House File 1049 - Introduced HOUSE FILE 1049 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO HSB 342) A BILL FOR An Act relating to and making appropriations to the department 1 of veterans affairs and the department of health and human 2 services, and related provisions and appropriations, 3 including aging and disability services; behavioral health, 4 public health, community access and eligibility; the 5 medical assistance program, state supplementary assistance, 6 Hawki, and other health-related programs; sex reassignment 7 surgeries or associated procedures; family well-being and 8 protection; state-operated specialty care, administration 9 and compliance; transfers, cash flows, and nonreversions; 10 prior appropriations; the beer and liquor control fund, 11 and the behavioral health fund; report on nonreversion of 12 moneys; emergency rules; and a hospital directed payment 13 program; and including effective date and retroactive 14 applicability provisions. 15 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 16 TLSB 1004HV (1) 91 lh/ko

H.F. 1049 DIVISION I 1 DEPARTMENT OF VETERANS AFFAIRS —— FY 2025-2026 2 Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is 3 appropriated from the general fund of the state to the 4 department of veterans affairs for the fiscal year beginning 5 July 1, 2025, and ending June 30, 2026, the following amounts, 6 or so much thereof as is necessary, to be used for the purposes 7 designated: 8 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 9 For salaries, support, maintenance, and miscellaneous 10 purposes, and for not more than the following full-time 11 equivalent positions: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14 2. IOWA VETERANS HOME 15 For salaries, support, maintenance, and miscellaneous 16 purposes: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 18 a. The Iowa veterans home billings involving the department 19 of health and human services shall be submitted to the 20 department on at least a monthly basis. 21 b. The Iowa veterans home expenditure report shall be 22 submitted monthly to the general assembly. 23 3. HOME OWNERSHIP ASSISTANCE PROGRAM 24 For transfer to the Iowa finance authority for the 25 continuation of the home ownership assistance program for 26 persons who are or were eligible members of the armed forces 27 of the United States or eligible service members pursuant to 28 section 16.54: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 30 DIVISION II 31 AGING AND DISABILITY SERVICES —— FY 2025-2026 32 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 33 AND DISABILITY SERVICES. There is appropriated from the 34 general fund of the state to the department of health and human 35 -1- LSB 1004HV (1) 91 lh/ko 1/ 35

H.F. 1049 services for the fiscal year beginning July 1, 2025, and ending 1 June 30, 2026, the following amount, or so much thereof as is 2 necessary, to be used for the purposes designated: 3 For aging programs for the department of health and human 4 services and area agencies on aging to provide citizens of 5 Iowa who are 60 years of age and older with case management; 6 for Iowa’s aging and disabilities resource centers; for the 7 return to community program; for the purposes of chapter 231E; 8 to administer the prevention of elder abuse, neglect, and 9 exploitation program pursuant to section 231.56A, in accordance 10 with the requirements of the federal Older Americans Act of 11 1965, 42 U.S.C. §3001 et seq., as amended; for the operation 12 of the dependent adult abuse services program pursuant to 13 chapter 235B; for other services which may include but are not 14 limited to adult day care, respite care, chore, information 15 and assistance, and material aid; for information and options 16 counseling for persons with disabilities; and for salaries, 17 support, administration, maintenance, and miscellaneous 18 purposes, and for not more than the following full-time 19 equivalent positions: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,208,180 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 88.00 22 1. Moneys appropriated in this section may be used to 23 supplement federal moneys received under federal regulations. 24 To receive moneys appropriated in this section, a local area 25 agency on aging shall match the moneys with moneys from other 26 sources according to rules adopted by the department. Moneys 27 appropriated in this section may be used for services not 28 specifically enumerated in this section only if approved by the 29 department as part of an area agency on aging’s area plan. 30 2. Of the moneys appropriated in this section, $949,282 31 shall be used for the family support center component of the 32 comprehensive family support program under section 225C.47. 33 3. Of the moneys appropriated in this section, $33,632 shall 34 be used to build community capacity through the coordination 35 -2- LSB 1004HV (1) 91 lh/ko 2/ 35

