House File 2698 - Reprinted HOUSE FILE 2698 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO LSB 5004HB) (As Amended and Passed by the House April 19, 2024 ) A BILL FOR An Act relating to and making appropriations for veterans 1 and health and human services, including other related 2 provisions and appropriations including but not limited 3 to the personal needs allowance for certain persons under 4 Medicaid and the state supplementary assistance programs, 5 replacement generation tax revenues, the Medicaid fraud and 6 health care trust funds, the retention of certain revenues 7 by the mental health institutes, the retention of Medicaid 8 eligibility by residents of mental health institutes, 9 the scope of services of the state resource centers, the 10 appropriation of moneys in the juvenile detention home fund, 11 the family investment program account and diversion program, 12 the child support collection services center refund account, 13 the quality assurance assessment payment period, the centers 14 of excellence grant program, an assisted living program 15 revised payment model study, funding for county commissions 16 of veteran affairs, foster care provisions including 17 those relating to a relative or fictive kin, health care 18 employment agencies and health care technology platforms, 19 medical cannabidiol practitioner requirements, nursing 20 facility oversight, and state-funded psychiatry residency 21 and fellowship positions, providing penalties, and including 22 effective date and retroactive applicability provisions. 23 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 24 HF 2698 (4) 90 pf/ko/md

H.F. 2698 DIVISION I 1 DEPARTMENT OF VETERANS AFFAIRS —— FY 2024-2025 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, 2024, and ending June 30, 2025, 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14 2. IOWA VETERANS HOME 15 For salaries, support, maintenance, and miscellaneous 16 purposes: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 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 of 27 the United States, pursuant to section 16.54: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 29 DIVISION II 30 AGING AND DISABILITY SERVICES —— FY 2024-2025 31 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 32 AND DISABILITY SERVICES. There is appropriated from the 33 general fund of the state to the department of health and human 34 services for the fiscal year beginning July 1, 2024, and ending 35 -1- HF 2698 (4) 90 pf/ko/md 1/ 59

H.F. 2698 June 30, 2025, the following amount, or so much thereof as is 1 necessary, to be used for the purposes designated: 2 For aging programs for the department of health and human 3 services and area agencies on aging to provide citizens of 4 Iowa who are 60 years of age and older with case management; 5 Iowa’s aging and disabilities resource centers; for the 6 return to community program; for the purposes of chapter 231E, 7 to administer the prevention of elder abuse, neglect, and 8 exploitation program pursuant to section 231.56A, in accordance 9 with the requirements of the federal Older Americans Act of 10 1965, 42 U.S.C. §3001 et seq., as amended; for the reporting 11 and evaluation of cases of dependant adult abuse pursuant to 12 chapter 235B; and for other services which may include but are 13 not limited to adult day, respite care, chore, information 14 and assistance, and material aid, for information and options 15 counseling for persons with disabilities, and for salaries, 16 support, administration, maintenance, and miscellaneous 17 purposes: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,088,714 19 1. Funds appropriated in this section may be used to 20 supplement federal funds under federal regulations. To 21 receive funds appropriated in this section, a local area 22 agency on aging shall match the funds with moneys from other 23 sources according to rules adopted by the department. Funds 24 appropriated in this section may be used for services not 25 specifically enumerated in this section only if approved by the 26 department as part of an area agency on aging’s area plan. 27 2. Of the funds appropriated in this section, $949,282 28 shall be used for the family support center component of the 29 comprehensive family support program under chapter 225C, 30 subchapter V. 31 3. Of the funds appropriated in this section, $33,632 shall 32 be used to build community capacity through the coordination 33 and provision of training opportunities in accordance with the 34 consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 35 -2- HF 2698 (4) 90 pf/ko/md 2/ 59

