Senate Study Bill 1228 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED GOVERNOR BUDGET BILL) A BILL FOR An Act relating to and making appropriations for veterans 1 and health and human services, and related provisions and 2 appropriations, including aging and disability services, 3 behavioral health, public health, community access and 4 eligibility, health-related programs, reimbursement rates, 5 family well-being and protection, state-operated specialty 6 care, the beer and liquor control fund, and the behavioral 7 health fund, and including effective date and retroactive 8 applicability provisions. 9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 10 TLSB 1013XG (27) 91 lh/ko

S.F. _____ 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: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,384,743 12 2. IOWA VETERANS HOME 13 For salaries, support, maintenance, and miscellaneous 14 purposes: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,234,502 16 a. The Iowa veterans home billings involving the department 17 of health and human services shall be submitted to the 18 department on at least a monthly basis. 19 b. The Iowa veterans home expenditure report shall be 20 submitted monthly to the general assembly. 21 3. HOME OWNERSHIP ASSISTANCE PROGRAM 22 For transfer to the Iowa finance authority for the 23 continuation of the home ownership assistance program for 24 persons who are or were eligible members of the armed forces of 25 the United States, pursuant to section 16.54: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,700,000 27 DIVISION II 28 AGING AND DISABILITY SERVICES —— FY 2025-2026 29 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 30 AND DISABILITY SERVICES. There is appropriated from the 31 general fund of the state to the department of health and human 32 services for the fiscal year beginning July 1, 2025, and ending 33 June 30, 2026, the following amount, or so much thereof as is 34 necessary, to be used for the purposes designated: 35 -1- LSB 1013XG (27) 91 lh/ko 1/ 32

S.F. _____ H.F. _____ For aging programs for the department of health and human 1 services and area agencies on aging to provide citizens of 2 Iowa who are 60 years of age and older with case management; 3 Iowa’s aging and disabilities resource centers; for the 4 return to community program; for the purposes of chapter 231E, 5 to administer the prevention of elder abuse, neglect, and 6 exploitation program pursuant to section 231.56A, in accordance 7 with the requirements of the federal Older Americans Act of 8 1965, 42 U.S.C. §3001 et seq., as amended; for the reporting 9 and evaluation of cases of dependent adult abuse pursuant to 10 chapter 235B; and for other services which may include but are 11 not limited to adult day, respite care, chore, information 12 and assistance, and material aid, for information and options 13 counseling for persons with disabilities, and for salaries, 14 support, administration, maintenance, and miscellaneous 15 purposes: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,208,822 17 1. Funds appropriated in this section may be used to 18 supplement federal funds under federal regulations. To 19 receive funds appropriated in this section, a local area 20 agency on aging shall match the funds with moneys from other 21 sources according to rules adopted by the department. Funds 22 appropriated in this section may be used for services not 23 specifically enumerated in this section only if approved by the 24 department as part of an area agency on aging’s area plan. 25 2. Of the funds appropriated in this section, $949,282 26 shall be used for the family support center component of the 27 comprehensive family support program under chapter 225C, 28 subchapter V. 29 3. Of the funds appropriated in this section, $33,632 shall 30 be used to build community capacity through the coordination 31 and provision of training opportunities in accordance with the 32 consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 33 Iowa, July 14, 1994). 34 DIVISION III 35 -2- LSB 1013XG (27) 91 lh/ko 2/ 32

