HF 726 (LSB 1319YH (10) 90)

HOUSE FILE 726

BY  ISENHART and WILSON

A BILL FOR

An Act relating to services, treatment, research, education, and other activities relating to substance use disorder, mental health, and other conditions including opioid addiction and providing appropriations.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  IOWA BOARD OF PHARMACY —— REDUCTION OF OPIOID MISUSE OR OVERUSE —— OPIOID SETTLEMENT.
   1.  There is appropriated from the opioid settlement fund created in section 12.51 to the board of pharmacy 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:
   a.  For the board of pharmacy to integrate the state’s prescription monitoring program with health care providers’ electronic medical record or pharmacy dispensing systems to allow a seamless connection between the prescription monitoring program and those systems:
   ...................................................................... $     60,000

   b.  For the board of pharmacy to implement the opioid and naloxone education (ONE) program to provide resources to pharmacists to educate patients regarding opioid misuse and accidental overdose in order to decrease opioid prescription rates and the related addiction and overdose deaths in the state:
   ...................................................................... $    450,000

   2.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the board of pharmacy for the fiscal year beginning July 1, 2023, and ending June 30, 2024, an amount sufficient to provide the total amounts specified under subsection 1 for the purposes designated under 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 the purposes designated until expended.
    Sec. 2.  INCREASED ACCESS TO NALOXONE —— OPIOID SETTLEMENT.
   1.  There is appropriated from the opioid settlement fund created in section 12.51 for deposit in the opioid antagonist medication fund created in section 135.190A for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, for the purpose designated:
   ...................................................................... $    250,000

   2.  The department of health and human services shall utilize the moneys appropriated for deposit under this section for the purchase, provision, maintenance, and replacement of opioid antagonist medication administered by first responders to persons experiencing an opioid-related overdose and to county health departments for distribution to accredited schools and institutions of higher education upon request.
   3.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G for deposit in the opioid antagonist medication fund created in section 135.190A for the fiscal year beginning July 1, 2023, and ending June 30, 2024, for direct appropriation to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, an amount sufficient to provide the total amount specified under subsection 1 for the purposes designated under this section.
   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 the purposes designated until expended.
    Sec. 3.  SUBSTANCE USE DISORDER RECOVERY HIGH SCHOOLS —— OPIOID SETTLEMENT.
   1.  There is appropriated from the opioid settlement fund created in section 12.51 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, for the purpose designated:
   ...................................................................... $     50,000

   2.  The department of health and human services, in collaboration with the department of education, shall study and make recommendations regarding the establishment of one or more public or private recovery high schools in Iowa designed for the education of students in recovery from substance use disorders or dependency or co-occurring disorders such as anxiety, depression, or attention deficit hyperactivity disorder. Such schools shall meet state requirements for awarding a secondary school diploma and support students engaged in a program of recovery. The department of health and human services shall complete the study and submit its recommendations to the governor and the general assembly by November 1, 2023. The recommendations shall include provisions for students to be eligible for education savings accounts without regard to family financial capacity.
   3.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G for the fiscal year beginning July 1, 2023, and ending June 30, 2024, to the department of health and human services an amount sufficient to provide the total amount specified under subsection 1 for the purposes designated under this section.
   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 the purposes designated until expended.
    Sec. 4.  SUBSTANCE USE DISORDER —— PERSONS COMMITTED TO CORRECTIONAL INSTITUTIONS AND COUNTY JAILS —— OPIOID SETTLEMENT.
   1.  a.  There is appropriated from the opioid settlement fund created in section 12.51 to the department of health and human services, annually, an amount sufficient to implement this section.
   b.  The department of health and human services shall transfer the amount appropriated under this section to the department of corrections for use in subsidizing the costs of providing medication-assisted treatment to persons committed to department of corrections institutions or county jails being treated for opioid use disorder to purchase state-of-the-art urine sample cups for use in the drug monitoring programs and to fund efforts to fight hepatitis C, a potentially devastating but curable disease spread through intravenous needle use of opioids and other drugs in prison populations. If a county is receiving opioid settlement funds to otherwise cover the costs of medication-assisted treatment, the county shall match the funding provided under this section on a dollar-for-dollar basis.
   2.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the department of health and human services for transfer to the department of corrections for the fiscal year beginning July 1, 2023, and ending June 30, 2024, an amount sufficient for the purposes designated under 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 the purposes designated until expended.
    Sec. 5.  VETERANS COURTS —— OPIOID SETTLEMENT.
   1.  There is appropriated from the opioid settlement fund created in section 12.51 to the department of veterans affairs for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, for the purpose designated:
   ...................................................................... $  1,000,000

