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    House Study Bill 253 - IntroducedA Bill ForAn Act 1relating to appropriations for health and human
    2services and veterans and including other related provisions
    3and appropriations, providing penalties, and including
    4effective date and retroactive and other applicability date
    5provisions.
    6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    1DIVISION I
    2DEPARTMENT ON AGING — FY 2019-2020
    3   Section 1.  DEPARTMENT ON AGING.  There is appropriated from
    4the general fund of the state to the department on aging for
    5the fiscal year beginning July 1, 2019, and ending June 30,
    62020, the following amount, or so much thereof as is necessary,
    7to be used for the purposes designated:
       8For aging programs for the department on aging and area
    9agencies on aging to provide citizens of Iowa who are 60 years
    10of age and older with case management for frail elders, Iowa’s
    11aging and disabilities resource center, and other services
    12which may include but are not limited to adult day services,
    13respite care, chore services, information and assistance,
    14and material aid, for information and options counseling for
    15persons with disabilities who are 18 years of age or older,
    16and for salaries, support, administration, maintenance, and
    17miscellaneous purposes, and for not more than the following
    18full-time equivalent positions:
    ..................................................  $1911,191,441
    ...............................................  FTEs2027.00
       211.  Funds appropriated in this section may be used to
    22supplement federal funds under federal regulations. To
    23receive funds appropriated in this section, a local area
    24agency on aging shall match the funds with moneys from other
    25sources according to rules adopted by the department. Funds
    26appropriated in this section may be used for elderly services
    27not specifically enumerated in this section only if approved
    28by an area agency on aging for provision of the service within
    29the area.
       302.  Of the funds appropriated in this section, $279,000 is
    31transferred to the economic development authority for the Iowa
    32commission on volunteer services to be used for the retired and
    33senior volunteer program.
       343.  a.  The department on aging shall establish and enforce
    35procedures relating to expenditure of state and federal funds
    -1-1by area agencies on aging that require compliance with both
    2state and federal laws, rules, and regulations, including but
    3not limited to all of the following:
       4(1)  Requiring that expenditures are incurred only for goods
    5or services received or performed prior to the end of the
    6fiscal period designated for use of the funds.
       7(2)  Prohibiting prepayment for goods or services not
    8received or performed prior to the end of the fiscal period
    9designated for use of the funds.
       10(3)  Prohibiting prepayment for goods or services not
    11defined specifically by good or service, time period, or
    12recipient.
       13(4)  Prohibiting the establishment of accounts from which
    14future goods or services which are not defined specifically by
    15good or service, time period, or recipient, may be purchased.
       16b.  The procedures shall provide that if any funds are
    17expended in a manner that is not in compliance with the
    18procedures and applicable federal and state laws, rules, and
    19regulations, and are subsequently subject to repayment, the
    20area agency on aging expending such funds in contravention of
    21such procedures, laws, rules and regulations, not the state,
    22shall be liable for such repayment.
       234.  Of the funds appropriated in this section, at least
    24$600,000 shall be used to fund home and community-based
    25services through the area agencies on aging that enable older
    26individuals to avoid more costly utilization of residential or
    27institutional services and remain in their own homes.
       285.  Of the funds appropriated in this section, $812,000 shall
    29be used for the purposes of chapter 231E and to administer
    30the prevention of elder abuse, neglect, and exploitation
    31program pursuant to section 231.56A, in accordance with the
    32requirements of the federal Older Americans Act of 1965, 42
    33U.S.C.§3001 et seq., as amended.
       346.  Of the funds appropriated in this section, $1,000,000
    35shall be used to fund continuation of the aging and disability
    -2-1resource center lifelong links to provide individuals and
    2caregivers with information and services to plan for and
    3maintain independence.
       47.  Of the funds appropriated in this section, $250,000
    5shall be used by the department on aging, in collaboration with
    6the department of human services and affected stakeholders, to
    7expand the pilot initiative to provide long-term care options
    8counseling utilizing support planning protocols, to assist
    9non-Medicaid eligible consumers who indicate a preference
    10to return to the community and are deemed appropriate for
    11discharge, to return to their community following a nursing
    12facility stay. The department on aging shall submit a report
    13regarding the outcomes of the pilot initiative to the governor
    14and the general assembly by December 15, 2019.
    15DIVISION II
    16OFFICE OF LONG-TERM CARE oMBUDSMAN — FY 2019-2020
    17   Sec. 2.  OFFICE OF LONG-TERM CARE OMBUDSMAN.   There is
    18appropriated from the general fund of the state to the office
    19of long-term care ombudsman for the fiscal year beginning July
    201, 2019, and ending June 30, 2020, the following amount, or
    21so much thereof as is necessary, to be used for the purposes
    22designated:
       23For salaries, support, administration, maintenance, and
    24miscellaneous purposes, and for not more than the following
    25full-time equivalent positions:
    ..................................................  $261,149,821
    ...............................................  FTEs2716.00
    28DIVISION III
    29DEPARTMENT OF PUBLIC HEALTH — FY 2019-2020
    30   Sec. 3.  DEPARTMENT OF PUBLIC HEALTH.  There is appropriated
    31from the general fund of the state to the department of public
    32health for the fiscal year beginning July 1, 2019, and ending
    33June 30, 2020, the following amounts, or so much thereof as is
    34necessary, to be used for the purposes designated:
       351.  ADDICTIVE DISORDERS
    -3-       1For reducing the prevalence of the use of tobacco, alcohol,
    2and other drugs, and treating individuals affected by addictive
    3behaviors, including gambling, and for not more than the
    4following full-time equivalent positions:
    ..................................................  $525,110,000
    ...............................................  FTEs611.00
       7a.  (1)  Of the funds appropriated in this subsection,
    8$4,021,000 shall be used for the tobacco use prevention
    9and control initiative, including efforts at the state and
    10local levels, as provided in chapter 142A. The commission
    11on tobacco use prevention and control established pursuant
    12to section 142A.3 shall advise the director of public health
    13in prioritizing funding needs and the allocation of moneys
    14appropriated for the programs and initiatives. Activities
    15of the programs and initiatives shall be in alignment with
    16the United States centers for disease control and prevention
    17best practices for comprehensive tobacco control programs that
    18include the goals of preventing youth initiation of tobacco
    19usage, reducing exposure to secondhand smoke, and promotion
    20of tobacco cessation. To maximize resources, the department
    21shall determine if third-party sources are available to
    22instead provide nicotine replacement products to an applicant
    23prior to provision of such products to an applicant under
    24the initiative. The department shall track and report to
    25the individuals specified in this Act, any reduction in
    26the provision of nicotine replacement products realized by
    27the initiative through implementation of the prerequisite
    28screening.
       29(2)  (a)  The department shall collaborate with the
    30alcoholic beverages division of the department of commerce for
    31enforcement of tobacco laws, regulations, and ordinances and to
    32engage in tobacco control activities approved by the division
    33of tobacco use prevention and control of the department of
    34public health as specified in the memorandum of understanding
    35entered into between the divisions.
    -4-       1(b)  For the fiscal year beginning July 1, 2019, and ending
    2June 30, 2020, the terms of the memorandum of understanding,
    3entered into between the division of tobacco use prevention
    4and control of the department of public health and the
    5alcoholic beverages division of the department of commerce,
    6governing compliance checks conducted to ensure licensed retail
    7tobacco outlet conformity with tobacco laws, regulations, and
    8ordinances relating to persons under 18 years of age, shall
    9continue to restrict the number of such checks to one check per
    10retail outlet, and one additional check for any retail outlet
    11found to be in violation during the first check.
       12b.  (1)  Of the funds appropriated in this subsection,
    13$21,089,000 shall be used for problem gambling and
    14substance-related disorder prevention, treatment, and recovery
    15services, including a 24-hour helpline, public information
    16resources, professional training, youth prevention, and program
    17evaluation.
       18(2)  Of the amount allocated under this paragraph, $306,000
    19shall be utilized by the department of public health, in
    20collaboration with the department of human services, to support
    21establishment and maintenance of a single statewide 24-hour
    22crisis hotline for the Iowa children’s behavioral health system
    23that incorporates warmline services which may be provided
    24through expansion of existing capabilities maintained by the
    25department of public health as required pursuant to 2018 Iowa
    26Acts, chapter 1056, section 16.
       27c.  The requirement of section 123.17, subsection 5, is met
    28by the appropriations and allocations made in this division of
    29this Act for purposes of substance-related disorder treatment
    30and addictive disorders for the fiscal year beginning July 1,
    312019.
       322.  HEALTHY CHILDREN AND FAMILIES
       33For promoting the optimum health status for children and
    34adolescents from birth through 21 years of age, and families,
    35and for not more than the following full-time equivalent
    -5-1positions:
    ..................................................  $25,817,057
    ...............................................  FTEs313.00
       4a.  Of the funds appropriated in this subsection, not more
    5than $734,000 shall be used for the healthy opportunities for
    6parents to experience success (HOPES)-healthy families Iowa
    7(HFI) program established pursuant to section 135.106.
       8b.  In order to implement the legislative intent stated
    9in sections 135.106 and 256I.9, priority for home visitation
    10program funding shall be given to programs using evidence-based
    11or promising models for home visitation.
       12c.  Of the funds appropriated in this subsection, $3,075,000
    13shall be used for continuation of the department’s initiative
    14to provide for adequate developmental surveillance and
    15screening during a child’s first five years. The funds shall
    16be used first to fully fund the current sites to ensure that
    17the sites are fully operational, with the remaining funds
    18to be used for expansion to additional sites. The full
    19implementation and expansion shall include enhancing the scope
    20of the initiative through collaboration with the child health
    21specialty clinics to promote healthy child development through
    22early identification and response to both biomedical and social
    23determinants of healthy development; by monitoring child
    24health metrics to inform practice, document long-term health
    25impacts and savings, and provide for continuous improvement
    26through training, education, and evaluation; and by providing
    27for practitioner consultation particularly for children with
    28behavioral conditions and needs. The department of public
    29health shall also collaborate with the Iowa Medicaid enterprise
    30and the child health specialty clinics to integrate the
    31activities of the first five initiative into the establishment
    32of patient-centered medical homes, community utilities,
    33accountable care organizations, and other integrated care
    34models developed to improve health quality and population
    35health while reducing health care costs. To the maximum extent
    -6-1possible, funding allocated in this paragraph shall be utilized
    2as matching funds for medical assistance program reimbursement.
       3d.  Of the funds appropriated in this subsection, $64,000
    4shall be used to provide funds for a donated dental services
    5program patterned after the projects developed by the lifeline
    6network to provide dental services to indigent individuals who
    7are elderly or with disabilities.
       8e.  Of the funds appropriated in this subsection, $156,000
    9shall be used to provide audiological services and hearing aids
    10for children.
       11f.  Of the funds appropriated in this subsection, $23,000 is
    12transferred to the university of Iowa college of dentistry for
    13provision of primary dental services to children. State funds
    14shall be matched on a dollar-for-dollar basis. The university
    15of Iowa college of dentistry shall coordinate efforts with the
    16department of public health, oral and health delivery system
    17bureau, to provide dental care to underserved populations
    18throughout the state.
       19g.  Of the funds appropriated in this subsection, $50,000
    20shall be used to address youth suicide prevention.
       21h.  Of the funds appropriated in this subsection, $40,000
    22shall be used to support the Iowa effort to address the survey
    23of children who experience adverse childhood experiences known
    24as ACEs.
       25i.  Of the funds appropriated in this subsection, up to
    26$494,000 shall be used for childhood obesity prevention.
       273.  CHRONIC CONDITIONS
       28For serving individuals identified as having chronic
    29conditions or special health care needs, and for not more than
    30the following full-time equivalent positions:
    ..................................................  $314,223,519
    ...............................................  FTEs329.00
       33a.  Of the funds appropriated in this subsection, $153,000
    34shall be used for grants to individual patients who have an
    35inherited metabolic disorder to assist with the costs of
    -7-1medically necessary foods and formula.
       2b.  Of the funds appropriated in this subsection, $1,055,000
    3shall be used for the brain injury services program pursuant to
    4section 135.22B, including for resource facilitator services in
    5accordance with section 135.22B, subsection 9, and to enhance
    6brain injury training and recruitment of service providers on a
    7statewide basis. Of the amount allocated in this paragraph,
    8$95,000 shall be used to fund one full-time equivalent position
    9to serve as the state brain injury services program manager.
       10c.  Of the funds appropriated in this subsection, $144,000
    11shall be used to provide education, client-centered programs,
    12and client and family support for people living with epilepsy
    13and their families. If the department does not administer
    14this paragraph “c” internally, the amount allocated in this
    15paragraph shall be matched dollar-for-dollar by the contractor
    16selected through the request for proposals process.
       17d.  Of the funds appropriated in this subsection, $809,000
    18shall be used for child health specialty clinics.
       19e.  Of the funds appropriated in this subsection, $384,000
    20shall be used by the regional autism assistance program
    21established pursuant to section 256.35, and administered by
    22the child health specialty clinic located at the university of
    23Iowa hospitals and clinics. The funds shall be used to enhance
    24interagency collaboration and coordination of educational,
    25medical, and other human services for persons with autism,
    26their families, and providers of services, including delivering
    27regionalized services of care coordination, family navigation,
    28and integration of services through the statewide system of
    29regional child health specialty clinics and fulfilling other
    30requirements as specified in chapter 225D. The university of
    31Iowa shall not receive funds allocated under this paragraph for
    32indirect costs associated with the regional autism assistance
    33program.
       34f.  Of the funds appropriated in this subsection, $577,000
    35shall be used for the comprehensive cancer control program to
    -8-1reduce the burden of cancer in Iowa through prevention, early
    2detection, effective treatment, and ensuring quality of life.
    3Of the funds allocated in this paragraph “f”, $150,000 shall
    4be used to support a melanoma research symposium, a melanoma
    5biorepository and registry, basic and translational melanoma
    6research, and clinical trials.
       7g.  Of the funds appropriated in this subsection, $97,000
    8shall be used for cervical and colon cancer screening, and
    9$177,000 shall be used to enhance the capacity of the cervical
    10cancer screening program to include provision of recommended
    11prevention and early detection measures to a broader range of
    12low-income women.
       13h.  Of the funds appropriated in this subsection, $506,000
    14shall be used for the center for congenital and inherited
    15disorders.
       164.  COMMUNITY CAPACITY
       17For strengthening the health care delivery system at the
    18local level, and for not more than the following full-time
    19equivalent positions:
    ..................................................  $205,516,677
    ...............................................  FTEs2113.00
       22a.  Of the funds appropriated in this subsection, $95,000
    23is allocated for continuation of the child vision screening
    24program implemented through the university of Iowa hospitals
    25and clinics in collaboration with early childhood Iowa areas.
    26The program shall submit a report to the department regarding
    27the use of funds allocated under this paragraph “a”. The
    28report shall include the objectives and results for the
    29program year including the target population and how the funds
    30allocated assisted the program in meeting the objectives; the
    31number, age, and location within the state of individuals
    32served; the type of services provided to the individuals
    33served; the distribution of funds based on service provided;
    34and the continuing needs of the program.
       35b.  Of the funds appropriated in this subsection, $48,000
    -9-1shall be used for a program to rotate intern psychologists
    2in placements in urban and rural mental health professional
    3shortage areas. For the purposes of this paragraph “b”,
    4“mental health professional shortage areas” means geographic
    5areas in this state that have been designated by the United
    6States department of health and human services, health
    7resources and services administration, bureau of health
    8professionals, as having a shortage of mental health
    9professionals.
       10c.  Of the funds appropriated in this subsection, the
    11following amounts are allocated to be used as follows
    12to support the goals of increased access, health system
    13integration, and engagement:
       14(1)  Not less than $542,000 is allocated for the
    15pharmaceutical infrastructure for safety net providers as
    16described in 2007 Iowa Acts, chapter 218, section 108, and for
    17the prescription drug donation repository program created in
    18chapter 135M.
       19(2)  Not less than $334,000 is allocated for free clinics
    20for necessary infrastructure, statewide coordination, provider
    21recruitment, service delivery, and provision of assistance to
    22patients in securing a medical home inclusive of oral health
    23care.
       24(3)  Not less than $25,000 is allocated for rural health
    25clinics for necessary infrastructure and service delivery
    26transformation.
       27(4)  Not less than $205,000 is allocated for the safety net
    28provider patients access to specialty health care initiative as
    29described in 2007 Iowa Acts, chapter 218, section 109.
       30d.  Of the funds appropriated in this subsection, $191,000
    31is allocated for the purposes of health care and public health
    32workforce initiatives.
       33e.  Of the funds appropriated in this subsection, $96,000
    34shall be used for a matching dental education loan repayment
    35program.
    -10-       1f.  Of the funds appropriated in this subsection, $100,000
    2shall be used for the purposes of the Iowa donor registry as
    3specified in section 142C.18.
