HF 724 (LSB 1004HV (1) 90)

HOUSE FILE 724

BY  COMMITTEE ON APPROPRIATIONS

(SUCCESSOR TO HSB 248)

A BILL FOR

An Act relating to appropriations for veterans and health and human services and including other related provisions and appropriations including health policy oversight, public assistance program provisions and a public assistance modernization fund, sprinkler systems for home and community-based services waiver recipient residences, a state-funded family medicine obstetrics fellowship program and fund, adoption subsidy program nonrecurring adoption expenses, real estate transactions involving departmental institutions, providing penalties, and including effective date and other applicability date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
DEPARTMENT OF VETERANS AFFAIRS —— FY 2023-2024

    Section 1.  DEPARTMENT OF VETERANS AFFAIRS.  There is appropriated from the general fund of the state to the department of veterans affairs for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   1.  DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
   For salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $  1,033,289

   ............................................................... FTEs         15.00

   2.  IOWA VETERANS HOME
   For salaries, support, maintenance, and miscellaneous purposes:
   ...................................................................... $  7,115,335

   a.  The Iowa veterans home billings involving the department of health and human services shall be submitted to the department on at least a monthly basis.
   b.  The Iowa veterans home expenditure report shall be submitted monthly to the general assembly.
   c.  The Iowa veterans home shall continue to include in the annual discharge report applicant information to provide for the collection of demographic information including but not limited to the number of individuals applying for admission and admitted or denied admittance and the basis for the admission or denial; the age, gender, and race of such individuals; and the level of care for which such individuals applied for admission including residential or nursing level of care.
   3.  HOME OWNERSHIP ASSISTANCE PROGRAM
   For transfer to the Iowa finance authority for the continuation of the home ownership assistance program for persons who are or were eligible members of the armed forces of the United States, pursuant to section 16.54:
   ...................................................................... $  2,200,000
    Sec. 2.  LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS FUND STANDING APPROPRIATIONS.  Notwithstanding the standing appropriation in section 35A.16 for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the amount appropriated from the general fund of the state pursuant to that section for the following designated purposes shall not exceed the following amount:
   For the county commissions of veteran affairs fund under section 35A.16:
   ...................................................................... $    990,000
DIVISION II
DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING —— FY 2023-2024

    Sec. 3.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For aging programs for the department of health and human services and area agencies on aging to provide citizens of Iowa who are 60 years of age and older with case management, Iowa’s aging and disabilities resource center, and other services which may include but are not limited to adult day, respite care, chore, information and assistance, and material aid, for information and options counseling for persons with disabilities who are 18 years of age or older, and for salaries, support, administration, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 11,799,361

   ............................................................... FTEs         31.00

   1.  Funds appropriated in this section may be used to supplement federal funds under federal regulations. To receive funds appropriated in this section, a local area agency on aging shall match the funds with moneys from other sources according to rules adopted by the department. Funds appropriated in this section may be used for elderly services not specifically enumerated in this section only if approved by an area agency on aging for provision of the service within the area.
   2.  Of the funds appropriated in this section, $418,700 is transferred to the Iowa commission on volunteer service to be used for the retired and senior volunteer program.
   3.  a.  The department of health and human services shall establish and enforce procedures relating to expenditure of state and federal funds by area agencies on aging that require compliance with both state and federal laws, rules, and regulations, including but not limited to all of the following:
   (1)  Requiring that expenditures are incurred only for goods or services received or performed prior to the end of the fiscal period designated for use of the funds.
   (2)  Prohibiting prepayment for goods or services not received or performed prior to the end of the fiscal period designated for use of the funds.
   (3)  Prohibiting prepayment for goods or services not defined specifically by good or service, time period, or recipient.
   (4)  Prohibiting the establishment of accounts from which future goods or services which are not defined specifically by good or service, time period, or recipient, may be purchased.
   b.  The procedures shall provide that if any funds are expended in a manner that is not in compliance with the procedures and applicable federal and state laws, rules, and regulations, and are subsequently subject to repayment, the area agency on aging expending such funds in contravention of such procedures, laws, rules and regulations, not the state, shall be liable for such repayment.
   4.  Of the funds appropriated in this section, $1,312,000 shall be used for the purposes of chapter 231E and to administer the prevention of elder abuse, neglect, and exploitation program pursuant to section 231.56A, in accordance with the requirements of the federal Older Americans Act of 1965, 42 U.S.C. §3001 et seq., as amended.
   5.  Of the funds appropriated in this section, $1,000,000 shall be used to fund continuation of the aging and disability resource center lifelong links to provide individuals and caregivers with information and services to plan for and maintain independence.
   6.  Of the funds appropriated in this section, $850,000 shall be used by the department of health and human services, in collaboration with affected stakeholders, to continue to expand the pilot initiative to provide long-term care options counseling utilizing support planning protocols, to assist non-Medicaid eligible consumers who indicate a preference to return to the community and are deemed appropriate for discharge, to return to their community following a nursing facility stay; and shall be used by the department to fund home and community-based services to enable older individuals to avoid more costly utilization of residential or institutional services and remain in their homes. The department shall submit a report regarding the outcomes of the pilot initiative to the governor and the general assembly by December 15, 2023.
DIVISION III
OFFICE OF LONG-TERM CARE OMBUDSMAN —— FY 2023-2024

    Sec. 4.  OFFICE OF LONG-TERM CARE OMBUDSMAN.  There is appropriated from the general fund of the state to the office of long-term care ombudsman for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For salaries, support, administration, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $  1,148,959

   ............................................................... FTEs         12.00
DIVISION IV
DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC HEALTH —— FY 2023-2024

    Sec. 5.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC HEALTH.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   1.  ADDICTIVE DISORDERS
   For reducing the prevalence of the use of tobacco, alcohol, and other drugs, and treating individuals affected by addictive behaviors, including gambling, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 23,656,992

   ............................................................... FTEs         12.00

   a.  (1)  Of the funds appropriated in this subsection, $4,020,894 shall be used for the tobacco use prevention and control initiative, including efforts at the state and local levels, as provided in chapter 142A. The commission on tobacco use prevention and control established pursuant to section 142A.3 shall advise the director of health and human services in prioritizing funding needs and the allocation of moneys appropriated for the programs and initiatives. Activities of the programs and initiatives shall be in alignment with the United States centers for disease control and prevention best practices for comprehensive tobacco control programs that include the goals of preventing youth initiation of tobacco usage, reducing exposure to secondhand smoke, and promotion of tobacco cessation. To maximize resources, the department shall determine if third-party sources are available to instead provide nicotine replacement products to an applicant prior to provision of such products to an applicant under the initiative. The department shall track and report to the governor and the general assembly any reduction in the provision of nicotine replacement products realized by the initiative through implementation of the prerequisite screening.
   (2)  (a)  The department shall collaborate with the department of revenue for enforcement of tobacco laws, regulations, and ordinances and to engage in tobacco control activities approved by the departments as specified in the memorandum of understanding entered into between the departments.
   (b)  For the fiscal year beginning July 1, 2023, and ending June 30, 2024, the terms of the memorandum of understanding, entered into between the department of revenue and the department, governing compliance checks conducted to ensure licensed retail tobacco outlet conformity with tobacco laws, regulations, and ordinances relating to persons under 21 years of age, shall continue to restrict the number of such checks to one check per retail outlet, and one additional check for any retail outlet found to be in violation during the first check.
   b.  (1)  Of the funds appropriated in this subsection, $19,638,485 shall be used for problem gambling and substance use disorder prevention, treatment, and recovery services, including a 24-hour helpline, public information resources, professional training, youth prevention, and program evaluation.
   (2)  Of the amount allocated under this paragraph, $306,000 shall be utilized by the department to maintain a single statewide 24-hour crisis hotline for the Iowa children’s behavioral health system that incorporates warmline services which may be provided through expansion of existing capabilities as required pursuant to 2018 Iowa Acts, chapter 1056, section 16.
   c.  The requirement of section 123.17, subsection 5, is met by the appropriations and allocations made in this division of this Act for purposes of substance use disorder treatment and addictive disorders for the fiscal year beginning July 1, 2023.
   2.  HEALTHY CHILDREN AND FAMILIES
   For promoting the optimum health status for children and adolescents from birth through 21 years of age, and families, and for not more than the following full-time equivalent positions:
   ...................................................................... $  5,815,491

   ............................................................... FTEs         14.00

   a.  Of the funds appropriated in this subsection, not more than $734,000 shall be used for the healthy opportunities for parents to experience success (HOPES)-healthy families Iowa (HFI) program established pursuant to section 135.106. 
   b.  In order to implement the legislative intent stated in sections 135.106 and 256I.9, priority for home visitation program funding shall be given to programs using evidence-based or promising models for home visitation. 
   c.  Of the funds appropriated in this subsection, $3,075,000 shall be used for continuation of the department’s initiative to provide for adequate developmental surveillance and screening during a child’s first five years. The funds shall be used first to fully fund the current sites to ensure that the sites are fully operational, with the remaining funds to be used for expansion to additional sites. The full implementation and expansion shall include enhancing the scope of the initiative through collaboration with the child health specialty clinics to promote healthy child development through early identification and response to both biomedical and social determinants of healthy development; by monitoring child health metrics to inform practice, document long-term health impacts and savings, and provide for continuous improvement through training, education, and evaluation; and by providing for practitioner consultation particularly for children with behavioral conditions and needs. The department shall also collaborate with the Medicaid program and the child health specialty clinics to integrate the activities of the first five initiative into the establishment of patient-centered medical homes, community utilities, accountable care organizations, and other integrated care models developed to improve health quality and population health while reducing health care costs. To the maximum extent possible, funding allocated in this paragraph shall be utilized as matching funds for Medicaid program reimbursement.
   d.  Of the funds appropriated in this subsection, $64,000 shall be distributed to a statewide dental carrier to provide funds to continue the donated dental services program patterned after the projects developed by the dental lifeline network to provide dental services to indigent individuals who are elderly or with disabilities.
   e.  Of the funds appropriated in this subsection, $156,000 shall be used to provide audiological services and hearing aids for children.
   f.  Of the funds appropriated in this subsection, $23,000 is transferred to the university of Iowa college of dentistry for provision of primary dental services to children. State funds shall be matched on a dollar-for-dollar basis. The university of Iowa college of dentistry shall coordinate efforts with the department to provide dental care to underserved populations throughout the state.
   g.  Of the funds appropriated in this subsection, $50,000 shall be used to address youth suicide prevention.
   h.  Of the funds appropriated in this subsection, $40,000 shall be used to support the Iowa effort to address the survey of children who experience adverse childhood experiences known as ACEs.
   i.  Of the funds appropriated in this subsection, up to $494,000 shall be used for childhood obesity prevention.
   3.  CHRONIC CONDITIONS
   For serving individuals identified as having chronic conditions or special health care needs, and for not more than the following full-time equivalent positions:
   ...................................................................... $  4,256,595

   ............................................................... FTEs         10.00

   a.  Of the funds appropriated in this subsection, $188,000 shall be used for grants to individual patients who have an inherited metabolic disorder to assist with the costs of medically necessary foods and formula.
   b.  Of the funds appropriated in this subsection, $1,055,000 shall be used for the brain injury services program pursuant to section 135.22B, including $861,000 for contracting with an existing nationally affiliated and statewide organization whose purpose is to educate, serve, and support Iowans with brain injury and their families, for resource facilitator services in accordance with section 135.22B, subsection 9, and for contracting to enhance brain injury training and recruitment of service providers on a statewide basis. Of the amount allocated in this paragraph, $95,000 shall be used to fund 1.00 full-time equivalent position to serve as the state brain injury services program manager.
   c.  Of the funds appropriated in this subsection, $144,000 shall be used for the public purpose of continuing to contract with an existing nationally affiliated organization to provide education, client-centered programs, and client and family support for people living with epilepsy and their families. The amount allocated in this paragraph in excess of $50,000 shall be matched dollar-for-dollar by the organization specified. Funds allocated under this paragraph shall be distributed in their entirety for the purpose specified on July 1, 2023.
   d.  Of the funds appropriated in this subsection, $809,000 shall be used for child health specialty clinics.
   e.  Of the funds appropriated in this subsection, $384,000 shall be used by the regional autism assistance program established pursuant to section 256.35, and administered by the child health specialty clinic located at the university of Iowa hospitals and clinics. The funds shall be used to enhance interagency collaboration and coordination of educational, medical, and other health and human services for persons with autism, their families, and providers of services, including delivering regionalized services of care coordination, family navigation, and integration of services through the statewide system of regional child health specialty clinics and fulfilling other requirements as specified in chapter 225D.  The university of Iowa shall not receive funds allocated under this paragraph for indirect costs associated with the regional autism assistance program.
   f.  Of the funds appropriated in this subsection, $577,000 shall be used for the comprehensive cancer control program to reduce the burden of cancer in Iowa through prevention, early detection, effective treatment, and ensuring quality of life. Of the funds allocated in this paragraph “f”, $150,000 shall be used to support a melanoma research symposium, a melanoma biorepository and registry, basic and translational melanoma research, and clinical trials.
   g.  Of the funds appropriated in this subsection, $97,000 shall be used for cervical and colon cancer screening, and $177,000 shall be used to enhance the capacity of the cervical cancer screening program to include provision of recommended prevention and early detection measures to a broader range of low-income women.
   h.  Of the funds appropriated in this subsection, $506,000 shall be used for the center for congenital and inherited disorders.
   4.  COMMUNITY CAPACITY
   For strengthening the health care delivery system at the local level, and for not more than the following full-time equivalent positions:
   ...................................................................... $  7,435,682

