Senate File 561 - Reprinted SENATE FILE 561 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO SSB 1213) (As Amended and Passed by the Senate April 27, 2023 ) A BILL FOR An Act relating to appropriations for veterans and health and 1 human services and including other related provisions and 2 appropriations including health policy oversight, public 3 assistance program provisions and a public assistance 4 modernization fund, sprinkler systems for home and 5 community-based services waiver recipient residences, a 6 state-funded family medicine obstetrics fellowship program 7 and fund, adoption subsidy program nonrecurring adoption 8 expenses, real estate transactions involving departmental 9 institutions, providing penalties, and including effective 10 date and other applicability date provisions. 11 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 12 SF 561 (3) 90 pf/rn/mb

S.F. 561 DIVISION I 1 DEPARTMENT OF VETERANS AFFAIRS —— FY 2023-2024 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, 2023, and ending June 30, 2024, 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,033,289 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14 2. IOWA VETERANS HOME 15 For salaries, support, maintenance, and miscellaneous 16 purposes: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,115,335 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 c. The Iowa veterans home shall continue to include in the 24 annual discharge report applicant information to provide for 25 the collection of demographic information including but not 26 limited to the number of individuals applying for admission and 27 admitted or denied admittance and the basis for the admission 28 or denial; the age, gender, and race of such individuals; 29 and the level of care for which such individuals applied for 30 admission including residential or nursing level of care. 31 3. HOME OWNERSHIP ASSISTANCE PROGRAM 32 For transfer to the Iowa finance authority for the 33 continuation of the home ownership assistance program for 34 persons who are or were eligible members of the armed forces of 35 -1- SF 561 (3) 90 pf/rn/mb 1/ 77

S.F. 561 the United States, pursuant to section 16.54 : 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 2 Sec. 2. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS 3 FUND STANDING APPROPRIATIONS. Notwithstanding the standing 4 appropriation in section 35A.16 for the fiscal year beginning 5 July 1, 2023, and ending June 30, 2024, the amount appropriated 6 from the general fund of the state pursuant to that section 7 for the following designated purposes shall not exceed the 8 following amount: 9 For the county commissions of veteran affairs fund under 10 section 35A.16 : 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 990,000 12 DIVISION II 13 DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING —— FY 14 2023-2024 15 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 16 AGING. There is appropriated from the general fund of the 17 state to the department of health and human services for the 18 fiscal year beginning July 1, 2023, and ending June 30, 2024, 19 the following amount, or so much thereof as is necessary, to be 20 used for the purposes designated: 21 For aging programs for the department of health and human 22 services and area agencies on aging to provide citizens of 23 Iowa who are 60 years of age and older with case management, 24 Iowa’s aging and disabilities resource center, and other 25 services which may include but are not limited to adult 26 day, respite care, chore, information and assistance, and 27 material aid, for information and options counseling for 28 persons with disabilities who are 18 years of age or older, 29 and for salaries, support, administration, maintenance, and 30 miscellaneous purposes, and for not more than the following 31 full-time equivalent positions: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,799,361 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 31.00 34 1. Funds appropriated in this section may be used to 35 -2- SF 561 (3) 90 pf/rn/mb 2/ 77

S.F. 561 supplement federal funds under federal regulations. To 1 receive funds appropriated in this section, a local area 2 agency on aging shall match the funds with moneys from other 3 sources according to rules adopted by the department. Funds 4 appropriated in this section may be used for elderly services 5 not specifically enumerated in this section only if approved 6 by an area agency on aging for provision of the service within 7 the area. 8 2. Of the funds appropriated in this section, $418,700 is 9 transferred to the Iowa commission on volunteer service to be 10 used for the retired and senior volunteer program. 11 3. a. The department of health and human services shall 12 establish and enforce procedures relating to expenditure 13 of state and federal funds by area agencies on aging that 14 require compliance with both state and federal laws, rules, and 15 regulations, including but not limited to all of the following: 16 (1) Requiring that expenditures are incurred only for goods 17 or services received or performed prior to the end of the 18 fiscal period designated for use of the funds. 19 (2) Prohibiting prepayment for goods or services not 20 received or performed prior to the end of the fiscal period 21 designated for use of the funds. 22 (3) Prohibiting prepayment for goods or services not 23 defined specifically by good or service, time period, or 24 recipient. 25 (4) Prohibiting the establishment of accounts from which 26 future goods or services which are not defined specifically by 27 good or service, time period, or recipient, may be purchased. 28 b. The procedures shall provide that if any funds are 29 expended in a manner that is not in compliance with the 30 procedures and applicable federal and state laws, rules, and 31 regulations, and are subsequently subject to repayment, the 32 area agency on aging expending such funds in contravention of 33 such procedures, laws, rules and regulations, not the state, 34 shall be liable for such repayment. 35 -3- SF 561 (3) 90 pf/rn/mb 3/ 77