       4g.  Of the funds appropriated in this subsection, $96,000
    5shall be used for efforts to preserve sight and prevent
    6blindness through education, nationally certified vision
    7screening and training, and community and patient service
    8programs for children and adults. If the department does
    9not administer this paragraph “g” internally, the contractor
    10selected through the request for proposals process shall
    11submit a report to the department regarding the use of funds
    12allocated under this paragraph “g”. The report shall include
    13the objectives and results for the program year including
    14the target population and how the funds allocated assisted
    15the program in meeting the objectives; the number, age, and
    16location within the state of individuals served; the type of
    17services provided to the individuals served; the distribution
    18of funds based on services provided; and the continuing needs
    19of the program.
       20h.  Of the funds appropriated in this subsection, $2,000,000
    21shall be deposited in the medical residency training account
    22created in section 135.175, subsection 5, paragraph “a”, and
    23is appropriated from the account to the department of public
    24health to be used for the purposes of the medical residency
    25training state matching grants program as specified in section
    26135.176.
       27i.  Of the funds appropriated in this subsection, $250,000
    28shall be used for the public purpose of providing funding to
    29Des Moines university to continue a provider education project
    30to provide primary care physicians with the training and skills
    31necessary to recognize the signs of mental illness in patients.
       32j.  Of the funds appropriated in this subsection, $400,000
    33shall be used for rural psychiatric residencies to support the
    34annual creation and training of four psychiatric residents who
    35will provide mental health services in underserved areas of the
    -11-1state.
       2k.  Of the funds appropriated in this subsection, $150,000
    3shall be used for psychiatric training to increase access to
    4mental health care services by expanding the mental health
    5workforce via training of additional physician assistants and
    6nurse practitioners.
       75.  ESSENTIAL PUBLIC HEALTH SERVICES
       8To provide public health services that reduce risks and
    9invest in promoting and protecting good health over the
    10course of a lifetime with a priority given to older Iowans and
    11vulnerable populations:
    ..................................................  $127,662,464
       136.  INFECTIOUS DISEASES
       14For reducing the incidence and prevalence of communicable
    15diseases, and for not more than the following full-time
    16equivalent positions:
    ..................................................  $171,796,426
    ...............................................  FTEs184.00
       197.  PUBLIC PROTECTION
       20For protecting the health and safety of the public through
    21establishing standards and enforcing regulations, and for not
    22more than the following full-time equivalent positions:
    ..................................................  $234,093,383
    ...............................................  FTEs24142.00
       25a.  Of the funds appropriated in this subsection, not more
    26than $304,000 shall be credited to the emergency medical
    27services fund created in section 135.25. Moneys in the
    28emergency medical services fund are appropriated to the
    29department to be used for the purposes of the fund.
       30b.  Of the funds appropriated in this subsection, up
    31to $243,000 shall be used for sexual violence prevention
    32programming, and for a training program for sexual assault
    33response team (SART) members, including representatives of
    34law enforcement, victim advocates, prosecutors, and certified
    35medical personnel. The amount allocated in this paragraph “b”
    -12-1shall not be used to supplant funding administered for other
    2sexual violence prevention or victims assistance programs.
       3c.  Of the funds appropriated in this subsection, up to
    4$500,000 shall be used for the state poison control center.
    5Pursuant to the directive under 2014 Iowa Acts, chapter
    61140, section 102, the federal matching funds available to
    7the state poison control center from the department of human
    8services under the federal Children’s Health Insurance Program
    9Reauthorization Act allotment shall be subject to the federal
    10administrative cap rule of 10 percent applicable to funding
    11provided under Tit.XXI of the federal Social Security Act and
    12included within the department’s calculations of the cap.
       13d.  Of the funds appropriated in this subsection, up to
    14$504,000 shall be used for childhood lead poisoning provisions.
       158.  RESOURCE MANAGEMENT
       16For establishing and sustaining the overall ability of the
    17department to deliver services to the public, and for not more
    18than the following full-time equivalent positions:
    ..................................................  $19971,215
    ...............................................  FTEs204.00
       219.  MISCELLANEOUS PROVISIONS
       22The university of Iowa hospitals and clinics under the
    23control of the state board of regents shall not receive
    24indirect costs from the funds appropriated in this section.
    25The university of Iowa hospitals and clinics billings to the
    26department shall be on at least a quarterly basis.
    27   Sec. 4.  USE OF REQUEST FOR PROPOSALS PROCESS — PROHIBITED
    28USE OF FUNDS FOR LOBBYING.
       291.  a.  If an entity is not specified to receive moneys
    30allocated or appropriated to administer a program or activity
    31in this division of this Act and the department elects not
    32to administer such program or activity internally, a request
    33for proposals process shall be utilized to select an entity to
    34administer such program or activity.
       35b.  Unless otherwise specifically provided, the department
    -13-1shall not retain any portion of the funds allocated or
    2appropriated for programs or activities administered by a
    3specified entity or by an entity selected through a request for
    4proposals process to be used for administrative costs under
    5this division of this Act.
       6c.  The department shall submit a report to the individuals
    7identified in this Act for submission of reports by December
    815, 2019, regarding the outcomes of any program or activity
    9administered by a specified entity or an entity selected
    10through a request for proposals process under this division of
    11this Act.
       122.  Moneys appropriated or allocated under this division of
    13this Act shall not be used, directly or indirectly, for the
    14compensation of a lobbyist. For the purposes of this section,
    15“lobbyist” means the same as defined in section 68B.2; however,
    16“lobbyist” does not include a person employed by a state agency
    17of the executive branch of state government who represents
    18the agency relative to the passage, defeat, approval, or
    19modification of legislation that is being considered by the
    20general assembly.
    21DIVISION IV
    22DEPARTMENT OF VETERANS AFFAIRS — FY 2019-2020
    23   Sec. 5.  DEPARTMENT OF VETERANS AFFAIRS.  There is
    24appropriated from the general fund of the state to the
    25department of veterans affairs for the fiscal year beginning
    26July 1, 2019, and ending June 30, 2020, the following amounts,
    27or so much thereof as is necessary, to be used for the purposes
    28designated:
       291.  DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
       30For salaries, support, maintenance, and miscellaneous
    31purposes, and for not more than the following full-time
    32equivalent positions:
    ..................................................  $331,225,500
    ...............................................  FTEs3415.00
       352.  IOWA VETERANS HOME
    -14-       1For salaries, support, maintenance, and miscellaneous
    2purposes:
    ..................................................  $37,162,976
       4a.  The Iowa veterans home billings involving the department
    5of human services shall be submitted to the department on at
    6least a monthly basis.
       7b.  Within available resources and in conformance with
    8associated state and federal program eligibility requirements,
    9the Iowa veterans home may implement measures to provide
    10financial assistance to or on behalf of veterans or their
    11spouses who are participating in the community reentry program.
       12c.  The Iowa veterans home expenditure report shall be
    13submitted monthly to the legislative services agency.
       14d.  The Iowa veterans home shall continue to include in the
    15annual discharge report applicant information to provide for
    16the collection of demographic information including but not
    17limited to the number of individuals applying for admission and
    18admitted or denied admittance and the basis for the admission
    19or denial; the age, gender, and race of such individuals;
    20and the level of care for which such individuals applied for
    21admission including residential or nursing level of care.
       223.  HOME OWNERSHIP ASSISTANCE PROGRAM
       23For transfer to the Iowa finance authority for the
    24continuation of the home ownership assistance program for
    25persons who are or were eligible members of the armed forces of
    26the United States, pursuant to section 16.54:
    ..................................................  $272,000,000
    28   Sec. 6.  LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS
    29FUND STANDING APPROPRIATIONS.      Notwithstanding the standing
    30appropriation in section 35A.16 for the fiscal year beginning
    31July 1, 2019, and ending June 30, 2020, the amount appropriated
    32from the general fund of the state pursuant to that section
    33for the following designated purposes shall not exceed the
    34following amount:
       35For the county commissions of veteran affairs fund under
    -15-1section 35A.16:
    ..................................................  $2990,000
    3DIVISION V
    4DEPARTMENT OF HUMAN SERVICES — FY 2019-2020
    5   Sec. 7.  TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
    6GRANT.      There is appropriated from the fund created in section
    78.41 to the department of human services for the fiscal year
    8beginning July 1, 2019, and ending June 30, 2020, from moneys
    9received under the federal temporary assistance for needy
    10families (TANF) block grant pursuant to the federal Personal
    11Responsibility and Work Opportunity Reconciliation Act of 1996,
    12Pub.L.No.104-193, and successor legislation, the following
    13amounts, or so much thereof as is necessary, to be used for the
    14purposes designated:
       151.  To be credited to the family investment program account
    16and used for assistance under the family investment program
    17under chapter 239B:
    ..................................................  $184,524,006
       192.  To be credited to the family investment program account
    20and used for the job opportunities and basic skills (JOBS)
    21program and implementing family investment agreements in
    22accordance with chapter 239B:
    ..................................................  $235,412,060
       243.  To be used for the family development and
    25self-sufficiency grant program in accordance with section
    26216A.107:
    ..................................................  $272,898,980
       28Notwithstanding section 8.33, moneys appropriated in this
    29subsection that remain unencumbered or unobligated at the close
    30of the fiscal year shall not revert but shall remain available
    31for expenditure for the purposes designated until the close of
    32the succeeding fiscal year. However, unless such moneys are
    33encumbered or obligated on or before September 30, 2020, the
    34moneys shall revert.
       354.  For field operations:
    -16-    ..................................................  $131,296,232
       25.  For general administration:
    ..................................................  $33,744,000
       46.  For state child care assistance:
    ..................................................  $547,166,826
       6a.  Of the funds appropriated in this subsection,
    7$26,205,412 is transferred to the child care and development
    8block grant appropriation made by the Eighty-eighth General
    9Assembly, 2019 session, for the federal fiscal year beginning
    10October 1, 2019, and ending September 30, 2020. Of this
    11amount, $200,000 shall be used for provision of educational
    12opportunities to registered child care home providers in order
    13to improve services and programs offered by this category
    14of providers and to increase the number of providers. The
    15department may contract with institutions of higher education
    16or child care resource and referral centers to provide
    17the educational opportunities. Allowable administrative
    18costs under the contracts shall not exceed 5 percent. The
    19application for a grant shall not exceed two pages in length.
       20b.  Any funds appropriated in this subsection remaining
    21unallocated shall be used for state child care assistance
    22payments for families who are employed including but not
    23limited to individuals enrolled in the family investment
    24program.
       257.  For child and family services:
    ..................................................  $2632,380,654
       278.  For child abuse prevention grants:
    ..................................................  $28125,000
       299.  For pregnancy prevention grants on the condition that
    30family planning services are funded:
    ..................................................  $311,913,203
       32Pregnancy prevention grants shall be awarded to programs
    33in existence on or before July 1, 2019, if the programs have
    34demonstrated positive outcomes. Grants shall be awarded to
    35pregnancy prevention programs which are developed after July
    -17-11, 2019, if the programs are based on existing models that
    2have demonstrated positive outcomes. Grants shall comply with
    3the requirements provided in 1997 Iowa Acts, chapter 208,
    4section 14, subsections 1 and 2, including the requirement that
    5grant programs must emphasize sexual abstinence. Priority in
    6the awarding of grants shall be given to programs that serve
    7areas of the state which demonstrate the highest percentage of
    8unplanned pregnancies of females of childbearing age within the
    9geographic area to be served by the grant.
       1010.  For technology needs and other resources necessary
    11to meet federal welfare reform reporting, tracking, and case
    12management requirements:
    ..................................................  $131,037,186
       1411.  a.  Notwithstanding any provision to the contrary,
    15including but not limited to requirements in section 8.41 or
    16provisions in 2018 Iowa Acts or 2019 Iowa Acts regarding the
    17receipt and appropriation of federal block grants, federal
    18funds from the temporary assistance for needy families block
    19grant received by the state and not otherwise appropriated
    20in this section and remaining available for the fiscal year
    21beginning July 1, 2019, are appropriated to the department of
    22human services to the extent as may be necessary to be used in
    23the following priority order: the family investment program,
    24for state child care assistance program payments for families
    25who are employed, and for the family investment program share
    26of system costs for eligibility determination and related
    27functions. The federal funds appropriated in this paragraph
    28“a” shall be expended only after all other funds appropriated
    29in subsection 1 for assistance under the family investment
    30program, in subsection 6 for state child care assistance, or
    31in subsection 10 for technology costs related to the family
    32investment program, as applicable, have been expended. For
    33the purposes of this subsection, the funds appropriated in
    34subsection 6, paragraph “a”, for transfer to the child care
    35and development block grant appropriation are considered fully
    -18-1expended when the full amount has been transferred.
       2b.  The department shall, on a quarterly basis, advise the
    3legislative services agency and department of management of
    4the amount of funds appropriated in this subsection that was
    5expended in the prior quarter.
       612.  Of the amounts appropriated in this section,
    7$12,962,008 for the fiscal year beginning July 1, 2019, is
    8transferred to the appropriation of the federal social services
    9block grant made to the department of human services for that
    10fiscal year.
       1113.  For continuation of the program providing categorical
    12eligibility for the food assistance program as specified
    13for the program in the section of this division of this Act
    14relating to the family investment program account:
    ..................................................  $1514,236
       1614.  The department may transfer funds allocated in this
    17section to the appropriations made in this division of this Act
    18for the same fiscal year for general administration and field
    19operations for resources necessary to implement and operate the
    20services referred to in this section and those funded in the
    21appropriation made in this division of this Act for the same
    22fiscal year for the family investment program from the general
    23fund of the state.
       2415.  With the exception of moneys allocated under this
    25section for the family development and self-sufficiency grant
    26program, to the extent moneys allocated in this section are
    27deemed by the department not to be necessary to support the
    28purposes for which they are allocated, such moneys may be
    29used in the same fiscal year for any other purpose for which
    30funds are allocated in this section or in section 8 of this
    31division for the family investment program account. If there
    32are conflicting needs, priority shall first be given to the
    33family investment program account as specified under subsection
    341 of this section and used for the purposes of assistance under
    35the family investment program in accordance with chapter 239B,
    -19-1followed by state child care assistance program payments for
    2families who are employed, followed by other priorities as
    3specified by the department.
    4   Sec. 8.  FAMILY INVESTMENT PROGRAM ACCOUNT.
       51.  Moneys credited to the family investment program (FIP)
    6account for the fiscal year beginning July 1, 2019, and
    7ending June 30, 2020, shall be used to provide assistance in
    8accordance with chapter 239B.
       92.  The department may use a portion of the moneys credited
    10to the FIP account under this section as necessary for
    11salaries, support, maintenance, and miscellaneous purposes.
       123.  The department may transfer funds allocated in
    13subsection 4, excluding the allocation under subsection 4,
    14paragraph “b”, to the appropriations made in this division of
    15this Act for the same fiscal year for general administration
    16and field operations for resources necessary to implement
    17and operate the services referred to in this section and
    18those funded in the appropriations made in section 7 for the
    19temporary assistance for needy families block grant and in
    20section 9 for the family investment program from the general
    21fund of the state in this division of this Act for the same
    22fiscal year.
       234.  Moneys appropriated in this division of this Act and
    24credited to the FIP account for the fiscal year beginning July
    251, 2019, and ending June 30, 2020, are allocated as follows:
       26a.  To be retained by the department of human services to
    27be used for coordinating with the department of human rights
    28to more effectively serve participants in FIP and other shared
    29clients and to meet federal reporting requirements under the
    30federal temporary assistance for needy families block grant:
    ..................................................  $3120,000
       32b.  To the department of human rights for staffing,
    33administration, and implementation of the family development
    34and self-sufficiency grant program in accordance with section
    35216A.107:
    -20-    ..................................................  $16,192,834
       2(1)  Of the funds allocated for the family development
    3and self-sufficiency grant program in this paragraph “b”,
    4not more than 5 percent of the funds shall be used for the
    5administration of the grant program.
       6(2)  The department of human rights may continue to implement
    7the family development and self-sufficiency grant program
    8statewide during fiscal year 2019-2020.
       9(3)  The department of human rights may engage in activities
    10to strengthen and improve family outcomes measures and
    11data collection systems under the family development and
    12self-sufficiency grant program.
       13c.  For the diversion subaccount of the FIP account:
    ..................................................  $14815,000
       15A portion of the moneys allocated for the diversion
    16subaccount may be used for field operations, salaries, data
    17management system development, and implementation costs and
    18support deemed necessary by the director of human services
    19in order to administer the FIP diversion program. To the
    20extent moneys allocated in this paragraph “c” are deemed by the
    21department not to be necessary to support diversion activities,
    22such moneys may be used for other efforts intended to increase
    23engagement by family investment program participants in work,
    24education, or training activities, or for the purposes of
    25assistance under the family investment program in accordance
    26with chapter 239B.
       27d.  For the food assistance employment and training program:
    ..................................................  $2866,588
       29(1)  The department shall apply the federal supplemental
    30nutrition assistance program (SNAP) employment and training
    31state plan in order to maximize to the fullest extent permitted
    32by federal law the use of the 50 percent federal reimbursement
    33provisions for the claiming of allowable federal reimbursement
    34funds from the United States department of agriculture
    35pursuant to the federal SNAP employment and training program
    -21-1for providing education, employment, and training services
    2for eligible food assistance program participants, including
    3but not limited to related dependent care and transportation
    4expenses.