   ............................................................... FTEs         14.00

   a.  Of the funds appropriated in this subsection, $95,000 is allocated for continuation of the child vision screening program implemented through the university of Iowa hospitals and clinics in collaboration with early childhood Iowa areas. The program shall submit a report to the department regarding the use of funds allocated under this paragraph “a”. The report shall include the objectives and results for the program year including the target population and how the funds allocated assisted the program in meeting the objectives; the number, age, and location within the state of individuals served; the type of services provided to the individuals served; the distribution of funds based on the services provided; and the continuing needs of the program.
   b.  Of the funds appropriated in this subsection, $48,000 shall be used for a grant to a statewide association of psychologists, that is affiliated with the American psychological association, to be used for continuation of a program to rotate intern psychologists in placements that serve urban and rural mental health professional shortage areas. Once an intern psychologist begins service, the intern psychologist may continue serving in the location of the intern psychologist’s placement, notwithstanding any change in the mental health professional shortage area designation of such location. The intern psychologist may also provide services via telehealth, to underserved populations, and to Medicaid members. For the purposes of this paragraph “b”, “mental health professional shortage area” means a geographic area in this state that has been designated by the United States department of health and human services, health resources and services administration, bureau of health professionals, as having a shortage of mental health professionals.
   c.  Of the funds appropriated in this subsection, the following amounts are allocated to be used as follows to support the goals of increased access, health system integration, and engagement:
   (1)  Not less than $600,000 is allocated to the Iowa prescription drug corporation for continuation of the pharmaceutical infrastructure originally established for safety net providers as described in 2007 Iowa Acts, chapter 218, section 108, and for the prescription drug donation repository program created in chapter 135M. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2023.
   (2)  Not less than $334,000 is allocated to free clinics and free clinics of Iowa for necessary infrastructure, statewide coordination, provider recruitment, service delivery, and provision of assistance to patients in securing a medical home inclusive of oral health care. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2023.
   (3)  Not less than $25,000 is allocated to the Iowa association of rural health clinics for necessary infrastructure and service delivery transformation. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2023.
   (4)  Not less than $225,000 is allocated to the Polk county medical society for continuation of the safety net provider patients access to specialty health care initiative as described in 
2007 Iowa Acts, chapter 218, section 109
. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2023.
   d.  Of the funds appropriated in this subsection, $191,000 is allocated for the purposes of health care and public health workforce initiatives. 
   e.  Of the funds appropriated in this subsection, $96,000 shall be used for a matching dental education loan repayment program to be allocated to a dental nonprofit health service corporation to continue to develop the criteria and implement the loan repayment program.
   f.  Of the funds appropriated in this subsection, $100,000 shall be used for the purposes of the Iowa donor registry as specified in section 142C.18.
   g.  Of the funds appropriated in this subsection, $96,000 shall be used for continuation of a grant to a nationally affiliated volunteer eye organization that has an established program for children and adults and that is solely dedicated to preserving sight and preventing blindness through education, nationally certified vision screening and training, and community and patient service programs. The contractor shall submit a report to the general assembly regarding the use of funds allocated under this paragraph “g”. The report shall include the objectives and results for the program year including the target population and how the funds allocated assisted the program in meeting the objectives; the number, age, grade level if appropriate, and location within the state of individuals served; the type of services provided to the individuals served; the distribution of funds based on the services provided; and the continuing needs of the program.
   h.  Of the funds appropriated in this subsection, $2,100,000 shall be deposited in the medical residency training account created in section 135.175, subsection 5, paragraph “a”, and is appropriated from the account to the department to be used for the purposes of the medical residency training state matching grants program as specified in section 135.176.
   i.  Of the funds appropriated in this subsection, $250,000 shall be used for the public purpose of providing funding to Des Moines university to continue a provider education project to provide primary care physicians with the training and skills necessary to recognize the signs of mental illness in patients.
   j.  Of the funds appropriated in this subsection, $800,000 shall be used for rural psychiatric residencies to annually fund six psychiatric residents who will provide mental health services in underserved areas of the state. Notwithstanding section 8.33, moneys that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated for subsequent fiscal years.
   k.  Of the funds appropriated in this subsection, $150,000 shall be used for psychiatric training to increase access to mental health care services by expanding the mental health workforce via training of additional physician assistants and nurse practitioners.
   1.  Of the funds appropriated in this subsection, $425,000 shall be used for the continuation of a center of excellence program to award two grants to encourage innovation and collaboration among regional health care providers in a rural area based upon the results of a regional community needs assessment to transform health care delivery in order to provide quality, sustainable care that meets the needs of the local communities. An applicant for the grant funds shall specify how the grant funds will be expended to accomplish the goals of the program and shall provide a detailed five-year sustainability plan prior to being awarded any grant funding. Following the receipt of grant funding, a recipient shall submit periodic reports as specified by the department to the governor and the general assembly regarding the recipient’s expenditure of the grant funds and progress in accomplishing the program’s goals.
   m.  Of the funds appropriated in this subsection, $560,000 shall be deposited in the family medicine obstetrics fellowship program fund to be used for the state family medicine obstetrics fellowship program, in accordance with section 135.182, if enacted in this Act, to meet a critical demand for well-trained family medicine obstetrics practitioners in rural and underserved areas in the state.
   n.  Of the funds appropriated in this subsection, $358,201 is allocated for the Iowa commission on volunteer service for purposes of the Iowa state commission grant program and the Iowa’s promise and Iowa mentoring partnership programs.
   (1)  Of the funds allocated in this paragraph, $75,000 shall be used for the purposes of the Iowa state commission grant program and $93,201 shall be used for the purposes of the Iowa’s promise and Iowa mentoring partnership programs.
   (2)  Notwithstanding section 8.33, funds allocated in this paragraph that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
   5.  ESSENTIAL PUBLIC HEALTH SERVICES
   To provide public health services that reduce risks and invest in promoting and protecting good health over the course of a lifetime with a priority given to older Iowans and vulnerable populations:
   ...................................................................... $  7,662,464

   6.  INFECTIOUS DISEASES
   For reducing the incidence and prevalence of communicable diseases, and for not more than the following full-time equivalent positions:
   ...................................................................... $  1,795,902

   ............................................................... FTEs            6.00

   7.  PUBLIC PROTECTION
   For protecting the health and safety of the public through establishing standards and enforcing regulations, and for not more than the following full-time equivalent positions:
   ...................................................................... $  4,581,792

   ............................................................... FTEs         57.00

   a.  Of the funds appropriated in this subsection, not more than $304,000 shall be credited to the emergency medical services fund created in section 135.25. Moneys in the emergency medical services fund are appropriated to the department to be used for the purposes of the fund.
   b.  Of the funds appropriated in this subsection, up to $243,000 shall be used for sexual violence prevention programming through a statewide organization representing programs serving victims of sexual violence through the department’s sexual violence prevention program, and for continuation of a training program for sexual assault response team (SART) members, including representatives of law enforcement, victim advocates, prosecutors, and certified medical personnel. The amount allocated in this paragraph “b” shall not be used to supplant funding administered for other sexual violence prevention or victims assistance programs.
   c.  Of the funds appropriated in this subsection, up to $750,000 shall be used for the state poison control center. Pursuant to the directive under 2014 Iowa Acts, chapter 1140, section 102, the federal matching funds available to the state poison control center from the department under the federal Children’s Health Insurance Program Reauthorization Act allotment shall be subject to the federal administrative cap rule of 10 percent applicable to funding provided under Tit. XXI of the federal Social Security Act and included within the department’s calculations of the cap.
   d.  Of the funds appropriated in this subsection, up to $504,000 shall be used for childhood lead poisoning provisions.
   8.  RESOURCE MANAGEMENT
   For establishing and sustaining the overall ability of the department to deliver services to the public, and for not more than the following full-time equivalent positions:
   ...................................................................... $    933,543

   ............................................................... FTEs            4.00

   9.  MISCELLANEOUS PROVISIONS
   The university of Iowa hospitals and clinics under the control of the state board of regents shall not receive indirect costs from the funds appropriated in this section. The university of Iowa hospitals and clinics billings to the department shall be on at least a quarterly basis.
   10.  IOWA HEALTH INFORMATION NETWORK ENHANCEMENTS
    The department shall work with the board established in chapter 135D to develop plans for program enhancements in the Iowa health information network, for the purpose of empowering Iowa patients to access and direct their health information utilizing the Iowa health information network. Program enhancements shall protect data privacy, facilitate the interchange of health data for the purpose of improving public health outcomes, and increase participation by health care providers.
    Sec. 6.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS WAGERING RECEIPTS FUND.  There is appropriated from the sports wagering receipts fund created in section 8.57, subsection 6, to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For problem gambling and substance use disorder prevention, treatment, and recovery services, including a 24-hour helpline, public information resources, professional training, youth prevention, and program evaluation:
   ...................................................................... $  1,750,000
DIVISION V
DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HUMAN SERVICES —— FY 2023-2024

    Sec. 7.  TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT.  There is appropriated from the fund created in section 8.41 to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, from moneys received under the federal temporary assistance for needy families (TANF) block grant pursuant to the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, and successor legislation, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   1.  To be credited to the family investment program (FIP) account and used for assistance under FIP in accordance with chapter 239B:
   ...................................................................... $  5,002,006

   2.  To be credited to the FIP account and used for the job opportunities and basic skills (JOBS) program and implementing family investment agreements in accordance with chapter 239B:
   ...................................................................... $  5,412,060

   3.  To be used for the family development and self-sufficiency grant program in accordance with section 216A.107:
   ...................................................................... $  2,888,980

   Notwithstanding section 8.33, moneys appropriated in this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year. However, unless such moneys are encumbered or obligated on or before September 30, 2024, the moneys shall revert.
   4.  For field operations:
   ...................................................................... $ 31,296,232

   5.  For general administration:
   ...................................................................... $  3,744,000

   6.  For state child care assistance:
   ...................................................................... $ 47,166,826

   a.  Of the funds appropriated in this subsection, $26,205,412 is transferred to the child care and development block grant appropriation made by the Ninetieth General Assembly, 2023 session, for the federal fiscal year beginning October 1, 2023, and ending September 30, 2024. Of this amount, $200,000 shall be used for provision of educational opportunities to registered child care home providers in order to improve services and programs offered by this category of providers and to increase the number of providers. The department may contract with institutions of higher education or child care resource and referral centers to provide the educational opportunities. Allowable administrative costs under the contracts shall not exceed 5 percent. The application for a grant shall not exceed two pages in length.
   b.  Any funds appropriated in this subsection remaining unallocated shall be used for state child care assistance payments for families who are employed including but not limited to individuals enrolled in FIP.
   7.  For child and family services:
   ...................................................................... $ 32,380,654

   8.  For child abuse prevention grants:
   ...................................................................... $    125,000

   9.  For pregnancy prevention grants on the condition that family planning services are funded:
   ...................................................................... $  1,913,203

   Pregnancy prevention grants shall be awarded to programs in existence on or before July 1, 2023, if the programs have demonstrated positive outcomes. Grants shall be awarded to pregnancy prevention programs which are developed after July 1, 2023, if the programs are based on existing models that have demonstrated positive outcomes. Grants shall comply with the requirements provided in 1997 Iowa Acts, chapter 208, section 14, subsections 1 and 2, including the requirement that grant programs must emphasize sexual abstinence. Priority in the awarding of grants shall be given to programs that serve areas of the state which demonstrate the highest percentage of unplanned pregnancies of females of childbearing age within the geographic area to be served by the grant.
   10.  For technology needs and other resources necessary to meet federal and state reporting, tracking, and case management requirements and other departmental needs:
   ...................................................................... $  1,037,186

   11.  a.  Notwithstanding any provision to the contrary, including but not limited to requirements in section 8.41 or provisions in 2022 Iowa Acts or 2023 Iowa Acts regarding the receipt and appropriation of federal block grants, federal funds from the temporary assistance for needy families block grant received by the state and not otherwise appropriated in this section and remaining available for the fiscal year beginning July 1, 2023, are appropriated to the department of health and human services to the extent as may be necessary to be used in the following priority order:  for FIP, for state child care assistance program payments for families who are employed, and for the FIP share of system costs for eligibility determination and related functions. The federal funds appropriated in this paragraph “a” shall be expended only after all other funds appropriated in subsection l for assistance under FIP, in subsection 6 for state child care assistance, or in subsection 10 for technology needs and other resources necessary to meet departmental needs, as applicable, have been expended. For the purposes of this subsection, the funds appropriated in subsection 6, paragraph “a”, for transfer to the child care and development block grant appropriation are considered fully expended when the full amount has been transferred.
   b.  The department shall, on a quarterly basis, advise the general assembly and department of management of the amount of funds appropriated in this subsection that was expended in the prior quarter.
   12.  Of the amounts appropriated in this section, $12,962,008 for the fiscal year beginning July 1, 2023, is transferred to the appropriation of the federal social services block grant made to the department of health and human services for that fiscal year.
   13.  For continuation of the program providing categorical eligibility for the supplemental nutrition assistance program (SNAP) as specified in section 239.2, if enacted by 2023 Iowa Acts, Senate File 494:
   ...................................................................... $     14,236

