House File 2716 - Introduced HOUSE FILE 2716 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 696) A BILL FOR An Act relating to the supplemental nutrition assistance 1 program; the medical assistance program; the special 2 supplemental nutrition program for women, infants, and 3 children; and other public assistance programs under the 4 purview of the department of health and human services. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 5348HV (8) 91 ak/ko

H.F. 2716 DIVISION I 1 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 2 Section 1. NEW SECTION . 135.16E Supplemental nutrition 3 assistance program error rate —— report. 4 Beginning with the fiscal quarter that starts on October 5 1, 2026, and every fiscal quarter thereafter, within thirty 6 calendar days of transmission of data to the food and nutrition 7 services of the United States department of agriculture, the 8 department shall submit a report to the general assembly 9 detailing payment error rates associated with the supplemental 10 nutrition assistance program for the immediately preceding 11 fiscal quarter. For the purposes of this section, “supplemental 12 nutrition assistance program” has the same meaning as defined 13 in section 239.1. 14 Sec. 2. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 15 —— WAIVER OF EARNED INCOME RULES. 16 1. The department of health and human services shall 17 request a waiver from the food and nutrition services of the 18 United States department of agriculture to provide that, for 19 purposes of state administration of the supplemental nutrition 20 assistance program, the earned income under 21 7 C.F.R. §273.9(c)(7) of household members that meet all of the 22 following criteria shall be excluded from household income: 23 a. Less than twenty-two years of age. 24 b. Enrolled in an elementary or secondary school. 25 c. Resides with a natural parent, adoptive parent, 26 stepparent, or other household member who exercises parental 27 control over the household member described in paragraphs “a” 28 and “b”. 29 2. The department of health and human services shall 30 implement the waiver upon receipt of approval of the waiver 31 from the United States department of agriculture. 32 Sec. 3. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 33 —— WAIVER OF ELIGIBILITY VERIFICATION RULES. 34 1. The department of health and human services shall 35 -1- LSB 5348HV (8) 91 ak/ko 1/ 18

H.F. 2716 request a waiver from the food and nutrition services of the 1 United States department of agriculture to provide that, for 2 purposes of state administration of the supplemental nutrition 3 assistance program, information from the following automated 4 sources be considered verified upon receipt for purposes 5 of 7 C.F.R. §272.12(c): 6 a. The national directory of new hires maintained by the 7 office of child support services of the United States office 8 for the administration of children and families. 9 b. The unemployment insurance benefits data released by the 10 Iowa department of workforce development. 11 c. The United States social security administration 12 benefits, death, social security number, and citizenship 13 records. 14 d. The residency and identity data released by the United 15 States department of transportation. 16 e. The state incarceration data released by the Iowa 17 department of corrections. 18 f. The automated employment verification service known as 19 work number, or equivalent third-party income verification 20 platforms. 21 2. The department of health and human services shall 22 implement the waiver upon receipt of approval of the waiver 23 from the United States department of agriculture. 24 Sec. 4. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 25 —— WAIVER OF EXPUNGEMENT RULES. 26 1. The department of health and human services shall 27 request a waiver from the food and nutrition services of the 28 United States department of agriculture to provide that, for 29 purposes of state administration of the supplemental nutrition 30 assistance program, expungement of benefits on a household’s 31 electronic benefit account under 7 C.F.R. §274.2(i) be 32 permitted after three months or ninety-one days of inactivity, 33 or of benefits remaining, on the electronic benefit account. 34 2. The department of health and human services shall 35 -2- LSB 5348HV (8) 91 ak/ko 2/ 18