       5(2)  The department shall continue the categorical federal
    6food assistance program eligibility at 160 percent of the
    7federal poverty level and continue to eliminate the asset test
    8from eligibility requirements, consistent with federal food
    9assistance program requirements. The department shall include
    10as many food assistance households as is allowed by federal
    11law. The eligibility provisions shall conform to all federal
    12requirements including requirements addressing individuals who
    13are incarcerated or otherwise ineligible.
       14e.  For the JOBS program:
    ..................................................  $1512,018,258
       165.  Of the child support collections assigned under FIP,
    17an amount equal to the federal share of support collections
    18shall be credited to the child support recovery appropriation
    19made in this division of this Act. Of the remainder of the
    20assigned child support collections received by the child
    21support recovery unit, a portion shall be credited to the FIP
    22account, a portion may be used to increase recoveries, and a
    23portion may be used to sustain cash flow in the child support
    24payments account. If as a consequence of the appropriations
    25and allocations made in this section the resulting amounts
    26are insufficient to sustain cash assistance payments and meet
    27federal maintenance of effort requirements, the department
    28shall seek supplemental funding. If child support collections
    29assigned under FIP are greater than estimated or are otherwise
    30determined not to be required for maintenance of effort, the
    31state share of either amount may be transferred to or retained
    32in the child support payments account.
       336.  The department may adopt emergency rules for the family
    34investment, JOBS, food assistance, and medical assistance
    35programs if necessary to comply with federal requirements.
    -22-    1   Sec. 9.  FAMILY INVESTMENT PROGRAM GENERAL FUND.  There
    2is appropriated from the general fund of the state to the
    3department of human services for the fiscal year beginning July
    41, 2019, and ending June 30, 2020, the following amount, or
    5so much thereof as is necessary, to be used for the purpose
    6designated:
       7To be credited to the family investment program (FIP)
    8account and used for family investment program assistance under
    9chapter 239B:
    ..................................................  $1039,849,365
       111.  Of the funds appropriated in this section, $6,606,198 is
    12allocated for the JOBS program.
       132.  Of the funds appropriated in this section, $3,313,854 is
    14allocated for the family development and self-sufficiency grant
    15program.
       163.  a.  Notwithstanding section 8.39, for the fiscal
    17year beginning July 1, 2019, if necessary to meet federal
    18maintenance of effort requirements or to transfer federal
    19temporary assistance for needy families block grant funding
    20to be used for purposes of the federal social services block
    21grant or to meet cash flow needs resulting from delays in
    22receiving federal funding or to implement, in accordance with
    23this division of this Act, activities currently funded with
    24juvenile court services, county, or community moneys and state
    25moneys used in combination with such moneys; to comply with
    26federal requirements; or to maximize the use of federal funds;
    27the department of human services may transfer funds within or
    28between any of the appropriations made in this division of this
    29Act and appropriations in law for the federal social services
    30block grant to the department for the following purposes,
    31provided that the combined amount of state and federal
    32temporary assistance for needy families block grant funding
    33for each appropriation remains the same before and after the
    34transfer:
       35(1)  For the family investment program.
    -23-       1(2)  For state child care assistance.
       2(3)  For child and family services.
       3(4)  For field operations.
       4(5)  For general administration.
       5b.  This subsection shall not be construed to prohibit the
    6use of existing state transfer authority for other purposes.
    7The department shall report any transfers made pursuant to this
    8subsection to the legislative services agency.
       94.  Of the funds appropriated in this section, $195,000 shall
    10be used for the provision of tax preparation assistance to
    11low-income Iowans in order to expand the usage of the earned
    12income tax credit. The purpose of the allocation is to supply
    13this assistance to underserved areas of the state.
       145.  Of the funds appropriated in this section, $70,000
    15shall be used for the parenting program as specified in
    16441 IAC ch.100, relating to parental obligations, in which
    17the child support recovery unit participates. The funds
    18allocated in this subsection shall be used to develop a larger
    19community effort, through public and private partnerships, to
    20support a broad-based multi-county parenthood initiative that
    21promotes payment of child support obligations, improved family
    22relationships, and full-time employment.
       236.  The department may transfer funds appropriated in this
    24section, excluding the allocation in subsection 2 for the
    25family development and self-sufficiency grant program, to the
    26appropriations made in this division of this Act for general
    27administration and field operations as necessary to administer
    28this section, section 7 for the temporary assistance for needy
    29families block grant, and section 8 for the family investment
    30program account.
    31   Sec. 10.  CHILD SUPPORT RECOVERY.  There is appropriated
    32from the general fund of the state to the department of human
    33services for the fiscal year beginning July 1, 2019, and ending
    34June 30, 2020, the following amount, or so much thereof as is
    35necessary, to be used for the purposes designated:
    -24-       1For child support recovery, including salaries, support,
    2maintenance, and miscellaneous purposes, and for not more than
    3the following full-time equivalent positions:
    ..................................................  $415,265,040
    ...............................................  FTEs5459.00
       61.  The department shall expend up to $24,000, including
    7federal financial participation, for the fiscal year beginning
    8July 1, 2019, for a child support public awareness campaign.
    9The department and the office of the attorney general shall
    10cooperate in continuation of the campaign. The public
    11awareness campaign shall emphasize, through a variety of
    12media activities, the importance of maximum involvement of
    13both parents in the lives of their children as well as the
    14importance of payment of child support obligations.
       152.  Federal access and visitation grant moneys shall be
    16issued directly to private not-for-profit agencies that provide
    17services designed to increase compliance with the child access
    18provisions of court orders, including but not limited to
    19neutral visitation sites and mediation services.
       203.  The appropriation made to the department for child
    21support recovery may be used throughout the fiscal year in the
    22manner necessary for purposes of cash flow management, and for
    23cash flow management purposes the department may temporarily
    24draw more than the amount appropriated, provided the amount
    25appropriated is not exceeded at the close of the fiscal year.
    26   Sec. 11.  HEALTH CARE TRUST FUND — MEDICAL ASSISTANCE —
    27FY 2019-2020.      Any funds remaining in the health care trust
    28fund created in section 453A.35A for the fiscal year beginning
    29July 1, 2019, and ending June 30, 2020, are appropriated to
    30the department of human services to supplement the medical
    31assistance program appropriations made in this division of this
    32Act, for medical assistance reimbursement and associated costs,
    33including program administration and costs associated with
    34program implementation.
    35   Sec. 12.  MEDICAID FRAUD FUND — MEDICAL ASSISTANCE — FY
    -25-12019-2020.      Any funds remaining in the Medicaid fraud fund
    2created in section 249A.50 for the fiscal year beginning
    3July 1, 2019, and ending June 30, 2020, are appropriated to
    4the department of human services to supplement the medical
    5assistance appropriations made in this division of this Act,
    6for medical assistance reimbursement and associated costs,
    7including program administration and costs associated with
    8program implementation.
    9   Sec. 13.  MEDICAL ASSISTANCE.  There is appropriated from the
    10general fund of the state to the department of human services
    11for the fiscal year beginning July 1, 2019, and ending June 30,
    122020, the following amount, or so much thereof as is necessary,
    13to be used for the purpose designated:
       14For medical assistance program reimbursement and associated
    15costs as specifically provided in the reimbursement
    16methodologies in effect on June 30, 2019, except as otherwise
    17expressly authorized by law, consistent with options under
    18federal law and regulations, and contingent upon receipt of
    19approval from the office of the governor of reimbursement for
    20each abortion performed under the program:
    ..................................................  $211,431,334,812
       221.  Iowans support reducing the number of abortions
    23performed in our state. Funds appropriated under this section
    24shall not be used for abortions, unless otherwise authorized
    25under this section.
       262.  The provisions of this section relating to abortions
    27shall also apply to the Iowa health and wellness plan created
    28pursuant to chapter 249N.
       293.  The department shall utilize not more than $60,000 of
    30the funds appropriated in this section to continue the AIDS/HIV
    31health insurance premium payment program as established in 1992
    32Iowa Acts, Second Extraordinary Session, chapter 1001, section
    33409, subsection 6. Of the funds allocated in this subsection,
    34not more than $5,000 may be expended for administrative
    35purposes.
    -26-       14.  Of the funds appropriated in this Act to the department
    2of public health for addictive disorders, $950,000 for
    3the fiscal year beginning July 1, 2019, is transferred
    4to the department of human services for an integrated
    5substance-related disorder managed care system. The
    6departments of human services and public health shall
    7work together to maintain the level of mental health and
    8substance-related disorder treatment services provided by the
    9managed care contractors. Each department shall take the steps
    10necessary to continue the federal waivers as necessary to
    11maintain the level of services.
       125.  a.  The department shall aggressively pursue options for
    13providing medical assistance or other assistance to individuals
    14with special needs who become ineligible to continue receiving
    15services under the early and periodic screening, diagnostic,
    16and treatment program under the medical assistance program
    17due to becoming 21 years of age who have been approved for
    18additional assistance through the department’s exception to
    19policy provisions, but who have health care needs in excess
    20of the funding available through the exception to policy
    21provisions.
       22b.  Of the funds appropriated in this section, $100,000
    23shall be used for participation in one or more pilot projects
    24operated by a private provider to allow the individual or
    25individuals to receive service in the community in accordance
    26with principles established in Olmstead v.L.C., 527 U.S.581
    27(1999), for the purpose of providing medical assistance or
    28other assistance to individuals with special needs who become
    29ineligible to continue receiving services under the early and
    30periodic screening, diagnostic, and treatment program under
    31the medical assistance program due to becoming 21 years of
    32age who have been approved for additional assistance through
    33the department’s exception to policy provisions, but who have
    34health care needs in excess of the funding available through
    35the exception to the policy provisions.
    -27-       16.  Of the funds appropriated in this section, up to
    2$3,050,082 may be transferred to the field operations or
    3general administration appropriations in this division of this
    4Act for operational costs associated with Part D of the federal
    5Medicare Prescription Drug Improvement and Modernization Act
    6of 2003, Pub.L.No.108-173.
       77.  Of the funds appropriated in this section, up to $442,100
    8may be transferred to the appropriation in this division
    9of this Act for medical contracts to be used for clinical
    10assessment services and prior authorization of services.
       118.  A portion of the funds appropriated in this section
    12may be transferred to the appropriations in this division of
    13this Act for general administration, medical contracts, the
    14children’s health insurance program, or field operations to be
    15used for the state match cost to comply with the payment error
    16rate measurement (PERM) program for both the medical assistance
    17and children’s health insurance programs as developed by the
    18centers for Medicare and Medicaid services of the United States
    19department of health and human services to comply with the
    20federal Improper Payments Information Act of 2002, Pub.L.
    21No.107-300, and to support other reviews and quality control
    22activities to improve the integrity of these programs.
       239.  The department shall continue to implement the
    24recommendations of the assuring better child health and
    25development initiative II (ABCDII) clinical panel to the
    26Iowa early and periodic screening, diagnostic, and treatment
    27services healthy mental development collaborative board
    28regarding changes to billing procedures, codes, and eligible
    29service providers.
       3010.  Of the funds appropriated in this section, a sufficient
    31amount is allocated to supplement the incomes of residents of
    32nursing facilities, intermediate care facilities for persons
    33with mental illness, and intermediate care facilities for
    34persons with an intellectual disability, with incomes of less
    35than $50 in the amount necessary for the residents to receive a
    -28-1personal needs allowance of $50 per month pursuant to section
    2249A.30A.
       311.  a.  Hospitals that meet the conditions specified
    4in subparagraphs (1) and (2) shall either certify public
    5expenditures or transfer to the medical assistance program
    6an amount equal to provide the nonfederal share for a
    7disproportionate share hospital payment in an amount up to the
    8hospital-specific limit as approved in the Medicaid state plan.
    9The hospitals that meet the conditions specified shall receive
    10and retain 100 percent of the total disproportionate share
    11hospital payment in an amount up to the hospital-specific limit
    12as approved in the Medicaid state plan.
       13(1)  The hospital qualifies for disproportionate share and
    14graduate medical education payments.
       15(2)  The hospital is an Iowa state-owned hospital with more
    16than 500 beds and eight or more distinct residency specialty
    17or subspecialty programs recognized by the American college of
    18graduate medical education.
       19b.  Distribution of the disproportionate share payments
    20shall be made on a monthly basis. The total amount of
    21disproportionate share payments including graduate medical
    22education, enhanced disproportionate share, and Iowa
    23state-owned teaching hospital payments shall not exceed the
    24amount of the state’s allotment under Pub.L.No.102-234.
    25In addition, the total amount of all disproportionate
    26share payments shall not exceed the hospital-specific
    27disproportionate share limits under Pub.L.No.103-66.
       2812.  One hundred percent of the nonfederal share of payments
    29to area education agencies that are medical assistance
    30providers for medical assistance-covered services provided to
    31medical assistance-covered children, shall be made from the
    32appropriation made in this section.
       3313.  A portion of the funds appropriated in this section
    34may be transferred to the appropriation in this division of
    35this Act for medical contracts to be used for administrative
    -29-1activities associated with the money follows the person
    2demonstration project.
       314.  Of the funds appropriated in this section, $349,011
    4shall be used for the administration of the health insurance
    5premium payment program, including salaries, support,
    6maintenance, and miscellaneous purposes.
       715.  For the fiscal year beginning July 1, 2019, and ending
    8June 30, 2020, the replacement generation tax revenues required
    9to be deposited in the property tax relief fund pursuant to
    10section 437A.8, subsection 4, paragraph “d”, and section
    11437A.15, subsection 3, paragraph “f”, shall instead be credited
    12to and supplement the appropriation made in this section and
    13used for the allocations made in this section.
       1416.  a.  Of the funds appropriated in this section, up
    15to $50,000 may be transferred by the department to the
    16appropriation made in this division of this Act to the
    17department for the same fiscal year for general administration
    18to be used for associated administrative expenses and for not
    19more than one full-time equivalent position, in addition to
    20those authorized for the same fiscal year, to be assigned to
    21implementing the children’s mental health home project.
       22b.  Of the funds appropriated in this section, up to $400,000
    23may be transferred by the department to the appropriation made
    24to the department in this division of this Act for the same
    25fiscal year for Medicaid program-related general administration
    26planning and implementation activities. The funds may be used
    27for contracts or for personnel in addition to the amounts
    28appropriated for and the positions authorized for general
    29administration for the fiscal year.
       30c.  Of the funds appropriated in this section, up to
    31$3,000,000 may be transferred by the department to the
    32appropriations made in this division of this Act for the same
    33fiscal year for general administration or medical contracts
    34to be used to support the development and implementation of
    35standardized assessment tools for persons with mental illness,
    -30-1an intellectual disability, a developmental disability, or a
    2brain injury.
       317.  Of the funds appropriated in this section, $150,000
    4shall be used for lodging expenses associated with care
    5provided at the university of Iowa hospitals and clinics for
    6patients with cancer whose travel distance is 30 miles or more
    7and whose income is at or below 200 percent of the federal
    8poverty level as defined by the most recently revised poverty
    9income guidelines published by the United States department of
    10health and human services. The department of human services
    11shall establish the maximum number of overnight stays and the
    12maximum rate reimbursed for overnight lodging, which may be
    13based on the state employee rate established by the department
    14of administrative services. The funds allocated in this
    15subsection shall not be used as nonfederal share matching
    16funds.
       1718.  Of the funds appropriated in this section, up to
    18$3,383,880 shall be used for administration of the state family
    19planning services program pursuant to section 217.41B, and
    20of this amount, the department may use up to $200,000 for
    21administrative expenses.
       2219.  Of the funds appropriated in this section, $1,545,530
    23shall be used and may be transferred to other appropriations
    24in this division of this Act as necessary to administer the
    25provisions in the division of this Act relating to Medicaid
    26program administration.
       2720.  The department shall continue to implement and
    28administer the provisions of 2018 Iowa Acts, chapter 1056.
    29Of the funds appropriated in this section, up to $39,069 may
    30be transferred to the department of inspections and appeals
    31for inspection costs related to such implementation and
    32administration.
       3321.  Of the funds appropriated in this section, up to
    34$1,200,000 shall be used to implement reductions in the waiting
    35list for the children’s mental health home and community-based
    -31-1services waiver.
       222.  Of the funds appropriated in this section, $1,500,000
    3shall be used to reinstate cost-based reimbursement and the
    4settlement process under the Medicaid program for critical
    5access hospitals in the state, as designated pursuant to 42
    6U.S.C.§1395i-4, to provide reimbursement at the rate provided
    7for such hospitals under the federal Medicare program.
