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House File 891 - 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$4,020,894 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
18that include the goals of preventing youth initiation of
19tobacco usage, reducing exposure to secondhand smoke, and
20promotion of tobacco cessation. To maximize resources,
21the department shall determine if third-party sources are
22available to instead provide nicotine replacement products
23to an applicant prior to provision of such products to an
24applicant under the initiative. The department shall track and
25report to the governor and the general assembly any reduction
26in the provision of nicotine replacement products realized
27by the 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$19,638,485 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:
.................................................. $314,258,373
............................................... FTEs3210.00
33a. Of the funds appropriated in this subsection, $188,000
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:
.................................................. $276,319,306
............................................... 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 $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.
35(2) Not less than $334,000 is allocated to free clinics and
-10-1free clinics of Iowa for necessary infrastructure, statewide
2coordination, provider recruitment, service delivery, and
3provision of assistance to patients in securing a medical home
4inclusive of oral health care. Funds allocated under this
5subparagraph shall be distributed in their entirety for the
6purpose specified on July 1, 2021.
7(3) Not less than $25,000 is allocated to the Iowa
8association of rural health clinics for necessary
9infrastructure and service delivery transformation. Funds
10allocated under this subparagraph shall be distributed in their
11entirety for the purpose specified on July 1, 2021.
12(4) Not less than $225,000 is allocated to the Polk county
13medical society for continuation of the safety net provider
14patient access to specialty health care initiative as described
15in 2007 Iowa Acts, chapter 218, section 109. Funds allocated
16under this subparagraph shall be distributed in their entirety
17for the purpose specified on July 1, 2021.
18d. Of the funds appropriated in this subsection, $191,000
19is allocated for the purposes of health care and public health
20workforce initiatives.
21e. Of the funds appropriated in this subsection, $96,000
22shall be used for a matching dental education loan repayment
23program to be allocated to a dental nonprofit health service
24corporation to continue to develop the criteria and implement
25the loan repayment program.
26f. Of the funds appropriated in this subsection, $100,000
27shall be used for the purposes of the Iowa donor registry as
28specified in section 142C.18.
29g. Of the funds appropriated in this subsection, $96,000
30shall be used for continuation of a grant to a nationally
31affiliated volunteer eye organization that has an established
32program for children and adults and that is solely dedicated to
33preserving sight and preventing blindness through education,
34nationally certified vision screening and training, and
35community and patient service programs. The contractor shall
-11-1submit a report to the general assembly regarding the use
2of funds allocated under this paragraph “g”. The report
3shall include the objectives and results for the program year
4including the target population and how the funds allocated
5assisted the program in meeting the objectives; the number,
6age, grade level if appropriate, and location within the state
7of individuals served; the type of services provided to the
8individuals served; the distribution of funds based on services
9provided; and the continuing needs of the program.
10h. Of the funds appropriated in this subsection, $2,100,000
11shall be deposited in the medical residency training account
12created in section 135.175, subsection 5, paragraph “a”, and
13is appropriated from the account to the department of public
14health to be used for the purposes of the medical residency
15training state matching grants program as specified in section
16135.176.
17i. Of the funds appropriated in this subsection, $250,000
18shall be used for the public purpose of providing funding to
19Des Moines university to continue a provider education project
20to provide primary care physicians with the training and skills
21necessary to recognize the signs of mental illness in patients.
22j. Of the funds appropriated in this subsection, $600,000
23shall be used for rural psychiatric residencies to support the
24annual creation and training of four psychiatric residents who
25will provide mental health services in underserved areas of
26the state. Notwithstanding section 8.33, moneys that remain
27unencumbered or unobligated at the close of the fiscal year
28shall not revert but shall remain available for expenditure for
29the purposes designated for subsequent fiscal years.
30k. Of the funds appropriated in this subsection, $150,000
31shall be used for psychiatric training to increase access to
32mental health care services by expanding the mental health
33workforce via training of additional physician assistants and
34nurse practitioners.
35l. Of the funds appropriated in this subsection, $425,000
-12-1shall be used for the creation of a center of excellence
2program to encourage innovation and collaboration among
3regional health care providers in a rural area based upon the
4results of a regional community needs assessment to transform
5health care delivery in order to provide quality, sustainable
6care that meets the needs of the local communities. An
7applicant for the funds shall specify how the funds will be
8expended to accomplish the goals of the program and shall
9provide a detailed five-year sustainability plan prior to
10being awarded any funding. Following the receipt of funding,
11a recipient shall submit periodic reports as specified by the
12department to the governor and the general assembly regarding
13the recipient’s expenditure of the funds and progress in
14accomplishing the program goals.
155. ESSENTIAL PUBLIC HEALTH SERVICES
16To provide public health services that reduce risks and
17invest in promoting and protecting good health over the
18course of a lifetime with a priority given to older Iowans and
19vulnerable populations:
.................................................. $207,662,464
216. INFECTIOUS DISEASES
22For reducing the incidence and prevalence of communicable
23diseases, and for not more than the following full-time
24equivalent positions:
.................................................. $251,796,206
............................................... FTEs266.00
277. PUBLIC PROTECTION
28For protecting the health and safety of the public through
29establishing standards and enforcing regulations, and for not
30more than the following full-time equivalent positions:
.................................................. $314,466,601
............................................... FTEs32142.00
33a. Of the funds appropriated in this subsection, not more
34than $304,000 shall be credited to the emergency medical
35services fund created in section 135.25. Moneys in the
-13-1emergency medical services fund are appropriated to the
2department to be used for the purposes of the fund.
3b. Of the funds appropriated in this subsection, up
4to $243,000 shall be used for sexual violence prevention
5programming through a statewide organization representing
6programs serving victims of sexual violence through the
7department’s sexual violence prevention program, and for
8continuation of a training program for sexual assault
9response team (SART) members, including representatives of
10law enforcement, victim advocates, prosecutors, and certified
11medical personnel. The amount allocated in this paragraph “b”
12shall not be used to supplant funding administered for other
13sexual violence prevention or victims assistance programs.
14c. Of the funds appropriated in this subsection, up to
15$500,000 shall be used for the state poison control center.
16Pursuant to the directive under 2014 Iowa Acts, chapter
171140, section 102, the federal matching funds available to
18the state poison control center from the department of human
19services under the federal Children’s Health Insurance Program
20Reauthorization Act allotment shall be subject to the federal
21administrative cap rule of 10 percent applicable to funding
22provided under Tit.XXI of the federal Social Security Act and
23included within the department’s calculations of the cap.
24d. Of the funds appropriated in this subsection, up to
25$504,000 shall be used for childhood lead poisoning provisions.
268. RESOURCE MANAGEMENT
27For establishing and sustaining the overall ability of the
28department to deliver services to the public, and for not more
29than the following full-time equivalent positions:
.................................................. $30933,871
............................................... FTEs314.00
329. MISCELLANEOUS PROVISIONS
33The university of Iowa hospitals and clinics under the
34control of the state board of regents shall not receive
35indirect costs from the funds appropriated in this section.
-14-1The university of Iowa hospitals and clinics billings to the
2department shall be on at least a quarterly basis.
3 Sec. 4. DEPARTMENT OF PUBLIC HEALTH — SPORTS WAGERING
4RECEIPTS FUND. There is appropriated from the sports wagering
5receipts fund created in section 8.57, subsection 6, to the
6department of public health for the fiscal year beginning July
71, 2021, and ending June 30, 2022, the following amount, or
8so much thereof as is necessary, to be used for the purposes
9designated:
10For problem gambling and substance-related disorder
11prevention, treatment, and recovery services, including a
1224-hour helpline, public information resources, professional
13training, youth prevention, and program evaluation:
.................................................. $141,750,000
15DIVISION IV
16DEPARTMENT OF VETERANS AFFAIRS — FY 2021-2022
17 Sec. 5. DEPARTMENT OF VETERANS AFFAIRS. There is
18appropriated from the general fund of the state to the
19department of veterans affairs for the fiscal year beginning
20July 1, 2021, and ending June 30, 2022, the following amounts,
21or so much thereof as is necessary, to be used for the purposes
22designated:
231. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
24For salaries, support, maintenance, and miscellaneous
25purposes, and for not more than the following full-time
26equivalent positions:
.................................................. $271,229,763
............................................... FTEs2815.00
292. IOWA VETERANS HOME
30For salaries, support, maintenance, and miscellaneous
31purposes:
.................................................. $327,131,552
33a. The Iowa veterans home billings involving the department
34of human services shall be submitted to the department on at
35least a monthly basis.
-15- 1b. The Iowa veterans home expenditure report shall be
2submitted monthly to the general assembly.
3c. The Iowa veterans home shall continue to include in the
4annual discharge report applicant information to provide for
5the collection of demographic information including but not
6limited to the number of individuals applying for admission and
7admitted or denied admittance and the basis for the admission
8or denial; the age, gender, and race of such individuals;
9and the level of care for which such individuals applied for
10admission including residential or nursing level of care.
113. HOME OWNERSHIP ASSISTANCE PROGRAM
12For transfer to the Iowa finance authority for the
13continuation of the home ownership assistance program for
14persons who are or were eligible members of the armed forces of
15the United States, pursuant to section 16.54:
.................................................. $162,000,000
17 Sec. 6. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS
18FUND STANDING APPROPRIATIONS. Notwithstanding the standing
19appropriation in section 35A.16 for the fiscal year beginning
20July 1, 2021, and ending June 30, 2022, the amount appropriated
21from the general fund of the state for the following designated
22purposes shall not exceed the following amount, and shall be
23allocated to each county commission of veterans affairs or to
24each county sharing the services of an executive director or
25administrator pursuant to chapter 28E, in equal amounts:
26For the county commissions of veteran affairs fund under
27section 35A.16:
.................................................. $281,289,970
29DIVISION V
30DEPARTMENT OF HUMAN SERVICES — FY 2021-2022
31 Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
32GRANT. There is appropriated from the fund created in section
338.41 to the department of human services for the fiscal year
34beginning July 1, 2021, and ending June 30, 2022, from moneys
35received under the federal temporary assistance for needy
-16-1families (TANF) block grant pursuant to the federal Personal
2Responsibility and Work Opportunity Reconciliation Act of 1996,
3Pub.L.No.104-193, and successor legislation, the following
4amounts, or so much thereof as is necessary, to be used for the
5purposes designated:
61. To be credited to the family investment program account
7and used for assistance under the family investment program
8under chapter 239B:
.................................................. $95,002,006
102. To be credited to the family investment program account
11and used for the job opportunities and basic skills (JOBS)
12program and implementing family investment agreements in
13accordance with chapter 239B:
.................................................. $145,412,060
153. To be used for the family development and
16self-sufficiency grant program in accordance with section
17216A.107:
.................................................. $182,888,980
19Notwithstanding section 8.33, moneys appropriated in this
20subsection that remain unencumbered or unobligated at the close
21of the fiscal year shall not revert but shall remain available
22for expenditure for the purposes designated until the close of
23the succeeding fiscal year. However, unless such moneys are
24encumbered or obligated on or before September 30, 2022, the
25moneys shall revert.
264. For field operations:
.................................................. $2731,296,232
285. For general administration:
.................................................. $293,744,000
306. For state child care assistance:
.................................................. $3147,166,826
32a. Of the funds appropriated in this subsection,
33$26,205,412 is transferred to the child care and development
34block grant appropriation made by the Eighty-ninth General
35Assembly, 2021 session, for the federal fiscal year beginning
-17-1October 1, 2021, and ending September 30, 2022. Of this
2amount, $200,000 shall be used for provision of educational
3opportunities to registered child care home providers in order
4to improve services and programs offered by this category
5of providers and to increase the number of providers. The
6department may contract with institutions of higher education
7or child care resource and referral centers to provide
8the educational opportunities. Allowable administrative
9costs under the contracts shall not exceed 5 percent. The
10application for a grant shall not exceed two pages in length.
11b. Any funds appropriated in this subsection remaining
12unallocated shall be used for state child care assistance
13payments for families who are employed including but not
14limited to individuals enrolled in the family investment
15program.
167. For child and family services:
.................................................. $1732,380,654
188. For child abuse prevention grants:
.................................................. $19125,000
209. For pregnancy prevention grants on the condition that
21family planning services are funded:
.................................................. $221,913,203
23Pregnancy prevention grants shall be awarded to programs
24in existence on or before July 1, 2021, if the programs have
25demonstrated positive outcomes. Grants shall be awarded to
26pregnancy prevention programs which are developed after July
271, 2021, if the programs are based on existing models that
28have demonstrated positive outcomes. Grants shall comply with
29the requirements provided in 1997 Iowa Acts, chapter 208,
30section 14, subsections 1 and 2, including the requirement that
31grant programs must emphasize sexual abstinence. Priority in
32the awarding of grants shall be given to programs that serve
33areas of the state which demonstrate the highest percentage of
34unplanned pregnancies of females of childbearing age within the
35geographic area to be served by the grant.
-18- 110. For technology needs and other resources necessary to
2meet federal, state, and welfare reform reporting, tracking,
3and case management requirements and other departmental needs:
.................................................. $41,037,186
511. a. Notwithstanding any provision to the contrary,
6including but not limited to requirements in section 8.41 or
7provisions in 2020 Iowa Acts or 2021 Iowa Acts regarding the
8receipt and appropriation of federal block grants, federal
9funds from the temporary assistance for needy families block
10grant received by the state and not otherwise appropriated
11in this section and remaining available for the fiscal year
12beginning July 1, 2021, are appropriated to the department of
13human services to the extent as may be necessary to be used in
14the following priority order: the family investment program,
15for state child care assistance program payments for families
16who are employed, and for the family investment program share
17of system costs for eligibility determination and related
18functions. The federal funds appropriated in this paragraph
19“a” shall be expended only after all other funds appropriated
20in subsection 1 for assistance under the family investment
21program, in subsection 6 for state child care assistance, or
22in subsection 10 for technology costs related to the family
23investment program, as applicable, have been expended. For
24the purposes of this subsection, the funds appropriated in
25subsection 6, paragraph “a”, for transfer to the child care
26and development block grant appropriation are considered fully
27expended when the full amount has been transferred.
28b. The department shall, on a quarterly basis, advise the
29general assembly and department of management of the amount of
30funds appropriated in this subsection that was expended in the
31prior quarter.
3212. Of the amounts appropriated in this section,
33$12,962,008 for the fiscal year beginning July 1, 2021, is
34transferred to the appropriation of the federal social services
35block grant made to the department of human services for that
-19-1fiscal year.
213. For continuation of the program providing categorical
3eligibility for the food assistance program as specified
4for the program in the section of this division of this Act
5relating to the family investment program account:
.................................................. $614,236
714. The department may transfer funds allocated in this
8section to the appropriations made in this division of this Act
9for the same fiscal year for general administration and field
10operations for resources necessary to implement and operate the
11services referred to in this section and those funded in the
12appropriation made in this division of this Act for the same
13fiscal year for the family investment program from the general
14fund of the state.
1515. With the exception of moneys allocated under this
16section for the family development and self-sufficiency grant
17program, to the extent moneys allocated in this section are
18deemed by the department not to be necessary to support the
19purposes for which they are allocated, such moneys may be used
20in the same fiscal year for any other purpose for which funds
21are allocated in this section or in section 8 of this division
22of this Act for the family investment program account. If
23there are conflicting needs, priority shall first be given
24to the family investment program account as specified under
25subsection 1 of this section and used for the purposes of
26assistance under the family investment program in accordance
27with chapter 239B, followed by state child care assistance
28program payments for families who are employed, followed by
29other priorities as specified by the department.
30 Sec. 8. FAMILY INVESTMENT PROGRAM ACCOUNT.
311. Moneys credited to the family investment program (FIP)
32account for the fiscal year beginning July 1, 2021, and
33ending June 30, 2022, shall be used to provide assistance in
34accordance with chapter 239B.
352. The department may use a portion of the moneys credited
-20-1to the FIP account under this section as necessary for
2salaries, support, maintenance, and miscellaneous purposes.
33. The department may transfer funds allocated in
4subsection 4, excluding the allocation under subsection 4,
5paragraph “b”, to the appropriations made in this division of
6this Act for the same fiscal year for general administration
7and field operations for resources necessary to implement
8and operate the services referred to in this section and
9those funded in the appropriations made in section 7 for the
10temporary assistance for needy families block grant and in
11section 9 for the family investment program from the general
12fund of the state in this division of this Act for the same
13fiscal year.
144. Moneys appropriated in this division of this Act and
15credited to the FIP account for the fiscal year beginning July
161, 2021, and ending June 30, 2022, are allocated as follows:
17a. To be retained by the department of human services to
18be used for coordinating with the department of human rights
19to more effectively serve participants in FIP and other shared
20clients and to meet federal reporting requirements under the
21federal temporary assistance for needy families block grant:
.................................................. $2210,000
23b. To the department of human rights for staffing,
24administration, and implementation of the family development
25and self-sufficiency grant program in accordance with section
26216A.107:
.................................................. $277,192,834
28(1) Of the funds allocated for the family development
29and self-sufficiency grant program in this paragraph “b”,
30not more than 5 percent of the funds shall be used for the
31administration of the grant program.
32(2) The department of human rights may continue to implement
33the family development and self-sufficiency grant program
34statewide during fiscal year 2021-2022.
35(3) The department of human rights may engage in activities
-21-1to strengthen and improve family outcomes measures and
2data collection systems under the family development and
3self-sufficiency grant program.
4c. For the diversion subaccount of the FIP account:
.................................................. $51,293,000
6A portion of the moneys allocated for the diversion
7subaccount may be used for field operations, salaries, data
8management system development, and implementation costs and
9support deemed necessary by the director of human services
10in order to administer the FIP diversion program. To the
11extent moneys allocated in this paragraph “c” are deemed by the
12department not to be necessary to support diversion activities,
13such moneys may be used for other efforts intended to increase
14engagement by family investment program participants in work,
15education, or training activities, or for the purposes of
16assistance under the family investment program in accordance
17with chapter 239B.
18d. For the food assistance employment and training program:
.................................................. $1966,588
20(1) The department shall apply the federal supplemental
21nutrition assistance program (SNAP) employment and training
22state plan in order to maximize to the fullest extent permitted
23by federal law the use of the 50 percent federal reimbursement
24provisions for the claiming of allowable federal reimbursement
25funds from the United States department of agriculture
26pursuant to the federal SNAP employment and training program
27for providing education, employment, and training services
28for eligible food assistance program participants, including
29but not limited to related dependent care and transportation
30expenses.
31(2) The department shall continue the categorical federal
32food assistance program eligibility at 160 percent of the
33federal poverty level and continue to eliminate the asset test
34from eligibility requirements, consistent with federal food
35assistance program requirements. The department shall include
-22-1as many food assistance households as is allowed by federal
2law. The eligibility provisions shall conform to all federal
3requirements including requirements addressing individuals who
4are incarcerated or otherwise ineligible.
5e. For the JOBS program, not more than:
.................................................. $612,018,258
75. Of the child support collections assigned under FIP,
8an amount equal to the federal share of support collections
9shall be credited to the child support recovery appropriation
10made in this division of this Act. Of the remainder of the
11assigned child support collections received by the child
12support recovery unit, a portion shall be credited to the FIP
13account, a portion may be used to increase recoveries, and a
14portion may be used to sustain cash flow in the child support
15payments account. If as a consequence of the appropriations
16and allocations made in this section the resulting amounts
17are insufficient to sustain cash assistance payments and meet
18federal maintenance of effort requirements, the department
19shall seek supplemental funding. If child support collections
20assigned under FIP are greater than estimated or are otherwise
21determined not to be required for maintenance of effort, the
22state share of either amount may be transferred to or retained
23in the child support payments account.
24 Sec. 9. FAMILY INVESTMENT PROGRAM GENERAL FUND. There
25is appropriated from the general fund of the state to the
26department of human services for the fiscal year beginning July
271, 2021, and ending June 30, 2022, the following amount, or
28so much thereof as is necessary, to be used for the purpose
29designated:
30To be credited to the family investment program (FIP)
31account and used for family investment program assistance
32under chapter 239B and other costs associated with providing
33needs-based benefits or assistance:
.................................................. $3441,003,978
351. Of the funds appropriated in this section, $6,606,198 is
-23-1allocated for the JOBS program.
22. Of the funds appropriated in this section, $4,313,854 is
3allocated for the family development and self-sufficiency grant
4program.
53. a. Notwithstanding section 8.39, for the fiscal
6year beginning July 1, 2021, if necessary to meet federal
7maintenance of effort requirements or to transfer federal
8temporary assistance for needy families block grant funding
9to be used for purposes of the federal social services block
10grant or to meet cash flow needs resulting from delays in
11receiving federal funding or to implement, in accordance with
12this division of this Act, activities currently funded with
13juvenile court services, county, or community moneys and state
14moneys used in combination with such moneys; to comply with
15federal requirements; or to maximize the use of federal funds;
16the department of human services may transfer funds within or
17between any of the appropriations made in this division of this
18Act and appropriations in law for the federal social services
19block grant to the department for the following purposes,
20provided that the combined amount of state and federal
21temporary assistance for needy families block grant funding
22for each appropriation remains the same before and after the
23transfer:
24(1) For the family investment program.
