SSB 3205 (LSB 5004XC (10) 90)

SENATE FILE _____ 

BY  (PROPOSED COMMITTEE ON APPROPRIATIONS BILL BY CHAIRPERSON KRAAYENBRINK)

A BILL FOR

An Act relating to and making appropriations for veterans and health and human services, including other related provisions and appropriations, and including effective date and retroactive applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
DEPARTMENT OF VETERANS AFFAIRS —— FY 2024-2025

    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, 2024, and ending June 30, 2025, 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:
   ...................................................................... $  1,369,205

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

   2.  IOWA VETERANS HOME
   For salaries, support, maintenance, and miscellaneous purposes:
   ...................................................................... $  8,145,736

   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, 2024, and ending June 30, 2025, 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
AGING AND DISABILITY SERVICES —— FY 2024-2025

    Sec. 3.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING AND DISABILITY 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, 2024, and ending June 30, 2025, 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 centers; for the return to community program; for the purposes of chapter 231E, 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; for the reporting and evaluation of cases of dependant adult abuse pursuant to chapter 235B; and for 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, and for salaries, support, administration, maintenance, and miscellaneous purposes:
   ...................................................................... $ 19,088,714

   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 services not specifically enumerated in this section only if approved by the department as part of an area agency on aging’s area plan.
   2.  Of the funds appropriated in this section, $949,282 shall be used for the family support center component of the comprehensive family support program under chapter 225C, subchapter V.
   3.  Of the funds appropriated in this section, $33,632 shall be used to build 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).
DIVISION III
BEHAVIORAL HEALTH —— FY 2024-2025

    Sec. 4.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— BEHAVIORAL 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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For behavioral health prevention, treatment, and recovery efforts to reduce the prevalence of the use of, provide treatment for, and support recovery from tobacco and substance use and misuse pursuant to the applicable policy, purpose, and intent described in sections 125.1 and 142A.1, alcohol, problem gambling, and other addictive behaviors. Activities shall align with accepted best practice guidance standards for behavioral health including those published by the centers for disease control and prevention and the substance abuse and mental health services administration of the United States department of health and human services for health promotion; universal, selective, and indicated prevention; treatment; and recovery services and supports; and shall include a 24-hour helpline, public information resources, professional training, youth prevention, program evaluation, and efforts at the state and local levels:
   ...................................................................... $ 24,400,114

   1.  Of the funds appropriated in this section, $300,000 shall be used to support the work of the children’s behavioral health system including evidence-based behavioral health prevention, treatment, and recovery services and supports for children and their families pursuant to the intent specified in section 225C.6B, subsection 1.
   2.  Of the funds appropriated in this section, $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 needed to maintain the level of services. 
    Sec. 5.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for behavioral health prevention, treatment, and recovery efforts to reduce the prevalence of the use of, provide treatment for, and support recovery from tobacco and substance use and misuse pursuant to the applicable policy, purpose, and intent described in sections 125.1 and 142A.1, alcohol, problem gambling, and other addictive behaviors:
   ...................................................................... $  1,750,000
DIVISION IV
PUBLIC HEALTH —— FY 2024-2025

    Sec. 6.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated: 
   For programs that support health promotion, protect the health and safety of the public, conduct disease surveillance and investigation to reduce the incidence of morbidity and mortality, serve individuals with chronic conditions including but not limited to cancer, support the Iowa donor registry as specified in section 142C.18, and strengthen the health care delivery system and workforce to improve health outcomes for all Iowans:
   ...................................................................... $ 22,916,821

   1.  Of the funds appropriated in this section, $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 subsection, a sufficient amount shall be used to support 1.00 full-time equivalent position to serve as the state brain injury services program manager.
   2.  Of the funds appropriated in this section, $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 subsection in excess of $50,000 shall be matched dollar-for-dollar by the organization specified. Funds allocated under this subsection shall be distributed in their entirety for the purpose specified on July 1, 2024.
   3.  Of the funds appropriated in this section, $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 subsection, “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.
   4.  Of the funds appropriated in this section, the following amounts are allocated to be used as follows to support the goals of increased access, health system integration, and engagement:
   a.  $600,000 is allocated to the Iowa prescription drug corporation for continuation of the pharmaceutical infrastructure for safety net providers originally established 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 paragraph shall be distributed in their entirety for the purpose specified on July 1, 2024.
   b.  $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 paragraph shall be distributed in their entirety for the purpose specified on July 1, 2024.
   c.  $25,000 is allocated to the Iowa association of rural health clinics for necessary infrastructure and service delivery transformation. Funds allocated under this paragraph shall be distributed in their entirety for the purpose specified on July 1, 2024.
   d.  $225,000 is allocated to the Polk county medical society for continuation of the safety net provider patients access to specialty care initiative as described in 2007 Iowa Acts, chapter 218, section 109. Funds allocated under this paragraph shall be distributed in their entirety for the purpose specified on July 1, 2024.
   5.  Of the funds appropriated in this section, $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.
   6.  Of the funds appropriated in this section, $250,000 shall be used for the public purpose of providing funding to Des Moines university to continue a provider education project that provides primary care physicians with the training and skills necessary to recognize the signs of mental illness in patients.
   7.  Of the funds appropriated in this section, $800,000 shall be used for rural psychiatric residencies to annually fund eight psychiatric residents who will provide mental health services in underserved areas of the state.
   8.  Of the funds appropriated in this section, $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.
   9.  Of the funds appropriated in this section, $425,000 shall be used for the continuation of a centers of excellence program for the awarding of 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 shall specify how the grant 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. Following receipt of the grant, 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 and progress in accomplishing the program’s goals.
   10.  Of the funds appropriated in this section, $560,000 shall be deposited in the state-funded family medicine obstetrics fellowship program fund to be used for the state-funded family medicine obstetrics fellowship program, in accordance with section 135.193.
   11.  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.
   12.  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.
DIVISION V
COMMUNITY ACCESS AND ELIGIBILITY —— FY 2024-2025

