HSB 696 (LSB 5348YC (15) 91)

HOUSE FILE _____ 

BY  (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON HARRIS)

A BILL FOR

An Act relating to the supplemental nutrition assistance program, the medical assistance program, and other public assistance programs under the purview of the department of health and human services.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM

    Section 1.  NEW SECTION.  135.16E  Supplemental nutrition assistance program error rate —— report.
   Beginning with the fiscal quarter that starts on October 1, 2026, and every fiscal quarter thereafter, within thirty calendar days of the end date of the immediately preceding fiscal quarter, the department shall submit a report to the general assembly detailing payment error rates associated with the supplemental nutrition assistance program for the immediately preceding fiscal quarter. For the purposes of this section, “supplemental nutrition assistance program” has the same meaning as defined in section 239.1.
    Sec. 2.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF EARNED INCOME RULES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, the earned income under 
7 C.F.R. §273.9(c)(7) of household members that meet all of the following criteria shall be excluded from household income:
   a.  Less than twenty-two years of age.
   b.  Enrolled in an elementary or secondary school.
   c.  Resides with a natural parent, adoptive parent, stepparent, or other household member who exercises parental control over the household member described in paragraphs “a” and “b”.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
    Sec. 3.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF ELIGIBILITY VERIFICATION RULES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, information from the following automated sources be considered verified upon receipt for purposes 
of 7 C.F.R. §272.12(c):
   a.  The United States bureau of labor statistics occupational employment and wage statistics program.
   b.  The national directory of new hires maintained by the office of child support services of the United States office for the administration of children and families.
   c.  The unemployment insurance benefits data released by the Iowa department of workforce development.
   d.  The United States social security administration benefits and death records.
   e.  The residency and identity data released by the United States department of transportation.
   f.  The state incarceration data released by the Iowa department of corrections.
   g.  The national vital statistic report released by the United States centers for disease control and prevention’s national center for health statistics.
   h.  The automated employment verification service known as work number, or equivalent third-party income verification platforms.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
    Sec. 4.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF EXPUNGEMENT RULES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, expungement of benefits on a household’s electronic benefit account under 7 C.F.R. §274.2(i) be permitted after three months or ninety-one days of inactivity, or of benefits remaining, on the electronic benefit account.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
    Sec. 5.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF PAYMENT QUALITY CONTROL SAMPLING PROCEDURES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, when reporting the state’s payment error rate as outlined by 7 C.F.R. §275.14, and food and nutrition services handbooks 310 and 311, the department of health and human services be permitted to report the payment error rate based only on errors directly attributable to the department.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver from the United States department of agriculture.
    Sec. 6.  FEDERAL SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— WAIVER OF REQUIRED APPLICATION INFORMATION RULES.
   1.  The department of health and human services shall request a waiver from the food and nutrition services of the United States department of agriculture to provide that, for purposes of state administration of the supplemental nutrition assistance program, applications under 7 C.F.R. §273.2 must include all of the following to be considered complete:
   a.  The applicant’s name.
   b.  The applicant’s address.
   c.  The signature of a responsible household member or authorized representative or verbal assent by the applicant to the information provided during the telephonic interview.
   d.  All eligibility information including household composition, household members’ income, expenses, citizenship status, and identity.
   2.  The department of health and human services shall implement the waiver upon receipt of approval of the waiver.
DIVISION II
MEDICAL ASSISTANCE PROGRAM

    Sec. 7.  Section 249A.3, subsection 2, paragraph a, subparagraph (1), Code 2026, is amended to read as follows:
   (1)  (a)  As allowed under 42 U.S.C. §1396a(a)(10)(A)(ii)(XIII), individuals with disabilities, who are less than sixty-five years of age, who are members of families whose income is less than two hundred fifty three hundred percent of the most recently revised official poverty guidelines published by the United States department of health and human services for the family, who have earned income and who are eligible for mandatory medical assistance or optional medical assistance under this section if earnings are disregarded. As allowed by 42 U.S.C. §1396a(r)(2), unearned income shall also be disregarded in determining whether an individual is eligible for assistance under this subparagraph. For the purposes of determining the amount of an individual’s resources under this subparagraph and as allowed by 42 U.S.C. §1396a(r)(2), a maximum of ten thousand dollars of available resources for an individual and twenty-one thousand dollars of available resources for a couple shall be disregarded, and any additional resources held in a retirement account, in a pension account, in a medical savings account, or in any other account approved under rules adopted by the department shall also be disregarded.
