H.F. 898 DIVISION I 1 PUBLIC HEALTH AND HEALTH CARE 2 Section 1. PUBLIC HEALTH —— STRUCTURE AND INFRASTRUCTURE 3 SUPPORT —— APPROPRIATIONS. 4 1. There is appropriated from the moneys received by the 5 state pursuant to the federal American Rescue Plan Act of 2021, 6 Pub. L. No. 117-2, to the university of Iowa college of public 7 health for the following fiscal years, the following amounts, 8 or so much thereof as is necessary, to be used for the purposes 9 designated: 10 a. To undertake a comprehensive longitudinal study, in 11 collaboration with the university of Iowa Carver college of 12 medicine, to identify the incidence and prevalence of the 13 chronic symptoms and disabilities attributable to COVID-19 on 14 Iowans who contracted the virus: 15 FY 2021-2022: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 750,000 17 b. To coordinate increased, systematic efforts with Iowa’s 18 local public health authorities to address the chronic health 19 conditions, maladaptive personal behaviors, and societal 20 conditions, including but not limited to obesity, diabetes, 21 heart disease, smoking, and social disparities, that are 22 identified as risk factors for poorer outcomes associated with 23 infectious disease: 24 FY 2021-2022: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 26 FY 2022-2023: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 28 Funding under this paragraph “b” may be utilized by the 29 college of public health, subject to securing local matching 30 funds, to provide grants to county boards of health to 31 implement evidence-based community programming, policies, and 32 collaborative projects with health care providers to reduce 33 such risk factors. The college of public health shall provide 34 technical assistance to grantees and grants shall include an 35 -1- LSB 2670YH (9) 89 pf/rh 1/ 8

H.F. 898 evaluation component. 1 c. To support the development and provide ongoing 2 facilitation of a state association of local boards of health: 3 FY 2021-2022: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 100,000 5 FY 2022-2023: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 100,000 7 d. To provide paid internships for students of the college 8 of public health with local health departments through which 9 an intern supports the local public health infrastructure, 10 conducts community health needs assessments, and assists in the 11 successful implementation of health improvement plans: 12 FY 2021-2022: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 200,000 14 FY 2022-2023: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 200,000 16 The funding provided under this paragraph “d” may be subject 17 to securing local matching funds. 18 e. To conduct a comprehensive review and evaluation of the 19 existing public health structure and infrastructure in the 20 state, with policy and funding recommendations, to improve the 21 capacity of the state and local communities to effectively 22 respond to public health threats including chronic and 23 infectious diseases: 24 FY 2021-2022: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 250,000 26 2. Notwithstanding section 8.33, moneys appropriated under 27 this section that remain unobligated or unexpended at the close 28 of a fiscal year shall not revert but shall remain available 29 for the purposes designated. However, the moneys appropriated 30 under this section shall be expended for the purposes 31 designated on or before December 31, 2024, as provided in the 32 federal American Rescue Plan Act of 2021, Pub. L. No. 117-2. 33 Sec. 2. ORAL HEALTH SERVICES —— APPROPRIATIONS. There is 34 appropriated from the moneys received by the state pursuant 35 -2- LSB 2670YH (9) 89 pf/rh 2/ 8

H.F. 898 to the federal American Rescue Plan Act of 2021, Pub. L. No. 1 117-2, to the department of human services for the following 2 fiscal years, the following amounts, or so much thereof as is 3 necessary, to be used for the purposes designated: 4 1. To fund increased reimbursement of providers of 5 specialized oral health services to Medicaid members referred 6 for services by community health centers, and for reimbursement 7 of dentists for the provision of services or referral to 8 medically necessary care to Medicaid members if the dentist was 9 a Medicaid participating provider prior to July 1, 2021: 10 FY 2021-2022: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 12 FY 2022-2023: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 14 2. a. To partner with the healthiest state initiative of 15 the department of public health to establish a food as medicine 16 pilot project using double up food bucks to be distributed to 17 Medicaid members through oral health providers: 18 FY 2021-2022: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 20 FY 2022-2023: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 22 b. Notwithstanding section 8.33, moneys appropriated under 23 this subsection that remain unobligated or unexpended at the 24 close of a fiscal year shall not revert but shall remain 25 available for the purposes designated. However, the moneys 26 appropriated under this subsection shall be expended for the 27 purposes designated on or before December 31, 2024, as provided 28 in the federal American Rescue Plan Act of 2021, Pub. L. No. 29 117-2. 30 Sec. 3. PUBLIC HEALTH DATA AND INFORMATION SYSTEMS —— 31 APPROPRIATION. There is appropriated from the moneys received 32 by the state pursuant to the federal American Rescue Plan Act 33 of 2021, Pub. L. No. 117-2, to the department of public health 34 for the fiscal year beginning July 1, 2021, and ending June 30, 35 -3- LSB 2670YH (9) 89 pf/rh 3/ 8