   2.  a.  The moneys appropriated under this section shall be transferred to the judicial branch to establish a veterans court with a full-time outreach coordinator in each judicial district to provide court services to veterans and to integrate court sanctions and incentives with substance use disorder treatment, mental health treatment, and transitional services for veterans in a judicially supervised setting.
   b.  It is the intent of the general assembly that the jurisdiction of the veterans court may be exercised by any district judge and by any district associate judge who is designated by the chief judge of a judicial district as a judge of the veterans court. The chief judge shall designate one or more district judges and district associate judges to act as judges of the veterans court for a judicial district. The chief judge may designate a veterans court judge to preside in more than one county.
   3.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G for the fiscal year beginning July 1, 2023, and ending June 30, 2024, to the department of veterans affairs for transfer to the judicial branch an amount sufficient to provide the total amount specified under subsection 1 for the purposes designated under this section.
   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 the purposes designated until expended.
    Sec. 6.  STATE EMPLOYEE BENEFITS —— SUBSTANCE USE DISORDER BENEFITS —— USE OF OPIOIDS —— OPIOID SETTLEMENT.
   1.  a.  There is appropriated from the opioid settlement fund created in section 12.51 to the department of administrative services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, for the purposes designated:
   ...................................................................... $    100,000
  b.  The department of administrative services, in cooperation with any health insurance plans or health plan administrators of benefits extended to state employees, shall utilize the funds appropriated in this subsection to create a model benefit plan designed to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to members receiving benefits through state plans, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatments and therapies, including nonpharmacological treatments.
   3.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the department of administrative services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, an amount sufficient to provide the total amount specified under subsection 1 for the purposes designated under this section.
   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 the purposes designated until expended.
    Sec. 7.  MEDICAID RECIPIENTS —— SUBSTANCE USE DISORDER BENEFITS —— USE OF OPIOIDS —— OPIOID SETTLEMENT.
   1.  a.  There is appropriated from the opioid settlement fund created in section 12.51 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, for the purposes designated:
   ...................................................................... $    100,000

   b.  The department of health and human services, in cooperation with Medicaid managed care organizations, shall utilize the funds appropriated under this section to design benefit plans to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to Medicaid recipients, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatment and therapies, including nonpharmacological treatments. The department shall seek any Medicaid state plan amendment or waiver necessary to administer this subsection.
   2.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, an amount sufficient to provide the total amount specified under subsection 1 for the purposes designated under 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 the purposes designated until expended.
    Sec. 8.  SUBSTANCE USE DISORDER AND OPIOID USE RESEARCH AND EDUCATION —— OPIOID SETTLEMENT.
   1.  There is appropriated from the opioid settlement fund created in section 12.51 to the following entities 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:
   a.  To the department of health and human services:
   (1)  To contract with the Iowa health care collaborative to do all of the following:
   (a)  To develop and pilot protocols for the treatment of emergency room patients experiencing opioid or heroin overdoses, including the provision of peer counseling and advocacy:
   ...................................................................... $    100,000

   (b)  To reduce opioid exposure by educating doctors and hospitals, especially in rural areas, to adopt the enhanced recovery after surgery (ERAS) principles:
   ...................................................................... $    100,000

   (2)  For the psychiatric residency programs involved with coordinated, collaborative care at newly established, community-based behavioral health treatment facilities offering residential substance use disorder treatment for twenty-nine days or more:
   ...................................................................... $  1,000,000