   (b)  Individuals eligible for assistance under this subparagraph, whose individual income exceeds one hundred fifty percent of the official poverty guidelines published by the United States department of health and human services for an individual, shall pay a premium. The amount of the premium shall be based on a sliding fee schedule adopted by rule of the department and shall be based on a percentage of the individual’s income. The maximum premium payable by an individual whose income exceeds one hundred fifty percent of the official poverty guidelines shall be commensurate with the cost of state employees’ group health insurance in this state. The payment to and acceptance by an automated case management system or the department of the premium required under this subparagraph shall not automatically confer initial or continuing program eligibility on an individual.  The department shall maintain a page on the department’s internet site where individuals can electronically pay any premium owed by an individual to the department. A premium paid to and accepted by the department’s premium payment process that is subsequently determined to be untimely or to have been paid on behalf of an individual ineligible for the program shall be refunded to the remitter in accordance with rules adopted by the department. Any unpaid premium shall be a debt owed to the department.
    Sec. 8.  Section 249A.4, Code 2026, is amended by adding the following new subsections:
   NEW SUBSECTION.  15.  Submit a quarterly report to the general assembly beginning with the fiscal quarter that starts on October 1, 2026, and every fiscal quarter thereafter, that details payment error rates associated with the medical assistance program for the immediately preceding fiscal quarter.
   NEW SUBSECTION.  16.  Submit an annual report to the general assembly on or before October 1 on petitions for a waiver, also referred to by the department as exceptions to policy, of rules governing the Medicaid program filed pursuant to the rules of the department. The report must include all the following for the immediately preceding fiscal year:
   a.  The total number of exceptions to policy granted.
   b.  The cumulative cost of the exceptions to policy that were granted.
   c.  The types of exceptions to policy that were granted.
   d.  Identifiable trends noted by the department including any of the following:
   (1)  The number of exceptions to policy granted in a particular geographic location.
   (2)  The types of Medicaid services that were the basis for exceptions to policy.
   (3)  The Medicaid program eligibility classification of individuals granted Medicaid program exceptions to policy.
    Sec. 9.  NEW SECTION.  249A.32C  Home and community-based service waivers —— rural provider rate increase.
   1.  For the purposes of this section, unless context otherwise requires:
   a.  “Consumer” means the same as defined in section 249A.29.
   b.  “Rural area” means a geographical area that is not part of a metropolitan statistical area as designated by the United States office of management and budget.
   c.  “Waiver” means the same as defined in section 249A.29.
   2.  The base reimbursement rate for a provider of services under a medical assistance program home and community-based services waiver shall be increased to cover the travel time and expenses incurred by the provider to provide services to a consumer who resides in a rural area.
    Sec. 10.  NEW SECTION.  249A.32D  Waivers —— cost neutrality.
   1.  As used in this section, “cost neutral” means federal approval of a waiver related to the medical assistance program submitted by the department to the federal government will not result in a net increase in spending for state administration of the medical assistance program.
   2.  Prior to submitting a request for a waiver to the United States department of health and human services related to the medical assistance program, the department shall conduct an analysis to determine if the waiver is cost neutral. For any waiver that is determined to be not cost neutral, the department shall not submit the request for a waiver unless the waiver has been presented to the general assembly and approved by a majority vote of both houses of the general assembly.
    Sec. 11.  MEDICAID EXCEPTIONS TO POLICY REVIEW —— REPORT TO GENERAL ASSEMBLY.  The department of health and human services shall conduct a review of petitions for a waiver, also referred to by the department as exceptions to policy, of rules governing the Medicaid program granted by the department between January 1, 2020, and January 1, 2026, and shall submit a report on or before December 15, 2026, of the findings of the review. The report shall include all of the following:
   1.  The total number of exceptions to policy granted.
   2.  The cumulative cost of the exceptions to policy that were granted.
   3.  The types of exceptions to policy that were granted.
   4.  Identifiable trends noted by the department including any of the following:
   a.  The number of exceptions to policy granted in a particular geographic location.
   b.  The types of Medicaid services that were the basis for the waiver.
   c.  The Medicaid program classification of individuals granted exception to policy.