H.F. 1049 and provision of training opportunities in accordance with the 1 consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 2 Iowa, July 15, 1994). 3 DIVISION III 4 BEHAVIORAL HEALTH —— FY 2025-2026 5 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 6 BEHAVIORAL HEALTH. There is appropriated from the general fund 7 of the state to the department of health and human services for 8 the fiscal year beginning July 1, 2025, and ending June 30, 9 2026, the following amount, or so much thereof as is necessary, 10 to be used for the purposes designated: 11 For behavioral health prevention, treatment, and recovery 12 efforts to reduce the prevalence of the use of, provide 13 treatment for, and support recovery from alcohol, tobacco, and 14 substance use and misuse, problem gambling, and other addictive 15 behaviors. Activities shall align with accepted best practice 16 guidance standards for behavioral health including those 17 published by the centers for disease control and prevention of 18 the United States department of health and human services, and 19 the substance abuse and mental health services administration 20 of the United States department of health and human services, 21 for health promotion; universal, selective, and indicated 22 prevention; treatment; and recovery services and supports; and 23 shall include a 24-hour helpline, public information resources, 24 professional training, youth prevention, program evaluation, 25 and efforts at the state and local levels, and for not more 26 than the following full-time equivalent positions: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,442,121 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 71.00 29 1. Of the moneys appropriated in this section, $300,000 30 shall be used to support the work of the children’s behavioral 31 health system including evidence-based behavioral health 32 prevention, treatment, and recovery services and supports for 33 children and their families pursuant to the intent specified in 34 section 225C.6B, subsection 1. 35 -3- LSB 1004HV (1) 91 lh/ko 3/ 35

H.F. 1049 2. Of the moneys appropriated in this section, $950,000 1 shall be used for an integrated substance use disorder managed 2 care system. The department shall maintain the level of mental 3 health and substance use disorder treatment services provided 4 by the managed care contractors, and shall take the steps 5 necessary to continue the federal waivers as needed to maintain 6 the level of services. 7 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 8 WAGERING RECEIPTS FUND. There is appropriated from the 9 sports wagering receipts fund created in section 8.57I, to the 10 department of health and human services for the fiscal year 11 beginning July 1, 2025, and ending June 30, 2026, the following 12 amount, or so much thereof as is necessary, to be used for 13 behavioral health prevention, treatment, and recovery efforts 14 to reduce the prevalence of the use of, provide treatment for, 15 and support recovery from alcohol, tobacco, and substance use 16 and misuse, problem gambling, and other addictive behaviors: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 18 DIVISION IV 19 PUBLIC HEALTH —— FY 2025-2026 20 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 21 HEALTH. There is appropriated from the general fund of the 22 state to the department of health and human services for the 23 fiscal year beginning July 1, 2025, and ending June 30, 2026, 24 the following amount, or so much thereof as is necessary, to be 25 used for the purposes designated: 26 For programs that support health promotion, protect the 27 health and safety of the public, conduct disease surveillance 28 and investigation to reduce the incidence of morbidity and 29 mortality, serve individuals with chronic conditions including 30 but not limited to cancer, support the Iowa donor registry as 31 specified in section 142C.18, and strengthen the health care 32 delivery system and workforce to improve health outcomes for 33 all Iowans, and for not more than the following full-time 34 equivalent positions: 35 -4- LSB 1004HV (1) 91 lh/ko 4/ 35