    8   Sec. 14.  MEDICAL CONTRACTS.  There is appropriated from the
    9general fund of the state to the department of human services
    10for the fiscal year beginning July 1, 2019, and ending June 30,
    112020, the following amount, or so much thereof as is necessary,
    12to be used for the purpose designated:
       13For medical contracts:
    ..................................................  $1417,992,530
       151.  The department of inspections and appeals shall
    16provide all state matching funds for survey and certification
    17activities performed by the department of inspections
    18and appeals. The department of human services is solely
    19responsible for distributing the federal matching funds for
    20such activities.
       212.  Of the funds appropriated in this section, $50,000 shall
    22be used for continuation of home and community-based services
    23waiver quality assurance programs, including the review and
    24streamlining of processes and policies related to oversight and
    25quality management to meet state and federal requirements.
       263.  Of the amount appropriated in this section, up to
    27$200,000 may be transferred to the appropriation for general
    28administration in this division of this Act to be used for
    29additional full-time equivalent positions in the development
    30of key health initiatives such as development and oversight
    31of managed care programs and development of health strategies
    32targeted toward improved quality and reduced costs in the
    33Medicaid program.
       344.  Of the funds appropriated in this section, $1,000,000
    35shall be used for planning and development, in cooperation with
    -32-1the department of public health, of a phased-in program to
    2provide a dental home for children.
       35.  a.  Of the funds appropriated in this section, $573,000
    4shall be credited to the autism support program fund created
    5in section 225D.2 to be used for the autism support program
    6created in chapter 225D, with the exception of the following
    7amount of this allocation which shall be used as follows:
       8b.  Of the funds allocated in this subsection, $25,000 shall
    9be used for the public purpose of continuation of a grant to a
    10nonprofit provider of child welfare services that has been in
    11existence for more than 115 years, is located in a county with
    12a population between 200,000 and 220,000 according to the most
    13recent federal decennial census, is licensed as a psychiatric
    14medical institution for children, and provides school-based
    15programming, to be used for support services for children with
    16autism spectrum disorder and their families.
    17   Sec. 15.  STATE SUPPLEMENTARY ASSISTANCE.
       181.  There is appropriated from the general fund of the
    19state to the department of human services for the fiscal year
    20beginning July 1, 2019, and ending June 30, 2020, the following
    21amount, or so much thereof as is necessary, to be used for the
    22purpose designated:
       23For the state supplementary assistance program:
    ..................................................  $247,812,909
       252.  The department shall increase the personal needs
    26allowance for residents of residential care facilities by the
    27same percentage and at the same time as federal supplemental
    28security income and federal social security benefits are
    29increased due to a recognized increase in the cost of living.
    30The department may adopt emergency rules to implement this
    31subsection.
       323.  If during the fiscal year beginning July 1, 2019,
    33the department projects that state supplementary assistance
    34expenditures for a calendar year will not meet the federal
    35pass-through requirement specified in Tit.XVI of the federal
    -33-1Social Security Act, section 1618, as codified in 42 U.S.C.
    2§1382g, the department may take actions including but not
    3limited to increasing the personal needs allowance for
    4residential care facility residents and making programmatic
    5adjustments or upward adjustments of the residential care
    6facility or in-home health-related care reimbursement rates
    7prescribed in this division of this Act to ensure that federal
    8requirements are met. In addition, the department may make
    9other programmatic and rate adjustments necessary to remain
    10within the amount appropriated in this section while ensuring
    11compliance with federal requirements. The department may adopt
    12emergency rules to implement the provisions of this subsection.
       134.  Notwithstanding section 8.33, moneys appropriated in
    14this section that remain unencumbered or unobligated at the
    15close of the fiscal year shall not revert but shall remain
    16available for expenditure for the purposes designated until the
    17close of the succeeding fiscal year.
    18   Sec. 16.  CHILDREN’S HEALTH INSURANCE PROGRAM.
       191.  There is appropriated from the general fund of the
    20state to the department of human services for the fiscal year
    21beginning July 1, 2019, and ending June 30, 2020, the following
    22amount, or so much thereof as is necessary, to be used for the
    23purpose designated:
       24For maintenance of the healthy and well kids in Iowa (hawk-i)
    25program pursuant to chapter 514I, including supplemental dental
    26services, for receipt of federal financial participation under
    27Tit.XXI of the federal Social Security Act, which creates the
    28children’s health insurance program:
    ..................................................  $2919,361,112
       302.  Of the funds appropriated in this section, $79,486 is
    31allocated for continuation of the contract for outreach with
    32the department of public health.
       333.  A portion of the funds appropriated in this section may
    34be transferred to the appropriations made in this division of
    35this Act for field operations or medical contracts to be used
    -34-1for the integration of hawk-i program eligibility, payment, and
    2administrative functions under the purview of the department
    3of human services, including for the Medicaid management
    4information system upgrade.
    5   Sec. 17.  CHILD CARE ASSISTANCE.  There is appropriated
    6from the general fund of the state to the department of human
    7services for the fiscal year beginning July 1, 2019, and ending
    8June 30, 2020, the following amount, or so much thereof as is
    9necessary, to be used for the purpose designated:
       10For child care programs:
    ..................................................  $1140,816,931
       121.  Of the funds appropriated in this section, $34,966,931
    13shall be used for state child care assistance in accordance
    14with section 237A.13.
       152.  Nothing in this section shall be construed or is
    16intended as or shall imply a grant of entitlement for services
    17to persons who are eligible for assistance due to an income
    18level consistent with the waiting list requirements of section
    19237A.13. Any state obligation to provide services pursuant to
    20this section is limited to the extent of the funds appropriated
    21in this section.
       223.  A list of the registered and licensed child care
    23facilities operating in the area served by a child care
    24resource and referral service shall be made available to the
    25families receiving state child care assistance in that area.
       264.  Of the funds appropriated in this section, $5,850,000
    27shall be credited to the early childhood programs grants
    28account in the early childhood Iowa fund created in section
    29256I.11. The moneys shall be distributed for funding of
    30community-based early childhood programs targeted to children
    31from birth through five years of age developed by early
    32childhood Iowa areas in accordance with approved community
    33plans as provided in section 256I.8.
       345.  The department may use any of the funds appropriated
    35in this section as a match to obtain federal funds for use in
    -35-1expanding child care assistance and related programs. For
    2the purpose of expenditures of state and federal child care
    3funding, funds shall be considered obligated at the time
    4expenditures are projected or are allocated to the department’s
    5service areas. Projections shall be based on current and
    6projected caseload growth, current and projected provider
    7rates, staffing requirements for eligibility determination
    8and management of program requirements including data systems
    9management, staffing requirements for administration of the
    10program, contractual and grant obligations and any transfers
    11to other state agencies, and obligations for decategorization
    12or innovation projects.
       136.  A portion of the state match for the federal child care
    14and development block grant shall be provided as necessary to
    15meet federal matching funds requirements through the state
    16general fund appropriation made for child development grants
    17and other programs for at-risk children in section 279.51.
       187.  If a uniform reduction ordered by the governor under
    19section 8.31 or other operation of law, transfer, or federal
    20funding reduction reduces the appropriation made in this
    21section for the fiscal year, the percentage reduction in the
    22amount paid out to or on behalf of the families participating
    23in the state child care assistance program shall be equal to or
    24less than the percentage reduction made for any other purpose
    25payable from the appropriation made in this section and the
    26federal funding relating to it. The percentage reduction to
    27the other allocations made in this section shall be the same as
    28the uniform reduction ordered by the governor or the percentage
    29change of the federal funding reduction, as applicable. If
    30there is an unanticipated increase in federal funding provided
    31for state child care services, the entire amount of the
    32increase, except as necessary to meet federal requirements
    33including quality set asides, shall be used for state child
    34care assistance payments. If the appropriations made for
    35purposes of the state child care assistance program for the
    -36-1fiscal year are determined to be insufficient, it is the intent
    2of the general assembly to appropriate sufficient funding for
    3the fiscal year in order to avoid establishment of waiting list
    4requirements.
       58.  Notwithstanding section 8.33, moneys advanced for
    6purposes of the programs developed by early childhood Iowa
    7areas, advanced for purposes of wraparound child care, or
    8received from the federal appropriations made for the purposes
    9of this section that remain unencumbered or unobligated at the
    10close of the fiscal year shall not revert to any fund but shall
    11remain available for expenditure for the purposes designated
    12until the close of the succeeding fiscal year.
    13   Sec. 18.  JUVENILE INSTITUTION.  There is appropriated
    14from the general fund of the state to the department of human
    15services for the fiscal year beginning July 1, 2019, and ending
    16June 30, 2020, the following amounts, or so much thereof as is
    17necessary, to be used for the purposes designated:
       181.  a.  For operation of the state training school at Eldora
    19and for salaries, support, maintenance, and miscellaneous
    20purposes, and for not more than the following full-time
    21equivalent positions:
    ..................................................  $2213,920,757
    ...............................................  FTEs23207.00
       24b.  Of the funds appropriated in this subsection, $91,000
    25shall be used for distribution to licensed classroom teachers
    26at this and other institutions under the control of the
    27department of human services based upon the average student
    28yearly enrollment at each institution as determined by the
    29department.
       30c.  The additional full-time equivalent positions authorized
    31in paragraph “a” shall include 1.00 youth services technician,
    321.00 clinical supervisor, and 1.00 registered nurse full-time
    33equivalent positions.
       342.  A portion of the moneys appropriated in this section
    35shall be used by the state training school at Eldora for
    -37-1grants for adolescent pregnancy prevention activities at the
    2institution in the fiscal year beginning July 1, 2019.
       33.  Of the funds appropriated in this subsection, $212,000
    4shall be used by the state training school at Eldora for a
    5substance use disorder treatment program at the institution for
    6the fiscal year beginning July 1, 2019.
       74.  Notwithstanding section 8.33, moneys appropriated in
    8this section that remain unencumbered or unobligated at the
    9close of the fiscal year shall not revert but shall remain
    10available for expenditure for the purposes designated until the
    11close of the succeeding fiscal year.
    12   Sec. 19.  CHILD AND FAMILY SERVICES.
       131.  There is appropriated from the general fund of the
    14state to the department of human services for the fiscal year
    15beginning July 1, 2019, and ending June 30, 2020, the following
    16amount, or so much thereof as is necessary, to be used for the
    17purpose designated:
       18For child and family services:
    ..................................................  $1989,071,761
       202.  The department may transfer funds appropriated in this
    21section as necessary to pay the nonfederal costs of services
    22reimbursed under the medical assistance program, state child
    23care assistance program, or the family investment program which
    24are provided to children who would otherwise receive services
    25paid under the appropriation in this section. The department
    26may transfer funds appropriated in this section to the
    27appropriations made in this division of this Act for general
    28administration and for field operations for resources necessary
    29to implement and operate the services funded in this section.
       303.  a.  Of the funds appropriated in this section, up to
    31$34,536,000 is allocated as the statewide expenditure target
    32under section 232.143 for group foster care maintenance and
    33services. If the department projects that such expenditures
    34for the fiscal year will be less than the target amount
    35allocated in this paragraph “a”, the department may reallocate
    -38-1the excess to provide additional funding for family foster
    2care, independent living, family safety, risk and permanency
    3services, shelter care, or the child welfare emergency services
    4addressed with the allocation for shelter care.
       5b.  If at any time after September 30, 2019, annualization
    6of a service area’s current expenditures indicates a service
    7area is at risk of exceeding its group foster care expenditure
    8target under section 232.143 by more than 5 percent, the
    9department and juvenile court services shall examine all
    10group foster care placements in that service area in order to
    11identify those which might be appropriate for termination.
    12In addition, any aftercare services believed to be needed
    13for the children whose placements may be terminated shall be
    14identified. The department and juvenile court services shall
    15initiate action to set dispositional review hearings for the
    16placements identified. In such a dispositional review hearing,
    17the juvenile court shall determine whether needed aftercare
    18services are available and whether termination of the placement
    19is in the best interest of the child and the community.
       204.  In accordance with the provisions of section 232.188,
    21the department shall continue the child welfare and juvenile
    22justice funding initiative during fiscal year 2019-2020. Of
    23the funds appropriated in this section, $1,717,000 is allocated
    24specifically for expenditure for fiscal year 2019-2020 through
    25the decategorization services funding pools and governance
    26boards established pursuant to section 232.188.
       275.  A portion of the funds appropriated in this section
    28may be used for emergency family assistance to provide other
    29resources required for a family participating in a family
    30preservation or reunification project or successor project to
    31stay together or to be reunified.
       326.  Of the funds appropriated in this section, a sufficient
    33amount is allocated for shelter care and the child welfare
    34emergency services contracting implemented to provide for or
    35prevent the need for shelter care.
    -39-       17.  Federal funds received by the state during the fiscal
    2year beginning July 1, 2019, as the result of the expenditure
    3of state funds appropriated during a previous state fiscal
    4year for a service or activity funded under this section are
    5appropriated to the department to be used as additional funding
    6for services and purposes provided for under this section.
    7Notwithstanding section 8.33, moneys received in accordance
    8with this subsection that remain unencumbered or unobligated at
    9the close of the fiscal year shall not revert to any fund but
    10shall remain available for the purposes designated until the
    11close of the succeeding fiscal year.
       128.  a.  Of the funds appropriated in this section, up to
    13$3,290,000 is allocated for the payment of the expenses of
    14court-ordered services provided to juveniles who are under the
    15supervision of juvenile court services, which expenses are a
    16charge upon the state pursuant to section 232.141, subsection
    174. Of the amount allocated in this paragraph “a”, up to
    18$1,556,000 shall be made available to provide school-based
    19supervision of children adjudicated under chapter 232, of which
    20not more than $15,000 may be used for the purpose of training.
    21A portion of the cost of each school-based liaison officer
    22shall be paid by the school district or other funding source as
    23approved by the chief juvenile court officer.
       24b.  Of the funds appropriated in this section, up to $748,000
    25is allocated for the payment of the expenses of court-ordered
    26services provided to children who are under the supervision
    27of the department, which expenses are a charge upon the state
    28pursuant to section 232.141, subsection 4.
       29c.  Notwithstanding section 232.141 or any other provision
    30of law to the contrary, the amounts allocated in this
    31subsection shall be distributed to the judicial districts
    32as determined by the state court administrator and to the
    33department’s service areas as determined by the administrator
    34of the department of human services’ division of child and
    35family services. The state court administrator and the
    -40-1division administrator shall make the determination of the
    2distribution amounts on or before June 15, 2019.
       3d.  Notwithstanding chapter 232 or any other provision of
    4law to the contrary, a district or juvenile court shall not
    5order any service which is a charge upon the state pursuant
    6to section 232.141 if there are insufficient court-ordered
    7services funds available in the district court or departmental
    8service area distribution amounts to pay for the service. The
    9chief juvenile court officer and the departmental service area
    10manager shall encourage use of the funds allocated in this
    11subsection such that there are sufficient funds to pay for
    12all court-related services during the entire year. The chief
    13juvenile court officers and departmental service area managers
    14shall attempt to anticipate potential surpluses and shortfalls
    15in the distribution amounts and shall cooperatively request the
    16state court administrator or division administrator to transfer
    17funds between the judicial districts’ or departmental service
    18areas’ distribution amounts as prudent.
       19e.  Notwithstanding any provision of law to the contrary,
    20a district or juvenile court shall not order a county to pay
    21for any service provided to a juvenile pursuant to an order
    22entered under chapter 232 which is a charge upon the state
    23under section 232.141, subsection 4.
       24f.  Of the funds allocated in this subsection, not more than
    25$83,000 may be used by the judicial branch for administration
    26of the requirements under this subsection.
       27g.  Of the funds allocated in this subsection, $17,000
    28shall be used by the department of human services to support
    29the interstate commission for juveniles in accordance with
    30the interstate compact for juveniles as provided in section
    31232.173.
       329.  Of the funds appropriated in this section, $12,253,000 is
    33allocated for juvenile delinquent graduated sanctions services.
    34Any state funds saved as a result of efforts by juvenile court
    35services to earn a federal Tit.IV-E match for juvenile court
    -41-1services administration may be used for the juvenile delinquent
    2graduated sanctions services.
       310.  Of the funds appropriated in this section, $1,658,000 is
    4transferred to the department of public health to be used for
    5the child protection center grant program for child protection
    6centers located in Iowa in accordance with section 135.118.
    7The grant amounts under the program shall be equalized so that
    8each center receives a uniform base amount of $245,000, and so
    9that the remaining funds are awarded through a funding formula
    10based upon the volume of children served.
       1111.  Of the funds appropriated in this section, $4,025,000 is
    12allocated for the preparation for adult living program pursuant
    13to section 234.46.
       1412.  Of the funds appropriated in this section, $227,000
    15shall be used for the public purpose of continuing a grant to a
    16nonprofit human services organization, providing services to
    17individuals and families in multiple locations in southwest
    18Iowa and Nebraska for support of a project providing immediate,
    19sensitive support and forensic interviews, medical exams, needs
    20assessments, and referrals for victims of child abuse and their
    21nonoffending family members.
       2213.  Of the funds appropriated in this section, $300,000
    23is allocated for the foster care youth council approach of
    24providing a support network to children placed in foster care.
