House File 891 - Introduced HOUSE FILE 891 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO LSB 1004YC) A BILL FOR An Act relating to appropriations for health and human 1 services and veterans and including other related provisions 2 and appropriations, providing penalties, and including 3 effective date and retroactive and other applicability date 4 provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 1004HV (2) 89 pf/rn
H.F. 891 DIVISION I 1 DEPARTMENT ON AGING —— FY 2021-2022 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, 2021, and ending June 30, 5 2022, 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 9 years of age and older with case management, Iowa’s aging and 10 disabilities resource center, and other services which may 11 include but are not limited to adult day, respite care, chore, 12 information and assistance, and material aid, for information 13 and options counseling for persons with disabilities who 14 are 18 years of age or older, and for salaries, support, 15 administration, maintenance, and miscellaneous purposes, and 16 for not more than the following full-time equivalent positions: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,164,382 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 27.00 19 1. Funds appropriated in this section may be used to 20 supplement federal funds under federal regulations. To 21 receive funds appropriated in this section, a local area 22 agency on aging shall match the funds with moneys from other 23 sources according to rules adopted by the department. Funds 24 appropriated in this section may be used for elderly services 25 not specifically enumerated in this section only if approved 26 by an area agency on aging for provision of the service within 27 the area. 28 2. Of the funds appropriated in this section, $279,000 is 29 transferred to the economic development authority for the Iowa 30 commission on volunteer services to be used for the retired and 31 senior volunteer program. 32 3. a. The department on aging shall establish and enforce 33 procedures relating to expenditure of state and federal funds 34 by area agencies on aging that require compliance with both 35 -1- LSB 1004HV (2) 89 pf/rn 1/ 79
H.F. 891 state and federal laws, rules, and regulations, including but 1 not limited to all of the following: 2 (1) Requiring that expenditures are incurred only for goods 3 or services received or performed prior to the end of the 4 fiscal period designated for use of the funds. 5 (2) Prohibiting prepayment for goods or services not 6 received or performed prior to the end of the fiscal period 7 designated for use of the funds. 8 (3) Prohibiting prepayment for goods or services not 9 defined specifically by good or service, time period, or 10 recipient. 11 (4) Prohibiting the establishment of accounts from which 12 future goods or services which are not defined specifically by 13 good or service, time period, or recipient, may be purchased. 14 b. The procedures shall provide that if any funds are 15 expended in a manner that is not in compliance with the 16 procedures and applicable federal and state laws, rules, and 17 regulations, and are subsequently subject to repayment, the 18 area agency on aging expending such funds in contravention of 19 such procedures, laws, rules and regulations, not the state, 20 shall be liable for such repayment. 21 4. Of the funds appropriated in this section, at least 22 $600,000 shall be used to fund home and community-based 23 services through the area agencies on aging that enable older 24 individuals to avoid more costly utilization of residential or 25 institutional services and remain in their own homes. 26 5. Of the funds appropriated in this section, $812,000 shall 27 be used for the purposes of chapter 231E and to administer 28 the prevention of elder abuse, neglect, and exploitation 29 program pursuant to section 231.56A , in accordance with the 30 requirements of the federal Older Americans Act of 1965, 42 31 U.S.C. §3001 et seq., as amended. 32 6. Of the funds appropriated in this section, $1,000,000 33 shall be used to fund continuation of the aging and disability 34 resource center lifelong links to provide individuals and 35 -2- LSB 1004HV (2) 89 pf/rn 2/ 79
H.F. 891 caregivers with information and services to plan for and 1 maintain independence. 2 7. Of the funds appropriated in this section, $250,000 3 shall be used by the department on aging, in collaboration with 4 the department of human services and affected stakeholders, 5 to continue to expand the pilot initiative to provide 6 long-term care options counseling utilizing support planning 7 protocols, to assist non-Medicaid eligible consumers who 8 indicate a preference to return to the community and are 9 deemed appropriate for discharge, to return to their community 10 following a nursing facility stay. The department on aging 11 shall submit a report regarding the outcomes of the pilot 12 initiative to the governor and the general assembly by December 13 15, 2021. 14 DIVISION II 15 OFFICE OF LONG-TERM CARE OMBUDSMAN —— FY 2021-2022 16 Sec. 2. OFFICE OF LONG-TERM CARE OMBUDSMAN. There is 17 appropriated from the general fund of the state to the office 18 of long-term care ombudsman for the fiscal year beginning July 19 1, 2021, and ending June 30, 2022, the following amount, or 20 so much thereof as is necessary, to be used for the purposes 21 designated: 22 For salaries, support, administration, maintenance, and 23 miscellaneous purposes, and for not more than the following 24 full-time equivalent positions: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,149,821 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 16.00 27 DIVISION III 28 DEPARTMENT OF PUBLIC HEALTH —— FY 2021-2022 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, 2021, and ending 32 June 30, 2022, 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 1004HV (2) 89 pf/rn 3/ 79
H.F. 891 For reducing the prevalence of the use of tobacco, alcohol, 1 and 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,659,379 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 12.00 6 a. (1) Of the funds appropriated in this subsection, 7 $4,020,894 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 initiatives. Activities 14 of the programs and initiatives shall be in alignment with 15 the United States centers for disease control and prevention 16 best practices for comprehensive tobacco control programs 17 that include the goals of preventing youth initiation of 18 tobacco usage, reducing exposure to secondhand smoke, and 19 promotion of tobacco cessation. To maximize resources, 20 the department shall determine if third-party sources are 21 available to instead provide nicotine replacement products 22 to an applicant prior to provision of such products to an 23 applicant under the initiative. The department shall track and 24 report to the governor and the general assembly any reduction 25 in the provision of nicotine replacement products realized 26 by the initiative through implementation of the prerequisite 27 screening. 28 (2) (a) The department shall collaborate with the 29 alcoholic beverages division of the department of commerce for 30 enforcement of tobacco laws, regulations, and ordinances and to 31 engage in tobacco control activities approved by the division 32 of tobacco use prevention and control of the department of 33 public health as specified in the memorandum of understanding 34 entered into between the divisions. 35 -4- LSB 1004HV (2) 89 pf/rn 4/ 79
H.F. 891 (b) For the fiscal year beginning July 1, 2021, and ending 1 June 30, 2022, the terms of the memorandum of understanding, 2 entered into between the division of tobacco use prevention 3 and control of the department of public health and the 4 alcoholic beverages division of the department of commerce, 5 governing compliance checks conducted to ensure licensed retail 6 tobacco outlet conformity with tobacco laws, regulations, and 7 ordinances relating to persons under 21 years of age, shall 8 continue to restrict the number of such checks to one check per 9 retail outlet, and one additional check for any retail outlet 10 found to be in violation during the first check. 11 b. (1) Of the funds appropriated in this subsection, 12 $19,638,485 shall be used for problem gambling and 13 substance-related disorder prevention, treatment, and recovery 14 services, including a 24-hour helpline, public information 15 resources, professional training, youth prevention, and program 16 evaluation. 17 (2) Of the amount allocated under this paragraph, $306,000 18 shall be utilized by the department of public health, in 19 collaboration with the department of human services, to 20 maintain a single statewide 24-hour crisis hotline for the Iowa 21 children’s behavioral health system that incorporates warmline 22 services which may be provided through expansion of existing 23 capabilities maintained by the department of public health as 24 required pursuant to 2018 Iowa Acts, chapter 1056, section 16 . 25 c. The requirement of section 123.17, subsection 5 , is met 26 by the appropriations and allocations made in this division of 27 this Act for purposes of substance-related disorder treatment 28 and addictive disorders for the fiscal year beginning July 1, 29 2021. 30 2. HEALTHY CHILDREN AND FAMILIES 31 For promoting the optimum health status for children and 32 adolescents from birth through 21 years of age, and families, 33 and for not more than the following full-time equivalent 34 positions: 35 -5- LSB 1004HV (2) 89 pf/rn 5/ 79
H.F. 891 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,816,681 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 14.00 2 a. Of the funds appropriated in this subsection, not more 3 than $734,000 shall be used for the healthy opportunities for 4 parents to experience success (HOPES)-healthy families Iowa 5 (HFI) program established pursuant to section 135.106 . 6 b. In order to implement the legislative intent stated 7 in sections 135.106 and 256I.9 , priority for home visitation 8 program funding shall be given to programs using evidence-based 9 or promising models for home visitation. 10 c. Of the funds appropriated in this subsection, $3,075,000 11 shall be used for continuation of the department’s initiative 12 to provide for adequate developmental surveillance and 13 screening during a child’s first five years. The funds shall 14 be used first to fully fund the current sites to ensure that 15 the sites are fully operational, with the remaining funds 16 to be used for expansion to additional sites. The full 17 implementation and expansion shall include enhancing the scope 18 of the initiative through collaboration with the child health 19 specialty clinics to promote healthy child development through 20 early identification and response to both biomedical and social 21 determinants of healthy development; by monitoring child 22 health metrics to inform practice, document long-term health 23 impacts and savings, and provide for continuous improvement 24 through training, education, and evaluation; and by providing 25 for practitioner consultation particularly for children with 26 behavioral conditions and needs. The department of public 27 health shall also collaborate with the Iowa Medicaid enterprise 28 and the child health specialty clinics to integrate the 29 activities of the first five initiative into the establishment 30 of patient-centered medical homes, community utilities, 31 accountable care organizations, and other integrated care 32 models developed to improve health quality and population 33 health while reducing health care costs. To the maximum extent 34 possible, funding allocated in this paragraph shall be utilized 35 -6- LSB 1004HV (2) 89 pf/rn 6/ 79
H.F. 891 as matching funds for medical assistance program reimbursement. 1 d. Of the funds appropriated in this subsection, $64,000 2 shall be distributed to a statewide dental carrier to provide 3 funds to continue the donated dental services program patterned 4 after the projects developed by the dental lifeline network to 5 provide dental services to indigent individuals who are elderly 6 or with disabilities. 7 e. Of the funds appropriated in this subsection, $156,000 8 shall be used to provide audiological services and hearing aids 9 for children. 10 f. Of the funds appropriated in this subsection, $23,000 is 11 transferred to the university of Iowa college of dentistry for 12 provision of primary dental services to children. State funds 13 shall be matched on a dollar-for-dollar basis. The university 14 of Iowa college of dentistry shall coordinate efforts with the 15 department of public health, oral and health delivery system 16 bureau, to provide dental care to underserved populations 17 throughout the state. 18 g. Of the funds appropriated in this subsection, $50,000 19 shall be used to address youth suicide prevention. 20 h. Of the funds appropriated in this subsection, $40,000 21 shall be used to support the Iowa effort to address the survey 22 of children who experience adverse childhood experiences known 23 as ACEs. 24 i. Of the funds appropriated in this subsection, up to 25 $494,000 shall be used for childhood obesity prevention. 26 3. CHRONIC CONDITIONS 27 For serving individuals identified as having chronic 28 conditions or special health care needs, and for not more than 29 the following full-time equivalent positions: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,258,373 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 10.00 32 a. Of the funds appropriated in this subsection, $188,000 33 shall be used for grants to individual patients who have an 34 inherited metabolic disorder to assist with the costs of 35 -7- LSB 1004HV (2) 89 pf/rn 7/ 79
H.F. 891 medically necessary foods and formula. 1 b. Of the funds appropriated in this subsection, $1,055,000 2 shall be used for the brain injury services program pursuant 3 to section 135.22B , including $861,000 for contracting with an 4 existing nationally affiliated and statewide organization whose 5 purpose is to educate, serve, and support Iowans with brain 6 injury and their families, for resource facilitator services 7 in accordance with section 135.22B, subsection 9 , and for 8 contracting to enhance brain injury training and recruitment 9 of service providers on a statewide basis. Of the amount 10 allocated in this paragraph, $95,000 shall be used to fund 11 1.00 full-time equivalent position to serve as the state brain 12 injury services program manager. 13 c. Of the funds appropriated in this subsection, $144,000 14 shall be used for the public purpose of continuing to contract 15 with an existing nationally affiliated organization to provide 16 education, client-centered programs, and client and family 17 support for people living with epilepsy and their families. 18 The amount allocated in this paragraph in excess of $50,000 19 shall be matched dollar-for-dollar by the organization 20 specified. Funds allocated under this paragraph shall be 21 distributed in their entirety for the purpose specified on July 22 1, 2021. 23 d. Of the funds appropriated in this subsection, $809,000 24 shall be used for child health specialty clinics. 25 e. Of the funds appropriated in this subsection, $384,000 26 shall be used by the regional autism assistance program 27 established pursuant to section 256.35 , and administered by 28 the child health specialty clinic located at the university of 29 Iowa hospitals and clinics. The funds shall be used to enhance 30 interagency collaboration and coordination of educational, 31 medical, and other human services for persons with autism, 32 their families, and providers of services, including delivering 33 regionalized services of care coordination, family navigation, 34 and integration of services through the statewide system of 35 -8- LSB 1004HV (2) 89 pf/rn 8/ 79
H.F. 891 regional child health specialty clinics and fulfilling other 1 requirements as specified in chapter 225D . The university of 2 Iowa shall not receive funds allocated under this paragraph for 3 indirect costs associated with the regional autism assistance 4 program. 5 f. Of the funds appropriated in this subsection, $577,000 6 shall be used for the comprehensive cancer control program to 7 reduce the burden of cancer in Iowa through prevention, early 8 detection, effective treatment, and ensuring quality of life. 9 Of the funds allocated in this paragraph “f”, $150,000 shall 10 be used to support a melanoma research symposium, a melanoma 11 biorepository and registry, basic and translational melanoma 12 research, and clinical trials. 13 g. Of the funds appropriated in this subsection, $97,000 14 shall be used for cervical and colon cancer screening, and 15 $177,000 shall be used to enhance the capacity of the cervical 16 cancer screening program to include provision of recommended 17 prevention and early detection measures to a broader range of 18 low-income women. 19 h. Of the funds appropriated in this subsection, $506,000 20 shall be used for the center for congenital and inherited 21 disorders. 22 4. COMMUNITY CAPACITY 23 For strengthening the health care delivery system at the 24 local level, and for not more than the following full-time 25 equivalent positions: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,319,306 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 13.00 28 a. Of the funds appropriated in this subsection, $95,000 29 is allocated for continuation of the child vision screening 30 program implemented through the university of Iowa hospitals 31 and clinics in collaboration with early childhood Iowa areas. 32 The program shall submit a report to the department regarding 33 the use of funds allocated under this paragraph “a”. The 34 report shall include the objectives and results for the 35 -9- LSB 1004HV (2) 89 pf/rn 9/ 79
H.F. 891 program year including the target population and how the funds 1 allocated assisted the program in meeting the objectives; the 2 number, age, and location within the state of individuals 3 served; the type of services provided to the individuals 4 served; the distribution of funds based on service provided; 5 and the continuing needs of the program. 6 b. Of the funds appropriated in this subsection, 7 $48,000 shall be used for a grant to a statewide association 8 of psychologists, that is affiliated with the American 9 psychological association, to be used for continuation of a 10 program to rotate intern psychologists in placements that 11 serve urban and rural mental health professional shortage 12 areas. Once an intern psychologist begins service, the intern 13 psychologist may continue serving in the location of the intern 14 psychologist’s placement, notwithstanding any change in the 15 mental health professional shortage area designation of such 16 location. The intern psychologist may also provide services 17 via telehealth, to underserved populations, and to Medicaid 18 members. For the purposes of this paragraph “b”, “mental 19 health professional shortage area” means a geographic area 20 in this state that has been designated by the United States 21 department of health and human services, health resources and 22 services administration, bureau of health professionals, as 23 having a shortage of mental health professionals. 24 c. Of the funds appropriated in this subsection, the 25 following amounts are allocated to be used as follows 26 to support the goals of increased access, health system 27 integration, and engagement: 28 (1) Not less than $600,000 is allocated to the Iowa 29 prescription drug corporation for continuation of the 30 pharmaceutical infrastructure for safety net providers as 31 described in 2007 Iowa Acts, chapter 218, section 108 , and for 32 the prescription drug donation repository program created in 33 chapter 135M . 34 (2) Not less than $334,000 is allocated to free clinics and 35 -10- LSB 1004HV (2) 89 pf/rn 10/ 79