H.F. 2698 Iowa, July 14, 1994). 1 DIVISION III 2 BEHAVIORAL HEALTH —— FY 2024-2025 3 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 4 BEHAVIORAL HEALTH. There is appropriated from the general fund 5 of the state to the department of health and human services for 6 the fiscal year beginning July 1, 2024, and ending June 30, 7 2025, the following amount, or so much thereof as is necessary, 8 to be used for the purposes designated: 9 For behavioral health prevention, treatment, and recovery 10 efforts to reduce the prevalence of the use of, provide 11 treatment for, and support recovery from tobacco and substance 12 use and misuse pursuant to the applicable policy, purpose, 13 and intent described in sections 125.1 and 142A.1, alcohol, 14 problem gambling, and other addictive behaviors. Activities 15 shall align with accepted best practice guidance standards for 16 behavioral health including those published by the centers for 17 disease control and prevention and the substance abuse and 18 mental health services administration of the United States 19 department of health and human services for health promotion; 20 universal, selective, and indicated prevention; treatment; and 21 recovery services and supports; and shall include a 24-hour 22 helpline, public information resources, professional training, 23 youth prevention, program evaluation, and efforts at the state 24 and local levels: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,400,114 26 1. Of the funds appropriated in this section, $300,000 shall 27 be used to support the work of the children’s behavioral health 28 system including evidence-based behavioral health prevention, 29 treatment, and recovery services and supports for children and 30 their families pursuant to the intent specified in section 31 225C.6B, subsection 1. 32 2. Of the funds appropriated in this section, $950,000 33 shall be used for an integrated substance use disorder managed 34 care system. The department shall maintain the level of mental 35 -3- HF 2698 (4) 90 pf/ko/md 3/ 59

H.F. 2698 health and substance use disorder treatment services provided 1 by the managed care contractors. The department shall take the 2 steps necessary to continue the federal waivers as needed to 3 maintain the level of services. 4 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 5 WAGERING RECEIPTS FUND. There is appropriated from the sports 6 wagering receipts fund created in section 8.57, subsection 6, 7 to the department of health and human services for the fiscal 8 year beginning July 1, 2024, and ending June 30, 2025, the 9 following amount, or so much thereof as is necessary, to be 10 used for behavioral health prevention, treatment, and recovery 11 efforts to reduce the prevalence of the use of, provide 12 treatment for, and support recovery from tobacco and substance 13 use and misuse pursuant to the applicable policy, purpose, and 14 intent described in sections 125.1 and 142A.1, alcohol, problem 15 gambling, and other addictive behaviors: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 17 DIVISION IV 18 PUBLIC HEALTH —— FY 2024-2025 19 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 20 HEALTH. There is appropriated from the general fund of the 21 state to the department of health and human services for the 22 fiscal year beginning July 1, 2024, and ending June 30, 2025, 23 the following amount, or so much thereof as is necessary, to be 24 used for the purposes designated: 25 For programs that support health promotion, protect the 26 health and safety of the public, conduct disease surveillance 27 and investigation to reduce the incidence of morbidity and 28 mortality, serve individuals with chronic conditions including 29 but not limited to cancer, support the Iowa donor registry as 30 specified in section 142C.18, and strengthen the health care 31 delivery system and workforce to improve health outcomes for 32 all Iowans: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,531,821 34 1. Of the funds appropriated in this section, $2,100,000 35 -4- HF 2698 (4) 90 pf/ko/md 4/ 59

H.F. 2698 shall be deposited in the medical residency training account 1 created in section 135.175, subsection 5, paragraph “a”, and is 2 appropriated from the account to the department to be used for 3 the purposes of the medical residency training state matching 4 grants program as specified in section 135.176. 5 2. Of the funds appropriated in this section, the following 6 amounts are allocated to be used as follows to support the 7 goals of increased access, health system integration, and 8 engagement: 9 a. $600,000 is allocated to the Iowa prescription 10 drug corporation for continuation of the pharmaceutical 11 infrastructure for safety net providers originally established 12 as described in 2007 Iowa Acts, chapter 218, section 108, and 13 for the prescription drug donation repository program created 14 in chapter 135M. Funds allocated under this paragraph shall 15 be distributed in their entirety for the purpose specified on 16 July 1, 2024. 17 b. $374,000 is allocated to free clinics and free clinics 18 of Iowa for necessary infrastructure, statewide coordination, 19 provider recruitment, service delivery, and provision of 20 assistance to patients in securing a medical home inclusive 21 of oral health care. Of the funds allocated, $40,000 shall 22 be used to cover fees associated with using an electronic 23 prescribing system. Funds allocated under this paragraph shall 24 be distributed in their entirety for the purpose specified on 25 July 1, 2024. 26 c. $25,000 is allocated to the Iowa association of rural 27 health clinics for necessary infrastructure and service 28 delivery transformation. Funds allocated under this paragraph 29 shall be distributed in their entirety for the purpose 30 specified on July 1, 2024. 31 d. $225,000 is allocated to the Polk county medical society 32 for continuation of the safety net provider patients access 33 to specialty care initiative as described in 2007 Iowa Acts, 34 chapter 218, section 109. Funds allocated under this paragraph 35 -5- HF 2698 (4) 90 pf/ko/md 5/ 59