       2514.  Of the funds appropriated in this section, $202,000 is
    26allocated for use pursuant to section 235A.1 for continuation
    27of the initiative to address child sexual abuse implemented
    28pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection
    2921.
       3015.  Of the funds appropriated in this section, $630,000 is
    31allocated for the community partnership for child protection
    32sites.
       3316.  Of the funds appropriated in this section, $371,000
    34is allocated for the department’s minority youth and family
    35projects under the redesign of the child welfare system.
    -42-       117.  Of the funds appropriated in this section, $851,000
    2is allocated for funding of the community circle of care
    3collaboration for children and youth in northeast Iowa.
       418.  Of the funds appropriated in this section, at least
    5$147,000 shall be used for the continuation of the child
    6welfare provider training academy, a collaboration between the
    7coalition for family and children’s services in Iowa and the
    8department.
       919.  Of the funds appropriated in this section, $211,000
    10shall be used for continuation of the central Iowa system of
    11care program grant through June 30, 2020.
       1220.  Of the funds appropriated in this section, $235,000
    13shall be used for the public purpose of the continuation
    14and expansion of a system of care program grant implemented
    15in Cerro Gordo and Linn counties to utilize a comprehensive
    16and long-term approach for helping children and families by
    17addressing the key areas in a child’s life of childhood basic
    18needs, education and work, family, and community.
       1921.  Of the funds appropriated in this section, at least
    20$25,000 shall be used to continue and to expand the foster
    21care respite pilot program in which postsecondary students in
    22social work and other human services-related programs receive
    23experience by assisting family foster care providers with
    24respite and other support.
       2522.  Of the funds appropriated in this section, $110,000
    26shall be used for the public purpose of funding community-based
    27services and other supports with a system of care approach
    28for children with a serious emotional disturbance and their
    29families through a nonprofit provider of child welfare services
    30that has been in existence for more than 115 years, is located
    31in a county with a population of more than 200,000 but less
    32than 220,000 according to the latest certified federal census,
    33is licensed as a psychiatric medical institution for children,
    34and was a system of care grantee prior to July 1, 2019.
       3523.  If a separate funding source is identified that reduces
    -43-1the need for state funds within an allocation under this
    2section, the allocated state funds may be redistributed to
    3other allocations under this section for the same fiscal year.
    4   Sec. 20.  ADOPTION SUBSIDY.
       51.  There is appropriated from the general fund of the
    6state to the department of human services for the fiscal year
    7beginning July 1, 2019, and ending June 30, 2020, the following
    8amount, or so much thereof as is necessary, to be used for the
    9purpose designated:
       10a.  For adoption subsidy payments and services:
    ..................................................  $1140,596,007
       12b.  (1)  The funds appropriated in this section shall be used
    13as authorized or allowed by federal law or regulation for any
    14of the following purposes:
       15(a)  For adoption subsidy payments and related costs.
       16(b)  For post-adoption services and for other purposes under
    17Tit.IV-B or Tit.IV-E of the federal Social Security Act.
       18(2)  The department of human services may transfer funds
    19appropriated in this subsection to the appropriation for
    20child and family services in this Act for the purposes of
    21post-adoption services as specified in this paragraph “b”.
       22c.  Notwithstanding section 8.33, moneys corresponding to
    23the state savings resulting from implementation of the federal
    24Fostering Connections to Success and Increasing Adoptions Act
    25of 2008, Pub.L. No.110-351, and successor legislation, as
    26determined in accordance with 42 U.S.C. §673(a)(8), that remain
    27unencumbered or unobligated at the close of the fiscal year,
    28shall not revert to any fund but shall remain available for the
    29purposes designated in this subsection until expended. The
    30amount of such savings and any corresponding funds remaining
    31at the close of the fiscal year shall be determined separately
    32and any changes in either amount between fiscal years shall not
    33result in an unfunded need.
       342.  The department may transfer funds appropriated in
    35this section to the appropriation made in this division of
    -44-1this Act for general administration for costs paid from the
    2appropriation relating to adoption subsidy.
       33.  Federal funds received by the state during the
    4fiscal year beginning July 1, 2019, as the result of the
    5expenditure of state funds during a previous state fiscal
    6year for a service or activity funded under this section are
    7appropriated to the department to be used as additional funding
    8for the services and activities funded under this section.
    9Notwithstanding section 8.33, moneys received in accordance
    10with this subsection that remain unencumbered or unobligated
    11at the close of the fiscal year shall not revert to any fund
    12but shall remain available for expenditure for the purposes
    13designated until the close of the succeeding fiscal year.
    14   Sec. 21.  JUVENILE DETENTION HOME FUND.  Moneys deposited
    15in the juvenile detention home fund created in section 232.142
    16during the fiscal year beginning July 1, 2019, and ending June
    1730, 2020, are appropriated to the department of human services
    18for the fiscal year beginning July 1, 2019, and ending June 30,
    192020, for distribution of an amount equal to a percentage of
    20the costs of the establishment, improvement, operation, and
    21maintenance of county or multicounty juvenile detention homes
    22in the fiscal year beginning July 1, 2018. Moneys appropriated
    23for distribution in accordance with this section shall be
    24allocated among eligible detention homes, prorated on the basis
    25of an eligible detention home’s proportion of the costs of all
    26eligible detention homes in the fiscal year beginning July
    271, 2018. The percentage figure shall be determined by the
    28department based on the amount available for distribution for
    29the fund. Notwithstanding section 232.142, subsection 3, the
    30financial aid payable by the state under that provision for the
    31fiscal year beginning July 1, 2019, shall be limited to the
    32amount appropriated for the purposes of this section.
    33   Sec. 22.  FAMILY SUPPORT SUBSIDY PROGRAM.
       341.  There is appropriated from the general fund of the
    35state to the department of human services for the fiscal year
    -45-1beginning July 1, 2019, and ending June 30, 2020, the following
    2amount, or so much thereof as is necessary, to be used for the
    3purpose designated:
       4For the family support subsidy program subject to the
    5enrollment restrictions in section 225C.37, subsection 3:
    ..................................................  $6949,282
       72.  At least $819,275 of the moneys appropriated in this
    8section is transferred to the department of public health for
    9the family support center component of the comprehensive family
    10support program under chapter 225C, subchapter V.
       113.  If at any time during the fiscal year, the amount of
    12funding available for the family support subsidy program
    13is reduced from the amount initially used to establish the
    14figure for the number of family members for whom a subsidy
    15is to be provided at any one time during the fiscal year,
    16notwithstanding section 225C.38, subsection 2, the department
    17shall revise the figure as necessary to conform to the amount
    18of funding available.
    19   Sec. 23.  CONNER DECREE.  There is appropriated from the
    20general fund of the state to the department of human services
    21for the fiscal year beginning July 1, 2019, and ending June 30,
    222020, the following amount, or so much thereof as is necessary,
    23to be used for the purpose designated:
       24For building community capacity through the coordination
    25and provision of training opportunities in accordance with the
    26consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D.
    27Iowa, July 14, 1994):
    ..................................................  $2833,632
    29   Sec. 24.  MENTAL HEALTH INSTITUTES.
       301.  There is appropriated from the general fund of the
    31state to the department of human services for the fiscal year
    32beginning July 1, 2019, and ending June 30, 2020, the following
    33amounts, or so much thereof as is necessary, to be used for the
    34purposes designated:
       35a.  (1)  For operation of the state mental health institute
    -46-1at Cherokee as required by chapters 218 and 226 for salaries,
    2support, maintenance, and miscellaneous purposes, and for not
    3more than the following full-time equivalent positions:
    ..................................................  $414,216,149
    ...............................................  FTEs5169.00
       6(2)  The additional full-time equivalent positions
    7authorized in this paragraph “a” shall include 3.50 security
    8staff and 3.00 support staff full-time equivalent positions.
       9b.  (1)  For operation of the state mental health institute
    10at Independence as required by chapters 218 and 226 for
    11salaries, support, maintenance, and miscellaneous purposes, and
    12for not more than the following full-time equivalent positions:
    ..................................................  $1319,165,110
    ...............................................  FTEs14208.00
       15(2)  The additional full-time equivalent positions
    16authorized in this paragraph “b” shall include 3.50 security
    17staff full-time equivalent positions.
       182.  Notwithstanding sections 218.78 and 249A.11, any revenue
    19received from the state mental health institute at Cherokee or
    20the state mental health institute at Independence pursuant to
    2142 C.F.R §438.6(e) may be retained and expended by the mental
    22health institute.
       233.  Notwithstanding any provision of law to the contrary,
    24a Medicaid member residing at the state mental health
    25institute at Cherokee or the state mental health institute
    26at Independence shall retain Medicaid eligibility during
    27the period of the Medicaid member’s stay for which federal
    28financial participation is available.
       294.  Notwithstanding section 8.33, moneys appropriated in
    30this section that remain unencumbered or unobligated at the
    31close of the fiscal year shall not revert but shall remain
    32available for expenditure for the purposes designated until the
    33close of the succeeding fiscal year.
    34   Sec. 25.  STATE RESOURCE CENTERS.
       351.  There is appropriated from the general fund of the
    -47-1state to the department of human services for the fiscal year
    2beginning July 1, 2019, and ending June 30, 2020, the following
    3amounts, or so much thereof as is necessary, to be used for the
    4purposes designated:
       5a.  For the state resource center at Glenwood for salaries,
    6support, maintenance, and miscellaneous purposes:
    ..................................................  $716,048,348
       8b.  For the state resource center at Woodward for salaries,
    9support, maintenance, and miscellaneous purposes:
    ..................................................  $1010,872,356
       112.  The department may continue to bill for state resource
    12center services utilizing a scope of services approach used for
    13private providers of intermediate care facilities for persons
    14with an intellectual disability services, in a manner which
    15does not shift costs between the medical assistance program,
    16counties, or other sources of funding for the state resource
    17centers.
       183.  The state resource centers may expand the time-limited
    19assessment and respite services during the fiscal year.
       204.  If the department’s administration and the department
    21of management concur with a finding by a state resource
    22center’s superintendent that projected revenues can reasonably
    23be expected to pay the salary and support costs for a new
    24employee position, or that such costs for adding a particular
    25number of new positions for the fiscal year would be less
    26than the overtime costs if new positions would not be added,
    27the superintendent may add the new position or positions. If
    28the vacant positions available to a resource center do not
    29include the position classification desired to be filled, the
    30state resource center’s superintendent may reclassify any
    31vacant position as necessary to fill the desired position. The
    32superintendents of the state resource centers may, by mutual
    33agreement, pool vacant positions and position classifications
    34during the course of the fiscal year in order to assist one
    35another in filling necessary positions.
    -48-       15.  If existing capacity limitations are reached in
    2operating units, a waiting list is in effect for a service or
    3a special need for which a payment source or other funding
    4is available for the service or to address the special need,
    5and facilities for the service or to address the special need
    6can be provided within the available payment source or other
    7funding, the superintendent of a state resource center may
    8authorize opening not more than two units or other facilities
    9and begin implementing the service or addressing the special
    10need during fiscal year 2019-2020.
       116.  Notwithstanding section 8.33, and notwithstanding
    12the amount limitation specified in section 222.92, moneys
    13appropriated in this section that remain unencumbered or
    14unobligated at the close of the fiscal year shall not revert
    15but shall remain available for expenditure for the purposes
    16designated until the close of the succeeding fiscal year.
    17   Sec. 26.  SEXUALLY VIOLENT PREDATORS.
       181.  a.  There is appropriated from the general fund of the
    19state to the department of human services for the fiscal year
    20beginning July 1, 2019, and ending June 30, 2020, the following
    21amount, or so much thereof as is necessary, to be used for the
    22purpose designated:
       23For costs associated with the commitment and treatment of
    24sexually violent predators in the unit located at the state
    25mental health institute at Cherokee, including costs of legal
    26services and other associated costs, including salaries,
    27support, maintenance, and miscellaneous purposes, and for not
    28more than the following full-time equivalent positions:
    ..................................................  $2912,053,093
    ...............................................  FTEs30139.00
       31b.  The additional full-time equivalent positions authorized
    32in paragraph “a” shall include 7.00 clinical and support staff
    33full-time equivalent positions.
       342.  Unless specifically prohibited by law, if the amount
    35charged provides for recoupment of at least the entire amount
    -49-1of direct and indirect costs, the department of human services
    2may contract with other states to provide care and treatment
    3of persons placed by the other states at the unit for sexually
    4violent predators at Cherokee. The moneys received under
    5such a contract shall be considered to be repayment receipts
    6and used for the purposes of the appropriation made in this
    7section.
       83.  Notwithstanding section 8.33, moneys appropriated in
    9this section that remain unencumbered or unobligated at the
    10close of the fiscal year shall not revert but shall remain
    11available for expenditure for the purposes designated until the
    12close of the succeeding fiscal year.
    13   Sec. 27.  FIELD OPERATIONS.
       141.  There is appropriated from the general fund of the
    15state to the department of human services for the fiscal year
    16beginning July 1, 2019, and ending June 30, 2020, the following
    17amount, or so much thereof as is necessary, to be used for the
    18purposes designated:
       19For field operations, including salaries, support,
    20maintenance, and miscellaneous purposes, and for not more than
    21the following full-time equivalent positions:
    ..................................................  $2255,396,906
    ...............................................  FTEs231,539.00
       242.  The additional full-time equivalent positions authorized
    25in subsection 1 shall include 29.00 full-time equivalent staff
    26positions to relieve caseloads and 6.00 full-time equivalent
    27positions related to the eligibility integrated application
    28solution (ELIAS) system.
       293.  Priority in filling full-time equivalent positions
    30shall be given to those positions related to child protection
    31services and eligibility determination for low-income families.
    32   Sec. 28.  GENERAL ADMINISTRATION.  There is appropriated
    33from the general fund of the state to the department of human
    34services for the fiscal year beginning July 1, 2019, and ending
    35June 30, 2020, the following amount, or so much thereof as is
    -50-1necessary, to be used for the purpose designated:
       2For general administration, including salaries, support,
    3maintenance, and miscellaneous purposes, and for not more than
    4the following full-time equivalent positions:
    ..................................................  $513,833,040
    ...............................................  FTEs6294.00
       71.  The department shall report at least monthly to the
    8legislative services agency concerning the department’s
    9operational and program expenditures.
       102.  Of the funds appropriated in this section, $150,000 shall
    11be used to continue the contract for the provision of a program
    12to provide technical assistance, support, and consultation to
    13providers of habilitation services and home and community-based
    14services waiver services for adults with disabilities under the
    15medical assistance program.
       163.  Of the funds appropriated in this section, $50,000
    17is transferred to the Iowa finance authority to be used
    18for administrative support of the council on homelessness
    19established in section 16.2D and for the council to fulfill its
    20duties in addressing and reducing homelessness in the state.
       214.  Of the funds appropriated in this section, $200,000 shall
    22be transferred to and deposited in the administrative fund of
    23the Iowa ABLE savings plan trust created in section 12I.4, to
    24be used for implementation and administration activities of the
    25Iowa ABLE savings plan trust.
       265.  Of the funds appropriated in this section, $200,000 is
    27transferred to the economic development authority for the Iowa
    28commission on volunteer services to continue to be used for
    29RefugeeRISE AmeriCorps program established under section 15H.8
    30for member recruitment and training to improve the economic
    31well-being and health of economically disadvantaged refugees in
    32local communities across Iowa. Funds transferred may be used
    33to supplement federal funds under federal regulations.
       346.  Of the funds appropriated in this section, up to $300,000
    35shall be used as follows:
    -51-       1a.  To fund not more than one full-time equivalent position
    2to address the department’s responsibility to support the work
    3of the children’s system state board and implementation of the
    4services required pursuant to 2018 Iowa Acts, chapter 1056,
    5section 13.
       6b.  To support the cost of establishing and implementing new
    7or additional services required pursuant to 2018 Iowa Acts,
    8chapter 1056, and any legislation enacted by the 2019 general
    9assembly establishing a children’s behavioral health system.
       10c.  Of the amount allocated, $32,000 shall be transferred
    11to the department of public health to support the costs of
    12establishing and implementing new or additional services
    13required pursuant to 2018 Iowa Acts, chapter 1056, and any
    14legislation enacted by the 2019 general assembly establishing a
    15children’s behavioral health system.
    16   Sec. 29.  DEPARTMENT-WIDE DUTIES.  There is appropriated
    17from the general fund of the state to the department of human
    18services for the fiscal year beginning July 1, 2019, and ending
    19June 30, 2020, the following amount, or so much thereof as is
    20necessary, to be used for the purposes designated:
       21For salaries, support, maintenance, and miscellaneous
    22purposes at facilities under the purview of the department of
    23human services:
    ..................................................  $242,879,274
    25   Sec. 30.  VOLUNTEERS.  There is appropriated from the general
    26fund of the state to the department of human services for the
    27fiscal year beginning July 1, 2019, and ending June 30, 2020,
    28the following amount, or so much thereof as is necessary, to be
    29used for the purpose designated:
       30For development and coordination of volunteer services:
    ..................................................  $3184,686
    32   Sec. 31.  CORPORATE TECHNOLOGY.  There is appropriated
    33from the general fund of the state to the department of human
    34services for the fiscal year beginning July 1, 2019, and ending
    35June 30, 2020, the following amount, or so much thereof as is
    -52-1necessary, to be used for the purposes designated:
       2For the purchase of department-wide technology and software
    3update needs:
    ..................................................  $4824,832
    5   Sec. 32.  MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
    6ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
    7DEPARTMENT OF HUMAN SERVICES.
