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    CHAPTER 85Appropriations — health and human servicesH.F. 766AN ACT relating to appropriations for health and human services and veterans and including other related provisions and appropriations, providing penalties, and including effective date and retroactive and other applicability date provisions.Be It Enacted by the General Assembly of the State of Iowa:DIVISION IDEPARTMENT ON AGING FY 2019-2020   Section 1.   DEPARTMENT ON AGING.  There is appropriated from the general fund of the state to the department on aging for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purposes designated:   For aging programs for the department on aging and area agencies on aging to provide citizens of Iowa who are 60 years of age and older with case management for frail elders, Iowa’s aging and disabilities resource center, and other services which may include but are not limited to adult day services, respite care, chore services, information and assistance, and material aid, for information and options counseling for persons with disabilities who are 18 years of age or older, and for salaries, support, administration, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 11,191,441  ......................................................... FTEs 27.00   1.  Funds appropriated in this section may be used to supplement federal funds under federal regulations. To receive funds appropriated in this section, a local area agency on aging shall match the funds with moneys from other sources according to rules adopted by the department. Funds appropriated in this section may be used for elderly services not specifically enumerated in this section only if approved by an area agency on aging for provision of the service within the area.   2.  Of the funds appropriated in this section, $279,000 is transferred to the economic development authority for the Iowa commission on volunteer services to be used for the retired and senior volunteer program.   3.  a.  The department on aging shall establish and enforce procedures relating to expenditure of state and federal funds by area agencies on aging that require compliance with both state and federal laws, rules, and regulations, including but not limited to all of the following:   (1)  Requiring that expenditures are incurred only for goods or services received or performed prior to the end of the fiscal period designated for use of the funds.   (2)  Prohibiting prepayment for goods or services not received or performed prior to the end of the fiscal period designated for use of the funds.   (3)  Prohibiting prepayment for goods or services not defined specifically by good or service, time period, or recipient.   (4)  Prohibiting the establishment of accounts from which future goods or services which are not defined specifically by good or service, time period, or recipient, may be purchased.   b.  The procedures shall provide that if any funds are expended in a manner that is not in compliance with the procedures and applicable federal and state laws, rules, and regulations, and are subsequently subject to repayment, the area agency on aging expending such funds in contravention of such procedures, laws, rules and regulations, not the state, shall be liable for such repayment.   4.  Of the funds appropriated in this section, at least $600,000 shall be used to fund home and community-based services through the area agencies on aging that enable older individuals to avoid more costly utilization of residential or institutional services and remain in their own homes.   5.  Of the funds appropriated in this section, $812,000 shall be used for the purposes of chapter 231E and to administer the prevention of elder abuse, neglect, and exploitation program pursuant to section 231.56A, in accordance with the requirements of the federal Older Americans Act of 1965, 42 U.S.C.§3001 et seq., as amended.   6.  Of the funds appropriated in this section, $1,000,000 shall be used to fund continuation of the aging and disability resource center lifelong links to provide individuals and caregivers with information and services to plan for and maintain independence.   7.  Of the funds appropriated in this section, $250,000 shall be used by the department on aging, in collaboration with the department of human services and affected stakeholders, to expand the pilot initiative to provide long-term care options counseling utilizing support planning protocols, to assist non-Medicaid eligible consumers who indicate a preference to return to the community and are deemed appropriate for discharge, to return to their community following a nursing facility stay. The department on aging shall submit a report regarding the outcomes of the pilot initiative to the governor and the general assembly by December 15, 2019.DIVISION IIOFFICE OF LONG-TERM CARE oMBUDSMAN FY 2019-2020   Sec. 2.   OFFICE OF LONG-TERM CARE OMBUDSMAN.  There is appropriated from the general fund of the state to the office of long-term care ombudsman for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purposes designated:   For salaries, support, administration, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 1,149,821  ......................................................... FTEs 16.00DIVISION IIIDEPARTMENT OF PUBLIC HEALTH FY 2019-2020   Sec. 3.   DEPARTMENT OF PUBLIC HEALTH.  There is appropriated from the general fund of the state to the department of public health for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:   1.  ADDICTIVE DISORDERS   For reducing the prevalence of the use of tobacco, alcohol, and other drugs, and treating individuals affected by addictive behaviors, including gambling, and for not more than the following full-time equivalent positions:  ............................................................ $ 25,110,000  ......................................................... FTEs 12.00   a.  (1)  Of the funds appropriated in this subsection, $4,021,000 shall be used for the tobacco use prevention and control initiative, including efforts at the state and local levels, as provided in chapter 142A. The commission on tobacco use prevention and control established pursuant to section 142A.3 shall advise the director of public health in prioritizing funding needs and the allocation of moneys appropriated for the programs and initiatives. Activities of the programs and initiatives shall be in alignment with the United States centers for disease control and prevention best practices for comprehensive tobacco control programs that include the goals of preventing youth initiation of tobacco usage, reducing exposure to secondhand smoke, and promotion of tobacco cessation. To maximize resources, the department shall determine if third-party sources are available to instead provide nicotine replacement products to an applicant prior to provision of such products to an applicant under the initiative. The department shall track and report to the individuals specified in this Act, any reduction in the provision of nicotine replacement products realized by the initiative through implementation of the prerequisite screening.   (2)  (a)  The department shall collaborate with the alcoholic beverages division of the department of commerce for enforcement of tobacco laws, regulations, and ordinances and to engage in tobacco control activities approved by the division of tobacco use prevention and control of the department of public health as specified in the memorandum of understanding entered into between the divisions.   (b)  For the fiscal year beginning July 1, 2019, and ending June 30, 2020, the terms of the memorandum of understanding, entered into between the division of tobacco use prevention and control of the department of public health and the alcoholic beverages division of the department of commerce, governing compliance checks conducted to ensure licensed retail tobacco outlet conformity with tobacco laws, regulations, and ordinances relating to persons under 18 years of age, shall continue to restrict the number of such checks to one check per retail outlet, and one additional check for any retail outlet found to be in violation during the first check.   b.  (1)  Of the funds appropriated in this subsection, $21,089,000 shall be used for problem gambling and substance-related disorder prevention, treatment, and recovery services, including a 24-hour helpline, public information resources, professional training, youth prevention, and program evaluation.   (2)  Of the amount allocated under this paragraph, $306,000 shall be utilized by the department of public health, in collaboration with the department of human services, to support establishment and maintenance of a single statewide 24-hour crisis hotline for the Iowa children’s behavioral health system that incorporates warmline services which may be provided through expansion of existing capabilities maintained by the department of public health as required pursuant to 2018 Iowa Acts, chapter 1056, section 16.   c.  The requirement of section 123.17, subsection 5, is met by the appropriations and allocations made in this division of this Act for purposes of substance-related disorder treatment and addictive disorders for the fiscal year beginning July 1, 2019.   2.  HEALTHY CHILDREN AND FAMILIES   For promoting the optimum health status for children and adolescents from birth through 21 years of age, and families, and for not more than the following full-time equivalent positions:  ............................................................ $ 5,817,057  ......................................................... FTEs 14.00   a.  Of the funds appropriated in this subsection, not more than $734,000 shall be used for the healthy opportunities for parents to experience success (HOPES)-healthy families Iowa (HFI) program established pursuant to section 135.106. The funding shall be distributed to renew the grants that were provided to the grantees that operated the program during the fiscal year ending June 30, 2018. However, the department shall issue a request for proposals and distribute grants to the grantees selected to operate the program no later than January 1, 2020. The department shall not retain any portion of the allocation under this paragraph for administrative costs.   b.  In order to implement the legislative intent stated in sections 135.106 and 256I.9, priority for home visitation program funding shall be given to programs using evidence-based or promising models for home visitation.    c.  Of the funds appropriated in this subsection, $3,075,000 shall be used for continuation of the department’s initiative to provide for adequate developmental surveillance and screening during a child’s first five years. The funds shall be used first to fully fund the current sites to ensure that the sites are fully operational, with the remaining funds to be used for expansion to additional sites. The full implementation and expansion shall include enhancing the scope of the initiative through collaboration with the child health specialty clinics to promote healthy child development through early identification and response to both biomedical and social determinants of healthy development; by monitoring child health metrics to inform practice, document long-term health impacts and savings, and provide for continuous improvement through training, education, and evaluation; and by providing for practitioner consultation particularly for children with behavioral conditions and needs. The department of public health shall also collaborate with the Iowa Medicaid enterprise and the child health specialty clinics to integrate the activities of the first five initiative into the establishment of patient-centered medical homes, community utilities, accountable care organizations, and other integrated care models developed to improve health quality and population health while reducing health care costs. To the maximum extent possible, funding allocated in this paragraph shall be utilized as matching funds for medical assistance program reimbursement.   d.  Of the funds appropriated in this subsection, $64,000 shall be distributed to a statewide dental carrier to provide funds to continue the donated dental services program patterned after the projects developed by the dental lifeline network to provide dental services to indigent individuals who are elderly or with disabilities.   e.  Of the funds appropriated in this subsection, $156,000 shall be used to provide audiological services and hearing aids for children.    f.  Of the funds appropriated in this subsection, $23,000 is transferred to the university of Iowa college of dentistry for provision of primary dental services to children. State funds shall be matched on a dollar-for-dollar basis. The university of Iowa college of dentistry shall coordinate efforts with the department of public health, oral and health delivery system bureau, to provide dental care to underserved populations throughout the state.   g.  Of the funds appropriated in this subsection, $50,000 shall be used to address youth suicide prevention.   h.  Of the funds appropriated in this subsection, $40,000 shall be used to support the Iowa effort to address the survey of children who experience adverse childhood experiences known as ACEs.   i.  Of the funds appropriated in this subsection, up to $494,000 shall be used for childhood obesity prevention.   3.  CHRONIC CONDITIONS   For serving individuals identified as having chronic conditions or special health care needs, and for not more than the following full-time equivalent positions:  ............................................................ $ 4,223,519  ......................................................... FTEs 9.00   a.  Of the funds appropriated in this subsection, $153,000 shall be used for grants to individual patients who have an inherited metabolic disorder to assist with the costs of medically necessary foods and formula.   b.  Of the funds appropriated in this subsection, $1,055,000 shall be used for the brain injury services program pursuant to section 135.22B, including $861,000 for contracting with an existing nationally affiliated and statewide organization whose purpose is to educate, serve, and support Iowans with brain injury and their families, for resource facilitator services in accordance with section 135.22B, subsection 9, and for contracting to enhance brain injury training and recruitment of service providers on a statewide basis. Of the amount allocated in this paragraph, $95,000 shall be used to fund 1.00 full-time equivalent position to serve as the state brain injury services program manager.   c.  Of the funds appropriated in this subsection, $144,000 shall be used for the public purpose of continuing to contract with an existing nationally affiliated organization to provide education, client-centered programs, and client and family support for people living with epilepsy and their families. The amount allocated in this paragraph in excess of $50,000 shall be matched dollar-for-dollar by the organization specified. Funds allocated under this paragraph shall be distributed in their entirety for the purpose specified on July 1, 2019.   d.  Of the funds appropriated in this subsection, $809,000 shall be used for child health specialty clinics.   e.  Of the funds appropriated in this subsection, $384,000 shall be used by the regional autism assistance program established pursuant to section 256.35, and administered by the child health specialty clinic located at the university of Iowa hospitals and clinics. The funds shall be used to enhance interagency collaboration and coordination of educational, medical, and other human services for persons with autism, their families, and providers of services, including delivering regionalized services of care coordination, family navigation, and integration of services through the statewide system of regional child health specialty clinics and fulfilling other requirements as specified in chapter 225D. The university of Iowa shall not receive funds allocated under this paragraph for indirect costs associated with the regional autism assistance program.   f.  Of the funds appropriated in this subsection, $577,000 shall be used for the comprehensive cancer control program to reduce the burden of cancer in Iowa through prevention, early detection, effective treatment, and ensuring quality of life. Of the funds allocated in this paragraph “f”, $150,000 shall be used to support a melanoma research symposium, a melanoma biorepository and registry, basic and translational melanoma research, and clinical trials.   g.  Of the funds appropriated in this subsection, $97,000 shall be used for cervical and colon cancer screening, and $177,000 shall be used to enhance the capacity of the cervical cancer screening program to include provision of recommended prevention and early detection measures to a broader range of low-income women.   h.  Of the funds appropriated in this subsection, $506,000 shall be used for the center for congenital and inherited disorders.   4.  COMMUNITY CAPACITY   For strengthening the health care delivery system at the local level, and for not more than the following full-time equivalent positions:  ............................................................ $ 5,594,677  ......................................................... FTEs 13.00   a.  Of the funds appropriated in this subsection, $95,000 is allocated for continuation of the child vision screening program implemented through the university of Iowa hospitals and clinics in collaboration with early childhood Iowa areas. The program shall submit a report to the department regarding the use of funds allocated under this paragraph “a”. The report shall include the objectives and results for the program year including the target population and how the funds allocated assisted the program in meeting the objectives; the number, age, and location within the state of individuals served; the type of services provided to the individuals served; the distribution of funds based on service provided; and the continuing needs of the program.   b.  Of the funds appropriated in this subsection, $48,000 shall be used for a grant to a statewide association of psychologists, that is affiliated with the American psychological association, to be used for continuation of a program to rotate intern psychologists in placements in urban and rural mental health professional shortage areas. For the purposes of this paragraph “b”, “mental health professional shortage area” means a geographic area in this state that has been designated by the United States department of health and human services, health resources and services administration, bureau of health professionals, as having a shortage of mental health professionals.   c.  Of the funds appropriated in this subsection, the following amounts are allocated to be used as follows to support the goals of increased access, health system integration, and engagement:   (1)  Not less than $600,000 is allocated to the Iowa prescription drug corporation for continuation of the pharmaceutical infrastructure for safety net providers as described in 2007 Iowa Acts, chapter 218, section 108, and for the prescription drug donation repository program created in chapter 135M. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2019.   (2)  Not less than $334,000 is allocated to free clinics and free clinics of Iowa for necessary infrastructure, statewide coordination, provider recruitment, service delivery, and provision of assistance to patients in securing a medical home inclusive of oral health care. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2019.   (3)  Not less than $25,000 is allocated to the Iowa association of rural health clinics for necessary infrastructure and service delivery transformation. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2019.   (4)  Not less than $225,000 is allocated to the Polk county medical society for continuation of the safety net provider patient access to specialty health care initiative as described in 2007 Iowa Acts, chapter 218, section 109. Funds allocated under this subparagraph shall be distributed in their entirety for the purpose specified on July 1, 2019.    d.  Of the funds appropriated in this subsection, $191,000 is allocated for the purposes of health care and public health workforce initiatives.    e.  Of the funds appropriated in this subsection, $96,000 shall be used for a matching dental education loan repayment program to be allocated to a dental nonprofit health service corporation to continue to develop the criteria and implement the loan repayment program.   f.  Of the funds appropriated in this subsection, $100,000 shall be used for the purposes of the Iowa donor registry as specified in section 142C.18.   g.  Of the funds appropriated in this subsection, $96,000 shall be used for continuation of a grant to a nationally affiliated volunteer eye organization that has an established program for children and adults and that is solely dedicated to preserving sight and preventing blindness through education, nationally certified vision screening and training, and community and patient service programs. The contractor shall submit a report to the individuals identified in this Act for submission of reports regarding the use of funds allocated under this paragraph “g”. The report shall include the objectives and results for the program year including the target population and how the funds allocated assisted the program in meeting the objectives; the number, age, grade level if appropriate, and location within the state of individuals served; the type of services provided to the individuals served; the distribution of funds based on services provided; and the continuing needs of the program.   h.  Of the funds appropriated in this subsection, $2,000,000 shall be deposited in the medical residency training account created in section 135.175, subsection 5, paragraph “a”, and is appropriated from the account to the department of public health to be used for the purposes of the medical residency training state matching grants program as specified in section 135.176.   i.  Of the funds appropriated in this subsection, $250,000 shall be used for the public purpose of providing funding to Des Moines university to continue a provider education project to provide primary care physicians with the training and skills necessary to recognize the signs of mental illness in patients.   j.  Of the funds appropriated in this subsection, $400,000 shall be used for rural psychiatric residencies to support the annual creation and training of four psychiatric residents who will provide mental health services in underserved areas of the state.   k.  Of the funds appropriated in this subsection, $150,000 shall be used for psychiatric training to increase access to mental health care services by expanding the mental health workforce via training of additional physician assistants and nurse practitioners.   5.  ESSENTIAL PUBLIC HEALTH SERVICES   To provide public health services that reduce risks and invest in promoting and protecting good health over the course of a lifetime with a priority given to older Iowans and vulnerable populations:  ............................................................ $ 7,662,464   6.  INFECTIOUS DISEASES   For reducing the incidence and prevalence of communicable diseases, and for not more than the following full-time equivalent positions:  ............................................................ $ 1,796,426  ......................................................... FTEs 4.00   7.  PUBLIC PROTECTION   For protecting the health and safety of the public through establishing standards and enforcing regulations, and for not more than the following full-time equivalent positions:  ............................................................ $ 4,093,383  ......................................................... FTEs 142.00   a.  Of the funds appropriated in this subsection, not more than $304,000 shall be credited to the emergency medical services fund created in section 135.25. Moneys in the emergency medical services fund are appropriated to the department to be used for the purposes of the fund.   b.  Of the funds appropriated in this subsection, up to $243,000 shall be used for sexual violence prevention programming through a statewide organization representing programs serving victims of sexual violence through the department’s sexual violence prevention program, and for continuation of a training program for sexual assault response team (SART) members, including representatives of law enforcement, victim advocates, prosecutors, and certified medical personnel. However, the department shall issue a request for proposals and execute a contract with the contractor selected to provide the programming and training as specified in this paragraph no later than January 1, 2020. The amount allocated in this paragraph “b” shall not be used to supplant funding administered for other sexual violence prevention or victims assistance programs. The department shall not retain any portion of the allocation under this paragraph for administrative costs.   c.  Of the funds appropriated in this subsection, up to $500,000 shall be used for the state poison control center. Pursuant to the directive under 2014 Iowa Acts, chapter 1140, section 102, the federal matching funds available to the state poison control center from the department of human services under the federal Children’s Health Insurance Program Reauthorization Act allotment shall be subject to the federal administrative cap rule of 10 percent applicable to funding provided under Tit.XXI of the federal Social Security Act and included within the department’s calculations of the cap.   d.  Of the funds appropriated in this subsection, up to $504,000 shall be used for childhood lead poisoning provisions.   8.  RESOURCE MANAGEMENT   For establishing and sustaining the overall ability of the department to deliver services to the public, and for not more than the following full-time equivalent positions:  ............................................................ $ 971,215  ......................................................... FTEs 4.00   9.  MISCELLANEOUS PROVISIONS   a. The university of Iowa hospitals and clinics under the control of the state board of regents shall not receive indirect costs from the funds appropriated in this section. The university of Iowa hospitals and clinics billings to the department shall be on at least a quarterly basis.   b.  The department of public health shall collaborate with applicable stakeholders to review the allocations, grants, and other distributions of funds appropriated under this division of this Act and shall submit a report to the individuals identified in this Act for submission of reports by December 15, 2019, regarding a proposal for the distribution of funds that more clearly reflects the department’s stated priorities and goals, provides increased flexibility in the distribution of funds to meet these priorities and goals, and ensures stakeholder accountability and a discernable return on investment.   