S.F. 534 Section 1. MEDICAID —— REIMBURSEMENT OF TRANSPORTATION 1 COSTS —— HOME HEALTH CARE PROVIDERS. The department of 2 health and human services shall establish a rate structure for 3 reimbursement of the transportation costs of home health care 4 providers by incorporating an increased reimbursement amount 5 into the existing home health care provider reimbursement rate 6 that reflects the total time expended by a home health care 7 provider, including the provider’s travel time, in the per 8 visit reimbursement. The department shall submit a report on 9 the reimbursement rate structure and the projected cost of 10 application of the reimbursement rate structure to the governor 11 and the general assembly by December 1, 2025. 12 Sec. 2. OPTIONS FOR LONG-TERM LIVING —— STUDY —— REPORT. 13 1. Pursuant to section 231.58, and considering the intent of 14 the general assembly for the long-term living system in Iowa 15 pursuant to section 231F.1, including maximizing independence, 16 choice, and dignity for consumers, the director of health 17 and human services shall convene a study group to facilitate 18 the coordination of long-term living system policy, service 19 delivery, and long-range planning by performing a focused 20 review of the alternatives for the long-term living system in 21 the state. 22 2. The study group shall include all of the following 23 members: 24 a. The director of health and human services. 25 b. The director of the division of aging and disability 26 services of the department of health and human services. 27 c. The director of the department of inspections, appeals, 28 and licensing. 29 d. The state director of AARP Iowa, or the state director’s 30 designee. 31 e. The chief executive officer of each area agency on aging, 32 or the chief executive officer’s designee. 33 f. The chairperson of the older Iowans legislature. 34 g. The executive director of the Iowa caregivers 35 -1- LSB 1475XS (3) 91 lh/ko 1/ 5

S.F. 534 association, or the executive director’s designee. 1 h. The executive director of the Alzheimer’s association, 2 Iowa chapter, or the executive director’s designee. 3 i. The executive director of disability rights Iowa, or the 4 executive director’s designee. 5 j. The director of the Barbara and Richard Csomay center 6 for gerontological excellence, at the state university of Iowa 7 college of nursing, or the director’s designee. 8 k. The director of the gerontology program at Iowa state 9 university of science and technology, or the director’s 10 designee. 11 l. The director of the university of northern Iowa school of 12 applied human sciences, or the director’s designee. 13 m. The president and vice president of the Hale group. 14 3. The review shall include a survey of existing long-term 15 living approaches utilized in other states and innovative 16 approaches such as the greenhouse system, adult family homes, 17 and elder group homes, with the goal of providing Iowans with 18 access to an extensive range of high-quality, affordable, and 19 cost-effective long-term living options. The review shall also 20 consider how the state may assist nursing facilities which are 21 not at full occupancy by incorporating other sectors including 22 but not limited to child care, adult day care, and home health 23 services. 24 4. The study group shall submit a report of its findings 25 and recommendations including a summary of existing and 26 innovative approaches, how other states have successfully 27 implemented existing approaches, and how the state of Iowa can 28 encourage development of the identified existing and innovative 29 approaches in this state, to the governor and the general 30 assembly by December 15, 2025. 31 Sec. 3. ADULT DAY CARE PROVIDERS —— MEDICAID 32 REIMBURSEMENT. For the fiscal year beginning July 1, 33 2025, reimbursement rates under the Medicaid program for adult 34 day care providers who provide services to Medicaid home and 35 -2- LSB 1475XS (3) 91 lh/ko 2/ 5