H.F. 2716 implement the waiver upon receipt of approval of the waiver 1 from the United States department of agriculture. 2 Sec. 5. FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM 3 —— WAIVER OF PAYMENT QUALITY CONTROL SAMPLING PROCEDURES. 4 1. The department of health and human services shall 5 request a waiver from the food and nutrition services of the 6 United States department of agriculture to provide that, for 7 purposes of state administration of the supplemental nutrition 8 assistance program, when reporting the state’s payment error 9 rate as outlined by 7 C.F.R. §275.14, and food and nutrition 10 services handbooks 310 and 311, the department of health and 11 human services be permitted to report the payment error rate 12 based only on errors directly attributable to the department. 13 2. The department of health and human services shall 14 implement the waiver upon receipt of approval of the waiver 15 from the United States department of agriculture. 16 DIVISION II 17 MEDICAL ASSISTANCE PROGRAM 18 Sec. 6. Section 249A.3, subsection 2, paragraph a, 19 subparagraph (1), Code 2026, is amended to read as follows: 20 (1) (a) As allowed under 42 U.S.C. 21 §1396a(a)(10)(A)(ii)(XIII), individuals with disabilities, 22 who are less than sixty-five years of age, who are members of 23 families whose income is less than two hundred fifty three 24 hundred percent of the most recently revised official poverty 25 guidelines published by the United States department of health 26 and human services for the family, who have earned income 27 and who are eligible for mandatory medical assistance or 28 optional medical assistance under this section if earnings are 29 disregarded. As allowed by 42 U.S.C. §1396a(r)(2), unearned 30 income shall also be disregarded in determining whether an 31 individual is eligible for assistance under this subparagraph. 32 For the purposes of determining the amount of an individual’s 33 resources under this subparagraph and as allowed by 42 U.S.C. 34 §1396a(r)(2), a maximum of ten thousand dollars of available 35 -3- LSB 5348HV (8) 91 ak/ko 3/ 18

H.F. 2716 resources for an individual and twenty-one thousand dollars 1 of available resources for a couple shall be disregarded, and 2 any additional resources held in a retirement account, in a 3 pension account, in a medical savings account, or in any other 4 account approved under rules adopted by the department shall 5 also be disregarded. 6 (b) Individuals eligible for assistance under this 7 subparagraph, whose individual income exceeds one hundred 8 fifty percent of the official poverty guidelines published 9 by the United States department of health and human services 10 for an individual, shall pay a premium. The amount of the 11 premium shall be based on a sliding fee schedule adopted by 12 rule of the department and shall be based on a percentage of 13 the individual’s income. The maximum premium payable by an 14 individual whose income exceeds one hundred fifty percent of 15 the official poverty guidelines shall be commensurate with 16 the cost of state employees’ group health insurance in this 17 state. The payment to and acceptance by an automated case 18 management system or the department of the premium required 19 under this subparagraph shall not automatically confer initial 20 or continuing program eligibility on an individual. The 21 department shall maintain a page on the department’s internet 22 site where individuals can electronically pay any premium owed 23 by an individual to the department. A premium paid to and 24 accepted by the department’s premium payment process that is 25 subsequently determined to be untimely or to have been paid on 26 behalf of an individual ineligible for the program shall be 27 refunded to the remitter in accordance with rules adopted by 28 the department. Any unpaid premium shall be a debt owed to the 29 department. 30 Sec. 7. Section 249A.4, Code 2026, is amended by adding the 31 following new subsections: 32 NEW SUBSECTION . 15. Submit a report to the general 33 assembly, including the official payment error rate and 34 a summary of the data submitted in the payment error rate 35 -4- LSB 5348HV (8) 91 ak/ko 4/ 18

H.F. 2716 measurement report, within thirty calendar days of receipt by 1 the department of the annual official payment error rate from 2 the centers for Medicare and Medicaid services of the United 3 States department of health and human services. 4 NEW SUBSECTION . 16. Submit an annual report to the general 5 assembly on or before October 1 on petitions for a waiver, also 6 referred to by the department as exceptions to policy, of rules 7 governing the Medicaid program filed pursuant to the rules of 8 the department. The report must include all the following for 9 the immediately preceding fiscal year: 10 a. The total number of exceptions to policy granted. 11 b. The cumulative cost of the exceptions to policy that were 12 granted. 13 c. The types of exceptions to policy that were granted. 14 d. Identifiable trends noted by the department including any 15 of the following: 16 (1) The number of exceptions to policy granted in a 17 particular geographic location. 18 (2) The types of Medicaid services that were the basis for 19 exceptions to policy. 20 (3) The Medicaid program eligibility classification of 21 individuals granted Medicaid program exceptions to policy. 22 Sec. 8. NEW SECTION . 249A.32C Home and community-based 23 service waivers —— rural provider rate increase. 24 1. For the purposes of this section, unless context 25 otherwise requires: 26 a. “Consumer” means the same as defined in section 249A.29. 27 b. “Rural area” means a geographical area that is not part 28 of a metropolitan statistical area as designated by the United 29 States office of management and budget. 30 c. “Waiver” means the same as defined in section 249A.29. 31 2. The base reimbursement rate for a provider of services 32 under a medical assistance program home and community-based 33 services waiver shall be increased to cover the travel time 34 and expenses incurred by the provider to provide services to a 35 -5- LSB 5348HV (8) 91 ak/ko 5/ 18