25(2) For state child care assistance.
26(3) For child and family services.
27(4) For field operations.
28(5) For general administration.
29b. This subsection shall not be construed to prohibit the
30use of existing state transfer authority for other purposes.
31The department shall report any transfers made pursuant to this
32subsection to the general assembly.
334. Of the funds appropriated in this section, $195,000
34shall be used for a contract for tax preparation assistance
35to low-income Iowans to expand the usage of the earned income
-24-1tax credit. The purpose of the contract is to supply this
2assistance to underserved areas of the state. The department
3shall not retain any portion of the allocation under this
4subsection for administrative costs.
55. Of the funds appropriated in this section, $70,000 shall
6be used for the continuation of the parenting program, as
7specified in 441 IAC ch.100, relating to parental obligations,
8in which the child support recovery unit participates, to
9support the efforts of a nonprofit organization committed to
10strengthening the community through youth development, healthy
11living, and social responsibility headquartered in a county
12with a population over 350,000 according to the 2010 certified
13federal census. The funds allocated in this subsection shall
14be used by the recipient organization to develop a larger
15community effort, through public and private partnerships, to
16support a broad-based multi-county parenthood initiative that
17promotes payment of child support obligations, improved family
18relationships, and full-time employment.
196. The department may transfer funds appropriated in this
20section, excluding the allocation in subsection 2 for the
21family development and self-sufficiency grant program, to the
22appropriations made in this division of this Act for general
23administration and field operations as necessary to administer
24this section, section 7 for the temporary assistance for needy
25families block grant, and section 8 for the family investment
26program account.
27 Sec. 10. CHILD SUPPORT RECOVERY. There is appropriated
28from the general fund of the state to the department of human
29services for the fiscal year beginning July 1, 2021, and ending
30June 30, 2022, the following amount, or so much thereof as is
31necessary, to be used for the purposes designated:
32For child support recovery, including salaries, support,
33maintenance, and miscellaneous purposes, and for not more than
34the following full-time equivalent positions:
.................................................. $3515,942,885
-25-............................................... FTEs1459.00
21. The department shall expend up to $24,000, including
3federal financial participation, for the fiscal year beginning
4July 1, 2021, for a child support public awareness campaign.
5The department and the office of the attorney general shall
6cooperate in continuation of the campaign. The public
7awareness campaign shall emphasize, through a variety of
8media activities, the importance of maximum involvement of
9both parents in the lives of their children as well as the
10importance of payment of child support obligations.
112. Federal access and visitation grant moneys shall be
12issued directly to private not-for-profit agencies that provide
13services designed to increase compliance with the child access
14provisions of court orders, including but not limited to
15neutral visitation sites and mediation services.
163. The appropriation made to the department for child
17support recovery may be used throughout the fiscal year in the
18manner necessary for purposes of cash flow management, and for
19cash flow management purposes the department may temporarily
20draw more than the amount appropriated, provided the amount
21appropriated is not exceeded at the close of the fiscal year.
22 Sec. 11. HEALTH CARE TRUST FUND — MEDICAL ASSISTANCE —
23FY 2021-2022. Any funds remaining in the health care trust
24fund created in section 453A.35A for the fiscal year beginning
25July 1, 2021, and ending June 30, 2022, are appropriated to
26the department of human services to supplement the medical
27assistance program appropriations made in this division of this
28Act, for medical assistance reimbursement and associated costs,
29including program administration and costs associated with
30program implementation.
31 Sec. 12. MEDICAID FRAUD FUND — MEDICAL ASSISTANCE — FY
322021-2022. Any funds remaining in the Medicaid fraud fund
33created in section 249A.50 for the fiscal year beginning
34July 1, 2021, and ending June 30, 2022, are appropriated to
35the department of human services to supplement the medical
-26-1assistance appropriations made in this division of this Act,
2for medical assistance reimbursement and associated costs,
3including program administration and costs associated with
4program implementation.
5 Sec. 13. MEDICAL ASSISTANCE. There is appropriated from the
6general fund of the state to the department of human services
7for the fiscal year beginning July 1, 2021, and ending June 30,
82022, the following amount, or so much thereof as is necessary,
9to be used for the purpose designated:
10For medical assistance program reimbursement and associated
11costs as specifically provided in the reimbursement
12methodologies in effect on June 30, 2021, except as otherwise
13expressly authorized by law, consistent with options under
14federal law and regulations, and contingent upon receipt of
15approval from the office of the governor of reimbursement for
16each abortion performed under the program:
.................................................. $171,504,667,393
181. Iowans support reducing the number of abortions
19performed in our state. Funds appropriated under this section
20shall not be used for abortions, unless otherwise authorized
21under this section.
222. The provisions of this section relating to abortions
23shall also apply to the Iowa health and wellness plan created
24pursuant to chapter 249N.
253. The department shall utilize not more than $60,000 of
26the funds appropriated in this section to continue the AIDS/HIV
27health insurance premium payment program as established in 1992
28Iowa Acts, Second Extraordinary Session, chapter 1001, section
29409, subsection 6. Of the funds allocated in this subsection,
30not more than $5,000 may be expended for administrative
31purposes.
324. Of the funds appropriated in this Act to the department
33of public health for addictive disorders, $950,000 for
34the fiscal year beginning July 1, 2021, is transferred
35to the department of human services for an integrated
-27-1substance-related disorder managed care system. The
2departments of human services and public health shall
3work together to maintain the level of mental health and
4substance-related disorder treatment services provided by the
5managed care contractors. Each department shall take the steps
6necessary to continue the federal waivers as necessary to
7maintain the level of services.
85. The department shall aggressively pursue options for
9providing medical assistance or other assistance to individuals
10with special needs who become ineligible to continue receiving
11services under the early and periodic screening, diagnostic,
12and treatment program under the medical assistance program
13due to becoming 21 years of age who have been approved for
14additional assistance through the department’s exception to
15policy provisions, but who have health care needs in excess
16of the funding available through the exception to policy
17provisions.
186. Of the funds appropriated in this section, up to
19$3,050,082 may be transferred to the field operations or
20general administration appropriations in this division of this
21Act for operational costs associated with Part D of the federal
22Medicare Prescription Drug Improvement and Modernization Act
23of 2003, Pub.L.No.108-173.
247. Of the funds appropriated in this section, up to $442,100
25may be transferred to the appropriation in this division of
26this Act for health program operations to be used for clinical
27assessment services and prior authorization of services.
288. A portion of the funds appropriated in this section may
29be transferred to the appropriations in this division of this
30Act for general administration, health program operations, the
31children’s health insurance program, or field operations to be
32used for the state match cost to comply with the payment error
33rate measurement (PERM) program for both the medical assistance
34and children’s health insurance programs as developed by the
35centers for Medicare and Medicaid services of the United States
-28-1department of health and human services to comply with the
2federal Improper Payments Information Act of 2002, Pub.L.
3No.107-300, and to support other reviews and quality control
4activities to improve the integrity of these programs.
59. Of the funds appropriated in this section, a sufficient
6amount is allocated to supplement the incomes of residents of
7nursing facilities, intermediate care facilities for persons
8with mental illness, and intermediate care facilities for
9persons with an intellectual disability, with incomes of less
10than $50 in the amount necessary for the residents to receive a
11personal needs allowance of $50 per month pursuant to section
12249A.30A.
1310. a. Hospitals that meet the conditions specified
14in subparagraphs (1) and (2) shall either certify public
15expenditures or transfer to the medical assistance program
16an amount equal to provide the nonfederal share for a
17disproportionate share hospital payment in an amount up to the
18hospital-specific limit as approved in the Medicaid state plan.
19The hospitals that meet the conditions specified shall receive
20and retain 100 percent of the total disproportionate share
21hospital payment in an amount up to the hospital-specific limit
22as approved in the Medicaid state plan.
23(1) The hospital qualifies for disproportionate share and
24graduate medical education payments.
25(2) The hospital is an Iowa state-owned hospital with more
26than 500 beds and eight or more distinct residency specialty
27or subspecialty programs recognized by the American college of
28graduate medical education.
29b. Distribution of the disproportionate share payments
30shall be made on a monthly basis. The total amount of
31disproportionate share payments including graduate medical
32education, enhanced disproportionate share, and Iowa
33state-owned teaching hospital payments shall not exceed the
34amount of the state’s allotment under Pub.L.No.102-234.
35In addition, the total amount of all disproportionate
-29-1share payments shall not exceed the hospital-specific
2disproportionate share limits under Pub.L.No.103-66.
311. One hundred percent of the nonfederal share of payments
4to area education agencies that are medical assistance
5providers for medical assistance-covered services provided to
6medical assistance-covered children, shall be made from the
7appropriation made in this section.
812. A portion of the funds appropriated in this section may
9be transferred to the appropriation in this division of this
10Act for health program operations to be used for administrative
11activities associated with the money follows the person
12demonstration project.
1313. Of the funds appropriated in this section, $349,011
14shall be used for the administration of the health insurance
15premium payment program, including salaries, support,
16maintenance, and miscellaneous purposes.
1714. a. The department may increase the amounts allocated
18for salaries, support, maintenance, and miscellaneous purposes
19associated with the medical assistance program, as necessary,
20to sustain cost management efforts. The department shall
21report any such increase to the general assembly and the
22department of management.
23b. If the savings to the medical assistance program from
24ongoing cost management efforts exceed the associated cost
25for the fiscal year beginning July 1, 2021, the department
26may transfer any savings generated for the fiscal year due
27to medical assistance program cost management efforts to the
28appropriation made in this division of this Act for health
29program operations or general administration to defray the
30costs associated with implementing the efforts.
3115. For the fiscal year beginning July 1, 2021, and ending
32June 30, 2022, the replacement generation tax revenues required
33to be deposited in the property tax relief fund pursuant to
34section 437A.8, subsection 4, paragraph “d”, and section
35437A.15, subsection 3, paragraph “f”, shall instead be credited
-30-1to and supplement the appropriation made in this section and
2used for the allocations made in this section.
316. a. Of the funds appropriated in this section, up
4to $50,000 may be transferred by the department to the
5appropriation made in this division of this Act to the
6department for the same fiscal year for general administration
7to be used for associated administrative expenses and for not
8more than 1.00 full-time equivalent position, in addition to
9those authorized for the same fiscal year, to be assigned to
10implementing the children’s mental health home project.
11b. Of the funds appropriated in this section, up to $400,000
12may be transferred by the department to the appropriation made
13to the department in this division of this Act for the same
14fiscal year for Medicaid program-related general administration
15planning and implementation activities. The funds may be used
16for contracts or for personnel in addition to the amounts
17appropriated for and the positions authorized for general
18administration for the fiscal year.
19c. Of the funds appropriated in this section, up to
20$3,000,000 may be transferred by the department to the
21appropriations made in this division of this Act for the
22same fiscal year for general administration or health
23program operations to be used to support the development
24and implementation of standardized assessment tools for
25persons with mental illness, an intellectual disability, a
26developmental disability, or a brain injury.
2717. Of the funds appropriated in this section, $150,000
28shall be used for lodging expenses associated with care
29provided at the university of Iowa hospitals and clinics for
30patients with cancer whose travel distance is 30 miles or more
31and whose income is at or below 200 percent of the federal
32poverty level as defined by the most recently revised poverty
33income guidelines published by the United States department of
34health and human services. The department of human services
35shall establish the maximum number of overnight stays and the
-31-1maximum rate reimbursed for overnight lodging, which may be
2based on the state employee rate established by the department
3of administrative services. The funds allocated in this
4subsection shall not be used as nonfederal share matching
5funds.
618. Of the funds appropriated in this section, up to
7$3,383,880 shall be used for administration of the state family
8planning services program pursuant to section 217.41B, and
9of this amount, the department may use up to $200,000 for
10administrative expenses.
1119. Of the funds appropriated in this section, $1,545,530
12shall be used and may be transferred to other appropriations
13in this division of this Act as necessary to administer the
14provisions in the division of this Act relating to Medicaid
15program administration.
1620. The department shall comply with the centers for
17Medicare and Medicaid services’ guidance related to Medicaid
18program and children’s health insurance program maintenance
19of effort provisions, including eligibility standards,
20methodologies, procedures, and continuous enrollment, to
21receive the enhanced federal medical assistance percentage
22under section 6008(b) of the federal Families First Coronavirus
23Response Act, Pub.L. No.116-127. The department shall
24utilize and implement all tools, processes, and resources
25available to expediently return to normal eligibility and
26enrollment operations in compliance with federal guidance and
27expectations.
2821. Of the funds appropriated in this section, up to
29$1,031,530 shall be used to implement reductions in the waiting
30list for the children’s mental health home and community-based
31services waiver.
32 Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated
33from the general fund of the state to the department of human
34services for the fiscal year beginning July 1, 2021, and ending
35June 30, 2022, the following amount, or so much thereof as is
-32-1necessary, to be used for the purpose designated:
2For health program operations:
.................................................. $317,831,343
41. The department of inspections and appeals shall
5provide all state matching funds for survey and certification
6activities performed by the department of inspections
7and appeals. The department of human services is solely
8responsible for distributing the federal matching funds for
9such activities.
102. Of the funds appropriated in this section, $50,000 shall
11be used for continuation of home and community-based services
12waiver quality assurance programs, including the review and
13streamlining of processes and policies related to oversight and
14quality management to meet state and federal requirements.
153. Of the amount appropriated in this section, up to
16$200,000 may be transferred to the appropriation for general
17administration in this division of this Act to be used for
18additional full-time equivalent positions in the development
19of key health initiatives such as development and oversight
20of managed care programs and development of health strategies
21targeted toward improved quality and reduced costs in the
22Medicaid program.
234. Of the funds appropriated in this section, $1,000,000
24shall be used for planning and development, in cooperation with
25the department of public health, of a phased-in program to
26provide a dental home for children.
275. a. Of the funds appropriated in this section, $573,000
28shall be credited to the autism support program fund created
29in section 225D.2 to be used for the autism support program
30created in chapter 225D, with the exception of the following
31amount of this allocation which shall be used as follows:
32b. Of the funds allocated in this subsection, $25,000 shall
33be used for the public purpose of continuation of a grant to
34a nonprofit provider of child welfare services that has been
35in existence for more than 115 years, is located in a county
-33-1with a population between 200,000 and 220,000 according to the
22010 federal decennial census, is licensed as a psychiatric
3medical institution for children, and provides school-based
4programming, to be used for support services for children with
5autism spectrum disorder and their families.
6 Sec. 15. STATE SUPPLEMENTARY ASSISTANCE.
71. There is appropriated from the general fund of the
8state to the department of human services for the fiscal year
9beginning July 1, 2021, and ending June 30, 2022, the following
10amount, or so much thereof as is necessary, to be used for the
11purpose designated:
12For the state supplementary assistance program:
.................................................. $137,349,002
142. The department shall increase the personal needs
15allowance for residents of residential care facilities by the
16same percentage and at the same time as federal supplemental
17security income and federal social security benefits are
18increased due to a recognized increase in the cost of living.
19The department may adopt emergency rules to implement this
20subsection.
213. If during the fiscal year beginning July 1, 2021,
22the department projects that state supplementary assistance
23expenditures for a calendar year will not meet the federal
24pass-through requirement specified in Tit.XVI of the federal
25Social Security Act, section 1618, as codified in 42 U.S.C.
26§1382g, the department may take actions including but not
27limited to increasing the personal needs allowance for
28residential care facility residents and making programmatic
29adjustments or upward adjustments of the residential care
30facility or in-home health-related care reimbursement rates
31prescribed in this division of this Act to ensure that federal
32requirements are met. In addition, the department may make
33other programmatic and rate adjustments necessary to remain
34within the amount appropriated in this section while ensuring
35compliance with federal requirements. The department may adopt
-34-1emergency rules to implement the provisions of this subsection.
24. Notwithstanding section 8.33, moneys appropriated
3in this section that remain unencumbered or unobligated
4at the close of the fiscal year shall not revert but
5shall remain available for expenditure for the purposes
6designated, including for liability amounts associated with the
7supplemental nutrition assistance program payment error rate,
8until the close of the succeeding fiscal year.
9 Sec. 16. CHILDREN’S HEALTH INSURANCE PROGRAM.
101. There is appropriated from the general fund of the
11state to the department of human services for the fiscal year
12beginning July 1, 2021, and ending June 30, 2022, the following
13amount, or so much thereof as is necessary, to be used for the
14purpose designated:
15For maintenance of the healthy and well kids in Iowa (hawk-i)
16program pursuant to chapter 514I, including supplemental dental
17services, for receipt of federal financial participation under
18Tit.XXI of the federal Social Security Act, which creates the
19children’s health insurance program:
.................................................. $2037,957,643
212. Of the funds appropriated in this section, $149,189 is
22allocated for continuation of the contract for outreach with
23the department of public health.
243. A portion of the funds appropriated in this section may
25be transferred to the appropriations made in this division of
26this Act for field operations or health program operations to
27be used for the integration of hawk-i program eligibility,
28payment, and administrative functions under the purview of
29the department of human services, including for the Medicaid
30management information system upgrade.
31 Sec. 17. CHILD CARE ASSISTANCE. There is appropriated
32from the general fund of the state to the department of human
33services for the fiscal year beginning July 1, 2021, and ending
34June 30, 2022, the following amount, or so much thereof as is
35necessary, to be used for the purpose designated:
-35- 1For child care programs:
.................................................. $240,816,931
31. Of the funds appropriated in this section, $34,966,931
4shall be used for state child care assistance in accordance
5with section 237A.13.
62. Nothing in this section shall be construed or is
7intended as or shall imply a grant of entitlement for services
8to persons who are eligible for assistance due to an income
9level consistent with the waiting list requirements of section
10237A.13. Any state obligation to provide services pursuant to
11this section is limited to the extent of the funds appropriated
12in this section.
133. A list of the registered and licensed child care
14facilities operating in the area served by a child care
15resource and referral service shall be made available to the
16families receiving state child care assistance in that area.
174. Of the funds appropriated in this section, $5,850,000
18shall be credited to the early childhood programs grants
19account in the early childhood Iowa fund created in section
20256I.11. The moneys shall be distributed for funding of
21community-based early childhood programs targeted to children
22from birth through five years of age developed by early
23childhood Iowa areas in accordance with approved community
24plans as provided in section 256I.8.
255. The department may use any of the funds appropriated
26in this section as a match to obtain federal funds for use in
27expanding child care assistance and related programs. For
28the purpose of expenditures of state and federal child care
29funding, funds shall be considered obligated at the time
30expenditures are projected or are allocated to the department’s
31service areas. Projections shall be based on current and
32projected caseload growth, current and projected provider
33rates, staffing requirements for eligibility determination
34and management of program requirements including data systems
35management, staffing requirements for administration of the
-36-1program, contractual and grant obligations and any transfers
2to other state agencies, and obligations for decategorization
3or innovation projects.
46. A portion of the state match for the federal child care
5and development block grant shall be provided as necessary to
6meet federal matching funds requirements through the state
7general fund appropriation made for child development grants
8and other programs for at-risk children in section 279.51.
97. If a uniform reduction ordered by the governor under
10section 8.31 or other operation of law, transfer, or federal
11funding reduction reduces the appropriation made in this
12section for the fiscal year, the percentage reduction in the
13amount paid out to or on behalf of the families participating
14in the state child care assistance program shall be equal to or
15less than the percentage reduction made for any other purpose
16payable from the appropriation made in this section and the
17federal funding relating to it. The percentage reduction to
18the other allocations made in this section shall be the same as
19the uniform reduction ordered by the governor or the percentage
20change of the federal funding reduction, as applicable. If
21there is an unanticipated increase in federal funding provided
22for state child care services, the entire amount of the
23increase, except as necessary to meet federal requirements
24including quality set asides, shall be used for state child
25care assistance payments. If the appropriations made for
26purposes of the state child care assistance program for the
27fiscal year are determined to be insufficient, it is the intent
28of the general assembly to appropriate sufficient funding for
29the fiscal year in order to avoid establishment of waiting list
30requirements.
318. Notwithstanding section 8.33, moneys advanced for
32purposes of the programs developed by early childhood Iowa
33areas, advanced for purposes of wraparound child care, or
34received from the federal appropriations made for the purposes
35of this section that remain unencumbered or unobligated at the
-37-1close of the fiscal year shall not revert to any fund but shall
2remain available for expenditure for the purposes designated
3until the close of the succeeding fiscal year.
4 Sec. 18. JUVENILE INSTITUTION. There is appropriated
5from the general fund of the state to the department of human
6services for the fiscal year beginning July 1, 2021, and ending
7June 30, 2022, the following amounts, or so much thereof as is
8necessary, to be used for the purposes designated:
91. a. For operation of the state training school at Eldora
10and for salaries, support, maintenance, and miscellaneous
11purposes, and for not more than the following full-time
12equivalent positions:
.................................................. $1317,397,068
............................................... FTEs14207.00
15b. Of the funds appropriated in this subsection, $91,000
16shall be used for distribution to licensed classroom teachers
17at this and other institutions under the control of the
18department of human services based upon the average student
19yearly enrollment at each institution as determined by the
20department.