H.F. 891 free clinics of Iowa for necessary infrastructure, statewide 1 coordination, provider recruitment, service delivery, and 2 provision of assistance to patients in securing a medical home 3 inclusive of oral health care. Funds allocated under this 4 subparagraph shall be distributed in their entirety for the 5 purpose specified on July 1, 2021. 6 (3) Not less than $25,000 is allocated to the Iowa 7 association of rural health clinics for necessary 8 infrastructure and service delivery transformation. Funds 9 allocated under this subparagraph shall be distributed in their 10 entirety for the purpose specified on July 1, 2021. 11 (4) Not less than $225,000 is allocated to the Polk county 12 medical society for continuation of the safety net provider 13 patient access to specialty health care initiative as described 14 in 2007 Iowa Acts, chapter 218, section 109 . Funds allocated 15 under this subparagraph shall be distributed in their entirety 16 for the purpose specified on July 1, 2021. 17 d. Of the funds appropriated in this subsection, $191,000 18 is allocated for the purposes of health care and public health 19 workforce initiatives. 20 e. Of the funds appropriated in this subsection, $96,000 21 shall be used for a matching dental education loan repayment 22 program to be allocated to a dental nonprofit health service 23 corporation to continue to develop the criteria and implement 24 the loan repayment program. 25 f. Of the funds appropriated in this subsection, $100,000 26 shall be used for the purposes of the Iowa donor registry as 27 specified in section 142C.18 . 28 g. Of the funds appropriated in this subsection, $96,000 29 shall be used for continuation of a grant to a nationally 30 affiliated volunteer eye organization that has an established 31 program for children and adults and that is solely dedicated to 32 preserving sight and preventing blindness through education, 33 nationally certified vision screening and training, and 34 community and patient service programs. The contractor shall 35 -11- LSB 1004HV (2) 89 pf/rn 11/ 79
H.F. 891 submit a report to the general assembly regarding the use 1 of funds allocated under this paragraph “g”. The report 2 shall include the objectives and results for the program year 3 including the target population and how the funds allocated 4 assisted the program in meeting the objectives; the number, 5 age, grade level if appropriate, and location within the state 6 of individuals served; the type of services provided to the 7 individuals served; the distribution of funds based on services 8 provided; and the continuing needs of the program. 9 h. Of the funds appropriated in this subsection, $2,100,000 10 shall be deposited in the medical residency training account 11 created in section 135.175, subsection 5 , paragraph “a”, and 12 is appropriated from the account to the department of public 13 health to be used for the purposes of the medical residency 14 training state matching grants program as specified in section 15 135.176 . 16 i. Of the funds appropriated in this subsection, $250,000 17 shall be used for the public purpose of providing funding to 18 Des Moines university to continue a provider education project 19 to provide primary care physicians with the training and skills 20 necessary to recognize the signs of mental illness in patients. 21 j. Of the funds appropriated in this subsection, $600,000 22 shall be used for rural psychiatric residencies to support the 23 annual creation and training of four psychiatric residents who 24 will provide mental health services in underserved areas of 25 the state. Notwithstanding section 8.33, moneys that remain 26 unencumbered or unobligated at the close of the fiscal year 27 shall not revert but shall remain available for expenditure for 28 the purposes designated for subsequent fiscal years. 29 k. Of the funds appropriated in this subsection, $150,000 30 shall be used for psychiatric training to increase access to 31 mental health care services by expanding the mental health 32 workforce via training of additional physician assistants and 33 nurse practitioners. 34 l. Of the funds appropriated in this subsection, $425,000 35 -12- LSB 1004HV (2) 89 pf/rn 12/ 79
H.F. 891 shall be used for the creation of a center of excellence 1 program to encourage innovation and collaboration among 2 regional health care providers in a rural area based upon the 3 results of a regional community needs assessment to transform 4 health care delivery in order to provide quality, sustainable 5 care that meets the needs of the local communities. An 6 applicant for the funds shall specify how the funds will be 7 expended to accomplish the goals of the program and shall 8 provide a detailed five-year sustainability plan prior to 9 being awarded any funding. Following the receipt of funding, 10 a recipient shall submit periodic reports as specified by the 11 department to the governor and the general assembly regarding 12 the recipient’s expenditure of the funds and progress in 13 accomplishing the program goals. 14 5. ESSENTIAL PUBLIC HEALTH SERVICES 15 To provide public health services that reduce risks and 16 invest in promoting and protecting good health over the 17 course of a lifetime with a priority given to older Iowans and 18 vulnerable populations: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,662,464 20 6. INFECTIOUS DISEASES 21 For reducing the incidence and prevalence of communicable 22 diseases, and for not more than the following full-time 23 equivalent positions: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,796,206 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 6.00 26 7. PUBLIC PROTECTION 27 For protecting the health and safety of the public through 28 establishing standards and enforcing regulations, and for not 29 more than the following full-time equivalent positions: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,466,601 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 142.00 32 a. Of the funds appropriated in this subsection, not more 33 than $304,000 shall be credited to the emergency medical 34 services fund created in section 135.25 . Moneys in the 35 -13- LSB 1004HV (2) 89 pf/rn 13/ 79
H.F. 891 emergency medical services fund are appropriated to the 1 department to be used for the purposes of the fund. 2 b. Of the funds appropriated in this subsection, up 3 to $243,000 shall be used for sexual violence prevention 4 programming through a statewide organization representing 5 programs serving victims of sexual violence through the 6 department’s sexual violence prevention program, and for 7 continuation of a training program for sexual assault 8 response team (SART) members, including representatives of 9 law enforcement, victim advocates, prosecutors, and certified 10 medical personnel. The amount allocated in this paragraph “b” 11 shall not be used to supplant funding administered for other 12 sexual violence prevention or victims assistance programs. 13 c. Of the funds appropriated in this subsection, up to 14 $500,000 shall be used for the state poison control center. 15 Pursuant to the directive under 2014 Iowa Acts, chapter 16 1140, section 102 , the federal matching funds available to 17 the state poison control center from the department of human 18 services under the federal Children’s Health Insurance Program 19 Reauthorization Act allotment shall be subject to the federal 20 administrative cap rule of 10 percent applicable to funding 21 provided under Tit. XXI of the federal Social Security Act and 22 included within the department’s calculations of the cap. 23 d. Of the funds appropriated in this subsection, up to 24 $504,000 shall be used for childhood lead poisoning provisions. 25 8. RESOURCE MANAGEMENT 26 For establishing and sustaining the overall ability of the 27 department to deliver services to the public, and for not more 28 than the following full-time equivalent positions: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 933,871 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 4.00 31 9. MISCELLANEOUS PROVISIONS 32 The university of Iowa hospitals and clinics under the 33 control of the state board of regents shall not receive 34 indirect costs from the funds appropriated in this section. 35 -14- LSB 1004HV (2) 89 pf/rn 14/ 79
H.F. 891 The university of Iowa hospitals and clinics billings to the 1 department shall be on at least a quarterly basis. 2 Sec. 4. DEPARTMENT OF PUBLIC HEALTH —— SPORTS WAGERING 3 RECEIPTS FUND. There is appropriated from the sports wagering 4 receipts fund created in section 8.57, subsection 6, to the 5 department of public health for the fiscal year beginning July 6 1, 2021, and ending June 30, 2022, the following amount, or 7 so much thereof as is necessary, to be used for the purposes 8 designated: 9 For problem gambling and substance-related disorder 10 prevention, treatment, and recovery services, including a 11 24-hour helpline, public information resources, professional 12 training, youth prevention, and program evaluation: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 14 DIVISION IV 15 DEPARTMENT OF VETERANS AFFAIRS —— FY 2021-2022 16 Sec. 5. DEPARTMENT OF VETERANS AFFAIRS. There is 17 appropriated from the general fund of the state to the 18 department of veterans affairs for the fiscal year beginning 19 July 1, 2021, and ending June 30, 2022, the following amounts, 20 or so much thereof as is necessary, to be used for the purposes 21 designated: 22 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 23 For salaries, support, maintenance, and miscellaneous 24 purposes, and for not more than the following full-time 25 equivalent positions: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,229,763 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 28 2. IOWA VETERANS HOME 29 For salaries, support, maintenance, and miscellaneous 30 purposes: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,131,552 32 a. The Iowa veterans home billings involving the department 33 of human services shall be submitted to the department on at 34 least a monthly basis. 35 -15- LSB 1004HV (2) 89 pf/rn 15/ 79
H.F. 891 b. The Iowa veterans home expenditure report shall be 1 submitted monthly to the general assembly. 2 c. The Iowa veterans home shall continue to include in the 3 annual discharge report applicant information to provide for 4 the collection of demographic information including but not 5 limited to the number of individuals applying for admission and 6 admitted or denied admittance and the basis for the admission 7 or denial; the age, gender, and race of such individuals; 8 and the level of care for which such individuals applied for 9 admission including residential or nursing level of care. 10 3. HOME OWNERSHIP ASSISTANCE PROGRAM 11 For transfer to the Iowa finance authority for the 12 continuation of the home ownership assistance program for 13 persons who are or were eligible members of the armed forces of 14 the United States, pursuant to section 16.54 : 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,000,000 16 Sec. 6. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS 17 FUND STANDING APPROPRIATIONS. Notwithstanding the standing 18 appropriation in section 35A.16 for the fiscal year beginning 19 July 1, 2021, and ending June 30, 2022, the amount appropriated 20 from the general fund of the state for the following designated 21 purposes shall not exceed the following amount, and shall be 22 allocated to each county commission of veterans affairs or to 23 each county sharing the services of an executive director or 24 administrator pursuant to chapter 28E, in equal amounts: 25 For the county commissions of veteran affairs fund under 26 section 35A.16 : 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,289,970 28 DIVISION V 29 DEPARTMENT OF HUMAN SERVICES —— FY 2021-2022 30 Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 31 GRANT. There is appropriated from the fund created in section 32 8.41 to the department of human services for the fiscal year 33 beginning July 1, 2021, and ending June 30, 2022, from moneys 34 received under the federal temporary assistance for needy 35 -16- LSB 1004HV (2) 89 pf/rn 16/ 79
H.F. 891 families (TANF) block grant pursuant to the federal Personal 1 Responsibility and Work Opportunity Reconciliation Act of 1996, 2 Pub. L. No. 104-193, and successor legislation, the following 3 amounts, or so much thereof as is necessary, to be used for the 4 purposes designated: 5 1. To be credited to the family investment program account 6 and used for assistance under the family investment program 7 under chapter 239B : 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,002,006 9 2. To be credited to the family investment program account 10 and used for the job opportunities and basic skills (JOBS) 11 program and implementing family investment agreements in 12 accordance with chapter 239B : 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,412,060 14 3. To be used for the family development and 15 self-sufficiency grant program in accordance with section 16 216A.107 : 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,888,980 18 Notwithstanding section 8.33 , moneys appropriated in this 19 subsection that remain unencumbered or unobligated at the close 20 of the fiscal year shall not revert but shall remain available 21 for expenditure for the purposes designated until the close of 22 the succeeding fiscal year. However, unless such moneys are 23 encumbered or obligated on or before September 30, 2022, the 24 moneys shall revert. 25 4. For field operations: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 31,296,232 27 5. For general administration: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,744,000 29 6. For state child care assistance: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 31 a. Of the funds appropriated in this subsection, 32 $26,205,412 is transferred to the child care and development 33 block grant appropriation made by the Eighty-ninth General 34 Assembly, 2021 session, for the federal fiscal year beginning 35 -17- LSB 1004HV (2) 89 pf/rn 17/ 79
H.F. 891 October 1, 2021, and ending September 30, 2022. Of this 1 amount, $200,000 shall be used for provision of educational 2 opportunities to registered child care home providers in order 3 to improve services and programs offered by this category 4 of providers and to increase the number of providers. The 5 department may contract with institutions of higher education 6 or child care resource and referral centers to provide 7 the educational opportunities. Allowable administrative 8 costs under the contracts shall not exceed 5 percent. The 9 application for a grant shall not exceed two pages in length. 10 b. Any funds appropriated in this subsection remaining 11 unallocated shall be used for state child care assistance 12 payments for families who are employed including but not 13 limited to individuals enrolled in the family investment 14 program. 15 7. For child and family services: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 32,380,654 17 8. For child abuse prevention grants: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 125,000 19 9. For pregnancy prevention grants on the condition that 20 family planning services are funded: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 22 Pregnancy prevention grants shall be awarded to programs 23 in existence on or before July 1, 2021, if the programs have 24 demonstrated positive outcomes. Grants shall be awarded to 25 pregnancy prevention programs which are developed after July 26 1, 2021, if the programs are based on existing models that 27 have demonstrated positive outcomes. Grants shall comply with 28 the requirements provided in 1997 Iowa Acts, chapter 208, 29 section 14, subsections 1 and 2 , including the requirement that 30 grant programs must emphasize sexual abstinence. Priority in 31 the awarding of grants shall be given to programs that serve 32 areas of the state which demonstrate the highest percentage of 33 unplanned pregnancies of females of childbearing age within the 34 geographic area to be served by the grant. 35 -18- LSB 1004HV (2) 89 pf/rn 18/ 79
H.F. 891 10. For technology needs and other resources necessary to 1 meet federal, state, and welfare reform reporting, tracking, 2 and case management requirements and other departmental needs: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,037,186 4 11. a. Notwithstanding any provision to the contrary, 5 including but not limited to requirements in section 8.41 or 6 provisions in 2020 Iowa Acts or 2021 Iowa Acts regarding the 7 receipt and appropriation of federal block grants, federal 8 funds from the temporary assistance for needy families block 9 grant received by the state and not otherwise appropriated 10 in this section and remaining available for the fiscal year 11 beginning July 1, 2021, are appropriated to the department of 12 human services to the extent as may be necessary to be used in 13 the following priority order: the family investment program, 14 for state child care assistance program payments for families 15 who are employed, and for the family investment program share 16 of system costs for eligibility determination and related 17 functions. The federal funds appropriated in this paragraph 18 “a” shall be expended only after all other funds appropriated 19 in subsection 1 for assistance under the family investment 20 program, in subsection 6 for state child care assistance, or 21 in subsection 10 for technology costs related to the family 22 investment program, as applicable, have been expended. For 23 the purposes of this subsection, the funds appropriated in 24 subsection 6, paragraph “a”, for transfer to the child care 25 and development block grant appropriation are considered fully 26 expended when the full amount has been transferred. 27 b. The department shall, on a quarterly basis, advise the 28 general assembly and department of management of the amount of 29 funds appropriated in this subsection that was expended in the 30 prior quarter. 31 12. Of the amounts appropriated in this section, 32 $12,962,008 for the fiscal year beginning July 1, 2021, is 33 transferred to the appropriation of the federal social services 34 block grant made to the department of human services for that 35 -19- LSB 1004HV (2) 89 pf/rn 19/ 79
H.F. 891 fiscal year. 1 13. For continuation of the program providing categorical 2 eligibility for the food assistance program as specified 3 for the program in the section of this division of this Act 4 relating to the family investment program account: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 14,236 6 14. The department may transfer funds allocated in this 7 section to the appropriations made in this division of this Act 8 for the same fiscal year for general administration and field 9 operations for resources necessary to implement and operate the 10 services referred to in this section and those funded in the 11 appropriation made in this division of this Act for the same 12 fiscal year for the family investment program from the general 13 fund of the state. 14 15. With the exception of moneys allocated under this 15 section for the family development and self-sufficiency grant 16 program, to the extent moneys allocated in this section are 17 deemed by the department not to be necessary to support the 18 purposes for which they are allocated, such moneys may be used 19 in the same fiscal year for any other purpose for which funds 20 are allocated in this section or in section 8 of this division 21 of this Act for the family investment program account. If 22 there are conflicting needs, priority shall first be given 23 to the family investment program account as specified under 24 subsection 1 of this section and used for the purposes of 25 assistance under the family investment program in accordance 26 with chapter 239B , followed by state child care assistance 27 program payments for families who are employed, followed by 28 other priorities as specified by the department. 29 Sec. 8. FAMILY INVESTMENT PROGRAM ACCOUNT. 30 1. Moneys credited to the family investment program (FIP) 31 account for the fiscal year beginning July 1, 2021, and 32 ending June 30, 2022, shall be used to provide assistance in 33 accordance with chapter 239B . 34 2. The department may use a portion of the moneys credited 35 -20- LSB 1004HV (2) 89 pf/rn 20/ 79