S.F. 561 4. Of the funds appropriated in this section, $1,312,000 1 shall be used for the purposes of chapter 231E and to 2 administer the prevention of elder abuse, neglect, and 3 exploitation program pursuant to section 231.56A , in accordance 4 with the requirements of the federal Older Americans Act of 5 1965, 42 U.S.C. §3001 et seq., as amended. 6 5. Of the funds appropriated in this section, $1,000,000 7 shall be used to fund continuation of the aging and disability 8 resource center lifelong links to provide individuals and 9 caregivers with information and services to plan for and 10 maintain independence. 11 6. Of the funds appropriated in this section, $850,000 12 shall be used by the department of health and human services, 13 in collaboration with affected stakeholders, to continue to 14 expand the pilot initiative to provide long-term care options 15 counseling utilizing support planning protocols, to assist 16 non-Medicaid eligible consumers who indicate a preference 17 to return to the community and are deemed appropriate for 18 discharge, to return to their community following a nursing 19 facility stay; and shall be used by the department to fund home 20 and community-based services to enable older individuals to 21 avoid more costly utilization of residential or institutional 22 services and remain in their homes. The department shall 23 submit a report regarding the outcomes of the pilot initiative 24 to the governor and the general assembly by December 15, 2023. 25 DIVISION III 26 OFFICE OF LONG-TERM CARE OMBUDSMAN —— FY 2023-2024 27 Sec. 4. OFFICE OF LONG-TERM CARE OMBUDSMAN. There is 28 appropriated from the general fund of the state to the office 29 of long-term care ombudsman for the fiscal year beginning July 30 1, 2023, and ending June 30, 2024, the following amount, or 31 so much thereof as is necessary, to be used for the purposes 32 designated: 33 For salaries, support, administration, maintenance, and 34 miscellaneous purposes, and for not more than the following 35 -4- SF 561 (3) 90 pf/rn/mb 4/ 77

S.F. 561 full-time equivalent positions: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,148,959 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 12.00 3 DIVISION IV 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC HEALTH —— FY 5 2023-2024 6 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 7 HEALTH. There is appropriated from the general fund of the 8 state to the department of health and human services for the 9 fiscal year beginning July 1, 2023, and ending June 30, 2024, 10 the following amounts, or so much thereof as is necessary, to 11 be used for the purposes designated: 12 1. ADDICTIVE DISORDERS 13 For reducing the prevalence of the use of tobacco, alcohol, 14 and other drugs, and treating individuals affected by addictive 15 behaviors, including gambling, and for not more than the 16 following full-time equivalent positions: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,656,992 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 12.00 19 a. (1) Of the funds appropriated in this subsection, 20 $4,020,894 shall be used for the tobacco use prevention and 21 control initiative, including efforts at the state and local 22 levels, as provided in chapter 142A . The commission on tobacco 23 use prevention and control established pursuant to section 24 142A.3 shall advise the director of health and human services 25 in prioritizing funding needs and the allocation of moneys 26 appropriated for the programs and initiatives. Activities 27 of the programs and initiatives shall be in alignment with 28 the United States centers for disease control and prevention 29 best practices for comprehensive tobacco control programs 30 that include the goals of preventing youth initiation of 31 tobacco usage, reducing exposure to secondhand smoke, and 32 promotion of tobacco cessation. To maximize resources, 33 the department shall determine if third-party sources are 34 available to instead provide nicotine replacement products 35 -5- SF 561 (3) 90 pf/rn/mb 5/ 77

