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Senate Study Bill 1267 - IntroducedA Bill ForAn Act 1relating to appropriations for health and human
2services and veterans and including other related provisions
3and appropriations, providing penalties, and including
4effective date and retroactive and other applicability date
5provisions.
6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2DEPARTMENT ON AGING — FY 2021-2022
3 Section 1. DEPARTMENT ON AGING. There is appropriated from
4the general fund of the state to the department on aging for
5the fiscal year beginning July 1, 2021, and ending June 30,
62022, the following amount, or so much thereof as is necessary,
7to be used for the purposes designated:
8For aging programs for the department on aging and area
9agencies on aging to provide citizens of Iowa who are 60
10years of age and older with case management, Iowa’s aging and
11disabilities resource center, and other services which may
12include but are not limited to adult day, respite care, chore,
13information and assistance, and material aid, for information
14and options counseling for persons with disabilities who
15are 18 years of age or older, and for salaries, support,
16administration, maintenance, and miscellaneous purposes, and
17for not more than the following full-time equivalent positions:
.................................................. $1811,164,382
............................................... FTEs1927.00
201. Funds appropriated in this section may be used to
21supplement federal funds under federal regulations. To
22receive funds appropriated in this section, a local area
23agency on aging shall match the funds with moneys from other
24sources according to rules adopted by the department. Funds
25appropriated in this section may be used for elderly services
26not specifically enumerated in this section only if approved
27by an area agency on aging for provision of the service within
28the area.
292. Of the funds appropriated in this section, $279,000 is
30transferred to the economic development authority for the Iowa
31commission on volunteer services to be used for the retired and
32senior volunteer program.
333. a. The department on aging shall establish and enforce
34procedures relating to expenditure of state and federal funds
35by area agencies on aging that require compliance with both
-1-1state and federal laws, rules, and regulations, including but
2not limited to all of the following:
3(1) Requiring that expenditures are incurred only for goods
4or services received or performed prior to the end of the
5fiscal period designated for use of the funds.
6(2) Prohibiting prepayment for goods or services not
7received or performed prior to the end of the fiscal period
8designated for use of the funds.
9(3) Prohibiting prepayment for goods or services not
10defined specifically by good or service, time period, or
11recipient.
12(4) Prohibiting the establishment of accounts from which
13future goods or services which are not defined specifically by
14good or service, time period, or recipient, may be purchased.
15b. The procedures shall provide that if any funds are
16expended in a manner that is not in compliance with the
17procedures and applicable federal and state laws, rules, and
18regulations, and are subsequently subject to repayment, the
19area agency on aging expending such funds in contravention of
20such procedures, laws, rules and regulations, not the state,
21shall be liable for such repayment.
224. Of the funds appropriated in this section, at least
23$600,000 shall be used to fund home and community-based
24services through the area agencies on aging that enable older
25individuals to avoid more costly utilization of residential or
26institutional services and remain in their own homes.
275. Of the funds appropriated in this section, $812,000 shall
28be used for the purposes of chapter 231E and to administer
29the prevention of elder abuse, neglect, and exploitation
30program pursuant to section 231.56A, in accordance with the
31requirements of the federal Older Americans Act of 1965, 42
32U.S.C.§3001 et seq., as amended.
336. Of the funds appropriated in this section, $1,000,000
34shall be used to fund continuation of the aging and disability
35resource center lifelong links to provide individuals and
-2-1caregivers with information and services to plan for and
2maintain independence.
37. Of the funds appropriated in this section, $250,000
4shall be used by the department on aging, in collaboration with
5the department of human services and affected stakeholders,
6to continue to expand the pilot initiative to provide
7long-term care options counseling utilizing support planning
8protocols, to assist non-Medicaid eligible consumers who
9indicate a preference to return to the community and are
10deemed appropriate for discharge, to return to their community
11following a nursing facility stay. The department on aging
12shall submit a report regarding the outcomes of the pilot
13initiative to the governor and the general assembly by December
1415, 2021.
15DIVISION II
16OFFICE OF LONG-TERM CARE oMBUDSMAN — FY 2021-2022
17 Sec. 2. OFFICE OF LONG-TERM CARE OMBUDSMAN. There is
18appropriated from the general fund of the state to the office
19of long-term care ombudsman for the fiscal year beginning July
201, 2021, and ending June 30, 2022, the following amount, or
21so much thereof as is necessary, to be used for the purposes
22designated:
23For salaries, support, administration, maintenance, and
24miscellaneous purposes, and for not more than the following
25full-time equivalent positions:
.................................................. $261,149,821
............................................... FTEs2716.00
28DIVISION III
29DEPARTMENT OF PUBLIC HEALTH — FY 2021-2022
30 Sec. 3. DEPARTMENT OF PUBLIC HEALTH. There is appropriated
31from the general fund of the state to the department of public
32health for the fiscal year beginning July 1, 2021, and ending
33June 30, 2022, the following amounts, or so much thereof as is
34necessary, to be used for the purposes designated:
351. ADDICTIVE DISORDERS
-3- 1For reducing the prevalence of the use of tobacco, alcohol,
2and other drugs, and treating individuals affected by addictive
3behaviors, including gambling, and for not more than the
4following full-time equivalent positions:
.................................................. $523,659,379
............................................... FTEs612.00
7a. (1) Of the funds appropriated in this subsection,
8$4,021,000 shall be used for the tobacco use prevention
9and control initiative, including efforts at the state and
10local levels, as provided in chapter 142A. The commission
11on tobacco use prevention and control established pursuant
12to section 142A.3 shall advise the director of public health
13in prioritizing funding needs and the allocation of moneys
14appropriated for the programs and initiatives. Activities
15of the programs and initiatives shall be in alignment with
16the United States centers for disease control and prevention
17best practices for comprehensive tobacco control programs that
18include the goals of preventing youth initiation of tobacco
19usage, reducing exposure to secondhand smoke, and promotion
20of tobacco cessation. To maximize resources, the department
21shall determine if third-party sources are available to
22instead provide nicotine replacement products to an applicant
23prior to provision of such products to an applicant under
24the initiative. The department shall track and report to
25the individuals specified in this Act, any reduction in
26the provision of nicotine replacement products realized by
27the initiative through implementation of the prerequisite
28screening.
29(2) (a) The department shall collaborate with the
30alcoholic beverages division of the department of commerce for
31enforcement of tobacco laws, regulations, and ordinances and to
32engage in tobacco control activities approved by the division
33of tobacco use prevention and control of the department of
34public health as specified in the memorandum of understanding
35entered into between the divisions.
-4- 1(b) For the fiscal year beginning July 1, 2021, and ending
2June 30, 2022, the terms of the memorandum of understanding,
3entered into between the division of tobacco use prevention
4and control of the department of public health and the
5alcoholic beverages division of the department of commerce,
6governing compliance checks conducted to ensure licensed retail
7tobacco outlet conformity with tobacco laws, regulations, and
8ordinances relating to persons under 21 years of age, shall
9continue to restrict the number of such checks to one check per
10retail outlet, and one additional check for any retail outlet
11found to be in violation during the first check.
12b. (1) Of the funds appropriated in this subsection,
13$19,639,000 shall be used for problem gambling and
14substance-related disorder prevention, treatment, and recovery
15services, including a 24-hour helpline, public information
16resources, professional training, youth prevention, and program
17evaluation.
18(2) Of the amount allocated under this paragraph, $306,000
19shall be utilized by the department of public health, in
20collaboration with the department of human services, to
21maintain a single statewide 24-hour crisis hotline for the Iowa
22children’s behavioral health system that incorporates warmline
23services which may be provided through expansion of existing
24capabilities maintained by the department of public health as
25required pursuant to 2018 Iowa Acts, chapter 1056, section 16.
26c. The requirement of section 123.17, subsection 5, is met
27by the appropriations and allocations made in this division of
28this Act for purposes of substance-related disorder treatment
29and addictive disorders for the fiscal year beginning July 1,
302021.
312. HEALTHY CHILDREN AND FAMILIES
32For promoting the optimum health status for children and
33adolescents from birth through 21 years of age, and families,
34and for not more than the following full-time equivalent
35positions:
-5-.................................................. $15,816,681
............................................... FTEs214.00
3a. Of the funds appropriated in this subsection, not more
4than $734,000 shall be used for the healthy opportunities for
5parents to experience success (HOPES)-healthy families Iowa
6(HFI) program established pursuant to section 135.106.
7b. In order to implement the legislative intent stated
8in sections 135.106 and 256I.9, priority for home visitation
9program funding shall be given to programs using evidence-based
10or promising models for home visitation.
11c. Of the funds appropriated in this subsection, $3,075,000
12shall be used for continuation of the department’s initiative
13to provide for adequate developmental surveillance and
14screening during a child’s first five years. The funds shall
15be used first to fully fund the current sites to ensure that
16the sites are fully operational, with the remaining funds
17to be used for expansion to additional sites. The full
18implementation and expansion shall include enhancing the scope
19of the initiative through collaboration with the child health
20specialty clinics to promote healthy child development through
21early identification and response to both biomedical and social
22determinants of healthy development; by monitoring child
23health metrics to inform practice, document long-term health
24impacts and savings, and provide for continuous improvement
25through training, education, and evaluation; and by providing
26for practitioner consultation particularly for children with
27behavioral conditions and needs. The department of public
28health shall also collaborate with the Iowa Medicaid enterprise
29and the child health specialty clinics to integrate the
30activities of the first five initiative into the establishment
31of patient-centered medical homes, community utilities,
32accountable care organizations, and other integrated care
33models developed to improve health quality and population
34health while reducing health care costs. To the maximum extent
35possible, funding allocated in this paragraph shall be utilized
-6-1as matching funds for medical assistance program reimbursement.
2d. Of the funds appropriated in this subsection, $64,000
3shall be distributed to a statewide dental carrier to provide
4funds to continue the donated dental services program patterned
5after the projects developed by the dental lifeline network to
6provide dental services to indigent individuals who are elderly
7or with disabilities.
8e. Of the funds appropriated in this subsection, $156,000
9shall be used to provide audiological services and hearing aids
10for children.
11f. Of the funds appropriated in this subsection, $23,000 is
12transferred to the university of Iowa college of dentistry for
13provision of primary dental services to children. State funds
14shall be matched on a dollar-for-dollar basis. The university
15of Iowa college of dentistry shall coordinate efforts with the
16department of public health, oral and health delivery system
17bureau, to provide dental care to underserved populations
18throughout the state.
19g. Of the funds appropriated in this subsection, $50,000
20shall be used to address youth suicide prevention.
21h. Of the funds appropriated in this subsection, $40,000
22shall be used to support the Iowa effort to address the survey
23of children who experience adverse childhood experiences known
24as ACEs.
25i. Of the funds appropriated in this subsection, up to
26$494,000 shall be used for childhood obesity prevention.
273. CHRONIC CONDITIONS
28For serving individuals identified as having chronic
29conditions or special health care needs, and for not more than
30the following full-time equivalent positions:
.................................................. $314,223,373
............................................... FTEs3210.00
33a. Of the funds appropriated in this subsection, $153,000
34shall be used for grants to individual patients who have an
35inherited metabolic disorder to assist with the costs of
-7-1medically necessary foods and formula.
2b. Of the funds appropriated in this subsection, $1,055,000
3shall be used for the brain injury services program pursuant
4to section 135.22B, including $861,000 for contracting with an
5existing nationally affiliated and statewide organization whose
6purpose is to educate, serve, and support Iowans with brain
7injury and their families, for resource facilitator services
8in accordance with section 135.22B, subsection 9, and for
9contracting to enhance brain injury training and recruitment
10of service providers on a statewide basis. Of the amount
11allocated in this paragraph, $95,000 shall be used to fund
121.00 full-time equivalent position to serve as the state brain
13injury services program manager.
14c. Of the funds appropriated in this subsection, $144,000
15shall be used for the public purpose of continuing to contract
16with an existing nationally affiliated organization to provide
17education, client-centered programs, and client and family
18support for people living with epilepsy and their families.
19The amount allocated in this paragraph in excess of $50,000
20shall be matched dollar-for-dollar by the organization
21specified. Funds allocated under this paragraph shall be
22distributed in their entirety for the purpose specified on July
231, 2021.
24d. Of the funds appropriated in this subsection, $809,000
25shall be used for child health specialty clinics.
26e. Of the funds appropriated in this subsection, $384,000
27shall be used by the regional autism assistance program
28established pursuant to section 256.35, and administered by
29the child health specialty clinic located at the university of
30Iowa hospitals and clinics. The funds shall be used to enhance
31interagency collaboration and coordination of educational,
32medical, and other human services for persons with autism,
33their families, and providers of services, including delivering
34regionalized services of care coordination, family navigation,
35and integration of services through the statewide system of
-8-1regional child health specialty clinics and fulfilling other
2requirements as specified in chapter 225D. The university of
3Iowa shall not receive funds allocated under this paragraph for
4indirect costs associated with the regional autism assistance
5program.
6f. Of the funds appropriated in this subsection, $577,000
7shall be used for the comprehensive cancer control program to
8reduce the burden of cancer in Iowa through prevention, early
9detection, effective treatment, and ensuring quality of life.
10Of the funds allocated in this paragraph “f”, $150,000 shall
11be used to support a melanoma research symposium, a melanoma
12biorepository and registry, basic and translational melanoma
13research, and clinical trials.
14g. Of the funds appropriated in this subsection, $97,000
15shall be used for cervical and colon cancer screening, and
16$177,000 shall be used to enhance the capacity of the cervical
17cancer screening program to include provision of recommended
18prevention and early detection measures to a broader range of
19low-income women.
20h. Of the funds appropriated in this subsection, $506,000
21shall be used for the center for congenital and inherited
22disorders.
234. COMMUNITY CAPACITY
24For strengthening the health care delivery system at the
25local level, and for not more than the following full-time
26equivalent positions:
.................................................. $278,044,306
............................................... FTEs2813.00
29a. Of the funds appropriated in this subsection, $95,000
30is allocated for continuation of the child vision screening
31program implemented through the university of Iowa hospitals
32and clinics in collaboration with early childhood Iowa areas.
33The program shall submit a report to the department regarding
34the use of funds allocated under this paragraph “a”. The
35report shall include the objectives and results for the
-9-1program year including the target population and how the funds
2allocated assisted the program in meeting the objectives; the
3number, age, and location within the state of individuals
4served; the type of services provided to the individuals
5served; the distribution of funds based on service provided;
6and the continuing needs of the program.
7b. Of the funds appropriated in this subsection,
8$48,000 shall be used for a grant to a statewide association
9of psychologists, that is affiliated with the American
10psychological association, to be used for continuation of a
11program to rotate intern psychologists in placements that
12serve urban and rural mental health professional shortage
13areas. Once an intern psychologist begins service, the intern
14psychologist may continue serving in the location of the intern
15psychologist’s placement, notwithstanding any change in the
16mental health professional shortage area designation of such
17location. The intern psychologist may also provide services
18via telehealth, to underserved populations, and to Medicaid
19members. For the purposes of this paragraph “b”, “mental
20health professional shortage area” means a geographic area
21in this state that has been designated by the United States
22department of health and human services, health resources and
23services administration, bureau of health professionals, as
24having a shortage of mental health professionals.
25c. Of the funds appropriated in this subsection, the
26following amounts are allocated to be used as follows
27to support the goals of increased access, health system
28integration, and engagement:
29(1) Not less than $1,600,000 is allocated to the Iowa
30prescription drug corporation for continuation of the
31pharmaceutical infrastructure for safety net providers as
32described in 2007 Iowa Acts, chapter 218, section 108, and for
33the prescription drug donation repository program created in
34chapter 135M. Of the amount allocated in this subparagraph,
35$1,000,000 shall be used as one-time funding to support
-10-1program expansion and to implement an automated multi-dose
2prescription packaging system. Funds allocated under this
3subparagraph shall be distributed in their entirety for the
4purpose specified on July 1, 2021.
5(2) Not less than $334,000 is allocated to free clinics and
6free clinics of Iowa for necessary infrastructure, statewide
7coordination, provider recruitment, service delivery, and
8provision of assistance to patients in securing a medical home
9inclusive of oral health care. Funds allocated under this
10subparagraph shall be distributed in their entirety for the
11purpose specified on July 1, 2021.
12(3) Not less than $25,000 is allocated to the Iowa
13association of rural health clinics for necessary
14infrastructure and service delivery transformation. Funds
15allocated under this subparagraph shall be distributed in their
16entirety for the purpose specified on July 1, 2021.
17(4) Not less than $225,000 is allocated to the Polk county
18medical society for continuation of the safety net provider
19patient access to specialty health care initiative as described
20in 2007 Iowa Acts, chapter 218, section 109. Funds allocated
21under this subparagraph shall be distributed in their entirety
22for the purpose specified on July 1, 2021.
23d. Of the funds appropriated in this subsection, $191,000
24is allocated for the purposes of health care and public health
25workforce initiatives.
26e. Of the funds appropriated in this subsection, $296,000
27shall be used for a matching dental education loan repayment
28program to be allocated to a dental nonprofit health service
29corporation to continue to develop the criteria and implement
30the loan repayment program.
31f. Of the funds appropriated in this subsection, $150,000
32shall be used for the purposes of the Iowa donor registry as
33specified in section 142C.18.
34g. Of the funds appropriated in this subsection, $96,000
35shall be used for continuation of a grant to a nationally
-11-1affiliated volunteer eye organization that has an established
2program for children and adults and that is solely dedicated to
3preserving sight and preventing blindness through education,
4nationally certified vision screening and training, and
5community and patient service programs. The contractor shall
6submit a report to the general assembly regarding the use
7of funds allocated under this paragraph “g”. The report
8shall include the objectives and results for the program year
9including the target population and how the funds allocated
10assisted the program in meeting the objectives; the number,
11age, grade level if appropriate, and location within the state
12of individuals served; the type of services provided to the
13individuals served; the distribution of funds based on services
14provided; and the continuing needs of the program.
15h. Of the funds appropriated in this subsection, $2,000,000
16shall be deposited in the medical residency training account
17created in section 135.175, subsection 5, paragraph “a”, and
18is appropriated from the account to the department of public
19health to be used for the purposes of the medical residency
20training state matching grants program as specified in section
21135.176.
22i. Of the funds appropriated in this subsection, $250,000
23shall be used for the public purpose of providing funding to
24Des Moines university to continue a provider education project
25to provide primary care physicians with the training and skills
26necessary to recognize the signs of mental illness in patients.
27j. Of the funds appropriated in this subsection, $600,000
28shall be used for rural psychiatric residencies to support the
29annual creation and training of four psychiatric residents who
30will provide mental health services in underserved areas of
31the state. Notwithstanding section 8.33, moneys that remain
32unencumbered or unobligated at the close of the fiscal year
33shall not revert but shall remain available for expenditure for
34the purposes designated for subsequent fiscal years.
35k. Of the funds appropriated in this subsection, $150,000
-12-1shall be used for psychiatric training to increase access to
2mental health care services by expanding the mental health
3workforce via training of additional physician assistants and
4nurse practitioners.
5l. Of the funds appropriated in this subsection, $1,000,000
6shall be used for the creation of two centers of excellence
7programs to encourage innovation and collaboration among
8regional health care providers to transform health care
9delivery in order to provide quality, sustainable care that
10meets the needs of local communities.
115. ESSENTIAL PUBLIC HEALTH SERVICES
12To provide public health services that reduce risks and
13invest in promoting and protecting good health over the
14course of a lifetime with a priority given to older Iowans and
15vulnerable populations:
.................................................. $167,662,464
176. INFECTIOUS DISEASES
18For reducing the incidence and prevalence of communicable
19diseases, and for not more than the following full-time
20equivalent positions:
.................................................. $211,796,206
............................................... FTEs224.00
237. PUBLIC PROTECTION
24For protecting the health and safety of the public through
25establishing standards and enforcing regulations, and for not
26more than the following full-time equivalent positions:
.................................................. $274,466,601
............................................... FTEs28142.00
29a. Of the funds appropriated in this subsection, not more
30than $304,000 shall be credited to the emergency medical
31services fund created in section 135.25. Moneys in the
32emergency medical services fund are appropriated to the
33department to be used for the purposes of the fund.
34b. Of the funds appropriated in this subsection, up
35to $243,000 shall be used for sexual violence prevention
-13-1programming through a statewide organization representing
2programs serving victims of sexual violence through the
3department’s sexual violence prevention program, and for
4continuation of a training program for sexual assault
5response team (SART) members, including representatives of
6law enforcement, victim advocates, prosecutors, and certified
7medical personnel. The amount allocated in this paragraph “b”
8shall not be used to supplant funding administered for other
9sexual violence prevention or victims assistance programs.
10c. Of the funds appropriated in this subsection, up to
11$500,000 shall be used for the state poison control center.
12Pursuant to the directive under 2014 Iowa Acts, chapter
131140, section 102, the federal matching funds available to
14the state poison control center from the department of human
15services under the federal Children’s Health Insurance Program
16Reauthorization Act allotment shall be subject to the federal
17administrative cap rule of 10 percent applicable to funding
18provided under Tit.XXI of the federal Social Security Act and
19included within the department’s calculations of the cap.
20d. Of the funds appropriated in this subsection, up to
21$504,000 shall be used for childhood lead poisoning provisions.
228. RESOURCE MANAGEMENT
23For establishing and sustaining the overall ability of the
24department to deliver services to the public, and for not more
25than the following full-time equivalent positions:
.................................................. $26933,871
............................................... FTEs274.00
289. MISCELLANEOUS PROVISIONS
29The university of Iowa hospitals and clinics under the
30control of the state board of regents shall not receive
31indirect costs from the funds appropriated in this section.
32The university of Iowa hospitals and clinics billings to the
33department shall be on at least a quarterly basis.
34 Sec. 4. DEPARTMENT OF PUBLIC HEALTH — SPORTS WAGERING
35RECEIPTS FUND. There is appropriated from the sports wagering
-14-1receipts fund created in section 8.57, subsection 6, to the
2department of public health for the fiscal year beginning July
31, 2021, and ending June 30, 2022, the following amount, or
4so much thereof as is necessary, to be used for the purposes
5designated:
6For problem gambling and substance-related disorder
7prevention, treatment, and recovery services, including a
824-hour helpline, public information resources, professional
9training, youth prevention, and program evaluation:
.................................................. $101,750,000
11DIVISION IV
12DEPARTMENT OF VETERANS AFFAIRS — FY 2021-2022
13 Sec. 5. DEPARTMENT OF VETERANS AFFAIRS. There is
14appropriated from the general fund of the state to the
15department of veterans affairs for the fiscal year beginning
16July 1, 2021, and ending June 30, 2022, the following amounts,
17or so much thereof as is necessary, to be used for the purposes
18designated:
191. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
20For salaries, support, maintenance, and miscellaneous
21purposes, and for not more than the following full-time
22equivalent positions:
.................................................. $231,229,763
............................................... FTEs2415.00
252. IOWA VETERANS HOME
26For salaries, support, maintenance, and miscellaneous
27purposes:
.................................................. $287,131,552
29a. The Iowa veterans home billings involving the department
30of human services shall be submitted to the department on at
31least a monthly basis.
32b. The Iowa veterans home expenditure report shall be
33submitted monthly to the general assembly.
34c. The Iowa veterans home shall continue to include in the
35annual discharge report applicant information to provide for
-15-1the collection of demographic information including but not
2limited to the number of individuals applying for admission and
3admitted or denied admittance and the basis for the admission
4or denial; the age, gender, and race of such individuals;
5and the level of care for which such individuals applied for
6admission including residential or nursing level of care.
73. HOME OWNERSHIP ASSISTANCE PROGRAM
8For transfer to the Iowa finance authority for the
9continuation of the home ownership assistance program for
10persons who are or were eligible members of the armed forces of
11the United States, pursuant to section 16.54:
.................................................. $122,000,000
13 Sec. 6. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS
14FUND STANDING APPROPRIATIONS. Notwithstanding the standing
15appropriation in section 35A.16 for the fiscal year beginning
16July 1, 2021, and ending June 30, 2022, the amount appropriated
17from the general fund of the state pursuant to that section
18for the following designated purposes shall not exceed the
19following amount:
20For the county commissions of veteran affairs fund under
21section 35A.16:
.................................................. $22990,000
23DIVISION V
24DEPARTMENT OF HUMAN SERVICES — FY 2021-2022
25 Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
26GRANT. There is appropriated from the fund created in section
278.41 to the department of human services for the fiscal year
28beginning July 1, 2021, and ending June 30, 2022, from moneys
29received under the federal temporary assistance for needy
30families (TANF) block grant pursuant to the federal Personal
31Responsibility and Work Opportunity Reconciliation Act of 1996,
32Pub.L.No.104-193, and successor legislation, the following
33amounts, or so much thereof as is necessary, to be used for the
34purposes designated:
351. To be credited to the family investment program account
-16-1and used for assistance under the family investment program
2under chapter 239B:
.................................................. $35,002,006
42. To be credited to the family investment program account
5and used for the job opportunities and basic skills (JOBS)
6program and implementing family investment agreements in
7accordance with chapter 239B:
.................................................. $85,412,060
93. To be used for the family development and
10self-sufficiency grant program in accordance with section
11216A.107:
.................................................. $122,888,980
13Notwithstanding section 8.33, moneys appropriated in this
14subsection that remain unencumbered or unobligated at the close
15of the fiscal year shall not revert but shall remain available
16for expenditure for the purposes designated until the close of
17the succeeding fiscal year. However, unless such moneys are
18encumbered or obligated on or before September 30, 2022, the
19moneys shall revert.
204. For field operations:
.................................................. $2131,296,232
225. For general administration:
.................................................. $233,744,000
246. For state child care assistance:
.................................................. $2547,166,826
26a. Of the funds appropriated in this subsection,
27$26,205,412 is transferred to the child care and development
28block grant appropriation made by the Eighty-ninth General
29Assembly, 2021 session, for the federal fiscal year beginning
30October 1, 2021, and ending September 30, 2022. Of this
31amount, $200,000 shall be used for provision of educational
32opportunities to registered child care home providers in order
33to improve services and programs offered by this category
34of providers and to increase the number of providers. The
35department may contract with institutions of higher education
-17-1or child care resource and referral centers to provide
2the educational opportunities. Allowable administrative
3costs under the contracts shall not exceed 5 percent. The
4application for a grant shall not exceed two pages in length.
5b. Any funds appropriated in this subsection remaining
6unallocated shall be used for state child care assistance
7payments for families who are employed including but not
8limited to individuals enrolled in the family investment
9program.
107. For child and family services:
.................................................. $1132,380,654
128. For child abuse prevention grants:
.................................................. $13125,000
149. For pregnancy prevention grants on the condition that
15family planning services are funded:
.................................................. $161,913,203
17Pregnancy prevention grants shall be awarded to programs
18in existence on or before July 1, 2021, if the programs have
19demonstrated positive outcomes. Grants shall be awarded to
20pregnancy prevention programs which are developed after July
211, 2021, if the programs are based on existing models that
22have demonstrated positive outcomes. Grants shall comply with
23the requirements provided in 1997 Iowa Acts, chapter 208,
24section 14, subsections 1 and 2, including the requirement that
25grant programs must emphasize sexual abstinence. Priority in
26the awarding of grants shall be given to programs that serve
27areas of the state which demonstrate the highest percentage of
28unplanned pregnancies of females of childbearing age within the
29geographic area to be served by the grant.
3010. For technology needs and other resources necessary to
31meet federal, state, and welfare reform reporting, tracking,
32and case management requirements and other departmental needs:
.................................................. $331,037,186
3411. a. Notwithstanding any provision to the contrary,
35including but not limited to requirements in section 8.41 or
-18-1provisions in 2020 Iowa Acts or 2021 Iowa Acts regarding the
2receipt and appropriation of federal block grants, federal
3funds from the temporary assistance for needy families block
4grant received by the state and not otherwise appropriated
5in this section and remaining available for the fiscal year
6beginning July 1, 2021, are appropriated to the department of
7human services to the extent as may be necessary to be used in
8the following priority order: the family investment program,
9for state child care assistance program payments for families
10who are employed, and for the family investment program share
11of system costs for eligibility determination and related
12functions. The federal funds appropriated in this paragraph
13“a” shall be expended only after all other funds appropriated
14in subsection 1 for assistance under the family investment
15program, in subsection 6 for state child care assistance, or
16in subsection 10 for technology costs related to the family
17investment program, as applicable, have been expended. For
18the purposes of this subsection, the funds appropriated in
19subsection 6, paragraph “a”, for transfer to the child care
20and development block grant appropriation are considered fully
21expended when the full amount has been transferred.
22b. The department shall, on a quarterly basis, advise the
23legislative services agency and department of management of
24the amount of funds appropriated in this subsection that was
25expended in the prior quarter.
2612. Of the amounts appropriated in this section,
27$12,962,008 for the fiscal year beginning July 1, 2021, is
28transferred to the appropriation of the federal social services
29block grant made to the department of human services for that
30fiscal year.
3113. For continuation of the program providing categorical
32eligibility for the food assistance program as specified
33for the program in the section of this division of this Act
34relating to the family investment program account:
.................................................. $3514,236
-19- 114. The department may transfer funds allocated in this
2section to the appropriations made in this division of this Act
3for the same fiscal year for general administration and field
4operations for resources necessary to implement and operate the
5services referred to in this section and those funded in the
6appropriation made in this division of this Act for the same
7fiscal year for the family investment program from the general
8fund of the state.
915. With the exception of moneys allocated under this
10section for the family development and self-sufficiency grant
11program, to the extent moneys allocated in this section are
12deemed by the department not to be necessary to support the
13purposes for which they are allocated, such moneys may be used
14in the same fiscal year for any other purpose for which funds
15are allocated in this section or in section 8 of this division
16of this Act for the family investment program account. If
17there are conflicting needs, priority shall first be given
18to the family investment program account as specified under
19subsection 1 of this section and used for the purposes of
20assistance under the family investment program in accordance
21with chapter 239B, followed by state child care assistance
22program payments for families who are employed, followed by
23other priorities as specified by the department.
24 Sec. 8. FAMILY INVESTMENT PROGRAM ACCOUNT.
251. Moneys credited to the family investment program (FIP)
26account for the fiscal year beginning July 1, 2021, and
27ending June 30, 2022, shall be used to provide assistance in
28accordance with chapter 239B.
292. The department may use a portion of the moneys credited
30to the FIP account under this section as necessary for
31salaries, support, maintenance, and miscellaneous purposes.
323. The department may transfer funds allocated in
33subsection 4, excluding the allocation under subsection 4,
34paragraph “b”, to the appropriations made in this division of
35this Act for the same fiscal year for general administration
-20-1and field operations for resources necessary to implement
2and operate the services referred to in this section and
3those funded in the appropriations made in section 7 for the
4temporary assistance for needy families block grant and in
5section 9 for the family investment program from the general
6fund of the state in this division of this Act for the same
7fiscal year.
