House Study Bill 342 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON APPROPRIATIONS BILL BY CHAIRPERSON MOHR) 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; reimbursement 7 rates; family well-being and protection; state-operated 8 specialty care, administration and compliance; transfers, 9 cash flows, and nonreversions; prior appropriations; the 10 beer and liquor control fund, and the behavioral health 11 fund; report on nonreversion of moneys; emergency rules; 12 autism spectrum disorder; involuntary commitment hearing 13 testimony; discharge of involuntarily committed persons; 14 medical residency and fellowships; maintenance and costs of 15 juvenile homes; and a hospital directed payment program; 16 and including effective date and retroactive applicability 17 provisions. 18 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 19 TLSB 1004YC (14) 91 lh/ko

H.F. _____ 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,619,205 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14 2. IOWA VETERANS HOME 15 For salaries, support, maintenance, and miscellaneous 16 purposes: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,234,502 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 4. VETERANS SERVICE ORGANIZATION GRANT FUND 31 Of the moneys allocated under subsection 1, $250,000 shall 32 be deposited in the veterans service organization grant fund 33 created in section 35A.23, as enacted by this division of this 34 Act. 35 -1- LSB 1004YC (14) 91 lh/ko 1/ 47

H.F. _____ Sec. 2. NEW SECTION . 35A.23 Veterans service organization 1 grant program. 2 1. A veterans service organization grant program is 3 established under the administration and control of the 4 department to award grants to veterans service organizations 5 for the purpose of ensuring adequate staff are employed to 6 assist veterans with claims. 7 2. A veterans service organization grant fund is created 8 within the state treasury under the control of the department. 9 The fund shall consist of moneys appropriated to the fund by 10 the general assembly and any other moneys available to and 11 obtained or accepted by the department for deposit in the fund. 12 All moneys in the fund are appropriated to the department for 13 purposes of administering the program and providing grants 14 under the program. Notwithstanding section 8.33, moneys in 15 the fund that remain unencumbered or unobligated at the close 16 of a fiscal year shall not revert but shall remain available 17 for expenditure for the purposes designated. Notwithstanding 18 section 12C.7, subsection 2, interest or earnings on moneys in 19 the fund shall be credited to the fund. 20 3. a. In administering the program, the department shall 21 award matching funds to veterans service organizations for the 22 purpose of employing staff to assist veterans with claims. 23 b. To receive a grant, a veterans service organization shall 24 demonstrate that moneys have been budgeted and will be expended 25 by the veterans service organization in the amount required to 26 provide matching funds for each staff position for which grant 27 moneys are sought. 28 c. For purposes of this section, “veterans service 29 organization” means an organization recognized by the United 30 States department of veterans affairs pursuant to 38 C.F.R. 31 §14.628(c). 32 4. The department shall adopt rules pursuant to chapter 17A 33 as necessary to implement and administer the program. 34 DIVISION II 35 -2- LSB 1004YC (14) 91 lh/ko 2/ 47

H.F. _____ AGING AND DISABILITY SERVICES —— FY 2025-2026 1 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 2 AND DISABILITY SERVICES. There is appropriated from the 3 general fund of the state to the department of health and human 4 services for the fiscal year beginning July 1, 2025, and ending 5 June 30, 2026, the following amount, or so much thereof as is 6 necessary, to be used for the purposes designated: 7 For aging programs for the department of health and human 8 services and area agencies on aging to provide citizens of 9 Iowa who are 60 years of age and older with case management; 10 for Iowa’s aging and disabilities resource centers; for the 11 return to community program; for the purposes of chapter 231E; 12 to administer the prevention of elder abuse, neglect, and 13 exploitation program pursuant to section 231.56A, in accordance 14 with the requirements of the federal Older Americans Act of 15 1965, 42 U.S.C. §3001 et seq., as amended; for the operation 16 of the dependent adult abuse services program pursuant to 17 chapter 235B; for other services which may include but are not 18 limited to adult day care, respite care, chore, information 19 and assistance, and material aid; for information and options 20 counseling for persons with disabilities; and for salaries, 21 support, administration, maintenance, and miscellaneous 22 purposes, and for not more than the following full-time 23 equivalent positions: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,208,822 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 88.00 26 1. Moneys appropriated in this section may be used to 27 supplement federal moneys received under federal regulations. 28 To receive moneys appropriated in this section, a local area 29 agency on aging shall match the moneys with moneys from other 30 sources according to rules adopted by the department. Moneys 31 appropriated in this section may be used for services not 32 specifically enumerated in this section only if approved by the 33 department as part of an area agency on aging’s area plan. 34 2. Of the moneys appropriated in this section, $949,282 35 -3- LSB 1004YC (14) 91 lh/ko 3/ 47