S.F. 561 to an applicant prior to provision of such products to an 1 applicant under the initiative. The department shall track and 2 report to the governor and the general assembly any reduction 3 in the provision of nicotine replacement products realized 4 by the initiative through implementation of the prerequisite 5 screening. 6 (2) (a) The department shall collaborate with the 7 department of revenue for enforcement of tobacco laws, 8 regulations, and ordinances and to engage in tobacco control 9 activities approved by the departments as specified in 10 the memorandum of understanding entered into between the 11 departments. 12 (b) For the fiscal year beginning July 1, 2023, and ending 13 June 30, 2024, the terms of the memorandum of understanding, 14 entered into between the department of revenue and the 15 department, governing compliance checks conducted to ensure 16 licensed retail tobacco outlet conformity with tobacco laws, 17 regulations, and ordinances relating to persons under 21 years 18 of age, shall continue to restrict the number of such checks to 19 one check per retail outlet, and one additional check for any 20 retail outlet found to be in violation during the first check. 21 b. (1) Of the funds appropriated in this subsection, 22 $19,638,485 shall be used for problem gambling and substance 23 use disorder prevention, treatment, and recovery services, 24 including a 24-hour helpline, public information resources, 25 professional training, youth prevention, and program 26 evaluation. 27 (2) Of the amount allocated under this paragraph, 28 $306,000 shall be utilized by the department to maintain 29 a single statewide 24-hour crisis hotline for the Iowa 30 children’s behavioral health system that incorporates warmline 31 services which may be provided through expansion of existing 32 capabilities as required pursuant to 2018 Iowa Acts, chapter 33 1056, section 16 . 34 c. The requirement of section 123.17, subsection 5 , is met 35 -6- SF 561 (3) 90 pf/rn/mb 6/ 77

S.F. 561 by the appropriations and allocations made in this division of 1 this Act for purposes of substance use disorder treatment and 2 addictive disorders for the fiscal year beginning July 1, 2023. 3 2. HEALTHY CHILDREN AND FAMILIES 4 For promoting the optimum health status for children and 5 adolescents from birth through 21 years of age, and families, 6 and for not more than the following full-time equivalent 7 positions: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,815,491 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 14.00 10 a. Of the funds appropriated in this subsection, not more 11 than $734,000 shall be used for the healthy opportunities for 12 parents to experience success (HOPES)-healthy families Iowa 13 (HFI) program established pursuant to section 135.106 . 14 b. In order to implement the legislative intent stated 15 in sections 135.106 and 256I.9 , priority for home visitation 16 program funding shall be given to programs using evidence-based 17 or promising models for home visitation. 18 c. Of the funds appropriated in this subsection, $3,075,000 19 shall be used for continuation of the department’s initiative 20 to provide for adequate developmental surveillance and 21 screening during a child’s first five years. The funds shall 22 be used first to fully fund the current sites to ensure that 23 the sites are fully operational, with the remaining funds 24 to be used for expansion to additional sites. The full 25 implementation and expansion shall include enhancing the scope 26 of the initiative through collaboration with the child health 27 specialty clinics to promote healthy child development through 28 early identification and response to both biomedical and social 29 determinants of healthy development; by monitoring child 30 health metrics to inform practice, document long-term health 31 impacts and savings, and provide for continuous improvement 32 through training, education, and evaluation; and by providing 33 for practitioner consultation particularly for children with 34 behavioral conditions and needs. The department shall also 35 -7- SF 561 (3) 90 pf/rn/mb 7/ 77