H.F. 1049 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,433,369 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 348.60 2 1. Of the moneys appropriated in this section, the following 3 amounts are allocated to the department of health and human 4 services to be used as follows to support the goals of 5 increased access, health system integration, and engagement: 6 a. $600,000 for distribution to a nonprofit organization 7 that established the first statewide drug donation repository 8 for continuation of the pharmaceutical infrastructure for 9 safety net providers established as described in 2007 Iowa 10 Acts, chapter 218, section 108, and for the prescription drug 11 donation repository program established in chapter 135M. 12 Moneys under this paragraph shall be distributed in their 13 entirety on July 1, 2025, for the purpose specified. 14 b. $374,000 for distribution to free clinics, as defined in 15 section 135.24, and a nonprofit organization that facilitates 16 the initiation, operation, and collaboration of free clinics 17 for necessary infrastructure, statewide coordination, provider 18 recruitment, service delivery, and provision of assistance to 19 patients in securing a medical home inclusive of oral health 20 care. Of the moneys allocated, $40,000 shall be used to lower 21 fees associated with using an electronic prescribing system. 22 Moneys under this paragraph shall be distributed in their 23 entirety on July 1, 2025, for the purpose specified. 24 c. $25,000 for distribution to an organization that raises 25 awareness about issues related to rural health clinics for 26 necessary infrastructure and service delivery transformation. 27 Moneys under this paragraph shall be distributed in their 28 entirety on July 1, 2025, for the purpose specified. 29 d. $225,000 for distribution to an organization that is 30 the oldest continuously operating medical society in the most 31 populous county in the state according to the most recently 32 published census for continuation of safety net provider 33 patients access to specialty care as described in 2007 Iowa 34 Acts, chapter 218, section 109. Moneys under this paragraph 35 -5- LSB 1004HV (1) 91 lh/ko 5/ 35

H.F. 1049 shall be distributed in their entirety on July 1, 2025, for the 1 purpose specified. 2 2. Of the moneys appropriated in this section, $600,000 3 shall be used for rural psychiatric residencies for residents 4 selected on or before June 30, 2025. 5 3. Of the moneys appropriated in this section, $20,000 shall 6 be used to make radon test kits available, free of charge, to 7 homeowners and renters in the state. The department shall 8 provide a link on the department’s internet site for homeowners 9 and renters in the state to order radon test kits. 10 4. Of the moneys appropriated in this section, $2,300,000 11 shall be used for Medicaid graduate medical education efforts 12 and consistent with the purpose of the department’s request for 13 approval to the centers of Medicare and Medicaid services of 14 the United States department of health and human services for 15 a Medicaid supplemental enhanced payment for the purposes of 16 maximizing federal funding opportunities for graduate medical 17 education as described in 2025 Iowa Acts, House File 972, or 18 successor legislation. 19 5. The university of Iowa hospitals and clinics under 20 the control of the state board of regents shall not receive 21 indirect costs from the moneys appropriated in this section. 22 The university of Iowa hospitals and clinics billings to the 23 department shall be, at a minimum, on a quarterly basis. 24 DIVISION V 25 COMMUNITY ACCESS AND ELIGIBILITY —— FY 2025-2026 26 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 27 ACCESS AND ELIGIBILITY. There is appropriated from the 28 general fund of the state to the department of health and human 29 services for the fiscal year beginning July 1, 2025, and ending 30 June 30, 2026, the following amount, or so much thereof as is 31 necessary, to be used for the purposes designated: 32 To be used for salaries, support, maintenance, and 33 miscellaneous purposes and for family investment program (FIP) 34 assistance in accordance with chapter 239B, and for other costs 35 -6- LSB 1004HV (1) 91 lh/ko 6/ 35

H.F. 1049 associated with providing needs-based benefits or assistance 1 including but not limited to maternal and child health, oral 2 health, obesity prevention, the promoting independence and 3 self-sufficiency through employment, job opportunities and the 4 basic skills (PROMISE JOBS) program, supplemental nutrition 5 assistance program (SNAP) employment and training, the FIP 6 diversion program, family planning, rent reimbursement, 7 and eligibility determinations for medical assistance, food 8 assistance, and the children’s health insurance program, and 9 for not more than the following full-time equivalent positions: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,542,456 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 870.40 12 1. Of the child support collections assigned under FIP, 13 the federal share of the child support collections shall be 14 credited to the child support services appropriation made in 15 this division of this Act. Of the remainder of the child 16 support collections assigned under FIP, a portion shall be 17 credited to community access and eligibility, and the remaining 18 moneys may be used to increase recoveries, to sustain cash flow 19 in the collection services center refund account as provided in 20 section 252B.13A, or for technology needs. If child support 21 collections assigned under FIP are greater than estimated or 22 are otherwise determined not to be required for maintenance of 23 efforts, the state share of either amount is appropriated to 24 the department for child support services as described in this 25 Act, or may be transferred to or retained in the collection 26 services center refund account. 27 2. Of the moneys appropriated in this section, $3,075,000 28 shall be used for continuation of the department’s initiative 29 to provide for adequate developmental surveillance and 30 screening during a child’s first five years. The moneys shall 31 be used first to fully fund the current participating counties 32 to ensure that those counties are fully operational, with 33 the remaining moneys to be used for expanding participation 34 to additional counties. Full implementation and expansion 35 -7- LSB 1004HV (1) 91 lh/ko 7/ 35