212. A portion of the moneys appropriated in this section
22shall be used by the state training school at Eldora for
23grants for adolescent pregnancy prevention activities at the
24institution in the fiscal year beginning July 1, 2021.
253. Of the funds appropriated in this subsection, $212,000
26shall be used by the state training school at Eldora for a
27substance use disorder treatment program at the institution for
28the fiscal year beginning July 1, 2021.
294. Notwithstanding section 8.33, moneys appropriated in
30this section that remain unencumbered or unobligated at the
31close of the fiscal year shall not revert but shall remain
32available for expenditure for the purposes designated until the
33close of the succeeding fiscal year.
34 Sec. 19. CHILD AND FAMILY SERVICES.
351. There is appropriated from the general fund of the
-38-1state to the department of human services for the fiscal year
2beginning July 1, 2021, and ending June 30, 2022, the following
3amount, or so much thereof as is necessary, to be used for the
4purpose designated:
5For child and family services:
.................................................. $689,071,930
72. The department may transfer funds appropriated in this
8section as necessary to pay the nonfederal costs of services
9reimbursed under the medical assistance program, state child
10care assistance program, or the family investment program which
11are provided to children who would otherwise receive services
12paid under the appropriation in this section. The department
13may transfer funds appropriated in this section to the
14appropriations made in this division of this Act for general
15administration and for field operations for resources necessary
16to implement and operate the services funded in this section.
173. a. Of the funds appropriated in this section, up to
18$31,500,000 is allocated as the statewide expenditure target
19under section 232.143 for group foster care maintenance and
20services. If the department projects that such expenditures
21for the fiscal year will be less than the target amount
22allocated in this paragraph “a”, the department may reallocate
23the excess to provide additional funding for family foster
24care, independent living, family-centered services, shelter
25care, or the child welfare emergency services addressed with
26the allocation for shelter care.
27b. If at any time after September 30, 2021, annualization
28of a service area’s current expenditures indicates a service
29area is at risk of exceeding its group foster care expenditure
30target under section 232.143 by more than 5 percent, the
31department and juvenile court services shall examine all
32group foster care placements in that service area in order to
33identify those which might be appropriate for termination.
34In addition, any aftercare services believed to be needed
35for the children whose placements may be terminated shall be
-39-1identified. The department and juvenile court services shall
2initiate action to set dispositional review hearings for the
3placements identified. In such a dispositional review hearing,
4the juvenile court shall determine whether needed aftercare
5services are available and whether termination of the placement
6is in the best interest of the child and the community.
74. In accordance with the provisions of section 232.188,
8the department shall continue the child welfare and juvenile
9justice funding initiative during fiscal year 2021-2022. Of
10the funds appropriated in this section, $1,717,000 is allocated
11specifically for expenditure for fiscal year 2021-2022 through
12the decategorization services funding pools and governance
13boards established pursuant to section 232.188.
145. A portion of the funds appropriated in this section
15may be used for emergency family assistance to provide other
16resources required for a family participating in a family
17preservation or reunification project or successor project to
18stay together or to be reunified.
196. Of the funds appropriated in this section, a sufficient
20amount is allocated for shelter care and the child welfare
21emergency services contracting implemented to provide for or
22prevent the need for shelter care.
237. Federal funds received by the state during the fiscal
24year beginning July 1, 2021, as the result of the expenditure
25of state funds appropriated during a previous state fiscal
26year for a service or activity funded under this section are
27appropriated to the department to be used as additional funding
28for services and purposes provided for under this section.
29Notwithstanding section 8.33, moneys received in accordance
30with this subsection that remain unencumbered or unobligated at
31the close of the fiscal year shall not revert to any fund but
32shall remain available for the purposes designated until the
33close of the succeeding fiscal year.
348. a. Of the funds appropriated in this section, up to
35$3,290,000 is allocated for the payment of the expenses of
-40-1court-ordered services provided to juveniles who are under the
2supervision of juvenile court services, which expenses are a
3charge upon the state pursuant to section 232.141, subsection
44. Of the amount allocated in this paragraph “a”, up to
5$1,556,000 shall be made available to provide school-based
6supervision of children adjudicated under chapter 232, of which
7not more than $15,000 may be used for the purpose of training.
8A portion of the cost of each school-based liaison officer
9shall be paid by the school district or other funding source as
10approved by the chief juvenile court officer.
11b. Of the funds appropriated in this section, up to $748,000
12is allocated for the payment of the expenses of court-ordered
13services provided to children who are under the supervision
14of the department, which expenses are a charge upon the state
15pursuant to section 232.141, subsection 4.
16c. Notwithstanding section 232.141 or any other provision
17of law to the contrary, the amounts allocated in this
18subsection shall be distributed to the judicial districts
19as determined by the state court administrator and to the
20department’s service areas as determined by the administrator
21of the department of human services’ division of child and
22family services. The state court administrator and the
23division administrator shall make the determination of the
24distribution amounts on or before June 15, 2021.
25d. Notwithstanding chapter 232 or any other provision of
26law to the contrary, a district or juvenile court shall not
27order any service which is a charge upon the state pursuant
28to section 232.141 if there are insufficient court-ordered
29services funds available in the district court or departmental
30service area distribution amounts to pay for the service. The
31chief juvenile court officer and the departmental service area
32manager shall encourage use of the funds allocated in this
33subsection such that there are sufficient funds to pay for
34all court-related services during the entire year. The chief
35juvenile court officers and departmental service area managers
-41-1shall attempt to anticipate potential surpluses and shortfalls
2in the distribution amounts and shall cooperatively request the
3state court administrator or division administrator to transfer
4funds between the judicial districts’ or departmental service
5areas’ distribution amounts as prudent.
6e. Notwithstanding any provision of law to the contrary,
7a district or juvenile court shall not order a county to pay
8for any service provided to a juvenile pursuant to an order
9entered under chapter 232 which is a charge upon the state
10under section 232.141, subsection 4.
11f. Of the funds allocated in this subsection, not more than
12$83,000 may be used by the judicial branch for administration
13of the requirements under this subsection.
14g. Of the funds allocated in this subsection, $17,000
15shall be used by the department of human services to support
16the interstate commission for juveniles in accordance with
17the interstate compact for juveniles as provided in section
18232.173.
199. Of the funds appropriated in this section, $12,253,000 is
20allocated for juvenile delinquent graduated sanctions services.
21Any state funds saved as a result of efforts by juvenile court
22services to earn a federal Tit.IV-E match for juvenile court
23services administration may be used for the juvenile delinquent
24graduated sanctions services.
2510. Of the funds appropriated in this section, $1,658,000 is
26transferred to the department of public health to be used for
27the child protection center grant program for child protection
28centers located in Iowa in accordance with section 135.118.
29The grant amounts under the program shall be equalized so that
30each center receives a uniform base amount of $245,000, and so
31that the remaining funds are awarded through a funding formula
32based upon the volume of children served. To increase access
33to child protection center services for children in rural
34areas, the funding formula for the awarding of the remaining
35funds shall provide for the awarding of an enhanced amount to
-42-1eligible grantees to develop and maintain satellite centers in
2underserved regions of the state.
311. Of the funds appropriated in this section, $4,025,000 is
4allocated for the preparation for adult living program pursuant
5to section 234.46.
612. Of the funds appropriated in this section, $227,000
7shall be used for the public purpose of continuing a grant to a
8nonprofit human services organization, providing services to
9individuals and families in multiple locations in southwest
10Iowa and Nebraska for support of a project providing immediate,
11sensitive support and forensic interviews, medical exams, needs
12assessments, and referrals for victims of child abuse and their
13nonoffending family members.
1413. Of the funds appropriated in this section, $300,000
15is allocated for the foster care youth council approach of
16providing a support network to children placed in foster care.
1714. Of the funds appropriated in this section, $202,000 is
18allocated for use pursuant to section 235A.1 for continuation
19of the initiative to address child sexual abuse implemented
20pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection
2121.
2215. Of the funds appropriated in this section, $630,000 is
23allocated for the community partnership for child protection
24sites.
2516. Of the funds appropriated in this section, $371,000
26is allocated for the department’s minority youth and family
27projects under the redesign of the child welfare system.
2817. Of the funds appropriated in this section, $851,000
29is allocated for funding of the community circle of care
30collaboration for children and youth in northeast Iowa.
3118. Of the funds appropriated in this section, at least
32$147,000 shall be used for the continuation of the child
33welfare provider training academy, a collaboration between the
34coalition for family and children’s services in Iowa and the
35department.
-43- 119. Of the funds appropriated in this section, $211,000
2shall be used for continuation of the central Iowa system of
3care program grant for the purposes of funding community-based
4services and other supports with a system of care approach for
5children with serious emotional disturbance and their families
6through a nonprofit provider that is located in a county
7with a population of more than 420,000 but less than 450,000
8according to the 2010 certified federal census, is licensed
9as a psychiatric medical institution for children, and was a
10system of care grantee prior to July 1, 2021.
1120. Of the funds appropriated in this section, $235,000
12shall be used for the public purpose of the continuation
13and expansion of a system of care program grant implemented
14in Cerro Gordo and Linn counties to utilize a comprehensive
15and long-term approach for helping children and families by
16addressing the key areas in a child’s life of childhood basic
17needs, education and work, family, and community.
1821. Of the funds appropriated in this section, $110,000
19shall be used for the public purpose of funding community-based
20services and other supports with a system of care approach
21for children with a serious emotional disturbance and their
22families through a nonprofit provider of child welfare services
23that has been in existence for more than 115 years, is located
24in a county with a population of more than 200,000 but less
25than 220,000 according to the 2010 certified federal census, is
26licensed as a psychiatric medical institution for children, and
27was a system of care grantee prior to July 1, 2021.
2822. If a separate funding source is identified that reduces
29the need for state funds within an allocation under this
30section, the allocated state funds may be redistributed to
31other allocations under this section for the same fiscal year.
3223. Of the funds appropriated in this section, a portion may
33be used for family-centered services for purposes of complying
34with the federal Family First Prevention Services Act of 2018,
35Pub.L. No.115-123, and successor legislation.
-44-1 Sec. 20. ADOPTION SUBSIDY.
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:
7a. For adoption subsidy payments and related costs and for
8other services provided for under paragraph “b”, subparagraph
9(2):
.................................................. $1040,596,007
11b. (1) Of the funds appropriated in this section, a
12sufficient amount is allocated for adoption subsidy payments
13and related costs.
14(2) Any funds appropriated in this section remaining after
15the allocation under subparagraph (1) are designated and
16allocated as state savings resulting from implementation of
17the federal Fostering Connections to Success and Increasing
18Adoptions Act of 2008, Pub.L. No.110-351, and successor
19legislation, as determined in accordance with 42 U.S.C.
20§673(a)(8), and shall be used for post-adoption services and
21for other purposes allowed under these federal laws, Tit.IV-B
22or Tit.IV-E of the federal Social Security Act.
23(a) The department of human services may transfer funds
24allocated in this subparagraph (2) to the appropriation for
25child and family services in this division of this Act for the
26purposes designated in this subparagraph (2).
27(b) Notwithstanding section 8.33, moneys allocated
28under this subparagraph (2) shall not revert to any fund but
29shall remain available for the purposes designated in this
30subparagraph (2) until expended.
312. The department may transfer funds appropriated in
32this section to the appropriation made in this division of
33this Act for general administration for costs paid from the
34appropriation relating to adoption subsidy.
353. Federal funds received by the state during the
-45-1fiscal year beginning July 1, 2021, as the result of the
2expenditure of state funds during a previous state fiscal
3year for a service or activity funded under this section are
4appropriated to the department to be used as additional funding
5for the services and activities funded under this section.
6Notwithstanding section 8.33, moneys received in accordance
7with this subsection that remain unencumbered or unobligated
8at the close of the fiscal year shall not revert to any fund
9but shall remain available for expenditure for the purposes
10designated until the close of the succeeding fiscal year.
11 Sec. 21. JUVENILE DETENTION HOME FUND. Moneys deposited
12in the juvenile detention home fund created in section 232.142
13during the fiscal year beginning July 1, 2021, and ending June
1430, 2022, are appropriated to the department of human services
15for the fiscal year beginning July 1, 2021, and ending June 30,
162022, for distribution of an amount equal to a percentage of
17the costs of the establishment, improvement, operation, and
18maintenance of county or multicounty juvenile detention homes
19in the fiscal year beginning July 1, 2020. Moneys appropriated
20for distribution in accordance with this section shall be
21allocated among eligible detention homes, prorated on the basis
22of an eligible detention home’s proportion of the costs of all
23eligible detention homes in the fiscal year beginning July
241, 2020. The percentage figure shall be determined by the
25department based on the amount available for distribution for
26the fund. Notwithstanding section 232.142, subsection 3, the
27financial aid payable by the state under that provision for the
28fiscal year beginning July 1, 2021, shall be limited to the
29amount appropriated for the purposes of this section.
30 Sec. 22. FAMILY SUPPORT SUBSIDY PROGRAM.
311. There is appropriated from the general fund of the
32state to the department of human services for the fiscal year
33beginning July 1, 2021, and ending June 30, 2022, the following
34amount, or so much thereof as is necessary, to be used for the
35purpose designated:
-46- 1For the family support subsidy program subject to the
2enrollment restrictions in section 225C.37, subsection 3:
.................................................. $3949,282
42. At least $899,291 of the moneys appropriated in this
5section is transferred to the department of public health for
6the family support center component of the comprehensive family
7support program under chapter 225C, subchapter V.
83. If at any time during the fiscal year, the amount of
9funding available for the family support subsidy program
10is reduced from the amount initially used to establish the
11figure for the number of family members for whom a subsidy
12is to be provided at any one time during the fiscal year,
13notwithstanding section 225C.38, subsection 2, the department
14shall revise the figure as necessary to conform to the amount
15of funding available.
16 Sec. 23. CONNER DECREE. There is appropriated from the
17general fund of the state to the department of human services
18for the fiscal year beginning July 1, 2021, and ending June 30,
192022, the following amount, or so much thereof as is necessary,
20to be used for the purpose designated:
21For building community capacity through the coordination
22and provision of training opportunities in accordance with the
23consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D.
24Iowa, July 14, 1994):
.................................................. $2533,632
26 Sec. 24. MENTAL HEALTH INSTITUTES.
271. There is appropriated from the general fund of the
28state to the department of human services for the fiscal year
29beginning July 1, 2021, and ending June 30, 2022, the following
30amounts, or so much thereof as is necessary, to be used for the
31purposes designated:
32a. For operation of the state mental health institute at
33Cherokee as required by chapters 218 and 226 for salaries,
34support, maintenance, and miscellaneous purposes, and for not
35more than the following full-time equivalent positions:
-47-.................................................. $115,457,597
............................................... FTEs2169.00
3b. For operation of the state mental health institute at
4Independence 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:
.................................................. $719,652,379
............................................... FTEs8208.00
92. a. Notwithstanding sections 218.78 and 249A.11, any
10revenue received from the state mental health institute at
11Cherokee or the state mental health institute at Independence
12pursuant to 42 C.F.R§438.6(e) may be retained and expended by
13the mental health institute.
14b. Notwithstanding sections 218.78 and 249A.11, any
15COVID-19 related funding received through federal funding
16sources by the state mental health institute at Cherokee or the
17state mental health institute at Independence may be retained
18and expended by the mental health institute.
193. Notwithstanding any provision of law to the contrary,
20a Medicaid member residing at the state mental health
21institute at Cherokee or the state mental health institute
22at Independence shall retain Medicaid eligibility during
23the period of the Medicaid member’s stay for which federal
24financial participation is available.
254. Notwithstanding section 8.33, moneys appropriated in
26this section that remain unencumbered or unobligated at the
27close of the fiscal year shall not revert but shall remain
28available for expenditure for the purposes designated until the
29close of the succeeding fiscal year.
30 Sec. 25. STATE RESOURCE CENTERS.
311. There is appropriated from the general fund of the
32state to the department of human services for the fiscal year
33beginning July 1, 2021, and ending June 30, 2022, the following
34amounts, or so much thereof as is necessary, to be used for the
35purposes designated:
-48- 1a. For the state resource center at Glenwood for salaries,
2support, maintenance, and miscellaneous purposes:
.................................................. $314,802,873
4b. For the state resource center at Woodward for salaries,
5support, maintenance, and miscellaneous purposes:
.................................................. $612,237,937
72. The department may continue to bill for state resource
8center services utilizing a scope of services approach used for
9private providers of intermediate care facilities for persons
10with an intellectual disability services, in a manner which
11does not shift costs between the medical assistance program,
12counties, or other sources of funding for the state resource
13centers.
143. The state resource centers may expand the time-limited
15assessment and respite services during the fiscal year.
164. If the department’s administration and the department
17of management concur with a finding by a state resource
18center’s superintendent that projected revenues can reasonably
19be expected to pay the salary and support costs for a new
20employee position, or that such costs for adding a particular
21number of new positions for the fiscal year would be less
22than the overtime costs if new positions would not be added,
23the superintendent may add the new position or positions. If
24the vacant positions available to a resource center do not
25include the position classification desired to be filled, the
26state resource center’s superintendent may reclassify any
27vacant position as necessary to fill the desired position. The
28superintendents of the state resource centers may, by mutual
29agreement, pool vacant positions and position classifications
30during the course of the fiscal year in order to assist one
31another in filling necessary positions.
325. If existing capacity limitations are reached in
33operating units, a waiting list is in effect for a service or
34a special need for which a payment source or other funding
35is available for the service or to address the special need,
-49-1and facilities for the service or to address the special need
2can be provided within the available payment source or other
3funding, the superintendent of a state resource center may
4authorize opening not more than two units or other facilities
5and begin implementing the service or addressing the special
6need during fiscal year 2021-2022.
76. Notwithstanding section 8.33, and notwithstanding
8the amount limitation specified in section 222.92, moneys
9appropriated in this section that remain unencumbered or
10unobligated at the close of the fiscal year shall not revert
11but shall remain available for expenditure for the purposes
12designated until the close of the succeeding fiscal year.
13 Sec. 26. SEXUALLY VIOLENT PREDATORS.
141. There is appropriated from the general fund of the
15state to the department of human services for the fiscal year
16beginning July 1, 2021, and ending June 30, 2022, the following
17amount, or so much thereof as is necessary, to be used for the
18purpose designated:
19For costs associated with the commitment and treatment of
20sexually violent predators in the unit located at the state
21mental health institute at Cherokee, including costs of legal
22services and other associated costs, including salaries,
23support, maintenance, and miscellaneous purposes, and for not
24more than the following full-time equivalent positions:
.................................................. $2513,643,727
............................................... FTEs26139.00
272. Unless specifically prohibited by law, if the amount
28charged provides for recoupment of at least the entire amount
29of direct and indirect costs, the department of human services
30may contract with other states to provide care and treatment
31of persons placed by the other states at the unit for sexually
32violent predators at Cherokee. The moneys received under
33such a contract shall be considered to be repayment receipts
34and used for the purposes of the appropriation made in this
35section.
-50- 13. Notwithstanding section 8.33, moneys appropriated in
2this section that remain unencumbered or unobligated at the
3close of the fiscal year shall not revert but shall remain
4available for expenditure for the purposes designated until the
5close of the succeeding fiscal year.
6 Sec. 27. FIELD OPERATIONS.
71. There is appropriated from the general fund of the
8state to the department of human services for the fiscal year
9beginning July 1, 2021, and ending June 30, 2022, the following
10amount, or so much thereof as is necessary, to be used for the
11purposes designated:
12For field operations, including salaries, support,
13maintenance, and miscellaneous purposes, and for not more than
14the following full-time equivalent positions:
.................................................. $1560,596,667
............................................... FTEs161,539.00
172. Priority in filling full-time equivalent positions
18shall be given to those positions related to child protection
19services and eligibility determination for low-income families.
20 Sec. 28. GENERAL ADMINISTRATION. There is appropriated
21from the general fund of the state to the department of human
22services for the fiscal year beginning July 1, 2021, and ending
23June 30, 2022, the following amount, or so much thereof as is
24necessary, to be used for the purpose designated:
25For general administration, including salaries, support,
26maintenance, and miscellaneous purposes, and for not more than
27the following full-time equivalent positions:
.................................................. $2815,342,189
............................................... FTEs29294.00
301. The department shall report at least monthly to the
31general assembly concerning the department’s operational and
32program expenditures.
332. Of the funds appropriated in this section, $150,000 shall
34be used for the provision of a program to provide technical
35assistance, support, and consultation to providers of home and
-51-1community-based services under the medical assistance program.