84. Moneys appropriated in this division of this Act and
9credited to the FIP account for the fiscal year beginning July
101, 2021, and ending June 30, 2022, are allocated as follows:
11a. To be retained by the department of human services to
12be used for coordinating with the department of human rights
13to more effectively serve participants in FIP and other shared
14clients and to meet federal reporting requirements under the
15federal temporary assistance for needy families block grant:
.................................................. $1610,000
17b. To the department of human rights for staffing,
18administration, and implementation of the family development
19and self-sufficiency grant program in accordance with section
20216A.107:
.................................................. $216,192,834
22(1) Of the funds allocated for the family development
23and self-sufficiency grant program in this paragraph “b”,
24not more than 5 percent of the funds shall be used for the
25administration of the grant program.
26(2) The department of human rights may continue to implement
27the family development and self-sufficiency grant program
28statewide during fiscal year 2021-2022.
29(3) The department of human rights may engage in activities
30to strengthen and improve family outcomes measures and
31data collection systems under the family development and
32self-sufficiency grant program.
33c. For the diversion subaccount of the FIP account:
.................................................. $341,293,000
35A portion of the moneys allocated for the diversion
-21-1subaccount may be used for field operations, salaries, data
2management system development, and implementation costs and
3support deemed necessary by the director of human services
4in order to administer the FIP diversion program. To the
5extent moneys allocated in this paragraph “c” are deemed by the
6department not to be necessary to support diversion activities,
7such moneys may be used for other efforts intended to increase
8engagement by family investment program participants in work,
9education, or training activities, or for the purposes of
10assistance under the family investment program in accordance
11with chapter 239B.
12d. For the food assistance employment and training program:
.................................................. $1366,588
14(1) The department shall apply the federal supplemental
15nutrition assistance program (SNAP) employment and training
16state plan in order to maximize to the fullest extent permitted
17by federal law the use of the 50 percent federal reimbursement
18provisions for the claiming of allowable federal reimbursement
19funds from the United States department of agriculture
20pursuant to the federal SNAP employment and training program
21for providing education, employment, and training services
22for eligible food assistance program participants, including
23but not limited to related dependent care and transportation
24expenses.
25(2) The department shall continue the categorical federal
26food assistance program eligibility at 160 percent of the
27federal poverty level and continue to eliminate the asset test
28from eligibility requirements, consistent with federal food
29assistance program requirements. The department shall include
30as many food assistance households as is allowed by federal
31law. The eligibility provisions shall conform to all federal
32requirements including requirements addressing individuals who
33are incarcerated or otherwise ineligible.
34e. For the JOBS program, not more than:
.................................................. $3512,018,258
-22- 15. Of the child support collections assigned under FIP,
2an amount equal to the federal share of support collections
3shall be credited to the child support recovery appropriation
4made in this division of this Act. Of the remainder of the
5assigned child support collections received by the child
6support recovery unit, a portion shall be credited to the FIP
7account, a portion may be used to increase recoveries, and a
8portion may be used to sustain cash flow in the child support
9payments account. If as a consequence of the appropriations
10and allocations made in this section the resulting amounts
11are insufficient to sustain cash assistance payments and meet
12federal maintenance of effort requirements, the department
13shall seek supplemental funding. If child support collections
14assigned under FIP are greater than estimated or are otherwise
15determined not to be required for maintenance of effort, the
16state share of either amount may be transferred to or retained
17in the child support payments account.
18 Sec. 9. FAMILY INVESTMENT PROGRAM GENERAL FUND. There
19is appropriated from the general fund of the state to the
20department of human services for the fiscal year beginning July
211, 2021, and ending June 30, 2022, the following amount, or
22so much thereof as is necessary, to be used for the purpose
23designated:
24To be credited to the family investment program (FIP)
25account and used for family investment program assistance
26under chapter 239B and other costs associated with providing
27needs-based benefits or assistance:
.................................................. $2840,003,978
291. Of the funds appropriated in this section, $6,606,198 is
30allocated for the JOBS program.
312. Of the funds appropriated in this section, $3,313,854 is
32allocated for the family development and self-sufficiency grant
33program.
343. a. Notwithstanding section 8.39, for the fiscal
35year beginning July 1, 2021, if necessary to meet federal
-23-1maintenance of effort requirements or to transfer federal
2temporary assistance for needy families block grant funding
3to be used for purposes of the federal social services block
4grant or to meet cash flow needs resulting from delays in
5receiving federal funding or to implement, in accordance with
6this division of this Act, activities currently funded with
7juvenile court services, county, or community moneys and state
8moneys used in combination with such moneys; to comply with
9federal requirements; or to maximize the use of federal funds;
10the department of human services may transfer funds within or
11between any of the appropriations made in this division of this
12Act and appropriations in law for the federal social services
13block grant to the department for the following purposes,
14provided that the combined amount of state and federal
15temporary assistance for needy families block grant funding
16for each appropriation remains the same before and after the
17transfer:
18(1) For the family investment program.
19(2) For state child care assistance.
20(3) For child and family services.
21(4) For field operations.
22(5) For general administration.
23b. This subsection shall not be construed to prohibit the
24use of existing state transfer authority for other purposes.
25The department shall report any transfers made pursuant to this
26subsection to the general assembly.
274. Of the funds appropriated in this section, $195,000
28shall be used for a contract for tax preparation assistance
29to low-income Iowans to expand the usage of the earned income
30tax credit. The purpose of the contract is to supply this
31assistance to underserved areas of the state. The department
32shall not retain any portion of the allocation under this
33subsection for administrative costs.
345. Of the funds appropriated in this section, $70,000 shall
35be used for the continuation of the parenting program, as
-24-1specified in 441 IAC ch.100, relating to parental obligations,
2in which the child support recovery unit participates, to
3support the efforts of a nonprofit organization committed
4to strengthening the community through youth development,
5healthy living, and social responsibility headquartered in
6a county with a population over 350,000 according to the
7latest certified federal census. The funds allocated in this
8subsection shall be used by the recipient organization to
9develop a larger community effort, through public and private
10partnerships, to support a broad-based multi-county parenthood
11initiative that promotes payment of child support obligations,
12improved family relationships, and full-time employment.
136. The department may transfer funds appropriated in this
14section, excluding the allocation in subsection 2 for the
15family development and self-sufficiency grant program, to the
16appropriations made in this division of this Act for general
17administration and field operations as necessary to administer
18this section, section 7 for the temporary assistance for needy
19families block grant, and section 8 for the family investment
20program account.
21 Sec. 10. CHILD SUPPORT RECOVERY. There is appropriated
22from the general fund of the state to the department of human
23services for the fiscal year beginning July 1, 2021, and ending
24June 30, 2022, the following amount, or so much thereof as is
25necessary, to be used for the purposes designated:
26For child support recovery, including salaries, support,
27maintenance, and miscellaneous purposes, and for not more than
28the following full-time equivalent positions:
.................................................. $2915,942,885
............................................... FTEs30459.00
311. The department shall expend up to $24,000, including
32federal financial participation, for the fiscal year beginning
33July 1, 2021, for a child support public awareness campaign.
34The department and the office of the attorney general shall
35cooperate in continuation of the campaign. The public
-25-1awareness campaign shall emphasize, through a variety of
2media activities, the importance of maximum involvement of
3both parents in the lives of their children as well as the
4importance of payment of child support obligations.
52. Federal access and visitation grant moneys shall be
6issued directly to private not-for-profit agencies that provide
7services designed to increase compliance with the child access
8provisions of court orders, including but not limited to
9neutral visitation sites and mediation services.
103. The appropriation made to the department for child
11support recovery may be used throughout the fiscal year in the
12manner necessary for purposes of cash flow management, and for
13cash flow management purposes the department may temporarily
14draw more than the amount appropriated, provided the amount
15appropriated is not exceeded at the close of the fiscal year.
16 Sec. 11. HEALTH CARE TRUST FUND — MEDICAL ASSISTANCE —
17FY 2021-2022. Any funds remaining in the health care trust
18fund created in section 453A.35A for the fiscal year beginning
19July 1, 2021, and ending June 30, 2022, are appropriated to
20the department of human services to supplement the medical
21assistance program appropriations made in this division of this
22Act, for medical assistance reimbursement and associated costs,
23including program administration and costs associated with
24program implementation.
25 Sec. 12. MEDICAID FRAUD FUND — MEDICAL ASSISTANCE — FY
262021-2022. Any funds remaining in the Medicaid fraud fund
27created in section 249A.50 for the fiscal year beginning
28July 1, 2021, and ending June 30, 2022, are appropriated to
29the department of human services to supplement the medical
30assistance appropriations made in this division of this Act,
31for medical assistance reimbursement and associated costs,
32including program administration and costs associated with
33program implementation.
34 Sec. 13. MEDICAL ASSISTANCE. There is appropriated from the
35general fund of the state to the department of human services
-26-1for the fiscal year beginning July 1, 2021, and ending June 30,
22022, the following amount, or so much thereof as is necessary,
3to be used for the purpose designated:
4For medical assistance program reimbursement and associated
5costs as specifically provided in the reimbursement
6methodologies in effect on June 30, 2021, except as otherwise
7expressly authorized by law, consistent with options under
8federal law and regulations, and contingent upon receipt of
9approval from the office of the governor of reimbursement for
10each abortion performed under the program:
.................................................. $111,479,602,321
121. Iowans support reducing the number of abortions
13performed in our state. Funds appropriated under this section
14shall not be used for abortions, unless otherwise authorized
15under this section.
162. The provisions of this section relating to abortions
17shall also apply to the Iowa health and wellness plan created
18pursuant to chapter 249N.
193. The department shall utilize not more than $60,000 of
20the funds appropriated in this section to continue the AIDS/HIV
21health insurance premium payment program as established in 1992
22Iowa Acts, Second Extraordinary Session, chapter 1001, section
23409, subsection 6. Of the funds allocated in this subsection,
24not more than $5,000 may be expended for administrative
25purposes.
264. Of the funds appropriated in this Act to the department
27of public health for addictive disorders, $950,000 for
28the fiscal year beginning July 1, 2021, is transferred
29to the department of human services for an integrated
30substance-related disorder managed care system. The
31departments of human services and public health shall
32work together to maintain the level of mental health and
33substance-related disorder treatment services provided by the
34managed care contractors. Each department shall take the steps
35necessary to continue the federal waivers as necessary to
-27-1maintain the level of services.
25. The department shall aggressively pursue options for
3providing medical assistance or other assistance to individuals
4with special needs who become ineligible to continue receiving
5services under the early and periodic screening, diagnostic,
6and treatment program under the medical assistance program
7due to becoming 21 years of age who have been approved for
8additional assistance through the department’s exception to
9policy provisions, but who have health care needs in excess
10of the funding available through the exception to policy
11provisions.
126. Of the funds appropriated in this section, up to
13$3,050,082 may be transferred to the field operations or
14general administration appropriations in this division of this
15Act for operational costs associated with Part D of the federal
16Medicare Prescription Drug Improvement and Modernization Act
17of 2003, Pub.L.No.108-173.
187. Of the funds appropriated in this section, up to $442,100
19may be transferred to the appropriation in this division of
20this Act for health program operations to be used for clinical
21assessment services and prior authorization of services.
228. A portion of the funds appropriated in this section may
23be transferred to the appropriations in this division of this
24Act for general administration, health program operations, the
25children’s health insurance program, or field operations to be
26used for the state match cost to comply with the payment error
27rate measurement (PERM) program for both the medical assistance
28and children’s health insurance programs as developed by the
29centers for Medicare and Medicaid services of the United States
30department of health and human services to comply with the
31federal Improper Payments Information Act of 2002, Pub.L.
32No.107-300, and to support other reviews and quality control
33activities to improve the integrity of these programs.
349. Of the funds appropriated in this section, a sufficient
35amount is allocated to supplement the incomes of residents of
-28-1nursing facilities, intermediate care facilities for persons
2with mental illness, and intermediate care facilities for
3persons with an intellectual disability, with incomes of less
4than $50 in the amount necessary for the residents to receive a
5personal needs allowance of $50 per month pursuant to section
6249A.30A.
710. a. Hospitals that meet the conditions specified
8in subparagraphs (1) and (2) shall either certify public
9expenditures or transfer to the medical assistance program
10an amount equal to provide the nonfederal share for a
11disproportionate share hospital payment in an amount up to the
12hospital-specific limit as approved in the Medicaid state plan.
13The hospitals that meet the conditions specified shall receive
14and retain 100 percent of the total disproportionate share
15hospital payment in an amount up to the hospital-specific limit
16as approved in the Medicaid state plan.
17(1) The hospital qualifies for disproportionate share and
18graduate medical education payments.
19(2) The hospital is an Iowa state-owned hospital with more
20than 500 beds and eight or more distinct residency specialty
21or subspecialty programs recognized by the American college of
22graduate medical education.
23b. Distribution of the disproportionate share payments
24shall be made on a monthly basis. The total amount of
25disproportionate share payments including graduate medical
26education, enhanced disproportionate share, and Iowa
27state-owned teaching hospital payments shall not exceed the
28amount of the state’s allotment under Pub.L.No.102-234.
29In addition, the total amount of all disproportionate
30share payments shall not exceed the hospital-specific
31disproportionate share limits under Pub.L.No.103-66.
3211. One hundred percent of the nonfederal share of payments
33to area education agencies that are medical assistance
34providers for medical assistance-covered services provided to
35medical assistance-covered children, shall be made from the
-29-1appropriation made in this section.
212. A portion of the funds appropriated in this section may
3be transferred to the appropriation in this division of this
4Act for health program operations to be used for administrative
5activities associated with the money follows the person
6demonstration project.
713. Of the funds appropriated in this section, $349,011
8shall be used for the administration of the health insurance
9premium payment program, including salaries, support,
10maintenance, and miscellaneous purposes.
1114. a. The department may increase the amounts allocated
12for salaries, support, maintenance, and miscellaneous purposes
13associated with the medical assistance program, as necessary,
14to sustain cost management efforts. The department shall
15report any such increase to the general assembly and the
16department of management.
17b. If the savings to the medical assistance program from
18ongoing cost management efforts exceed the associated cost
19for the fiscal year beginning July 1, 2021, the department
20may transfer any savings generated for the fiscal year due
21to medical assistance program cost management efforts to the
22appropriation made in this division of this Act for health
23program operations or general administration to defray the
24costs associated with implementing the efforts.
2515. For the fiscal year beginning July 1, 2021, and ending
26June 30, 2022, the replacement generation tax revenues required
27to be deposited in the property tax relief fund pursuant to
28section 437A.8, subsection 4, paragraph “d”, and section
29437A.15, subsection 3, paragraph “f”, shall instead be credited
30to and supplement the appropriation made in this section and
31used for the allocations made in this section.
3216. a. Of the funds appropriated in this section, up
33to $50,000 may be transferred by the department to the
34appropriation made in this division of this Act to the
35department for the same fiscal year for general administration
-30-1to be used for associated administrative expenses and for not
2more than 1.00 full-time equivalent position, in addition to
3those authorized for the same fiscal year, to be assigned to
4implementing the children’s mental health home project.
5b. Of the funds appropriated in this section, up to $400,000
6may be transferred by the department to the appropriation made
7to the department in this division of this Act for the same
8fiscal year for Medicaid program-related general administration
9planning and implementation activities. The funds may be used
10for contracts or for personnel in addition to the amounts
11appropriated for and the positions authorized for general
12administration for the fiscal year.
13c. Of the funds appropriated in this section, up to
14$3,000,000 may be transferred by the department to the
15appropriations made in this division of this Act for the
16same fiscal year for general administration or health
17program operations to be used to support the development
18and implementation of standardized assessment tools for
19persons with mental illness, an intellectual disability, a
20developmental disability, or a brain injury.
2117. Of the funds appropriated in this section, $150,000
22shall be used for lodging expenses associated with care
23provided at the university of Iowa hospitals and clinics for
24patients with cancer whose travel distance is 30 miles or more
25and whose income is at or below 200 percent of the federal
26poverty level as defined by the most recently revised poverty
27income guidelines published by the United States department of
28health and human services. The department of human services
29shall establish the maximum number of overnight stays and the
30maximum rate reimbursed for overnight lodging, which may be
31based on the state employee rate established by the department
32of administrative services. The funds allocated in this
33subsection shall not be used as nonfederal share matching
34funds.
3518. Of the funds appropriated in this section, up to
-31-1$3,383,880 shall be used for administration of the state family
2planning services program pursuant to section 217.41B, and
3of this amount, the department may use up to $200,000 for
4administrative expenses.
519. Of the funds appropriated in this section, $1,545,530
6shall be used and may be transferred to other appropriations
7in this division of this Act as necessary to administer the
8provisions in the division of this Act relating to Medicaid
9program administration.
10 Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated
11from the general fund of the state to the department of human
12services for the fiscal year beginning July 1, 2021, and ending
13June 30, 2022, the following amount, or so much thereof as is
14necessary, to be used for the purpose designated:
15For health program operations:
.................................................. $1617,831,343
171. The department of inspections and appeals shall
18provide all state matching funds for survey and certification
19activities performed by the department of inspections
20and appeals. The department of human services is solely
21responsible for distributing the federal matching funds for
22such activities.
232. Of the funds appropriated in this section, $50,000 shall
24be used for continuation of home and community-based services
25waiver quality assurance programs, including the review and
26streamlining of processes and policies related to oversight and
27quality management to meet state and federal requirements.
283. Of the amount appropriated in this section, up to
29$200,000 may be transferred to the appropriation for general
30administration in this division of this Act to be used for
31additional full-time equivalent positions in the development
32of key health initiatives such as development and oversight
33of managed care programs and development of health strategies
34targeted toward improved quality and reduced costs in the
35Medicaid program.
-32- 14. Of the funds appropriated in this section, $1,000,000
2shall be used for planning and development, in cooperation with
3the department of public health, of a phased-in program to
4provide a dental home for children.
55. a. Of the funds appropriated in this section, $573,000
6shall be credited to the autism support program fund created
7in section 225D.2 to be used for the autism support program
8created in chapter 225D, with the exception of the following
9amount of this allocation which shall be used as follows:
10b. Of the funds allocated in this subsection, $25,000 shall
11be used for the public purpose of continuation of a grant to a
12nonprofit provider of child welfare services that has been in
13existence for more than 115 years, is located in a county with
14a population between 200,000 and 220,000 according to the most
15recent federal decennial census, is licensed as a psychiatric
16medical institution for children, and provides school-based
17programming, to be used for support services for children with
18autism spectrum disorder and their families.
19 Sec. 15. STATE SUPPLEMENTARY ASSISTANCE.
201. There is appropriated from the general fund of the
21state to the department of human services for the fiscal year
22beginning July 1, 2021, and ending June 30, 2022, the following
23amount, or so much thereof as is necessary, to be used for the
24purpose designated:
25For the state supplementary assistance program:
.................................................. $267,349,002
272. The department shall increase the personal needs
28allowance for residents of residential care facilities by the
29same percentage and at the same time as federal supplemental
30security income and federal social security benefits are
31increased due to a recognized increase in the cost of living.
32The department may adopt emergency rules to implement this
33subsection.
343. If during the fiscal year beginning July 1, 2021,
35the department projects that state supplementary assistance
-33-1expenditures for a calendar year will not meet the federal
2pass-through requirement specified in Tit.XVI of the federal
3Social Security Act, section 1618, as codified in 42 U.S.C.
4§1382g, the department may take actions including but not
5limited to increasing the personal needs allowance for
6residential care facility residents and making programmatic
7adjustments or upward adjustments of the residential care
8facility or in-home health-related care reimbursement rates
9prescribed in this division of this Act to ensure that federal
10requirements are met. In addition, the department may make
11other programmatic and rate adjustments necessary to remain
12within the amount appropriated in this section while ensuring
13compliance with federal requirements. The department may adopt
14emergency rules to implement the provisions of this subsection.
154. Notwithstanding section 8.33, moneys appropriated
16in this section that remain unencumbered or unobligated
17at the close of the fiscal year shall not revert but
18shall remain available for expenditure for the purposes
19designated, including for liability amounts associated with the
20supplemental nutrition assistance program payment error rate,
21until the close of the succeeding fiscal year.
22 Sec. 16. CHILDREN’S HEALTH INSURANCE PROGRAM.
231. There is appropriated from the general fund of the
24state to the department of human services for the fiscal year
25beginning July 1, 2021, and ending June 30, 2022, the following
26amount, or so much thereof as is necessary, to be used for the
27purpose designated:
28For maintenance of the healthy and well kids in Iowa (hawk-i)
29program pursuant to chapter 514I, including supplemental dental
30services, for receipt of federal financial participation under
31Tit.XXI of the federal Social Security Act, which creates the
32children’s health insurance program:
.................................................. $3337,957,643
342. Of the funds appropriated in this section, $149,189 is
35allocated for continuation of the contract for outreach with
-34-1the department of public health.
23. A portion of the funds appropriated in this section may
3be transferred to the appropriations made in this division of
4this Act for field operations or health program operations to
5be used for the integration of hawk-i program eligibility,
6payment, and administrative functions under the purview of
7the department of human services, including for the Medicaid
8management information system upgrade.
9 Sec. 17. CHILD CARE ASSISTANCE. There is appropriated
10from the general fund of the state to the department of human
11services for the fiscal year beginning July 1, 2021, and ending
12June 30, 2022, the following amount, or so much thereof as is
13necessary, to be used for the purpose designated:
14For child care programs:
.................................................. $1540,816,931
161. Of the funds appropriated in this section, $34,966,931
17shall be used for state child care assistance in accordance
18with section 237A.13.
192. Nothing in this section shall be construed or is
20intended as or shall imply a grant of entitlement for services
21to persons who are eligible for assistance due to an income
22level consistent with the waiting list requirements of section
23237A.13. Any state obligation to provide services pursuant to
24this section is limited to the extent of the funds appropriated
25in this section.
263. A list of the registered and licensed child care
27facilities operating in the area served by a child care
28resource and referral service shall be made available to the
29families receiving state child care assistance in that area.
304. Of the funds appropriated in this section, $5,850,000
31shall be credited to the early childhood programs grants
32account in the early childhood Iowa fund created in section
33256I.11. The moneys shall be distributed for funding of
34community-based early childhood programs targeted to children
35from birth through five years of age developed by early
-35-1childhood Iowa areas in accordance with approved community
2plans as provided in section 256I.8.
35. The department may use any of the funds appropriated
4in this section as a match to obtain federal funds for use in
5expanding child care assistance and related programs. For
6the purpose of expenditures of state and federal child care
7funding, funds shall be considered obligated at the time
8expenditures are projected or are allocated to the department’s
9service areas. Projections shall be based on current and
10projected caseload growth, current and projected provider
11rates, staffing requirements for eligibility determination
12and management of program requirements including data systems
13management, staffing requirements for administration of the
14program, contractual and grant obligations and any transfers
15to other state agencies, and obligations for decategorization
16or innovation projects.
176. A portion of the state match for the federal child care
18and development block grant shall be provided as necessary to
19meet federal matching funds requirements through the state
20general fund appropriation made for child development grants
21and other programs for at-risk children in section 279.51.
227. If a uniform reduction ordered by the governor under
23section 8.31 or other operation of law, transfer, or federal
24funding reduction reduces the appropriation made in this
25section for the fiscal year, the percentage reduction in the
26amount paid out to or on behalf of the families participating
27in the state child care assistance program shall be equal to or
28less than the percentage reduction made for any other purpose
29payable from the appropriation made in this section and the
30federal funding relating to it. The percentage reduction to
31the other allocations made in this section shall be the same as
32the uniform reduction ordered by the governor or the percentage
33change of the federal funding reduction, as applicable. If
34there is an unanticipated increase in federal funding provided
35for state child care services, the entire amount of the
-36-1increase, except as necessary to meet federal requirements
2including quality set asides, shall be used for state child
3care assistance payments. If the appropriations made for
4purposes of the state child care assistance program for the
5fiscal year are determined to be insufficient, it is the intent
6of the general assembly to appropriate sufficient funding for
7the fiscal year in order to avoid establishment of waiting list
8requirements.
98. Notwithstanding section 8.33, moneys advanced for
10purposes of the programs developed by early childhood Iowa
11areas, advanced for purposes of wraparound child care, or
12received from the federal appropriations made for the purposes
13of this section that remain unencumbered or unobligated at the
14close of the fiscal year shall not revert to any fund but shall
15remain available for expenditure for the purposes designated
16until the close of the succeeding fiscal year.
17 Sec. 18. JUVENILE INSTITUTION. There is appropriated
18from the general fund of the state to the department of human
19services for the fiscal year beginning July 1, 2021, and ending
20June 30, 2022, the following amounts, or so much thereof as is
21necessary, to be used for the purposes designated:
221. a. For operation of the state training school at Eldora
23and for salaries, support, maintenance, and miscellaneous
24purposes, and for not more than the following full-time
25equivalent positions:
.................................................. $2617,397,068
............................................... FTEs27207.00
28b. Of the funds appropriated in this subsection, $91,000
29shall be used for distribution to licensed classroom teachers
30at this and other institutions under the control of the
31department of human services based upon the average student
32yearly enrollment at each institution as determined by the
33department.
342. A portion of the moneys appropriated in this section
35shall be used by the state training school at Eldora for
-37-1grants for adolescent pregnancy prevention activities at the
2institution in the fiscal year beginning July 1, 2021.
33. Of the funds appropriated in this subsection, $212,000
4shall be used by the state training school at Eldora for a
5substance use disorder treatment program at the institution for
6the fiscal year beginning July 1, 2021.
74. Notwithstanding section 8.33, moneys appropriated in
8this section that remain unencumbered or unobligated at the
9close of the fiscal year shall not revert but shall remain
10available for expenditure for the purposes designated until the
11close of the succeeding fiscal year.
12 Sec. 19. CHILD AND FAMILY SERVICES.
131. There is appropriated from the general fund of the
14state to the department of human services for the fiscal year
15beginning July 1, 2021, and ending June 30, 2022, the following
16amount, or so much thereof as is necessary, to be used for the
17purpose designated:
18For child and family services:
.................................................. $1989,071,930
202. The department may transfer funds appropriated in this
21section as necessary to pay the nonfederal costs of services
22reimbursed under the medical assistance program, state child
23care assistance program, or the family investment program which
24are provided to children who would otherwise receive services
25paid under the appropriation in this section. The department
26may transfer funds appropriated in this section to the
27appropriations made in this division of this Act for general
28administration and for field operations for resources necessary
29to implement and operate the services funded in this section.
303. a. Of the funds appropriated in this section, up to
31$31,500,000 is allocated as the statewide expenditure target
32under section 232.143 for group foster care maintenance and
33services. If the department projects that such expenditures
34for the fiscal year will be less than the target amount
35allocated in this paragraph “a”, the department may reallocate
-38-1the excess to provide additional funding for family foster
2care, independent living, family-centered services, shelter
3care, or the child welfare emergency services addressed with
4the allocation for shelter care.
5b. If at any time after September 30, 2021, annualization
6of a service area’s current expenditures indicates a service
7area is at risk of exceeding its group foster care expenditure
8target under section 232.143 by more than 5 percent, the
9department and juvenile court services shall examine all
10group foster care placements in that service area in order to
11identify those which might be appropriate for termination.
12In addition, any aftercare services believed to be needed
13for the children whose placements may be terminated shall be
14identified. The department and juvenile court services shall
15initiate action to set dispositional review hearings for the
16placements identified. In such a dispositional review hearing,
17the juvenile court shall determine whether needed aftercare
18services are available and whether termination of the placement
19is in the best interest of the child and the community.
204. In accordance with the provisions of section 232.188,
21the department shall continue the child welfare and juvenile
22justice funding initiative during fiscal year 2021-2022. Of
23the funds appropriated in this section, $1,717,000 is allocated
24specifically for expenditure for fiscal year 2021-2022 through
25the decategorization services funding pools and governance
26boards established pursuant to section 232.188.
275. A portion of the funds appropriated in this section
28may be used for emergency family assistance to provide other
29resources required for a family participating in a family
30preservation or reunification project or successor project to
31stay together or to be reunified.
326. Of the funds appropriated in this section, a sufficient
33amount is allocated for shelter care and the child welfare
34emergency services contracting implemented to provide for or
35prevent the need for shelter care.
-39- 17. Federal funds received by the state during the fiscal
2year beginning July 1, 2021, as the result of the expenditure
3of state funds appropriated during a previous state fiscal
4year for a service or activity funded under this section are
5appropriated to the department to be used as additional funding
6for services and purposes provided for under this section.
7Notwithstanding section 8.33, moneys received in accordance
8with this subsection that remain unencumbered or unobligated at
9the close of the fiscal year shall not revert to any fund but
10shall remain available for the purposes designated until the
11close of the succeeding fiscal year.
128. a. Of the funds appropriated in this section, up to
13$3,290,000 is allocated for the payment of the expenses of
14court-ordered services provided to juveniles who are under the
15supervision of juvenile court services, which expenses are a
16charge upon the state pursuant to section 232.141, subsection
174. Of the amount allocated in this paragraph “a”, up to
18$1,556,000 shall be made available to provide school-based
19supervision of children adjudicated under chapter 232, of which
20not more than $15,000 may be used for the purpose of training.
21A portion of the cost of each school-based liaison officer
22shall be paid by the school district or other funding source as
23approved by the chief juvenile court officer.
24b. Of the funds appropriated in this section, up to $748,000
25is allocated for the payment of the expenses of court-ordered
26services provided to children who are under the supervision
27of the department, which expenses are a charge upon the state
28pursuant to section 232.141, subsection 4.
29c. Notwithstanding section 232.141 or any other provision
30of law to the contrary, the amounts allocated in this
31subsection shall be distributed to the judicial districts
32as determined by the state court administrator and to the
33department’s service areas as determined by the administrator
34of the department of human services’ division of child and
35family services. The state court administrator and the
-40-1division administrator shall make the determination of the
2distribution amounts on or before June 15, 2021.
3d. Notwithstanding chapter 232 or any other provision of
4law to the contrary, a district or juvenile court shall not
5order any service which is a charge upon the state pursuant
6to section 232.141 if there are insufficient court-ordered
7services funds available in the district court or departmental
8service area distribution amounts to pay for the service. The
9chief juvenile court officer and the departmental service area
10manager shall encourage use of the funds allocated in this
11subsection such that there are sufficient funds to pay for
12all court-related services during the entire year. The chief
13juvenile court officers and departmental service area managers
14shall attempt to anticipate potential surpluses and shortfalls
15in the distribution amounts and shall cooperatively request the
16state court administrator or division administrator to transfer
17funds between the judicial districts’ or departmental service
18areas’ distribution amounts as prudent.