H.F. _____ shall be used for the family support center component of the 1 comprehensive family support program under section 225C.47. 2 3. Of the moneys appropriated in this section, $33,632 shall 3 be used to build community capacity through the coordination 4 and provision of training opportunities in accordance with the 5 consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 6 Iowa, July 15, 1994). 7 4. Of the moneys appropriated in this section, $100,000 8 shall be used by the department of health and human services 9 for a dementia services coordinator position. The duties of 10 the dementia services coordinator shall include but are not 11 limited to all of the following: 12 a. Coordinating state-funded and privately funded dementia 13 services within the state. 14 b. Coordinating the implementation of the Alzheimer’s 15 disease and related dementias state plan. 16 c. Assessing and analyzing dementia-related data collected 17 by the state. 18 d. Evaluating state-funded dementia services. 19 e. Identifying and supporting the development of 20 dementia-specific trainings. 21 f. Performing other duties as may be required to ensure the 22 state is addressing Alzheimer’s and related dementias. 23 DIVISION III 24 BEHAVIORAL HEALTH —— FY 2025-2026 25 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 26 BEHAVIORAL HEALTH. There is appropriated from the general fund 27 of the state to the department of health and human services for 28 the fiscal year beginning July 1, 2025, and ending June 30, 29 2026, the following amount, or so much thereof as is necessary, 30 to be used for the purposes designated: 31 For behavioral health prevention, treatment, and recovery 32 efforts to reduce the prevalence of the use of, provide 33 treatment for, and support recovery from alcohol, tobacco, and 34 substance use and misuse, problem gambling, and other addictive 35 -4- LSB 1004YC (14) 91 lh/ko 4/ 47

H.F. _____ behaviors. Activities shall align with accepted best practice 1 guidance standards for behavioral health including those 2 published by the centers for disease control and prevention of 3 the United States department of health and human services, and 4 the substance abuse and mental health services administration 5 of the United States department of health and human services, 6 for health promotion; universal, selective, and indicated 7 prevention; treatment; and recovery services and supports; and 8 shall include a 24-hour helpline, public information resources, 9 professional training, youth prevention, program evaluation, 10 and efforts at the state and local levels, and for not more 11 than the following full-time equivalent positions: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,400,114 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 71.00 14 1. Of the moneys appropriated in this section, $300,000 15 shall be used to support the work of the children’s behavioral 16 health system including evidence-based behavioral health 17 prevention, treatment, and recovery services and supports for 18 children and their families pursuant to the intent specified in 19 section 225C.6B, subsection 1. 20 2. Of the moneys appropriated in this section, $950,000 21 shall be used for an integrated substance use disorder managed 22 care system. The department shall maintain the level of mental 23 health and substance use disorder treatment services provided 24 by the managed care contractors, and shall take the steps 25 necessary to continue the federal waivers as needed to maintain 26 the level of services. 27 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 28 WAGERING RECEIPTS FUND. There is appropriated from the 29 sports wagering receipts fund created in section 8.57I, to the 30 department of health and human services for the fiscal year 31 beginning July 1, 2025, and ending June 30, 2026, the following 32 amount, or so much thereof as is necessary, to be used for 33 behavioral health prevention, treatment, and recovery efforts 34 to reduce the prevalence of the use of, provide treatment for, 35 -5- LSB 1004YC (14) 91 lh/ko 5/ 47

H.F. _____ and support recovery from alcohol, tobacco, and substance use 1 and misuse, problem gambling, and other addictive behaviors: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 3 DIVISION IV 4 PUBLIC HEALTH —— FY 2025-2026 5 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 6 HEALTH. There is appropriated from the general fund of the 7 state to the department of health and human services for the 8 fiscal year beginning July 1, 2025, and ending June 30, 2026, 9 the following amount, or so much thereof as is necessary, to be 10 used for the purposes designated: 11 For programs that support health promotion, protect the 12 health and safety of the public, conduct disease surveillance 13 and investigation to reduce the incidence of morbidity and 14 mortality, serve individuals with chronic conditions including 15 but not limited to cancer, support the Iowa donor registry as 16 specified in section 142C.18, and strengthen the health care 17 delivery system and workforce to improve health outcomes for 18 all Iowans, and for not more than the following full-time 19 equivalent positions: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 21,037,821 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 286.00 22 1. Of the moneys appropriated in this section, the following 23 amounts are allocated to the department of health and human 24 services to be used as follows to support the goals of 25 increased access, health system integration, and engagement: 26 a. $600,000 for distribution to a nonprofit organization 27 that established the first statewide drug donation repository 28 for continuation of the pharmaceutical infrastructure for 29 safety net providers established as described in 2007 Iowa 30 Acts, chapter 218, section 108, and for the prescription drug 31 donation repository program established in chapter 135M. 32 Moneys under this paragraph shall be distributed in their 33 entirety on July 1, 2025, for the purpose specified. 34 b. $374,000 for distribution to free clinics, as defined in 35 -6- LSB 1004YC (14) 91 lh/ko 6/ 47