   (3)  To pilot the establishment and operation of three community-based syringe service programs developed to provide substance use prevention and response including linkages to substance use disorder treatment; vaccination, testing, and access to care for infectious diseases; and access to, education regarding the safe utilization of, and proper disposal of, fentanyl test strips, sterile syringes, and injection equipment:
   ...................................................................... $    450,000

   The pilot program supported with the funding appropriated under this subparagraph is conditioned on the implementation of written agreements with local law enforcement agencies and county attorneys to refrain from charging or prosecuting program sponsors or participants for violations of section 124.414.
   b.  To the state board of regents:
   (1)  To fund research on medication-assisted treatment for substance use disorders conducted at the university of Iowa college of public health to identify variability in outcomes, demonstrate efficacy of treatment, and refine evidence-based protocols: 
   ...................................................................... $    500,000

   (2)  To fund research and education conducted at the university of Iowa Carver college of medicine for the nonnarcotic treatment of pain:
   ...................................................................... $  1,000,000

   c.  To the department of public safety to establish and direct a task force, in collaboration with the department of health and human services, to make recommendations, based on public health principles, to restructure the response of the state’s health and justice systems to illicit drug use and to individuals suffering from substance use disorders:
   ...................................................................... $    500,000

   The department of public safety shall submit a report of the recommendations specified in this paragraph “c” to the governor and the general assembly by July 1, 2024.
   2.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the entities specified in subsection 1, for the fiscal year beginning July 1, 2023, and ending June 30, 2024, a sufficient amount to provide the total amounts specified to the entities specified under subsection 1 for the purposes designated under 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 the purposes designated until the close of the succeeding fiscal year.
    Sec. 9.  PUBLIC HEALTH STRUCTURE AND INFRASTRUCTURE AND SUBSTANCE USE DISORDER PREVENTION AND TREATMENT —— OPIOID SETTLEMENT.
   1.  There is appropriated from the opioid settlement fund created in section 12.51 to the university of Iowa college of public health 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:
   a.  To conduct a comprehensive review and evaluation of the existing public health structure and infrastructure in Iowa, and to make recommendations for policy and funding to improve capacity of the state and local communities to address substance use and related issues:
   ...................................................................... $    250,000

   b.  To coordinate increased, systematic efforts with local public health authorities to address the personal behaviors, societal conditions, and lack of access to services that are identified as risk factors for substance use disorders and related co-occurring health conditions:
   ...................................................................... $  1,000,000

   The amount appropriated may be used to provide grants to county boards of health to implement evidence-based community programming, policies, and collaborative projects with health care providers to address the identified risk factors.
   c.  To provide paid internships for college of public health students paired with local health departments to support the development of local public health infrastructure, conduct community health needs assessments, and assist in the successful implementation of health improvement plans to address substance use disorders and co-occurring brain health and related conditions:
   ...................................................................... $    500,000

   2.  If sufficient funds are not available through the opioid settlement fund created in section 12.51 to satisfy the appropriations under subsection 1, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the university of Iowa college of public health for the fiscal year beginning July 1, 2023, and ending June 30, 2024, a sufficient amount to provide the total amounts specified under subsection 1 for the purposes designated under 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 the purposes designated until the close of the succeeding fiscal year.
    Sec. 10.  SUBSTANCE USE DISORDER —— RECOVERY HOUSING —— SUPPORTIVE SERVICES —— OPIOID SETTLEMENT.
   1.  a.  There is appropriated from the opioid settlement fund created in section 12.51 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, for the purpose designated:
   ...................................................................... $  2,000,000