S.F. 561 collaborate with the Medicaid program and the child health 1 specialty clinics to integrate the activities of the first five 2 initiative into the establishment of patient-centered medical 3 homes, community utilities, accountable care organizations, 4 and other integrated care models developed to improve health 5 quality and population health while reducing health care costs. 6 To the maximum extent possible, funding allocated in this 7 paragraph shall be utilized as matching funds for Medicaid 8 program reimbursement. 9 d. Of the funds appropriated in this subsection, $64,000 10 shall be distributed to a statewide dental carrier to provide 11 funds to continue the donated dental services program patterned 12 after the projects developed by the dental lifeline network to 13 provide dental services to indigent individuals who are elderly 14 or with disabilities. 15 e. Of the funds appropriated in this subsection, $156,000 16 shall be used to provide audiological services and hearing aids 17 for children. 18 f. Of the funds appropriated in this subsection, $23,000 is 19 transferred to the university of Iowa college of dentistry for 20 provision of primary dental services to children. State funds 21 shall be matched on a dollar-for-dollar basis. The university 22 of Iowa college of dentistry shall coordinate efforts with the 23 department to provide dental care to underserved populations 24 throughout the state. 25 g. Of the funds appropriated in this subsection, $50,000 26 shall be used to address youth suicide prevention. 27 h. Of the funds appropriated in this subsection, $40,000 28 shall be used to support the Iowa effort to address the survey 29 of children who experience adverse childhood experiences known 30 as ACEs. 31 i. Of the funds appropriated in this subsection, up to 32 $494,000 shall be used for childhood obesity prevention. 33 3. CHRONIC CONDITIONS 34 For serving individuals identified as having chronic 35 -8- SF 561 (3) 90 pf/rn/mb 8/ 77

S.F. 561 conditions or special health care needs, and for not more than 1 the following full-time equivalent positions: 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,256,595 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 10.00 4 a. Of the funds appropriated in this subsection, $188,000 5 shall be used for grants to individual patients who have an 6 inherited metabolic disorder to assist with the costs of 7 medically necessary foods and formula. 8 b. Of the funds appropriated in this subsection, $1,055,000 9 shall be used for the brain injury services program pursuant 10 to section 135.22B , including $861,000 for contracting with an 11 existing nationally affiliated and statewide organization whose 12 purpose is to educate, serve, and support Iowans with brain 13 injury and their families, for resource facilitator services 14 in accordance with section 135.22B, subsection 9 , and for 15 contracting to enhance brain injury training and recruitment 16 of service providers on a statewide basis. Of the amount 17 allocated in this paragraph, $95,000 shall be used to fund 18 1.00 full-time equivalent position to serve as the state brain 19 injury services program manager. 20 c. Of the funds appropriated in this subsection, $144,000 21 shall be used for the public purpose of continuing to contract 22 with an existing nationally affiliated organization to provide 23 education, client-centered programs, and client and family 24 support for people living with epilepsy and their families. 25 The amount allocated in this paragraph in excess of $50,000 26 shall be matched dollar-for-dollar by the organization 27 specified. Funds allocated under this paragraph shall be 28 distributed in their entirety for the purpose specified on July 29 1, 2023. 30 d. Of the funds appropriated in this subsection, $809,000 31 shall be used for child health specialty clinics. 32 e. Of the funds appropriated in this subsection, $384,000 33 shall be used by the regional autism assistance program 34 established pursuant to section 256.35 , and administered by 35 -9- SF 561 (3) 90 pf/rn/mb 9/ 77

S.F. 561 the child health specialty clinic located at the university of 1 Iowa hospitals and clinics. The funds shall be used to enhance 2 interagency collaboration and coordination of educational, 3 medical, and other health and human services for persons with 4 autism, their families, and providers of services, including 5 delivering regionalized services of care coordination, 6 family navigation, and integration of services through the 7 statewide system of regional child health specialty clinics and 8 fulfilling other requirements as specified in chapter 225D . 9 The university of Iowa shall not receive funds allocated under 10 this paragraph for indirect costs associated with the regional 11 autism assistance program. 12 f. Of the funds appropriated in this subsection, $577,000 13 shall be used for the comprehensive cancer control program to 14 reduce the burden of cancer in Iowa through prevention, early 15 detection, effective treatment, and ensuring quality of life. 16 Of the funds allocated in this paragraph “f”, $150,000 shall 17 be used to support a melanoma research symposium, a melanoma 18 biorepository and registry, basic and translational melanoma 19 research, and clinical trials. 20 g. Of the funds appropriated in this subsection, $97,000 21 shall be used for cervical and colon cancer screening, and 22 $177,000 shall be used to enhance the capacity of the cervical 23 cancer screening program to include provision of recommended 24 prevention and early detection measures to a broader range of 25 low-income women. 26 h. Of the funds appropriated in this subsection, $506,000 27 shall be used for the center for congenital and inherited 28 disorders. 29 4. COMMUNITY CAPACITY 30 For strengthening the health care delivery system at the 31 local level, and for not more than the following full-time 32 equivalent positions: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,435,682 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 14.00 35 -10- SF 561 (3) 90 pf/rn/mb 10/ 77