   14.  The department may transfer funds allocated in this section to the appropriations made in this division of this Act for the same fiscal year for general administration and field operations for resources necessary to implement and operate the services referred to in this section and those funded in the appropriation made in this division of this Act for the same fiscal year for FIP from the general fund of the state.
   15.  With the exception of moneys allocated under this section for the family development and self-sufficiency grant program, to the extent moneys allocated in this section are deemed by the department not to be necessary to support the purposes for which they are allocated, such moneys may be used in the same fiscal year for any other purpose for which funds are allocated in this section or in section 8 of this division of this Act for the FIP account. If there are conflicting needs, priority shall first be given to the FIP account as specified under subsection 1 of this section and used for the purposes of assistance under FIP in accordance with chapter 239B, followed by state child care assistance program payments for families who are employed, followed by other priorities as specified by the department.
    Sec. 8.  FAMILY INVESTMENT PROGRAM ACCOUNT.
   1.  Moneys credited to the FIP account for the fiscal year beginning July 1, 2023, and ending June 30, 2024, shall be used to provide assistance in accordance with chapter 239B.
   2.  The department may use a portion of the moneys credited to the FIP account under this section as necessary for salaries, support, maintenance, and miscellaneous purposes, including administrative and information technology costs associated with rent reimbursement and other income assistance programs administered by the department.
   3.  The department may transfer funds allocated in subsection 4, excluding the allocation under subsection 4, paragraph “b”, to the appropriations made in this division of this Act for the same fiscal year for general administration and field operations for resources necessary to implement and operate the services referred to in this section and those funded in the appropriations made in section 7 for the temporary assistance for needy families block grant and in section 9 for FIP from the general fund of the state in this division of this Act for the same fiscal year.
   4.  Moneys appropriated in this division of this Act and credited to the FIP account for the fiscal year beginning July 1, 2023, and ending June 30, 2024, are allocated as follows:
   a.  To be used by the department of health and human services to more effectively serve participants in FIP and other clients and to meet federal reporting requirements under the federal temporary assistance for needy families block grant:
   ...................................................................... $     10,000

   b.  To the department of health and human services for staffing, administration, and implementation of the family development and self-sufficiency grant program in accordance with section 216A.107:
   ...................................................................... $  7,192,834

   (1)  Of the funds allocated for the family development and self-sufficiency grant program in this paragraph “b”, not more than 5 percent of the funds shall be used for the administration of the grant program.
   (2)  The department of health and human services may continue to implement the family development and self-sufficiency grant program statewide during fiscal year 2023-2024.
   (3)  The department of health and human services may engage in activities to strengthen and improve family outcomes measures and data collection systems under the family development and self-sufficiency grant program.
   c.  For the diversion subaccount of the FIP account:
   ...................................................................... $  1,293,000

   A portion of the moneys allocated for the diversion subaccount may be used for field operations, salaries, data management system development, and implementation costs and support deemed necessary by the director of health and human services in order to administer the FIP diversion program. To the extent moneys allocated in this paragraph “c” are deemed by the department not to be necessary to support diversion activities, such moneys may be used for other efforts intended to increase engagement by FIP participants in work, education, or training activities, or for the purposes of assistance under FIP in accordance with chapter 239B.
   d.  For the SNAP employment and training program:
   ...................................................................... $     66,588

   (1)  The department shall apply the federal SNAP employment and training state plan in order to maximize to the fullest extent permitted by federal law the use of the 50 percent federal reimbursement provisions for the claiming of allowable federal reimbursement funds from the United States department of agriculture pursuant to the federal SNAP employment and training program for providing education, employment, and training services for eligible SNAP participants, including but not limited to related dependent care and transportation expenses.
   (2)  The department shall continue categorical federal SNAP eligibility as specified in section 239.2, if enacted by 2023 Iowa Acts, Senate File 494, consistent with federal SNAP requirements. The eligibility provisions shall conform to all federal requirements including requirements addressing individuals who are disqualified for committing an intentional program violation or are otherwise ineligible.
   e.  For the JOBS program, not more than:
   ...................................................................... $ 12,018,258

   5.  Of the child support collections assigned under FIP, an amount equal to the federal share of support collections shall be credited to the child support services appropriation made in this division of this Act. Of the remainder of the assigned child support collections received by child support services, a portion shall be credited to the FIP account, a portion may be used to increase recoveries, and a portion may be used to sustain cash flow in the child support payments account. If as a consequence of the appropriations and allocations made in this section the resulting amounts are insufficient to sustain cash assistance payments and meet federal maintenance of effort requirements, the department shall seek supplemental funding. If child support collections assigned under FIP are greater than estimated or are otherwise determined not to be required for maintenance of effort, the state share of either amount may be transferred to or retained in the child support payments account.
    Sec. 9.  FAMILY INVESTMENT PROGRAM GENERAL FUND.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   To be credited to the FIP account and used for FIP assistance in accordance with chapter 239B and for other costs associated with providing needs-based benefits or assistance:
   ...................................................................... $ 41,003,575

   1.  Of the funds appropriated in this section, $6,606,198 is allocated for the JOBS program.
   2.  Of the funds appropriated in this section, $4,313,854 is allocated for the family development and self-sufficiency grant program.
   3.  a.  Notwithstanding section 8.39, for the fiscal year beginning July 1, 2023, if necessary to meet federal maintenance of effort requirements or to transfer federal temporary assistance for needy families block grant funding to be used for purposes of the federal social services block grant or to meet cash flow needs resulting from delays in receiving federal funding or to implement, in accordance with this division of this Act, activities currently funded with juvenile court services, county, or community moneys and state moneys used in combination with such moneys; to comply with federal requirements; or to maximize the use of federal funds; the department of health and human services may transfer funds within or between any of the appropriations made in this division of this Act and appropriations in law for the federal social services block grant to the department for the following purposes, provided that the combined amount of state and federal temporary assistance for needy families block grant funding for each appropriation remains the same before and after the transfer:
   (1)  For FIP.
   (2)  For state child care assistance.
   (3)  For child and family services.
   (4)  For field operations.
   (5)  For general administration.
   b.  This subsection shall not be construed to prohibit the use of existing state transfer authority for other purposes. The department shall report any transfers made pursuant to this subsection to the general assembly.
   4.  Of the funds appropriated in this section, $195,000 shall be used for a contract for tax preparation assistance to low-income Iowans to expand the usage of the earned income tax credit. The purpose of the contract is to supply this assistance to underserved areas of the state. The department shall not retain any portion of the allocation under this subsection for administrative costs.
   5.  Of the funds appropriated in this section, $70,000 shall be used for the continuation of the parenting program, as specified in 
441 IAC ch. 100
, relating to parental obligations, in which child support services participates, to support the efforts of a nonprofit organization committed to strengthening the community through youth development, healthy living, and social responsibility headquartered in a county with a population over 450,000 according to the 2020 certified federal census. The funds allocated in this subsection shall be used by the recipient organization to develop a larger community effort, through public and private partnerships, to support a broad-based multi-county parenthood initiative that promotes payment of child support obligations, improved family relationships, and full-time employment.
   6.  The department may transfer funds appropriated in this section, excluding the allocation in subsection 2 for the family development and self-sufficiency grant program, to the appropriations made in this division of this Act for general administration and field operations as necessary to administer this section, section 7 for the temporary assistance for needy families block grant, and section 8 for the FIP account.
    Sec. 10.  CHILD SUPPORT SERVICES.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For child support services, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 15,914,329

   ............................................................... FTEs        459.00

   1.  The department shall expend up to $24,000, including federal financial participation, for the fiscal year beginning July 1, 2023, for a child support public awareness campaign. The department and the office of the attorney general shall cooperate in continuation of the campaign. The public awareness campaign shall emphasize, through a variety of media activities, the importance of maximum involvement of both parents in the lives of their children as well as the importance of payment of child support obligations.
   2.  Federal access and visitation grant moneys shall be issued directly to private not-for-profit agencies that provide services designed to increase compliance with the child access provisions of court orders, including but not limited to neutral visitation sites and mediation services.
   3.  The appropriation made to the department for child support services may be used throughout the fiscal year in the manner necessary for purposes of cash flow management, and for cash flow management purposes the department may temporarily draw more than the amount appropriated, provided the amount appropriated is not exceeded at the close of the fiscal year.
    Sec. 11.  HEALTH CARE TRUST FUND —— MEDICAL ASSISTANCE —— FY 2023-2024.  Any funds remaining in the health care trust fund created in section 453A.35A for the fiscal year beginning July 1, 2023, and ending June 30, 2024, are appropriated to the department of health and human services to supplement the medical assistance program appropriations made in this division of this Act, for medical assistance reimbursement and associated costs, including program administration and costs associated with program implementation.
    Sec. 12.  MEDICAID FRAUD FUND —— MEDICAL ASSISTANCE —— FY 2023-2024.  Any funds remaining in the Medicaid fraud fund created in section 249A.50 for the fiscal year beginning July 1, 2023, and ending June 30, 2024, are appropriated to the department of health and human services to supplement the medical assistance appropriations made in this division of this Act, for medical assistance reimbursement and associated costs, including program administration and costs associated with program implementation.
    Sec. 13.  MEDICAL ASSISTANCE.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies in effect on June 30, 2023, except as otherwise expressly authorized by law, consistent with options under federal law and regulations, and contingent upon receipt of approval from the office of the governor of reimbursement for each abortion performed under the program:
   ...................................................................... $ 1,543,626,779

   1.  Iowans support reducing the number of abortions performed in our state. Funds appropriated under this section shall not be used for abortions, unless otherwise authorized under this section.
   2.  The provisions of this section relating to abortions shall also apply to the Iowa health and wellness plan created pursuant to chapter 249N.
   3.  The department shall utilize not more than $60,000 of the funds appropriated in this section to continue the AIDS/HIV health insurance premium payment program as established in 1992 Iowa Acts, Second Extraordinary Session, chapter 1001, section 409, subsection 6. Of the funds allocated in this subsection, not more than $5,000 may be expended for administrative purposes.
   4.  Of the funds appropriated in this Act to the department of health and human services for addictive disorders, $950,000 shall be used for an integrated substance use disorder managed care system. The department shall maintain the level of mental health and substance use disorder treatment services provided by the managed care contractors. The department shall take the steps necessary to continue the federal waivers as necessary to maintain the level of services.
   5.  The department shall aggressively pursue options for providing medical assistance or other assistance to individuals with special needs who become ineligible to continue receiving services under the early and periodic screening, diagnostic, and treatment program under the medical assistance program due to becoming 21 years of age who have been approved for additional assistance through the department’s exception to policy provisions, but who have health care needs in excess of the funding available through the exception to policy provisions.
   6.  Of the funds appropriated in this section, up to $3,050,082 may be transferred to the field operations or general administration appropriations in this division of this Act for operational costs associated with Part D of the federal Medicare Prescription Drug Improvement and Modernization Act of 2003, Pub. L. No. 108-173.
   7.  Of the funds appropriated in this section, up to $442,100 may be transferred to the appropriation in this division of this Act for health program operations to be used for clinical assessment services and prior authorization of services.
   8.  A portion of the funds appropriated in this section may be transferred to the appropriations in this division of this Act for general administration, health program operations, the children’s health insurance program, or field operations to be used for the state match cost to comply with the payment error rate measurement (PERM) program for both the medical assistance and children’s health insurance programs as developed by the centers for Medicare and Medicaid services of the United States department of health and human services to comply with the federal Improper Payments Information Act of 2002, Pub. L. No. 107-300, and to support other reviews and quality control activities to improve the integrity of these programs.
   9.  Of the funds appropriated in this section, a sufficient amount is allocated to supplement the incomes of residents of nursing facilities, intermediate care facilities for persons with mental illness, and intermediate care facilities for persons with an intellectual disability, with incomes of less than $50 in the amount necessary for the residents to receive a personal needs allowance of $50 per month pursuant to section 249A.30A.
   10.  One hundred percent of the nonfederal share of payments to area education agencies that are medical assistance providers for medical assistance-covered services provided to medical assistance-covered children, shall be made from the appropriation made in this section.
   11.  A portion of the funds appropriated in this section may be transferred to the appropriation in this division of this Act for health program operations to be used for administrative activities associated with the money follows the person demonstration project.
   12.  Of the funds appropriated in this section, $349,011 shall be used for the administration of the health insurance premium payment program, including salaries, support, maintenance, and miscellaneous purposes.
   13.  a.  The department may increase the amounts allocated for salaries, support, maintenance, and miscellaneous purposes associated with the medical assistance program, as necessary, to sustain cost management efforts. The department shall report any such increase to the general assembly and the department of management.
   b.  If the savings to the medical assistance program from ongoing cost management efforts exceed the associated cost for the fiscal year beginning July 1, 2023, the department may transfer any savings generated for the fiscal year due to medical assistance program cost management efforts to the appropriation made in this division of this Act for health program operations or general administration to defray the costs associated with implementing the efforts.
   14.  For the fiscal year beginning July 1, 2023, and ending June 30, 2024, the replacement generation tax revenues required to be deposited in the property tax relief fund pursuant to section 437A.8, subsection 4, paragraph “d”, and section 437A.15, subsection 3, paragraph “f”, shall instead be credited to and supplement the appropriation made in this section and used for the allocations made in this section.
   15.  a.  Of the funds appropriated in this section, up to $50,000 may be transferred by the department to the appropriation made in this division of this Act to the department for the same fiscal year for general administration to be used for associated administrative expenses and for not more than 1.00 full-time equivalent position, in addition to those authorized for the same fiscal year, to be assigned to implementing the children’s mental health home project.
   b.  Of the funds appropriated in this section, up to $400,000 may be transferred by the department to the appropriation made to the department in this division of this Act for the same fiscal year for Medicaid program-related general administration planning and implementation activities. The funds may be used for contracts or for personnel in addition to the amounts appropriated for and the positions authorized for general administration for the fiscal year.
   c.  Of the funds appropriated in this section, up to $3,000,000 may be transferred by the department to the appropriations made in this division of this Act for the same fiscal year for general administration or health program operations to be used to support the development and implementation of standardized assessment tools for persons with mental illness, an intellectual disability, a developmental disability, or a brain injury.
   16.  Of the funds appropriated in this section, $150,000 shall be used for lodging expenses associated with care provided at the university of Iowa hospitals and clinics for patients with cancer whose travel distance is 30 miles or more and whose income is at or below 200 percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services. The department of health and human services shall establish the maximum number of overnight stays and the maximum rate reimbursed for overnight lodging, which may be based on the state employee rate established by the department of administrative services. The funds allocated in this subsection shall not be used as nonfederal share matching funds.
   17.  Of the funds appropriated in this section, up to $3,383,880 shall be used for administration of the state family planning services program pursuant to section 217.41B, and of this amount, the department may use up to $200,000 for administrative expenses.
   18.  Of the funds appropriated in this section, $1,545,530 shall be used and may be transferred to other appropriations in this division of this Act as necessary to administer the provisions in the division of this Act relating to Medicaid program administration.
   19.  The department shall comply with the centers for Medicare and Medicaid services’ guidance related to Medicaid program and children’s health insurance program maintenance of effort provisions, including eligibility standards, methodologies, procedures, and continuous enrollment, to receive the enhanced federal medical assistance percentage under section 6008(b) of the federal Families First Coronavirus Response Act, Pub. L. No. 116-127 and section 5131 of the federal Consolidated Appropriations Act, 2023, Pub. L. No. 117-328. The department shall utilize and implement all tools, processes, and resources available to expediently return to normal eligibility and enrollment operations in compliance with federal guidance and expectations.
   20.  A portion of the funds appropriated in this section may be transferred to the appropriation made in this division of this Act for the children’s health insurance program, if the children’s health insurance program appropriation is insufficient to cover the designated purposes of that appropriation.
   21.  Notwithstanding any provision to the contrary, of the funds appropriated in this section, $13,000,000 shall be used to increase reimbursement rates for mental health and substance use disorder providers in accordance with a methodology determined by the department. Of the amount allocated under this subsection, $7,000,000 shall be used to increase reimbursement rates for individual mental health therapy providers, $3,000,000 shall be used to increase reimbursement rates for mental health providers, and $3,000,000 shall be used to increase reimbursement rates for substance use disorder providers.
   22.  Of the funds appropriated in this section, $5,500,000 shall be used to maintain the reimbursement rates of eligible home and community-based services providers at the rates in effect on June 30, 2023. 
    Sec. 14.  HEALTH PROGRAM OPERATIONS.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For health program operations:
   ...................................................................... $ 17,446,067