H.F. 1049 shall include enhancing the scope of the initiative through 1 collaboration with child health specialty clinics to promote 2 the use of developmental surveillance and screening to 3 support healthy child development through early identification 4 and response to both biomedical and social determinants of 5 healthy development by providing practitioner consultation 6 and continuous improvement through training and education, 7 particularly for children with behavioral conditions and 8 needs. The department shall also collaborate with the Medicaid 9 program and child health specialty clinics to assist in 10 coordinating the activities of the first five initiative into 11 the establishment of patient-centered medical homes developed 12 to improve health quality and population health while reducing 13 health care costs. To the maximum extent possible, moneys 14 allocated in this subsection shall be utilized as matching 15 moneys for Medicaid program reimbursement. 16 3. Of the moneys appropriated in this section, $1,145,102 17 is allocated to the Iowa commission on volunteer service for 18 programs and grants. 19 4. The university of Iowa hospitals and clinics under 20 the control of the state board of regents shall not receive 21 indirect costs from the moneys appropriated in this section. 22 The university of Iowa hospitals and clinics billings to the 23 department shall be, at a minimum, on a quarterly basis. 24 CHILD SUPPORT SERVICES 25 Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from 26 the general fund of the state to the department of health and 27 human services for the fiscal year beginning July 1, 2025, and 28 ending June 30, 2026, the following amount, or so much thereof 29 as is necessary, to be used for the purposes designated: 30 For child support services, including salaries, support, 31 maintenance, and miscellaneous purposes, and for not more than 32 the following full-time equivalent positions: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 464.00 35 -8- LSB 1004HV (1) 91 lh/ko 8/ 35

H.F. 1049 1. Federal access and visitation grant moneys shall be used 1 for services designed to increase compliance with the child 2 access provisions of court orders, including but not limited to 3 neutral visitation sites and mediation services. 4 2. The appropriation made to the department for child 5 support services may be used throughout the fiscal year in the 6 manner necessary for purposes of cash flow management, and for 7 cash flow management purposes the department may temporarily 8 draw more than the amount appropriated provided the amount 9 appropriated is not exceeded at the close of the fiscal year. 10 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT 11 Sec. 8. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 12 GRANT. There is appropriated from the special fund created in 13 section 8.41 to the department of health and human services 14 for the fiscal year beginning July 1, 2025, and ending June 15 30, 2026, from moneys received under the federal temporary 16 assistance for needy families (TANF) block grant pursuant 17 to the federal Personal Responsibility and Work Opportunity 18 Reconciliation Act of 1996, Pub. L. No. 104-193, and successor 19 legislation, including any TANF block grant moneys received in 20 any prior fiscal year that were deposited in the special fund 21 and remain unencumbered or unobligated on June 30, 2025, the 22 following amounts, or so much thereof as is necessary, to be 23 used for the purposes designated: 24 1. For community access and eligibility: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627 26 2. For community access and eligibility to provide 27 pregnancy prevention grants on the condition that family 28 planning services are funded: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 30 Pregnancy prevention grants shall be awarded to programs 31 in existence on or before July 1, 2025, if the programs have 32 demonstrated positive outcomes. Grants shall be awarded 33 to pregnancy prevention programs developed after July 1, 34 2025, if the programs are based on existing models that have 35 -9- LSB 1004HV (1) 91 lh/ko 9/ 35