H.F. 898 2022, the following amount, or so much thereof as is necessary, 1 for the purposes designated: 2 For information technology infrastructure upgrades, 3 improvements, or replacements to provide for accurate and 4 timely collection and reporting of data and information related 5 to infectious diseases and infectious disease outbreaks in the 6 state and other critical public health data and information 7 related to the population health priorities and goals of the 8 state board of health and county boards of health: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,000,000 10 Of the funds appropriated under this section, up to fifty 11 percent may be used to ensure the capacity of county boards of 12 health to interact and work with the information technology 13 systems. Any system improvement shall ensure ease of public 14 access to data or information not otherwise required by law to 15 be kept confidential. 16 Notwithstanding section 8.33, moneys appropriated under this 17 section that remain unobligated or unexpended at the close of 18 the fiscal year shall not revert but shall remain available 19 for the purposes designated. However, the moneys appropriated 20 under this section shall be expended for the purposes 21 designated on or before December 31, 2024, as provided in the 22 federal American Rescue Plan Act of 2021, Pub. L. No. 117-2. 23 DIVISION II 24 SUBSTANCE USE —— RESEARCH, EDUCATION, PREVENTION, AND TREATMENT 25 Sec. 4. NEW SECTION . 135.193 Opioid use research, 26 education, prevention, and treatment fund. 27 1. An opioid use research, education, prevention, and 28 treatment fund is created in the state treasury under the 29 control of the department. The fund is established to 30 expand treatment for, and access to, treatment for opioid 31 use disorders and to assist opioid drug use prevention and 32 treatment programs in the state including but not limited to 33 medication-assisted treatment programs that provide appropriate 34 holistic services and treatment programs licensed by the 35 -4- LSB 2670YH (9) 89 pf/rh 4/ 8

H.F. 898 department, in accordance with programs sponsored by community 1 organizations, programs that provide emergency responders 2 with affordable access to opioid antagonists, and programs 3 that assist in paying treatment costs for individuals who 4 are ineligible for Medicaid services or private insurance 5 coverage. The fund shall also provide support for the 6 expansion of substance use and pain management curricula at the 7 university of Iowa college of medicine, evidence-based public 8 health research on nonnarcotic pain treatment and management 9 alternatives, and mental health and substance use education 10 and training for emergency medical care providers as defined 11 in section 147A.1. 12 2. Distribution of moneys from the opioid use research, 13 education, prevention, and treatment fund shall be made to 14 eligible applicants in the following order of priority: 15 a. A public entity, including but not limited to a state, 16 county, or local community health clinic or federally qualified 17 health center, or a public health agency, as defined in section 18 135D.2, that provides opioid use disorder treatment. 19 b. A nonpublic entity that, in addition to opioid use 20 disorder treatment services, provides required primary health 21 services as described in 42 U.S.C. §254b(b)(1)(A). 22 c. A nonpublic entity that provides opioid use disorder 23 treatment but does not provide required primary health services 24 as described in 42 U.S.C. §254b(b)(1)(A). 25 3. The fund shall consist of all moneys deposited in 26 the fund and any other moneys available to, or obtained or 27 accepted by, the department for placement in the fund. Moneys 28 in the fund are not subject to section 8.33. However, any 29 moneys received by the state pursuant to the federal American 30 Rescue Plan Act of 2021, Pub. L. No. 117-2 and deposited in 31 the fund shall be expended for the purposes designated in the 32 appropriation of the moneys from the fund on or before December 33 31, 2024, as provided in the federal Act. Notwithstanding 34 section 12C.7, interest or earnings on moneys in the fund shall 35 -5- LSB 2670YH (9) 89 pf/rh 5/ 8