   1.  The department of inspections, appeals, and licensing shall provide all state matching funds for survey and certification activities performed by the department of inspections, appeals, and licensing. The department of health and human services is solely responsible for distributing the federal matching funds for such activities.
   2.  Of the funds appropriated in this section, $50,000 shall be used for continuation of home and community-based services waiver quality assurance programs, including the review and streamlining of processes and policies related to oversight and quality management to meet state and federal requirements.
   3.  Of the amount appropriated in this section, up to $200,000 may be transferred to the appropriation for general administration in this division of this Act to be used for additional full-time equivalent positions in the development of key health initiatives such as development and oversight of managed care programs and development of health strategies targeted toward improved quality and reduced costs in the Medicaid program.
   4.  Of the funds appropriated in this section, $1,000,000 shall be used for planning and development of a phased-in program to provide a dental home for children.
   5.  a.  Of the funds appropriated in this section, $188,000 shall be credited to the autism support program fund created in section 225D.2 to be used for the autism support program created in chapter 225D, with the exception of the following amount of this allocation which shall be used as follows:
   b.  Of the funds allocated in this subsection, $25,000 shall be used for the public purpose of continuation of a grant to a nonprofit provider of child welfare services that has been in existence for more than 115 years, is located in a county with a population between 220,000 and 250,000 according to the 2020 federal decennial census, is licensed as a psychiatric medical institution for children, and provides school-based programming, to be used for support services for children with autism spectrum disorder and their families.
    Sec. 15.  STATE SUPPLEMENTARY ASSISTANCE.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For the state supplementary assistance program:
   ...................................................................... $  7,349,002

   2.  The department shall increase the personal needs allowance for residents of residential care facilities by the same percentage and at the same time as federal supplemental security income and federal social security benefits are increased due to a recognized increase in the cost of living. The department may adopt emergency rules to implement this subsection.
   3.  If during the fiscal year beginning July 1, 2023, the department projects that state supplementary assistance expenditures for a calendar year will not meet the federal pass-through requirement specified in Tit. XVI of the federal Social Security Act, section 1618, as codified in 42 U.S.C. §1382g, the department may take actions including but not limited to increasing the personal needs allowance for residential care facility residents and making programmatic adjustments or upward adjustments of the residential care facility or in-home health-related care reimbursement rates prescribed in this division of this Act to ensure that federal requirements are met. In addition, the department may make other programmatic and rate adjustments necessary to remain within the amount appropriated in this section while ensuring compliance with federal requirements. The department may adopt emergency rules to implement the provisions of this subsection.
   4.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated, including for liability amounts associated with the SNAP payment error rate, until the close of the succeeding fiscal year.
    Sec. 16.  CHILDREN’S HEALTH INSURANCE PROGRAM.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For maintenance of the healthy and well kids in Iowa (Hawki) program pursuant to chapter 514I, including supplemental dental services, for receipt of federal financial participation under Tit. XXI of the federal Social Security Act, which creates the children’s health insurance program:
   ...................................................................... $ 38,661,688

   2.  Of the funds appropriated in this section, a sufficient amount is allocated for continuation of the contract for outreach.
   3.  A portion of the funds appropriated in this section may be transferred to the appropriations made in this division of this Act for field operations or health program operations to be used for the integration of Hawki program eligibility, payment, and administrative functions under the purview of the department of health and human services, including for the Medicaid management information system upgrade.
    Sec. 17.  CHILD CARE ASSISTANCE.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For child care programs:
   ...................................................................... $ 64,223,730

   1.  Of the funds appropriated in this section, $34,966,931 shall be used for state child care assistance in accordance with section 237A.13.
   2.  Nothing in this section shall be construed or is intended as or shall imply a grant of entitlement for services to persons who are eligible for assistance due to an income level consistent with the waiting list requirements of section 237A.13. Any state obligation to provide services pursuant to this section is limited to the extent of the funds appropriated in this section.
   3.  A list of the registered and licensed child care facilities operating in the area served by a child care resource and referral service shall be made available to the families receiving state child care assistance in that area.
   4.  Of the funds appropriated in this section, $29,256,799 shall be deposited in the school ready children grants account of the early childhood Iowa fund created in section 256I.11, and shall be allocated as follows for the fiscal year beginning July 1, 2023:
   a.  Of the amount deposited under this subsection, not more than $265,950 is allocated for the early childhood Iowa program and other technical assistance activities. Moneys allocated under this lettered paragraph may be used by the early childhood Iowa state board for the purpose of skills development and support for ongoing training of staff. The early childhood Iowa state board may reserve a portion of the allocation under paragraph “b”, not to exceed $88,650, for the technical assistance expenses of the early childhood Iowa program, including the reimbursement of staff. However, except as otherwise provided in this subsection, moneys shall not be used for additional staff or for the reimbursement of staff.
   b.  Of the amount deposited under this subsection, $2,318,018 shall be used for efforts to improve the quality of early care, health, and education programs. Moneys allocated pursuant to this lettered paragraph may be used for additional staff and for the reimbursement of staff in early childhood Iowa areas and for local quality improvement efforts. The early childhood Iowa state board shall determine the methodology to make the most productive use of the funding, which may include use of the distribution formula, grants, or other means.
   c.  Of the amount deposited under this subsection, $825,030 shall be used for support of professional development and training activities for persons working in early care, health, and education by the early childhood Iowa state board in collaboration with the professional development component group maintained by the early childhood Iowa stakeholders alliance pursuant to section 256I.12, and the early childhood Iowa area boards. Expenditures shall be limited to professional development and training activities, and strategic plan implementation staff as agreed upon by the parties participating in the collaboration as approved by the early childhood Iowa state board.
   d.  Of the amount deposited under this subsection, $200,000 shall be used to invest in the state’s early childhood database system that integrates state administrative data to provide results that inform and improve the early childhood system of programs and services in the state.
   e.  Of the amount deposited under this subsection, $5,850,000 shall be distributed for funding of community-based early childhood programs targeted to children from birth through five years of age developed by early childhood Iowa areas in accordance with approved community plans as provided in section 256I.8. Up to $65,000 of the funds allocated in this paragraph may be used for additional technical assistance staff.
   5.  The department may use any of the funds appropriated in this section as a match to obtain federal funds for use in expanding child care assistance and related programs. For the purpose of expenditures of state and federal child care funding, funds shall be considered obligated at the time expenditures are projected or are allocated to the department’s service areas. Projections shall be based on current and projected caseload growth, current and projected provider rates, staffing requirements for eligibility determination and management of program requirements including data systems management, staffing requirements for administration of the program, contractual and grant obligations and any transfers to other state agencies, and obligations for decategorization or innovation projects.
   6.  A portion of the state match for the federal child care and development block grant shall be provided as necessary to meet federal matching funds requirements through the state general fund appropriation made for child development grants and other programs for at-risk children in section 279.51.
   7.  If a uniform reduction ordered by the governor under section 8.31 or other operation of law, transfer, or federal funding reduction reduces the appropriation made in this section for the fiscal year, the percentage reduction in the amount paid out to or on behalf of the families participating in the state child care assistance program shall be equal to or less than the percentage reduction made for any other purpose payable from the appropriation made in this section and the federal funding relating to it. The percentage reduction to the other allocations made in this section shall be the same as the uniform reduction ordered by the governor or the percentage change of the federal funding reduction, as applicable. If there is an unanticipated increase in federal funding provided for state child care services, the entire amount of the increase, except as necessary to meet federal requirements including quality set asides, shall be used for state child care assistance payments. If the appropriations made for purposes of the state child care assistance program for the fiscal year are determined to be insufficient, it is the intent of the general assembly to appropriate sufficient funding for the fiscal year in order to avoid establishment of waiting list requirements.
   8.  Notwithstanding section 8.33, moneys advanced for purposes of the programs developed by early childhood Iowa areas, advanced for purposes of wraparound child care, or received from the federal appropriations made for the purposes of this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert to any fund but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
    Sec. 18.  JUVENILE INSTITUTION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   1.  a.  For operation of the state training school at Eldora and for salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 17,568,511

   ............................................................... FTEs        207.00

   b.  Of the funds appropriated in this subsection, $91,000 shall be used for distribution to licensed classroom teachers at this and other institutions under the control of the department of health and human services based upon the average student yearly enrollment at each institution as determined by the department.
   2.  A portion of the moneys appropriated in this section shall be used by the state training school at Eldora for grants for adolescent pregnancy prevention activities at the institution in the fiscal year beginning July 1, 2023.
   3.  Of the funds appropriated in this subsection, $212,000 shall be used by the state training school at Eldora for a substance use disorder treatment program at the institution for the fiscal year beginning July 1, 2023.
   4.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
    Sec. 19.  CHILD AND FAMILY SERVICES.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For child and family services:
   ...................................................................... $ 79,027,794