   b.  Moneys appropriated under this section shall be used by the department, in collaboration with the Iowa finance authority and community-based organizations, to engage in work to increase the availability of recovery housing throughout the state. The moneys shall be distributed as grants to recovery housing providers whose application for assistance is in accordance with a county community health needs assessment and health improvement plan. If a county is otherwise receiving opioid settlement funds, the county shall match the grant funding provided under this section on a dollar-for-dollar basis.
   2.  If sufficient funds are not available through the opioid settlement fund created in section 12.51 to satisfy the appropriations under subsection 1, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, a sufficient amount to provide the total amount specified under subsection 1 for the purposes designated under 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 the purposes designated until the close of the succeeding fiscal year.
    Sec. 11.  COMPREHENSIVE STUDY AND REPORT OF SUBSTANCE USE DISORDER TREATMENT COVERAGE, UTILIZATION, AND EXPENDITURES —— OPIOID SETTLEMENT.
   1.  a.  There is appropriated from the opioid settlement fund created in section 12.51 to the department of insurance and financial services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, for the purposes designated:
   ...................................................................... $    100,000

   b.  The department of insurance and financial services shall utilize the funds appropriated under this subsection to perform a comprehensive study and prepare a comprehensive report on insurance coverage and payment policies for services related to the treatment of substance use disorders by commercial insurance companies and self-funded plans, as well as data on current utilization and expenditures associated with such benefit plans. The report shall be submitted to the general assembly by January 1, 2024.
   2.  If sufficient funds are not available through the opioid settlement fund created in section 12.51, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G to the department of insurance and financial services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, an amount sufficient to provide the total amount specified under subsection 1 for the purposes designated under 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 the purposes designated until the close of the succeeding fiscal year.
    Sec. 12.  TASK FORCE ON AN INTEGRATED SYSTEM FOR PREVENTION, TREATMENT, RECOVERY, AND RESOURCES —— APPROPRIATIONS.
   1.  a.  The director of health and human services shall convene a task force to research and develop policy recommendations to implement an integrated behavioral health and substance use disorder system and services structure that blends funding in the areas of prevention, treatment, recovery, and resources.
   b.  The task force shall include the director of health and human services, appropriate departmental personnel, two representatives of each mental health and disability services region appointed by the region, and three experts each representing the fields of prevention, treatment, and recovery selected by the department based on recommendations from the mental health and disability services region chief executive officers.
   c.  The task force shall submit a report to the governor and the general assembly by June 30, 2024, including recommendations that address all of the following:
   (1)  Prevention policy, including measures to ensure consistent and sustained funding for prevention activities, enhanced early intervention techniques, and a plan for well-rounded prevention programs that address alcohol, methamphetamine, opioid use, and co-occurring disorders.
   (2)  Treatment policy, built on the premise that co-occurring issues are the norm rather than the exception, and includes methods to deliver services through integrated care models that regulate team-based care or close coordination between providers, use of dual treatment planning methods, standards for counselors to attain and practice with dual certification, licensure solutions for dual programs and practitioners, and effective treatment modalities for short-term and long-term outcomes.
   (3)  Recovery policy, including practices to integrate co-occurring approaches in mobile crisis response and other crisis services, implementation of harm reduction practices, integration of feasible medication strategies to support mental health issues in alignment with substance use disorder recovery, and incentive programs to support recovery efforts.
   (4)  Resource deployment policy including all of the following:
   (a)  The combining and leveraging of state, regional, and local partnerships to optimize opioid settlement funds available to the state and counties.
   (b)  Allocation of federal substance abuse and mental health services administration block grants for substance abuse prevention and treatment and community mental health services.
   (c)  Other related federal government and private funding opportunities.
   (5)  Provisions for peer support workers consistent with the guidance of the federal substance abuse and mental health services administration’s bringing recovery supports to scale technical assistance center strategy.
   (6)  Opportunities through the alignment of the department of health and human services to integrate the fragmented behavioral health and substance use disorder services systems into a system of comprehensive, whole-person care, that utilizes public funding more efficiently and increases the return on investment through enhanced community health for all Iowans.
   2.  There is appropriated from the opioid settlement fund created in section 12.51 to the department of health and human services, for task force support for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, for the purposes designated:
   ...................................................................... $    150,000