19e. Notwithstanding any provision of law to the contrary,
20a district or juvenile court shall not order a county to pay
21for any service provided to a juvenile pursuant to an order
22entered under chapter 232 which is a charge upon the state
23under section 232.141, subsection 4.
24f. Of the funds allocated in this subsection, not more than
25$83,000 may be used by the judicial branch for administration
26of the requirements under this subsection.
27g. Of the funds allocated in this subsection, $17,000
28shall be used by the department of human services to support
29the interstate commission for juveniles in accordance with
30the interstate compact for juveniles as provided in section
31232.173.
329. Of the funds appropriated in this section, $12,253,000 is
33allocated for juvenile delinquent graduated sanctions services.
34Any state funds saved as a result of efforts by juvenile court
35services to earn a federal Tit.IV-E match for juvenile court
-41-1services administration may be used for the juvenile delinquent
2graduated sanctions services.
310. Of the funds appropriated in this section, $1,658,000 is
4transferred to the department of public health to be used for
5the child protection center grant program for child protection
6centers located in Iowa in accordance with section 135.118.
7The grant amounts under the program shall be equalized so that
8each center receives a uniform base amount of $245,000, and so
9that the remaining funds are awarded through a funding formula
10based upon the volume of children served. To increase access
11to child protection center services for children in rural
12areas, the funding formula for the awarding of the remaining
13funds shall provide for the awarding of an enhanced amount to
14eligible grantees to develop and maintain satellite centers in
15underserved regions of the state.
1611. Of the funds appropriated in this section, $4,025,000 is
17allocated for the preparation for adult living program pursuant
18to section 234.46.
1912. Of the funds appropriated in this section, $227,000
20shall be used for the public purpose of continuing a grant to a
21nonprofit human services organization, providing services to
22individuals and families in multiple locations in southwest
23Iowa and Nebraska for support of a project providing immediate,
24sensitive support and forensic interviews, medical exams, needs
25assessments, and referrals for victims of child abuse and their
26nonoffending family members.
2713. Of the funds appropriated in this section, $300,000
28is allocated for the foster care youth council approach of
29providing a support network to children placed in foster care.
3014. Of the funds appropriated in this section, $202,000 is
31allocated for use pursuant to section 235A.1 for continuation
32of the initiative to address child sexual abuse implemented
33pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection
3421.
3515. Of the funds appropriated in this section, $630,000 is
-42-1allocated for the community partnership for child protection
2sites.
316. Of the funds appropriated in this section, $371,000
4is allocated for the department’s minority youth and family
5projects under the redesign of the child welfare system.
617. Of the funds appropriated in this section, $851,000
7is allocated for funding of the community circle of care
8collaboration for children and youth in northeast Iowa.
918. Of the funds appropriated in this section, at least
10$147,000 shall be used for the continuation of the child
11welfare provider training academy, a collaboration between the
12coalition for family and children’s services in Iowa and the
13department.
1419. Of the funds appropriated in this section, $211,000
15shall be used for continuation of the central Iowa system of
16care program grant through June 30, 2022.
1720. Of the funds appropriated in this section, $235,000
18shall be used for the public purpose of the continuation
19and expansion of a system of care program grant implemented
20in Cerro Gordo and Linn counties to utilize a comprehensive
21and long-term approach for helping children and families by
22addressing the key areas in a child’s life of childhood basic
23needs, education and work, family, and community.
2421. Of the funds appropriated in this section, $110,000
25shall be used for the public purpose of funding community-based
26services and other supports with a system of care approach
27for children with a serious emotional disturbance and their
28families through a nonprofit provider of child welfare services
29that has been in existence for more than 115 years, is located
30in a county with a population of more than 200,000 but less
31than 220,000 according to the latest certified federal census,
32is licensed as a psychiatric medical institution for children,
33and was a system of care grantee prior to July 1, 2021.
3422. If a separate funding source is identified that reduces
35the need for state funds within an allocation under this
-43-1section, the allocated state funds may be redistributed to
2other allocations under this section for the same fiscal year.
323. Of the funds appropriated in this section, a portion may
4be used for family-centered services for purposes of complying
5with the federal Family First Prevention Services Act of 2018,
6Pub.L. No.115-123, and successor legislation.
7 Sec. 20. ADOPTION SUBSIDY.
81. There is appropriated from the general fund of the
9state to the department of human services for the fiscal year
10beginning July 1, 2021, and ending June 30, 2022, the following
11amount, or so much thereof as is necessary, to be used for the
12purpose designated:
13a. For adoption subsidy payments and related costs and for
14other services provided for under paragraph “b”, subparagraph
15(2):
.................................................. $1640,596,007
17b. (1) Of the funds appropriated in this section, a
18sufficient amount is allocated for adoption subsidy payments
19and related costs.
20(2) Any funds appropriated in this section remaining after
21the allocation under subparagraph (1) are designated and
22allocated as state savings resulting from implementation of
23the federal Fostering Connections to Success and Increasing
24Adoptions Act of 2008, Pub.L. No.110-351, and successor
25legislation, as determined in accordance with 42 U.S.C.
26§673(a)(8), and shall be used for post-adoption services and
27for other purposes allowed under these federal laws, Tit.IV-B
28or Tit.IV-E of the federal Social Security Act.
29(a) The department of human services may transfer funds
30allocated in this subparagraph (2) to the appropriation for
31child and family services in this division of this Act for the
32purposes designated in this subparagraph (2).
33(b) Notwithstanding section 8.33, moneys allocated
34under this subparagraph (2) shall not revert to any fund but
35shall remain available for the purposes designated in this
-44-1subparagraph (2) until expended.
22. The department may transfer funds appropriated in
3this section to the appropriation made in this division of
4this Act for general administration for costs paid from the
5appropriation relating to adoption subsidy.
63. Federal funds received by the state during the
7fiscal year beginning July 1, 2021, as the result of the
8expenditure of state funds during a previous state fiscal
9year for a service or activity funded under this section are
10appropriated to the department to be used as additional funding
11for the services and activities funded under this section.
12Notwithstanding section 8.33, moneys received in accordance
13with this subsection that remain unencumbered or unobligated
14at the close of the fiscal year shall not revert to any fund
15but shall remain available for expenditure for the purposes
16designated until the close of the succeeding fiscal year.
17 Sec. 21. JUVENILE DETENTION HOME FUND. Moneys deposited
18in the juvenile detention home fund created in section 232.142
19during the fiscal year beginning July 1, 2021, and ending June
2030, 2022, are appropriated to the department of human services
21for the fiscal year beginning July 1, 2021, and ending June 30,
222022, for distribution of an amount equal to a percentage of
23the costs of the establishment, improvement, operation, and
24maintenance of county or multicounty juvenile detention homes
25in the fiscal year beginning July 1, 2020. Moneys appropriated
26for distribution in accordance with this section shall be
27allocated among eligible detention homes, prorated on the basis
28of an eligible detention home’s proportion of the costs of all
29eligible detention homes in the fiscal year beginning July
301, 2020. The percentage figure shall be determined by the
31department based on the amount available for distribution for
32the fund. Notwithstanding section 232.142, subsection 3, the
33financial aid payable by the state under that provision for the
34fiscal year beginning July 1, 2021, shall be limited to the
35amount appropriated for the purposes of this section.
-45-1 Sec. 22. FAMILY SUPPORT SUBSIDY PROGRAM.
21. There is appropriated from the general fund of the
3state to the department of human services for the fiscal year
4beginning July 1, 2021, and ending June 30, 2022, the following
5amount, or so much thereof as is necessary, to be used for the
6purpose designated:
7For the family support subsidy program subject to the
8enrollment restrictions in section 225C.37, subsection 3:
.................................................. $9949,282
102. At least $899,291 of the moneys appropriated in this
11section is transferred to the department of public health for
12the family support center component of the comprehensive family
13support program under chapter 225C, subchapter V.
143. If at any time during the fiscal year, the amount of
15funding available for the family support subsidy program
16is reduced from the amount initially used to establish the
17figure for the number of family members for whom a subsidy
18is to be provided at any one time during the fiscal year,
19notwithstanding section 225C.38, subsection 2, the department
20shall revise the figure as necessary to conform to the amount
21of funding available.
22 Sec. 23. CONNER DECREE. There is appropriated from the
23general fund of the state to the department of human services
24for the fiscal year beginning July 1, 2021, and ending June 30,
252022, the following amount, or so much thereof as is necessary,
26to be used for the purpose designated:
27For building community capacity through the coordination
28and provision of training opportunities in accordance with the
29consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D.
30Iowa, July 14, 1994):
.................................................. $3133,632
32 Sec. 24. MENTAL HEALTH INSTITUTES.
331. There is appropriated from the general fund of the
34state to the department of human services for the fiscal year
35beginning July 1, 2021, and ending June 30, 2022, the following
-46-1amounts, or so much thereof as is necessary, to be used for the
2purposes designated:
3a. For operation of the state mental health institute at
4Cherokee as required by chapters 218 and 226 for salaries,
5support, maintenance, and miscellaneous purposes, and for not
6more than the following full-time equivalent positions:
.................................................. $716,058,356
............................................... FTEs8169.00
9b. For operation of the state mental health institute at
10Independence as required by chapters 218 and 226 for salaries,
11support, maintenance, and miscellaneous purposes, and for not
12more than the following full-time equivalent positions:
.................................................. $1320,628,077
............................................... FTEs14208.00
152. a. Notwithstanding sections 218.78 and 249A.11, any
16revenue received from the state mental health institute at
17Cherokee or the state mental health institute at Independence
18pursuant to 42 C.F.R§438.6(e) may be retained and expended by
19the mental health institute.
20b. Notwithstanding sections 218.78 and 249A.11, any
21COVID-19 related funding received through federal funding
22sources by the state mental health institute at Cherokee or the
23state mental health institute at Independence may be retained
24and expended by the mental health institute.
253. Notwithstanding any provision of law to the contrary,
26a Medicaid member residing at the state mental health
27institute at Cherokee or the state mental health institute
28at Independence shall retain Medicaid eligibility during
29the period of the Medicaid member’s stay for which federal
30financial participation is available.
314. Notwithstanding section 8.33, moneys appropriated in
32this section that remain unencumbered or unobligated at the
33close of the fiscal year shall not revert but shall remain
34available for expenditure for the purposes designated until the
35close of the succeeding fiscal year.
-47-1 Sec. 25. STATE RESOURCE CENTERS.
21. There is appropriated from the general fund of the
3state to the department of human services for the fiscal year
4beginning July 1, 2021, and ending June 30, 2022, the following
5amounts, or so much thereof as is necessary, to be used for the
6purposes designated:
7a. For the state resource center at Glenwood for salaries,
8support, maintenance, and miscellaneous purposes:
.................................................. $914,802,873
10b. For the state resource center at Woodward for salaries,
11support, maintenance, and miscellaneous purposes:
.................................................. $1213,698,094
132. The department may continue to bill for state resource
14center services utilizing a scope of services approach used for
15private providers of intermediate care facilities for persons
16with an intellectual disability services, in a manner which
17does not shift costs between the medical assistance program,
18counties, or other sources of funding for the state resource
19centers.
203. The state resource centers may expand the time-limited
21assessment and respite services during the fiscal year.
224. If the department’s administration and the department
23of management concur with a finding by a state resource
24center’s superintendent that projected revenues can reasonably
25be expected to pay the salary and support costs for a new
26employee position, or that such costs for adding a particular
27number of new positions for the fiscal year would be less
28than the overtime costs if new positions would not be added,
29the superintendent may add the new position or positions. If
30the vacant positions available to a resource center do not
31include the position classification desired to be filled, the
32state resource center’s superintendent may reclassify any
33vacant position as necessary to fill the desired position. The
34superintendents of the state resource centers may, by mutual
35agreement, pool vacant positions and position classifications
-48-1during the course of the fiscal year in order to assist one
2another in filling necessary positions.
35. If existing capacity limitations are reached in
4operating units, a waiting list is in effect for a service or
5a special need for which a payment source or other funding
6is available for the service or to address the special need,
7and facilities for the service or to address the special need
8can be provided within the available payment source or other
9funding, the superintendent of a state resource center may
10authorize opening not more than two units or other facilities
11and begin implementing the service or addressing the special
12need during fiscal year 2021-2022.
136. Notwithstanding section 8.33, and notwithstanding
14the amount limitation specified in section 222.92, moneys
15appropriated in this section that remain unencumbered or
16unobligated at the close of the fiscal year shall not revert
17but shall remain available for expenditure for the purposes
18designated until the close of the succeeding fiscal year.
19 Sec. 26. SEXUALLY VIOLENT PREDATORS.
201. There is appropriated from the general fund of the
21state to the department of human services for the fiscal year
22beginning July 1, 2021, and ending June 30, 2022, the following
23amount, or so much thereof as is necessary, to be used for the
24purpose designated:
25For costs associated with the commitment and treatment of
26sexually violent predators in the unit located at the state
27mental health institute at Cherokee, including costs of legal
28services and other associated costs, including salaries,
29support, maintenance, and miscellaneous purposes, and for not
30more than the following full-time equivalent positions:
.................................................. $3113,643,727
............................................... FTEs32139.00
332. Unless specifically prohibited by law, if the amount
34charged provides for recoupment of at least the entire amount
35of direct and indirect costs, the department of human services
-49-1may contract with other states to provide care and treatment
2of persons placed by the other states at the unit for sexually
3violent predators at Cherokee. The moneys received under
4such a contract shall be considered to be repayment receipts
5and used for the purposes of the appropriation made in this
6section.
73. Notwithstanding section 8.33, moneys appropriated in
8this section that remain unencumbered or unobligated at the
9close of the fiscal year shall not revert but shall remain
10available for expenditure for the purposes designated until the
11close of the succeeding fiscal year.
12 Sec. 27. FIELD OPERATIONS.
131. There is appropriated from the general fund of the
14state to the department of human services for the fiscal year
15beginning July 1, 2021, and ending June 30, 2022, the following
16amount, or so much thereof as is necessary, to be used for the
17purposes designated:
18For field operations, including salaries, support,
19maintenance, and miscellaneous purposes, and for not more than
20the following full-time equivalent positions:
.................................................. $2160,596,667
............................................... FTEs221,539.00
232. Priority in filling full-time equivalent positions
24shall be given to those positions related to child protection
25services and eligibility determination for low-income families.
26 Sec. 28. GENERAL ADMINISTRATION. There is appropriated
27from the general fund of the state to the department of human
28services for the fiscal year beginning July 1, 2021, and ending
29June 30, 2022, the following amount, or so much thereof as is
30necessary, to be used for the purpose designated:
31For general administration, including salaries, support,
32maintenance, and miscellaneous purposes, and for not more than
33the following full-time equivalent positions:
.................................................. $3414,542,189
............................................... FTEs35294.00
-50- 11. The department shall report at least monthly to the
2general assembly concerning the department’s operational and
3program expenditures.
42. Of the funds appropriated in this section, $150,000
5shall be used for the provision of a program to provide
6technical assistance, support, and consultation to providers
7of habilitation services and home and community-based services
8waiver services for adults with disabilities under the medical
9assistance program.
103. Of the funds appropriated in this section, $50,000
11is transferred to the Iowa finance authority to be used
12for administrative support of the council on homelessness
13established in section 16.2D and for the council to fulfill its
14duties in addressing and reducing homelessness in the state.
154. Of the funds appropriated in this section, $200,000 shall
16be transferred to and deposited in the administrative fund of
17the Iowa ABLE savings plan trust created in section 12I.4, to
18be used for implementation and administration activities of the
19Iowa ABLE savings plan trust.
205. Of the funds appropriated in this section, $200,000 is
21transferred to the economic development authority for the Iowa
22commission on volunteer services to continue to be used for the
23RefugeeRISE AmeriCorps program established under section 15H.8
24for member recruitment and training to improve the economic
25well-being and health of economically disadvantaged refugees in
26local communities across Iowa. Funds transferred may be used
27to supplement federal funds under federal regulations.
286. Of the funds appropriated in this section, up to $300,000
29shall be used as follows:
30a. To fund not more than one full-time equivalent position
31to address the department’s responsibility to support the work
32of the children’s behavioral health system state board and
33implementation of the services required pursuant to section
34331.397.
35b. To support the cost of establishing and implementing new
-51-1or additional services required pursuant to sections 331.397
2and 331.397A.
3c. Of the amount allocated, $32,000 shall be transferred
4to the department of public health to support the costs of
5establishing and implementing new or additional services
6required pursuant to sections 331.397 and 331.397A.
7 Sec. 29. DEPARTMENT-WIDE DUTIES. There is appropriated
8from the general fund of the state to the department of human
9services for the fiscal year beginning July 1, 2021, and ending
10June 30, 2022, the following amount, or so much thereof as is
11necessary, to be used for the purposes designated:
12For salaries, support, maintenance, and miscellaneous
13purposes at facilities under the purview of the department of
14human services:
.................................................. $152,879,274
16 Sec. 30. VOLUNTEERS. There is appropriated from the general
17fund of the state to the department of human services for the
18fiscal year beginning July 1, 2021, and ending June 30, 2022,
19the following amount, or so much thereof as is necessary, to be
20used for the purpose designated:
21For development and coordination of volunteer services:
.................................................. $2284,686
23 Sec. 31. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
24ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
25DEPARTMENT OF HUMAN SERVICES.
261. a. (1) (a) Notwithstanding any provision of law to
27the contrary, for the fiscal year beginning July 1, 2021, the
28department shall not rebase case-mix nursing facility rates,
29but shall instead reimburse case-mix nursing facilities by
30adjusting the nursing facility case-mix adjusted rates that
31were effective July 1, 2019, using the mid-points of each of
32the most recent cost reports submitted by the nursing facility
33for the period ending on or before December 31, 2018, and
34inflating these costs forward applying the inflation factor as
35determined using the latest available quarterly publication of
-52-1the HCFA/SNF index, to the extent possible within the state
2funding, including the $8,002,912 provided for this purpose.
3(b) For the fiscal year beginning July 1, 2021, non-case-mix
4and special population nursing facilities shall be reimbursed
5in accordance with the methodology in effect on June 30 of the
6prior fiscal year.
7(c) For managed care claims, the department of human
8services shall adjust the payment rate floor for nursing
9facilities, annually, to maintain a rate floor that is no
10lower than the Medicaid fee-for-service case-mix adjusted rate
11calculated in accordance with subparagraph division (a) and
12441 IAC 81.6. The department shall then calculate adjusted
13reimbursement rates, including but not limited to add-on
14payments, annually, and shall notify Medicaid managed care
15organizations of the adjusted reimbursement rates within 30
16days of determining the adjusted reimbursement rates. Any
17adjustment of reimbursement rates under this subparagraph
18division shall be budget neutral to the state budget.
19(d) For the fiscal year beginning July 1, 2021, Medicaid
20managed care long-term services and supports capitation rates
21shall be adjusted to reflect the case-mix adjusted rates
22specified pursuant to subparagraph division (a) for the patient
23populations residing in Medicaid-certified nursing facilities.
24(2) Medicaid managed care organizations shall adjust
25facility-specific rates based upon payment rate listings issued
26by the department. The rate adjustments shall be applied
27prospectively from the effective date of the rate letter issued
28by the department.
29b. (1) For the fiscal year beginning July 1, 2021, the
30department shall establish the fee-for-service pharmacy
31dispensing fee reimbursement at $10.07 per prescription,
32until a cost of dispensing survey is completed. The actual
33dispensing fee shall be determined by a cost of dispensing
34survey performed by the department and required to be completed
35by all medical assistance program participating pharmacies
-53-1every two years, adjusted as necessary to maintain expenditures
2within the amount appropriated to the department for this
3purpose for the fiscal year. A change in the dispensing
4fee shall become effective following federal approval of the
5Medicaid state plan.
6(2) The department shall amend Medicaid managed care
7organization contracts to authorize establishment of a managed
8care pharmacy dispensing fee reimbursement in accordance with
9either of the following:
10(a) The established fee-for-service pharmacy dispensing fee
11reimbursement of $10.07 per prescription as specified pursuant
12to subparagraph (1).
13(b) A dispensing fee determined contractually by mutual
14agreement between the managed care organization and a
15participating pharmacy with multiple locations and headquarters
16located outside the state, not to exceed the established
17fee-for-service pharmacy dispensing fee reimbursement of $10.07
18per prescription as specified pursuant to subparagraph (1).
19(3) The department shall utilize an average acquisition
20cost reimbursement methodology for all drugs covered under the
21medical assistance program in accordance with 2012 Iowa Acts,
22chapter 1133, section 33.
23c. (1) For the fiscal year beginning July 1, 2021,
24reimbursement rates for outpatient hospital services shall
25remain at the rates in effect on June 30, 2021, subject to
26Medicaid program upper payment limit rules, and adjusted
27as necessary to maintain expenditures within the amount
28appropriated to the department for this purpose for the fiscal
29year.
30(2) For the fiscal year beginning July 1, 2021,
31reimbursement rates for inpatient hospital services shall
32be rebased effective October 1, 2021, subject to Medicaid
33program upper payment limit rules, and adjusted as necessary
34to maintain expenditures within the amount appropriated to the
35department for this purpose for the fiscal year.
-54- 1(3) For the fiscal year beginning July 1, 2021, under
2both fee-for-service and managed care administration of
3the Medicaid program, critical access hospitals shall be
4reimbursed for inpatient and outpatient services based on the
5hospital-specific critical access hospital cost adjustment
6factor methodology utilizing the most recent and complete cost
7reporting period as applied prospectively within the funds
8appropriated for such purpose for the fiscal year.
9(4) For the fiscal year beginning July 1, 2021, the graduate
10medical education and disproportionate share hospital fund
11shall remain at the amount in effect on June 30, 2021, except
12that the portion of the fund attributable to graduate medical
13education shall be reduced in an amount that reflects the
14elimination of graduate medical education payments made to
15out-of-state hospitals.
16(5) In order to ensure the efficient use of limited state
17funds in procuring health care services for low-income Iowans,
18funds appropriated in this Act for hospital services shall
19not be used for activities which would be excluded from a
20determination of reasonable costs under the federal Medicare
21program pursuant to 42 U.S.C.§1395x(v)(1)(N).
22d. For the fiscal year beginning July 1, 2021, reimbursement
23rates for hospices and acute psychiatric hospitals shall be
24increased in accordance with increases under the federal
25Medicare program or as supported by their Medicare audited
26costs.
27e. For the fiscal year beginning July 1, 2021, independent
28laboratories and rehabilitation agencies shall be reimbursed
29using the same methodology in effect on June 30, 2021.
30f. (1) For the fiscal year beginning July 1, 2021,
31reimbursement rates for home health agencies shall continue to
32be based on the Medicare low utilization payment adjustment
33(LUPA) methodology with state geographic wage adjustments.
34The department shall continue to update the rates every two
35years to reflect the most recent Medicare LUPA rates to the
-55-1extent possible within the state funding appropriated for this
2purpose.
3(2) For the fiscal year beginning July 1, 2021, rates for
4private duty nursing and personal care services under the early
5and periodic screening, diagnostic, and treatment program
6benefit shall be calculated based on the methodology in effect
7on June 30, 2021.
8g. For the fiscal year beginning July 1, 2021, federally
9qualified health centers and rural health clinics shall receive
10cost-based reimbursement for 100 percent of the reasonable
11costs for the provision of services to recipients of medical
12assistance.
13h. For the fiscal year beginning July 1, 2021, the
14reimbursement rates for dental services shall remain at the
15rates in effect on June 30, 2021.
16i. (1) For the fiscal year beginning July 1, 2021,
17reimbursement rates for non-state-owned psychiatric medical
18institutions for children shall be increased to the extent
19possible within the $3,900,000 appropriated for this purpose.
20(2) As a condition of participation in the medical
21assistance program, enrolled providers shall accept the medical
22assistance reimbursement rate for any covered goods or services
23provided to recipients of medical assistance who are children
24under the custody of a psychiatric medical institution for
25children.
26j. For the fiscal year beginning July 1, 2021, unless
27otherwise specified in this Act, all noninstitutional medical
28assistance provider reimbursement rates shall remain at the
29rates in effect on June 30, 2021, except for area education
30agencies, local education agencies, infant and toddler
31services providers, home and community-based services providers
32including consumer-directed attendant care providers under a
33section 1915(c) or 1915(i) waiver, targeted case management
34providers, and those providers whose rates are required to be
35determined pursuant to section 249A.20, or to meet federal
-56-1mental health parity requirements.
2k. Notwithstanding any provision to the contrary, for the
3fiscal year beginning July 1, 2021, the reimbursement rate for
4anesthesiologists shall remain at the rates in effect on June
530, 2021, and updated on January 1, 2022, to align with the
6most current Iowa Medicare anesthesia rate.
7l. Notwithstanding section 249A.20, for the fiscal year
8beginning July 1, 2021, the average reimbursement rate for
9health care providers eligible for use of the federal Medicare
10resource-based relative value scale reimbursement methodology
11under section 249A.20 shall remain at the rate in effect on
12June 30, 2021; however, this rate shall not exceed the maximum
13level authorized by the federal government.
14m. For the fiscal year beginning July 1, 2021, the
15reimbursement rate for residential care facilities shall not
16be less than the minimum payment level as established by the
17federal government to meet the federally mandated maintenance
18of effort requirement. The flat reimbursement rate for
19facilities electing not to file annual cost reports shall not
20be less than the minimum payment level as established by the
21federal government to meet the federally mandated maintenance
22of effort requirement.
23n. For the fiscal year beginning July 1, 2021, the
24reimbursement rates for inpatient mental health services
25provided at hospitals shall be rebased effective October 1,
262021, subject to Medicaid program upper payment limit rules
27and adjusted as necessary to maintain expenditures within the
28amount appropriated to the department for this purpose for
29the fiscal year; and psychiatrists shall be reimbursed at the
30medical assistance program fee-for-service rate in effect on
31June 30, 2021.
32o. For the fiscal year beginning July 1, 2021, community
33mental health centers may choose to be reimbursed for the
34services provided to recipients of medical assistance through
35either of the following options:
-57- 1(1) For 100 percent of the reasonable costs of the services.
2(2) In accordance with the alternative reimbursement rate
3methodology approved by the department of human services in
4effect on June 30, 2021.
5p. For the fiscal year beginning July 1, 2021, the
6reimbursement rate for providers of family planning services
7that are eligible to receive a 90 percent federal match shall
8remain at the rates in effect on June 30, 2021.
9q. For the fiscal year beginning July 1, 2021, the upper
10limits and reimbursement rates for providers of home and
11community-based services waiver services and habilitation
12services shall be increased to the extent possible within the
13$8,000,000 appropriated for this purpose.
14r. For the fiscal year beginning July 1, 2021, the
15reimbursement rates for emergency medical service providers
16shall remain at the rates in effect on June 30, 2021, or as
17approved by the centers for Medicare and Medicaid services of
18the United States department of health and human services.
19s. For the fiscal year beginning July 1, 2021, reimbursement
20rates for substance-related disorder treatment programs
21licensed under section 125.13 shall remain at the rates in
22effect on June 30, 2021.
23t. For the fiscal year beginning July 1, 2021, assertive
24community treatment per diem rates shall remain at the rates in
25effect on June 30, 2021.
26u. For the fiscal year beginning July 1, 2021, the
27reimbursement rate for family-centered services providers shall
28be established by contract.
29v. For the fiscal year beginning July 1, 2021, the
30reimbursement rate for air ambulance services shall be
31increased to the extent possible within the additional $100,000
32appropriated for this purpose.
33w. For the fiscal year beginning July 1, 2021, the
34reimbursement rate for specialized respite, home health aide,
35and nursing services provided through home and community-based
-58-1services waivers shall be a fee schedule rate no less than the
2current upper rate paid to all providers of such services for
3the fiscal year ending June 30, 2021.
42. For the fiscal year beginning July 1, 2021, the
5reimbursement rate for providers reimbursed under the
6in-home-related care program shall not be less than the minimum
7payment level as established by the federal government to meet
8the federally mandated maintenance of effort requirement.
93. Unless otherwise directed in this section, when the
10department’s reimbursement methodology for any provider
11reimbursed in accordance with this section includes an
12inflation factor, this factor shall not exceed the amount
13by which the consumer price index for all urban consumers
14increased during the calendar year ending December 31, 2002.
154. Notwithstanding section 234.38, for the fiscal
16year beginning July 1, 2021, the foster family basic daily
17maintenance rate and the maximum adoption subsidy rate for
18children ages 0 through 5 years shall be $16.78, the rate for
19children ages 6 through 11 years shall be $17.45, the rate for
20children ages 12 through 15 years shall be $19.10, and the
21rate for children and young adults ages 16 and older shall
22be $19.35. For youth ages 18 to 23 who have exited foster
23care, the preparation for adult living program maintenance
24rate shall be up to $602.70 per month as calculated based on
25the age of the participant. The maximum payment for adoption
26subsidy nonrecurring expenses shall be limited to $500 and the
27disallowance of additional amounts for court costs and other
28related legal expenses implemented pursuant to 2010 Iowa Acts,
29chapter 1031, section 408, shall be continued.
305. For the fiscal year beginning July 1, 2021, the maximum
31reimbursement rates for social services providers under
32contract shall remain at the rates in effect on June 30, 2021,
33or the provider’s actual and allowable cost plus inflation for
34each service, whichever is less. However, if a new service
35or service provider is added after June 30, 2021, the initial
-59-1reimbursement rate for the service or provider shall be based
2upon a weighted average of provider rates for similar services.
36. a. For the fiscal year beginning July 1, 2021, the
4reimbursement rates for resource family recruitment and
5retention contractors shall be established by contract.
6b. For the fiscal year beginning July 1, 2021, the
7reimbursement rates for supervised apartment living foster care
8providers shall be established by contract.
97. For the fiscal year beginning July 1, 2021, the
10reimbursement rate for group foster care providers shall be the
11combined service and maintenance reimbursement rate established
12by contract.
138. The group foster care reimbursement rates paid for
14placement of children out of state shall be calculated
15according to the same rate-setting principles as those used for
16in-state providers, unless the director of human services or
17the director’s designee determines that appropriate care cannot
18be provided within the state. The payment of the daily rate
19shall be based on the number of days in the calendar month in
20which service is provided.
219. a. For the fiscal year beginning July 1, 2021, the
22reimbursement rate paid for shelter care and the child welfare
23emergency services implemented to provide or prevent the need
24for shelter care shall be established by contract.
25b. For the fiscal year beginning July 1, 2021, the combined
26service and maintenance components of the reimbursement rate
27paid for shelter care services shall be based on the financial
28and statistical report submitted to the department. The
29maximum reimbursement rate shall be $101.83 per day. The
30department shall reimburse a shelter care provider at the
31provider’s actual and allowable unit cost, plus inflation, not
32to exceed the maximum reimbursement rate.