S.F. _____ H.F. _____ BEHAVIORAL HEALTH —— FY 2025-2026 1 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 2 BEHAVIORAL HEALTH. There is appropriated from the general fund 3 of the state to the department of health and human services for 4 the fiscal year beginning July 1, 2025, and ending June 30, 5 2026, the following amount, or so much thereof as is necessary, 6 to be used for the purposes designated: 7 For behavioral health prevention, treatment, and recovery 8 efforts to reduce the prevalence of the use of, provide 9 treatment for, and support recovery from alcohol, tobacco, and 10 substance use and misuse, problem gambling, and other addictive 11 behaviors. Activities shall align with accepted best practice 12 guidance standards for behavioral health including those 13 published by the centers for disease control and prevention and 14 the substance abuse and mental health services administration 15 of the United States department of health and human services 16 for health promotion; universal, selective, and indicated 17 prevention; treatment; and recovery services and supports; and 18 shall include a 24-hour helpline, public information resources, 19 professional training, youth prevention, program evaluation, 20 and efforts at the state and local levels: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,442,347 22 1. Of the funds appropriated in this section, $300,000 shall 23 be used to support the work of the children’s behavioral health 24 system including evidence-based behavioral health prevention, 25 treatment, and recovery services and supports for children and 26 their families pursuant to the intent specified in section 27 225C.6B, subsection 1. 28 2. Of the funds appropriated in this section, $950,000 29 shall be used for an integrated substance use disorder managed 30 care system. The department shall maintain the level of mental 31 health and substance use disorder treatment services provided 32 by the managed care contractors. The department shall take the 33 steps necessary to continue the federal waivers as needed to 34 maintain the level of services. 35 -3- LSB 1013XG (27) 91 lh/ko 3/ 32

S.F. _____ H.F. _____ Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 1 WAGERING RECEIPTS FUND. There is appropriated from the 2 sports wagering receipts fund created in section 8.57I, to the 3 department of health and human services for the fiscal year 4 beginning July 1, 2025, and ending June 30, 2026, the following 5 amount, or so much thereof as is necessary, to be used for 6 behavioral health prevention, treatment, and recovery efforts 7 to reduce the prevalence of the use of, provide treatment for, 8 and support recovery from alcohol, tobacco, and substance use 9 and misuse, problem gambling, and other addictive behaviors: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 11 DIVISION IV 12 PUBLIC HEALTH —— FY 2025-2026 13 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 14 HEALTH. There is appropriated from the general fund of the 15 state to the department of health and human services for the 16 fiscal year beginning July 1, 2025, and ending June 30, 2026, 17 the following amount, or so much thereof as is necessary, to be 18 used for the purposes designated: 19 For programs that support health promotion, protect the 20 health and safety of the public, conduct disease surveillance 21 and investigation to reduce the incidence of morbidity and 22 mortality, serve individuals with chronic conditions including 23 but not limited to cancer, support the Iowa donor registry as 24 specified in section 142C.18, and strengthen the health care 25 delivery system and workforce to improve health outcomes for 26 all Iowans: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,413,883 28 1. Of the funds appropriated in this section, the following 29 amounts are allocated to be used as follows to support the 30 goals of increased access, health system integration, and 31 engagement: 32 a. $600,000 is allocated to the Iowa prescription 33 drug corporation for continuation of the pharmaceutical 34 infrastructure for safety net providers originally established 35 -4- LSB 1013XG (27) 91 lh/ko 4/ 32

S.F. _____ H.F. _____ as described in 2007 Iowa Acts, chapter 218, section 108, and 1 for the prescription drug donation repository program created 2 in chapter 135M. Funds allocated under this paragraph shall 3 be distributed in their entirety for the purpose specified on 4 July 1, 2025. 5 b. $374,000 is allocated to free clinics and free clinics 6 of Iowa for necessary infrastructure, statewide coordination, 7 provider recruitment, service delivery, and provision of 8 assistance to patients in securing a medical home inclusive of 9 oral health care. Funds allocated under this paragraph shall 10 be distributed in their entirety for the purpose specified on 11 July 1, 2025. 12 c. $25,000 is allocated to the Iowa association of rural 13 health clinics for necessary infrastructure and service 14 delivery transformation. Funds allocated under this paragraph 15 shall be distributed in their entirety for the purpose 16 specified on July 1, 2025. 17 d. $225,000 is allocated to the Polk county medical society 18 for continuation of the safety net provider patients access 19 to specialty care initiative as described in 2007 Iowa Acts, 20 chapter 218, section 109. Funds allocated under this paragraph 21 shall be distributed in their entirety for the purpose 22 specified on July 1, 2025. 23 2. Of the funds appropriated in this section, $600,000 24 shall be used for rural psychiatric residencies for residents 25 selected on or before June 30, 2025. 26 3. The university of Iowa hospitals and clinics under 27 the control of the state board of regents shall not receive 28 indirect costs from the funds appropriated in this section. 29 The university of Iowa hospitals and clinics billings to the 30 department shall be on at least a quarterly basis. 31 DIVISION V 32 COMMUNITY ACCESS AND ELIGIBILITY —— FY 2025-2026 33 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 34 ACCESS AND ELIGIBILITY. There is appropriated from the 35 -5- LSB 1013XG (27) 91 lh/ko 5/ 32