   2.  The department may transfer funds appropriated in this section as necessary to pay the nonfederal costs of services reimbursed under the medical assistance program, the state child care assistance program, or FIP which are provided to children who would otherwise receive services paid under the appropriation in this section. The department may transfer funds appropriated in this section to the appropriations made in this division of this Act for general administration and for field operations for resources necessary to implement and operate the services funded in this section.
   3.  Of the funds appropriated in this section, up to $40,500,000 is allocated for group foster care maintenance and services. 
   4.  In accordance with the provisions of section 232.188, the department shall continue the child welfare and juvenile justice funding initiative during fiscal year 2023-2024. Of the funds appropriated in this section, $1,717,000 is allocated specifically for expenditure for fiscal year 2023-2024 through the decategorization services funding pools and governance boards established pursuant to section 232.188.
   5.  A portion of the funds appropriated in this section may be used for emergency family assistance to provide other resources required for a family participating in a family preservation or reunification project or successor project to stay together or to be reunified.
   6.  Of the funds appropriated in this section, a sufficient amount is allocated for shelter care and the child welfare emergency services contracting implemented to provide for or prevent the need for shelter care.
   7.  Federal funds received by the state during the fiscal year beginning July 1, 2023, as the result of the expenditure of state funds appropriated during a previous state fiscal year for a service or activity funded under this section are appropriated to the department to be used as additional funding for services and purposes provided for under this section. Notwithstanding section 8.33, moneys received in accordance with this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert to any fund but shall remain available for the purposes designated until the close of the succeeding fiscal year.
   8.  a.  Of the funds appropriated in this section, up to $748,000 is allocated for the payment of the expenses of court-ordered services provided to children who are under the supervision of the department, which expenses are a charge upon the state pursuant to section 232.141, subsection 4.
   b.  Notwithstanding section 232.141 or any other provision of law to the contrary, the amounts allocated in this subsection shall be distributed as determined by the department. The department shall make the determination of the distribution amounts on or before June 15, 2023.
   c.  Notwithstanding chapter 232 or any other provision of law to the contrary, a district or juvenile court shall not order any service which is a charge upon the state pursuant to section 232.141 if the court-ordered services distribution amount is insufficient to pay for the service. The department shall encourage use of the funds allocated in this subsection such that there are sufficient funds to pay for all court-related services during the entire year. The department shall attempt to anticipate potential surpluses and shortfalls in the distribution amounts and shall transfer distribution amounts as prudent.
   d.  Notwithstanding any provision of law to the contrary, a district or juvenile court shall not order a county to pay for any service provided to a juvenile pursuant to an order entered under chapter 232 which is a charge upon the state under section 232.141, subsection 4.
   9.  Of the funds appropriated in this section, $1,658,000 shall be used for the child protection center grant program for child protection centers located in Iowa in accordance with section 135.118. The grant amounts under the program shall be equalized so that each center receives a uniform base amount of $245,000, and so that the remaining funds are awarded through a funding formula based upon the volume of children served. To increase access to child protection center services for children in rural areas, the funding formula for the awarding of the remaining funds shall provide for the awarding of an enhanced amount to eligible grantees to develop and maintain satellite centers in underserved regions of the state.
   10.  Of the funds appropriated in this section, up to $4,025,000 is allocated for the preparation for adult living program pursuant to section 234.46.
   11.  Of the funds appropriated in this section, $227,000 shall be used for the public purpose of continuing a grant to a nonprofit human services organization, providing services to individuals and families in multiple locations in southwest Iowa and Nebraska for support of a project providing immediate, sensitive support and forensic interviews, medical exams, needs assessments, and referrals for victims of child abuse and their nonoffending family members.
   12.  Of the funds appropriated in this section, $300,000 is allocated for the foster care youth council approach of providing a support network to children placed in foster care.
   13.  Of the funds appropriated in this section, $202,000 is allocated for use pursuant to section 235A.1 for continuation of the initiative to address child sexual abuse implemented pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection 21.
   14.  Of the funds appropriated in this section, $630,000 is allocated for the community partnership for child protection sites.
   15.  Of the funds appropriated in this section, up to $371,000 is allocated for the department’s minority youth and family projects under the redesign of the child welfare system.
   16.  Of the funds appropriated in this section, $851,000 is allocated for funding of the community circle of care collaboration for children and youth in northeast Iowa.
   17.  Of the funds appropriated in this section, at least $147,000 shall be used for the continuation of the child welfare provider training program.
   18.  Of the funds appropriated in this section, $211,000 shall be used for continuation of the central Iowa system of care program grant for the purposes of funding community-based services and other supports with a system of care approach for children with serious emotional disturbance and their families through a nonprofit provider that is located in a county with a population of more than 450,000 according to the 2020 certified federal census, is licensed as a psychiatric medical institution for children, and was a system of care grantee prior to July 1, 2023.
   19.  Of the funds appropriated in this section, $235,000 shall be used for the public purpose of the continuation and expansion of a system of care program grant implemented in Cerro Gordo and Linn counties to utilize a comprehensive and long-term approach for helping children and families by addressing the key areas in a child’s life of childhood basic needs, education and work, family, and community.
   20.  Of the funds appropriated in this section, $110,000 shall be used for the public purpose of funding community-based services and other supports with a system of care approach for children with a serious emotional disturbance and their families through a nonprofit provider of child welfare services that has been in existence for more than 115 years, is located in a county with a population of more than 230,000 according to the 2020 certified federal census, is licensed as a psychiatric medical institution for children, and was a system of care grantee prior to July 1, 2023.
   21.  If a separate funding source is identified that reduces the need for state funds within an allocation under this section, the allocated state funds may be redistributed to other allocations under this section for the same fiscal year.
   22.  Of the funds appropriated in this section, a portion may be used for family-centered services for purposes of complying with the federal Family First Prevention Services Act of 2018, Pub. L. No. 115-123, and successor legislation. 
    Sec. 20.  ADOPTION SUBSIDY.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   a.  For adoption subsidy payments and related costs and for other operations and services provided for under paragraph “b”:
   ...................................................................... $ 40,883,507

   b.  (1)  Of the funds appropriated in this section, a sufficient amount is allocated for adoption subsidy payments and related costs.
   (2)  Any funds appropriated in this section remaining after the allocation under subparagraph (1) are designated and allocated as state savings resulting from implementation of the federal Fostering Connections to Success and Increasing Adoptions Act of 2008, Pub. L. No. 110-351, and successor legislation, as determined in accordance with 42 U.S.C. §673(a)(8), and shall be used for post-adoption services and for other purposes allowed under these federal laws, Tit. IV-B or Tit. IV-E of the federal Social Security Act.
   (a)  The department of health and human services may transfer funds allocated in this subparagraph (2) to the appropriation for child and family services in this division of this Act for the purposes designated in this subparagraph (2).
   (b)  Notwithstanding section 8.33, moneys allocated under this subparagraph (2) shall not revert to any fund but shall remain available for the purposes designated in this subparagraph (2) until expended.
   2.  The department may transfer funds appropriated in this section remaining after the transfer of funds under subsection 1, paragraph “b”, to the appropriation made in this division of this Act for general administration for costs paid from the appropriation relating to adoption subsidy.
   3.  Federal funds received by the state during the fiscal year beginning July 1, 2023, as the result of the expenditure of state funds during a previous state fiscal year for a service or activity funded under this section are appropriated to the department to be used as additional funding for the services and activities funded under this section. Notwithstanding section 8.33, moneys received in accordance with this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert to any fund but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
   4.  The maximum payment for adoption subsidy nonrecurring expenses shall be established in accordance with section 234.48, if enacted in this Act.
   5.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.
    Sec. 21.  FAMILY SUPPORT SUBSIDY PROGRAM.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For the family support subsidy program subject to the enrollment restrictions in section 225C.37, subsection 3:
   ...................................................................... $    949,282

   2.  At least $931,536 of the moneys appropriated in this section shall be used for the family support center component of the comprehensive family support program under chapter 225C, subchapter V.
   3.  If at any time during the fiscal year, the amount of funding available for the family support subsidy program is reduced from the amount initially used to establish the figure for the number of family members for whom a subsidy is to be provided at any one time during the fiscal year, notwithstanding section 225C.38, subsection 2, the department shall revise the figure as necessary to conform to the amount of funding available.
    Sec. 22.  CONNER DECREE.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For building community capacity through the coordination and provision of training opportunities in accordance with the consent decree of Conner v. Branstad, No. 4-86-CV-30871(S.D. Iowa, July 14, 1994):
   ...................................................................... $     33,632
    Sec. 23.  MENTAL HEALTH INSTITUTES.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   a.  For operation of the state mental health institute at Cherokee as required by chapters 218 and 226 for salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 15,923,252

   ............................................................... FTEs        188.00

   b.  For operation of the state mental health institute at Independence as required by chapters 218 and 226 for salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 19,811,470

   ............................................................... FTEs        211.00

   2.  a.  Notwithstanding sections 218.78 and 249A.11, any revenue received from the state mental health institute at Cherokee or the state mental health institute at Independence pursuant to 
42 C.F.R. §438.6(e)
 may be retained and expended by the mental health institute.
   b.  Notwithstanding sections 218.78 and 249A.11, any COVID-19 related funding received through federal funding sources by the state mental health institute at Cherokee or the state mental health institute at Independence may be retained and expended by the mental health institute.
   3.  Notwithstanding any provision of law to the contrary, a Medicaid member residing at the state mental health institute at Cherokee or the state mental health institute at Independence shall retain Medicaid eligibility during the period of the Medicaid member’s stay for which federal financial participation is available.
   4.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
    Sec. 24.  STATE RESOURCE CENTERS.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   a.  For the state resource center at Glenwood for salaries, support, maintenance, and miscellaneous purposes:
   ...................................................................... $ 16,255,132

   b.  For the state resource center at Woodward for salaries, support, maintenance, and miscellaneous purposes:
   ...................................................................... $ 13,389,577

   2.  The department may continue to bill for state resource center services utilizing a scope of services approach used for private providers of intermediate care facilities for persons with an intellectual disability services, in a manner which does not shift costs between the medical assistance program, mental health and disability services regions, or other sources of funding for the state resource centers.
   3.  The state resource centers may expand the time-limited assessment and respite services during the fiscal year.
   4.  If the department’s administration and the department of management concur with a finding by a state resource center’s superintendent that projected revenues can reasonably be expected to pay the salary and support costs for a new employee position, or that such costs for adding a particular number of new positions for the fiscal year would be less than the overtime costs if new positions would not be added, the superintendent may add the new position or positions. If the vacant positions available to a resource center do not include the position classification desired to be filled, the state resource center’s superintendent may reclassify any vacant position as necessary to fill the desired position. The superintendents of the state resource centers may, by mutual agreement, pool vacant positions and position classifications during the course of the fiscal year in order to assist one another in filling necessary positions.
   5.  If existing capacity limitations are reached in operating units, a waiting list is in effect for a service or a special need for which a payment source or other funding is available for the service or to address the special need, and facilities for the service or to address the special need can be provided within the available payment source or other funding, the superintendent of a state resource center may authorize opening not more than two units or other facilities and begin implementing the service or addressing the special need during fiscal year 2023-2024.
   6.  Notwithstanding section 8.33, and notwithstanding the amount limitation specified in section 222.92, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
    Sec. 25.  SEXUALLY VIOLENT PREDATORS.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For costs associated with the commitment and treatment of sexually violent predators in the unit located at the state mental health institute at Cherokee, including costs of legal services and other associated costs, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 14,865,337

   ............................................................... FTEs        167.00

   2.  Unless specifically prohibited by law, if the amount charged provides for recoupment of at least the entire amount of direct and indirect costs, the department of health and human services may contract with other states to provide care and treatment of persons placed by the other states at the unit for sexually violent predators at Cherokee. The moneys received under such a contract shall be considered to be repayment receipts and used for the purposes of the appropriation made in this section.
   3.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.
    Sec. 26.  FIELD OPERATIONS.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For field operations, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 67,056,945

   ............................................................... FTEs     1,589.00

   2.  Of the funds appropriated in this section, $1,370,436 shall be used for the purpose of increasing compensation for child welfare case workers and to support case workers with complex cases in all service areas.
   3.  In addition to subsection 2, priority in filling full-time equivalent positions shall be given to those positions related to child protection services and eligibility determination for low-income families.
    Sec. 27.  GENERAL ADMINISTRATION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For general administration, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $ 18,913,662

   ............................................................... FTEs        341.86

   1.  The department shall report at least monthly to the general assembly concerning the department’s operational and program expenditures.
   2.  Of the funds appropriated in this section, $150,000 shall be used for the provision of a program to provide technical assistance, support, and consultation to providers of home and community-based services under the medical assistance program.
   3.  Of the funds appropriated in this section, $50,000 is transferred to the Iowa finance authority to be used for administrative support of the council on homelessness established in section 16.2D and for the council to fulfill its duties in addressing and reducing homelessness in the state.
   4.  Of the funds appropriated in this section, $200,000 shall be transferred to and deposited in the administrative fund of the Iowa ABLE savings plan trust created in section 12I.4, to be used for implementation and administration activities of the Iowa ABLE savings plan trust.
   5.  Of the funds appropriated in this section, $200,000 is transferred to the Iowa commission on volunteer service to continue to be used for the RefugeeRISE AmeriCorps program established under section 15H.8 for member recruitment and training to improve the economic well-being and health of economically disadvantaged refugees in local communities across Iowa. Funds transferred may be used to supplement federal funds under federal regulations.
   6.  Of the funds appropriated in this section, up to $300,000 shall be used as follows:
   a.  To fund not more than 1.00 full-time equivalent position to address the department’s responsibility to support the work of the children’s behavioral health system state board and implementation of the services required pursuant to section 331.397.
   b.  To support the cost of establishing and implementing new or additional services required pursuant to sections 331.397 and 331.397A.
   c.  Of the amount allocated, $32,000 shall be used to support the costs of establishing and implementing new or additional services required pursuant to sections 331.397 and 331.397A.
   7.  Of the funds appropriated in this section, $800,000 shall be used for the renovation and construction of certain nursing facilities, consistent with the provisions of chapter 249K.
   8.  Of the funds appropriated under this section, $1,000,000 shall be used for the purposes of program administration and provision of pregnancy support services through the more options for maternal support program in accordance with section 217.41C.
   9.  Of the funds appropriated under this section, $2,602,312 shall be used for the child advocacy board for foster care review and the court appointed special advocate program, including for salaries, support, maintenance, and miscellaneous purposes.
   a.  The department, in coordination with the child advocacy board, shall submit an application for funding available pursuant to Tit. IV-E of the federal Social Security Act for claims for child advocacy board administrative review costs.
   b.  The court appointed special advocate program shall investigate and develop opportunities for expanding fundraising for the program.
   c.  Administrative costs charged by the department for items funded under this subsection shall not exceed 4 percent of the amount appropriated in this subsection.
    Sec. 28.  DEPARTMENT-WIDE DUTIES.
   1.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For salaries, support, maintenance, and miscellaneous purposes at facilities under the purview of the department of health and human services:
   ...................................................................... $  7,157,590