DIVISION III
ELIGIBILITY FOR CERTAIN PROGRAMS

    Sec. 12.  NEW SECTION.  234.6A  Program eligibility —— residency.
   1.  As used in this section, “public assistance program” means any of the following:
   a.  The state child care assistance program under section 237A.13.
   b.  The family investment program under chapter 239B.
   c.  The medical assistance program under chapter 249A.
   d.  The supplemental nutrition assistance program administered by the state pursuant to 7 C.F.R. pts. 270 – 283, as amended.
   e.  The special supplemental nutrition program for women, infants, and children as provided in 42 U.S.C. §1786 et seq.
   2.  a.  Unless prohibited under federal law, the department may require from an applicant to a public assistance program proof of at least twelve months of continuous residency within the state including any of the following:
   (1)  A statement from the applicant attesting to the applicant’s reasons for being in the state and length of residency within the state.
   (2)  A statement from the applicant’s employer confirming the applicant’s employment in the state.
   (3)  Any other statement from other persons with knowledge who can attest to the applicant’s reasons for being in the state and length of residency within the state.
   (4)  A copy of the applicant’s most recently filed Iowa state income tax return.
   b.  Paragraph “a” shall not apply to applicants who receive benefits under the federal Social Security Act, 42 U.S.C. §423 et seq.
    Sec. 13.  Section 239.6, subsection 1, paragraph a, subparagraph (4), Code 2026, is amended to read as follows:
   (4)  Information maintained by the United States citizenship and immigration services of the United States department of homeland security, including information accessible through the systematic alien verification for entitlements online service.
    Sec. 14.  Section 239.6, subsection 2, Code 2026, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  g.  The systematic alien verification for entitlements online service maintained by the United States citizenship and immigration services of the United States department of homeland security to verify immigration and United States citizenship information.
DIVISION IV
MISCELLANEOUS PUBLIC ASSISTANCE PROGRAMS

    Sec. 15.  NEW SECTION.  135.16E  Special supplemental nutrition program for women, infants, and children —— citizens and qualified aliens.
   The department shall restrict participation in the special supplemental nutrition program for women, infants, and children to citizens and qualified aliens pursuant to section 742 of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193.
    Sec. 16.  Section 249N.6, subsection 5, Code 2026, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  c.  Notwithstanding any other provision of law to the contrary, an Iowa health and wellness plan provider may impose a fee of no more than five dollars on a member based on the member’s failure to attend a scheduled appointment with the provider.
    Sec. 17.  Section 249N.7, subsection 1, Code 2026, is amended to read as follows:
   1.  Membership in the Iowa health and wellness plan shall require payment of monthly contributions for members whose household income is at or above fifty one hundred percent of the federal poverty level. Members shall be subject to an eight dollar copayment amounts applicable only to for nonemergency use of a hospital emergency department. Total member cost-sharing, annually, shall align with the cost-sharing limitations requirements for the American health benefits exchanges under the Affordable Care Act One Big Beautiful Bill Act, Pub. L. No. 119-21. Contributions Monthly contributions and copayment amounts for members shall be established by rule of the department.
    Sec. 18.  Section 249N.7, Code 2026, is amended by adding the following new subsections:
   NEW SUBSECTION.  3.  Notwithstanding subsection 1, a member who fails to complete all required preventative care services and wellness activities specified during the prior annual membership period shall be subject to a monthly five dollar fee during the subsequent year of membership.
   NEW SUBSECTION.  4.  Notwithstanding subsection 1, a member whose household income is at or above one hundred percent of the federal poverty level shall be subject to the following copay amounts:
   a.  A five dollar copay for a diagnostic dental procedure. As used in this paragraph, “diagnostic dental procedure” means a dental procedure that is not performed for preventative purposes.
   b.  A one dollar copay for a prescription drug when a suitable generic equivalent drug approved by the United States food and drug administration is available to the member.