S.F. _____ H.F. _____ general fund of the state to the department of health and human 1 services for the fiscal year beginning July 1, 2025, and ending 2 June 30, 2026, the following amount, or so much thereof as is 3 necessary, to be used for the purposes designated: 4 To be used for salaries, support, maintenance, and 5 miscellaneous purposes and for family investment program (FIP) 6 assistance in accordance with chapter 239B, and for other costs 7 associated with providing needs-based benefits or assistance 8 including but not limited to maternal and child health, oral 9 health, obesity prevention, the promoting independence and 10 self-sufficiency through employment, job opportunities and 11 basic skills (PROMISE JOBS) program, supplemental nutrition 12 assistance program (SNAP) employment and training, the FIP 13 diversion program, family planning, rent reimbursement, 14 and eligibility determinations for medical assistance, food 15 assistance, and the children’s health insurance program: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,545,138 17 1. Of the child support collections assigned under FIP, 18 the federal share of support collections shall be credited to 19 the child support services appropriation made in this division 20 of this Act. Of the remainder of the assigned child support 21 collections received by child support services, a portion 22 shall be credited to community access and eligibility, and 23 the remaining funds may be used to increase recoveries, to 24 sustain cash flow in the child support payments account, or for 25 technology needs. If child support collections assigned under 26 FIP are greater than estimated or are otherwise determined 27 not to be required for maintenance of effort, the state share 28 of either amount is appropriated to the department for child 29 support services as described in this Act or may be transferred 30 to or retained in the child support payments account. 31 2. Of the funds appropriated in this section, $3,075,000 32 shall be used for continuation of the department’s initiative 33 to provide for adequate developmental surveillance and 34 screening during a child’s first five years. The funds shall 35 -6- LSB 1013XG (27) 91 lh/ko 6/ 32

S.F. _____ H.F. _____ be used first to fully fund the current participating counties 1 to ensure that those counties are fully operational, with the 2 remaining funds to be used for expanding participation to 3 additional counties. The full implementation and expansion 4 shall include enhancing the scope of the initiative through 5 collaboration with the child health specialty clinics to 6 promote the use of developmental surveillance and screening to 7 support healthy child development through early identification 8 and response to both biomedical and social determinants of 9 healthy development by providing practitioner consultation 10 and continuous improvement through training and education, 11 particularly for children with behavioral conditions and 12 needs. The department shall also collaborate with the Medicaid 13 program and the child health specialty clinics to assist in 14 coordinating the activities of the first five initiative into 15 the establishment of patient-centered medical homes developed 16 to improve health quality and population health while reducing 17 health care costs. To the maximum extent possible, funding 18 allocated in this subsection shall be utilized as matching 19 funds for Medicaid program reimbursement. 20 3. Of the funds appropriated in this section, $1,145,102 21 is allocated to the Iowa commission on volunteer service for 22 programs and grants. 23 4. The university of Iowa hospitals and clinics under 24 the control of the state board of regents shall not receive 25 indirect costs from the funds appropriated in this section. 26 The university of Iowa hospitals and clinics billings to the 27 department shall be on at least a quarterly basis. 28 CHILD SUPPORT SERVICES 29 Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from 30 the general fund of the state to the department of health and 31 human services for the fiscal year beginning July 1, 2025, and 32 ending June 30, 2026, the following amount, or so much thereof 33 as is necessary, to be used for the purposes designated: 34 For child support services, including salaries, support, 35 -7- LSB 1013XG (27) 91 lh/ko 7/ 32