   2.  Of the funds appropriated under this section, $5,000,000 shall be used for support of institutions listed under section 218.6. Any transfer of these funds for the institutions listed under section 218.6 shall comply with section 218.6. The department shall submit a report to the general assembly detailing the expenditure of such funds. 
    Sec. 29.  VOLUNTEERS.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   For development and coordination of volunteer services:
   ...................................................................... $     84,686
    Sec. 30.  MEDICAL ASSISTANCE, STATE SUPPLEMENTARY ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.
   1.  a.  (1)  (a)  (i)  Notwithstanding any provision of law to the contrary, for the fiscal period beginning July 1, 2023, and ending June 30, 2025, the department of health and human services shall rebase case-mix nursing facility rates beginning July 1, 2023, using the Medicaid cost reports on file for the period ending December 31, 2022, and applying a minimum occupancy factor of 70 percent, as provided pursuant to 2021 Iowa Acts, chapter 182, section 39, to the extent possible within the state funding, including the $15,000,000 provided for this purpose.
   (ii)  For the fiscal year beginning July 1, 2023, the department of health and human services shall determine and adjust each nursing facility’s case-mix index on a semiannual basis. A separate calculation shall be made to determine the average case-mix index for a nursing facility-wide case-mix index, and a case-mix index for the residents of a nursing facility who are medical assistance program recipients using all of the minimum data set reports by the nursing facility for the previous semiannual period of the state fiscal year using a day weighted calculation.
   (b)  For the fiscal year beginning July 1, 2023, non-case-mix and special population nursing facilities shall be reimbursed in accordance with the methodology in effect on June 30, 2023.
   (c)  For managed care claims, the department of health and human services shall adjust the payment rate floor for nursing facilities, annually, to maintain a rate floor that is no lower than the Medicaid fee-for-service case-mix adjusted rate calculated in accordance with subparagraph division (a) and 
441 IAC 81.6
. The department shall then calculate adjusted reimbursement rates, including but not limited to add-on payments, annually, and shall notify Medicaid managed care organizations of the adjusted reimbursement rates within 30 days of determining the adjusted reimbursement rates. Any adjustment of reimbursement rates under this subparagraph division shall be budget neutral to the state budget.
   (d)  For the fiscal year beginning July 1, 2023, Medicaid managed care long-term services and supports capitation rates shall be adjusted to reflect the case-mix adjusted rates specified pursuant to subparagraph division (a) for the patient populations residing in Medicaid-certified nursing facilities.
   (2)  Medicaid managed care organizations shall adjust facility-specific rates based upon payment rate listings issued by the department. The rate adjustments shall be applied prospectively from the effective date of the rate letter issued by the department. 
   b.  (1)  For the fiscal year beginning July 1, 2023, the department shall establish the fee-for-service pharmacy dispensing fee reimbursement at $10.38 per prescription, until a cost of dispensing survey is completed. The actual dispensing fee shall be determined by a cost of dispensing survey performed by the department and required to be completed by all medical assistance program participating pharmacies every two years, adjusted as necessary to maintain expenditures within the amount appropriated to the department for this purpose for the fiscal year. A change in the dispensing fee shall become effective following federal approval of the Medicaid state plan.
   (2)  The department shall utilize an average acquisition cost reimbursement methodology for all drugs covered under the medical assistance program in accordance with 2012 Iowa Acts, chapter 1133, section 33.
   c.  (1)  For the fiscal year beginning July 1, 2023, reimbursement rates for outpatient hospital services shall be rebased effective January 1, 2024, subject to Medicaid program upper payment limit rules, and adjusted as necessary to maintain expenditures within the amount appropriated to the department for this purpose for the fiscal year.
   (2)  For the fiscal year beginning July 1, 2023, reimbursement rates for inpatient hospital services shall remain at the rates in effect on June 30, 2023, subject to Medicaid program upper payment limit rules, and adjusted as necessary to maintain expenditures within the amount appropriated to the department for this purpose for the fiscal year.
   (3)  For the fiscal year beginning July 1, 2023, under both fee-for-service and managed care administration of the Medicaid program, critical access hospitals shall be reimbursed for inpatient and outpatient services based on the hospital-specific critical access hospital cost adjustment factor methodology utilizing the most recent and complete cost reporting period as applied prospectively within the funds appropriated for such purpose for the fiscal year. 
   (4)  For the fiscal year beginning July 1, 2023, the graduate medical education and disproportionate share hospital fund shall remain at the amount in effect on June 30, 2023, except that the portion of the fund attributable to graduate medical education shall be reduced in an amount that reflects the elimination of graduate medical education payments made to out-of-state hospitals.
   (5)  In order to ensure the efficient use of limited state funds in procuring health care services for low-income Iowans, funds appropriated in this Act for hospital services shall not be used for activities which would be excluded from a determination of reasonable costs under the federal Medicare program pursuant to 42 U.S.C. §1395x(v)(1)(N).
   d.  For the fiscal year beginning July 1, 2023, reimbursement rates for hospices and acute psychiatric hospitals shall be increased in accordance with increases under the federal Medicare program or as supported by their Medicare audited costs.
   e.  For the fiscal year beginning July 1, 2023, independent laboratories and rehabilitation agencies shall be reimbursed using the same methodology in effect on June 30, 2023.
   f.  (1)  For the fiscal year beginning July 1, 2023, reimbursement rates for home health agencies shall continue to be based on the Medicare low utilization payment adjustment (LUPA) methodology with state geographic wage adjustments. The department shall continue to update the rates every two years to reflect the most recent Medicare LUPA rates to the extent possible within the state funding appropriated for this purpose.
   (2)  For the fiscal year beginning July 1, 2023, the department shall continue the reimbursement rate structure that provides incentives to home health care providers located in rural areas and providing home health care to Medicaid members. The rate structure shall include a telehealth component to incentivize the provision of necessary supervision for skilled care without requiring travel time. For the purposes of this subparagraph (2), “rural area” means an area that is not an Iowa core based statistical area as defined by the federal office of management and budget.
   (3)  For the fiscal year beginning July 1, 2023, rates for private duty nursing and personal care services under the early and periodic screening, diagnostic, and treatment program benefit shall be calculated based on the methodology in effect on June 30, 2023.
   g.  For the fiscal year beginning July 1, 2023, federally qualified health centers and rural health clinics shall receive cost-based reimbursement for 100 percent of the reasonable costs for the provision of services to recipients of medical assistance.
   h.  For the fiscal year beginning July 1, 2023, the reimbursement rates for dental services shall remain at the rates in effect on June 30, 2023.
   i.  (1)  For the fiscal year beginning July 1, 2023, reimbursement rates for non-state-owned psychiatric medical institutions for children shall be based on the reimbursement methodology in effect on June 30, 2023.
   (2)  As a condition of participation in the medical assistance program, enrolled providers shall accept the medical assistance reimbursement rate for any covered goods or services provided to recipients of medical assistance who are children under the custody of a psychiatric medical institution for children.
   j.  For the fiscal year beginning July 1, 2023, unless otherwise specified in this Act, all noninstitutional medical assistance provider reimbursement rates shall remain at the rates in effect on June 30, 2023, except for area education agencies, local education agencies, infant and toddler services providers, home and community-based services providers including consumer-directed attendant care providers under a section 1915(c) or 1915(i) waiver, targeted case management providers, and those providers whose rates are required to be determined pursuant to section 249A.20, or to meet federal mental health parity requirements.
   k.  Notwithstanding any provision to the contrary, for the fiscal year beginning July 1, 2023, the reimbursement rate for anesthesiologists shall remain at the rates in effect on June 30, 2023, and updated on January 1, 2024, to align with the most current Iowa Medicare anesthesia rate.
   l.  Notwithstanding section 249A.20, for the fiscal year beginning July 1, 2023, the average reimbursement rate for health care providers eligible for use of the federal Medicare resource-based relative value scale reimbursement methodology under section 249A.20 shall remain at the rate in effect on June 30, 2023; however, this rate shall not exceed the maximum level authorized by the federal government.
   m.  For the fiscal year beginning July 1, 2023, the reimbursement rate for residential care facilities shall not be less than the minimum payment level as established by the federal government to meet the federally mandated maintenance of effort requirement. The flat reimbursement rate for facilities electing not to file annual cost reports shall not be less than the minimum payment level as established by the federal government to meet the federally mandated maintenance of effort requirement.
   n.  (1)  For the fiscal year beginning July 1, 2023, the reimbursement rates for inpatient mental health services provided at hospitals shall remain at the rates in effect on June 30, 2023, subject to Medicaid program upper payment limit rules and adjusted as necessary to maintain expenditures within the amount appropriated to the department for this purpose for the fiscal year; and psychiatrists shall be reimbursed at the medical assistance program fee-for-service rate in effect on June 30, 2023.
   (2)  The department of health and human services shall continue the tiered rate reimbursement methodology for psychiatric intensive inpatient care.
   o.  For the fiscal year beginning July 1, 2023, community mental health centers may choose to be reimbursed for the services provided to recipients of medical assistance through either of the following options:
   (1)  For 100 percent of the reasonable costs of the services.
   (2)  In accordance with the alternative reimbursement rate methodology approved by the department of health and human services in effect on June 30, 2023.
   p.  For the fiscal year beginning July 1, 2023, the reimbursement rate for providers of family planning services that are eligible to receive a 90 percent federal match shall remain at the rates in effect on June 30, 2023.
   q.  For the fiscal year beginning July 1, 2023, the reimbursement rates for emergency medical service providers shall remain at the rates in effect on June 30, 2023, or as approved by the centers for Medicare and Medicaid services of the United States department of health and human services.
   r.  For the fiscal year beginning July 1, 2023, reimbursement rates for substance use disorder treatment programs licensed under section 125.13 shall remain at the rates in effect on June 30, 2023.
   s.  For the fiscal year beginning July 1, 2023, assertive community treatment per diem rates shall remain at the rates in effect on June 30, 2023.
   t.  For the fiscal year beginning July 1, 2023, the reimbursement rate for family-centered services providers shall be established by contract.
   u.  For the fiscal year beginning July 1, 2023, the reimbursement rate for air ambulance services shall remain at the rate in effect on June 30, 2023.
   v.  For the fiscal year beginning July 1, 2023, all applied behavioral analysis services reimbursement rates shall remain at the rates in effect on June 30, 2023.
   w.  For the fiscal year beginning July 1, 2023, all behavioral health intervention services reimbursement rates shall remain at the rates in effect on June 30, 2023.
   2.  For the fiscal year beginning July 1, 2023, the reimbursement rate for providers reimbursed under the in-home-related care program shall not be less than the minimum payment level as established by the federal government to meet the federally mandated maintenance of effort requirement.
   3.  Unless otherwise directed in this section, when the department’s reimbursement methodology for any provider reimbursed in accordance with this section includes an inflation factor, this factor shall not exceed the amount by which the consumer price index for all urban consumers increased during the most recently ended calendar year.
   4.  Notwithstanding section 234.38, for the fiscal year beginning July 1, 2023, the foster family basic daily maintenance rate and the maximum adoption subsidy rate for children ages 0 through 5 years shall be $16.78, the rate for children ages 6 through 11 years shall be $17.45, the rate for children ages 12 through 15 years shall be $19.10, and the rate for children and young adults ages 16 and older shall be $19.35. For youth ages 18 to 23 who have exited foster care, the preparation for adult living program maintenance rate shall be up to $602.70 per month as calculated based on the age of the participant.
   5.  For the fiscal year beginning July 1, 2023, the maximum reimbursement rates for social services providers under contract shall remain at the rates in effect on June 30, 2023, or the provider’s actual and allowable cost plus inflation for each service, whichever is less. However, if a new service or service provider is added after June 30, 2023, the initial reimbursement rate for the service or provider shall be based upon a weighted average of provider rates for similar services.
   6.  a.  For the fiscal year beginning July 1, 2023, the reimbursement rates for resource family recruitment and retention contractors shall be established by contract.
   b.  For the fiscal year beginning July 1, 2023, the reimbursement rates for supervised apartment living foster care providers shall be established by contract.
   7.  For the fiscal year beginning July 1, 2023, the reimbursement rate for group foster care providers shall be the combined service and maintenance reimbursement rate established by contract.
   8.  The group foster care reimbursement rates paid for placement of children out of state shall be calculated according to the same rate-setting principles as those used for in-state providers, unless the director of health and human services or the director’s designee determines that appropriate care cannot be provided within the state. The payment of the daily rate shall be based on the number of days in the calendar month in which service is provided.
   9.  a.  For the fiscal year beginning July 1, 2023, the reimbursement rate paid for shelter care and the child welfare emergency services implemented to provide or prevent the need for shelter care shall be established by contract.
   b.  For the fiscal year beginning July 1, 2023, the combined service and maintenance components of the per day reimbursement rate paid for shelter care services shall be based on the financial and statistical report submitted to the department. The maximum per day reimbursement rate shall be the maximum per day reimbursement rate in effect on June 30, 2023. The department shall reimburse a shelter care provider at the provider’s actual and allowable unit cost, plus inflation, not to exceed the maximum reimbursement rate.
   10.  For the fiscal year beginning July 1, 2023, the department shall calculate reimbursement rates for intermediate care facilities for persons with an intellectual disability at the 80th percentile. Beginning July 1, 2023, the rate calculation methodology shall utilize the consumer price index inflation factor applicable to the fiscal year beginning July 1, 2023.
   11.  The department may adopt emergency rules to implement this section.
    Sec. 31.  EMERGENCY RULES.
   1.  If necessary to comply with federal requirements including time frames, or if specifically authorized by a provision of this division of this Act, the department of health and human services or the mental health and disability services commission shall adopt administrative rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this division of this Act and shall submit such rules to the administrative rules coordinator and the administrative code editor pursuant to section 17A.5, subsection 1, within the same period. The rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
   2.  If during a fiscal year, the department of health and human services is adopting rules in accordance with this section or as otherwise directed or authorized by state law, and the rules will result in an expenditure increase beyond the amount anticipated in the budget process or if the expenditure was not addressed in the budget process for the fiscal year, the department shall notify the general assembly and the department of management concerning the rules and the expenditure increase. The notification shall be provided at least thirty calendar days prior to the date notice of the rules is submitted to the administrative rules coordinator and the administrative code editor.
    Sec. 32.  REPORTS.  Unless otherwise provided, any reports or other information required to be compiled and submitted under this Act during the fiscal year beginning July 1, 2023, shall be submitted on or before the dates specified for submission of the reports or information.
    Sec. 33.  EFFECTIVE UPON ENACTMENT.  The following provision of this division of this Act, being deemed of immediate importance, takes effect upon enactment:
   The provision relating to section 232.141 and directing the department of health and human services to make the determination, by June 15, 2023, of the distribution of funds allocated for the payment of the expenses of court-ordered services provided to juveniles which are a charge upon the state.
DIVISION VI
DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HUMAN RIGHTS