23. Of the funds appropriated in this section, $50,000
3is transferred to the Iowa finance authority to be used
4for administrative support of the council on homelessness
5established in section 16.2D and for the council to fulfill its
6duties in addressing and reducing homelessness in the state.
74. Of the funds appropriated in this section, $200,000 shall
8be transferred to and deposited in the administrative fund of
9the Iowa ABLE savings plan trust created in section 12I.4, to
10be used for implementation and administration activities of the
11Iowa ABLE savings plan trust.
125. Of the funds appropriated in this section, $200,000 is
13transferred to the economic development authority for the Iowa
14commission on volunteer services to continue to be used for the
15RefugeeRISE AmeriCorps program established under section 15H.8
16for member recruitment and training to improve the economic
17well-being and health of economically disadvantaged refugees in
18local communities across Iowa. Funds transferred may be used
19to supplement federal funds under federal regulations.
206. Of the funds appropriated in this section, up to $300,000
21shall be used as follows:
22a. To fund not more than one full-time equivalent position
23to address the department’s responsibility to support the work
24of the children’s behavioral health system state board and
25implementation of the services required pursuant to section
26331.397.
27b. To support the cost of establishing and implementing new
28or additional services required pursuant to sections 331.397
29and 331.397A.
30c. Of the amount allocated, $32,000 shall be transferred
31to the department of public health to support the costs of
32establishing and implementing new or additional services
33required pursuant to sections 331.397 and 331.397A.
347. Of the funds appropriated in this section, $800,000 shall
35be used for the renovation and construction of certain nursing
-52-1facilities, consistent with the provisions of chapter 249K.
2 Sec. 29. DEPARTMENT-WIDE DUTIES. There is appropriated
3from the general fund of the state to the department of human
4services for the fiscal year beginning July 1, 2021, and ending
5June 30, 2022, the following amount, or so much thereof as is
6necessary, to be used for the purposes designated:
7For salaries, support, maintenance, and miscellaneous
8purposes at facilities under the purview of the department of
9human services:
.................................................. $102,879,274
11 Sec. 30. VOLUNTEERS. There is appropriated from the general
12fund of the state to the department of human services for the
13fiscal year beginning July 1, 2021, and ending June 30, 2022,
14the following amount, or so much thereof as is necessary, to be
15used for the purpose designated:
16For development and coordination of volunteer services:
.................................................. $1784,686
18 Sec. 31. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
19ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
20DEPARTMENT OF HUMAN SERVICES.
211. a. (1) (a) Notwithstanding any provision of law to
22the contrary, for the fiscal year beginning July 1, 2021, the
23department shall not rebase case-mix nursing facility rates,
24but shall instead reimburse case-mix nursing facilities by
25adjusting the nursing facility case-mix adjusted rates that
26were effective July 1, 2019, using the mid-points of each of
27the most recent cost reports submitted by the nursing facility
28for the period ending on or before December 31, 2018, and
29inflating these costs forward applying the inflation factor as
30determined using the latest available quarterly publication of
31the HCFA/SNF index, to the extent possible within the state
32funding, including the $20,000,000 provided for this purpose.
33(b) For the fiscal year beginning July 1, 2021, non-case-mix
34and special population nursing facilities shall be reimbursed
35in accordance with the methodology in effect on June 30 of the
-53-1prior fiscal year.
2(c) For managed care claims, the department of human
3services shall adjust the payment rate floor for nursing
4facilities, annually, to maintain a rate floor that is no
5lower than the Medicaid fee-for-service case-mix adjusted rate
6calculated in accordance with subparagraph division (a) and
7441 IAC 81.6. The department shall then calculate adjusted
8reimbursement rates, including but not limited to add-on
9payments, annually, and shall notify Medicaid managed care
10organizations of the adjusted reimbursement rates within 30
11days of determining the adjusted reimbursement rates. Any
12adjustment of reimbursement rates under this subparagraph
13division shall be budget neutral to the state budget.
14(d) For the fiscal year beginning July 1, 2021, Medicaid
15managed care long-term services and supports capitation rates
16shall be adjusted to reflect the case-mix adjusted rates
17specified pursuant to subparagraph division (a) for the patient
18populations residing in Medicaid-certified nursing facilities.
19(2) Medicaid managed care organizations shall adjust
20facility-specific rates based upon payment rate listings issued
21by the department. The rate adjustments shall be applied
22prospectively from the effective date of the rate letter issued
23by the department.
24b. (1) For the fiscal year beginning July 1, 2021, the
25department shall establish the fee-for-service pharmacy
26dispensing fee reimbursement at $10.38 per prescription,
27until a cost of dispensing survey is completed. The actual
28dispensing fee shall be determined by a cost of dispensing
29survey performed by the department and required to be completed
30by all medical assistance program participating pharmacies
31every two years.
32(2) The department shall utilize an average acquisition
33cost reimbursement methodology for all drugs covered under the
34medical assistance program in accordance with 2012 Iowa Acts,
35chapter 1133, section 33.
-54- 1c. (1) For the fiscal year beginning July 1, 2021,
2reimbursement rates for outpatient hospital services shall
3remain at the rates in effect on June 30, 2021, subject to
4Medicaid program upper payment limit rules, and adjusted
5as necessary to maintain expenditures within the amount
6appropriated to the department for this purpose for the fiscal
7year.
8(2) For the fiscal year beginning July 1, 2021,
9reimbursement rates for inpatient hospital services shall
10be rebased effective October 1, 2021, subject to Medicaid
11program upper payment limit rules, and adjusted as necessary
12to maintain expenditures within the amount appropriated to the
13department for this purpose for the fiscal year.
14(3) For the fiscal year beginning July 1, 2021, under
15both fee-for-service and managed care administration of
16the Medicaid program, critical access hospitals shall be
17reimbursed for inpatient and outpatient services based on the
18hospital-specific critical access hospital cost adjustment
19factor methodology utilizing the most recent and complete cost
20reporting period as applied prospectively within the funds
21appropriated for such purpose for the fiscal year.
22(4) For the fiscal year beginning July 1, 2021, the graduate
23medical education and disproportionate share hospital fund
24shall remain at the amount in effect on June 30, 2021, except
25that the portion of the fund attributable to graduate medical
26education shall be reduced in an amount that reflects the
27elimination of graduate medical education payments made to
28out-of-state hospitals.
29(5) In order to ensure the efficient use of limited state
30funds in procuring health care services for low-income Iowans,
31funds appropriated in this Act for hospital services shall
32not be used for activities which would be excluded from a
33determination of reasonable costs under the federal Medicare
34program pursuant to 42 U.S.C.§1395x(v)(1)(N).
35d. For the fiscal year beginning July 1, 2021, reimbursement
-55-1rates for hospices and acute psychiatric hospitals shall be
2increased in accordance with increases under the federal
3Medicare program or as supported by their Medicare audited
4costs.
5e. For the fiscal year beginning July 1, 2021, independent
6laboratories and rehabilitation agencies shall be reimbursed
7using the same methodology in effect on June 30, 2021.
8f. (1) For the fiscal year beginning July 1, 2021,
9reimbursement rates for home health agencies shall continue to
10be based on the Medicare low utilization payment adjustment
11(LUPA) methodology with state geographic wage adjustments and
12shall be adjusted to increase the rates to the extent possible
13within the state funding, including the $2,000,000 appropriated
14for this purpose. The department shall continue to update the
15rates every two years to reflect the most recent Medicare LUPA
16rates.
17(2) For the fiscal year beginning July 1, 2021, rates for
18private duty nursing and personal care services under the early
19and periodic screening, diagnostic, and treatment program
20benefit shall be calculated based on the methodology in effect
21on June 30, 2021.
22g. For the fiscal year beginning July 1, 2021, federally
23qualified health centers and rural health clinics shall receive
24cost-based reimbursement for 100 percent of the reasonable
25costs for the provision of services to recipients of medical
26assistance.
27h. For the fiscal year beginning July 1, 2021, the
28reimbursement rates for dental services shall remain at the
29rates in effect on June 30, 2021.
30i. (1) For the fiscal year beginning July 1, 2021,
31reimbursement rates for non-state-owned psychiatric medical
32institutions for children shall be increased to the extent
33possible within the $3,900,000 appropriated for this purpose.
34(2) As a condition of participation in the medical
35assistance program, enrolled providers shall accept the medical
-56-1assistance reimbursement rate for any covered goods or services
2provided to recipients of medical assistance who are children
3under the custody of a psychiatric medical institution for
4children.
5j. For the fiscal year beginning July 1, 2021, unless
6otherwise specified in this Act, all noninstitutional medical
7assistance provider reimbursement rates shall remain at the
8rates in effect on June 30, 2021, except for area education
9agencies, local education agencies, infant and toddler
10services providers, home and community-based services providers
11including consumer-directed attendant care providers under a
12section 1915(c) or 1915(i) waiver, targeted case management
13providers, and those providers whose rates are required to be
14determined pursuant to section 249A.20, or to meet federal
15mental health parity requirements.
16k. Notwithstanding any provision to the contrary, for the
17fiscal year beginning July 1, 2021, the reimbursement rate for
18anesthesiologists shall remain at the rates in effect on June
1930, 2021, and updated on January 1, 2022, to align with the
20most current Iowa Medicare anesthesia rate.
21l. Notwithstanding section 249A.20, for the fiscal year
22beginning July 1, 2021, the average reimbursement rate for
23health care providers eligible for use of the federal Medicare
24resource-based relative value scale reimbursement methodology
25under section 249A.20 shall remain at the rate in effect on
26June 30, 2021; however, this rate shall not exceed the maximum
27level authorized by the federal government.
28m. For the fiscal year beginning July 1, 2021, the
29reimbursement rate for residential care facilities shall not
30be less than the minimum payment level as established by the
31federal government to meet the federally mandated maintenance
32of effort requirement. The flat reimbursement rate for
33facilities electing not to file annual cost reports shall not
34be less than the minimum payment level as established by the
35federal government to meet the federally mandated maintenance
-57-1of effort requirement.
2n. For the fiscal year beginning July 1, 2021, the
3reimbursement rates for inpatient mental health services
4provided at hospitals shall be rebased effective October 1,
52021, subject to Medicaid program upper payment limit rules
6and adjusted as necessary to maintain expenditures within the
7amount appropriated to the department for this purpose for
8the fiscal year; and psychiatrists shall be reimbursed at the
9medical assistance program fee-for-service rate in effect on
10June 30, 2021.
11o. For the fiscal year beginning July 1, 2021, community
12mental health centers may choose to be reimbursed for the
13services provided to recipients of medical assistance through
14either of the following options:
15(1) For 100 percent of the reasonable costs of the services.
16(2) In accordance with the alternative reimbursement rate
17methodology approved by the department of human services in
18effect on June 30, 2021.
19p. For the fiscal year beginning July 1, 2021, the
20reimbursement rate for providers of family planning services
21that are eligible to receive a 90 percent federal match shall
22remain at the rates in effect on June 30, 2021.
23q. (1) For the fiscal year beginning July 1, 2021,
24reimbursement rates for providers of home and community-based
25services waiver and habilitation services shall be increased by
265.25 percent over the rates in effect on June 30, 2021.
27(2) For the fiscal year beginning July 1, 2021,
28reimbursement rates for providers of state plan home and
29community-based services home-based habilitation services
30shall be increased with the $7,134,214 appropriated for this
31purpose. The reimbursement rates for home-based habilitation
32services shall be based on a fee schedule that incorporates the
33acuity-based tiers.
34r. For the fiscal year beginning July 1, 2021, the
35reimbursement rates for emergency medical service providers
-58-1shall remain at the rates in effect on June 30, 2021, or as
2approved by the centers for Medicare and Medicaid services of
3the United States department of health and human services.
4s. For the fiscal year beginning July 1, 2021, reimbursement
5rates for substance-related disorder treatment programs
6licensed under section 125.13 shall remain at the rates in
7effect on June 30, 2021.
8t. For the fiscal year beginning July 1, 2021, assertive
9community treatment per diem rates shall remain at the rates in
10effect on June 30, 2021.
11u. For the fiscal year beginning July 1, 2021, the
12reimbursement rate for family-centered services providers shall
13be established by contract.
142. For the fiscal year beginning July 1, 2021, the
15reimbursement rate for providers reimbursed under the
16in-home-related care program shall not be less than the minimum
17payment level as established by the federal government to meet
18the federally mandated maintenance of effort requirement.
193. Unless otherwise directed in this section, when the
20department’s reimbursement methodology for any provider
21reimbursed in accordance with this section includes an
22inflation factor, this factor shall not exceed the amount
23by which the consumer price index for all urban consumers
24increased during the calendar year ending December 31, 2002.
254. Notwithstanding section 234.38, for the fiscal
26year beginning July 1, 2021, the foster family basic daily
27maintenance rate and the maximum adoption subsidy rate for
28children ages 0 through 5 years shall be $16.78, the rate for
29children ages 6 through 11 years shall be $17.45, the rate for
30children ages 12 through 15 years shall be $19.10, and the
31rate for children and young adults ages 16 and older shall
32be $19.35. For youth ages 18 to 23 who have exited foster
33care, the preparation for adult living program maintenance
34rate shall be up to $602.70 per month as calculated based on
35the age of the participant. The maximum payment for adoption
-59-1subsidy nonrecurring expenses shall be limited to $500 and the
2disallowance of additional amounts for court costs and other
3related legal expenses implemented pursuant to 2010 Iowa Acts,
4chapter 1031, section 408, shall be continued.
55. For the fiscal year beginning July 1, 2021, the maximum
6reimbursement rates for social services providers under
7contract shall remain at the rates in effect on June 30, 2021,
8or the provider’s actual and allowable cost plus inflation for
9each service, whichever is less. However, if a new service
10or service provider is added after June 30, 2021, the initial
11reimbursement rate for the service or provider shall be based
12upon a weighted average of provider rates for similar services.
136. a. For the fiscal year beginning July 1, 2021, the
14reimbursement rates for resource family recruitment and
15retention contractors shall be established by contract.
16b. For the fiscal year beginning July 1, 2021, the
17reimbursement rates for supervised apartment living foster care
18providers shall be established by contract.
197. For the fiscal year beginning July 1, 2021, the
20reimbursement rate for group foster care providers shall be the
21combined service and maintenance reimbursement rate established
22by contract.
238. The group foster care reimbursement rates paid for
24placement of children out of state shall be calculated
25according to the same rate-setting principles as those used for
26in-state providers, unless the director of human services or
27the director’s designee determines that appropriate care cannot
28be provided within the state. The payment of the daily rate
29shall be based on the number of days in the calendar month in
30which service is provided.
319. a. For the fiscal year beginning July 1, 2021, the
32reimbursement rate paid for shelter care and the child welfare
33emergency services implemented to provide or prevent the need
34for shelter care shall be established by contract.
35b. For the fiscal year beginning July 1, 2021, the combined
-60-1service and maintenance components of the reimbursement rate
2paid for shelter care services shall be based on the financial
3and statistical report submitted to the department. The
4maximum reimbursement rate shall be $101.83 per day. The
5department shall reimburse a shelter care provider at the
6provider’s actual and allowable unit cost, plus inflation, not
7to exceed the maximum reimbursement rate.
8c. Notwithstanding section 232.141, subsection 8, for the
9fiscal year beginning July 1, 2021, the amount of the statewide
10average of the actual and allowable rates for reimbursement of
11juvenile shelter care homes that is utilized for the limitation
12on recovery of unpaid costs shall remain at the amount in
13effect for this purpose in the fiscal year beginning July 1,
142020.
1510. For the fiscal year beginning July 1, 2021, the
16department shall calculate reimbursement rates for intermediate
17care facilities for persons with an intellectual disability
18at the 80th percentile. Beginning July 1, 2021, the rate
19calculation methodology shall utilize the consumer price index
20inflation factor applicable to the fiscal year beginning July
211, 2021.
2211. Effective July 1, 2021, the department of human services
23shall set the reimbursement rate of child care providers whose
24reimbursement rates are below the fiftieth percentile of the
25most recent market rate survey at the fiftieth percentile of
26the most recent market rate survey. Reimbursement rates of
27child care providers whose reimbursement rates are at or above
28the fiftieth percentile of the most recent market rate survey
29shall remain at the rates in effect on June 30, 2021. The
30department shall also adjust quality rating system bonuses to
31reflect increased child care provider reimbursement rates as
32appropriate. The department shall set rates in a manner so as
33to provide incentives for a nonregistered provider to become
34registered by applying any increase only to registered and
35licensed providers.
-61- 112. The department may adopt emergency rules to implement
2this section.
3 Sec. 32. EMERGENCY RULES.
41. If necessary to comply with federal requirements
5including time frames, or if specifically authorized by a
6provision of this division of this Act, the department of
7human services or the mental health and disability services
8commission may adopt administrative rules under section 17A.4,
9subsection 3, and section 17A.5, subsection 2, paragraph “b”,
10to implement the provisions of this division of this Act and
11the rules shall become effective immediately upon filing or
12on a later effective date specified in the rules, unless the
13effective date of the rules is delayed or the applicability
14of the rules is suspended by the administrative rules review
15committee. Any rules adopted in accordance with this section
16shall not take effect before the rules are reviewed by the
17administrative rules review committee. The delay authority
18provided to the administrative rules review committee under
19section 17A.4, subsection 7, and section 17A.8, subsections
209 and 10, shall be applicable to a delay imposed under this
21section, notwithstanding a provision in those subsections
22making them inapplicable to section 17A.5, subsection 2,
23paragraph “b”. Any rules adopted in accordance with the
24provisions of this section shall also be published as a notice
25of intended action as provided in section 17A.4.
262. If during a fiscal year, the department of human
27services is adopting rules in accordance with this section
28or as otherwise directed or authorized by state law, and
29the rules will result in an expenditure increase beyond the
30amount anticipated in the budget process or if the expenditure
31was not addressed in the budget process for the fiscal
32year, the department shall notify the general assembly and
33the department of management concerning the rules and the
34expenditure increase. The notification shall be provided at
35least 30 calendar days prior to the date notice of the rules
-62-1is submitted to the administrative rules coordinator and the
2administrative code editor.
3 Sec. 33. REPORTS. Unless otherwise provided, any reports or
4other information required to be compiled and submitted under
5this Act during the fiscal year beginning July 1, 2021, shall
6be submitted on or before the dates specified for submission
7of the reports or information.
8 Sec. 34. EFFECTIVE UPON ENACTMENT. The following provision
9of this division of this Act, being deemed of immediate
10importance, takes effect upon enactment:
111. The provision relating to section 232.141 and directing
12the state court administrator and the division administrator of
13the department of human services division of child and family
14services to make the determination, by June 15, 2021, of the
15distribution of funds allocated for the payment of the expenses
16of court-ordered services provided to juveniles which are a
17charge upon the state.
18DIVISION VI
19HEALTH CARE ACCOUNTS AND FUNDS — FY 2021-2022
20 Sec. 35. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is
21appropriated from the pharmaceutical settlement account created
22in section 249A.33 to the department of human services for the
23fiscal year beginning July 1, 2021, and ending June 30, 2022,
24the following amount, or so much thereof as is necessary, to be
25used for the purpose designated:
26Notwithstanding any provision of law to the contrary, to
27supplement the appropriations made in this Act for health
28program operations under the medical assistance program for the
29fiscal year beginning July 1, 2021, and ending June 30, 2022:
.................................................. $30234,193
31 Sec. 36. QUALITY ASSURANCE TRUST FUND — DEPARTMENT OF HUMAN
32SERVICES. Notwithstanding any provision to the contrary and
33subject to the availability of funds, there is appropriated
34from the quality assurance trust fund created in section
35249L.4 to the department of human services for the fiscal year
-63-1beginning July 1, 2021, and ending June 30, 2022, the following
2amounts, or so much thereof as is necessary, for the purposes
3designated:
4To supplement the appropriation made in this Act from the
5general fund of the state to the department of human services
6for medical assistance for the same fiscal year:
.................................................. $756,305,139
8 Sec. 37. HOSPITAL HEALTH CARE ACCESS TRUST FUND —
9DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to
10the contrary and subject to the availability of funds, there is
11appropriated from the hospital health care access trust fund
12created in section 249M.4 to the department of human services
13for the fiscal year beginning July 1, 2021, and ending June
1430, 2022, the following amounts, or so much thereof as is
15necessary, for the purposes designated:
16To supplement the appropriation made in this Act from the
17general fund of the state to the department of human services
18for medical assistance for the same fiscal year:
.................................................. $1933,920,554
20 Sec. 38. MEDICAL ASSISTANCE PROGRAM — NONREVERSION
21FOR FY 2021-2022. Notwithstanding section 8.33, if moneys
22appropriated for purposes of the medical assistance program for
23the fiscal year beginning July 1, 2021, and ending June 30,
242022, from the general fund of the state, the quality assurance
25trust fund, and the hospital health care access trust fund, are
26in excess of actual expenditures for the medical assistance
27program and remain unencumbered or unobligated at the close
28of the fiscal year, the excess moneys shall not revert but
29shall remain available for expenditure for the purposes of the
30medical assistance program until the close of the succeeding
31fiscal year.