Sec. 4.   CONTRACTED SERVICES PROHIBITED USE OF GENERAL FUND MONEYS FOR LOBBYING.   1.  The department shall submit a report to the individuals identified in this Act for submission of reports by January 1, 2020, regarding the outcomes of any program or activity for which funding is appropriated or allocated from the general fund of the state to the department under this division of this Act, and for which a request for proposals process is specifically required.   2.  The department shall incorporate into the general conditions applicable to all award documents involving funding appropriated or allocated from the general fund of the state to the department under this division of this Act, a prohibition against the use of such funding for the compensation of a lobbyist. For the purposes of this section, “lobbyist” means the same as defined in section 68B.2; however, “lobbyist” does not include a person employed by a state agency of the executive branch of state government who represents the agency relative to the passage, defeat, approval, or modification of legislation that is being considered by the general assembly.DIVISION IVDEPARTMENT OF VETERANS AFFAIRS FY 2019-2020   Sec. 5.   DEPARTMENT OF VETERANS AFFAIRS.  There is appropriated from the general fund of the state to the department of veterans affairs for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:   1.  DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION   For salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 1,225,500  ......................................................... FTEs 15.00   2.  IOWA VETERANS HOME   For salaries, support, maintenance, and miscellaneous purposes:  ............................................................ $ 7,162,976   a.  The Iowa veterans home billings involving the department of human services shall be submitted to the department on at least a monthly basis.   b.  Within available resources and in conformance with associated state and federal program eligibility requirements, the Iowa veterans home may implement measures to provide financial assistance to or on behalf of veterans or their spouses who are participating in the community reentry program.   c.  The Iowa veterans home expenditure report shall be submitted monthly to the legislative services agency.   d.  The Iowa veterans home shall continue to include in the annual discharge report applicant information to provide for the collection of demographic information including but not limited to the number of individuals applying for admission and admitted or denied admittance and the basis for the admission or denial; the age, gender, and race of such individuals; and the level of care for which such individuals applied for admission including residential or nursing level of care.   3.  HOME OWNERSHIP ASSISTANCE PROGRAM   For transfer to the Iowa finance authority for the continuation of the home ownership assistance program for persons who are or were eligible members of the armed forces of the United States, pursuant to section 16.54:  ............................................................ $ 2,000,000   Sec. 6.   LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS FUND STANDING APPROPRIATIONS.  Notwithstanding the standing appropriation in section 35A.16 for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the amount appropriated from the general fund of the state pursuant to that section for the following designated purposes shall not exceed the following amount:   For the county commissions of veteran affairs fund under section 35A.16:  ............................................................ $ 990,000DIVISION VDEPARTMENT OF HUMAN SERVICES FY 2019-2020   Sec. 7.   TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT.  There is appropriated from the fund created in section 8.41 to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, from moneys received under the federal temporary assistance for needy families (TANF) block grant pursuant to the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub.L.No.104-193, and successor legislation, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:   1.  To be credited to the family investment program account and used for assistance under the family investment program under chapter 239B:  ............................................................ $ 4,524,006   2.  To be credited to the family investment program account and used for the job opportunities and basic skills (JOBS) program and implementing family investment agreements in accordance with chapter 239B:  ............................................................ $ 5,412,060   3.  To be used for the family development and self-sufficiency grant program in accordance with section 216A.107:  ............................................................ $ 2,898,980   Notwithstanding section 8.33, moneys appropriated in this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year. However, unless such moneys are encumbered or obligated on or before September 30, 2020, the moneys shall revert.   4.  For field operations:  ............................................................ $ 31,296,232   5.  For general administration:  ............................................................ $ 3,744,000   6.  For state child care assistance:  ............................................................ $ 47,166,826   a.  Of the funds appropriated in this subsection, $26,205,412 is transferred to the child care and development block grant appropriation made by the Eighty-eighth General Assembly, 2019 session, for the federal fiscal year beginning October 1, 2019, and ending September 30, 2020. Of this amount, $200,000 shall be used for provision of educational opportunities to registered child care home providers in order to improve services and programs offered by this category of providers and to increase the number of providers. The department may contract with institutions of higher education or child care resource and referral centers to provide the educational opportunities. Allowable administrative costs under the contracts shall not exceed 5 percent. The application for a grant shall not exceed two pages in length.   b.  Any funds appropriated in this subsection remaining unallocated shall be used for state child care assistance payments for families who are employed including but not limited to individuals enrolled in the family investment program.   7.  For child and family services:  ............................................................ $ 32,380,654   8.  For child abuse prevention grants:  ............................................................ $ 125,000   9.  For pregnancy prevention grants on the condition that family planning services are funded:  ............................................................ $ 1,913,203   Pregnancy prevention grants shall be awarded to programs in existence on or before July 1, 2019, if the programs have demonstrated positive outcomes. Grants shall be awarded to pregnancy prevention programs which are developed after July 1, 2019, if the programs are based on existing models that have demonstrated positive outcomes. Grants shall comply with the requirements provided in 1997 Iowa Acts, chapter 208, section 14, subsections 1 and 2, including the requirement that grant programs must emphasize sexual abstinence. Priority in the awarding of grants shall be given to programs that serve areas of the state which demonstrate the highest percentage of unplanned pregnancies of females of childbearing age within the geographic area to be served by the grant.   10.  For technology needs and other resources necessary to meet federal welfare reform reporting, tracking, and case management requirements:  ............................................................ $ 1,037,186   11.  a.  Notwithstanding any provision to the contrary, including but not limited to requirements in section 8.41 or provisions in 2018 Iowa Acts or 2019 Iowa Acts regarding the receipt and appropriation of federal block grants, federal funds from the temporary assistance for needy families block grant received by the state and not otherwise appropriated in this section and remaining available for the fiscal year beginning July 1, 2019, are appropriated to the department of human services to the extent as may be necessary to be used in the following priority order:the family investment program, for state child care assistance program payments for families who are employed, and for the family investment program share of system costs for eligibility determination and related functions. The federal funds appropriated in this paragraph “a” shall be expended only after all other funds appropriated in subsection 1 for assistance under the family investment program, in subsection 6 for state child care assistance, or in subsection 10 for technology costs related to the family investment program, as applicable, have been expended. For the purposes of this subsection, the funds appropriated in subsection 6, paragraph “a”, for transfer to the child care and development block grant appropriation are considered fully expended when the full amount has been transferred.   b.  The department shall, on a quarterly basis, advise the legislative services agency and department of management of the amount of funds appropriated in this subsection that was expended in the prior quarter.   12.  Of the amounts appropriated in this section, $12,962,008 for the fiscal year beginning July 1, 2019, is transferred to the appropriation of the federal social services block grant made to the department of human services for that fiscal year.   13.  For continuation of the program providing categorical eligibility for the food assistance program as specified for the program in the section of this division of this Act relating to the family investment program account:  ............................................................ $ 14,236   14.  The department may transfer funds allocated in this section to the appropriations made in this division of this Act for the same fiscal year for general administration and field operations for resources necessary to implement and operate the services referred to in this section and those funded in the appropriation made in this division of this Act for the same fiscal year for the family investment program from the general fund of the state.   15.  With the exception of moneys allocated under this section for the family development and self-sufficiency grant program, to the extent moneys allocated in this section are deemed by the department not to be necessary to support the purposes for which they are allocated, such moneys may be used in the same fiscal year for any other purpose for which funds are allocated in this section or in section 8 of this division for the family investment program account. If there are conflicting needs, priority shall first be given to the family investment program account as specified under subsection 1 of this section and used for the purposes of assistance under the family investment program in accordance with chapter 239B, followed by state child care assistance program payments for families who are employed, followed by other priorities as specified by the department.   Sec. 8.   FAMILY INVESTMENT PROGRAM ACCOUNT.   1.  Moneys credited to the family investment program (FIP) account for the fiscal year beginning July 1, 2019, and ending June 30, 2020, shall be used to provide assistance in accordance with chapter 239B.   2.  The department may use a portion of the moneys credited to the FIP account under this section as necessary for salaries, support, maintenance, and miscellaneous purposes.   3.  The department may transfer funds allocated in subsection 4, excluding the allocation under subsection 4, paragraph “b”, to the appropriations made in this division of this Act for the same fiscal year for general administration and field operations for resources necessary to implement and operate the services referred to in this section and those funded in the appropriations made in section 7 for the temporary assistance for needy families block grant and in section 9 for the family investment program from the general fund of the state in this division of this Act for the same fiscal year.   4.  Moneys appropriated in this division of this Act and credited to the FIP account for the fiscal year beginning July 1, 2019, and ending June 30, 2020, are allocated as follows:   a.  To be retained by the department of human services to be used for coordinating with the department of human rights to more effectively serve participants in FIP and other shared clients and to meet federal reporting requirements under the federal temporary assistance for needy families block grant:  ............................................................ $ 20,000   b.  To the department of human rights for staffing, administration, and implementation of the family development and self-sufficiency grant program in accordance with section 216A.107:  ............................................................ $ 6,192,834   (1)  Of the funds allocated for the family development and self-sufficiency grant program in this paragraph “b”, not more than 5 percent of the funds shall be used for the administration of the grant program.   (2)  The department of human rights may continue to implement the family development and self-sufficiency grant program statewide during fiscal year 2019-2020.   (3)  The department of human rights may engage in activities to strengthen and improve family outcomes measures and data collection systems under the family development and self-sufficiency grant program.   c.  For the diversion subaccount of the FIP account:  ............................................................ $ 815,000   A portion of the moneys allocated for the diversion subaccount may be used for field operations, salaries, data management system development, and implementation costs and support deemed necessary by the director of human services in order to administer the FIP diversion program. To the extent moneys allocated in this paragraph “c” are deemed by the department not to be necessary to support diversion activities, such moneys may be used for other efforts intended to increase engagement by family investment program participants in work, education, or training activities, or for the purposes of assistance under the family investment program in accordance with chapter 239B.   d.  For the food assistance employment and training program:  ............................................................ $ 66,588   (1)  The department shall apply the federal supplemental nutrition assistance program (SNAP) employment and training state plan in order to maximize to the fullest extent permitted by federal law the use of the 50 percent federal reimbursement provisions for the claiming of allowable federal reimbursement funds from the United States department of agriculture pursuant to the federal SNAP employment and training program for providing education, employment, and training services for eligible food assistance program participants, including but not limited to related dependent care and transportation expenses.   (2)  The department shall continue the categorical federal food assistance program eligibility at 160 percent of the federal poverty level and continue to eliminate the asset test from eligibility requirements, consistent with federal food assistance program requirements. The department shall include as many food assistance households as is allowed by federal law. The eligibility provisions shall conform to all federal requirements including requirements addressing individuals who are incarcerated or otherwise ineligible.   e.  For the JOBS program:  ............................................................ $ 12,018,258   5.  Of the child support collections assigned under FIP, an amount equal to the federal share of support collections shall be credited to the child support recovery appropriation made in this division of this Act. Of the remainder of the assigned child support collections received by the child support recovery unit, a portion shall be credited to the FIP account, a portion may be used to increase recoveries, and a portion may be used to sustain cash flow in the child support payments account. If as a consequence of the appropriations and allocations made in this section the resulting amounts are insufficient to sustain cash assistance payments and meet federal maintenance of effort requirements, the department shall seek supplemental funding. If child support collections assigned under FIP are greater than estimated or are otherwise determined not to be required for maintenance of effort, the state share of either amount may be transferred to or retained in the child support payments account.   6.  The department may adopt emergency rules for the family investment, JOBS, food assistance, and medical assistance programs if necessary to comply with federal requirements.   Sec. 9.   FAMILY INVESTMENT PROGRAM GENERAL FUND.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   To be credited to the family investment program (FIP) account and used for family investment program assistance under chapter 239B:  ............................................................ $ 40,365,037   1.  Of the funds appropriated in this section, $6,606,198 is allocated for the JOBS program.   2.  Of the funds appropriated in this section, $3,313,854 is allocated for the family development and self-sufficiency grant program.   3.  a.  Notwithstanding section 8.39, for the fiscal year beginning July 1, 2019, if necessary to meet federal maintenance of effort requirements or to transfer federal temporary assistance for needy families block grant funding to be used for purposes of the federal social services block grant or to meet cash flow needs resulting from delays in receiving federal funding or to implement, in accordance with this division of this Act, activities currently funded with juvenile court services, county, or community moneys and state moneys used in combination with such moneys; to comply with federal requirements; or to maximize the use of federal funds; the department of human services may transfer funds within or between any of the appropriations made in this division of this Act and appropriations in law for the federal social services block grant to the department for the following purposes, provided that the combined amount of state and federal temporary assistance for needy families block grant funding for each appropriation remains the same before and after the transfer:   (1)  For the family investment program.   (2)  For state child care assistance.   (3)  For child and family services.   (4)  For field operations.   (5)  For general administration.   b.  This subsection shall not be construed to prohibit the use of existing state transfer authority for other purposes. The department shall report any transfers made pursuant to this subsection to the legislative services agency.   4.  Of the funds appropriated in this section, $195,000 shall be used for continuation of a grant to an Iowa-based nonprofit organization with a history of providing tax preparation assistance to low-income Iowans in order to expand the usage of the earned income tax credit. The purpose of the grant is to supply this assistance to underserved areas of the state. However, the department shall issue a request for proposals and execute a contract with the contractor selected to administer the program no later than January 1, 2020. The department shall not retain any portion of the allocation under this subsection for administrative costs.   5.  Of the funds appropriated in this section, $70,000 shall be used for the continuation of the parenting program, as specified in 441 IAC ch.100, relating to parental obligations, in which the child support recovery unit participates, to support the efforts of a nonprofit organization committed to strengthening the community through youth development, healthy living, and social responsibility headquartered in a county with a population over 350,000 according to the latest certified federal census. The funds allocated in this subsection shall be used by the recipient organization to develop a larger community effort, through public and private partnerships, to support a broad-based multi-county parenthood initiative that promotes payment of child support obligations, improved family relationships, and full-time employment.   6.  The department may transfer funds appropriated in this section, excluding the allocation in subsection 2 for the family development and self-sufficiency grant program, to the appropriations made in this division of this Act for general administration and field operations as necessary to administer this section, section 7 for the temporary assistance for needy families block grant, and section 8 for the family investment program account.   Sec. 10.   CHILD SUPPORT RECOVERY.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purposes designated:   For child support recovery, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 14,749,368  ......................................................... FTEs 459.00   1.  The department shall expend up to $24,000, including federal financial participation, for the fiscal year beginning July 1, 2019, for a child support public awareness campaign. The department and the office of the attorney general shall cooperate in continuation of the campaign. The public awareness campaign shall emphasize, through a variety of media activities, the importance of maximum involvement of both parents in the lives of their children as well as the importance of payment of child support obligations.   2.  Federal access and visitation grant moneys shall be issued directly to private not-for-profit agencies that provide services designed to increase compliance with the child access provisions of court orders, including but not limited to neutral visitation sites and mediation services.   3.  The appropriation made to the department for child support recovery may be used throughout the fiscal year in the manner necessary for purposes of cash flow management, and for cash flow management purposes the department may temporarily draw more than the amount appropriated, provided the amount appropriated is not exceeded at the close of the fiscal year.   Sec. 11.   HEALTH CARE TRUST FUND MEDICAL ASSISTANCE FY 2019-2020.  Any funds remaining in the health care trust fund created in section 453A.35A for the fiscal year beginning July 1, 2019, and ending June 30, 2020, are appropriated to the department of human services to supplement the medical assistance program appropriations made in this division of this Act, for medical assistance reimbursement and associated costs, including program administration and costs associated with program implementation.   Sec. 12.   MEDICAID FRAUD FUND MEDICAL ASSISTANCE FY 2019-2020.  Any funds remaining in the Medicaid fraud fund created in section 249A.50 for the fiscal year beginning July 1, 2019, and ending June 30, 2020, are appropriated to the department of human services to supplement the medical assistance appropriations made in this division of this Act, for medical assistance reimbursement and associated costs, including program administration and costs associated with program implementation.   Sec. 13.   MEDICAL ASSISTANCE.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies in effect on June 30, 2019, except as otherwise expressly authorized by law, consistent with options under federal law and regulations, and contingent upon receipt of approval from the office of the governor of reimbursement for each abortion performed under the program:  ............................................................ $ 1,427,379,707   1.  Iowans support reducing the number of abortions performed in our state. Funds appropriated under this section shall not be used for abortions, unless otherwise authorized under this section.   2.  The provisions of this section relating to abortions shall also apply to the Iowa health and wellness plan created pursuant to chapter 249N.   3.  The department shall utilize not more than $60,000 of the funds appropriated in this section to continue the AIDS/HIV health insurance premium payment program as established in 1992 Iowa Acts, Second Extraordinary Session, chapter 1001, section 409, subsection 6. Of the funds allocated in this subsection, not more than $5,000 may be expended for administrative purposes.   4.  Of the funds appropriated in this Act to the department of public health for addictive disorders, $950,000 for the fiscal year beginning July 1, 2019, is transferred to the department of human services for an integrated substance-related disorder managed care system. The departments of human services and public health shall work together to maintain the level of mental health and substance-related disorder treatment services provided by the managed care contractors. Each department shall take the steps necessary to continue the federal waivers as necessary to maintain the level of services.   5.  a.  The department shall aggressively pursue options for providing medical assistance or other assistance to individuals with special needs who become ineligible to continue receiving services under the early and periodic screening, diagnostic, and treatment program under the medical assistance program due to becoming 21 years of age who have been approved for additional assistance through the department’s exception to policy provisions, but who have health care needs in excess of the funding available through the exception to policy provisions.   b.  Of the funds appropriated in this section, $100,000 shall be used for participation in one or more pilot projects operated by a private provider to allow the individual or individuals to receive service in the community in accordance with principles established in Olmstead v.L.C., 527 U.S.581 (1999), for the purpose of providing medical assistance or other assistance to individuals with special needs who become ineligible to continue receiving services under the early and periodic screening, diagnostic, and treatment program under the medical assistance program due to becoming 21 years of age who have been approved for additional assistance through the department’s exception to policy provisions, but who have health care needs in excess of the funding available through the exception to the policy provisions.   6.  