H.F. 891 to the FIP account under this section as necessary for 1 salaries, support, maintenance, and miscellaneous purposes. 2 3. The department may transfer funds allocated in 3 subsection 4, excluding the allocation under subsection 4, 4 paragraph “b”, to the appropriations made in this division of 5 this Act for the same fiscal year for general administration 6 and field operations for resources necessary to implement 7 and operate the services referred to in this section and 8 those funded in the appropriations made in section 7 for the 9 temporary assistance for needy families block grant and in 10 section 9 for the family investment program from the general 11 fund of the state in this division of this Act for the same 12 fiscal year. 13 4. Moneys appropriated in this division of this Act and 14 credited to the FIP account for the fiscal year beginning July 15 1, 2021, and ending June 30, 2022, are allocated as follows: 16 a. To be retained by the department of human services to 17 be used for coordinating with the department of human rights 18 to more effectively serve participants in FIP and other shared 19 clients and to meet federal reporting requirements under the 20 federal temporary assistance for needy families block grant: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,000 22 b. To the department of human rights for staffing, 23 administration, and implementation of the family development 24 and self-sufficiency grant program in accordance with section 25 216A.107 : 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,192,834 27 (1) Of the funds allocated for the family development 28 and self-sufficiency grant program in this paragraph “b”, 29 not more than 5 percent of the funds shall be used for the 30 administration of the grant program. 31 (2) The department of human rights may continue to implement 32 the family development and self-sufficiency grant program 33 statewide during fiscal year 2021-2022. 34 (3) The department of human rights may engage in activities 35 -21- LSB 1004HV (2) 89 pf/rn 21/ 79
H.F. 891 to strengthen and improve family outcomes measures and 1 data collection systems under the family development and 2 self-sufficiency grant program. 3 c. For the diversion subaccount of the FIP account: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,293,000 5 A portion of the moneys allocated for the diversion 6 subaccount may be used for field operations, salaries, data 7 management system development, and implementation costs and 8 support deemed necessary by the director of human services 9 in order to administer the FIP diversion program. To the 10 extent moneys allocated in this paragraph “c” are deemed by the 11 department not to be necessary to support diversion activities, 12 such moneys may be used for other efforts intended to increase 13 engagement by family investment program participants in work, 14 education, or training activities, or for the purposes of 15 assistance under the family investment program in accordance 16 with chapter 239B . 17 d. For the food assistance employment and training program: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 66,588 19 (1) The department shall apply the federal supplemental 20 nutrition assistance program (SNAP) employment and training 21 state plan in order to maximize to the fullest extent permitted 22 by federal law the use of the 50 percent federal reimbursement 23 provisions for the claiming of allowable federal reimbursement 24 funds from the United States department of agriculture 25 pursuant to the federal SNAP employment and training program 26 for providing education, employment, and training services 27 for eligible food assistance program participants, including 28 but not limited to related dependent care and transportation 29 expenses. 30 (2) The department shall continue the categorical federal 31 food assistance program eligibility at 160 percent of the 32 federal poverty level and continue to eliminate the asset test 33 from eligibility requirements, consistent with federal food 34 assistance program requirements. The department shall include 35 -22- LSB 1004HV (2) 89 pf/rn 22/ 79
H.F. 891 as many food assistance households as is allowed by federal 1 law. The eligibility provisions shall conform to all federal 2 requirements including requirements addressing individuals who 3 are incarcerated or otherwise ineligible. 4 e. For the JOBS program, not more than: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,018,258 6 5. Of the child support collections assigned under FIP, 7 an amount equal to the federal share of support collections 8 shall be credited to the child support recovery appropriation 9 made in this division of this Act. Of the remainder of the 10 assigned child support collections received by the child 11 support recovery unit, a portion shall be credited to the FIP 12 account, a portion may be used to increase recoveries, and a 13 portion may be used to sustain cash flow in the child support 14 payments account. If as a consequence of the appropriations 15 and allocations made in this section the resulting amounts 16 are insufficient to sustain cash assistance payments and meet 17 federal maintenance of effort requirements, the department 18 shall seek supplemental funding. If child support collections 19 assigned under FIP are greater than estimated or are otherwise 20 determined not to be required for maintenance of effort, the 21 state share of either amount may be transferred to or retained 22 in the child support payments account. 23 Sec. 9. FAMILY INVESTMENT PROGRAM GENERAL FUND. There 24 is appropriated from the general fund of the state to the 25 department of human services for the fiscal year beginning July 26 1, 2021, and ending June 30, 2022, the following amount, or 27 so much thereof as is necessary, to be used for the purpose 28 designated: 29 To be credited to the family investment program (FIP) 30 account and used for family investment program assistance 31 under chapter 239B and other costs associated with providing 32 needs-based benefits or assistance: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 41,003,978 34 1. Of the funds appropriated in this section, $6,606,198 is 35 -23- LSB 1004HV (2) 89 pf/rn 23/ 79
H.F. 891 allocated for the JOBS program. 1 2. Of the funds appropriated in this section, $4,313,854 is 2 allocated for the family development and self-sufficiency grant 3 program. 4 3. a. Notwithstanding section 8.39 , for the fiscal 5 year beginning July 1, 2021, if necessary to meet federal 6 maintenance of effort requirements or to transfer federal 7 temporary assistance for needy families block grant funding 8 to be used for purposes of the federal social services block 9 grant or to meet cash flow needs resulting from delays in 10 receiving federal funding or to implement, in accordance with 11 this division of this Act, activities currently funded with 12 juvenile court services, county, or community moneys and state 13 moneys used in combination with such moneys; to comply with 14 federal requirements; or to maximize the use of federal funds; 15 the department of human services may transfer funds within or 16 between any of the appropriations made in this division of this 17 Act and appropriations in law for the federal social services 18 block grant to the department for the following purposes, 19 provided that the combined amount of state and federal 20 temporary assistance for needy families block grant funding 21 for each appropriation remains the same before and after the 22 transfer: 23 (1) For the family investment program. 24 (2) For state child care assistance. 25 (3) For child and family services. 26 (4) For field operations. 27 (5) For general administration. 28 b. This subsection shall not be construed to prohibit the 29 use of existing state transfer authority for other purposes. 30 The department shall report any transfers made pursuant to this 31 subsection to the general assembly. 32 4. Of the funds appropriated in this section, $195,000 33 shall be used for a contract for tax preparation assistance 34 to low-income Iowans to expand the usage of the earned income 35 -24- LSB 1004HV (2) 89 pf/rn 24/ 79
H.F. 891 tax credit. The purpose of the contract is to supply this 1 assistance to underserved areas of the state. The department 2 shall not retain any portion of the allocation under this 3 subsection for administrative costs. 4 5. Of the funds appropriated in this section, $70,000 shall 5 be used for the continuation of the parenting program, as 6 specified in 441 IAC ch. 100 , relating to parental obligations, 7 in which the child support recovery unit participates, to 8 support the efforts of a nonprofit organization committed to 9 strengthening the community through youth development, healthy 10 living, and social responsibility headquartered in a county 11 with a population over 350,000 according to the 2010 certified 12 federal census. The funds allocated in this subsection shall 13 be used by the recipient organization to develop a larger 14 community effort, through public and private partnerships, to 15 support a broad-based multi-county parenthood initiative that 16 promotes payment of child support obligations, improved family 17 relationships, and full-time employment. 18 6. The department may transfer funds appropriated in this 19 section, excluding the allocation in subsection 2 for the 20 family development and self-sufficiency grant program, to the 21 appropriations made in this division of this Act for general 22 administration and field operations as necessary to administer 23 this section, section 7 for the temporary assistance for needy 24 families block grant, and section 8 for the family investment 25 program account. 26 Sec. 10. CHILD SUPPORT RECOVERY. There is appropriated 27 from the general fund of the state to the department of human 28 services for the fiscal year beginning July 1, 2021, and ending 29 June 30, 2022, the following amount, or so much thereof as is 30 necessary, to be used for the purposes designated: 31 For child support recovery, including salaries, support, 32 maintenance, and miscellaneous purposes, and for not more than 33 the following full-time equivalent positions: 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,942,885 35 -25- LSB 1004HV (2) 89 pf/rn 25/ 79
H.F. 891 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 459.00 1 1. The department shall expend up to $24,000, including 2 federal financial participation, for the fiscal year beginning 3 July 1, 2021, for a child support public awareness campaign. 4 The department and the office of the attorney general shall 5 cooperate in continuation of the campaign. The public 6 awareness campaign shall emphasize, through a variety of 7 media activities, the importance of maximum involvement of 8 both parents in the lives of their children as well as the 9 importance of payment of child support obligations. 10 2. Federal access and visitation grant moneys shall be 11 issued directly to private not-for-profit agencies that provide 12 services designed to increase compliance with the child access 13 provisions of court orders, including but not limited to 14 neutral visitation sites and mediation services. 15 3. The appropriation made to the department for child 16 support recovery may be used throughout the fiscal year in the 17 manner necessary for purposes of cash flow management, and for 18 cash flow management purposes the department may temporarily 19 draw more than the amount appropriated, provided the amount 20 appropriated is not exceeded at the close of the fiscal year. 21 Sec. 11. HEALTH CARE TRUST FUND —— MEDICAL ASSISTANCE —— 22 FY 2021-2022. Any funds remaining in the health care trust 23 fund created in section 453A.35A for the fiscal year beginning 24 July 1, 2021, and ending June 30, 2022, are appropriated to 25 the department of human services to supplement the medical 26 assistance program appropriations made in this division of this 27 Act, for medical assistance reimbursement and associated costs, 28 including program administration and costs associated with 29 program implementation. 30 Sec. 12. MEDICAID FRAUD FUND —— MEDICAL ASSISTANCE —— FY 31 2021-2022. Any funds remaining in the Medicaid fraud fund 32 created in section 249A.50 for the fiscal year beginning 33 July 1, 2021, and ending June 30, 2022, are appropriated to 34 the department of human services to supplement the medical 35 -26- LSB 1004HV (2) 89 pf/rn 26/ 79
H.F. 891 assistance appropriations made in this division of this Act, 1 for medical assistance reimbursement and associated costs, 2 including program administration and costs associated with 3 program implementation. 4 Sec. 13. MEDICAL ASSISTANCE. There is appropriated from the 5 general fund of the state to the department of human services 6 for the fiscal year beginning July 1, 2021, and ending June 30, 7 2022, the following amount, or so much thereof as is necessary, 8 to be used for the purpose designated: 9 For medical assistance program reimbursement and associated 10 costs as specifically provided in the reimbursement 11 methodologies in effect on June 30, 2021, except as otherwise 12 expressly authorized by law, consistent with options under 13 federal law and regulations, and contingent upon receipt of 14 approval from the office of the governor of reimbursement for 15 each abortion performed under the program: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,504,667,393 17 1. Iowans support reducing the number of abortions 18 performed in our state. Funds appropriated under this section 19 shall not be used for abortions, unless otherwise authorized 20 under this section. 21 2. The provisions of this section relating to abortions 22 shall also apply to the Iowa health and wellness plan created 23 pursuant to chapter 249N . 24 3. The department shall utilize not more than $60,000 of 25 the funds appropriated in this section to continue the AIDS/HIV 26 health insurance premium payment program as established in 1992 27 Iowa Acts, Second Extraordinary Session, chapter 1001, section 28 409, subsection 6 . Of the funds allocated in this subsection, 29 not more than $5,000 may be expended for administrative 30 purposes. 31 4. Of the funds appropriated in this Act to the department 32 of public health for addictive disorders, $950,000 for 33 the fiscal year beginning July 1, 2021, is transferred 34 to the department of human services for an integrated 35 -27- LSB 1004HV (2) 89 pf/rn 27/ 79
H.F. 891 substance-related disorder managed care system. The 1 departments of human services and public health shall 2 work together to maintain the level of mental health and 3 substance-related disorder treatment services provided by the 4 managed care contractors. Each department shall take the steps 5 necessary to continue the federal waivers as necessary to 6 maintain the level of services. 7 5. The department shall aggressively pursue options for 8 providing medical assistance or other assistance to individuals 9 with special needs who become ineligible to continue receiving 10 services under the early and periodic screening, diagnostic, 11 and treatment program under the medical assistance program 12 due to becoming 21 years of age who have been approved for 13 additional assistance through the department’s exception to 14 policy provisions, but who have health care needs in excess 15 of the funding available through the exception to policy 16 provisions. 17 6. Of the funds appropriated in this section, up to 18 $3,050,082 may be transferred to the field operations or 19 general administration appropriations in this division of this 20 Act for operational costs associated with Part D of the federal 21 Medicare Prescription Drug Improvement and Modernization Act 22 of 2003, Pub. L. No. 108-173. 23 7. Of the funds appropriated in this section, up to $442,100 24 may be transferred to the appropriation in this division of 25 this Act for health program operations to be used for clinical 26 assessment services and prior authorization of services. 27 8. A portion of the funds appropriated in this section may 28 be transferred to the appropriations in this division of this 29 Act for general administration, health program operations, the 30 children’s health insurance program, or field operations to be 31 used for the state match cost to comply with the payment error 32 rate measurement (PERM) program for both the medical assistance 33 and children’s health insurance programs as developed by the 34 centers for Medicare and Medicaid services of the United States 35 -28- LSB 1004HV (2) 89 pf/rn 28/ 79
H.F. 891 department of health and human services to comply with the 1 federal Improper Payments Information Act of 2002, Pub. L. 2 No. 107-300, and to support other reviews and quality control 3 activities to improve the integrity of these programs. 4 9. Of the funds appropriated in this section, a sufficient 5 amount is allocated to supplement the incomes of residents of 6 nursing facilities, intermediate care facilities for persons 7 with mental illness, and intermediate care facilities for 8 persons with an intellectual disability, with incomes of less 9 than $50 in the amount necessary for the residents to receive a 10 personal needs allowance of $50 per month pursuant to section 11 249A.30A . 12 10. a. Hospitals that meet the conditions specified 13 in subparagraphs (1) and (2) shall either certify public 14 expenditures or transfer to the medical assistance program 15 an amount equal to provide the nonfederal share for a 16 disproportionate share hospital payment in an amount up to the 17 hospital-specific limit as approved in the Medicaid state plan. 18 The hospitals that meet the conditions specified shall receive 19 and retain 100 percent of the total disproportionate share 20 hospital payment in an amount up to the hospital-specific limit 21 as approved in the Medicaid state plan. 22 (1) The hospital qualifies for disproportionate share and 23 graduate medical education payments. 24 (2) The hospital is an Iowa state-owned hospital with more 25 than 500 beds and eight or more distinct residency specialty 26 or subspecialty programs recognized by the American college of 27 graduate medical education. 28 b. Distribution of the disproportionate share payments 29 shall be made on a monthly basis. The total amount of 30 disproportionate share payments including graduate medical 31 education, enhanced disproportionate share, and Iowa 32 state-owned teaching hospital payments shall not exceed the 33 amount of the state’s allotment under Pub. L. No. 102-234. 34 In addition, the total amount of all disproportionate 35 -29- LSB 1004HV (2) 89 pf/rn 29/ 79
H.F. 891 share payments shall not exceed the hospital-specific 1 disproportionate share limits under Pub. L. No. 103-66. 2 11. One hundred percent of the nonfederal share of payments 3 to area education agencies that are medical assistance 4 providers for medical assistance-covered services provided to 5 medical assistance-covered children, shall be made from the 6 appropriation made in this section. 7 12. A portion of the funds appropriated in this section may 8 be transferred to the appropriation in this division of this 9 Act for health program operations to be used for administrative 10 activities associated with the money follows the person 11 demonstration project. 12 13. Of the funds appropriated in this section, $349,011 13 shall be used for the administration of the health insurance 14 premium payment program, including salaries, support, 15 maintenance, and miscellaneous purposes. 16 14. a. The department may increase the amounts allocated 17 for salaries, support, maintenance, and miscellaneous purposes 18 associated with the medical assistance program, as necessary, 19 to sustain cost management efforts. The department shall 20 report any such increase to the general assembly and the 21 department of management. 22 b. If the savings to the medical assistance program from 23 ongoing cost management efforts exceed the associated cost 24 for the fiscal year beginning July 1, 2021, the department 25 may transfer any savings generated for the fiscal year due 26 to medical assistance program cost management efforts to the 27 appropriation made in this division of this Act for health 28 program operations or general administration to defray the 29 costs associated with implementing the efforts. 30 15. For the fiscal year beginning July 1, 2021, and ending 31 June 30, 2022, the replacement generation tax revenues required 32 to be deposited in the property tax relief fund pursuant to 33 section 437A.8, subsection 4 , paragraph “d”, and section 34 437A.15, subsection 3 , paragraph “f”, shall instead be credited 35 -30- LSB 1004HV (2) 89 pf/rn 30/ 79