    Sec. 7.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY ACCESS AND ELIGIBILITY.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   To be used for salaries, support, maintenance, and miscellaneous purposes and for family investment program (FIP) assistance in accordance with chapter 239B, and for other costs associated with providing needs-based benefits or assistance including but not limited to maternal and child health, oral health, obesity prevention, the promoting independence and self-sufficiency through employment, job opportunities and basic skills (PROMISE JOBS) program, supplemental nutrition assistance program (SNAP) employment and training, the FIP diversion program, family planning, rent reimbursement, and eligibility determinations for medical assistance, food assistance, the children’s health insurance program, and the Iowa commission on volunteer service programs and grants:
   ...................................................................... $ 68,043,944

   1.  Of the child support collections assigned under FIP, 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 community access and eligibility, and the remaining funds may be used to increase recoveries, to sustain cash flow in the child support payments account, or for technology needs. 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.
   2.  Of the funds appropriated in this section, $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 participating counties to ensure that those counties are fully operational, with the remaining funds to be used for expanding participation to additional counties. The full implementation and expansion shall include enhancing the scope of the initiative through collaboration with the child health specialty clinics to promote the use of developmental surveillance and screening to support healthy child development through early identification and response to both biomedical and social determinants of healthy development by providing practitioner consultation and continuous improvement through training and education, particularly for children with behavioral conditions and needs. The department shall also collaborate with the Medicaid program and the child health specialty clinics to assist in coordinating the activities of the first five initiative into the establishment of patient-centered medical homes developed to improve health quality and population health while reducing health care costs. To the maximum extent possible, funding allocated in this subsection shall be utilized as matching funds for Medicaid program reimbursement.
   3.  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. 

CHILD SUPPORT SERVICES
    Sec. 8.  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, 2024, and ending June 30, 2025, 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:
   ...................................................................... $ 15,434,282

   1.  Federal access and visitation grant moneys shall be used for services designed to increase compliance with the child access provisions of court orders, including but not limited to neutral visitation sites and mediation services.
   2.  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.

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT
    Sec. 9.  TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT.  There is appropriated from the special fund created in section 8.41 to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, 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.  For community access and eligibility, FIP, the PROMISE JOBS program, implementing family investment agreements in accordance with chapter 239B, and for continuation of the program promoting awareness of the benefits of a healthy marriage:
   ...................................................................... $ 12,988,627

   2.  For community access and eligibility to provide 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, 2024, if the programs have demonstrated positive outcomes. Grants shall be awarded to pregnancy prevention programs which are developed after July 1, 2024, 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.
   3.  For community access and eligibility to meet one of the four core purposes of TANF as specified in 45 C.F.R. §260.20, including by modernizing the program to promote economic mobility and self-sufficiency, ensuring that families are able to overcome benefit cliffs, encouraging healthy families, and streamlining service delivery to reduce duplication:
   ...................................................................... $  5,000,000

   4.   For technology needs related to child support modernization of the Iowa collections and reporting (ICAR) system and for a closed loop referral system for the thrive Iowa program:
   ...................................................................... $  5,000,000

   5.  For early intervention and supports for the family development and self-sufficiency (FaDSS) grant program in accordance with section 216A.107:
   ...................................................................... $  2,888,980

   Of the funds allocated for the FaDSS grant program in this subsection, not more than 5 percent of the funds shall be used for administrative purposes.
   6.  For early intervention and supports for child abuse prevention grants:
   ...................................................................... $    125,000

   7.  For accountability, compliance, program integrity, technology needs, and other resources necessary to meet federal and state reporting, tracking, and case management requirements and other departmental needs:
   ...................................................................... $  3,533,647

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

   9.  For child protective services:
   ...................................................................... $ 62,364,100

   10.  For child protective services for the kinship stipend program:
   ...................................................................... $  3,000,000
DIVISION VI
MEDICAL ASSISTANCE —— STATE SUPPLEMENTARY ASSISTANCE —— HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED PROGRAMS —— FY 2024-2025

    Sec. 10.  MEDICAL ASSISTANCE, STATE SUPPLEMENTARY ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies in effect on June 30, 2024, 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; for the state supplementary assistance program; for the health insurance premium payment program; and 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; and for other specified health-related programs:
   ...................................................................... $ 1,627,974,166

   1.  Of the funds appropriated in this section, $1,581,251,282 is allocated for medical assistance program reimbursement and associated costs.
   a.  Of the funds allocated in this subsection, $800,000 shall be used for the renovation and construction of certain nursing facilities, consistent with the provisions of chapter 249K.
   b.  Of the funds allocated in this subsection, $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 paragraph shall not be used as nonfederal share matching funds.
   c.  Of the funds allocated in this subsection, $3,383,880 shall be used for program administration, outreach, and enrollment activities of the state family planning services program pursuant to section 217.41B, and of this amount, the department may use $200,000 for administrative expenses.
   2.  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.
   3.  The provisions of this section relating to abortions shall also apply to the Iowa health and wellness plan created pursuant to chapter 249N.
   4.  Of the funds appropriated in this section, $4,479,762 is allocated for the state supplementary assistance program.
   5.  Of the funds appropriated in this section, $42,243,122 is allocated for maintenance of the 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.