H.F. 2716 consumer who resides in a rural area. 1 Sec. 9. NEW SECTION . 249A.32D Waivers —— cost neutrality. 2 1. As used in this section, “cost neutral” means federal 3 approval of a waiver related to the medical assistance program 4 submitted by the department to the federal government will not 5 result in a net increase in spending for state administration 6 of the medical assistance program. 7 2. Prior to submitting a request for a waiver to the United 8 States department of health and human services related to 9 the medical assistance program, the department shall conduct 10 an analysis to determine if the waiver is cost neutral. For 11 any waiver that is determined to be not cost neutral, the 12 department shall not submit the request for a waiver unless the 13 waiver has been presented to the general assembly and approved 14 by a majority vote of both houses of the general assembly. 15 Sec. 10. MEDICAID EXCEPTIONS TO POLICY REVIEW —— REPORT 16 TO GENERAL ASSEMBLY. The department of health and human 17 services shall conduct a review of petitions for a waiver, 18 also referred to by the department as exceptions to policy, of 19 rules governing the Medicaid program granted by the department 20 between January 1, 2020, and January 1, 2026, and shall submit 21 a report on or before December 15, 2026, of the findings of the 22 review. The report shall include all of the following: 23 1. The total number of exceptions to policy granted. 24 2. The cumulative cost of the exceptions to policy that were 25 granted. 26 3. The types of exceptions to policy that were granted. 27 4. Identifiable trends noted by the department including 28 any of the following: 29 a. The number of exceptions to policy granted in a 30 particular geographic location. 31 b. The types of Medicaid services that were the basis for 32 the waiver. 33 c. The Medicaid program classification of individuals 34 granted exception to policy. 35 -6- LSB 5348HV (8) 91 ak/ko 6/ 18

H.F. 2716 Sec. 11. CONTINGENT EFFECTIVE DATE. The following takes 1 effect contingent upon receipt of federal approval by the 2 department of health and human services from the centers for 3 Medicare and Medicaid services of the United States department 4 of health and human services: 5 The section of this division of this Act amending section 6 249A.3, subsection 2, paragraph “a”, subparagraph (1), Code 7 2026, relating to Medicaid eligibility for employed individuals 8 with disabilities. 9 DIVISION III 10 ELIGIBILITY FOR CERTAIN PROGRAMS 11 Sec. 12. NEW SECTION . 234.6A Program eligibility —— 12 residency. 13 1. As used in this section, “public assistance program” 14 means any of the following: 15 a. The state child care assistance program under section 16 237A.13. 17 b. The family investment program under chapter 239B. 18 c. The medical assistance program under chapter 249A. 19 d. The supplemental nutrition assistance program 20 administered by the state pursuant to 7 C.F.R. pts. 270 – 283, 21 as amended. 22 e. The special supplemental nutrition program for women, 23 infants, and children as provided in 42 U.S.C. §1786 et seq. 24 2. a. Unless prohibited under federal law, the department 25 may require from an applicant to a public assistance program 26 proof of at least twelve months of continuous residency within 27 the state including any of the following: 28 (1) A statement from the applicant attesting to the 29 applicant’s reasons for being in the state and length of 30 residency within the state. 31 (2) A statement from the applicant’s employer confirming 32 the applicant’s employment in the state. 33 (3) Any other statement from other persons with knowledge 34 who can attest to the applicant’s reasons for being in the 35 -7- LSB 5348HV (8) 91 ak/ko 7/ 18