S.F. 561 a. Of the funds appropriated in this subsection, $95,000 1 is allocated for continuation of the child vision screening 2 program implemented through the university of Iowa hospitals 3 and clinics in collaboration with early childhood Iowa areas. 4 The program shall submit a report to the department regarding 5 the use of funds allocated under this paragraph “a”. The 6 report shall include the objectives and results for the 7 program year including the target population and how the funds 8 allocated assisted the program in meeting the objectives; the 9 number, age, and location within the state of individuals 10 served; the type of services provided to the individuals 11 served; the distribution of funds based on the services 12 provided; and the continuing needs of the program. 13 b. Of the funds appropriated in this subsection, 14 $48,000 shall be used for a grant to a statewide association 15 of psychologists, that is affiliated with the American 16 psychological association, to be used for continuation of a 17 program to rotate intern psychologists in placements that 18 serve urban and rural mental health professional shortage 19 areas. Once an intern psychologist begins service, the intern 20 psychologist may continue serving in the location of the intern 21 psychologist’s placement, notwithstanding any change in the 22 mental health professional shortage area designation of such 23 location. The intern psychologist may also provide services 24 via telehealth, to underserved populations, and to Medicaid 25 members. For the purposes of this paragraph “b”, “mental 26 health professional shortage area” means a geographic area 27 in this state that has been designated by the United States 28 department of health and human services, health resources and 29 services administration, bureau of health professionals, as 30 having a shortage of mental health professionals. 31 c. Of the funds appropriated in this subsection, the 32 following amounts are allocated to be used as follows 33 to support the goals of increased access, health system 34 integration, and engagement: 35 -11- SF 561 (3) 90 pf/rn/mb 11/ 77

S.F. 561 (1) Not less than $600,000 is allocated to the Iowa 1 prescription drug corporation for continuation of the 2 pharmaceutical infrastructure originally established for safety 3 net providers as described in 2007 Iowa Acts, chapter 218, 4 section 108 , and for the prescription drug donation repository 5 program created in chapter 135M . Funds allocated under this 6 subparagraph shall be distributed in their entirety for the 7 purpose specified on July 1, 2023. 8 (2) Not less than $334,000 is allocated to free clinics and 9 free clinics of Iowa for necessary infrastructure, statewide 10 coordination, provider recruitment, service delivery, and 11 provision of assistance to patients in securing a medical home 12 inclusive of oral health care. Funds allocated under this 13 subparagraph shall be distributed in their entirety for the 14 purpose specified on July 1, 2023. 15 (3) Not less than $25,000 is allocated to the Iowa 16 association of rural health clinics for necessary 17 infrastructure and service delivery transformation. Funds 18 allocated under this subparagraph shall be distributed in their 19 entirety for the purpose specified on July 1, 2023. 20 (4) Not less than $225,000 is allocated to the Polk 21 county medical society for continuation of the safety net 22 provider patients access to specialty health care initiative as 23 described in 2007 Iowa Acts, chapter 218, section 109 . Funds 24 allocated under this subparagraph shall be distributed in their 25 entirety for the purpose specified on July 1, 2023. 26 d. Of the funds appropriated in this subsection, $191,000 27 is allocated for the purposes of health care and public health 28 workforce initiatives. 29 e. Of the funds appropriated in this subsection, $96,000 30 shall be used for a matching dental education loan repayment 31 program to be allocated to a dental nonprofit health service 32 corporation to continue to develop the criteria and implement 33 the loan repayment program. 34 f. Of the funds appropriated in this subsection, $100,000 35 -12- SF 561 (3) 90 pf/rn/mb 12/ 77