   The task force shall approve any contract for external assistance to the task force.
   3.  a.  There is appropriated from the opioid settlement fund created in section 12.51 to the department of health and human services, for the fiscal year beginning July 1, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary for the purposes designated:
   ...................................................................... $ 10,000,000

   b.  For dollar-for-dollar matching grants to mental health and disability services regions to be used for long-term residential treatment and recovery services for persons diagnosed with one or more disorders including a substance use disorder in accordance with the recommendations of the task force convened under this section.
   c.  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 the purposes designated until expended.
    Sec. 13.  IOWA FINANCE AUTHORITY —— TRANSITIONAL HOUSING FOR ELIGIBLE SERVICE MEMBERS.  There is appropriated from the opioid settlement fund established in section 12.51 to the Iowa finance authority 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:
   To provide grants, low-interest loans, and loan guarantees to veteran-led nonprofit organizations:
   ...................................................................... $  4,300,000

   1.  Amounts appropriated pursuant to this section shall be distributed to veteran-led nonprofit organizations provided that the organization meets all of the following conditions:
   a.  The funds will be used to purchase land, construct housing, or furnish housing for the purpose of providing transitional housing to homeless veterans.
   b.  The veterans receiving transitional housing benefits pursuant to paragraph “a” are suffering from or are at risk of opioid or other substance abuse disorder, post-traumatic stress disorder, or another mental illness or life disruption as the Iowa finance authority, in consultation with the department of health and human services and the department of veterans affairs, deems appropriate.
   c.  The funds are used as a part of a wraparound health and social services program provided by or through the organization.
   2.  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.
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 services, treatment, research, education, and other activities relating to substance use disorders, mental health, and other conditions, including those relating to opioids, and provides appropriations. 
   BOARD OF PHARMACY. The bill appropriates funds from the opioid settlement fund created in Code section 12.51 to the board of pharmacy for fiscal year 2023-2024 for the board of pharmacy to integrate the state’s prescription monitoring program with health care providers’ electronic medical record or pharmacy dispensing systems to allow a seamless connection between the prescription monitoring program and those systems; and for the board of pharmacy to implement the opioid and naloxone education (ONE) program to provide resources to pharmacists to educate patients regarding opioid misuse and accidental overdose in order to decrease opioid prescription rates and the related addiction and overdose deaths in the state. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriations, there is appropriated from the Iowa coronavirus fiscal recovery fund created in Code section 8.57G to the board of pharmacy for fiscal year 2023-2024, an amount sufficient to provide the total amounts specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   ACCESS TO NALOXONE. The bill appropriates funds from the opioid settlement fund for deposit in the opioid antagonist medication fund created in Code section 135.190A for fiscal year 2023-2024 to be used by the department of health and human services (HHS) for the purchase, provision, maintenance, and replacement of opioid antagonist medication administered by first responders to persons experiencing an opioid-related overdose and to county health departments for distribution to accredited schools and institutions of higher education upon request. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund for fiscal year 2023-2024 for deposit in the opioid antagonist medication fund an amount sufficient to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   RECOVERY HIGH SCHOOLS. The bill appropriates funds from the opioid settlement fund to HHS for fiscal year 2023-2024 to be used by HHS in collaboration with the department of education to study and make recommendations regarding the establishment of one or more public or private recovery high schools in Iowa designed for the education of students in recovery from substance use disorders or dependency or co-occurring disorders such as anxiety, depression, or attention deficit hyperactivity disorder. The schools must meet state requirements for awarding a secondary school diploma and support students engaged in a program of recovery. The department of health and human services shall complete the study and submit its recommendations to the governor and the general assembly by November 1, 2023. The recommendations shall include provisions for students to be eligible for education savings accounts without regard to family financial capacity. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund for fiscal year 2023-2024 to HHS an amount sufficient to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   CORRECTIONAL INSTITUTIONS AND COUNTY JAILS. The bill appropriates funds from the opioid settlement fund to HHS for fiscal year 2023-2024 for HHS to transfer to the department of corrections for use in subsidizing the costs of providing medication-assisted treatment to persons confined to correctional institutions or county jails being treated for opioid use disorder, to purchase state-of-the-art urine sample cups for use in the drug monitoring programs, and to fund efforts to fight hepatitis C, a potentially devastating but curable disease spread through intravenous needle use of opioids and other drugs in prison populations. For counties, the funding is subject to a dollar-to-dollar match of county opioid settlement funds. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund to HHS for transfer to the department of corrections for fiscal year 2023-2024 an amount sufficient to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   VETERANS COURTS. The bill appropriates funds from the opioid settlement fund to the department of veterans affairs for fiscal year 2023-2024 to be transferred to the judicial branch to establish a veterans court with a full-time outreach coordinator in each judicial district to provide court services to veterans and to integrate court sanctions and incentives with substance use disorder treatment, mental health treatment, and transitional services for veterans in a judicially supervised setting. The jurisdiction of the veterans court may be exercised by any district judge and by any district associate judge who is designated by the chief judge of a judicial district as a judge of the veterans court. The chief judge shall designate one or more district judges and district associate judges to act as judges of the veterans courts for a judicial district. The chief judge may designate a veterans court judge to preside in more than one county. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund for fiscal year 2023-2024 to the department of veterans affairs for transfer to the judicial branch an amount sufficient to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   STATE EMPLOYEE BENEFITS. The bill appropriates funds from the opioid settlement fund to the department of administrative services (DAS) for fiscal year 2023-2024 to be used by DAS in cooperation with any health insurance plans or health plan administrators of benefits extended to state employees to create a model benefit plan designed to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to members receiving benefits through state plans, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatments and therapies, including nonpharmacological treatments. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund to DAS for fiscal year 2023-2024 an amount sufficient to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   MEDICAID RECIPIENTS. The bill appropriates funds from the opioid settlement fund to HHS for fiscal year 2023-2024 to be used by HHS, in cooperation with Medicaid managed care organizations, to design benefit plans to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to Medicaid recipients, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatment and therapies, including nonpharmacological treatments. The department of health and human services shall seek any Medicaid state plan amendment or waiver necessary to administer this provision of the bill. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund to HHS for fiscal year 2023-2024 an amount sufficient to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   RESEARCH AND EDUCATION. The bill appropriates funds from the opioid settlement fund to HHS, the state board of regents, and the department of public safety. The appropriation to HHS is to contract with the Iowa health care collaborative to develop and pilot protocols for the treatment of emergency room patients experiencing opioid or heroin overdoses, including the provisions of peer counseling and advocacy and to reduce opioid exposure by educating doctors and hospitals, especially in rural areas, to adopt the enhanced recovery after surgery (ERAS) principles; for the psychiatric residency programs involved with coordinated, collaborative care at newly established, community-based behavioral health treatment facilities offering residential substance use disorder treatment for 29 days or more; and to pilot the establishment and operation of three community-based syringe service programs, conditioned on the implementation of written agreements with local law enforcement agencies and county attorneys to refrain from charging or prosecuting program sponsors or participants for violations of Code section 124.414 (drug paraphernalia). The appropriation to the state board of regents is to be used to fund research on medication-assisted treatment for substance use disorders conducted at the university of Iowa college of public health to identify variability in outcomes, demonstrate efficacy of treatment, and refine evidence-based protocols; and to fund research and education conducted at the university of Iowa Carver college of medicine for the nonnarcotic treatment of pain. The appropriation to the department of public safety is to be used to establish and direct a task force, in collaboration with HHS, to make recommendations, based on public health principles, to restructure the response of the state’s health and justice systems to illicit drug use and to individuals suffering from substance use disorders, with a report submitted to the governor and the general assembly by July 1, 2024. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriations, there is appropriated from the Iowa coronavirus fiscal recovery fund created in section 8.57G, to the entities specified for fiscal year 2023-2024, sufficient amounts to provide the total amounts specified to the entities specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