       81.  a.  (1)  (a)  For the fiscal year beginning July 1,
    92019, the department shall rebase case-mix nursing facility
    10rates effective July 1, 2019, to the extent possible within the
    11state funding, including the $27,479,942, appropriated for this
    12purpose.
       13(b)  For the fiscal year beginning July 1, 2019, non-case-mix
    14and special population nursing facilities shall be reimbursed
    15in accordance with the methodology in effect on June 30 of the
    16prior fiscal year.
       17(c)  For managed care claims, the department of human
    18services shall adjust the payment rate floor for nursing
    19facilities, annually, to maintain a rate floor that is no
    20lower than the Medicaid fee-for-service case-mix adjusted
    21rate calculated in accordance with subparagraph division
    22(a) and 441 IAC 81.6. The department shall then calculate
    23adjusted reimbursement rates, including but not limited to
    24add-on-payments, annually, and shall notify Medicaid managed
    25care organizations of the adjusted reimbursement rates within
    2630 days of determining the adjusted reimbursement rates. Any
    27adjustment of reimbursement rates under this subparagraph
    28division shall be budget neutral to the state budget.
       29(d)  For the fiscal year beginning July 1, 2019, Medicaid
    30managed care long-term services and supports capitation
    31rates shall be adjusted to reflect the rebasing pursuant to
    32subparagraph division (a) for the patient populations residing
    33in Medicaid-certified nursing facilities.
       34(2)  Medicaid managed care organizations shall adjust
    35facility-specific rates based upon payment rate listings issued
    -53-1by the department. The rate adjustments shall be applied
    2prospectively from the effective date of the rate letter issued
    3by the department.
       4b.  (1)  For the fiscal year beginning July 1, 2019,
    5the department shall establish the pharmacy dispensing fee
    6reimbursement at $10.07 per prescription, until a cost of
    7dispensing survey is completed. The actual dispensing fee
    8shall be determined by a cost of dispensing survey performed
    9by the department and required to be completed by all medical
    10assistance program participating pharmacies every two years,
    11adjusted as necessary to maintain expenditures within the
    12amount appropriated to the department for this purpose for the
    13fiscal year.
       14(2)  The department shall utilize an average acquisition
    15cost reimbursement methodology for all drugs covered under the
    16medical assistance program in accordance with 2012 Iowa Acts,
    17chapter 1133, section 33.
       18c.  (1)  For the fiscal year beginning July 1, 2019,
    19reimbursement rates for outpatient hospital services shall
    20remain at the rates in effect on June 30, 2019, subject to
    21Medicaid program upper payment limit rules, and adjusted
    22as necessary to maintain expenditures within the amount
    23appropriated to the department for this purpose for the fiscal
    24year.
       25(2)  For the fiscal year beginning July 1, 2019,
    26reimbursement rates for inpatient hospital services shall
    27remain at the rates in effect on June 30, 2019, subject to
    28Medicaid program upper payment limit rules, and adjusted
    29as necessary to maintain expenditures within the amount
    30appropriated to the department for this purpose for the fiscal
    31year.
       32(3)  For the fiscal year beginning July 1, 2019, critical
    33access hospitals in the state, as designated pursuant to
    3442 U.S.C. §1395i-4, shall receive cost-based reimbursement
    35utilizing a settlement process to provide reimbursement at
    -54-1the rate provided such hospitals under the federal Medicare
    2program.
       3(4)  For the fiscal year beginning July 1, 2019, the graduate
    4medical education and disproportionate share hospital fund
    5shall remain at the amount in effect on June 30, 2019, except
    6that the portion of the fund attributable to graduate medical
    7education shall be reduced in an amount that reflects the
    8elimination of graduate medical education payments made to
    9out-of-state hospitals.
       10(5)  In order to ensure the efficient use of limited state
    11funds in procuring health care services for low-income Iowans,
    12funds appropriated in this Act for hospital services shall
    13not be used for activities which would be excluded from a
    14determination of reasonable costs under the federal Medicare
    15program pursuant to 42 U.S.C.§1395x(v)(1)(N).
       16d.  For the fiscal year beginning July 1, 2019, reimbursement
    17rates for hospices and acute psychiatric hospitals shall be
    18increased in accordance with increases under the federal
    19Medicare program or as supported by their Medicare audited
    20costs.
       21e.  For the fiscal year beginning July 1, 2019, independent
    22laboratories and rehabilitation agencies shall be reimbursed
    23using the same methodology in effect on June 30, 2019.
       24f.  (1)  For the fiscal year beginning July 1, 2019,
    25reimbursement rates for home health agencies shall be rebased,
    26to the extent possible, within the state funding appropriated
    27for this purpose, and shall continue to be based on the
    28Medicare low utilization payment adjustment (LUPA) methodology
    29with state geographic wage adjustments to reflect the most
    30recent Medicare LUPA rates to the extent possible within the
    31state funding appropriated for this purpose.
       32(2)  For the fiscal year beginning July 1, 2019, rates for
    33private duty nursing and personal care services under the early
    34and periodic screening, diagnostic, and treatment program
    35benefit shall be calculated based on the methodology in effect
    -55-1on June 30, 2019.
       2g.  For the fiscal year beginning July 1, 2019, federally
    3qualified health centers and rural health clinics shall receive
    4cost-based reimbursement for 100 percent of the reasonable
    5costs for the provision of services to recipients of medical
    6assistance.
       7h.  For the fiscal year beginning July 1, 2019, the
    8reimbursement rates for dental services shall remain at the
    9rates in effect on June 30, 2019.
       10i.  (1)  For the fiscal year beginning July 1, 2019,
    11reimbursement rates for non-state-owned psychiatric medical
    12institutions for children shall be based on the reimbursement
    13methodology in effect on June 30, 2019.
       14(2)  As a condition of participation in the medical
    15assistance program, enrolled providers shall accept the medical
    16assistance reimbursement rate for any covered goods or services
    17provided to recipients of medical assistance who are children
    18under the custody of a psychiatric medical institution for
    19children.
       20j.  For the fiscal year beginning July 1, 2019, unless
    21otherwise specified in this Act, all noninstitutional medical
    22assistance provider reimbursement rates shall remain at the
    23rates in effect on June 30, 2019, except for area education
    24agencies, local education agencies, infant and toddler
    25services providers, home and community-based services providers
    26including consumer-directed attendant care providers under a
    27section 1915(c) or 1915(i) waiver, targeted case management
    28providers, and those providers whose rates are required to be
    29determined pursuant to section 249A.20, or to meet federal
    30mental health parity requirements.
       31k.  Notwithstanding any provision to the contrary, for the
    32fiscal year beginning July 1, 2019, the reimbursement rate for
    33anesthesiologists shall remain at the rates in effect on June
    3430, 2019, and updated on January 1, 2020, to align with the
    35most current Iowa Medicare anesthesia rate.
    -56-       1l.  Notwithstanding section 249A.20, for the fiscal year
    2beginning July 1, 2019, the average reimbursement rate for
    3health care providers eligible for use of the federal Medicare
    4resource-based relative value scale reimbursement methodology
    5under section 249A.20 shall remain at the rate in effect on
    6June 30, 2019; however, this rate shall not exceed the maximum
    7level authorized by the federal government.
       8m.  For the fiscal year beginning July 1, 2019, the
    9reimbursement rate for residential care facilities shall not
    10be less than the minimum payment level as established by the
    11federal government to meet the federally mandated maintenance
    12of effort requirement. The flat reimbursement rate for
    13facilities electing not to file annual cost reports shall not
    14be less than the minimum payment level as established by the
    15federal government to meet the federally mandated maintenance
    16of effort requirement.
       17n.  For the fiscal year beginning July 1, 2019, the
    18reimbursement rates for inpatient mental health services
    19provided at hospitals shall remain at the rates in effect on
    20June 30, 2019, subject to Medicaid program upper payment limit
    21rules; and psychiatrists shall be reimbursed at the medical
    22assistance program fee-for-service rate in effect on June 30,
    232019.
       24o.  For the fiscal year beginning July 1, 2019, community
    25mental health centers may choose to be reimbursed for the
    26services provided to recipients of medical assistance through
    27either of the following options:
       28(1)  For 100 percent of the reasonable costs of the services.
       29(2)  In accordance with the alternative reimbursement rate
    30methodology approved by the department of human services in
    31effect on June 30, 2019.
       32p.  For the fiscal year beginning July 1, 2019, the
    33reimbursement rate for providers of family planning services
    34that are eligible to receive a 90 percent federal match shall
    35remain at the rates in effect on June 30, 2019.
    -57-       1q.  Unless otherwise subject to a tiered rate methodology,
    2for the fiscal year beginning July 1, 2019, the upper
    3limits and reimbursement rates for providers of home and
    4community-based services waiver services shall be reimbursed
    5using the reimbursement methodology in effect on June 30, 2019.
       6r.  For the fiscal year beginning July 1, 2019, the
    7reimbursement rates for emergency medical service providers
    8shall remain at the rates in effect on June 30, 2019.
       9s.  For the fiscal year beginning July 1, 2019, reimbursement
    10rates for substance-related disorder treatment programs
    11licensed under section 125.13 shall remain at the rates in
    12effect on June 30, 2019.
       13t.  For the fiscal year beginning July 1, 2019, assertive
    14community treatment per diem rates shall be adjusted to
    15reflect an actual average per diem cost within the $1,088,437
    16appropriated for this purpose.
       172.  For the fiscal year beginning July 1, 2019, the
    18reimbursement rate for providers reimbursed under the
    19in-home-related care program shall not be less than the minimum
    20payment level as established by the federal government to meet
    21the federally mandated maintenance of effort requirement.
       223.  Unless otherwise directed in this section, when the
    23department’s reimbursement methodology for any provider
    24reimbursed in accordance with this section includes an
    25inflation factor, this factor shall not exceed the amount
    26by which the consumer price index for all urban consumers
    27increased during the calendar year ending December 31, 2002.
       284.   Notwithstanding section 234.38, for the fiscal
    29year beginning July 1, 2019, the foster family basic daily
    30maintenance rate and the maximum adoption subsidy rate for
    31children ages 0 through 5 years shall be $16.78, the rate for
    32children ages 6 through 11 years shall be $17.45, the rate for
    33children ages 12 through 15 years shall be $19.10, and the
    34rate for children and young adults ages 16 and older shall
    35be $19.35. For youth ages 18 to 21 who have exited foster
    -58-1care, the preparation for adult living program maintenance rate
    2shall be $602.70 per month. The maximum payment for adoption
    3subsidy nonrecurring expenses shall be limited to $500 and the
    4disallowance of additional amounts for court costs and other
    5related legal expenses implemented pursuant to 2010 Iowa Acts,
    6chapter 1031, section 408, shall be continued.
       75.  For the fiscal year beginning July 1, 2019, the maximum
    8reimbursement rates for social services providers under
    9contract shall remain at the rates in effect on June 30, 2019,
    10or the provider’s actual and allowable cost plus inflation for
    11each service, whichever is less. However, if a new service
    12or service provider is added after June 30, 2019, the initial
    13reimbursement rate for the service or provider shall be based
    14upon a weighted average of provider rates for similar services.
       156.  a.  For the fiscal year beginning July 1, 2019, the
    16reimbursement rates for resource family recruitment and
    17retention contractors shall be established by contract.
       18b.  For the fiscal year beginning July 1, 2019, the
    19reimbursement rates for supervised apartment living foster care
    20providers shall be established by contract.
       217.  For the fiscal year beginning July 1, 2019, the
    22reimbursement rate for group foster care providers shall be the
    23combined service and maintenance reimbursement rate established
    24by contract.
       258.  The group foster care reimbursement rates paid for
    26placement of children out of state shall be calculated
    27according to the same rate-setting principles as those used for
    28in-state providers, unless the director of human services or
    29the director’s designee determines that appropriate care cannot
    30be provided within the state. The payment of the daily rate
    31shall be based on the number of days in the calendar month in
    32which service is provided.
       339.  a.  For the fiscal year beginning July 1, 2019, the
    34reimbursement rate paid for shelter care and the child welfare
    35emergency services implemented to provide or prevent the need
    -59-1for shelter care shall be established by contract.
       2b.  For the fiscal year beginning July 1, 2019, the combined
    3service and maintenance components of the reimbursement rate
    4paid for shelter care services shall be based on the financial
    5and statistical report submitted to the department. The
    6maximum reimbursement rate shall be $101.83 per day. The
    7department shall reimburse a shelter care provider at the
    8provider’s actual and allowable unit cost, plus inflation, not
    9to exceed the maximum reimbursement rate.
       10c.  Notwithstanding section 232.141, subsection 8, for the
    11fiscal year beginning July 1, 2019, the amount of the statewide
    12average of the actual and allowable rates for reimbursement of
    13juvenile shelter care homes that is utilized for the limitation
    14on recovery of unpaid costs shall remain at the amount in
    15effect for this purpose in the fiscal year beginning July 1,
    162018.
       1710.  For the fiscal year beginning July 1, 2019, the
    18department shall calculate reimbursement rates for intermediate
    19care facilities for persons with an intellectual disability
    20at the 80th percentile. Beginning July 1, 2019, the rate
    21calculation methodology shall utilize the consumer price index
    22inflation factor applicable to the fiscal year beginning July
    231, 2019.
       2411.  Effective July 1, 2019, the child care provider
    25reimbursement rates shall remain at the rates in effect on June
    2630, 2019. The department shall set rates in a manner so as
    27to provide incentives for a nonregistered provider to become
    28registered by applying the increase only to registered and
    29licensed providers.
       3012.  The department may adopt emergency rules to implement
    31this section.
    32   Sec. 33.  USE OF REQUEST FOR PROPOSALS PROCESS — PROHIBITED
    33USE OF FUNDS FOR LOBBYING.
       341.  a.  If an entity is not specified to receive moneys
    35allocated or appropriated to administer a program or activity
    -60-1in this division of this Act and the department elects not
    2to administer such program or activity internally, a request
    3for proposals process shall be utilized to select an entity to
    4administer such program or activity.
       5b.  Unless otherwise specifically provided, the department
    6shall not retain any portion of the funds allocated or
    7appropriated for programs or activities administered by a
    8specified entity or by an entity selected through a request for
    9proposals process to be used for administrative costs under
    10this division of this Act.
       11c.  The department shall submit a report to the individuals
    12identified in this Act for submission of reports by December
    1315, 2019, regarding the outcomes of any program or activity
    14administered by a specified entity or an entity selected
    15through a request for proposals process under this division of
    16this Act.
       172.  Moneys appropriated or allocated under this division of
    18this Act shall not be used, directly or indirectly, for the
    19compensation of a lobbyist. For the purposes of this section,
    20“lobbyist” means the same as defined in section 68B.2; however,
    21“lobbyist” does not include a person employed by a state agency
    22of the executive branch of state government who represents
    23the agency relative to the passage, defeat, approval, or
    24modification of legislation that is being considered by the
    25general assembly.
    26   Sec. 34.  EMERGENCY RULES.
       271.  If specifically authorized by a provision of this
    28division of this Act, the department of human services or
    29the mental health and disability services commission may
    30adopt administrative rules under section 17A.4, subsection
    313, and section 17A.5, subsection 2, paragraph “b”, to
    32implement the provisions of this division of this Act and
    33the rules shall become effective immediately upon filing or
    34on a later effective date specified in the rules, unless the
    35effective date of the rules is delayed or the applicability
    -61-1of the rules is suspended by the administrative rules review
    2committee. Any rules adopted in accordance with this section
    3shall not take effect before the rules are reviewed by the
    4administrative rules review committee. The delay authority
    5provided to the administrative rules review committee under
    6section 17A.4, subsection 7, and section 17A.8, subsection 9,
    7shall be applicable to a delay imposed under this section,
    8notwithstanding a provision in those sections making them
    9inapplicable to section 17A.5, subsection 2, paragraph “b”.
    10Any rules adopted in accordance with the provisions of this
    11section shall also be published as a notice of intended action
    12as provided in section 17A.4.
       132.  If during a fiscal year, the department of human
    14services is adopting rules in accordance with this section
    15or as otherwise directed or authorized by state law, and the
    16rules will result in an expenditure increase beyond the amount
    17anticipated in the budget process or if the expenditure was
    18not addressed in the budget process for the fiscal year, the
    19department shall notify the persons designated by this division
    20of this Act for submission of reports, the chairpersons and
    21ranking members of the committees on appropriations, and
    22the department of management concerning the rules and the
    23expenditure increase. The notification shall be provided at
    24least 30 calendar days prior to the date notice of the rules
    25is submitted to the administrative rules coordinator and the
    26administrative code editor.