S.F. _____ H.F. _____ maintenance, and miscellaneous purposes: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,645,242 2 1. Federal access and visitation grant moneys shall be used 3 for services designed to increase compliance with the child 4 access provisions of court orders, including but not limited to 5 neutral visitation sites and mediation services. 6 2. The appropriation made to the department for child 7 support services may be used throughout the fiscal year in the 8 manner necessary for purposes of cash flow management, and for 9 cash flow management purposes the department may temporarily 10 draw more than the amount appropriated, provided the amount 11 appropriated is not exceeded at the close of the fiscal year. 12 DIVISION VI 13 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 14 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 15 PROGRAMS —— FY 2025-2026 16 Sec. 8. MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY 17 ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There 18 is appropriated from the general fund of the state to the 19 department of health and human services for the fiscal year 20 beginning July 1, 2025, and ending June 30, 2026, the following 21 amount, or so much thereof as is necessary, to be used for the 22 purposes designated: 23 For medical assistance program reimbursement and associated 24 costs as specifically provided in the reimbursement 25 methodologies in effect on June 30, 2025, except as otherwise 26 expressly authorized by law, consistent with options under 27 federal law and regulations, and contingent upon receipt of 28 approval from the office of the governor of reimbursement 29 for each abortion performed under the program; for the state 30 supplementary assistance program; for the health insurance 31 premium payment program; and for maintenance of the healthy and 32 well kids in Iowa (Hawki) program pursuant to chapter 514I, 33 including supplemental dental services, for receipt of federal 34 financial participation under Tit. XXI of the federal Social 35 -8- LSB 1013XG (27) 91 lh/ko 8/ 32

S.F. _____ H.F. _____ Security Act, which creates the children’s health insurance 1 program; and for other specified health-related programs: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,873,384,884 3 1. Of the funds appropriated in this section, 4 $1,808,383,124 is allocated for medical assistance program 5 reimbursement and associated costs. 6 a. Of the funds allocated in this subsection, $800,000 shall 7 be used for the renovation and construction of certain nursing 8 facilities, consistent with the provisions of chapter 249K. 9 b. Of the funds allocated in this subsection, $3,383,880 10 shall be used for program administration, outreach, and 11 enrollment activities of the state family planning services 12 program pursuant to section 217.41B, and of this amount, the 13 department may use $200,000 for administrative expenses. 14 2. Iowans support reducing the number of abortions 15 performed in our state. Funds appropriated under this section 16 shall not be used for abortions, unless otherwise authorized 17 under this section. 18 3. The provisions of this section relating to abortions 19 shall also apply to the Iowa health and wellness plan created 20 pursuant to chapter 249N. 21 4. Of the funds appropriated in this section, $4,479,762 is 22 allocated for the state supplementary assistance program. 23 5. Of the funds appropriated in this section, $60,521,998 24 is allocated for maintenance of the Hawki program pursuant 25 to chapter 514I, including supplemental dental services, for 26 receipt of federal financial participation under Tit. XXI of 27 the federal Social Security Act, which creates the children’s 28 health insurance program. 29 HEALTH PROGRAM OPERATIONS 30 Sec. 9. HEALTH PROGRAM OPERATIONS. There is appropriated 31 from the general fund of the state to the department of health 32 and human services for the fiscal year beginning July 1, 33 2025, and ending June 30, 2026, the following amount, or so 34 much thereof as is necessary, to be used for the purposes 35 -9- LSB 1013XG (27) 91 lh/ko 9/ 32

