House File 2518 - Introduced HOUSE FILE 2518 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 621) A BILL FOR An Act relating to reporting requirements for the department 1 of health and human services for shelter care, qualified 2 residential treatment providers, and medical assistance 3 provider reimbursement rates. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5344HV (1) 91 ak/ko

H.F. 2518 Section 1. Section 235.2, Code 2026, is amended by adding 1 the following new subsection: 2 NEW SUBSECTION . 9. Upon implementation by the department 3 of a uniform cost report for shelter care and qualified 4 residential treatment providers, the department shall 5 biennially conduct a review of shelter care and qualified 6 residential treatment provider costs compared to current 7 shelter care and qualified residential treatment provider 8 rates. On or before October 1 of the calendar year immediately 9 succeeding the calendar year in which the review is conducted, 10 the department shall submit a report to the governor and the 11 general assembly detailing the results of the department’s 12 review and recommendations for rate adjustments. 13 Sec. 2. Section 249A.4, Code 2026, is amended by adding the 14 following new subsection: 15 NEW SUBSECTION . 15. a. Conduct an annual review of 16 provider reimbursement rates for all medical and health 17 services provided pursuant to this chapter. The department 18 shall compare each provider reimbursement rate to the 19 reimbursement rates for all of the following: 20 (1) Medicaid programs in states contiguous to Iowa. 21 (2) Medicaid programs in states with populations comparable 22 to Iowa as based on the most recent decennial census released 23 by the United States census bureau. 24 (3) The federal Medicare program, if applicable. 25 b. The department shall submit an annual report that 26 summarizes the department’s review under paragraph “a” to the 27 general assembly on or before December 1. 28 Sec. 3. NEW SECTION . 249A.32C Home and community-based 29 service waivers —— provider rate limits. 30 1. For purposes of this section: 31 a. “Consumer” means the same as defined in section 249A.29. 32 b. “Provider” means the same as defined in section 249A.29. 33 c. “Waiver” means the same as defined in section 249A.29. 34 2. a. Beginning July 1, 2026, the department, with input 35 -1- LSB 5344HV (1) 91 ak/ko 1/ 3

H.F. 2518 from the public, providers, and other stakeholders, shall 1 conduct a review at least biennially of provider reimbursement 2 rates for all services rendered under a waiver during the 3 period of review specified by the department. The review shall 4 include but is not limited to all of the following: 5 (1) Aggregate cost to the state to reimburse providers for 6 services rendered to consumers under a waiver. 7 (2) Utilization of services available to consumers. 8 (3) The demonstrated capacity of providers to meet consumer 9 demand for services with available resources and indicators of 10 need for increased resources. 11 b. Based upon the review pursuant to paragraph “a” , the 12 department shall develop proposed rate models and related 13 changes to departmental policy and procedures. The department 14 shall submit a report to the general assembly on or before 15 December 31 of the year in which the review is completed 16 and must include proposed rate models, the projected fiscal 17 impact of implementing the proposed rate models including 18 documentation supporting the actuarial soundness of the 19 proposed rate models, and the proposed changes to the 20 department’s policies and procedures. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 This bill relates to reporting requirements for the 25 department of health and human services (HHS) for shelter 26 care, qualified residential treatment providers, and medical 27 assistance provider reimbursement rates. 28 The bill requires that upon implementation of a uniform cost 29 report for shelter care and qualified residential treatment 30 providers, HHS shall biennially conduct a rate review. On or 31 before October 1 of the calendar year following completion of 32 the review, HHS shall report the results of the review and 33 provide recommendations for rate adjustments to the governor 34 and the general assembly. 35 -2- LSB 5344HV (1) 91 ak/ko 2/ 3

H.F. 2518 The bill requires HHS to conduct an annual review of rates 1 for all medical and health services provided under the medical 2 assistance program. HHS shall compare each rate to the 3 rates for Medicaid programs in states contiguous to Iowa, in 4 states with populations comparable to Iowa, and to the federal 5 Medicare program, if applicable. The bill requires HHS to 6 submit an annual report to the general assembly that summarizes 7 the review. 8 The bill requires HHS, with input from the public, 9 providers, and other stakeholders, to conduct a review at 10 least biennially beginning on July 1, 2026, of rates for 11 services rendered under home and community-based services 12 waivers (waivers) during the period of review specified by HHS; 13 the review shall include the aggregate cost to the state and 14 consumer utilization of waivers, along with the demonstrated 15 capacity of providers to meet consumer demand for services 16 with available resources and indicators of need for more 17 resources. The bill requires HHS to use the findings of the 18 review to develop proposed rate models and related changes to 19 HHS policies and procedures. The bill defines “consumer”, 20 “provider”, and “waiver”. 21 The bill requires HHS to submit to the general assembly, on 22 or before December 31 of the year that the review is completed, 23 a report detailing the proposed rate models, the fiscal impact 24 of implementing such rates with documents supporting the 25 actuarial soundness of the models, and the proposed changes to 26 HHS policies and procedures. 27 -3- LSB 5344HV (1) 91 ak/ko 3/ 3