 30 program created in chapter 135M . 31 k. Of the funds appropriated in this subsection, $215,263 32 shall be used for the costs of the medical home system advisory 33 council established pursuant to section 135.159 including 34 incorporation of the development and implementation of the 35 -11- LSB 1004SV (4) 85 pf/jp 11/ 122
S.F. 446 prevention and chronic care management state initiative. 1 l. Of the funds appropriated in this subsection, $139,719 2 shall be used to fund the state comprehensive Alzheimer’s 3 disease response strategy as enacted in this Act. 4 4. COMMUNITY CAPACITY 5 For strengthening the health care delivery system at the 6 local level, and for not more than the following full-time 7 equivalent positions: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,514,110 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 14.00 10 a. Of the funds appropriated in this subsection, $100,000 11 is allocated for continuation of the child vision screening 12 program implemented through the university of Iowa hospitals 13 and clinics in collaboration with early childhood Iowa areas. 14 The program shall submit a report to the individuals identified 15 in this Act for submission of reports regarding the use of 16 funds allocated under this paragraph “a”. The report shall 17 include the objectives and results for the program year 18 including the target population and how the funds allocated 19 assisted the program in meeting the objectives; the number, 20 age, and location within the state of individuals served; 21 the type of services provided to the individuals served; the 22 distribution of funds based on service provided; and the 23 continuing needs of the program. 24 b. Of the funds appropriated in this subsection, $111,308 is 25 allocated for continuation of an initiative implemented at the 26 university of Iowa and $100,493 is allocated for continuation 27 of an initiative at the state mental health institute at 28 Cherokee to expand and improve the workforce engaged in mental 29 health treatment and services. The initiatives shall receive 30 input from the university of Iowa, the department of human 31 services, the department of public health, and the mental 32 health and disability services commission to address the focus 33 of the initiatives. 34 c. Of the funds appropriated in this subsection, $1,171,491 35 -12- LSB 1004SV (4) 85 pf/jp 12/ 122
S.F. 446 shall be used for essential public health services that promote 1 healthy aging throughout the lifespan, contracted through a 2 formula for local boards of health, to enhance health promotion 3 and disease prevention services. 4 d. Of the funds appropriated in this section, $100,000 shall 5 be deposited in the governmental public health system fund 6 created in section 135A.8 to be used for the purposes of the 7 fund. 8 e. Of the funds appropriated in this subsection, $144,542 9 shall be used for the mental health professional shortage area 10 program implemented pursuant to section 135.180 . 11 f. Of the funds appropriated in this subsection, 12 $38,263 shall be used for a grant to a statewide association 13 of psychologists that is affiliated with the American 14 psychological association to be used for continuation of a 15 program to rotate intern psychologists in placements in urban 16 and rural mental health professional shortage areas, as defined 17 in section 135.180 . 18 g. Of the funds appropriated in this subsection, the 19 following amounts shall be allocated to the Iowa collaborative 20 safety net provider network established pursuant to section 21 135.153 to be used for the purposes designated. The following 22 amounts allocated under this lettered paragraph shall be 23 distributed to the specified provider and shall not be reduced 24 for administrative or other costs prior to distribution: 25 (1) For distribution to the Iowa primary care association 26 for statewide coordination of the Iowa collaborative safety net 27 provider network: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 146,563 29 (2) For distribution to the Iowa primary care association 30 to be used to continue a training program for sexual assault 31 response team (SART) members, including representatives of 32 law enforcement, victim advocates, prosecutors, and certified 33 medical personnel: 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 50,000 35 -13- LSB 1004SV (4) 85 pf/jp 13/ 122
S.F. 446 (3) For distribution to federally qualified health centers 1 for necessary infrastructure, statewide coordination, provider 2 recruitment, service delivery, and provision of assistance to 3 patients in determining an appropriate medical home: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 75,000 5 (4) For distribution to the local boards of health that 6 provide direct services for pilot programs in three counties to 7 assist patients in securing a medical home inclusive of dental 8 care: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 77,609 10 (5) For distribution to maternal and child health centers 11 for pilot programs in three service areas to assist patients in 12 securing a medical home inclusive of dental care: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 95,582 14 (6) For distribution to free clinics for necessary 15 infrastructure, statewide coordination, provider recruitment, 16 service delivery, and provision of assistance to patients in 17 securing a medical home inclusive of dental care: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 400,000 19 (7) For distribution to rural health clinics for necessary 20 infrastructure, statewide coordination, provider recruitment, 21 service delivery, and provision of assistance to patients in 22 determining an appropriate medical home: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 142,192 24 (8) For continuation of the safety net provider patient 25 access to a specialty health care initiative as described in 26 2007 Iowa Acts, chapter 218, section 109: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 450,000 28 (9) For continuation of the pharmaceutical infrastructure 29 for safety net providers as described in 2007 Iowa Acts, 30 chapter 218, section 108: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 415,000 32 (10) For distribution to the Iowa family planning network 33 agencies for necessary infrastructure, statewide coordination, 34 provider recruitment, service delivery, and provision of 35 -14- LSB 1004SV (4) 85 pf/jp 14/ 122
S.F. 446 assistance to patients in determining an appropriate medical 1 home: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 100,000 3 The Iowa collaborative safety net provider network may 4 continue to distribute funds allocated pursuant to this 5 lettered paragraph through existing contracts or renewal of 6 existing contracts. 7 h. (1) Of the funds appropriated in this subsection, 8 $206,750 shall be used for continuation of the work of the 9 direct care worker advisory council established pursuant to 10 2008 Iowa Acts, chapter 1188, section 69, in implementing the 11 recommendations in the final report submitted by the advisory 12 council to the governor and the general assembly in March 2012. 13 (2) The advisory council, in collaboration with the board 14 of direct care professionals created in chapter 152F, if 15 enacted in 2013 Iowa Acts, Senate File 232, or 2013 successor 16 legislation, shall do all of the following: 17 (a) Develop and conduct necessary outreach and education 18 for individuals providing direct care services, consumers, 19 training providers including but not limited to community 20 college health occupation and training centers, employers, and 21 other interested parties to provide information about and the 22 process for participation in direct care professional voluntary 23 certification. 24 (b) Determine data collection needs, collect data, and 25 track and analyze data to determine the effect of certification 26 on recruitment and retention, turnover rates, the cost of 27 turnover, consumer and employer satisfaction, and public 28 protection. The analysis of the data collected shall also be 29 used to inform changes in the certification system to provide 30 for continuous improvement for direct care professionals, 31 consumers and employers, and the public. 32 i. (1) Of the funds appropriated in this subsection, 33 $207,750 shall be used for allocation to an independent 34 statewide direct care worker association under continuation 35 -15- LSB 1004SV (4) 85 pf/jp 15/ 122
S.F. 446 of the contract in effect during the fiscal year ending June 1 30, 2013, with terms determined by the director of public 2 health relating to education, outreach, leadership development, 3 mentoring, and other initiatives intended to enhance the 4 recruitment and retention of direct care workers in health care 5 and long-term care settings. 6 (2) Of the funds appropriated in this subsection, $75,000 7 shall be used to provide scholarships or other forms of 8 subsidization for direct care worker educational conferences, 9 training, or outreach activities. 10 (3) Of the funds appropriated in this subsection, up 11 to $300,000 shall be used for the board of direct care 12 professionals created pursuant to chapter 152F, if enacted 13 in 2013 Iowa Acts, Senate File 232, or 2013 successor 14 legislation. However, expenditure of the funds allocated 15 in this subparagraph (3) shall be limited to $184,530 for 16 the initial 5,000 applications for certification received. 17 Expenditure of the remainder shall be expended incrementally, 18 according to the number of additional applications received. 19 j. Of the funds appropriated in this subsection, the 20 department may use up to $58,518 for up to one full-time 21 equivalent position to administer the volunteer health care 22 provider program pursuant to section 135.24 . 23 k. Of the funds appropriated in this subsection, $50,000 24 shall be used for a matching dental education loan repayment 25 program to be allocated to a dental nonprofit health service 26 corporation to develop the criteria and implement the loan 27 repayment program. 28 l. Of the funds appropriated in this subsection, $105,823 29 shall be transferred to the college student aid commission for 30 deposit in the rural Iowa primary care trust fund created in 31 section 261.113 to be used for the purposes of the fund. 32 m. Of the funds appropriated in this subsection, $150,000 33 shall be used for the purposes of the Iowa donor registry as 34 specified in section 142C.18. 35 -16- LSB 1004SV (4) 85 pf/jp 16/ 122
S.F. 446 n. Of the funds appropriated in this subsection, $100,000 1 shall be used for continuation of a grant to a nationally 2 affiliated volunteer eye organization that has an established 3 program for children and adults and that is solely dedicated to 4 preserving sight and preventing blindness through education, 5 nationally certified vision screening and training, and 6 community and patient service programs. The organization 7 shall submit a report to the individuals identified in this 8 Act for submission of reports regarding the use of funds 9 allocated under this paragraph “n”. The report shall include 10 the objectives and results for the program year including 11 the target population and how the funds allocated assisted 12 the program in meeting the objectives; the number, age, and 13 location within the state of individuals served; the type of 14 services provided to the individuals served; the distribution 15 of funds based on service provided; and the continuing needs 16 of the program. 17 o. Of the funds appropriated in this subsection, $25,000 18 shall be used for the establishment of wellness council under 19 the direction of the director of public health to increase 20 support for wellness activities in the state. 21 p. Of the funds appropriated in this section, $1,158,150 22 is allocated to the Iowa collaborative safety net provider 23 network established pursuant to section 135.153 to be used for 24 development and implementation of a statewide regionally-based 25 network to provide an integrated approach to health care 26 delivery through care coordination that supports primary 27 care providers and links patients with community resources 28 necessary to empower patients in addressing biomedical and 29 social determinants of health to improve health outcomes. The 30 Iowa collaborative safety net provider network shall submit a 31 report to the individuals designated in this Act for submission 32 of reports by June 30, 2013, including progress in developing 33 and implementing the network, how the funds were distributed 34 and used in developing and implementing the network, and the 35 -17- LSB 1004SV (4) 85 pf/jp 17/ 122
S.F. 446 remaining needs in developing and implementing the network. 1 q. Of the funds appropriated in this section, $500,000 shall 2 be deposited in the area health education centers fund, as 3 enacted by this Act, to be used for the purposes of the fund. 4 r. Of the funds appropriated in this section, $50,000 shall 5 be used for the public purpose of supporting a partnership 6 between medical providers and parents through community health 7 centers to promote reading and encourage literacy skills so 8 children enter school prepared for success in reading. 9 5. HEALTHY AGING 10 To provide public health services that reduce risks and 11 invest in promoting and protecting good health over the 12 course of a lifetime with a priority given to older Iowans and 13 vulnerable populations: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,297,142 15 a. Of the funds appropriated in this subsection, $2,009,187 16 shall be used for local public health nursing services. 17 b. Of the funds appropriated in this subsection, $5,287,955 18 shall be used for home care aide services. 19 6. ENVIRONMENTAL HAZARDS 20 For reducing the public’s exposure to hazards in the 21 environment, primarily chemical hazards, and for not more than 22 the following full-time equivalent positions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 803,870 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 4.00 25 Of the funds appropriated in this subsection, $544,377 shall 26 be used for childhood lead poisoning provisions. 27 7. INFECTIOUS DISEASES 28 For reducing the incidence and prevalence of communicable 29 diseases, and for not more than the following full-time 30 equivalent positions: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,335,155 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 4.00 33 8. PUBLIC PROTECTION 34 For protecting the health and safety of the public through 35 -18- LSB 1004SV (4) 85 pf/jp 18/ 122
S.F. 446 establishing standards and enforcing regulations, and for not 1 more than the following full-time equivalent positions: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,259,571 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 130.00 4 a. Of the funds appropriated in this subsection, not more 5 than $500,334 shall be credited to the emergency medical 6 services fund created in section 135.25 . Moneys in the 7 emergency medical services fund are appropriated to the 8 department to be used for the purposes of the fund. 9 b. Of the funds appropriated in this subsection, $210,619 10 shall be used for sexual violence prevention programming 11 through a statewide organization representing programs serving 12 victims of sexual violence through the department’s sexual 13 violence prevention program. The amount allocated in this 14 lettered paragraph shall not be used to supplant funding 15 administered for other sexual violence prevention or victims 16 assistance programs. 17 c. Of the funds appropriated in this subsection, not more 18 than $539,477 shall be used for the state poison control 19 center. 20 d. Of the funds appropriated in this section, $368,000 shall 21 be used for maintenance of environmental health programs to 22 ensure public safety. 23 e. Of the funds appropriated in this section, $28,000 shall 24 be used as one-time funding to transition the licensing of 25 orthotists, prosthetists, and pedorthists to a fee-supported 26 licensing model. 27 f. Of the funds appropriated in this section, $28,644 shall 28 be used for the costs of the emergency medical services task 29 force as enacted in this Act. 30 g. Of the funds appropriated in this section, $55,800 shall 31 be used as one-time funding for the board of behavioral science 32 to incorporate the provisions of 2013 Iowa Acts, House File 33 569, if enacted, relating to the licensure of professionals 34 practicing substance and addictive disorder counseling or 35 -19- LSB 1004SV (4) 85 pf/jp 19/ 122
S.F. 446 providing substance and addictive disorder prevention services. 1 9. RESOURCE MANAGEMENT 2 For establishing and sustaining the overall ability of the 3 department to deliver services to the public, and for not more 4 than the following full-time equivalent positions: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 804,054 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 7.00 7 The university of Iowa hospitals and clinics under the 8 control of the state board of regents shall not receive 9 indirect costs from the funds appropriated in this section. 10 The university of Iowa hospitals and clinics billings to the 11 department shall be on at least a quarterly basis. 12 The department of public health shall submit a report to the 13 individuals specified in this Act for submission of reports by 14 December 15, 2013, providing recommendations for improvements 15 in the intraoperability and interoperability of communications 16 technology under the purview of the department to improve 17 efficiency and reduce costs. 18 DIVISION IV 19 DEPARTMENT OF VETERANS AFFAIRS —— FY 2013-2014 20 Sec. 4. DEPARTMENT OF VETERANS AFFAIRS. There is 21 appropriated from the general fund of the state to the 22 department of veterans affairs for the fiscal year beginning 23 July 1, 2013, and ending June 30, 2014, the following amounts, 24 or so much thereof as is necessary, to be used for the purposes 25 designated: 26 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 27 For salaries, support, maintenance, and miscellaneous 28 purposes, including the war orphans educational assistance fund 29 created in section 35.8 , or a successor funding provision for 30 war orphans educational assistance, if enacted, and for not 31 more than the following full-time equivalent positions: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,093,508 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 13.00 34 2. IOWA VETERANS HOME 35 -20- LSB 1004SV (4) 85 pf/jp 20/ 122
S.F. 446 For salaries, support, maintenance, and miscellaneous 1 purposes: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,025,714 3 a. The Iowa veterans home billings involving the department 4 of human services shall be submitted to the department on at 5 least a monthly basis. 6 b. If there is a change in the employer of employees 7 providing services at the Iowa veterans home under a collective 8 bargaining agreement, such employees and the agreement shall 9 be continued by the successor employer as though there had not 10 been a change in employer. 11 c. Within available resources and in conformance with 12 associated state and federal program eligibility requirements, 13 the Iowa veterans home may implement measures to provide 14 financial assistance to or on behalf of veterans or their 15 spouses who are participating in the community reentry program. 16 d. The Iowa veterans home expenditure report shall be 17 submitted monthly to the legislative services agency. 18 3. STATE EDUCATIONAL ASSISTANCE —— CHILDREN OF DECEASED 19 VETERANS 20 For provision of educational assistance pursuant to section 21 35A.20 : 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,416 23 4. HOME OWNERSHIP ASSISTANCE PROGRAM 24 For transfer to the Iowa finance authority for the 25 continuation of the home ownership assistance program for 26 persons who are or were eligible members of the armed forces of 27 the United States, pursuant to section 16.54: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,600,000 29 Sec. 5. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS 30 FUND STANDING APPROPRIATIONS. Notwithstanding the standing 31 appropriation in the following designated section for the 32 fiscal year beginning July 1, 2013, and ending June 30, 2014, 33 the amounts appropriated from the general fund of the state 34 pursuant to that section for the following designated purposes 35 -21- LSB 1004SV (4) 85 pf/jp 21/ 122
S.F. 446 shall not exceed the following amount: 1 For the county commissions of veteran affairs fund under 2 section 35A.16 : 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 990,000 4 DIVISION V 5 DEPARTMENT OF HUMAN SERVICES —— FY 2013-2014 6 Sec. 6. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 7 GRANT. There is appropriated from the fund created in section 8 8.41 to the department of human services for the fiscal year 9 beginning July 1, 2013, and ending June 30, 2014, from moneys 10 received under the federal temporary assistance for needy 11 families (TANF) block grant pursuant to the federal Personal 12 Responsibility and Work Opportunity Reconciliation Act of 1996, 13 Pub. L. No. 104-193, and successor legislation, the following 14 amounts, or so much thereof as is necessary, to be used for the 15 purposes designated: 16 1. To be credited to the family investment program account 17 and used for assistance under the family investment program 18 under chapter 239B : 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 18,116,948 20 2. To be credited to the family investment program account 21 and used for the job opportunities and basic skills (JOBS) 22 program and implementing family investment agreements in 23 accordance with chapter 239B : 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,866,439 25 3. To be used for the family development and 26 self-sufficiency grant program in accordance with section 27 216A.107 : 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,898,980 29 Notwithstanding section 8.33 , moneys appropriated in this 30 subsection that remain unencumbered or unobligated at the close 31 of the fiscal year shall not revert but shall remain available 32 for expenditure for the purposes designated until the close of 33 the succeeding fiscal year. However, unless such moneys are 34 encumbered or obligated on or before September 30, 2014, the 35 -22- LSB 1004SV (4) 85 pf/jp 22/ 122
S.F. 446 moneys shall revert. 1 4. For field operations: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 31,296,232 3 5. For general administration: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,744,000 5 6. For state child care assistance: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,382,687 7 The funds appropriated in this subsection shall be 8 transferred to the child care and development block grant 9 appropriation made by the Eighty-fifth General Assembly, 2013 10 Session, for the federal fiscal year beginning October 1, 11 2013, and ending September 30, 2014. Of this amount, $200,000 12 shall be used for provision of educational opportunities to 13 registered child care home providers in order to improve 14 services and programs offered by this category of providers 15 and to increase the number of providers. The department may 16 contract with institutions of higher education or child care 17 resource and referral centers to provide the educational 18 opportunities. Allowable administrative costs under the 19 contracts shall not exceed 5 percent. The application for a 20 grant shall not exceed two pages in length. 21 7. For transfer to the property tax relief fund and 22 distribution to counties for mental health and disability 23 services as provided in an appropriation made for this purpose: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,894,052 25 8. For child and family services: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 32,084,430 27 9. For child abuse prevention grants: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 125,000 29 10. For pregnancy prevention grants on the condition that 30 family planning services are funded: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,930,067 32 Pregnancy prevention grants shall be awarded to programs 33 in existence on or before July 1, 2013, if the programs have 34 demonstrated positive outcomes. Grants shall be awarded to 35 -23- LSB 1004SV (4) 85 pf/jp 23/ 122
S.F. 446 pregnancy prevention programs which are developed after July 1 1, 2013, if the programs are based on existing models that 2 have demonstrated positive outcomes. Grants shall comply with 3 the requirements provided in 1997 Iowa Acts, chapter 208, 4 section 14, subsections 1 and 2, including the requirement that 5 grant programs must emphasize sexual abstinence. Priority in 6 the awarding of grants shall be given to programs that serve 7 areas of the state which demonstrate the highest percentage of 8 unplanned pregnancies of females of childbearing age within the 9 geographic area to be served by the grant. 10 11. For technology needs and other resources necessary 11 to meet federal welfare reform reporting, tracking, and case 12 management requirements: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,037,186 14 12. To be credited to the state child care assistance 15 appropriation made in this section to be used for funding of 16 community-based early childhood programs targeted to children 17 from birth through five years of age developed by early 18 childhood Iowa areas as provided in section 256I.8 : 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,350,000 20 The department shall transfer TANF block grant funding 21 appropriated and allocated in this subsection to the child care 22 and development block grant appropriation in accordance with 23 federal law as necessary to comply with the provisions of this 24 subsection. 25 13. a. Notwithstanding any provision to the contrary, 26 including but not limited to requirements in section 8.41 or 27 provisions in 2012 or 2013 Iowa Acts regarding the receipt and 28 appropriation of federal block grants, federal funds from the 29 temporary assistance for needy families block grant received 30 by the state not otherwise appropriated in this section and 31 remaining available for the fiscal year beginning July 1, 32 2013, are appropriated to the department of human services to 33 the extent as may be necessary to be used in the following 34 priority order: the family investment program for the fiscal 35 -24- LSB 1004SV (4) 85 pf/jp 24/ 122
S.F. 446 year and for state child care assistance program payments for 1 individuals enrolled in the family investment program who are 2 employed. The federal funds appropriated in this paragraph “a” 3 shall be expended only after all other funds appropriated in 4 subsection 1 for the assistance under the family investment 5 program under chapter 239B have been expended. 6 b. The department shall, on a quarterly basis, advise the 7 legislative services agency and department of management of 8 the amount of funds appropriated in this subsection that was 9 expended in the prior quarter. 10 14. Of the amounts appropriated in this section, 11 $12,962,008 for the fiscal year beginning July 1, 2013, shall 12 be transferred to the appropriation of the federal social 13 services block grant made to the department of human services 14 for that fiscal year. 15 15. For continuation of the program providing categorical 16 eligibility for the food assistance program: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000 18 16. The department may transfer funds allocated in this 19 section to the appropriations made in this division of this Act 20 for the same fiscal year for general administration and field 21 operations for resources necessary to implement and operate the 22 services referred to in this section and those funded in the 23 appropriation made in this division of this Act for the same 24 fiscal year for the family investment program from the general 25 fund of the state. 26 Sec. 7. FAMILY INVESTMENT PROGRAM ACCOUNT. 27 1. Moneys credited to the family investment program (FIP) 28 account for the fiscal year beginning July 1, 2013, and 29 ending June 30, 2014, shall be used to provide assistance in 30 accordance with chapter 239B . 31 2. The department may use a portion of the moneys credited 32 to the FIP account under this section as necessary for 33 salaries, support, maintenance, and miscellaneous purposes. 34 3. The department may transfer funds allocated in this 35 -25- LSB 1004SV (4) 85 pf/jp 25/ 122