H.F. _____ section 135.24, and a nonprofit organization that facilitates 1 the initiation, operation, and collaboration of free clinics 2 for necessary infrastructure, statewide coordination, provider 3 recruitment, service delivery, e-prescribing capacity, and 4 provision of assistance to patients in securing a medical home. 5 Moneys under this paragraph shall be distributed in their 6 entirety on July 1, 2025, for the purpose specified. 7 c. $25,000 for distribution to an organization that raises 8 awareness about issues related to rural health clinics, and 9 necessary infrastructure and service delivery transformation. 10 Moneys under this paragraph shall be distributed in their 11 entirety on July 1, 2025, for the purpose specified. 12 d. $225,000 for distribution to an organization that is 13 the oldest continuously operating medical society in the state 14 for continuation of safety net provider patients access to 15 specialty care as described in 2007 Iowa Acts, chapter 218, 16 section 109. Moneys under this paragraph shall be distributed 17 in their entirety on July 1, 2025, for the purpose specified. 18 2. Of the moneys appropriated in this section, $600,000 19 shall be used for rural psychiatric residencies for residents 20 selected on or before June 30, 2025. 21 3. The university of Iowa hospitals and clinics under 22 the control of the state board of regents shall not receive 23 indirect costs from the moneys appropriated in this section. 24 The university of Iowa hospitals and clinics billings to the 25 department shall be, at a minimum, on a quarterly basis. 26 4. Of the moneys appropriated in this section, $20,000 shall 27 be used to make radon test kits available, free of charge, to 28 homeowners and renters in the state. The department shall 29 provide a link on the department’s internet site for homeowners 30 and renters in the state to order radon test kits. 31 5. Of the moneys appropriated in this section, $1,000,000 32 shall be used to provide grants to support the double up 33 food bucks program administered by the Iowa healthiest state 34 initiative to make fresh fruits and vegetables sold at farmers 35 -7- LSB 1004YC (14) 91 lh/ko 7/ 47

H.F. _____ markets, grocery stores, and other participating locations 1 accessible to individuals and families who reside in this 2 state and receive assistance through the federal supplemental 3 nutrition assistance program. 4 DIVISION V 5 COMMUNITY ACCESS AND ELIGIBILITY —— FY 2025-2026 6 Sec. 7. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 7 ACCESS AND ELIGIBILITY. There is appropriated from the 8 general fund of the state to the department of health and human 9 services for the fiscal year beginning July 1, 2025, and ending 10 June 30, 2026, the following amount, or so much thereof as is 11 necessary, to be used for the purposes designated: 12 To be used for salaries, support, maintenance, and 13 miscellaneous purposes and for family investment program (FIP) 14 assistance in accordance with chapter 239B, and for other costs 15 associated with providing needs-based benefits or assistance 16 including but not limited to maternal and child health, oral 17 health, obesity prevention, the promotion of independence 18 and self-sufficiency through employment, job opportunities 19 and the basic skills (PROMISE JOBS) program, supplemental 20 nutrition assistance program (SNAP) employment and training, 21 the FIP diversion program, family planning, rent reimbursement, 22 and eligibility determinations for medical assistance, food 23 assistance, and the children’s health insurance program, and 24 for not more than the following full-time equivalent positions: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,043,944 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 948.00 27 1. Of the child support collections assigned under FIP, 28 the federal share of the child support collections shall be 29 credited to the child support services appropriation made in 30 this division of this Act. Of the remainder of the child 31 support collections assigned under FIP, a portion shall be 32 credited to community access and eligibility, and the remaining 33 moneys may be used to increase recoveries, to sustain cash flow 34 in the collection services center refund account as provided in 35 -8- LSB 1004YC (14) 91 lh/ko 8/ 47