H.F. 891 to and supplement the appropriation made in this section and 1 used for the allocations made in this section. 2 16. a. Of the funds appropriated in this section, up 3 to $50,000 may be transferred by the department to the 4 appropriation made in this division of this Act to the 5 department for the same fiscal year for general administration 6 to be used for associated administrative expenses and for not 7 more than 1.00 full-time equivalent position, in addition to 8 those authorized for the same fiscal year, to be assigned to 9 implementing the children’s mental health home project. 10 b. Of the funds appropriated in this section, up to $400,000 11 may be transferred by the department to the appropriation made 12 to the department in this division of this Act for the same 13 fiscal year for Medicaid program-related general administration 14 planning and implementation activities. The funds may be used 15 for contracts or for personnel in addition to the amounts 16 appropriated for and the positions authorized for general 17 administration for the fiscal year. 18 c. Of the funds appropriated in this section, up to 19 $3,000,000 may be transferred by the department to the 20 appropriations made in this division of this Act for the 21 same fiscal year for general administration or health 22 program operations to be used to support the development 23 and implementation of standardized assessment tools for 24 persons with mental illness, an intellectual disability, a 25 developmental disability, or a brain injury. 26 17. Of the funds appropriated in this section, $150,000 27 shall be used for lodging expenses associated with care 28 provided at the university of Iowa hospitals and clinics for 29 patients with cancer whose travel distance is 30 miles or more 30 and whose income is at or below 200 percent of the federal 31 poverty level as defined by the most recently revised poverty 32 income guidelines published by the United States department of 33 health and human services. The department of human services 34 shall establish the maximum number of overnight stays and the 35 -31- LSB 1004HV (2) 89 pf/rn 31/ 79
H.F. 891 maximum rate reimbursed for overnight lodging, which may be 1 based 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 18. Of the funds appropriated in this section, up to 6 $3,383,880 shall be used for administration of the state family 7 planning services program pursuant to section 217.41B , and 8 of this amount, the department may use up to $200,000 for 9 administrative expenses. 10 19. Of the funds appropriated in this section, $1,545,530 11 shall be used and may be transferred to other appropriations 12 in this division of this Act as necessary to administer the 13 provisions in the division of this Act relating to Medicaid 14 program administration. 15 20. The department shall comply with the centers for 16 Medicare and Medicaid services’ guidance related to Medicaid 17 program and children’s health insurance program maintenance 18 of effort provisions, including eligibility standards, 19 methodologies, procedures, and continuous enrollment, to 20 receive the enhanced federal medical assistance percentage 21 under section 6008(b) of the federal Families First Coronavirus 22 Response Act, Pub. L. No. 116-127. The department shall 23 utilize and implement all tools, processes, and resources 24 available to expediently return to normal eligibility and 25 enrollment operations in compliance with federal guidance and 26 expectations. 27 21. Of the funds appropriated in this section, up to 28 $1,031,530 shall be used to implement reductions in the waiting 29 list for the children’s mental health home and community-based 30 services waiver. 31 Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated 32 from the general fund of the state to the department of human 33 services for the fiscal year beginning July 1, 2021, and ending 34 June 30, 2022, the following amount, or so much thereof as is 35 -32- LSB 1004HV (2) 89 pf/rn 32/ 79
H.F. 891 necessary, to be used for the purpose designated: 1 For health program operations: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 17,831,343 3 1. The department of inspections and appeals shall 4 provide all state matching funds for survey and certification 5 activities performed by the department of inspections 6 and appeals. The department of human services is solely 7 responsible for distributing the federal matching funds for 8 such activities. 9 2. Of the funds appropriated in this section, $50,000 shall 10 be used for continuation of home and community-based services 11 waiver quality assurance programs, including the review and 12 streamlining of processes and policies related to oversight and 13 quality management to meet state and federal requirements. 14 3. Of the amount appropriated in this section, up to 15 $200,000 may be transferred to the appropriation for general 16 administration in this division of this Act to be used for 17 additional full-time equivalent positions in the development 18 of key health initiatives such as development and oversight 19 of managed care programs and development of health strategies 20 targeted toward improved quality and reduced costs in the 21 Medicaid program. 22 4. Of the funds appropriated in this section, $1,000,000 23 shall be used for planning and development, in cooperation with 24 the department of public health, of a phased-in program to 25 provide a dental home for children. 26 5. a. Of the funds appropriated in this section, $573,000 27 shall be credited to the autism support program fund created 28 in section 225D.2 to be used for the autism support program 29 created in chapter 225D , with the exception of the following 30 amount of this allocation which shall be used as follows: 31 b. Of the funds allocated in this subsection, $25,000 shall 32 be used for the public purpose of continuation of a grant to 33 a nonprofit provider of child welfare services that has been 34 in existence for more than 115 years, is located in a county 35 -33- LSB 1004HV (2) 89 pf/rn 33/ 79
H.F. 891 with a population between 200,000 and 220,000 according to the 1 2010 federal decennial census, is licensed as a psychiatric 2 medical institution for children, and provides school-based 3 programming, to be used for support services for children with 4 autism spectrum disorder and their families. 5 Sec. 15. STATE SUPPLEMENTARY ASSISTANCE. 6 1. There is appropriated from the general fund of the 7 state to the department of human services for the fiscal year 8 beginning July 1, 2021, and ending June 30, 2022, the following 9 amount, or so much thereof as is necessary, to be used for the 10 purpose designated: 11 For the state supplementary assistance program: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,349,002 13 2. The department shall increase the personal needs 14 allowance for residents of residential care facilities by the 15 same percentage and at the same time as federal supplemental 16 security income and federal social security benefits are 17 increased due to a recognized increase in the cost of living. 18 The department may adopt emergency rules to implement this 19 subsection. 20 3. If during the fiscal year beginning July 1, 2021, 21 the department projects that state supplementary assistance 22 expenditures for a calendar year will not meet the federal 23 pass-through requirement specified in Tit. XVI of the federal 24 Social Security Act, section 1618, as codified in 42 U.S.C. 25 §1382g, the department may take actions including but not 26 limited to increasing the personal needs allowance for 27 residential care facility residents and making programmatic 28 adjustments or upward adjustments of the residential care 29 facility or in-home health-related care reimbursement rates 30 prescribed in this division of this Act to ensure that federal 31 requirements are met. In addition, the department may make 32 other programmatic and rate adjustments necessary to remain 33 within the amount appropriated in this section while ensuring 34 compliance with federal requirements. The department may adopt 35 -34- LSB 1004HV (2) 89 pf/rn 34/ 79
H.F. 891 emergency rules to implement the provisions of this subsection. 1 4. Notwithstanding section 8.33 , moneys appropriated 2 in this section that remain unencumbered or unobligated 3 at the close of the fiscal year shall not revert but 4 shall remain available for expenditure for the purposes 5 designated, including for liability amounts associated with the 6 supplemental nutrition assistance program payment error rate, 7 until the close of the succeeding fiscal year. 8 Sec. 16. CHILDREN’S HEALTH INSURANCE PROGRAM. 9 1. There is appropriated from the general fund of the 10 state to the department of human services for the fiscal year 11 beginning July 1, 2021, and ending June 30, 2022, the following 12 amount, or so much thereof as is necessary, to be used for the 13 purpose designated: 14 For maintenance of the healthy and well kids in Iowa (hawk-i) 15 program pursuant to chapter 514I , including supplemental dental 16 services, for receipt of federal financial participation under 17 Tit. XXI of the federal Social Security Act, which creates the 18 children’s health insurance program: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 37,957,643 20 2. Of the funds appropriated in this section, $149,189 is 21 allocated for continuation of the contract for outreach with 22 the department of public health. 23 3. A portion of the funds appropriated in this section may 24 be transferred to the appropriations made in this division of 25 this Act for field operations or health program operations to 26 be used for the integration of hawk-i program eligibility, 27 payment, and administrative functions under the purview of 28 the department of human services, including for the Medicaid 29 management information system upgrade. 30 Sec. 17. CHILD CARE ASSISTANCE. There is appropriated 31 from the general fund of the state to the department of human 32 services for the fiscal year beginning July 1, 2021, and ending 33 June 30, 2022, the following amount, or so much thereof as is 34 necessary, to be used for the purpose designated: 35 -35- LSB 1004HV (2) 89 pf/rn 35/ 79
H.F. 891 For child care programs: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 40,816,931 2 1. Of the funds appropriated in this section, $34,966,931 3 shall be used for state child care assistance in accordance 4 with section 237A.13 . 5 2. Nothing in this section shall be construed or is 6 intended as or shall imply a grant of entitlement for services 7 to persons who are eligible for assistance due to an income 8 level consistent with the waiting list requirements of section 9 237A.13 . Any state obligation to provide services pursuant to 10 this section is limited to the extent of the funds appropriated 11 in this section. 12 3. A list of the registered and licensed child care 13 facilities operating in the area served by a child care 14 resource and referral service shall be made available to the 15 families receiving state child care assistance in that area. 16 4. Of the funds appropriated in this section, $5,850,000 17 shall be credited to the early childhood programs grants 18 account in the early childhood Iowa fund created in section 19 256I.11 . The moneys shall be distributed for funding of 20 community-based early childhood programs targeted to children 21 from birth through five years of age developed by early 22 childhood Iowa areas in accordance with approved community 23 plans as provided in section 256I.8 . 24 5. The department may use any of the funds appropriated 25 in this section as a match to obtain federal funds for use in 26 expanding child care assistance and related programs. For 27 the purpose of expenditures of state and federal child care 28 funding, funds shall be considered obligated at the time 29 expenditures are projected or are allocated to the department’s 30 service areas. Projections shall be based on current and 31 projected caseload growth, current and projected provider 32 rates, staffing requirements for eligibility determination 33 and management of program requirements including data systems 34 management, staffing requirements for administration of the 35 -36- LSB 1004HV (2) 89 pf/rn 36/ 79
H.F. 891 program, contractual and grant obligations and any transfers 1 to other state agencies, and obligations for decategorization 2 or innovation projects. 3 6. A portion of the state match for the federal child care 4 and development block grant shall be provided as necessary to 5 meet federal matching funds requirements through the state 6 general fund appropriation made for child development grants 7 and other programs for at-risk children in section 279.51 . 8 7. If a uniform reduction ordered by the governor under 9 section 8.31 or other operation of law, transfer, or federal 10 funding reduction reduces the appropriation made in this 11 section for the fiscal year, the percentage reduction in the 12 amount paid out to or on behalf of the families participating 13 in the state child care assistance program shall be equal to or 14 less than the percentage reduction made for any other purpose 15 payable from the appropriation made in this section and the 16 federal funding relating to it. The percentage reduction to 17 the other allocations made in this section shall be the same as 18 the uniform reduction ordered by the governor or the percentage 19 change of the federal funding reduction, as applicable. If 20 there is an unanticipated increase in federal funding provided 21 for state child care services, the entire amount of the 22 increase, except as necessary to meet federal requirements 23 including quality set asides, shall be used for state child 24 care assistance payments. If the appropriations made for 25 purposes of the state child care assistance program for the 26 fiscal year are determined to be insufficient, it is the intent 27 of the general assembly to appropriate sufficient funding for 28 the fiscal year in order to avoid establishment of waiting list 29 requirements. 30 8. Notwithstanding section 8.33 , moneys advanced for 31 purposes of the programs developed by early childhood Iowa 32 areas, advanced for purposes of wraparound child care, or 33 received from the federal appropriations made for the purposes 34 of this section that remain unencumbered or unobligated at the 35 -37- LSB 1004HV (2) 89 pf/rn 37/ 79
H.F. 891 close of the fiscal year shall not revert to any fund but shall 1 remain available for expenditure for the purposes designated 2 until the close of the succeeding fiscal year. 3 Sec. 18. JUVENILE INSTITUTION. There is appropriated 4 from the general fund of the state to the department of human 5 services for the fiscal year beginning July 1, 2021, and ending 6 June 30, 2022, the following amounts, or so much thereof as is 7 necessary, to be used for the purposes designated: 8 1. a. For operation of the state training school at Eldora 9 and for salaries, support, maintenance, and miscellaneous 10 purposes, and for not more than the following full-time 11 equivalent positions: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 17,397,068 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 207.00 14 b. Of the funds appropriated in this subsection, $91,000 15 shall be used for distribution to licensed classroom teachers 16 at this and other institutions under the control of the 17 department of human services based upon the average student 18 yearly enrollment at each institution as determined by the 19 department. 20 2. A portion of the moneys appropriated in this section 21 shall be used by the state training school at Eldora for 22 grants for adolescent pregnancy prevention activities at the 23 institution in the fiscal year beginning July 1, 2021. 24 3. Of the funds appropriated in this subsection, $212,000 25 shall be used by the state training school at Eldora for a 26 substance use disorder treatment program at the institution for 27 the fiscal year beginning July 1, 2021. 28 4. Notwithstanding section 8.33 , moneys appropriated in 29 this section that remain unencumbered or unobligated at the 30 close of the fiscal year shall not revert but shall remain 31 available for expenditure for the purposes designated until the 32 close of the succeeding fiscal year. 33 Sec. 19. CHILD AND FAMILY SERVICES. 34 1. There is appropriated from the general fund of the 35 -38- LSB 1004HV (2) 89 pf/rn 38/ 79
H.F. 891 state to the department of human services for the fiscal year 1 beginning July 1, 2021, and ending June 30, 2022, the following 2 amount, or so much thereof as is necessary, to be used for the 3 purpose designated: 4 For child and family services: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 89,071,930 6 2. The department may transfer funds appropriated in this 7 section as necessary to pay the nonfederal costs of services 8 reimbursed under the medical assistance program, state child 9 care assistance program, or the family investment program which 10 are provided to children who would otherwise receive services 11 paid under the appropriation in this section. The department 12 may transfer funds appropriated in this section to the 13 appropriations made in this division of this Act for general 14 administration and for field operations for resources necessary 15 to implement and operate the services funded in this section. 16 3. a. Of the funds appropriated in this section, up to 17 $31,500,000 is allocated as the statewide expenditure target 18 under section 232.143 for group foster care maintenance and 19 services. If the department projects that such expenditures 20 for the fiscal year will be less than the target amount 21 allocated in this paragraph “a”, the department may reallocate 22 the excess to provide additional funding for family foster 23 care, independent living, family-centered services, shelter 24 care, or the child welfare emergency services addressed with 25 the allocation for shelter care. 26 b. If at any time after September 30, 2021, annualization 27 of a service area’s current expenditures indicates a service 28 area is at risk of exceeding its group foster care expenditure 29 target under section 232.143 by more than 5 percent, the 30 department and juvenile court services shall examine all 31 group foster care placements in that service area in order to 32 identify those which might be appropriate for termination. 33 In addition, any aftercare services believed to be needed 34 for the children whose placements may be terminated shall be 35 -39- LSB 1004HV (2) 89 pf/rn 39/ 79