H.F. 2698 shall be distributed in their entirety for the purpose 1 specified on July 1, 2024. 2 3. Of the funds appropriated in this section, $800,000 3 shall be used for rural psychiatric residencies to annually 4 fund eight psychiatric residents who will provide mental health 5 services in underserved areas of the state. 6 4. Of the funds appropriated in this section, $560,000 shall 7 be deposited in the state-funded family medicine obstetrics 8 fellowship program fund to be used for the state-funded family 9 medicine obstetrics fellowship program, in accordance with 10 section 135.193. 11 5. The department shall work with the board established 12 in chapter 135D to develop plans for program enhancements 13 in the Iowa health information network for the purpose of 14 empowering Iowa patients to access and direct their health 15 information utilizing the Iowa health information network. 16 Program enhancements shall protect data privacy, facilitate the 17 interchange of health data for the purpose of improving public 18 health outcomes, and increase participation by health care 19 providers. 20 6. The university of Iowa hospitals and clinics under 21 the control of the state board of regents shall not receive 22 indirect costs from the funds appropriated in this section. 23 The university of Iowa hospitals and clinics billings to the 24 department shall be on at least a quarterly basis. 25 DIVISION V 26 COMMUNITY ACCESS AND ELIGIBILITY —— FY 2024-2025 27 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 28 ACCESS AND ELIGIBILITY. There is appropriated from the 29 general fund of the state to the department of health and human 30 services for the fiscal year beginning July 1, 2024, and ending 31 June 30, 2025, the following amount, or so much thereof as is 32 necessary, to be used for the purposes designated: 33 To be used for salaries, support, maintenance, and 34 miscellaneous purposes and for family investment program (FIP) 35 -6- HF 2698 (4) 90 pf/ko/md 6/ 59

H.F. 2698 assistance in accordance with chapter 239B, and for other costs 1 associated with providing needs-based benefits or assistance 2 including but not limited to maternal and child health, oral 3 health, obesity prevention, the promoting independence and 4 self-sufficiency through employment, job opportunities and 5 basic skills (PROMISE JOBS) program, supplemental nutrition 6 assistance program (SNAP) employment and training, the FIP 7 diversion program, family planning, rent reimbursement, 8 and eligibility determinations for medical assistance, food 9 assistance, and the children’s health insurance program: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,043,944 11 1. Of the child support collections assigned under FIP, 12 the federal share of support collections shall be credited to 13 the child support services appropriation made in this division 14 of this Act. Of the remainder of the assigned child support 15 collections received by child support services, a portion 16 shall be credited to community access and eligibility, and 17 the remaining funds may be used to increase recoveries, to 18 sustain cash flow in the child support payments account, or for 19 technology needs. If child support collections assigned under 20 FIP are greater than estimated or are otherwise determined not 21 to be required for maintenance of effort, the state share of 22 either amount may be transferred to or retained in the child 23 support payments account. 24 2. Of the funds appropriated in this section, $3,075,000 25 shall be used for continuation of the department’s initiative 26 to provide for adequate developmental surveillance and 27 screening during a child’s first five years. The funds shall 28 be used first to fully fund the current participating counties 29 to ensure that those counties are fully operational, with the 30 remaining funds to be used for expanding participation to 31 additional counties. The full implementation and expansion 32 shall include enhancing the scope of the initiative through 33 collaboration with the child health specialty clinics to 34 promote the use of developmental surveillance and screening to 35 -7- HF 2698 (4) 90 pf/ko/md 7/ 59