33c. Notwithstanding section 232.141, subsection 8, for the
34fiscal year beginning July 1, 2021, the amount of the statewide
35average of the actual and allowable rates for reimbursement of
-60-1juvenile shelter care homes that is utilized for the limitation
2on recovery of unpaid costs shall remain at the amount in
3effect for this purpose in the fiscal year beginning July 1,
42020.
510. For the fiscal year beginning July 1, 2021, the
6department shall calculate reimbursement rates for intermediate
7care facilities for persons with an intellectual disability
8at the 80th percentile. Beginning July 1, 2021, the rate
9calculation methodology shall utilize the consumer price index
10inflation factor applicable to the fiscal year beginning July
111, 2021.
1211. Effective July 1, 2021, the child care provider
13reimbursement rates shall remain at the rates in effect on June
1430, 2021. The department shall set rates in a manner so as
15to provide incentives for a nonregistered provider to become
16registered by applying any increase only to registered and
17licensed providers.
1812. The department may adopt emergency rules to implement
19this section.
20 Sec. 32. EMERGENCY RULES.
211. If necessary to comply with federal requirements
22including time frames, or if specifically authorized by a
23provision of this division of this Act, the department of
24human services or the mental health and disability services
25commission may adopt administrative rules under section 17A.4,
26subsection 3, and section 17A.5, subsection 2, paragraph “b”,
27to implement the provisions of this division of this Act and
28the rules shall become effective immediately upon filing or
29on a later effective date specified in the rules, unless the
30effective date of the rules is delayed or the applicability
31of the rules is suspended by the administrative rules review
32committee. Any rules adopted in accordance with this section
33shall not take effect before the rules are reviewed by the
34administrative rules review committee. The delay authority
35provided to the administrative rules review committee under
-61-1section 17A.4, subsection 7, and section 17A.8, subsection 9,
2shall be applicable to a delay imposed under this section,
3notwithstanding a provision in those sections making them
4inapplicable to section 17A.5, subsection 2, paragraph “b”.
5Any rules adopted in accordance with the provisions of this
6section shall also be published as a notice of intended action
7as provided in section 17A.4.
82. If during a fiscal year, the department of human
9services is adopting rules in accordance with this section
10or as otherwise directed or authorized by state law, and the
11rules will result in an expenditure increase beyond the amount
12anticipated in the budget process or if the expenditure was
13not addressed in the budget process for the fiscal year, the
14department shall notify the legislative services agency and
15the department of management concerning the rules and the
16expenditure increase. The notification shall be provided at
17least 30 calendar days prior to the date notice of the rules
18is submitted to the administrative rules coordinator and the
19administrative code editor.
20 Sec. 33. REPORTS. Any reports or other information required
21to be compiled and submitted under this Act during the fiscal
22year beginning July 1, 2021, shall be submitted to the general
23assembly on or before the dates specified for submission of the
24reports or information.
25 Sec. 34. EFFECTIVE UPON ENACTMENT. The following provision
26of this division of this Act, being deemed of immediate
27importance, takes effect upon enactment:
281. The provision relating to section 232.141 and directing
29the state court administrator and the division administrator of
30the department of human services division of child and family
31services to make the determination, by June 15, 2021, of the
32distribution of funds allocated for the payment of the expenses
33of court-ordered services provided to juveniles which are a
34charge upon the state.
35DIVISION VI
-62-1HEALTH CARE ACCOUNTS AND FUNDS — FY 2021-2022
2 Sec. 35. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is
3appropriated from the pharmaceutical settlement account created
4in section 249A.33 to the department of human services for the
5fiscal year beginning July 1, 2021, and ending June 30, 2022,
6the following amount, or so much thereof as is necessary, to be
7used for the purpose designated:
8Notwithstanding any provision of law to the contrary, to
9supplement the appropriations made in this Act for health
10program operations under the medical assistance program for the
11fiscal year beginning July 1, 2021, and ending June 30, 2022:
.................................................. $12234,193
13 Sec. 36. QUALITY ASSURANCE TRUST FUND — DEPARTMENT OF HUMAN
14SERVICES. Notwithstanding any provision to the contrary and
15subject to the availability of funds, there is appropriated
16from the quality assurance trust fund created in section
17249L.4 to the department of human services for the fiscal year
18beginning July 1, 2021, and ending June 30, 2022, the following
19amounts, or so much thereof as is necessary, for the purposes
20designated:
21To supplement the appropriation made in this Act from the
22general fund of the state to the department of human services
23for medical assistance for the same fiscal year:
.................................................. $2456,305,139
25 Sec. 37. HOSPITAL HEALTH CARE ACCESS TRUST FUND —
26DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to
27the contrary and subject to the availability of funds, there is
28appropriated from the hospital health care access trust fund
29created in section 249M.4 to the department of human services
30for the fiscal year beginning July 1, 2021, and ending June
3130, 2022, the following amounts, or so much thereof as is
32necessary, for the purposes designated:
33To supplement the appropriation made in this Act from the
34general fund of the state to the department of human services
35for medical assistance for the same fiscal year:
-63-.................................................. $133,920,554
2 Sec. 38. MEDICAL ASSISTANCE PROGRAM — NONREVERSION
3FOR FY 2021-2022. Notwithstanding section 8.33, if moneys
4appropriated for purposes of the medical assistance program for
5the fiscal year beginning July 1, 2021, and ending June 30,
62022, from the general fund of the state, the quality assurance
7trust fund, and the hospital health care access trust fund, are
8in excess of actual expenditures for the medical assistance
9program and remain unencumbered or unobligated at the close
10of the fiscal year, the excess moneys shall not revert but
11shall remain available for expenditure for the purposes of the
12medical assistance program until the close of the succeeding
13fiscal year.
14DIVISION VII
15NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
16JULY 1, 2023, THROUGH JUNE 30, 2025
17 Sec. 39. NURSING FACILITY REIMBURSEMENT METHODOLOGY —
18FISCAL PERIOD JULY 1, 2023, THROUGH JUNE 30, 2025.
19Notwithstanding any provision of law to the contrary, for the
20fiscal period beginning July 1, 2023, and ending June 30, 2025,
21the department of human services shall rebase case-mix nursing
22facility rates beginning July 1, 2023, using the Medicaid cost
23reports on file for the period ending December 31, 2022, and
24applying a minimum occupancy factor of 70 percent.
25DIVISION VIII
26NURSING FACILITY REIMBURSEMENT STUDY
27 Sec. 40. NURSING FACILITY CASE-MIX REIMBURSEMENT — STUDY
28AND RECOMMENDATIONS. The department of human services shall
29convene a workgroup including representatives of nursing
30facilities, managed care organizations, and other appropriate
31stakeholders to review the case-mix reimbursement methodology
32and process for nursing facilities, including but not limited
33to rebasing, the use of cost reports, and the application
34of quarterly case-mix index adjustments, and shall submit
35recommendations to the governor and the general assembly by
-64-1December 1, 2021, for improvements including those related to
2the methodology, the process, the use of prospective payments,
3and the applicable time frames to increase efficiencies
4and accuracy in the determination of reimbursements, reduce
5duplication of effort, more adequately reflect the actual costs
6of care, address changes in patient acuity levels without
7reliance on retroactive rate adjustments, and incentivize
8quality outcomes.
9DIVISION IX
10MEDICAID-ELIGIBLE CHILDREN — PEDIATRIC HEALTH CARE SERVICES
11 Sec. 41. MEDICAID-ELIGIBLE CHILDREN — PROVISION OF
12PEDIATRIC HEALTH CARE SERVICES — REVIEW AND REPORT. The
13department of human services shall review federal Medicare
14and state law and administrative rule restrictions related
15to the provision of physical therapy, occupational therapy,
16speech-language pathology, applied behavior analysis, and other
17pediatric health care services to Medicaid-eligible children
18to determine necessary changes in law and policy to ensure
19that these services are provided consistent with the early and
20periodic screening, diagnostic, and treatment program. The
21department shall submit a report including the findings of the
22review and recommendations to the governor and the general
23assembly by October 1, 2021.
24DIVISION X
25DECATEGORIZATION CARRYOVER FUNDING
26 Sec. 42. DECATEGORIZATION CARRYOVER FUNDING FY 2019 —
27TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188,
28subsection 5, paragraph “b”, any state-appropriated moneys in
29the funding pool that remained unencumbered or unobligated
30at the close of the fiscal year beginning July 1, 2018, and
31were deemed carryover funding to remain available for the two
32succeeding fiscal years that still remain unencumbered or
33unobligated at the close of the fiscal year beginning July 1,
342020, shall not revert but shall be transferred to the medical
35assistance program for the fiscal year beginning July 1, 2021.
-65-1 Sec. 43. EFFECTIVE DATE. This division of this Act, being
2deemed of immediate importance, takes effect upon enactment.
3 Sec. 44. RETROACTIVE APPLICABILITY. This division of this
4Act applies retroactively to July 1, 2020.
5DIVISION XI
6PRIOR APPROPRIATIONS AND OTHER PROVISIONS
7COURT-ORDERED SERVICES REIMBURSEMENT BY MANAGED CARE
8ORGANIZATIONS
9 Sec. 45. 2018 Iowa Acts, chapter 1165, section 128,
10subsection 2, paragraph a, is amended to read as follows:
11a. If a Medicaid member is receiving court-ordered services
12or treatment for a substance-related disorder pursuant to
13chapter 125 or for a mental illness pursuant to chapter 229,
14such services or treatment shall be provided and reimbursed
15for an initial period of three days before a managed care
16organization may apply medical necessity criteria to determine
17the most appropriate services, treatment, or placement for the
18Medicaid member.
19FAMILY INVESTMENT PROGRAM ACCOUNT
20 Sec. 46. 2019 Iowa Acts, chapter 85, section 9, as amended
21by 2020 Iowa Acts, chapter 1121, section 20, is amended by
22adding the following new subsection:
23 NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
24appropriated in this section that remain unencumbered or
25unobligated at the close of the fiscal year shall not revert
26but shall remain available for expenditure for the purposes
27designated, and may be transferred to other appropriations made
28in this division of this Act as necessary to carry out the
29initiatives included in the report submitted on nonreversion
30of funds required pursuant to 2020 Iowa Acts, chapter 1121,
31section 43, until the close of the succeeding fiscal year.
32Child and family services
33 Sec. 47. 2019 Iowa Acts, chapter 85, section 19, as amended
34by 2020 Iowa Acts, chapter 1121, section 23, is amended by
35adding the following new subsection:
-66-1 NEW SUBSECTION. 25. Notwithstanding section 8.33, moneys
2appropriated in this section that remain unencumbered or
3unobligated at the close of the fiscal year shall not revert
4but shall remain available for expenditure for the purpose of
5the redesign of the child welfare system, until the close of
6the succeeding fiscal year.
7 Sec. 48. EFFECTIVE DATE. This division of this Act, being
8deemed of immediate importance, takes effect upon enactment.
9DIVISION XII
10EXTENSION OF FUTURE REPEAL — HOSPITAL HEALTH CARE ACCESS
11ASSESSMENT PROGRAM
12 Sec. 49. Section 249M.5, Code 2021, is amended to read as
13follows:
14249M.5 Future repeal.
15This chapter is repealed July 1, 2021 2023.
16 Sec. 50. EFFECTIVE DATE. This division of this Act, being
17deemed of immediate importance, takes effect upon enactment.
18DIVISION XIII
19PUBLIC ASSISTANCE PROGRAM OVERSIGHT
20 Sec. 51. NEW SECTION. 239.1 Definitions.
21As used in this chapter, unless the context otherwise
22requires:
231. “Applicant” means an individual who is applying for
24public assistance benefits in the state.
252. “Asset” or “asset test” means all assets of the members
26of the applicant’s household, including all of the following:
27a. All bank accounts, excluding retirement accounts of
28members of the household.
29b. All cash, excluding the first two thousand dollars of
30members of the household.
31c. All lottery and gambling income of the household whether
32received as a lump sum or installment payments.
33d. All real estate, excluding the primary household
34residence and surrounding lot.
35e. All other personal property excluding personal
-67-1belongings, household goods, and one vehicle.
23. “Department” means the department of human services.
34. “Public assistance” means SNAP (the supplemental
4nutrition assistance program), the Medicaid program, FIP (the
5family investment program), and CHIP (the children’s health
6insurance program).
75. “Real-time system” means real-time electronic access
8to a system that allows verification of all applicable public
9assistance program eligibility information based on the
10most recent information available to the department through
11nonmodeled earned and unearned income, such as commercially
12available wage data.
136. “Recipient” means an individual who is receiving public
14assistance benefits in the state.
15 Sec. 52. NEW SECTION. 239.2 Asset test for supplemental
16nutrition assistance program.
171. For the purposes of determining eligibility for receipt
18of SNAP benefits, the department shall conduct an asset test
19on all members of the applicant’s household. The allowable
20financial resources to be included in or excluded from a
21determination of eligibility for SNAP shall be those specified
22in 7 U.S.C.§2014(g)(1).
232. Prior to determining eligibility for SNAP benefits,
24the department shall access, at a minimum, for every member
25of the applicant’s household, the following information from
26the following federal, state, and miscellaneous sources, or
27successor sources:
28a. Federal sources and information:
29(1) Earned and unearned income information maintained by
30the internal revenue service.
31(2) The following sources and information maintained by the
32United States social security administration:
33(a) Earned income information.
34(b) Death register information.
35(c) Prisoner or incarceration status information.
-68- 1(d) Supplemental security income information maintained in
2the state data exchange database.
3(e) Beneficiary records and earnings information maintained
4in the beneficiary and earnings data exchange database.
5(f) Earnings and pension information maintained in the
6beneficiary earnings exchange record system database.
7(3) The following sources and information maintained by the
8United States department of health and human services:
9(a) Income and employment information maintained in the
10national directory of new hires database by the office of child
11support enforcement of the administration for children and
12families.
13(b) Other federal data sources maintained by the office of
14child support enforcement of the administration for children
15and families.
16b. State sources and information:
17(1) The department’s sources and information including but
18not limited to all of the following:
19(a) Income and employment information maintained by the
20child support recovery unit.
21(b) Child care assistance information maintained by the
22division of child and family services.
23(c) Enrollment status in other public assistance programs.
24(2) The department of workforce development sources and
25information including all of the following:
26(a) Employment information.
27(b) Employer weekly, monthly, and quarterly reports of
28income and unemployment insurance payments.
29(3) The Iowa public employees’ retirement system for
30earnings and pension information.
31c. Miscellaneous sources:
32(1) Any existing real-time database of persons currently
33receiving benefits in other states, such as the national
34accuracy clearinghouse.
35(2) Any databases maintained by the Iowa lottery
-69-1commission.
2(3) Any existing real-time eligibility system that includes
3employment and income information maintained by a consumer
4reporting agency, as defined by the federal Fair Credit
5Reporting Act, 15 U.S.C. §1681a, for the purpose of obtaining
6real-time employment and income information.
73. Prior to determining eligibility for SNAP benefits, the
8department shall access information for every member of the
9applicant’s household from the following public records:
10a. A nationwide public records data source of physical asset
11ownership. The data source may include but is not limited to
12real property, automobiles, watercraft, aircraft, and luxury
13vehicles, or any other vehicle owned by the applicant.
14b. National and state financial institutions in order
15to locate undisclosed depository accounts or verify account
16balances of disclosed accounts.
174. The department shall enter into a memorandum of
18understanding with any department, division, bureau, section,
19unit, or any other subunit of a department to obtain the
20information specified in this section.
215. The provisions of this section shall not apply if every
22member of the applicant’s household receives supplemental
23security income.
24 Sec. 53. NEW SECTION. 239.3 Verification and authentication
25systems — public assistance programs.
261. By July 1, 2023, the department shall redesign an
27existing system; establish a new computerized income, asset,
28and identity eligibility verification system; or contract with
29a third-party vendor to provide for identity verification,
30identity authentication, asset verification, and dual
31enrollment prevention in order to deter waste, fraud, and
32abuse in each public assistance program administered by the
33department.
342. The department may contract with a third-party vendor
35to develop or provide a service for a real-time eligibility
-70-1system that allows the department to verify or authenticate
2income, assets, and identity eligibility of applicants and
3recipients to prevent fraud, misrepresentation, and inadequate
4documentation when determining eligibility for public
5assistance programs. The system shall be accessed prior to
6determining eligibility, periodically between eligibility
7redeterminations, and during eligibility redeterminations
8and reviews. The department may also contract with a
9third-party vendor to provide information to facilitate
10reviews of recipient eligibility conducted by the department.
11Specifically, the department may contract with a third-party
12consumer reporting agency, as defined by the federal Fair
13Credit Reporting Act, 15 U.S.C. §1681a, for the purpose of
14obtaining real-time employment and income information.
153. A contract entered into under this section shall provide,
16at a minimum, for all of the following:
17a. The establishment of the annual savings amount from
18utilization of the system or service, and a provision that the
19contract may be terminated contingent upon the savings not
20exceeding the total yearly cost to the state for utilization of
21the system or service.
22b. That the contract shall not preclude the department
23from continuing to conduct additional eligibility verification
24or authentication processes, to receive, review, or verify
25additional information related to the eligibility of an
26individual, or from contracting with a third-party vendor to
27provide additional eligibility authentication or verification
28information.
294. The department shall seek federal approval as necessary
30to implement and administer this section.
31 Sec. 54. NEW SECTION. 239.4 Public assistance programs —
32applicant and recipient eligibility verification.
331. All applications for initial public assistance
34program benefits and all determinations of ongoing recipient
35eligibility shall be processed through a system as specified
-71-1in this section. Complete initial applications shall be
2processed within the minimum period required by federal law.
3Prior to determining initial eligibility of an applicant for,
4or ongoing eligibility of a recipient of, public assistance,
5the department shall access information for every applicant or
6recipient from the following federal, state, and other sources:
7a. Federal sources and information:
8(1) Earned and unearned income information maintained by
9the internal revenue service.
10(2) The following sources and information maintained by the
11United States social security administration:
12(a) Earned income information.
13(b) Death register information.
14(c) Prisoner or incarceration status information.
15(d) Supplemental security income information maintained in
16the state data exchange database.
17(e) Beneficiary records and earnings information maintained
18in the beneficiary and earnings data exchange database.
19(f) Earnings and pension information maintained in the
20beneficiary earnings exchange record system database.
21(3) The following sources and information maintained by the
22United States department of health and human services:
23(a) Income and employment information maintained in the
24national directory of new hires database by the office of child
25support enforcement of the administration for children and
26families.
27(b) Other federal data sources maintained by the office of
28child support enforcement of the administration for children
29and families.
30(4) Information maintained by the United States citizenship
31and immigration services of the United States department of
32homeland security.
33(5) Payment information for public housing and section 8
34housing assistance guidelines maintained by the United States
35department of housing and urban development.
-72- 1(6) National fleeing felon information maintained by the
2United States federal bureau of investigation.
3b. State sources and information:
4(1) The department’s sources and information including but
5not limited to all of the following:
6(a) Income and employment information maintained by the
7child support recovery unit.
8(b) Child care assistance information maintained by the
9division of child and family services.
10(c) Enrollment status in other public assistance programs.
11(2) The department of workforce development sources and
12information including all of the following:
13(a) Employment information.
14(b) Employer weekly, monthly, and quarterly reports of
15income and unemployment insurance payments.
16(3) The Iowa public employees’ retirement system for
17earnings and pension information.
18c. Other sources including all of the following:
19(1) Any existing real-time database of persons currently
20receiving benefits in other states, such as the national
21accuracy clearinghouse.
22(2) An available database of persons who currently hold a
23license, permit, or certificate from any state agency, the cost
24of which exceeds five hundred dollars.
25(3) Wage reporting and similar information maintained by
26states contiguous to Iowa.
27(4) A third-party consumer reporting agency, as defined
28by the federal Fair Credit Reporting Act, 15 U.S.C. §1681a,
29for the purpose of obtaining real-time employment and income
30information.
312. Prior to determining the initial eligibility of an
32applicant for, or the ongoing eligibility of a recipient
33of, public assistance benefits, the department shall access
34information for every applicant or recipient from, at a
35minimum, the following public records:
-73- 1a. A nationwide public records data source of physical asset
2ownership. The data source may include but is not limited to
3real property, automobiles, watercraft, aircraft, and luxury
4vehicles, or any other vehicle owned by the applicant for or
5recipient of assistance.
6b. A nationwide public records data source of incarcerated
7individuals.
8c. A nationwide best address and driver’s license data
9source to verify that individuals are residents of the state.
10d. A comprehensive public records database from which the
11department may identify potential identity fraud or identity
12theft that is capable of closely associating name, social
13security number, date of birth, phone, and address information.
14e. National and local financial institutions in order
15to locate undisclosed depository accounts or verify account
16balances of disclosed accounts.
17f. Outstanding default or arrest warrant information.
183. The state may contract with a third-party consumer
19reporting agency, as defined by the federal Fair Credit
20Reporting Act, 15 U.S.C. §1681a, for the purpose of obtaining
21real-time employment and income information under this section.
22 Sec. 55. NEW SECTION. 239.5 Identity authentication.
23Unless otherwise prohibited by federal law or regulation,
24prior to the department awarding public assistance benefits, an
25applicant shall complete a computerized identity authentication
26process to confirm the identity of the applicant. Identity
27authentication shall be accomplished through a knowledge-based
28questionnaire consisting of financial and personal questions.
29The questionnaire shall contain questions tailored to assist
30persons without a bank account or those who have poor access
31to financial and banking services or who do not have an
32established credit history. The questionnaire may be submitted
33by the applicant online, in person, or via telephone.
34 Sec. 56. NEW SECTION. 239.6 Case review of applicant and
35recipient information.
-74- 11. If the information obtained from a review of an
2applicant’s or recipient’s information under this chapter does
3not result in the department finding a discrepancy or change
4in an individual’s circumstances affecting eligibility, the
5department shall take no further action.
62. If the information obtained from a review of the
7applicant’s or recipient’s information under this chapter
8results in the department finding a discrepancy or change in
9the individual’s circumstances affecting eligibility, the
10department shall respond in accordance with the provisions of
11section 239.8.
12 Sec. 57. NEW SECTION. 239.7 Notice and right to be heard.
131. An applicant for, or recipient of, public assistance
14shall be provided written notice and the opportunity to explain
15any issues identified in a review performed under this chapter
16for initial eligibility or redetermination of eligibility.
17Unless otherwise prohibited by federal law or regulation,
18a self-declaration by an applicant or recipient shall not
19be accepted as verification of categorical and financial
20eligibility during such review.
212. The notice provided to the applicant or recipient shall
22describe in sufficient detail the circumstances of the issue
23identified, the manner in which the applicant or recipient
24may respond, and the consequences of failing to respond to
25the notice or resolve the issue identified. The applicant or
26recipient shall be provided ten days to respond to the notice.
27The department may request additional information as necessary
28to reach a decision.
293. An applicant or recipient may respond to the notice as
30follows:
31a. By disagreeing with the findings of the department. If
32the applicant or recipient responds in a timely manner and
33disagrees with the findings of the department, the department
34shall reevaluate the circumstances to determine if the
35applicant’s or recipient’s position is valid. If, through
-75-1reevaluation, the department finds that the department is in
2error, the department shall take immediate action to correct
3the error. If, through reevaluation, the department affirms
4that the applicant’s or recipient’s position is invalid, the
5department shall determine the effect on the applicant’s or
6recipient’s eligibility and take appropriate action. Written
7notice of the department’s determination and the actions taken
8shall be provided to the applicant or recipient.
9b. By agreeing with the findings of the department. If
10the applicant or recipient responds in a timely manner and
11agrees with the findings of the department, the department
12shall determine the effect on the applicant’s or recipient’s
13eligibility and take appropriate action. Written notice of the
14department’s determination and actions taken shall be provided
15to the applicant or recipient.
164. If the applicant or recipient fails to respond to the
17notice in a timely manner, the department shall provide notice
18to terminate the applicant’s application or to discontinue
19the recipient’s enrollment for failure to cooperate, and
20shall terminate the applicant’s application or discontinue
21the recipient’s enrollment. The applicant’s or recipient’s
22eligibility for such public assistance shall not be established
23or reestablished until the issue has been resolved.
24 Sec. 58. NEW SECTION. 239.8 Referrals for fraud,
25misrepresentation, or inadequate documentation.
261. Following a review of an applicant’s or recipient’s
27eligibility under this chapter, the department may refer cases
28of suspected fraud along with any supportive information to the
29department of inspections and appeals for review.
302. In cases of substantiated fraud, upon conviction, the
31state shall review all appropriate legal options including
32but not limited to removal of a recipient from other public
33assistance programs and garnishment of wages or state income
34tax refunds until the department recovers an equal amount of
35benefits fraudulently claimed.
-76- 13. The department may refer suspected cases of fraud,
2misrepresentation, or inadequate documentation relating to
3initial or continued eligibility to appropriate state agencies,
4divisions, or departments for review of eligibility issues in
5programs providing public benefits other than those as defined
6in this chapter.
7 Sec. 59. NEW SECTION. 239.9 Administration — rules —
8reporting.
91. The department of human services shall adopt rules
10pursuant to chapter 17A to administer this chapter.
112. The department shall submit a report to the governor
12and the general assembly by January 15, 2024, and by January
1315 annually thereafter through January 15, 2028, detailing the
14impact of the verification and authentication measures taken
15under this chapter. The report shall include data for all
16affected public assistance programs including the number of
17cases reviewed, the number of cases closed, the number of fraud
18investigation referrals made, and the amount of savings and
19cost avoidance realized from the provisions of this chapter.
20 Sec. 60. IMPLEMENTATION.
211. The department of human services shall request federal
22approval including for any state plan amendment or waiver
23necessary to administer this division of this Act.
242. The provisions of this division of this Act requiring
25federal approval shall be implemented upon receipt of such
26federal approval.
273. The provisions of this division of this Act not requiring
28federal approval shall be implemented as specified in this
29division of this Act, or if not specified in this division of
30this Act, no later than July 1, 2023.
314. The department may contract with multiple third-party
32vendors to administer this division of this Act.
33EXPLANATION
34The inclusion of this explanation does not constitute agreement with
35the explanation’s substance by the members of the general assembly.
-77- 1This bill relates to appropriations for health and human
2services for fiscal year 2021-2022 to the department of
3veterans affairs, Iowa veterans home, department on aging
4(IDA), office of long-term care ombudsman, department of public
5health (DPH), Iowa finance authority, department of human
6rights, and department of human services (DHS). The bill is
7organized into divisions for each fiscal year.
8DEPARTMENT ON AGING. This division makes appropriations
9from the general fund of the state to the department on aging.
10OFFICE OF LONG-TERM CARE OMBUDSMAN. This division makes
11appropriations from the general fund of the state to the office
12of long-term care ombudsman.
13DEPARTMENT OF PUBLIC HEALTH. This division makes
14appropriations from the general fund of the state and from
15the sports wagering receipts fund to the department of public
16health.
17DEPARTMENT OF VETERANS AFFAIRS AND IOWA VETERANS HOME. This
18division makes appropriations from the general fund of the
19state to the department of veterans affairs for administration,
20the Iowa veterans home, for transfer to the Iowa finance
21authority for the home ownership assistance program and for the
22county commissions of veteran affairs.
23DEPARTMENT OF HUMAN SERVICES. This division makes
24appropriations from the general fund of the state and the
25federal temporary assistance for needy families block
26grant to DHS. The allocation for the family development
27and self-sufficiency grant program is made directly to
28the department of human rights. The reimbursement section
29addresses reimbursement for providers reimbursed by the
30department of human services.
31HEALTH CARE ACCOUNTS AND FUNDS. This division makes certain
32health-related appropriations. A number of the appropriations
33are made for purposes of the Medicaid program in addition to
34the general fund appropriations made for this purpose for the
35same fiscal year.
-78- 1NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
2JULY 1, 2023, THROUGH JUNE 30, 2025. This division provides
3that notwithstanding any provision of law to the contrary,
4for the fiscal period beginning July 1, 2023, and ending June
530, 2025, DHS shall rebase case-mix nursing facility rates
6beginning July 1, 2023, using the Medicaid cost reports on file
7for the period ending December 31, 2022, and applying a minimum
8occupancy factor of 70 percent.
9NURSING FACILITY REIMBURSEMENT STUDY. This division
10requires DHS to convene a workgroup to review the case-mix
11reimbursement methodology and process for nursing facilities
12and submit recommendations for improvements to the governor and
13the general assembly by December 1, 2021.
14MEDICAID-ELIGIBLE CHILDREN — PEDIATRIC HEALTH CARE
15SERVICES. This division requires DHS to review and submit a
16report to the governor and the general assembly by October 1,
172021, regarding the provision of pediatric health care services
18provided to Medicaid-eligible children in accordance with
19the early and periodic screening, diagnostic, and treatment
20program.
21DECATEGORIZATION CARRYOVER FUNDING. This division provides
22for the transfer of carryover decategorization funds that
23remained unencumbered or unobligated at the close of the fiscal
24year beginning July 1, 2020, to the Medicaid program for
25FY 2021-2022. The division takes effect upon enactment and is
26retroactively applicable to July 1, 2020.
27PRIOR APPROPRIATIONS AND OTHER PROVISIONS. This
28division amends a provision relating to the provision and
29reimbursement of court-ordered services and treatment for
30a substance-related disorder or for a mental illness by a
31managed care organization by eliminating the limitation that
32the services or treatment are court-ordered pursuant to Code
33chapter 125 (substance-related disorders) or Code chapter
34229 (hospitalization of persons with mental illness) and by
35eliminating the reference to “treatment” and only referencing
-79-1“services”.
2The division provides that funds appropriated to the
3department of human services and credited to the family
4investment program account that remain unencumbered or
5unobligated at the close of FY 2020-2021 shall not revert
6but shall remain available for expenditure for the purposes
7designated, and may be transferred to other appropriations as
8necessary to carry out the initiatives included in the report
9submitted on nonreversion of funds required pursuant to 2020
10Iowa Acts, chapter 1121, section 43, until the close of the
11succeeding fiscal year.
12The division also provides that funds appropriated to the
13department of human services for child and family services that
14remain unencumbered or unobligated at the close of FY 2020-2021
15shall not revert but shall remain available for expenditure for
16the purpose of the redesign of the child welfare system, until
17the close of the succeeding fiscal year.
18The division takes effect upon enactment.
19EXTENSION OF REPEAL FOR HOSPITAL HEALTH CARE ACCESS
20ASSESSMENT PROGRAM. This division extends the repeal of
21the hospital health care access assessment program chapter,
22Code chapter 249M, from July 1, 2021, to July 1, 2023. This
23provision takes effect upon enactment.
24PUBLIC ASSISTANCE PROGRAM OVERSIGHT. This division relates
25to public assistance program oversight, including various
26eligibility verification and authentication measures under
27new Code chapter 239 relating to the supplemental nutrition
28assistance program (SNAP), the Medicaid program, the family
29investment program (FIP), and the children’s health insurance
30program (CHIP).