H.F. 2716 state and length of residency within the state. 1 (4) A copy of the applicant’s most recently filed Iowa state 2 income tax return. 3 b. Paragraph “a” shall not apply to applicants who receive 4 benefits under the federal Social Security Act, 42 U.S.C. §423 5 et seq. 6 Sec. 13. Section 239.6, subsection 1, paragraph a, 7 subparagraph (4), Code 2026, is amended to read as follows: 8 (4) Information maintained by the United States citizenship 9 and immigration services of the United States department of 10 homeland security , including but not limited to information 11 accessible through the systematic alien verification for 12 entitlements online service . 13 Sec. 14. Section 239.6, subsection 2, Code 2026, is amended 14 by adding the following new paragraph: 15 NEW PARAGRAPH . g. The systematic alien verification for 16 entitlements online service maintained by the United States 17 citizenship and immigration services of the United States 18 department of homeland security or other accessible sources to 19 verify immigration and United States citizenship information. 20 DIVISION IV 21 MISCELLANEOUS PUBLIC ASSISTANCE PROGRAMS 22 Sec. 15. NEW SECTION . 135.16E Special supplemental 23 nutrition program for women, infants, and children —— citizens 24 and qualified aliens. 25 The department shall restrict participation in the special 26 supplemental nutrition program for women, infants, and children 27 to citizens and qualified aliens pursuant to section 742 of 28 the federal Personal Responsibility and Work Opportunity 29 Reconciliation Act of 1996, Pub. L. No. 104-193. 30 Sec. 16. Section 249N.6, subsection 5, Code 2026, is amended 31 by adding the following new paragraph: 32 NEW PARAGRAPH . c. Notwithstanding any other provision of 33 law to the contrary, an Iowa health and wellness plan provider 34 may impose a fee of no more than five dollars on a member based 35 -8- LSB 5348HV (8) 91 ak/ko 8/ 18

H.F. 2716 on the member’s failure to attend a scheduled appointment with 1 the provider. 2 Sec. 17. Section 249N.7, subsection 1, Code 2026, is amended 3 to read as follows: 4 1. Membership in the Iowa health and wellness plan shall 5 require payment of monthly contributions for members whose 6 household income is at or above fifty one hundred percent 7 of the federal poverty level. Members shall be subject 8 to an eight dollar copayment amounts applicable only to 9 for nonemergency use of a hospital emergency department. 10 Total member cost-sharing, annually, shall align with the 11 cost-sharing limitations requirements for the American health 12 benefits exchanges under the Affordable Care Act One Big 13 Beautiful Bill Act, Pub. L. No. 119-21 . Contributions Monthly 14 contributions and copayment amounts for members shall be 15 established by rule of the department. 16 Sec. 18. Section 249N.7, Code 2026, is amended by adding the 17 following new subsections: 18 NEW SUBSECTION . 3. Notwithstanding subsection 1, a member 19 who fails to complete all required preventative care services 20 and wellness activities specified during the prior annual 21 membership period shall be subject to a monthly five dollar fee 22 during the subsequent year of membership. 23 NEW SUBSECTION . 4. Notwithstanding subsection 1, a member 24 whose household income is at or above one hundred percent of 25 the federal poverty level shall be subject to the following 26 copay amounts: 27 a. A five dollar copay for a diagnostic dental procedure. 28 As used in this paragraph, “diagnostic dental procedure” means 29 a dental procedure that is not performed for preventative 30 purposes. 31 b. A one dollar copay for a prescription drug when a 32 suitable generic equivalent drug approved by the United States 33 food and drug administration is available to the member. 34 Sec. 19. 2023 Iowa Acts, chapter 104, section 12, subsection 35 -9- LSB 5348HV (8) 91 ak/ko 9/ 18