Of the funds appropriated in this section, up to $3,050,082 may be transferred to the field operations or general administration appropriations in this division of this Act for operational costs associated with Part D of the federal Medicare Prescription Drug Improvement and Modernization Act of 2003, Pub.L.No.108-173.   7.  Of the funds appropriated in this section, up to $442,100 may be transferred to the appropriation in this division of this Act for medical contracts to be used for clinical assessment services and prior authorization of services.   8.  A portion of the funds appropriated in this section may be transferred to the appropriations in this division of this Act for general administration, medical contracts, the children’s health insurance program, or field operations to be used for the state match cost to comply with the payment error rate measurement (PERM) program for both the medical assistance and children’s health insurance programs as developed by the centers for Medicare and Medicaid services of the United States department of health and human services to comply with the federal Improper Payments Information Act of 2002, Pub.L.No.107-300, and to support other reviews and quality control activities to improve the integrity of these programs.   9.  The department shall continue to implement the recommendations of the assuring better child health and development initiative II (ABCDII) clinical panel to the Iowa early and periodic screening, diagnostic, and treatment services healthy mental development collaborative board regarding changes to billing procedures, codes, and eligible service providers.   10.  Of the funds appropriated in this section, a sufficient amount is allocated to supplement the incomes of residents of nursing facilities, intermediate care facilities for persons with mental illness, and intermediate care facilities for persons with an intellectual disability, with incomes of less than $50 in the amount necessary for the residents to receive a personal needs allowance of $50 per month pursuant to section 249A.30A.   11.  a.  Hospitals that meet the conditions specified in subparagraphs (1) and (2) shall either certify public expenditures or transfer to the medical assistance program an amount equal to provide the nonfederal share for a disproportionate share hospital payment in an amount up to the hospital-specific limit as approved in the Medicaid state plan. The hospitals that meet the conditions specified shall receive and retain 100 percent of the total disproportionate share hospital payment in an amount up to the hospital-specific limit as approved in the Medicaid state plan.   (1)  The hospital qualifies for disproportionate share and graduate medical education payments.   (2)  The hospital is an Iowa state-owned hospital with more than 500 beds and eight or more distinct residency specialty or subspecialty programs recognized by the American college of graduate medical education.   b.  Distribution of the disproportionate share payments shall be made on a monthly basis. The total amount of disproportionate share payments including graduate medical education, enhanced disproportionate share, and Iowa state-owned teaching hospital payments shall not exceed the amount of the state’s allotment under Pub.L.No.102-234. In addition, the total amount of all disproportionate share payments shall not exceed the hospital-specific disproportionate share limits under Pub.L.No.103-66.   12.  One hundred percent of the nonfederal share of payments to area education agencies that are medical assistance providers for medical assistance-covered services provided to medical assistance-covered children, shall be made from the appropriation made in this section.   13.  A portion of the funds appropriated in this section may be transferred to the appropriation in this division of this Act for medical contracts to be used for administrative activities associated with the money follows the person demonstration project.   14.  Of the funds appropriated in this section, $349,011 shall be used for the administration of the health insurance premium payment program, including salaries, support, maintenance, and miscellaneous purposes.   15.  a.  The department may increase the amounts allocated for salaries, support, maintenance, and miscellaneous purposes associated with the medical assistance program, as necessary, to sustain cost management efforts. The department shall report any such increase to the legislative services agency and the department of management.   b.  If the savings to the medical assistance program from ongoing cost management efforts exceed the associated cost for the fiscal year beginning July 1, 2019, the department may transfer any savings generated for the fiscal year due to medical assistance program cost management efforts to the appropriation made in this division of this Act for medical contracts or general administration to defray the costs associated with implementing the efforts.   16.  For the fiscal year beginning July 1, 2019, and ending June 30, 2020, the replacement generation tax revenues required to be deposited in the property tax relief fund pursuant to section 437A.8, subsection 4, paragraph “d”, and section 437A.15, subsection 3, paragraph “f”, shall instead be credited to and supplement the appropriation made in this section and used for the allocations made in this section.   17.  a.  Of the funds appropriated in this section, up to $50,000 may be transferred by the department to the appropriation made in this division of this Act to the department for the same fiscal year for general administration to be used for associated administrative expenses and for not more than 1.00 full-time equivalent position, in addition to those authorized for the same fiscal year, to be assigned to implementing the children’s mental health home project.   b.  Of the funds appropriated in this section, up to $400,000 may be transferred by the department to the appropriation made to the department in this division of this Act for the same fiscal year for Medicaid program-related general administration planning and implementation activities. The funds may be used for contracts or for personnel in addition to the amounts appropriated for and the positions authorized for general administration for the fiscal year.   c.  Of the funds appropriated in this section, up to $3,000,000 may be transferred by the department to the appropriations made in this division of this Act for the same fiscal year for general administration or medical contracts to be used to support the development and implementation of standardized assessment tools for persons with mental illness, an intellectual disability, a developmental disability, or a brain injury.   18.  Of the funds appropriated in this section, $150,000 shall be used for lodging expenses associated with care provided at the university of Iowa hospitals and clinics for patients with cancer whose travel distance is 30 miles or more and whose income is at or below 200 percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services. The department of human services shall establish the maximum number of overnight stays and the maximum rate reimbursed for overnight lodging, which may be based on the state employee rate established by the department of administrative services. The funds allocated in this subsection shall not be used as nonfederal share matching funds.   19.  Of the funds appropriated in this section, up to $3,383,880 shall be used for administration of the state family planning services program pursuant to section 217.41B, and of this amount, the department may use up to $200,000 for administrative expenses.   20.  Of the funds appropriated in this section, $1,545,530 shall be used and may be transferred to other appropriations in this division of this Act as necessary to administer the provisions in the division of this Act relating to Medicaid program administration.   21.  The department shall continue to implement and administer the provisions of 2018 Iowa Acts, chapter 1056. Of the funds appropriated in this section, up to $39,069 may be transferred to the department of inspections and appeals for inspection costs related to such implementation and administration.   22.  Of the funds appropriated in this section, up to $1,200,000 shall be used to implement reductions in the waiting list for the children’s mental health home and community-based services waiver.   23.  Of the funds appropriated in this section, $1,500,000 shall be used to provide reimbursement to critical access hospitals for inpatient and outpatient services based on a critical access hospital adjustment factor methodology developed by the department as provided in this division of this Act.   24.  The department of human services shall utilize $1,000,000 of the funds appropriated under this section to increase the current supported community living provider daily rates for all tiers under the tiered rate reimbursement methodology effective with dates of service beginning July 1, 2019. The funding amount shall be divided equally among all tiers and applied within each tier in accordance with the recommendations of the actuary. However, no resulting rates shall be lower than the rates in effect on June 30, 2019.   Sec. 14.   MEDICAL CONTRACTS.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For medical contracts:  ............................................................ $ 17,992,530   1.  The department of inspections and appeals shall provide all state matching funds for survey and certification activities performed by the department of inspections and appeals. The department of human services is solely responsible for distributing the federal matching funds for such activities.   2.  Of the funds appropriated in this section, $50,000 shall be used for continuation of home and community-based services waiver quality assurance programs, including the review and streamlining of processes and policies related to oversight and quality management to meet state and federal requirements.   3.  Of the amount appropriated in this section, up to $200,000 may be transferred to the appropriation for general administration in this division of this Act to be used for additional full-time equivalent positions in the development of key health initiatives such as development and oversight of managed care programs and development of health strategies targeted toward improved quality and reduced costs in the Medicaid program.   4.  Of the funds appropriated in this section, $1,000,000 shall be used for planning and development, in cooperation with the department of public health, of a phased-in program to provide a dental home for children.   5.  a.  Of the funds appropriated in this section, $573,000 shall be credited to the autism support program fund created in section 225D.2 to be used for the autism support program created in chapter 225D, with the exception of the following amount of this allocation which shall be used as follows:   b.  Of the funds allocated in this subsection, $25,000 shall be used for the public purpose of continuation of a grant to a nonprofit provider of child welfare services that has been in existence for more than 115 years, is located in a county with a population between 200,000 and 220,000 according to the most recent federal decennial census, is licensed as a psychiatric medical institution for children, and provides school-based programming, to be used for support services for children with autism spectrum disorder and their families.   Sec. 15.   STATE SUPPLEMENTARY ASSISTANCE.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For the state supplementary assistance program:  ............................................................ $ 7,812,909   2.  The department shall increase the personal needs allowance for residents of residential care facilities by the same percentage and at the same time as federal supplemental security income and federal social security benefits are increased due to a recognized increase in the cost of living. The department may adopt emergency rules to implement this subsection.   3.  If during the fiscal year beginning July 1, 2019, the department projects that state supplementary assistance expenditures for a calendar year will not meet the federal pass-through requirement specified in Tit.XVI of the federal Social Security Act, section 1618, as codified in 42 U.S.C.§1382g, the department may take actions including but not limited to increasing the personal needs allowance for residential care facility residents and making programmatic adjustments or upward adjustments of the residential care facility or in-home health-related care reimbursement rates prescribed in this division of this Act to ensure that federal requirements are met. In addition, the department may make other programmatic and rate adjustments necessary to remain within the amount appropriated in this section while ensuring compliance with federal requirements. The department may adopt emergency rules to implement the provisions of this subsection.   4.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.   Sec. 16.   CHILDREN’S HEALTH INSURANCE PROGRAM.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For maintenance of the healthy and well kids in Iowa (hawk-i) program pursuant to chapter 514I, including supplemental dental services, for receipt of federal financial participation under Tit.XXI of the federal Social Security Act, which creates the children’s health insurance program:  ............................................................ $ 19,361,112   2.  Of the funds appropriated in this section, $79,486 is allocated for continuation of the contract for outreach with the department of public health.   3.  A portion of the funds appropriated in this section may be transferred to the appropriations made in this division of this Act for field operations or medical contracts to be used for the integration of hawk-i program eligibility, payment, and administrative functions under the purview of the department of human services, including for the Medicaid management information system upgrade.   Sec. 17.   CHILD CARE ASSISTANCE.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For child care programs:  ............................................................ $ 40,816,931   1.  Of the funds appropriated in this section, $34,966,931 shall be used for state child care assistance in accordance with section 237A.13.   2.  Nothing in this section shall be construed or is intended as or shall imply a grant of entitlement for services to persons who are eligible for assistance due to an income level consistent with the waiting list requirements of section 237A.13. Any state obligation to provide services pursuant to this section is limited to the extent of the funds appropriated in this section.   3.  A list of the registered and licensed child care facilities operating in the area served by a child care resource and referral service shall be made available to the families receiving state child care assistance in that area.   4.  Of the funds appropriated in this section, $5,850,000 shall be credited to the early childhood programs grants account in the early childhood Iowa fund created in section 256I.11. The moneys shall be distributed for funding of community-based early childhood programs targeted to children from birth through five years of age developed by early childhood Iowa areas in accordance with approved community plans as provided in section 256I.8.   5.  The department may use any of the funds appropriated in this section as a match to obtain federal funds for use in expanding child care assistance and related programs. For the purpose of expenditures of state and federal child care funding, funds shall be considered obligated at the time expenditures are projected or are allocated to the department’s service areas. Projections shall be based on current and projected caseload growth, current and projected provider rates, staffing requirements for eligibility determination and management of program requirements including data systems management, staffing requirements for administration of the program, contractual and grant obligations and any transfers to other state agencies, and obligations for decategorization or innovation projects.   6.  A portion of the state match for the federal child care and development block grant shall be provided as necessary to meet federal matching funds requirements through the state general fund appropriation made for child development grants and other programs for at-risk children in section 279.51.   7.  If a uniform reduction ordered by the governor under section 8.31 or other operation of law, transfer, or federal funding reduction reduces the appropriation made in this section for the fiscal year, the percentage reduction in the amount paid out to or on behalf of the families participating in the state child care assistance program shall be equal to or less than the percentage reduction made for any other purpose payable from the appropriation made in this section and the federal funding relating to it. The percentage reduction to the other allocations made in this section shall be the same as the uniform reduction ordered by the governor or the percentage change of the federal funding reduction, as applicable. If there is an unanticipated increase in federal funding provided for state child care services, the entire amount of the increase, except as necessary to meet federal requirements including quality set asides, shall be used for state child care assistance payments. If the appropriations made for purposes of the state child care assistance program for the fiscal year are determined to be insufficient, it is the intent of the general assembly to appropriate sufficient funding for the fiscal year in order to avoid establishment of waiting list requirements.   8.  Notwithstanding section 8.33, moneys advanced for purposes of the programs developed by early childhood Iowa areas, advanced for purposes of wraparound child care, or received from the federal appropriations made for the purposes of this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert to any fund but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.   Sec. 18.   JUVENILE INSTITUTION.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:   1.  a.  For operation of the state training school at Eldora and for salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 13,920,757  ......................................................... FTEs 207.00   b.  Of the funds appropriated in this subsection, $91,000 shall be used for distribution to licensed classroom teachers at this and other institutions under the control of the department of human services based upon the average student yearly enrollment at each institution as determined by the department.   c.  The additional full-time equivalent positions authorized in paragraph “a” shall include 1.00 youth services technician, 1.00 clinical supervisor, and 1.00 registered nurse, or comparable additional, full-time equivalent positions.   2.  A portion of the moneys appropriated in this section shall be used by the state training school at Eldora for grants for adolescent pregnancy prevention activities at the institution in the fiscal year beginning July 1, 2019.   3.  Of the funds appropriated in this subsection, $212,000 shall be used by the state training school at Eldora for a substance use disorder treatment program at the institution for the fiscal year beginning July 1, 2019.   4.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.   Sec. 19.   CHILD AND FAMILY SERVICES.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For child and family services:  ............................................................ $ 89,071,761   2.  The department may transfer funds appropriated in this section as necessary to pay the nonfederal costs of services reimbursed under the medical assistance program, state child care assistance program, or the family investment program which are provided to children who would otherwise receive services paid under the appropriation in this section. The department may transfer funds appropriated in this section to the appropriations made in this division of this Act for general administration and for field operations for resources necessary to implement and operate the services funded in this section.   3.  a.  Of the funds appropriated in this section, up to $34,536,000 is allocated as the statewide expenditure target under section 232.143 for group foster care maintenance and services. If the department projects that such expenditures for the fiscal year will be less than the target amount allocated in this paragraph “a”, the department may reallocate the excess to provide additional funding for family foster care, independent living, family safety, risk and permanency services, shelter care, or the child welfare emergency services addressed with the allocation for shelter care.   b.  If at any time after September 30, 2019, annualization of a service area’s current expenditures indicates a service area is at risk of exceeding its group foster care expenditure target under section 232.143 by more than 5 percent, the department and juvenile court services shall examine all group foster care placements in that service area in order to identify those which might be appropriate for termination. In addition, any aftercare services believed to be needed for the children whose placements may be terminated shall be identified. The department and juvenile court services shall initiate action to set dispositional review hearings for the placements identified. In such a dispositional review hearing, the juvenile court shall determine whether needed aftercare services are available and whether termination of the placement is in the best interest of the child and the community.   4.  In accordance with the provisions of section 232.188, the department shall continue the child welfare and juvenile justice funding initiative during fiscal year 2019-2020. Of the funds appropriated in this section, $1,717,000 is allocated specifically for expenditure for fiscal year 2019-2020 through the decategorization services funding pools and governance boards established pursuant to section 232.188.   5.  A portion of the funds appropriated in this section may be used for emergency family assistance to provide other resources required for a family participating in a family preservation or reunification project or successor project to stay together or to be reunified.   6.  Of the funds appropriated in this section, a sufficient amount is allocated for shelter care and the child welfare emergency services contracting implemented to provide for or prevent the need for shelter care.   7.  Federal funds received by the state during the fiscal year beginning July 1, 2019, as the result of the expenditure of state funds appropriated during a previous state fiscal year for a service or activity funded under this section are appropriated to the department to be used as additional funding for services and purposes provided for under this section. Notwithstanding section 8.33, moneys received in accordance with this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert to any fund but shall remain available for the purposes designated until the close of the succeeding fiscal year.   8.  a.  Of the funds appropriated in this section, up to $3,290,000 is allocated for the payment of the expenses of court-ordered services provided to juveniles who are under the supervision of juvenile court services, which expenses are a charge upon the state pursuant to section 232.141, subsection 4. Of the amount allocated in this paragraph “a”, up to $1,556,000 shall be made available to provide school-based supervision of children adjudicated under chapter 232, of which not more than $15,000 may be used for the purpose of training. A portion of the cost of each school-based liaison officer shall be paid by the school district or other funding source as approved by the chief juvenile court officer.   b.  Of the funds appropriated in this section, up to $748,000 is allocated for the payment of the expenses of court-ordered services provided to children who are under the supervision of the department, which expenses are a charge upon the state pursuant to section 232.141, subsection 4.   c.  Notwithstanding section 232.141 or any other provision of law to the contrary, the amounts allocated in this subsection shall be distributed to the judicial districts as determined by the state court administrator and to the department’s service areas as determined by the administrator of the department of human services’ division of child and family services. The state court administrator and the division administrator shall make the determination of the distribution amounts on or before June 15, 2019.   d.  Notwithstanding chapter 232 or any other provision of law to the contrary, a district or juvenile court shall not order any service which is a charge upon the state pursuant to section 232.141 if there are insufficient court-ordered services funds available in the district court or departmental service area distribution amounts to pay for the service. The chief juvenile court officer and the departmental service area manager shall encourage use of the funds allocated in this subsection such that there are sufficient funds to pay for all court-related services during the entire year. The chief juvenile court officers and departmental service area managers shall attempt to anticipate potential surpluses and shortfalls in the distribution amounts and shall cooperatively request the state court administrator or division administrator to transfer funds between the judicial districts’ or departmental service areas’ distribution amounts as prudent.   e.  Notwithstanding any provision of law to the contrary, a district or juvenile court shall not order a county to pay for any service provided to a juvenile pursuant to an order entered under chapter 232 which is a charge upon the state under section 232.141, subsection 4.   f.  Of the funds allocated in this subsection, not more than $83,000 may be used by the judicial branch for administration of the requirements under this subsection.   g.  Of the funds allocated in this subsection, $17,000 shall be used by the department of human services to support the interstate commission for juveniles in accordance with the interstate compact for juveniles as provided in section 232.173.   9.  Of the funds appropriated in this section, $12,253,000 is allocated for juvenile delinquent graduated sanctions services. Any state funds saved as a result of efforts by juvenile court services to earn a federal Tit.IV-E match for juvenile court services administration may be used for the juvenile delinquent graduated sanctions services.   10.  