    Sec. 19.  2023 Iowa Acts, chapter 104, section 12, subsection 3, is amended to read as follows:
   3.  Unless otherwise provided in this Act, the department of health and human services shall implement the provisions of this Act in an incremental fashion, beginning July 1, 2023, with a goal of full implementation no later than July 1, 2025 completed by January 1, 2027, to minimize duplication of efforts and to maximize coordination with the implementation time frames of other departmental resource enhancements.
    Sec. 20.  IOWA HEALTH AND WELLNESS PLAN —— MEMBER REENROLLMENT FOLLOWING TERMINATION FOR NONPAYMENT OF MONTHLY CONTRIBUTIONS.  The department of human services shall seek approval of an amendment to the section 1115 demonstration waiver for the Iowa health and wellness plan from the centers for Medicare and Medicaid services of the United States department of health and human services to provide the following:
   1.  An Iowa health and wellness plan member who is subject to payment of a monthly contribution as the result of failure to complete required preventative care services and wellness activities, and whose eligibility for the program is terminated due to nonpayment of monthly contributions, shall be allowed to subsequently reenroll in the program without first paying any outstanding monthly contributions, if the member has not been terminated from the program previously for nonpayment of monthly contributions. 
   2.  If an Iowa health and wellness plan member has been terminated from the program previously for nonpayment of monthly contributions, and is subsequently terminated from the program for nonpayment of monthly contributions owed as a result of failure to complete required preventative care services and wellness activities, the member shall be subject to payment of any outstanding monthly contributions prior to reenrollment in the program.
    Sec. 21.  ADMINISTRATIVE RULES —— SPECIAL POPULATION NURSING FACILITY REIMBURSEMENT RATES.  The department of health and human services shall amend the department’s rules establishing the rate component limits for the direct care rate and the nondirect care rate patient-day-weighted medians and modified price-base reimbursement rates to apply the same rates provided to special population nursing facilities enrolled in Medicare on or after June 1, 1993, to those enrolled on or after July 1, 2023.
DIVISION V
PUBLIC ASSISTANCE FRAUD —— REPORT

    Sec. 22.  NEW SECTION.  10A.404  Fraud in public assistance —— report.
   On or before October 1, 2026, and every fiscal year thereafter, the department shall submit a report to the general assembly concerning the department’s activities relative to fraud in public assistance programs for the immediately preceding fiscal year. The report shall include but is not limited to a summary of the number of cases investigated, case outcomes, overpayment dollars identified, amount of cost avoidance, and actual dollars recovered.
DIVISION VI
HIGH-ACUITY PEDIATRIC WORK GROUP —— REPORT

    Sec. 23.  HIGH-ACUITY PEDIATRIC WORK GROUP —— REPORT TO GENERAL ASSEMBLY.
   1.  The department of health and human services shall convene a work group to examine the unique service needs of high-acuity pediatric recipients of medical assistance under chapter 249A, and high-acuity pediatric members of the healthy and well kids in Iowa program under chapter 514I. The work group shall do all of the following:
   a.  Identify the barriers that prevent the high-acuity pediatric recipients and members from remaining in the least restrictive environment possible.
   b.  Develop a proposal for a tiered reimbursement methodology to provide high-acuity home health services tailored to meet the allowable medical and nonmedical support needs of high-acuity pediatric recipients and members.
   2.  The work group shall be comprised of at least one representative of a provider of high-acuity home health services, one representative of the Iowa chapter of the American academy of pediatrics, one representative of the Iowa association of community providers, one representative of the Iowa health care association, and other individuals or organizations deemed appropriate by the department.
   3.  On or before December 1, 2026, the department shall submit a report to the general assembly that includes all of the following:
   a.  The barriers identified by the work group that prevent high-acuity pediatric recipients and members from remaining in the least restrictive environment possible.
   b.  The working group’s proposed tiered reimbursement methodology and the estimated fiscal impact on affected providers and health care facilities.