    27   Sec. 35.  REPORTS.  Any reports or other information
    28required to be compiled and submitted under this Act during the
    29fiscal year beginning July 1, 2019, shall be submitted to the
    30chairpersons and ranking members of the joint appropriations
    31subcommittee on health and human services, the legislative
    32services agency, and the legislative caucus staffs on or
    33before the dates specified for submission of the reports or
    34information.
    35   Sec. 36.  EFFECTIVE UPON ENACTMENT.  The following
    -62-1provisions of this division of this Act, being deemed of
    2immediate importance, take effect upon enactment:
       31.  The provision relating to section 232.141 and directing
    4the state court administrator and the division administrator of
    5the department of human services division of child and family
    6services to make the determination, by June 15, 2019, of the
    7distribution of funds allocated for the payment of the expenses
    8of court-ordered services provided to juveniles which are a
    9charge upon the state.
    10DIVISION VI
    11HEALTH CARE ACCOUNTS AND FUNDS — FY 2019-2020
    12   Sec. 37.  PHARMACEUTICAL SETTLEMENT ACCOUNT.  There is
    13appropriated from the pharmaceutical settlement account created
    14in section 249A.33 to the department of human services for the
    15fiscal year beginning July 1, 2019, and ending June 30, 2020,
    16the following amount, or so much thereof as is necessary, to be
    17used for the purpose designated:
       18Notwithstanding any provision of law to the contrary, to
    19supplement the appropriations made in this Act for medical
    20contracts under the medical assistance program for the fiscal
    21year beginning July 1, 2019, and ending June 30, 2020:
    ..................................................  $22234,193
    23   Sec. 38.  QUALITY ASSURANCE TRUST FUND — DEPARTMENT OF HUMAN
    24SERVICES.      Notwithstanding any provision to the contrary and
    25subject to the availability of funds, there is appropriated
    26from the quality assurance trust fund created in section
    27249L.4 to the department of human services for the fiscal year
    28beginning July 1, 2019, and ending June 30, 2020, the following
    29amounts, or so much thereof as is necessary, for the purposes
    30designated:
       31To supplement the appropriation made in this Act from the
    32general fund of the state to the department of human services
    33for medical assistance for the same fiscal year:
    ..................................................  $3458,570,397
    35   Sec. 39.  HOSPITAL HEALTH CARE ACCESS TRUST FUND —
    -63-1DEPARTMENT OF HUMAN SERVICES.      Notwithstanding any provision to
    2the contrary and subject to the availability of funds, there is
    3appropriated from the hospital health care access trust fund
    4created in section 249M.4 to the department of human services
    5for the fiscal year beginning July 1, 2019, and ending June
    630, 2020, the following amounts, or so much thereof as is
    7necessary, for the purposes designated:
       8To supplement the appropriation made in this Act from the
    9general fund of the state to the department of human services
    10for medical assistance for the same fiscal year:
    ..................................................  $1133,920,554
    12   Sec. 40.  MEDICAL ASSISTANCE PROGRAM — NONREVERSION
    13FOR FY 2019-2020.      Notwithstanding section 8.33, if moneys
    14appropriated for purposes of the medical assistance program for
    15the fiscal year beginning July 1, 2019, and ending June 30,
    162020, from the general fund of the state, the quality assurance
    17trust fund and the hospital health care access trust fund, are
    18in excess of actual expenditures for the medical assistance
    19program and remain unencumbered or unobligated at the close
    20of the fiscal year, the excess moneys shall not revert but
    21shall remain available for expenditure for the purposes of the
    22medical assistance program until the close of the succeeding
    23fiscal year.
    24DIVISION VII
    25GRADUATED SANCTION, COURT-ORDERED, AND GROUP FOSTER CARE
    26SERVICES AND FUNDING WORK GROUP
    27   Sec. 41.  GRADUATED SANCTION, COURT-ORDERED, AND GROUP
    28FOSTER CARE SERVICES AND FUNDING WORK GROUP.
       291.  As used in this section, unless the context otherwise
    30requires:
       31a.  “Court-ordered services” means the defined or specific
    32care and treatment that is ordered by the court for an eligible
    33child and for which no other payment source is available to
    34cover the cost.
       35b.  “Department” means the department of human services.
    -64-       1c.  “Eligible child” means a child who has been adjudicated
    2delinquent, is at risk, or has been certified by the chief
    3juvenile court officer as eligible for court-ordered services.
       4d.  “Graduated sanction services” includes community-based
    5interventions, school-based supervision, and supportive
    6enhancements provided in community-based settings to an
    7eligible child who is adjudicated delinquent or who is at risk
    8of adjudication.
       92.  The division of criminal and juvenile justice planning
    10of the department of human rights shall convene and provide
    11administrative support to a work group to review and develop
    12a plan to transfer the administration of graduated sanctions
    13and court-ordered services and funding and the oversight of
    14group foster care placements for eligible children from the
    15department to the office of the state court administrator.
    16The plan shall ensure that the office of the state court
    17administrator has the capacity, resources, and expertise to
    18manage the funding and services effectively.
       193.  a.  In addition to a representative of the division of
    20criminal and juvenile justice planning of the department of
    21human rights, the membership of the work group shall include
    22but is not limited to representatives of all of the following:
       23(1)  The judicial branch, including the state court
    24administrator or the state court administrator’s designee,
    25a juvenile court judge, at least one chief juvenile court
    26officer, and a representative with fiscal and contract
    27experience.
       28(2)  The department of human services, including
    29representatives with experience managing graduated sanctions
    30funding and group foster care placements.
       31(3)  The department of justice.
       32(4)  The juvenile justice advisory committee.
       33(5)  Member and nonmember agencies of the coalition for
    34family and children’s services in Iowa.
       35(6)  Providers of community-based services for eligible
    -65-1children.
       2(7)  Providers of group foster care.
       3(8)  Attorneys who represent children in juvenile justice
    4proceedings.
       5(9)  County attorneys.
       6(10)  Federal Title IV-E funding and services subject matter
    7experts.
       8(11)  Individuals who formerly received services as eligible
    9children or their parents.
       10b.  In addition, the work group membership shall include
    11four members of the general assembly. The legislative members
    12shall serve as ex officio, nonvoting members of the work group,
    13with one member to be appointed by each of the following: the
    14majority leader of the senate, the minority leader of the
    15senate, the speaker of the house of representatives, and the
    16minority leader of the house of representatives.
       17c.  In addition to the members specified, the division
    18of criminal and juvenile justice planning may include other
    19stakeholders with interest or expertise on the work group.
       20d.  Any expenses incurred by a member of the work group
    21shall be the responsibility of the individual member or the
    22respective entity represented by the member.
       234.  The work group shall do all of the following:
       24a.  Develop an action plan to transfer the administration
    25of juvenile court graduated sanction services, court-ordered
    26services, and associated funding from the department to the
    27office of the state court administrator by July 1, 2020.
       28b.  Develop an action plan to transfer the oversight of
    29group foster care services for eligible children from the
    30department to the office of the state court administrator or
    31other appropriate state entity with the necessary expertise to
    32provide such services by July 1, 2020.
       33c.  Evaluate current resources to determine the most
    34efficient means of suitably equipping the office of the state
    35court administrator with the policies and legal authority;
    -66-1staffing; contracting, procurement, data, and quality assurance
    2capabilities; and other resources necessary to manage such
    3funds and associated services effectively. The evaluation
    4shall require collaboration with the department to manage
    5transition activities.
       6d.  Recommend statutory and administrative policies and
    7court rules to promote collaborative case planning and quality
    8assurance between the department and juvenile court services
    9for youth who may be involved in both the child welfare and
    10juvenile justice systems or who may utilize the same providers
    11or services.
       12e.  Determine the impact and role of the federal Family
    13First Prevention Services Act relative to the various funding
    14streams and services under the purview of the work group, and
    15recommend statutory and administrative policies and rules to
    16coordinate the duties of the work group with implementation and
    17administration of the federal Act.
       18f.  Determine the role of the decategorization of child
    19welfare and juvenile justice funding initiative pursuant
    20to section 232.188 relative to the other funding streams
    21and services under the purview of the work group, and make
    22recommendations regarding the future of the initiative
    23including the potential transfer of administration of the
    24initiative from the department to the office of the state court
    25administrator.
       26g.  Consult with other state juvenile court systems and
    27subject matter experts to review administration of similar
    28programs, to glean information on lessons learned and best
    29practices, and to determine the types of community and
    30residential services that have demonstrated effectiveness for
    31eligible children.
       325.  The division of criminal and juvenile justice planning
    33of the department of human rights shall submit a report of the
    34findings and recommendations of the work group to the governor
    35and the general assembly by December 15, 2019.
    -67-    1DIVISION VIII
    2PLAN FOR TRANSFER OF DEPARTMENT OF PUBLIC HEALTH, DIVISION OF
    3BEHAVIORAL HEALTH, BUREAU OF SUBSTANCE ABUSE TO DEPARTMENT OF
    4HUMAN SERVICES
    5   Sec. 42.  PLAN FOR TRANSFER OF DEPARTMENT OF PUBLIC HEALTH,
    6DIVISION OF BEHAVIORAL HEALTH, BUREAU OF SUBSTANCE ABUSE TO
    7DEPARTMENT OF HUMAN SERVICES.      The department of public health
    8and the department of human services shall collaborate to
    9develop a plan to transfer the duties; full-time positions
    10and associated expenses; federal, state, and other funds; and
    11all other associated operations of the department of public
    12health, division of behavioral health, bureau of substance
    13abuse, including the authority to be the single state substance
    14use authority, to the department of human services. The plan
    15shall be submitted to the governor and the general assembly by
    16December 15, 2019.
    17DIVISION IX
    18MEDICAID MANAGED CARE CONTRACTS
    19   Sec. 43.  MEDICAID MANAGED CARE CONTRACTS — NOTIFICATION
    20TO GENERAL ASSEMBLY.      The department of human services shall
    21notify the chairpersons and ranking members of the joint
    22appropriations subcommittee on health and human services, the
    23legislative services agency, and the legislative caucus staffs
    24as follows:
       251.  Within thirty days of the execution of a Medicaid managed
    26care contract or amendment to a Medicaid managed care contract.
       272.  Within thirty days of the determination by the
    28department during each measurement year whether to return the
    29incentive payment withhold amount to the Medicaid managed care
    30organization based upon performance and the criteria used in
    31making the determination.
    32DIVISION X
    33IOWA DEPARTMENT ON AGING — MEDICAID CLAIMING
    34   Sec. 44.  IOWA DEPARTMENT ON AGING — MEDICAID CLAIMING.  The
    35department on aging and the department of human services shall
    -68-1continue to collaborate to develop a cost allocation plan
    2requesting Medicaid administrative funding to provide for the
    3claiming of federal financial participation for aging and
    4disability resource center activities that are performed to
    5assist with administration of the Medicaid program. By January
    61, 2021, the department of human services shall submit to
    7the centers for Medicare and Medicaid services of the United
    8States department of health and human services any Medicaid
    9state plan amendment as necessary and shall enter into any
    10interagency agreement with the department on aging to implement
    11this section.
    12DIVISION XI
    13DECATEGORIZATION FY 2017 CARRYOVER FUNDING
    14   Sec. 45.  DECATEGORIZATION CARRYOVER FUNDING FY 2017 —
    15TRANSFER TO MEDICAID PROGRAM.      Notwithstanding section 232.188,
    16subsection 5, paragraph “b”, any state-appropriated moneys in
    17the funding pool that remained unencumbered or unobligated
    18at the close of the fiscal year beginning July 1, 2016, and
    19were deemed carryover funding to remain available for the two
    20succeeding fiscal years that still remain unencumbered or
    21unobligated at the close of the fiscal year beginning July 1,
    222018, shall not revert but shall be transferred to the medical
    23assistance program for the fiscal year beginning July 1, 2019.
    24   Sec. 46.  EFFECTIVE DATE.  This division of this Act, being
    25deemed of immediate importance, takes effect upon enactment.
    26   Sec. 47.  RETROACTIVE APPLICABILITY.  This division of this
    27Act applies retroactively to July 1, 2018.
    28DIVISION XII
    29PRIOR APPROPRIATIONS AND OTHER PROVISIONS
    30TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)
    31   Sec. 48.  2017 Iowa Acts, chapter 174, section 45, as amended
    32by 2018 Iowa Acts, chapter 1165, section 10, is amended to read
    33as follows:
       34SEC. 45.  TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
    35GRANT.      There is appropriated from the fund created in section
    -69-18.41 to the department of human services for the fiscal year
    2beginning July 1, 2018, and ending June 30, 2019, from moneys
    3received under the federal temporary assistance for needy
    4families (TANF) block grant pursuant to the federal Personal
    5Responsibility and Work Opportunity Reconciliation Act of 1996,
    6Pub.L.No.104-193, and successor legislation, the following
    7amounts, or so much thereof as is necessary, to be used for the
    8purposes designated:
       91.  To be credited to the family investment program account
    10and used for assistance under the family investment program
    11under chapter 239B:
    ..................................................  $124,539,006
    134,025,108
       142.  To be credited to the family investment program account
    15and used for the job opportunities and basic skills (JOBS)
    16program and implementing family investment agreements in
    17accordance with chapter 239B:
    ..................................................  $185,412,060
     195,192,060
       203.  To be used for the family development and
    21self-sufficiency grant program in accordance with section
    22216A.107:
    ..................................................  $232,883,980
    242,898,980
       25Notwithstanding section 8.33, moneys appropriated in this
    26subsection that remain unencumbered or unobligated at the close
    27of the fiscal year shall not revert but shall remain available
    28for expenditure for the purposes designated until the close of
    29the succeeding fiscal year. However, unless such moneys are
    30encumbered or obligated on or before September 30, 2019, the
    31moneys shall revert.
       324.  For field operations:
    ..................................................  $3331,296,232
    3432,465,681
       355.  For general administration:
    -70-    ..................................................  $13,744,000
       26.  For state child care assistance:
    ..................................................  $347,166,826
       4a.  Of the funds appropriated in this subsection,
    5$26,205,412 is transferred to the child care and development
    6block grant appropriation made by the Eighty-seventh General
    7Assembly, 2018 session, for the federal fiscal year beginning
    8October 1, 2018, and ending September 30, 2019. Of this
    9amount, $200,000 shall be used for provision of educational
    10opportunities to registered child care home providers in order
    11to improve services and programs offered by this category
    12of providers and to increase the number of providers. The
    13department may contract with institutions of higher education
    14or child care resource and referral centers to provide
    15the educational opportunities. Allowable administrative
    16costs under the contracts shall not exceed 5 percent. The
    17application for a grant shall not exceed two pages in length.
       18b.  Any funds appropriated in this subsection remaining
    19unallocated shall be used for state child care assistance
    20payments for families who are employed including but not
    21limited to individuals enrolled in the family investment
    22program.
       237.  For child and family services:
    ..................................................  $2432,380,654
       258.  For child abuse prevention grants:
    ..................................................  $26125,000
       279.  For pregnancy prevention grants on the condition that
    28family planning services are funded:
    ..................................................  $291,913,203
     301,890,203
       31Pregnancy prevention grants shall be awarded to programs
    32in existence on or before July 1, 2018, if the programs have
    33demonstrated positive outcomes. Grants shall be awarded to
    34pregnancy prevention programs which are developed after July
    351, 2018, if the programs are based on existing models that
    -71-1have demonstrated positive outcomes. Grants shall comply with
    2the requirements provided in 1997 Iowa Acts, chapter 208,
    3section 14, subsections 1 and 2, including the requirement that
    4grant programs must emphasize sexual abstinence. Priority in
    5the awarding of grants shall be given to programs that serve
    6areas of the state which demonstrate the highest percentage of
    7unplanned pregnancies of females of childbearing age within the
    8geographic area to be served by the grant.
       910.  For technology needs and other resources necessary
    10to meet federal welfare reform reporting, tracking, and case
    11management requirements:
    ..................................................  $121,037,186
    13862,186
       1411.  a.  Notwithstanding any provision to the contrary,
    15including but not limited to requirements in section 8.41 or
    16provisions in 2017 or 2018 Iowa Acts regarding the receipt and
    17appropriation of federal block grants, federal funds from the
    18temporary assistance for needy families block grant received by
    19the state and not otherwise appropriated in this section and
    20remaining available for the fiscal year beginning July 1, 2018,
    21are appropriated to the department of human services to the
    22extent as may be necessary to be used in the following priority
    23order: the family investment program, for state child care
    24assistance program payments for families who are employed, and
    25for the family investment program share of system costs for
    26eligibility determination and related functions. The federal
    27funds appropriated in this paragraph “a” shall be expended
    28only after all other funds appropriated in subsection 1 for
    29assistance under the family investment program, in subsection 6
    30for child care assistance, or in subsection 10 for technology
    31costs related to the family investment program, as applicable,
    32have been expended. For the purposes of this subsection, the
    33funds appropriated in subsection 6, paragraph “a”, for transfer
    34to the child care and development block grant appropriation
    35are considered fully expended when the full amount has been
    -72-1transferred.