HEALTH PROGRAM OPERATIONS
    Sec. 11.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated: 
   For health program operations and the autism support program:
   ...................................................................... $ 39,597,231

   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, a sufficient amount shall be used for the administration of the health insurance premium payment program, including salaries, support, maintenance, and miscellaneous purposes.
   3.  Of the funds appropriated in this section, $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 of 2009 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.
   4.  Unless otherwise provided, annual increases for services provided through contracts funded under this section shall not exceed the amount by which the consumer price index for all urban consumers increased during the most recently ended calendar year.

HEALTH CARE ACCOUNTS AND FUNDS
    Sec. 12.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   Notwithstanding any provision of law to the contrary, to supplement the appropriation made in this Act for health program operations under the medical assistance program for the same fiscal year:
   ...................................................................... $    234,193
    Sec. 13.  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, 2024, and ending June 30, 2025, the following amount, 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. 14.  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, 2024, and ending June 30, 2025, the following amount, 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

REIMBURSEMENT RATES
    Sec. 15.  REIMBURSEMENT RATES.  Reimbursement for medical assistance, state supplementary assistance, and social service providers and services reimbursed under the purview of the department of health and human services shall remain at the reimbursement rate or shall be determined pursuant to the reimbursement methodology in effect on June 30, 2024, unless reimbursement is otherwise negotiated by contract or pursuant to an updated fee schedule.
DIVISION VII
FAMILY WELL-BEING AND PROTECTION —— FY 2024-2025

STATE CHILD CARE ASSISTANCE
    Sec. 16.  STATE 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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated: 
   For state child care assistance in accordance with section 237A.13:
   ...................................................................... $ 34,966,931

   1.  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.
   2.  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.

EARLY INTERVENTION AND SUPPORTS
    Sec. 17.  EARLY INTERVENTION AND SUPPORTS.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For promoting the optimum health status for children and adolescents from birth through 21 years of age, and for families:
   ...................................................................... $ 35,277,739

   1.  Of the funds appropriated in this section, 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.
   2.  Of the funds appropriated in this section, $4,313,854 is allocated for the FaDSS grant program. Of the funds allocated for the FaDSS grant program in this subsection, not more than 5 percent of the funds shall be used for administration of the grant program.
   3.  Of the funds appropriated in this section, $29,256,799 shall be used for the purposes of the early childhood Iowa fund created in section 256I.11.
   4.  Of the funds appropriated in 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.

CHILD PROTECTIVE SERVICES
    Sec. 18.  CHILD PROTECTIVE 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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated: 
   For child, family, and adoption services, and for salaries, support, maintenance, and miscellaneous purposes:
   ...................................................................... $164,644,037

   1.  Of the funds appropriated in this section, $1,717,000 is allocated specifically for expenditure for fiscal year 2024-2025 through the decategorization services funding pools and governance boards established pursuant to section 232.188.
   2.  A portion of the funds appropriated in this section may be used to provide other resources based on client need required to support family preservation, emergency client need, or family reunification efforts.
   3.  Of the funds appropriated in this section, a sufficient amount is allocated for group foster care maintenance and services, shelter care, child welfare emergency services, and supervised apartment living contracts.
   4.  Federal funds received by the state during the fiscal year beginning July 1, 2024, 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.
   5.  a.  Of the funds appropriated in this section, $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 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.
   6.  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.
   7.  Of the funds appropriated in this section, $4,359,500 is allocated for the preparation for adult living program pursuant to section 234.46.
   8.  Of the funds appropriated in this section, up to $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.
   9.  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.
   10.  a.  Of the funds appropriated in this section, a sufficient amount is allocated for adoption subsidy payments and related costs. 
   b.  Any funds allocated in this subsection remaining after the allocation under paragraph “a” 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.
   11.  Of the funds appropriated in this section, a sufficient amount is allocated to support training needs for child welfare providers and to address disproportionality within the child welfare system.
   12.  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.
DIVISION VIII
STATE SPECIALTY CARE —— FY 2024-2025

    Sec. 19.  STATE SPECIALTY CARE.  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, 2024, and ending June 30, 2025, 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 institutions under the jurisdiction of the department of health and human services:
   ...................................................................... $100,006,128