S.F. _____ H.F. _____ designated: 1 For health program operations and the autism support 2 program: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,672,838 4 1. The department of inspections, appeals, and licensing 5 shall provide all state matching funds for survey and 6 certification activities performed by the department of 7 inspections, appeals, and licensing. The department of health 8 and human services is solely responsible for distributing the 9 federal matching funds for such activities. 10 2. Of the funds appropriated in this section, a sufficient 11 amount shall be used for the administration of the health 12 insurance premium payment program, including salaries, support, 13 maintenance, and miscellaneous purposes. 14 3. Of the funds appropriated in this section, $750,000 shall 15 be used for the state poison control center. Pursuant to the 16 directive under 2014 Iowa Acts, chapter 1140, section 102, the 17 federal matching funds available to the state poison control 18 center from the department under the federal Children’s Health 19 Insurance Program Reauthorization Act of 2009 allotment shall 20 be subject to the federal administrative cap rule of 10 percent 21 applicable to funding provided under Tit. XXI of the federal 22 Social Security Act and included within the department’s 23 calculations of the cap. 24 4. Unless otherwise provided by law, if a contract for 25 services provided under this section initially entered into 26 during the fiscal year beginning July 1, 2025, and ending 27 June 30, 2026, provides for an annual increase of the cost of 28 services provided under the contract, the annual increase shall 29 not exceed the amount by which the consumer price index for all 30 urban consumers increased during the most recently concluded 31 calendar year. This subsection shall not affect a contract 32 entered into on or before June 30, 2025, that is for a term of 33 more than one year. 34 HEALTH CARE ACCOUNTS AND FUNDS 35 -10- LSB 1013XG (27) 91 lh/ko 10/ 32

S.F. _____ H.F. _____ Sec. 10. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT 1 OF HEALTH AND HUMAN SERVICES. There is appropriated from the 2 pharmaceutical settlement account created in section 249A.33 to 3 the department of health and human services for the fiscal year 4 beginning July 1, 2025, and ending June 30, 2026, the following 5 amount, or so much thereof as is necessary, to be used for the 6 purposes designated: 7 Notwithstanding any provision of law to the contrary, to 8 supplement the appropriation made in this Act for health 9 program operations under the medical assistance program for the 10 same fiscal year: 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 12 Sec. 11. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF 13 HEALTH AND HUMAN SERVICES. Notwithstanding any provision to 14 the contrary and subject to the availability of funds, there is 15 appropriated from the quality assurance trust fund created in 16 section 249L.4 to the department of health and human services 17 for the fiscal year beginning July 1, 2025, and ending June 30, 18 2026, the following amount, or so much thereof as is necessary, 19 for the purposes designated: 20 To supplement the appropriation made in this Act from the 21 general fund of the state to the department of health and human 22 services for medical assistance for the same fiscal year: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 24 Sec. 12. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 25 DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding any 26 provision to the contrary and subject to the availability of 27 funds, there is appropriated from the hospital health care 28 access trust fund created in section 249M.4 to the department 29 of health and human services for the fiscal year beginning July 30 1, 2025, and ending June 30, 2026, the following amount, or so 31 much thereof as is necessary, for the purposes designated: 32 To supplement the appropriation made in this Act from the 33 general fund of the state to the department of health and human 34 services for medical assistance for the same fiscal year: 35 -11- LSB 1013XG (27) 91 lh/ko 11/ 32