    Sec. 34.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HUMAN RIGHTS.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   1.  HUMAN RIGHTS CENTRAL ADMINISTRATION
   For salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $    186,913

   ............................................................... FTEs            5.54

   2.  COMMUNITY ADVOCACY AND SERVICES
   For salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $    956,894

   ............................................................... FTEs            7.55

   3.  CRIMINAL AND JUVENILE JUSTICE PLANNING
   a.  For salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:
   ...................................................................... $  1,318,547

   ............................................................... FTEs            9.00

   b.  (1)  For a single grant to a program located in a city with a higher than average juvenile crime rate as determined by the department of health and human services and a population greater than 80,000 as determined by the 2020 federal decennial census, which may be used for studying, planning, programming, and capital, that is committed to deterring juvenile delinquency through early intervention in the criminal justice system by providing a comprehensive, multifaceted delivery of social services and which shall meet the guiding principles and standards for assessment centers set forth by the national assessment center association:
   ...................................................................... $    140,000

   (2)  The program shall use no more than 5 percent of the grant for administrative costs.
   (3)  A city shall not receive a grant under this paragraph, or a similar grant from the state, for more than two consecutive fiscal years unless no other city meets the requirements specified in subparagraph (1).
   c.  The justice advisory board and the juvenile justice advisory council shall coordinate their efforts in carrying out their respective duties relative to juvenile justice.
    Sec. 35.  JUVENILE DETENTION HOME FUND.  Moneys deposited in the juvenile detention home fund created in section 232.142 during the fiscal year beginning July 1, 2023, and ending June 30, 2024, are appropriated to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, for distribution of an amount equal to a percentage of the costs of the establishment, improvement, operation, and maintenance of county or multicounty juvenile detention homes in the fiscal year beginning July 1, 2022. Moneys appropriated for distribution in accordance with this section shall be allocated among eligible detention homes, prorated on the basis of an eligible detention home’s proportion of the costs of all eligible detention homes in the fiscal year beginning July 1, 2022. The percentage figure shall be determined by the department of health and human services based on the amount available for distribution for the fund. Notwithstanding section 232.142, the financial aid percentage of total costs payable by the state under that provision for the fiscal year beginning July 1, 2023, shall be limited to the amount appropriated for the purposes of this section.
DIVISION VII
HEALTH AND HUMAN SERVICES —— HEALTH CARE ACCOUNTS AND FUNDS —— FY 2023-2024

    Sec. 36.  PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT OF HEALTH AND HUMAN SERVICES.  There is appropriated from the pharmaceutical settlement account created in section 249A.33 to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purpose designated:
   Notwithstanding any provision of law to the contrary, to supplement the appropriations made in this Act for health program operations under the medical assistance program for the fiscal year beginning July 1, 2023, and ending June 30, 2024:
   ...................................................................... $    234,193
    Sec. 37.  QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF HEALTH AND HUMAN SERVICES.  Notwithstanding any provision to the contrary and subject to the availability of funds, there is appropriated from the quality assurance trust fund created in section 249L.4 to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, for the purposes designated:
   To supplement the appropriation made in this Act from the general fund of the state to the department of health and human services for medical assistance for the same fiscal year:
   ...................................................................... $111,216,205
    Sec. 38.  HOSPITAL HEALTH CARE ACCESS TRUST FUND —— DEPARTMENT OF HEALTH AND HUMAN SERVICES.  Notwithstanding any provision to the contrary and subject to the availability of funds, there is appropriated from the hospital health care access trust fund created in section 249M.4 to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amounts, or so much thereof as is necessary, for the purposes designated:
   To supplement the appropriation made in this Act from the general fund of the state to the department of health and human services for medical assistance for the same fiscal year:
   ...................................................................... $ 33,920,554
    Sec. 39.  MEDICAL ASSISTANCE PROGRAM —— NONREVERSION FOR FY 2023-2024.  Notwithstanding section 8.33, if moneys appropriated for purposes of the medical assistance program for the fiscal year beginning July 1, 2023, and ending June 30, 2024, from the general fund of the state, the quality assurance trust fund, and the hospital health care access trust fund, are in excess of actual expenditures for the medical assistance program and remain unencumbered or unobligated at the close of the fiscal year, the excess moneys shall not revert but shall remain available for expenditure for the purposes of the medical assistance program until the close of the succeeding fiscal year.
DIVISION VIII
DECATEGORIZATION CARRYOVER FUNDING —— TRANSFER TO MEDICAID PROGRAM

    Sec. 40.  DECATEGORIZATION CARRYOVER FUNDING FY 2021 —— TRANSFER TO MEDICAID PROGRAM.  Notwithstanding section 232.188, subsection 5, paragraph “b”, any state-appropriated moneys in the funding pool that remained unencumbered or unobligated at the close of the fiscal year beginning July 1, 2020, and were deemed carryover funding to remain available for the three succeeding fiscal years that still remain unencumbered or unobligated at the close of the fiscal year beginning July 1, 2023, shall not revert but shall be transferred to the medical assistance program for the fiscal year beginning July 1, 2024.
DIVISION IX
HEALTH AND HUMAN SERVICES —— PRIOR APPROPRIATIONS AND OTHER PROVISIONS

FAMILY INVESTMENT PROGRAM GENERAL FUND
    Sec. 41.  2022 Iowa Acts, chapter 1131, section 9, is amended by adding the following new subsection:
   NEW SUBSECTION.  7.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.

STATE CHILD CARE ASSISTANCE
    Sec. 42.  2022 Iowa Acts, chapter 1131, section 17, subsection 8, is amended to read as follows:
   8.  Notwithstanding section 8.33, moneys advanced for purposes of the programs developed by early childhood Iowa areas, advanced for purposes of wraparound child care, or received from the federal appropriations made for the purposes of appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert to any fund but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.

CHILD AND FAMILY SERVICES
    Sec. 43.  2022 Iowa Acts, chapter 1131, section 19, is amended by adding the following new subsection:
   NEW SUBSECTION.  25.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.

FIELD OPERATIONS
    Sec. 44.  2022 Iowa Acts, chapter 1131, section 27, is amended by adding the following new subsection:
   NEW SUBSECTION.  3.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.

MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM
    Sec. 45.  2022 Iowa Acts, chapter 1131, section 28, subsection 8, is amended to read as follows:
   8.  Of the funds appropriated under this section, $500,000 shall be used for the purposes of program administration and provision of pregnancy support services through the more options for maternal support program created in this Act.  Notwithstanding section 8.33, moneys allocated in this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.

GENERAL ADMINISTRATION
    Sec. 46.  2022 Iowa Acts, chapter 1131, section 28, is amended by adding the following new subsection:
   NEW SUBSECTION.  9.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.

QUALITY ASSURANCE TRUST FUND

    Sec. 47.  2022 Iowa Acts, chapter 1131, section 36, unnumbered paragraph 2, is amended to read as follows:
   To supplement the appropriation made in this Act from the general fund of the state to the department of health and human services for medical assistance for the same fiscal year:
   ...................................................................... $ 56,305,139

                                                                         66,282,906
    Sec. 48.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION X
HEALTH AND HUMAN SERVICES —— REPORT ON NONREVERSION OF FUNDS

    Sec. 49.  REPORT ON NONREVERSION OF FUNDS.  The department of health and human services shall report the expenditure of any moneys for which nonreversion authorization was provided for the fiscal year beginning July 1, 2022, and ending June 30, 2023, to the general assembly on a quarterly basis beginning October 1, 2023. 
DIVISION XI
ELIMINATION OF REPEAL OF HOSPITAL HEALTH CARE ACCESS ASSESSMENT PROGRAM

    Sec. 50.  REPEAL.  Section 249M.5, Code 2023, is repealed.
    Sec. 51.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION XII
HEALTH AND HUMAN SERVICES —— REALIGNMENT PROVISIONS

DIRECTOR OF HEALTH AND HUMAN SERVICES —— INSTITUTIONS —— BUYING AND SELLING OF REAL ESTATE
    Sec. 52.  Section 218.94, as amended by 2023 Iowa Acts, Senate File 514, section 411, as enacted, is amended to read as follows:
   218.94  Director may buy and sell real estate —— options —— fund.
   1.  a.  The director may secure options to purchase real estate, to acquire and sell real estate, and to grant utility easements, for the proper uses of the institutions. Real estate shall be acquired and sold and utility easements granted, upon such terms and conditions as the director may determine. Upon sale of the real estate, the proceeds shall be deposited with the treasurer of state and credited to the general fund of the state in a health and human services capital reinvestment fund created in the state treasury under the control of the department. There is appropriated from the general such capital reinvestment fund of the state a sum equal to the proceeds deposited and credited to the general capital reinvestment fund of the state to the department, which may be used to purchase other real estate, or for capital improvements upon property under the director’s control, or for improvements to property which is owned by the state and utilized by the department.
   b.  Notwithstanding section 8.33, moneys in the capital reinvestment fund shall not revert at the close of a fiscal year, and shall not be transferred, used, obligated, appropriated, or otherwise encumbered, except as provided in this section. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the fund shall be credited to the fund.
   c.  Any proceeds from the sale of real estate that were credited to the general fund of the state pursuant to section 218.94, Code 2022, and that remain available on June 30, 2023, are transferred to the capital reinvestment fund to be used for the purposes of the fund.
   2.  The costs incident to securing of options, acquisition and sale of real estate and granting of utility easements, including but not limited to appraisals, invitations for offers, abstracts, and other necessary costs, may be paid from moneys appropriated for support and maintenance to the institution at which the real estate is located. Such costs shall be and the source from which the moneys were appropriated shall be reimbursed from the proceeds of the sale.

SCHOOL READY CHILDREN GRANTS ACCOUNT
    Sec. 53.  Section 256I.11, subsection 2, unnumbered paragraph 1, as amended by 2023 Iowa Acts, Senate File 514, section 1005, is amended to read as follows:
   A school ready children grants account is created in the fund under the authority of the director of the department of education. Moneys credited to the account are appropriated to and shall be distributed by the department of education in the form of grants to early childhood Iowa areas pursuant to criteria established by the state board in accordance with law.
DIVISION XIII
HEALTH POLICY OVERSIGHT COMMITTEE —— MEDICAID PROGRAM

    Sec. 54.  Section 2.45, subsection 5, Code 2023, is amended to read as follows:
   5.  The legislative health policy oversight committee, which shall be composed of ten members of the general assembly, consisting of five members from each house, to be appointed by the legislative council. The legislative health policy oversight committee shall may meet at least two times, annually, during the legislative interim to provide continuing oversight for Medicaid managed care, and to ensure effective and efficient administration of the program, address stakeholder concerns, monitor program costs and expenditures, and make recommendations.
DIVISION XIV
PUBLIC ASSISTANCE PROGRAM PROVISIONS

    Sec. 55.  Section 239.1, subsections 2 and 3, if enacted by 2023 Iowa Acts, Senate File 494, are amended by striking the subsections and inserting in lieu thereof the following:
   2.  “Asset” for the purposes of the asset test for the supplemental nutrition assistance program under section 239.4 means all of the following resources countable toward the maximum allowed household asset limit of fifteen thousand dollars:
   a.  All liquid resources.
   b.  All other personal property excluding one vehicle and the fair market value in excess of ten thousand dollars of an additional vehicle.
   3.  “Asset test” for the purposes of the asset test for the supplemental nutrition assistance program under section 239.4 means the comparison of the collective value of all countable assets of the members of the applicant’s household to the maximum allowed household asset limit of fifteen thousand dollars.
    Sec. 56.  Section 239.4, subsection 1, if enacted by 2023 Iowa Acts, Senate File 494, is amended to read as follows:
   1.  For the purposes of determining eligibility for receipt of SNAP benefits, the department shall conduct an asset test on all members of the applicant’s household. The allowable financial resources to be included in or excluded from a determination of eligibility for SNAP shall be those specified in 7 U.S.C. §2014(g)(1) 7 U.S.C. §2014(g), to the extent consistent with the term “asset” as defined in this chapter.
    Sec. 57.  Section 239.9, subsection 1, if enacted by 2023 Iowa Acts, Senate File 494, is amended to read as follows:
   1.  Following a review of an applicant’s or recipient’s eligibility under this chapter, the department may refer cases of suspected fraud along with any supportive information to the department of inspections, and appeals, and licensing for review.
    Sec. 58.  Section 239.10, subsection 1, if enacted by 2023 Iowa Acts, Senate File 494, is amended to read as follows:
   1.  The department of health and human services shall adopt rules pursuant to chapter 17A to administer this chapter.
    Sec. 59.  2023 Iowa Acts, Senate File 494, if enacted, is amended by adding the following new section:
   NEW SECTION.  SEC. 10A.  NEW SECTION.  239.11  Public assistance modernization fund.
   1.  A public assistance modernization fund is created in the state treasury under the control of the department. The fund shall consist of moneys appropriated or transferred to, or deposited in, the fund as provided by law.
   2.  The moneys in the fund shall be used and shall be appropriated only for the purposes of modernizing information technology systems and for other modernization initiatives related to delivery of public assistance programs. 
   3.  The moneys deposited in the fund are not subject to section 8.33 and shall not be transferred, used, obligated, appropriated, or otherwise encumbered except as provided in this section. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the state capitol maintenance fund shall be credited to the fund.
   4.  This section is repealed July 1, 2028.
    Sec. 60.  2023 Iowa Acts, Senate File 494, section 12, subsection 6, if enacted, is amended to read as follows:
   6.  The department of health and human services may contract with multiple third-party vendors to administer this Act.
    Sec. 61.  ONE-TIME SETTLEMENT FUNDS —— DEPOSIT IN PUBLIC ASSISTANCE MODERNIZATION FUND.  For the fiscal year beginning July 1, 2023, and ending June 30, 2024, the department of health and human services shall deposit up to $8,000,000 received from one-time medical assistance settlement funds in the public assistance modernization fund, if enacted in this division of this Act.
DIVISION XV
HOME AND COMMUNITY-BASED SERVICES WAIVER RECIPIENT RESIDENCES —— SPRINKLER SYSTEMS