S.F. 534 community-based services waiver recipients shall be increased 1 by five percent over the reimbursement rates in effect on June 2 30, 2025. 3 Sec. 4. IOWA RETURN TO COMMUNITY PROGRAM —— 4 APPROPRIATION. There is appropriated from the general 5 fund of the state to the department of health and human 6 services for the fiscal year beginning July 1, 2025, and 7 ending June 30, 2026, the following amount, or so much 8 thereof as is necessary, to be used in collaboration with 9 affected stakeholders to continue to expand the Iowa return to 10 community program to assist non-Medicaid-eligible consumers 11 who indicate a preference to return to the community and are 12 deemed appropriate for discharge, to return to their community 13 following a nursing facility or hospital stay: 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,000,000 15 The department of health and human services shall submit to 16 the governor and the general assembly by December 15, 2025, an 17 estimate of the cost to fully fund an expansion of the Iowa 18 return to community program to provide access to all interested 19 consumers. 20 Sec. 5. STATEWIDE DEMENTIA CARE COORDINATOR —— DEMENTIA 21 SERVICE SPECIALISTS —— APPROPRIATION. There is appropriated 22 from the general fund of the state to the department of health 23 and human services for the fiscal year beginning July 1, 2025, 24 and ending June 30, 2026, the following amount or so much 25 thereof as is necessary, for the department of health and 26 human services to employ a statewide dementia care coordinator 27 within the department to provide statewide coordination of 28 dementia-friendly initiatives including efforts pursuant to 29 section 231.62; to coordinate dementia service specialists 30 in each area agency on aging; to provide grants to each 31 area agency on aging to employ a dementia service specialist 32 to increase access and connections to local supports and 33 services for persons living with dementia, their families, 34 and caregivers; to evaluate the availability of respite care 35 -3- LSB 1475XS (3) 91 lh/ko 3/ 5

S.F. 534 for family caregivers of persons with dementia and to provide 1 recommendations to the department and the general assembly 2 on how to meet the demand; and to increase awareness about 3 dementia within the network of area agency on aging providers 4 as well as in communities, businesses, health care facilities, 5 and assisted living programs throughout the state: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 750,000 7 EXPLANATION 8 The inclusion of this explanation does not constitute agreement with 9 the explanation’s substance by the members of the general assembly. 10 This bill relates to options for long-term living and 11 funding of long-term care services. 12 The bill requires the department of health and human 13 services (HHS) to establish a rate structure for reimbursement 14 of the transportation costs of home health care providers by 15 incorporating an increased reimbursement amount for travel 16 time into the per visit reimbursement. The department shall 17 submit a report of the rate structure and the projected cost of 18 application of the reimbursement rate structure to the governor 19 and the general assembly by December 1, 2025. 20 The bill requires that pursuant to Code section 231.58 21 (long-term living coordination) and considering the intent of 22 the general assembly for the long-term living system in Iowa 23 pursuant to Code section 231F.1 (intent for Iowa’s long-term 24 living system), including maximizing independence, choice, 25 and dignity for consumers, the director of HHS shall convene 26 a study group that includes members specified in the bill to 27 perform a focused review of the alternatives for long-term 28 living options in the state. The review shall include a 29 survey of existing approaches utilized in other states and 30 innovative approaches to provide Iowans with access to an 31 extensive range of high-quality, affordable, and cost-effective 32 long-term living options. The review shall also consider how 33 the state may assist nursing facilities not at full occupancy 34 by incorporating other sectors. The study group shall submit a 35 -4- LSB 1475XS (3) 91 lh/ko 4/ 5

S.F. 534 report of its findings and recommendations to the governor and 1 the general assembly by December 15, 2025. 2 The bill provides that for FY 2025-2026, Medicaid 3 reimbursement rates for adult day care providers who provide 4 services to Medicaid home and community-based services waiver 5 recipients shall be increased by 5 percent over the rates in 6 effect on June 30, 2025. 7 The bill makes an appropriation to HHS for FY 2025-2026 from 8 the general fund of the state to be used in collaboration with 9 affected stakeholders to continue to expand the Iowa return 10 to community program. The bill requires HHS to submit to the 11 governor and the general assembly by December 15, 2025, an 12 estimate of the cost to fund an expansion of the Iowa return 13 to community program to provide access to all interested 14 consumers. 15 The bill makes an appropriation to HHS for FY 2025-2026 16 from the general fund of the state to be used by HHS to employ 17 a statewide dementia care coordinator within HHS to provide 18 coordination services related to statewide dementia care as 19 described in the bill. 20 -5- LSB 1475XS (3) 91 lh/ko 5/ 5