-80-pf/rn
2services and veterans and including other related provisions
3and appropriations, providing penalties, and including
4effective date and retroactive and other applicability date
5provisions.
6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2DEPARTMENT ON AGING — FY 2021-2022
3 Section 1. DEPARTMENT ON AGING. There is appropriated from
4the general fund of the state to the department on aging for
5the fiscal year beginning July 1, 2021, and ending June 30,
62022, the following amount, or so much thereof as is necessary,
7to be used for the purposes designated:
8For aging programs for the department on aging and area
9agencies on aging to provide citizens of Iowa who are 60
10years of age and older with case management, Iowa’s aging and
11disabilities resource center, and other services which may
12include but are not limited to adult day, respite care, chore,
13information and assistance, and material aid, for information
14and options counseling for persons with disabilities who
15are 18 years of age or older, and for salaries, support,
16administration, maintenance, and miscellaneous purposes, and
17for not more than the following full-time equivalent positions:
.................................................. $1811,164,382
............................................... FTEs1927.00
201. Funds appropriated in this section may be used to
21supplement federal funds under federal regulations. To
22receive funds appropriated in this section, a local area
23agency on aging shall match the funds with moneys from other
24sources according to rules adopted by the department. Funds
25appropriated in this section may be used for elderly services
26not specifically enumerated in this section only if approved
27by an area agency on aging for provision of the service within
28the area.
292. Of the funds appropriated in this section, $279,000 is
30transferred to the economic development authority for the Iowa
31commission on volunteer services to be used for the retired and
32senior volunteer program.
333. a. The department on aging shall establish and enforce
34procedures relating to expenditure of state and federal funds
35by area agencies on aging that require compliance with both
-1-1state and federal laws, rules, and regulations, including but
2not limited to all of the following:
3(1) Requiring that expenditures are incurred only for goods
4or services received or performed prior to the end of the
5fiscal period designated for use of the funds.
6(2) Prohibiting prepayment for goods or services not
7received or performed prior to the end of the fiscal period
8designated for use of the funds.
9(3) Prohibiting prepayment for goods or services not
10defined specifically by good or service, time period, or
11recipient.
12(4) Prohibiting the establishment of accounts from which
13future goods or services which are not defined specifically by
14good or service, time period, or recipient, may be purchased.
15b. The procedures shall provide that if any funds are
16expended in a manner that is not in compliance with the
17procedures and applicable federal and state laws, rules, and
18regulations, and are subsequently subject to repayment, the
19area agency on aging expending such funds in contravention of
20such procedures, laws, rules and regulations, not the state,
21shall be liable for such repayment.
224. Of the funds appropriated in this section, at least
23$600,000 shall be used to fund home and community-based
24services through the area agencies on aging that enable older
25individuals to avoid more costly utilization of residential or
26institutional services and remain in their own homes.
275. Of the funds appropriated in this section, $812,000 shall
28be used for the purposes of chapter 231E and to administer
29the prevention of elder abuse, neglect, and exploitation
30program pursuant to section 231.56A, in accordance with the
31requirements of the federal Older Americans Act of 1965, 42
32U.S.C.§3001 et seq., as amended.
336. Of the funds appropriated in this section, $1,000,000
34shall be used to fund continuation of the aging and disability
35resource center lifelong links to provide individuals and
-2-1caregivers with information and services to plan for and
2maintain independence.
37. Of the funds appropriated in this section, $250,000
4shall be used by the department on aging, in collaboration with
5the department of human services and affected stakeholders,
6to continue to expand the pilot initiative to provide
7long-term care options counseling utilizing support planning
8protocols, to assist non-Medicaid eligible consumers who
9indicate a preference to return to the community and are
10deemed appropriate for discharge, to return to their community
11following a nursing facility stay. The department on aging
12shall submit a report regarding the outcomes of the pilot
13initiative to the governor and the general assembly by December
1415, 2021.
15DIVISION II
16OFFICE OF LONG-TERM CARE oMBUDSMAN — FY 2021-2022
17 Sec. 2. OFFICE OF LONG-TERM CARE OMBUDSMAN. There is
18appropriated from the general fund of the state to the office
19of long-term care ombudsman for the fiscal year beginning July
201, 2021, and ending June 30, 2022, the following amount, or
21so much thereof as is necessary, to be used for the purposes
22designated:
23For salaries, support, administration, maintenance, and
24miscellaneous purposes, and for not more than the following
25full-time equivalent positions:
.................................................. $261,149,821
............................................... FTEs2716.00
28DIVISION III
29DEPARTMENT OF PUBLIC HEALTH — FY 2021-2022
30 Sec. 3. DEPARTMENT OF PUBLIC HEALTH. There is appropriated
31from the general fund of the state to the department of public
32health for the fiscal year beginning July 1, 2021, and ending
33June 30, 2022, the following amounts, or so much thereof as is
34necessary, to be used for the purposes designated:
351. ADDICTIVE DISORDERS
-3- 1For reducing the prevalence of the use of tobacco, alcohol,
2and other drugs, and treating individuals affected by addictive
3behaviors, including gambling, and for not more than the
4following full-time equivalent positions:
.................................................. $523,659,379
............................................... FTEs612.00
7a. (1) Of the funds appropriated in this subsection,
8$4,021,000 shall be used for the tobacco use prevention
9and control initiative, including efforts at the state and
10local levels, as provided in chapter 142A. The commission
11on tobacco use prevention and control established pursuant
12to section 142A.3 shall advise the director of public health
13in prioritizing funding needs and the allocation of moneys
14appropriated for the programs and initiatives. Activities
15of the programs and initiatives shall be in alignment with
16the United States centers for disease control and prevention
17best practices for comprehensive tobacco control programs that
18include the goals of preventing youth initiation of tobacco
19usage, reducing exposure to secondhand smoke, and promotion
20of tobacco cessation. To maximize resources, the department
21shall determine if third-party sources are available to
22instead provide nicotine replacement products to an applicant
23prior to provision of such products to an applicant under
24the initiative. The department shall track and report to
25the individuals specified in this Act, any reduction in
26the provision of nicotine replacement products realized by
27the initiative through implementation of the prerequisite
28screening.
29(2) (a) The department shall collaborate with the
30alcoholic beverages division of the department of commerce for
31enforcement of tobacco laws, regulations, and ordinances and to
32engage in tobacco control activities approved by the division
33of tobacco use prevention and control of the department of
34public health as specified in the memorandum of understanding
35entered into between the divisions.
-4- 1(b) For the fiscal year beginning July 1, 2021, and ending
2June 30, 2022, the terms of the memorandum of understanding,
3entered into between the division of tobacco use prevention
4and control of the department of public health and the
5alcoholic beverages division of the department of commerce,
6governing compliance checks conducted to ensure licensed retail
7tobacco outlet conformity with tobacco laws, regulations, and
8ordinances relating to persons under 21 years of age, shall
9continue to restrict the number of such checks to one check per
10retail outlet, and one additional check for any retail outlet
11found to be in violation during the first check.
12b. (1) Of the funds appropriated in this subsection,
13$19,639,000 shall be used for problem gambling and
14substance-related disorder prevention, treatment, and recovery
15services, including a 24-hour helpline, public information
16resources, professional training, youth prevention, and program
17evaluation.
18(2) Of the amount allocated under this paragraph, $306,000
19shall be utilized by the department of public health, in
20collaboration with the department of human services, to
21maintain a single statewide 24-hour crisis hotline for the Iowa
22children’s behavioral health system that incorporates warmline
23services which may be provided through expansion of existing
24capabilities maintained by the department of public health as
25required pursuant to 2018 Iowa Acts, chapter 1056, section 16.
26c. The requirement of section 123.17, subsection 5, is met
27by the appropriations and allocations made in this division of
28this Act for purposes of substance-related disorder treatment
29and addictive disorders for the fiscal year beginning July 1,
302021.
312. HEALTHY CHILDREN AND FAMILIES
32For promoting the optimum health status for children and
33adolescents from birth through 21 years of age, and families,
34and for not more than the following full-time equivalent
35positions:
-5-.................................................. $15,816,681
............................................... FTEs214.00
3a. Of the funds appropriated in this subsection, not more
4than $734,000 shall be used for the healthy opportunities for
5parents to experience success (HOPES)-healthy families Iowa
6(HFI) program established pursuant to section 135.106.
7b. In order to implement the legislative intent stated
8in sections 135.106 and 256I.9, priority for home visitation
9program funding shall be given to programs using evidence-based
10or promising models for home visitation.
11c. Of the funds appropriated in this subsection, $3,075,000
12shall be used for continuation of the department’s initiative
13to provide for adequate developmental surveillance and
14screening during a child’s first five years. The funds shall
15be used first to fully fund the current sites to ensure that
16the sites are fully operational, with the remaining funds
17to be used for expansion to additional sites. The full
18implementation and expansion shall include enhancing the scope
19of the initiative through collaboration with the child health
20specialty clinics to promote healthy child development through
21early identification and response to both biomedical and social
22determinants of healthy development; by monitoring child
23health metrics to inform practice, document long-term health
24impacts and savings, and provide for continuous improvement
25through training, education, and evaluation; and by providing
26for practitioner consultation particularly for children with
27behavioral conditions and needs. The department of public
28health shall also collaborate with the Iowa Medicaid enterprise
29and the child health specialty clinics to integrate the
30activities of the first five initiative into the establishment
31of patient-centered medical homes, community utilities,
32accountable care organizations, and other integrated care
33models developed to improve health quality and population
34health while reducing health care costs. To the maximum extent
35possible, funding allocated in this paragraph shall be utilized
-6-1as matching funds for medical assistance program reimbursement.
2d. Of the funds appropriated in this subsection, $64,000
3shall be distributed to a statewide dental carrier to provide
4funds to continue the donated dental services program patterned
5after the projects developed by the dental lifeline network to
6provide dental services to indigent individuals who are elderly
7or with disabilities.
8e. Of the funds appropriated in this subsection, $156,000
9shall be used to provide audiological services and hearing aids
10for children.
11f. Of the funds appropriated in this subsection, $23,000 is
12transferred to the university of Iowa college of dentistry for
13provision of primary dental services to children. State funds
14shall be matched on a dollar-for-dollar basis. The university
15of Iowa college of dentistry shall coordinate efforts with the
16department of public health, oral and health delivery system
17bureau, to provide dental care to underserved populations
18throughout the state.
19g. Of the funds appropriated in this subsection, $50,000
20shall be used to address youth suicide prevention.
21h. Of the funds appropriated in this subsection, $40,000
22shall be used to support the Iowa effort to address the survey
23of children who experience adverse childhood experiences known
24as ACEs.
25i. Of the funds appropriated in this subsection, up to
26$494,000 shall be used for childhood obesity prevention.
273. CHRONIC CONDITIONS
28For serving individuals identified as having chronic
29conditions or special health care needs, and for not more than
30the following full-time equivalent positions:
.................................................. $314,223,373
............................................... FTEs3210.00
33a. Of the funds appropriated in this subsection, $153,000
34shall be used for grants to individual patients who have an
35inherited metabolic disorder to assist with the costs of
-7-1medically necessary foods and formula.
2b. Of the funds appropriated in this subsection, $1,055,000
3shall be used for the brain injury services program pursuant
4to section 135.22B, including $861,000 for contracting with an
5existing nationally affiliated and statewide organization whose
6purpose is to educate, serve, and support Iowans with brain
7injury and their families, for resource facilitator services
8in accordance with section 135.22B, subsection 9, and for
9contracting to enhance brain injury training and recruitment
10of service providers on a statewide basis. Of the amount
11allocated in this paragraph, $95,000 shall be used to fund
121.00 full-time equivalent position to serve as the state brain
13injury services program manager.
14c. Of the funds appropriated in this subsection, $144,000
15shall be used for the public purpose of continuing to contract
16with an existing nationally affiliated organization to provide
17education, client-centered programs, and client and family
18support for people living with epilepsy and their families.
19The amount allocated in this paragraph in excess of $50,000
20shall be matched dollar-for-dollar by the organization
21specified. Funds allocated under this paragraph shall be
22distributed in their entirety for the purpose specified on July
231, 2021.
24d. Of the funds appropriated in this subsection, $809,000
25shall be used for child health specialty clinics.
26e. Of the funds appropriated in this subsection, $384,000
27shall be used by the regional autism assistance program
28established pursuant to section 256.35, and administered by
29the child health specialty clinic located at the university of
30Iowa hospitals and clinics. The funds shall be used to enhance
31interagency collaboration and coordination of educational,
32medical, and other human services for persons with autism,
33their families, and providers of services, including delivering
34regionalized services of care coordination, family navigation,
35and integration of services through the statewide system of
-8-1regional child health specialty clinics and fulfilling other
2requirements as specified in chapter 225D. The university of
3Iowa shall not receive funds allocated under this paragraph for
4indirect costs associated with the regional autism assistance
5program.
6f. Of the funds appropriated in this subsection, $577,000
7shall be used for the comprehensive cancer control program to
8reduce the burden of cancer in Iowa through prevention, early
9detection, effective treatment, and ensuring quality of life.
10Of the funds allocated in this paragraph “f”, $150,000 shall
11be used to support a melanoma research symposium, a melanoma
12biorepository and registry, basic and translational melanoma
13research, and clinical trials.
14g. Of the funds appropriated in this subsection, $97,000
15shall be used for cervical and colon cancer screening, and
16$177,000 shall be used to enhance the capacity of the cervical
17cancer screening program to include provision of recommended
18prevention and early detection measures to a broader range of
19low-income women.
20h. Of the funds appropriated in this subsection, $506,000
21shall be used for the center for congenital and inherited
22disorders.
234. COMMUNITY CAPACITY
24For strengthening the health care delivery system at the
25local level, and for not more than the following full-time
26equivalent positions:
.................................................. $278,044,306
............................................... FTEs2813.00
29a. Of the funds appropriated in this subsection, $95,000
30is allocated for continuation of the child vision screening
31program implemented through the university of Iowa hospitals
32and clinics in collaboration with early childhood Iowa areas.
33The program shall submit a report to the department regarding
34the use of funds allocated under this paragraph “a”. The
35report shall include the objectives and results for the
-9-1program year including the target population and how the funds
2allocated assisted the program in meeting the objectives; the
3number, age, and location within the state of individuals
4served; the type of services provided to the individuals
5served; the distribution of funds based on service provided;
6and the continuing needs of the program.
7b. Of the funds appropriated in this subsection,
8$48,000 shall be used for a grant to a statewide association
9of psychologists, that is affiliated with the American
10psychological association, to be used for continuation of a
11program to rotate intern psychologists in placements that
12serve urban and rural mental health professional shortage
13areas. Once an intern psychologist begins service, the intern
14psychologist may continue serving in the location of the intern
15psychologist’s placement, notwithstanding any change in the
16mental health professional shortage area designation of such
17location. The intern psychologist may also provide services
18via telehealth, to underserved populations, and to Medicaid
19members. For the purposes of this paragraph “b”, “mental
20health professional shortage area” means a geographic area
21in this state that has been designated by the United States
22department of health and human services, health resources and
23services administration, bureau of health professionals, as
24having a shortage of mental health professionals.
25c. Of the funds appropriated in this subsection, the
26following amounts are allocated to be used as follows
27to support the goals of increased access, health system
28integration, and engagement:
29(1) Not less than $1,600,000 is allocated to the Iowa
30prescription drug corporation for continuation of the
31pharmaceutical infrastructure for safety net providers as
32described in 2007 Iowa Acts, chapter 218, section 108, and for
33the prescription drug donation repository program created in
34chapter 135M. Of the amount allocated in this subparagraph,
35$1,000,000 shall be used as one-time funding to support
-10-1program expansion and to implement an automated multi-dose
2prescription packaging system. Funds allocated under this
3subparagraph shall be distributed in their entirety for the
4purpose specified on July 1, 2021.
5(2) Not less than $334,000 is allocated to free clinics and
6free clinics of Iowa for necessary infrastructure, statewide
7coordination, provider recruitment, service delivery, and
8provision of assistance to patients in securing a medical home
9inclusive of oral health care. Funds allocated under this
10subparagraph shall be distributed in their entirety for the
11purpose specified on July 1, 2021.
12(3) Not less than $25,000 is allocated to the Iowa
13association of rural health clinics for necessary
14infrastructure and service delivery transformation. Funds
15allocated under this subparagraph shall be distributed in their
16entirety for the purpose specified on July 1, 2021.
17(4) Not less than $225,000 is allocated to the Polk county
18medical society for continuation of the safety net provider
19patient access to specialty health care initiative as described
20in 2007 Iowa Acts, chapter 218, section 109. Funds allocated
21under this subparagraph shall be distributed in their entirety
22for the purpose specified on July 1, 2021.
23d. Of the funds appropriated in this subsection, $191,000
24is allocated for the purposes of health care and public health
25workforce initiatives.
26e. Of the funds appropriated in this subsection, $296,000
27shall be used for a matching dental education loan repayment
28program to be allocated to a dental nonprofit health service
29corporation to continue to develop the criteria and implement
30the loan repayment program.
31f. Of the funds appropriated in this subsection, $150,000
32shall be used for the purposes of the Iowa donor registry as
33specified in section 142C.18.
34g. Of the funds appropriated in this subsection, $96,000
35shall be used for continuation of a grant to a nationally
-11-1affiliated volunteer eye organization that has an established
2program for children and adults and that is solely dedicated to
3preserving sight and preventing blindness through education,
4nationally certified vision screening and training, and
5community and patient service programs. The contractor shall
6submit a report to the general assembly regarding the use
7of funds allocated under this paragraph “g”. The report
8shall include the objectives and results for the program year
9including the target population and how the funds allocated
10assisted the program in meeting the objectives; the number,
11age, grade level if appropriate, and location within the state
12of individuals served; the type of services provided to the
13individuals served; the distribution of funds based on services
14provided; and the continuing needs of the program.
15h. Of the funds appropriated in this subsection, $2,000,000
16shall be deposited in the medical residency training account
17created in section 135.175, subsection 5, paragraph “a”, and
18is appropriated from the account to the department of public
19health to be used for the purposes of the medical residency
20training state matching grants program as specified in section
21135.176.
22i. Of the funds appropriated in this subsection, $250,000
23shall be used for the public purpose of providing funding to
24Des Moines university to continue a provider education project
25to provide primary care physicians with the training and skills
26necessary to recognize the signs of mental illness in patients.
27j. Of the funds appropriated in this subsection, $600,000
28shall be used for rural psychiatric residencies to support the
29annual creation and training of four psychiatric residents who
30will provide mental health services in underserved areas of
31the state. Notwithstanding section 8.33, moneys that remain
32unencumbered or unobligated at the close of the fiscal year
33shall not revert but shall remain available for expenditure for
34the purposes designated for subsequent fiscal years.
35k. Of the funds appropriated in this subsection, $150,000
-12-1shall be used for psychiatric training to increase access to
2mental health care services by expanding the mental health
3workforce via training of additional physician assistants and
4nurse practitioners.
5l. Of the funds appropriated in this subsection, $1,000,000
6shall be used for the creation of two centers of excellence
7programs to encourage innovation and collaboration among
8regional health care providers to transform health care
9delivery in order to provide quality, sustainable care that
10meets the needs of local communities.
115. ESSENTIAL PUBLIC HEALTH SERVICES
12To provide public health services that reduce risks and
13invest in promoting and protecting good health over the
14course of a lifetime with a priority given to older Iowans and
15vulnerable populations:
.................................................. $167,662,464
176. INFECTIOUS DISEASES
18For reducing the incidence and prevalence of communicable
19diseases, and for not more than the following full-time
20equivalent positions:
.................................................. $211,796,206
............................................... FTEs224.00
237. PUBLIC PROTECTION
24For protecting the health and safety of the public through
25establishing standards and enforcing regulations, and for not
26more than the following full-time equivalent positions:
.................................................. $274,466,601
............................................... FTEs28142.00
29a. Of the funds appropriated in this subsection, not more
30than $304,000 shall be credited to the emergency medical
31services fund created in section 135.25. Moneys in the
32emergency medical services fund are appropriated to the
33department to be used for the purposes of the fund.
34b. Of the funds appropriated in this subsection, up
35to $243,000 shall be used for sexual violence prevention
-13-1programming through a statewide organization representing
2programs serving victims of sexual violence through the
3department’s sexual violence prevention program, and for
4continuation of a training program for sexual assault
5response team (SART) members, including representatives of
6law enforcement, victim advocates, prosecutors, and certified
7medical personnel. The amount allocated in this paragraph “b”
8shall not be used to supplant funding administered for other
9sexual violence prevention or victims assistance programs.
10c. Of the funds appropriated in this subsection, up to
11$500,000 shall be used for the state poison control center.
12Pursuant to the directive under 2014 Iowa Acts, chapter
131140, section 102, the federal matching funds available to
14the state poison control center from the department of human
15services under the federal Children’s Health Insurance Program
16Reauthorization Act allotment shall be subject to the federal
17administrative cap rule of 10 percent applicable to funding
18provided under Tit.XXI of the federal Social Security Act and
19included within the department’s calculations of the cap.
20d. Of the funds appropriated in this subsection, up to
21$504,000 shall be used for childhood lead poisoning provisions.
228. RESOURCE MANAGEMENT
23For establishing and sustaining the overall ability of the
24department to deliver services to the public, and for not more
25than the following full-time equivalent positions:
.................................................. $26933,871
............................................... FTEs274.00
289. MISCELLANEOUS PROVISIONS
29The university of Iowa hospitals and clinics under the
30control of the state board of regents shall not receive
31indirect costs from the funds appropriated in this section.
32The university of Iowa hospitals and clinics billings to the
33department shall be on at least a quarterly basis.
34 Sec. 4. DEPARTMENT OF PUBLIC HEALTH — SPORTS WAGERING
35RECEIPTS FUND. There is appropriated from the sports wagering
-14-1receipts fund created in section 8.57, subsection 6, to the
2department of public health for the fiscal year beginning July
31, 2021, and ending June 30, 2022, the following amount, or
4so much thereof as is necessary, to be used for the purposes
5designated:
6For problem gambling and substance-related disorder
7prevention, treatment, and recovery services, including a
824-hour helpline, public information resources, professional
9training, youth prevention, and program evaluation:
.................................................. $101,750,000
11DIVISION IV
12DEPARTMENT OF VETERANS AFFAIRS — FY 2021-2022
13 Sec. 5. DEPARTMENT OF VETERANS AFFAIRS. There is
14appropriated from the general fund of the state to the
15department of veterans affairs for the fiscal year beginning
16July 1, 2021, and ending June 30, 2022, the following amounts,
17or so much thereof as is necessary, to be used for the purposes
18designated:
191. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
20For salaries, support, maintenance, and miscellaneous
21purposes, and for not more than the following full-time
22equivalent positions:
.................................................. $231,229,763
............................................... FTEs2415.00
252. IOWA VETERANS HOME
26For salaries, support, maintenance, and miscellaneous
27purposes:
.................................................. $287,131,552
29a. The Iowa veterans home billings involving the department
30of human services shall be submitted to the department on at
31least a monthly basis.
32b. The Iowa veterans home expenditure report shall be
33submitted monthly to the general assembly.
34c. The Iowa veterans home shall continue to include in the
35annual discharge report applicant information to provide for
-15-1the collection of demographic information including but not
2limited to the number of individuals applying for admission and
3admitted or denied admittance and the basis for the admission
4or denial; the age, gender, and race of such individuals;
5and the level of care for which such individuals applied for
6admission including residential or nursing level of care.
73. HOME OWNERSHIP ASSISTANCE PROGRAM
8For transfer to the Iowa finance authority for the
9continuation of the home ownership assistance program for
10persons who are or were eligible members of the armed forces of
11the United States, pursuant to section 16.54:
.................................................. $122,000,000
13 Sec. 6. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS
14FUND STANDING APPROPRIATIONS. Notwithstanding the standing
15appropriation in section 35A.16 for the fiscal year beginning
16July 1, 2021, and ending June 30, 2022, the amount appropriated
17from the general fund of the state pursuant to that section
18for the following designated purposes shall not exceed the
19following amount:
20For the county commissions of veteran affairs fund under
21section 35A.16:
.................................................. $22990,000
23DIVISION V
24DEPARTMENT OF HUMAN SERVICES — FY 2021-2022
25 Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
26GRANT. There is appropriated from the fund created in section
278.41 to the department of human services for the fiscal year
28beginning July 1, 2021, and ending June 30, 2022, from moneys
29received under the federal temporary assistance for needy
30families (TANF) block grant pursuant to the federal Personal
31Responsibility and Work Opportunity Reconciliation Act of 1996,
32Pub.L.No.104-193, and successor legislation, the following
33amounts, or so much thereof as is necessary, to be used for the
34purposes designated:
351. To be credited to the family investment program account
-16-1and used for assistance under the family investment program
2under chapter 239B:
.................................................. $35,002,006
42. To be credited to the family investment program account
5and used for the job opportunities and basic skills (JOBS)
6program and implementing family investment agreements in
7accordance with chapter 239B:
.................................................. $85,412,060
93. To be used for the family development and
10self-sufficiency grant program in accordance with section
11216A.107:
.................................................. $122,888,980
13Notwithstanding section 8.33, moneys appropriated in this
14subsection that remain unencumbered or unobligated at the close
15of the fiscal year shall not revert but shall remain available
16for expenditure for the purposes designated until the close of
17the succeeding fiscal year. However, unless such moneys are
18encumbered or obligated on or before September 30, 2022, the
19moneys shall revert.
204. For field operations:
.................................................. $2131,296,232
225. For general administration:
.................................................. $233,744,000
246. For state child care assistance:
.................................................. $2547,166,826
26a. Of the funds appropriated in this subsection,
27$26,205,412 is transferred to the child care and development
28block grant appropriation made by the Eighty-ninth General
29Assembly, 2021 session, for the federal fiscal year beginning
30October 1, 2021, and ending September 30, 2022. Of this
31amount, $200,000 shall be used for provision of educational
32opportunities to registered child care home providers in order
33to improve services and programs offered by this category
34of providers and to increase the number of providers. The
35department may contract with institutions of higher education
-17-1or child care resource and referral centers to provide
2the educational opportunities. Allowable administrative
3costs under the contracts shall not exceed 5 percent. The
4application for a grant shall not exceed two pages in length.
5b. Any funds appropriated in this subsection remaining
6unallocated shall be used for state child care assistance
7payments for families who are employed including but not
8limited to individuals enrolled in the family investment
9program.
107. For child and family services:
.................................................. $1132,380,654
128. For child abuse prevention grants:
.................................................. $13125,000
149. For pregnancy prevention grants on the condition that
15family planning services are funded:
.................................................. $161,913,203
17Pregnancy prevention grants shall be awarded to programs
18in existence on or before July 1, 2021, if the programs have
19demonstrated positive outcomes. Grants shall be awarded to
20pregnancy prevention programs which are developed after July
211, 2021, if the programs are based on existing models that
22have demonstrated positive outcomes. Grants shall comply with
23the requirements provided in 1997 Iowa Acts, chapter 208,
24section 14, subsections 1 and 2, including the requirement that
25grant programs must emphasize sexual abstinence. Priority in
26the awarding of grants shall be given to programs that serve
27areas of the state which demonstrate the highest percentage of
28unplanned pregnancies of females of childbearing age within the
29geographic area to be served by the grant.
3010. For technology needs and other resources necessary to
31meet federal, state, and welfare reform reporting, tracking,
32and case management requirements and other departmental needs:
.................................................. $331,037,186
3411. a. Notwithstanding any provision to the contrary,
35including but not limited to requirements in section 8.41 or
-18-1provisions in 2020 Iowa Acts or 2021 Iowa Acts regarding the
2receipt and appropriation of federal block grants, federal
3funds from the temporary assistance for needy families block
4grant received by the state and not otherwise appropriated
5in this section and remaining available for the fiscal year
6beginning July 1, 2021, are appropriated to the department of
7human services to the extent as may be necessary to be used in
8the following priority order: the family investment program,
9for state child care assistance program payments for families
10who are employed, and for the family investment program share
11of system costs for eligibility determination and related
12functions. The federal funds appropriated in this paragraph
13“a” shall be expended only after all other funds appropriated
14in subsection 1 for assistance under the family investment
15program, in subsection 6 for state child care assistance, or
16in subsection 10 for technology costs related to the family
17investment program, as applicable, have been expended. For
18the purposes of this subsection, the funds appropriated in
19subsection 6, paragraph “a”, for transfer to the child care
20and development block grant appropriation are considered fully
21expended when the full amount has been transferred.
22b. The department shall, on a quarterly basis, advise the
23legislative services agency and department of management of
24the amount of funds appropriated in this subsection that was
25expended in the prior quarter.
2612. Of the amounts appropriated in this section,
27$12,962,008 for the fiscal year beginning July 1, 2021, is
28transferred to the appropriation of the federal social services
29block grant made to the department of human services for that
30fiscal year.
3113. For continuation of the program providing categorical
32eligibility for the food assistance program as specified
33for the program in the section of this division of this Act
34relating to the family investment program account:
.................................................. $3514,236
-19- 114. The department may transfer funds allocated in this
2section to the appropriations made in this division of this Act
3for the same fiscal year for general administration and field
4operations for resources necessary to implement and operate the
5services referred to in this section and those funded in the
6appropriation made in this division of this Act for the same
7fiscal year for the family investment program from the general
8fund of the state.
915. With the exception of moneys allocated under this
10section for the family development and self-sufficiency grant
11program, to the extent moneys allocated in this section are
12deemed by the department not to be necessary to support the
13purposes for which they are allocated, such moneys may be used
14in the same fiscal year for any other purpose for which funds
15are allocated in this section or in section 8 of this division
16of this Act for the family investment program account. If
17there are conflicting needs, priority shall first be given
18to the family investment program account as specified under
19subsection 1 of this section and used for the purposes of
20assistance under the family investment program in accordance
21with chapter 239B, followed by state child care assistance
22program payments for families who are employed, followed by
23other priorities as specified by the department.
24 Sec. 8. FAMILY INVESTMENT PROGRAM ACCOUNT.
251. Moneys credited to the family investment program (FIP)
26account for the fiscal year beginning July 1, 2021, and
27ending June 30, 2022, shall be used to provide assistance in
28accordance with chapter 239B.
292. The department may use a portion of the moneys credited
30to the FIP account under this section as necessary for
31salaries, support, maintenance, and miscellaneous purposes.
323. The department may transfer funds allocated in
33subsection 4, excluding the allocation under subsection 4,
34paragraph “b”, to the appropriations made in this division of
35this Act for the same fiscal year for general administration
-20-1and field operations for resources necessary to implement
2and operate the services referred to in this section and
3those funded in the appropriations made in section 7 for the
4temporary assistance for needy families block grant and in
5section 9 for the family investment program from the general
6fund of the state in this division of this Act for the same
7fiscal year.