Of the funds appropriated in this section, $1,658,000 is transferred to the department of public health to be used for the child protection center grant program for child protection centers located in Iowa in accordance with section 135.118. The grant amounts under the program shall be equalized so that each center receives a uniform base amount of $245,000, and so that the remaining funds are awarded through a funding formula based upon the volume of children served. To increase access to child protection center services for children in rural areas, the funding formula for the awarding of the remaining funds shall provide for the awarding of an enhanced amount to eligible grantees to develop and maintain satellite centers in underserved regions of the state.   11.  Of the funds appropriated in this section, $4,025,000 is allocated for the preparation for adult living program pursuant to section 234.46.   12.  Of the funds appropriated in this section, $227,000 shall be used for the public purpose of continuing a grant to a nonprofit human services organization, providing services to individuals and families in multiple locations in southwest Iowa and Nebraska for support of a project providing immediate, sensitive support and forensic interviews, medical exams, needs assessments, and referrals for victims of child abuse and their nonoffending family members.   13.  Of the funds appropriated in this section, $300,000 is allocated for the foster care youth council approach of providing a support network to children placed in foster care.   14.  Of the funds appropriated in this section, $202,000 is allocated for use pursuant to section 235A.1 for continuation of the initiative to address child sexual abuse implemented pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection 21.   15.  Of the funds appropriated in this section, $630,000 is allocated for the community partnership for child protection sites.   16.  Of the funds appropriated in this section, $371,000 is allocated for the department’s minority youth and family projects under the redesign of the child welfare system.   17.  Of the funds appropriated in this section, $851,000 is allocated for funding of the community circle of care collaboration for children and youth in northeast Iowa.   18.  Of the funds appropriated in this section, at least $147,000 shall be used for the continuation of the child welfare provider training academy, a collaboration between the coalition for family and children’s services in Iowa and the department.   19.  Of the funds appropriated in this section, $211,000 shall be used for continuation of the central Iowa system of care program grant through June 30, 2020.   20.  Of the funds appropriated in this section, $235,000 shall be used for the public purpose of the continuation and expansion of a system of care program grant implemented in Cerro Gordo and Linn counties to utilize a comprehensive and long-term approach for helping children and families by addressing the key areas in a child’s life of childhood basic needs, education and work, family, and community.   21.  Of the funds appropriated in this section, at least $25,000 shall be used to continue and to expand the foster care respite pilot program in which postsecondary students in social work and other human services-related programs receive experience by assisting family foster care providers with respite and other support.   22.  Of the funds appropriated in this section, $110,000 shall be used for the public purpose of funding community-based services and other supports with a system of care approach for children with a serious emotional disturbance and their families through a nonprofit provider of child welfare services that has been in existence for more than 115 years, is located in a county with a population of more than 200,000 but less than 220,000 according to the latest certified federal census, is licensed as a psychiatric medical institution for children, and was a system of care grantee prior to July 1, 2019.   23.  If a separate funding source is identified that reduces the need for state funds within an allocation under this section, the allocated state funds may be redistributed to other allocations under this section for the same fiscal year.   Sec. 20.   ADOPTION SUBSIDY.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   a.  For adoption subsidy payments and services:  ............................................................ $ 40,596,007   b.  (1)  The funds appropriated in this section shall be used as authorized or allowed by federal law or regulation for any of the following purposes:   (a)  For adoption subsidy payments and related costs.   (b)  For post-adoption services and for other purposes under Tit.IV-B or Tit.IV-E of the federal Social Security Act.   (2)  The department of human services may transfer funds appropriated in this subsection to the appropriation for child and family services in this Act for the purposes of post-adoption services as specified in this paragraph “b”.   c.  Notwithstanding section 8.33, moneys corresponding to the state savings resulting from implementation of the federal Fostering Connections to Success and Increasing Adoptions Act of 2008, Pub.L. No.110-351, and successor legislation, as determined in accordance with 42 U.S.C.§673(a)(8), that remain unencumbered or unobligated at the close of the fiscal year, shall not revert to any fund but shall remain available for the purposes designated in this subsection until expended. The amount of such savings and any corresponding funds remaining at the close of the fiscal year shall be determined separately and any changes in either amount between fiscal years shall not result in an unfunded need.   2.  The department may transfer funds appropriated in this section to the appropriation made in this division of this Act for general administration for costs paid from the appropriation relating to adoption subsidy.   3.  Federal funds received by the state during the fiscal year beginning July 1, 2019, as the result of the expenditure of state funds during a previous state fiscal year for a service or activity funded under this section are appropriated to the department to be used as additional funding for the services and activities funded under this section. Notwithstanding section 8.33, moneys received in accordance with this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert to any fund but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.   Sec. 21.   JUVENILE DETENTION HOME FUND.  Moneys deposited in the juvenile detention home fund created in section 232.142 during the fiscal year beginning July 1, 2019, and ending June 30, 2020, are appropriated to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, for distribution of an amount equal to a percentage of the costs of the establishment, improvement, operation, and maintenance of county or multicounty juvenile detention homes in the fiscal year beginning July 1, 2018. Moneys appropriated for distribution in accordance with this section shall be allocated among eligible detention homes, prorated on the basis of an eligible detention home’s proportion of the costs of all eligible detention homes in the fiscal year beginning July 1, 2018. The percentage figure shall be determined by the department based on the amount available for distribution for the fund. Notwithstanding section 232.142, subsection 3, the financial aid payable by the state under that provision for the fiscal year beginning July 1, 2019, shall be limited to the amount appropriated for the purposes of this section.   Sec. 22.   FAMILY SUPPORT SUBSIDY PROGRAM.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For the family support subsidy program subject to the enrollment restrictions in section 225C.37, subsection 3:  ............................................................ $ 949,282   2.  At least $819,275 of the moneys appropriated in this section is transferred to the department of public health for the family support center component of the comprehensive family support program under chapter 225C, subchapter V.   3.  If at any time during the fiscal year, the amount of funding available for the family support subsidy program is reduced from the amount initially used to establish the figure for the number of family members for whom a subsidy is to be provided at any one time during the fiscal year, notwithstanding section 225C.38, subsection 2, the department shall revise the figure as necessary to conform to the amount of funding available.   Sec. 23.   CONNER DECREE.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For building community capacity through the coordination and provision of training opportunities in accordance with the consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D. Iowa, July 14, 1994):  ............................................................ $ 33,632   Sec. 24.   MENTAL HEALTH INSTITUTES.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:   a.  (1)  For operation of the state mental health institute at Cherokee as required by chapters 218 and 226 for salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 14,216,149  ......................................................... FTEs 169.00   (2)  The additional full-time equivalent positions authorized in this paragraph “a” shall include 3.50 security staff and 3.00 support staff, or comparable additional, full-time equivalent positions.   b.  (1)  For operation of the state mental health institute at Independence as required by chapters 218 and 226 for salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 19,165,110  ......................................................... FTEs 208.00   (2)  The additional full-time equivalent positions authorized in this paragraph “b” shall include 3.50 security staff, or comparable additional, full-time equivalent positions.   2.  Notwithstanding sections 218.78 and 249A.11, any revenue received from the state mental health institute at Cherokee or the state mental health institute at Independence pursuant to 42 C.F.R§438.6(e) may be retained and expended by the mental health institute.   3.  Notwithstanding any provision of law to the contrary, a Medicaid member residing at the state mental health institute at Cherokee or the state mental health institute at Independence shall retain Medicaid eligibility during the period of the Medicaid member’s stay for which federal financial participation is available.   4.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.   Sec. 25.   STATE RESOURCE CENTERS.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:   a.  For the state resource center at Glenwood for salaries, support, maintenance, and miscellaneous purposes:  ............................................................ $ 16,048,348   b.  For the state resource center at Woodward for salaries, support, maintenance, and miscellaneous purposes:  ............................................................ $ 10,872,356   2.  The department may continue to bill for state resource center services utilizing a scope of services approach used for private providers of intermediate care facilities for persons with an intellectual disability services, in a manner which does not shift costs between the medical assistance program, counties, or other sources of funding for the state resource centers.   3.  The state resource centers may expand the time-limited assessment and respite services during the fiscal year.   4.  If the department’s administration and the department of management concur with a finding by a state resource center’s superintendent that projected revenues can reasonably be expected to pay the salary and support costs for a new employee position, or that such costs for adding a particular number of new positions for the fiscal year would be less than the overtime costs if new positions would not be added, the superintendent may add the new position or positions. If the vacant positions available to a resource center do not include the position classification desired to be filled, the state resource center’s superintendent may reclassify any vacant position as necessary to fill the desired position. The superintendents of the state resource centers may, by mutual agreement, pool vacant positions and position classifications during the course of the fiscal year in order to assist one another in filling necessary positions.   5.  If existing capacity limitations are reached in operating units, a waiting list is in effect for a service or a special need for which a payment source or other funding is available for the service or to address the special need, and facilities for the service or to address the special need can be provided within the available payment source or other funding, the superintendent of a state resource center may authorize opening not more than two units or other facilities and begin implementing the service or addressing the special need during fiscal year 2019-2020.   6.  Notwithstanding section 8.33, and notwithstanding the amount limitation specified in section 222.92, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.   Sec. 26.   SEXUALLY VIOLENT PREDATORS.   1.  a.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For costs associated with the commitment and treatment of sexually violent predators in the unit located at the state mental health institute at Cherokee, including costs of legal services and other associated costs, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 12,053,093  ......................................................... FTEs 139.00   b.  The additional full-time equivalent positions authorized in paragraph “a” shall include 7.00 clinical and support staff, or comparable additional, full-time equivalent positions.   2.  Unless specifically prohibited by law, if the amount charged provides for recoupment of at least the entire amount of direct and indirect costs, the department of human services may contract with other states to provide care and treatment of persons placed by the other states at the unit for sexually violent predators at Cherokee. The moneys received under such a contract shall be considered to be repayment receipts and used for the purposes of the appropriation made in this section.   3.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.   Sec. 27.   FIELD OPERATIONS.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purposes designated:   For field operations, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 55,396,906  ......................................................... FTEs 1,539.00   2.  The additional full-time equivalent positions authorized in subsection 1 shall include 29.00 full-time equivalent staff positions to relieve caseloads and 6.00 full-time equivalent positions related to the eligibility integrated application solution (ELIAS) system.    3.  Priority in filling full-time equivalent positions shall be given to those positions related to child protection services and eligibility determination for low-income families.    Sec. 28.   GENERAL ADMINISTRATION.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For general administration, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 13,833,040  ......................................................... FTEs 294.00   1.  The department shall report at least monthly to the legislative services agency concerning the department’s operational and program expenditures.   2.  Of the funds appropriated in this section, $150,000 shall be used to continue the contract for the provision of a program to provide technical assistance, support, and consultation to providers of habilitation services and home and community-based services waiver services for adults with disabilities under the medical assistance program.    3.  Of the funds appropriated in this section, $50,000 is transferred to the Iowa finance authority to be used for administrative support of the council on homelessness established in section 16.2D and for the council to fulfill its duties in addressing and reducing homelessness in the state.   4.  Of the funds appropriated in this section, $200,000 shall be transferred to and deposited in the administrative fund of the Iowa ABLE savings plan trust created in section 12I.4, to be used for implementation and administration activities of the Iowa ABLE savings plan trust.   5.  Of the funds appropriated in this section, $200,000 is transferred to the economic development authority for the Iowa commission on volunteer services to continue to be used for the RefugeeRISE AmeriCorps program established under section 15H.8 for member recruitment and training to improve the economic well-being and health of economically disadvantaged refugees in local communities across Iowa. Funds transferred may be used to supplement federal funds under federal regulations.   6.  Of the funds appropriated in this section, up to $300,000 shall be used as follows:   a.  To fund not more than one full-time equivalent position to address the department’s responsibility to support the work of the children’s system state board and implementation of the services required pursuant to 2018 Iowa Acts, chapter 1056, section 13.   b.  To support the cost of establishing and implementing new or additional services required pursuant to 2018 Iowa Acts, chapter 1056, and any legislation enacted by the 2019 general assembly establishing a children’s behavioral health system.   c.  Of the amount allocated, $32,000 shall be transferred to the department of public health to support the costs of establishing and implementing new or additional services required pursuant to 2018 Iowa Acts, chapter 1056, and any legislation enacted by the 2019 general assembly establishing a children’s behavioral health system.   Sec. 29.   DEPARTMENT-WIDE DUTIES.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purposes designated:   For salaries, support, maintenance, and miscellaneous purposes at facilities under the purview of the department of human services:  ............................................................ $ 2,879,274   Sec. 30.   VOLUNTEERS.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For development and coordination of volunteer services:  ............................................................ $ 84,686   Sec. 31.   MEDICAL ASSISTANCE, STATE SUPPLEMENTARY ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE DEPARTMENT OF HUMAN SERVICES.   1.  a.  (1)  (a)  For the fiscal year beginning July 1, 2019, the department shall rebase case-mix nursing facility rates effective July 1, 2019, to the extent possible within the state funding, including the $23,401,942, appropriated for this purpose.   (b)  For the fiscal year beginning July 1, 2019, non-case-mix and special population nursing facilities shall be reimbursed in accordance with the methodology in effect on June 30 of the prior fiscal year.   (c)  For managed care claims, the department of human services shall adjust the payment rate floor for nursing facilities, annually, to maintain a rate floor that is no lower than the Medicaid fee-for-service case-mix adjusted rate calculated in accordance with subparagraph division (a) and 441 IAC 81.6. The department shall then calculate adjusted reimbursement rates, including but not limited to add-on-payments, annually, and shall notify Medicaid managed care organizations of the adjusted reimbursement rates within 30 days of determining the adjusted reimbursement rates. Any adjustment of reimbursement rates under this subparagraph division shall be budget neutral to the state budget.   (d)  For the fiscal year beginning July 1, 2019, Medicaid managed care long-term services and supports capitation rates shall be adjusted to reflect the rebasing pursuant to subparagraph division (a) for the patient populations residing in Medicaid-certified nursing facilities.   (2)  Medicaid managed care organizations shall adjust facility-specific rates based upon payment rate listings issued by the department. The rate adjustments shall be applied prospectively from the effective date of the rate letter issued by the department.    b.  (1)  For the fiscal year beginning July 1, 2019, the department shall establish the pharmacy dispensing fee reimbursement at $10.07 per prescription, until a cost of dispensing survey is completed. The actual dispensing fee shall be determined by a cost of dispensing survey performed by the department and required to be completed by all medical assistance program participating pharmacies every two years, adjusted as necessary to maintain expenditures within the amount appropriated to the department for this purpose for the fiscal year.   (2)  The department shall utilize an average acquisition cost reimbursement methodology for all drugs covered under the medical assistance program in accordance with 2012 Iowa Acts, chapter 1133, section 33.   c.  (1)  For the fiscal year beginning July 1, 2019, reimbursement rates for outpatient hospital services shall remain at the rates in effect on June 30, 2019, subject to Medicaid program upper payment limit rules, and adjusted as necessary to maintain expenditures within the amount appropriated to the department for this purpose for the fiscal year.   (2)  For the fiscal year beginning July 1, 2019, reimbursement rates for inpatient hospital services shall remain at the rates in effect on June 30, 2019, subject to Medicaid program upper payment limit rules, and adjusted as necessary to maintain expenditures within the amount appropriated to the department for this purpose for the fiscal year.   (3)  For the fiscal year beginning July 1, 2019, under both fee-for-service and managed care administration of the Medicaid program, critical access hospitals shall be reimbursed for inpatient and outpatient services based on a critical access hospital adjustment factor methodology developed by the department. The adjustment factor methodology shall be hospital-specific, shall be based on the most recent and complete cost reporting period, and shall be applied prospectively within the funds appropriated for such purpose for the fiscal year. Implementation of the critical access hospital adjustment factor methodology shall be contingent on the department’s receipt of approval from the centers for Medicare and Medicaid services of the United States department of health and human services.   (4)  For the fiscal year beginning July 1, 2019, the graduate medical education and disproportionate share hospital fund shall remain at the amount in effect on June 30, 2019, except that the portion of the fund attributable to graduate medical education shall be reduced in an amount that reflects the elimination of graduate medical education payments made to out-of-state hospitals.   (5)  In order to ensure the efficient use of limited state funds in procuring health care services for low-income Iowans, funds appropriated in this Act for hospital services shall not be used for activities which would be excluded from a determination of reasonable costs under the federal Medicare program pursuant to 42 U.S.C.§1395x(v)(1)(N).   d.  For the fiscal year beginning July 1, 2019, reimbursement rates for hospices and acute psychiatric hospitals shall be increased in accordance with increases under the federal Medicare program or as supported by their Medicare audited costs.   e.  For the fiscal year beginning July 1, 2019, independent laboratories and rehabilitation agencies shall be reimbursed using the same methodology in effect on June 30, 2019.   f.  (1)  For the fiscal year beginning July 1, 2019, reimbursement rates for home health agencies shall continue to be based on the Medicare low utilization payment adjustment (LUPA) methodology with state geographic wage adjustments. The department shall continue to update the rates every two years to reflect the most recent Medicare LUPA rates to the extent possible within the state funding appropriated for this purpose.   (2)  For the fiscal year beginning July 1, 2019, rates for private duty nursing and personal care services under the early and periodic screening, diagnostic, and treatment program benefit shall be calculated based on the methodology in effect on June 30, 2019.   g.  For the fiscal year beginning July 1, 2019, federally qualified health centers and rural health clinics shall receive cost-based reimbursement for 100 percent of the reasonable costs for the provision of services to recipients of medical assistance.   h.  For the fiscal year beginning July 1, 2019, the reimbursement rates for dental services shall remain at the rates in effect on June 30, 2019.   i.  (1)  For the fiscal year beginning July 1, 2019, reimbursement rates for non-state-owned psychiatric medical institutions for children shall be based on the reimbursement methodology in effect on June 30, 2019.   (2)  As a condition of participation in the medical assistance program, enrolled providers shall accept the medical assistance reimbursement rate for any covered goods or services provided to recipients of medical assistance who are children under the custody of a psychiatric medical institution for children.   j.  For the fiscal year beginning July 1, 2019, unless otherwise specified in this Act, all noninstitutional medical assistance provider reimbursement rates shall remain at the rates in effect on June 30, 2019, except for area education agencies, local education agencies, infant and toddler services providers, home and community-based services providers including consumer-directed attendant care providers under a section 1915(c) or 1915(i) waiver, targeted case management providers, and those providers whose rates are required to be determined pursuant to section 249A.20, or to meet federal mental health parity requirements.   k.  Notwithstanding any provision to the contrary, for the fiscal year beginning July 1, 2019, the reimbursement rate for anesthesiologists shall remain at the rates in effect on June 30, 2019, and updated on January 1, 2020, to align with the most current Iowa Medicare anesthesia rate.   l.  Notwithstanding section 249A.20, for the fiscal year beginning July 1, 2019, the average reimbursement rate for health care providers eligible for use of the federal Medicare resource-based relative value scale reimbursement methodology under section 249A.20 shall remain at the rate in effect on June 30, 2019; however, this rate shall not exceed the maximum level authorized by the federal government.   m.  For the fiscal year beginning July 1, 2019, the reimbursement rate for residential care facilities shall not be less than the minimum payment level as established by the federal government to meet the federally mandated maintenance of effort requirement. The flat reimbursement rate for facilities electing not to file annual cost reports shall not be less than the minimum payment level as established by the federal government to meet the federally mandated maintenance of effort requirement.   n.  