    PUBLIC HEALTH STRUCTURE AND INFRASTRUCTURE. The bill appropriates funds from the opioid settlement fund to the university of Iowa college of public health for fiscal year 2023-2024 to conduct a comprehensive review and evaluation of the existing public health structure and infrastructure in Iowa, and to make recommendations for policy and funding to improve capacity of the state and local communities to address substance use and related issues; to coordinate increased, systematic efforts with local public health authorities to address the personal behaviors, societal conditions, and lack of access to services that are identified as risk factors for substance use disorders and related co-occurring health conditions; and to provide paid internships for college of public health students paired with local health departments to support the development of local public health infrastructure, conduct community health needs assessments, and assist in the successful implementation of health improvement plans to address substance use disorders and co-occurring brain health and related conditions. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriations, there is appropriated from the Iowa coronavirus fiscal recovery fund to the university of Iowa college of public health for fiscal year 2023-2024 a sufficient amount to provide the total amounts specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   RECOVERY HOUSING. The bill appropriates funds from the opioid settlement fund to HHS for fiscal year 2023-2024, to be used by HHS, in collaboration with the Iowa finance authority and community-based organizations, to engage in work to increase the availability of recovery housing throughout the state. The moneys shall be distributed as grants to recovery housing providers whose application for assistance is in accordance with a county community health needs assessment and health improvement plan. A county otherwise receiving opioid settlement funds shall match the grant funding provided on a dollar-for-dollar basis. If sufficient funds are not available through the opioid settlement to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund to HHS for fiscal year 2023-2024, a sufficient amount to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   INSURANCE COVERAGE STUDY —— REPORT. The bill appropriates funds from the opioid settlement fund to the department of insurance and financial services, for fiscal year 2023-2024, for the department of insurance and financial services to perform a comprehensive study and prepare a comprehensive report on insurance coverage and payment policies for services related to the treatment of substance use disorders by commercial insurance companies and self-funded plans, as well as data on current utilization and expenditures associated with such benefit plans. The report shall be submitted to the general assembly by January 1, 2024. If sufficient funds are not available through the opioid settlement fund to satisfy the appropriation, there is appropriated from the Iowa coronavirus fiscal recovery fund to the division of insurance of the department of commerce for fiscal year 2023-2024 an amount sufficient to provide the total amount specified for the purposes designated. Funds appropriated shall not revert but shall remain available until the close of the succeeding fiscal year.
   INTEGRATED SYSTEM FOR PREVENTION, TREATMENT, RECOVERY, AND RESOURCES. The bill requires the director of health and human services to convene a task force to develop recommendations regarding an integrated system for prevention, treatment, recovery, and resources. The bill specifies the membership of the task force, and requires the task force to submit a report to the governor and the general assembly by June 30, 2024, specifying recommendations for an integrated system that blends funding and provides an efficient system of comprehensive, whole-person care. The bill appropriates funding from the opioid settlement fund to support the task force and provides that the task force shall approve any contract for external assistance to the task force. The bill appropriates funds from the opioid settlement fund to the department of health and human services for FY 2024-2025 to provide for dollar-for-dollar matching grants to mental health and disability services regions to be used for long-term residential treatment and recovery services in accordance with the recommendations of the task force. Moneys appropriated shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.
   TRANSITIONAL HOUSING FOR HOMELESS VETERANS. The bill relates to transitional housing for specified homeless veterans.
   The bill appropriates $4.3 million from the opioid settlement fund to the Iowa finance authority (IFA) for FY 2023-2024 to provide grants, low-interest loans, and loan guarantees to veteran-led nonprofit organizations (VNO).
   The bill makes the distribution of such moneys appropriated to the IFA contingent on a VNO using the funds to purchase land, construct housing, or furnish housing for the purpose of providing transitional housing to homeless veterans; ensuring the veterans receiving such transitional housing benefits are suffering from or are at risk of opioid or other substance abuse disorder, post-traumatic stress disorder, or another mental illness or life disruption as the IFA, in consultation with the department of health and human services and the department of veterans affairs, deems appropriate; and that the funds are used as a part of a wraparound health and social services program provided by or through the VNO.
   All moneys appropriated pursuant to this section of the bill 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.