S.F. 561 shall be used for the purposes of the Iowa donor registry as 1 specified in section 142C.18 . 2 g. Of the funds appropriated in this subsection, $96,000 3 shall be used for continuation of a grant to a nationally 4 affiliated volunteer eye organization that has an established 5 program for children and adults and that is solely dedicated to 6 preserving sight and preventing blindness through education, 7 nationally certified vision screening and training, and 8 community and patient service programs. The contractor shall 9 submit a report to the general assembly regarding the use 10 of funds allocated under this paragraph “g”. The report 11 shall include the objectives and results for the program year 12 including the target population and how the funds allocated 13 assisted the program in meeting the objectives; the number, 14 age, grade level if appropriate, and location within the state 15 of individuals served; the type of services provided to the 16 individuals served; the distribution of funds based on the 17 services provided; and the continuing needs of the program. 18 h. Of the funds appropriated in this subsection, $2,100,000 19 shall be deposited in the medical residency training account 20 created in section 135.175, subsection 5 , paragraph “a”, and is 21 appropriated from the account to the department to be used for 22 the purposes of the medical residency training state matching 23 grants program as specified in section 135.176 . 24 i. Of the funds appropriated in this subsection, $250,000 25 shall be used for the public purpose of providing funding to 26 Des Moines university to continue a provider education project 27 to provide primary care physicians with the training and skills 28 necessary to recognize the signs of mental illness in patients. 29 j. Of the funds appropriated in this subsection, $800,000 30 shall be used for rural psychiatric residencies to annually 31 fund six psychiatric residents who will provide mental health 32 services in underserved areas of the state. Notwithstanding 33 section 8.33, moneys that remain unencumbered or unobligated 34 at the close of the fiscal year shall not revert but shall 35 -13- SF 561 (3) 90 pf/rn/mb 13/ 77

S.F. 561 remain available for expenditure for the purposes designated 1 for subsequent fiscal years. 2 k. Of the funds appropriated in this subsection, $150,000 3 shall be used for psychiatric training to increase access to 4 mental health care services by expanding the mental health 5 workforce via training of additional physician assistants and 6 nurse practitioners. 7 1. Of the funds appropriated in this subsection, $425,000 8 shall be used for the continuation of a center of excellence 9 program to award two grants to encourage innovation and 10 collaboration among regional health care providers in a rural 11 area based upon the results of a regional community needs 12 assessment to transform health care delivery in order to 13 provide quality, sustainable care that meets the needs of the 14 local communities. An applicant for the grant funds shall 15 specify how the grant funds will be expended to accomplish the 16 goals of the program and shall provide a detailed five-year 17 sustainability plan prior to being awarded any grant funding. 18 Following the receipt of grant funding, a recipient shall 19 submit periodic reports as specified by the department to the 20 governor and the general assembly regarding the recipient’s 21 expenditure of the grant funds and progress in accomplishing 22 the program’s goals. 23 m. Of the funds appropriated in this subsection, $560,000 24 shall be deposited in the family medicine obstetrics fellowship 25 program fund to be used for the state family medicine 26 obstetrics fellowship program in accordance with section 27 135.182, if enacted in this Act, to meet a critical demand for 28 well-trained family medicine obstetrics practitioners in rural 29 and underserved areas in the state. 30 n. Of the funds appropriated in this subsection, $358,201 31 is allocated for the Iowa commission on volunteer service for 32 purposes of the Iowa state commission grant program and the 33 Iowa’s promise and Iowa mentoring partnership programs. 34 (1) Of the funds allocated in this paragraph, $75,000 shall 35 -14- SF 561 (3) 90 pf/rn/mb 14/ 77

