HF 1014 (LSB 1459HZ (1) 91)

HOUSE FILE 1014

BY  COMMITTEE ON APPROPRIATIONS

(SUCCESSOR TO HF 757)
(SUCCESSOR TO HSB 215)

(COMPANION TO SF 620 BY COMMITTEE ON WAYS AND MEANS)

A BILL FOR

An Act relating to matters under the purview of the department of health and human services, including administrative services organizations, child foster care, child and dependent adult abuse, internal audit and examination information, and the region incentive fund in the mental health and disability services regional service fund, health maintenance organization’s premium tax, and making appropriations and including effective date and retroactive applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
ADMINISTRATIVE SERVICES ORGANIZATIONS

    Section 1.  Section 97B.1A, subsection 8, paragraph b, Code 2025, is amended by adding the following new subparagraph:
   NEW SUBPARAGRAPH.  (10)  Employees of an administrative services organization as defined in section 225A.1.
    Sec. 2.  Section 229.19, subsection 1, paragraph a, Code 2025, is amended by striking the paragraph and inserting in lieu thereof the following:
   a.  (1)  The board of supervisors of each county shall appoint an individual to act as an advocate representing the interests of patients involuntarily hospitalized by the court in matters relating to a patient’s hospitalization or treatment under section 229.14 or 229.15. The individual shall have prior experience advocating for or promoting the welfare and rehabilitation of persons with mental illness.
   (2)  A person appointed under this section shall not be any of the following:
   (a)  An officer or employee of the department.
   (b)  An officer or employee of an administrative services organization.
   (c)  An officer or employee of an agency or facility providing care or treatment to persons with mental illness.
DIVISION II
CHILD FOSTER CARE