H.F. 1049 demonstrated positive outcomes. Grants shall comply with the 1 requirements provided in 1997 Iowa Acts, chapter 208, section 2 14, subsections 1 and 2, including the requirement that a 3 program awarded a grant must emphasize sexual abstinence. 4 Priority in the awarding of grants shall be given to programs 5 that serve areas of the state which demonstrate the highest 6 percentage of unplanned pregnancies of females of childbearing 7 age within the geographic area to be served by the grant. 8 3. To meet one of the four purposes of TANF as specified 9 in 45 C.F.R. §260.20, including by modernizing the program 10 to promote economic mobility and self-sufficiency, ensuring 11 that families are able to overcome benefit cliffs, encouraging 12 healthy families, and streamlining service delivery to reduce 13 duplication: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 25,000,000 15 4. For early intervention and supports for child 16 abuse prevention grants and the family development and 17 self-sufficiency (FaDSS) grant program in accordance with 18 section 216A.107: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,013,980 20 5. For accountability, compliance, program integrity, 21 technology needs, and other resources necessary to meet 22 federal and state reporting, tracking, and case management 23 requirements, and other departmental needs: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 25 6. For state child care assistance: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 27 7. For child protective services: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 65,364,100 29 DIVISION VI 30 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 31 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 32 PROGRAMS —— FY 2025-2026 33 Sec. 9. MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY 34 ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There 35 -10- LSB 1004HV (1) 91 lh/ko 10/ 35

H.F. 1049 is appropriated from the general fund of the state to the 1 department of health and human services for the fiscal year 2 beginning July 1, 2025, and ending June 30, 2026, the following 3 amount, or so much thereof as is necessary, to be used for the 4 purposes designated: 5 For medical assistance program reimbursement and associated 6 costs as specifically provided in the reimbursement 7 methodologies in effect on June 30, 2025, except as otherwise 8 expressly authorized by law, consistent with options under 9 federal law and regulations, and contingent upon receipt of 10 approval from the office of the governor of reimbursement for 11 each abortion performed under the medical assistance program; 12 for the state supplementary assistance program; for the health 13 insurance premium payment program; and for maintenance of 14 the healthy and well kids in Iowa (Hawki) program pursuant 15 to chapter 514I, including supplemental dental services, 16 for receipt of federal financial participation under Tit. 17 XXI of the federal Social Security Act, which creates the 18 children’s health insurance program; and for other specified 19 health-related programs: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,903,550,706 21 1. Of the moneys appropriated in this section, 22 $1,837,804,073 is allocated for medical assistance program 23 reimbursement and associated costs. 24 a. Of the moneys allocated in this subsection, $3,383,880 25 shall be used for program administration, outreach, and 26 enrollment activities of the state family planning services 27 program pursuant to section 217.41B, and of this amount, the 28 department may use $200,000 for administrative expenses. 29 b. Of the moneys allocated in this subsection, $3,050,000 30 shall be used to expand the capacity of intermittent 31 community-based services that allow an individual to remain 32 in the community and that provide support to the individual, 33 including employment services, hourly supported community 34 living services, respite services, and day habilitation 35 -11- LSB 1004HV (1) 91 lh/ko 11/ 35