   1.  The department shall utilize the funds appropriated in this section as necessary to maximize bed capacity and to most effectively meet the needs of the individuals served.
   2.  Of the amount appropriated in this section, the following amounts are allocated to each institution as follows:
   a.  For the state mental health institute at Cherokee:
   ...................................................................... $ 18,482,310

   b.  For the state mental health institute at Independence:
   ...................................................................... $ 22,876,090

   c.  For the civil commitment unit for sexual offenders at Cherokee:
   ...................................................................... $ 16,793,575

   d.  For the state resource center at Woodward:
   ...................................................................... $ 13,389,577

   e.  For the state resource center at Glenwood:
   ...................................................................... $  5,255,132

   f.  For the state training school at Eldora:
   ...................................................................... $ 18,529,635
DIVISION IX
ADMINISTRATION AND COMPLIANCE —— FY 2024-2025

    Sec. 20.  ACCOUNTABILITY, COMPLIANCE, AND PROGRAM INTEGRITY.  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, 2024, and ending June 30, 2025, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   For accountability, compliance, and program integrity, including salaries, support, maintenance, and miscellaneous purposes:
   ...................................................................... $ 21,194,894

   1.  Of the funds appropriated in this section, $200,000 shall be transferred to and deposited in the Iowa ABLE savings plan trust administrative fund created in section 12I.4, to be used for implementation and administration activities of the Iowa ABLE savings plan trust.
   2.  Of the funds appropriated in this section, $2,602,312 shall be used for foster care review and the court appointed special advocate program, including for salaries, support, maintenance, and miscellaneous purposes.
   3.  Of the funds appropriated in this section, $1,148,959 shall be used for the office of long-term care ombudsman for salaries, support, administration, maintenance, and miscellaneous purposes.
   4.  For the fiscal year beginning July 1, 2024, and ending June 30, 2025, the department of health and human services may utilize the funds appropriated from the general fund of the state to the department under this Act for up to 4,156.00 full-time equivalent positions. The department shall report to the general assembly by December 15, 2024, the distribution of the approved number of full-time equivalent positions across the organizational divisions of the department.
DIVISION X
DEPARTMENT OF HEALTH AND HUMAN SERVICES TRANSFERS, CASHFLOW, AND NONREVERSIONS

    Sec. 21.  DEPARTMENT OF HEALTH AND HUMAN SERVICES TRANSFERS AND CASHFLOW.
   1.  The department of health and human services may transfer funds appropriated in this Act to support continuing alignment efforts, to maximize federal support in accordance with the department’s federal costs allocation plan, and for resources necessary to implement and administer the services for which funds are provided. The department shall report any transfers made pursuant to this subsection to the general assembly.
   2.  If the savings to the appropriations made for the Medicaid program from ongoing cost management efforts exceed the associated costs for the fiscal year, the department may transfer any savings generated for the fiscal year due to cost management efforts to the appropriations made in this Act for health program operations or for accountability, compliance, and program integrity to defray the costs associated with implementation of the cost management efforts.
   3.  The department may transfer funds appropriated for child protective services to pay the nonfederal share costs of services reimbursed under the medical assistance program, state child care assistance program, or the family investment program which are provided to children who would otherwise receive services paid under the appropriation for child protective services.
   4.  The department may transfer funds from the temporary assistance for needy families block grant to the federal social services block grant appropriation, and to the child care and development block grant appropriation, in accordance with federal law.
   5.  To the extent the department determines that moneys appropriated under this Act or allocated for a specific purpose under the Act will remain unencumbered or unobligated at the close of the fiscal year, such unencumbered or unobligated moneys may be used in the same fiscal year for any other purpose for which the moneys appropriated may be used, or for any other allocation within the same appropriation.
   6.  To the extent the department determines that moneys appropriated under this Act will remain unencumbered or unobligated at the close of the fiscal year or that services will not be impacted, the department may utilize such unencumbered or unobligated moneys appropriated to develop and support the thrive Iowa program, a closed-loop referral system utilizing a navigator model, that acts as the connection point to link Iowans on an individualized path to prosperity and self-sufficiency to available resources in all sectors of the community.
    Sec. 22.  DEPARTMENT OF HEALTH AND HUMAN SERVICES NONREVERSIONS.
   1.  Notwithstanding section 8.33, moneys appropriated from the general fund of the state and the temporary assistance for needy families block grant to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, for the purposes of the FaDSS grant program 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.
   2.  Notwithstanding section 8.33, of the moneys appropriated from the general fund of the state, the quality assurance trust fund, and the hospital health care access trust fund to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, for the purposes of the medical assistance program, the amount that is in excess of actual expenditures for the medical assistance program that remains unencumbered or unobligated at the close of the fiscal year shall not revert, but shall remain available for expenditure for the medical assistance program until the close of the succeeding fiscal year.
   3.  Notwithstanding section 8.33, and notwithstanding the nonreversion amount limitation specified in section 222.92, moneys appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, for the purposes of state specialty care 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. 
   4.  Notwithstanding section 8.33, moneys appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, and allocated for rural psychiatric residencies to annually fund eight psychiatric residents who will provide mental health services to underserved areas of the state 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.  Notwithstanding section 8.33, moneys appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, and allocated for adoption subsidy payments and related costs or for post-adoption services and related allowable purposes 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.
DIVISION XI
HEALTH AND HUMAN SERVICES —— PRIOR APPROPRIATIONS AND OTHER PROVISIONS —— FY 2022-2023

RURAL PSYCHIATRIC RESIDENCIES
    Sec. 23.  2022 Iowa Acts, chapter 1131, section 3, subsection 4, paragraph j, is amended to read as follows:
   j.  Of the funds appropriated in this subsection, $800,000 shall be used for rural psychiatric residencies to support the annual creation and training of six eight 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.