    Sec. 3.  Section 232.69, subsection 1, paragraph b, subparagraph (9), Code 2025, is amended to read as follows:
   (9)  An employee or operator of a child foster care facility licensed or approved under chapter 237.
    Sec. 4.  Section 232.78, subsection 8, paragraph a, subparagraph (4), Code 2025, is amended to read as follows:
   (4)  An individual licensed to provide foster care pursuant to licensee under chapter 237. If the child is placed with a licensed foster care provider an individual licensee, the department shall assign decision-making authority to the foster care provider individual licensee for the purpose of applying the reasonable and prudent parent standard during the child’s placement.
    Sec. 5.  Section 232.95, subsection 2, paragraph c, subparagraph (4), Code 2025, is amended to read as follows:
   (4)  An individual licensed to provide foster care pursuant to licensee under chapter 237. If the child is placed with a licensed foster care provider an individual licensee, the department shall assign decision-making authority to the foster care provider individual licensee for the purpose of applying the reasonable and prudent parent standard during the child’s placement.
    Sec. 6.  Section 232.102, subsection 1, paragraph a, subparagraph (4), Code 2025, is amended to read as follows:
   (4)  An individual licensed to provide foster care pursuant to licensee under chapter 237. If the child is placed with a licensed foster care provider an individual licensee, the department shall assign decision-making authority to the foster care provider individual licensee for the purpose of applying the reasonable and prudent parent standard during the child’s placement.
    Sec. 7.  Section 234.1, subsection 1, paragraph a, subparagraphs (1) and (2), Code 2025, are amended to read as follows:
   (1)  After reaching eighteen years of age, the person has remained continuously and voluntarily under the care of an individual, as defined in section 237.1, licensed to provide foster care pursuant to licensee under chapter 237, or in a supervised apartment living arrangement, in this state.
   (2)  The person aged out of foster care after reaching eighteen years of age and subsequently voluntarily applied for placement with an individual, as defined in section 237.1, licensed to provide foster care pursuant to licensee under chapter 237, or for placement in a supervised apartment living arrangement, in this state.
    Sec. 8.  Section 234.39, subsection 2, paragraph b, Code 2025, is amended to read as follows:
   b.  This subsection An assignment of support under paragraph “a” shall not apply when a child is placed with a relative or fictive kin as those terms are defined in section 232.2, who unless the relative or fictive kin is not licensed a licensee under chapter 237 to provide child foster care.
    Sec. 9.  Section 237.1, subsection 3, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   “Child foster care” means the provision of parental nurturing, including but not limited to the furnishing of food, lodging, training, education, supervision, treatment, or other care, to a child on a full-time basis by a person, including a relative or fictive kin of the child if the relative or fictive kin is licensed under this chapter, but not including a guardian of the child. “Child foster care” does not include any of the following care situations:
    Sec. 10.  Section 237.1, subsection 3, paragraph f, Code 2025, is amended to read as follows:
   f.  Care furnished by a relative or fictive kin of a child or an individual person with a meaningful relationship with the child where the child is not under the placement, care, or supervision of the department.
    Sec. 11.  Section 237.1, Code 2025, is amended by adding the following new subsections:
   NEW SUBSECTION.  6A.  “Fictive kin” means the same as defined in section 232.2.
   NEW SUBSECTION.  6B.  “Foster family home” means a licensed single-family home environment in which an individual provides child foster care.
    Sec. 12.  Section 237.1, subsections 8 and 9, Code 2025, are amended to read as follows:
   8.  “Licensee” means an individual or an agency licensed under this chapter, or an individual who has been approved by the department to provide child foster care.
   9.  “Reasonable and prudent parent standard” means the standard characterized by careful and sensible parenting decisions that maintain the health, safety, and best interests of a child, while at the same time encouraging the emotional and developmental growth of a child, that a caregiver shall use when determining whether to allow a child in foster care under the placement, care, or supervision of the department to participate in extracurricular, enrichment, cultural, or social activities. For the purposes of this subsection, “caregiver” means an individual or an agency licensed under this chapter a licensee with which a child in foster care has been placed or a juvenile shelter care home approved under chapter 232 in which a child in foster care has been placed.
    Sec. 13.  Section 237.2, Code 2025, is amended to read as follows:
   237.2  Purpose.
   It is the policy of this state to provide appropriate protection for children who are separated from the direct personal care of their parents, relatives, fictive kin, or guardians and, as a result, are subject to difficulty in achieving appropriate physical, mental, emotional, educational, or social development. This chapter shall be construed and administered to further that policy by assuring that child foster care is adequately provided by competently staffed and well-equipped child foster care facilities, including but not limited to residential treatment centers, group homes, and foster family homes.
    Sec. 14.  Section 237.3, subsection 10, Code 2025, is amended to read as follows:
   10.  The department shall adopt rules to administer the exception to the definition of child care in section 237A.1, subsection 2, paragraph “l”, allowing a child care facility, for purposes of providing respite care to a foster family home, to provide care, supervision, or guidance of a child for a period of twenty-four hours or more who is placed with the licensed foster family home.
    Sec. 15.  Section 237.4, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   An individual or an agency, as defined in section 237.1, shall not provide child foster care unless the individual or agency obtains a license issued under this chapter is a licensee. However, a license under this chapter is not required of the following:
    Sec. 16.  Section 237.4, subsection 8, Code 2025, is amended to read as follows:
   8.  An individual providing child care as a babysitter at the request of a parent, guardian, fictive kin, or relative having lawful custody of the child.
    Sec. 17.  Section 237.9, Code 2025, is amended to read as follows:
   237.9  Confidential information.