H.F. 891 identified. The department and juvenile court services shall 1 initiate action to set dispositional review hearings for the 2 placements identified. In such a dispositional review hearing, 3 the juvenile court shall determine whether needed aftercare 4 services are available and whether termination of the placement 5 is in the best interest of the child and the community. 6 4. In accordance with the provisions of section 232.188 , 7 the department shall continue the child welfare and juvenile 8 justice funding initiative during fiscal year 2021-2022. Of 9 the funds appropriated in this section, $1,717,000 is allocated 10 specifically for expenditure for fiscal year 2021-2022 through 11 the decategorization services funding pools and governance 12 boards established pursuant to section 232.188 . 13 5. A portion of the funds appropriated in this section 14 may be used for emergency family assistance to provide other 15 resources required for a family participating in a family 16 preservation or reunification project or successor project to 17 stay together or to be reunified. 18 6. Of the funds appropriated in this section, a sufficient 19 amount is allocated for shelter care and the child welfare 20 emergency services contracting implemented to provide for or 21 prevent the need for shelter care. 22 7. Federal funds received by the state during the fiscal 23 year beginning July 1, 2021, as the result of the expenditure 24 of state funds appropriated during a previous state fiscal 25 year for a service or activity funded under this section are 26 appropriated to the department to be used as additional funding 27 for services and purposes provided for under this section. 28 Notwithstanding section 8.33 , moneys received in accordance 29 with this subsection that remain unencumbered or unobligated at 30 the close of the fiscal year shall not revert to any fund but 31 shall remain available for the purposes designated until the 32 close of the succeeding fiscal year. 33 8. a. Of the funds appropriated in this section, up to 34 $3,290,000 is allocated for the payment of the expenses of 35 -40- LSB 1004HV (2) 89 pf/rn 40/ 79
H.F. 891 court-ordered services provided to juveniles who are under the 1 supervision of juvenile court services, which expenses are a 2 charge upon the state pursuant to section 232.141, subsection 3 4 . Of the amount allocated in this paragraph “a”, up to 4 $1,556,000 shall be made available to provide school-based 5 supervision of children adjudicated under chapter 232 , of which 6 not more than $15,000 may be used for the purpose of training. 7 A portion of the cost of each school-based liaison officer 8 shall be paid by the school district or other funding source as 9 approved by the chief juvenile court officer. 10 b. Of the funds appropriated in this section, up to $748,000 11 is allocated for the payment of the expenses of court-ordered 12 services provided to children who are under the supervision 13 of the department, which expenses are a charge upon the state 14 pursuant to section 232.141, subsection 4 . 15 c. Notwithstanding section 232.141 or any other provision 16 of law to the contrary, the amounts allocated in this 17 subsection shall be distributed to the judicial districts 18 as determined by the state court administrator and to the 19 department’s service areas as determined by the administrator 20 of the department of human services’ division of child and 21 family services. The state court administrator and the 22 division administrator shall make the determination of the 23 distribution amounts on or before June 15, 2021. 24 d. Notwithstanding chapter 232 or any other provision of 25 law to the contrary, a district or juvenile court shall not 26 order any service which is a charge upon the state pursuant 27 to section 232.141 if there are insufficient court-ordered 28 services funds available in the district court or departmental 29 service area distribution amounts to pay for the service. The 30 chief juvenile court officer and the departmental service area 31 manager shall encourage use of the funds allocated in this 32 subsection such that there are sufficient funds to pay for 33 all court-related services during the entire year. The chief 34 juvenile court officers and departmental service area managers 35 -41- LSB 1004HV (2) 89 pf/rn 41/ 79
H.F. 891 shall attempt to anticipate potential surpluses and shortfalls 1 in the distribution amounts and shall cooperatively request the 2 state court administrator or division administrator to transfer 3 funds between the judicial districts’ or departmental service 4 areas’ distribution amounts as prudent. 5 e. Notwithstanding any provision of law to the contrary, 6 a district or juvenile court shall not order a county to pay 7 for any service provided to a juvenile pursuant to an order 8 entered under chapter 232 which is a charge upon the state 9 under section 232.141, subsection 4 . 10 f. Of the funds allocated in this subsection, not more than 11 $83,000 may be used by the judicial branch for administration 12 of the requirements under this subsection. 13 g. Of the funds allocated in this subsection, $17,000 14 shall be used by the department of human services to support 15 the interstate commission for juveniles in accordance with 16 the interstate compact for juveniles as provided in section 17 232.173 . 18 9. Of the funds appropriated in this section, $12,253,000 is 19 allocated for juvenile delinquent graduated sanctions services. 20 Any state funds saved as a result of efforts by juvenile court 21 services to earn a federal Tit. IV-E match for juvenile court 22 services administration may be used for the juvenile delinquent 23 graduated sanctions services. 24 10. Of the funds appropriated in this section, $1,658,000 is 25 transferred to the department of public health to be used for 26 the child protection center grant program for child protection 27 centers located in Iowa in accordance with section 135.118 . 28 The grant amounts under the program shall be equalized so that 29 each center receives a uniform base amount of $245,000, and so 30 that the remaining funds are awarded through a funding formula 31 based upon the volume of children served. To increase access 32 to child protection center services for children in rural 33 areas, the funding formula for the awarding of the remaining 34 funds shall provide for the awarding of an enhanced amount to 35 -42- LSB 1004HV (2) 89 pf/rn 42/ 79
H.F. 891 eligible grantees to develop and maintain satellite centers in 1 underserved regions of the state. 2 11. Of the funds appropriated in this section, $4,025,000 is 3 allocated for the preparation for adult living program pursuant 4 to section 234.46 . 5 12. Of the funds appropriated in this section, $227,000 6 shall be used for the public purpose of continuing a grant to a 7 nonprofit human services organization, providing services to 8 individuals and families in multiple locations in southwest 9 Iowa and Nebraska for support of a project providing immediate, 10 sensitive support and forensic interviews, medical exams, needs 11 assessments, and referrals for victims of child abuse and their 12 nonoffending family members. 13 13. Of the funds appropriated in this section, $300,000 14 is allocated for the foster care youth council approach of 15 providing a support network to children placed in foster care. 16 14. Of the funds appropriated in this section, $202,000 is 17 allocated for use pursuant to section 235A.1 for continuation 18 of the initiative to address child sexual abuse implemented 19 pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection 20 21 . 21 15. Of the funds appropriated in this section, $630,000 is 22 allocated for the community partnership for child protection 23 sites. 24 16. Of the funds appropriated in this section, $371,000 25 is allocated for the department’s minority youth and family 26 projects under the redesign of the child welfare system. 27 17. Of the funds appropriated in this section, $851,000 28 is allocated for funding of the community circle of care 29 collaboration for children and youth in northeast Iowa. 30 18. Of the funds appropriated in this section, at least 31 $147,000 shall be used for the continuation of the child 32 welfare provider training academy, a collaboration between the 33 coalition for family and children’s services in Iowa and the 34 department. 35 -43- LSB 1004HV (2) 89 pf/rn 43/ 79
H.F. 891 19. Of the funds appropriated in this section, $211,000 1 shall be used for continuation of the central Iowa system of 2 care program grant for the purposes of funding community-based 3 services and other supports with a system of care approach for 4 children with serious emotional disturbance and their families 5 through a nonprofit provider that is located in a county 6 with a population of more than 420,000 but less than 450,000 7 according to the 2010 certified federal census, is licensed 8 as a psychiatric medical institution for children, and was a 9 system of care grantee prior to July 1, 2021. 10 20. Of the funds appropriated in this section, $235,000 11 shall be used for the public purpose of the continuation 12 and expansion of a system of care program grant implemented 13 in Cerro Gordo and Linn counties to utilize a comprehensive 14 and long-term approach for helping children and families by 15 addressing the key areas in a child’s life of childhood basic 16 needs, education and work, family, and community. 17 21. Of the funds appropriated in this section, $110,000 18 shall be used for the public purpose of funding community-based 19 services and other supports with a system of care approach 20 for children with a serious emotional disturbance and their 21 families through a nonprofit provider of child welfare services 22 that has been in existence for more than 115 years, is located 23 in a county with a population of more than 200,000 but less 24 than 220,000 according to the 2010 certified federal census, is 25 licensed as a psychiatric medical institution for children, and 26 was a system of care grantee prior to July 1, 2021. 27 22. If a separate funding source is identified that reduces 28 the need for state funds within an allocation under this 29 section, the allocated state funds may be redistributed to 30 other allocations under this section for the same fiscal year. 31 23. Of the funds appropriated in this section, a portion may 32 be used for family-centered services for purposes of complying 33 with the federal Family First Prevention Services Act of 2018, 34 Pub. L. No. 115-123, and successor legislation. 35 -44- LSB 1004HV (2) 89 pf/rn 44/ 79
H.F. 891 Sec. 20. ADOPTION SUBSIDY. 1 1. There is appropriated from the general fund of the 2 state to the department of human services for the fiscal year 3 beginning July 1, 2021, and ending June 30, 2022, the following 4 amount, or so much thereof as is necessary, to be used for the 5 purpose designated: 6 a. For adoption subsidy payments and related costs and for 7 other services provided for under paragraph “b”, subparagraph 8 (2): 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 40,596,007 10 b. (1) Of the funds appropriated in this section, a 11 sufficient amount is allocated for adoption subsidy payments 12 and related costs. 13 (2) Any funds appropriated in this section remaining after 14 the allocation under subparagraph (1) are designated and 15 allocated as state savings resulting from implementation of 16 the federal Fostering Connections to Success and Increasing 17 Adoptions Act of 2008, Pub. L. No. 110-351, and successor 18 legislation, as determined in accordance with 42 U.S.C. 19 §673(a)(8), and shall be used for post-adoption services and 20 for other purposes allowed under these federal laws, Tit. IV-B 21 or Tit. IV-E of the federal Social Security Act. 22 (a) The department of human services may transfer funds 23 allocated in this subparagraph (2) to the appropriation for 24 child and family services in this division of this Act for the 25 purposes designated in this subparagraph (2). 26 (b) Notwithstanding section 8.33, moneys allocated 27 under this subparagraph (2) shall not revert to any fund but 28 shall remain available for the purposes designated in this 29 subparagraph (2) until expended. 30 2. The department may transfer funds appropriated in 31 this section to the appropriation made in this division of 32 this Act for general administration for costs paid from the 33 appropriation relating to adoption subsidy. 34 3. Federal funds received by the state during the 35 -45- LSB 1004HV (2) 89 pf/rn 45/ 79
H.F. 891 fiscal year beginning July 1, 2021, as the result of the 1 expenditure of state funds 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 the services and activities funded under this section. 5 Notwithstanding section 8.33 , moneys received in accordance 6 with this subsection that remain unencumbered or unobligated 7 at the close of the fiscal year shall not revert to any fund 8 but shall remain available for expenditure for the purposes 9 designated until the close of the succeeding fiscal year. 10 Sec. 21. JUVENILE DETENTION HOME FUND. Moneys deposited 11 in the juvenile detention home fund created in section 232.142 12 during the fiscal year beginning July 1, 2021, and ending June 13 30, 2022, are appropriated to the department of human services 14 for the fiscal year beginning July 1, 2021, and ending June 30, 15 2022, for distribution of an amount equal to a percentage of 16 the costs of the establishment, improvement, operation, and 17 maintenance of county or multicounty juvenile detention homes 18 in the fiscal year beginning July 1, 2020. Moneys appropriated 19 for distribution in accordance with this section shall be 20 allocated among eligible detention homes, prorated on the basis 21 of an eligible detention home’s proportion of the costs of all 22 eligible detention homes in the fiscal year beginning July 23 1, 2020. The percentage figure shall be determined by the 24 department based on the amount available for distribution for 25 the fund. Notwithstanding section 232.142, subsection 3 , the 26 financial aid payable by the state under that provision for the 27 fiscal year beginning July 1, 2021, shall be limited to the 28 amount appropriated for the purposes of this section. 29 Sec. 22. FAMILY SUPPORT SUBSIDY PROGRAM. 30 1. There is appropriated from the general fund of the 31 state to the department of human services for the fiscal year 32 beginning July 1, 2021, and ending June 30, 2022, the following 33 amount, or so much thereof as is necessary, to be used for the 34 purpose designated: 35 -46- LSB 1004HV (2) 89 pf/rn 46/ 79
H.F. 891 For the family support subsidy program subject to the 1 enrollment restrictions in section 225C.37, subsection 3 : 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 949,282 3 2. At least $899,291 of the moneys appropriated in this 4 section is transferred to the department of public health for 5 the family support center component of the comprehensive family 6 support program under chapter 225C, subchapter V . 7 3. If at any time during the fiscal year, the amount of 8 funding available for the family support subsidy program 9 is reduced from the amount initially used to establish the 10 figure for the number of family members for whom a subsidy 11 is to be provided at any one time during the fiscal year, 12 notwithstanding section 225C.38, subsection 2 , the department 13 shall revise the figure as necessary to conform to the amount 14 of funding available. 15 Sec. 23. CONNER DECREE. There is appropriated from the 16 general fund of the state to the department of human services 17 for the fiscal year beginning July 1, 2021, and ending June 30, 18 2022, the following amount, or so much thereof as is necessary, 19 to be used for the purpose designated: 20 For building community capacity through the coordination 21 and provision of training opportunities in accordance with the 22 consent decree of Conner v. Branstad, No. 4-86-CV-30871(S.D. 23 Iowa, July 14, 1994): 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,632 25 Sec. 24. MENTAL HEALTH INSTITUTES. 26 1. There is appropriated from the general fund of the 27 state to the department of human services for the fiscal year 28 beginning July 1, 2021, and ending June 30, 2022, the following 29 amounts, or so much thereof as is necessary, to be used for the 30 purposes designated: 31 a. For operation of the state mental health institute at 32 Cherokee as required by chapters 218 and 226 for salaries, 33 support, maintenance, and miscellaneous purposes, and for not 34 more than the following full-time equivalent positions: 35 -47- LSB 1004HV (2) 89 pf/rn 47/ 79
H.F. 891 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,457,597 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 169.00 2 b. For operation of the state mental health institute at 3 Independence as required by chapters 218 and 226 for salaries, 4 support, maintenance, and miscellaneous purposes, and for not 5 more than the following full-time equivalent positions: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,652,379 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 208.00 8 2. a. Notwithstanding sections 218.78 and 249A.11 , any 9 revenue received from the state mental health institute at 10 Cherokee or the state mental health institute at Independence 11 pursuant to 42 C.F.R §438.6(e) may be retained and expended by 12 the mental health institute. 13 b. Notwithstanding sections 218.78 and 249A.11, any 14 COVID-19 related funding received through federal funding 15 sources by the state mental health institute at Cherokee or the 16 state mental health institute at Independence may be retained 17 and expended by the mental health institute. 18 3. Notwithstanding any provision of law to the contrary, 19 a Medicaid member residing at the state mental health 20 institute at Cherokee or the state mental health institute 21 at Independence shall retain Medicaid eligibility during 22 the period of the Medicaid member’s stay for which federal 23 financial participation is available. 24 4. Notwithstanding section 8.33 , moneys appropriated in 25 this section that remain unencumbered or unobligated at the 26 close of the fiscal year shall not revert but shall remain 27 available for expenditure for the purposes designated until the 28 close of the succeeding fiscal year. 29 Sec. 25. STATE RESOURCE CENTERS. 30 1. There is appropriated from the general fund of the 31 state to the department of human services for the fiscal year 32 beginning July 1, 2021, and ending June 30, 2022, the following 33 amounts, or so much thereof as is necessary, to be used for the 34 purposes designated: 35 -48- LSB 1004HV (2) 89 pf/rn 48/ 79
H.F. 891 a. For the state resource center at Glenwood for salaries, 1 support, maintenance, and miscellaneous purposes: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 14,802,873 3 b. For the state resource center at Woodward for salaries, 4 support, maintenance, and miscellaneous purposes: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,237,937 6 2. The department may continue to bill for state resource 7 center services utilizing a scope of services approach used for 8 private providers of intermediate care facilities for persons 9 with an intellectual disability services, in a manner which 10 does not shift costs between the medical assistance program, 11 counties, or other sources of funding for the state resource 12 centers. 13 3. The state resource centers may expand the time-limited 14 assessment and respite services during the fiscal year. 15 4. If the department’s administration and the department 16 of management concur with a finding by a state resource 17 center’s superintendent that projected revenues can reasonably 18 be expected to pay the salary and support costs for a new 19 employee position, or that such costs for adding a particular 20 number of new positions for the fiscal year would be less 21 than the overtime costs if new positions would not be added, 22 the superintendent may add the new position or positions. If 23 the vacant positions available to a resource center do not 24 include the position classification desired to be filled, the 25 state resource center’s superintendent may reclassify any 26 vacant position as necessary to fill the desired position. The 27 superintendents of the state resource centers may, by mutual 28 agreement, pool vacant positions and position classifications 29 during the course of the fiscal year in order to assist one 30 another in filling necessary positions. 31 5. If existing capacity limitations are reached in 32 operating units, a waiting list is in effect for a service or 33 a special need for which a payment source or other funding 34 is available for the service or to address the special need, 35 -49- LSB 1004HV (2) 89 pf/rn 49/ 79