H.F. _____ section 252B.13A, or for technology needs. If child support 1 collections assigned under FIP are greater than estimated or 2 are otherwise determined not to be required for maintenance of 3 efforts, the state share of either amount is appropriated to 4 the department for child support services as described in this 5 Act, or may be transferred to or retained in the collection 6 services center refund account. 7 2. Of the moneys appropriated in this section, $3,075,000 8 shall be used for continuation of the department’s initiative 9 to provide for adequate developmental surveillance and 10 screening during a child’s first five years. The moneys shall 11 be used first to fully fund the current participating counties 12 to ensure that those counties are fully operational, with 13 the remaining moneys to be used for expanding participation 14 to additional counties. Full implementation and expansion 15 shall include enhancing the scope of the initiative through 16 collaboration with child health specialty clinics to promote 17 the use of developmental surveillance and screening to 18 support healthy child development through early identification 19 and response to both biomedical and social determinants of 20 healthy development by providing practitioner consultation 21 and continuous improvement through training and education, 22 particularly for children with behavioral conditions and 23 needs. The department shall also collaborate with the Medicaid 24 program and child health specialty clinics to assist in 25 coordinating the activities of the first five initiative into 26 the establishment of patient-centered medical homes developed 27 to improve health quality and population health while reducing 28 health care costs. To the maximum extent possible, moneys 29 allocated in this subsection shall be utilized as matching 30 moneys for Medicaid program reimbursement. 31 3. Of the moneys appropriated in this section, $1,145,102 32 is allocated to the Iowa commission on volunteer service for 33 programs and grants. 34 4. The university of Iowa hospitals and clinics under 35 -9- LSB 1004YC (14) 91 lh/ko 9/ 47

H.F. _____ the control of the state board of regents shall not receive 1 indirect costs from the moneys appropriated in this section. 2 The university of Iowa hospitals and clinics billings to the 3 department shall be, at a minimum, on a quarterly basis. 4 CHILD SUPPORT SERVICES 5 Sec. 8. CHILD SUPPORT SERVICES. There is appropriated from 6 the general fund of the state to the department of health and 7 human services for the fiscal year beginning July 1, 2025, and 8 ending June 30, 2026, the following amount, or so much thereof 9 as is necessary, to be used for the purposes designated: 10 For child support services, including salaries, support, 11 maintenance, and miscellaneous purposes, and for not more than 12 the following full-time equivalent positions: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,434,282 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 464.00 15 1. Federal access and visitation grant moneys shall be used 16 for services designed to increase compliance with the child 17 access provisions of court orders, including but not limited to 18 neutral visitation sites and mediation services. 19 2. The appropriation made to the department for child 20 support services may be used throughout the fiscal year in the 21 manner necessary for purposes of cash flow management, and for 22 cash flow management purposes the department may temporarily 23 draw more than the amount appropriated provided the amount 24 appropriated is not exceeded at the close of the fiscal year. 25 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT 26 Sec. 9. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 27 GRANT. There is appropriated from the special fund created in 28 section 8.41 to the department of health and human services 29 for the fiscal year beginning July 1, 2025, and ending June 30 30, 2026, from moneys received under the federal temporary 31 assistance for needy families (TANF) block grant pursuant 32 to the federal Personal Responsibility and Work Opportunity 33 Reconciliation Act of 1996, Pub. L. No. 104-193, and successor 34 legislation, the following amounts, or so much thereof as is 35 -10- LSB 1004YC (14) 91 lh/ko 10/ 47

H.F. _____ necessary, to be used for the purposes designated: 1 1. For community access and eligibility, FIP, the PROMISE 2 JOBS program, implementing family investment agreements in 3 accordance with chapter 239B, and for continuation of the 4 program promoting awareness of the benefits of a healthy 5 marriage: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627 7 2. For community access and eligibility to provide 8 pregnancy prevention grants on the condition that family 9 planning services are funded: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 11 Pregnancy prevention grants shall be awarded to programs 12 in existence on or before July 1, 2025, if the programs have 13 demonstrated positive outcomes. Grants shall be awarded 14 to pregnancy prevention programs developed after July 1, 15 2025, if the programs are based on existing models that have 16 demonstrated positive outcomes. Grants shall comply with the 17 requirements provided in 1997 Iowa Acts, chapter 208, section 18 14, subsections 1 and 2, including the requirement that a 19 program awarded a grant must emphasize sexual abstinence. 20 Priority in the awarding of grants shall be given to programs 21 that serve areas of the state which demonstrate the highest 22 percentage of unplanned pregnancies of females of childbearing 23 age within the geographic area to be served by the grant. 24 3. For community access and eligibility to meet one of 25 the four purposes of TANF as specified in 45 C.F.R. §260.20, 26 including by modernizing the program to promote economic 27 mobility and self-sufficiency, ensuring that families are able 28 to overcome benefit cliffs, encouraging healthy families, and 29 streamlining service delivery to reduce duplication: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 31 4. For technology needs related to child support 32 modernization of the Iowa collections and reporting (ICAR) 33 system and for a closed loop referral system for the thrive 34 Iowa program: 35 -11- LSB 1004YC (14) 91 lh/ko 11/ 47