For the fiscal year beginning July 1, 2019, the reimbursement rates for inpatient mental health services provided at hospitals shall remain at the rates in effect on June 30, 2019, subject to Medicaid program upper payment limit rules; and psychiatrists shall be reimbursed at the medical assistance program fee-for-service rate in effect on June 30, 2019.   o.  For the fiscal year beginning July 1, 2019, community mental health centers may choose to be reimbursed for the services provided to recipients of medical assistance through either of the following options:   (1)  For 100 percent of the reasonable costs of the services.   (2)  In accordance with the alternative reimbursement rate methodology approved by the department of human services in effect on June 30, 2019.   p.  For the fiscal year beginning July 1, 2019, the reimbursement rate for providers of family planning services that are eligible to receive a 90 percent federal match shall remain at the rates in effect on June 30, 2019.   q.  Unless otherwise subject to a tiered rate methodology, for the fiscal year beginning July 1, 2019, the upper limits and reimbursement rates for providers of home and community-based services waiver services shall be reimbursed using the reimbursement methodology in effect on June 30, 2019.   r.  For the fiscal year beginning July 1, 2019, the reimbursement rates for emergency medical service providers shall remain at the rates in effect on June 30, 2019, or as approved by the centers for Medicare and Medicaid services of the United States department of health and human services.   s.  For the fiscal year beginning July 1, 2019, reimbursement rates for substance-related disorder treatment programs licensed under section 125.13 shall remain at the rates in effect on June 30, 2019.   t.  For the fiscal year beginning July 1, 2019, assertive community treatment per diem rates shall be adjusted to reflect an actual average per diem cost within the additional $211,332 appropriated for this purpose.    2.  For the fiscal year beginning July 1, 2019, the reimbursement rate for providers reimbursed under the in-home-related care program shall not be less than the minimum payment level as established by the federal government to meet the federally mandated maintenance of effort requirement.   3.  Unless otherwise directed in this section, when the department’s reimbursement methodology for any provider reimbursed in accordance with this section includes an inflation factor, this factor shall not exceed the amount by which the consumer price index for all urban consumers increased during the calendar year ending December 31, 2002.   4.  Notwithstanding section 234.38, for the fiscal year beginning July 1, 2019, the foster family basic daily maintenance rate and the maximum adoption subsidy rate for children ages 0 through 5 years shall be $16.78, the rate for children ages 6 through 11 years shall be $17.45, the rate for children ages 12 through 15 years shall be $19.10, and the rate for children and young adults ages 16 and older shall be $19.35. For youth ages 18 to 21 who have exited foster care, the preparation for adult living program maintenance rate shall be $602.70 per month. The maximum payment for adoption subsidy nonrecurring expenses shall be limited to $500 and the disallowance of additional amounts for court costs and other related legal expenses implemented pursuant to 2010 Iowa Acts, chapter 1031, section 408, shall be continued.   5.  For the fiscal year beginning July 1, 2019, the maximum reimbursement rates for social services providers under contract shall remain at the rates in effect on June 30, 2019, or the provider’s actual and allowable cost plus inflation for each service, whichever is less. However, if a new service or service provider is added after June 30, 2019, the initial reimbursement rate for the service or provider shall be based upon a weighted average of provider rates for similar services.   6.  a.  For the fiscal year beginning July 1, 2019, the reimbursement rates for resource family recruitment and retention contractors shall be established by contract.   b.  For the fiscal year beginning July 1, 2019, the reimbursement rates for supervised apartment living foster care providers shall be established by contract.   7.  For the fiscal year beginning July 1, 2019, the reimbursement rate for group foster care providers shall be the combined service and maintenance reimbursement rate established by contract.   8.  The group foster care reimbursement rates paid for placement of children out of state shall be calculated according to the same rate-setting principles as those used for in-state providers, unless the director of human services or the director’s designee determines that appropriate care cannot be provided within the state. The payment of the daily rate shall be based on the number of days in the calendar month in which service is provided.   9.  a.  For the fiscal year beginning July 1, 2019, the reimbursement rate paid for shelter care and the child welfare emergency services implemented to provide or prevent the need for shelter care shall be established by contract.   b.  For the fiscal year beginning July 1, 2019, the combined service and maintenance components of the reimbursement rate paid for shelter care services shall be based on the financial and statistical report submitted to the department. The maximum reimbursement rate shall be $101.83 per day. The department shall reimburse a shelter care provider at the provider’s actual and allowable unit cost, plus inflation, not to exceed the maximum reimbursement rate.   c.  Notwithstanding section 232.141, subsection 8, for the fiscal year beginning July 1, 2019, the amount of the statewide average of the actual and allowable rates for reimbursement of juvenile shelter care homes that is utilized for the limitation on recovery of unpaid costs shall remain at the amount in effect for this purpose in the fiscal year beginning July 1, 2018.   10.  For the fiscal year beginning July 1, 2019, the department shall calculate reimbursement rates for intermediate care facilities for persons with an intellectual disability at the 80th percentile. Beginning July 1, 2019, the rate calculation methodology shall utilize the consumer price index inflation factor applicable to the fiscal year beginning July 1, 2019.   11.  Effective July 1, 2019, the child care provider reimbursement rates shall remain at the rates in effect on June 30, 2019. The department shall set rates in a manner so as to provide incentives for a nonregistered provider to become registered by applying any increase only to registered and licensed providers.   12.  The department may adopt emergency rules to implement this section.   Sec. 32.   CONTRACTED SERVICES PROHIBITED USE OF STATE FUNDING FOR LOBBYING.   1.  The department shall submit a report to the individuals identified in this Act for submission of reports by December 15, 2019, regarding the outcomes of any program or activity for which funding is appropriated or allocated from the general fund of the state to the department under this division of this Act, and for which a request for proposals process is required.   2.  The department shall incorporate into the general conditions applicable to all award documents involving funding appropriated or allocated from the general fund of the state to the department under this division of this Act, a prohibition against the use of such funding for the compensation of a lobbyist. For the purposes of this section, “lobbyist” means the same as defined in section 68B.2; however, “lobbyist” does not include a person employed by a state agency of the executive branch of state government who represents the agency relative to the passage, defeat, approval, or modification of legislation that is being considered by the general assembly.   Sec. 33.   EMERGENCY RULES.   1.  If specifically authorized by a provision of this division of this Act, the department of human services or the mental health and disability services commission may adopt administrative rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this division of this Act and the rules shall become effective immediately upon filing or on a later effective date specified in the rules, unless the effective date of the rules is delayed or the applicability of the rules is suspended by the administrative rules review committee. Any rules adopted in accordance with this section shall not take effect before the rules are reviewed by the administrative rules review committee. The delay authority provided to the administrative rules review committee under section 17A.4, subsection 7, and section 17A.8, subsection 9, shall be applicable to a delay imposed under this section, notwithstanding a provision in those sections making them inapplicable to section 17A.5, subsection 2, paragraph “b”. Any rules adopted in accordance with the provisions of this section shall also be published as a notice of intended action as provided in section 17A.4.   2.  If during a fiscal year, the department of human services is adopting rules in accordance with this section or as otherwise directed or authorized by state law, and the rules will result in an expenditure increase beyond the amount anticipated in the budget process or if the expenditure was not addressed in the budget process for the fiscal year, the department shall notify the persons designated by this division of this Act for submission of reports, the chairpersons and ranking members of the committees on appropriations, and the department of management concerning the rules and the expenditure increase. The notification shall be provided at least 30 calendar days prior to the date notice of the rules is submitted to the administrative rules coordinator and the administrative code editor.   Sec. 34.   REPORTS.  Any reports or other information required to be compiled and submitted under this Act during the fiscal year beginning July 1, 2019, shall be submitted to the chairpersons and ranking members of the joint appropriations subcommittee on health and human services, the legislative services agency, and the legislative caucus staffs on or before the dates specified for submission of the reports or information.   Sec. 35.   EFFECTIVE UPON ENACTMENT.  The following provisions of this division of this Act, being deemed of immediate importance, take effect upon enactment:   1.  The provision relating to section 232.141 and directing the state court administrator and the division administrator of the department of human services division of child and family services to make the determination, by June 15, 2019, of the distribution of funds allocated for the payment of the expenses of court-ordered services provided to juveniles which are a charge upon the state.DIVISION VIHEALTH CARE ACCOUNTS AND FUNDS FY 2019-2020   Sec. 36.   PHARMACEUTICAL SETTLEMENT ACCOUNT.  There is appropriated from the pharmaceutical settlement account created in section 249A.33 to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   Notwithstanding any provision of law to the contrary, to supplement the appropriations made in this Act for medical contracts under the medical assistance program for the fiscal year beginning July 1, 2019, and ending June 30, 2020:  ............................................................ $ 234,193   Sec. 37.   QUALITY ASSURANCE TRUST FUND DEPARTMENT OF HUMAN SERVICES.  Notwithstanding any provision to the contrary and subject to the availability of funds, there is appropriated from the quality assurance trust fund created in section 249L.4 to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amounts, or so much thereof as is necessary, for the purposes designated:   To supplement the appropriation made in this Act from the general fund of the state to the department of human services for medical assistance for the same fiscal year:  ............................................................ $ 58,570,397   Sec. 38.   HOSPITAL HEALTH CARE ACCESS TRUST FUND DEPARTMENT OF HUMAN SERVICES.  Notwithstanding any provision to the contrary and subject to the availability of funds, there is appropriated from the hospital health care access trust fund created in section 249M.4 to the department of human services for the fiscal year beginning July 1, 2019, and ending June 30, 2020, the following amounts, or so much thereof as is necessary, for the purposes designated:   To supplement the appropriation made in this Act from the general fund of the state to the department of human services for medical assistance for the same fiscal year:  ............................................................ $ 33,920,554   Sec. 39.   MEDICAL ASSISTANCE PROGRAM NONREVERSION FOR FY 2019-2020.  Notwithstanding section 8.33, if moneys appropriated for purposes of the medical assistance program for the fiscal year beginning July 1, 2019, and ending June 30, 2020, from the general fund of the state, the quality assurance trust fund, and the hospital health care access trust fund, are in excess of actual expenditures for the medical assistance program and remain unencumbered or unobligated at the close of the fiscal year, the excess moneys shall not revert but shall remain available for expenditure for the purposes of the medical assistance program until the close of the succeeding fiscal year.DIVISION VIIGRADUATED SANCTION, COURT-ORDERED, AND GROUP FOSTER CARE SERVICES AND FUNDING WORK GROUP   Sec. 40.   GRADUATED SANCTION, COURT-ORDERED, AND GROUP FOSTER CARE SERVICES AND FUNDING WORK GROUP.   1.  As used in this section, unless the context otherwise requires:   a.  “Court-ordered services” means the defined or specific care and treatment that is ordered by the court for an eligible child and for which no other payment source is available to cover the cost.   b.  “Department” means the department of human services.   c.  “Eligible child” means a child who has been adjudicated delinquent, is at risk, or has been certified by the chief juvenile court officer as eligible for court-ordered services.    d.  “Graduated sanction services” includes community-based interventions, school-based supervision, and supportive enhancements provided in community-based settings to an eligible child who is adjudicated delinquent or who is at risk of adjudication.   2.  The division of criminal and juvenile justice planning of the department of human rights shall convene and provide administrative support to a work group to review and develop a plan to transfer the administration of graduated sanctions and court-ordered services and funding and the oversight of group foster care placements for eligible children from the department to the office of the state court administrator. The plan shall ensure that the office of the state court administrator has the capacity, resources, and expertise to manage the funding and services effectively.   3.  a.  In addition to a representative of the division of criminal and juvenile justice planning of the department of human rights, the membership of the work group shall include but is not limited to representatives of all of the following:   (1)  The judicial branch, including the state court administrator or the state court administrator’s designee, a juvenile court judge, at least one chief juvenile court officer, and a representative with fiscal and contract experience.   (2)  The department of human services, including representatives with experience managing graduated sanctions funding and group foster care placements.   (3)  The department of justice.   (4)  The juvenile justice advisory committee.   (5)  Member and nonmember agencies of the coalition for family and children’s services in Iowa.   (6)  Providers of community-based services for eligible children.   (7)  Providers of group foster care.   (8)  Attorneys who represent children in juvenile justice proceedings.   (9)  County attorneys.   (10)  Federal Title IV-E funding and services subject matter experts.   (11)  Individuals who formerly received services as eligible children or their parents.   b.  In addition, the work group membership shall include four members of the general assembly. The legislative members shall serve as ex officio, nonvoting members of the work group, with one member to be appointed by each of the following: the majority leader of the senate, the minority leader of the senate, the speaker of the house of representatives, and the minority leader of the house of representatives.   c.  In addition to the members specified, the division of criminal and juvenile justice planning may include other stakeholders with interest or expertise on the work group.   d.  Any expenses incurred by a member of the work group shall be the responsibility of the individual member or the respective entity represented by the member.    4.  The work group shall do all of the following:   a.  Develop an action plan to transfer the administration of juvenile court graduated sanction services, court-ordered services, and associated funding from the department to the office of the state court administrator or other appropriate state entity.   b.  Develop an action plan to transfer the oversight of group foster care services for eligible children from the department to the office of the state court administrator or other appropriate state entity with the necessary expertise to provide such services.   c.  Develop an action plan to transfer administration of the juvenile detention home fund created in section 232.142 from the department to the office of the state court administrator or other appropriate state entity.   d.  Evaluate current resources to determine the most efficient means of suitably equipping the office of the state court administrator or other appropriate state entity with the policies and legal authority; staffing; contracting, procurement, data, and quality assurance capabilities; and other resources necessary to manage such funds and associated services effectively. The evaluation shall require collaboration with the department to manage transition activities.    e.  Recommend statutory and administrative policies and court rules to promote collaborative case planning and quality assurance between the department and juvenile court services for youth who may be involved in both the child welfare and juvenile justice systems or who may utilize the same providers or services.   f.  Determine the impact and role of the federal Family First Prevention Services Act relative to the various funding streams and services under the purview of the work group, and recommend statutory and administrative policies and rules to coordinate the duties of the work group with implementation and administration of the federal Act.   g.  Determine the role of the decategorization of child welfare and juvenile justice funding initiative pursuant to section 232.188 relative to the other funding streams and services under the purview of the work group, and make recommendations regarding the future of the initiative including the potential transfer of administration of the initiative from the department to the office of the state court administrator or other appropriate state entity.   h.  Consult with other state juvenile court systems and subject matter experts to review administration of similar programs, to glean information on lessons learned and best practices, and to determine the types of community and residential services that have demonstrated effectiveness for eligible children.   5.  The division of criminal and juvenile justice planning of the department of human rights shall submit a report of the findings and recommendations of the work group, including a plan to implement the recommendations by July 1, 2021, to the governor and the general assembly by December 15, 2019.DIVISION VIIICO-OCCURRING CONDITIONS ENHANCED DELIVERY OF SERVICES REVIEW   Sec. 41.   REVIEW TO PROVIDE ENHANCED DELIVERY OF SERVICES FOR CO-OCCURRING CONDITIONS.  The director of the department of public health and the director of the department of human services shall develop recommendations for the enhanced delivery of co-occurring conditions services. The directors shall examine the current service delivery system to identify opportunities for reducing the administrative burden on the departments and providers, evaluate the use of an integrated helpline and website and improvements in data collection and sharing of outcomes, and create a structure for ongoing collaboration. The directors shall submit a report including findings, a five-year plan to address co-occurring conditions across provider types and payors, and other recommendations to the governor and general assembly by December 15, 2019.DIVISION IXMEDICAID MANAGED CARE CONTRACTS   Sec. 42.   MEDICAID MANAGED CARE CONTRACTS NOTIFICATION TO GENERAL ASSEMBLY.  The department of human services shall notify the chairpersons and ranking members of the joint appropriations subcommittee on health and human services, the legislative services agency, and the legislative caucus staffs as follows:   1.  Within thirty days of the execution of a Medicaid managed care contract or amendment to a Medicaid managed care contract.   2.  Within thirty days of the determination by the department during each measurement year whether to return the incentive payment withhold amount to the Medicaid managed care organization based upon performance and the criteria used in making the determination.DIVISION XIOWA DEPARTMENT ON AGING MEDICAID CLAIMING   Sec. 43.   IOWA DEPARTMENT ON AGING MEDICAID CLAIMING.  The department on aging and the department of human services shall continue to collaborate to develop a cost allocation plan requesting Medicaid administrative funding to provide for the claiming of federal financial participation for aging and disability resource center activities that are performed to assist with administration of the Medicaid program. By January 1, 2021, the department of human services shall submit to the centers for Medicare and Medicaid services of the United States department of health and human services any Medicaid state plan amendment as necessary and shall enter into any interagency agreement with the department on aging to implement this section.DIVISION XIDECATEGORIZATION FY 2017 CARRYOVER FUNDING   Sec. 44.   DECATEGORIZATION CARRYOVER FUNDING FY 2017 TRANSFER TO MEDICAID PROGRAM.  Notwithstanding section 232.188, subsection 5, paragraph “b”, any state-appropriated moneys in the funding pool that remained unencumbered or unobligated at the close of the fiscal year beginning July 1, 2016, and were deemed carryover funding to remain available for the two succeeding fiscal years that still remain unencumbered or unobligated at the close of the fiscal year beginning July 1, 2018, shall not revert but shall be transferred to the medical assistance program for the fiscal year beginning July 1, 2019.   Sec. 45.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.   Sec. 46.   RETROACTIVE APPLICABILITY.  This division of this Act applies retroactively to July 1, 2018.DIVISION XIIPRIOR APPROPRIATIONS AND OTHER PROVISIONSTEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)   Sec. 47.   2017 Iowa Acts, chapter 174, section 45, as amended by 2018 Iowa Acts, chapter 1165, section 10, is amended to read as follows:   SEC. 45.  TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT.  There is appropriated from the fund created in section 8.41 to the department of human services for the fiscal year beginning July 1, 2018, and ending June 30, 2019, from moneys received under the federal temporary assistance for needy families (TANF) block grant pursuant to the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub.L.No.104-193, and successor legislation, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:   1.  To be credited to the family investment program account and used for assistance under the family investment program under chapter 239B:  ............................................................ $ 4,539,006............................................................ $ 4,025,108   2.  To be credited to the family investment program account and used for the job opportunities and basic skills (JOBS) program and implementing family investment agreements in accordance with chapter 239B:  ............................................................ $ 5,412,060............................................................ $  5,192,060   3.  To be used for the family development and self-sufficiency grant program in accordance with section 216A.107:  ............................................................ $ 2,883,980............................................................ $ 2,898,980   Notwithstanding section 8.33, moneys appropriated in this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year. However, unless such moneys are encumbered or obligated on or before September 30, 2019, the moneys shall revert.   4.  For field operations:  ............................................................ $ 31,296,232............................................................ $ 32,465,681   5.  For general administration:  ............................................................ $ 3,744,000   6.  For state child care assistance:  ............................................................ $ 47,166,826   a.  Of the funds appropriated in this subsection, $26,205,412 is transferred to the child care and development block grant appropriation made by the Eighty-seventh General Assembly, 2018 session, for the federal fiscal year beginning October 1, 2018, and ending September 30, 2019. Of this amount, $200,000 shall be used for provision of educational opportunities to registered child care home providers in order to improve services and programs offered by this category of providers and to increase the number of providers. The department may contract with institutions of higher education or child care resource and referral centers to provide the educational opportunities. Allowable administrative costs under the contracts shall not exceed 5 percent. The application for a grant shall not exceed two pages in length.   b.  Any funds appropriated in this subsection remaining unallocated shall be used for state child care assistance payments for families who are employed including but not limited to individuals enrolled in the family investment program.   7.  For child and family services:  ............................................................ $ 32,380,654   8.  For child abuse prevention grants:  ............................................................ $ 125,000   9.  For pregnancy prevention grants on the condition that family planning services are funded:  ............................................................ $ 1,913,203............................................................ $  1,890,203   Pregnancy prevention grants shall be awarded to programs in existence on or before July 1, 2018, if the programs have demonstrated positive outcomes. Grants shall be awarded to pregnancy prevention programs which are developed after July 1, 2018, if the programs are based on existing models that have demonstrated positive outcomes. Grants shall comply with the requirements provided in 1997 Iowa Acts, chapter 208, section 14, subsections 1 and 2, including the requirement that grant programs must emphasize sexual abstinence. Priority in the awarding of grants shall be given to programs that serve areas of the state which demonstrate the highest percentage of unplanned pregnancies of females of childbearing age within the geographic area to be served by the grant.   10.  For technology needs and other resources necessary to meet federal welfare reform reporting, tracking, and case management requirements:  ............................................................ $ 1,037,186............................................................ $ 862,186   11.  a.  Notwithstanding any provision to the contrary, including but not limited to requirements in section 8.41 or provisions in 2017 or 2018 Iowa Acts regarding the receipt and appropriation of federal block grants, federal funds from the temporary assistance for needy families block grant received by the state and not otherwise appropriated in this section and remaining available for the fiscal year beginning July 1, 2018, are appropriated to the department of human services to the extent as may be necessary to be used in the following priority order:the family investment program, for state child care assistance program payments for families who are employed, and for the family investment program share of system costs for eligibility determination and related functions. The federal funds appropriated in this paragraph “a” shall be expended only after all other funds appropriated in subsection 1 for assistance under the family investment program, in subsection 6 for child care assistance, or in subsection 10 for technology costs related to the family investment program, as applicable, have been expended. For the purposes of this subsection, the funds appropriated in subsection 6, paragraph “a”, for transfer to the child care and development block grant appropriation are considered fully expended when the full amount has been transferred.   b.  The department shall, on a quarterly basis, advise the legislative services agency and department of management of the amount of funds appropriated in this subsection that was expended in the prior quarter.   12.  Of the amounts appropriated in this section, $12,962,008 for the fiscal year beginning July 1, 2018, is transferred to the appropriation of the federal social services block grant made to the department of human services for that fiscal year.   13.  For continuation of the program providing categorical eligibility for the food assistance program as specified for the program in the section of this division of this Act relating to the family investment program account:  ............................................................ $ 14,236............................................................ $ 13,000   14.  The department may transfer funds allocated in this section to the appropriations made in this division of this Act for the same fiscal year for general administration and field operations for resources necessary to implement and operate the services referred to in this section and those funded in the appropriation made in this division of this Act for the same fiscal year for the family investment program from the general fund of the state.   15.  With the exception of moneys allocated under this section for the family development and self-sufficiency grant program, to the extent moneys allocated in this section are deemed by the department not to be necessary to support the purposes for which they are allocated, such moneys may be used in the same fiscal year for any other purpose for which funds are allocated in this section or in section 7 of this division for the family investment program account. If there are conflicting needs, priority shall first be given to the family investment program account as specified under subsection 1 of this section and used for the purposes of assistance under the family investment program under chapter 239B, followed by state child care assistance program payments for families who are employed, followed by other priorities as specified by the department.FAMILY INVESTMENT PROGRAM ADJUSTMENTS   Sec. 48.   2017 Iowa Acts, chapter 174, section 46, subsection 4, as amended by 2018 Iowa Acts, chapter 1165, section 11, is amended to read as follows:   4.  Moneys appropriated in this division of this Act and credited to the FIP account for the fiscal year beginning July 1, 2018, and ending June 30, 2019, are allocated as follows:   a.  To be retained by the department of human services to be used for coordinating with the department of human rights to more effectively serve participants in FIP and other shared clients and to meet federal reporting requirements under the federal temporary assistance for needy families block grant:  ............................................................ $ 5,000............................................................ $ 20,000   b.  To the department of human rights for staffing, administration, and implementation of the family development and self-sufficiency grant program in accordance with section 216A.107:  ............................................................ $ 6,192,834   (1)  Of the funds allocated for the family development and self-sufficiency grant program in this paragraph “b”, not more than 5 percent of the funds shall be used for the administration of the grant program.   (2)  The department of human rights may continue to implement the family development and self-sufficiency grant program statewide during fiscal year 2018-2019.   (3)  The department of human rights may engage in activities to strengthen and improve family outcomes measures and data collection systems under the family development and self-sufficiency grant program.   c.  For the diversion subaccount of the FIP account:  ............................................................ $ 749,694............................................................ $ 815,000   A portion of the moneys allocated for the subaccount may be used for field operations, salaries, data management system development, and implementation costs and support deemed necessary by the director of human services in order to administer the FIP diversion program. To the extent moneys allocated in this paragraph “c” are deemed by the department not to be necessary to support diversion activities, such moneys may be used for other efforts intended to increase engagement by family investment program participants in work, education, or training activities, or for the purposes of assistance under the family investment program in accordance with chapter 239B.   d.  For the food assistance employment and training program:  ............................................................ $ 66,588   (1)  The department shall apply the federal supplemental nutrition assistance program (SNAP) employment and training state plan in order to maximize to the fullest extent permitted by federal law the use of the 50 percent federal reimbursement provisions for the claiming of allowable federal reimbursement funds from the United States department of agriculture pursuant to the federal SNAP employment and training program for providing education, employment, and training services for eligible food assistance program participants, including but not limited to related dependent care and transportation expenses.   (2)  The department shall continue the categorical federal food assistance program eligibility at 160 percent of the federal poverty level and continue to eliminate the asset test from eligibility requirements, consistent with federal food assistance program requirements. The department shall include as many food assistance households as is are allowed by federal law. The eligibility provisions shall conform to all federal requirements including requirements addressing individuals who are incarcerated or otherwise ineligible.   e.  For the JOBS program:  ............................................................ $ 12,139,821............................................................ $ 11,919,821MEDICAL ASSISTANCE PROGRAM ADJUSTMENT   Sec. 49.   2017 Iowa Acts, chapter 174, section 51, unnumbered paragraph 2, as amended by 2018 Iowa Acts, chapter 1165, section 18, is amended to read as follows:   For medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies in effect on June 30, 2018, except as otherwise expressly authorized by law, consistent with options under federal law and regulations, and contingent upon receipt of approval from the office of the governor of reimbursement for each abortion performed under the program:  ............................................................ $ 1,337,841,375............................................................ $ 1,488,141,375GROUP FOSTER CARE REALLOCATION   Sec. 50.   2017 Iowa Acts, chapter 174, section 57, subsection 3, paragraph a, as amended by 2018 Iowa Acts, chapter 1165, section 28, is amended to read as follows:   a.  Of the funds appropriated in this section, up to $34,536,648 is allocated as the statewide expenditure target under section 232.143 for group foster care maintenance and services. If the department projects that such expenditures for the fiscal year will be less than the target amount allocated in this paragraph “a”, the department may reallocate the excess to provide additional funding for family foster care, independent living, family safety, risk and permanency services, shelter care, or the child welfare emergency services addressed with the allocation for shelter care.SHELTER CARE ALLOCATION   Sec. 51.   2017 Iowa Acts, chapter 174, section 57, subsection 6, as amended by 2018 Iowa Acts, chapter 1165, section 28, is amended to read as follows:   6.  Notwithstanding section 234.35 or any other provision of law to the contrary, state funding Of the funds appropriated in this section, a sufficient amount is allocated for shelter care and the child welfare emergency services contracting implemented to provide for or prevent the need for shelter care shall be limited to $8,096,158.OTHER FUNDING FOR CHILD WELFARE SERVICES   Sec. 52.   2017 Iowa Acts, chapter 174, section 57, as amended by 2018 Iowa Acts, chapter 1165, section 28, is amended by adding the following new subsection:   NEW SUBSECTION.  24.  If a separate funding source is identified that reduces the need for state funds within an allocation under this section, the allocated state funds may be redistributed to other allocations under this section for the same fiscal year.    Sec. 53.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.   Sec. 54.   RETROACTIVE APPLICABILITY.  This division of this Act applies retroactively to July 1, 2018.DIVISION XIIIHOSPITAL HEALTH CARE ACCESS ASSESSMENT PROGRAM FUTURE REPEAL   Sec. 55.   Section 249M.5, Code 2019, is amended to read as follows:   249M.5  Future repeal.   This chapter is repealed July 1, 2019 2021.   Sec. 56.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.DIVISION XIVMENTAL HEALTH AND DISABILITY SERVICES TRANSFER OF FUNDS   Sec. 57.   MENTAL HEALTH AND DISABILITY SERVICES TRANSFER OF FUNDS.  Notwithstanding section 331.432, a county with a population of over 300,000 based on the most recent federal decennial census, may transfer funds from any other fund of the county to the mental health and disability regional services fund for the purposes of providing mental health and disability services for the fiscal year beginning July 1, 2019, and ending June 30, 2020. The county shall submit a report to the governor and the general assembly by September 1, 2020, including the source of any funds transferred, the amount of the funds transferred, and the mental health and disability services provided with the transferred funds.DIVISION XVOPERATION OF BOARD OF MEDICINE, BOARD OF NURSING, BOARD OF PHARMACY, AND THE DENTAL BOARD   Sec. 58.   Section 135.11A, subsection 1, Code 2019, is amended to read as follows:   1.  There shall be a professional licensure division within the department of public health. Each board under chapter 147 or under the administrative authority of the department, except the board of nursing, board of medicine, dental board, and board of pharmacy, shall receive administrative and clerical support from the division and may not employ its own support staff for administrative and clerical duties.The executive director of the board of nursing, board of medicine, dental board, and board of pharmacy shall be appointed pursuant to section 135.11B.   Sec. 59.   NEW SECTION.  135.11B  Appointment of certain executive directors.   1.  The director shall appoint and supervise a full-time executive director for each of the following boards:   a.  The board of medicine.   b.  The board of nursing.   c.  The dental board.   d.  The board of pharmacy.   2.  Each board listed in subsection 1 shall advise the director in evaluating potential candidates for the position of executive director, consult with the director in the hiring of the executive director, and review and advise the director on the performance of the executive director in the discharge of the executive director’s duties.   3.  Each board listed in subsection 1 shall retain sole discretion and authority to execute the core functions of the board including but not limited to policymaking, advocating for and against legislation, rulemaking, licensing, licensee investigations, licensee disciplinary proceedings, and oversight of professional health programs. The director’s supervision of the executive director shall not interfere with the board’s discretion and authority in executing the core functions of the board.   Sec. 60.   Section 147.80, subsection 3, Code 2019, is amended to read as follows:   3.  The board of medicine, the board of pharmacy, the dental board, and the board of nursing shall retain individual executive officers pursuant to section 135.11B, but shall make every effort to share administrative, clerical, and investigative staff to the greatest extent possible.   Sec. 61.   Section 152.2, Code 2019, is amended to read as follows:   152.2  Executive director.   The board shall appoint retain a full-time executive director, who shall be appointed pursuant to section 135B.11. The executive director shall be a registered nurse and shall not be a member of the board. The governor, with the approval of the executive council pursuant to section 8A.413, subsection 3, under the pay plan for exempt positions in the executive branch of government, shall set the salary of the executive director.   Sec. 62.   Section 153.33, subsection 2, Code 2019, is amended to read as follows:   2.  All employees needed to administer this chapter except the executive director shall be appointed pursuant to the merit system. The executive director shall serve at the pleasure of the board be appointed pursuant to section 135.11B and shall be exempt from the merit system provisions of chapter 8A, subchapter IV.DIVISION XVIMEDICAID MEDICAL PRIOR AUTHORIZATION UNIFORM PROCESS CENTRAL PORTAL   Sec. 63.   MEDICAID MEDICAL PRIOR AUTHORIZATION UNIFORM PROCESS.  The department of human services shall adopt rules pursuant to chapter 17A by October 1, 2019, to require that both managed care and fee-for-service payment and delivery systems utilize a uniform process, including but not limited to uniform forms, information requirements, and time frames, to request medical prior authorization under the Medicaid program. The rules shall require the managed care organizations, by contract, to implement the uniform process by a date as determined by the department.   Sec. 64.   MEDICAID MANAGEMENT INFORMATION SYSTEM CENTRAL PORTAL REVIEW.  The department shall review the costs associated with expanding the medical assistance management information system to integrate a single, statewide system to serve as a central portal for submission of all medical prior authorization requests for the Medicaid program. The portal shall not be designed to make or review final determinations of managed care organization medical prior authorization requests, but shall only serve as a conduit to deliver medical prior authorization requests to the appropriate managed care organization. The results of the study shall be submitted to the governor and the general assembly no later than March 31, 2020.   Sec. 65.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.DIVISION XVIIHEALTH AND HUMAN SERVICES EXECUTIVE BRANCH ENTITIES REFORMIowa collaborative safety net provider network   Sec. 66.   Section 135.24, subsection 7, paragraph e, Code 2019, is amended to read as follows:   e.  “Specialty health care provider office” means the private office or clinic of an individual specialty health care provider or group of specialty health care providers as referred by the Iowa collaborative safety net provider network established in section 135.153, but does not include a field dental clinic, a free clinic, or a hospital.   Sec. 67.   Section 135.159, subsection 1, paragraph h, Code 2019, is amended by striking the paragraph.   Sec. 68.   REPEAL.  Section 135.153, Code 2019, is repealed.Hospital health care access trust fund board   Sec. 69.   Section 249M.4, Code 2019, is amended to read as follows:   249M.4  Hospital health care access trust fund board.   1.  A hospital health care access trust fund is created in the state treasury under the authority of the department. Moneys received through the collection of the hospital health care access assessment imposed under this chapter and any other moneys specified for deposit in the trust fund shall be deposited in the trust fund.   2.  Moneys in the trust fund shall be used, subject to their appropriation by the general assembly, by the department to reimburse participating hospitals the medical assistance program upper payment limit for inpatient and outpatient hospital services as calculated in this section. Following payment of such upper payment limit to participating hospitals, any remaining funds in the trust fund on an annual basis may be used for any of the following purposes:   a.  To support medical assistance program utilization shortfalls.   b.  To maintain the state’s capacity to provide access to and delivery of services for vulnerable Iowans.   c.  To fund the health care workforce support initiative created pursuant to section 135.175.   d.  To support access to health care services for uninsured Iowans.   e.  To support Iowa hospital programs and services which expand access to health care services for Iowans.   3.  The trust fund shall be separate from the general fund of the state and shall not be considered part of the general fund. The moneys in the trust fund shall not be considered revenue of the state, but rather shall be funds of the hospital health care access assessment program. The moneys deposited in the trust fund are not subject to section 8.33 and shall not be transferred, used, obligated, appropriated, or otherwise encumbered, except to provide for the purposes of this chapter. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the trust fund shall be credited to the trust fund.   4.  The department shall adopt rules pursuant to chapter 17A to administer the trust fund and reimbursements and expenditures as specified in this chapter made from the trust fund.   5.  a.  Beginning July 1, 2010, or the implementation date of the hospital health care access assessment program as determined by receipt of approval from the centers for Medicare and Medicaid services of the United States department of health and human services, whichever is later, the department shall increase the diagnostic related groups and ambulatory patient classifications base rates to provide payments to participating hospitals at the Medicare upper payment limit for the fiscal year beginning July 1, 2010, calculated as of July 31, 2010. Each participating hospital shall receive the same percentage increase, but the percentage may differ depending on whether the basis for the base rate increase is the diagnostic related groups or ambulatory patient classifications.   b.  The percentage increase shall be calculated by dividing the amount calculated under subparagraph (1) by the amount calculated under subparagraph (2) as follows:   (1)  The amount under the Medicare upper payment limit for the fiscal year beginning July 1, 2010, for participating hospitals.   (2)  The projected expenditures for participating hospitals for the fiscal year beginning July 1, 2010, as determined by the fiscal management division of the department, plus the amount calculated under subparagraph (1).   6.  For the fiscal year beginning July 1, 2011, and for each fiscal year beginning July 1, thereafter, the payments to participating hospitals shall continue to be calculated based on the upper payment limit as calculated for the fiscal year beginning July 1, 2010.   7.  Reimbursement of participating hospitals shall incorporate the rebasing process for inpatient and outpatient services for state fiscal year 2012. However, the total amount of increased funding available for reimbursement attributable to rebasing shall not exceed four million five hundred thousand dollars for state fiscal year 2012 and six million dollars for state fiscal year 2013.   8.  Any payments to participating hospitals under this section shall result in budget neutrality to the general fund of the state.   9.  a.  A hospital health care access trust fund board is established consisting of the following members:   (1)  The co-chairpersons and the ranking members of the joint appropriations subcommittee on health and human services.   (2)  The Iowa medical assistance program director.   (3)  Two hospital executives representing the two largest private health care systems in the state.   (4)  The president of the Iowa hospital association.   (5)  A representative of a consumer advocacy group, involved in both state and national initiatives, that provides data on key indicators of well-being for children and families in order to inform policymakers to help children and families succeed.   b.  The board shall do all of the following:   (1)  Provide oversight of the trust fund.   (2)  Make recommendations regarding the hospital health care access assessment program, including recommendations regarding the assessment calculation, assessment amounts, payments to participating hospitals, and use of the moneys in the trust fund.   (3)  Submit an annual report to the governor and the general assembly regarding the use and expenditure of moneys deposited in the trust fund.   c.  The department shall provide administrative assistance to the board.Advisory COMMITTEE TO THE CENTER for rural health and primary care   Sec. 70.   Section 135.107, subsection 5, Code 2019, is amended by striking the subsection.   Sec. 71.   Section 262.78, subsection 3, Code 2019, is amended to read as follows:   3.  The president of the university of Iowa, in consultation with the president of Iowa state university of science and technology, shall employ a full-time director of the center. The center may employ staff to carry out the center’s purpose. The director shall coordinate the agricultural health and safety programs of the center. The director shall regularly meet and consult with the advisory committee to the center for rural health and primary care. The director shall provide the board of regents with relevant information regarding the center.Governmental public health advisory council   Sec. 72.   Section 135A.2, subsection 2, Code 2019, is amended by striking the subsection.   Sec. 73.   Section 135A.9, subsection 1, Code 2019, is amended by striking the subsection.   Sec. 74.   REPEAL.  Section 135A.4, Code 2019, is repealed.Patient-centered health advisory council   Sec. 75.   REPEAL.  Section 135.159, Code 2019, is repealed.Combining state medical examiner advisory council with the interagency coordinating council   Sec. 76.   Section 691.6B, Code 2019, is amended to read as follows:   691.6B  Interagency coordinating council.   1.  An interagency coordinating council is created to advise do all of the following:   a.  Advise and consult with the state medical examiner on a range of issues affecting the organization and functions of the office of the state medical examiner and the effectiveness of the medical examiner system in the state.   b.  Advise the state medical examiner concerning the assurance of effective coordination of the functions and operations of the office of the state medical examiner with the needs and interests of the departments of public safety and public health.   2.  Members of the interagency coordinating council shall include the all of the following:   a.  The state medical examiner, or when the state medical examiner is not available, the deputy state medical examiner; the.   b.  The commissioner of public safety or the commissioner’s designee; the.   c.  The director of public health or the director’s designee; and the.   d.  The governor or the governor’s designee.   e.  Representatives from the office of the attorney general, the Iowa county attorneys association, the Iowa medical society, the Iowa association of pathologists, the Iowa association of county medical examiners, the statewide emergency medical system, and the Iowa funeral directors association.   3.  The interagency coordinating council shall meet on a regular basis, and shall be organized and function as established by the state medical examiner by rule.   Sec. 77.   REPEAL.  Section 691.6C, Code 2019, is repealed.Trauma system advisory council   Sec. 78.   Section 147A.24, subsection 2, Code 2019, is amended to read as follows:   2.  The council shall consist of seven members to be appointed by the director from the recommendations of the organizations in subsection 1 for terms of two years. Vacancies on the council shall be filled for the remainder of the term of the original appointment. Members whose terms expire may be reappointed.   Sec. 79.   TRANSITION PROVISIONS.  Notwithstanding any provision of section 147A.24, subsection 2, to the contrary, a member of the trauma system advisory council on July 1, 2019, shall continue serving until the expiration of that member’s term or until a vacancy occurs prior to the expiration of the applicable term, and such vacancy shall only be filled to the extent consistent with and necessary to maintain the total number of members of the council specified in section 147A.24, subsection 2, as amended in this Act. Teleconference option for state entities   Sec. 80.   NEW SECTION.  135.11B  Statutory board, commission, committee, or council of committee teleconference option.   