S.F. _____ H.F. _____ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 1 NURSING FACILITIES —— REIMBURSEMENT METHODOLOGY PROPOSAL 2 Sec. 13. NURSING FACILITIES —— MEDICAID REIMBURSEMENT 3 METHODOLOGY PROPOSAL. 4 1. By April 1, 2026, the department of health and human 5 services shall develop a reimbursement methodology proposal for 6 reimbursement of nursing facilities under the Medicaid program 7 that includes all of the following: 8 a. A base-rate payment component. 9 b. A quality assurance assessment pass-through component. 10 c. A quality assurance add-on component, which includes a 11 fixed fee payment and a quality-based payment. 12 2. The reimbursement methodology proposal shall include 13 recommendations developed by the department of health and human 14 services, in consultation with stakeholders including the Iowa 15 health care association and leadingage Iowa, for specific 16 metrics the department of health and human services will use 17 to determine whether a nursing facility is eligible to receive 18 all or a portion of the quality-based payment portion of the 19 reimbursement to the nursing facility. 20 3. The total state expenditures for reimbursement of 21 nursing facilities under the Medicaid program using the 22 reimbursement methodology proposed in this section shall 23 not exceed the amount appropriated for this purpose for the 24 applicable fiscal year. 25 DIVISION VII 26 REIMBURSEMENT RATES 27 Sec. 14. REIMBURSEMENT RATES —— MEDICAL ASSISTANCE, STATE 28 SUPPLEMENTARY ASSISTANCE, HEALTHY AND WELL KIDS IN IOWA, AND 29 OTHER HEALTH-RELATED PROGRAMS. 30 1. Reimbursement for medical assistance, state 31 supplementary assistance, and social service providers and 32 services reimbursed under the purview of the department of 33 health and human services shall remain at the reimbursement 34 rate or shall be determined pursuant to the reimbursement 35 -12- LSB 1013XG (27) 91 lh/ko 12/ 32

S.F. _____ H.F. _____ methodology in effect on June 30, 2025, with the exception of 1 the following: 2 a. If reimbursement is otherwise negotiated by contract or 3 pursuant to an updated fee schedule. 4 b. As otherwise provided in this section. 5 2. a. Notwithstanding any provision of law to the contrary, 6 for the fiscal year beginning July 1, 2025, and ending June 7 30, 2026, the department of health and human services shall 8 rebase case-mix nursing facility rates beginning July 1, 2025, 9 using the Medicaid cost reports on file for the period ending 10 December 31, 2024, to the extent possible within state funding, 11 including the allocation provided for this purpose in this Act. 12 b. The department of health and human services shall 13 calculate each nursing facility’s case-mix index for the period 14 beginning July 1, 2024, using weighting based on the current 15 patient-driven payment model schedule. Rosters shall be 16 made to show a separate calculation to determine the average 17 case-mix index for a nursing-facility-wide case-mix index, and 18 a case-mix index for the residents of a nursing facility who 19 are Medicaid recipients using all minimum data set reports by 20 the nursing facility for the previous semiannual period using a 21 day weighted calculation. 22 3. For the fiscal year beginning July 1, 2025, Medicaid 23 provider and service rates shall be adjusted to 85 percent of 24 the benchmark rates based on the department’s 2024 Medicaid 25 rate review for the following Medicaid providers: 26 a. Physicians, provider type 02 and 03. 27 b. Dentists, excluding orthodontic services, provider type 28 04. 29 c. Podiatrists, provider type 05. 30 d. Optometrists, provider type 06. 31 e. Opticians, provider type 07. 32 f. Pharmacy, enrolled to provide medical supplies and 33 equipment, provider type 08. 34 g. Independent laboratories, provider type 10. 35 -13- LSB 1013XG (27) 91 lh/ko 13/ 32

S.F. _____ H.F. _____ h. Medical supplies, provider type 12. 1 i. Clinics, provider type 14. 2 j. Physical therapists, provider type 15. 3 k. Chiropractors, provider type 16. 4 l. Audiologists, provider type 17. 5 m. Rehabilitation agencies, provider type 19. 6 n. Community mental health centers, provider type 21. 7 o. Family planning clinics, provider type 22. 8 p. Psychologists, provider type 29. 9 q. Screening centers, provider type 30. 10 r. Occupational therapists, provider type 32. 11 s. Ambulatory surgical centers, provider type 36. 12 t. Certified nurse midwives, provider type 38. 13 u. Certified registered nurse anesthetists, provider type 14 44. 15 v. Clinical social workers, provider type 48. 16 w. Nurse practitioners, provider type 50. 17 x. Behavioral health services, provider type 62. 18 y. Physician assistants, provider type 68. 19 z. Independent speech pathologists, provider type 69. 20 aa. Public health agencies, provider type 72. 21 ab. Crisis response services, provider type 80. 22 4. For the fiscal year beginning July 1, 2025, reimbursement 23 rates for maternal health providers shall be increased compared 24 to the rates in effect on June 30, 2025, to the extent possible 25 within the additional $420,000 appropriated for this purpose. 26 5. For the fiscal year beginning July 1, 2025, reimbursement 27 rates for certified nurse midwives shall be increased compared 28 to the rates in effect on June 30, 2025, to the extent possible 29 within the additional $2,000 appropriated for this purpose. 30 6. For the fiscal year beginning July 1, 2025, reimbursement 31 shall be provided for doula services within the additional 32 $220,000 appropriated for this purpose. 33 7. For the fiscal year beginning July 1, 2025, the pharmacy 34 dispensing fee shall be adjusted to $11.37, as determined by 35 -14- LSB 1013XG (27) 91 lh/ko 14/ 32