   A person who receives information from or through the department concerning a child who has received or is receiving child foster care, a relative or guardian of the child, a single-family, home licensee, or an individual employee of a licensee, shall not disclose that information directly or indirectly, except as authorized by section 217.30, or as authorized or required by section 232.69. if the information concerns any of the following:
   1.  A child who has received or is receiving child foster care.
   2.  A relative, fictive kin, or guardian of a child who has received or is receiving child foster care.
   3.  An individual licensee.
   4.  An employee of a licensee.
    Sec. 18.  Section 237.11, Code 2025, is amended to read as follows:
   237.11  Penalty.
   An individual or an agency who provides child foster care without obtaining a license under this chapter, or approval from the department to provide child foster care, or who knowingly violates this chapter or the rules promulgated pursuant to this chapter is guilty of a serious misdemeanor.
    Sec. 19.  Section 237.12, Code 2025, is amended to read as follows:
   237.12  Injunctive relief.
   An individual or an agency who provides child foster care without obtaining a license under this chapter, or approval from the department to provide child foster care, or who knowingly violates this chapter or the rules promulgated pursuant to this chapter may be temporarily or permanently enjoined by a court in an action brought by the state, a political subdivision of the state or an interested person.
    Sec. 20.  Section 237.13, Code 2025, is amended to read as follows:
   237.13  Foster family home insurance fund.
   1.  For the purposes of this section, “foster home” means an individual, as defined in section 237.1, subsection 7, who is licensed to provide child foster care and shall also be known as a “licensed foster home”.
   2.  The foster family home insurance fund shall be administered by the department. The fund shall consist of all moneys appropriated by the general assembly for deposit in the fund. The department shall use moneys in the fund to provide home and property coverage for foster parents to cover damages to property resulting from the actions of a foster child residing in a foster family home or to reimburse foster parents for the cost of purchasing foster care liability insurance and to perform the administrative functions necessary to carry out this section. The department may establish limitations of liability for individual claims as deemed reasonable by the department.
   3.  2.  The department shall adopt rules, pursuant to chapter 17A, to carry out the provisions of this section.
    Sec. 21.  Section 237.15, subsection 1, paragraph a, Code 2025, is amended to read as follows:
   a.  The efforts to place the child with a relative or fictive kin.
    Sec. 22.  Section 237.15, subsection 5, Code 2025, is amended by striking the subsection.
    Sec. 23.  Section 237A.3A, subsection 1, paragraph d, Code 2025, is amended to read as follows:
   d.  A person who holds a child foster care license licensee under chapter 237 shall register as a child development home provider in order to provide child care.
    Sec. 24.  Section 237C.1, subsection 2, paragraph f, Code 2025, is amended to read as follows:
   f.  Care furnished by a child foster care facility licensed licensee under chapter 237.
    Sec. 25.  Section 237C.3, subsection 2, Code 2025, is amended to read as follows:
   2.  Standards established by the department under this chapter shall at a minimum address the basic health and educational needs of children; protection of children from mistreatment, abuse, and neglect; background and records checks of persons providing care to children in facilities certified under this chapter; the use of seclusion, restraint, or other restrictive interventions; health; safety; emergency; and the physical premises on which care is provided by a children’s residential facility. The background check requirements shall be substantially equivalent to those applied under chapter 237 for a child foster care facility provider licensee.
    Sec. 26.  Section 282.19, subsection 2, Code 2025, is amended to read as follows:
   2.  A child who is living in a licensed individual or agency child foster care facility, as defined in section 237.1, or in an unlicensed relative foster care placement, shall remain enrolled in and attend an accredited school in the school district in which the child resided and is enrolled at the time of placement, unless it is determined by the juvenile court or the public or private agency of this state that has responsibility for the child’s placement that remaining in such school is not in the best interests of the child. If such a determination is made, the child may attend an accredited school located in the school district in which the child is living and not in the school district in which the child resided prior to receiving foster care.
    Sec. 27.  Section 335.25, subsection 2, paragraph c, Code 2025, is amended to read as follows:
   c.  “Family home” means a community-based residential home which is licensed as a residential care facility under chapter 135C or as a child foster care facility under chapter 237 to provide room and board, personal care, habilitation services, and supervision in a family environment exclusively for not more than eight persons with a developmental disability or brain injury and any necessary support personnel. However, family home does not mean an individual a foster family home licensed under chapter 237.
    Sec. 28.  Section 414.22, subsection 2, paragraph c, Code 2025, is amended to read as follows:
   c.  “Family home” means a community-based residential home which is licensed as a residential care facility under chapter 135C or as a child foster care facility under chapter 237 to provide room and board, personal care, habilitation services, and supervision in a family environment exclusively for not more than eight persons with a developmental disability or brain injury and any necessary support personnel. However, family home does not mean an individual a foster care family home licensed under chapter 237.
    Sec. 29.  Section 423.3, subsection 18, paragraph b, Code 2025, is amended to read as follows:
   b.  Residential facilities licensed by the department of health and human services pursuant to chapter 237, other than those maintained by individuals an individual as defined in section 237.1, subsection 7.
    Sec. 30.  Section 709.16, subsection 2, paragraph b, subparagraph (1), Code 2025, is amended to read as follows:
   (1)  A child foster care facility licensed under section 237.4 chapter 237.
    Sec. 31.  RULES.  The department of health and human services shall adopt rules pursuant to chapter 17A to administer this division of this Act, including rules for the approval of relatives or fictive kin to provide child foster care.
DIVISION III
CHILD AND DEPENDENT ADULT ABUSE