H.F. 891 and facilities for the service or to address the special need 1 can be provided within the available payment source or other 2 funding, the superintendent of a state resource center may 3 authorize opening not more than two units or other facilities 4 and begin implementing the service or addressing the special 5 need during fiscal year 2021-2022. 6 6. Notwithstanding section 8.33 , and notwithstanding 7 the amount limitation specified in section 222.92 , moneys 8 appropriated in this section that remain unencumbered or 9 unobligated at the close of the fiscal year shall not revert 10 but shall remain available for expenditure for the purposes 11 designated until the close of the succeeding fiscal year. 12 Sec. 26. SEXUALLY VIOLENT PREDATORS. 13 1. There is appropriated from the general fund of the 14 state to the department of human services for the fiscal year 15 beginning July 1, 2021, and ending June 30, 2022, the following 16 amount, or so much thereof as is necessary, to be used for the 17 purpose designated: 18 For costs associated with the commitment and treatment of 19 sexually violent predators in the unit located at the state 20 mental health institute at Cherokee, including costs of legal 21 services and other associated costs, including salaries, 22 support, maintenance, and miscellaneous purposes, and for not 23 more than the following full-time equivalent positions: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13,643,727 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 139.00 26 2. Unless specifically prohibited by law, if the amount 27 charged provides for recoupment of at least the entire amount 28 of direct and indirect costs, the department of human services 29 may contract with other states to provide care and treatment 30 of persons placed by the other states at the unit for sexually 31 violent predators at Cherokee. The moneys received under 32 such a contract shall be considered to be repayment receipts 33 and used for the purposes of the appropriation made in this 34 section. 35 -50- LSB 1004HV (2) 89 pf/rn 50/ 79
H.F. 891 3. Notwithstanding section 8.33 , moneys appropriated in 1 this section that remain unencumbered or unobligated at the 2 close of the fiscal year shall not revert but shall remain 3 available for expenditure for the purposes designated until the 4 close of the succeeding fiscal year. 5 Sec. 27. FIELD OPERATIONS. 6 1. There is appropriated from the general fund of the 7 state to the department of human services for the fiscal year 8 beginning July 1, 2021, and ending June 30, 2022, the following 9 amount, or so much thereof as is necessary, to be used for the 10 purposes designated: 11 For field operations, including salaries, support, 12 maintenance, and miscellaneous purposes, and for not more than 13 the following full-time equivalent positions: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 60,596,667 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 1,539.00 16 2. Priority in filling full-time equivalent positions 17 shall be given to those positions related to child protection 18 services and eligibility determination for low-income families. 19 Sec. 28. GENERAL ADMINISTRATION. There is appropriated 20 from the general fund of the state to the department of human 21 services for the fiscal year beginning July 1, 2021, and ending 22 June 30, 2022, the following amount, or so much thereof as is 23 necessary, to be used for the purpose designated: 24 For general administration, including salaries, support, 25 maintenance, and miscellaneous purposes, and for not more than 26 the following full-time equivalent positions: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,342,189 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 294.00 29 1. The department shall report at least monthly to the 30 general assembly concerning the department’s operational and 31 program expenditures. 32 2. Of the funds appropriated in this section, $150,000 shall 33 be used for the provision of a program to provide technical 34 assistance, support, and consultation to providers of home and 35 -51- LSB 1004HV (2) 89 pf/rn 51/ 79
H.F. 891 community-based services under the medical assistance program. 1 3. Of the funds appropriated in this section, $50,000 2 is transferred to the Iowa finance authority to be used 3 for administrative support of the council on homelessness 4 established in section 16.2D and for the council to fulfill its 5 duties in addressing and reducing homelessness in the state. 6 4. Of the funds appropriated in this section, $200,000 shall 7 be transferred to and deposited in the administrative fund of 8 the Iowa ABLE savings plan trust created in section 12I.4 , to 9 be used for implementation and administration activities of the 10 Iowa ABLE savings plan trust. 11 5. Of the funds appropriated in this section, $200,000 is 12 transferred to the economic development authority for the Iowa 13 commission on volunteer services to continue to be used for the 14 RefugeeRISE AmeriCorps program established under section 15H.8 15 for member recruitment and training to improve the economic 16 well-being and health of economically disadvantaged refugees in 17 local communities across Iowa. Funds transferred may be used 18 to supplement federal funds under federal regulations. 19 6. Of the funds appropriated in this section, up to $300,000 20 shall be used as follows: 21 a. To fund not more than one full-time equivalent position 22 to address the department’s responsibility to support the work 23 of the children’s behavioral health system state board and 24 implementation of the services required pursuant to section 25 331.397. 26 b. To support the cost of establishing and implementing new 27 or additional services required pursuant to sections 331.397 28 and 331.397A. 29 c. Of the amount allocated, $32,000 shall be transferred 30 to the department of public health to support the costs of 31 establishing and implementing new or additional services 32 required pursuant to sections 331.397 and 331.397A. 33 7. Of the funds appropriated in this section, $800,000 shall 34 be used for the renovation and construction of certain nursing 35 -52- LSB 1004HV (2) 89 pf/rn 52/ 79
H.F. 891 facilities, consistent with the provisions of chapter 249K. 1 Sec. 29. DEPARTMENT-WIDE DUTIES. There is appropriated 2 from the general fund of the state to the department of human 3 services for the fiscal year beginning July 1, 2021, and ending 4 June 30, 2022, the following amount, or so much thereof as is 5 necessary, to be used for the purposes designated: 6 For salaries, support, maintenance, and miscellaneous 7 purposes at facilities under the purview of the department of 8 human services: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,879,274 10 Sec. 30. VOLUNTEERS. There is appropriated from the general 11 fund of the state to the department of human services for the 12 fiscal year beginning July 1, 2021, and ending June 30, 2022, 13 the following amount, or so much thereof as is necessary, to be 14 used for the purpose designated: 15 For development and coordination of volunteer services: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 84,686 17 Sec. 31. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY 18 ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE 19 DEPARTMENT OF HUMAN SERVICES. 20 1. a. (1) (a) Notwithstanding any provision of law to 21 the contrary, for the fiscal year beginning July 1, 2021, the 22 department shall not rebase case-mix nursing facility rates, 23 but shall instead reimburse case-mix nursing facilities by 24 adjusting the nursing facility case-mix adjusted rates that 25 were effective July 1, 2019, using the mid-points of each of 26 the most recent cost reports submitted by the nursing facility 27 for the period ending on or before December 31, 2018, and 28 inflating these costs forward applying the inflation factor as 29 determined using the latest available quarterly publication of 30 the HCFA/SNF index, to the extent possible within the state 31 funding, including the $20,000,000 provided for this purpose. 32 (b) For the fiscal year beginning July 1, 2021, non-case-mix 33 and special population nursing facilities shall be reimbursed 34 in accordance with the methodology in effect on June 30 of the 35 -53- LSB 1004HV (2) 89 pf/rn 53/ 79
H.F. 891 prior fiscal year. 1 (c) For managed care claims, the department of human 2 services shall adjust the payment rate floor for nursing 3 facilities, annually, to maintain a rate floor that is no 4 lower than the Medicaid fee-for-service case-mix adjusted rate 5 calculated in accordance with subparagraph division (a) and 6 441 IAC 81.6. The department shall then calculate adjusted 7 reimbursement rates, including but not limited to add-on 8 payments, annually, and shall notify Medicaid managed care 9 organizations of the adjusted reimbursement rates within 30 10 days of determining the adjusted reimbursement rates. Any 11 adjustment of reimbursement rates under this subparagraph 12 division shall be budget neutral to the state budget. 13 (d) For the fiscal year beginning July 1, 2021, Medicaid 14 managed care long-term services and supports capitation rates 15 shall be adjusted to reflect the case-mix adjusted rates 16 specified pursuant to subparagraph division (a) for the patient 17 populations residing in Medicaid-certified nursing facilities. 18 (2) Medicaid managed care organizations shall adjust 19 facility-specific rates based upon payment rate listings issued 20 by the department. The rate adjustments shall be applied 21 prospectively from the effective date of the rate letter issued 22 by the department. 23 b. (1) For the fiscal year beginning July 1, 2021, the 24 department shall establish the fee-for-service pharmacy 25 dispensing fee reimbursement at $10.38 per prescription, 26 until a cost of dispensing survey is completed. The actual 27 dispensing fee shall be determined by a cost of dispensing 28 survey performed by the department and required to be completed 29 by all medical assistance program participating pharmacies 30 every two years. 31 (2) The department shall utilize an average acquisition 32 cost reimbursement methodology for all drugs covered under the 33 medical assistance program in accordance with 2012 Iowa Acts, 34 chapter 1133, section 33 . 35 -54- LSB 1004HV (2) 89 pf/rn 54/ 79
H.F. 891 c. (1) For the fiscal year beginning July 1, 2021, 1 reimbursement rates for outpatient hospital services shall 2 remain at the rates in effect on June 30, 2021, subject to 3 Medicaid program upper payment limit rules, and adjusted 4 as necessary to maintain expenditures within the amount 5 appropriated to the department for this purpose for the fiscal 6 year. 7 (2) For the fiscal year beginning July 1, 2021, 8 reimbursement rates for inpatient hospital services shall 9 be rebased effective October 1, 2021, subject to Medicaid 10 program upper payment limit rules, and adjusted as necessary 11 to maintain expenditures within the amount appropriated to the 12 department for this purpose for the fiscal year. 13 (3) For the fiscal year beginning July 1, 2021, under 14 both fee-for-service and managed care administration of 15 the Medicaid program, critical access hospitals shall be 16 reimbursed for inpatient and outpatient services based on the 17 hospital-specific critical access hospital cost adjustment 18 factor methodology utilizing the most recent and complete cost 19 reporting period as applied prospectively within the funds 20 appropriated for such purpose for the fiscal year. 21 (4) For the fiscal year beginning July 1, 2021, the graduate 22 medical education and disproportionate share hospital fund 23 shall remain at the amount in effect on June 30, 2021, except 24 that the portion of the fund attributable to graduate medical 25 education shall be reduced in an amount that reflects the 26 elimination of graduate medical education payments made to 27 out-of-state hospitals. 28 (5) In order to ensure the efficient use of limited state 29 funds in procuring health care services for low-income Iowans, 30 funds appropriated in this Act for hospital services shall 31 not be used for activities which would be excluded from a 32 determination of reasonable costs under the federal Medicare 33 program pursuant to 42 U.S.C. §1395x(v)(1)(N). 34 d. For the fiscal year beginning July 1, 2021, reimbursement 35 -55- LSB 1004HV (2) 89 pf/rn 55/ 79
H.F. 891 rates for hospices and acute psychiatric hospitals shall be 1 increased in accordance with increases under the federal 2 Medicare program or as supported by their Medicare audited 3 costs. 4 e. For the fiscal year beginning July 1, 2021, independent 5 laboratories and rehabilitation agencies shall be reimbursed 6 using the same methodology in effect on June 30, 2021. 7 f. (1) For the fiscal year beginning July 1, 2021, 8 reimbursement rates for home health agencies shall continue to 9 be based on the Medicare low utilization payment adjustment 10 (LUPA) methodology with state geographic wage adjustments and 11 shall be adjusted to increase the rates to the extent possible 12 within the state funding, including the $2,000,000 appropriated 13 for this purpose. The department shall continue to update the 14 rates every two years to reflect the most recent Medicare LUPA 15 rates. 16 (2) For the fiscal year beginning July 1, 2021, rates for 17 private duty nursing and personal care services under the early 18 and periodic screening, diagnostic, and treatment program 19 benefit shall be calculated based on the methodology in effect 20 on June 30, 2021. 21 g. For the fiscal year beginning July 1, 2021, federally 22 qualified health centers and rural health clinics shall receive 23 cost-based reimbursement for 100 percent of the reasonable 24 costs for the provision of services to recipients of medical 25 assistance. 26 h. For the fiscal year beginning July 1, 2021, the 27 reimbursement rates for dental services shall remain at the 28 rates in effect on June 30, 2021. 29 i. (1) For the fiscal year beginning July 1, 2021, 30 reimbursement rates for non-state-owned psychiatric medical 31 institutions for children shall be increased to the extent 32 possible within the $3,900,000 appropriated for this purpose. 33 (2) As a condition of participation in the medical 34 assistance program, enrolled providers shall accept the medical 35 -56- LSB 1004HV (2) 89 pf/rn 56/ 79
H.F. 891 assistance reimbursement rate for any covered goods or services 1 provided to recipients of medical assistance who are children 2 under the custody of a psychiatric medical institution for 3 children. 4 j. For the fiscal year beginning July 1, 2021, unless 5 otherwise specified in this Act, all noninstitutional medical 6 assistance provider reimbursement rates shall remain at the 7 rates in effect on June 30, 2021, except for area education 8 agencies, local education agencies, infant and toddler 9 services providers, home and community-based services providers 10 including consumer-directed attendant care providers under a 11 section 1915(c) or 1915(i) waiver, targeted case management 12 providers, and those providers whose rates are required to be 13 determined pursuant to section 249A.20 , or to meet federal 14 mental health parity requirements. 15 k. Notwithstanding any provision to the contrary, for the 16 fiscal year beginning July 1, 2021, the reimbursement rate for 17 anesthesiologists shall remain at the rates in effect on June 18 30, 2021, and updated on January 1, 2022, to align with the 19 most current Iowa Medicare anesthesia rate. 20 l. Notwithstanding section 249A.20 , for the fiscal year 21 beginning July 1, 2021, the average reimbursement rate for 22 health care providers eligible for use of the federal Medicare 23 resource-based relative value scale reimbursement methodology 24 under section 249A.20 shall remain at the rate in effect on 25 June 30, 2021; however, this rate shall not exceed the maximum 26 level authorized by the federal government. 27 m. For the fiscal year beginning July 1, 2021, the 28 reimbursement rate for residential care facilities shall not 29 be less than the minimum payment level as established by the 30 federal government to meet the federally mandated maintenance 31 of effort requirement. The flat reimbursement rate for 32 facilities electing not to file annual cost reports shall not 33 be less than the minimum payment level as established by the 34 federal government to meet the federally mandated maintenance 35 -57- LSB 1004HV (2) 89 pf/rn 57/ 79
H.F. 891 of effort requirement. 1 n. For the fiscal year beginning July 1, 2021, the 2 reimbursement rates for inpatient mental health services 3 provided at hospitals shall be rebased effective October 1, 4 2021, subject to Medicaid program upper payment limit rules 5 and adjusted as necessary to maintain expenditures within the 6 amount appropriated to the department for this purpose for 7 the fiscal year; and psychiatrists shall be reimbursed at the 8 medical assistance program fee-for-service rate in effect on 9 June 30, 2021. 10 o. For the fiscal year beginning July 1, 2021, community 11 mental health centers may choose to be reimbursed for the 12 services provided to recipients of medical assistance through 13 either of the following options: 14 (1) For 100 percent of the reasonable costs of the services. 15 (2) In accordance with the alternative reimbursement rate 16 methodology approved by the department of human services in 17 effect on June 30, 2021. 18 p. For the fiscal year beginning July 1, 2021, the 19 reimbursement rate for providers of family planning services 20 that are eligible to receive a 90 percent federal match shall 21 remain at the rates in effect on June 30, 2021. 22 q. (1) For the fiscal year beginning July 1, 2021, 23 reimbursement rates for providers of home and community-based 24 services waiver and habilitation services shall be increased by 25 5.25 percent over the rates in effect on June 30, 2021. 26 (2) For the fiscal year beginning July 1, 2021, 27 reimbursement rates for providers of state plan home and 28 community-based services home-based habilitation services 29 shall be increased with the $7,134,214 appropriated for this 30 purpose. The reimbursement rates for home-based habilitation 31 services shall be based on a fee schedule that incorporates the 32 acuity-based tiers. 33 r. For the fiscal year beginning July 1, 2021, the 34 reimbursement rates for emergency medical service providers 35 -58- LSB 1004HV (2) 89 pf/rn 58/ 79
H.F. 891 shall remain at the rates in effect on June 30, 2021, or as 1 approved by the centers for Medicare and Medicaid services of 2 the United States department of health and human services. 3 s. For the fiscal year beginning July 1, 2021, reimbursement 4 rates for substance-related disorder treatment programs 5 licensed under section 125.13 shall remain at the rates in 6 effect on June 30, 2021. 7 t. For the fiscal year beginning July 1, 2021, assertive 8 community treatment per diem rates shall remain at the rates in 9 effect on June 30, 2021. 10 u. For the fiscal year beginning July 1, 2021, the 11 reimbursement rate for family-centered services providers shall 12 be established by contract. 13 2. For the fiscal year beginning July 1, 2021, the 14 reimbursement rate for providers reimbursed under the 15 in-home-related care program shall not be less than the minimum 16 payment level as established by the federal government to meet 17 the federally mandated maintenance of effort requirement. 18 3. Unless otherwise directed in this section, when the 19 department’s reimbursement methodology for any provider 20 reimbursed in accordance with this section includes an 21 inflation factor, this factor shall not exceed the amount 22 by which the consumer price index for all urban consumers 23 increased during the calendar year ending December 31, 2002. 24 4. Notwithstanding section 234.38 , for the fiscal 25 year beginning July 1, 2021, the foster family basic daily 26 maintenance rate and the maximum adoption subsidy rate for 27 children ages 0 through 5 years shall be $16.78, the rate for 28 children ages 6 through 11 years shall be $17.45, the rate for 29 children ages 12 through 15 years shall be $19.10, and the 30 rate for children and young adults ages 16 and older shall 31 be $19.35. For youth ages 18 to 23 who have exited foster 32 care, the preparation for adult living program maintenance 33 rate shall be up to $602.70 per month as calculated based on 34 the age of the participant. The maximum payment for adoption 35 -59- LSB 1004HV (2) 89 pf/rn 59/ 79