32DIVISION VII
33NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
34JULY 1, 2023, THROUGH JUNE 30, 2025
35 Sec. 39. NURSING FACILITY REIMBURSEMENT METHODOLOGY —
-64-1FISCAL PERIOD JULY 1, 2023, THROUGH JUNE 30, 2025.
2Notwithstanding any provision of law to the contrary, for the
3fiscal period beginning July 1, 2023, and ending June 30, 2025,
4the department of human services shall rebase case-mix nursing
5facility rates beginning July 1, 2023, using the Medicaid cost
6reports on file for the period ending December 31, 2022, and
7applying a minimum occupancy factor of 70 percent.
8DIVISION VIII
9DECATEGORIZATION CARRYOVER FUNDING
10 Sec. 40. DECATEGORIZATION CARRYOVER FUNDING FY 2019 —
11TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188,
12subsection 5, paragraph “b”, any state-appropriated moneys in
13the funding pool that remained unencumbered or unobligated
14at the close of the fiscal year beginning July 1, 2018, and
15were deemed carryover funding to remain available for the two
16succeeding fiscal years that still remain unencumbered or
17unobligated at the close of the fiscal year beginning July 1,
182020, shall not revert but shall be transferred to the medical
19assistance program for the fiscal year beginning July 1, 2021.
20 Sec. 41. EFFECTIVE DATE. This division of this Act, being
21deemed of immediate importance, takes effect upon enactment.
22 Sec. 42. RETROACTIVE APPLICABILITY. This division of this
23Act applies retroactively to July 1, 2020.
24DIVISION IX
25PRIOR APPROPRIATIONS AND OTHER PROVISIONS
26FAMILY INVESTMENT PROGRAM ACCOUNT
27 Sec. 43. 2019 Iowa Acts, chapter 85, section 9, as amended
28by 2020 Iowa Acts, chapter 1121, section 20, is amended by
29adding the following new subsection:
30 NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
31appropriated in this section that remain unencumbered or
32unobligated at the close of the fiscal year shall not revert
33but shall remain available for expenditure for the purposes
34designated, and may be transferred to other appropriations made
35in this division of this Act as necessary to carry out the
-65-1initiatives included in the report submitted on nonreversion
2of funds required pursuant to 2020 Iowa Acts, chapter 1121,
3section 43, until the close of the succeeding fiscal year.
4Child and family services
5 Sec. 44. 2019 Iowa Acts, chapter 85, section 19, as amended
6by 2020 Iowa Acts, chapter 1121, section 23, is amended by
7adding the following new subsection:
8 NEW SUBSECTION. 25. Notwithstanding section 8.33, moneys
9appropriated in this section that remain unencumbered or
10unobligated at the close of the fiscal year shall not revert
11but shall remain available for expenditure for the purpose of
12the redesign of the child welfare system, until the close of
13the succeeding fiscal year.
14FIELD OPERATIONS
15 Sec. 45. 2019 Iowa Acts, chapter 85, section 27, as amended
16by 2020 Iowa Acts, chapter 1121, section 25, is amended by
17adding the following new subsection:
18 NEW SUBSECTION. 5. Notwithstanding section 8.33, moneys
19appropriated in this section that remain unencumbered or
20unobligated at the close of the fiscal year shall not revert
21but shall remain available for expenditure for the purposes
22designated until the close of the succeeding fiscal year.
23GENERAL ADMINISTRATION
24 Sec. 46. 2019 Iowa Acts, chapter 85, section 28, as amended
25by 2020 Iowa Acts, chapter 1121, section 26, is amended by
26adding the following new subsection:
27 NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
28appropriated in this section that remain unencumbered or
29unobligated at the close of the fiscal year shall not revert
30but shall remain available for expenditure for the purposes
31designated until the close of the succeeding fiscal year.
32 Sec. 47. EFFECTIVE DATE. This division of this Act, being
33deemed of immediate importance, takes effect upon enactment.
34DIVISION X
35EXTENSION OF FUTURE REPEAL — HOSPITAL HEALTH CARE ACCESS
-66-1ASSESSMENT PROGRAM
2 Sec. 48. Section 249M.5, Code 2021, is amended to read as
3follows:
4249M.5 Future repeal.
5This chapter is repealed July 1, 2021 2023.
6 Sec. 49. EFFECTIVE DATE. This division of this Act, being
7deemed of immediate importance, takes effect upon enactment.
8DIVISION XI
9MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS
10 Sec. 50. MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER
11OF FUNDS. Notwithstanding section 331.432, a county with a
12population of over 300,000 based on the 2010 federal decennial
13census may transfer funds from any other fund of the county to
14the mental health and disability regional services fund for the
15purposes of providing mental health and disability services for
16the fiscal year beginning July 1, 2021, and ending June 30,
172022. The county shall submit a report to the governor and the
18general assembly by September 1, 2022, including the source of
19any funds transferred, the amount of the funds transferred, and
20the mental health and disability services provided with the
21transferred funds. The county shall work with the department
22to maximize the use of the medical assistance program and other
23third-party payment sources, including but not limited to
24identifying individuals enrolled with or eligible for Medicaid
25whose Medicaid-covered services are being paid by the county or
26could be converted to Medicaid-covered services.
27DIVISION XII
28TELEHEALTH — MENTAL HEALTH — REIMBURSEMENT PARITY
29 Sec. 51. Section 514C.34, subsection 1, Code 2021, is
30amended by adding the following new paragraphs:
31 NEW PARAGRAPH. 0a. “Covered person” means the same as
32defined in section 514J.102.
33 NEW PARAGRAPH. 00a. “Facility” means the same as defined in
34section 514J.102.
35 NEW PARAGRAPH. 0c. “Health carrier” means the same as
-67-1defined in section 514J.102.
2 Sec. 52. Section 514C.34, subsection 1, paragraph c, Code
32021, is amended to read as follows:
4c. “Telehealth” means the delivery of health care services
5through the use of real-time interactive audio and video, or
6other real-time interactive electronic media, regardless of
7where the health care professional and the covered person are
8each located. “Telehealth” does not include the delivery of
9health care services delivered solely through an audio-only
10telephone, electronic mail message, or facsimile transmission.
11 Sec. 53. Section 514C.34, Code 2021, is amended by adding
12the following new subsection:
13 NEW SUBSECTION. 3A. a. A health carrier shall reimburse
14a health care professional and a facility for health care
15services provided by telehealth to a covered person for a
16mental health condition, illness, injury, or disease on the
17same basis and at the same rate as the health carrier would
18apply to the same health care services for a mental health
19condition, illness, injury, or disease provided in person to a
20covered person by the health care professional or the facility.
21b. As a condition of reimbursement pursuant to paragraph
22“a”, a health carrier shall not require that an additional
23health care professional be located in the same room as a
24covered person while health care services for a mental health
25condition, illness, injury, or disease are provided via
26telehealth by another health care professional to the covered
27person.
28 Sec. 54. EFFECTIVE DATE. This division of this Act, being
29deemed of immediate importance, takes effect upon enactment.
30 Sec. 55. RETROACTIVE APPLICABILITY. This division of
31this Act applies to health care services for a mental health
32condition, illness, injury, or disease provided by a health
33care professional or a facility to a covered person by
34telehealth on or after January 1, 2021.
35DIVISION XIII
-68-1IN-PERSON SUPERVISION REQUIREMENTS FOR LICENSURE — CERTAIN
2PROFESSIONALS
3 Sec. 56. Section 154C.3, subsection 1, paragraph c,
4subparagraph (5), subparagraph division (a), Code 2021, is
5amended by adding the following new subparagraph subdivision:
6 NEW SUBPARAGRAPH SUBDIVISION. (0ii) By a person licensed
7under section 154D.2 to practice marital and family therapy
8without supervision or mental health counseling without
9supervision.
10 Sec. 57. Section 154C.3, Code 2021, is amended by adding the
11following new subsection:
12 NEW SUBSECTION. 4. Supervision. The board shall not, by
13rule or other means, require that supervision be completed
14in-person as a condition for an applicant to receive a license,
15a reciprocal license, or a renewed license under this chapter.
16 Sec. 58. Section 154D.2, Code 2021, is amended to read as
17follows:
18154D.2 Licensure — marital and family therapy — mental
19health counseling.
201. An applicant for a license to practice marital and family
21therapy or mental health counseling shall be granted a license
22by the board when the applicant satisfies all of the following
23requirements:
241. a. Possesses a master’s degree in marital and family
25therapy or mental health counseling, as applicable, consisting
26of at least sixty semester hours, or its equivalent, from a
27nationally accredited institution or from a program approved
28by the board.
292. b. Has at least two years of supervised clinical
30experience or its equivalent as approved by the board.
31Standards for supervision, including the required
32qualifications for supervisors, shall be determined pursuant
33to the requirements in subsection 2 and by the board by rule,
34provided that a supervisor may be a person licensed under this
35section to practice marital and family therapy or mental health
-69-1counseling without supervision or a licensed independent social
2worker licensed under chapter 154C.
33. c. Passes an examination approved by the board.
42. The board shall not, by rule or other means, require any
5in-person supervised clinical experience.
6 Sec. 59. Section 154D.4, subsection 2, paragraph b, Code
72021, is amended to read as follows:
8b. A person who practices marital and family therapy or
9mental health counseling under the supervision of a person
10licensed under this chapter as part of a clinical experience as
11described in section 154D.2, subsection 2 1, paragraph “b”.
12 Sec. 60. BOARD OF SOCIAL WORK AND BOARD OF BEHAVIORAL
13SCIENCE — RULES. The board of social work and the board
14of behavioral science shall amend their administrative
15rules pursuant to chapter 17A to remove any requirement for
16supervised clinical experience and supervised professional
17practice to be completed in-person as a condition for the
18licensure of marital and family therapists, mental health
19counselors, and social workers pursuant to chapters 154C and
20154D. The board of social work and the board of behavioral
21science shall replace all licensing requirements for in-person
22supervision with the ability to have supervision requirements
23completed electronically.
24 Sec. 61. EMERGENCY RULES.
251. The board of social work and the board of behavioral
26science shall adopt emergency rules under section 17A.4,
27subsection 3, and section 17A.5, subsection 2, to implement
28the sections of this division of this Act amending section
29154C.3 and section 154D.2, and the rules shall be effective
30immediately upon filing unless a later date is specified in the
31rules. Any emergency rules adopted in accordance with this
32section shall also be published as a notice of intended action
33as provided in section 17A.4, subsection 1.
342. The board of social work and the board of behavioral
35science shall jointly develop rules adopted pursuant to this
-70-1subsection through a collaborative process. The respective
2boards may establish subcommittees or designate other personnel
3to facilitate such a process. Such rules shall consist of
4substantively identical standards applicable to the professions
5regulated by the respective boards and shall, to the greatest
6extent possible, consist of substantially similar language
7in a substantially similar format. Prior to a vote to adopt
8such rules by either board, each board shall, by a separate
9vote, approve the language to be adopted by the other board.
10Neither board shall vote to adopt such rules until the rules
11to be adopted by both boards have been so approved. Such rules
12shall have the same effective date and shall be submitted to
13the administrative rules coordinator and the administrative
14code editor for publication in the same issue of the Iowa
15administrative bulletin pursuant to sections 17A.4 and 17A.5.
16 Sec. 62. EFFECTIVE DATE. This division of this Act, being
17deemed of immediate importance, takes effect upon enactment.
18DIVISION XIV
19CHILD CARE ASSISTANCE — ELIGIBILITY PHASE-OUT
20 Sec. 63. NEW SECTION. 237A.14 Child care assistance —
21graduated eligibility phase-out.
221. At the time of a twelve-month eligibility
23redetermination for a family receiving state child care
24assistance, the family shall remain eligible to receive
25child care assistance, subject to the graduated eligibility
26phase-out program as specified in subsection 2, if either of
27the following conditions are met:
28a. The family’s nonexempt gross monthly income is determined
29to be at least two hundred twenty-five percent but less
30than two hundred fifty percent of the federal poverty level
31applicable to the family size for children needing basic care.
32b. The family’s nonexempt gross monthly income is determined
33to be at least two hundred twenty-five percent but less than
34two hundred seventy-five percent of the federal poverty level
35applicable to the family size for children needing special
-71-1needs care.
22. a. A family with an income at the following percentages
3of the federal poverty level applicable to the family size
4for children needing basic care shall be responsible for the
5following share of child care costs:
6(1) A family with an income above two hundred twenty-five
7percent of the federal poverty level but less than two hundred
8thirty-five percent of the federal poverty level shall pay for
9thirty-three percent of the family child care costs.
10(2) A family with an income at or above two hundred
11thirty-five percent of the federal poverty level but less than
12two hundred forty-five percent of the federal poverty level
13shall pay for forty-five percent of the family child care
14costs.
15(3) A family with an income at or above two hundred
16forty-five percent of the federal poverty level but at or less
17than two hundred fifty percent of the federal poverty level
18shall pay for sixty percent of the family child care costs.
19b. A family with an income at the following percentages of
20the federal poverty level applicable to the family size for
21children needing special needs care shall be responsible for
22the following share of child care costs:
23(1) A family with an income above two hundred twenty-five
24percent of the federal poverty level but less than two hundred
25forty-five percent of the federal poverty level shall pay for
26thirty-three percent of the family child care costs.
27(2) A family with an income at or above two hundred
28forty-five percent of the federal poverty level but less than
29two hundred sixty-five percent of the federal poverty level
30shall pay for forty-five percent of the family child care
31costs.
32(3) A family with an income at or above two hundred
33sixty-five percent of the federal poverty level but at or less
34than two hundred seventy-five percent of the federal poverty
35level shall pay for sixty percent of the family child care
-72-1costs.
2c. The graduated eligibility phase-out as provided in
3paragraphs “a” and “b” shall be implemented no later than July
41, 2022.
53. Child care provider reimbursement rates under the
6graduated eligibility phase-out program shall be the same rates
7as the child care provider reimbursement rates.
84. The department of human services shall adopt rules
9pursuant to chapter 17A in accordance with this section.
10DIVISION XV
11MEDICAL RESIDENCY LIABILITY COSTS
12 Sec. 64. Section 135.176, subsection 1, Code 2021, is
13amended by adding the following new paragraph:
14 NEW PARAGRAPH. d. For the period beginning July 1, 2021,
15and ending June 30, 2026, the payment by the sponsor of medical
16residency program liability costs subject to provision by the
17sponsor of dollar-for-dollar matching funds used for payment
18of such costs. This paragraph shall not apply to medical
19residency programs to which chapter 669 applies.
20 Sec. 65. Section 135.176, subsection 2, paragraphs e and f,
21Code 2021, are amended to read as follows:
22e. The maximum award of grant funds to a particular
23individual sponsor per year. An individual sponsor that
24establishes a new or alternative campus accredited medical
25residency training program as defined in subsection 1,
26paragraph “a”, shall not receive more than fifty percent
27of the state matching funds available each year to support
28the program. An individual sponsor proposing the provision
29of a new residency position within an existing accredited
30medical residency or fellowship training program as specified
31in subsection 1, paragraph “b”, or the funding of residency
32positions which are in excess of the federal residency cap as
33defined in subsection 1, paragraph “c”, or the funding of the
34payment by the sponsor of medical residency program liability
35costs subject to provision by the sponsor of dollar-for-dollar
-73-1matching funds used for payment of such costs as specified
2in subsection 1, paragraph “d”, shall not receive more than
3twenty-five percent of the state matching funds available each
4year to support the program.
5f. Use of the funds awarded. Funds may be used to pay the
6costs of establishing, expanding, or supporting an accredited
7graduate medical education program as specified in this
8section, including but not limited to the costs associated
9with residency stipends and physician faculty stipends. For
10the period beginning July 1, 2021, and ending June 30, 2026,
11use of the funds awarded may include payment by the sponsor of
12medical residency program liability costs in accordance with
13subsection 1, paragraph “d”, and subject to provision by the
14sponsor of dollar-for-dollar matching funds used for payment
15of such costs.
16DIVISION XVI
17PUBLIC HEALTH EMERGENCY PROVISIONS
18COVID-19 REGULATIONS
19 Sec. 66. COVID-19 FEDERAL REGULATIONS. For the time
20period beginning on the effective date of this division of
21this Act, and ending June 30, 2022, notwithstanding state
22administrative rules to the contrary, to the extent federal
23regulations relating to the COVID-19 pandemic differ from state
24administrative rules, including applicable federal waivers,
25the federal regulations are controlling during the pendency of
26the federally declared state of emergency and for such period
27of time following the end of the federally declared state of
28emergency applicable to the respective federal regulations.
29DIVISION XVII
30REPORT ON NONREVERSION OF FUNDS
31 Sec. 67. REPORT ON NONREVERSION OF FUNDS. The department
32of human services shall report the expenditure of any moneys
33for which nonreversion authorization was provided for the
34fiscal year beginning July 1, 2020, and ending June 30, 2021,
35for field operations or general administration to the general
-74-1assembly on a quarterly basis beginning October 1, 2021.
2DIVISION XVIII
3FOSTER HOME INSURANCE FUND
4 Sec. 68. Section 237.13, subsection 2, Code 2021, is amended
5to read as follows:
62. The foster home insurance fund shall be administered by
7the department of human services. The fund shall consist of
8all moneys appropriated by the general assembly for deposit
9in the fund. The department shall use moneys in the fund to
10provide home and property coverage for foster parents to cover
11damages to property resulting from the actions of a foster
12child residing in a foster home or to reimburse foster parents
13for the cost of purchasing foster care liability insurance and
14to perform the administrative functions necessary to carry out
15this section. The department may establish limitations of
16liability for individual claims as deemed reasonable by the
17department.
18EXPLANATION
19The inclusion of this explanation does not constitute agreement with
20the explanation’s substance by the members of the general assembly.
21This bill relates to appropriations for health and human
22services for fiscal year 2021-2022 to the department of
23veterans affairs, Iowa veterans home, department on aging
24(IDA), office of long-term care ombudsman, department of public
25health (DPH), Iowa finance authority, department of human
26rights, and department of human services (DHS). The bill is
27organized into divisions for each fiscal year.
28DEPARTMENT ON AGING. This division makes appropriations
29from the general fund of the state to the department on aging.
30OFFICE OF LONG-TERM CARE OMBUDSMAN. This division makes
31appropriations from the general fund of the state to the office
32of long-term care ombudsman.
33DEPARTMENT OF PUBLIC HEALTH. This division makes
34appropriations from the general fund of the state and from
35the sports wagering receipts fund to the department of public
-75-1health.
2DEPARTMENT OF VETERANS AFFAIRS AND IOWA VETERANS HOME. This
3division makes appropriations from the general fund of the
4state to the department of veterans affairs for administration,
5the Iowa veterans home, for transfer to the Iowa finance
6authority for the home ownership assistance program and for the
7county commissions of veteran affairs.
8DEPARTMENT OF HUMAN SERVICES. This division makes
9appropriations from the general fund of the state and the
10federal temporary assistance for needy families block
11grant to DHS. The allocation for the family development
12and self-sufficiency grant program is made directly to
13the department of human rights. The reimbursement section
14addresses reimbursement for providers reimbursed by the
15department of human services.
16HEALTH CARE ACCOUNTS AND FUNDS. This division makes certain
17health-related appropriations. A number of the appropriations
18are made for purposes of the Medicaid program in addition to
19the general fund appropriations made for this purpose for the
20same fiscal year.
21NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
22JULY 1, 2023, THROUGH JUNE 30, 2025. This division provides
23that notwithstanding any provision of law to the contrary,
24for the fiscal period beginning July 1, 2023, and ending June
2530, 2025, DHS shall rebase case-mix nursing facility rates
26beginning July 1, 2023, using the Medicaid cost reports on file
27for the period ending December 31, 2022, and applying a minimum
28occupancy factor of 70 percent.
29DECATEGORIZATION CARRYOVER FUNDING. This division provides
30for the transfer of carryover decategorization funds that
31remained unencumbered or unobligated at the close of the fiscal
32year beginning July 1, 2020, to the Medicaid program for
33FY 2021-2022. The division takes effect upon enactment and is
34retroactively applicable to July 1, 2020.
35PRIOR APPROPRIATIONS AND OTHER PROVISIONS. This division
-76-1provides that funds appropriated to the department of human
2services and credited to the family investment program account
3that remain unencumbered or unobligated at the close of FY
42020-2021 shall not revert but shall remain available for
5expenditure for the purposes designated, and may be transferred
6to other appropriations as necessary to carry out the
7initiatives included in the report submitted on nonreversion
8of funds required pursuant to 2020 Iowa Acts, chapter 1121,
9section 43, until the close of the succeeding fiscal year.
10The division provides that funds appropriated to the
11department of human services for child and family services that
12remain unencumbered or unobligated at the close of FY 2020-2021
13shall not revert but shall remain available for expenditure for
14the purpose of the redesign of the child welfare system, until
15the close of the succeeding fiscal year.