FAMILY INVESTMENT PROGRAM
    Sec. 24.  2022 Iowa Acts, chapter 1131, section 9, subsection 7, as enacted by 2023 Iowa Acts, chapter 112, section 41, is amended to read as follows:
   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, or may be transferred to other appropriations in this division of this Act or used as necessary to enhance agency accountability, program integrity, compliance, and efficiency, until the close of the succeeding fiscal year.

STATE SUPPLEMENTARY ASSISTANCE
    Sec. 25.  2022 Iowa Acts, chapter 1131, section 15, subsection 4, is amended to read as follows:
   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 supplemental nutrition assistance program payment error rate, or may be transferred to other appropriations in this division of this Act or used as necessary to enhance agency accountability, program integrity, compliance, and efficiency, until the close of the succeeding fiscal year.
    Sec. 26.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
    Sec. 27.  RETROACTIVE APPLICABILITY.  This division of this Act applies retroactively to July 1, 2022.
DIVISION XII
HEALTH AND HUMAN SERVICES —— PRIOR APPROPRIATIONS AND OTHER PROVISIONS —— FY 2023-2024

OFFICE OF PUBLIC GUARDIAN
    Sec. 28.  2023 Iowa Acts, chapter 112, section 3, is amended by adding the following new subsection:
   NEW SUBSECTION.  7.  Notwithstanding section 8.33, moneys appropriated in this section for the state office of public guardian established under chapter 231E 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.

RURAL PSYCHIATRIC RESIDENCIES
    Sec. 29.  2023 Iowa Acts, chapter 112, section 5, subsection 4, paragraph j, is amended to read as follows:
   j.  Of the funds appropriated in this subsection, $800,000 shall be used for rural psychiatric residencies to annually fund six eight 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.

FAMILY INVESTMENT PROGRAM
    Sec. 30.  2023 Iowa Acts, chapter 112, 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, or may be transferred to other appropriations in this division of this Act or used as necessary to enhance agency accountability, program integrity, compliance, and efficiency, until the close of the succeeding fiscal year. 

STATE SUPPLEMENTARY ASSISTANCE
    Sec. 31.  2023 Iowa Acts, chapter 112, section 15, subsection 4, is amended to read as follows:
   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, or may be transferred to other appropriations in this division of this Act or used as necessary to enhance agency accountability, program integrity, compliance, and efficiency, until the close of the succeeding fiscal year.

CHILD CARE ASSISTANCE
    Sec. 32.  2023 Iowa Acts, chapter 112, 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. 33.  2023 Iowa Acts, chapter 112, section 19, is amended by adding the following new subsection:
   NEW SUBSECTION.  23.  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. 34.  2023 Iowa Acts, chapter 112, section 26, is amended by adding the following new subsection:
   NEW 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 the purposes designated until the close of the succeeding fiscal year.

GENERAL ADMINISTRATION —— MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM
    Sec. 35.  2023 Iowa Acts, chapter 112, section 27, subsection 8, is amended to read as follows:
   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.  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. 36.  2023 Iowa Acts, chapter 112, section 27, is amended by adding the following new subsection:
   NEW SUBSECTION.  10.  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.

LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM ADMINISTRATIVE ALLOCATION —— FEDERAL BLOCK GRANT
    Sec. 37.  2023 Iowa Acts, chapter 161, section 10, subsection 3, is amended to read as follows:
   3.  After subtracting the allocation in subsection 2, up to 10 no less than 8.4 percent of the remaining moneys for each federal fiscal year are allocated for administrative expenses of low-income home energy assistance program contractors and up to 1.6 percent of the remaining moneys for each fiscal year are allocated for the administrative expenses of the department of health and human services under the low-income home energy assistance program of which $377,000 is allocated each federal fiscal year for administrative expenses of the department of health and human services. The costs of auditing the use and administration of the portion of the appropriation in this section that is retained by the state shall be paid from the amount allocated in this subsection each federal fiscal year to the department of health and human services. The auditor of state shall bill the department of health and human services for the audit costs.
    Sec. 38.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
    Sec. 39.  RETROACTIVE APPLICABILITY.  This division of this Act applies retroactively to July 1, 2023.
DIVISION XIII
EMERGENCY RULES AND REPORTS

    Sec. 40.  EMERGENCY RULES.
   1.  If necessary to comply with federal requirements including time frames, or if specifically authorized by a provision 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 applicable provisions of this Act. 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. 41.  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, 2024, shall be submitted on or before the date specified for submission of the reports or information.
DIVISION XIV
CODIFIED PROVISIONS

SUBSTANCE USE DISORDER —— BEER AND LIQUOR CONTROL FUND
    Sec. 42.  Section 123.17, subsection 5, Code 2024, is amended to read as follows:
   5.  After any transfer provided for in subsection 3 is made, the department shall transfer into a special revenue account in the general fund of the state, a sum of money at least equal to seven percent of the gross amount of sales made by the department from the beer and liquor control fund on a monthly basis but not less than nine million dollars annually. Of the amounts transferred, two million dollars, plus an additional amount determined by the general assembly, shall be appropriated to the department of health and human services for use by the staff who administer the comprehensive substance use disorder program under chapter 125 for substance use disorder treatment and prevention programs. Any amounts received in excess of the amounts appropriated to the department of health and human services for use by the staff who administer the comprehensive substance use disorder program under chapter 125 shall be considered part of the general fund balance.