S.F. 446 section to the appropriations made in this division of this Act 1 for the same fiscal year for general administration and field 2 operations for resources necessary to implement and operate the 3 services referred to in this section and those funded in the 4 appropriation made in this division of this Act for the same 5 fiscal year for the family investment program from the general 6 fund of the state. 7 4. Moneys appropriated in this division of this Act and 8 credited to the FIP account for the fiscal year beginning July 9 1, 2013, and ending June 30, 2014, are allocated as follows: 10 a. To be retained by the department of human services to 11 be used for coordinating with the department of human rights 12 to more effectively serve participants in the FIP program and 13 other shared clients and to meet federal reporting requirements 14 under the federal temporary assistance for needy families block 15 grant: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 20,000 17 b. To the department of human rights for staffing, 18 administration, and implementation of the family development 19 and self-sufficiency grant program in accordance with section 20 216A.107 : 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,500,000 22 (1) Of the funds allocated for the family development and 23 self-sufficiency grant program in this lettered paragraph, 24 not more than 5 percent of the funds shall be used for the 25 administration of the grant program. 26 (2) The department of human rights may continue to implement 27 the family development and self-sufficiency grant program 28 statewide during fiscal year 2013-2014. 29 c. For the diversion subaccount of the FIP account: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,698,400 31 A portion of the moneys allocated for the subaccount may 32 be used for field operations salaries, data management system 33 development, and implementation costs and support deemed 34 necessary by the director of human services in order to 35 -26- LSB 1004SV (4) 85 pf/jp 26/ 122
S.F. 446 administer the FIP diversion program. 1 d. For the food assistance employment and training program: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 66,588 3 (1) The department shall apply the federal supplemental 4 nutrition assistance program (SNAP) employment and training 5 state plan in order to maximize to the fullest extent permitted 6 by federal law the use of the 50 percent federal reimbursement 7 provisions for the claiming of allowable federal reimbursement 8 funds from the United States department of agriculture 9 pursuant to the federal SNAP employment and training program 10 for providing education, employment, and training services 11 for eligible food assistance program participants, including 12 but not limited to related dependent care and transportation 13 expenses. 14 (2) The department shall continue the categorical federal 15 food assistance program eligibility at 160 percent of the 16 federal poverty level and continue to eliminate the asset test 17 from eligibility requirements, consistent with federal food 18 assistance program requirements. The department shall include 19 as many food assistance households as is allowed by federal 20 law. The eligibility provisions shall conform to all federal 21 requirements including requirements addressing individuals who 22 are incarcerated or otherwise ineligible. 23 e. For the JOBS program: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,690,816 25 5. Of the child support collections assigned under FIP, 26 an amount equal to the federal share of support collections 27 shall be credited to the child support recovery appropriation 28 made in this division of this Act. Of the remainder of the 29 assigned child support collections received by the child 30 support recovery unit, a portion shall be credited to the FIP 31 account, a portion may be used to increase recoveries, and a 32 portion may be used to sustain cash flow in the child support 33 payments account. If as a consequence of the appropriations 34 and allocations made in this section the resulting amounts 35 -27- LSB 1004SV (4) 85 pf/jp 27/ 122
S.F. 446 are insufficient to sustain cash assistance payments and meet 1 federal maintenance of effort requirements, the department 2 shall seek supplemental funding. If child support collections 3 assigned under FIP are greater than estimated or are otherwise 4 determined not to be required for maintenance of effort, the 5 state share of either amount may be transferred to or retained 6 in the child support payment account. 7 6. The department may adopt emergency rules for the family 8 investment, JOBS, food assistance, and medical assistance 9 programs if necessary to comply with federal requirements. 10 Sec. 8. FAMILY INVESTMENT PROGRAM GENERAL FUND. There 11 is appropriated from the general fund of the state to the 12 department of human services for the fiscal year beginning July 13 1, 2013, and ending June 30, 2014, the following amount, or 14 so much thereof as is necessary, to be used for the purpose 15 designated: 16 To be credited to the family investment program (FIP) 17 account and used for family investment program assistance under 18 chapter 239B : 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 48,894,380 20 1. Of the funds appropriated in this section, $7,824,377 is 21 allocated for the JOBS program. 22 2. Of the funds appropriated in this section, $3,621,020 is 23 allocated for the family development and self-sufficiency grant 24 program. 25 3. Notwithstanding section 8.39 , for the fiscal year 26 beginning July 1, 2013, if necessary to meet federal 27 maintenance of effort requirements or to transfer federal 28 temporary assistance for needy families block grant funding 29 to be used for purposes of the federal social services block 30 grant or to meet cash flow needs resulting from delays in 31 receiving federal funding or to implement, in accordance with 32 this division of this Act, activities currently funded with 33 juvenile court services, county, or community moneys and state 34 moneys used in combination with such moneys, the department 35 -28- LSB 1004SV (4) 85 pf/jp 28/ 122
S.F. 446 of human services may transfer funds within or between any 1 of the appropriations made in this division of this Act and 2 appropriations in law for the federal social services block 3 grant to the department for the following purposes, provided 4 that the combined amount of state and federal temporary 5 assistance for needy families block grant funding for each 6 appropriation remains the same before and after the transfer: 7 a. For the family investment program. 8 b. For child care assistance. 9 c. For child and family services. 10 d. For field operations. 11 e. For general administration. 12 f. For distribution to counties for state case services for 13 persons with mental illness, an intellectual disability, or a 14 developmental disability. 15 This subsection shall not be construed to prohibit the use 16 of existing state transfer authority for other purposes. The 17 department shall report any transfers made pursuant to this 18 subsection to the legislative services agency. 19 4. Of the funds appropriated in this section, $195,678 shall 20 be used for continuation of a grant to an Iowa-based nonprofit 21 organization with a history of providing tax preparation 22 assistance to low-income Iowans in order to expand the usage of 23 the earned income tax credit. The purpose of the grant is to 24 supply this assistance to underserved areas of the state. 25 5. Of the funds appropriated in this section, $40,000 26 shall be used to fund the expansion of an existing unfunded 27 pilot project, as defined in 441 IAC 100.1, relating to 28 parental obligations, in which the child support recovery 29 unit participates, to support the efforts of a nonprofit 30 organization committed to strengthening the community through 31 youth development, healthy living, and social responsibility in 32 a county with a population over 350,000. The funds allocated 33 in this subsection shall be used by the recipient organization 34 to develop a larger community effort, through public and 35 -29- LSB 1004SV (4) 85 pf/jp 29/ 122
S.F. 446 private partnerships, to support a broad-based fatherhood 1 initiative that promotes payment of child support obligations, 2 improved family relationships, and full-time employment. 3 6. The department may transfer funds appropriated in this 4 section to the appropriations made in this division of this Act 5 for general administration and field operations as necessary 6 to administer this section and the overall family investment 7 program. 8 Sec. 9. CHILD SUPPORT RECOVERY. There is appropriated 9 from the general fund of the state to the department of human 10 services for the fiscal year beginning July 1, 2013, and ending 11 June 30, 2014, the following amount, or so much thereof as is 12 necessary, to be used for the purposes designated: 13 For child support recovery, including salaries, support, 14 maintenance, and miscellaneous purposes, and for not more than 15 the following full-time equivalent positions: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 14,173,770 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 464.00 18 1. The department shall expend up to $24,329, including 19 federal financial participation, for the fiscal year beginning 20 July 1, 2013, for a child support public awareness campaign. 21 The department and the office of the attorney general shall 22 cooperate in continuation of the campaign. The public 23 awareness campaign shall emphasize, through a variety of 24 media activities, the importance of maximum involvement of 25 both parents in the lives of their children as well as the 26 importance of payment of child support obligations. 27 2. Federal access and visitation grant moneys shall be 28 issued directly to private not-for-profit agencies that provide 29 services designed to increase compliance with the child access 30 provisions of court orders, including but not limited to 31 neutral visitation sites and mediation services. 32 3. The appropriation made to the department for child 33 support recovery may be used throughout the fiscal year in the 34 manner necessary for purposes of cash flow management, and for 35 -30- LSB 1004SV (4) 85 pf/jp 30/ 122
S.F. 446 cash flow management purposes the department may temporarily 1 draw more than the amount appropriated, provided the amount 2 appropriated is not exceeded at the close of the fiscal year. 3 4. With the exception of the funding amount specified, the 4 requirements established under 2001 Iowa Acts, chapter 191, 5 section 3, subsection 5, paragraph “c”, subparagraph (3), shall 6 be applicable to parental obligation pilot projects for the 7 fiscal year beginning July 1, 2013, and ending June 30, 2014. 8 Notwithstanding 441 IAC 100.8, providing for termination of 9 rules relating to the pilot projects, the rules shall remain 10 in effect until June 30, 2014. 11 Sec. 10. HEALTH CARE TRUST FUND —— MEDICAL ASSISTANCE —— 12 FY 2013-2014. Any funds remaining in the health care trust 13 fund created in section 453A.35A for the fiscal year beginning 14 July 1, 2013, and ending June 30, 2014, are appropriated to 15 the department of human services to supplement the medical 16 assistance program appropriations made in this division of this 17 Act, for medical assistance reimbursement and associated costs, 18 including program administration and costs associated with 19 program implementation. 20 Sec. 11. MEDICAL ASSISTANCE. There is appropriated from the 21 general fund of the state to the department of human services 22 for the fiscal year beginning July 1, 2013, and ending June 30, 23 2014, the following amount, or so much thereof as is necessary, 24 to be used for the purpose designated: 25 For medical assistance program reimbursement and associated 26 costs as specifically provided in the reimbursement 27 methodologies in effect on June 30, 2013, except as otherwise 28 expressly authorized by law, and consistent with options under 29 federal law and regulations: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,292,985,748 31 1. The funds appropriated in this section shall be used 32 in accordance with 2011 Iowa Acts, chapter 129, section 10, 33 subsection 1. 34 2. The department shall utilize not more than $60,000 of 35 -31- LSB 1004SV (4) 85 pf/jp 31/ 122
S.F. 446 the funds appropriated in this section to continue the AIDS/HIV 1 health insurance premium payment program as established in 1992 2 Iowa Acts, Second Extraordinary Session, chapter 1001, section 3 409, subsection 6. Of the funds allocated in this subsection, 4 not more than $5,000 may be expended for administrative 5 purposes. 6 3. Of the funds appropriated in this Act to the department 7 of public health for addictive disorders, $950,000 for the 8 fiscal year beginning July 1, 2013, shall be transferred 9 to the department of human services for an integrated 10 substance-related disorder managed care system. The department 11 shall not assume management of the substance-related disorder 12 system in place of the managed care contractor unless such 13 a change in approach is specifically authorized in law. 14 The departments of human services and public health shall 15 work together to maintain the level of mental health and 16 substance-related disorder treatment services provided by the 17 managed care contractor through the Iowa plan for behavioral 18 health. Each department shall take the steps necessary to 19 continue the federal waivers as necessary to maintain the level 20 of services. 21 4. a. The department shall aggressively pursue options for 22 providing medical assistance or other assistance to individuals 23 with special needs who become ineligible to continue receiving 24 services under the early and periodic screening, diagnostic, 25 and treatment program under the medical assistance program 26 due to becoming 21 years of age who have been approved for 27 additional assistance through the department’s exception to 28 policy provisions, but who have health care needs in excess 29 of the funding available through the exception to policy 30 provisions. 31 b. Of the funds appropriated in this section, $100,000 32 shall be used for participation in one or more pilot projects 33 operated by a private provider to allow the individual or 34 individuals to receive service in the community in accordance 35 -32- LSB 1004SV (4) 85 pf/jp 32/ 122
S.F. 446 with principles established in Olmstead v. L.C., 527 U.S. 581 1 (1999), for the purpose of providing medical assistance or 2 other assistance to individuals with special needs who become 3 ineligible to continue receiving services under the early and 4 periodic screening, diagnostic, and treatment program under 5 the medical assistance program due to becoming 21 years of 6 age who have been approved for additional assistance through 7 the department’s exception to policy provisions, but who have 8 health care needs in excess of the funding available through 9 the exception to the policy provisions. 10 5. Of the funds appropriated in this section, up to 11 $3,050,082 may be transferred to the field operations or 12 general administration appropriations in this division of this 13 Act for operational costs associated with Part D of the federal 14 Medicare Prescription Drug Improvement and Modernization Act 15 of 2003, Pub. L. No. 108-173. 16 6. Of the funds appropriated in this section, up to $442,100 17 may be transferred to the appropriation in this division 18 of this Act for medical contracts to be used for clinical 19 assessment services and prior authorization of services. 20 7. A portion of the funds appropriated in this section 21 may be transferred to the appropriations in this division of 22 this Act for general administration, medical contracts, the 23 children’s health insurance program, or field operations to be 24 used for the state match cost to comply with the payment error 25 rate measurement (PERM) program for both the medical assistance 26 and children’s health insurance programs as developed by the 27 centers for Medicare and Medicaid services of the United States 28 department of health and human services to comply with the 29 federal Improper Payments Information Act of 2002, Pub. L. No. 30 107-300. 31 8. It is the intent of the general assembly that the 32 department continue to implement the recommendations of 33 the assuring better child health and development initiative 34 II (ABCDII) clinical panel to the Iowa early and periodic 35 -33- LSB 1004SV (4) 85 pf/jp 33/ 122
S.F. 446 screening, diagnostic, and treatment services healthy mental 1 development collaborative board regarding changes to billing 2 procedures, codes, and eligible service providers. 3 9. Of the funds appropriated in this section, a sufficient 4 amount is allocated to supplement the incomes of residents of 5 nursing facilities, intermediate care facilities for persons 6 with mental illness, and intermediate care facilities for 7 persons with an intellectual disability, with incomes of less 8 than $50 in the amount necessary for the residents to receive a 9 personal needs allowance of $50 per month pursuant to section 10 249A.30A. 11 10. Of the funds appropriated in this section, the following 12 amounts shall be transferred to the appropriations made in this 13 division of this Act for the state mental health institutes: 14 a. Cherokee mental health institute . . . . . . . . . . . $ 9,098,425 15 b. Clarinda mental health institute . . . . . . . . . . . $ 1,977,305 16 c. Independence mental health institute . . . . . . . $ 9,045,894 17 d. Mount Pleasant mental health institute . . . . . $ 5,752,587 18 11. a. Of the funds appropriated in this section, 19 $7,969,074 is allocated for the state match for a 20 disproportionate share hospital payment of $19,133,430 to 21 hospitals that meet both of the conditions specified in 22 subparagraphs (1) and (2). In addition, the hospitals that 23 meet the conditions specified shall either certify public 24 expenditures or transfer to the medical assistance program 25 an amount equal to provide the nonfederal share for a 26 disproportionate share hospital payment of $7,500,000. The 27 hospitals that meet the conditions specified shall receive and 28 retain 100 percent of the total disproportionate share hospital 29 payment of $26,633,430. 30 (1) The hospital qualifies for disproportionate share and 31 graduate medical education payments. 32 (2) The hospital is an Iowa state-owned hospital with more 33 than 500 beds and eight or more distinct residency specialty 34 or subspecialty programs recognized by the American college of 35 -34- LSB 1004SV (4) 85 pf/jp 34/ 122
S.F. 446 graduate medical education. 1 b. Distribution of the disproportionate share payments 2 shall be made on a monthly basis. The total amount of 3 disproportionate share payments including graduate medical 4 education, enhanced disproportionate share, and Iowa 5 state-owned teaching hospital payments shall not exceed the 6 amount of the state’s allotment under Pub. L. No. 102-234. 7 In addition, the total amount of all disproportionate 8 share payments shall not exceed the hospital-specific 9 disproportionate share limits under Pub. L. No. 103-66. 10 12. The university of Iowa hospitals and clinics shall 11 either certify public expenditures or transfer to the 12 appropriations made in this division of this Act for medical 13 assistance an amount equal to provide the nonfederal share 14 for increased medical assistance payments for inpatient and 15 outpatient hospital services of $9,900,000. The university of 16 Iowa hospitals and clinics shall receive and retain 100 percent 17 of the total increase in medical assistance payments. 18 13. Of the funds appropriated in this section, up to 19 $11,921,225 may be transferred to the IowaCare account created 20 in section 249J.24 . 21 14. Of the funds appropriated in this section, $200,000 22 shall be used for the Iowa chronic care consortium pursuant to 23 2003 Iowa Acts, chapter 112, section 12, as amended by 2003 24 Iowa Acts, chapter 179, sections 166 and 167. 25 15. One hundred percent of the nonfederal share of payments 26 to area education agencies that are medical assistance 27 providers for medical assistance-covered services provided to 28 medical assistance-covered children, shall be made from the 29 appropriation made in this section. 30 16. Any new or renewed contract entered into by the 31 department with a third party to administer behavioral health 32 services under the medical assistance program shall provide 33 that any interest earned on payments from the state during 34 the state fiscal year shall be remitted to the department 35 -35- LSB 1004SV (4) 85 pf/jp 35/ 122
S.F. 446 and treated as recoveries to offset the costs of the medical 1 assistance program. 2 17. The department shall continue to implement the 3 provisions in 2007 Iowa Acts, chapter 218, section 124 and 4 section 126, as amended by 2008 Iowa Acts, chapter 1188, 5 section 55, relating to eligibility for certain persons with 6 disabilities under the medical assistance program in accordance 7 with the federal Family Opportunity Act. 8 18. A portion of the funds appropriated in this section 9 may be transferred to the appropriation in this division of 10 this Act for medical contracts to be used for administrative 11 activities associated with the money follows the person 12 demonstration project. 13 19. Of the funds appropriated in this section, $349,011 14 shall be used for the administration of the health insurance 15 premium payment program, including salaries, support, 16 maintenance, and miscellaneous purposes. 17 20. a. The department shall implement the following cost 18 containment strategies for the medical assistance program and 19 shall adopt emergency rules for such implementation: 20 (1) Notwithstanding any provision of law to the contrary, 21 the department shall integrate medical assistance program 22 habilitation services into the Iowa plan contract for the 23 fiscal year beginning July 1, 2013. 24 (2) The department shall require prior authorization for 25 provision of any home health services for adults in excess of 26 one hundred visits per year. 27 (3) The department shall prohibit coverage for elective, 28 nonmedically necessary cesarean sections. 29 (4) The department shall require prior authorization based 30 on specified criteria before providing reimbursement for 31 hospital swing bed placements and continued stays. 32 (5) The department shall align payment methodologies and 33 rates between medical and nonmedical transportation services 34 through the transportation brokerage provider. 35 -36- LSB 1004SV (4) 85 pf/jp 36/ 122
S.F. 446 (6) The department shall require that all fees for employee 1 records checks shall be paid by the medical assistance home and 2 community-based waiver services consumer-directed attendant 3 care or consumer choices option provider, with the exception 4 of one initial state records check per employee which shall be 5 paid by the Iowa Medicaid enterprise. 6 (7) The department shall require transition of the 7 provision by individual providers of personal care under the 8 consumer-directed attendant care option to agency-provided 9 personal care services and shall retain the consumer choice 10 option for those individuals able and desiring to self-direct 11 services. 12 (8) The department shall require that persons with an 13 intellectual disability receiving services under the medical 14 assistance program receive a functional assessment utilizing 15 the supports intensity scale tool. The department shall 16 contract with an independent entity to perform the functional 17 assessments. The department shall implement a tiered resource 18 allocation methodology for service plans under the medical 19 assistance home and community-based services waiver for persons 20 with an intellectual disability. 21 (9) The department shall develop a new reimbursement 22 methodology for medical assistance targeted case management 23 that applies appropriate cost limits. 24 (10) The department shall implement an integrated health 25 home approach under the medical assistance program for persons 26 with chronic mental illness. The approach shall integrate the 27 functions of medical assistance targeted case management. 28 (11) The department shall expand the categories of diabetic 29 supplies for which a rebate may be received. 30 (12) The department shall limit authorizations for 31 institutional-based care to 30 days for members following 32 discharge from a hospital if the member previously lived in a 33 community-based setting. 34 b. The department shall not implement the cost containment 35 -37- LSB 1004SV (4) 85 pf/jp 37/ 122
S.F. 446 strategy to require a primary care referral for the provision 1 of chiropractic services. 2 c. The department may increase the amounts allocated for 3 salaries, support, maintenance, and miscellaneous purposes 4 associated with the medical assistance program, as necessary, 5 to implement the cost containment strategies. The department 6 shall report any such increase to the legislative services 7 agency and the department of management. 8 d. If the savings to the medical assistance program exceed 9 the cost for the fiscal year, the department may transfer any 10 savings generated for the fiscal year due to medical assistance 11 program cost containment efforts to the appropriation 12 made in this division of this Act for medical contracts or 13 general administration to defray the increased contract costs 14 associated with implementing such efforts. 15 e. The department shall report the implementation of 16 any cost containment strategies under this subsection to 17 the individuals specified in this division of this Act for 18 submission of reports on a quarterly basis. 19 21. Notwithstanding any provision of law to the contrary, 20 the department of human services shall continue implementation 21 of the amended section 1915(b) waiver and Iowa plan contract 22 for inclusion of remedial services under the Iowa plan contract 23 for the fiscal year beginning July 1, 2013. 24 22. Of the funds appropriated in this section, $7,041,689 25 shall be used to implement reductions in the waiting lists 26 of all medical assistance home and community-based services 27 waivers. 28 23. a. Of the funds appropriated in this section, $900,000 29 shall be used to implement the children’s mental health 30 home project proposed by the department of human services 31 and reported to the general assembly’s mental health and 32 disability services study committee in December 2011. Of this 33 amount, up to $50,000 may be transferred by the department to 34 the appropriation made in this division of this Act to the 35 -38- LSB 1004SV (4) 85 pf/jp 38/ 122