H.F. 2698 support healthy child development through early identification 1 and response to both biomedical and social determinants of 2 healthy development by providing practitioner consultation 3 and continuous improvement through training and education, 4 particularly for children with behavioral conditions and 5 needs. The department shall also collaborate with the Medicaid 6 program and the child health specialty clinics to assist in 7 coordinating the activities of the first five initiative into 8 the establishment of patient-centered medical homes developed 9 to improve health quality and population health while reducing 10 health care costs. To the maximum extent possible, funding 11 allocated in this subsection shall be utilized as matching 12 funds for Medicaid program reimbursement. 13 3. Of the funds appropriated in this section, $1,145,102 14 is allocated to the Iowa commission on volunteer service for 15 programs and grants. 16 4. The university of Iowa hospitals and clinics under 17 the control of the state board of regents shall not receive 18 indirect costs from the funds appropriated in this section. 19 The university of Iowa hospitals and clinics billings to the 20 department shall be on at least a quarterly basis. 21 CHILD SUPPORT SERVICES 22 Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from 23 the general fund of the state to the department of health and 24 human services for the fiscal year beginning July 1, 2024, and 25 ending June 30, 2025, the following amount, or so much thereof 26 as is necessary, to be used for the purposes designated: 27 For child support services, including salaries, support, 28 maintenance, and miscellaneous purposes: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,434,282 30 1. Federal access and visitation grant moneys shall be used 31 for services designed to increase compliance with the child 32 access provisions of court orders, including but not limited to 33 neutral visitation sites and mediation services. 34 2. The appropriation made to the department for child 35 -8- HF 2698 (4) 90 pf/ko/md 8/ 59

H.F. 2698 support services may be used throughout the fiscal year in the 1 manner necessary for purposes of cash flow management, and for 2 cash flow management purposes the department may temporarily 3 draw more than the amount appropriated, provided the amount 4 appropriated is not exceeded at the close of the fiscal year. 5 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT 6 Sec. 8. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 7 GRANT. There is appropriated from the special fund created in 8 section 8.41 to the department of health and human services 9 for the fiscal year beginning July 1, 2024, and ending June 10 30, 2025, from moneys received under the federal temporary 11 assistance for needy families (TANF) block grant pursuant 12 to the federal Personal Responsibility and Work Opportunity 13 Reconciliation Act of 1996, Pub. L. No. 104-193, and successor 14 legislation, the following amounts, or so much thereof as is 15 necessary, to be used for the purposes designated: 16 1. For community access and eligibility, FIP, the PROMISE 17 JOBS program, implementing family investment agreements in 18 accordance with chapter 239B, and for continuation of the 19 program promoting awareness of the benefits of a healthy 20 marriage: 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627 22 2. For community access and eligibility to provide 23 pregnancy prevention grants on the condition that family 24 planning services are funded: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 26 Pregnancy prevention grants shall be awarded to programs 27 in existence on or before July 1, 2024, if the programs have 28 demonstrated positive outcomes. Grants shall be awarded to 29 pregnancy prevention programs which are developed after July 30 1, 2024, if the programs are based on existing models that 31 have demonstrated positive outcomes. Grants shall comply with 32 the requirements provided in 1997 Iowa Acts, chapter 208, 33 section 14, subsections 1 and 2, including the requirement that 34 grant programs must emphasize sexual abstinence. Priority in 35 -9- HF 2698 (4) 90 pf/ko/md 9/ 59

H.F. 2698 the awarding of grants shall be given to programs that serve 1 areas of the state which demonstrate the highest percentage of 2 unplanned pregnancies of females of childbearing age within the 3 geographic area to be served by the grant. 4 3. For community access and eligibility to meet one of the 5 four core purposes of TANF as specified in 45 C.F.R. §260.20, 6 including by modernizing the program to promote economic 7 mobility and self-sufficiency, ensuring that families are able 8 to overcome benefit cliffs, encouraging healthy families, and 9 streamlining service delivery to reduce duplication: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 11 4. For technology needs related to child support 12 modernization of the Iowa collections and reporting (ICAR) 13 system and for a closed loop referral system for the thrive 14 Iowa program: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 16 5. For early intervention and supports for the family 17 development and self-sufficiency (FaDSS) grant program in 18 accordance with section 216A.107: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,888,980 20 Of the funds allocated for the FaDSS grant program in this 21 subsection, not more than 5 percent of the funds shall be used 22 for administrative purposes. 23 6. For early intervention and supports for child abuse 24 prevention grants: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 125,000 26 7. For accountability, compliance, program integrity, 27 technology needs, and other resources necessary to meet federal 28 and state reporting, tracking, and case management requirements 29 and other departmental needs: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 31 8. For state child care assistance: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 33 9. For child protective services: 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 62,364,100 35 -10- HF 2698 (4) 90 pf/ko/md 10/ 59