84. Moneys appropriated in this division of this Act and
9credited to the FIP account for the fiscal year beginning July
101, 2021, and ending June 30, 2022, are allocated as follows:
11a. To be retained by the department of human services to
12be used for coordinating with the department of human rights
13to more effectively serve participants in FIP and other shared
14clients and to meet federal reporting requirements under the
15federal temporary assistance for needy families block grant:
.................................................. $1610,000
17b. To the department of human rights for staffing,
18administration, and implementation of the family development
19and self-sufficiency grant program in accordance with section
20216A.107:
.................................................. $216,192,834
22(1) Of the funds allocated for the family development
23and self-sufficiency grant program in this paragraph “b”,
24not more than 5 percent of the funds shall be used for the
25administration of the grant program.
26(2) The department of human rights may continue to implement
27the family development and self-sufficiency grant program
28statewide during fiscal year 2021-2022.
29(3) The department of human rights may engage in activities
30to strengthen and improve family outcomes measures and
31data collection systems under the family development and
32self-sufficiency grant program.
33c. For the diversion subaccount of the FIP account:
.................................................. $341,293,000
35A portion of the moneys allocated for the diversion
-21-1subaccount may be used for field operations, salaries, data
2management system development, and implementation costs and
3support deemed necessary by the director of human services
4in order to administer the FIP diversion program. To the
5extent moneys allocated in this paragraph “c” are deemed by the
6department not to be necessary to support diversion activities,
7such moneys may be used for other efforts intended to increase
8engagement by family investment program participants in work,
9education, or training activities, or for the purposes of
10assistance under the family investment program in accordance
11with chapter 239B.
12d. For the food assistance employment and training program:
.................................................. $1366,588
14(1) The department shall apply the federal supplemental
15nutrition assistance program (SNAP) employment and training
16state plan in order to maximize to the fullest extent permitted
17by federal law the use of the 50 percent federal reimbursement
18provisions for the claiming of allowable federal reimbursement
19funds from the United States department of agriculture
20pursuant to the federal SNAP employment and training program
21for providing education, employment, and training services
22for eligible food assistance program participants, including
23but not limited to related dependent care and transportation
24expenses.
25(2) The department shall continue the categorical federal
26food assistance program eligibility at 160 percent of the
27federal poverty level and continue to eliminate the asset test
28from eligibility requirements, consistent with federal food
29assistance program requirements. The department shall include
30as many food assistance households as is allowed by federal
31law. The eligibility provisions shall conform to all federal
32requirements including requirements addressing individuals who
33are incarcerated or otherwise ineligible.
34e. For the JOBS program, not more than:
.................................................. $3512,018,258
-22- 15. Of the child support collections assigned under FIP,
2an amount equal to the federal share of support collections
3shall be credited to the child support recovery appropriation
4made in this division of this Act. Of the remainder of the
5assigned child support collections received by the child
6support recovery unit, a portion shall be credited to the FIP
7account, a portion may be used to increase recoveries, and a
8portion may be used to sustain cash flow in the child support
9payments account. If as a consequence of the appropriations
10and allocations made in this section the resulting amounts
11are insufficient to sustain cash assistance payments and meet
12federal maintenance of effort requirements, the department
13shall seek supplemental funding. If child support collections
14assigned under FIP are greater than estimated or are otherwise
15determined not to be required for maintenance of effort, the
16state share of either amount may be transferred to or retained
17in the child support payments account.
18 Sec. 9. FAMILY INVESTMENT PROGRAM GENERAL FUND. There
19is appropriated from the general fund of the state to the
20department of human services for the fiscal year beginning July
211, 2021, and ending June 30, 2022, the following amount, or
22so much thereof as is necessary, to be used for the purpose
23designated:
24To be credited to the family investment program (FIP)
25account and used for family investment program assistance
26under chapter 239B and other costs associated with providing
27needs-based benefits or assistance:
.................................................. $2840,003,978
291. Of the funds appropriated in this section, $6,606,198 is
30allocated for the JOBS program.
312. Of the funds appropriated in this section, $3,313,854 is
32allocated for the family development and self-sufficiency grant
33program.
343. a. Notwithstanding section 8.39, for the fiscal
35year beginning July 1, 2021, if necessary to meet federal
-23-1maintenance of effort requirements or to transfer federal
2temporary assistance for needy families block grant funding
3to be used for purposes of the federal social services block
4grant or to meet cash flow needs resulting from delays in
5receiving federal funding or to implement, in accordance with
6this division of this Act, activities currently funded with
7juvenile court services, county, or community moneys and state
8moneys used in combination with such moneys; to comply with
9federal requirements; or to maximize the use of federal funds;
10the department of human services may transfer funds within or
11between any of the appropriations made in this division of this
12Act and appropriations in law for the federal social services
13block grant to the department for the following purposes,
14provided that the combined amount of state and federal
15temporary assistance for needy families block grant funding
16for each appropriation remains the same before and after the
17transfer:
18(1) For the family investment program.
19(2) For state child care assistance.
20(3) For child and family services.
21(4) For field operations.
22(5) For general administration.
23b. This subsection shall not be construed to prohibit the
24use of existing state transfer authority for other purposes.
25The department shall report any transfers made pursuant to this
26subsection to the general assembly.
274. Of the funds appropriated in this section, $195,000
28shall be used for a contract for tax preparation assistance
29to low-income Iowans to expand the usage of the earned income
30tax credit. The purpose of the contract is to supply this
31assistance to underserved areas of the state. The department
32shall not retain any portion of the allocation under this
33subsection for administrative costs.
345. Of the funds appropriated in this section, $70,000 shall
35be used for the continuation of the parenting program, as
-24-1specified in 441 IAC ch.100, relating to parental obligations,
2in which the child support recovery unit participates, to
3support the efforts of a nonprofit organization committed
4to strengthening the community through youth development,
5healthy living, and social responsibility headquartered in
6a county with a population over 350,000 according to the
7latest certified federal census. The funds allocated in this
8subsection shall be used by the recipient organization to
9develop a larger community effort, through public and private
10partnerships, to support a broad-based multi-county parenthood
11initiative that promotes payment of child support obligations,
12improved family relationships, and full-time employment.
136. The department may transfer funds appropriated in this
14section, excluding the allocation in subsection 2 for the
15family development and self-sufficiency grant program, to the
16appropriations made in this division of this Act for general
17administration and field operations as necessary to administer
18this section, section 7 for the temporary assistance for needy
19families block grant, and section 8 for the family investment
20program account.
21 Sec. 10. CHILD SUPPORT RECOVERY. There is appropriated
22from the general fund of the state to the department of human
23services for the fiscal year beginning July 1, 2021, and ending
24June 30, 2022, the following amount, or so much thereof as is
25necessary, to be used for the purposes designated:
26For child support recovery, including salaries, support,
27maintenance, and miscellaneous purposes, and for not more than
28the following full-time equivalent positions:
.................................................. $2915,942,885
............................................... FTEs30459.00
311. The department shall expend up to $24,000, including
32federal financial participation, for the fiscal year beginning
33July 1, 2021, for a child support public awareness campaign.
34The department and the office of the attorney general shall
35cooperate in continuation of the campaign. The public
-25-1awareness campaign shall emphasize, through a variety of
2media activities, the importance of maximum involvement of
3both parents in the lives of their children as well as the
4importance of payment of child support obligations.
52. Federal access and visitation grant moneys shall be
6issued directly to private not-for-profit agencies that provide
7services designed to increase compliance with the child access
8provisions of court orders, including but not limited to
9neutral visitation sites and mediation services.
103. The appropriation made to the department for child
11support recovery may be used throughout the fiscal year in the
12manner necessary for purposes of cash flow management, and for
13cash flow management purposes the department may temporarily
14draw more than the amount appropriated, provided the amount
15appropriated is not exceeded at the close of the fiscal year.
16 Sec. 11. HEALTH CARE TRUST FUND — MEDICAL ASSISTANCE —
17FY 2021-2022. Any funds remaining in the health care trust
18fund created in section 453A.35A for the fiscal year beginning
19July 1, 2021, and ending June 30, 2022, are appropriated to
20the department of human services to supplement the medical
21assistance program appropriations made in this division of this
22Act, for medical assistance reimbursement and associated costs,
23including program administration and costs associated with
24program implementation.
25 Sec. 12. MEDICAID FRAUD FUND — MEDICAL ASSISTANCE — FY
262021-2022. Any funds remaining in the Medicaid fraud fund
27created in section 249A.50 for the fiscal year beginning
28July 1, 2021, and ending June 30, 2022, are appropriated to
29the department of human services to supplement the medical
30assistance appropriations made in this division of this Act,
31for medical assistance reimbursement and associated costs,
32including program administration and costs associated with
33program implementation.
34 Sec. 13. MEDICAL ASSISTANCE. There is appropriated from the
35general fund of the state to the department of human services
-26-1for the fiscal year beginning July 1, 2021, and ending June 30,
22022, the following amount, or so much thereof as is necessary,
3to be used for the purpose designated:
4For medical assistance program reimbursement and associated
5costs as specifically provided in the reimbursement
6methodologies in effect on June 30, 2021, except as otherwise
7expressly authorized by law, consistent with options under
8federal law and regulations, and contingent upon receipt of
9approval from the office of the governor of reimbursement for
10each abortion performed under the program:
.................................................. $111,479,602,321
121. Iowans support reducing the number of abortions
13performed in our state. Funds appropriated under this section
14shall not be used for abortions, unless otherwise authorized
15under this section.
162. The provisions of this section relating to abortions
17shall also apply to the Iowa health and wellness plan created
18pursuant to chapter 249N.
193. The department shall utilize not more than $60,000 of
20the funds appropriated in this section to continue the AIDS/HIV
21health insurance premium payment program as established in 1992
22Iowa Acts, Second Extraordinary Session, chapter 1001, section
23409, subsection 6. Of the funds allocated in this subsection,
24not more than $5,000 may be expended for administrative
25purposes.
264. Of the funds appropriated in this Act to the department
27of public health for addictive disorders, $950,000 for
28the fiscal year beginning July 1, 2021, is transferred
29to the department of human services for an integrated
30substance-related disorder managed care system. The
31departments of human services and public health shall
32work together to maintain the level of mental health and
33substance-related disorder treatment services provided by the
34managed care contractors. Each department shall take the steps
35necessary to continue the federal waivers as necessary to
-27-1maintain the level of services.
25. The department shall aggressively pursue options for
3providing medical assistance or other assistance to individuals
4with special needs who become ineligible to continue receiving
5services under the early and periodic screening, diagnostic,
6and treatment program under the medical assistance program
7due to becoming 21 years of age who have been approved for
8additional assistance through the department’s exception to
9policy provisions, but who have health care needs in excess
10of the funding available through the exception to policy
11provisions.
126. Of the funds appropriated in this section, up to
13$3,050,082 may be transferred to the field operations or
14general administration appropriations in this division of this
15Act for operational costs associated with Part D of the federal
16Medicare Prescription Drug Improvement and Modernization Act
17of 2003, Pub.L.No.108-173.
187. Of the funds appropriated in this section, up to $442,100
19may be transferred to the appropriation in this division of
20this Act for health program operations to be used for clinical
21assessment services and prior authorization of services.
228. A portion of the funds appropriated in this section may
23be transferred to the appropriations in this division of this
24Act for general administration, health program operations, the
25children’s health insurance program, or field operations to be
26used for the state match cost to comply with the payment error
27rate measurement (PERM) program for both the medical assistance
28and children’s health insurance programs as developed by the
29centers for Medicare and Medicaid services of the United States
30department of health and human services to comply with the
31federal Improper Payments Information Act of 2002, Pub.L.
32No.107-300, and to support other reviews and quality control
33activities to improve the integrity of these programs.
349. Of the funds appropriated in this section, a sufficient
35amount is allocated to supplement the incomes of residents of
-28-1nursing facilities, intermediate care facilities for persons
2with mental illness, and intermediate care facilities for
3persons with an intellectual disability, with incomes of less
4than $50 in the amount necessary for the residents to receive a
5personal needs allowance of $50 per month pursuant to section
6249A.30A.
710. a. Hospitals that meet the conditions specified
8in subparagraphs (1) and (2) shall either certify public
9expenditures or transfer to the medical assistance program
10an amount equal to provide the nonfederal share for a
11disproportionate share hospital payment in an amount up to the
12hospital-specific limit as approved in the Medicaid state plan.
13The hospitals that meet the conditions specified shall receive
14and retain 100 percent of the total disproportionate share
15hospital payment in an amount up to the hospital-specific limit
16as approved in the Medicaid state plan.
17(1) The hospital qualifies for disproportionate share and
18graduate medical education payments.
19(2) The hospital is an Iowa state-owned hospital with more
20than 500 beds and eight or more distinct residency specialty
21or subspecialty programs recognized by the American college of
22graduate medical education.
23b. Distribution of the disproportionate share payments
24shall be made on a monthly basis. The total amount of
25disproportionate share payments including graduate medical
26education, enhanced disproportionate share, and Iowa
27state-owned teaching hospital payments shall not exceed the
28amount of the state’s allotment under Pub.L.No.102-234.
29In addition, the total amount of all disproportionate
30share payments shall not exceed the hospital-specific
31disproportionate share limits under Pub.L.No.103-66.
3211. One hundred percent of the nonfederal share of payments
33to area education agencies that are medical assistance
34providers for medical assistance-covered services provided to
35medical assistance-covered children, shall be made from the
-29-1appropriation made in this section.
212. A portion of the funds appropriated in this section may
3be transferred to the appropriation in this division of this
4Act for health program operations to be used for administrative
5activities associated with the money follows the person
6demonstration project.
713. Of the funds appropriated in this section, $349,011
8shall be used for the administration of the health insurance
9premium payment program, including salaries, support,
10maintenance, and miscellaneous purposes.
1114. a. The department may increase the amounts allocated
12for salaries, support, maintenance, and miscellaneous purposes
13associated with the medical assistance program, as necessary,
14to sustain cost management efforts. The department shall
15report any such increase to the general assembly and the
16department of management.
17b. If the savings to the medical assistance program from
18ongoing cost management efforts exceed the associated cost
19for the fiscal year beginning July 1, 2021, the department
20may transfer any savings generated for the fiscal year due
21to medical assistance program cost management efforts to the
22appropriation made in this division of this Act for health
23program operations or general administration to defray the
24costs associated with implementing the efforts.
2515. For the fiscal year beginning July 1, 2021, and ending
26June 30, 2022, the replacement generation tax revenues required
27to be deposited in the property tax relief fund pursuant to
28section 437A.8, subsection 4, paragraph “d”, and section
29437A.15, subsection 3, paragraph “f”, shall instead be credited
30to and supplement the appropriation made in this section and
31used for the allocations made in this section.
3216. a. Of the funds appropriated in this section, up
33to $50,000 may be transferred by the department to the
34appropriation made in this division of this Act to the
35department for the same fiscal year for general administration
-30-1to be used for associated administrative expenses and for not
2more than 1.00 full-time equivalent position, in addition to
3those authorized for the same fiscal year, to be assigned to
4implementing the children’s mental health home project.
5b. Of the funds appropriated in this section, up to $400,000
6may be transferred by the department to the appropriation made
7to the department in this division of this Act for the same
8fiscal year for Medicaid program-related general administration
9planning and implementation activities. The funds may be used
10for contracts or for personnel in addition to the amounts
11appropriated for and the positions authorized for general
12administration for the fiscal year.
13c. Of the funds appropriated in this section, up to
14$3,000,000 may be transferred by the department to the
15appropriations made in this division of this Act for the
16same fiscal year for general administration or health
17program operations to be used to support the development
18and implementation of standardized assessment tools for
19persons with mental illness, an intellectual disability, a
20developmental disability, or a brain injury.
2117. Of the funds appropriated in this section, $150,000
22shall be used for lodging expenses associated with care
23provided at the university of Iowa hospitals and clinics for
24patients with cancer whose travel distance is 30 miles or more
25and whose income is at or below 200 percent of the federal
26poverty level as defined by the most recently revised poverty
27income guidelines published by the United States department of
28health and human services. The department of human services
29shall establish the maximum number of overnight stays and the
30maximum rate reimbursed for overnight lodging, which may be
31based on the state employee rate established by the department
32of administrative services. The funds allocated in this
33subsection shall not be used as nonfederal share matching
34funds.
3518. Of the funds appropriated in this section, up to
-31-1$3,383,880 shall be used for administration of the state family
2planning services program pursuant to section 217.41B, and
3of this amount, the department may use up to $200,000 for
4administrative expenses.
519. Of the funds appropriated in this section, $1,545,530
6shall be used and may be transferred to other appropriations
7in this division of this Act as necessary to administer the
8provisions in the division of this Act relating to Medicaid
9program administration.
10 Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated
11from the general fund of the state to the department of human
12services for the fiscal year beginning July 1, 2021, and ending
13June 30, 2022, the following amount, or so much thereof as is
14necessary, to be used for the purpose designated:
15For health program operations:
.................................................. $1617,831,343
171. The department of inspections and appeals shall
18provide all state matching funds for survey and certification
19activities performed by the department of inspections
20and appeals. The department of human services is solely
21responsible for distributing the federal matching funds for
22such activities.
232. Of the funds appropriated in this section, $50,000 shall
24be used for continuation of home and community-based services
25waiver quality assurance programs, including the review and
26streamlining of processes and policies related to oversight and
27quality management to meet state and federal requirements.
283. Of the amount appropriated in this section, up to
29$200,000 may be transferred to the appropriation for general
30administration in this division of this Act to be used for
31additional full-time equivalent positions in the development
32of key health initiatives such as development and oversight
33of managed care programs and development of health strategies
34targeted toward improved quality and reduced costs in the
35Medicaid program.
-32- 14. Of the funds appropriated in this section, $1,000,000
2shall be used for planning and development, in cooperation with
3the department of public health, of a phased-in program to
4provide a dental home for children.
55. a. Of the funds appropriated in this section, $573,000
6shall be credited to the autism support program fund created
7in section 225D.2 to be used for the autism support program
8created in chapter 225D, with the exception of the following
9amount of this allocation which shall be used as follows:
10b. Of the funds allocated in this subsection, $25,000 shall
11be used for the public purpose of continuation of a grant to a
12nonprofit provider of child welfare services that has been in
13existence for more than 115 years, is located in a county with
14a population between 200,000 and 220,000 according to the most
15recent federal decennial census, is licensed as a psychiatric
16medical institution for children, and provides school-based
17programming, to be used for support services for children with
18autism spectrum disorder and their families.
19 Sec. 15. STATE SUPPLEMENTARY ASSISTANCE.
201. There is appropriated from the general fund of the
21state to the department of human services for the fiscal year
22beginning July 1, 2021, and ending June 30, 2022, the following
23amount, or so much thereof as is necessary, to be used for the
24purpose designated:
25For the state supplementary assistance program:
.................................................. $267,349,002
272. The department shall increase the personal needs
28allowance for residents of residential care facilities by the
29same percentage and at the same time as federal supplemental
30security income and federal social security benefits are
31increased due to a recognized increase in the cost of living.
32The department may adopt emergency rules to implement this
33subsection.
343. If during the fiscal year beginning July 1, 2021,
35the department projects that state supplementary assistance
-33-1expenditures for a calendar year will not meet the federal
2pass-through requirement specified in Tit.XVI of the federal
3Social Security Act, section 1618, as codified in 42 U.S.C.
4§1382g, the department may take actions including but not
5limited to increasing the personal needs allowance for
6residential care facility residents and making programmatic
7adjustments or upward adjustments of the residential care
8facility or in-home health-related care reimbursement rates
9prescribed in this division of this Act to ensure that federal
10requirements are met. In addition, the department may make
11other programmatic and rate adjustments necessary to remain
12within the amount appropriated in this section while ensuring
13compliance with federal requirements. The department may adopt
14emergency rules to implement the provisions of this subsection.
154. Notwithstanding section 8.33, moneys appropriated
16in this section that remain unencumbered or unobligated
17at the close of the fiscal year shall not revert but
18shall remain available for expenditure for the purposes
19designated, including for liability amounts associated with the
20supplemental nutrition assistance program payment error rate,
21until the close of the succeeding fiscal year.
22 Sec. 16. CHILDREN’S HEALTH INSURANCE PROGRAM.
231. There is appropriated from the general fund of the
24state to the department of human services for the fiscal year
25beginning July 1, 2021, and ending June 30, 2022, the following
26amount, or so much thereof as is necessary, to be used for the
27purpose designated:
28For maintenance of the healthy and well kids in Iowa (hawk-i)
29program pursuant to chapter 514I, including supplemental dental
30services, for receipt of federal financial participation under
31Tit.XXI of the federal Social Security Act, which creates the
32children’s health insurance program:
.................................................. $3337,957,643
342. Of the funds appropriated in this section, $149,189 is
35allocated for continuation of the contract for outreach with
-34-1the department of public health.
23. A portion of the funds appropriated in this section may
3be transferred to the appropriations made in this division of
4this Act for field operations or health program operations to
5be used for the integration of hawk-i program eligibility,
6payment, and administrative functions under the purview of
7the department of human services, including for the Medicaid
8management information system upgrade.
9 Sec. 17. CHILD CARE ASSISTANCE. There is appropriated
10from the general fund of the state to the department of human
11services for the fiscal year beginning July 1, 2021, and ending
12June 30, 2022, the following amount, or so much thereof as is
13necessary, to be used for the purpose designated:
14For child care programs:
.................................................. $1540,816,931
161. Of the funds appropriated in this section, $34,966,931
17shall be used for state child care assistance in accordance
18with section 237A.13.
192. Nothing in this section shall be construed or is
20intended as or shall imply a grant of entitlement for services
21to persons who are eligible for assistance due to an income
22level consistent with the waiting list requirements of section
23237A.13. Any state obligation to provide services pursuant to
24this section is limited to the extent of the funds appropriated
25in this section.
263. A list of the registered and licensed child care
27facilities operating in the area served by a child care
28resource and referral service shall be made available to the
29families receiving state child care assistance in that area.
304. Of the funds appropriated in this section, $5,850,000
31shall be credited to the early childhood programs grants
32account in the early childhood Iowa fund created in section
33256I.11. The moneys shall be distributed for funding of
34community-based early childhood programs targeted to children
35from birth through five years of age developed by early
-35-1childhood Iowa areas in accordance with approved community
2plans as provided in section 256I.8.
35. The department may use any of the funds appropriated
4in this section as a match to obtain federal funds for use in
5expanding child care assistance and related programs. For
6the purpose of expenditures of state and federal child care
7funding, funds shall be considered obligated at the time
8expenditures are projected or are allocated to the department’s
9service areas. Projections shall be based on current and
10projected caseload growth, current and projected provider
11rates, staffing requirements for eligibility determination
12and management of program requirements including data systems
13management, staffing requirements for administration of the
14program, contractual and grant obligations and any transfers
15to other state agencies, and obligations for decategorization
16or innovation projects.
176. A portion of the state match for the federal child care
18and development block grant shall be provided as necessary to
19meet federal matching funds requirements through the state
20general fund appropriation made for child development grants
21and other programs for at-risk children in section 279.51.
227. If a uniform reduction ordered by the governor under
23section 8.31 or other operation of law, transfer, or federal
24funding reduction reduces the appropriation made in this
25section for the fiscal year, the percentage reduction in the
26amount paid out to or on behalf of the families participating
27in the state child care assistance program shall be equal to or
28less than the percentage reduction made for any other purpose
29payable from the appropriation made in this section and the
30federal funding relating to it. The percentage reduction to
31the other allocations made in this section shall be the same as
32the uniform reduction ordered by the governor or the percentage
33change of the federal funding reduction, as applicable. If
34there is an unanticipated increase in federal funding provided
35for state child care services, the entire amount of the
-36-1increase, except as necessary to meet federal requirements
2including quality set asides, shall be used for state child
3care assistance payments. If the appropriations made for
4purposes of the state child care assistance program for the
5fiscal year are determined to be insufficient, it is the intent
6of the general assembly to appropriate sufficient funding for
7the fiscal year in order to avoid establishment of waiting list
8requirements.
98. Notwithstanding section 8.33, moneys advanced for
10purposes of the programs developed by early childhood Iowa
11areas, advanced for purposes of wraparound child care, or
12received from the federal appropriations made for the purposes
13of this section that remain unencumbered or unobligated at the
14close of the fiscal year shall not revert to any fund but shall
15remain available for expenditure for the purposes designated
16until the close of the succeeding fiscal year.
17 Sec. 18. JUVENILE INSTITUTION. There is appropriated
18from the general fund of the state to the department of human
19services for the fiscal year beginning July 1, 2021, and ending
20June 30, 2022, the following amounts, or so much thereof as is
21necessary, to be used for the purposes designated:
221. a. For operation of the state training school at Eldora
23and for salaries, support, maintenance, and miscellaneous
24purposes, and for not more than the following full-time
25equivalent positions:
.................................................. $2617,397,068
............................................... FTEs27207.00
28b. Of the funds appropriated in this subsection, $91,000
29shall be used for distribution to licensed classroom teachers
30at this and other institutions under the control of the
31department of human services based upon the average student
32yearly enrollment at each institution as determined by the
33department.
342. A portion of the moneys appropriated in this section
35shall be used by the state training school at Eldora for
-37-1grants for adolescent pregnancy prevention activities at the
2institution in the fiscal year beginning July 1, 2021.
33. Of the funds appropriated in this subsection, $212,000
4shall be used by the state training school at Eldora for a
5substance use disorder treatment program at the institution for
6the fiscal year beginning July 1, 2021.
74. Notwithstanding section 8.33, moneys appropriated in
8this section that remain unencumbered or unobligated at the
9close of the fiscal year shall not revert but shall remain
10available for expenditure for the purposes designated until the
11close of the succeeding fiscal year.
12 Sec. 19. CHILD AND FAMILY SERVICES.
131. There is appropriated from the general fund of the
14state to the department of human services for the fiscal year
15beginning July 1, 2021, and ending June 30, 2022, the following
16amount, or so much thereof as is necessary, to be used for the
17purpose designated:
18For child and family services:
.................................................. $1989,071,930
202. The department may transfer funds appropriated in this
21section as necessary to pay the nonfederal costs of services
22reimbursed under the medical assistance program, state child
23care assistance program, or the family investment program which
24are provided to children who would otherwise receive services
25paid under the appropriation in this section. The department
26may transfer funds appropriated in this section to the
27appropriations made in this division of this Act for general
28administration and for field operations for resources necessary
29to implement and operate the services funded in this section.
303. a. Of the funds appropriated in this section, up to
31$31,500,000 is allocated as the statewide expenditure target
32under section 232.143 for group foster care maintenance and
33services. If the department projects that such expenditures
34for the fiscal year will be less than the target amount
35allocated in this paragraph “a”, the department may reallocate
-38-1the excess to provide additional funding for family foster
2care, independent living, family-centered services, shelter
3care, or the child welfare emergency services addressed with
4the allocation for shelter care.
5b. If at any time after September 30, 2021, annualization
6of a service area’s current expenditures indicates a service
7area is at risk of exceeding its group foster care expenditure
8target under section 232.143 by more than 5 percent, the
9department and juvenile court services shall examine all
10group foster care placements in that service area in order to
11identify those which might be appropriate for termination.
12In addition, any aftercare services believed to be needed
13for the children whose placements may be terminated shall be
14identified. The department and juvenile court services shall
15initiate action to set dispositional review hearings for the
16placements identified. In such a dispositional review hearing,
17the juvenile court shall determine whether needed aftercare
18services are available and whether termination of the placement
19is in the best interest of the child and the community.
204. In accordance with the provisions of section 232.188,
21the department shall continue the child welfare and juvenile
22justice funding initiative during fiscal year 2021-2022. Of
23the funds appropriated in this section, $1,717,000 is allocated
24specifically for expenditure for fiscal year 2021-2022 through
25the decategorization services funding pools and governance
26boards established pursuant to section 232.188.
275. A portion of the funds appropriated in this section
28may be used for emergency family assistance to provide other
29resources required for a family participating in a family
30preservation or reunification project or successor project to
31stay together or to be reunified.
326. Of the funds appropriated in this section, a sufficient
33amount is allocated for shelter care and the child welfare
34emergency services contracting implemented to provide for or
35prevent the need for shelter care.
-39- 17. Federal funds received by the state during the fiscal
2year beginning July 1, 2021, as the result of the expenditure
3of state funds appropriated during a previous state fiscal
4year for a service or activity funded under this section are
5appropriated to the department to be used as additional funding
6for services and purposes provided for under this section.
7Notwithstanding section 8.33, moneys received in accordance
8with this subsection that remain unencumbered or unobligated at
9the close of the fiscal year shall not revert to any fund but
10shall remain available for the purposes designated until the
11close of the succeeding fiscal year.
128. a. Of the funds appropriated in this section, up to
13$3,290,000 is allocated for the payment of the expenses of
14court-ordered services provided to juveniles who are under the
15supervision of juvenile court services, which expenses are a
16charge upon the state pursuant to section 232.141, subsection
174. Of the amount allocated in this paragraph “a”, up to
18$1,556,000 shall be made available to provide school-based
19supervision of children adjudicated under chapter 232, of which
20not more than $15,000 may be used for the purpose of training.
21A portion of the cost of each school-based liaison officer
22shall be paid by the school district or other funding source as
23approved by the chief juvenile court officer.
24b. Of the funds appropriated in this section, up to $748,000
25is allocated for the payment of the expenses of court-ordered
26services provided to children who are under the supervision
27of the department, which expenses are a charge upon the state
28pursuant to section 232.141, subsection 4.
29c. Notwithstanding section 232.141 or any other provision
30of law to the contrary, the amounts allocated in this
31subsection shall be distributed to the judicial districts
32as determined by the state court administrator and to the
33department’s service areas as determined by the administrator
34of the department of human services’ division of child and
35family services. The state court administrator and the
-40-1division administrator shall make the determination of the
2distribution amounts on or before June 15, 2021.
3d. Notwithstanding chapter 232 or any other provision of
4law to the contrary, a district or juvenile court shall not
5order any service which is a charge upon the state pursuant
6to section 232.141 if there are insufficient court-ordered
7services funds available in the district court or departmental
8service area distribution amounts to pay for the service. The
9chief juvenile court officer and the departmental service area
10manager shall encourage use of the funds allocated in this
11subsection such that there are sufficient funds to pay for
12all court-related services during the entire year. The chief
13juvenile court officers and departmental service area managers
14shall attempt to anticipate potential surpluses and shortfalls
15in the distribution amounts and shall cooperatively request the
16state court administrator or division administrator to transfer
17funds between the judicial districts’ or departmental service
18areas’ distribution amounts as prudent.
19e. Notwithstanding any provision of law to the contrary,
20a district or juvenile court shall not order a county to pay
21for any service provided to a juvenile pursuant to an order
22entered under chapter 232 which is a charge upon the state
23under section 232.141, subsection 4.