   4.  The department of health and human services shall provide administrative support, including scheduling meetings of the work group as necessary to complete the work of the work group.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to public assistance programs, including the supplemental nutrition assistance program, the medical assistance program, and other public assistance programs under the purview of the department of health and human services (HHS).
   DIVISION I —— SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM.  Beginning October 1, 2026, the bill requires HHS to submit a report to the general assembly every fiscal quarter detailing the payment error rates associated with the supplemental nutrition assistance program (SNAP) for the immediately preceding fiscal quarter; it must be submitted within 30 calendar days of the immediately preceding fiscal quarter.
   The bill requires that HHS request an appropriate waiver of specific federal SNAP regulations regarding earned income, independent verification of eligibility, expungement of benefits from certain electronic benefit accounts, calculations by HHS of the program payment error rate, and required program application information. HHS shall implement any requested waiver upon receipt of approval of the waiver by the federal government.
   DIVISION II —— MEDICAL ASSISTANCE PROGRAM. Code section 249A.3 sets forth program eligibility criteria for Medicaid for employed persons with disabilities (MEPD) pursuant to 42 U.S.C. §1396a. The bill amends current eligibility provisions requiring the department to cap premiums for individuals whose income falls below 250 percent of the federal poverty level (FPL), and that any acceptance by the department of the payment of a premium does not automatically confer initial or continuing MEPD eligibility on an individual. Code section 249A.3 also requires HHS to not consider certain assets when determining asset eligibility under MEPD.
   The bill requires that HHS extend MEPD eligibility to those with household incomes up to 300 percent of the FPL. Moneys in a pension fund are not to be considered by HHS for purposes of determining asset eligibility under MEPD. The bill provides that HHS must allow for the electronic payment of MEPD premiums through a page maintained on the department’s internet site.
   Beginning October 1, 2026, the bill requires the director of HHS to submit a report every fiscal quarter to the general assembly detailing payment error rates associated with the medical assistance program for the preceding fiscal quarter. 
   The bill also requires the director of HHS to submit an annual report to the general assembly on or before October 1, 2026, with specific information as detailed in the bill related to petitions for a waiver, which the department refers to as exceptions to policy, to rules governing the Medicaid program granted by HHS during the immediately preceding fiscal year.
   Under current law, the reimbursement rate set by HHS for providers under the home and community-based waivers does not cover the provider’s travel time and other expenses associated with providing care to a resident in a rural area of the state. The bill requires HHS to cover such costs for those providers.
   The bill requires HHS to conduct an analysis to determine if a waiver related to the medical assistance program is cost neutral prior to submission of a request for the waiver to the United States department of health and human services. Prior to submitting a waiver request related to the medical assistance program that is not cost neutral, HHS must seek the approval of the general assembly by majority vote of both houses of the general assembly. “Cost neutral” is defined to mean that approval of a waiver by the federal government will not result in a net increase in spending on the administration of the program by the state.
   HHS is required to conduct a review of petitions for a waiver, also referred to by the department as exceptions to policy, of rules governing the Medicaid program granted by the department between January 1, 2020, and January 1, 2026. On or before December 15, 2026, the department shall submit a report to the general assembly with specific information as detailed in the bill.
   DIVISION III —— ELIGIBILITY FOR CERTAIN PROGRAMS. The bill permits HHS, unless prohibited by federal law, for purposes of determining eligibility for assistance from certain public assistance programs under the purview of HHS, to require proof of 12 months of continuous residency through documentation that attests to employment within the state and other reasons for being in the state, as well as the length of residency of the applicant. HHS may not require proof of residency for people who are receiving social security benefits. “Public assistance program” is defined as the family investment program, medical assistance program, supplemental nutrition assistance program, and the special nutrition assistance program for women, infants, and children.
   The bill requires HHS, prior to determining the initial eligibility of an applicant for, or the ongoing eligibility of a recipient of, public assistance benefits to verify immigration and United States citizenship information of the applicant or recipient through the systematic alien verification for entitlements online service maintained by the United States citizenship and immigration services of the United States department of homeland security.