S.F. 446 department for the same fiscal year for general administration 1 to be used for associated administrative expenses and for not 2 more than one full-time equivalent position, in addition to 3 those authorized for the same fiscal year, to be assigned to 4 implementing the project. 5 b. Of the funds appropriated in this section, up to $400,000 6 may be transferred by the department to the appropriation 7 made to the department in this division of this Act for 8 the same fiscal year for general administration to support 9 the redesign of mental health and disability services and 10 the state balancing incentive payments program planning and 11 implementation activities. The funds may be used for contracts 12 or for personnel in addition to the amounts appropriated for 13 and the positions authorized for general administration for the 14 same fiscal year. 15 c. Of the funds appropriated in this section, up to 16 $3,000,000 may be transferred by the department to the 17 appropriations made to the department in this division of 18 this Act for the same fiscal year for general administration 19 or medical contracts to be used to support the development 20 and implementation of standardized assessment tools for 21 persons with mental illness, an intellectual disability, a 22 developmental disability, or a brain injury. 23 d. For the fiscal year beginning July 1, 2013, and ending 24 June 30, 2014, the replacement generation tax revenues required 25 to be deposited in the property tax relief fund pursuant to 26 section 437A.8, subsection 4, paragraph “d”, and section 27 437A.15, subsection 3, paragraph “f”, shall instead be credited 28 to and supplement the appropriation made in this section and 29 used for the allocations made in this subsection. 30 24. Of the funds appropriated in this section, $250,000 31 shall be used for lodging expenses associated with patient 32 care provided at the university of Iowa hospitals and clinics 33 under chapter 249J. The department of human services shall 34 establish the maximum number of overnight stays and the maximum 35 -39- LSB 1004SV (4) 85 pf/jp 39/ 122
S.F. 446 rate reimbursed for overnight lodging, which may be based 1 on the state employee rate established by the department 2 of administrative services. The funds allocated in this 3 subsection shall not be used as nonfederal share matching 4 funds. 5 Sec. 12. MEDICAL CONTRACTS. There is appropriated from the 6 general fund of the state to the department of human services 7 for the fiscal year beginning July 1, 2013, and ending June 30, 8 2014, the following amount, or so much thereof as is necessary, 9 to be used for the purpose designated: 10 For medical contracts: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13,691,569 12 1. The department of inspections and appeals shall 13 provide all state matching funds for survey and certification 14 activities performed by the department of inspections 15 and appeals. The department of human services is solely 16 responsible for distributing the federal matching funds for 17 such activities. 18 2. Of the funds appropriated in this section, $50,000 shall 19 be used for continuation of home and community-based services 20 waiver quality assurance programs, including the review and 21 streamlining of processes and policies related to oversight and 22 quality management to meet state and federal requirements. 23 3. Of the amount appropriated in this section, up to 24 $200,000 may be transferred to the appropriation for general 25 administration in this division of this Act to be used for 26 additional full-time equivalent positions in the development of 27 key health initiatives such as cost containment, development 28 and oversight of managed care programs, and development of 29 health strategies targeted toward improved quality and reduced 30 costs in the Medicaid program. 31 4. Of the funds appropriated in this section, $64,398 shall 32 be used for provision of the IowaCare program nurse helpline 33 for the expansion population as provided in section 249J.6. 34 5. Of the funds appropriated in this section, $80,000 shall 35 -40- LSB 1004SV (4) 85 pf/jp 40/ 122
S.F. 446 be used for costs related to audits, performance evaluations, 1 and studies required pursuant to chapter 249J. 2 6. Of the funds appropriated in this section, $194,654 shall 3 be used for administrative costs associated with chapter 249J. 4 7. Of the funds appropriated in this section, $1,000,000 5 shall be used for planning and development, in cooperation with 6 the department of public health, of a phased-in program to 7 provide a dental home for children in accordance with section 8 249J.14. 9 8. Of the funds appropriated in this section, $270,000 shall 10 be used for payment to the publicly owned acute care teaching 11 hospital located in a county with a population of over 350,000 12 that is a participating provider pursuant to chapter 249J. 13 Disbursements under this subsection shall be made monthly. 14 The hospital shall submit a report following the close of 15 the fiscal year regarding use of the funds allocated in this 16 subsection to the persons specified in this Act to receive 17 reports. 18 9. Of the funds appropriated in this section, $100,000 shall 19 be used for continuation of an accountable care organization 20 pilot project. 21 10. Of the funds appropriated in this section, $75,000 shall 22 be used for continued implementation of a uniform cost report. 23 11. Of the funds appropriated in this section, $3,300,000 24 shall be used for the autism support program created in chapter 25 225D, as enacted in this Act. 26 Sec. 13. STATE SUPPLEMENTARY ASSISTANCE. 27 1. There is appropriated from the general fund of the 28 state to the department of human services for the fiscal year 29 beginning July 1, 2013, and ending June 30, 2014, the following 30 amount, or so much thereof as is necessary, to be used for the 31 purpose designated: 32 For the state supplementary assistance program: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 16,512,174 34 2. The department shall increase the personal needs 35 -41- LSB 1004SV (4) 85 pf/jp 41/ 122
S.F. 446 allowance for residents of residential care facilities by the 1 same percentage and at the same time as federal supplemental 2 security income and federal social security benefits are 3 increased due to a recognized increase in the cost of living. 4 The department may adopt emergency rules to implement this 5 subsection. 6 3. If during the fiscal year beginning July 1, 2013, 7 the department projects that state supplementary assistance 8 expenditures for a calendar year will not meet the federal 9 pass-through requirement specified in Tit. XVI of the federal 10 Social Security Act, section 1618, as codified in 42 U.S.C. 11 § 1382g, the department may take actions including but not 12 limited to increasing the personal needs allowance for 13 residential care facility residents and making programmatic 14 adjustments or upward adjustments of the residential care 15 facility or in-home health-related care reimbursement rates 16 prescribed in this division of this Act to ensure that federal 17 requirements are met. In addition, the department may make 18 other programmatic and rate adjustments necessary to remain 19 within the amount appropriated in this section while ensuring 20 compliance with federal requirements. The department may adopt 21 emergency rules to implement the provisions of this subsection. 22 Sec. 14. CHILDREN’S HEALTH INSURANCE PROGRAM. 23 1. There is appropriated from the general fund of the 24 state to the department of human services for the fiscal year 25 beginning July 1, 2013, and ending June 30, 2014, the following 26 amount, or so much thereof as is necessary, to be used for the 27 purpose designated: 28 For maintenance of the healthy and well kids in Iowa (hawk-i) 29 program pursuant to chapter 514I , including supplemental dental 30 services, for receipt of federal financial participation under 31 Tit. XXI of the federal Social Security Act, which creates the 32 children’s health insurance program: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 36,806,102 34 2. Of the funds appropriated in this section, $141,450 is 35 -42- LSB 1004SV (4) 85 pf/jp 42/ 122
S.F. 446 allocated for continuation of the contract for outreach with 1 the department of public health. 2 Sec. 15. CHILD CARE ASSISTANCE. There is appropriated 3 from the general fund of the state to the department of human 4 services for the fiscal year beginning July 1, 2013, and ending 5 June 30, 2014, the following amount, or so much thereof as is 6 necessary, to be used for the purpose designated: 7 For child care programs: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 72,931,661 9 1. Of the funds appropriated in this section, $71,327,056 10 shall be used for state child care assistance in accordance 11 with section 237A.13 . 12 2. Nothing in this section shall be construed or is 13 intended as or shall imply a grant of entitlement for services 14 to persons who are eligible for assistance due to an income 15 level consistent with the waiting list requirements of section 16 237A.13 . Any state obligation to provide services pursuant to 17 this section is limited to the extent of the funds appropriated 18 in this section. 19 3. Of the funds appropriated in this section, $432,453 is 20 allocated for the statewide program for child care resource 21 and referral services under section 237A.26 . A list of the 22 registered and licensed child care facilities operating in the 23 area served by a child care resource and referral service shall 24 be made available to the families receiving state child care 25 assistance in that area. 26 4. Of the funds appropriated in this section, $936,974 27 is allocated for child care quality improvement initiatives 28 including but not limited to the voluntary quality rating 29 system in accordance with section 237A.30 . 30 5. Of the funds appropriated in this section, $135,178 31 shall be used for the cost of a child care provider conducting 32 a federally-required national criminal history check of a 33 person’s fingerprints through the United States department of 34 justice, federal bureau of investigation. 35 -43- LSB 1004SV (4) 85 pf/jp 43/ 122
S.F. 446 6. Of the amount appropriated in this section, up to 1 $25,000 shall be used to implement a searchable internet-based 2 application as part of the consumer information made available 3 under section 237A.25. The application shall provide a listing 4 of the child care providers in this state that have received 5 a rating under the quality rating system implemented pursuant 6 to section 237A.30 and information on whether a provider 7 specializes in child care for infants, school-age children, 8 children with special needs, or other populations or provides 9 any other specialized services to support family needs. 10 7. Of the amount appropriated in this section, up to $75,000 11 shall be used by the department to conduct an independent 12 evaluation of Iowa’s child care quality rating system. The 13 evaluation shall address the system’s strengths and weaknesses, 14 and shall provide recommendations for change. The department 15 shall submit a final report on or before December 16, 2013, to 16 the governor and general assembly concerning the evaluation. 17 The evaluation shall also include but is not limited to all of 18 the following: 19 a. An assessment of the validity of the system’s key 20 underlying concepts. 21 b. An assessment of the techniques utilized and 22 psychometric properties of the measures used in the system to 23 assess quality. 24 c. An analysis of the outputs quantified by the rating 25 process. 26 d. An analysis of the relationship between the ratings 27 utilized and child outcomes realized. 28 8. The department shall change the standard period for 29 redetermining the eligibility of a state child care assistance 30 program participant to 12 months and increase the income 31 eligibility for employed families under the program to 148 32 percent of the federal poverty level, in accordance with the 33 amendments in this Act to section 237A.13. 34 9. The department may use any of the funds appropriated 35 -44- LSB 1004SV (4) 85 pf/jp 44/ 122
S.F. 446 in this section as a match to obtain federal funds for use in 1 expanding child care assistance and related programs. For 2 the purpose of expenditures of state and federal child care 3 funding, funds shall be considered obligated at the time 4 expenditures are projected or are allocated to the department’s 5 service areas. Projections shall be based on current and 6 projected caseload growth, current and projected provider 7 rates, staffing requirements for eligibility determination 8 and management of program requirements including data systems 9 management, staffing requirements for administration of the 10 program, contractual and grant obligations and any transfers 11 to other state agencies, and obligations for decategorization 12 or innovation projects. 13 10. A portion of the state match for the federal child care 14 and development block grant shall be provided as necessary to 15 meet federal matching funds requirements through the state 16 general fund appropriation made for child development grants 17 and other programs for at-risk children in section 279.51 . 18 11. If a uniform reduction ordered by the governor under 19 section 8.31 or other operation of law, transfer, or federal 20 funding reduction reduces the appropriation made in this 21 section for the fiscal year, the percentage reduction in the 22 amount paid out to or on behalf of the families participating 23 in the state child care assistance program shall be equal to or 24 less than the percentage reduction made for any other purpose 25 payable from the appropriation made in this section and the 26 federal funding relating to it. The percentage reduction to 27 the other allocations made in this section shall be the same as 28 the uniform reduction ordered by the governor or the percentage 29 change of the federal funding reduction, as applicable. 30 If there is an unanticipated increase in federal funding 31 provided for state child care assistance, the entire amount 32 of the increase shall be used for state child care assistance 33 payments. If the appropriations made for purposes of the 34 state child care assistance program for the fiscal year are 35 -45- LSB 1004SV (4) 85 pf/jp 45/ 122
S.F. 446 determined to be insufficient, it is the intent of the general 1 assembly to appropriate sufficient funding for the fiscal year 2 in order to avoid establishment of waiting list requirements. 3 12. Notwithstanding section 8.33 , moneys advanced for 4 purposes of the programs developed by early childhood Iowa 5 areas, advanced for purposes of wraparound child care, or 6 received from the federal appropriations made for the purposes 7 of this section that remain unencumbered or unobligated at the 8 close of the fiscal year shall not revert to any fund but shall 9 remain available for expenditure for the purposes designated 10 until the close of the succeeding fiscal year. 11 Sec. 16. JUVENILE INSTITUTIONS. There is appropriated 12 from the general fund of the state to the department of human 13 services for the fiscal year beginning July 1, 2013, and ending 14 June 30, 2014, the following amounts, or so much thereof as is 15 necessary, to be used for the purposes designated: 16 1. For operation of the Iowa juvenile home at Toledo and for 17 salaries, support, maintenance, and miscellaneous purposes, and 18 for not more than the following full-time equivalent positions: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,859,355 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 114.00 21 2. For operation of the state training school at Eldora and 22 for salaries, support, maintenance, and miscellaneous purposes, 23 and for not more than the following full-time equivalent 24 positions: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,256,969 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 164.30 27 Of the funds appropriated in this subsection, $91,150 shall 28 be used for distribution to licensed classroom teachers at this 29 and other institutions under the control of the department of 30 human services based upon the average student yearly enrollment 31 at each institution as determined by the department. 32 3. A portion of the moneys appropriated in this section 33 shall be used by the state training school and by the Iowa 34 juvenile home for grants for adolescent pregnancy prevention 35 -46- LSB 1004SV (4) 85 pf/jp 46/ 122
S.F. 446 activities at the institutions in the fiscal year beginning 1 July 1, 2013. 2 Sec. 17. CHILD AND FAMILY SERVICES. 3 1. There is appropriated from the general fund of the 4 state to the department of human services for the fiscal year 5 beginning July 1, 2013, and ending June 30, 2014, the following 6 amount, or so much thereof as is necessary, to be used for the 7 purpose designated: 8 For child and family services: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 93,188,770 10 2. In order to address a reduction of $5,200,000 from the 11 amount allocated under the appropriation made for the purposes 12 of this section in prior years for purposes of juvenile 13 delinquent graduated sanction services, up to $5,200,000 of the 14 amount of federal temporary assistance for needy families block 15 grant funding appropriated in this division of this Act for 16 child and family services shall be made available for purposes 17 of juvenile delinquent graduated sanction services. 18 3. The department may transfer funds appropriated in this 19 section as necessary to pay the nonfederal costs of services 20 reimbursed under the medical assistance program, state child 21 care assistance program, or the family investment program which 22 are provided to children who would otherwise receive services 23 paid under the appropriation in this section. The department 24 may transfer funds appropriated in this section to the 25 appropriations made in this division of this Act for general 26 administration and for field operations for resources necessary 27 to implement and operate the services funded in this section. 28 4. a. Of the funds appropriated in this section, up to 29 $32,242,363 is allocated as the statewide expenditure target 30 under section 232.143 for group foster care maintenance and 31 services. If the department projects that such expenditures 32 for the fiscal year will be less than the target amount 33 allocated in this lettered paragraph, the department may 34 reallocate the excess to provide additional funding for shelter 35 -47- LSB 1004SV (4) 85 pf/jp 47/ 122
S.F. 446 care or the child welfare emergency services addressed with the 1 allocation for shelter care. 2 b. If at any time after September 30, 2013, annualization 3 of a service area’s current expenditures indicates a service 4 area is at risk of exceeding its group foster care expenditure 5 target under section 232.143 by more than 5 percent, the 6 department and juvenile court services shall examine all 7 group foster care placements in that service area in order to 8 identify those which might be appropriate for termination. 9 In addition, any aftercare services believed to be needed 10 for the children whose placements may be terminated shall be 11 identified. The department and juvenile court services shall 12 initiate action to set dispositional review hearings for the 13 placements identified. In such a dispositional review hearing, 14 the juvenile court shall determine whether needed aftercare 15 services are available and whether termination of the placement 16 is in the best interest of the child and the community. 17 5. In accordance with the provisions of section 232.188 , 18 the department shall continue the child welfare and juvenile 19 justice funding initiative during fiscal year 2013-2014. Of 20 the funds appropriated in this section, $1,717,753 is allocated 21 specifically for expenditure for fiscal year 2013-2014 through 22 the decategorization service funding pools and governance 23 boards established pursuant to section 232.188 . 24 6. A portion of the funds appropriated in this section 25 may be used for emergency family assistance to provide other 26 resources required for a family participating in a family 27 preservation or reunification project or successor project to 28 stay together or to be reunified. 29 7. Notwithstanding section 234.35 or any other provision 30 of law to the contrary, state funding for shelter care and 31 the child welfare emergency services contracting implemented 32 to provide for or prevent the need for shelter care shall be 33 limited to $7,616,048. 34 8. Federal funds received by the state during the fiscal 35 -48- LSB 1004SV (4) 85 pf/jp 48/ 122
S.F. 446 year beginning July 1, 2013, as the result of the expenditure 1 of state funds appropriated during a previous state fiscal 2 year for a service or activity funded under this section are 3 appropriated to the department to be used as additional funding 4 for services and purposes provided for under this section. 5 Notwithstanding section 8.33 , moneys received in accordance 6 with this subsection that remain unencumbered or unobligated at 7 the close of the fiscal year shall not revert to any fund but 8 shall remain available for the purposes designated until the 9 close of the succeeding fiscal year. 10 9. a. Of the funds appropriated in this section, up to 11 $3,290,000 is allocated for the payment of the expenses of 12 court-ordered services provided to juveniles who are under the 13 supervision of juvenile court services, which expenses are a 14 charge upon the state pursuant to section 232.141, subsection 15 4 . Of the amount allocated in this lettered paragraph, up to 16 $1,556,287 shall be made available to provide school-based 17 supervision of children adjudicated under chapter 232 , of which 18 not more than $15,000 may be used for the purpose of training. 19 A portion of the cost of each school-based liaison officer 20 shall be paid by the school district or other funding source as 21 approved by the chief juvenile court officer. 22 b. Of the funds appropriated in this section, up to $748,985 23 is allocated for the payment of the expenses of court-ordered 24 services provided to children who are under the supervision 25 of the department, which expenses are a charge upon the state 26 pursuant to section 232.141, subsection 4 . 27 c. Notwithstanding section 232.141 or any other provision 28 of law to the contrary, the amounts allocated in this 29 subsection shall be distributed to the judicial districts 30 as determined by the state court administrator and to the 31 department’s service areas as determined by the administrator 32 of the department’s division of child and family services. The 33 state court administrator and the division administrator shall 34 make the determination of the distribution amounts on or before 35 -49- LSB 1004SV (4) 85 pf/jp 49/ 122
S.F. 446 June 15, 2013. 1 d. Notwithstanding chapter 232 or any other provision of 2 law to the contrary, a district or juvenile court shall not 3 order any service which is a charge upon the state pursuant 4 to section 232.141 if there are insufficient court-ordered 5 services funds available in the district court or departmental 6 service area distribution amounts to pay for the service. The 7 chief juvenile court officer and the departmental service area 8 manager shall encourage use of the funds allocated in this 9 subsection such that there are sufficient funds to pay for 10 all court-related services during the entire year. The chief 11 juvenile court officers and departmental service area managers 12 shall attempt to anticipate potential surpluses and shortfalls 13 in the distribution amounts and shall cooperatively request the 14 state court administrator or division administrator to transfer 15 funds between the judicial districts’ or departmental service 16 areas’ distribution amounts as prudent. 17 e. Notwithstanding any provision of law to the contrary, 18 a district or juvenile court shall not order a county to pay 19 for any service provided to a juvenile pursuant to an order 20 entered under chapter 232 which is a charge upon the state 21 under section 232.141, subsection 4 . 22 f. Of the funds allocated in this subsection, not more than 23 $83,000 may be used by the judicial branch for administration 24 of the requirements under this subsection. 25 g. Of the funds allocated in this subsection, $17,000 26 shall be used by the department of human services to support 27 the interstate commission for juveniles in accordance with 28 the interstate compact for juveniles as provided in section 29 232.173 . 30 10. Of the funds appropriated in this section, $9,053,226 is 31 allocated for juvenile delinquent graduated sanctions services. 32 Any state funds saved as a result of efforts by juvenile court 33 services to earn federal Tit. IV-E match for juvenile court 34 services administration may be used for the juvenile delinquent 35 -50- LSB 1004SV (4) 85 pf/jp 50/ 122
S.F. 446 graduated sanctions services. 1 11. Of the funds appropriated in this section, $1,933,285 2 shall be transferred to the department of public health to be 3 used for equalization and renewal of the grants under the child 4 protection center grant program in accordance with section 5 135.118 . 6 12. If the department receives federal approval to 7 implement a waiver under Tit. IV-E of the federal Social 8 Security Act to enable providers to serve children who remain 9 in the children’s families and communities, for purposes of 10 eligibility under the medical assistance program, children who 11 participate in the waiver shall be considered to be placed in 12 foster care. 13 13. Of the funds appropriated in this section, $3,092,375 is 14 allocated for the preparation for adult living program pursuant 15 to section 234.46 . 16 14. Of the funds appropriated in this section, $1,000,000 17 shall be used for juvenile drug courts. The amount allocated 18 in this subsection shall be distributed as follows: 19 To the judicial branch for salaries to assist with the 20 operation of juvenile drug court programs operated in the 21 following jurisdictions: 22 a. Marshall county: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 99,540 24 b. Woodbury county: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 258,804 26 c. Polk county: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 430,843 28 d. The third judicial district: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 111,274 30 e. The eighth judicial district: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 99,539 32 15. Of the funds appropriated in this section, $227,337 33 shall be used for the public purpose of continuing a grant to 34 a nonprofit human services organization providing services to 35 -51- LSB 1004SV (4) 85 pf/jp 51/ 122
S.F. 446 individuals and families in multiple locations in southwest 1 Iowa and Nebraska for support of a project providing immediate, 2 sensitive support and forensic interviews, medical exams, needs 3 assessments, and referrals for victims of child abuse and their 4 nonoffending family members. 5 16. Of the funds appropriated in this section, $200,590 6 is allocated for the foster care youth council approach of 7 providing a support network to children placed in foster care. 8 17. Of the funds appropriated in this section, $202,000 is 9 allocated for use pursuant to section 235A.1 for continuation 10 of the initiative to address child sexual abuse implemented 11 pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection 12 21. 13 18. Of the funds appropriated in this section, $630,240 is 14 allocated for the community partnership for child protection 15 sites. 16 19. Of the funds appropriated in this section, $371,250 17 is allocated for the department’s minority youth and family 18 projects under the redesign of the child welfare system. 19 20. Of the funds appropriated in this section, $1,436,595 20 is allocated for funding of the community circle of care 21 collaboration for children and youth in northeast Iowa. 22 21. Of the funds appropriated in this section, at least 23 $147,158 shall be used for the child welfare training academy. 24 22. Of the funds appropriated in this section, $25,000 25 shall be used for the public purpose of continuation of a 26 grant to a child welfare services provider headquartered in a 27 county with a population between 205,000 and 215,000 in the 28 latest certified federal census that provides multiple services 29 including but not limited to a psychiatric medical institution 30 for children, shelter, residential treatment, after school 31 programs, school-based programming, and an Asperger’s syndrome 32 program, to be used for support services for children with 33 autism spectrum disorder and their families. 34 23. Of the funds appropriated in this section, $25,000 35 -52- LSB 1004SV (4) 85 pf/jp 52/ 122