24f. Of the funds allocated in this subsection, not more than
25$83,000 may be used by the judicial branch for administration
26of the requirements under this subsection.
27g. Of the funds allocated in this subsection, $17,000
28shall be used by the department of human services to support
29the interstate commission for juveniles in accordance with
30the interstate compact for juveniles as provided in section
31232.173.
329. Of the funds appropriated in this section, $12,253,000 is
33allocated for juvenile delinquent graduated sanctions services.
34Any state funds saved as a result of efforts by juvenile court
35services to earn a federal Tit.IV-E match for juvenile court
-41-1services administration may be used for the juvenile delinquent
2graduated sanctions services.
310. Of the funds appropriated in this section, $1,658,000 is
4transferred to the department of public health to be used for
5the child protection center grant program for child protection
6centers located in Iowa in accordance with section 135.118.
7The grant amounts under the program shall be equalized so that
8each center receives a uniform base amount of $245,000, and so
9that the remaining funds are awarded through a funding formula
10based upon the volume of children served. To increase access
11to child protection center services for children in rural
12areas, the funding formula for the awarding of the remaining
13funds shall provide for the awarding of an enhanced amount to
14eligible grantees to develop and maintain satellite centers in
15underserved regions of the state.
1611. Of the funds appropriated in this section, $4,025,000 is
17allocated for the preparation for adult living program pursuant
18to section 234.46.
1912. Of the funds appropriated in this section, $227,000
20shall be used for the public purpose of continuing a grant to a
21nonprofit human services organization, providing services to
22individuals and families in multiple locations in southwest
23Iowa and Nebraska for support of a project providing immediate,
24sensitive support and forensic interviews, medical exams, needs
25assessments, and referrals for victims of child abuse and their
26nonoffending family members.
2713. Of the funds appropriated in this section, $300,000
28is allocated for the foster care youth council approach of
29providing a support network to children placed in foster care.
3014. Of the funds appropriated in this section, $202,000 is
31allocated for use pursuant to section 235A.1 for continuation
32of the initiative to address child sexual abuse implemented
33pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection
3421.
3515. Of the funds appropriated in this section, $630,000 is
-42-1allocated for the community partnership for child protection
2sites.
316. Of the funds appropriated in this section, $371,000
4is allocated for the department’s minority youth and family
5projects under the redesign of the child welfare system.
617. Of the funds appropriated in this section, $851,000
7is allocated for funding of the community circle of care
8collaboration for children and youth in northeast Iowa.
918. Of the funds appropriated in this section, at least
10$147,000 shall be used for the continuation of the child
11welfare provider training academy, a collaboration between the
12coalition for family and children’s services in Iowa and the
13department.
1419. Of the funds appropriated in this section, $211,000
15shall be used for continuation of the central Iowa system of
16care program grant through June 30, 2022.
1720. Of the funds appropriated in this section, $235,000
18shall be used for the public purpose of the continuation
19and expansion of a system of care program grant implemented
20in Cerro Gordo and Linn counties to utilize a comprehensive
21and long-term approach for helping children and families by
22addressing the key areas in a child’s life of childhood basic
23needs, education and work, family, and community.
2421. Of the funds appropriated in this section, $110,000
25shall be used for the public purpose of funding community-based
26services and other supports with a system of care approach
27for children with a serious emotional disturbance and their
28families through a nonprofit provider of child welfare services
29that has been in existence for more than 115 years, is located
30in a county with a population of more than 200,000 but less
31than 220,000 according to the latest certified federal census,
32is licensed as a psychiatric medical institution for children,
33and was a system of care grantee prior to July 1, 2021.
3422. If a separate funding source is identified that reduces
35the need for state funds within an allocation under this
-43-1section, the allocated state funds may be redistributed to
2other allocations under this section for the same fiscal year.
323. Of the funds appropriated in this section, a portion may
4be used for family-centered services for purposes of complying
5with the federal Family First Prevention Services Act of 2018,
6Pub.L. No.115-123, and successor legislation.
7 Sec. 20. ADOPTION SUBSIDY.
81. There is appropriated from the general fund of the
9state to the department of human services for the fiscal year
10beginning July 1, 2021, and ending June 30, 2022, the following
11amount, or so much thereof as is necessary, to be used for the
12purpose designated:
13a. For adoption subsidy payments and related costs and for
14other services provided for under paragraph “b”, subparagraph
15(2):
.................................................. $1640,596,007
17b. (1) Of the funds appropriated in this section, a
18sufficient amount is allocated for adoption subsidy payments
19and related costs.
20(2) Any funds appropriated in this section remaining after
21the allocation under subparagraph (1) are designated and
22allocated as state savings resulting from implementation of
23the federal Fostering Connections to Success and Increasing
24Adoptions Act of 2008, Pub.L. No.110-351, and successor
25legislation, as determined in accordance with 42 U.S.C.
26§673(a)(8), and shall be used for post-adoption services and
27for other purposes allowed under these federal laws, Tit.IV-B
28or Tit.IV-E of the federal Social Security Act.
29(a) The department of human services may transfer funds
30allocated in this subparagraph (2) to the appropriation for
31child and family services in this division of this Act for the
32purposes designated in this subparagraph (2).
33(b) Notwithstanding section 8.33, moneys allocated
34under this subparagraph (2) shall not revert to any fund but
35shall remain available for the purposes designated in this
-44-1subparagraph (2) until expended.
22. The department may transfer funds appropriated in
3this section to the appropriation made in this division of
4this Act for general administration for costs paid from the
5appropriation relating to adoption subsidy.
63. Federal funds received by the state during the
7fiscal year beginning July 1, 2021, as the result of the
8expenditure of state funds during a previous state fiscal
9year for a service or activity funded under this section are
10appropriated to the department to be used as additional funding
11for the services and activities funded under this section.
12Notwithstanding section 8.33, moneys received in accordance
13with this subsection that remain unencumbered or unobligated
14at the close of the fiscal year shall not revert to any fund
15but shall remain available for expenditure for the purposes
16designated until the close of the succeeding fiscal year.
17 Sec. 21. JUVENILE DETENTION HOME FUND. Moneys deposited
18in the juvenile detention home fund created in section 232.142
19during the fiscal year beginning July 1, 2021, and ending June
2030, 2022, are appropriated to the department of human services
21for the fiscal year beginning July 1, 2021, and ending June 30,
222022, for distribution of an amount equal to a percentage of
23the costs of the establishment, improvement, operation, and
24maintenance of county or multicounty juvenile detention homes
25in the fiscal year beginning July 1, 2020. Moneys appropriated
26for distribution in accordance with this section shall be
27allocated among eligible detention homes, prorated on the basis
28of an eligible detention home’s proportion of the costs of all
29eligible detention homes in the fiscal year beginning July
301, 2020. The percentage figure shall be determined by the
31department based on the amount available for distribution for
32the fund. Notwithstanding section 232.142, subsection 3, the
33financial aid payable by the state under that provision for the
34fiscal year beginning July 1, 2021, shall be limited to the
35amount appropriated for the purposes of this section.
-45-1 Sec. 22. FAMILY SUPPORT SUBSIDY PROGRAM.
21. There is appropriated from the general fund of the
3state to the department of human services for the fiscal year
4beginning July 1, 2021, and ending June 30, 2022, the following
5amount, or so much thereof as is necessary, to be used for the
6purpose designated:
7For the family support subsidy program subject to the
8enrollment restrictions in section 225C.37, subsection 3:
.................................................. $9949,282
102. At least $899,291 of the moneys appropriated in this
11section is transferred to the department of public health for
12the family support center component of the comprehensive family
13support program under chapter 225C, subchapter V.
143. If at any time during the fiscal year, the amount of
15funding available for the family support subsidy program
16is reduced from the amount initially used to establish the
17figure for the number of family members for whom a subsidy
18is to be provided at any one time during the fiscal year,
19notwithstanding section 225C.38, subsection 2, the department
20shall revise the figure as necessary to conform to the amount
21of funding available.
22 Sec. 23. CONNER DECREE. There is appropriated from the
23general fund of the state to the department of human services
24for the fiscal year beginning July 1, 2021, and ending June 30,
252022, the following amount, or so much thereof as is necessary,
26to be used for the purpose designated:
27For building community capacity through the coordination
28and provision of training opportunities in accordance with the
29consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D.
30Iowa, July 14, 1994):
.................................................. $3133,632
32 Sec. 24. MENTAL HEALTH INSTITUTES.
331. There is appropriated from the general fund of the
34state to the department of human services for the fiscal year
35beginning July 1, 2021, and ending June 30, 2022, the following
-46-1amounts, or so much thereof as is necessary, to be used for the
2purposes designated:
3a. For operation of the state mental health institute at
4Cherokee as required by chapters 218 and 226 for salaries,
5support, maintenance, and miscellaneous purposes, and for not
6more than the following full-time equivalent positions:
.................................................. $716,058,356
............................................... FTEs8169.00
9b. For operation of the state mental health institute at
10Independence as required by chapters 218 and 226 for salaries,
11support, maintenance, and miscellaneous purposes, and for not
12more than the following full-time equivalent positions:
.................................................. $1320,628,077
............................................... FTEs14208.00
152. a. Notwithstanding sections 218.78 and 249A.11, any
16revenue received from the state mental health institute at
17Cherokee or the state mental health institute at Independence
18pursuant to 42 C.F.R§438.6(e) may be retained and expended by
19the mental health institute.
20b. Notwithstanding sections 218.78 and 249A.11, any
21COVID-19 related funding received through federal funding
22sources by the state mental health institute at Cherokee or the
23state mental health institute at Independence may be retained
24and expended by the mental health institute.
253. Notwithstanding any provision of law to the contrary,
26a Medicaid member residing at the state mental health
27institute at Cherokee or the state mental health institute
28at Independence shall retain Medicaid eligibility during
29the period of the Medicaid member’s stay for which federal
30financial participation is available.
314. Notwithstanding section 8.33, moneys appropriated in
32this section that remain unencumbered or unobligated at the
33close of the fiscal year shall not revert but shall remain
34available for expenditure for the purposes designated until the
35close of the succeeding fiscal year.
-47-1 Sec. 25. STATE RESOURCE CENTERS.
21. There is appropriated from the general fund of the
3state to the department of human services for the fiscal year
4beginning July 1, 2021, and ending June 30, 2022, the following
5amounts, or so much thereof as is necessary, to be used for the
6purposes designated:
7a. For the state resource center at Glenwood for salaries,
8support, maintenance, and miscellaneous purposes:
.................................................. $914,802,873
10b. For the state resource center at Woodward for salaries,
11support, maintenance, and miscellaneous purposes:
.................................................. $1213,698,094
132. The department may continue to bill for state resource
14center services utilizing a scope of services approach used for
15private providers of intermediate care facilities for persons
16with an intellectual disability services, in a manner which
17does not shift costs between the medical assistance program,
18counties, or other sources of funding for the state resource
19centers.
203. The state resource centers may expand the time-limited
21assessment and respite services during the fiscal year.
224. If the department’s administration and the department
23of management concur with a finding by a state resource
24center’s superintendent that projected revenues can reasonably
25be expected to pay the salary and support costs for a new
26employee position, or that such costs for adding a particular
27number of new positions for the fiscal year would be less
28than the overtime costs if new positions would not be added,
29the superintendent may add the new position or positions. If
30the vacant positions available to a resource center do not
31include the position classification desired to be filled, the
32state resource center’s superintendent may reclassify any
33vacant position as necessary to fill the desired position. The
34superintendents of the state resource centers may, by mutual
35agreement, pool vacant positions and position classifications
-48-1during the course of the fiscal year in order to assist one
2another in filling necessary positions.
35. If existing capacity limitations are reached in
4operating units, a waiting list is in effect for a service or
5a special need for which a payment source or other funding
6is available for the service or to address the special need,
7and facilities for the service or to address the special need
8can be provided within the available payment source or other
9funding, the superintendent of a state resource center may
10authorize opening not more than two units or other facilities
11and begin implementing the service or addressing the special
12need during fiscal year 2021-2022.
136. Notwithstanding section 8.33, and notwithstanding
14the amount limitation specified in section 222.92, moneys
15appropriated in this section that remain unencumbered or
16unobligated at the close of the fiscal year shall not revert
17but shall remain available for expenditure for the purposes
18designated until the close of the succeeding fiscal year.
19 Sec. 26. SEXUALLY VIOLENT PREDATORS.
201. There is appropriated from the general fund of the
21state to the department of human services for the fiscal year
22beginning July 1, 2021, and ending June 30, 2022, the following
23amount, or so much thereof as is necessary, to be used for the
24purpose designated:
25For costs associated with the commitment and treatment of
26sexually violent predators in the unit located at the state
27mental health institute at Cherokee, including costs of legal
28services and other associated costs, including salaries,
29support, maintenance, and miscellaneous purposes, and for not
30more than the following full-time equivalent positions:
.................................................. $3113,643,727
............................................... FTEs32139.00
332. Unless specifically prohibited by law, if the amount
34charged provides for recoupment of at least the entire amount
35of direct and indirect costs, the department of human services
-49-1may contract with other states to provide care and treatment
2of persons placed by the other states at the unit for sexually
3violent predators at Cherokee. The moneys received under
4such a contract shall be considered to be repayment receipts
5and used for the purposes of the appropriation made in this
6section.
73. Notwithstanding section 8.33, moneys appropriated in
8this section that remain unencumbered or unobligated at the
9close of the fiscal year shall not revert but shall remain
10available for expenditure for the purposes designated until the
11close of the succeeding fiscal year.
12 Sec. 27. FIELD OPERATIONS.
131. There is appropriated from the general fund of the
14state to the department of human services for the fiscal year
15beginning July 1, 2021, and ending June 30, 2022, the following
16amount, or so much thereof as is necessary, to be used for the
17purposes designated:
18For field operations, including salaries, support,
19maintenance, and miscellaneous purposes, and for not more than
20the following full-time equivalent positions:
.................................................. $2160,596,667
............................................... FTEs221,539.00
232. Priority in filling full-time equivalent positions
24shall be given to those positions related to child protection
25services and eligibility determination for low-income families.
26 Sec. 28. GENERAL ADMINISTRATION. There is appropriated
27from the general fund of the state to the department of human
28services for the fiscal year beginning July 1, 2021, and ending
29June 30, 2022, the following amount, or so much thereof as is
30necessary, to be used for the purpose designated:
31For general administration, including salaries, support,
32maintenance, and miscellaneous purposes, and for not more than
33the following full-time equivalent positions:
.................................................. $3414,542,189
............................................... FTEs35294.00
-50- 11. The department shall report at least monthly to the
2general assembly concerning the department’s operational and
3program expenditures.
42. Of the funds appropriated in this section, $150,000
5shall be used for the provision of a program to provide
6technical assistance, support, and consultation to providers
7of habilitation services and home and community-based services
8waiver services for adults with disabilities under the medical
9assistance program.
103. Of the funds appropriated in this section, $50,000
11is transferred to the Iowa finance authority to be used
12for administrative support of the council on homelessness
13established in section 16.2D and for the council to fulfill its
14duties in addressing and reducing homelessness in the state.
154. Of the funds appropriated in this section, $200,000 shall
16be transferred to and deposited in the administrative fund of
17the Iowa ABLE savings plan trust created in section 12I.4, to
18be used for implementation and administration activities of the
19Iowa ABLE savings plan trust.
205. Of the funds appropriated in this section, $200,000 is
21transferred to the economic development authority for the Iowa
22commission on volunteer services to continue to be used for the
23RefugeeRISE AmeriCorps program established under section 15H.8
24for member recruitment and training to improve the economic
25well-being and health of economically disadvantaged refugees in
26local communities across Iowa. Funds transferred may be used
27to supplement federal funds under federal regulations.
286. Of the funds appropriated in this section, up to $300,000
29shall be used as follows:
30a. To fund not more than one full-time equivalent position
31to address the department’s responsibility to support the work
32of the children’s behavioral health system state board and
33implementation of the services required pursuant to section
34331.397.
35b. To support the cost of establishing and implementing new
-51-1or additional services required pursuant to sections 331.397
2and 331.397A.
3c. Of the amount allocated, $32,000 shall be transferred
4to the department of public health to support the costs of
5establishing and implementing new or additional services
6required pursuant to sections 331.397 and 331.397A.
7 Sec. 29. DEPARTMENT-WIDE DUTIES. There is appropriated
8from the general fund of the state to the department of human
9services for the fiscal year beginning July 1, 2021, and ending
10June 30, 2022, the following amount, or so much thereof as is
11necessary, to be used for the purposes designated:
12For salaries, support, maintenance, and miscellaneous
13purposes at facilities under the purview of the department of
14human services:
.................................................. $152,879,274
16 Sec. 30. VOLUNTEERS. There is appropriated from the general
17fund of the state to the department of human services for the
18fiscal year beginning July 1, 2021, and ending June 30, 2022,
19the following amount, or so much thereof as is necessary, to be
20used for the purpose designated:
21For development and coordination of volunteer services:
.................................................. $2284,686
23 Sec. 31. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
24ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
25DEPARTMENT OF HUMAN SERVICES.
261. a. (1) (a) Notwithstanding any provision of law to
27the contrary, for the fiscal year beginning July 1, 2021, the
28department shall not rebase case-mix nursing facility rates,
29but shall instead reimburse case-mix nursing facilities by
30adjusting the nursing facility case-mix adjusted rates that
31were effective July 1, 2019, using the mid-points of each of
32the most recent cost reports submitted by the nursing facility
33for the period ending on or before December 31, 2018, and
34inflating these costs forward applying the inflation factor as
35determined using the latest available quarterly publication of
-52-1the HCFA/SNF index, to the extent possible within the state
2funding, including the $8,002,912 provided for this purpose.
3(b) For the fiscal year beginning July 1, 2021, non-case-mix
4and special population nursing facilities shall be reimbursed
5in accordance with the methodology in effect on June 30 of the
6prior fiscal year.
7(c) For managed care claims, the department of human
8services shall adjust the payment rate floor for nursing
9facilities, annually, to maintain a rate floor that is no
10lower than the Medicaid fee-for-service case-mix adjusted rate
11calculated in accordance with subparagraph division (a) and
12441 IAC 81.6. The department shall then calculate adjusted
13reimbursement rates, including but not limited to add-on
14payments, annually, and shall notify Medicaid managed care
15organizations of the adjusted reimbursement rates within 30
16days of determining the adjusted reimbursement rates. Any
17adjustment of reimbursement rates under this subparagraph
18division shall be budget neutral to the state budget.
19(d) For the fiscal year beginning July 1, 2021, Medicaid
20managed care long-term services and supports capitation rates
21shall be adjusted to reflect the case-mix adjusted rates
22specified pursuant to subparagraph division (a) for the patient
23populations residing in Medicaid-certified nursing facilities.
24(2) Medicaid managed care organizations shall adjust
25facility-specific rates based upon payment rate listings issued
26by the department. The rate adjustments shall be applied
27prospectively from the effective date of the rate letter issued
28by the department.
29b. (1) For the fiscal year beginning July 1, 2021, the
30department shall establish the fee-for-service pharmacy
31dispensing fee reimbursement at $10.07 per prescription,
32until a cost of dispensing survey is completed. The actual
33dispensing fee shall be determined by a cost of dispensing
34survey performed by the department and required to be completed
35by all medical assistance program participating pharmacies
-53-1every two years, adjusted as necessary to maintain expenditures
2within the amount appropriated to the department for this
3purpose for the fiscal year. A change in the dispensing
4fee shall become effective following federal approval of the
5Medicaid state plan.
6(2) The department shall amend Medicaid managed care
7organization contracts to authorize establishment of a managed
8care pharmacy dispensing fee reimbursement in accordance with
9either of the following:
10(a) The established fee-for-service pharmacy dispensing fee
11reimbursement of $10.07 per prescription as specified pursuant
12to subparagraph (1).
13(b) A dispensing fee determined contractually by mutual
14agreement between the managed care organization and a
15participating pharmacy with multiple locations and headquarters
16located outside the state, not to exceed the established
17fee-for-service pharmacy dispensing fee reimbursement of $10.07
18per prescription as specified pursuant to subparagraph (1).
19(3) The department shall utilize an average acquisition
20cost reimbursement methodology for all drugs covered under the
21medical assistance program in accordance with 2012 Iowa Acts,
22chapter 1133, section 33.
23c. (1) For the fiscal year beginning July 1, 2021,
24reimbursement rates for outpatient hospital services shall
25remain at the rates in effect on June 30, 2021, subject to
26Medicaid program upper payment limit rules, and adjusted
27as necessary to maintain expenditures within the amount
28appropriated to the department for this purpose for the fiscal
29year.
30(2) For the fiscal year beginning July 1, 2021,
31reimbursement rates for inpatient hospital services shall
32be rebased effective October 1, 2021, subject to Medicaid
33program upper payment limit rules, and adjusted as necessary
34to maintain expenditures within the amount appropriated to the
35department for this purpose for the fiscal year.
-54- 1(3) For the fiscal year beginning July 1, 2021, under
2both fee-for-service and managed care administration of
3the Medicaid program, critical access hospitals shall be
4reimbursed for inpatient and outpatient services based on the
5hospital-specific critical access hospital cost adjustment
6factor methodology utilizing the most recent and complete cost
7reporting period as applied prospectively within the funds
8appropriated for such purpose for the fiscal year.
9(4) For the fiscal year beginning July 1, 2021, the graduate
10medical education and disproportionate share hospital fund
11shall remain at the amount in effect on June 30, 2021, except
12that the portion of the fund attributable to graduate medical
13education shall be reduced in an amount that reflects the
14elimination of graduate medical education payments made to
15out-of-state hospitals.
16(5) In order to ensure the efficient use of limited state
17funds in procuring health care services for low-income Iowans,
18funds appropriated in this Act for hospital services shall
19not be used for activities which would be excluded from a
20determination of reasonable costs under the federal Medicare
21program pursuant to 42 U.S.C.§1395x(v)(1)(N).
22d. For the fiscal year beginning July 1, 2021, reimbursement
23rates for hospices and acute psychiatric hospitals shall be
24increased in accordance with increases under the federal
25Medicare program or as supported by their Medicare audited
26costs.
27e. For the fiscal year beginning July 1, 2021, independent
28laboratories and rehabilitation agencies shall be reimbursed
29using the same methodology in effect on June 30, 2021.
30f. (1) For the fiscal year beginning July 1, 2021,
31reimbursement rates for home health agencies shall continue to
32be based on the Medicare low utilization payment adjustment
33(LUPA) methodology with state geographic wage adjustments.
34The department shall continue to update the rates every two
35years to reflect the most recent Medicare LUPA rates to the
-55-1extent possible within the state funding appropriated for this
2purpose.
3(2) For the fiscal year beginning July 1, 2021, rates for
4private duty nursing and personal care services under the early
5and periodic screening, diagnostic, and treatment program
6benefit shall be calculated based on the methodology in effect
7on June 30, 2021.
8g. For the fiscal year beginning July 1, 2021, federally
9qualified health centers and rural health clinics shall receive
10cost-based reimbursement for 100 percent of the reasonable
11costs for the provision of services to recipients of medical
12assistance.
13h. For the fiscal year beginning July 1, 2021, the
14reimbursement rates for dental services shall remain at the
15rates in effect on June 30, 2021.
16i. (1) For the fiscal year beginning July 1, 2021,
17reimbursement rates for non-state-owned psychiatric medical
18institutions for children shall be increased to the extent
19possible within the $3,900,000 appropriated for this purpose.
20(2) As a condition of participation in the medical
21assistance program, enrolled providers shall accept the medical
22assistance reimbursement rate for any covered goods or services
23provided to recipients of medical assistance who are children
24under the custody of a psychiatric medical institution for
25children.
26j. For the fiscal year beginning July 1, 2021, unless
27otherwise specified in this Act, all noninstitutional medical
28assistance provider reimbursement rates shall remain at the
29rates in effect on June 30, 2021, except for area education
30agencies, local education agencies, infant and toddler
31services providers, home and community-based services providers
32including consumer-directed attendant care providers under a
33section 1915(c) or 1915(i) waiver, targeted case management
34providers, and those providers whose rates are required to be
35determined pursuant to section 249A.20, or to meet federal
-56-1mental health parity requirements.
2k. Notwithstanding any provision to the contrary, for the
3fiscal year beginning July 1, 2021, the reimbursement rate for
4anesthesiologists shall remain at the rates in effect on June
530, 2021, and updated on January 1, 2022, to align with the
6most current Iowa Medicare anesthesia rate.
7l. Notwithstanding section 249A.20, for the fiscal year
8beginning July 1, 2021, the average reimbursement rate for
9health care providers eligible for use of the federal Medicare
10resource-based relative value scale reimbursement methodology
11under section 249A.20 shall remain at the rate in effect on
12June 30, 2021; however, this rate shall not exceed the maximum
13level authorized by the federal government.
14m. For the fiscal year beginning July 1, 2021, the
15reimbursement rate for residential care facilities shall not
16be less than the minimum payment level as established by the
17federal government to meet the federally mandated maintenance
18of effort requirement. The flat reimbursement rate for
19facilities electing not to file annual cost reports shall not
20be less than the minimum payment level as established by the
21federal government to meet the federally mandated maintenance
22of effort requirement.
23n. For the fiscal year beginning July 1, 2021, the
24reimbursement rates for inpatient mental health services
25provided at hospitals shall be rebased effective October 1,
262021, subject to Medicaid program upper payment limit rules
27and adjusted as necessary to maintain expenditures within the
28amount appropriated to the department for this purpose for
29the fiscal year; and psychiatrists shall be reimbursed at the
30medical assistance program fee-for-service rate in effect on
31June 30, 2021.
32o. For the fiscal year beginning July 1, 2021, community
33mental health centers may choose to be reimbursed for the
34services provided to recipients of medical assistance through
35either of the following options:
-57- 1(1) For 100 percent of the reasonable costs of the services.
2(2) In accordance with the alternative reimbursement rate
3methodology approved by the department of human services in
4effect on June 30, 2021.
5p. For the fiscal year beginning July 1, 2021, the
6reimbursement rate for providers of family planning services
7that are eligible to receive a 90 percent federal match shall
8remain at the rates in effect on June 30, 2021.
9q. For the fiscal year beginning July 1, 2021, the upper
10limits and reimbursement rates for providers of home and
11community-based services waiver services and habilitation
12services shall be increased to the extent possible within the
13$8,000,000 appropriated for this purpose.
14r. For the fiscal year beginning July 1, 2021, the
15reimbursement rates for emergency medical service providers
16shall remain at the rates in effect on June 30, 2021, or as
17approved by the centers for Medicare and Medicaid services of
18the United States department of health and human services.
19s. For the fiscal year beginning July 1, 2021, reimbursement
20rates for substance-related disorder treatment programs
21licensed under section 125.13 shall remain at the rates in
22effect on June 30, 2021.
23t. For the fiscal year beginning July 1, 2021, assertive
24community treatment per diem rates shall remain at the rates in
25effect on June 30, 2021.
26u. For the fiscal year beginning July 1, 2021, the
27reimbursement rate for family-centered services providers shall
28be established by contract.
29v. For the fiscal year beginning July 1, 2021, the
30reimbursement rate for air ambulance services shall be
31increased to the extent possible within the additional $100,000
32appropriated for this purpose.
33w. For the fiscal year beginning July 1, 2021, the
34reimbursement rate for specialized respite, home health aide,
35and nursing services provided through home and community-based
-58-1services waivers shall be a fee schedule rate no less than the
2current upper rate paid to all providers of such services for
3the fiscal year ending June 30, 2021.
42. For the fiscal year beginning July 1, 2021, the
5reimbursement rate for providers reimbursed under the
6in-home-related care program shall not be less than the minimum
7payment level as established by the federal government to meet
8the federally mandated maintenance of effort requirement.
93. Unless otherwise directed in this section, when the
10department’s reimbursement methodology for any provider
11reimbursed in accordance with this section includes an
12inflation factor, this factor shall not exceed the amount
13by which the consumer price index for all urban consumers
14increased during the calendar year ending December 31, 2002.
154. Notwithstanding section 234.38, for the fiscal
16year beginning July 1, 2021, the foster family basic daily
17maintenance rate and the maximum adoption subsidy rate for
18children ages 0 through 5 years shall be $16.78, the rate for
19children ages 6 through 11 years shall be $17.45, the rate for
20children ages 12 through 15 years shall be $19.10, and the
21rate for children and young adults ages 16 and older shall
22be $19.35. For youth ages 18 to 23 who have exited foster
23care, the preparation for adult living program maintenance
24rate shall be up to $602.70 per month as calculated based on
25the age of the participant. The maximum payment for adoption
26subsidy nonrecurring expenses shall be limited to $500 and the
27disallowance of additional amounts for court costs and other
28related legal expenses implemented pursuant to 2010 Iowa Acts,
29chapter 1031, section 408, shall be continued.
305. For the fiscal year beginning July 1, 2021, the maximum
31reimbursement rates for social services providers under
32contract shall remain at the rates in effect on June 30, 2021,
33or the provider’s actual and allowable cost plus inflation for
34each service, whichever is less. However, if a new service
35or service provider is added after June 30, 2021, the initial
-59-1reimbursement rate for the service or provider shall be based
2upon a weighted average of provider rates for similar services.
36. a. For the fiscal year beginning July 1, 2021, the
4reimbursement rates for resource family recruitment and
5retention contractors shall be established by contract.
6b. For the fiscal year beginning July 1, 2021, the
7reimbursement rates for supervised apartment living foster care
8providers shall be established by contract.
97. For the fiscal year beginning July 1, 2021, the
10reimbursement rate for group foster care providers shall be the
11combined service and maintenance reimbursement rate established
12by contract.
138. The group foster care reimbursement rates paid for
14placement of children out of state shall be calculated
15according to the same rate-setting principles as those used for
16in-state providers, unless the director of human services or
17the director’s designee determines that appropriate care cannot
18be provided within the state. The payment of the daily rate
19shall be based on the number of days in the calendar month in
20which service is provided.
219. a. For the fiscal year beginning July 1, 2021, the
22reimbursement rate paid for shelter care and the child welfare
23emergency services implemented to provide or prevent the need
24for shelter care shall be established by contract.
25b. For the fiscal year beginning July 1, 2021, the combined
26service and maintenance components of the reimbursement rate
27paid for shelter care services shall be based on the financial
28and statistical report submitted to the department. The
29maximum reimbursement rate shall be $101.83 per day. The
30department shall reimburse a shelter care provider at the
31provider’s actual and allowable unit cost, plus inflation, not
32to exceed the maximum reimbursement rate.