    Sec. 32.  Section 235A.1, subsection 1, paragraph b, Code 2025, is amended to read as follows:
   b.  Funds for the programs or projects shall be applied for and received by a community-based volunteer coalition or council entity.
    Sec. 33.  Section 235A.15, subsection 1, Code 2025, is amended to read as follows:
   1.  Notwithstanding chapter 22, the Child abuse information shall be confidential and shall not be a public record under chapter 22. The confidentiality of all child abuse information shall be maintained, except as specifically provided by this section.
    Sec. 34.  Section 235B.2, subsection 5, paragraph a, subparagraph (1), subparagraph division (c), Code 2025, is amended to read as follows:
   (c)  Exploitation of a dependent adult which means the act or process of taking unfair advantage an individual, including a caregiver or fiduciary, that uses the resources of a dependent adult or the adult’s physical or financial resources, without the informed consent of the dependent adult, including theft, by the use of undue influence, harassment, duress, deception, false representation, or false pretenses for monetary or personal benefit, profit, or gain, or that results in depriving a dependent adult of rightful access to, or use of, benefits, resources, belongings, or assets.
    Sec. 35.  Section 235B.3, subsection 7, Code 2025, is amended to read as follows:
   7.  a.  Upon a showing of probable cause that a dependent adult has been abused, a court may authorize a person, also authorized by the department, to make an evaluation, to enter the residence of, and to examine the dependent adult.
   b.  Upon a showing of probable cause that there has been exploitation of a dependent adult has been financially exploited, a court may authorize a person, also authorized by the department, to make an evaluation, and to gain access to the financial records that the department reasonably believes are related to the resources of the dependent adult.
    Sec. 36.  Section 235B.6, subsection 1, Code 2025, is amended to read as follows:
   1.  Notwithstanding chapter 22, the Dependent adult abuse information shall be confidential and shall not be a public record under chapter 22. The confidentiality of all dependent adult abuse information shall be maintained, except as specifically provided by subsections 2 and 3.
    Sec. 37.  Section 235B.6, subsection 2, paragraph e, subparagraph (2), Code 2025, is amended to read as follows:
   (2)  Registry or department personnel when necessary to the performance of their official duties, or a person, an instrumentality of the state, or an agency under contract with the department to carry out official duties and functions of the registry.
    Sec. 38.  Section 249A.4, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  16.  Require providers to share information with the department as necessary to identify, prevent, or respond to child abuse as defined in section 232.68, and dependent adult abuse as defined in section 235B.2.
DIVISION IV
DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CONFIDENTIALITY OF INTERNAL AUDIT AND EXAMINATION INFORMATION