H.F. 1049 services. 1 2. Iowans support reducing the number of abortions 2 performed in our state. Moneys appropriated under this section 3 shall not be used for abortions, unless otherwise authorized 4 under this section. 5 3. The provisions of this section relating to abortions 6 shall also apply to the Iowa health and wellness plan created 7 pursuant to chapter 249N. 8 4. Of the moneys appropriated in this section, $4,479,762 is 9 allocated for the state supplementary assistance program. 10 5. Of the moneys appropriated in this section, $61,266,871 11 is allocated for maintenance of the Hawki program pursuant 12 to chapter 514I, including supplemental dental services, for 13 receipt of federal financial participation under Tit. XXI of 14 the federal Social Security Act, which creates the children’s 15 health insurance program. 16 HEALTH PROGRAM OPERATIONS 17 Sec. 10. HEALTH PROGRAM OPERATIONS. There is appropriated 18 from the general fund of the state to the department of health 19 and human services for the fiscal year beginning July 1, 20 2025, and ending June 30, 2026, the following amount, or so 21 much thereof as is necessary, to be used for the purposes 22 designated: 23 For health program operations, and the autism support 24 program under section 225D.2, and for not more than the 25 following full-time equivalent positions: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,672,433 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 82.00 28 1. The department of inspections, appeals, and licensing 29 shall provide all state matching moneys for survey and 30 certification activities performed by the department of 31 inspections, appeals, and licensing. The department of health 32 and human services shall be solely responsible for distributing 33 the federal matching moneys for such activities. 34 2. Of the moneys appropriated in this section, a sufficient 35 -12- LSB 1004HV (1) 91 lh/ko 12/ 35

H.F. 1049 amount shall be allocated for the administration of the health 1 insurance premium payment program, including salaries, support, 2 maintenance, and miscellaneous purposes. 3 3. Of the moneys appropriated in this section, $750,000 4 shall be allocated for a nonprofit organization that provides 5 access to emergency poison information and treatment. Pursuant 6 to the directive under 2014 Iowa Acts, chapter 1140, section 7 102, the federal matching moneys available to the nonprofit 8 organization from the department under the federal Children’s 9 Health Insurance Program Reauthorization Act of 2009 shall be 10 subject to the federal administrative cap rule of 10 percent 11 applicable to moneys provided under Tit. XXI of the federal 12 Social Security Act and shall be included in the department’s 13 calculations of the cap. 14 4. Unless otherwise provided by law, if a contract for 15 services provided under this section initially entered into 16 during the fiscal year beginning July 1, 2025, and ending 17 June 30, 2026, provides for an annual increase of the cost of 18 services provided under the contract, the annual increase shall 19 not exceed the amount by which the consumer price index for 20 all urban consumers increased during the immediately preceding 21 calendar year. This subsection shall not affect a contract 22 entered into on or before June 30, 2025, that is for a term of 23 more than one year. 24 HEALTH CARE ACCOUNTS AND FUNDS 25 Sec. 11. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT 26 OF HEALTH AND HUMAN SERVICES. There is appropriated from the 27 pharmaceutical settlement account created in section 249A.33 to 28 the department of health and human services for the fiscal year 29 beginning July 1, 2025, and ending June 30, 2026, the following 30 amount, or so much thereof as is necessary, to be used for the 31 purposes designated: 32 Notwithstanding any provision of law to the contrary, to 33 supplement the appropriation made in this Act from the general 34 fund of the state for health program operations under the 35 -13- LSB 1004HV (1) 91 lh/ko 13/ 35

H.F. 1049 medical assistance program for the same fiscal year: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 2 Sec. 12. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF 3 HEALTH AND HUMAN SERVICES. Notwithstanding any provision of 4 law to the contrary, and subject to the availability of moneys, 5 there is appropriated from the quality assurance trust fund 6 created in section 249L.4 to the department of health and human 7 services for the fiscal year beginning July 1, 2025, and ending 8 June 30, 2026, the following amount, or so much thereof as is 9 necessary, for the purposes designated: 10 To supplement the appropriation made in this Act from the 11 general fund of the state to the department of health and human 12 services for medical assistance for the same fiscal year: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 14 Sec. 13. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 15 DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding 16 any provision of law to the contrary, and subject to the 17 availability of moneys, there is appropriated from the hospital 18 health care access trust fund created in section 249M.4 to the 19 department of health and human services for the fiscal year 20 beginning July 1, 2025, and ending June 30, 2026, the following 21 amount, or so much thereof as is necessary, for the purposes 22 designated: 23 To supplement the appropriation made in this Act from the 24 general fund of the state to the department of health and human 25 services for medical assistance for the same fiscal year: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 27 SEX REASSIGNMENT SURGERIES OR ASSOCIATED PROCEDURES 28 Sec. 14. NEW SECTION . 249A.14 Sex reassignment surgeries or 29 associated procedures —— reimbursement prohibited. 30 1. Moneys appropriated from the general fund of the state 31 to the department for the medical assistance program shall 32 not be used for reimbursement for sex reassignment surgery 33 or associated procedures, including hormone therapy or other 34 medical interventions intended to alter primary or secondary 35 -14- LSB 1004HV (1) 91 lh/ko 14/ 35