H.F. 2698 10. For child protective services for the kinship stipend 1 program: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,000,000 3 DIVISION VI 4 MEDICAL ASSISTANCE —— STATE SUPPLEMENTARY ASSISTANCE —— HEALTHY 5 AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED PROGRAMS 6 —— FY 2024-2025 7 Sec. 9. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY 8 ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There 9 is appropriated from the general fund of the state to the 10 department of health and human services for the fiscal year 11 beginning July 1, 2024, and ending June 30, 2025, the following 12 amount, or so much thereof as is necessary, to be used for the 13 purposes designated: 14 For medical assistance program reimbursement and associated 15 costs as specifically provided in the reimbursement 16 methodologies in effect on June 30, 2024, except as otherwise 17 expressly authorized by law, consistent with options under 18 federal law and regulations, and contingent upon receipt of 19 approval from the office of the governor of reimbursement 20 for each abortion performed under the program; for the state 21 supplementary assistance program; for the health insurance 22 premium payment program; and for maintenance of the healthy and 23 well kids in Iowa (Hawki) program pursuant to chapter 514I, 24 including supplemental dental services, for receipt of federal 25 financial participation under Tit. XXI of the federal Social 26 Security Act, which creates the children’s health insurance 27 program; and for other specified health-related programs: 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,650,866,536 29 1. Of the funds appropriated in this section, 30 $1,605,063,804 is allocated for medical assistance program 31 reimbursement and associated costs. 32 a. Of the funds allocated in this subsection, $800,000 shall 33 be used for the renovation and construction of certain nursing 34 facilities, consistent with the provisions of chapter 249K. 35 -11- HF 2698 (4) 90 pf/ko/md 11/ 59

H.F. 2698 b. Of the funds allocated in this subsection, $3,383,880 1 shall be used for program administration, outreach, and 2 enrollment activities of the state family planning services 3 program pursuant to section 217.41B, and of this amount, the 4 department may use $200,000 for administrative expenses. 5 c. Of the funds allocated in this subsection, 6 $1,700,000 shall be used to provide for additional home and 7 community-based services waiver slots for individuals with an 8 intellectual disability. 9 2. Iowans support reducing the number of abortions 10 performed in our state. Funds appropriated under this section 11 shall not be used for abortions, unless otherwise authorized 12 under this section. 13 3. The provisions of this section relating to abortions 14 shall also apply to the Iowa health and wellness plan created 15 pursuant to chapter 249N. 16 4. Of the funds appropriated in this section, $4,479,762 is 17 allocated for the state supplementary assistance program. 18 5. Of the funds appropriated in this section, $41,322,970 19 is allocated for maintenance of the Hawki program pursuant 20 to chapter 514I, including supplemental dental services, for 21 receipt of federal financial participation under Tit. XXI of 22 the federal Social Security Act, which creates the children’s 23 health insurance program. 24 HEALTH PROGRAM OPERATIONS 25 Sec. 10. HEALTH PROGRAM OPERATIONS. There is appropriated 26 from the general fund of the state to the department of health 27 and human services for the fiscal year beginning July 1, 28 2024, and ending June 30, 2025, the following amount, or so 29 much thereof as is necessary, to be used for the purposes 30 designated: 31 For health program operations and the autism support 32 program: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,597,231 34 1. The department of inspections, appeals, and licensing 35 -12- HF 2698 (4) 90 pf/ko/md 12/ 59