    Sec. 39.  Section 11.41, subsection 4, paragraph a, Code 2025, is amended by adding the following new subparagraph:
   NEW SUBPARAGRAPH.  (10)  Information created or received by the department of health and human services in the course of an internal audit or examination, including any allegations of misconduct or noncompliance and all audit or examination workpapers, as specified in section 217.31A.
    Sec. 40.  NEW SECTION.  217.31A  Internal audits and examinations —— confidentiality.
   1.  Information created or received by the department in the course of an internal audit or examination, including any allegations of misconduct or noncompliance, and all audit or examination workpapers, shall be maintained as confidential.
   2.  Information maintained as confidential under subsection 1 may be disclosed for any of the following reasons:
   a.  As necessary to complete the audit or examination.
   b.  To the extent the department’s auditor is required by law to report the same or to testify in court.
DIVISION V
REGION INCENTIVE FUND —— DISTRIBUTIONS AND TRANSFERS

    Sec. 41.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— BEHAVIORAL HEALTH SERVICES SYSTEM —— REGION INCENTIVE FUND.
   1.  For purposes of this section:
   a.  “Administrative services organization” means the same as defined in 2024 Iowa Acts, chapter 1161, section 1.
   b.  “Behavioral health fund” means the behavioral health fund established in 2024 Iowa Acts, chapter 1161, section 7, subsection 2.
   c.  “Behavioral health services system” means the behavioral health services system established in 2024 Iowa Acts, chapter 1161, section 3, subsection 1.
   d.  “Mental health and disability services system” means the mental health and disability services system described in section 225C.6B.
   2.  Notwithstanding any provision of law to the contrary, there is appropriated from the region incentive fund created in section 225C.7A, subsection 8, to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, an amount necessary to ensure the continuity of care for persons transferring from the mental health and disability services system to the behavioral health services system, and for distribution to administrative services organizations to be used for expenses related to the duties of the administrative services organizations under the behavioral health services system.
   3.  Moneys distributed to and used by an administrative services organization pursuant to subsection 1, shall not be considered in the computation of any limit on the administrative costs of an administrative services organization including those prescribed in 2024 Iowa Acts, chapter 1161, section 7, subsection 5.
   4.  Moneys in the mental health and disability services regional service fund established in section 225C.7A, subsection 1, that remain unencumbered or unobligated on June 30, 2025, shall be transferred to the behavioral health fund.
    Sec. 42.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
    Sec. 43.  RETROACTIVE APPLICABILITY.  This division of this Act applies retroactively to July 1, 2024.
DIVISION VI
HEALTH MAINTENANCE ORGANIZATION —— APPLICABLE PERCENTAGE FOR PREMIUM TAX