16The division also provides that funds appropriated to the
17department of human services for field operations and general
18administration that remain unencumbered or unobligated at
19the close of FY 2020-2021 shall not revert but shall remain
20available for expenditure for the purposes designated until the
21close of the succeeding fiscal year.
22The division takes effect upon enactment.
23EXTENSION OF REPEAL FOR HOSPITAL HEALTH CARE ACCESS
24ASSESSMENT PROGRAM. This division extends the repeal of
25the hospital health care access assessment program chapter,
26Code chapter 249M, from July 1, 2021, to July 1, 2023. This
27provision takes effect upon enactment.
28MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS.
29 The division authorizes a county with a population of over
30300,000 to transfer funds from any other fund of the county to
31the mental health and disability regional services fund for the
32purposes of providing mental health and disability services for
33the fiscal year beginning July 1, 2021, and ending June 30,
342022.
35TELEHEALTH — MENTAL HEALTH — REIMBURSEMENT PARITY. This
-77-1division requires a health carrier to reimburse a health care
2professional or a facility for health care services for a
3mental health condition, illness, injury, or disease provided
4to a covered person via telehealth on the same basis and at the
5same rate as the health carrier would apply to the same health
6care services provided to the covered person by the health care
7professional or facility in person.
8The division takes effect upon enactment and applies
9retroactively to health care services for a mental health
10condition, illness, injury, or disease provided to a covered
11person via telehealth on or after January 1, 2021.
12IN-PERSON SUPERVISION REQUIREMENTS. This division relates
13to supervision requirements for licensed marital and family
14therapists, mental health counselors, and social workers. The
15division takes effect upon enactment.
16CHILD CARE ELIGIBILITY PHASE-OUT. This division establishes
17a graduated eligibility phase-out program for state child care
18assistance.
19MEDICAL RESIDENCY LIABILITY COSTS. This division provides
20for the use of medical residency training state matching
21grants program funds toward payment by the sponsor of program
22liability costs subject to provision of dollar-for-dollar
23matching funds.
24PUBLIC HEALTH EMERGENCY PROVISIONS. This division provides
25that for the time period beginning on the effective date of
26the bill, and ending June 30, 2022, notwithstanding state
27administrative rules to the contrary, to the extent federal
28regulations relating to the COVID-19 pandemic differ from state
29administrative rules, including applicable federal waivers,
30the federal regulations are controlling during the pendency of
31the federally declared state of emergency and for such period
32of time following the end of the federally declared state of
33emergency applicable to the respective federal regulations.
34REPORT ON NONREVERSION OF FUNDS. This division requires the
35department of human services to report the expenditure of any
-78-1moneys for which nonreversion authorization was provided for
2FY 2021-2022 for field operations or general administration to
3the general assembly on a quarterly basis beginning October 1,
42021.
5FOSTER HOME INSURANCE FUND. This division amends the foster
6home insurance fund provisions under Code section 237.13 to
7authorize the department of human services to use the moneys in
8the fund, in addition to the current authorization to reimburse
9foster parents for the cost of purchasing foster care liability
10insurance, to provide home and property coverage for foster
11parents to cover damages to property resulting from actions
12of a foster child residing in a foster home. The division
13also authorizes the department of human services to establish
14limitations of liability for individual claims as deemed
15reasonable by the department of human services.
-79-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$4,020,894 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
18that include the goals of preventing youth initiation of
19tobacco usage, reducing exposure to secondhand smoke, and
20promotion of tobacco cessation. To maximize resources,
21the department shall determine if third-party sources are
22available to instead provide nicotine replacement products
23to an applicant prior to provision of such products to an
24applicant under the initiative. The department shall track and
25report to the governor and the general assembly any reduction
26in the provision of nicotine replacement products realized
27by the 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$19,638,485 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:
.................................................. $314,258,373
............................................... FTEs3210.00
33a. Of the funds appropriated in this subsection, $188,000
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:
.................................................. $276,319,306
............................................... 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 $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.
35(2) Not less than $334,000 is allocated to free clinics and
-10-1free clinics of Iowa for necessary infrastructure, statewide
2coordination, provider recruitment, service delivery, and
3provision of assistance to patients in securing a medical home
4inclusive of oral health care. Funds allocated under this
5subparagraph shall be distributed in their entirety for the
6purpose specified on July 1, 2021.
7(3) Not less than $25,000 is allocated to the Iowa
8association of rural health clinics for necessary
9infrastructure and service delivery transformation. Funds
10allocated under this subparagraph shall be distributed in their
11entirety for the purpose specified on July 1, 2021.
12(4) Not less than $225,000 is allocated to the Polk county
13medical society for continuation of the safety net provider
14patient access to specialty health care initiative as described
15in 2007 Iowa Acts, chapter 218, section 109. Funds allocated
16under this subparagraph shall be distributed in their entirety
17for the purpose specified on July 1, 2021.
18d. Of the funds appropriated in this subsection, $191,000
19is allocated for the purposes of health care and public health
20workforce initiatives.
21e. Of the funds appropriated in this subsection, $96,000
22shall be used for a matching dental education loan repayment
23program to be allocated to a dental nonprofit health service
24corporation to continue to develop the criteria and implement
25the loan repayment program.
26f. Of the funds appropriated in this subsection, $100,000
27shall be used for the purposes of the Iowa donor registry as
28specified in section 142C.18.
29g. Of the funds appropriated in this subsection, $96,000
30shall be used for continuation of a grant to a nationally
31affiliated volunteer eye organization that has an established
32program for children and adults and that is solely dedicated to
33preserving sight and preventing blindness through education,
34nationally certified vision screening and training, and
35community and patient service programs. The contractor shall
-11-1submit a report to the general assembly regarding the use
2of funds allocated under this paragraph “g”. The report
3shall include the objectives and results for the program year
4including the target population and how the funds allocated
5assisted the program in meeting the objectives; the number,
6age, grade level if appropriate, and location within the state
7of individuals served; the type of services provided to the
8individuals served; the distribution of funds based on services
9provided; and the continuing needs of the program.
10h. Of the funds appropriated in this subsection, $2,100,000
11shall be deposited in the medical residency training account
12created in section 135.175, subsection 5, paragraph “a”, and
13is appropriated from the account to the department of public
14health to be used for the purposes of the medical residency
15training state matching grants program as specified in section
16135.176.
17i. Of the funds appropriated in this subsection, $250,000
18shall be used for the public purpose of providing funding to
19Des Moines university to continue a provider education project
20to provide primary care physicians with the training and skills
21necessary to recognize the signs of mental illness in patients.
22j. Of the funds appropriated in this subsection, $600,000
23shall be used for rural psychiatric residencies to support the
24annual creation and training of four psychiatric residents who
25will provide mental health services in underserved areas of
26the state. Notwithstanding section 8.33, moneys that remain
27unencumbered or unobligated at the close of the fiscal year
28shall not revert but shall remain available for expenditure for
29the purposes designated for subsequent fiscal years.
30k. Of the funds appropriated in this subsection, $150,000
31shall be used for psychiatric training to increase access to
32mental health care services by expanding the mental health
33workforce via training of additional physician assistants and
34nurse practitioners.
35l. Of the funds appropriated in this subsection, $425,000
-12-1shall be used for the creation of a center of excellence
2program to encourage innovation and collaboration among
3regional health care providers in a rural area based upon the
4results of a regional community needs assessment to transform
5health care delivery in order to provide quality, sustainable
6care that meets the needs of the local communities. An
7applicant for the funds shall specify how the funds will be
8expended to accomplish the goals of the program and shall
9provide a detailed five-year sustainability plan prior to
10being awarded any funding. Following the receipt of funding,
11a recipient shall submit periodic reports as specified by the
12department to the governor and the general assembly regarding
13the recipient’s expenditure of the funds and progress in
14accomplishing the program goals.
155. ESSENTIAL PUBLIC HEALTH SERVICES
16To provide public health services that reduce risks and
17invest in promoting and protecting good health over the
18course of a lifetime with a priority given to older Iowans and
19vulnerable populations:
.................................................. $207,662,464
216. INFECTIOUS DISEASES
22For reducing the incidence and prevalence of communicable
23diseases, and for not more than the following full-time
24equivalent positions:
.................................................. $251,796,206
............................................... FTEs266.00
277. PUBLIC PROTECTION
28For protecting the health and safety of the public through
29establishing standards and enforcing regulations, and for not
30more than the following full-time equivalent positions:
.................................................. $314,466,601
............................................... FTEs32142.00
33a. Of the funds appropriated in this subsection, not more
34than $304,000 shall be credited to the emergency medical
35services fund created in section 135.25. Moneys in the
-13-1emergency medical services fund are appropriated to the
2department to be used for the purposes of the fund.
3b. Of the funds appropriated in this subsection, up
4to $243,000 shall be used for sexual violence prevention
5programming through a statewide organization representing
6programs serving victims of sexual violence through the
7department’s sexual violence prevention program, and for
8continuation of a training program for sexual assault
9response team (SART) members, including representatives of
10law enforcement, victim advocates, prosecutors, and certified
11medical personnel. The amount allocated in this paragraph “b”
12shall not be used to supplant funding administered for other
13sexual violence prevention or victims assistance programs.
14c. Of the funds appropriated in this subsection, up to
15$500,000 shall be used for the state poison control center.
16Pursuant to the directive under 2014 Iowa Acts, chapter
171140, section 102, the federal matching funds available to
18the state poison control center from the department of human
19services under the federal Children’s Health Insurance Program
20Reauthorization Act allotment shall be subject to the federal
21administrative cap rule of 10 percent applicable to funding
22provided under Tit.XXI of the federal Social Security Act and
23included within the department’s calculations of the cap.
24d. Of the funds appropriated in this subsection, up to
25$504,000 shall be used for childhood lead poisoning provisions.
268. RESOURCE MANAGEMENT
27For establishing and sustaining the overall ability of the
28department to deliver services to the public, and for not more
29than the following full-time equivalent positions:
.................................................. $30933,871
............................................... FTEs314.00
329. MISCELLANEOUS PROVISIONS
33The university of Iowa hospitals and clinics under the
34control of the state board of regents shall not receive
35indirect costs from the funds appropriated in this section.
-14-1The university of Iowa hospitals and clinics billings to the
2department shall be on at least a quarterly basis.
3 Sec. 4. DEPARTMENT OF PUBLIC HEALTH — SPORTS WAGERING
4RECEIPTS FUND. There is appropriated from the sports wagering
5receipts fund created in section 8.57, subsection 6, to the
6department of public health for the fiscal year beginning July
71, 2021, and ending June 30, 2022, the following amount, or
8so much thereof as is necessary, to be used for the purposes
9designated:
10For problem gambling and substance-related disorder
11prevention, treatment, and recovery services, including a
1224-hour helpline, public information resources, professional
13training, youth prevention, and program evaluation:
.................................................. $141,750,000
15DIVISION IV
16DEPARTMENT OF VETERANS AFFAIRS — FY 2021-2022
17 Sec. 5. DEPARTMENT OF VETERANS AFFAIRS. There is
18appropriated from the general fund of the state to the
19department of veterans affairs for the fiscal year beginning
20July 1, 2021, and ending June 30, 2022, the following amounts,
21or so much thereof as is necessary, to be used for the purposes
22designated:
231. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
24For salaries, support, maintenance, and miscellaneous
25purposes, and for not more than the following full-time
26equivalent positions:
.................................................. $271,229,763
............................................... FTEs2815.00
292. IOWA VETERANS HOME
30For salaries, support, maintenance, and miscellaneous
31purposes:
.................................................. $327,131,552
33a. The Iowa veterans home billings involving the department
34of human services shall be submitted to the department on at
35least a monthly basis.
-15- 1b. The Iowa veterans home expenditure report shall be
2submitted monthly to the general assembly.
3c. The Iowa veterans home shall continue to include in the
4annual discharge report applicant information to provide for
5the collection of demographic information including but not
6limited to the number of individuals applying for admission and
7admitted or denied admittance and the basis for the admission
8or denial; the age, gender, and race of such individuals;
9and the level of care for which such individuals applied for
10admission including residential or nursing level of care.
113. HOME OWNERSHIP ASSISTANCE PROGRAM
12For transfer to the Iowa finance authority for the
13continuation of the home ownership assistance program for
14persons who are or were eligible members of the armed forces of
15the United States, pursuant to section 16.54:
.................................................. $162,000,000
17 Sec. 6. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS
18FUND STANDING APPROPRIATIONS. Notwithstanding the standing
19appropriation in section 35A.16 for the fiscal year beginning
20July 1, 2021, and ending June 30, 2022, the amount appropriated
21from the general fund of the state for the following designated
22purposes shall not exceed the following amount, and shall be
23allocated to each county commission of veterans affairs or to
24each county sharing the services of an executive director or
25administrator pursuant to chapter 28E, in equal amounts:
26For the county commissions of veteran affairs fund under
27section 35A.16:
.................................................. $281,289,970
29DIVISION V
30DEPARTMENT OF HUMAN SERVICES — FY 2021-2022
31 Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
32GRANT. There is appropriated from the fund created in section
338.41 to the department of human services for the fiscal year
34beginning July 1, 2021, and ending June 30, 2022, from moneys
35received under the federal temporary assistance for needy
-16-1families (TANF) block grant pursuant to the federal Personal
2Responsibility and Work Opportunity Reconciliation Act of 1996,
3Pub.L.No.104-193, and successor legislation, the following
4amounts, or so much thereof as is necessary, to be used for the
5purposes designated:
61. To be credited to the family investment program account
7and used for assistance under the family investment program
8under chapter 239B:
.................................................. $95,002,006
102. To be credited to the family investment program account
11and used for the job opportunities and basic skills (JOBS)
12program and implementing family investment agreements in
13accordance with chapter 239B:
.................................................. $145,412,060
153. To be used for the family development and
16self-sufficiency grant program in accordance with section
17216A.107:
.................................................. $182,888,980
19Notwithstanding section 8.33, moneys appropriated in this
20subsection that remain unencumbered or unobligated at the close
21of the fiscal year shall not revert but shall remain available
22for expenditure for the purposes designated until the close of
23the succeeding fiscal year. However, unless such moneys are
24encumbered or obligated on or before September 30, 2022, the
25moneys shall revert.
264. For field operations:
.................................................. $2731,296,232
285. For general administration:
.................................................. $293,744,000
306. For state child care assistance:
.................................................. $3147,166,826
32a. Of the funds appropriated in this subsection,
33$26,205,412 is transferred to the child care and development
34block grant appropriation made by the Eighty-ninth General
35Assembly, 2021 session, for the federal fiscal year beginning
-17-1October 1, 2021, and ending September 30, 2022. Of this
2amount, $200,000 shall be used for provision of educational
3opportunities to registered child care home providers in order
4to improve services and programs offered by this category
5of providers and to increase the number of providers. The
6department may contract with institutions of higher education
7or child care resource and referral centers to provide
8the educational opportunities. Allowable administrative
9costs under the contracts shall not exceed 5 percent. The
10application for a grant shall not exceed two pages in length.
11b. Any funds appropriated in this subsection remaining
12unallocated shall be used for state child care assistance
13payments for families who are employed including but not
14limited to individuals enrolled in the family investment
15program.
167. For child and family services:
.................................................. $1732,380,654
188. For child abuse prevention grants:
.................................................. $19125,000
209. For pregnancy prevention grants on the condition that
21family planning services are funded:
.................................................. $221,913,203
23Pregnancy prevention grants shall be awarded to programs
24in existence on or before July 1, 2021, if the programs have
25demonstrated positive outcomes. Grants shall be awarded to
26pregnancy prevention programs which are developed after July
271, 2021, if the programs are based on existing models that
28have demonstrated positive outcomes. Grants shall comply with
29the requirements provided in 1997 Iowa Acts, chapter 208,
30section 14, subsections 1 and 2, including the requirement that
31grant programs must emphasize sexual abstinence. Priority in
32the awarding of grants shall be given to programs that serve
33areas of the state which demonstrate the highest percentage of
34unplanned pregnancies of females of childbearing age within the
35geographic area to be served by the grant.
-18- 110. For technology needs and other resources necessary to
2meet federal, state, and welfare reform reporting, tracking,
3and case management requirements and other departmental needs:
.................................................. $41,037,186
511. a. Notwithstanding any provision to the contrary,
6including but not limited to requirements in section 8.41 or
7provisions in 2020 Iowa Acts or 2021 Iowa Acts regarding the
8receipt and appropriation of federal block grants, federal
9funds from the temporary assistance for needy families block
10grant received by the state and not otherwise appropriated
11in this section and remaining available for the fiscal year
12beginning July 1, 2021, are appropriated to the department of
13human services to the extent as may be necessary to be used in
14the following priority order: the family investment program,
15for state child care assistance program payments for families
16who are employed, and for the family investment program share
17of system costs for eligibility determination and related
18functions. The federal funds appropriated in this paragraph
19“a” shall be expended only after all other funds appropriated
20in subsection 1 for assistance under the family investment
21program, in subsection 6 for state child care assistance, or
22in subsection 10 for technology costs related to the family
23investment program, as applicable, have been expended. For
24the purposes of this subsection, the funds appropriated in
25subsection 6, paragraph “a”, for transfer to the child care
26and development block grant appropriation are considered fully
27expended when the full amount has been transferred.
28b. The department shall, on a quarterly basis, advise the
29general assembly and department of management of the amount of
30funds appropriated in this subsection that was expended in the
31prior quarter.
3212. Of the amounts appropriated in this section,
33$12,962,008 for the fiscal year beginning July 1, 2021, is
34transferred to the appropriation of the federal social services
35block grant made to the department of human services for that
-19-1fiscal year.
213. For continuation of the program providing categorical
3eligibility for the food assistance program as specified
4for the program in the section of this division of this Act
5relating to the family investment program account:
.................................................. $614,236
714. The department may transfer funds allocated in this
8section to the appropriations made in this division of this Act
9for the same fiscal year for general administration and field
10operations for resources necessary to implement and operate the
11services referred to in this section and those funded in the
12appropriation made in this division of this Act for the same
13fiscal year for the family investment program from the general
14fund of the state.
1515. With the exception of moneys allocated under this
16section for the family development and self-sufficiency grant
17program, to the extent moneys allocated in this section are
18deemed by the department not to be necessary to support the
19purposes for which they are allocated, such moneys may be used
20in the same fiscal year for any other purpose for which funds
21are allocated in this section or in section 8 of this division
22of this Act for the family investment program account. If
23there are conflicting needs, priority shall first be given
24to the family investment program account as specified under
25subsection 1 of this section and used for the purposes of
26assistance under the family investment program in accordance
27with chapter 239B, followed by state child care assistance
28program payments for families who are employed, followed by
29other priorities as specified by the department.
30 Sec. 8. FAMILY INVESTMENT PROGRAM ACCOUNT.
311. Moneys credited to the family investment program (FIP)
32account for the fiscal year beginning July 1, 2021, and
33ending June 30, 2022, shall be used to provide assistance in
34accordance with chapter 239B.
352. The department may use a portion of the moneys credited
-20-1to the FIP account under this section as necessary for
2salaries, support, maintenance, and miscellaneous purposes.
33. The department may transfer funds allocated in
4subsection 4, excluding the allocation under subsection 4,
5paragraph “b”, to the appropriations made in this division of
6this Act for the same fiscal year for general administration
7and field operations for resources necessary to implement
8and operate the services referred to in this section and
9those funded in the appropriations made in section 7 for the
10temporary assistance for needy families block grant and in
11section 9 for the family investment program from the general
12fund of the state in this division of this Act for the same
13fiscal year.
144. Moneys appropriated in this division of this Act and
15credited to the FIP account for the fiscal year beginning July
161, 2021, and ending June 30, 2022, are allocated as follows:
17a. To be retained by the department of human services to
18be used for coordinating with the department of human rights
19to more effectively serve participants in FIP and other shared
20clients and to meet federal reporting requirements under the
21federal temporary assistance for needy families block grant:
.................................................. $2210,000
23b. To the department of human rights for staffing,
24administration, and implementation of the family development
25and self-sufficiency grant program in accordance with section
26216A.107:
.................................................. $277,192,834
28(1) Of the funds allocated for the family development
29and self-sufficiency grant program in this paragraph “b”,
30not more than 5 percent of the funds shall be used for the
31administration of the grant program.
32(2) The department of human rights may continue to implement
33the family development and self-sufficiency grant program
34statewide during fiscal year 2021-2022.
35(3) The department of human rights may engage in activities
-21-1to strengthen and improve family outcomes measures and
2data collection systems under the family development and
3self-sufficiency grant program.
4c. For the diversion subaccount of the FIP account:
.................................................. $51,293,000
6A portion of the moneys allocated for the diversion
7subaccount may be used for field operations, salaries, data
8management system development, and implementation costs and
9support deemed necessary by the director of human services
10in order to administer the FIP diversion program. To the
11extent moneys allocated in this paragraph “c” are deemed by the
12department not to be necessary to support diversion activities,
13such moneys may be used for other efforts intended to increase
14engagement by family investment program participants in work,
15education, or training activities, or for the purposes of
16assistance under the family investment program in accordance
17with chapter 239B.