S.F. 561 be used for the purposes of the Iowa state commission grant 1 program and $93,201 shall be used for the purposes of the 2 Iowa’s promise and Iowa mentoring partnership programs. 3 (2) Notwithstanding section 8.33, funds allocated in this 4 paragraph that remain unencumbered or unobligated at the close 5 of the fiscal year shall not revert but shall remain available 6 for expenditure for the purposes designated until the close of 7 the succeeding fiscal year. 8 5. ESSENTIAL PUBLIC HEALTH SERVICES 9 To provide public health services that reduce risks and 10 invest in promoting and protecting good health over the 11 course of a lifetime with a priority given to older Iowans and 12 vulnerable populations: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,662,464 14 6. INFECTIOUS DISEASES 15 For reducing the incidence and prevalence of communicable 16 diseases, and for not more than the following full-time 17 equivalent positions: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,795,902 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 6.00 20 7. PUBLIC PROTECTION 21 For protecting the health and safety of the public through 22 establishing standards and enforcing regulations, and for not 23 more than the following full-time equivalent positions: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,581,792 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 57.00 26 a. Of the funds appropriated in this subsection, not more 27 than $304,000 shall be credited to the emergency medical 28 services fund created in section 135.25 . Moneys in the 29 emergency medical services fund are appropriated to the 30 department to be used for the purposes of the fund. 31 b. Of the funds appropriated in this subsection, up 32 to $243,000 shall be used for sexual violence prevention 33 programming through a statewide organization representing 34 programs serving victims of sexual violence through the 35 -15- SF 561 (3) 90 pf/rn/mb 15/ 77

S.F. 561 department’s sexual violence prevention program, and for 1 continuation of a training program for sexual assault 2 response team (SART) members, including representatives of 3 law enforcement, victim advocates, prosecutors, and certified 4 medical personnel. The amount allocated in this paragraph “b” 5 shall not be used to supplant funding administered for other 6 sexual violence prevention or victims assistance programs. 7 c. Of the funds appropriated in this subsection, up to 8 $750,000 shall be used for the state poison control center. 9 Pursuant to the directive under 2014 Iowa Acts, chapter 1140, 10 section 102 , the federal matching funds available to the 11 state poison control center from the department under the 12 federal Children’s Health Insurance Program Reauthorization Act 13 allotment shall be subject to the federal administrative cap 14 rule of 10 percent applicable to funding provided under Tit. 15 XXI of the federal Social Security Act and included within the 16 department’s calculations of the cap. 17 d. Of the funds appropriated in this subsection, up to 18 $504,000 shall be used for childhood lead poisoning provisions. 19 8. RESOURCE MANAGEMENT 20 For establishing and sustaining the overall ability of the 21 department to deliver services to the public, and for not more 22 than the following full-time equivalent positions: 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 933,543 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 4.00 25 9. MISCELLANEOUS PROVISIONS 26 The university of Iowa hospitals and clinics under the 27 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 10. IOWA HEALTH INFORMATION NETWORK ENHANCEMENTS 32 The department shall work with the board established 33 in chapter 135D to develop plans for program enhancements 34 in the Iowa health information network, for the purpose of 35 -16- SF 561 (3) 90 pf/rn/mb 16/ 77

S.F. 561 empowering Iowa patients to access and direct their health 1 information utilizing the Iowa health information network. 2 Program enhancements shall protect data privacy, facilitate the 3 interchange of health data for the purpose of improving public 4 health outcomes, and increase participation by health care 5 providers. 6 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 7 WAGERING RECEIPTS FUND. There is appropriated from the sports 8 wagering receipts fund created in section 8.57, subsection 6, 9 to the department of health and human services for the fiscal 10 year beginning July 1, 2023, and ending June 30, 2024, the 11 following amount, or so much thereof as is necessary, to be 12 used for the purposes designated: 13 For problem gambling and substance use disorder prevention, 14 treatment, and recovery services, including a 24-hour helpline, 15 public information resources, professional training, youth 16 prevention, and program evaluation: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 18 DIVISION V 19 DEPARTMENT OF HEALTH AND HUMAN SERVICES —— HUMAN SERVICES —— 20 FY 2023-2024 21 Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK 22 GRANT. There is appropriated from the fund created in section 23 8.41 to the department of health and human services for the 24 fiscal year beginning July 1, 2023, and ending June 30, 2024, 25 from moneys received under the federal temporary assistance 26 for needy families (TANF) block grant pursuant to the federal 27 Personal Responsibility and Work Opportunity Reconciliation Act 28 of 1996, Pub. L. No. 104-193, and successor legislation, the 29 following amounts, or so much thereof as is necessary, to be 30 used for the purposes designated: 31 1. To be credited to the family investment program (FIP) 32 account and used for assistance under FIP in accordance with 33 chapter 239B : 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,002,006 35 -17- SF 561 (3) 90 pf/rn/mb 17/ 77