    Sec. 44.  Section 432.1, subsection 2, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   The “applicable percent” for purposes of subsection 1 of this section, section 432.1B, and section 432.2 is the following:
    Sec. 45.  Section 432.1B, subsection 1, Code 2025, is amended to read as follows:
   1.  Pursuant to section 514B.31, subsection 3, a health maintenance organization contracting with the department of health and human services to administer the medical assistance program under chapter 249A, shall pay as taxes to the director of the department of revenue for deposit in the Medicaid managed care organization premiums fund created in section 249A.13, an amount equal to two and one-half the applicable percent of the premiums received and taxable under section 514B.31, subsection 3.
    Sec. 46.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
    Sec. 47.  RETROACTIVE APPLICABILITY.  This division of this Act applies retroactively to January 1, 2024.
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 matters under the purview of the department of health and human services (HHS).
   DIVISION I —— ADMINISTRATIVE SERVICES ORGANIZATIONS. The bill excludes persons employed by an administrative services organization (ASO) from the definition of an employee for the purposes of the Iowa public employees’ retirement system.
   The bill prohibits an ASO, or an officer or an employee of an ASO, from acting as a county’s advocate to represent the interests of patients involuntarily hospitalized by the court in matters relating to a patient’s hospitalization or treatment.
   DIVISION II —— CHILD FOSTER CARE. Under current law, a person’s periodic support payments pursuant to an order or judgment are deemed assigned to HHS if the person is or has a child receiving foster care services. The assignment does not apply when a child is placed with a relative or fictive kin of the child who is not licensed to provide child foster care. The bill permits the assignment unless the relative or fictive kin is not licensed to provide child foster care and not approved by HHS to provide services as specified by HHS.
   The bill defines “fictive kin” as an adult person who is not a relative of a child but who has an emotionally positive significant relationship with the child or the child’s family.
   The bill defines “foster family home” as a licensed single-family home environment in which an individual provides child foster care.
   The bill includes within the Code chapter 237 (child foster care facilities) definition of “licensee”, an individual who has been approved by HHS to provide child foster care.
   The bill makes several changes to Code chapter 237 and to Code sections 232.78 (temporary custody of a child pursuant to ex parte court order), 232.98 (hearing concerning temporary removal), 232.102 (transfer of legal custody of child and placement), 234.1 (child and family services —— definitions), 234.39 (child and family services —— responsibility for costs of services), 237A.3A (child development homes), and 423.3 (streamlined sales and use tax Act —— exemptions).
   DIVISION III —— CHILD AND DEPENDENT ADULT ABUSE. The bill allows a community-based entity to apply for and receive funds appropriated to HHS by the general assembly for child abuse prevention. Under current law, only a community-based volunteer coalition or council can apply for and receive such funds.
   The bill makes child abuse information, and information obtained in the course of an assessment or evaluation of a report of dependent adult abuse, confidential records.
   The bill defines “exploitation of a dependent adult” as the act or process of an individual, including a caregiver or fiduciary, that uses the resources of a dependent adult for monetary or personal benefit, profit, or gain, or that results in depriving a dependent adult of rightful access to, or use of, benefits, resources, belongings, or assets.
   Under current law, upon a showing of probable cause that a dependent adult has been financially exploited a court may authorize a person, who is also authorized by HHS, to gain access to the financial records of the dependent adult. The bill amends the statute so the person authorized by the court and HHS can gain access to financial records that HHS has a reasonable belief are related to the financial resources of the dependent adult.
   The bill authorizes an instrumentality of the state to access dependent adult abuse records.
   The bill requires the director of HHS to require providers under the medical assistance program to share information with HHS as necessary to identify, prevent, or respond to child or dependent adult abuse.
   DIVISION IV —— DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CONFIDENTIALITY OF INTERNAL AUDIT AND EXAMINATION INFORMATION.  The bill makes information, including allegations of misconduct or noncompliance and audit or examination workpapers, created or received by HHS during an internal audit or examination (information) confidential. HHS may disclose the information as necessary to complete an audit or examination, or to the extent HHS’s auditor is required by law to report the same or to testify in court. The bill also prevents the state auditor from accessing the information except as required to comply with the standards for engagement described in Code section 11.3 (when audits and examinations begin), to comply with state or federal regulations, or in case of alleged or suspected embezzlement or theft.
   DIVISION V —— REGION INCENTIVE FUND —— DISTRIBUTIONS AND TRANSFERS. The bill appropriates from the region incentive fund of the mental health and disability services regional service fund to HHS for FY 2024-2025, an amount as necessary to ensure the continuity of care for persons transferring services from the mental health and disability services system to the behavioral health services system (BHSS) and for distribution to ASOs to be used for expenses related to the duties of the ASO under the BHSS. The moneys used by an ASO do not count toward any limit on the ASO’s administrative costs.
   The bill requires any unobligated and unencumbered moneys remaining in the mental health and disability services regional service fund on June 30, 2025, to be transferred to the behavioral health fund.
   This division of the bill is effective upon enactment and applies retroactively to July 1, 2024.
   DIVISION VI —— HEALTH MAINTENANCE ORGANIZATION —— APPLICABLE PERCENTAGE FOR PREMIUM TAX. Under current law, a health maintenance organization contracting with HHS to administer the medical assistance program must pay taxes to the director of the department of revenue for deposit in the Medicaid managed care organization premiums fund, an amount equal to 2.5 percent of the premiums received and taxable. The bill changes such amount to the applicable percent of the premiums received and taxable. The “applicable percent” is defined in Code section 432.1(2) (tax on gross premiums —— exclusions), and is .95 percent for the 2025 calendar year, .925 percent for the 2026 calendar year, and .9 percent for the 2027 calendar year and all subsequent calendar years.
   This division of the bill is effective upon enactment and applies retroactively to January 1, 2024.