18d. For the food assistance employment and training program:
.................................................. $1966,588
20(1) The department shall apply the federal supplemental
21nutrition assistance program (SNAP) employment and training
22state plan in order to maximize to the fullest extent permitted
23by federal law the use of the 50 percent federal reimbursement
24provisions for the claiming of allowable federal reimbursement
25funds from the United States department of agriculture
26pursuant to the federal SNAP employment and training program
27for providing education, employment, and training services
28for eligible food assistance program participants, including
29but not limited to related dependent care and transportation
30expenses.
31(2) The department shall continue the categorical federal
32food assistance program eligibility at 160 percent of the
33federal poverty level and continue to eliminate the asset test
34from eligibility requirements, consistent with federal food
35assistance program requirements. The department shall include
-22-1as many food assistance households as is allowed by federal
2law. The eligibility provisions shall conform to all federal
3requirements including requirements addressing individuals who
4are incarcerated or otherwise ineligible.
5e. For the JOBS program, not more than:
.................................................. $612,018,258
75. Of the child support collections assigned under FIP,
8an amount equal to the federal share of support collections
9shall be credited to the child support recovery appropriation
10made in this division of this Act. Of the remainder of the
11assigned child support collections received by the child
12support recovery unit, a portion shall be credited to the FIP
13account, a portion may be used to increase recoveries, and a
14portion may be used to sustain cash flow in the child support
15payments account. If as a consequence of the appropriations
16and allocations made in this section the resulting amounts
17are insufficient to sustain cash assistance payments and meet
18federal maintenance of effort requirements, the department
19shall seek supplemental funding. If child support collections
20assigned under FIP are greater than estimated or are otherwise
21determined not to be required for maintenance of effort, the
22state share of either amount may be transferred to or retained
23in the child support payments account.
24 Sec. 9. FAMILY INVESTMENT PROGRAM GENERAL FUND. There
25is appropriated from the general fund of the state to the
26department of human services for the fiscal year beginning July
271, 2021, and ending June 30, 2022, the following amount, or
28so much thereof as is necessary, to be used for the purpose
29designated:
30To be credited to the family investment program (FIP)
31account and used for family investment program assistance
32under chapter 239B and other costs associated with providing
33needs-based benefits or assistance:
.................................................. $3441,003,978
351. Of the funds appropriated in this section, $6,606,198 is
-23-1allocated for the JOBS program.
22. Of the funds appropriated in this section, $4,313,854 is
3allocated for the family development and self-sufficiency grant
4program.
53. a. Notwithstanding section 8.39, for the fiscal
6year beginning July 1, 2021, if necessary to meet federal
7maintenance of effort requirements or to transfer federal
8temporary assistance for needy families block grant funding
9to be used for purposes of the federal social services block
10grant or to meet cash flow needs resulting from delays in
11receiving federal funding or to implement, in accordance with
12this division of this Act, activities currently funded with
13juvenile court services, county, or community moneys and state
14moneys used in combination with such moneys; to comply with
15federal requirements; or to maximize the use of federal funds;
16the department of human services may transfer funds within or
17between any of the appropriations made in this division of this
18Act and appropriations in law for the federal social services
19block grant to the department for the following purposes,
20provided that the combined amount of state and federal
21temporary assistance for needy families block grant funding
22for each appropriation remains the same before and after the
23transfer:
24(1) For the family investment program.
25(2) For state child care assistance.
26(3) For child and family services.
27(4) For field operations.
28(5) For general administration.
29b. This subsection shall not be construed to prohibit the
30use of existing state transfer authority for other purposes.
31The department shall report any transfers made pursuant to this
32subsection to the general assembly.
334. Of the funds appropriated in this section, $195,000
34shall be used for a contract for tax preparation assistance
35to low-income Iowans to expand the usage of the earned income
-24-1tax credit. The purpose of the contract is to supply this
2assistance to underserved areas of the state. The department
3shall not retain any portion of the allocation under this
4subsection for administrative costs.
55. Of the funds appropriated in this section, $70,000 shall
6be used for the continuation of the parenting program, as
7specified in 441 IAC ch.100, relating to parental obligations,
8in which the child support recovery unit participates, to
9support the efforts of a nonprofit organization committed to
10strengthening the community through youth development, healthy
11living, and social responsibility headquartered in a county
12with a population over 350,000 according to the 2010 certified
13federal census. The funds allocated in this subsection shall
14be used by the recipient organization to develop a larger
15community effort, through public and private partnerships, to
16support a broad-based multi-county parenthood initiative that
17promotes payment of child support obligations, improved family
18relationships, and full-time employment.
196. The department may transfer funds appropriated in this
20section, excluding the allocation in subsection 2 for the
21family development and self-sufficiency grant program, to the
22appropriations made in this division of this Act for general
23administration and field operations as necessary to administer
24this section, section 7 for the temporary assistance for needy
25families block grant, and section 8 for the family investment
26program account.
27 Sec. 10. CHILD SUPPORT RECOVERY. There is appropriated
28from the general fund of the state to the department of human
29services for the fiscal year beginning July 1, 2021, and ending
30June 30, 2022, the following amount, or so much thereof as is
31necessary, to be used for the purposes designated:
32For child support recovery, including salaries, support,
33maintenance, and miscellaneous purposes, and for not more than
34the following full-time equivalent positions:
.................................................. $3515,942,885
-25-............................................... FTEs1459.00
21. The department shall expend up to $24,000, including
3federal financial participation, for the fiscal year beginning
4July 1, 2021, for a child support public awareness campaign.
5The department and the office of the attorney general shall
6cooperate in continuation of the campaign. The public
7awareness campaign shall emphasize, through a variety of
8media activities, the importance of maximum involvement of
9both parents in the lives of their children as well as the
10importance of payment of child support obligations.
112. Federal access and visitation grant moneys shall be
12issued directly to private not-for-profit agencies that provide
13services designed to increase compliance with the child access
14provisions of court orders, including but not limited to
15neutral visitation sites and mediation services.
163. The appropriation made to the department for child
17support recovery may be used throughout the fiscal year in the
18manner necessary for purposes of cash flow management, and for
19cash flow management purposes the department may temporarily
20draw more than the amount appropriated, provided the amount
21appropriated is not exceeded at the close of the fiscal year.
22 Sec. 11. HEALTH CARE TRUST FUND — MEDICAL ASSISTANCE —
23FY 2021-2022. Any funds remaining in the health care trust
24fund created in section 453A.35A for the fiscal year beginning
25July 1, 2021, and ending June 30, 2022, are appropriated to
26the department of human services to supplement the medical
27assistance program appropriations made in this division of this
28Act, for medical assistance reimbursement and associated costs,
29including program administration and costs associated with
30program implementation.
31 Sec. 12. MEDICAID FRAUD FUND — MEDICAL ASSISTANCE — FY
322021-2022. Any funds remaining in the Medicaid fraud fund
33created in section 249A.50 for the fiscal year beginning
34July 1, 2021, and ending June 30, 2022, are appropriated to
35the department of human services to supplement the medical
-26-1assistance appropriations made in this division of this Act,
2for medical assistance reimbursement and associated costs,
3including program administration and costs associated with
4program implementation.
5 Sec. 13. MEDICAL ASSISTANCE. There is appropriated from the
6general fund of the state to the department of human services
7for the fiscal year beginning July 1, 2021, and ending June 30,
82022, the following amount, or so much thereof as is necessary,
9to be used for the purpose designated:
10For medical assistance program reimbursement and associated
11costs as specifically provided in the reimbursement
12methodologies in effect on June 30, 2021, except as otherwise
13expressly authorized by law, consistent with options under
14federal law and regulations, and contingent upon receipt of
15approval from the office of the governor of reimbursement for
16each abortion performed under the program:
.................................................. $171,504,667,393
181. Iowans support reducing the number of abortions
19performed in our state. Funds appropriated under this section
20shall not be used for abortions, unless otherwise authorized
21under this section.
222. The provisions of this section relating to abortions
23shall also apply to the Iowa health and wellness plan created
24pursuant to chapter 249N.
253. The department shall utilize not more than $60,000 of
26the funds appropriated in this section to continue the AIDS/HIV
27health insurance premium payment program as established in 1992
28Iowa Acts, Second Extraordinary Session, chapter 1001, section
29409, subsection 6. Of the funds allocated in this subsection,
30not more than $5,000 may be expended for administrative
31purposes.
324. Of the funds appropriated in this Act to the department
33of public health for addictive disorders, $950,000 for
34the fiscal year beginning July 1, 2021, is transferred
35to the department of human services for an integrated
-27-1substance-related disorder managed care system. The
2departments of human services and public health shall
3work together to maintain the level of mental health and
4substance-related disorder treatment services provided by the
5managed care contractors. Each department shall take the steps
6necessary to continue the federal waivers as necessary to
7maintain the level of services.
85. The department shall aggressively pursue options for
9providing medical assistance or other assistance to individuals
10with special needs who become ineligible to continue receiving
11services under the early and periodic screening, diagnostic,
12and treatment program under the medical assistance program
13due to becoming 21 years of age who have been approved for
14additional assistance through the department’s exception to
15policy provisions, but who have health care needs in excess
16of the funding available through the exception to policy
17provisions.
186. Of the funds appropriated in this section, up to
19$3,050,082 may be transferred to the field operations or
20general administration appropriations in this division of this
21Act for operational costs associated with Part D of the federal
22Medicare Prescription Drug Improvement and Modernization Act
23of 2003, Pub.L.No.108-173.
247. Of the funds appropriated in this section, up to $442,100
25may be transferred to the appropriation in this division of
26this Act for health program operations to be used for clinical
27assessment services and prior authorization of services.
288. A portion of the funds appropriated in this section may
29be transferred to the appropriations in this division of this
30Act for general administration, health program operations, the
31children’s health insurance program, or field operations to be
32used for the state match cost to comply with the payment error
33rate measurement (PERM) program for both the medical assistance
34and children’s health insurance programs as developed by the
35centers for Medicare and Medicaid services of the United States
-28-1department of health and human services to comply with the
2federal Improper Payments Information Act of 2002, Pub.L.
3No.107-300, and to support other reviews and quality control
4activities to improve the integrity of these programs.
59. Of the funds appropriated in this section, a sufficient
6amount is allocated to supplement the incomes of residents of
7nursing facilities, intermediate care facilities for persons
8with mental illness, and intermediate care facilities for
9persons with an intellectual disability, with incomes of less
10than $50 in the amount necessary for the residents to receive a
11personal needs allowance of $50 per month pursuant to section
12249A.30A.
1310. a. Hospitals that meet the conditions specified
14in subparagraphs (1) and (2) shall either certify public
15expenditures or transfer to the medical assistance program
16an amount equal to provide the nonfederal share for a
17disproportionate share hospital payment in an amount up to the
18hospital-specific limit as approved in the Medicaid state plan.
19The hospitals that meet the conditions specified shall receive
20and retain 100 percent of the total disproportionate share
21hospital payment in an amount up to the hospital-specific limit
22as approved in the Medicaid state plan.
23(1) The hospital qualifies for disproportionate share and
24graduate medical education payments.
25(2) The hospital is an Iowa state-owned hospital with more
26than 500 beds and eight or more distinct residency specialty
27or subspecialty programs recognized by the American college of
28graduate medical education.
29b. Distribution of the disproportionate share payments
30shall be made on a monthly basis. The total amount of
31disproportionate share payments including graduate medical
32education, enhanced disproportionate share, and Iowa
33state-owned teaching hospital payments shall not exceed the
34amount of the state’s allotment under Pub.L.No.102-234.
35In addition, the total amount of all disproportionate
-29-1share payments shall not exceed the hospital-specific
2disproportionate share limits under Pub.L.No.103-66.
311. One hundred percent of the nonfederal share of payments
4to area education agencies that are medical assistance
5providers for medical assistance-covered services provided to
6medical assistance-covered children, shall be made from the
7appropriation made in this section.
812. A portion of the funds appropriated in this section may
9be transferred to the appropriation in this division of this
10Act for health program operations to be used for administrative
11activities associated with the money follows the person
12demonstration project.
1313. Of the funds appropriated in this section, $349,011
14shall be used for the administration of the health insurance
15premium payment program, including salaries, support,
16maintenance, and miscellaneous purposes.
1714. a. The department may increase the amounts allocated
18for salaries, support, maintenance, and miscellaneous purposes
19associated with the medical assistance program, as necessary,
20to sustain cost management efforts. The department shall
21report any such increase to the general assembly and the
22department of management.
23b. If the savings to the medical assistance program from
24ongoing cost management efforts exceed the associated cost
25for the fiscal year beginning July 1, 2021, the department
26may transfer any savings generated for the fiscal year due
27to medical assistance program cost management efforts to the
28appropriation made in this division of this Act for health
29program operations or general administration to defray the
30costs associated with implementing the efforts.
3115. For the fiscal year beginning July 1, 2021, and ending
32June 30, 2022, the replacement generation tax revenues required
33to be deposited in the property tax relief fund pursuant to
34section 437A.8, subsection 4, paragraph “d”, and section
35437A.15, subsection 3, paragraph “f”, shall instead be credited
-30-1to and supplement the appropriation made in this section and
2used for the allocations made in this section.
316. a. Of the funds appropriated in this section, up
4to $50,000 may be transferred by the department to the
5appropriation made in this division of this Act to the
6department for the same fiscal year for general administration
7to be used for associated administrative expenses and for not
8more than 1.00 full-time equivalent position, in addition to
9those authorized for the same fiscal year, to be assigned to
10implementing the children’s mental health home project.
11b. Of the funds appropriated in this section, up to $400,000
12may be transferred by the department to the appropriation made
13to the department in this division of this Act for the same
14fiscal year for Medicaid program-related general administration
15planning and implementation activities. The funds may be used
16for contracts or for personnel in addition to the amounts
17appropriated for and the positions authorized for general
18administration for the fiscal year.
19c. Of the funds appropriated in this section, up to
20$3,000,000 may be transferred by the department to the
21appropriations made in this division of this Act for the
22same fiscal year for general administration or health
23program operations to be used to support the development
24and implementation of standardized assessment tools for
25persons with mental illness, an intellectual disability, a
26developmental disability, or a brain injury.
2717. Of the funds appropriated in this section, $150,000
28shall be used for lodging expenses associated with care
29provided at the university of Iowa hospitals and clinics for
30patients with cancer whose travel distance is 30 miles or more
31and whose income is at or below 200 percent of the federal
32poverty level as defined by the most recently revised poverty
33income guidelines published by the United States department of
34health and human services. The department of human services
35shall establish the maximum number of overnight stays and the
-31-1maximum rate reimbursed for overnight lodging, which may be
2based on the state employee rate established by the department
3of administrative services. The funds allocated in this
4subsection shall not be used as nonfederal share matching
5funds.
618. Of the funds appropriated in this section, up to
7$3,383,880 shall be used for administration of the state family
8planning services program pursuant to section 217.41B, and
9of this amount, the department may use up to $200,000 for
10administrative expenses.
1119. Of the funds appropriated in this section, $1,545,530
12shall be used and may be transferred to other appropriations
13in this division of this Act as necessary to administer the
14provisions in the division of this Act relating to Medicaid
15program administration.
1620. The department shall comply with the centers for
17Medicare and Medicaid services’ guidance related to Medicaid
18program and children’s health insurance program maintenance
19of effort provisions, including eligibility standards,
20methodologies, procedures, and continuous enrollment, to
21receive the enhanced federal medical assistance percentage
22under section 6008(b) of the federal Families First Coronavirus
23Response Act, Pub.L. No.116-127. The department shall
24utilize and implement all tools, processes, and resources
25available to expediently return to normal eligibility and
26enrollment operations in compliance with federal guidance and
27expectations.
2821. Of the funds appropriated in this section, up to
29$1,031,530 shall be used to implement reductions in the waiting
30list for the children’s mental health home and community-based
31services waiver.
32 Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated
33from the general fund of the state to the department of human
34services for the fiscal year beginning July 1, 2021, and ending
35June 30, 2022, the following amount, or so much thereof as is
-32-1necessary, to be used for the purpose designated:
2For health program operations:
.................................................. $317,831,343
41. The department of inspections and appeals shall
5provide all state matching funds for survey and certification
6activities performed by the department of inspections
7and appeals. The department of human services is solely
8responsible for distributing the federal matching funds for
9such activities.
102. Of the funds appropriated in this section, $50,000 shall
11be used for continuation of home and community-based services
12waiver quality assurance programs, including the review and
13streamlining of processes and policies related to oversight and
14quality management to meet state and federal requirements.
153. Of the amount appropriated in this section, up to
16$200,000 may be transferred to the appropriation for general
17administration in this division of this Act to be used for
18additional full-time equivalent positions in the development
19of key health initiatives such as development and oversight
20of managed care programs and development of health strategies
21targeted toward improved quality and reduced costs in the
22Medicaid program.
234. Of the funds appropriated in this section, $1,000,000
24shall be used for planning and development, in cooperation with
25the department of public health, of a phased-in program to
26provide a dental home for children.
275. a. Of the funds appropriated in this section, $573,000
28shall be credited to the autism support program fund created
29in section 225D.2 to be used for the autism support program
30created in chapter 225D, with the exception of the following
31amount of this allocation which shall be used as follows:
32b. Of the funds allocated in this subsection, $25,000 shall
33be used for the public purpose of continuation of a grant to
34a nonprofit provider of child welfare services that has been
35in existence for more than 115 years, is located in a county
-33-1with a population between 200,000 and 220,000 according to the
22010 federal decennial census, is licensed as a psychiatric
3medical institution for children, and provides school-based
4programming, to be used for support services for children with
5autism spectrum disorder and their families.
6 Sec. 15. STATE SUPPLEMENTARY ASSISTANCE.
71. There is appropriated from the general fund of the
8state to the department of human services for the fiscal year
9beginning July 1, 2021, and ending June 30, 2022, the following
10amount, or so much thereof as is necessary, to be used for the
11purpose designated:
12For the state supplementary assistance program:
.................................................. $137,349,002
142. The department shall increase the personal needs
15allowance for residents of residential care facilities by the
16same percentage and at the same time as federal supplemental
17security income and federal social security benefits are
18increased due to a recognized increase in the cost of living.
19The department may adopt emergency rules to implement this
20subsection.
213. If during the fiscal year beginning July 1, 2021,
22the department projects that state supplementary assistance
23expenditures for a calendar year will not meet the federal
24pass-through requirement specified in Tit.XVI of the federal
25Social Security Act, section 1618, as codified in 42 U.S.C.
26§1382g, the department may take actions including but not
27limited to increasing the personal needs allowance for
28residential care facility residents and making programmatic
29adjustments or upward adjustments of the residential care
30facility or in-home health-related care reimbursement rates
31prescribed in this division of this Act to ensure that federal
32requirements are met. In addition, the department may make
33other programmatic and rate adjustments necessary to remain
34within the amount appropriated in this section while ensuring
35compliance with federal requirements. The department may adopt
-34-1emergency rules to implement the provisions of this subsection.
24. Notwithstanding section 8.33, moneys appropriated
3in this section that remain unencumbered or unobligated
4at the close of the fiscal year shall not revert but
5shall remain available for expenditure for the purposes
6designated, including for liability amounts associated with the
7supplemental nutrition assistance program payment error rate,
8until the close of the succeeding fiscal year.
9 Sec. 16. CHILDREN’S HEALTH INSURANCE PROGRAM.
101. There is appropriated from the general fund of the
11state to the department of human services for the fiscal year
12beginning July 1, 2021, and ending June 30, 2022, the following
13amount, or so much thereof as is necessary, to be used for the
14purpose designated:
15For maintenance of the healthy and well kids in Iowa (hawk-i)
16program pursuant to chapter 514I, including supplemental dental
17services, for receipt of federal financial participation under
18Tit.XXI of the federal Social Security Act, which creates the
19children’s health insurance program:
.................................................. $2037,957,643
212. Of the funds appropriated in this section, $149,189 is
22allocated for continuation of the contract for outreach with
23the department of public health.
243. A portion of the funds appropriated in this section may
25be transferred to the appropriations made in this division of
26this Act for field operations or health program operations to
27be used for the integration of hawk-i program eligibility,
28payment, and administrative functions under the purview of
29the department of human services, including for the Medicaid
30management information system upgrade.
31 Sec. 17. CHILD CARE ASSISTANCE. There is appropriated
32from the general fund of the state to the department of human
33services for the fiscal year beginning July 1, 2021, and ending
34June 30, 2022, the following amount, or so much thereof as is
35necessary, to be used for the purpose designated:
-35- 1For child care programs:
.................................................. $240,816,931
31. Of the funds appropriated in this section, $34,966,931
4shall be used for state child care assistance in accordance
5with section 237A.13.
62. Nothing in this section shall be construed or is
7intended as or shall imply a grant of entitlement for services
8to persons who are eligible for assistance due to an income
9level consistent with the waiting list requirements of section
10237A.13. Any state obligation to provide services pursuant to
11this section is limited to the extent of the funds appropriated
12in this section.