S.F. 446 shall be used for the public purpose of continuing a grant to 1 a hospital-based provider headquartered in a county with a 2 population between 90,000 and 95,000 in the latest certified 3 federal census that provides multiple services including 4 but not limited to diagnostic, therapeutic, and behavioral 5 services to individuals with autism spectrum disorder across 6 the lifespan. The grant recipient shall utilize the funds 7 to continue the pilot project to determine the necessary 8 support services for children with autism spectrum disorder and 9 their families to be included in the children’s disabilities 10 services system. The grant recipient shall submit findings and 11 recommendations based upon the results of the pilot project 12 to the individuals specified in this division of this Act for 13 submission of reports by December 31, 2013. 14 24. Of the funds appropriated in this section, $327,947 15 shall be used for continuation of the central Iowa system of 16 care program grant through June 30, 2014. 17 25. Of the funds appropriated in this section, $160,000 18 shall be used for the public purpose of the continuation of 19 a system of care grant implemented in Cerro Gordo and Linn 20 counties. 21 26. Of the funds appropriated in this section, at least 22 $25,000 shall be used to continue and to expand the foster 23 care respite pilot program in which postsecondary students in 24 social work and other human services-related programs receive 25 experience by assisting family foster care providers with 26 respite and other support. 27 27. Of the funds appropriated in this section, up to 28 $100,000 shall be used to implement a children’s cabinet under 29 the department of human services, if enacted by 2013 Iowa Acts, 30 Senate File 415 or successor legislation. 31 Sec. 18. ADOPTION SUBSIDY. 32 1. There is appropriated from the general fund of the 33 state to the department of human services for the fiscal year 34 beginning July 1, 2013, and ending June 30, 2014, the following 35 -53- LSB 1004SV (4) 85 pf/jp 53/ 122
S.F. 446 amount, or so much thereof as is necessary, to be used for the 1 purpose designated: 2 For adoption subsidy payments and services: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 40,729,282 4 2. The department may transfer funds appropriated in 5 this section to the appropriation made in this division of 6 this Act for general administration for costs paid from the 7 appropriation relating to adoption subsidy. 8 3. Federal funds received by the state during the 9 fiscal year beginning July 1, 2013, as the result of the 10 expenditure of state funds during a previous state fiscal 11 year for a service or activity funded under this section are 12 appropriated to the department to be used as additional funding 13 for the services and activities funded under this section. 14 Notwithstanding section 8.33 , moneys received in accordance 15 with this subsection that remain unencumbered or unobligated 16 at the close of the fiscal year shall not revert to any fund 17 but shall remain available for expenditure for the purposes 18 designated until the close of the succeeding fiscal year. 19 Sec. 19. JUVENILE DETENTION HOME FUND. Moneys deposited 20 in the juvenile detention home fund created in section 232.142 21 during the fiscal year beginning July 1, 2013, and ending June 22 30, 2014, are appropriated to the department of human services 23 for the fiscal year beginning July 1, 2013, and ending June 30, 24 2014, for distribution of an amount equal to a percentage of 25 the costs of the establishment, improvement, operation, and 26 maintenance of county or multicounty juvenile detention homes 27 in the fiscal year beginning July 1, 2012. Moneys appropriated 28 for distribution in accordance with this section shall be 29 allocated among eligible detention homes, prorated on the basis 30 of an eligible detention home’s proportion of the costs of all 31 eligible detention homes in the fiscal year beginning July 32 1, 2012. The percentage figure shall be determined by the 33 department based on the amount available for distribution for 34 the fund. Notwithstanding section 232.142, subsection 3 , the 35 -54- LSB 1004SV (4) 85 pf/jp 54/ 122
S.F. 446 financial aid payable by the state under that provision for the 1 fiscal year beginning July 1, 2013, shall be limited to the 2 amount appropriated for the purposes of this section. 3 Sec. 20. FAMILY SUPPORT SUBSIDY PROGRAM. 4 1. There is appropriated from the general fund of the 5 state to the department of human services for the fiscal year 6 beginning July 1, 2013, and ending June 30, 2014, the following 7 amount, or so much thereof as is necessary, to be used for the 8 purpose designated: 9 For the family support subsidy program subject to the 10 enrollment restrictions in section 225C.37, subsection 3 : 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,092,955 12 2. The department shall use at least $483,500 of the moneys 13 appropriated in this section for the family support center 14 component of the comprehensive family support program under 15 section 225C.47 . Not more than $25,000 of the amount allocated 16 in this subsection shall be used for administrative costs. 17 3. If at any time during the fiscal year, the amount of 18 funding available for the family support subsidy program 19 is reduced from the amount initially used to establish the 20 figure for the number of family members for whom a subsidy 21 is to be provided at any one time during the fiscal year, 22 notwithstanding section 225C.38, subsection 2 , the department 23 shall revise the figure as necessary to conform to the amount 24 of funding available. 25 Sec. 21. CONNER DECREE. There is appropriated from the 26 general fund of the state to the department of human services 27 for the fiscal year beginning July 1, 2013, and ending June 30, 28 2014, the following amount, or so much thereof as is necessary, 29 to be used for the purpose designated: 30 For building community capacity through the coordination 31 and provision of training opportunities in accordance with the 32 consent decree of Conner v. Branstad, No. 4-86-CV-30871(S.D. 33 Iowa, July 14, 1994): 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,622 35 -55- LSB 1004SV (4) 85 pf/jp 55/ 122
S.F. 446 Sec. 22. MENTAL HEALTH INSTITUTES. There is appropriated 1 from the general fund of the state to the department of human 2 services for the fiscal year beginning July 1, 2013, and ending 3 June 30, 2014, the following amounts, or so much thereof as is 4 necessary, to be used for the purposes designated: 5 1. For the state mental health institute at Cherokee for 6 salaries, support, maintenance, and miscellaneous purposes, and 7 for not more than the following full-time equivalent positions: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,954,464 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 169.20 10 2. For the state mental health institute at Clarinda for 11 salaries, support, maintenance, and miscellaneous purposes, and 12 for not more than the following full-time equivalent positions: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,751,868 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 86.10 15 3. For the state mental health institute at Independence for 16 salaries, support, maintenance, and miscellaneous purposes, and 17 for not more than the following full-time equivalent positions: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,318,778 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 233.00 20 4. For the state mental health institute at Mount Pleasant 21 for salaries, support, maintenance, and miscellaneous purposes, 22 and for not more than the following full-time equivalent 23 positions: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,366,686 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 97.32 26 Sec. 23. STATE RESOURCE CENTERS. 27 1. There is appropriated from the general fund of the 28 state to the department of human services for the fiscal year 29 beginning July 1, 2013, and ending June 30, 2014, the following 30 amounts, or so much thereof as is necessary, to be used for the 31 purposes designated: 32 a. For the state resource center at Glenwood for salaries, 33 support, maintenance, and miscellaneous purposes: 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 20,502,425 35 -56- LSB 1004SV (4) 85 pf/jp 56/ 122
S.F. 446 b. For the state resource center at Woodward for salaries, 1 support, maintenance, and miscellaneous purposes: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 14,631,359 3 2. The department may continue to bill for state resource 4 center services utilizing a scope of services approach used for 5 private providers of ICFID services, in a manner which does not 6 shift costs between the medical assistance program, counties, 7 or other sources of funding for the state resource centers. 8 3. The state resource centers may expand the time-limited 9 assessment and respite services during the fiscal year. 10 4. If the department’s administration and the department 11 of management concur with a finding by a state resource 12 center’s superintendent that projected revenues can reasonably 13 be expected to pay the salary and support costs for a new 14 employee position, or that such costs for adding a particular 15 number of new positions for the fiscal year would be less 16 than the overtime costs if new positions would not be added, 17 the superintendent may add the new position or positions. If 18 the vacant positions available to a resource center do not 19 include the position classification desired to be filled, the 20 state resource center’s superintendent may reclassify any 21 vacant position as necessary to fill the desired position. The 22 superintendents of the state resource centers may, by mutual 23 agreement, pool vacant positions and position classifications 24 during the course of the fiscal year in order to assist one 25 another in filling necessary positions. 26 5. If existing capacity limitations are reached in 27 operating units, a waiting list is in effect for a service or 28 a special need for which a payment source or other funding 29 is available for the service or to address the special need, 30 and facilities for the service or to address the special need 31 can be provided within the available payment source or other 32 funding, the superintendent of a state resource center may 33 authorize opening not more than two units or other facilities 34 and begin implementing the service or addressing the special 35 -57- LSB 1004SV (4) 85 pf/jp 57/ 122
S.F. 446 need during fiscal year 2013-2014. 1 Sec. 24. SEXUALLY VIOLENT PREDATORS. 2 1. There is appropriated from the general fund of the 3 state to the department of human services for the fiscal year 4 beginning July 1, 2013, and ending June 30, 2014, the following 5 amount, or so much thereof as is necessary, to be used for the 6 purpose designated: 7 For costs associated with the commitment and treatment of 8 sexually violent predators in the unit located at the state 9 mental health institute at Cherokee, including costs of legal 10 services and other associated costs, including salaries, 11 support, maintenance, and miscellaneous purposes, and for not 12 more than the following full-time equivalent positions: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,142,979 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 115.50 15 2. Unless specifically prohibited by law, if the amount 16 charged provides for recoupment of at least the entire amount 17 of direct and indirect costs, the department of human services 18 may contract with other states to provide care and treatment 19 of persons placed by the other states at the unit for sexually 20 violent predators at Cherokee. The moneys received under 21 such a contract shall be considered to be repayment receipts 22 and used for the purposes of the appropriation made in this 23 section. 24 Sec. 25. FIELD OPERATIONS. There is appropriated from the 25 general fund of the state to the department of human services 26 for the fiscal year beginning July 1, 2013, and ending June 30, 27 2014, the following amount, or so much thereof as is necessary, 28 to be used for the purposes designated: 29 For field operations, including salaries, support, 30 maintenance, and miscellaneous purposes, and for not more than 31 the following full-time equivalent positions: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 67,008,683 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 1,837.00 34 1. As a condition of this appropriation, the department 35 -58- LSB 1004SV (4) 85 pf/jp 58/ 122
S.F. 446 shall make every possible effort to fill the entire number of 1 positions authorized by this section and, unless specifically 2 provided otherwise by an applicable collective bargaining 3 agreement, the department is not subject to any approval 4 requirement external to the department to fill a field 5 operations vacancy within the number of full-time equivalent 6 positions authorized by this section. The department shall 7 report on the first of each month to the chairpersons and 8 ranking members of the appropriations committees of the senate 9 and house of representatives, and the persons designated by 10 this Act for submission of reports concerning the status of 11 filling the positions. 12 2. Priority in filling full-time equivalent positions 13 shall be given to those positions related to child protection 14 services and eligibility determination for low-income families. 15 Sec. 26. GENERAL ADMINISTRATION. There is appropriated 16 from the general fund of the state to the department of human 17 services for the fiscal year beginning July 1, 2013, and ending 18 June 30, 2014, the following amount, or so much thereof as is 19 necessary, to be used for the purpose designated: 20 For general administration, including salaries, support, 21 maintenance, and miscellaneous purposes, and for not more than 22 the following full-time equivalent positions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 16,231,171 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 309.00 25 1. Of the funds appropriated in this section, $63,543 26 allocated for the prevention of disabilities policy council 27 established in section 225B.3 . Of the amount allocated 28 in this subsection, $25,000 shall be passed through to the 29 council for the costs involved with holding a summit meeting 30 of the multiple entities providing services to persons with 31 disabilities. The focus of the summit meeting shall be to 32 review existing disability prevention activities in order to 33 identify cost effective public policy options for reaching 34 the greatest number of children and adults in order to 35 -59- LSB 1004SV (4) 85 pf/jp 59/ 122
S.F. 446 eliminate the risk of disabilities. The review shall also 1 address options for health care services available to youth 2 transitioning to the adult system of health care. 3 2. The department shall report at least monthly to the 4 legislative services agency concerning the department’s 5 operational and program expenditures. 6 3. Of the funds appropriated in this section, $132,300 shall 7 be used to continue the contract for the provision of a program 8 to provide technical assistance, support, and consultation to 9 providers of habilitation services and home and community-based 10 services waiver services for adults with disabilities under the 11 medical assistance program. 12 4. Of the funds appropriated in this section, $176,400 shall 13 be used to continue the contract to expand the provision of 14 nationally accredited and recognized internet-based training to 15 include mental health and disability services providers. 16 5. Of the funds appropriated in this section, $50,000 17 shall be transferred to the Iowa finance authority to be used 18 for administrative support of the council on homelessness 19 established in section 16.100A and for the council to fulfill 20 its duties in addressing and reducing homelessness in the 21 state. 22 Sec. 27. VOLUNTEERS. There is appropriated from the general 23 fund of the state to the department of human services for the 24 fiscal year beginning July 1, 2013, and ending June 30, 2014, 25 the following amount, or so much thereof as is necessary, to be 26 used for the purpose designated: 27 For development and coordination of volunteer services: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 84,660 29 Sec. 28. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY 30 ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE 31 DEPARTMENT OF HUMAN SERVICES. 32 1. a. (1) For the fiscal year beginning July 1, 2013, 33 the total state funding amount for the nursing facility budget 34 shall not exceed $267,712,511. 35 -60- LSB 1004SV (4) 85 pf/jp 60/ 122
S.F. 446 (2) For the fiscal year beginning July 1, 2013, the 1 department shall rebase case-mix nursing facility rates 2 effective July 1, 2013. However, total nursing facility budget 3 expenditures, including both case-mix and noncase-mix, shall 4 not exceed the amount specified in subparagraph (1). When 5 calculating case-mix per diem cost and the patient-day-weighted 6 medians used in rate-setting for nursing facilities effective 7 July 1, 2013, the inflation factor applied from the midpoint 8 of the cost report period to the first day of the state fiscal 9 year rate period shall be adjusted to maintain state funding 10 within the amount specified in subparagraph (1). 11 (3) The department, in cooperation with nursing facility 12 representatives, shall review projections for state funding 13 expenditures for reimbursement of nursing facilities on a 14 quarterly basis and the department shall determine if an 15 adjustment to the medical assistance reimbursement rate is 16 necessary in order to provide reimbursement within the state 17 funding amount for the fiscal year. Notwithstanding 2001 18 Iowa Acts, chapter 192, section 4, subsection 2, paragraph 19 “c”, and subsection 3, paragraph “a”, subparagraph (2), 20 if the state funding expenditures for the nursing facility 21 budget for the fiscal year is projected to exceed the amount 22 specified in subparagraph (1), the department shall adjust 23 the reimbursement for nursing facilities reimbursed under the 24 case-mix reimbursement system to maintain expenditures of the 25 nursing facility budget within the specified amount for the 26 fiscal year. 27 (4) For the fiscal year beginning July 1, 2013, special 28 population nursing facilities shall be reimbursed in accordance 29 with the methodology in effect on June 30, 2013. 30 b. (1) For the fiscal year beginning July 1, 2013, 31 the department shall establish the pharmacy dispensing fee 32 reimbursement at $10.02 per prescription. Any subsequent 33 actual dispensing fee shall be established within the range 34 determined by a cost of dispensing survey performed by 35 -61- LSB 1004SV (4) 85 pf/jp 61/ 122
S.F. 446 the department and required to be completed by all medical 1 assistance program participating pharmacies every two years 2 beginning in FY 2014-2015. 3 (2) The department shall continue to implement an average 4 acquisition cost reimbursement methodology for pharmacy 5 ingredient cost reimbursement of all drugs covered under the 6 medical assistance program in accordance with 2012 Iowa Acts, 7 chapter 1133, section 33. 8 c. (1) For the fiscal year beginning July 1, 2013, 9 reimbursement rates for outpatient hospital services shall be 10 increased 1.5 percent over the rates in effect on June 30, 11 2013. 12 (2) For the fiscal year beginning July 1, 2013, 13 reimbursement rates for inpatient hospital services shall by 14 increased by 1.5 percent over the rates in effect on June 30, 15 2013. 16 (3) For the fiscal year beginning July 1, 2013, the graduate 17 medical education and disproportionate share hospital fund 18 shall remain at the amount in effect on June 30, 2013, except 19 that the portion of the fund attributable to graduate medical 20 education shall be reduced in an amount that reflects the 21 elimination of graduate medical education payments made to 22 out-of-state hospitals. 23 (4) In order to ensure the efficient use of limited state 24 funds in procuring health care services for low-income Iowans, 25 funds appropriated in this Act for hospital services shall 26 not be used for activities which would be excluded from a 27 determination of reasonable costs under the federal Medicare 28 program pursuant to 42 U.S.C. § 1395X(v)(1)(N). 29 d. For the fiscal year beginning July 1, 2013, reimbursement 30 rates for rural health clinics, hospices, and acute mental 31 hospitals shall be increased in accordance with increases under 32 the federal Medicare program or as supported by their Medicare 33 audited costs. 34 e. For the fiscal year beginning July 1, 2013, independent 35 -62- LSB 1004SV (4) 85 pf/jp 62/ 122
S.F. 446 laboratories and rehabilitation agencies shall be reimbursed 1 using the same methodology in effect on June 30, 2013. 2 f. For the fiscal year beginning July 1, 2013, rates for 3 home health services shall be reimbursed based on the Medicare 4 low utilization payment amount (LUPA) methodology with state 5 geographic wage adjustments. The Medicare LUPA per-visit 6 rates in effect on July 1, 2013, shall be utilized as the 7 basis for establishing the initial reimbursement schedule. 8 The department shall update the rates every two years to 9 reflect the most recent Medicare LUPA rates. For the fiscal 10 year beginning July 1, 2013, the department shall adjust the 11 reimbursement rate as calculated under this paragraph to 12 distribute an additional $2,765,655 over the rates in effect on 13 June 30, 2013, in state reimbursement for home health services 14 with the exception of early and periodic screening, diagnostic 15 and treatment program private duty nursing and personal care 16 services. 17 g. (1) For the fiscal year beginning July 1, 2013, 18 federally qualified health centers shall receive cost-based 19 reimbursement for 100 percent of the reasonable costs for the 20 provision of services to recipients of medical assistance. 21 (2) The department of human services shall amend the medical 22 assistance state plan to allow reimbursement of a federally 23 qualified health center for provision of multiple medical, 24 behavioral health, or dental services provided at the federally 25 qualified health center to a medical assistance program 26 recipient during the course of the same calendar day. 27 h. For the fiscal year beginning July 1, 2013, the 28 reimbursement rates for dental services shall be increased by 29 1.5 percent over the rates in effect on June 30, 2013. 30 i. (1) For the fiscal year beginning July 1, 2013, 31 state-owned psychiatric medical institutions for children shall 32 receive cost-based reimbursement for 100 percent of the actual 33 and allowable costs for the provision of services to recipients 34 of medical assistance. 35 -63- LSB 1004SV (4) 85 pf/jp 63/ 122
S.F. 446 (2) For the nonstate-owned psychiatric medical institutions 1 for children, reimbursement rates shall be based on the 2 reimbursement methodology developed by the department as 3 required for federal compliance. 4 (3) As a condition of participation in the medical 5 assistance program, enrolled providers shall accept the medical 6 assistance reimbursement rate for any covered goods or services 7 provided to recipients of medical assistance who are children 8 under the custody of a psychiatric medical institution for 9 children. 10 j. For the fiscal year beginning July 1, 2013, unless 11 otherwise specified in this Act, all noninstitutional medical 12 assistance provider reimbursement rates shall be increased by 13 1.5 percent over the rates in effect on June 30, 2013, except 14 for area education agencies, local education agencies, infant 15 and toddler services providers, and those providers whose rates 16 are required to be determined pursuant to section 249A.20 . 17 k. Notwithstanding any provision to the contrary, for the 18 fiscal year beginning July 1, 2013, the reimbursement rate for 19 anesthesiologists shall be increased by 1.5 percent over the 20 rate in effect on June 30, 2013. 21 l. Notwithstanding section 249A.20 , for the fiscal year 22 beginning July 1, 2013, the average reimbursement rate for 23 health care providers eligible for use of the federal Medicare 24 resource-based relative value scale reimbursement methodology 25 under that section shall be increased by 1.5 percent over the 26 rate in effect on June 30, 2013; however, this rate shall not 27 exceed the maximum level authorized by the federal government. 28 m. For the fiscal year beginning July 1, 2013, the 29 reimbursement rate for residential care facilities shall not 30 be less than the minimum payment level as established by the 31 federal government to meet the federally mandated maintenance 32 of effort requirement. The flat reimbursement rate for 33 facilities electing not to file annual cost reports shall not 34 be less than the minimum payment level as established by the 35 -64- LSB 1004SV (4) 85 pf/jp 64/ 122
S.F. 446 federal government to meet the federally mandated maintenance 1 of effort requirement. 2 n. For the fiscal year beginning July 1, 2013, inpatient 3 mental health services provided at hospitals shall be increased 4 by 1.5 percent over the rates in effect on June 30, 2013, 5 subject to Medicaid program upper payment limit rules; 6 community mental health centers and providers of mental health 7 services to county residents pursuant to a waiver approved 8 under section 225C.7, subsection 3 , shall be reimbursed at 100 9 percent of the reasonable costs for the provision of services 10 to recipients of medical assistance; and psychiatrists shall be 11 reimbursed at the medical assistance program fee-for-service 12 rate. 13 o. For the fiscal year beginning July 1, 2013, the 14 reimbursement rate for consumer-directed attendant care shall 15 be increased by 1.5 percent over the rates in effect on June 16 30, 2013. 17 p. For the fiscal year beginning July 1, 2013, the 18 reimbursement rate for providers of family planning services 19 that are eligible to receive a 90 percent federal match shall 20 be increased by 1.5 percent over the rates in effect on June 21 30, 2013. 22 q. For the fiscal year beginning July 1, 2013, the upper 23 limits on reimbursement rates for providers of home and 24 community-based services waiver services shall be the limits 25 in effect on June 30, 2013, pursuant to 441 IAC 79.1(2) based 26 on federal Medicare rates, federal veterans administration 27 rates, or the dollar amount specified in the rule, increased 28 by 3 percent. 29 2. For the fiscal year beginning July 1, 2013, the 30 reimbursement rate for providers reimbursed under the 31 in-home-related care program shall not be less than the minimum 32 payment level as established by the federal government to meet 33 the federally mandated maintenance of effort requirement. 34 3. Unless otherwise directed in this section, when the 35 -65- LSB 1004SV (4) 85 pf/jp 65/ 122
S.F. 446 department’s reimbursement methodology for any provider 1 reimbursed in accordance with this section includes an 2 inflation factor, this factor shall not exceed the amount 3 by which the consumer price index for all urban consumers 4 increased during the calendar year ending December 31, 2002. 5 4. a. For the fiscal year beginning July 1, 2013, 6 notwithstanding section 234.38 , the foster family basic daily 7 maintenance rate and the maximum adoption subsidy rate for 8 children ages 0 through 5 years shall be $16.78, the rate for 9 children ages 6 through 11 years shall be $17.45, the rate for 10 children ages 12 through 15 years shall be $19.10, and the 11 rate for children and young adults ages 16 and older shall be 12 $19.35. For youth ages 18 to 21 who have exited foster care, 13 the maximum preparation for adult living program maintenance 14 rate shall be $602.70 per month. The maximum payment for 15 adoption subsidy nonrecurring expenses shall be limited to $500 16 and the disallowance of additional amounts for court costs and 17 other related legal expenses implemented pursuant to 2010 Iowa 18 Acts, chapter 1031, section 408 shall be continued. 19 b. (1) For the fiscal year beginning July 1, 2013, the 20 reimbursement rates for child welfare services providers shall 21 be increased by 5 percent over the rates in effect on June 22 30, 2013, and the maximum reimbursement rate for group foster 23 care providers, including service and maintenance costs, shall 24 be rebased to be equal to the maximum rate allowed for each 25 service level as of June 30, 2013, and the rebased rate shall 26 be increased by 5 percent. 27 (2) For purposes of this lettered paragraph, “child welfare 28 services providers” means the resource family recruitment and 29 retention contractors, the family safety, risk, and permanency 30 services (family-centered) contractors, the child welfare 31 emergency services contractors, and supervised apartment living 32 foster care providers. The reimbursement rates for child 33 welfare services providers and group foster care providers in 34 succeeding fiscal years, including base rates and incentive 35 -66- LSB 1004SV (4) 85 pf/jp 66/ 122