TOBACCO USE PREVENTION AND CONTROL
    Sec. 43.  Section 142A.5, Code 2024, is amended by adding the following new subsection:
   NEW SUBSECTION.  9.  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.

PERSONAL NEEDS ALLOWANCE FOR FACILITIES UNDER MEDICAID
    Sec. 44.  Section 249A.30A, Code 2024, is amended to read as follows:
   249A.30A  Medical assistance —— personal needs allowance.
   1.  The personal needs allowance under the medical assistance program, which may be retained by a person who is a resident of a nursing facility, an intermediate care facility for persons with an intellectual disability, or an intermediate care facility for persons with mental illness, as defined in section 135C.1, or a person who is a resident of a psychiatric medical institution for children as defined in section 135H.1, shall be fifty dollars per month.
   2.  A resident who has income of less than fifty dollars per month shall receive a supplement from the state in the amount necessary to receive a personal needs allowance of fifty dollars per month, if funding is specifically appropriated for this purpose.  The general assembly shall annually appropriate a sufficient amount from the general fund of the state to the department of health and human services for this purpose.

REPLACEMENT GENERATION TAX REVENUES
    Sec. 45.  Section 437A.8, subsection 4, paragraph d, Code 2024, is amended to read as follows:
   d.  Notwithstanding paragraph “a”, a taxpayer who owns or leases a new electric power generating plant and who has no other operating property in the state of Iowa except for operating property directly serving the new electric power generating plant as described in section 437A.16 shall pay the replacement generation tax associated with the allocation of the local amount to the county treasurer of the county in which the local amount is located and shall remit the remaining replacement generation tax, if any, to the director according to paragraph “a” for remittance of the tax to county treasurers. The director shall notify each taxpayer on or before August 31 following a tax year of its remaining replacement generation tax to be remitted to the director. All remaining replacement generation tax revenues received by the director shall be deposited in the property tax relief fund created in section 426B.1, and shall be distributed as provided in section 426B.2

appropriated annually to the department of health and human services to supplement any appropriation made for medical assistance.
   If a taxpayer has paid an amount of replacement tax, penalty, or interest which was deposited into the property tax relief fund appropriated to the department of health and human services under this paragraph and which was not due, all of the provisions of section 437A.14, subsection 1, paragraph “b”, shall apply with regard to any claim for refund or credit filed by the taxpayer. The director shall have sole discretion as to whether the erroneous payment will be refunded to the taxpayer or credited against any replacement tax due, or to become due, from the taxpayer that would be subject to deposit in the property tax relief fund appropriated to the department of health and human services under this paragraph.
    Sec. 46.  Section 437A.15, subsection 3, paragraph f, Code 2024, is amended to read as follows:
   f.  Notwithstanding the provisions of this section, if a taxpayer is a municipal utility or a municipal owner of an electric power facility financed under the provisions of chapter 28F or 476A, the assessed value, other than the local amount, of a new electric power generating plant shall be allocated to each taxing district in which the municipal utility or municipal owner is serving customers and has electric meters in operation in the ratio that the number of operating electric meters of the municipal utility or municipal owner located in the taxing district bears to the total number of operating electric meters of the municipal utility or municipal owner in the state as of January 1 of the tax year. If the municipal utility or municipal owner of an electric power facility financed under the provisions of chapter 28F or 476A has a new electric power generating plant but the municipal utility or municipal owner has no operating electric meters in this state, the municipal utility or municipal owner shall pay the replacement generation tax associated with the new electric power generating plant allocation of the local amount to the county treasurer of the county in which the local amount is located and shall remit the remaining replacement generation tax, if any, to the director at the times contained in section 437A.8, subsection 4, for remittance of the tax to the county treasurers. All remaining replacement generation tax revenues received by the director shall be deposited in the property tax relief fund created in section 426B.1, and shall be distributed as provided in section 426B.2 appropriated annually to the department of health and human services to supplement any appropriation made for medical assistance.

PERSONAL NEEDS ALLOWANCE FOR STATE SUPPLEMENTARY ASSISTANCE
    Sec. 47.  NEW SECTION.  249.9A  Personal needs allowance.
   1.  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.
   2.  If during a fiscal year, 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 to ensure compliance with federal requirements. In addition, the department may make other programmatic and rate adjustments necessary to remain within the funds appropriated for a fiscal year while ensuring compliance with federal requirements.
   3.  The department may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this section and 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.