H.F. 2716 3, is amended to read as follows: 1 3. Unless otherwise provided in this Act, the department 2 of health and human services shall implement the provisions of 3 this Act in an incremental fashion, beginning July 1, 2023, 4 with a goal of full implementation no later than July 1, 2025 5 completed by January 1, 2027 , to minimize duplication of 6 efforts and to maximize coordination with the implementation 7 time frames of other departmental resource enhancements. 8 Sec. 20. IOWA HEALTH AND WELLNESS PLAN —— MEMBER 9 REENROLLMENT FOLLOWING TERMINATION FOR NONPAYMENT OF MONTHLY 10 CONTRIBUTIONS. The department of human services shall seek 11 approval of an amendment to the section 1115 demonstration 12 waiver for the Iowa health and wellness plan from the centers 13 for Medicare and Medicaid services of the United States 14 department of health and human services to provide the 15 following: 16 1. An Iowa health and wellness plan member who is subject 17 to payment of a monthly contribution as the result of failure 18 to complete required preventative care services and wellness 19 activities, and whose eligibility for the program is terminated 20 due to nonpayment of monthly contributions, shall be allowed 21 to subsequently reenroll in the program without first paying 22 any outstanding monthly contributions, if the member has not 23 been terminated from the program previously for nonpayment of 24 monthly contributions. 25 2. If an Iowa health and wellness plan member has been 26 terminated from the program previously for nonpayment of 27 monthly contributions, and is subsequently terminated from 28 the program for nonpayment of monthly contributions owed as 29 a result of failure to complete required preventative care 30 services and wellness activities, the member shall be subject 31 to payment of any outstanding monthly contributions prior to 32 reenrollment in the program. 33 DIVISION V 34 PUBLIC ASSISTANCE FRAUD —— REPORT 35 -10- LSB 5348HV (8) 91 ak/ko 10/ 18

H.F. 2716 Sec. 21. NEW SECTION . 10A.404 Fraud in public assistance 1 —— report. 2 On or before October 1, 2026, and every fiscal year 3 thereafter, the department shall submit a report to the general 4 assembly concerning the department’s activities relative 5 to fraud in public assistance programs for the immediately 6 preceding fiscal year. The report shall include but is not 7 limited to a summary of the number of cases investigated, 8 case outcomes, overpayment dollars identified, amount of cost 9 avoidance, and actual dollars recovered. 10 Sec. 22. NEW SECTION . 10A.404A Fraud in special 11 supplemental nutrition program for women, infants, and children 12 —— report. 13 On or before November 1, 2026, and by November 1 every 14 fiscal year thereafter, the department shall submit a report 15 to the general assembly concerning the department’s activities 16 relative to fraud in the special supplemental nutrition 17 program for women, infants, and children. The report shall 18 include but is not limited to a summary of the number of cases 19 investigated, case outcomes, violation points issued, and 20 actual dollars recovered. 21 DIVISION VI 22 HIGH-ACUITY PEDIATRIC WORK GROUP —— REPORT 23 Sec. 23. HIGH-ACUITY PEDIATRIC WORK GROUP —— REPORT TO 24 GENERAL ASSEMBLY. 25 1. The department of health and human services shall convene 26 a work group to examine the unique service needs of high-acuity 27 pediatric recipients of medical assistance under chapter 249A, 28 and high-acuity pediatric members of the healthy and well kids 29 in Iowa program under chapter 514I. The work group shall do 30 all of the following: 31 a. Identify the barriers that prevent the high-acuity 32 pediatric recipients and members from remaining in the least 33 restrictive environment possible. 34 b. Develop a proposal for a tiered reimbursement 35 -11- LSB 5348HV (8) 91 ak/ko 11/ 18