S.F. _____ H.F. _____ the cost of dispensing survey, within the allocation provided 1 for this purpose in this Act. The change in dispensing fee 2 shall become effective following federal approval of the 3 Medicaid state plan. 4 8. a. For the fiscal year beginning July 1, 2025, 5 reimbursement rates for home health agencies shall continue to 6 be based on the Medicare low utilization payment adjustment 7 (LUPA) methodology with state geographic wage adjustments and 8 shall be adjusted to increase the rates to the extent possible 9 within the state funding appropriated. 10 b. For the fiscal year beginning July 1, 2026, and for 11 each fiscal year thereafter, the department shall review the 12 reimbursement rates for home health agencies and pharmacy 13 dispensing fees. 14 Sec. 15. REIMBURSEMENT RATES —— CHILD PROTECTIVE SERVICES. 15 1. For the fiscal year beginning July 1, 2025, the 16 department of health and human services shall increase 17 reimbursement rates to qualified residential treatment 18 program providers to the extent possible within the additional 19 $3,245,594 appropriated for this purpose. 20 2. For the fiscal year beginning July 1, 2025, the 21 department of health and human services shall increase 22 reimbursement rates to shelter care providers to the extent 23 possible within the additional $1,590,842 appropriated for this 24 purpose. 25 DIVISION VIII 26 FAMILY WELL-BEING AND PROTECTION —— FY 2025-2026 27 STATE CHILD CARE ASSISTANCE 28 Sec. 16. STATE CHILD CARE ASSISTANCE. There is appropriated 29 from the general fund of the state to the department of health 30 and human services for the fiscal year beginning July 1, 31 2025, and ending June 30, 2026, the following amount, or so 32 much thereof as is necessary, to be used for the purposes 33 designated: 34 For state child care assistance in accordance with section 35 -15- LSB 1013XG (27) 91 lh/ko 15/ 32

S.F. _____ H.F. _____ 237A.13: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34,983,087 2 1. If the appropriations made for purposes of the state 3 child care assistance program for the fiscal year are 4 determined to be insufficient, it is the intent of the general 5 assembly to appropriate sufficient funding for the fiscal year 6 in order to avoid establishment of waiting list requirements. 7 2. A portion of the state match for the federal child care 8 and development block grant shall be provided as necessary to 9 meet federal matching funds requirements through the state 10 general fund appropriation made for child development grants 11 and other programs for at-risk children in section 279.51. 12 EARLY INTERVENTION AND SUPPORTS 13 Sec. 17. EARLY INTERVENTION AND SUPPORTS. There is 14 appropriated from the general fund of the state to the 15 department of health and human services for the fiscal year 16 beginning July 1, 2025, and ending June 30, 2026, the following 17 amount, or so much thereof as is necessary, to be used for the 18 purposes designated: 19 For promoting the optimum health status for children 20 and adolescents from birth through 21 years of age, and for 21 families: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35,302,034 23 1. Of the funds appropriated in this section, not more 24 than $734,000 shall be used for the healthy opportunities for 25 parents to experience success (HOPES)-healthy families Iowa 26 (HFI) program established pursuant to section 135.106. 27 2. Of the funds appropriated in this section, $4,313,845 is 28 allocated for the FaDSS grant program. Of the funds allocated 29 for the FaDSS grant program in this subsection, not more than 5 30 percent of the funds shall be used for administration of the 31 grant program. 32 3. Of the funds appropriated in this section, $29,256,799 33 shall be used for the purposes of the early childhood Iowa fund 34 created in section 256I.11. 35 -16- LSB 1013XG (27) 91 lh/ko 16/ 32