S.F. 446 payments, shall incorporate an inflation factor. The inflation 1 factor shall be equal to the percentage amount by which the 2 annual average consumer price index for all urban consumers, 3 United States city average, issued by the United States 4 department of labor, bureau of labor statistics, increased 5 during the average of the three preceding calendar years ending 6 December 31. 7 c. For the fiscal year beginning July 1, 2013, the maximum 8 reimbursement rates under the supervised apartment living 9 program other than foster care-related, and for social services 10 providers under contract, shall be increased by 5 percent over 11 the rates in effect on June 30, 2013, or the provider’s actual 12 and allowable cost plus inflation for each service, whichever 13 is less. However, if a new service or service provider is 14 added after June 30, 2013, the initial reimbursement rate for 15 the service or provider shall be based upon a weighted average 16 of provider rates for similar services. 17 d. The group foster care reimbursement rates paid for 18 placement of children out of state shall be calculated 19 according to the same rate-setting principles as those used for 20 in-state providers, unless the director of human services or 21 the director’s designee determines that appropriate care cannot 22 be provided within the state. The payment of the daily rate 23 shall be based on the number of days in the calendar month in 24 which service is provided. 25 5. a. For the fiscal year beginning July 1, 2013, the 26 reimbursement rate paid for shelter care and the child welfare 27 emergency services implemented to provide or prevent the need 28 for shelter care shall be established by contract. 29 b. For the fiscal year beginning July 1, 2013, the combined 30 service and maintenance components of the reimbursement rate 31 paid for shelter care services shall be based on the financial 32 and statistical report submitted to the department. The 33 maximum reimbursement rate shall be $96.98 per day. The 34 department shall reimburse a shelter care provider at the 35 -67- LSB 1004SV (4) 85 pf/jp 67/ 122
S.F. 446 provider’s actual and allowable unit cost, plus inflation, not 1 to exceed the maximum reimbursement rate. 2 c. Notwithstanding section 232.141, subsection 8 , for the 3 fiscal year beginning July 1, 2013, the amount of the statewide 4 average of the actual and allowable rates for reimbursement of 5 juvenile shelter care homes that is utilized for the limitation 6 on recovery of unpaid costs shall be increased by $4.62 over 7 the amount in effect for this purpose in the preceding fiscal 8 year. 9 6. For the fiscal year beginning July 1, 2013, the 10 department shall calculate reimbursement rates for intermediate 11 care facilities for persons with intellectual disabilities 12 at the 80th percentile. Beginning July 1, 2013, the rate 13 calculation methodology shall utilize the consumer price index 14 inflation factor applicable to the fiscal year beginning July 15 1, 2013. 16 7. For the fiscal year beginning July 1, 2013, for child 17 care providers reimbursed under the state child care assistance 18 program, the department shall set provider reimbursement 19 rates based on the rate reimbursement survey completed 20 in December 2006. Effective July 1, 2013, the child care 21 provider reimbursement rates shall be increased by 5 percent 22 over the rates in effect on June 30, 2013. The department 23 shall set rates in a manner so as to provide incentives for a 24 nonregistered provider to become registered by applying the 25 increase only to registered and licensed providers. 26 8. Any increase specified in a provider’s reimbursement 27 rate in accordance with this section shall be used to increase 28 compensation and costs of employment, including benefits, for 29 nonadministrative staff. 30 9. The department may adopt emergency rules to implement 31 this section. 32 Sec. 29. EMERGENCY RULES. 33 1. If specifically authorized by a provision of this 34 division of this Act for the fiscal year beginning July 1, 35 -68- LSB 1004SV (4) 85 pf/jp 68/ 122
S.F. 446 2013, the department of human services or the mental health 1 and disability services commission may adopt administrative 2 rules under section 17A.4, subsection 3 , and section 17A.5, 3 subsection 2 , paragraph “b”, to implement the provisions and 4 the rules shall become effective immediately upon filing or 5 on a later effective date specified in the rules, unless the 6 effective date is delayed by the administrative rules review 7 committee. Any rules adopted in accordance with this section 8 shall not take effect before the rules are reviewed by the 9 administrative rules review committee. The delay authority 10 provided to the administrative rules review committee under 11 section 17A.4, subsection 7 , and section 17A.8, subsection 9 , 12 shall be applicable to a delay imposed under this section, 13 notwithstanding a provision in those sections making them 14 inapplicable to section 17A.5, subsection 2 , paragraph “b”. 15 Any rules adopted in accordance with the provisions of this 16 section shall also be published as notice of intended action 17 as provided in section 17A.4 . 18 2. If during the fiscal year beginning July 1, 2013, the 19 department of human services is adopting rules in accordance 20 with this section or as otherwise directed or authorized by 21 state law, and the rules will result in an expenditure increase 22 beyond the amount anticipated in the budget process or if the 23 expenditure was not addressed in the budget process for the 24 fiscal year, the department shall notify the persons designated 25 by this division of this Act for submission of reports, 26 the chairpersons and ranking members of the committees on 27 appropriations, and the department of management concerning the 28 rules and the expenditure increase. The notification shall be 29 provided at least 30 calendar days prior to the date notice of 30 the rules is submitted to the administrative rules coordinator 31 and the administrative code editor. 32 Sec. 30. REPORTS. Any reports or other information 33 required to be compiled and submitted under this Act during the 34 fiscal year beginning July 1, 2013, shall be submitted to the 35 -69- LSB 1004SV (4) 85 pf/jp 69/ 122
S.F. 446 chairpersons and ranking members of the joint appropriations 1 subcommittee on health and human services, the legislative 2 services agency, and the legislative caucus staffs on or 3 before the dates specified for submission of the reports or 4 information. 5 DIVISION VI 6 HEALTH CARE ACCOUNTS AND FUNDS —— FY 2013-2014 7 Sec. 31. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is 8 appropriated from the pharmaceutical settlement account created 9 in section 249A.33 to the department of human services for the 10 fiscal year beginning July 1, 2013, and ending June 30, 2014, 11 the following amount, or so much thereof as is necessary, to be 12 used for the purpose designated: 13 Notwithstanding any provision of law to the contrary, to 14 supplement the appropriations made in this Act for medical 15 contracts under the medical assistance program for the fiscal 16 year beginning July 1, 2013, and ending June 30, 2014: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,650,000 18 Sec. 32. APPROPRIATIONS FROM IOWACARE ACCOUNT. 19 1. There is appropriated from the IowaCare account 20 created in section 249J.24 to the state board of regents for 21 distribution to the university of Iowa hospitals and clinics 22 for the fiscal year beginning July 1, 2013, and ending June 30, 23 2014, for the program period beginning July 1, 2013, and ending 24 December 31, 2013, the following amount, or so much thereof as 25 is necessary, to be used for the purposes designated: 26 For salaries, support, maintenance, equipment, and 27 miscellaneous purposes, for the provision of medical and 28 surgical treatment of indigent patients, for provision of 29 services to members of the expansion population pursuant to 30 chapter 249J , and for medical education: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13,642,292 32 a. Funds appropriated in this subsection shall be used 33 in accordance with 2011 Iowa Acts, chapter 129, section 35, 34 subsection 1, paragraph “a”. 35 -70- LSB 1004SV (4) 85 pf/jp 70/ 122
S.F. 446 b. Notwithstanding any provision of law to the contrary, 1 the amount appropriated in this subsection shall be distributed 2 based on claims submitted, adjudicated, and paid by the Iowa 3 Medicaid enterprise. 4 c. The university of Iowa hospitals and clinics shall 5 certify public expenditures in an amount equal to provide 6 the nonfederal share on total expenditures not to exceed 7 $10,000,000. 8 2. There is appropriated from the IowaCare account 9 created in section 249J.24 to the state board of regents for 10 distribution to the university of Iowa hospitals and clinics 11 for the fiscal year beginning July 1, 2013, and ending June 30, 12 2014, for the program period beginning July 1, 2013, and ending 13 December 31, 2013, the following amount, or so much thereof as 14 is necessary, to be used for the purposes designated: 15 For salaries, support, maintenance, equipment, and 16 miscellaneous purposes, for the provision of medical and 17 surgical treatment of indigent patients, for provision of 18 services to members of the expansion population pursuant to 19 chapter 249J , and for medical education: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 26,284,600 21 Notwithstanding any provision of law to the contrary, the 22 amount appropriated in this subsection shall be distributed 23 based on claims submitted, adjudicated, and paid by the Iowa 24 Medicaid enterprise. 25 3. There is appropriated from the IowaCare account 26 created in section 249J.24 to the state board of regents for 27 distribution to university of Iowa physicians for the fiscal 28 year beginning July 1, 2013, and ending June 30, 2014, for the 29 program period beginning July 1, 2013, and ending December 31, 30 2013, the following amount, or so much thereof as is necessary 31 to be used for the purposes designated: 32 For salaries, support, maintenance, equipment, and 33 miscellaneous purposes for the provision of medical and 34 surgical treatment of indigent patients, for provision of 35 -71- LSB 1004SV (4) 85 pf/jp 71/ 122
S.F. 446 services to members of the expansion population pursuant to 1 chapter 249J , and for medical education: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 9,903,183 3 Notwithstanding any provision of law to the contrary, the 4 amount appropriated in this subsection shall be distributed 5 based on claims submitted, adjudicated, and paid by the Iowa 6 Medicaid enterprise. Once the entire amount appropriated in 7 this subsection has been distributed, claims shall continue to 8 be submitted and adjudicated by the Iowa Medicaid enterprise; 9 however, no payment shall be made based upon such claims. 10 4. There is appropriated from the IowaCare account created 11 in section 249J.24 to the department of human services for 12 the fiscal year beginning July 1, 2013, and ending June 30, 13 2014, for the program period beginning July 1, 2013, and ending 14 December 31, 2013, the following amount, or so much thereof as 15 is necessary, to be used for the purposes designated: 16 For distribution to a publicly owned acute care teaching 17 hospital located in a county with a population over 350,000 for 18 the provision of medical and surgical treatment of indigent 19 patients, for provision of services to members of the expansion 20 population pursuant to chapter 249J , and for medical education: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,750,000 22 a. Notwithstanding any provision of law to the contrary, 23 the amount appropriated in this subsection shall be distributed 24 based on claims submitted, adjudicated, and paid by the Iowa 25 Medicaid enterprise plus a monthly disproportionate share 26 hospital payment. Any amount appropriated in this subsection 27 in excess of $32,000,000 shall be distributed only if the sum 28 of the expansion population claims adjudicated and paid by the 29 Iowa Medicaid enterprise plus the estimated disproportionate 30 share hospital payments exceeds $32,000,000. The amount paid 31 in excess of $32,000,000 shall not adjust the original monthly 32 payment amount but shall be distributed monthly based on actual 33 claims adjudicated and paid by the Iowa Medicaid enterprise 34 plus the estimated disproportionate share hospital amount. Any 35 -72- LSB 1004SV (4) 85 pf/jp 72/ 122
S.F. 446 amount appropriated in this subsection in excess of $32,000,000 1 shall be allocated only if federal funds are available to match 2 the amount allocated. Pursuant to paragraph “b”, of the amount 3 appropriated in this subsection, not more than $2,000,000 shall 4 be distributed for prescription drugs, podiatry services, 5 optometric services, and durable medical equipment. 6 b. Notwithstanding any provision of law to the contrary, the 7 hospital identified in this subsection shall be reimbursed for 8 outpatient prescription drugs, podiatry services, optometric 9 services, and durable medical equipment provided to members 10 of the expansion population pursuant to all applicable 11 medical assistance program rules, in an amount not to exceed 12 $2,000,000. 13 c. Notwithstanding the total amount of proceeds distributed 14 pursuant to section 249J.24, subsection 4 , paragraph “a”, 15 unnumbered paragraph 1, for the fiscal year beginning July 16 1, 2013, and ending June 30, 2014, the county treasurer of a 17 county with a population of over 350,000 in which a publicly 18 owned acute care teaching hospital is located shall distribute 19 the proceeds collected pursuant to section 347.7 between 20 July 1, 2013, and December 31, 2013, in a total amount of 21 $19,000,000, which would otherwise be distributed to the county 22 hospital, to the treasurer of state for deposit in the IowaCare 23 account. 24 d. Notwithstanding the amount collected and distributed 25 for deposit in the IowaCare account pursuant to section 26 249J.24, subsection 4 , paragraph “a”, subparagraph (1), the 27 first $19,000,000 in proceeds collected pursuant to section 28 347.7 between July 1, 2013, and December 31, 2013, shall be 29 distributed to the treasurer of state for deposit in the 30 IowaCare account and collections during this time period in 31 excess of $19,000,000 shall be distributed to the acute care 32 teaching hospital identified in this subsection. Of the 33 collections in excess of the $19,000,000 received by the acute 34 care teaching hospital under this paragraph “d”, $2,000,000 35 -73- LSB 1004SV (4) 85 pf/jp 73/ 122
S.F. 446 shall be distributed by the acute care teaching hospital to the 1 treasurer of state for deposit in the IowaCare account in the 2 month of January 2014, following the July 1 through December 3 31, 2013, period. 4 5. There is appropriated from the IowaCare account created 5 in section 249J.24 to the department of human services for 6 the fiscal year beginning July 1, 2013, and ending June 30, 7 2014, for the program period beginning July 1, 2013, and ending 8 December 31, 2013, the following amount, or so much thereof as 9 is necessary to be used for the purpose designated: 10 For payment to the regional provider network specified 11 by the department pursuant to section 249J.7 for provision 12 of covered services to members of the expansion population 13 pursuant to chapter 249J : 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,993,183 15 Notwithstanding any provision of law to the contrary, the 16 amount appropriated in this subsection shall be distributed 17 based on claims submitted, adjudicated, and paid by the Iowa 18 Medicaid enterprise. Once the entire amount appropriated in 19 this subsection has been distributed, claims shall continue to 20 be submitted and adjudicated by the Iowa Medicaid enterprise; 21 however, no payment shall be made based upon such claims. 22 6. There is appropriated from the IowaCare account created 23 in section 249J.24 to the department of human services for 24 the fiscal year beginning July 1, 2013, and ending June 30, 25 2014, for the program period beginning July 1, 2013, and ending 26 December 31, 2013, the following amount, or so much thereof as 27 is necessary, to be used for the purposes designated: 28 For a laboratory test and radiology pool for services 29 authorized by a federally qualified health center designated 30 by the department as part of the IowaCare regional provider 31 network that does not have the capability to provide these 32 services on site: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,500,000 34 Notwithstanding sections 249J.6 and 249J.7 , the amount 35 -74- LSB 1004SV (4) 85 pf/jp 74/ 122
S.F. 446 appropriated in this subsection is intended to provide 1 reimbursement for services provided to expansion population 2 members that have previously been paid for through expenditure 3 by designated regional provider network providers of their 4 own funds, not to expand coverage under the IowaCare program 5 or to expand the expansion population provider network. The 6 department shall designate the laboratory and radiology 7 provider associated with each designated regional provider 8 network provider that may receive reimbursement. The 9 department shall adopt administrative rules pursuant to chapter 10 17A to establish a prior authorization process and to identify 11 covered services for reimbursement under this subsection. 12 All other medical assistance program payment policies and 13 rules for laboratory and radiology services shall apply to 14 services provided under this subsection. If the entire amount 15 appropriated under this subsection is expended, laboratory 16 tests and radiology services ordered by a designated regional 17 provider network provider shall be the financial responsibility 18 of the regional provider network provider. 19 Sec. 33. APPROPRIATIONS FROM NONPARTICIPATING 20 PROVIDER REIMBURSEMENT FUND —— DEPARTMENT OF HUMAN 21 SERVICES. Notwithstanding any provision to the contrary, and 22 subject to the availability of funds, there is appropriated 23 from the nonparticipating provider reimbursement fund created 24 in section 249J.24A to the department of human services for 25 the fiscal year beginning July 1, 2013, and ending June 30, 26 2014, for the program period beginning July 1, 2013, and ending 27 December 31, 2013, the following amount, or so much thereof as 28 is necessary, for the purposes designated: 29 To reimburse nonparticipating providers in accordance with 30 section 249J.24A : 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 32 Sec. 34. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF HUMAN 33 SERVICES. Notwithstanding any provision to the contrary and 34 subject to the availability of funds, there is appropriated 35 -75- LSB 1004SV (4) 85 pf/jp 75/ 122
S.F. 446 from the quality assurance trust fund created in section 1 249L.4 to the department of human services for the fiscal year 2 beginning July 1, 2013, and ending June 30, 2014, the following 3 amounts, or so much thereof as is necessary, for the purposes 4 designated: 5 To supplement the appropriation made in this Act from the 6 general fund of the state to the department of human services 7 for medical assistance for the same fiscal year: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 28,788,917 9 Sec. 35. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 10 DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to 11 the contrary and subject to the availability of funds, there is 12 appropriated from the hospital health care access trust fund 13 created in section 249M.4 to the department of human services 14 for the fiscal year beginning July 1, 2013, and ending June 15 30, 2014, the following amounts, or so much thereof as is 16 necessary, for the purposes designated: 17 1. To supplement the appropriation made in this Act from the 18 general fund of the state to the department of human services 19 for medical assistance for the same fiscal year: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34,288,000 21 2. For deposit in the nonparticipating provider 22 reimbursement fund created in section 249J.24A to be used for 23 the purposes of the fund: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 412,000 25 Sec. 36. MEDICAL ASSISTANCE PROGRAM —— NONREVERSION 26 FOR FY 2013-2014. Notwithstanding section 8.33 , if moneys 27 appropriated for purposes of the medical assistance program for 28 the fiscal year beginning July 1, 2013, and ending June 30, 29 2014, from the general fund of the state, the quality assurance 30 trust fund and the hospital health care access trust fund, are 31 in excess of actual expenditures for the medical assistance 32 program and remain unencumbered or unobligated at the close 33 of the fiscal year, the excess moneys shall not revert but 34 shall remain available for expenditure for the purposes of the 35 -76- LSB 1004SV (4) 85 pf/jp 76/ 122
S.F. 446 medical assistance program until the close of the succeeding 1 fiscal year. 2 DIVISION VII 3 CHILDREN’S HEALTH INSURANCE PROGRAM —— CHILD ENROLLMENT 4 CONTINGENCY FUND —— FY 2013-2014 5 Sec. 37. CHILDREN’S HEALTH INSURANCE PROGRAM —— CHILD 6 ENROLLMENT CONTINGENCY FUND —— DIRECTIVES FOR USE OF FUNDS —— 7 FY 2013-2014. 8 1. Any funds remaining on June 30, 2013, from moneys 9 received from the federal government through the child 10 enrollment contingency fund established pursuant to section 11 103 of the federal Children’s Health Insurance Program 12 Reauthorization Act of 2009, Pub. L. No. 111-3, are transferred 13 to the rebuild Iowa infrastructure fund established pursuant 14 to section 8.57 and are appropriated to the department of 15 administrative services for the fiscal year beginning July 1, 16 2013, and ending June 30, 2014, to be used for projects related 17 to major repairs and major maintenance for state buildings and 18 facilities. The department of human services shall work with 19 the department of administrative services in drawing down the 20 federal funds. 21 DIVISION VIII 22 PRIOR YEAR APPROPRIATIONS 23 RESPITE 24 Sec. 38. 2011 Iowa Acts, chapter 129, section 128, as 25 amended by 2012 Iowa Acts, chapter 1133, section 22, subsection 26 26, is amended to read as follows: 27 26. Of the funds appropriated in this section, at least 28 $25,000 shall be used to continue and to expand the foster 29 care respite pilot program in which postsecondary students in 30 social work and other human services-related programs receive 31 experience by assisting family foster care providers with 32 respite and other support. Notwithstanding section 8.33, 33 moneys allocated in this subsection that remain unencumbered or 34 unobligated at the close of the fiscal year shall not revert 35 -77- LSB 1004SV (4) 85 pf/jp 77/ 122
S.F. 446 but shall remain available for expenditure for the purposes 1 designated until the close of the succeeding fiscal year. 2 MEDICAL ASSISTANCE —— GENERAL FUND 3 Sec. 39. 2011 Iowa Acts, chapter 129, section 122, 4 unnumbered paragraph 2, is amended to read as follows: 5 For medical assistance program reimbursement and associated 6 costs as specifically provided in the reimbursement 7 methodologies in effect on June 30, 2012, except as otherwise 8 expressly authorized by law, and consistent with options under 9 federal law and regulations: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 914,993,421 11 968,276,514 12 MEDICAL ASSISTANCE —— IOWACARE TRANSFER ALLOCATION 13 Sec. 40. 2011 Iowa Acts, chapter 129, section 122, 14 subsection 13, as amended by 2012 Iowa Acts, chapter 1133, 15 section 10, is amended to read as follows: 16 13. Of the funds appropriated in this section, up to 17 $8,684,329 $16,004,422 may be transferred to the IowaCare 18 account created in section 249J.24 . 19 ADOPTION SUBSIDY —— GENERAL FUND 20 Sec. 41. 2011 Iowa Acts, chapter 129, section 129, as 21 amended by 2012 Iowa Acts, chapter 1133, section 23, subsection 22 1, is amended to read as follows: 23 1. There is appropriated from the general fund of the 24 state to the department of human services for the fiscal year 25 beginning July 1, 2012, and ending June 30, 2013, the following 26 amount, or so much thereof as is necessary, to be used for the 27 purpose designated: 28 For adoption subsidy payments and services: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 36,788,576 30 37,780,672 31 NURSING FACILITY REIMBURSEMENT 32 Sec. 42. 2011 Iowa Acts, chapter 129, section 141, 33 subsection 1, paragraph a, subparagraph (1), as amended by 34 2012 Iowa Acts, chapter 1133, section 32, is amended to read 35 -78- LSB 1004SV (4) 85 pf/jp 78/ 122
S.F. 446 as follows: 1 (1) For the fiscal year beginning July 1, 2012, the total 2 state funding amount for the nursing facility budget shall not 3 exceed $237,226,901 $239,226,901 . 4 Sec. 43. EFFECTIVE UPON ENACTMENT. This division of this 5 Act, being deemed of immediate importance, takes effect upon 6 enactment. 7 DIVISION IX 8 CHILD WELFARE AND CHILD CARE 9 Sec. 44. Section 232.142, subsection 5, Code 2013, is 10 amended to read as follows: 11 5. The director shall approve annually all such homes 12 established and maintained under the provisions of this 13 chapter . A home shall not be approved unless it complies with 14 minimal rules and standards adopted by the director and has 15 been inspected by the department of inspections and appeals. 16 The statewide number of beds in the homes approved by the 17 director shall not exceed the number of beds in approved homes 18 as of July 1, 2012. 19 Sec. 45. Section 237A.13, subsection 7, paragraph c, Code 20 2013, is amended to read as follows: 21 c. Families with an income of more than one hundred percent 22 but not more than one hundred forty-five forty-eight percent of 23 the federal poverty level whose members are employed at least 24 twenty-eight hours per week. 25 Sec. 46. Section 237A.13, subsection 8, Code 2013, is 26 amended to read as follows: 27 8. Nothing in this section shall be construed as or is 28 intended as, or shall imply, a grant of entitlement for 29 services to persons who are eligible for assistance due to 30 an income level or other eligibility circumstance addressed 31 in this section . Any state obligation to provide services 32 pursuant to this section is limited to the extent of the funds 33 appropriated for the purposes of state child care assistance. 34 The standard period for redetermining the eligibility of a 35 -79- LSB 1004SV (4) 85 pf/jp 79/ 122