H.F. 1049 sex characteristics related to an individual’s gender dysphoria 1 diagnosis. 2 2. This section shall not be construed to prohibit Medicaid 3 program reimbursement for services not described under 4 subsection 1 that are otherwise covered under the Medicaid 5 program. 6 3. The department of health and human services shall adopt 7 rules pursuant to chapter 17A to administer this section. 8 REIMBURSEMENT RATES 9 Sec. 15. REIMBURSEMENT RATES. 10 1. Reimbursement for medical assistance, state 11 supplementary assistance, and social service providers and 12 services reimbursed under the purview of the department of 13 health and human services shall remain at the reimbursement 14 rate in effect on June 30, 2025, or shall be determined 15 pursuant to the reimbursement methodology in effect on June 30, 16 2025, with the exception of the following: 17 a. If reimbursement is otherwise negotiated by contract or 18 pursuant to an updated fee schedule. 19 b. As otherwise provided in this section of this Act. 20 2. Of the moneys appropriated for medical assistance 21 program reimbursement and associated costs as specifically 22 provided in the reimbursement methodologies June 30, 2025, the 23 following amounts, or so much thereof as is necessary, are 24 allocated to the department of health and human services to be 25 used for the following purposes: 26 a. (1) Notwithstanding any provision of law to the 27 contrary, for the fiscal year beginning July 1, 2025, and 28 ending June 30, 2026, the department of health and human 29 services shall rebase case-mix nursing facility rates beginning 30 July 1, 2025, using the Medicaid cost reports on file for 31 the period ending December 31, 2024, to the extent possible 32 within state funding, including no more than $20,000,000 33 from the allocation provided for medical assistance program 34 reimbursement and associated costs. 35 -15- LSB 1004HV (1) 91 lh/ko 15/ 35

H.F. 1049 (2) The department of health and human services shall 1 calculate each nursing facility’s case-mix index for the period 2 beginning July 1, 2024, using weighting based on the current 3 patient-driven payment model schedule. Rosters shall be 4 made to show a separate calculation to determine the average 5 case-mix index for a nursing-facility-wide case-mix index, and 6 a case-mix index for the residents of a nursing facility who 7 are Medicaid recipients using all minimum data set reports by 8 the nursing facility for the previous semiannual period using a 9 day weighted calculation. 10 b. For the fiscal year beginning July 1, 2025, $2,136,304 11 shall be used to increase to the extent possible reimbursement 12 rates for dentists, excluding orthodontic services, compared to 13 rates in effect on June 30, 2025. 14 c. For the fiscal year beginning July 1, 2025, $420,000 15 shall be used to increase to the extent possible reimbursement 16 rates for maternal health providers compared to the rates in 17 effect on June 30, 2025. 18 d. For the fiscal year beginning July 1, 2025, $100,000 19 shall be used to increase to the extent possible reimbursement 20 rates for prosthetics compared to rates in effect on June 30, 21 2025. 22 3. For the fiscal year beginning July 1, 2025, reimbursement 23 rates for home health agencies shall continue to be based 24 on the Medicare low utilization payment adjustment (LUPA) 25 methodology with state geographic wage adjustments, and shall 26 be adjusted to increase the rates to the extent possible. 27 4. For the fiscal year beginning July 1, 2026, and for 28 each fiscal year thereafter, the department shall review the 29 reimbursement rates for home health agencies and pharmacy 30 dispensing fees. 31 5. On or before December 15, 2025, the department shall 32 review the current rate limit calculation and application for 33 special population nursing facility rates. 34 -16- LSB 1004HV (1) 91 lh/ko 16/ 35