MEDICAID FRAUD FUND AND HEALTH CARE TRUST FUND 
    Sec. 48.  Section 249A.50, subsection 3, Code 2024, is amended to read as follows:
   3.  a.  A Medicaid fraud fund is created in the state treasury under the authority of the department of inspections, appeals, and licensing. Moneys from penalties, investigative costs recouped by the Medicaid fraud control unit, and other amounts received as a result of prosecutions involving the department of inspections, appeals, and licensing investigations and audits to ensure compliance with the medical assistance program that are not credited to the program shall be credited to the fund.
   b.  Notwithstanding section 8.33, moneys credited to the fund from any other account or fund shall not revert to the other account or fund. Moneys in the fund shall only be used as provided in appropriations from the fund and shall be used in accordance with applicable laws, regulations, and the policies of the office of inspector general of the United States department of health and human services.
   c.  Any funds remaining in the Medicaid fraud fund at the close of a fiscal year are appropriated to the department of health and human services to supplement any medical assistance program appropriation for the same fiscal year to be used for medical assistance reimbursement and associated costs, including program administration and costs associated with program implementation.
   c.  d.  For the purposes of this subsection, “investigative costs” means the reasonable value of a Medicaid fraud control unit investigator’s, auditor’s or employee’s time, any moneys expended by the Medicaid fraud control unit, and the reasonable fair market value of resources used or expended by the Medicaid fraud control unit in a case resulting in a criminal conviction of a provider under this chapter or chapter 714 or 715A.
    Sec. 49.  Section 453A.35A, Code 2024, is amended to read as follows:
   453A.35A  Health care trust fund —— appropriation to Medicaid program.
   1.  A health care trust fund is created in the office of the treasurer of state. The fund consists of the revenues generated from the tax on cigarettes pursuant to section 453A.6, subsection 1, and from the tax on tobacco products as specified in section 453A.43, subsections 1, 2, 3, and 4, that are credited to the health care trust fund, annually, pursuant to section 453A.35. Moneys in the fund shall be separate from the general fund of the state and shall not be considered part of the general fund of the state. However, the fund shall be considered a special account for the purposes of section 8.53 relating to generally accepted accounting principles. Moneys in the fund shall be used only as specified in this section and shall be appropriated only for the uses specified. Moneys 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 fund shall be credited to the fund.
   2.  Moneys in the fund shall be used only for purposes related to health care, substance use disorder treatment and prevention, and tobacco use prevention, cessation, and control.
   3.  Any funds remaining in the health care trust fund at the close of a fiscal year are appropriated to the department of health and human services to supplement any medical assistance program appropriation for the same fiscal year to be used for medical assistance reimbursement and associated costs, including program administration and costs associated with program implementation.

MENTAL HEALTH INSTITUTES —— RETAINING OF REVENUE
    Sec. 50.  NEW SECTION.  218.97  Retaining of revenue by mental health institutes.
   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.

RESIDENTS OF MENTAL HEALTH INSTITUTES —— RETAINING MEDICAID ELIGIBILITY
    Sec. 51.  NEW SECTION.  249A.38A  Residents of mental health institutes —— retaining of Medicaid eligibility.
   Notwithstanding any provision of law to the contrary, a Medicaid recipient 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 recipient’s stay for which federal financial participation is available.

STATE RESOURCES CENTERS —— SCOPE OF SERVICES
    Sec. 52.  NEW SECTION.  218.97A  State resource centers —— scope of services approach —— time-limited assessment and respite services.
   1.  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.
   2.  The state resource centers may expand the time-limited assessment and respite services during a fiscal year.

JUVENILE DETENTION HOME FUND —— APPROPRIATION
    Sec. 53.  Section 232.142, Code 2024, is amended to read as follows:
   232.142  Maintenance and cost of juvenile homes —— fund —— appropriation of moneys in fund.
   1.  County boards of supervisors which singly or in conjunction with one or more other counties provide and maintain juvenile detention and juvenile shelter care homes are subject to this section.
   2.  For the purpose of providing and maintaining a county or multicounty home, the board of supervisors of any county may issue general county purpose bonds in accordance with sections 331.441 through 331.449. Expenses for providing and maintaining a multicounty home shall be paid by the counties participating in a manner to be determined by the boards of supervisors.
   3.  A county or multicounty juvenile detention home approved pursuant to this section shall receive financial aid from the state in a manner approved by the director. Aid paid by the state shall be at least ten percent and not more than fifty percent of the total cost of the establishment, improvements, operation, and maintenance of the home. 
   4.  The director shall adopt minimal rules and standards for the establishment, maintenance, and operation of such homes as shall be necessary to effect the purposes of this chapter. The rules shall apply the requirements of section 237.8, concerning employment and evaluation of persons with direct responsibility for a child or with access to a child when the child is alone and persons residing in a child foster care facility, to persons employed by, residing in, or volunteering for a home approved under this section. The director shall, upon request, give guidance and consultation in the establishment and administration of the homes and programs for the homes. 
   5.  The director shall approve annually all such homes established and maintained under the provisions of this chapter. A home shall not be approved unless it complies with minimal rules and standards adopted by the director and has been inspected by the department of inspections, appeals, and licensing. The statewide number of beds in the homes approved by the director shall not exceed two hundred seventy-two beds beginning July 1, 2017. 
   6.  a.  A juvenile detention home fund is created in the state treasury under the authority of the department. The fund shall consist of moneys deposited in the fund pursuant to section 602.8108. The moneys in the fund shall be used for the costs of the establishment, improvement, operation, and maintenance of county or multicounty juvenile detention homes in accordance with annual appropriations made by the general assembly from the fund for these purposes this subsection. 
   b.  (1)  Moneys deposited in the juvenile detention home fund during a fiscal year are appropriated to the department for the same fiscal year 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 prior fiscal year. Such percentage shall be determined by the department based on the amount available for distribution from the fund.
   (2)  Moneys appropriated for distribution in accordance with this subsection 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 prior fiscal year.