       2b.  The department shall, on a quarterly basis, advise the
    3legislative services agency and department of management of
    4the amount of funds appropriated in this subsection that was
    5expended in the prior quarter.
       612.  Of the amounts appropriated in this section,
    7$12,962,008 for the fiscal year beginning July 1, 2018, is
    8transferred to the appropriation of the federal social services
    9block grant made to the department of human services for that
    10fiscal year.
       1113.  For continuation of the program providing categorical
    12eligibility for the food assistance program as specified
    13for the program in the section of this division of this Act
    14relating to the family investment program account:
    ..................................................  $1514,236
    1613,000
       1714.  The department may transfer funds allocated in this
    18section to the appropriations made in this division of this Act
    19for the same fiscal year for general administration and field
    20operations for resources necessary to implement and operate the
    21services referred to in this section and those funded in the
    22appropriation made in this division of this Act for the same
    23fiscal year for the family investment program from the general
    24fund of the state.
       2515.  With the exception of moneys allocated under this
    26section for the family development and self-sufficiency grant
    27program, to the extent moneys allocated in this section are
    28deemed by the department not to be necessary to support the
    29purposes for which they are allocated, such moneys may be
    30used in the same fiscal year for any other purpose for which
    31funds are allocated in this section or in section 7 of this
    32division for the family investment program account. If there
    33are conflicting needs, priority shall first be given to the
    34family investment program account as specified under subsection
    351 of this section and used for the purposes of assistance under
    -73-1the family investment program under chapter 239B, followed by
    2state child care assistance program payments for families who
    3are employed, followed by other priorities as specified by the
    4department.
    5FAMILY INVESTMENT PROGRAM ADJUSTMENTS
    6   Sec. 49.  2017 Iowa Acts, chapter 174, section 46, subsection
    74, as amended by 2018 Iowa Acts, chapter 1165, section 11, is
    8amended to read as follows:
       94.  Moneys appropriated in this division of this Act and
    10credited to the FIP account for the fiscal year beginning July
    111, 2018, and ending June 30, 2019, are allocated as follows:
       12a.  To be retained by the department of human services to
    13be used for coordinating with the department of human rights
    14to more effectively serve participants in FIP and other shared
    15clients and to meet federal reporting requirements under the
    16federal temporary assistance for needy families block grant:
    ..................................................  $175,000
    1820,000
       19b.  To the department of human rights for staffing,
    20administration, and implementation of the family development
    21and self-sufficiency grant program in accordance with section
    22216A.107:
    ..................................................  $236,192,834
       24(1)  Of the funds allocated for the family development
    25and self-sufficiency grant program in this paragraph “b”,
    26not more than 5 percent of the funds shall be used for the
    27administration of the grant program.
       28(2)  The department of human rights may continue to implement
    29the family development and self-sufficiency grant program
    30statewide during fiscal year 2018-2019.
       31(3)  The department of human rights may engage in activities
    32to strengthen and improve family outcomes measures and
    33data collection systems under the family development and
    34self-sufficiency grant program.
       35c.  For the diversion subaccount of the FIP account:
    -74-    ..................................................  $1749,694
    2815,000
       3A portion of the moneys allocated for the subaccount may
    4be used for field operations, salaries, data management
    5system development, and implementation costs and support
    6deemed necessary by the director of human services in order to
    7administer the FIP diversion program. To the extent moneys
    8allocated in this paragraph “c” are deemed by the department
    9not to be necessary to support diversion activities, such
    10moneys may be used for other efforts intended to increase
    11engagement by family investment program participants in work,
    12education, or training activities, or for the purposes of
    13assistance under the family investment program in accordance
    14with chapter 239B.
       15d.  For the food assistance employment and training program:
    ..................................................  $1666,588
       17(1)  The department shall apply the federal supplemental
    18nutrition assistance program (SNAP) employment and training
    19state plan in order to maximize to the fullest extent permitted
    20by federal law the use of the 50 percent federal reimbursement
    21provisions for the claiming of allowable federal reimbursement
    22funds from the United States department of agriculture
    23pursuant to the federal SNAP employment and training program
    24for providing education, employment, and training services
    25for eligible food assistance program participants, including
    26but not limited to related dependent care and transportation
    27expenses.
       28(2)  The department shall continue the categorical federal
    29food assistance program eligibility at 160 percent of the
    30federal poverty level and continue to eliminate the asset test
    31from eligibility requirements, consistent with federal food
    32assistance program requirements. The department shall include
    33as many food assistance households as is allowed by federal
    34law. The eligibility provisions shall conform to all federal
    35requirements including requirements addressing individuals who
    -75-1are incarcerated or otherwise ineligible.
       2e.  For the JOBS program:
    ..................................................  $312,139,821
    411,919,821
    5MEDICAL ASSISTANCE PROGRAM ADJUSTMENT
    6   Sec. 50.  2017 Iowa Acts, chapter 174, section 51, unnumbered
    7paragraph 2, as amended by 2018 Iowa Acts, chapter 1165,
    8section 18, is amended to read as follows:
       9For medical assistance program reimbursement and associated
    10costs as specifically provided in the reimbursement
    11methodologies in effect on June 30, 2018, except as otherwise
    12expressly authorized by law, consistent with options under
    13federal law and regulations, and contingent upon receipt of
    14approval from the office of the governor of reimbursement for
    15each abortion performed under the program:
    ..................................................  $161,337,841,375
    171,488,141,375
    18GROUP FOSTER CARE REALLOCATION
    19   Sec. 51.  2017 Iowa Acts, chapter 174, section 57, subsection
    203, paragraph a, as amended by 2018 Iowa Acts, chapter 1165,
    21section 28, is amended to read as follows:
       223.  a.  Of the funds appropriated in this section, up to
    23$34,536,648 is allocated as the statewide expenditure target
    24under section 232.143 for group foster care maintenance and
    25services. If the department projects that such expenditures
    26for the fiscal year will be less than the target amount
    27allocated in this paragraph “a”, the department may reallocate
    28the excess to provide additional funding for family foster
    29care, independent living, family safety, risk and permanency
    30services,     shelter care, or the child welfare emergency services
    31addressed with the allocation for shelter care.
    32SHELTER CARE ALLOCATION
    33   Sec. 52.  2017 Iowa Acts, chapter 174, section 57, subsection
    346, as amended by 2018 Iowa Acts, chapter 1165, section 28, is
    35amended to read as follows:
    -76-   16.  Notwithstanding section 234.35 or any other provision of
    2law to the contrary, state funding     Of the funds appropriated
    3in this section, a sufficient amount is allocated     for shelter
    4care and the child welfare emergency services contracting
    5implemented to provide for or prevent the need for shelter care
    6shall be limited to $8,096,158.
    7OTHER FUNDING FOR CHILD WELFARE SERVICES
    8   Sec. 53.  2017 Iowa Acts, chapter 174, section 57, subsection
    96, as amended by 2018 Iowa Acts, chapter 1165, section 28, is
    10amended by adding the following new subsection:
    11   NEW SUBSECTION.  24.  If a separate funding source is
    12identified that reduces the need for state funds within an
    13allocation under this section, the allocated state funds may be
    14redistributed to other allocations under this section for the
    15same fiscal year.
    16   Sec. 54.  EFFECTIVE DATE.  This division of this Act, being
    17deemed of immediate importance, takes effect upon enactment.
    18   Sec. 55.  RETROACTIVE APPLICABILITY.  This division of this
    19Act applies retroactively to July 1, 2018.
    20DIVISION XIII
    21HOSPITAL HEALTH CARE ACCESS ASSESSMENT PROGRAM FUTURE REPEAL
    22   Sec. 56.  Section 249M.5, Code 2019, is amended to read as
    23follows:
       24249M.5  Future repeal.
       25This chapter is repealed July 1, 2019 2021.
    26   Sec. 57.  EFFECTIVE DATE.  This division of this Act, being
    27deemed of immediate importance, takes effect upon enactment.
    28DIVISION XIV
    29MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS
    30   Sec. 58.  MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER
    31OF FUNDS.      Notwithstanding section 331.432, a county with a
    32population of over 300,000 based on the most recent federal
    33decennial census, may transfer funds from any other fund of the
    34county to the mental health and disability regional services
    35fund for the purposes of providing mental health and disability
    -77-1services for the fiscal year beginning July 1, 2019, and
    2ending June 30, 2020. The county shall submit a report to
    3the governor and the general assembly by September 1, 2020,
    4including the source of any funds transferred, the amount of
    5the funds transferred, and the mental health and disability
    6services provided with the transferred funds.
    7DIVISION XV
    8OPERATION OF BOARD OF MEDICINE, BOARD OF NURSING, BOARD OF
    9PHARMACY, AND THE DENTAL BOARD
    10   Sec. 59.  Section 135.11A, subsection 1, Code 2019, is
    11amended to read as follows:
       121.  There shall be a professional licensure division within
    13the department of public health. Each board under chapter 147
    14or under the administrative authority of the department, except
    15the board of nursing, board of medicine, dental board, and
    16board of pharmacy, shall receive administrative and clerical
    17support from the division and may not employ its own support
    18staff for administrative and clerical duties. The executive
    19director of the board of nursing, board of medicine, dental
    20board, and board of pharmacy shall be appointed pursuant to
    21section 135.11B.
    22   Sec. 60.  NEW SECTION.  135.11B  Appointment of certain
    23executive directors.
       241.  The director shall appoint and supervise a full-time
    25executive director for each of the following boards:
       26a.  The board of medicine.
       27b.  The board of nursing.
       28c.  The dental board.
       29d.  The board of pharmacy.
       302.  Each board listed in subsection 1 shall advise the
    31director in evaluating potential candidates for the position of
    32executive director, consult with the director in the hiring of
    33the executive director, and review and advise the director on
    34the performance of the executive director in the discharge of
    35the executive director’s duties.
    -78-       13.  Each board listed in subsection 1 shall retain sole
    2discretion and authority to execute the core functions of the
    3board including but not limited to policymaking, advocating
    4for and against legislation, rulemaking, licensing, licensee
    5investigations, licensee disciplinary proceedings, and
    6oversight of professional health programs. The director’s
    7supervision of the executive director shall not interfere with
    8the board’s discretion and authority in executing the core
    9functions of the board.
    10   Sec. 61.  Section 147.80, subsection 3, Code 2019, is amended
    11to read as follows:
       123.  The board of medicine, the board of pharmacy, the
    13dental board, and the board of nursing shall retain individual
    14executive officers pursuant to section 135.11B, but shall
    15make every effort to share administrative, clerical, and
    16investigative staff to the greatest extent possible.
    17   Sec. 62.  Section 152.2, Code 2019, is amended to read as
    18follows:
       19152.2  Executive director.
       20The board shall appoint retain a full-time executive
    21director, who shall be appointed pursuant to section 135B.11.
    22The executive director shall be a registered nurse and shall
    23not be a member of the board    . The governor, with the approval
    24of the executive council pursuant to section 8A.413, subsection
    253, under the pay plan for exempt positions in the executive
    26branch of government, shall set the salary of the executive
    27director.
    28   Sec. 63.  Section 153.33, subsection 2, Code 2019, is amended
    29to read as follows:
       302.  All employees needed to administer this chapter except
    31the executive director shall be appointed pursuant to the merit
    32system. The executive director shall serve at the pleasure of
    33the board     be appointed pursuant to section 135.11B and shall
    34be exempt from the merit system provisions of chapter 8A,
    35subchapter IV.
    -79-    1EXPLANATION
    2The inclusion of this explanation does not constitute agreement with
    3the explanation’s substance by the members of the general assembly.
       4This bill relates to appropriations for health and human
    5services for fiscal year 2019-2020 to the department of
    6veterans affairs, Iowa veterans home, department on aging
    7(IDA), office of long-term care ombudsman, department of public
    8health (DPH), Iowa finance authority, department of human
    9rights, and department of human services (DHS). The bill is
    10organized into divisions.
       11DEPARTMENT ON AGING. This division makes appropriations
    12from the general fund of the state to the department on aging.
       13OFFICE OF LONG-TERM CARE OMBUDSMAN. This division makes
    14appropriations from the general fund of the state to the office
    15of long-term care ombudsman.
       16DEPARTMENT OF PUBLIC HEALTH. This division makes
    17appropriations from the general fund of the state to the
    18department of public health.
       19DEPARTMENT OF VETERANS AFFAIRS AND IOWA VETERANS HOME. This
    20division makes appropriations from the general fund of the
    21state to the department of veterans affairs for administration,
    22the Iowa veterans home, for transfer to the Iowa finance
    23authority for the home ownership assistance program, and for
    24the county commissions of veteran affairs.
       25DEPARTMENT OF HUMAN SERVICES. This division makes
    26appropriations from the general fund of the state and the
    27federal temporary assistance for needy families block
    28grant to DHS. The allocation for the family development
    29and self-sufficiency grant program is made directly to
    30the department of human rights. The reimbursement section
    31addresses reimbursement for providers reimbursed by the
    32department of human services.
       33HEALTH CARE ACCOUNTS AND FUNDS. This division makes certain
    34health-related appropriations. A number of the appropriations
    35are made for purposes of the Medicaid program in addition to
    -80-1the general fund appropriations made for this purpose for the
    2same fiscal year.
       3GRADUATED SANCTIONS, COURT-ORDERED, AND GROUP FOSTER CARE
    4SERVICES AND FUNDING WORK GROUP. This division requires
    5the division of criminal and juvenile justice planning
    6of the department of human rights to convene and provide
    7administrative support to a work group to review and develop
    8a plan to transfer the administration of graduated sanctions
    9and court-ordered services and funding and the oversight
    10of group foster care placements for juvenile delinquents
    11from the department of human services to the office of state
    12court administrator. The division of criminal and juvenile
    13justice planning shall submit a report of the findings and
    14recommendations of the work group to the governor and the
    15general assembly by December 15, 2019.
       16PLAN FOR TRANSFER OF DPH, DIVISION OF BEHAVIORAL HEALTH,
    17BUREAU OF SUBSTANCE ABUSE TO DHS. This division requires DPH
    18and DHS to collaborate to develop a plan to transfer the duties
    19of the DPH, division of behavioral health, bureau of substance
    20abuse to DHS. The plan shall be submitted to the governor and
    21the general assembly by December 15, 2019.
       22MEDICAID MANAGED CARE CONTRACTS. This division requires DHS
    23to notify the chairpersons and ranking members of the joint
    24appropriations subcommittee on health and human services,
    25the legislative services agency, and the legislative caucus
    26staffs within 30 days of the execution of a Medicaid managed
    27care contract or amendment to a contract and within 30 days of
    28the determination of whether to return the incentive payment
    29withhold amount to a managed care organization.
       30MEDICAID CLAIMING. This division directs IDA and DHS to
    31continue to collaborate to develop a cost allocation plan for
    32the claiming of federal financial participation for aging and
    33disability resource center activities, and to submit a request
    34for federal approval of the cost allocation plan by January 1,
    352021.
    -81-       1DECATEGORIZATION FISCAL YEAR 2017. This division provides
    2for transfer of carryover decategorization funding to the
    3medical assistance program. The division takes effect upon
    4enactment and is retroactively applicable to July 1, 2018.
       5PRIOR APPROPRIATIONS AND OTHER PROVISIONS. This division
    6includes amendments to prior appropriations relating to
    7temporary assistance for needy families, the family investment
    8program, the group foster care reallocation, the shelter care
    9allocation, other funding for child welfare services, and the
    10medical assistance program. The division takes effect upon
    11enactment and is retroactively applicable to July 1, 2018.
       12HOSPITAL HEALTH CARE ACCESS ASSESSMENT PROGRAM FUTURE
    13REPEAL. This division eliminates the repeal of Code chapter
    14249M (hospital health care access assessment program). The
    15division takes effect upon enactment.
       16MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS.
    17 This division provides that notwithstanding a provision to the
    18contrary, a county with a population of over 300,000 based on
    19the most recent federal decennial census, may transfer funds
    20from any other fund of the county not comprised of revenue
    21generated by a levy to the mental health and disability
    22regional services fund for purposes of providing mental health
    23and disability services for the fiscal year beginning July 1,
    242019, and ending June 30, 2020. The county is required to
    25submit a report to the governor and the general assembly by
    26September 1, 2020, regarding the activities related to the
    27transfer of any funds.
       28APPOINTMENT OF EXECUTIVE DIRECTORS OF CERTAIN HEALTH
    29PROFESSION BOARDS. This division relates to the appointment
    30of the executive directors of the board of medicine, board
    31of nursing, board of pharmacy, and dental board. The bill
    32provides that the director of public health shall appoint
    33each such executive director. The bill instructs each board
    34to advise and consult with the director of public health
    35relative to potential candidates for the position of executive
    -82-1director and the performance of current executive directors,
    2and provides that each board shall retain sole discretion and
    3authority to execute the core functions of the board.
    -83-    pf/rn