   DIVISION IV —— MISCELLANEOUS PUBLIC ASSISTANCE PROGRAM PROVISIONS. Section 742 of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 neither prohibits a state from providing nor requires a state to provide food assistance to a person who is not a citizen or qualified alien under certain programs, including the special supplemental nutrition program for women, infants, and children (WIC). The bill provides that HHS shall restrict participation in WIC to citizens and qualified aliens pursuant to federal law.
   Under current law, a provider under the Iowa health and wellness plan (IHAWP) cannot charge a member a nonattendance fee. Under the bill, a provider can charge a member a nonattendance fee. HHS has established monthly member contributions and copayment amounts for IHAWP members by rule. Under the bill, IHAWP providers may charge a member a $5 nonattendance fee and all IHAWP members must pay an $8 copayment for each nonemergency use of a hospital emergency department.
   Under current law, IHAWP members with household incomes above 50 percent and not in excess of 100 percent of the FPL who fail to complete the required preventative services and wellness services annually are required to pay a monthly contribution of $5, while those members with household incomes in excess of 100 percent of the FPL that fail to complete the required preventative services and wellness services annually are required to pay a monthly contribution of $10. The bill instead requires any member that fails to complete the required preventative services and wellness services annually to pay a monthly fee of $5 during the subsequent membership year.
   The bill requires an IHAWP member whose household income is at or above 100 percent of the FPL to pay a $5 copay when receiving diagnostic dental procedures, and a $1 copay when buying a prescription drug when an equivalent generic drug is available. The bill defines “diagnostic dental procedure”.
   Current Code chapter 239 sets forth specific requirements for specifically defined public assistance programs under the purview of HHS. Under current law, HHS set a goal of fully implementing the requirements for public assistance programs pursuant to Code chapter 239 by July 1, 2025. Under the bill, the department must fully implement the requirements pursuant to Code chapter 239 by January 1, 2027.
   The bill requires HHS to seek approval of an amendment to the section 1115 demonstration waiver for the Iowa health and wellness plan from the centers for Medicare and Medicaid services of the United States department of health and human services to provide that an IHAWP member whose eligibility for the program is terminated due to nonpayment of monthly contributions owed as a result of an IHAWP member’s failure to complete required preventative care services and wellness activities shall be allowed to subsequently reenroll in the program without first paying any outstanding monthly contributions, if the member has not been terminated from the program previously for nonpayment of monthly contributions; if the IHAWP member has previously been terminated from the program for nonpayment of monthly contributions, the member shall be subject to payment of any outstanding monthly contributions prior to reenrollment in the program.
   Currently, HHS has established by rule certain reimbursement rate limits for special population nursing facilities enrolled in the Medicare program on or after June 1, 1993. The bill requires HHS to apply these same reimbursement rate limits to special population nursing facilities enrolled in the federal Medicare program on or after July 1, 2023.
   DIVISION V —— PUBLIC ASSISTANCE FRAUD —— REPORT. The bill requires the department of inspections, appeals, and licensing to submit a report on or before October 1, 2026, to the general assembly concerning the department’s activities relative to fraud in public assistance programs for the immediately preceding fiscal year. The report shall include but is not limited to a summary of the number of cases investigated, case outcomes, overpayment dollars identified, amount of cost avoidance, and actual dollars recovered.
   DIVISION VI —— HIGH-ACUITY WORK GROUP —— REPORT. Under the bill, HHS is required to convene a work group to identify barriers to the ability of high-acuity Medicaid recipients and members of Iowa health and wellness kids in Iowa (Hawki) to remain in the least restrictive environment possible, and develop a proposal for a tiered reimbursement methodology to provide high-acuity home health services tailored to meet the allowable medical and nonmedical support needs of such individuals. The work group shall be composed of at least one representative from providers of high-acuity home health services, the Iowa chapter of the American academy of pediatrics, the Iowa association of community providers, the Iowa health care association, and other individuals or organizations deemed appropriate by HHS. The work group shall submit a report to the general assembly on or before December 1, 2026, that outlines barriers identified by the work group to high-acuity pediatric members remaining in the least restrictive environment possible, and provides the estimated fiscal impact of the work group’s proposed tiered reimbursement methodology on affected providers and health care facilities. HHS shall provide administrative support to the work group.