H.F. 2698 shall provide all state matching funds for survey and 1 certification activities performed by the department of 2 inspections, appeals, and licensing. The department of health 3 and human services is solely responsible for distributing the 4 federal matching funds for such activities. 5 2. Of the funds appropriated in this section, a sufficient 6 amount shall be used for the administration of the health 7 insurance premium payment program, including salaries, support, 8 maintenance, and miscellaneous purposes. 9 3. Of the funds appropriated in this section, $750,000 shall 10 be used for the state poison control center. Pursuant to the 11 directive under 2014 Iowa Acts, chapter 1140, section 102, the 12 federal matching funds available to the state poison control 13 center from the department under the federal Children’s Health 14 Insurance Program Reauthorization Act of 2009 allotment shall 15 be subject to the federal administrative cap rule of 10 percent 16 applicable to funding provided under Tit. XXI of the federal 17 Social Security Act and included within the department’s 18 calculations of the cap. 19 4. Unless otherwise provided, annual increases for services 20 provided through contracts funded under this section shall 21 not exceed the amount by which the consumer price index for 22 all urban consumers increased during the most recently ended 23 calendar year. 24 HEALTH CARE ACCOUNTS AND FUNDS 25 Sec. 11. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT 26 OF HEALTH AND HUMAN SERVICES. There is appropriated from the 27 pharmaceutical settlement account created in section 249A.33 to 28 the department of health and human services for the fiscal year 29 beginning July 1, 2024, and ending June 30, 2025, the following 30 amount, or so much thereof as is necessary, to be used for the 31 purposes designated: 32 Notwithstanding any provision of law to the contrary, to 33 supplement the appropriation made in this Act for health 34 program operations under the medical assistance program for the 35 -13- HF 2698 (4) 90 pf/ko/md 13/ 59

H.F. 2698 same fiscal year: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 2 Sec. 12. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF 3 HEALTH AND HUMAN SERVICES. Notwithstanding any provision to 4 the contrary and subject to the availability of funds, there is 5 appropriated from the quality assurance trust fund created in 6 section 249L.4 to the department of health and human services 7 for the fiscal year beginning July 1, 2024, and ending June 30, 8 2025, the following amount, or so much thereof as is necessary, 9 for the purposes designated: 10 To supplement the appropriation made in this Act from the 11 general fund of the state to the department of health and human 12 services for medical assistance for the same fiscal year: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 14 Sec. 13. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 15 DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding any 16 provision to the contrary and subject to the availability of 17 funds, there is appropriated from the hospital health care 18 access trust fund created in section 249M.4 to the department 19 of health and human services for the fiscal year beginning July 20 1, 2024, and ending June 30, 2025, the following amount, or so 21 much thereof as is necessary, for the purposes designated: 22 To supplement the appropriation made in this Act from the 23 general fund of the state to the department of health and human 24 services for medical assistance for the same fiscal year: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 26 REIMBURSEMENT RATES 27 Sec. 14. REIMBURSEMENT RATES. 28 1. Reimbursement for medical assistance, state 29 supplementary assistance, and social service providers and 30 services reimbursed under the purview of the department of 31 health and human services shall remain at the reimbursement 32 rate or shall be determined pursuant to the reimbursement 33 methodology in effect on June 30, 2024, with the exception of 34 the following: 35 -14- HF 2698 (4) 90 pf/ko/md 14/ 59

H.F. 2698 a. If reimbursement is otherwise negotiated by contract or 1 pursuant to an updated fee schedule. 2 b. As otherwise provided in this section. 3 2. a. Notwithstanding any provision of law to the contrary, 4 for the fiscal year beginning July 1, 2024, and ending June 5 30, 2025, the department of health and human services shall 6 reimburse case-mix nursing facility rates at the amounts in 7 effect on June 30, 2024. 8 b. The department of health and human services shall 9 calculate each nursing facility’s case-mix index for the period 10 beginning July 1, 2023, using weighting based on the current 11 patient driven payment model (PDPM) schedule. Rosters shall be 12 made to show a separate calculation to determine the average 13 case-mix index for a nursing-facility-wide case mix index, and 14 a case-mix index for the residents of a nursing facility who 15 are Medicaid recipients using all minimum data set reports by 16 the nursing facility for the previous semi-annual period using 17 a day weighted calculation. 18 3. For the fiscal year beginning July 1, 2024, Medicaid 19 provider rates shall be adjusted to 85 percent of the benchmark 20 rates based on the department’s 2023 Medicaid rate review for 21 all of the following Medicaid providers: 22 a. Medical supply providers. 23 b. Physician assistants. 24 c. Physical therapists. 25 d. Occupational therapists. 26 e. Certified nurse midwives. 27 4. For the fiscal year beginning July 1, 2024, reimbursement 28 rates for home and community-based services providers shall be 29 increased compared to the rates in effect on June 30, 2024, to 30 the extent possible within the state funding, including the 31 $14,600,000 provided for this purpose. 32 5. For the fiscal year beginning July 1, 2024, reimbursement 33 rates for community mental health centers shall be increased 34 compared to the rates in effect on June 30, 2024, to the extent 35 -15- HF 2698 (4) 90 pf/ko/md 15/ 59