    Sec. 62.  Section 335.34, Code 2023, is amended to read as follows:
   335.34  Home and community-based services waiver recipient residence.
   1.  A county, county board of supervisors, or county zoning commission shall consider the residence of the recipient of services under a home and community-based services waiver as a residential use of property for the purposes of zoning and shall treat the use of the residence as a permitted use in all residential zones or districts, including all single-family residential zones or districts, of the county.
   2.  A county, county board of supervisors, or a county zoning commission shall not require that the recipient, or the owner of such a residence if other than the recipient, obtain a conditional use permit, special use permit, special exception, or variance. A county, county board of supervisors, or county zoning commission shall not establish limitations regarding the proximity of one such residence to another.
   3.  A county, county board of supervisors, or a county zoning commission shall not classify such a residence as a residential group R-3 occupancy or as a care facility within a dwelling for the purposes of enforcement of compliance with the sprinkler systems provisions specified in section 903.3.1.3 of the international building code or section P2904 of the international residential code, if adopted, or if such residence is inspected by the county.
   3.  4.  This section applies to the residence of a recipient of services under a home and community-based services waiver if the residence meets any of the following conditions:
   a.  The residence is a single-family dwelling owned or rented by the recipient.
   b.  The residence is a multifamily dwelling which does not hold itself out to the public as a community-based residential provider otherwise regulated by law, including but not limited to a residential care facility, and which provides dwelling units to no more than four recipients of services under a home and community-based services waiver at any one time.
   4.  5.  For the purposes of this section, “home and community-based services waiver” means “waiver” as defined in section 249A.29.
    Sec. 63.  Section 414.32, Code 2023, is amended to read as follows:
   414.32  Home and community-based services waiver recipient residence.
   1.  A city, city council, or city zoning commission shall consider the residence of the recipient of services under a home and community-based services waiver as a residential use of property for the purposes of zoning and shall treat the use of the residence as a permitted use in all residential zones or districts, including all single-family residential zones or districts, of the city.
   2.  A city, city council, or city zoning commission shall not require that the recipient, or owner of such residence if other than the recipient, obtain a conditional use permit, special use permit, special exception, or variance. A city, city council, or city zoning commission shall not establish limitations regarding the proximity of one such residence to another.
   3.  A city, city council, or city zoning commission shall not classify such a residence as a residential group R-3 occupancy or as a care facility within a dwelling for the purposes of enforcement of compliance with the sprinkler systems provisions specified in section 903.3.1.3 of the international building code or section P2904 of the international residential code, if adopted, or if such residence is inspected by the city.
   3.  4.  This section applies to the residence of a recipient of services under a home and community-based services waiver if the residence meets any of the following conditions:
   a.  The residence is a single-family dwelling owned or rented by the recipient.
   b.  The residence is a multifamily dwelling which does not hold itself out to the public as a community-based residential provider otherwise regulated by law, including but not limited to a residential care facility, and which provides dwelling units to no more than four recipients of services under a home and community-based services waiver at any one time.
   4.  5.  For the purposes of this section, “home and community-based services waiver” means “waiver” as defined in section 249A.29.
    Sec. 64.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION XVI
STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM

    Sec. 65.  NEW SECTION.  135.182  State-funded family medicine obstetrics fellowship program —— fund.
   1.  The department shall establish a state-funded family medicine obstetrics fellowship program to increase access to family medicine obstetrics practitioners in rural and underserved areas of the state. A person who has completed an accreditation council for graduate medical education residency program in family medicine is eligible for participation in the fellowship program. Participating fellows shall enter into a program agreement with a participating teaching hospital which, at a minimum, requires the fellow to complete a one-year fellowship and to engage in full-time family medicine obstetrics practice in a rural or underserved area of the state for a period of at least five years within nine months following completion of the fellowship and receipt of a license to practice medicine in the state.
   2.  Each fellow participating in the program shall be eligible for a salary and benefits including a stipend as determined by the participating teaching hospital which shall be funded through the family medicine obstetrics fellowship program fund.
   3.  The department shall adopt rules pursuant to chapter 17A to administer the program, including defining rural and underserved areas for the purpose of the required full-time practice of a person following completion of the fellowship.
   4.  a.  A family medicine obstetrics fellowship program fund is created in the state treasury consisting of the moneys appropriated or credited to the fund by law. Notwithstanding section 8.33, moneys in the fund at the end of each fiscal year shall not revert to any other fund but shall remain in the fund for use in subsequent fiscal years. Moneys in the fund are appropriated to the department to be used to fund fellowship positions as provided in this section.
   b.  For the fiscal year beginning July 1, 2023, and each fiscal year beginning July 1 thereafter, there is appropriated from the general fund of the state for deposit in the family medicine obstetrics fellowship program fund an amount sufficient to support the creation of four fellowship positions as provided in this section.
   5.  The department and the participating teaching hospitals shall regularly evaluate and document their experiences including identifying ways the program may be modified or expanded to facilitate increased access to family medicine obstetrics practitioners in rural and underserved areas of the state. The department shall submit an annual report to the general assembly by January 1. The report shall include the number of fellowships funded to date and any other information identified by the department and the participating teaching hospitals as indicators of outcomes and the effectiveness of the program.
   6.  For the purposes of this section, “teaching hospital” means a hospital or medical center that provides medical education to prospective and current health professionals.
DIVISION XVII
ADOPTION SUBSIDY PROGRAM —— NONRECURRING ADOPTION EXPENSES

    Sec. 66.  NEW SECTION.  234.48  Adoption subsidy —— nonrecurring adoption expenses.
   Notwithstanding any provision to the contrary, the maximum reimbursement provided to an adoptive parent under the adoption subsidy program for nonrecurring adoption expenses is one thousand dollars. For the purposes of this section, “nonrecurring adoption expenses” means the same as defined in 45 C.F.R. §1356.41. The department shall adopt rules pursuant to chapter 17A to administer this section.
    Sec. 67.  REPEAL.  2010 Iowa Acts, chapter 1031, section 408, is repealed.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to appropriations for veterans and health and human services for FY 2023-2024 to the department of veterans affairs, the Iowa veterans home, the department of health and human services —— aging, the office of the long-term care ombudsman, the department of health and human services —— public health, the department of health and human services —— human services, and the department of health and human services —— human rights.
   DEPARTMENT OF VETERANS AFFAIRS AND IOWA VETERANS HOME. This division makes appropriations from the general fund of the state to the department of veterans affairs for administration, for the Iowa veterans home, for transfer to the Iowa finance authority for the home ownership assistance program, and for the county commissions of veterans affairs.
   DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING. This division makes appropriations from the general fund of the state to the department of health and human services for programs and services related to aging.
   LONG-TERM CARE OMBUDSMAN. This division makes appropriations from the general fund of the state to the office of long-term care ombudsman.
   DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC HEALTH. This division makes appropriations from the general fund of the state and from the sports wagering receipts fund to the department of health and human services for programs and services related to public health.
   DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HUMAN SERVICES. This division makes appropriations from the general fund of the state and the federal temporary assistance for needy families block grant to the department of health and human services for programs and services relating to human services. The reimbursement section addresses reimbursement for providers reimbursed by the department of health and human services.
   DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HUMAN RIGHTS. This division makes appropriations from the general fund of the state to the department of health and human services for programs and services related to human rights and from the juvenile detention home fund to the department of health and human services for juvenile detention homes.
   HEALTH CARE ACCOUNTS AND FUNDS. This division makes certain health-related appropriations. A number of the appropriations are made for purposes of the Medicaid program in addition to the general fund appropriations made for this purpose for the same fiscal year.
   DECATEGORIZATION AND CARRYOVER FUNDING. This division provides for the transfer of carryover decategorization funds that remained unencumbered or unobligated at the close of FY 2020-2021, to the Medicaid program for FY 2024-2025.
   PRIOR APPROPRIATIONS AND OTHER PROVISIONS. This division provides for nonreversion of funds appropriated for the family investment program general fund, state child care assistance, child and family services, field operations, the more options for maternal support program, and general administration for FY 2022-2023 to the close of the succeeding fiscal year. The division also increases the appropriation for FY 2022-2023 from the quality assurance trust fund to the department of health and human services to supplement the medical assistance program appropriation. The division takes effect upon enactment.
   REPORT OF NONREVERSION OF FUNDS. This division requires the department of health and human services to report the expenditure of any moneys for which nonreversion authorization was provided for FY 2022-2023 to the general assembly on a quarterly basis beginning October 1, 2023.
   ELIMINATION OF REPEAL OF HOSPITAL HEALTH CARE ACCESS ASSESSMENT PROGRAM. This division eliminates the repeal of Code chapter 249M, the hospital health care access assessment program. The division takes effect upon enactment.
   REALIGNMENT PROVISIONS. This division amends provisions of 2023 Iowa Acts, Senate File 514, relating to the director of health and human services buying and selling real estate and relating to the department of health and human services rather than the department of education distributing school ready children grants account moneys.
   HEALTH POLICY OVERSIGHT. This division amends provisions relating to the legislative health policy oversight committee to provide that instead of being required to meet at least two times annually during the legislative interim, the committee may meet annually.
   HOME AND COMMUNITY-BASED SERVICES WAIVER RECIPIENT RESIDENCES —— SPRINKLER SYSTEMS. This division provides that a county, county board of supervisors, or a county zoning commission for a county, or a city, city council, or city zoning commission for a city shall not classify a home and community-based services waiver recipient residence as a residential group R-3 occupancy or as a care facility within a dwelling for the purposes of enforcement of compliance with certain international building code and international residential building code provisions relating to sprinkler systems.
   STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM AND FUND. This division requires the department of health and human services to establish a state-funded family medicine obstetrics fellowship program to increase access to family medicine obstetrics practitioners in rural and underserved areas of the state. A person who has completed an accreditation council for graduate medical education residency program in family medicine is eligible for participation in the fellowship program. Participating fellows shall enter into a program agreement with a participating teaching hospital which, at a minimum, requires the fellow to complete a one-year fellowship and to engage in full-time family medicine obstetrics practice in a rural or underserved area of the state for a period of at least five years within nine months following completion of the fellowship and receipt of a license to practice medicine in the state. Each fellow participating in the program shall be eligible for salary and benefits including a stipend as determined by the participating teaching hospital and funded through the family medicine obstetrics fellowship program fund.
   The division requires the department of health and human services to adopt administrative rules to administer the program, including defining rural and underserved areas for the purpose of the required full-time practice of a person following completion of the fellowship.
   The division creates a family medicine obstetrics fellowship program fund in the state treasury consisting of the moneys appropriated or credited to the fund by law. Moneys in the fund at the end of each fiscal year shall not revert to any other fund but shall remain in the fund for use in subsequent fiscal years. Moneys in the fund are appropriated to HHS to be used to fund fellowship positions as provided in the division. The division appropriates a sufficient amount from the general fund of the state to the fund annually to support the creation of four fellowship positions.
   The division requires the department and the participating teaching hospitals to regularly evaluate and document their experiences including identifying ways the program may be modified or expanded to facilitate increased access to family medicine obstetrics practitioners in rural and underserved areas of the state. The department shall submit an annual report to the general assembly by January 1. The report shall include the number of fellowships funded to date and any other information identified by HHS and the participating teaching hospitals as indicators of outcomes and the effectiveness of the program.
   ADOPTION SUBSIDY PROGRAM —— NONRECURRING ADOPTION EXPENSES.  This division provides that the maximum reimbursement provided to an adoptive parent under the adoption subsidy program for nonrecurring adoption expenses is $1,000. The division defines “nonrecurring adoption expenses” as the reasonable and necessary adoption fees, court costs, attorney fees, and other expenses which are directly related to the legal adoption of a child with special needs which are not incurred in violation of state, tribal, or federal law, and which have not been reimbursed from other sources or other funds. Under federal regulation, “other expenses which are directly related to the legal adoption of a child with special needs” means the costs of the adoption incurred by or on behalf of the parents and for which parents carry the ultimate liability for payment. Such costs may include the adoption study, including health and psychological examination, supervision of the placement prior to adoption, transportation, and the reasonable costs of lodging and food for the child or the adoptive parents when necessary to complete the placement or adoption process. The department of health and human services shall adopt administrative rules to administer the division. The division also repeals a provision in 2010 Iowa Acts which limited the nonrecurring adoption expenses to $500 and prohibited additional amounts for court costs and other related legal expenses.