H.F. 2716 methodology to provide high-acuity home health services 1 tailored to meet the allowable medical and nonmedical support 2 needs of high-acuity pediatric recipients and members. 3 2. The work group shall be comprised of at least one 4 representative of a provider of high-acuity home health 5 services, one representative of the Iowa chapter of the 6 American academy of pediatrics, one representative of the 7 Iowa association of community providers, one representative 8 of the Iowa health care association, and other individuals or 9 organizations deemed appropriate by the department. 10 3. On or before December 1, 2026, the department shall 11 submit a report to the general assembly that includes all of 12 the following: 13 a. The barriers identified by the work group that prevent 14 high-acuity pediatric recipients and members from remaining in 15 the least restrictive environment possible. 16 b. The working group’s proposed tiered reimbursement 17 methodology and the estimated fiscal impact on affected 18 providers and health care facilities. 19 4. The department of health and human services shall provide 20 administrative support, including scheduling meetings of the 21 work group as necessary to complete the work of the work group. 22 DIVISION VII 23 MEDICAID REIMBURSEMENT RATE —— SPECIAL POPULATION NURSING 24 FACILITIES 25 Sec. 24. Section 249A.2, Code 2026, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 15. “Special population nursing facility” 28 refers to a nursing facility that serves one of the following 29 populations and has been designated as a special population 30 nursing facility by the department: 31 a. One hundred percent of the residents served are aged 32 thirty and under and require a skilled level of care. 33 b. Seventy percent of the residents served require a skilled 34 level of care for neurological disorders. 35 -12- LSB 5348HV (8) 91 ak/ko 12/ 18

H.F. 2716 c. One hundred percent of the residents require care from a 1 facility licensed by the department of inspections, appeals, 2 and licensing as an intermediate care facility for persons with 3 mental illness. 4 d. One hundred percent of the residents require care from a 5 facility licensed by the department of inspections, appeals, 6 and licensing as an intermediate care facility for persons with 7 medical complexity. 8 Sec. 25. NEW SECTION . 249A.38C Medicaid reimbursement rate 9 —— special population nursing facilities. 10 The provider reimbursement rate for each special population 11 nursing facility enrolled in Medicaid before July 1, 2025, must 12 be the special population nursing facility’s average allowable 13 per diem costs as adjusted for inflation. The inflation factor 14 is based on the most recent centers for Medicare and Medicaid 15 services total skilled nursing facility market basket index. 16 If a special population nursing facility subject to this 17 section increases the special population nursing facility’s 18 number of beds or expands to provide additional services on 19 or after July 1, 2025, the reimbursement rate in this section 20 shall apply to such additional beds or services. 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 the supplemental nutrition assistance 25 program (SNAP), the medical assistance program (Medicaid), the 26 special supplemental nutrition program for women, infants, and 27 children (WIC), and other public assistance programs under the 28 purview of the department of health and human services (HHS). 29 DIVISION I —— SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM. 30 Beginning October 1, 2026, the bill requires HHS to submit 31 a report to the general assembly every fiscal quarter 32 detailing the payment error rates associated with SNAP for the 33 immediately preceding fiscal quarter. 34 The bill requires HHS to request waivers of specific 35 -13- LSB 5348HV (8) 91 ak/ko 13/ 18

H.F. 2716 federal SNAP regulations regarding earned income, independent 1 verification of eligibility, expungement of benefits from 2 certain electronic benefit accounts, and determining the 3 state’s SNAP payment error rate. HHS shall implement any 4 requested waiver upon receipt of approval of the waiver by the 5 federal government. 6 DIVISION II —— MEDICAL ASSISTANCE PROGRAM. Under current 7 law, for an individual to be eligible for the Medicaid for 8 employed persons with disabilities (MEPD) program, their 9 household income must be below 250 percent of the federal 10 poverty level (FPL), and the individual must also meet the 11 maximum amount of resources allowed under federal law, with 12 certain resources being disregarded by HHS in determining an 13 individual’s MEPD program eligibility. Individuals in the MEPD 14 program pay a set premium every month to HHS on a sliding scale 15 based on household income. A premium payment accepted directly 16 or indirectly through an automated case management system by 17 HHS does not automatically make an individual eligible for 18 MEPD. 19 The bill requires HHS to extend MEPD eligibility to 20 individuals with household incomes up to 300 percent of the 21 FPL. Moneys in a pension fund are not to be considered by HHS 22 for purposes of determining asset eligibility under MEPD. The 23 bill strikes the maximum MEPD premium payable by individuals 24 whose income exceeds 150 percent of the FPL, and the policy 25 that an individual’s MEPD premium payment being accepted 26 directly or indirectly through an automated case management 27 system by HHS does not make the individual automatically 28 eligible for MEPD. The bill provides that HHS must allow 29 for the electronic payment of MEPD premiums through a page 30 maintained on the department’s internet site. 31 The bill requires the director of HHS to submit a report to 32 the general assembly within thirty days of the release of the 33 official Medicaid payment error rate by the federal centers for 34 Medicare and Medicaid services (CMS), detailing the official 35 -14- LSB 5348HV (8) 91 ak/ko 14/ 18