S.F. 446 program participant is twelve months after the date of the 1 initial determination of eligibility and every twelve months 2 thereafter. 3 DIVISION X 4 AGING 5 Sec. 47. Section 231.33, subsection 21, Code 2013, if 6 enacted by 2013 Iowa Acts, Senate File 184, section 22, is 7 amended to read as follows: 8 21. Comply with all applicable requirements of the Iowa 9 public employees’ retirement system established pursuant to 10 chapter 97B. Notwithstanding any provision to the contrary, 11 an employee of an area agency on aging that was enrolled in 12 an alternative qualified plan prior to July 1, 2012, may 13 continue participation in that alternative qualified plan in 14 lieu of mandatory participation in the Iowa public employees’ 15 retirement system. 16 Sec. 48. Section 231.42, subsection 7, paragraph a, Code 17 2013, is amended to read as follows: 18 a. An officer, owner, director, or employee of a long-term 19 care facility, assisted living program, or elder group home who 20 intentionally prevents, interferes with, or attempts to impede 21 the work of the state or a local long-term care resident’s 22 advocate is subject to a penalty imposed by the director of not 23 more than one thousand five hundred dollars for each violation. 24 If the director imposes a penalty for a violation under this 25 paragraph, no other state agency shall impose a penalty for the 26 same interference violation. Any moneys collected pursuant 27 to this subsection shall be deposited in the general fund of 28 the state and are appropriated to the office of long-term care 29 ombudsman to be used for administration and the duties of the 30 office . 31 Sec. 49. REPEAL. Section 231E.13, Code 2013, is repealed. 32 Sec. 50. TASK FORCE ON ELDER ABUSE PREVENTION AND 33 INTERVENTION. 34 1. The department on aging shall convene a task force 35 -80- LSB 1004SV (4) 85 pf/jp 80/ 122
S.F. 446 on elder abuse prevention and intervention to continue the 1 work of the elder abuse task force established pursuant to 2 2012 Iowa Acts, chapter 1056. The task force shall include 3 representatives of the department on aging, the office of 4 long-term care resident’s advocate, the department of human 5 services, the department of inspections and appeals, the 6 department of public health, the office of the attorney 7 general, the department of veterans affairs, the department 8 of public safety, the insurance division of the department 9 of commerce, a county attorney’s office with experience 10 in prosecuting elder abuse, the superintendent of banking, 11 the courts, the elder law section of the Iowa state bar 12 association, and other affected stakeholders. The task force 13 shall form workgroups as necessary to address the specific 14 recommendations. 15 2. The task force shall review the report of the elder 16 abuse task force submitted in December 2012, develop an 17 implementation plan for the recommendations, and make any 18 additional recommendations as necessary. The implementation 19 plan and additional recommendations shall address all of the 20 following: 21 a. The design of the comprehensive approach to elder 22 abuse prevention and intervention in the state utilizing the 23 prevention of elder abuse program pursuant to section 231.56A 24 and the office of substitute decision maker created pursuant 25 to chapter 231E. The design shall also address all of the 26 following: 27 (1) Harmonization of the approach design with the 28 existing dependent adult abuse system pursuant to chapter 29 235B, including but not limited to standardized training, 30 collaboration between the elder abuse approach and the 31 department of human services when a report of dependent adult 32 abuse involves an older individual, and the membership of 33 multidisciplinary teams. 34 (2) Incorporation of the approach design into other 35 -81- LSB 1004SV (4) 85 pf/jp 81/ 122
S.F. 446 existing and developing components of the system including 1 the area agencies on aging, the mental health and disability 2 services regions, local public health departments, the local 3 offices of the department on human services, the courts, and 4 other appropriate entities, to most effectively and efficiently 5 address the needs of older individuals. 6 (3) A determination as to whether to provide specialized 7 elder abuse units in police departments, the office of the 8 attorney general, prosecutors’ offices, and other sectors. 9 (4) A determination as to whether to develop specialized 10 elder law courts as a mechanism for addressing elder abuse and 11 the needs of older individuals in the court system. 12 b. The definition of elder abuse to be used in the approach 13 to elder abuse. The task force shall address continued use 14 of the definition of “elder abuse” as specified under the 15 federal Older Americans Act and utilized by the prevention of 16 elder abuse program under section 231.56A, or shall provide a 17 specific alternative definition. 18 c. The designation of a single point of contact to report 19 elder abuse. The task force shall specifically address 20 utilizing the aging and disability resource center network as 21 the single point of contact. 22 d. The means of addressing financial exploitation of older 23 individuals, including those relating to powers of attorney and 24 conservatorships as described in the 2012 task force report. 25 The task force shall do all of the following: 26 (1) Enlist the involvement of the elder law and probate 27 sections of the Iowa state bar association to review, develop, 28 and submit as proposed legislation for the 2014 legislative 29 session, the uniform power of attorney Act. 30 (2) Determine whether and what specific crimes should 31 be established to address financial exploitation of older 32 individuals. 33 e. Promotion of public awareness of elder abuse and the 34 services and support available to older individuals at risk of 35 -82- LSB 1004SV (4) 85 pf/jp 82/ 122
S.F. 446 or experiencing elder abuse. 1 f. Any specific changes in statute and rules necessary to 2 achieve the recommendations of the task force. 3 3. The task force shall submit a progress report to the 4 elder abuse prevention and intervention legislative interim 5 committee established pursuant to this Act for review, by 6 October 31, 2013, and shall submit a final report of its 7 recommendations and proposed legislation following approval 8 by the legislative interim committee to the governor and the 9 general assembly no later than December 31, 2013. 10 Sec. 51. LEGISLATIVE INTERIM COMMITTEE. The legislative 11 council is requested to establish a legislative interim 12 committee on elder abuse prevention and intervention for the 13 2013 legislative interim to monitor the progress of, and 14 provide direction to, the task force on elder abuse prevention 15 and intervention created in this Act. The legislative 16 committee shall review the progress report and approve the 17 final report of the task force and shall submit the committee’s 18 recommendations and a final report to the general assembly 19 following completion of the committee’s work. 20 Sec. 52. PILOT PROJECT —— GUARDIANSHIP AND CONSERVATORSHIP 21 MONITORING. The department on aging shall collaborate 22 with the national health law and policy resource center 23 at the university of Iowa college of law to establish a 24 three-year pilot project to train, recruit, and oversee 25 volunteers to assist the courts in monitoring guardianships and 26 conservatorships and to provide assistance to guardians and 27 conservators. The pilot project shall be implemented initially 28 in the sixth judicial district. The pilot project shall be 29 utilized to establish a basis for an ongoing guardianship and 30 conservatorship monitoring and assistance program administered 31 through the department on aging. The department on aging 32 shall submit an annual report to the individuals identified 33 in this Act for submission of reports. The annual report 34 shall include the objectives and results for the pilot project 35 -83- LSB 1004SV (4) 85 pf/jp 83/ 122
S.F. 446 year, how the funds allocated were utilized in meeting the 1 pilot project’s objectives, the number of individuals served, 2 the types of services provided, any other sources of funding 3 utilized or identified as available for the pilot project, and 4 the continuing needs of the pilot project. 5 Sec. 53. EFFECTIVE UPON ENACTMENT. The section of this 6 division of this Act establishing a task force on elder abuse 7 prevention, being deemed of immediate importance, takes effect 8 upon enactment. 9 Sec. 54. EFFECTIVE UPON ENACTMENT. The section of this 10 division of this Act amending section 231.33, subsection 21, 11 if enacted by 2013 Iowa Acts, Senate File 184, being deemed of 12 immediate importance, takes effect upon enactment. 13 Sec. 55. RETROACTIVE APPLICABILITY. The section of this 14 division of this Act amending section 231.33, subsection 21, 15 if enacted by 2013 Iowa Acts, applies retroactively to July 1, 16 2012. 17 DIVISION XI 18 EMS TASK FORCE 19 Sec. 56. EMERGENCY MEDICAL SERVICES TASK FORCE AND REPORT. 20 1. The department of public health shall establish a task 21 force to ensure the future availability of quality emergency 22 medical services for the state. 23 2. The members of the task force shall be appointed by the 24 director of the department of public health, or the director’s 25 designee, as follows: 26 a. A manager of a rural volunteer emergency medical 27 transport service. 28 b. A manager of a rural paid emergency medical transport 29 service. 30 c. A manager of an urban emergency medical transport 31 service. 32 d. A manager of a nontransport emergency medical service. 33 e. A representative of a fire department-based emergency 34 medical service. 35 -84- LSB 1004SV (4) 85 pf/jp 84/ 122
S.F. 446 f. A representative of a hospital-based emergency medical 1 service. 2 g. A representative of a private, for-profit emergency 3 medical transport service. 4 h. A representative of a not-for-profit emergency medical 5 transport service. 6 i. A representative of the Iowa emergency medical services 7 association board of directors. 8 j. A representative of an emergency medical services 9 training agency. 10 k. An urban emergency department physician. 11 l. A rural emergency department physician. 12 m. A representative of the Iowa emergency nurses 13 association. 14 n. A representative of the Iowa alliance in home care. 15 o. A representative of an emergency medical service air 16 ambulance. 17 p. A representative of the Iowa hospital association. 18 q. A representative of the private insurance industry. 19 r. A representative of the Iowa Medicaid enterprise 20 division of the department of human services. 21 s. A representative of city government. 22 t. A representative of county government. 23 u. A representative of the nursing facility industry. 24 v. A representative of the Iowa behavioral health 25 association. 26 w. A consumer of emergency medical services. 27 x. An advanced registered nurse practitioner. 28 3. The task force shall discuss the current state of 29 emergency medical services in Iowa and make recommendations for 30 enhancement of Iowa’s emergency medical services system. The 31 recommendations shall address issues facing volunteer and paid 32 rural emergency medical services, cost projections including 33 administration costs for all recommendations, the Medicaid 34 reimbursement fee schedule for ambulance services, and the 35 -85- LSB 1004SV (4) 85 pf/jp 85/ 122
S.F. 446 nature and scope of any recommended changes in regulations 1 governing emergency medical services. 2 4. The task force shall, by April 30, 2014, submit a final 3 report of its findings and recommendations to the governor, 4 the general assembly, the department of public health, and the 5 emergency medical services advisory council. The emergency 6 medical services advisory council shall review the report and 7 make recommendations related to implementation of the report’s 8 recommendations to the director of the department of public 9 health. 10 DIVISION XII 11 MEDICATION THERAPY MANAGEMENT 12 Sec. 57. MEDICATION THERAPY MANAGEMENT —— MEDICAID. 13 1. As used in this section, “medication therapy management” 14 means a systematic process performed by a licensed pharmacist, 15 designed to improve quality outcomes for patients and lower 16 health care costs, including emergency room, hospital, 17 provider, and other costs, by optimizing appropriate medication 18 use linked directly to achievement of the clinical goals of 19 therapy. Medication therapy management shall include all of 20 the following services: 21 a. A medication therapy review and in-person consultation 22 relating to all medications, vitamins, and herbal supplements 23 currently being taken by an eligible individual. 24 b. A medication action plan, subject to the limitations 25 specified in this section, communicated to the individual and 26 the individual’s primary care physician or other appropriate 27 prescriber to address issues including appropriateness, 28 effectiveness, safety, drug interactions, and adherence. The 29 medication action plan may include drug therapy recommendations 30 to prescribers that are needed to meet clinical goals and 31 achieve optimal patient outcomes. 32 c. Documentation and follow-up to ensure consistent levels 33 of pharmacy services and positive outcomes. 34 2. a. The department of human services shall utilize a 35 -86- LSB 1004SV (4) 85 pf/jp 86/ 122
S.F. 446 request for proposals process and shall enter into a contract 1 for the provision of medication therapy management services for 2 eligible medical assistance program recipients who meet any of 3 the following criteria: 4 (1) An individual who takes four or more prescription drugs 5 to treat or prevent two or more chronic medical conditions. 6 (2) An individual with a prescription drug therapy problem 7 who is identified by the prescribing physician or other 8 appropriate prescriber, and referred to a pharmacist for 9 medication therapy management services. 10 (3) An individual who meets other criteria established by 11 the Iowa Medicaid enterprise. 12 b. The fees for pharmacist-delivered medication therapy 13 management services shall be separate from the reimbursement 14 for prescription drug product or dispensing services, and 15 shall be reasonable based on the resources and time required 16 to provide the service. 17 c. A fee shall be established for physician reimbursement 18 for services delivered for medication therapy management and 19 shall be reasonable based on the resources and time required 20 to provide the service. 21 d. If any part of the medication therapy management 22 plan developed by a pharmacist incorporates services which 23 are outside the pharmacist’s independent scope of practice 24 including the initiation of therapy, modification of dosages, 25 therapeutic interchange, or changes in drug therapy, the 26 express authorization of the individual’s physician or other 27 appropriate prescriber shall be required. 28 Sec. 58. EFFECTIVE UPON ENACTMENT. This division of this 29 Act, being deemed of immediate importance, takes effect upon 30 enactment. 31 DIVISION XIII 32 HOSPITAL PROVIDER TAX 33 Sec. 59. Section 249M.5, Code 2013, is amended to read as 34 follows: 35 -87- LSB 1004SV (4) 85 pf/jp 87/ 122
S.F. 446 249M.5 Future repeal. 1 This chapter is repealed June 30, 2013 2016 . 2 Sec. 60. EFFECTIVE UPON ENACTMENT. The section of this 3 division of this Act relating to the future repeal of the 4 hospital health care access assessment program chapter, being 5 deemed of immediate importance, takes effect upon enactment. 6 DIVISION XIV 7 ILL AND HANDICAPPED WAIVER NAME CHANGE 8 Sec. 61. Section 423.3, subsection 18, paragraph f, 9 subparagraph (1), Code 2013, is amended to read as follows: 10 (1) Ill and handicapped Health and disability waiver 11 service providers, described in 441 IAC 77.30. 12 DIVISION XV 13 MILLER TRUST 14 Sec. 62. Section 633C.2, Code 2013, is amended to read as 15 follows: 16 633C.2 Disposition of medical assistance special needs 17 trusts. 18 Regardless of the terms of a medical assistance special 19 needs trust, any income received or asset added to the trust 20 during a one-month period shall be expended as provided for 21 medical assistance income trusts under section 633C.3 , on 22 a monthly basis, during the life of the beneficiary. Any 23 increase in income or principal retained in the trust from 24 a previous month may be expended, during the life of the 25 beneficiary, only for reasonable and necessary expenses of 26 the trust, not to exceed ten twenty-five dollars per month 27 without court approval, for special needs of the beneficiary 28 attributable to the beneficiary’s disability and approved by 29 the district court, for medical care or services that would 30 otherwise be covered by medical assistance under chapter 249A , 31 or to reimburse the state for medical assistance paid on behalf 32 of the beneficiary. 33 Sec. 63. Section 633C.3, subsection 1, unnumbered paragraph 34 1, Code 2013, is amended to read as follows: 35 -88- LSB 1004SV (4) 85 pf/jp 88/ 122
S.F. 446 Regardless of the terms of a medical assistance income 1 trust, if the beneficiary’s total monthly income is less 2 than one hundred and twenty-five percent of the average 3 statewide charge for nursing facility services to a private 4 pay resident of a nursing facility, then, during the life of 5 the beneficiary, any property received or held by the trust 6 shall be expended only as follows, as applicable, and in the 7 following order of priority: 8 Sec. 64. Section 633C.3, subsection 1, paragraph a, Code 9 2013, is amended to read as follows: 10 a. A reasonable amount may be paid or set aside each 11 month for necessary expenses of the trust, not to exceed ten 12 twenty-five dollars per month without court approval. 13 Sec. 65. Section 633C.3, subsection 2, unnumbered paragraph 14 1, Code 2013, is amended to read as follows: 15 Regardless of the terms of a medical assistance income 16 trust, if the beneficiary’s total monthly income is at or above 17 one hundred and twenty-five percent of the average statewide 18 charge for nursing facility services to a private-pay resident, 19 then, during the life of the beneficiary, any property received 20 or held by the trust shall be expended only as follows, as 21 applicable, in the following order of priority: 22 Sec. 66. Section 633C.3, subsection 2, paragraph a, Code 23 2013, is amended to read as follows: 24 a. A reasonable amount may be paid or set aside each 25 month for necessary expenses of the trust, not to exceed ten 26 twenty-five dollars per month without court approval. 27 Sec. 67. APPLICABILITY. The sections of this division of 28 this Act amending sections 633C.2 and 633C.3 apply to trusts in 29 existence on or after July 1, 2013. 30 DIVISION XVI 31 FAMILY PLANNING WAIVER —— STATE PLAN 32 Sec. 68. Section 249A.3, subsection 2, paragraph a, 33 subparagraph (10), Code 2013, is amended to read as follows: 34 (10) Individuals eligible for family planning services 35 -89- LSB 1004SV (4) 85 pf/jp 89/ 122
S.F. 446 under a federally approved demonstration waiver or state plan . 1 Sec. 69. MEDICAID STATE PLAN AMENDMENT —— FAMILY 2 PLANNING. The department of human services shall amend the 3 medical assistance state plan to include, effective no later 4 than January 1, 2014, the eligibility provisions of the Iowa 5 family planning network section 1115 demonstration waiver in 6 effect on January 1, 2013, as the criteria is amended to be 7 applicable to individuals who are uninsured or who have health 8 insurance coverage subject to the medical assistance program 9 being the payer of last resort. The department shall implement 10 the state plan amendment upon receipt of approval by the 11 centers for Medicare and Medicaid services of the United States 12 department of health and human services. 13 Sec. 70. 2010 Iowa Acts, chapter 1192, section 11, 14 subsection 24, paragraph a, subparagraph (1), subparagraph 15 division (a), is amended to read as follows: 16 (a) Are uninsured or have health insurance coverage that 17 does not include coverage for benefits provided under the Iowa 18 family planning network subject to the medical assistance 19 program being the payer of last resort . 20 Sec. 71. EFFECTIVE UPON ENACTMENT AND CONTINGENT 21 IMPLEMENTATION. The sections of this division of this 22 Act relating to the family planning waiver and state plan 23 amendment, being deemed of immediate importance, take effect 24 upon enactment. However, the department of human services 25 shall only implement those sections to the extent the 26 department receives federal approval of the requests relating 27 to the waiver and the medical assistance state plan amendment 28 necessary to implement those sections. 29 DIVISION XVII 30 MISCELLANEOUS HEALTH CARE AMENDMENTS 31 Sec. 72. Section 249A.2, subsection 1, Code 2013, is amended 32 by striking the subsection. 33 Sec. 73. Section 249A.2, subsections 4 and 7, Code 2013, are 34 amended to read as follows: 35 -90- LSB 1004SV (4) 85 pf/jp 90/ 122
S.F. 446 4. “Discretionary medical assistance” means mandatory 1 medical assistance or additional optional medical assistance 2 provided to medically needy individuals whose income and 3 resources are in excess of eligibility limitations but are 4 insufficient to meet all of the costs of necessary medical 5 care and services, provided that if the assistance includes 6 services in institutions for mental diseases or intermediate 7 care facilities for persons with an intellectual disability, 8 or both, for any group of such individuals, the assistance 9 also includes for all covered groups of such individuals at 10 least the care and services enumerated in Tit. XIX of the 11 federal Social Security Act, section 1905(a), paragraphs (1) 12 through (5), and (17), as codified in 42 U.S.C. § 1396d(a), 13 pars. (1) through (5), and (17), or any seven of the care and 14 services enumerated in Tit. XIX of the federal Social Security 15 Act, section 1905(a), paragraphs (1) through (7) and (9) 16 through (18) (24) , as codified in 42 U.S.C. § 1396d(a), pars. 17 paragraphs (1) through (7), and (9) through (18) (24) . 18 7. “Medical assistance” means payment of all or part of 19 the costs of the care and services required to be provided by 20 made in accordance with Tit. XIX of the federal Social Security 21 Act , section 1905(a), paragraphs (1) through (5), and (17), as 22 codified in 42 U.S.C. § 1396d(a), pars. (1) through (5), and 23 (17) and authorized pursuant to this chapter . 24 Sec. 74. Section 249A.2, Code 2013, is amended by adding the 25 following new subsections: 26 NEW SUBSECTION . 6A. “Mandatory medical assistance” means 27 payment of all or part of the costs of the care and services 28 required to be provided by Tit. XIX of the federal Social 29 Security Act, section 1905(a), paragraphs (1) through (5), 30 (17),(21), and (28), as codified in 42 U.S.C. § 1396d(a), 31 paragraphs (1) through (5), (17), (21), and (28). 32 NEW SUBSECTION . 7A. “Medical assistance program” means 33 the program established under this chapter to provide medical 34 assistance. 35 -91- LSB 1004SV (4) 85 pf/jp 91/ 122
S.F. 446 NEW SUBSECTION . 8A. “Optional medical assistance” means 1 payment of all or part of the costs of any or all of the care 2 and services authorized to be provided by Tit. XIX of the 3 federal Social Security Act, section 1905(a), paragraphs (6) 4 through (16), (18) through (20), (22) through (27), and (29), 5 as codified in 42 U.S.C. § 1396d(a), paragraphs (6) through 6 (16), and (18) through (20), (22) through (27), and (29). 7 Sec. 75. Section 249A.3, subsection 1, unnumbered paragraph 8 1, Code 2013, is amended to read as follows: 9 Medical Mandatory medical assistance shall be provided to, 10 or on behalf of, any individual or family residing in the state 11 of Iowa, including those residents who are temporarily absent 12 from the state, who: 13 Sec. 76. Section 249A.3, subsection 1, paragraph l, 14 subparagraph (2), Code 2013, is amended to read as follows: 15 (2) Additionally, effective July 1, 2009, medical 16 assistance shall be provided to Is a pregnant woman or infant 17 whose family income is at or below three hundred percent of the 18 federal poverty level, as defined by the most recently revised 19 poverty income guidelines published by the United States 20 department of health and human services, if otherwise eligible. 21 Sec. 77. Section 249A.3, subsection 2, paragraph a, 22 unnumbered paragraph 1, Code 2013, is amended to read as 23 follows: 24 Medical Mandatory medical assistance may also, within the 25 limits of available funds and in accordance with section 26 249A.4, subsection 1 , be provided to, or on behalf of, 27 other individuals and families who are not excluded under 28 subsection 5 of this section and whose incomes and resources 29 are insufficient to meet the cost of necessary medical care and 30 services in accordance with the following order of priorities: 31 Sec. 78. Section 249A.3, subsection 2, paragraph a, 32 subparagraph (1), subparagraph division (a), Code 2013, is 33 amended to read as follows: 34 (a) As allowed under 42 U.S.C. § 1396a(a)(10)(A)(ii)(XIII), 35 -92- LSB 1004SV (4) 85 pf/jp 92/ 122
S.F. 446 individuals with disabilities, who are less than sixty-five 1 years of age, who are members of families whose income is less 2 than two hundred fifty percent of the most recently revised 3 official poverty guidelines published by the United States 4 department of health and human services for the family, who 5 have earned income and who are eligible for mandatory medical 6 assistance or additional optional medical assistance under this 7 section if earnings are disregarded. As allowed by 42 U.S.C. 8 § 1396a(r)(2), unearned income shall also be disregarded in 9 determining whether an individual is eligible for assistance 10 under this subparagraph. For the purposes of determining the 11 amount of an individual’s resources under this subparagraph 12 and as allowed by 42 U.S.C. § 1396a(r)(2), a maximum of ten 13 thousand dollars of available resources shall be disregarded, 14 and any additional resources held in a retirement account, in a 15 medical savings account, or in any other account approved under 16 rules adopted by the department shall also be disregarded. 17 Sec. 79. Section 249A.3, subsection 2, paragraph a, 18 subparagraph (3), Code 2013, is amended to read as follows: 19 (3) Individuals who are receiving care in a hospital or 20 in a basic nursing home, intermediate nursing home, skilled 21 nursing home or extended care facility, as defined by section 22 135C.1 , and who meet all eligibility requirements for federal 23 supplemental security income except that their income exceeds 24 the allowable maximum therefor for such eligibility , but 25 whose income is not in excess of the maximum established 26 by subsection 4 for eligibility for discretionary medical 27 assistance and is insufficient to meet the full cost of their 28 care in the hospital or health care facility on the basis of 29 standards established by the department. 30 Sec. 80. Section 249A.3, subsection 2, paragraph b, Code 31 2013, is amended to read as follows: 32 b. Notwithstanding the provisions of this subsection 33 establishing priorities for individuals and families to 34 receive mandatory medical assistance, the department may 35 -93- LSB 1004SV (4) 85 pf/jp 93/ 122
S.F. 446 determine within the priorities listed in this subsection which 1 persons shall receive mandatory medical assistance based on 2 income levels established by the department, subject to the 3 limitations provided in subsection 4 . 4 Sec. 81. Section 249A.3, subsection 3, Code 2013, is amended 5 to read as follows: 6 3. Additional Optional medical assistance may, within 7 the limits of available funds and in accordance with section 8 249A.4, subsection 1 , be provided to, or on behalf of, either 9 of the following groups of individuals and families : 10 a. Only those individuals and families described in 11 subsection 1 of this section ; or . 12 b. Those individuals and families described in both 13 subsections 1 and 2 . 14 Sec. 82. Section 249A.4, subsection 9, unnumbered paragraph 15 1, Code 2013, is amended to read as follows: 16 Adopt rules pursuant to chapter 17A in determining the 17 method and level of reimbursement for all medical and health 18 services referred to in section 249A.2, subsection 1 or 7 19 to be provided under the medical assistance program , after 20 considering all of the following: 21 Sec. 83. Section 249B.1, subsection 6, Code 2013, is amended 22 to read as follows: 23 6. “Medical assistance” means mandatory medical assistance” , 24 “additional “optional medical assistance” , “discretionary medical 25 assistance” or “medicare cost sharing” as defined in section 26 249A.2 which is provided to an individual pursuant to chapter 27 249A and Tit. XIX of the federal Social Security Act. 28 Sec. 84. Section 249F.1, subsection 1, Code 2013, is amended 29 to read as follows: 30 1. “Medical assistance” means mandatory medical 31 assistance”, “additional “optional medical assistance”, 32 “discretionary medical assistance”, or “Medicare cost sharing” 33 as each is defined in section 249A.2 which is provided to an 34 individual pursuant to chapter 249A and Tit. XIX of the federal 35 -94- LSB 1004SV (4) 85 pf/jp 94/ 122