H.F. 891 subsidy nonrecurring expenses shall be limited to $500 and the 1 disallowance of additional amounts for court costs and other 2 related legal expenses implemented pursuant to 2010 Iowa Acts, 3 chapter 1031, section 408 , shall be continued. 4 5. For the fiscal year beginning July 1, 2021, the maximum 5 reimbursement rates for social services providers under 6 contract shall remain at the rates in effect on June 30, 2021, 7 or the provider’s actual and allowable cost plus inflation for 8 each service, whichever is less. However, if a new service 9 or service provider is added after June 30, 2021, the initial 10 reimbursement rate for the service or provider shall be based 11 upon a weighted average of provider rates for similar services. 12 6. a. For the fiscal year beginning July 1, 2021, the 13 reimbursement rates for resource family recruitment and 14 retention contractors shall be established by contract. 15 b. For the fiscal year beginning July 1, 2021, the 16 reimbursement rates for supervised apartment living foster care 17 providers shall be established by contract. 18 7. For the fiscal year beginning July 1, 2021, the 19 reimbursement rate for group foster care providers shall be the 20 combined service and maintenance reimbursement rate established 21 by contract. 22 8. The group foster care reimbursement rates paid for 23 placement of children out of state shall be calculated 24 according to the same rate-setting principles as those used for 25 in-state providers, unless the director of human services or 26 the director’s designee determines that appropriate care cannot 27 be provided within the state. The payment of the daily rate 28 shall be based on the number of days in the calendar month in 29 which service is provided. 30 9. a. For the fiscal year beginning July 1, 2021, the 31 reimbursement rate paid for shelter care and the child welfare 32 emergency services implemented to provide or prevent the need 33 for shelter care shall be established by contract. 34 b. For the fiscal year beginning July 1, 2021, the combined 35 -60- LSB 1004HV (2) 89 pf/rn 60/ 79
H.F. 891 service and maintenance components of the reimbursement rate 1 paid for shelter care services shall be based on the financial 2 and statistical report submitted to the department. The 3 maximum reimbursement rate shall be $101.83 per day. The 4 department shall reimburse a shelter care provider at the 5 provider’s actual and allowable unit cost, plus inflation, not 6 to exceed the maximum reimbursement rate. 7 c. Notwithstanding section 232.141, subsection 8 , for the 8 fiscal year beginning July 1, 2021, the amount of the statewide 9 average of the actual and allowable rates for reimbursement of 10 juvenile shelter care homes that is utilized for the limitation 11 on recovery of unpaid costs shall remain at the amount in 12 effect for this purpose in the fiscal year beginning July 1, 13 2020. 14 10. For the fiscal year beginning July 1, 2021, the 15 department shall calculate reimbursement rates for intermediate 16 care facilities for persons with an intellectual disability 17 at the 80th percentile. Beginning July 1, 2021, the rate 18 calculation methodology shall utilize the consumer price index 19 inflation factor applicable to the fiscal year beginning July 20 1, 2021. 21 11. Effective July 1, 2021, the department of human services 22 shall set the reimbursement rate of child care providers whose 23 reimbursement rates are below the fiftieth percentile of the 24 most recent market rate survey at the fiftieth percentile of 25 the most recent market rate survey. Reimbursement rates of 26 child care providers whose reimbursement rates are at or above 27 the fiftieth percentile of the most recent market rate survey 28 shall remain at the rates in effect on June 30, 2021. The 29 department shall also adjust quality rating system bonuses to 30 reflect increased child care provider reimbursement rates as 31 appropriate. The department shall set rates in a manner so as 32 to provide incentives for a nonregistered provider to become 33 registered by applying any increase only to registered and 34 licensed providers. 35 -61- LSB 1004HV (2) 89 pf/rn 61/ 79
H.F. 891 12. The department may adopt emergency rules to implement 1 this section. 2 Sec. 32. EMERGENCY RULES. 3 1. If necessary to comply with federal requirements 4 including time frames, or if specifically authorized by a 5 provision of this division of this Act, the department of 6 human services or the mental health and disability services 7 commission may adopt administrative rules under section 17A.4, 8 subsection 3, and section 17A.5, subsection 2, paragraph “b”, 9 to implement the provisions of this division of this Act and 10 the rules shall become effective immediately upon filing or 11 on a later effective date specified in the rules, unless the 12 effective date of the rules is delayed or the applicability 13 of the rules is suspended by the administrative rules review 14 committee. Any rules adopted in accordance with this section 15 shall not take effect before the rules are reviewed by the 16 administrative rules review committee. The delay authority 17 provided to the administrative rules review committee under 18 section 17A.4, subsection 7, and section 17A.8, subsections 19 9 and 10, shall be applicable to a delay imposed under this 20 section, notwithstanding a provision in those subsections 21 making them inapplicable to section 17A.5, subsection 2, 22 paragraph “b”. Any rules adopted in accordance with the 23 provisions of this section shall also be published as a notice 24 of intended action as provided in section 17A.4. 25 2. If during a fiscal year, the department of human 26 services is adopting rules in accordance with this section 27 or as otherwise directed or authorized by state law, and 28 the rules will result in an expenditure increase beyond the 29 amount anticipated in the budget process or if the expenditure 30 was not addressed in the budget process for the fiscal 31 year, the department shall notify the general assembly and 32 the department of management concerning the rules and the 33 expenditure increase. The notification shall be provided at 34 least 30 calendar days prior to the date notice of the rules 35 -62- LSB 1004HV (2) 89 pf/rn 62/ 79
H.F. 891 is submitted to the administrative rules coordinator and the 1 administrative code editor. 2 Sec. 33. REPORTS. Unless otherwise provided, any reports or 3 other information required to be compiled and submitted under 4 this Act during the fiscal year beginning July 1, 2021, shall 5 be submitted on or before the dates specified for submission 6 of the reports or information. 7 Sec. 34. EFFECTIVE UPON ENACTMENT. The following provision 8 of this division of this Act, being deemed of immediate 9 importance, takes effect upon enactment: 10 1. The provision relating to section 232.141 and directing 11 the state court administrator and the division administrator of 12 the department of human services division of child and family 13 services to make the determination, by June 15, 2021, of the 14 distribution of funds allocated for the payment of the expenses 15 of court-ordered services provided to juveniles which are a 16 charge upon the state. 17 DIVISION VI 18 HEALTH CARE ACCOUNTS AND FUNDS —— FY 2021-2022 19 Sec. 35. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is 20 appropriated from the pharmaceutical settlement account created 21 in section 249A.33 to the department of human services for the 22 fiscal year beginning July 1, 2021, and ending June 30, 2022, 23 the following amount, or so much thereof as is necessary, to be 24 used for the purpose designated: 25 Notwithstanding any provision of law to the contrary, to 26 supplement the appropriations made in this Act for health 27 program operations under the medical assistance program for the 28 fiscal year beginning July 1, 2021, and ending June 30, 2022: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 30 Sec. 36. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF HUMAN 31 SERVICES. Notwithstanding any provision to the contrary and 32 subject to the availability of funds, there is appropriated 33 from the quality assurance trust fund created in section 34 249L.4 to the department of human services for the fiscal year 35 -63- LSB 1004HV (2) 89 pf/rn 63/ 79
H.F. 891 beginning July 1, 2021, and ending June 30, 2022, the following 1 amounts, or so much thereof as is necessary, for the purposes 2 designated: 3 To supplement the appropriation made in this Act from the 4 general fund of the state to the department of human services 5 for medical assistance for the same fiscal year: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 56,305,139 7 Sec. 37. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 8 DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to 9 the contrary and subject to the availability of funds, there is 10 appropriated from the hospital health care access trust fund 11 created in section 249M.4 to the department of human services 12 for the fiscal year beginning July 1, 2021, and ending June 13 30, 2022, the following amounts, or so much thereof as is 14 necessary, for the purposes designated: 15 To supplement the appropriation made in this Act from the 16 general fund of the state to the department of human services 17 for medical assistance for the same fiscal year: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 19 Sec. 38. MEDICAL ASSISTANCE PROGRAM —— NONREVERSION 20 FOR FY 2021-2022. Notwithstanding section 8.33 , if moneys 21 appropriated for purposes of the medical assistance program for 22 the fiscal year beginning July 1, 2021, and ending June 30, 23 2022, from the general fund of the state, the quality assurance 24 trust fund, and the hospital health care access trust fund, are 25 in excess of actual expenditures for the medical assistance 26 program and remain unencumbered or unobligated at the close 27 of the fiscal year, the excess moneys shall not revert but 28 shall remain available for expenditure for the purposes of the 29 medical assistance program until the close of the succeeding 30 fiscal year. 31 DIVISION VII 32 NURSING FACILITY REIMBURSEMENT METHODOLOGY —— FISCAL PERIOD 33 JULY 1, 2023, THROUGH JUNE 30, 2025 34 Sec. 39. NURSING FACILITY REIMBURSEMENT METHODOLOGY —— 35 -64- LSB 1004HV (2) 89 pf/rn 64/ 79
H.F. 891 FISCAL PERIOD JULY 1, 2023, THROUGH JUNE 30, 2025. 1 Notwithstanding any provision of law to the contrary, for the 2 fiscal period beginning July 1, 2023, and ending June 30, 2025, 3 the department of human services shall rebase case-mix nursing 4 facility rates beginning July 1, 2023, using the Medicaid cost 5 reports on file for the period ending December 31, 2022, and 6 applying a minimum occupancy factor of 70 percent. 7 DIVISION VIII 8 DECATEGORIZATION CARRYOVER FUNDING 9 Sec. 40. DECATEGORIZATION CARRYOVER FUNDING FY 2019 —— 10 TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188, 11 subsection 5, paragraph “b”, any state-appropriated moneys in 12 the funding pool that remained unencumbered or unobligated 13 at the close of the fiscal year beginning July 1, 2018, and 14 were deemed carryover funding to remain available for the two 15 succeeding fiscal years that still remain unencumbered or 16 unobligated at the close of the fiscal year beginning July 1, 17 2020, shall not revert but shall be transferred to the medical 18 assistance program for the fiscal year beginning July 1, 2021. 19 Sec. 41. EFFECTIVE DATE. This division of this Act, being 20 deemed of immediate importance, takes effect upon enactment. 21 Sec. 42. RETROACTIVE APPLICABILITY. This division of this 22 Act applies retroactively to July 1, 2020. 23 DIVISION IX 24 PRIOR APPROPRIATIONS AND OTHER PROVISIONS 25 FAMILY INVESTMENT PROGRAM ACCOUNT 26 Sec. 43. 2019 Iowa Acts, chapter 85, section 9, as amended 27 by 2020 Iowa Acts, chapter 1121, section 20, is amended by 28 adding the following new subsection: 29 NEW SUBSECTION . 8. Notwithstanding section 8.33, moneys 30 appropriated in this section that remain unencumbered or 31 unobligated at the close of the fiscal year shall not revert 32 but shall remain available for expenditure for the purposes 33 designated, and may be transferred to other appropriations made 34 in this division of this Act as necessary to carry out the 35 -65- LSB 1004HV (2) 89 pf/rn 65/ 79
H.F. 891 initiatives included in the report submitted on nonreversion 1 of funds required pursuant to 2020 Iowa Acts, chapter 1121, 2 section 43, until the close of the succeeding fiscal year. 3 CHILD AND FAMILY SERVICES 4 Sec. 44. 2019 Iowa Acts, chapter 85, section 19, as amended 5 by 2020 Iowa Acts, chapter 1121, section 23, is amended by 6 adding the following new subsection: 7 NEW SUBSECTION . 25. Notwithstanding section 8.33, moneys 8 appropriated in this section that remain unencumbered or 9 unobligated at the close of the fiscal year shall not revert 10 but shall remain available for expenditure for the purpose of 11 the redesign of the child welfare system, until the close of 12 the succeeding fiscal year. 13 FIELD OPERATIONS 14 Sec. 45. 2019 Iowa Acts, chapter 85, section 27, as amended 15 by 2020 Iowa Acts, chapter 1121, section 25, is amended by 16 adding the following new subsection: 17 NEW SUBSECTION . 5. Notwithstanding section 8.33, moneys 18 appropriated in this section that remain unencumbered or 19 unobligated at the close of the fiscal year shall not revert 20 but shall remain available for expenditure for the purposes 21 designated until the close of the succeeding fiscal year. 22 GENERAL ADMINISTRATION 23 Sec. 46. 2019 Iowa Acts, chapter 85, section 28, as amended 24 by 2020 Iowa Acts, chapter 1121, section 26, is amended by 25 adding the following new subsection: 26 NEW SUBSECTION . 8. Notwithstanding section 8.33, moneys 27 appropriated in this section that remain unencumbered or 28 unobligated at the close of the fiscal year shall not revert 29 but shall remain available for expenditure for the purposes 30 designated until the close of the succeeding fiscal year. 31 Sec. 47. EFFECTIVE DATE. This division of this Act, being 32 deemed of immediate importance, takes effect upon enactment. 33 DIVISION X 34 EXTENSION OF FUTURE REPEAL —— HOSPITAL HEALTH CARE ACCESS 35 -66- LSB 1004HV (2) 89 pf/rn 66/ 79
H.F. 891 ASSESSMENT PROGRAM 1 Sec. 48. Section 249M.5, Code 2021, is amended to read as 2 follows: 3 249M.5 Future repeal. 4 This chapter is repealed July 1, 2021 2023 . 5 Sec. 49. EFFECTIVE DATE. This division of this Act, being 6 deemed of immediate importance, takes effect upon enactment. 7 DIVISION XI 8 MENTAL HEALTH AND DISABILITY SERVICES —— TRANSFER OF FUNDS 9 Sec. 50. MENTAL HEALTH AND DISABILITY SERVICES —— TRANSFER 10 OF FUNDS. Notwithstanding section 331.432, a county with a 11 population of over 300,000 based on the 2010 federal decennial 12 census may transfer funds from any other fund of the county to 13 the mental health and disability regional services fund for the 14 purposes of providing mental health and disability services for 15 the fiscal year beginning July 1, 2021, and ending June 30, 16 2022. The county shall submit a report to the governor and the 17 general assembly by September 1, 2022, including the source of 18 any funds transferred, the amount of the funds transferred, and 19 the mental health and disability services provided with the 20 transferred funds. The county shall work with the department 21 to maximize the use of the medical assistance program and other 22 third-party payment sources, including but not limited to 23 identifying individuals enrolled with or eligible for Medicaid 24 whose Medicaid-covered services are being paid by the county or 25 could be converted to Medicaid-covered services. 26 DIVISION XII 27 TELEHEALTH —— MENTAL HEALTH —— REIMBURSEMENT PARITY 28 Sec. 51. Section 514C.34, subsection 1, Code 2021, is 29 amended by adding the following new paragraphs: 30 NEW PARAGRAPH . 0a. “Covered person” means the same as 31 defined in section 514J.102. 32 NEW PARAGRAPH . 00a. “Facility” means the same as defined in 33 section 514J.102. 34 NEW PARAGRAPH . 0c. “Health carrier” means the same as 35 -67- LSB 1004HV (2) 89 pf/rn 67/ 79
H.F. 891 defined in section 514J.102. 1 Sec. 52. Section 514C.34, subsection 1, paragraph c, Code 2 2021, is amended to read as follows: 3 c. “Telehealth” means the delivery of health care services 4 through the use of real-time interactive audio and video , or 5 other real-time interactive electronic media, regardless of 6 where the health care professional and the covered person are 7 each located . “Telehealth” does not include the delivery of 8 health care services delivered solely through an audio-only 9 telephone, electronic mail message, or facsimile transmission. 10 Sec. 53. Section 514C.34, Code 2021, is amended by adding 11 the following new subsection: 12 NEW SUBSECTION . 3A. a. A health carrier shall reimburse 13 a health care professional and a facility for health care 14 services provided by telehealth to a covered person for a 15 mental health condition, illness, injury, or disease on the 16 same basis and at the same rate as the health carrier would 17 apply to the same health care services for a mental health 18 condition, illness, injury, or disease provided in person to a 19 covered person by the health care professional or the facility. 20 b. As a condition of reimbursement pursuant to paragraph 21 “a” , a health carrier shall not require that an additional 22 health care professional be located in the same room as a 23 covered person while health care services for a mental health 24 condition, illness, injury, or disease are provided via 25 telehealth by another health care professional to the covered 26 person. 27 Sec. 54. EFFECTIVE DATE. This division of this Act, being 28 deemed of immediate importance, takes effect upon enactment. 29 Sec. 55. RETROACTIVE APPLICABILITY. This division of 30 this Act applies to health care services for a mental health 31 condition, illness, injury, or disease provided by a health 32 care professional or a facility to a covered person by 33 telehealth on or after January 1, 2021. 34 DIVISION XIII 35 -68- LSB 1004HV (2) 89 pf/rn 68/ 79