Any statutorily established board, commission, committee, or council established under the purview of the department shall provide for a teleconference option for board, commission, committee, or council members to participate in official meetings.Elimination of payment of expenses for public members of certain state entities   Sec. 81.   Section 105.3, subsection 6, Code 2019, is amended by striking the subsection.   Sec. 82.   Section 135.43, subsection 2, unnumbered paragraph 1, Code 2019, is amended to read as follows:   The membership of the review team is subject to the provisions of sections 69.16 and 69.16A, relating to political affiliation and gender balance. Review team members who are not designated by another appointing authority shall be appointed by the state medical examiner. Membership terms shall be for three years. A membership vacancy shall be filled in the same manner as the original appointment. The review team shall elect a chairperson and other officers as deemed necessary by the review team. The review team shall meet upon the call of the state medical examiner or as determined by the review team. The members of the team are eligible for reimbursement of actual and necessary expenses incurred in the performance of their official duties. The review team shall include the following:   Sec. 83.   Section 135.62, subsection 2, paragraph e, Code 2019, is amended by striking the paragraph.   Sec. 84.   Section 147A.3, Code 2019, is amended to read as follows:   147A.3  Meetings of the council quorum expenses.   Membership, terms of office, and quorum, and expenses shall be determined by the director pursuant to chapter 135.   Sec. 85.   Section 256I.3, subsection 3, Code 2019, is amended by striking the subsection.Elimination of CHILD WELFARE ADVISORY COMMITTEE, CHILD SUPPORT ADVISORY COMMITTEE, CHILDREN’S MENTAL HEALTH WAIVER IMPLEMENTATION COMMITTEE, AND PROPERTY TAX RELIEF FUND RISK POOL   Sec. 86.   Section 217.3A, subsection 1, Code 2019, is amended to read as follows:   1.  General.  The council on human services shall establish and utilize the advisory committees committee identified in this section and may establish and utilize other advisory committees. The council shall establish appointment provisions, membership terms, operating guidelines, and other operational requirements for committees established pursuant to this section.   Sec. 87.   Section 217.3A, subsections 3 and 4, Code 2019, are amended by striking the subsections.   Sec. 88.   Section 426B.5, subsection 1, Code 2019, is amended by striking the subsection.   Sec. 89.   2005 Iowa Acts, chapter 117, section 4, subsection 3, is amended by striking the subsection.DIVISION XVIIIMEDICAL ASSISTANCE ADVISORY COUNCIL   Sec. 90.   Section 217.3, subsection 4, Code 2019, is amended to read as follows:   4.  Approve the budget of the department of human services prior to submission to the governor. Prior to approval of the budget, the council shall publicize and hold a public hearing to provide explanations and hear questions, opinions, and suggestions regarding the budget. Invitations to the hearing shall be extended to the governor, the governor-elect, the director of the department of management, and other persons deemed by the council as integral to the budget process. The budget materials submitted to the governor shall include a review of options for revising the medical assistance program made available by federal action or by actions implemented by other states as identified by the department, the medical assistance advisory council and the executive committee of the medical assistance advisory council created in section 249A.4B, and by county representatives. The review shall address what potential revisions could be made in this state and how the changes would be beneficial to Iowans.   Sec. 91.   Section 249A.4B, Code 2019, is amended to read as follows:   249A.4B  Medical assistance advisory council.   1.  A medical assistance advisory council is created to comply with 42 C.F.R. §431.12 based on section 1902(a)(4) of the federal Social Security Act and to advise the director about health and medical care services under the medical assistance program. The council shall meet no more than quarterly. The director of public health and a public member of the council selected by the public members of the council specified in subsection 2, paragraph “b”, shall serve as co-chairpersons of the council.   2.  a.  The council shall consist of the following voting members:   (1)  Five professional or business entity members selected by the entities specified pursuant to subsection 3, paragraph “a”.   (2)  Five public members appointed pursuant to subsection 3, paragraph “b”. Of the five public members, at least one member shall be a recipient of medical assistance.   b.  The council shall include all of the following nonvoting members:   (1)  The director of public health, or the director’s designee.   (2)  The director of the department on aging, or the director’s designee.   (3)  The long-term care ombudsman, or the long-term care ombudsman’s designee.   (4)  The dean of Des Moines university — osteopathic medical center, or the dean’s designee.   (5)  The dean of the university of Iowa college of medicine, or the dean’s designee.   (6)  A member of the hawk-i board created in section 514I.5, selected by the members of the hawk-i board.   (7)  The following members of the general assembly, each for a term of two years as provided in section 69.16B:   (a)  Two members of the house of representatives, one appointed by the speaker of the house of representatives and one appointed by the minority leader of the house of representatives from their respective parties.   (b)  Two members of the senate, one appointed by the president of the senate after consultation with the majority leader of the senate and one appointed by the minority leader of the senate.   2.  3.  The voting membership of the council shall include all of the following voting members be selected or appointed as follows:   a.  The five professional or business entity members shall be selected by the entities specified under this paragraph “a”. The five professional or business entity members selected shall be the president, or the president’s representative, of each of the following professional or business entities entity, or a member of each of the following professional or business entities, selected entity, designated by the entity:.   (1)  The Iowa medical society.   (2)  The Iowa osteopathic medical association.   (3)  The Iowa academy of family physicians.   (4)  The Iowa chapter of the American academy of pediatrics.   (5)  The Iowa physical therapy association.   (6)  The Iowa dental association.   (7)  The Iowa nurses association.   (8)  The Iowa pharmacy association.   (9)  The Iowa podiatric medical society.   (10)  The Iowa optometric association.   (11)  The Iowa association of community providers.   (12)  The Iowa psychological association.   (13)  The Iowa psychiatric society.   (14)  The Iowa chapter of the national association of social workers.   (15)  The coalition for family and children’s services in Iowa.   (16)  The Iowa hospital association.   (17)  The Iowa association of rural health clinics.   (18)  The Iowa primary care association.   (19)  Free clinics of Iowa.   (20)  The opticians’ association of Iowa, inc.   (21)  The Iowa association of hearing health professionals.   (22)  The Iowa speech and hearing association.   (23)  The Iowa health care association.   (24)  The Iowa association of area agencies on aging.   (25)  AARP.   (26)  The Iowa caregivers association.   (27)  Leading age Iowa.   (28)  The Iowa association for home care.   (29)  The Iowa council of health care centers.   (30)  The Iowa physician assistant society.   (31)  The Iowa association of nurse practitioners.   (32)  The Iowa nurse practitioner society.   (33)  The Iowa occupational therapy association.   (34)  The ARC of Iowa, formerly known as the association for retarded citizens of Iowa.   (35)  The national alliance on mental illness.   (36)  The Iowa state association of counties.   (37)  The Iowa developmental disabilities council.   (38)  The Iowa chiropractic society.   (39)  The Iowa academy of nutrition and dietetics.   (40)  The Iowa behavioral health association.   (41)  The midwest association for medical equipment services or an affiliated Iowa organization.   b.  Ten The five public members shall be public representatives which may include members of consumer groups, including recipients of medical assistance or their families, consumer organizations, and others, appointed by the governor for staggered terms of two years each, none of whom shall be members of, or practitioners of, or have a pecuniary interest in any of the professional or business entities specifically represented under paragraph “a”, and a majority of whom shall be current or former recipients of medical assistance or members of the families of current or former recipients.   c.  A member of the hawk-i board created in section 514I.5, selected by the members of the hawk-i board.   3.  The council shall include all of the following nonvoting members:   a.  The director of public health, or the director’s designee.   b.  The director of the department on aging, or the director’s designee.   c.  The long-term care ombudsman, or the long-term care ombudsman’s designee.   d.  The dean of Des Moines university osteopathic medical center, or the dean’s designee.   e.  The dean of the university of Iowa college of medicine, or the dean’s designee.   f.  The following members of the general assembly, each for a term of two years as provided in section 69.16B:   (1)  Two members of the house of representatives, one appointed by the speaker of the house of representatives and one appointed by the minority leader of the house of representatives from their respective parties.   (2)  Two members of the senate, one appointed by the president of the senate after consultation with the majority leader of the senate and one appointed by the minority leader of the senate.   4.  a.  An executive committee of the council is created and shall consist of the following members of the council:   (1)  Five of the professional or business entity members designated pursuant to subsection 2, paragraph “a”, and selected by the members specified under that paragraph, as voting members.   (2)  Five of the public members appointed pursuant to subsection 2, paragraph “b”, and selected by the members specified under that paragraph, as voting members. Of the five public members, at least one member shall be a recipient of medical assistance.   (3)  The director of public health, or the director’s designee, as a nonvoting member.   b.  The executive committee shall meet on a monthly basis. The director of public health and the public member serving as co-chairperson of the council shall serve as co-chairpersons of the executive committee.   c.  4.  Based upon the deliberations of the council and the executive committee, the executive committee council shall make recommendations to the director regarding the budget, policy, and administration of the medical assistance program.   5.  For each council meeting, other than those held during the time the general assembly is in session, each legislative member of the council shall be reimbursed for actual travel and other necessary expenses and shall receive a per diem as specified in section 7E.6 for each day in attendance, as shall the members of the council or the executive committee who are recipients or the family members of recipients of medical assistance, regardless of whether the general assembly is in session.   6.  The department shall provide staff support and independent technical assistance to the council and the executive committee.   7.  The director shall consider the recommendations offered by the council and the executive committee in the director’s preparation of medical assistance budget recommendations to the council on human services pursuant to section 217.3 and in implementation of medical assistance program policies.DIVISION XIXMEDICAID COVERAGE PREGNANT WOMEN LAWFULLY ADMITTED FOR PERMANENT RESIDENCE   Sec. 92.   MEDICAID COVERAGE PREGNANT WOMEN LAWFULLY ADMITTED FOR PERMANENT RESIDENCE IN THE UNITED STATES WITHOUT APPLICATION OF FIVE-YEAR WAITING PERIOD.   1.  The department of human services shall seek a waiver from the centers for Medicare and Medicaid services of the United States department of health and human services to provide coverage under the Medicaid program for pregnant women lawfully admitted for permanent residence in the United States, without application of the five-year waiting period.   2.  If federal approval is received by the department, the department shall provide Medicaid coverage for pregnant women lawfully admitted for permanent residence in the United States, without application of the five-year waiting period, effective the first day of the month following the department’s receipt of federal approval.DIVISION XXPROVISION OF CERTAIN SURGERIES OR PROCEDURES EXEMPTION FROM REQUIRED ACCOMMODATIONS OR SERVICES   Sec. 93.   Section 216.7, Code 2019, is amended by adding the following new subsection:   NEW SUBSECTION.  3.  This section shall not require any state or local government unit or tax-supported district to provide for sex reassignment surgery or any other cosmetic, reconstructive, or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder.   Sec. 94.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.DIVISION XXIREVISION OF MEDICAID MANAGED CARE CONTRACTS LIQUIDATED DAMAGES   Sec. 95.   REVISION OF MEDICAID MANAGED CARE CONTRACTS LIQUIDATED DAMAGES.  The department shall revise the Medicaid managed care contracts to include all of the following provisions:   1.  The assessment of liquidated damages for prior authorization and claims payment system issues that were reported by the managed care organization to the department as corrected, but reoccurred within 60 days of the reported correction.   2.  The assessment of liquidated damages for the failure of a managed care organization to complete provider credentialing or to accurately load provider rosters as required in the contract.DIVISION XXIIHEALTH DATA COLLECTION AND USE   Sec. 96.   Section 135.166, subsection 1, Code 2019, is amended to read as follows:   1.  a.  The department of public health shall enter into a memorandum of understanding to utilize the Iowa hospital association with the contractor selected through a request for proposals process to act as the department’s intermediary in collecting, maintaining, and disseminating hospital inpatient, outpatient, and ambulatory data, as initially authorized in 1996 Iowa Acts, ch.1212, §5, subsection 1, paragraph “a”, subparagraph (4), and 641 IAC 177.3.   b.  The memorandum of understanding shall include but is not limited to provisions that address the duties of the department and the Iowa hospital association contractor regarding the collection, reporting, disclosure, storage, and confidentiality of the data.   Sec. 97.   REQUEST FOR PROPOSALS PROCESS TRANSITION.  The department of public health shall continue the memorandum of understanding with the entity acting as intermediary on June 30, 2019, pursuant to section 135.166, until the contractor selected through a request for proposals process assumes the duties of intermediary on January 1, 2021, as specified under this division of this Act.DIVISION XXIIIdistribution of federal funds restrictions abortion   Sec. 98.   DISTRIBUTION OF FEDERAL PUBLIC HEALTH SERVICES ACT FUNDS FOR FAMILY PLANNING.   1.  The department of public health shall annually apply to the United States department of health and human services for grant funding under Tit.X of the federal Public Health Services Act, 42 U.S.C.§300 et seq. The department shall distribute all grant funding received to applicants in the following order of priority:   a.  Public entities that provide family planning services including state, county, or local community health clinics, federally qualified health centers, and community action organizations.   b.  Nonpublic entities that, in addition to family planning services, provide required primary health services as described in 42 U.S.C.§254b(b)(1)(A).   c.  Nonpublic entities that provide family planning services but do not provide required primary health services as described in 42 U.S.C.§254b(b)(1)(A).   2.  Distribution of funds under this section shall be made in a manner that continues access to family planning services.   3.  a.  (1)  Distribution of funds under this section shall not be made to any entity that performs abortions, promotes abortions, maintains or operates a facility where abortions are performed or promoted, contracts or subcontracts with an entity that performs or promotes abortions, becomes or continues to be an affiliate of any entity that performs or promotes abortions, or regularly makes referrals to an entity that provides or promotes abortions or maintains or operates a facility where abortions are performed. However, the prohibition specified in this subparagraph (1) shall not be interpreted to include a nonpublic entity that is a distinct location of a nonprofit health care delivery system, if the distinct location provides family planning services but does not perform abortions or maintain or operate as a facility where abortions are performed.   (2)  The department of public health shall adopt rules pursuant to chapter 17A to require that as a condition of eligibility as an applicant under this section, each distinct location of a nonprofit health care delivery system shall be assigned a distinct provider identification number and complete an attestation that abortions are not performed at the distinct location.   b.  For the purposes of this section, “nonprofit health care delivery system” means an Iowa nonprofit corporation that controls, directly or indirectly, a regional health care network consisting of hospital facilities and various ambulatory and clinic locations that provide a range of primary, secondary, and tertiary inpatient, outpatient, and physician services.   c.  For the purposes of this section, “abortion” does not include any of the following:   (1)  The treatment of a woman for a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death.   (2)  The treatment of a woman for a spontaneous abortion, commonly known as a miscarriage, when not all of the products of human conception are expelled.   4.  Funds distributed in accordance with this section shall not be used for direct or indirect costs, including but not limited to administrative costs or expenses, overhead, employee salaries, rent, and telephone and other utility costs, related to providing or promoting abortions as specified in this section.   5.  The department of public health shall submit a report to the governor and the general assembly, annually by January 1, listing any entities that received funds pursuant to subsection 1, paragraph “c”, and the amount and type of funds received by such entities during the preceding calendar year. The report shall provide a detailed explanation of how the department determined that distribution of funds to such an entity, instead of to an entity described in subsection 1, paragraph “a” or “b”, was necessary to prevent severe limitation or elimination of access to family planning services in the region of the state where the entity is located.   Sec. 99.   ADMINISTRATION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM AND SEXUAL RISK AVOIDANCE EDUCATION GRANT PROGRAM FUNDS.   1.  Any contract entered into on or after July 1, 2019, by the department of public health to administer the personal responsibility education program as specified in 42 U.S.C.§713 or to administer the sexual risk avoidance education grant program authorized pursuant to section 510 of Tit.V of the federal Social Security Act, 42 U.S.C.§710, as amended by section 50502 of the federal Bipartisan Budget Act of 2018, Pub.L. No.115-123, and as further amended by division S, Title VII, section 701 of the federal Consolidated Appropriations Act of 2018, Pub.L. No.115-141, shall exclude as an eligible applicant, any applicant entity that performs abortions, promotes abortions, maintains or operates a facility where abortions are performed or promoted, contracts or subcontracts with an entity that performs or promotes abortions, becomes or continues to be an affiliate of any entity that performs or promotes abortions, or regularly makes referrals to an entity that provides or promotes abortions or maintains or operates a facility where abortions are performed. However, the prohibition specified in this section shall not be interpreted to include a nonpublic entity that is a distinct location of a nonprofit health care delivery system, if the distinct location provides personal responsibility education program or sexual risk avoidance education grant program services but does not perform abortions or maintain or operate as a facility where abortions are performed.   2.  The department of public health shall adopt rules pursuant to chapter 17A to require that as a condition of eligibility as an applicant, grantee, grantee contractor, or grantee subcontractor under the personal responsibility education program or sexual risk avoidance education grant program, each distinct location of a nonprofit health care delivery system shall be assigned a distinct identification number and complete an attestation that abortions are not performed at the distinct location.   3.  For the purposes of this section, “nonprofit health care delivery system” means an Iowa nonprofit corporation that controls, directly or indirectly, a regional health care network consisting of hospital facilities and various ambulatory and clinic locations that provide a range of primary, secondary, and tertiary inpatient, outpatient, and physician services.   4.  For the purposes of this section, “abortion” does not include any of the following:   a.  The treatment of a woman for a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death.   b.  The treatment of a woman for a spontaneous abortion, commonly known as a miscarriage, when not all of the products of human conception are expelled.   Sec. 100.   AWARD OF COMMUNITY ADOLESCENT PREGNANCY PREVENTION AND SERVICES PROGRAM GRANT FUNDS.   1.  Any contract entered into on or after July 1, 2019, by the department of human services to award a community adolescent pregnancy prevention and services program grant using federal temporary assistance for needy families block grant funds appropriated to the department shall exclude from eligibility any applicant, grantee, grantee contractor, or grantee subcontractor that performs abortions, promotes abortions, maintains or operates a facility where abortions are performed or promoted, contracts or subcontracts with an entity that performs or promotes abortions, becomes or continues to be an affiliate of any entity that performs or promotes abortions, or regularly makes referrals to an entity that provides or promotes abortions or maintains or operates a facility where abortions are performed.    2.  The eligibility exclusion specified in subsection 1 shall not be interpreted to include a nonpublic entity that is a distinct location of a nonprofit health care delivery system, if the distinct location provides community adolescent pregnancy prevention program services but does not perform abortions or maintain or operate as a facility where abortions are performed.   3.  The department of human services shall adopt rules pursuant to chapter 17A to require that as a condition of eligibility as an applicant, grantee, grantee contractor, or grantee subcontractor under the adolescent pregnancy prevention and services program, each distinct location of a nonprofit health care delivery system shall be assigned a distinct identification number and complete an attestation that abortions are not performed at the distinct location.   4.  For the purposes of this section, “nonprofit health care delivery system” means an Iowa nonprofit corporation that controls, directly or indirectly, a regional health care network consisting of hospital facilities and various ambulatory and clinic locations that provide a range of primary, secondary, and tertiary inpatient, outpatient, and physician services.   5.  For the purposes of this section, “abortion” does not include any of the following:   a.  The treatment of a woman for a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death.   b.  The treatment of a woman for a spontaneous abortion, commonly known as a miscarriage, when not all of the products of human conception are expelled.   Sec. 101.   SEVERABILITY.  If any provision of this division of this Act or the application of this division of this Act to any person or circumstances is held invalid, the invalidity shall not affect other provisions or applications of this division of this Act which can be given effect without the invalid provisions or application and, to this end, the provisions of this division of this Act are severable.   Sec. 102.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.DIVISION XXIVNON-STATE GOVERNMENT-OWNED NURSING FACILITY QUALITY OF CARE RATE ADD-ON PROGRAM   Sec. 103.   Section 249L.2, subsections 7 and 8, Code 2019, are amended to read as follows:   7.  “Non-state government-owned nursing facility” means a nursing facility that is owned or operated by a non-state governmental entity and for which a non-state governmental entity holds the nursing facility’s license and is party to the nursing facility’s Medicaid contract.   8.  “Nursing facility” means a licensed nursing facility as defined in section 135C.1 that is a freestanding facility or a nursing facility operated by a hospital licensed pursuant to chapter 135B, but does not include a distinct-part skilled nursing unit or a swing-bed unit operated by a hospital, or a nursing facility owned by the state or federal government or other governmental unit. “Nursing facility” includes a non-state government-owned nursing facility if the nursing facility participates in the non-state government-owned nursing facility upper payment limit alternative payment quality of care rate add-on program.   Sec. 104.   NON-STATE GOVERNMENT-OWNED NURSING FACILITY QUALITY OF CARE RATE ADD-ON PROGRAM.   1.  As used in this section, unless the context otherwise requires:   a.  “Department” means the department of human services.   b.  “Intergovernmental transfer” means a transfer of state share funds from a non-state governmental entity to the department of human services.   c.  “Non-state governmental entity” or “NSGE” means a hospital authority, hospital district, health care district, city, or county.   d.  “Non-state government-owned nursing facility” or “NSGO nursing facility” means a nursing facility that is owned or operated by a non-state governmental entity and for which a non-state governmental entity holds the nursing facility’s license and is party to the nursing facility’s Medicaid contract.   e.  “Program” means the non-state government-owned nursing facility quality of care rate add-on program described in this section.   f.  “Quality of care rate add-on calculation period” means the fiscal year for which quality of care rate add-on amounts are calculated based on adjudicated claims for days of service provided.   g.  “Upper payment limit” means a reasonable estimate of the amount that would be paid for the services furnished by a facility under Medicare payment principles.   2.  The department of human services shall submit to the centers for Medicare and Medicaid services of the United States department of health and human services (CMS), a Medicaid state plan amendment to allow a qualifying NSGE to receive a quality of care rate add-on in accordance with the upper payment limit requirements pursuant to 42 C.F.R.§447.272 and managed care requirements pursuant to 42 C.F.R.§438.6.   3.  The Medicaid state plan amendment submitted shall provide for all of the following:   a.  Purpose.  The NSGO nursing facility quality of care rate add-on shall be made to a qualified NSGE to promote, maintain, and improve resident quality of care and health outcomes.   b.  Non-state government-owned nursing facility qualifications.  An NSGO nursing facility shall qualify for participation in the program if all of the following conditions are met:   (1)  The NSGE for the NSGO nursing facility has executed a participation agreement with the department.   (2)  The NSGE for the NSGO nursing facility has provided proof that the entity holds the NSGO nursing facility’s license and has complete operational responsibility for the NSGO nursing facility.   (3)  The NSGE for the NSGO nursing facility has filed a certification of eligibility application for the quality of care rate add-on program with the department and has received approval from the department for participation in the program.   (4)  The NSGO nursing facility is an active participant in established Medicaid managed care value-based purchasing programs and initiatives in the state.   (5)  The NSGO nursing facility and the NSGE for the NSGO nursing facility are in compliance with care criteria requirements.   c.  NSGE participation requirements.  An NSGE shall qualify for participation in the program if all of the following conditions are met:   (1)  The NSGE has executed a nursing facility provider contract with an NSGO nursing facility.   (2)  The NSGE has provided, and identified the source of, state share dollars for the intergovernmental transfer.   (3)  The NSGE has provided proof of ownership, if applicable, as the licensed operator of the NSGO nursing facility.   (4)  The NSGE has provided, to the department, an executed management agreement between the NSGE and the NSGO nursing facility manager.   d.  Care criteria requirements.  A participating NSGO nursing facility shall comply with all of the following care criteria quality metrics, shall adhere to all of the following performance measures to improve the quality of care delivered to residents and to improve efficiency and care avoidance costs for the overall Medicaid program, and shall do all of the following:   (1)  Develop a written action plan that includes satisfaction survey results, an analysis of the satisfaction survey results with identification of areas in need of improvement, and a process for addressing areas in need of improvement.   (2)  Develop and implement, within six months of commencement of participation in the program, a written plan for the mitigation of unnecessary inpatient admissions within 30 days of a nursing facility discharge. The written plan shall include or address all of the following:   (a)  The inpatient admission management tool which identifies those residents at high risk for the potential return to acute care.   (b)  The tools to support effective communications.   (c)  Advance directive planning and implementation.   (d)  Application of a quality assurance and program integrity methodology to provide a root cause analysis and identify teaching needs.   (3)  Develop and implement a written plan providing for a proactive pneumonia and influenza vaccination program which shall improve vaccination scores above the national average, as measured using CMS quality metrics. The written plan shall include all of the following:   (a)  The latest available three-quarter average of both the CMS measure for the percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine and of the CMS measure for the percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine, to establish a baseline.   (b)  The current measure code score for the CMS measures described in subparagraph division (a).   (c)  A written plan for an influenza and pneumonia vaccination program to address new admissions and current residents.   (4)  Elevate healthy aging in the state by implementing a plan that accomplishes at least one of the following strategies:   (a)  Prevention and reduction of falls.   (b)  Improved nutrition.   (c)  Increased physical activity.   (d)  Reduction in the incidence of depression.   (5)  Demonstrate improvement above the facility-specific baseline in the CMS five-star quality measures composite scoring. Metrics shall be determined based upon the CMS nursing home compare composite score over the preceding twelve-month period.    (a)  A participating NSGO nursing facility shall provide the most recent three-quarter average of the CMS quality measure star rating to establish a baseline.   (b)  A participating NSGO nursing facility shall have a star rating of three or better or must demonstrate improvement over the previous quarter with no two quarters below three stars to participate in the program.   (c)  A participating NSGO nursing facility with a quality measure star rating of three or better for the most recent quarter or that demonstrates improvement in composite scoring with no two quarters consistently below a three-star rating, shall be deemed to have met the care criteria.    e.  Quality of care rate add-on.   (1)  The nursing facility quality of care rate add-on provided to a participating NSGE under the program shall not exceed Medicare payment principles pursuant to 42 C.F.R.§447.272 and shall be calculated pursuant to 42 C.F.R.§438.6. The quality of care rate add-on shall be calculated and paid as follows:   (a)  The methodology utilized to calculate the upper payment limit shall be based on the data available during the calculation period.   (b)  The eligible amount used in determining the quality of care rate add-on shall be the difference between the state Medicaid payment and the Medicare upper payment limit as determined, based on compliance with the care criteria metrics, on an annual basis.   (c)  The difference calculated under subparagraph division (b) shall be divided by total patient days as determined under subparagraph division (b).    (d)  The quality of care rate add-on shall be paid prospectively.   (2)  The amount of the quality of care rate add-on shall be associated with improvement in care of Medicaid nursing facility residents in the state as demonstrated through the specified care criteria. A participating NSGE shall receive payment under the program based on earned percentages related to the care criteria. A participating NSGE shall meet or exceed at least two of the five established care criteria metrics to be eligible for the rate add-on payment for each quarter. After at least two of the five metrics have been met, the participating NSGE shall be eligible for seventy percent of the total eligible quality of care rate add-on amount for a participating NSGO nursing facility. The participating NSGE may qualify for the remaining thirty percent of the total eligible quality of care rate add-on amount, by attribution in ten percent increments, for each additional care criterion that is met up to the full one hundred percent of the eligible quality of care rate add-on amount.   f.  Change of ownership.   (1)  A participating NSGO nursing facility shall notify the department of any change of ownership that may affect the participating NSGO nursing facility’s continued eligibility for the program, within thirty days after such change.    (2)  If a participating NSGO nursing facility changes ownership on or after the first day of the quality of care rate add-on calculation period, the data used for calculations shall include data from the participating NSGO nursing facility for the entire quality of care rate add-on calculation period relating to payments for days of service provided under the prior owner, prorated to reflect only the number of calendar days during the calculation period that the participating NSGO nursing facility is owned by the new owner.   g.  Payment to participating NSGO nursing facilities. A participating NSGO nursing facility shall secure allowable intergovernmental transfer funds from a participating NSGE to provide the state share amount. The process for the intergovernmental transfer shall comply with the following:   (1)  The department, or the department’s designee, shall notify the participating NSGE of the state share amount to be transferred in the form of an intergovernmental transfer for purposes of seeking federal financial participation for the rate add-on payment, within twenty-five business days after the end of a quarter. The amount shall reflect the percentage of metrics achieved under the care criteria requirement. The participating NSGE shall have five business days from the date of receipt of the departmental notification to sign the participation agreement and remit payment of the state share amount in the form of an intergovernmental transfer to the department or the department’s designee.   (2)  If the total intergovernmental transfer amount is received by the department or the department’s designee within the five business days as specified, the quality of care rate add-on shall be included in the current quarter per diem rate calculation for the participating NSGO nursing facility.    h.  Penalties and adjustments. Failure by a participating NSGE to remit the full intergovernmental transfer amount or the correct amount as indicated by the department or the department’s designee within the following defined time frames indicates the participating NSGE has voluntarily elected to withdraw from program participation for that current quarter and must reapply for participation in the program in any subsequent quarter. All of the following shall apply when determining the application of penalties and adjustments:   (1)  The total amount of the intergovernmental transfer must be received from the participating NSGE by the department or the department’s designee within five business days from receipt by the participating NSGE of notification from the department or the department’s designee of the state share amount.    (a)  Receipt of the total intergovernmental transfer amount by the department or the department’s designee within five business days is not subject to penalty.   (b)  The date of receipt of notification of the state share amount by the participating NSGE from the department or the department’s designee is the official reference date in measuring the commencement of the five business days.   (2)  Any intergovernmental transfer amount received by the department or the department’s designee after the fifth business day as specified, but with a date stamp or mailing postal mark indicating a date on or prior to five business days from the date of notification by the department or the department’s designee of the state share amount, shall not be subject to penalty.   (3)  (a)  Any intergovernmental transfer amount received by the department or the department’s designee after the fifth business day as specified, but with a date stamp or postal mark indicating a date after five business days but not exceeding eight business days from the date of notification by the department or the department’s designee of the state share amount, shall be deemed late and the participating NSGE shall receive the quality of care rate add-on, including an assessed penalty of five percent, based on the total intergovernmental transfer payments received during the late period. The five percent penalty shall be applied to the quality of care rate add-on for the quarter in which the intergovernmental transfer amount is late.   (b)  The department shall notify the participating NSGE of the assessed penalty in writing. If the participating NSGE fails to pay the department or the department’s designee the assessed penalty within the time frame noted on the written notice to the participating NSGE, the assessed penalty shall be deducted in accordance with the state Medicaid fee-for-service recoupment process. The penalty shall be paid regardless of any appeal requested by the participating NSGE. If an appeal results in a decision to disallow a portion of or the entire assessed penalty, reimbursement to the participating NSGE shall be made as part of future Medicaid payments to the participating NSGO nursing facility.    (4)  If a participating NSGO nursing facility fails to achieve, at a minimum, two of the required care criteria metrics for two consecutive quarters, the participating NSGO nursing facility shall be suspended from participation in the program for two subsequent quarters. An NSGO nursing facility that has been suspended for a total of four quarters within a two-year period due to noncompliance with the required care criteria shall be terminated from the program, and shall be required to reapply for approval to participate at a subsequent time. Readmittance into the program is at the sole discretion of the department, taking into consideration input from stakeholders. If the NSGO nursing facility is subsequently readmitted to the program, terms of participation may include a probationary period with defined requirements related to care.   4.  The quality of care rate add-on shall only be implemented upon receipt by the department of approval of the Medicaid state plan amendment by CMS, and if such approval is received, the rate add-on is applicable no earlier than the first day of the calendar quarter following the date of receipt of such approval.   Sec. 105.   REPEAL.  2016 Iowa Acts, chapter 1139, sections 80, 81, 82, 83, and 84, are repealed.   Sec. 106.   REPEAL.  2017 Iowa Acts, chapter 174, sections 113, 114, 115, and 116, are repealed.   Sec. 107.   EFFECTIVE UPON ENACTMENT.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.   Sec. 108.   IMPLEMENTATION PROVISIONS.   1.  The section of this division of this Act directing the department of human services to submit a Medicaid state plan amendment to CMS shall be implemented as soon as possible following enactment, consistent with all applicable federal requirements.   2.  The section of this division of this Act amending section 249L.2, shall only be implemented upon receipt by the department of human services of approval of the Medicaid state plan amendment by CMS, and if such approval is received, is applicable no earlier than the first day of the calendar quarter following the date of receipt of such approval.DIVISION XXVPREPARATION FOR ADULT LIVING PROGRAM   Sec. 109.   Section 234.46, subsection 1, paragraph b, Code 2019, is amended to read as follows:   b.  The person is age eighteen, nineteen, or twenty, twenty-one, or twenty-two.DIVISION XXVICHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD   Sec. 110.   Section 225C.51, if enacted by 2019 Iowa Acts, House File 690,Chapter 61 herein section 8, is amended to read as follows:   SEC. 8.  NEW SECTION.  225C.51  Children’s behavioral health system state board.   1.  A children’s behavioral health system state board is created as the state body to provide guidance on the implementation and management of a children’s behavioral health system for the provision of services to children with a serious emotional disturbance. The state board’s public voting members shall be appointed to four-year staggered terms by the governor and are subject to confirmation by the senate. All other state board voting members shall be appointed to four-year staggered terms and are not subject to confirmation by the senate. State board members shall be appointed on the basis of interest and experience in the fields of children’s behavioral health to ensure adequate representation from persons with life experiences and from persons knowledgeable about children’s behavioral health services. The department shall provide support to the state board, and the board may utilize staff support and other assistance provided to the state board by other persons. The state board shall meet at least four times per year. The membership of the state board shall consist of the following persons who, at the time of appointment to the state board, are active members of the indicated groups:    a.  The director of the department of human services or the director’s designee.   b.  The director of the department of education or the director’s designee.   c.  The director of the department of public health or the director’s designee.   d.  The director of workforce development or the director’s designee.   e.  A member of the mental health and disability services commission.   e.  f.  Members appointed by the governor who are active members of each of the indicated groups:   (1)  One member shall be selected from nominees submitted by the state court administrator.   f.  (2)  One member shall be selected from nominees submitted by the early childhood Iowa office in the department of management.   g.  One member shall be a member of the mental health and disability services commission.    h.  (3)  One member shall be a board member or an employee of a provider of mental health services to children.   i.  (4)  One member shall be a board member or an employee of a provider of child welfare services.   j.  (5)  One member shall be an administrator of an area education agency.   k.  (6)  One member shall be an educator, counselor, or administrator of a school district.   l.  (7)  One member shall be a representative of an established advocacy organization whose mission or purpose it is, in part, to further goals related to children’s mental health.   m.  (8)  One member shall be a parent or guardian of a child currently utilizing or who has utilized behavioral health services.   n.  (9)  One member shall be a sheriff.   o.  (10)  One member shall be a pediatrician.   p.  (11)  One member shall be a representative from a health care system.   q.  (12)  One member shall be a chief executive officer of a mental health and disability services region.   r.  f.  In addition to the voting members, the membership shall include four members of the general assembly with one member designated by each of the following: the majority leader of the senate, the minority leader of the senate, the speaker of the house of representatives, and the minority leader of the house of representatives. A legislative member serves for a term as provided in section 69.16B in a nonvoting, ex officio capacity and is not eligible for per diem and expenses as provided in section 2.10.   2.  Members appointed by the governor shall serve four-year staggered terms and are subject to confirmation by the senate. The four-year terms shall begin and end as provided in section 69.19. Vacancies on the state board shall be filled as provided in section 2.32. A member shall not be appointed for more than two consecutive four-year terms.   3.  The director of the department of human services and the director of the department of education, or their designees, shall serve as co-chairpersons of the state board. Board members shall not be entitled to a per diem as specified in section 7E.6 and shall not be entitled to actual and necessary expenses incurred while engaged in their official duties.DIVISION XXVIIPRIOR YEAR CARRYFORWARD PROVISIONSFAMILY INVESTMENT PROGRAM GENERAL FUND ACCOUNT   Sec. 111.   2017 Iowa Acts, chapter 174, section 47, is amended by adding the following new subsection:   NEW SUBSECTION.  7.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated, and may be transferred to the appropriations made in this division of this Act for general administration and field operations for technology needs including the eligibility integrated applications solutions (ELIAS) project, or may be transferred to the appropriations made in this division of this Act for the juvenile institution, the mental health institutes, or the state resource centers, to be used for the purposes of those appropriations, until the close of the succeeding fiscal year.STATE RESOURCE CENTERS   Sec. 112.   2017 Iowa Acts, chapter 174, section 63, is amended by adding the following new subsection:   NEW SUBSECTION.  6.  Notwithstanding section 8.33, and notwithstanding the amount limitation specified in section 222.92, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated, including year-end purchases and technology needs, and may be transferred to the appropriations made in this division of this Act for the juvenile institution or the mental health institutes, to be used for the purposes of those appropriations, until the close of the succeeding fiscal year.FIELD OPERATIONS   Sec. 113.   2017 Iowa Acts, chapter 174, section 65, as amended by 2018 Iowa Acts, chapter 1165, section 35, is amended to read as follows:   SEC. 65.  FIELD OPERATIONS.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2018, and ending June 30, 2019, the following amount, or so much thereof as is necessary, to be used for the purposes designated:   For field operations, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 49,074,517  ......................................................... FTEs 1,539.00   Priority in filling full-time equivalent positions shall be given to those positions related to child protection services and eligibility determination for low-income families.   Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated, including for technology needs, personal computer replacements, and accelerated hiring, and may be transferred to the appropriations made in this division of this Act for the juvenile institution, the mental health institutes, or the state resource centers, to be used for the purposes of those appropriations, until the close of the succeeding fiscal year.GENERAL ADMINISTRATION   Sec. 114.   2017 Iowa Acts, chapter 174, section 66, as amended by 2018 Iowa Acts, chapter 1165, section 36, is amended to read as follows:   SEC. 66.  GENERAL ADMINISTRATION.   1.  There is appropriated from the general fund of the state to the department of human services for the fiscal year beginning July 1, 2018, and ending June 30, 2019, the following amount, or so much thereof as is necessary, to be used for the purpose designated:   For general administration, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time equivalent positions:  ............................................................ $ 13,833,040  ......................................................... FTEs 294.00   2.  Of the funds appropriated in this section, $150,000 shall be used to continue the contract for the provision of a program to provide technical assistance, support, and consultation to providers of habilitation services and home and community-based services waiver services for adults with disabilities under the medical assistance program.   3.  Of the funds appropriated in this section, $50,000 is transferred to the Iowa finance authority to be used for administrative support of the council on homelessness established in section 16.2D and for the council to fulfill its duties in addressing and reducing homelessness in the state.   4.  Of the funds appropriated in this section, $200,000 shall be transferred to and deposited in the administrative fund of the Iowa ABLE savings plan trust created in section 12I.4, to be used for implementation and administration activities of the Iowa ABLE savings plan trust.   5.  Of the funds appropriated in this section, $200,000 is transferred to the economic development authority for the Iowa commission on volunteer services to continue to be used for the RefugeeRISE AmeriCorps program established under section 15H.8 for member recruitment and training to improve the economic well-being and health of economically disadvantaged refugees in local communities across Iowa. Funds transferred may be used to supplement federal funds under federal regulations.   7.  Of the funds appropriated in this section, $300,000 shall be used to contract for children’s well-being collaboratives grants for the development and implementation of children’s well-being collaboratives to establish and coordinate prevention and early intervention services to promote improved mental health and well-being for children and families, as enacted in 2017 Iowa Acts, chapter 174, section 88.   8.  The department of human services shall submit the strategic plan to create and implement a children’s mental health system submitted to the governor by the children’s system state board established by Executive Order Number TwoPublished in IAB XL, No. 23 (5/9/18) p. 2899 issued April 23, 2018, to the general assembly by November 15, 2018.    9.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated, including for technology needs and the relocation of the Iowa Medicaid enterprise, and may be transferred to the appropriations made in this division of this Act for the juvenile institution, the mental health institutes, or the state resource centers, to be used for the purposes of those appropriations, until the close of the succeeding fiscal year.STATE SUPPLEMENTARY ASSISTANCE   Sec. 115.   2018 Iowa Acts, chapter 1165, section 53, subsection 4, is amended to read as follows:   4.  Notwithstanding section 8.33, moneys appropriated in this section that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated, including for technology needs, and may be transferred to the appropriations made in this division of this Act for general administration, field operations, the juvenile institution, the mental health institutes, or the state resource centers, to be used for the purposes of those appropriations, until the close of the succeeding fiscal year.   Sec. 116.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.   Sec. 117.   RETROACTIVE APPLICABILITY.  This division of this Act applies retroactively to July 1, 2017.DIVISION XXVIIIVACCINE AND IMMUNIZATION ADMINISTRATION FUTURE REPEAL   Sec. 118.   2018 Iowa Acts, chapter 1142, section 8, is amended to read as follows:   SEC. 8.  FUTURE REPEAL.  Section 155A.44, Code 2018, is repealed effective July 1, 2019 2020.   Sec. 119.   EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.Approved May 3, 2019