H.F. 2698 possible within the state funding, including the $276,947 1 provided for this purpose. 2 6. For the fiscal year beginning July 1, 2024, enhanced 3 reimbursement shall be provided within the additional $369,000 4 appropriated for this purpose for a psychiatric medical 5 institution for children that meets the selection criteria 6 specified in 2024 Iowa Acts, House File 2402, or successor 7 legislation, if enacted. 8 7. For the fiscal year beginning July 1, 2024, the pharmacy 9 dispensing fee shall be adjusted within the additional $500,000 10 appropriated for this purpose. 11 8. For the fiscal year beginning July 1, 2024, the 12 reimbursement rates for mental health providers shall be 13 increased within the additional $2,104,186 appropriated for 14 this purpose. 15 9. For the fiscal year beginning July 1, 2024, 16 residential-based supported community living provider 17 rates shall be increased within the additional $1,352,750 18 appropriated for this purpose. 19 10. For the fiscal year beginning July 1, 2024, 20 reimbursement rates for home heath agencies shall continue to 21 be based on the Medicare low utilization payment adjustment 22 (LUPA) methodology with state geographic wage adjustments and 23 shall be adjusted to increase the rates to the extent possible 24 within the state funding appropriated. The department shall 25 continue to update the rates every two years to reflect the 26 most recent Medicare LUPA rates. 27 11. For the fiscal year beginning July 1, 2024, 28 reimbursement rates for air medical services provided by an 29 entity that has over 40 years of experience and is the largest 30 community-based provider of air medical services shall be 31 increased within the additional $250,000 appropriated for this 32 purpose. 33 DIVISION VII 34 FAMILY WELL-BEING AND PROTECTION —— FY 2024-2025 35 -16- HF 2698 (4) 90 pf/ko/md 16/ 59

H.F. 2698 STATE CHILD CARE ASSISTANCE 1 Sec. 15. STATE CHILD CARE ASSISTANCE. There is appropriated 2 from the general fund of the state to the department of health 3 and human services for the fiscal year beginning July 1, 4 2024, and ending June 30, 2025, the following amount, or so 5 much thereof as is necessary, to be used for the purposes 6 designated: 7 For state child care assistance in accordance with section 8 237A.13: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34,966,931 10 1. If the appropriations made for purposes of the state 11 child care assistance program for the fiscal year are 12 determined to be insufficient, it is the intent of the general 13 assembly to appropriate sufficient funding for the fiscal year 14 in order to avoid establishment of waiting list requirements. 15 2. A portion of the state match for the federal child care 16 and development block grant shall be provided as necessary to 17 meet federal matching funds requirements through the state 18 general fund appropriation made for child development grants 19 and other programs for at-risk children in section 279.51. 20 EARLY INTERVENTION AND SUPPORTS 21 Sec. 16. EARLY INTERVENTION AND SUPPORTS. There is 22 appropriated from the general fund of the state to the 23 department of health and human services for the fiscal year 24 beginning July 1, 2024, and ending June 30, 2025, the following 25 amount, or so much thereof as is necessary, to be used for the 26 purposes designated: 27 For promoting the optimum health status for children 28 and adolescents from birth through 21 years of age, and for 29 families: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35,277,739 31 1. Of the funds appropriated in this section, not more 32 than $734,000 shall be used for the healthy opportunities for 33 parents to experience success (HOPES)-healthy families Iowa 34 (HFI) program established pursuant to section 135.106. 35 -17- HF 2698 (4) 90 pf/ko/md 17/ 59