H.F. 891 IN-PERSON SUPERVISION REQUIREMENTS FOR LICENSURE —— CERTAIN 1 PROFESSIONALS 2 Sec. 56. Section 154C.3, subsection 1, paragraph c, 3 subparagraph (5), subparagraph division (a), Code 2021, is 4 amended by adding the following new subparagraph subdivision: 5 NEW SUBPARAGRAPH SUBDIVISION . (0ii) By a person licensed 6 under section 154D.2 to practice marital and family therapy 7 without supervision or mental health counseling without 8 supervision. 9 Sec. 57. Section 154C.3, Code 2021, is amended by adding the 10 following new subsection: 11 NEW SUBSECTION . 4. Supervision. The board shall not, by 12 rule or other means, require that supervision be completed 13 in-person as a condition for an applicant to receive a license, 14 a reciprocal license, or a renewed license under this chapter. 15 Sec. 58. Section 154D.2, Code 2021, is amended to read as 16 follows: 17 154D.2 Licensure —— marital and family therapy —— mental 18 health counseling. 19 1. An applicant for a license to practice marital and family 20 therapy or mental health counseling shall be granted a license 21 by the board when the applicant satisfies all of the following 22 requirements: 23 1. a. Possesses a master’s degree in marital and family 24 therapy or mental health counseling, as applicable, consisting 25 of at least sixty semester hours, or its equivalent, from a 26 nationally accredited institution or from a program approved 27 by the board. 28 2. b. Has at least two years of supervised clinical 29 experience or its equivalent as approved by the board. 30 Standards for supervision, including the required 31 qualifications for supervisors, shall be determined pursuant 32 to the requirements in subsection 2 and by the board by rule , 33 provided that a supervisor may be a person licensed under this 34 section to practice marital and family therapy or mental health 35 -69- LSB 1004HV (2) 89 pf/rn 69/ 79
H.F. 891 counseling without supervision or a licensed independent social 1 worker licensed under chapter 154C . 2 3. c. Passes an examination approved by the board. 3 2. The board shall not, by rule or other means, require any 4 in-person supervised clinical experience. 5 Sec. 59. Section 154D.4, subsection 2, paragraph b, Code 6 2021, is amended to read as follows: 7 b. A person who practices marital and family therapy or 8 mental health counseling under the supervision of a person 9 licensed under this chapter as part of a clinical experience as 10 described in section 154D.2, subsection 2 1, paragraph “b” . 11 Sec. 60. BOARD OF SOCIAL WORK AND BOARD OF BEHAVIORAL 12 SCIENCE —— RULES. The board of social work and the board 13 of behavioral science shall amend their administrative 14 rules pursuant to chapter 17A to remove any requirement for 15 supervised clinical experience and supervised professional 16 practice to be completed in-person as a condition for the 17 licensure of marital and family therapists, mental health 18 counselors, and social workers pursuant to chapters 154C and 19 154D. The board of social work and the board of behavioral 20 science shall replace all licensing requirements for in-person 21 supervision with the ability to have supervision requirements 22 completed electronically. 23 Sec. 61. EMERGENCY RULES. 24 1. The board of social work and the board of behavioral 25 science shall adopt emergency rules under section 17A.4, 26 subsection 3, and section 17A.5, subsection 2, to implement 27 the sections of this division of this Act amending section 28 154C.3 and section 154D.2, and the rules shall be effective 29 immediately upon filing unless a later date is specified in the 30 rules. Any emergency rules adopted in accordance with this 31 section shall also be published as a notice of intended action 32 as provided in section 17A.4, subsection 1. 33 2. The board of social work and the board of behavioral 34 science shall jointly develop rules adopted pursuant to this 35 -70- LSB 1004HV (2) 89 pf/rn 70/ 79
H.F. 891 subsection through a collaborative process. The respective 1 boards may establish subcommittees or designate other personnel 2 to facilitate such a process. Such rules shall consist of 3 substantively identical standards applicable to the professions 4 regulated by the respective boards and shall, to the greatest 5 extent possible, consist of substantially similar language 6 in a substantially similar format. Prior to a vote to adopt 7 such rules by either board, each board shall, by a separate 8 vote, approve the language to be adopted by the other board. 9 Neither board shall vote to adopt such rules until the rules 10 to be adopted by both boards have been so approved. Such rules 11 shall have the same effective date and shall be submitted to 12 the administrative rules coordinator and the administrative 13 code editor for publication in the same issue of the Iowa 14 administrative bulletin pursuant to sections 17A.4 and 17A.5. 15 Sec. 62. EFFECTIVE DATE. This division of this Act, being 16 deemed of immediate importance, takes effect upon enactment. 17 DIVISION XIV 18 CHILD CARE ASSISTANCE —— ELIGIBILITY PHASE-OUT 19 Sec. 63. NEW SECTION . 237A.14 Child care assistance —— 20 graduated eligibility phase-out. 21 1. At the time of a twelve-month eligibility 22 redetermination for a family receiving state child care 23 assistance, the family shall remain eligible to receive 24 child care assistance, subject to the graduated eligibility 25 phase-out program as specified in subsection 2, if either of 26 the following conditions are met: 27 a. The family’s nonexempt gross monthly income is determined 28 to be at least two hundred twenty-five percent but less 29 than two hundred fifty percent of the federal poverty level 30 applicable to the family size for children needing basic care. 31 b. The family’s nonexempt gross monthly income is determined 32 to be at least two hundred twenty-five percent but less than 33 two hundred seventy-five percent of the federal poverty level 34 applicable to the family size for children needing special 35 -71- LSB 1004HV (2) 89 pf/rn 71/ 79
H.F. 891 needs care. 1 2. a. A family with an income at the following percentages 2 of the federal poverty level applicable to the family size 3 for children needing basic care shall be responsible for the 4 following share of child care costs: 5 (1) A family with an income above two hundred twenty-five 6 percent of the federal poverty level but less than two hundred 7 thirty-five percent of the federal poverty level shall pay for 8 thirty-three percent of the family child care costs. 9 (2) A family with an income at or above two hundred 10 thirty-five percent of the federal poverty level but less than 11 two hundred forty-five percent of the federal poverty level 12 shall pay for forty-five percent of the family child care 13 costs. 14 (3) A family with an income at or above two hundred 15 forty-five percent of the federal poverty level but at or less 16 than two hundred fifty percent of the federal poverty level 17 shall pay for sixty percent of the family child care costs. 18 b. A family with an income at the following percentages of 19 the federal poverty level applicable to the family size for 20 children needing special needs care shall be responsible for 21 the following share of child care costs: 22 (1) A family with an income above two hundred twenty-five 23 percent of the federal poverty level but less than two hundred 24 forty-five percent of the federal poverty level shall pay for 25 thirty-three percent of the family child care costs. 26 (2) A family with an income at or above two hundred 27 forty-five percent of the federal poverty level but less than 28 two hundred sixty-five percent of the federal poverty level 29 shall pay for forty-five percent of the family child care 30 costs. 31 (3) A family with an income at or above two hundred 32 sixty-five percent of the federal poverty level but at or less 33 than two hundred seventy-five percent of the federal poverty 34 level shall pay for sixty percent of the family child care 35 -72- LSB 1004HV (2) 89 pf/rn 72/ 79
H.F. 891 costs. 1 c. The graduated eligibility phase-out as provided in 2 paragraphs “a” and “b” shall be implemented no later than July 3 1, 2022. 4 3. Child care provider reimbursement rates under the 5 graduated eligibility phase-out program shall be the same rates 6 as the child care provider reimbursement rates. 7 4. The department of human services shall adopt rules 8 pursuant to chapter 17A in accordance with this section. 9 DIVISION XV 10 MEDICAL RESIDENCY LIABILITY COSTS 11 Sec. 64. Section 135.176, subsection 1, Code 2021, is 12 amended by adding the following new paragraph: 13 NEW PARAGRAPH . d. For the period beginning July 1, 2021, 14 and ending June 30, 2026, the payment by the sponsor of medical 15 residency program liability costs subject to provision by the 16 sponsor of dollar-for-dollar matching funds used for payment 17 of such costs. This paragraph shall not apply to medical 18 residency programs to which chapter 669 applies. 19 Sec. 65. Section 135.176, subsection 2, paragraphs e and f, 20 Code 2021, are amended to read as follows: 21 e. The maximum award of grant funds to a particular 22 individual sponsor per year. An individual sponsor that 23 establishes a new or alternative campus accredited medical 24 residency training program as defined in subsection 1, 25 paragraph “a” , shall not receive more than fifty percent 26 of the state matching funds available each year to support 27 the program. An individual sponsor proposing the provision 28 of a new residency position within an existing accredited 29 medical residency or fellowship training program as specified 30 in subsection 1, paragraph “b” , or the funding of residency 31 positions which are in excess of the federal residency cap as 32 defined in subsection 1, paragraph “c” , or the funding of the 33 payment by the sponsor of medical residency program liability 34 costs subject to provision by the sponsor of dollar-for-dollar 35 -73- LSB 1004HV (2) 89 pf/rn 73/ 79
H.F. 891 matching funds used for payment of such costs as specified 1 in subsection 1, paragraph “d” , shall not receive more than 2 twenty-five percent of the state matching funds available each 3 year to support the program. 4 f. Use of the funds awarded. Funds may be used to pay the 5 costs of establishing, expanding, or supporting an accredited 6 graduate medical education program as specified in this 7 section , including but not limited to the costs associated 8 with residency stipends and physician faculty stipends. For 9 the period beginning July 1, 2021, and ending June 30, 2026, 10 use of the funds awarded may include payment by the sponsor of 11 medical residency program liability costs in accordance with 12 subsection 1, paragraph “d” , and subject to provision by the 13 sponsor of dollar-for-dollar matching funds used for payment 14 of such costs. 15 DIVISION XVI 16 PUBLIC HEALTH EMERGENCY PROVISIONS 17 COVID-19 REGULATIONS 18 Sec. 66. COVID-19 FEDERAL REGULATIONS. For the time 19 period beginning on the effective date of this division of 20 this Act, and ending June 30, 2022, notwithstanding state 21 administrative rules to the contrary, to the extent federal 22 regulations relating to the COVID-19 pandemic differ from state 23 administrative rules, including applicable federal waivers, 24 the federal regulations are controlling during the pendency of 25 the federally declared state of emergency and for such period 26 of time following the end of the federally declared state of 27 emergency applicable to the respective federal regulations. 28 DIVISION XVII 29 REPORT ON NONREVERSION OF FUNDS 30 Sec. 67. REPORT ON NONREVERSION OF FUNDS. The department 31 of human services shall report the expenditure of any moneys 32 for which nonreversion authorization was provided for the 33 fiscal year beginning July 1, 2020, and ending June 30, 2021, 34 for field operations or general administration to the general 35 -74- LSB 1004HV (2) 89 pf/rn 74/ 79
H.F. 891 assembly on a quarterly basis beginning October 1, 2021. 1 DIVISION XVIII 2 FOSTER HOME INSURANCE FUND 3 Sec. 68. Section 237.13, subsection 2, Code 2021, is amended 4 to read as follows: 5 2. The foster home insurance fund shall be administered by 6 the department of human services. The fund shall consist of 7 all moneys appropriated by the general assembly for deposit 8 in the fund. The department shall use moneys in the fund to 9 provide home and property coverage for foster parents to cover 10 damages to property resulting from the actions of a foster 11 child residing in a foster home or to reimburse foster parents 12 for the cost of purchasing foster care liability insurance and 13 to perform the administrative functions necessary to carry out 14 this section . The department may establish limitations of 15 liability for individual claims as deemed reasonable by the 16 department. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill relates to appropriations for health and human 21 services for fiscal year 2021-2022 to the department of 22 veterans affairs, Iowa veterans home, department on aging 23 (IDA), office of long-term care ombudsman, department of public 24 health (DPH), Iowa finance authority, department of human 25 rights, and department of human services (DHS). The bill is 26 organized into divisions for each fiscal year. 27 DEPARTMENT ON AGING. This division makes appropriations 28 from the general fund of the state to the department on aging. 29 OFFICE OF LONG-TERM CARE OMBUDSMAN. This division makes 30 appropriations from the general fund of the state to the office 31 of long-term care ombudsman. 32 DEPARTMENT OF PUBLIC HEALTH. This division makes 33 appropriations from the general fund of the state and from 34 the sports wagering receipts fund to the department of public 35 -75- LSB 1004HV (2) 89 pf/rn 75/ 79
H.F. 891 health. 1 DEPARTMENT OF VETERANS AFFAIRS AND IOWA VETERANS HOME. This 2 division makes appropriations from the general fund of the 3 state to the department of veterans affairs for administration, 4 the Iowa veterans home, for transfer to the Iowa finance 5 authority for the home ownership assistance program and for the 6 county commissions of veteran affairs. 7 DEPARTMENT OF HUMAN SERVICES. This division makes 8 appropriations from the general fund of the state and the 9 federal temporary assistance for needy families block 10 grant to DHS. The allocation for the family development 11 and self-sufficiency grant program is made directly to 12 the department of human rights. The reimbursement section 13 addresses reimbursement for providers reimbursed by the 14 department of human services. 15 HEALTH CARE ACCOUNTS AND FUNDS. This division makes certain 16 health-related appropriations. A number of the appropriations 17 are made for purposes of the Medicaid program in addition to 18 the general fund appropriations made for this purpose for the 19 same fiscal year. 20 NURSING FACILITY REIMBURSEMENT METHODOLOGY —— FISCAL PERIOD 21 JULY 1, 2023, THROUGH JUNE 30, 2025. This division provides 22 that notwithstanding any provision of law to the contrary, 23 for the fiscal period beginning July 1, 2023, and ending June 24 30, 2025, DHS shall rebase case-mix nursing facility rates 25 beginning July 1, 2023, using the Medicaid cost reports on file 26 for the period ending December 31, 2022, and applying a minimum 27 occupancy factor of 70 percent. 28 DECATEGORIZATION CARRYOVER FUNDING. This division provides 29 for the transfer of carryover decategorization funds that 30 remained unencumbered or unobligated at the close of the fiscal 31 year beginning July 1, 2020, to the Medicaid program for 32 FY 2021-2022. The division takes effect upon enactment and is 33 retroactively applicable to July 1, 2020. 34 PRIOR APPROPRIATIONS AND OTHER PROVISIONS. This division 35 -76- LSB 1004HV (2) 89 pf/rn 76/ 79
H.F. 891 provides that funds appropriated to the department of human 1 services and credited to the family investment program account 2 that remain unencumbered or unobligated at the close of FY 3 2020-2021 shall not revert but shall remain available for 4 expenditure for the purposes designated, and may be transferred 5 to other appropriations as necessary to carry out the 6 initiatives included in the report submitted on nonreversion 7 of funds required pursuant to 2020 Iowa Acts, chapter 1121, 8 section 43, until the close of the succeeding fiscal year. 9 The division provides that funds appropriated to the 10 department of human services for child and family services that 11 remain unencumbered or unobligated at the close of FY 2020-2021 12 shall not revert but shall remain available for expenditure for 13 the purpose of the redesign of the child welfare system, until 14 the close of the succeeding fiscal year. 15 The division also provides that funds appropriated to the 16 department of human services for field operations and general 17 administration that remain unencumbered or unobligated at 18 the close of FY 2020-2021 shall not revert but shall remain 19 available for expenditure for the purposes designated until the 20 close of the succeeding fiscal year. 21 The division takes effect upon enactment. 22 EXTENSION OF REPEAL FOR HOSPITAL HEALTH CARE ACCESS 23 ASSESSMENT PROGRAM. This division extends the repeal of 24 the hospital health care access assessment program chapter, 25 Code chapter 249M, from July 1, 2021, to July 1, 2023. This 26 provision takes effect upon enactment. 27 MENTAL HEALTH AND DISABILITY SERVICES —— TRANSFER OF FUNDS. 28 The division authorizes a county with a population of over 29 300,000 to transfer funds from any other fund of the county to 30 the mental health and disability regional services fund for the 31 purposes of providing mental health and disability services for 32 the fiscal year beginning July 1, 2021, and ending June 30, 33 2022. 34 TELEHEALTH —— MENTAL HEALTH —— REIMBURSEMENT PARITY. This 35 -77- LSB 1004HV (2) 89 pf/rn 77/ 79
H.F. 891 division requires a health carrier to reimburse a health care 1 professional or a facility for health care services for a 2 mental health condition, illness, injury, or disease provided 3 to a covered person via telehealth on the same basis and at the 4 same rate as the health carrier would apply to the same health 5 care services provided to the covered person by the health care 6 professional or facility in person. 7 The division takes effect upon enactment and applies 8 retroactively to health care services for a mental health 9 condition, illness, injury, or disease provided to a covered 10 person via telehealth on or after January 1, 2021. 11 IN-PERSON SUPERVISION REQUIREMENTS. This division relates 12 to supervision requirements for licensed marital and family 13 therapists, mental health counselors, and social workers. The 14 division takes effect upon enactment. 15 CHILD CARE ELIGIBILITY PHASE-OUT. This division establishes 16 a graduated eligibility phase-out program for state child care 17 assistance. 18 MEDICAL RESIDENCY LIABILITY COSTS. This division provides 19 for the use of medical residency training state matching 20 grants program funds toward payment by the sponsor of program 21 liability costs subject to provision of dollar-for-dollar 22 matching funds. 23 PUBLIC HEALTH EMERGENCY PROVISIONS. This division provides 24 that for the time period beginning on the effective date of 25 the bill, and ending June 30, 2022, notwithstanding state 26 administrative rules to the contrary, to the extent federal 27 regulations relating to the COVID-19 pandemic differ from state 28 administrative rules, including applicable federal waivers, 29 the federal regulations are controlling during the pendency of 30 the federally declared state of emergency and for such period 31 of time following the end of the federally declared state of 32 emergency applicable to the respective federal regulations. 33 REPORT ON NONREVERSION OF FUNDS. This division requires the 34 department of human services to report the expenditure of any 35 -78- LSB 1004HV (2) 89 pf/rn 78/ 79
H.F. 891 moneys for which nonreversion authorization was provided for 1 FY 2021-2022 for field operations or general administration to 2 the general assembly on a quarterly basis beginning October 1, 3 2021. 4 FOSTER HOME INSURANCE FUND. This division amends the foster 5 home insurance fund provisions under Code section 237.13 to 6 authorize the department of human services to use the moneys in 7 the fund, in addition to the current authorization to reimburse 8 foster parents for the cost of purchasing foster care liability 9 insurance, to provide home and property coverage for foster 10 parents to cover damages to property resulting from actions 11 of a foster child residing in a foster home. The division 12 also authorizes the department of human services to establish 13 limitations of liability for individual claims as deemed 14 reasonable by the department of human services. 15 -79- LSB 1004HV (2) 89 pf/rn 79/ 79