H.F. _____ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 1 5. For early intervention and supports for the family 2 development and self-sufficiency (FaDSS) grant program in 3 accordance with section 216A.107: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,888,980 5 Of the moneys allocated for the FaDSS grant program in this 6 subsection, not more than 5 percent of the moneys shall be used 7 for administrative purposes. 8 6. For early intervention and supports for child abuse 9 prevention grants: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 125,000 11 7. For accountability, compliance, program integrity, 12 technology needs, and other resources necessary to meet 13 federal and state reporting, tracking, and case management 14 requirements, and other departmental needs: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 16 8. For state child care assistance: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 18 9. For child protective services: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 62,364,100 20 10. For child protective services for the kinship caregiver 21 payment program: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,000,000 23 DIVISION VI 24 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 25 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 26 PROGRAMS —— FY 2025-2026 27 Sec. 10. MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY 28 ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There 29 is appropriated from the general fund of the state to the 30 department of health and human services for the fiscal year 31 beginning July 1, 2025, and ending June 30, 2026, the following 32 amount, or so much thereof as is necessary, to be used for the 33 purposes designated: 34 For medical assistance program reimbursement and associated 35 -12- LSB 1004YC (14) 91 lh/ko 12/ 47

H.F. _____ costs as specifically provided in the reimbursement 1 methodologies in effect on June 30, 2025, except as otherwise 2 expressly authorized by law, consistent with federal law and 3 regulations, and contingent upon receipt of approval from the 4 office of the governor of reimbursement for each abortion 5 performed under the medical assistance program; for the state 6 supplementary assistance program; for the health insurance 7 premium payment program; and for maintenance of the healthy and 8 well kids in Iowa (Hawki) program pursuant to chapter 514I, 9 including supplemental dental services, for receipt of federal 10 financial participation under Tit. XXI of the federal Social 11 Security Act, which creates the children’s health insurance 12 program; and for other specified health-related programs: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,899,238,628 14 1. Of the moneys appropriated in this section, 15 $1,833,843,866 is allocated for medical assistance program 16 reimbursement and associated costs. 17 a. Of the moneys allocated in this subsection, $794,859 18 shall be used for the renovation and construction of certain 19 nursing facilities, consistent with chapter 249K. 20 b. Of the moneys allocated in this subsection, $3,383,880 21 shall be used for program administration, outreach, and 22 enrollment activities of the state family planning services 23 program pursuant to section 217.41B, and of this amount, the 24 department may use $200,000 for administrative expenses. 25 2. Iowans support reducing the number of abortions 26 performed in our state. Moneys appropriated under this section 27 shall not be used for abortions, unless otherwise authorized 28 under this section. 29 3. The provisions of this section relating to abortions 30 shall also apply to the Iowa health and wellness plan created 31 pursuant to chapter 249N. 32 4. Of the moneys appropriated in this section, $4,479,762 is 33 allocated for the state supplementary assistance program. 34 5. Of the moneys appropriated in this section, $61,275,000 35 -13- LSB 1004YC (14) 91 lh/ko 13/ 47