H.F. 2716 Medicaid payment error rate and a summary of the payment error 1 data as submitted to CMS by HHS. 2 The bill also requires the director of HHS to submit an 3 annual report to the general assembly on or before October 4 1, 2026, with specific information as detailed in the bill 5 related to certain petitions for a waiver to rules adopted by 6 HHS (exceptions to policy) to administer Medicaid during the 7 immediately preceding fiscal year. 8 Under current law, the reimbursement rate set by HHS for 9 providers under home and community-based service waiver 10 programs does not cover the provider’s travel and other 11 expenses associated with providing care to a resident in a 12 rural area of the state. The bill requires HHS to cover such 13 costs for those providers. 14 Prior to submission of a request by HHS for certain Medicaid 15 waivers, the bill requires HHS to conduct a cost-neutrality 16 analysis. If the waiver is determined by HHS to not be cost 17 neutral, HHS must seek the approval of the general assembly 18 by majority vote of both houses of the general assembly. 19 “Cost neutral” is defined to mean that approval of a waiver 20 by CMS will not result in a net increase in spending on the 21 administration of Medicaid by the state. 22 HHS is required to conduct a review of exceptions to policy 23 granted by the department between January 1, 2020, and January 24 1, 2026. On or before December 15, 2026, the department 25 shall submit a report to the general assembly with specific 26 information about these exceptions as detailed in the bill. 27 The bill provides that the provisions of the bill related to 28 MEPD take effect contingent upon receipt of federal approval. 29 DIVISION III —— ELIGIBILITY FOR CERTAIN PROGRAMS. Unless 30 prohibited by federal law, the bill permits HHS, for purposes 31 of determining eligibility for assistance for certain 32 public assistance programs, to require proof of 12 months of 33 continuous residency through documentation as detailed in the 34 bill. HHS may not require proof of residency for people who 35 -15- LSB 5348HV (8) 91 ak/ko 15/ 18

H.F. 2716 are receiving social security benefits. “Public assistance 1 program” is defined as the state child care assistance program, 2 the family investment program, medical assistance program, 3 supplemental nutrition assistance program, and the special 4 nutrition assistance program for women, infants, and children. 5 The bill requires HHS, prior to determining the initial 6 eligibility of an applicant for, or the ongoing eligibility 7 of a recipient of, public assistance benefits to verify 8 immigration and United States citizenship information of 9 the applicant or recipient through the systematic alien 10 verification for entitlements online service maintained by the 11 United States citizenship and immigration services, or other 12 accessible source. 13 DIVISION IV —— MISCELLANEOUS PUBLIC ASSISTANCE PROGRAMS. 14 The bill provides that HHS shall restrict participation in 15 WIC to citizens and qualified aliens pursuant to section 742 16 of the federal Personal Responsibility and Work Opportunity 17 Reconciliation Act of 1996. 18 Under current law, a provider under the Iowa health and 19 wellness plan (IHAWP) cannot charge a member a fee for missing 20 an appointment with the provider. Under the bill, IHAWP 21 providers may charge a member up to a $5 fee for missing an 22 appointment. Under current law, members whose household 23 income is at or above 50 percent of the FPL must pay a monthly 24 contribution. The bill changes the requirement to 100 percent 25 of the FPL. Under the bill, all IHAWP members must pay an 26 $8 copayment for nonemergency use of a hospital emergency 27 department. Monthly contributions and copayment amounts are 28 established by HHS by rule. 29 Under current law, IHAWP members with household incomes 30 between 51 percent and 100 percent of the FPL who fail to 31 complete the required preventative services and wellness 32 services annually are required to pay a monthly contribution 33 of $5, while those members with household incomes in excess 34 of 100 percent of the FPL that fail to complete the required 35 -16- LSB 5348HV (8) 91 ak/ko 16/ 18