33c. Notwithstanding section 232.141, subsection 8, for the
34fiscal year beginning July 1, 2021, the amount of the statewide
35average of the actual and allowable rates for reimbursement of
-60-1juvenile shelter care homes that is utilized for the limitation
2on recovery of unpaid costs shall remain at the amount in
3effect for this purpose in the fiscal year beginning July 1,
42020.
510. For the fiscal year beginning July 1, 2021, the
6department shall calculate reimbursement rates for intermediate
7care facilities for persons with an intellectual disability
8at the 80th percentile. Beginning July 1, 2021, the rate
9calculation methodology shall utilize the consumer price index
10inflation factor applicable to the fiscal year beginning July
111, 2021.
1211. Effective July 1, 2021, the child care provider
13reimbursement rates shall remain at the rates in effect on June
1430, 2021. The department shall set rates in a manner so as
15to provide incentives for a nonregistered provider to become
16registered by applying any increase only to registered and
17licensed providers.
1812. The department may adopt emergency rules to implement
19this section.
20 Sec. 32. EMERGENCY RULES.
211. If necessary to comply with federal requirements
22including time frames, or if specifically authorized by a
23provision of this division of this Act, the department of
24human services or the mental health and disability services
25commission may adopt administrative rules under section 17A.4,
26subsection 3, and section 17A.5, subsection 2, paragraph “b”,
27to implement the provisions of this division of this Act and
28the rules shall become effective immediately upon filing or
29on a later effective date specified in the rules, unless the
30effective date of the rules is delayed or the applicability
31of the rules is suspended by the administrative rules review
32committee. Any rules adopted in accordance with this section
33shall not take effect before the rules are reviewed by the
34administrative rules review committee. The delay authority
35provided to the administrative rules review committee under
-61-1section 17A.4, subsection 7, and section 17A.8, subsection 9,
2shall be applicable to a delay imposed under this section,
3notwithstanding a provision in those sections making them
4inapplicable to section 17A.5, subsection 2, paragraph “b”.
5Any rules adopted in accordance with the provisions of this
6section shall also be published as a notice of intended action
7as provided in section 17A.4.
82. If during a fiscal year, the department of human
9services is adopting rules in accordance with this section
10or as otherwise directed or authorized by state law, and the
11rules will result in an expenditure increase beyond the amount
12anticipated in the budget process or if the expenditure was
13not addressed in the budget process for the fiscal year, the
14department shall notify the legislative services agency and
15the department of management concerning the rules and the
16expenditure increase. The notification shall be provided at
17least 30 calendar days prior to the date notice of the rules
18is submitted to the administrative rules coordinator and the
19administrative code editor.
20 Sec. 33. REPORTS. Any reports or other information required
21to be compiled and submitted under this Act during the fiscal
22year beginning July 1, 2021, shall be submitted to the general
23assembly on or before the dates specified for submission of the
24reports or information.
25 Sec. 34. EFFECTIVE UPON ENACTMENT. The following provision
26of this division of this Act, being deemed of immediate
27importance, takes effect upon enactment:
281. The provision relating to section 232.141 and directing
29the state court administrator and the division administrator of
30the department of human services division of child and family
31services to make the determination, by June 15, 2021, of the
32distribution of funds allocated for the payment of the expenses
33of court-ordered services provided to juveniles which are a
34charge upon the state.
35DIVISION VI
-62-1HEALTH CARE ACCOUNTS AND FUNDS — FY 2021-2022
2 Sec. 35. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is
3appropriated from the pharmaceutical settlement account created
4in section 249A.33 to the department of human services for the
5fiscal year beginning July 1, 2021, and ending June 30, 2022,
6the following amount, or so much thereof as is necessary, to be
7used for the purpose designated:
8Notwithstanding any provision of law to the contrary, to
9supplement the appropriations made in this Act for health
10program operations under the medical assistance program for the
11fiscal year beginning July 1, 2021, and ending June 30, 2022:
.................................................. $12234,193
13 Sec. 36. QUALITY ASSURANCE TRUST FUND — DEPARTMENT OF HUMAN
14SERVICES. Notwithstanding any provision to the contrary and
15subject to the availability of funds, there is appropriated
16from the quality assurance trust fund created in section
17249L.4 to the department of human services for the fiscal year
18beginning July 1, 2021, and ending June 30, 2022, the following
19amounts, or so much thereof as is necessary, for the purposes
20designated:
21To supplement the appropriation made in this Act from the
22general fund of the state to the department of human services
23for medical assistance for the same fiscal year:
.................................................. $2456,305,139
25 Sec. 37. HOSPITAL HEALTH CARE ACCESS TRUST FUND —
26DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to
27the contrary and subject to the availability of funds, there is
28appropriated from the hospital health care access trust fund
29created in section 249M.4 to the department of human services
30for the fiscal year beginning July 1, 2021, and ending June
3130, 2022, the following amounts, or so much thereof as is
32necessary, for the purposes designated:
33To supplement the appropriation made in this Act from the
34general fund of the state to the department of human services
35for medical assistance for the same fiscal year:
-63-.................................................. $133,920,554
2 Sec. 38. MEDICAL ASSISTANCE PROGRAM — NONREVERSION
3FOR FY 2021-2022. Notwithstanding section 8.33, if moneys
4appropriated for purposes of the medical assistance program for
5the fiscal year beginning July 1, 2021, and ending June 30,
62022, from the general fund of the state, the quality assurance
7trust fund, and the hospital health care access trust fund, are
8in excess of actual expenditures for the medical assistance
9program and remain unencumbered or unobligated at the close
10of the fiscal year, the excess moneys shall not revert but
11shall remain available for expenditure for the purposes of the
12medical assistance program until the close of the succeeding
13fiscal year.
14DIVISION VII
15NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
16JULY 1, 2023, THROUGH JUNE 30, 2025
17 Sec. 39. NURSING FACILITY REIMBURSEMENT METHODOLOGY —
18FISCAL PERIOD JULY 1, 2023, THROUGH JUNE 30, 2025.
19Notwithstanding any provision of law to the contrary, for the
20fiscal period beginning July 1, 2023, and ending June 30, 2025,
21the department of human services shall rebase case-mix nursing
22facility rates beginning July 1, 2023, using the Medicaid cost
23reports on file for the period ending December 31, 2022, and
24applying a minimum occupancy factor of 70 percent.
25DIVISION VIII
26NURSING FACILITY REIMBURSEMENT STUDY
27 Sec. 40. NURSING FACILITY CASE-MIX REIMBURSEMENT — STUDY
28AND RECOMMENDATIONS. The department of human services shall
29convene a workgroup including representatives of nursing
30facilities, managed care organizations, and other appropriate
31stakeholders to review the case-mix reimbursement methodology
32and process for nursing facilities, including but not limited
33to rebasing, the use of cost reports, and the application
34of quarterly case-mix index adjustments, and shall submit
35recommendations to the governor and the general assembly by
-64-1December 1, 2021, for improvements including those related to
2the methodology, the process, the use of prospective payments,
3and the applicable time frames to increase efficiencies
4and accuracy in the determination of reimbursements, reduce
5duplication of effort, more adequately reflect the actual costs
6of care, address changes in patient acuity levels without
7reliance on retroactive rate adjustments, and incentivize
8quality outcomes.
9DIVISION IX
10MEDICAID-ELIGIBLE CHILDREN — PEDIATRIC HEALTH CARE SERVICES
11 Sec. 41. MEDICAID-ELIGIBLE CHILDREN — PROVISION OF
12PEDIATRIC HEALTH CARE SERVICES — REVIEW AND REPORT. The
13department of human services shall review federal Medicare
14and state law and administrative rule restrictions related
15to the provision of physical therapy, occupational therapy,
16speech-language pathology, applied behavior analysis, and other
17pediatric health care services to Medicaid-eligible children
18to determine necessary changes in law and policy to ensure
19that these services are provided consistent with the early and
20periodic screening, diagnostic, and treatment program. The
21department shall submit a report including the findings of the
22review and recommendations to the governor and the general
23assembly by October 1, 2021.
24DIVISION X
25DECATEGORIZATION CARRYOVER FUNDING
26 Sec. 42. DECATEGORIZATION CARRYOVER FUNDING FY 2019 —
27TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188,
28subsection 5, paragraph “b”, any state-appropriated moneys in
29the funding pool that remained unencumbered or unobligated
30at the close of the fiscal year beginning July 1, 2018, and
31were deemed carryover funding to remain available for the two
32succeeding fiscal years that still remain unencumbered or
33unobligated at the close of the fiscal year beginning July 1,
342020, shall not revert but shall be transferred to the medical
35assistance program for the fiscal year beginning July 1, 2021.
-65-1 Sec. 43. EFFECTIVE DATE. This division of this Act, being
2deemed of immediate importance, takes effect upon enactment.
3 Sec. 44. RETROACTIVE APPLICABILITY. This division of this
4Act applies retroactively to July 1, 2020.
5DIVISION XI
6PRIOR APPROPRIATIONS AND OTHER PROVISIONS
7COURT-ORDERED SERVICES REIMBURSEMENT BY MANAGED CARE
8ORGANIZATIONS
9 Sec. 45. 2018 Iowa Acts, chapter 1165, section 128,
10subsection 2, paragraph a, is amended to read as follows:
11a. If a Medicaid member is receiving court-ordered services
12or treatment for a substance-related disorder pursuant to
13chapter 125 or for a mental illness pursuant to chapter 229,
14such services or treatment shall be provided and reimbursed
15for an initial period of three days before a managed care
16organization may apply medical necessity criteria to determine
17the most appropriate services, treatment, or placement for the
18Medicaid member.
19FAMILY INVESTMENT PROGRAM ACCOUNT
20 Sec. 46. 2019 Iowa Acts, chapter 85, section 9, as amended
21by 2020 Iowa Acts, chapter 1121, section 20, is amended by
22adding the following new subsection:
23 NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
24appropriated in this section that remain unencumbered or
25unobligated at the close of the fiscal year shall not revert
26but shall remain available for expenditure for the purposes
27designated, and may be transferred to other appropriations made
28in this division of this Act as necessary to carry out the
29initiatives included in the report submitted on nonreversion
30of funds required pursuant to 2020 Iowa Acts, chapter 1121,
31section 43, until the close of the succeeding fiscal year.
32Child and family services
33 Sec. 47. 2019 Iowa Acts, chapter 85, section 19, as amended
34by 2020 Iowa Acts, chapter 1121, section 23, is amended by
35adding the following new subsection:
-66-1 NEW SUBSECTION. 25. Notwithstanding section 8.33, moneys
2appropriated in this section that remain unencumbered or
3unobligated at the close of the fiscal year shall not revert
4but shall remain available for expenditure for the purpose of
5the redesign of the child welfare system, until the close of
6the succeeding fiscal year.
7 Sec. 48. EFFECTIVE DATE. This division of this Act, being
8deemed of immediate importance, takes effect upon enactment.
9DIVISION XII
10EXTENSION OF FUTURE REPEAL — HOSPITAL HEALTH CARE ACCESS
11ASSESSMENT PROGRAM
12 Sec. 49. Section 249M.5, Code 2021, is amended to read as
13follows:
14249M.5 Future repeal.
15This chapter is repealed July 1, 2021 2023.
16 Sec. 50. EFFECTIVE DATE. This division of this Act, being
17deemed of immediate importance, takes effect upon enactment.
18DIVISION XIII
19PUBLIC ASSISTANCE PROGRAM OVERSIGHT
20 Sec. 51. NEW SECTION. 239.1 Definitions.
21As used in this chapter, unless the context otherwise
22requires:
231. “Applicant” means an individual who is applying for
24public assistance benefits in the state.
252. “Asset” or “asset test” means all assets of the members
26of the applicant’s household, including all of the following:
27a. All bank accounts, excluding retirement accounts of
28members of the household.
29b. All cash, excluding the first two thousand dollars of
30members of the household.
31c. All lottery and gambling income of the household whether
32received as a lump sum or installment payments.
33d. All real estate, excluding the primary household
34residence and surrounding lot.
35e. All other personal property excluding personal
-67-1belongings, household goods, and one vehicle.
23. “Department” means the department of human services.
34. “Public assistance” means SNAP (the supplemental
4nutrition assistance program), the Medicaid program, FIP (the
5family investment program), and CHIP (the children’s health
6insurance program).
75. “Real-time system” means real-time electronic access
8to a system that allows verification of all applicable public
9assistance program eligibility information based on the
10most recent information available to the department through
11nonmodeled earned and unearned income, such as commercially
12available wage data.
136. “Recipient” means an individual who is receiving public
14assistance benefits in the state.
15 Sec. 52. NEW SECTION. 239.2 Asset test for supplemental
16nutrition assistance program.
171. For the purposes of determining eligibility for receipt
18of SNAP benefits, the department shall conduct an asset test
19on all members of the applicant’s household. The allowable
20financial resources to be included in or excluded from a
21determination of eligibility for SNAP shall be those specified
22in 7 U.S.C.§2014(g)(1).
232. Prior to determining eligibility for SNAP benefits,
24the department shall access, at a minimum, for every member
25of the applicant’s household, the following information from
26the following federal, state, and miscellaneous sources, or
27successor sources:
28a. Federal sources and information:
29(1) Earned and unearned income information maintained by
30the internal revenue service.
31(2) The following sources and information maintained by the
32United States social security administration:
33(a) Earned income information.
34(b) Death register information.
35(c) Prisoner or incarceration status information.
-68- 1(d) Supplemental security income information maintained in
2the state data exchange database.
3(e) Beneficiary records and earnings information maintained
4in the beneficiary and earnings data exchange database.
5(f) Earnings and pension information maintained in the
6beneficiary earnings exchange record system database.
7(3) The following sources and information maintained by the
8United States department of health and human services:
9(a) Income and employment information maintained in the
10national directory of new hires database by the office of child
11support enforcement of the administration for children and
12families.
13(b) Other federal data sources maintained by the office of
14child support enforcement of the administration for children
15and families.
16b. State sources and information:
17(1) The department’s sources and information including but
18not limited to all of the following:
19(a) Income and employment information maintained by the
20child support recovery unit.
21(b) Child care assistance information maintained by the
22division of child and family services.
23(c) Enrollment status in other public assistance programs.
24(2) The department of workforce development sources and
25information including all of the following:
26(a) Employment information.
27(b) Employer weekly, monthly, and quarterly reports of
28income and unemployment insurance payments.
29(3) The Iowa public employees’ retirement system for
30earnings and pension information.
31c. Miscellaneous sources:
32(1) Any existing real-time database of persons currently
33receiving benefits in other states, such as the national
34accuracy clearinghouse.
35(2) Any databases maintained by the Iowa lottery
-69-1commission.
2(3) Any existing real-time eligibility system that includes
3employment and income information maintained by a consumer
4reporting agency, as defined by the federal Fair Credit
5Reporting Act, 15 U.S.C. §1681a, for the purpose of obtaining
6real-time employment and income information.
73. Prior to determining eligibility for SNAP benefits, the
8department shall access information for every member of the
9applicant’s household from the following public records:
10a. A nationwide public records data source of physical asset
11ownership. The data source may include but is not limited to
12real property, automobiles, watercraft, aircraft, and luxury
13vehicles, or any other vehicle owned by the applicant.
14b. National and state financial institutions in order
15to locate undisclosed depository accounts or verify account
16balances of disclosed accounts.
174. The department shall enter into a memorandum of
18understanding with any department, division, bureau, section,
19unit, or any other subunit of a department to obtain the
20information specified in this section.
215. The provisions of this section shall not apply if every
22member of the applicant’s household receives supplemental
23security income.
24 Sec. 53. NEW SECTION. 239.3 Verification and authentication
25systems — public assistance programs.
261. By July 1, 2023, the department shall redesign an
27existing system; establish a new computerized income, asset,
28and identity eligibility verification system; or contract with
29a third-party vendor to provide for identity verification,
30identity authentication, asset verification, and dual
31enrollment prevention in order to deter waste, fraud, and
32abuse in each public assistance program administered by the
33department.
342. The department may contract with a third-party vendor
35to develop or provide a service for a real-time eligibility
-70-1system that allows the department to verify or authenticate
2income, assets, and identity eligibility of applicants and
3recipients to prevent fraud, misrepresentation, and inadequate
4documentation when determining eligibility for public
5assistance programs. The system shall be accessed prior to
6determining eligibility, periodically between eligibility
7redeterminations, and during eligibility redeterminations
8and reviews. The department may also contract with a
9third-party vendor to provide information to facilitate
10reviews of recipient eligibility conducted by the department.
11Specifically, the department may contract with a third-party
12consumer reporting agency, as defined by the federal Fair
13Credit Reporting Act, 15 U.S.C. §1681a, for the purpose of
14obtaining real-time employment and income information.
153. A contract entered into under this section shall provide,
16at a minimum, for all of the following:
17a. The establishment of the annual savings amount from
18utilization of the system or service, and a provision that the
19contract may be terminated contingent upon the savings not
20exceeding the total yearly cost to the state for utilization of
21the system or service.
22b. That the contract shall not preclude the department
23from continuing to conduct additional eligibility verification
24or authentication processes, to receive, review, or verify
25additional information related to the eligibility of an
26individual, or from contracting with a third-party vendor to
27provide additional eligibility authentication or verification
28information.
294. The department shall seek federal approval as necessary
30to implement and administer this section.
31 Sec. 54. NEW SECTION. 239.4 Public assistance programs —
32applicant and recipient eligibility verification.
331. All applications for initial public assistance
34program benefits and all determinations of ongoing recipient
35eligibility shall be processed through a system as specified
-71-1in this section. Complete initial applications shall be
2processed within the minimum period required by federal law.
3Prior to determining initial eligibility of an applicant for,
4or ongoing eligibility of a recipient of, public assistance,
5the department shall access information for every applicant or
6recipient from the following federal, state, and other sources:
7a. Federal sources and information:
8(1) Earned and unearned income information maintained by
9the internal revenue service.
10(2) The following sources and information maintained by the
11United States social security administration:
12(a) Earned income information.
13(b) Death register information.
14(c) Prisoner or incarceration status information.
15(d) Supplemental security income information maintained in
16the state data exchange database.
17(e) Beneficiary records and earnings information maintained
18in the beneficiary and earnings data exchange database.
19(f) Earnings and pension information maintained in the
20beneficiary earnings exchange record system database.
21(3) The following sources and information maintained by the
22United States department of health and human services:
23(a) Income and employment information maintained in the
24national directory of new hires database by the office of child
25support enforcement of the administration for children and
26families.
27(b) Other federal data sources maintained by the office of
28child support enforcement of the administration for children
29and families.
30(4) Information maintained by the United States citizenship
31and immigration services of the United States department of
32homeland security.
33(5) Payment information for public housing and section 8
34housing assistance guidelines maintained by the United States
35department of housing and urban development.
-72- 1(6) National fleeing felon information maintained by the
2United States federal bureau of investigation.
3b. State sources and information:
4(1) The department’s sources and information including but
5not limited to all of the following:
6(a) Income and employment information maintained by the
7child support recovery unit.
8(b) Child care assistance information maintained by the
9division of child and family services.
10(c) Enrollment status in other public assistance programs.
11(2) The department of workforce development sources and
12information including all of the following:
13(a) Employment information.
14(b) Employer weekly, monthly, and quarterly reports of
15income and unemployment insurance payments.
16(3) The Iowa public employees’ retirement system for
17earnings and pension information.
18c. Other sources including all of the following:
19(1) Any existing real-time database of persons currently
20receiving benefits in other states, such as the national
21accuracy clearinghouse.
22(2) An available database of persons who currently hold a
23license, permit, or certificate from any state agency, the cost
24of which exceeds five hundred dollars.
25(3) Wage reporting and similar information maintained by
26states contiguous to Iowa.
27(4) A third-party consumer reporting agency, as defined
28by the federal Fair Credit Reporting Act, 15 U.S.C. §1681a,
29for the purpose of obtaining real-time employment and income
30information.
312. Prior to determining the initial eligibility of an
32applicant for, or the ongoing eligibility of a recipient
33of, public assistance benefits, the department shall access
34information for every applicant or recipient from, at a
35minimum, the following public records:
-73- 1a. A nationwide public records data source of physical asset
2ownership. The data source may include but is not limited to
3real property, automobiles, watercraft, aircraft, and luxury
4vehicles, or any other vehicle owned by the applicant for or
5recipient of assistance.
6b. A nationwide public records data source of incarcerated
7individuals.
8c. A nationwide best address and driver’s license data
9source to verify that individuals are residents of the state.
10d. A comprehensive public records database from which the
11department may identify potential identity fraud or identity
12theft that is capable of closely associating name, social
13security number, date of birth, phone, and address information.
14e. National and local financial institutions in order
15to locate undisclosed depository accounts or verify account
16balances of disclosed accounts.
17f. Outstanding default or arrest warrant information.
183. The state may contract with a third-party consumer
19reporting agency, as defined by the federal Fair Credit
20Reporting Act, 15 U.S.C. §1681a, for the purpose of obtaining
21real-time employment and income information under this section.
22 Sec. 55. NEW SECTION. 239.5 Identity authentication.
23Unless otherwise prohibited by federal law or regulation,
24prior to the department awarding public assistance benefits, an
25applicant shall complete a computerized identity authentication
26process to confirm the identity of the applicant. Identity
27authentication shall be accomplished through a knowledge-based
28questionnaire consisting of financial and personal questions.
29The questionnaire shall contain questions tailored to assist
30persons without a bank account or those who have poor access
31to financial and banking services or who do not have an
32established credit history. The questionnaire may be submitted
33by the applicant online, in person, or via telephone.
34 Sec. 56. NEW SECTION. 239.6 Case review of applicant and
35recipient information.
-74- 11. If the information obtained from a review of an
2applicant’s or recipient’s information under this chapter does
3not result in the department finding a discrepancy or change
4in an individual’s circumstances affecting eligibility, the
5department shall take no further action.
62. If the information obtained from a review of the
7applicant’s or recipient’s information under this chapter
8results in the department finding a discrepancy or change in
9the individual’s circumstances affecting eligibility, the
10department shall respond in accordance with the provisions of
11section 239.8.
12 Sec. 57. NEW SECTION. 239.7 Notice and right to be heard.
131. An applicant for, or recipient of, public assistance
14shall be provided written notice and the opportunity to explain
15any issues identified in a review performed under this chapter
16for initial eligibility or redetermination of eligibility.
17Unless otherwise prohibited by federal law or regulation,
18a self-declaration by an applicant or recipient shall not
19be accepted as verification of categorical and financial
20eligibility during such review.
212. The notice provided to the applicant or recipient shall
22describe in sufficient detail the circumstances of the issue
23identified, the manner in which the applicant or recipient
24may respond, and the consequences of failing to respond to
25the notice or resolve the issue identified. The applicant or
26recipient shall be provided ten days to respond to the notice.
27The department may request additional information as necessary
28to reach a decision.
293. An applicant or recipient may respond to the notice as
30follows:
31a. By disagreeing with the findings of the department. If
32the applicant or recipient responds in a timely manner and
33disagrees with the findings of the department, the department
34shall reevaluate the circumstances to determine if the
35applicant’s or recipient’s position is valid. If, through
-75-1reevaluation, the department finds that the department is in
2error, the department shall take immediate action to correct
3the error. If, through reevaluation, the department affirms
4that the applicant’s or recipient’s position is invalid, the
5department shall determine the effect on the applicant’s or
6recipient’s eligibility and take appropriate action. Written
7notice of the department’s determination and the actions taken
8shall be provided to the applicant or recipient.
9b. By agreeing with the findings of the department. If
10the applicant or recipient responds in a timely manner and
11agrees with the findings of the department, the department
12shall determine the effect on the applicant’s or recipient’s
13eligibility and take appropriate action. Written notice of the
14department’s determination and actions taken shall be provided
15to the applicant or recipient.
164. If the applicant or recipient fails to respond to the
17notice in a timely manner, the department shall provide notice
18to terminate the applicant’s application or to discontinue
19the recipient’s enrollment for failure to cooperate, and
20shall terminate the applicant’s application or discontinue
21the recipient’s enrollment. The applicant’s or recipient’s
22eligibility for such public assistance shall not be established
23or reestablished until the issue has been resolved.
24 Sec. 58. NEW SECTION. 239.8 Referrals for fraud,
25misrepresentation, or inadequate documentation.
261. Following a review of an applicant’s or recipient’s
27eligibility under this chapter, the department may refer cases
28of suspected fraud along with any supportive information to the
29department of inspections and appeals for review.
302. In cases of substantiated fraud, upon conviction, the
31state shall review all appropriate legal options including
32but not limited to removal of a recipient from other public
33assistance programs and garnishment of wages or state income
34tax refunds until the department recovers an equal amount of
35benefits fraudulently claimed.
-76- 13. The department may refer suspected cases of fraud,
2misrepresentation, or inadequate documentation relating to
3initial or continued eligibility to appropriate state agencies,
4divisions, or departments for review of eligibility issues in
5programs providing public benefits other than those as defined
6in this chapter.
7 Sec. 59. NEW SECTION. 239.9 Administration — rules —
8reporting.
91. The department of human services shall adopt rules
10pursuant to chapter 17A to administer this chapter.
112. The department shall submit a report to the governor
12and the general assembly by January 15, 2024, and by January
1315 annually thereafter through January 15, 2028, detailing the
14impact of the verification and authentication measures taken
15under this chapter. The report shall include data for all
16affected public assistance programs including the number of
17cases reviewed, the number of cases closed, the number of fraud
18investigation referrals made, and the amount of savings and
19cost avoidance realized from the provisions of this chapter.
20 Sec. 60. IMPLEMENTATION.
211. The department of human services shall request federal
22approval including for any state plan amendment or waiver
23necessary to administer this division of this Act.
242. The provisions of this division of this Act requiring
25federal approval shall be implemented upon receipt of such
26federal approval.
273. The provisions of this division of this Act not requiring
28federal approval shall be implemented as specified in this
29division of this Act, or if not specified in this division of
30this Act, no later than July 1, 2023.
314. The department may contract with multiple third-party
32vendors to administer this division of this Act.
33EXPLANATION
34The inclusion of this explanation does not constitute agreement with
35the explanation’s substance by the members of the general assembly.
-77- 1This bill relates to appropriations for health and human
2services for fiscal year 2021-2022 to the department of
3veterans affairs, Iowa veterans home, department on aging
4(IDA), office of long-term care ombudsman, department of public
5health (DPH), Iowa finance authority, department of human
6rights, and department of human services (DHS). The bill is
7organized into divisions for each fiscal year.
8DEPARTMENT ON AGING. This division makes appropriations
9from the general fund of the state to the department on aging.
10OFFICE OF LONG-TERM CARE OMBUDSMAN. This division makes
11appropriations from the general fund of the state to the office
12of long-term care ombudsman.
13DEPARTMENT OF PUBLIC HEALTH. This division makes
14appropriations from the general fund of the state and from
15the sports wagering receipts fund to the department of public
16health.
17DEPARTMENT OF VETERANS AFFAIRS AND IOWA VETERANS HOME. This
18division makes appropriations from the general fund of the
19state to the department of veterans affairs for administration,
20the Iowa veterans home, for transfer to the Iowa finance
21authority for the home ownership assistance program and for the
22county commissions of veteran affairs.
23DEPARTMENT OF HUMAN SERVICES. This division makes
24appropriations from the general fund of the state and the
25federal temporary assistance for needy families block
26grant to DHS. The allocation for the family development
27and self-sufficiency grant program is made directly to
28the department of human rights. The reimbursement section
29addresses reimbursement for providers reimbursed by the
30department of human services.
31HEALTH CARE ACCOUNTS AND FUNDS. This division makes certain
32health-related appropriations. A number of the appropriations
33are made for purposes of the Medicaid program in addition to
34the general fund appropriations made for this purpose for the
35same fiscal year.
-78- 1NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
2JULY 1, 2023, THROUGH JUNE 30, 2025. This division provides
3that notwithstanding any provision of law to the contrary,
4for the fiscal period beginning July 1, 2023, and ending June
530, 2025, DHS shall rebase case-mix nursing facility rates
6beginning July 1, 2023, using the Medicaid cost reports on file
7for the period ending December 31, 2022, and applying a minimum
8occupancy factor of 70 percent.
9NURSING FACILITY REIMBURSEMENT STUDY. This division
10requires DHS to convene a workgroup to review the case-mix
11reimbursement methodology and process for nursing facilities
12and submit recommendations for improvements to the governor and
13the general assembly by December 1, 2021.
14MEDICAID-ELIGIBLE CHILDREN — PEDIATRIC HEALTH CARE
15SERVICES. This division requires DHS to review and submit a
16report to the governor and the general assembly by October 1,
172021, regarding the provision of pediatric health care services
18provided to Medicaid-eligible children in accordance with
19the early and periodic screening, diagnostic, and treatment
20program.
21DECATEGORIZATION CARRYOVER FUNDING. This division provides
22for the transfer of carryover decategorization funds that
23remained unencumbered or unobligated at the close of the fiscal
24year beginning July 1, 2020, to the Medicaid program for
25FY 2021-2022. The division takes effect upon enactment and is
26retroactively applicable to July 1, 2020.
27PRIOR APPROPRIATIONS AND OTHER PROVISIONS. This
28division amends a provision relating to the provision and
29reimbursement of court-ordered services and treatment for
30a substance-related disorder or for a mental illness by a
31managed care organization by eliminating the limitation that
32the services or treatment are court-ordered pursuant to Code
33chapter 125 (substance-related disorders) or Code chapter
34229 (hospitalization of persons with mental illness) and by
35eliminating the reference to “treatment” and only referencing
-79-1“services”.
2The division provides that funds appropriated to the
3department of human services and credited to the family
4investment program account that remain unencumbered or
5unobligated at the close of FY 2020-2021 shall not revert
6but shall remain available for expenditure for the purposes
7designated, and may be transferred to other appropriations as
8necessary to carry out the initiatives included in the report
9submitted on nonreversion of funds required pursuant to 2020
10Iowa Acts, chapter 1121, section 43, until the close of the
11succeeding fiscal year.
12The division also provides that funds appropriated to the
13department of human services for child and family services that
14remain unencumbered or unobligated at the close of FY 2020-2021
15shall not revert but shall remain available for expenditure for
16the purpose of the redesign of the child welfare system, until
17the close of the succeeding fiscal year.
18The division takes effect upon enactment.
19EXTENSION OF REPEAL FOR HOSPITAL HEALTH CARE ACCESS
20ASSESSMENT PROGRAM. This division extends the repeal of
21the hospital health care access assessment program chapter,
22Code chapter 249M, from July 1, 2021, to July 1, 2023. This
23provision takes effect upon enactment.
24PUBLIC ASSISTANCE PROGRAM OVERSIGHT. This division relates
25to public assistance program oversight, including various
26eligibility verification and authentication measures under
27new Code chapter 239 relating to the supplemental nutrition
28assistance program (SNAP), the Medicaid program, the family
29investment program (FIP), and the children’s health insurance
30program (CHIP).
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