H.F. _____ is allocated for maintenance of the Hawki program pursuant 1 to chapter 514I, including supplemental dental services, for 2 receipt of federal financial participation under Tit. XXI of 3 the federal Social Security Act, which creates the children’s 4 health insurance program. 5 HEALTH PROGRAM OPERATIONS 6 Sec. 11. HEALTH PROGRAM OPERATIONS. There is appropriated 7 from the general fund of the state to the department of health 8 and human services for the fiscal year beginning July 1, 9 2025, and ending June 30, 2026, the following amount, or so 10 much thereof as is necessary, to be used for the purposes 11 designated: 12 For health program operations, and the autism support 13 program under section 225D.2, and for not more than the 14 following full-time equivalent positions: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,652,231 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 82.00 17 1. The department of inspections, appeals, and licensing 18 shall provide all state matching moneys for survey and 19 certification activities performed by the department of 20 inspections, appeals, and licensing. The department of health 21 and human services shall be solely responsible for distributing 22 the federal matching moneys for such activities. 23 2. Of the moneys appropriated in this section, a sufficient 24 amount shall be allocated for the administration of the health 25 insurance premium payment program, including salaries, support, 26 maintenance, and miscellaneous purposes. 27 3. Of the moneys appropriated in this section, $750,000 28 shall be allocated for a nonprofit organization that provides 29 access to emergency poison information and treatment. Pursuant 30 to the directive under 2014 Iowa Acts, chapter 1140, section 31 102, the federal matching moneys available to the nonprofit 32 organization from the department under the federal Children’s 33 Health Insurance Program Reauthorization Act of 2009 shall be 34 subject to the federal administrative cap rule of 10 percent 35 -14- LSB 1004YC (14) 91 lh/ko 14/ 47

H.F. _____ applicable to moneys provided under Tit. XXI of the federal 1 Social Security Act and shall be included in the department’s 2 calculations of the cap. 3 4. Of the moneys appropriated in this section, $55,000 4 shall be allocated to expand enrollment in the ground emergency 5 medical transportation program pursuant to section 249A.5, if 6 enacted by 2025 Iowa Acts, House File 977. 7 5. Unless otherwise provided by law, if a contract for 8 services provided under this section initially entered into 9 during the fiscal year beginning July 1, 2025, and ending 10 June 30, 2026, provides for an annual increase of the cost of 11 services provided under the contract, the annual increase shall 12 not exceed the amount by which the consumer price index for 13 all urban consumers increased during the immediately preceding 14 calendar year. This subsection shall not affect a contract 15 entered into on or before June 30, 2025, that is for a term of 16 more than one year. 17 HEALTH CARE ACCOUNTS AND FUNDS 18 Sec. 12. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT 19 OF HEALTH AND HUMAN SERVICES. There is appropriated from the 20 pharmaceutical settlement account created in section 249A.33 to 21 the department of health and human services for the fiscal year 22 beginning July 1, 2025, and ending June 30, 2026, the following 23 amount, or so much thereof as is necessary, to be used for the 24 purposes designated: 25 Notwithstanding any provision of law to the contrary, to 26 supplement the appropriation made in this Act from the general 27 fund of the state for health program operations under the 28 medical assistance program for the same fiscal year: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 30 Sec. 13. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF 31 HEALTH AND HUMAN SERVICES. Notwithstanding any provision of 32 law to the contrary, and subject to the availability of moneys, 33 there is appropriated from the quality assurance trust fund 34 created in section 249L.4 to the department of health and human 35 -15- LSB 1004YC (14) 91 lh/ko 15/ 47

H.F. _____ 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, for the purposes designated: 3 To supplement the appropriation made in this Act from the 4 general fund of the state to the department of health and human 5 services for medical assistance for the same fiscal year: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 7 Sec. 14. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 8 DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding 9 any provision of law to the contrary, and subject to the 10 availability of moneys, there is appropriated from the hospital 11 health care access trust fund created in section 249M.4 to the 12 department of health and human services for the fiscal year 13 beginning July 1, 2025, and ending June 30, 2026, the following 14 amount, or so much thereof as is necessary, for the purposes 15 designated: 16 To supplement the appropriation made in this Act from the 17 general fund of the state to the department of health and human 18 services for medical assistance for the same fiscal year: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 20 NURSING FACILITIES —— MEDICAID REIMBURSEMENT METHODOLOGY 21 PROPOSAL 22 Sec. 15. NURSING FACILITIES —— MEDICAID REIMBURSEMENT 23 METHODOLOGY PROPOSAL. 24 1. By April 1, 2026, the department of health and human 25 services shall develop a reimbursement methodology proposal for 26 reimbursement of nursing facilities under the Medicaid program 27 that includes all of the following: 28 a. A base-rate payment component. 29 b. A quality assurance assessment pass-through component. 30 c. A quality assurance add-on component, which includes a 31 fixed fee payment and a quality-based payment. 32 2. The reimbursement methodology proposal shall include 33 recommendations developed by the department of health and human 34 services, in consultation with stakeholders including the Iowa 35 -16- LSB 1004YC (14) 91 lh/ko 16/ 47