H.F. 2716 preventative services and wellness services annually are 1 required to pay a monthly contribution of $10. The bill 2 instead requires any member that fails to complete the required 3 preventative services and wellness services annually to pay a 4 monthly fee of $5 during the subsequent membership year. 5 The bill requires an IHAWP member whose household income 6 is at or above 100 percent of the FPL to pay a $5 copay for 7 diagnostic dental procedures, and a $1 copay for a prescription 8 drug when an equivalent generic drug is available. The bill 9 defines “diagnostic dental procedure”. 10 Under current law, HHS was to have fully implemented the 11 requirements for public assistance programs pursuant to Code 12 chapter 239 by July 1, 2025. Under the bill, the department 13 must fully implement the requirements by January 1, 2027. 14 The bill requires HHS to seek approval of an amendment to 15 the section 1115 demonstration waiver for the Iowa health and 16 wellness plan from CMS to provide that an IHAWP member whose 17 eligibility for the program is terminated due to nonpayment of 18 monthly contributions owed as a result of the member’s failure 19 to complete required preventative care services and wellness 20 activities will be allowed to subsequently reenroll without 21 first paying any outstanding monthly contributions, if the 22 member has not been terminated from the program previously 23 for nonpayment of monthly contributions. If the IHAWP member 24 has previously been terminated for nonpayment of monthly 25 contributions, the member shall be subject to payment of any 26 outstanding monthly contributions prior to reenrollment. 27 DIVISION V —— PUBLIC ASSISTANCE FRAUD —— REPORT. The bill 28 requires the department of inspections, appeals, and licensing 29 to submit an annual report on or before October 1, 2026, to 30 the general assembly concerning the department’s activities 31 relative to fraud in public assistance programs for the 32 immediately preceding fiscal year. The report shall include 33 a summary of the number of cases investigated, case outcomes, 34 overpayment dollars identified, amount of cost avoidance, and 35 -17- LSB 5348HV (8) 91 ak/ko 17/ 18

H.F. 2716 actual dollars recovered. 1 The bill requires HHS to submit an annual report on or before 2 November 1 to the general assembly concerning the department’s 3 activities relative to fraud in WIC. The report shall include 4 a summary of the number of cases investigated, case outcomes, 5 violation points issued, and actual dollars recovered. 6 DIVISION VI —— HIGH-ACUITY PEDIATRIC WORK GROUP —— REPORT. 7 Under the bill, HHS is required to convene a work group to 8 identify the unique service needs of high-acuity pediatric 9 Medicaid recipients and members of the healthy and well 10 kids in Iowa (Hawki) program. The work group must identify 11 barriers to the individuals remaining in the least restrictive 12 environment possible, and develop a proposal for a tiered 13 reimbursement methodology to provide high-acuity home health 14 services tailored to meet the allowable medical and nonmedical 15 support needs of such individuals. The required members of 16 the work group are detailed in the bill. The work group 17 shall submit a report to the general assembly on or before 18 December 1, 2026, that outlines barriers identified by the work 19 group to high-acuity pediatric members remaining in the least 20 restrictive environment possible, and provides the estimated 21 fiscal impact of the work group’s proposed tiered reimbursement 22 methodology on affected providers and health care facilities. 23 HHS shall provide administrative support to the work group. 24 DIVISION VII —— MEDICAID REIMBURSEMENT RATE —— SPECIAL 25 POPULATION NURSING FACILITIES. The bill defines “special 26 population nursing facility” (SPNF). The bill requires HHS 27 to set the Medicaid reimbursement rate for certain SPNFs at 28 the average allowable per diem cost adjusted for inflation 29 based on the special nursing facility market basket index. If 30 an SPNF increases the number of beds or expands to provide 31 additional services, such reimbursement rate will also apply to 32 the additional beds or services. 33 -18- LSB 5348HV (8) 91 ak/ko 18/ 18