S.F. _____ H.F. _____ 4. Of the funds appropriated in this section, $1,000,000 1 shall be used for the purposes of program administration and 2 provision of pregnancy support services through the more 3 options for maternal support program in accordance with section 4 217.41C. 5 EARLY CHILDHOOD IOWA INITIATIVE 6 Sec. 18. Section 256I.11, subsection 1, Code 2025, is 7 amended to read as follows: 8 1. a. An early childhood Iowa fund is created in the state 9 treasury. The moneys credited to the fund are not subject to 10 section 8.33 and moneys in the fund shall not be transferred, 11 used, obligated, appropriated, or otherwise encumbered except 12 as provided by law. Notwithstanding section 12C.7, subsection 13 2 , interest or earnings on moneys deposited in the fund shall 14 be credited to the fund. 15 b. Moneys appropriated to the department for purposes of the 16 early childhood Iowa fund shall not be used to supplant other 17 appropriated moneys, including any of the following: 18 (1) To provide for the payment of child care for an 19 individual otherwise eligible for the state child care 20 assistance program established in section 237A.13. 21 (2) To award a child care scholarship to an individual who 22 has been approved for the state child care assistance program 23 established in section 237A.13. 24 (3) To provide for the payment of preschool tuition for 25 the amount of time a child enrolled in the statewide preschool 26 program for four-year-old children pursuant to chapter 256C 27 receives instruction in a preschool program under chapter 256C. 28 2. Moneys appropriated to the department for purposes of 29 the early childhood Iowa initiative may be used to provide 30 payment for child care for an individual whose income exceeds 31 the income eligibility percentage for the state child care 32 assistance program under section 237A.13. 33 CHILD PROTECTIVE SERVICES 34 Sec. 19. CHILD PROTECTIVE SERVICES. There is appropriated 35 -17- LSB 1013XG (27) 91 lh/ko 17/ 32

S.F. _____ H.F. _____ from the general fund of the state to the department of health 1 and human services for the fiscal year beginning July 1, 2 2025, and ending June 30, 2026, the following amount, or so 3 much thereof as is necessary, to be used for the purposes 4 designated: 5 For child, family, and adoption services, and for salaries, 6 support, maintenance, and miscellaneous purposes: 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $172,151,751 8 1. Of the funds appropriated in this section, $1,717,000 9 is allocated specifically for expenditure for the fiscal year 10 beginning July 1, 2025, through the decategorization services 11 funding pools and governance boards established pursuant to 12 section 232.188. 13 2. A portion of the funds appropriated in this section 14 may be used to provide other resources based on client need 15 required to support family preservation, emergency client need, 16 or family reunification efforts. 17 3. Of the funds appropriated in this section, a sufficient 18 amount is allocated for foster family care, group foster 19 care maintenance and services, shelter care, child welfare 20 emergency services, qualified residential treatment programs, 21 and supervised apartment living contracts. 22 4. Federal funds received by the state during the fiscal 23 year beginning July 1, 2025, as the result of the expenditure 24 of state funds appropriated during a previous state fiscal 25 year for a service or activity funded under this section, are 26 appropriated to the department to be used as additional funding 27 for services and purposes provided for under this section. 28 Notwithstanding section 8.33, moneys received in accordance 29 with this subsection that remain unencumbered or unobligated at 30 the close of the fiscal year shall not revert but shall remain 31 available for the purposes designated until the close of the 32 succeeding fiscal year. 33 5. a. Of the funds appropriated in this section, $748,000 34 is allocated for the payment of the expenses of court-ordered 35 -18- LSB 1013XG (27) 91 lh/ko 18/ 32