S.F. 446 Social Security Act. 1 Sec. 85. Section 509.1, subsection 7, Code 2013, is amended 2 to read as follows: 3 7. A policy issued to the department of human services, 4 which shall be deemed the policyholder, to insure eligible 5 persons for medical assistance, or for both mandatory medical 6 assistance and additional optional medical assistance, as 7 defined by chapter 249A as hereafter amended. 8 Sec. 86. Section 514.1, subsection 2, Code 2013, is amended 9 to read as follows: 10 2. For the purposes of this chapter , “subscriber” means an 11 individual who enters into a contract for health care services 12 with a corporation subject to this chapter and includes a 13 person eligible for mandatory medical assistance or additional 14 optional medical assistance as defined under chapter 249A , with 15 respect to whom the department of human services has entered 16 into a contract with a firm operating under this chapter. For 17 purposes of this chapter , “provider” means a person as defined 18 in section 4.1, subsection 20 , which is licensed or authorized 19 in this state to furnish health care services. “Health care” 20 means that care necessary for the purpose of preventing, 21 alleviating, curing, or healing human physical or mental 22 illness, injury, or disability. 23 DIVISION XVIII 24 ALZHEIMER’S COORDINATION AND STRATEGY 25 Sec. 87. NEW SECTION . 135P.1 Definitions. 26 As used in this chapter, unless the context otherwise 27 requires: 28 1. “Alzheimer’s disease” or “Alzheimer’s” means a 29 progressive, degenerative, fatal disorder that results in loss 30 of memory, loss of thinking and language skills, and behavioral 31 changes. “Alzheimer’s disease” includes related dementias 32 including vascular dementia, Parkinson’s disease, dementia 33 with Lewy bodies, frontotemporal dementia, Creutzfeldt-Jacob 34 disease, normal pressure hydrocephalus, and mixed dementia. 35 -95- LSB 1004SV (4) 85 pf/jp 95/ 122
S.F. 446 2. “Department” means the department of public health. 1 Sec. 88. NEW SECTION . 135P.2 Alzheimer’s disease —— 2 state-level coordination and comprehensive response strategy. 3 1. The department shall develop and administer, and 4 provide for state-level coordination of, a comprehensive 5 Alzheimer’s disease response strategy in accordance with the 6 recommendations of the stakeholder workgroup convened pursuant 7 to 2011 Iowa Acts, chapter 61. The response strategy shall 8 include development and monitoring of short-term and long-term 9 objectives and action steps to ensure that individuals with 10 Alzheimer’s disease have access to the highest quality and 11 most appropriate care at all stages of the disease and in 12 all settings across the service and supports continuum. The 13 response strategy may include prioritization of objectives 14 and action steps to most efficiently utilize resources and 15 funding. The department shall update the initial response 16 strategy biennially and shall submit a progress report annually 17 in January to the governor and the general assembly. 18 2. In providing state-level coordination, the department 19 shall integrate public and private resources and programs, 20 reduce duplication, evaluate programs and services to ensure 21 that evidence-based, high-quality programs and services are 22 available to maximize the positive impact for individuals with 23 Alzheimer’s and their families and caregivers, and promote 24 public awareness. 25 3. In developing the comprehensive Alzheimer’s disease 26 response strategy, the department shall do all of the 27 following: 28 a. Establish an Alzheimer’s disease coordinator position 29 in the department in a manner similar to those positions 30 that address other chronic conditions in the state. The 31 coordinator, in partnership with public and private entities 32 and the multidisciplinary advisory council convened pursuant to 33 paragraph “b” , shall do all of the following: 34 (1) Implement the recommendations of the Alzheimer’s 35 -96- LSB 1004SV (4) 85 pf/jp 96/ 122
S.F. 446 disease stakeholder workgroup convened pursuant to 2011 Iowa 1 Acts, chapter 61, and establish standards for the comprehensive 2 Alzheimer’s disease response strategy. 3 (2) Inform, educate, and empower the public regarding the 4 impact of Alzheimer’s disease, in order to increase awareness 5 of the disease and in particular the benefits of early 6 detection, while working to decrease the stigma associated with 7 Alzheimer’s disease. 8 (3) Monitor the prevalence of Alzheimer’s disease and 9 cognitive impairment in the state through data collection and 10 coordination efforts. Such data shall be made available to 11 and used to assist public and private efforts in developing 12 evidence-based programs and policies that address Alzheimer’s 13 disease. 14 (4) Evaluate, and promote the improved effectiveness, 15 accessibility, and quality of, clinical and population-based 16 Alzheimer’s services. The evaluation and promotion efforts 17 shall include coordination of services to reach rural and 18 underserved areas of the state. 19 (5) Ensure a competent public and private sector workforce 20 specific to the challenges of Alzheimer’s disease. The effort 21 shall include coordinating existing state efforts to develop, 22 implement, and evaluate curricula and training requirements 23 for providers of services who interact with individuals with 24 Alzheimer’s disease. 25 (6) Act as a liaison to the aging and disabilities resource 26 centers, area agencies on aging, Alzheimer’s association 27 chapters, the health and long-term care access advisory council 28 created by the department to implement the directives of 29 sections 135.163 and 135.164, and other entities to ensure 30 Alzheimer’s disease is appropriately addressed in the state. 31 (7) Secure public and private funding relating to dementia 32 to fulfill the duties specified under this chapter. 33 b. Convene a multidisciplinary advisory council. The 34 council shall assist and advise the department and the 35 -97- LSB 1004SV (4) 85 pf/jp 97/ 122
S.F. 446 coordinator; develop partnerships to provide coordination, 1 collaboration, and support for Alzheimer’s-related services 2 and programs throughout the state; and advocate on behalf of 3 persons with Alzheimer’s disease and their families. The 4 advisory council shall, at a minimum, include representation 5 from individuals with Alzheimer’s disease and their families; 6 caregivers and other providers of services and supports; 7 medical providers including primary and specialty care 8 providers, which shall include geriatricians, neurologists, 9 and others with expertise in Alzheimer’s disease; the 10 Alzheimer’s association; community-based organizations and 11 other organizations with interest or expertise in Alzheimer’s 12 disease; academic institutions and programs with a focus 13 on Alzheimer’s disease and dementia; and appropriate state 14 agencies including but not limited to the department on 15 aging, the department of human services, the department of 16 inspections and appeals, the department of public safety, and 17 the department of workforce development. The department shall 18 enlist private entities in providing staff support for the 19 council. 20 Sec. 89. REPEAL. Section 135.171, Code 2013, is repealed. 21 Sec. 90. INCORPORATION OF EXISTING STATE DUTIES. The 22 department of public health shall incorporate the requirements 23 specified in section 135.171, Code 2013, into the comprehensive 24 Alzheimer’s disease strategy developed and administered 25 pursuant to this division of this Act. 26 DIVISION XIX 27 AREA HEALTH EDUCATION CENTERS 28 Sec. 91. NEW SECTION . 135.179 Area health education centers 29 fund. 30 An area health education centers fund is created in the 31 state treasury as a separate fund under the control of the 32 department. The department may receive appropriations, 33 contributions, grants, and in-kind contributions to support 34 the purposes of the fund. The fund shall be separate from the 35 -98- LSB 1004SV (4) 85 pf/jp 98/ 122
S.F. 446 general fund of the state and shall not be considered part of 1 the general fund of the state. The moneys in the fund shall 2 not be considered revenue of the state, but rather shall be 3 moneys of the fund. The moneys in the fund are appropriated 4 to the department to be distributed to a publicly owned acute 5 care teaching hospital located in a county with a population 6 over three hundred fifty thousand that shall subcontract 7 with health care entities that host regional area health 8 education centers to recruit and retain a skilled health care 9 workforce in rural and underserved areas of the state. The 10 funds distributed shall be used to provide the nonfederal 11 funding match requirement for receipt of federal grants for 12 area health education centers from the federal health resources 13 and services administration of the United States department of 14 health and human services and to assist with continuation of 15 existing educational health care programs and activities. The 16 moneys in the fund are not subject to section 8.33 and shall 17 not be transferred, used, obligated, appropriated, or otherwise 18 encumbered, except to provide for the purposes of this section. 19 Notwithstanding section 12C.7, subsection 2, interest or 20 earnings on moneys deposited in the fund shall be credited to 21 the fund. 22 Sec. 92. CODE EDITOR DIRECTIVE. The Code editor shall 23 create a new division in chapter 135 codifying section 135.179, 24 as enacted in this division of this Act, as the area health 25 education centers fund. 26 DIVISION XX 27 MEDICAID BREAST AND CERVICAL CANCER 28 Sec. 93. Section 249A.3, subsection 2, paragraph a, 29 subparagraph (2), Code 2013, is amended to read as follows: 30 (2) (a) As provided under the federal Breast and Cervical 31 Cancer Prevention and Treatment Act of 2000, Pub. L. No. 32 106-354, women individuals who meet all of the following 33 criteria: 34 (i) Are not described in 42 U.S.C. § 1396a(a)(10)(A)(i). 35 -99- LSB 1004SV (4) 85 pf/jp 99/ 122
S.F. 446 (ii) Have not attained age sixty-five. 1 (iii) Have been screened for breast and cervical cancer 2 under the United States centers for disease control and 3 prevention breast and cervical cancer early detection program 4 established under 42 U.S.C. § 300k et seq., in accordance 5 with the requirements of 42 U.S.C. § 300n, and need treatment 6 for breast or cervical cancer. A woman An individual is 7 considered screened for breast and cervical cancer under this 8 subparagraph subdivision if the woman individual is screened 9 by any provider or entity, and the state grantee of the United 10 States centers for disease control and prevention funds under 11 Tit. XV of the federal Public Health Services Act has elected 12 to include screening activities by that provider or entity 13 as screening activities pursuant to Tit. XV of the federal 14 Public Health Services Act. This screening includes but is 15 not limited to breast or cervical cancer screenings or related 16 diagnostic services provided or funded by family planning or 17 centers, community health centers and breast cancer screenings 18 funded by the Susan G. Komen foundation which , or nonprofit 19 organizations, and the screenings or services are provided 20 to women individuals who meet the eligibility requirements 21 established by the state grantee of the United States centers 22 for disease control and prevention funds under Tit. XV of the 23 federal Public Health Services Act. 24 (iv) Are not otherwise covered under creditable coverage as 25 defined in 42 U.S.C. § 300gg(c). 26 (b) A woman An individual who meets the criteria of this 27 subparagraph (2) shall be presumptively eligible for medical 28 assistance. 29 Sec. 94. MEDICAID STATE PLAN AMENDMENT. The department of 30 human services shall submit a medical assistance state plan 31 amendment to the centers for Medicare and Medicaid services of 32 the United States department of health and human services to 33 provide for applicability of the federal Breast and Cervical 34 Cancer Prevention and Treatment Act of 2000, Pub. L. No. 35 -100- LSB 1004SV (4) 85 pf/jp 100/ 122
S.F. 446 106-354, to both men and women. The department shall implement 1 applicability of the program to both men and women upon receipt 2 of federal approval. 3 DIVISION XXI 4 HEALTH AND LONG-TERM CARE 5 Sec. 95. Section 135.164, subsection 1, paragraph d, Code 6 2013, is amended by striking the paragraph. 7 Sec. 96. Section 135.164, subsection 4, Code 2013, is 8 amended by striking the subsection. 9 Sec. 97. COST PROJECTION REPORT —— STRATEGIC PLAN. The 10 department of public health shall develop cost projections 11 for implementing the strategic plan for health care delivery 12 infrastructure and health care workforce resources as specified 13 in section 135.164, and shall submit a report of such cost 14 projections and any recommendations to the individuals 15 identified in this Act for submission of reports by December 16 15, 2013. 17 DIVISION XXII 18 AUTISM SUPPORT PROGRAM 19 Sec. 98. NEW SECTION . 225D.1 Definitions. 20 As used in this chapter unless the context otherwise 21 requires: 22 1. “Applied behavioral analysis” , “autism service provider” , 23 “pharmacy care” , “psychiatric care” , “psychological care” , 24 “rehabilitative care” , “therapeutic care” , and “treatment plan” 25 mean the same as defined in section 514C.28. 26 2. “Autism” means autism spectrum disorders as defined in 27 section 514C.28. 28 3. “Autism support fund” or “fund” means the autism support 29 fund created in section 225D.2. 30 4. “Behavioral health treatment” means clinically relevant 31 counseling and treatment programs, including applied behavioral 32 analysis, that meet both of the following requirements: 33 a. Are necessary to develop, maintain, or restore, to the 34 maximum extent practicable, the functioning of an individual. 35 -101- LSB 1004SV (4) 85 pf/jp 101/ 122
S.F. 446 b. Are provided or supervised by a board-certified 1 behavior analyst or a licensed psychologist, as long as the 2 services performed by a psychologist are commensurate with 3 the psychologist’s formal university training and supervised 4 experience. 5 5. “Clinically relevant” means medically necessary and 6 resulting in an improved clinical status as determined by 7 department guidelines for managed care entities. 8 6. “Department” means the department of human services. 9 7. “Diagnostic assessment of autism spectrum disorders” means 10 medically necessary assessment, evaluations, or tests performed 11 by a licensed physician, licensed physician assistant, licensed 12 psychologist, or licensed registered nurse practitioner, with 13 expertise and special training in developmental disabilities or 14 autism, to diagnose whether an individual has autism. 15 8. “Eligible individual” means a child less than nine years 16 of age who has been diagnosed with autism based on a diagnostic 17 assessment of autism spectrum disorders, is not otherwise 18 eligible for coverage under the medical assistance program, is 19 not eligible for coverage under section 514C.28 or for private 20 insurance coverage, and whose household income does not exceed 21 four hundred percent of the federal poverty level. 22 9. “Federal poverty level” means the most recently revised 23 poverty income guidelines published by the United States 24 department of health and human services. 25 10. “Household income” means household income as determined 26 using the modified adjusted gross income methodology pursuant 27 to section 2002 of the federal Patient Protection and 28 Affordable Care Act, Pub. L. No. 111-148. 29 11. “Medical assistance” or “Medicaid” means assistance 30 provided under the medical assistance program pursuant to 31 chapter 249A. 32 12. “Regional autism assistance program” means the regional 33 autism assistance program created in section 256.35. 34 13. “Treatment of autism” means treatment that is 35 -102- LSB 1004SV (4) 85 pf/jp 102/ 122
S.F. 446 identified in a treatment plan and includes medically necessary 1 behavioral health treatment, pharmacy care, psychiatric care, 2 psychological care, rehabilitative care, and therapeutic care 3 that is one of the following: 4 a. Prescribed, ordered, or provided by a licensed 5 physician, licensed physician assistant, licensed psychologist, 6 licensed social worker, or licensed advanced registered nurse 7 practitioner. 8 b. Provided by an autism service provider. 9 c. Provided by a person, entity, or group that works under 10 the direction of an autism service provider. 11 Sec. 99. NEW SECTION . 225D.2 Autism support program —— 12 fund. 13 1. The department shall implement an autism support 14 program to provide payment for the treatment of autism for 15 eligible individuals. The department shall adopt rules, 16 including standards and guidelines pursuant to chapter 17A to 17 implement and administer the program. In adopting the rules, 18 standards, and guidelines for the program, the department shall 19 consult with and incorporate the recommendations of an expert 20 panel convened by the regional autism assistance program to 21 provide expert opinion on clinically relevant practices and 22 guidance on program implementation and administration. The 23 expert panel shall consist of families of individuals with 24 autism; educational, medical, and human services specialists, 25 professionals, and providers; and others with interest in or 26 expertise related to autism. The program shall be implemented 27 and administered in a manner so that services are available 28 throughout the state, including in rural and under-resourced 29 areas. 30 2. At a minimum, the rules, standards, and guidelines for 31 the program shall address all of the following: 32 a. A maximum annual benefit amount for an eligible 33 individual of thirty-six thousand dollars. 34 b. A maximum of twenty-four months of applied behavioral 35 -103- LSB 1004SV (4) 85 pf/jp 103/ 122
S.F. 446 analysis treatment. 1 c. Notwithstanding the age limitation for an eligible 2 individual, a provision that if an eligible individual reaches 3 nine years of age prior to completion of the maximum applied 4 behavioral analysis treatment period specified in paragraph 5 “b” , the individual may complete such treatment in accordance 6 with the individual’s treatment plan, not to exceed the maximum 7 treatment period. 8 d. A graduated schedule for cost-sharing by an eligible 9 individual based on a percentage of the total benefit amount 10 expended for the eligible individual, annually. Cost-sharing 11 shall be applicable to eligible individuals with household 12 incomes at or above two hundred percent of the federal poverty 13 level in incrementally increased amounts up to a maximum of 14 ten percent. The rules shall provide a financial hardship 15 exemption from payment of the cost-sharing based on criteria 16 established by rule of the department. 17 e. Application, approval, compliance, and appeal processes 18 for eligible individuals as necessary to operate and manage the 19 program. 20 f. Enrollment, renewal, and reimbursement of claims 21 provisions for autism service providers participating in the 22 program. 23 g. A requirement of family engagement and participation as 24 part of the eligible individual’s treatment plan. 25 h. A requirement that the administrator of the program 26 utilize the regional autism assistance program to coordinate 27 interventions between eligible individuals and their families 28 receiving support through the autism support program with 29 appropriate medical, educational, and treatment providers, 30 including integrated health homes. The regional autism 31 assistance program shall provide for family navigation and 32 coordination and integration of services through the statewide 33 system of regional child health specialty clinics, utilizing 34 the community child health team model. As necessitated by 35 -104- LSB 1004SV (4) 85 pf/jp 104/ 122
S.F. 446 the availability of resources in the community where services 1 are delivered, telehealth may be used in delivering and 2 coordinating interventions with appropriate providers. To the 3 extent available and accessible to an eligible individual, 4 the eligible individual shall be enrolled in an integrated 5 health home that is an approved provider enrolled in the 6 medical assistance program. Health home services that are 7 covered services under the medical assistance program shall be 8 reimbursed under the autism support program at rates consistent 9 with those established under the medical assistance program. 10 i. Requirements related to review of treatment plans, 11 which may require review once every six months, subject to 12 utilization review requirements established by rule. A more 13 or less frequent review may be agreed upon by the eligible 14 individual and the licensed physician or licensed psychologist 15 developing the treatment plan. 16 j. Recognition of the results of a diagnostic assessment of 17 autism as valid for a period of not less than twelve months, 18 unless a licensed physician or licensed psychologist determines 19 that a more frequent assessment is necessary. 20 3. Moneys in the autism support fund created under 21 subsection 5 shall be expended only for eligible individuals 22 who are not eligible for coverage for the same treatment 23 services under the medical assistance program, section 514C.28, 24 or private insurance. Payment for treatment services through 25 the fund shall be limited to only those services that are 26 clinically relevant and only to the extent approved under the 27 guidelines established by rule of the department. 28 4. This section shall not be construed as granting an 29 entitlement for any program, service, or other support for 30 eligible individuals. Any state obligation to provide a 31 program, service, or other support pursuant to this section 32 is limited to the extent of the funds appropriated for the 33 purposes of the program. The department may establish a 34 waiting list or terminate participation of eligible individuals 35 -105- LSB 1004SV (4) 85 pf/jp 105/ 122
S.F. 446 if the department determines that moneys in the autism support 1 fund are insufficient to cover future claims for reimbursement 2 beyond ninety days. 3 5. a. An autism support fund is created in the state 4 treasury under the authority of the department. Moneys 5 appropriated to and all other moneys specified for deposit 6 in the fund shall be deposited in the fund and used for the 7 purposes of the program. 8 b. The fund shall be separate from the general fund of the 9 state and shall not be considered part of the general fund of 10 the state. The moneys in the fund shall not be considered 11 revenue of the state, but rather shall be funds of the autism 12 support program. The moneys deposited in the fund are not 13 subject to section 8.33 and shall not be transferred, used, 14 obligated, appropriated, or otherwise encumbered, except to 15 provide for the purposes of this section. Notwithstanding 16 section 12C.7, subsection 2, interest or earnings on moneys 17 deposited in the fund shall be credited to the fund. 18 c. The department shall adopt rules pursuant to chapter 17A 19 to administer the fund and reimbursements made from the fund. 20 d. Moneys in the fund are appropriated to the department and 21 shall be used by the department for the purposes of the autism 22 support program. The department shall be the administrator of 23 the fund for auditing purposes. 24 e. The department shall submit an annual report to the 25 governor and the general assembly no later than January 1 26 of each year that includes but is not limited to all of the 27 following: 28 (1) The total number of applications received under the 29 program for the immediately preceding fiscal year. 30 (2) The number of applications approved and the total amount 31 of funding expended for reimbursements under the program in the 32 immediately preceding fiscal year. 33 (3) The cost of administering the program in the immediately 34 preceding fiscal year. 35 -106- LSB 1004SV (4) 85 pf/jp 106/ 122
S.F. 446 (4) The number of eligible individuals on a waiting list, if 1 any, and the amount of funding necessary to reduce the existing 2 waiting list. 3 (5) Recommendations for any changes to the program. 4 Sec. 100. IMPLEMENTATION. 5 1. The department of human services shall implement the 6 autism support program within one hundred twenty days of 7 the effective date of this division of this Act, subject to 8 available funding. 9 2. Notwithstanding section 8.47 or any other provision of 10 law to the contrary, the department may utilize a sole-source 11 contract and utilize the managed care entity under contract 12 with the department to manage behavioral health services under 13 the medical assistance program to administer the program. 14 Total administrative costs of the program shall not exceed ten 15 percent of the funds expended through the program, annually. 16 Sec. 101. EFFECTIVE UPON ENACTMENT. This division of this 17 Act, being deemed of immediate importance, takes effect upon 18 enactment. 19 DIVISION XXIII 20 DEPARTMENT OF HUMAN SERVICES —— CHILD, ADULT, AND FAMILY 21 SERVICES 22 Sec. 102. Section 225C.38, subsection 1, paragraph c, Code 23 2013, is amended to read as follows: 24 c. Except as provided in section 225C.41 , a family support 25 subsidy for a fiscal year shall be in an amount determined by 26 the department in consultation with the comprehensive family 27 support council created in section 225C.48 . The parent or 28 legal guardian receiving a family support subsidy may elect 29 to receive a payment amount which is less than the amount 30 determined in accordance with this paragraph. 31 Sec. 103. Section 225C.42, subsection 1, Code 2013, is 32 amended to read as follows: 33 1. The department shall conduct an annual evaluation of 34 the family support subsidy program in conjunction with the 35 -107- LSB 1004SV (4) 85 pf/jp 107/ 122
S.F. 446 comprehensive family support council and shall submit the 1 evaluation report with recommendations to the governor and 2 general assembly. The report shall be submitted on or before 3 October 30 and provide an evaluation of the latest completed 4 fiscal year. 5 Sec. 104. Section 225C.47, subsection 5, unnumbered 6 paragraph 1, Code 2013, is amended to read as follows: 7 The department shall design the program in consultation with 8 the comprehensive family support council created in section 9 225C.48 . The department shall adopt rules to implement the 10 program which provide for all of the following: 11 Sec. 105. Section 225C.49, subsection 4, Code 2013, is 12 amended to read as follows: 13 4. The department shall designate one individual whose sole 14 duties are to provide central coordination of the programs 15 under sections 225C.36 and 225C.47 and to work with the 16 comprehensive family support council to oversee development and 17 implementation of the programs. 18 Sec. 106. Section 239B.5, Code 2013, is amended by adding 19 the following new subsection: 20 NEW SUBSECTION . 4. a. The department shall implement 21 policies and procedures as necessary to comply with provisions 22 of the federal Middle Class Tax Relief and Job Creation Act 23 of 2012, Pub. L. No. 112-96, to prevent assistance provided 24 under this chapter from being used in any electronic benefit 25 transfer transaction in any liquor store; any casino, gambling 26 casino, or gaming establishment; or any retail establishment 27 which provides adult-oriented entertainment in which performers 28 disrobe or perform in an unclothed state for entertainment. 29 For purposes of this paragraph, the definitions found in the 30 federal Middle Class Tax Relief and Job Creation Act and 31 related rules and statutes apply. 32 b. Unless otherwise precluded by federal law or regulation, 33 policies and procedures implemented under this subsection shall 34 at a minimum impose the prohibition described in paragraph “a” 35 -108- LSB 1004SV (4) 85 pf/jp 108/ 122