H.F. 898 be credited to the fund. 1 Sec. 5. SUBSTANCE USE DISORDER AND OPIOID USE RESEARCH, 2 EDUCATION, PREVENTION, AND TREATMENT —— APPROPRIATIONS. Of the 3 moneys received by the state pursuant to the federal American 4 Rescue Plan Act of 2021, Pub. L. No. 117-2, $10,000,000 shall 5 be deposited in the opioid use research, education, prevention, 6 and treatment fund created in this division of this Act, and 7 is appropriated to the following entities for the fiscal year 8 beginning July 1, 2021, and ending June 30, 2022, for the 9 purposes designated: 10 1. To the department of public health: 11 a. To provide for training, equipment, and initial 12 operation in twelve county jails throughout the state 13 of appropriate evidence-based treatment of incarcerated 14 individuals diagnosed with substance use disorders, in 15 accordance with rules adopted by the department: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,500,000 17 b. To contract with the Iowa health care collaborative to 18 develop and pilot protocols for the treatment of emergency 19 room patients experiencing opioid or heroin overdoses, only 20 to the extent funding is matched on a dollar-for-dollar basis 21 from private or public sources secured by the Iowa health care 22 collaborative: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 100,000 24 c. For the psychiatric residency programs involved 25 with coordinated, collaborative care at newly established, 26 community-based behavioral health treatment facilities offering 27 residential substance use disorder treatment for twenty-nine 28 days or more: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 30 d. To pilot the establishment and operation of three 31 community-based syringe service programs developed to provide 32 substance use prevention and response including linkages 33 to substance use disorder treatment; vaccination, testing, 34 and access to care for infectious diseases; and access to, 35 -6- LSB 2670YH (9) 89 pf/rh 6/ 8

H.F. 898 education regarding the safe utilization of, and proper 1 disposal of sterile syringes and injection equipment: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 450,000 3 The pilot program supported with the funding appropriated 4 under this paragraph is conditioned on the implementation 5 of written agreements with local law enforcement agencies 6 and county attorneys to refrain from charging or prosecuting 7 program sponsors or participants for violations of section 8 124.414. 9 2. To the state board of regents: 10 a. To fund research on medication-assisted treatment for 11 substance use disorders conducted at the university of Iowa 12 college of public health to identify variability in outcomes, 13 demonstrate efficacy of treatment, and refine evidence-based 14 protocols: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 500,000 16 b. To fund research and education conducted at the 17 university of Iowa Carver college of medicine for the 18 nonnarcotic treatment of pain: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 20 3. To the governor’s office of drug control policy to 21 establish and direct a task force, in collaboration with the 22 department of public health, department of human services, and 23 department of public safety, to make recommendations, based on 24 public health principles, to restructure the response of the 25 state’s health and justice systems to illicit drug use and to 26 individuals suffering from substance use disorders: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 500,000 28 The governor’s office of drug control policy shall submit a 29 report of the recommendations specified in this subsection to 30 the governor and the general assembly by November 1, 2022. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to public health and health care. 35 -7- LSB 2670YH (9) 89 pf/rh 7/ 8

H.F. 898 Division I of the bill makes appropriations of moneys 1 received by the state pursuant to the federal American Rescue 2 Plan Act of 2021, Pub. L. No. 117-2, to the university of Iowa 3 college of public health, the department of human services, and 4 the department of public health for purposes related to public 5 health structure and infrastructure, for oral health services 6 provided to Medicaid members, and for public health information 7 and data systems. 8 Division II of the bill creates an opioid use research, 9 education, prevention, and treatment fund (fund) in the state 10 treasury under the control of the department of public health 11 to expand treatment for, and access to, treatment for opioid 12 use disorders and to assist opioid drug use prevention and 13 treatment programs, and to provide support for the expansion of 14 substance use and pain management curricula at the university 15 of Iowa Carver college of medicine, evidence-based public 16 health research on nonnarcotic pain treatment and management 17 alternatives, and mental health and substance use education and 18 training for emergency care providers. Distribution of the 19 moneys in the fund is prioritized. 20 The division provides that a specified amount of the moneys 21 received by the state pursuant to the federal American Rescue 22 Plan Act of 2021, Pub. L. No. 117-2, shall be deposited in the 23 fund, and is appropriated to the department of public health, 24 the state board of regents, and the governor’s office of drug 25 control policy for FY 2021-2022 for the purposes designated in 26 the division. 27 -8- LSB 2670YH (9) 89 pf/rh 8/ 8