FAMILY INVESTMENT PROGRAM ACCOUNT ELIMINATION
    Sec. 54.  Section 239B.14, subsection 2, Code 2024, is amended to read as follows:
   2.  An individual who commits a fraudulent practice under this section is personally liable for the amount of assistance or other benefits fraudulently obtained. The amount of the assistance or other benefits may be recovered from the offender or the offender’s estate in an action brought or by claim filed in the name of the state and the recovered funds shall be deposited in the family investment program account credited to the appropriation to the department for community access and eligibility to be used for the purposes of the family investment program. The action or claim filed in the name of the state shall not be considered an election of remedies to the exclusion of other remedies.
    Sec. 55.  Section 252B.27, subsection 1, Code 2024, is amended to read as follows:
   1.  The director, within the limitations of the amount appropriated for child support services, or moneys transferred for this purpose from the family investment program account created in section 239B.11 appropriation to the department for community access and eligibility, may establish new positions and add employees to child support services if the director determines that both the current and additional employees together can reasonably be expected to maintain or increase net state revenue at or beyond the budgeted level for the fiscal year.
    Sec. 56.  REPEAL.  Section 239B.11, Code 2024, is repealed.
    Sec. 57.  TRANSITION PROVISION.  All unencumbered and unobligated moneys remaining on June 30, 2024, in the family investment program account created in section 239B.11, are appropriated to the department of health and human services for community access and eligibility.

CHILD SUPPORT COLLECTION SERVICES CENTER REFUND ACCOUNT
    Sec. 58.  Section 252B.13A, Code 2024, is amended by adding the following new subsection:
   NEW SUBSECTION.  3.  Support payments received by the collection services center shall be deposited in the collection services center refund account. The account shall be separate from the general fund of the state and shall not be considered part of the general fund of the state. The moneys deposited in the account are not subject to section 8.33 and shall not be transferred, used, obligated, appropriated, or otherwise encumbered except as provided for the purposes of this chapter. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the account shall be credited to the account. 

FOSTER CARE SERVICES —— RESPONSIBILITY FOR SERVICES —— PLACEMENT WITH RELATIVE OR FICTIVE KIN
    Sec. 59.  Section 234.39, subsection 2, Code 2024, is amended to read as follows:
   2.  a.  A person entitled to periodic support payments pursuant to an order or judgment entered in any action for support, who also is or has a child receiving foster care services, is deemed to have assigned to the department current and accruing support payments attributable to the child effective as of the date the child enters foster care placement, to the extent of expenditure of foster care funds. The department shall notify the clerk of the district court when a child entitled to support payments is receiving foster care services pursuant to chapter 234. Upon notification by the department that a child entitled to periodic support payments is receiving foster care services, the clerk of the district court shall make a notation of the automatic assignment in the judgment docket and lien index. The notation constitutes constructive notice of assignment. The clerk of court shall furnish the department with copies of all orders and decrees awarding support when the child is receiving foster care services. At the time the child ceases to receive foster care services, the assignment of support shall be automatically terminated. Unpaid support accrued under the assignment of support rights during the time that the child was in foster care remains due to the department up to the amount of unreimbursed foster care funds expended. The department shall notify the clerk of court of the automatic termination of the assignment. Unless otherwise specified in the support order, an equal and proportionate share of any child support awarded shall be presumed to be payable on behalf of each child subject to the order or judgment for purposes of an assignment under this section.
   b.  This subsection shall not apply when a child is placed with a relative or fictive kin as those terms are defined in section 232.2, who is not licensed under chapter 237 to provide child foster care.

QUALITY ASSURANCE ASSESSMENT —— PAYMENT PERIOD BASIS
    Sec. 60.  Section 249L.3, subsection 2, Code 2024, is amended to read as follows:
   2.  The quality assurance assessment shall be paid by each nursing facility to the department on a quarterly monthly basis after the nursing facility’s medical assistance payment rates are adjusted to include funds appropriated from the quality assurance trust fund for that purpose. The department shall prepare and distribute a form upon which nursing facilities shall calculate and report the quality assurance assessment. A nursing facility shall submit the completed form with the assessment amount no later than thirty days following the end of each calendar quarter.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill makes appropriations from the general fund of the state to the department of veterans affairs and to the department of health and human services (HHS) for fiscal year 2024-2025. The appropriations from the general fund of the state to the department of veterans affairs include appropriations for administration, the state veterans cemetery, the Iowa veterans home, the home ownership assistance program, and county commissions of veterans affairs. The appropriations from the general fund of the state to HHS include appropriations for aging and disability services; behavioral health; public health; community access and eligibility including for child support services; Medicaid, state supplementary assistance, the healthy and well kids in Iowa (Hawki) program, and other specified health-related programs including health program operations and reimbursement rate provisions; family well-being and protection including state child care assistance, early intervention and supports, and child protective services; state specialty care; and administration and compliance. The bill also makes appropriations to HHS from the temporary assistance for needy families block grant, the pharmaceutical settlement account, the quality assurance trust fund, and the hospital health care access trust fund.
   The bill includes transfer, cashflow, and nonreversion provisions; emergency rulemaking authority and reporting requirements; and certain codified provisions relating to the duties and programs under the purview of HHS.