S.F. 446 as a condition for continued eligibility for assistance under 1 this chapter. 2 c. The department may implement additional measures as may 3 be necessary to comply with federal regulations in implementing 4 paragraph “a” . 5 d. The department shall adopt rules as necessary to 6 implement this subsection. 7 Sec. 107. Section 239B.14, subsection 1, Code 2013, is 8 amended to read as follows: 9 1. a. An individual who obtains, or attempts to obtain, 10 or aids or abets an individual to obtain, by means of a 11 willfully false statement or representation, by knowingly 12 failing to disclose a material fact, or by impersonation, or 13 any fraudulent device, any assistance or other benefits under 14 this chapter to which the individual is not entitled, commits 15 a fraudulent practice. 16 b. An individual who accesses benefits provided under 17 this chapter in violation of any prohibition imposed by the 18 department pursuant to section 239B.5, subsection 4, commits 19 a fraudulent practice. 20 Sec. 108. Section 249A.3, subsection 1, Code 2013, is 21 amended by adding the following new paragraph: 22 NEW PARAGRAPH . v. Beginning January 1, 2014, is an 23 individual who meets all of the following requirements: 24 (1) Is under twenty-six years of age. 25 (2) Was in foster care under the responsibility of the state 26 on the date of attaining eighteen years of age or such higher 27 age to which foster care is provided. 28 (3) Was enrolled in the medical assistance program under 29 this chapter while in such foster care. 30 Sec. 109. Section 249A.3, subsection 2, paragraph a, 31 subparagraph (9), Code 2013, is amended by striking the 32 subparagraph. 33 Sec. 110. Section 249J.26, subsection 2, Code 2013, is 34 amended to read as follows: 35 -109- LSB 1004SV (4) 85 pf/jp 109/ 122
S.F. 446 2. This chapter is repealed October December 31, 2013. 1 Sec. 111. Section 514I.4, subsection 5, paragraph a, Code 2 2013, is amended by striking the paragraph. 3 Sec. 112. Section 514I.5, subsection 7, paragraph f, Code 4 2013, is amended to read as follows: 5 f. Review, in consultation with the department, and take 6 necessary steps to improve interaction between the program and 7 other public and private programs which provide services to the 8 population of eligible children. The board, in consultation 9 with the department, shall also develop and implement a plan 10 to improve the medical assistance program in coordination with 11 the hawk-i program, including but not limited to a provision to 12 coordinate eligibility between the medical assistance program 13 and the hawk-i program, and to provide for common processes 14 and procedures under both programs to reduce duplication and 15 bureaucracy. 16 Sec. 113. Section 514I.5, subsection 8, paragraphs b and f, 17 Code 2013, are amended by striking the paragraphs. 18 Sec. 114. Section 514I.7, subsection 2, paragraphs a and g, 19 Code 2013, are amended to read as follows: 20 a. Determine individual eligibility for program enrollment 21 based upon review of completed applications and supporting 22 documentation as prescribed by federal law and regulation, 23 using policies and procedures adopted by rule of the department 24 pursuant to chapter 17A . The administrative contractor shall 25 not enroll a child who has group health coverage , unless 26 expressly authorized by such rules . 27 g. Create and Utilize the department’s eligibility system 28 to maintain eligibility files that are compatible with the 29 data system of the department with pertinent eligibility 30 determination and ongoing enrollment information including , but 31 not limited to , data regarding beneficiaries, enrollment dates, 32 disenrollments, and annual financial redeterminations. 33 Sec. 115. Section 514I.7, subsection 2, paragraphs c, d, e, 34 f, and k, Code 2013, are amended by striking the paragraphs. 35 -110- LSB 1004SV (4) 85 pf/jp 110/ 122
S.F. 446 Sec. 116. Section 514I.8, subsection 1, Code 2013, is 1 amended to read as follows: 2 1. a. Effective July 1, 1998, and notwithstanding any 3 medical assistance program eligibility criteria to the 4 contrary, medical assistance shall be provided to, or on behalf 5 of, an eligible child under the age of nineteen whose family 6 income does not exceed one hundred thirty-three percent of the 7 federal poverty level, as defined by the most recently revised 8 poverty income guidelines published by the United States 9 department of health and human services. 10 b. Additionally, effective Effective July 1, 2000, and 11 notwithstanding any medical assistance program eligibility 12 criteria to the contrary, medical assistance shall be provided 13 to, or on behalf of, an eligible infant whose family income 14 does not exceed two hundred percent of the federal poverty 15 level, as defined by the most recently revised poverty income 16 guidelines published by the United States department of health 17 and human services. 18 c. Effective July 1, 2009, and notwithstanding any medical 19 assistance program eligibility criteria to the contrary, 20 medical assistance shall be provided to, or on behalf of, a 21 pregnant woman or an eligible child who is an infant and whose 22 family income is at or below three hundred percent of the 23 federal poverty level, as defined by the most recently revised 24 poverty income guidelines published by the United States 25 department of health and human services. 26 Sec. 117. Section 514I.8, subsection 2, paragraph c, Code 27 2013, is amended to read as follows: 28 c. Is a member of a family whose income does not exceed 29 three hundred percent of the federal poverty level, as defined 30 in 42 U.S.C. § 9902(2), including any revision required by 31 such section, and in accordance with the federal Children’s 32 Health Insurance Program Reauthorization Act of 2009, Pub. L. 33 No. 111-3. The modified adjusted gross income methodology 34 prescribed in section 2101 of the federal Patient Protection 35 -111- LSB 1004SV (4) 85 pf/jp 111/ 122
S.F. 446 and Affordable Care Act, Pub. L. No. 111-148, to determine 1 family income under this paragraph. 2 Sec. 118. Section 514I.8, subsections 3 and 4, Code 2013, 3 are amended to read as follows: 4 3. In accordance with the rules adopted by the board, 5 a child may be determined to be presumptively eligible for 6 the program pending a final eligibility determination. 7 Following final determination of eligibility by the 8 administrative contractor , a child shall be eligible for a 9 twelve-month period. At the end of the twelve-month period, 10 the administrative contractor shall conduct a review of the 11 circumstances of the eligible child’s family shall be conducted 12 to establish eligibility and cost sharing for the subsequent 13 twelve-month period. 14 4. Once an eligible child is enrolled in a plan, the 15 eligible child shall remain enrolled in the plan unless a 16 determination is made, according to criteria established by the 17 board, that the eligible child should be allowed to enroll in 18 another qualified child health plan or should be disenrolled. 19 An enrollee may request to change plans within ninety days of 20 initial enrollment for any reason and at any time for cause, as 21 defined in 42 C.F.R. § 438.56(d)(2). Otherwise, an enrollee 22 may change plan enrollment once a year on the enrollee’s 23 anniversary date. 24 Sec. 119. Section 514I.8, subsections 5 and 6, Code 2013, 25 are amended by striking the subsections. 26 Sec. 120. Section 514I.9, Code 2013, is amended to read as 27 follows: 28 514I.9 Program benefits. 29 1. Until June 30, 1999, the benefits provided under the 30 program shall be those benefits established by rule of the 31 board and in compliance with Tit. XXI of the federal Social 32 Security Act. 33 2. On or before June 30, 1999, the hawk-i board shall adopt 34 rules to amend the benefits package based upon review of the 35 -112- LSB 1004SV (4) 85 pf/jp 112/ 122
S.F. 446 results of the initial benefits package used. 1 3. Subsequent to June 30, 1999, the The hawk-i board shall 2 review the benefits package annually and shall determine 3 additions to or deletions from the benefits package offered. 4 The hawk-i board shall submit the recommendations to the 5 general assembly for any amendment to the benefits package. 6 4. 2. Benefits, in addition to those required by rule, may 7 be provided to eligible children by a participating insurer if 8 the benefits are provided at no additional cost to the state. 9 Sec. 121. REPEAL. Section 225C.48, Code 2013, is repealed. 10 Sec. 122. EFFECTIVE DATE. The following provision or 11 provisions of this Act take effect December 31, 2013: 12 1. The section of this Act amending section 249A.3, 13 subsection 2, paragraph “a”, subparagraph (9). 14 DIVISION XXIV 15 OPTIONS —— PERSONS WITH AGGRESSIVE OR PSYCHIATRIC BEHAVIORS 16 Sec. 123. FACILITY FOR PERSONS WITH AGGRESSIVE OR 17 PSYCHIATRIC BEHAVIORS —— COMMITTEE —— REPORT. 18 1. The department of inspections and appeals, in 19 conjunction with the department of human services, shall 20 establish and facilitate a committee of stakeholders to examine 21 options for designating a facility to provide care for persons 22 in this state who are sexually aggressive, combative, or have 23 unmet psychiatric needs. 24 2. The membership of the committee shall include but is not 25 limited to the following: 26 a. Representatives of the departments of inspections and 27 appeals, human services, corrections, and public health, the 28 department on aging, the state public defender, the office of 29 the citizens’ aide, the office of the state long-term care 30 resident’s advocate, and the judicial branch. 31 b. Consumers of services provided by long-term care 32 facilities and family members of consumers. 33 c. Representatives from leadingage Iowa, the Iowa health 34 care association, and the Iowa association of community 35 -113- LSB 1004SV (4) 85 pf/jp 113/ 122
S.F. 446 providers. 1 d. Direct care workers employed by long-term care 2 facilities. 3 e. Representatives from Iowa legal aid. 4 f. Representatives from AARP Iowa. 5 g. Representatives from the Iowa civil liberties union. 6 h. Other stakeholders as the department of inspections and 7 appeals and the department of human services deem appropriate. 8 3. The committee shall discuss whether a long-term care 9 facility, as defined in section 142D.2, should have the 10 ability to refuse admission to, or discharge, residents who 11 are sexually aggressive, combative, or have unmet psychiatric 12 needs. The committee shall consider options for establishment 13 of a facility to provide care for persons who are sexually 14 aggressive, combative, or have unmet psychiatric needs. The 15 committee shall identify the characteristics of residents 16 for such a facility, options for creating a new facility 17 to house such residents, options for the expansion of an 18 existing facility to house such residents, options for using 19 any alternative facilities for such residents, the workforce 20 and training necessary for the workforce in such facility, 21 options to qualify a facility for Medicaid reimbursement, cost 22 projections for any recommendations, and other information 23 deemed relevant by the department of inspections and appeals. 24 4. The committee shall provide a report detailing its 25 findings and recommendations to the governor and the general 26 assembly by December 15, 2013. 27 DIVISION XXV 28 SPORTS INJURY PREVENTION 29 Sec. 124. MUNICIPAL YOUTH SPORTS INJURY PREVENTION STUDY 30 AND REPORT. 31 1. A municipal youth sports injury prevention study is 32 established to make recommendations regarding how cities can 33 most effectively prevent concussions and other sports-related 34 injuries in children participating in municipal youth 35 -114- LSB 1004SV (4) 85 pf/jp 114/ 122
S.F. 446 sports programs. The national center for sports safety is 1 requested to administer the study in coordination with the 2 department of public health and interested parties representing 3 cities, municipal youth sports programs, parents, coaches, 4 trainers, and other stakeholders. The study shall include 5 recommendations for safety equipment for participants and 6 training for employees and volunteers to be required by cities 7 as part of municipal youth sports programs. 8 2. The national center for sports safety is requested to 9 submit a report on its findings and recommendations to the 10 general assembly by January 10, 2014. 11 EXPLANATION 12 This bill relates to appropriations for health and human 13 services for FY 2013-2014 to the department of veterans 14 affairs, the Iowa veterans home, the department on aging, the 15 department of public health, Iowa finance authority, state 16 board of regents, department of inspections and appeals, 17 department of human rights, and the department of human 18 services (DHS). 19 The bill is organized into divisions. 20 DEPARTMENT ON AGING —— FY 2013-2014. This division makes 21 appropriations from the general fund of the state for the 22 department on aging for FY 2013-2014. 23 DEPARTMENT OF PUBLIC HEALTH —— FY 2013-2014. This division 24 makes appropriations from the general fund of the state for the 25 department of public health for FY 2013-2014. 26 DEPARTMENT OF VETERANS AFFAIRS —— FY 2013-2014. This 27 division makes appropriations from the general fund of the 28 state for the department of veterans affairs for FY 2013-2014. 29 DEPARTMENT OF HUMAN SERVICES —— FY 2013-2014. This division 30 makes appropriations from the general fund of the state, the 31 health care trust fund, and the federal temporary assistance 32 for needy families block grant to DHS. The allocation for the 33 family development and self-sufficiency grant program is made 34 directly to the department of human rights. The reimbursement 35 -115- LSB 1004SV (4) 85 pf/jp 115/ 122
S.F. 446 section addresses reimbursement for providers reimbursed by the 1 department of human services. 2 HEALTH CARE ACCOUNTS AND FUND —— FY 2013-2014. This division 3 makes health-related appropriations for fiscal year 2013-2014. 4 A number of the appropriations are made for purposes of the 5 medical assistance (Medicaid) program in addition to the 6 general fund appropriations made for this purpose for the same 7 fiscal year. 8 The appropriation from the pharmaceutical settlement account 9 to DHS supplements the Medicaid program medical contracts 10 appropriations. 11 The appropriations from the IowaCare account are made to the 12 state board of regents for distribution to the university of 13 Iowa hospitals and clinics and to DHS for distribution to a 14 publicly owned acute care teaching hospital in a county with a 15 population over 350,000. 16 The appropriation from the nonparticipating provider 17 reimbursement fund is made to DHS to reimburse nonparticipating 18 providers under the IowaCare program. 19 The appropriations made to supplement the Medicaid program 20 are from the quality assurance trust fund and the hospital 21 health care access trust fund. In addition, an appropriation 22 is made from the hospital health care access trust fund for the 23 nonparticipating provider reimbursement fund. 24 The division provides that if the total amounts appropriated 25 from all sources for the medical assistance program for fiscal 26 year 2013-2014 exceed the amount needed, the excess remains 27 available to be used for the program in the succeeding fiscal 28 year. 29 CHILDREN’S HEALTH INSURANCE PROGRAM —— CHILD ENROLLMENT 30 CONTINGENCY FUND —— FY 2013-2014. Approximately $20.6 million 31 of the moneys received from the federal government through the 32 child enrollment contingency fund established pursuant to the 33 federal Children’s Health Insurance Program Reauthorization 34 Act of 2009 are transferred to the rebuild Iowa infrastructure 35 -116- LSB 1004SV (4) 85 pf/jp 116/ 122
S.F. 446 fund and are appropriated to the department of administrative 1 services to be used to supplement infrastructure projects for 2 major repairs and major maintenance of state buildings and 3 facilities. 4 PRIOR YEAR APPROPRIATIONS. This division relates to 5 appropriations made for FY 2012-2013 or earlier. 6 An allocation for foster family respite services for FY 7 2012-2013 enacted in 2012 Iowa Acts, chapter 1133, section 22, 8 is amended to carry forward the allocation for the succeeding 9 fiscal year. 10 The Medicaid appropriation made from the general fund of the 11 state for FY 2012-2013 in 2011 Iowa Acts, chapter 129, section 12 122, is increased. In addition, a transfer of funds in that 13 appropriation to the IowaCare account is increased. 14 The appropriation made for FY 2012-2013 for adoption subsidy 15 payments and services in 2011 Iowa Acts, chapter 129, section 16 141, as amended by 2012 Iowa Acts, chapter 1133, section 23, 17 subsection 1, is increased. 18 The Medicaid program reimbursement provision setting a cap 19 on the nursing facility budget for FY 2012-2013, in 2011 Iowa 20 Acts, chapter 129, section 141, is increased. 21 The division takes effect upon enactment. 22 CHILD WELFARE AND CHILD CARE. This division includes 23 statutory changes involving child welfare and child care. 24 Code section 232.142, relating to county and multicounty 25 juvenile detention homes, is amended. The homes are subject to 26 approval by the director of the department of human services 27 and the bill limits the statewide number of beds in the homes 28 approved by the director to the number of beds in approved 29 homes as of July 1, 2012. 30 Code section 237A.13, relating to the state child care 31 assistance program, is amended. The program is administered 32 by DHS to furnish financial assistance for child care needs 33 provided to children in families with low income or other 34 special needs. Income eligibility requirements for the program 35 -117- LSB 1004SV (4) 85 pf/jp 117/ 122
S.F. 446 are outlined in a priority list specifying how a waiting list 1 is to be applied based on the availability of funding. The 2 current provision for employed families with an income of more 3 than 100 percent but not more than 145 percent of the federal 4 poverty level is increased to 148 percent. The standard period 5 for redetermining eligibility of a program participant is 6 changed to require the eligibility redetermination to be 12 7 months from the date of the eligibility determination and every 8 12 months thereafter. 9 AGING. This division relates to programs and services 10 involving the department on aging. 11 Code section 231.42, relating to the duties of the office 12 of long-term care resident’s advocate, is amended to provide a 13 standing appropriation of a financial penalty to the office. 14 Code section 231E.13, providing that implementation of the 15 substitute decision maker Act is subject to the availability 16 of funding, is repealed. 17 The division includes a contingent provision for 2013 Iowa 18 Acts, Senate File 184, if enacted, amending Code section 19 231.33, subsection 21, relating to an area agency on aging 20 complying with all applicable requirements of the Iowa public 21 employees’ retirement system (IPERS). The division provides 22 that an employee of an area agency on aging that was enrolled 23 in an alternative qualified plan prior to July 1, 2012, may 24 continue participation in that alternative qualified plan in 25 lieu of mandatory participation in the Iowa public employees’ 26 retirement system. This provision takes effect upon enactment 27 and applies retroactively to July 1, 2012. 28 The department is required to convene a task force on elder 29 abuse prevention and intervention to continue the work of a 30 previous task force on elder abuse. The task force is required 31 to develop an overall design for a comprehensive approach to 32 elder abuse prevention and intervention. The task force final 33 report is due to the governor and general assembly by December 34 31, 2013. The legislative council is requested to establish a 35 -118- LSB 1004SV (4) 85 pf/jp 118/ 122
S.F. 446 legislative interim committee to monitor the work of the task 1 force. 2 The department is also required to collaborate with 3 the national health law and policy resource center at the 4 university of Iowa college of law in establishing a three-year 5 pilot project to train, recruit, and oversee volunteers to 6 assist the courts in monitoring guardianships and conservators. 7 EMS TASK FORCE. This division requires the department 8 of public health to establish a task force to ensure the 9 availability of quality emergency medical services for this 10 state. The task force is required to submit a final report 11 with findings and recommendations to the governor, general 12 assembly, and others by April 30, 2014. 13 MEDICATION THERAPY MANAGEMENT. This division requires the 14 department of human services to enter into a contract for 15 the provision of medication therapy management services for 16 Medicaid program recipients who have chronic conditions and 17 take four or more prescription drugs or meet other criteria. 18 The division takes effect upon enactment. 19 HOSPITAL PROVIDER TAX. This division extends the sunset 20 provision providing for repeal of Code chapter 249M, relating 21 to the hospital health care access assessment program, from 22 June 30, 2013, to June 30, 2016. The division takes effect 23 upon enactment. 24 ILL AND HANDICAPPED WAIVER NAME CHANGE. This division 25 revises the name of the Medicaid program’s ill and handicapped 26 home and community-based services waiver to the health and 27 disability waiver in Code section 423.3, relating to the 28 exemptions from the streamlined sales and use tax Act. 29 MILLER TRUST. This division revises dollar amount and 30 income thresholds in Code chapter 633C, relating to Medicaid 31 special needs trusts and income trusts, known as Miller trusts. 32 The changes apply to trusts in existence on or after July 1, 33 2013. 34 FAMILY PLANNING WAIVER —— STATE PLAN. This division 35 -119- LSB 1004SV (4) 85 pf/jp 119/ 122
S.F. 446 relates to family planning services available under the 1 Medicaid program by requiring DHS to amend the state plan 2 for the program to include such services currently provided 3 through a federally approved demonstration waiver. The waiver 4 requirements outlined in 2010 Iowa Acts, chapter 1192, are 5 amended to specify the Medicaid program is the payer of last 6 resort if the recipient of services through the waiver has 7 health insurance coverage. The division takes effect upon 8 enactment and implementation is subject to federal approval. 9 MISCELLANEOUS HEALTH CARE AMENDMENTS. This division updates 10 various Medicaid program references throughout the Code to 11 distinguish between mandatory, optional, and discretionary 12 medical assistance. 13 ALZHEIMER’S COORDINATION AND STRATEGY. This division 14 relates to state-level coordination of a comprehensive response 15 strategy for Alzheimer’s disease. The division creates a new 16 Code chapter, Code chapter 135P, to direct that the department 17 of public health (DPH) is to develop and administer, and 18 provide for state-level coordination of, a comprehensive 19 Alzheimer’s disease response strategy. 20 AREA HEALTH EDUCATION CENTERS. This division creates an 21 area health education centers fund in the state treasury 22 as a separate fund under the control of the department of 23 public health. The moneys in the fund are appropriated to the 24 department to be distributed to a publicly owned acute care 25 teaching hospital located in a county with a population over 26 350,000 to subcontract with health care entities that host 27 AHECs to recruit and retain health care providers in rural and 28 underserved areas of the state. The funds distributed are to 29 be used to provide the nonfederal funding match requirement for 30 receipt of federal grants for AHECs from the federal health 31 resources and services administration of the United States 32 department of health and human services and to provide for 33 continuation of existing educational health care programs and 34 activities. 35 -120- LSB 1004SV (4) 85 pf/jp 120/ 122
S.F. 446 BREAST AND CERVICAL CANCER TREATMENT —— MEDICAID. This 1 division amends the coverage provisions under the Medicaid 2 program for breast and cervical cancer treatment to provide 3 that the required screening may be provided or funded by family 4 planning centers, community health centers, or nonprofit 5 organizations. The amendment also replaces the application of 6 the program to only women with application to any individuals. 7 The division also directs DHS to submit a Medicaid state plan 8 amendment to the centers for Medicare and Medicaid services 9 of the United States department of health and human services 10 to provide for applicability of the coverage to both men and 11 women. The division directs DHS to implement applicability 12 of the program to both women and men upon receipt of federal 13 approval. 14 HEALTH AND LONG-TERM CARE. This division amends Code 15 section 135.164, relating to the strategic plan for health care 16 delivery and health care workforce resources, to eliminate a 17 requirement for the department of public health to establish 18 a technical advisory committee. The division also directs 19 DPH to develop and submit cost projections for developing and 20 implementing the strategic plan by December 15, 2013. 21 AUTISM SUPPORT PROGRAM. This division requires the 22 department of human services to implement an autism support 23 program for children younger than age nine who are not eligible 24 for the Medicaid program and do not have private insurance 25 coverage. 26 CHILD, ADULT, AND FAMILY SERVICES —— DHS. This division 27 relates to child, adult, and family services under the purview 28 of the department of human services. 29 The division eliminates the comprehensive family support 30 council and strikes references to the council. 31 The division directs DHS to implement policies and 32 procedures necessary to comply with the federal Middle 33 Class Tax Relief and Job Creation Act of 2012, to prevent 34 family investment program assistance from being used in any 35 -121- LSB 1004SV (4) 85 pf/jp 121/ 122
S.F. 446 electronic benefit transfer transaction in a liquor store; a 1 casino, gambling casino, or gaming establishment; or a retail 2 establishment that provides adult-oriented entertainment. The 3 division also provides that an individual accessing benefits 4 through the family investment program in a way prohibited under 5 the policies and procedures implemented by the department 6 commits a fraudulent practice. 7 The division extends the repeal date of the IowaCare program 8 from October 31, 2013, to December 31, 2013. 9 The division amends provisions relating to the medical 10 assistance (Medicaid) and hawk-i programs to comply with 11 provisions of the federal Patient Protection and Affordable 12 Care Act (ACA). 13 OPTIONS —— PERSONS WITH AGGRESSIVE OR PSYCHIATRIC BEHAVIORS. 14 This division relates to housing of persons who are sexually 15 aggressive or combative or who have unmet psychiatric needs. 16 The division directs the department of inspections and appeals, 17 in conjunction with the department of human services, to 18 establish and facilitate a committee to address the placement 19 or housing of such persons. The committee must provide a 20 report of findings and recommendations to the governor and 21 general assembly by December 15, 2013. 22 SPORTS INJURY PREVENTION. This division establishes 23 a municipal youth sports injury prevention study to make 24 recommendations regarding how cities can most effectively 25 prevent sports-related injuries in children participating 26 in municipal youth sports programs. The national center 27 for sports safety is requested to administer the study in 28 coordination with the Iowa department of public health 29 and other interested parties. The study must include 30 recommendations for safety equipment for participants and 31 training for employees and volunteers to be required by 32 cities as part of municipal youth sports programs. The 33 center is requested to submit a report on its findings and 34 recommendations to the general assembly by January 10, 2014. 35 -122- LSB 1004SV (4) 85 pf/jp 122/ 122