133. A list of the registered and licensed child care
14facilities operating in the area served by a child care
15resource and referral service shall be made available to the
16families receiving state child care assistance in that area.
174. Of the funds appropriated in this section, $5,850,000
18shall be credited to the early childhood programs grants
19account in the early childhood Iowa fund created in section
20256I.11. The moneys shall be distributed for funding of
21community-based early childhood programs targeted to children
22from birth through five years of age developed by early
23childhood Iowa areas in accordance with approved community
24plans as provided in section 256I.8.
255. The department may use any of the funds appropriated
26in this section as a match to obtain federal funds for use in
27expanding child care assistance and related programs. For
28the purpose of expenditures of state and federal child care
29funding, funds shall be considered obligated at the time
30expenditures are projected or are allocated to the department’s
31service areas. Projections shall be based on current and
32projected caseload growth, current and projected provider
33rates, staffing requirements for eligibility determination
34and management of program requirements including data systems
35management, staffing requirements for administration of the
-36-1program, contractual and grant obligations and any transfers
2to other state agencies, and obligations for decategorization
3or innovation projects.
46. A portion of the state match for the federal child care
5and development block grant shall be provided as necessary to
6meet federal matching funds requirements through the state
7general fund appropriation made for child development grants
8and other programs for at-risk children in section 279.51.
97. If a uniform reduction ordered by the governor under
10section 8.31 or other operation of law, transfer, or federal
11funding reduction reduces the appropriation made in this
12section for the fiscal year, the percentage reduction in the
13amount paid out to or on behalf of the families participating
14in the state child care assistance program shall be equal to or
15less than the percentage reduction made for any other purpose
16payable from the appropriation made in this section and the
17federal funding relating to it. The percentage reduction to
18the other allocations made in this section shall be the same as
19the uniform reduction ordered by the governor or the percentage
20change of the federal funding reduction, as applicable. If
21there is an unanticipated increase in federal funding provided
22for state child care services, the entire amount of the
23increase, except as necessary to meet federal requirements
24including quality set asides, shall be used for state child
25care assistance payments. If the appropriations made for
26purposes of the state child care assistance program for the
27fiscal year are determined to be insufficient, it is the intent
28of the general assembly to appropriate sufficient funding for
29the fiscal year in order to avoid establishment of waiting list
30requirements.
318. Notwithstanding section 8.33, moneys advanced for
32purposes of the programs developed by early childhood Iowa
33areas, advanced for purposes of wraparound child care, or
34received from the federal appropriations made for the purposes
35of this section that remain unencumbered or unobligated at the
-37-1close of the fiscal year shall not revert to any fund but shall
2remain available for expenditure for the purposes designated
3until the close of the succeeding fiscal year.
4 Sec. 18. JUVENILE INSTITUTION. There is appropriated
5from the general fund of the state to the department of human
6services for the fiscal year beginning July 1, 2021, and ending
7June 30, 2022, the following amounts, or so much thereof as is
8necessary, to be used for the purposes designated:
91. a. For operation of the state training school at Eldora
10and for salaries, support, maintenance, and miscellaneous
11purposes, and for not more than the following full-time
12equivalent positions:
.................................................. $1317,397,068
............................................... FTEs14207.00
15b. Of the funds appropriated in this subsection, $91,000
16shall be used for distribution to licensed classroom teachers
17at this and other institutions under the control of the
18department of human services based upon the average student
19yearly enrollment at each institution as determined by the
20department.
212. A portion of the moneys appropriated in this section
22shall be used by the state training school at Eldora for
23grants for adolescent pregnancy prevention activities at the
24institution in the fiscal year beginning July 1, 2021.
253. Of the funds appropriated in this subsection, $212,000
26shall be used by the state training school at Eldora for a
27substance use disorder treatment program at the institution for
28the fiscal year beginning July 1, 2021.
294. Notwithstanding section 8.33, moneys appropriated in
30this section that remain unencumbered or unobligated at the
31close of the fiscal year shall not revert but shall remain
32available for expenditure for the purposes designated until the
33close of the succeeding fiscal year.
34 Sec. 19. CHILD AND FAMILY SERVICES.
351. There is appropriated from the general fund of the
-38-1state to the department of human services for the fiscal year
2beginning July 1, 2021, and ending June 30, 2022, the following
3amount, or so much thereof as is necessary, to be used for the
4purpose designated:
5For child and family services:
.................................................. $689,071,930
72. The department may transfer funds appropriated in this
8section as necessary to pay the nonfederal costs of services
9reimbursed under the medical assistance program, state child
10care assistance program, or the family investment program which
11are provided to children who would otherwise receive services
12paid under the appropriation in this section. The department
13may transfer funds appropriated in this section to the
14appropriations made in this division of this Act for general
15administration and for field operations for resources necessary
16to implement and operate the services funded in this section.
173. a. Of the funds appropriated in this section, up to
18$31,500,000 is allocated as the statewide expenditure target
19under section 232.143 for group foster care maintenance and
20services. If the department projects that such expenditures
21for the fiscal year will be less than the target amount
22allocated in this paragraph “a”, the department may reallocate
23the excess to provide additional funding for family foster
24care, independent living, family-centered services, shelter
25care, or the child welfare emergency services addressed with
26the allocation for shelter care.
27b. If at any time after September 30, 2021, annualization
28of a service area’s current expenditures indicates a service
29area is at risk of exceeding its group foster care expenditure
30target under section 232.143 by more than 5 percent, the
31department and juvenile court services shall examine all
32group foster care placements in that service area in order to
33identify those which might be appropriate for termination.
34In addition, any aftercare services believed to be needed
35for the children whose placements may be terminated shall be
-39-1identified. The department and juvenile court services shall
2initiate action to set dispositional review hearings for the
3placements identified. In such a dispositional review hearing,
4the juvenile court shall determine whether needed aftercare
5services are available and whether termination of the placement
6is in the best interest of the child and the community.
74. In accordance with the provisions of section 232.188,
8the department shall continue the child welfare and juvenile
9justice funding initiative during fiscal year 2021-2022. Of
10the funds appropriated in this section, $1,717,000 is allocated
11specifically for expenditure for fiscal year 2021-2022 through
12the decategorization services funding pools and governance
13boards established pursuant to section 232.188.
145. A portion of the funds appropriated in this section
15may be used for emergency family assistance to provide other
16resources required for a family participating in a family
17preservation or reunification project or successor project to
18stay together or to be reunified.
196. Of the funds appropriated in this section, a sufficient
20amount is allocated for shelter care and the child welfare
21emergency services contracting implemented to provide for or
22prevent the need for shelter care.
237. Federal funds received by the state during the fiscal
24year beginning July 1, 2021, as the result of the expenditure
25of state funds appropriated during a previous state fiscal
26year for a service or activity funded under this section are
27appropriated to the department to be used as additional funding
28for services and purposes provided for under this section.
29Notwithstanding section 8.33, moneys received in accordance
30with this subsection that remain unencumbered or unobligated at
31the close of the fiscal year shall not revert to any fund but
32shall remain available for the purposes designated until the
33close of the succeeding fiscal year.
348. a. Of the funds appropriated in this section, up to
35$3,290,000 is allocated for the payment of the expenses of
-40-1court-ordered services provided to juveniles who are under the
2supervision of juvenile court services, which expenses are a
3charge upon the state pursuant to section 232.141, subsection
44. Of the amount allocated in this paragraph “a”, up to
5$1,556,000 shall be made available to provide school-based
6supervision of children adjudicated under chapter 232, of which
7not more than $15,000 may be used for the purpose of training.
8A portion of the cost of each school-based liaison officer
9shall be paid by the school district or other funding source as
10approved by the chief juvenile court officer.
11b. Of the funds appropriated in this section, up to $748,000
12is allocated for the payment of the expenses of court-ordered
13services provided to children who are under the supervision
14of the department, which expenses are a charge upon the state
15pursuant to section 232.141, subsection 4.
16c. Notwithstanding section 232.141 or any other provision
17of law to the contrary, the amounts allocated in this
18subsection shall be distributed to the judicial districts
19as determined by the state court administrator and to the
20department’s service areas as determined by the administrator
21of the department of human services’ division of child and
22family services. The state court administrator and the
23division administrator shall make the determination of the
24distribution amounts on or before June 15, 2021.
25d. Notwithstanding chapter 232 or any other provision of
26law to the contrary, a district or juvenile court shall not
27order any service which is a charge upon the state pursuant
28to section 232.141 if there are insufficient court-ordered
29services funds available in the district court or departmental
30service area distribution amounts to pay for the service. The
31chief juvenile court officer and the departmental service area
32manager shall encourage use of the funds allocated in this
33subsection such that there are sufficient funds to pay for
34all court-related services during the entire year. The chief
35juvenile court officers and departmental service area managers
-41-1shall attempt to anticipate potential surpluses and shortfalls
2in the distribution amounts and shall cooperatively request the
3state court administrator or division administrator to transfer
4funds between the judicial districts’ or departmental service
5areas’ distribution amounts as prudent.
6e. Notwithstanding any provision of law to the contrary,
7a district or juvenile court shall not order a county to pay
8for any service provided to a juvenile pursuant to an order
9entered under chapter 232 which is a charge upon the state
10under section 232.141, subsection 4.
11f. Of the funds allocated in this subsection, not more than
12$83,000 may be used by the judicial branch for administration
13of the requirements under this subsection.
14g. Of the funds allocated in this subsection, $17,000
15shall be used by the department of human services to support
16the interstate commission for juveniles in accordance with
17the interstate compact for juveniles as provided in section
18232.173.
199. Of the funds appropriated in this section, $12,253,000 is
20allocated for juvenile delinquent graduated sanctions services.
21Any state funds saved as a result of efforts by juvenile court
22services to earn a federal Tit.IV-E match for juvenile court
23services administration may be used for the juvenile delinquent
24graduated sanctions services.
2510. Of the funds appropriated in this section, $1,658,000 is
26transferred to the department of public health to be used for
27the child protection center grant program for child protection
28centers located in Iowa in accordance with section 135.118.
29The grant amounts under the program shall be equalized so that
30each center receives a uniform base amount of $245,000, and so
31that the remaining funds are awarded through a funding formula
32based upon the volume of children served. To increase access
33to child protection center services for children in rural
34areas, the funding formula for the awarding of the remaining
35funds shall provide for the awarding of an enhanced amount to
-42-1eligible grantees to develop and maintain satellite centers in
2underserved regions of the state.
311. Of the funds appropriated in this section, $4,025,000 is
4allocated for the preparation for adult living program pursuant
5to section 234.46.
612. Of the funds appropriated in this section, $227,000
7shall be used for the public purpose of continuing a grant to a
8nonprofit human services organization, providing services to
9individuals and families in multiple locations in southwest
10Iowa and Nebraska for support of a project providing immediate,
11sensitive support and forensic interviews, medical exams, needs
12assessments, and referrals for victims of child abuse and their
13nonoffending family members.
1413. Of the funds appropriated in this section, $300,000
15is allocated for the foster care youth council approach of
16providing a support network to children placed in foster care.
1714. Of the funds appropriated in this section, $202,000 is
18allocated for use pursuant to section 235A.1 for continuation
19of the initiative to address child sexual abuse implemented
20pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection
2121.
2215. Of the funds appropriated in this section, $630,000 is
23allocated for the community partnership for child protection
24sites.
2516. Of the funds appropriated in this section, $371,000
26is allocated for the department’s minority youth and family
27projects under the redesign of the child welfare system.
2817. Of the funds appropriated in this section, $851,000
29is allocated for funding of the community circle of care
30collaboration for children and youth in northeast Iowa.
3118. Of the funds appropriated in this section, at least
32$147,000 shall be used for the continuation of the child
33welfare provider training academy, a collaboration between the
34coalition for family and children’s services in Iowa and the
35department.
-43- 119. Of the funds appropriated in this section, $211,000
2shall be used for continuation of the central Iowa system of
3care program grant for the purposes of funding community-based
4services and other supports with a system of care approach for
5children with serious emotional disturbance and their families
6through a nonprofit provider that is located in a county
7with a population of more than 420,000 but less than 450,000
8according to the 2010 certified federal census, is licensed
9as a psychiatric medical institution for children, and was a
10system of care grantee prior to July 1, 2021.
1120. Of the funds appropriated in this section, $235,000
12shall be used for the public purpose of the continuation
13and expansion of a system of care program grant implemented
14in Cerro Gordo and Linn counties to utilize a comprehensive
15and long-term approach for helping children and families by
16addressing the key areas in a child’s life of childhood basic
17needs, education and work, family, and community.
1821. Of the funds appropriated in this section, $110,000
19shall be used for the public purpose of funding community-based
20services and other supports with a system of care approach
21for children with a serious emotional disturbance and their
22families through a nonprofit provider of child welfare services
23that has been in existence for more than 115 years, is located
24in a county with a population of more than 200,000 but less
25than 220,000 according to the 2010 certified federal census, is
26licensed as a psychiatric medical institution for children, and
27was a system of care grantee prior to July 1, 2021.
2822. If a separate funding source is identified that reduces
29the need for state funds within an allocation under this
30section, the allocated state funds may be redistributed to
31other allocations under this section for the same fiscal year.
3223. Of the funds appropriated in this section, a portion may
33be used for family-centered services for purposes of complying
34with the federal Family First Prevention Services Act of 2018,
35Pub.L. No.115-123, and successor legislation.
-44-1 Sec. 20. ADOPTION SUBSIDY.
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:
7a. For adoption subsidy payments and related costs and for
8other services provided for under paragraph “b”, subparagraph
9(2):
.................................................. $1040,596,007
11b. (1) Of the funds appropriated in this section, a
12sufficient amount is allocated for adoption subsidy payments
13and related costs.
14(2) Any funds appropriated in this section remaining after
15the allocation under subparagraph (1) are designated and
16allocated as state savings resulting from implementation of
17the federal Fostering Connections to Success and Increasing
18Adoptions Act of 2008, Pub.L. No.110-351, and successor
19legislation, as determined in accordance with 42 U.S.C.
20§673(a)(8), and shall be used for post-adoption services and
21for other purposes allowed under these federal laws, Tit.IV-B
22or Tit.IV-E of the federal Social Security Act.
23(a) The department of human services may transfer funds
24allocated in this subparagraph (2) to the appropriation for
25child and family services in this division of this Act for the
26purposes designated in this subparagraph (2).
27(b) Notwithstanding section 8.33, moneys allocated
28under this subparagraph (2) shall not revert to any fund but
29shall remain available for the purposes designated in this
30subparagraph (2) until expended.
312. The department may transfer funds appropriated in
32this section to the appropriation made in this division of
33this Act for general administration for costs paid from the
34appropriation relating to adoption subsidy.
353. Federal funds received by the state during the
-45-1fiscal year beginning July 1, 2021, as the result of the
2expenditure of state funds during a previous state fiscal
3year for a service or activity funded under this section are
4appropriated to the department to be used as additional funding
5for the services and activities funded under this section.
6Notwithstanding section 8.33, moneys received in accordance
7with this subsection that remain unencumbered or unobligated
8at the close of the fiscal year shall not revert to any fund
9but shall remain available for expenditure for the purposes
10designated until the close of the succeeding fiscal year.
11 Sec. 21. JUVENILE DETENTION HOME FUND. Moneys deposited
12in the juvenile detention home fund created in section 232.142
13during the fiscal year beginning July 1, 2021, and ending June
1430, 2022, are appropriated to the department of human services
15for the fiscal year beginning July 1, 2021, and ending June 30,
162022, for distribution of an amount equal to a percentage of
17the costs of the establishment, improvement, operation, and
18maintenance of county or multicounty juvenile detention homes
19in the fiscal year beginning July 1, 2020. Moneys appropriated
20for distribution in accordance with this section shall be
21allocated among eligible detention homes, prorated on the basis
22of an eligible detention home’s proportion of the costs of all
23eligible detention homes in the fiscal year beginning July
241, 2020. The percentage figure shall be determined by the
25department based on the amount available for distribution for
26the fund. Notwithstanding section 232.142, subsection 3, the
27financial aid payable by the state under that provision for the
28fiscal year beginning July 1, 2021, shall be limited to the
29amount appropriated for the purposes of this section.
30 Sec. 22. FAMILY SUPPORT SUBSIDY PROGRAM.
311. There is appropriated from the general fund of the
32state to the department of human services for the fiscal year
33beginning July 1, 2021, and ending June 30, 2022, the following
34amount, or so much thereof as is necessary, to be used for the
35purpose designated:
-46- 1For the family support subsidy program subject to the
2enrollment restrictions in section 225C.37, subsection 3:
.................................................. $3949,282
42. At least $899,291 of the moneys appropriated in this
5section is transferred to the department of public health for
6the family support center component of the comprehensive family
7support program under chapter 225C, subchapter V.
83. If at any time during the fiscal year, the amount of
9funding available for the family support subsidy program
10is reduced from the amount initially used to establish the
11figure for the number of family members for whom a subsidy
12is to be provided at any one time during the fiscal year,
13notwithstanding section 225C.38, subsection 2, the department
14shall revise the figure as necessary to conform to the amount
15of funding available.
16 Sec. 23. CONNER DECREE. There is appropriated from the
17general fund of the state to the department of human services
18for the fiscal year beginning July 1, 2021, and ending June 30,
192022, the following amount, or so much thereof as is necessary,
20to be used for the purpose designated:
21For building community capacity through the coordination
22and provision of training opportunities in accordance with the
23consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D.
24Iowa, July 14, 1994):
.................................................. $2533,632
26 Sec. 24. MENTAL HEALTH INSTITUTES.
271. There is appropriated from the general fund of the
28state to the department of human services for the fiscal year
29beginning July 1, 2021, and ending June 30, 2022, the following
30amounts, or so much thereof as is necessary, to be used for the
31purposes designated:
32a. For operation of the state mental health institute at
33Cherokee as required by chapters 218 and 226 for salaries,
34support, maintenance, and miscellaneous purposes, and for not
35more than the following full-time equivalent positions:
-47-.................................................. $115,457,597
............................................... FTEs2169.00
3b. For operation of the state mental health institute at
4Independence 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:
.................................................. $719,652,379
............................................... FTEs8208.00
92. a. Notwithstanding sections 218.78 and 249A.11, any
10revenue received from the state mental health institute at
11Cherokee or the state mental health institute at Independence
12pursuant to 42 C.F.R§438.6(e) may be retained and expended by
13the mental health institute.
14b. Notwithstanding sections 218.78 and 249A.11, any
15COVID-19 related funding received through federal funding
16sources by the state mental health institute at Cherokee or the
17state mental health institute at Independence may be retained
18and expended by the mental health institute.
193. Notwithstanding any provision of law to the contrary,
20a Medicaid member residing at the state mental health
21institute at Cherokee or the state mental health institute
22at Independence shall retain Medicaid eligibility during
23the period of the Medicaid member’s stay for which federal
24financial participation is available.
254. Notwithstanding section 8.33, moneys appropriated in
26this section that remain unencumbered or unobligated at the
27close of the fiscal year shall not revert but shall remain
28available for expenditure for the purposes designated until the
29close of the succeeding fiscal year.
30 Sec. 25. STATE RESOURCE CENTERS.
311. There is appropriated from the general fund of the
32state to the department of human services for the fiscal year
33beginning July 1, 2021, and ending June 30, 2022, the following
34amounts, or so much thereof as is necessary, to be used for the
35purposes designated:
-48- 1a. For the state resource center at Glenwood for salaries,
2support, maintenance, and miscellaneous purposes:
.................................................. $314,802,873
4b. For the state resource center at Woodward for salaries,
5support, maintenance, and miscellaneous purposes:
.................................................. $612,237,937
72. The department may continue to bill for state resource
8center services utilizing a scope of services approach used for
9private providers of intermediate care facilities for persons
10with an intellectual disability services, in a manner which
11does not shift costs between the medical assistance program,
12counties, or other sources of funding for the state resource
13centers.
143. The state resource centers may expand the time-limited
15assessment and respite services during the fiscal year.
164. If the department’s administration and the department
17of management concur with a finding by a state resource
18center’s superintendent that projected revenues can reasonably
19be expected to pay the salary and support costs for a new
20employee position, or that such costs for adding a particular
21number of new positions for the fiscal year would be less
22than the overtime costs if new positions would not be added,
23the superintendent may add the new position or positions. If
24the vacant positions available to a resource center do not
25include the position classification desired to be filled, the
26state resource center’s superintendent may reclassify any
27vacant position as necessary to fill the desired position. The
28superintendents of the state resource centers may, by mutual
29agreement, pool vacant positions and position classifications
30during the course of the fiscal year in order to assist one
31another in filling necessary positions.
325. If existing capacity limitations are reached in
33operating units, a waiting list is in effect for a service or
34a special need for which a payment source or other funding
35is available for the service or to address the special need,
-49-1and facilities for the service or to address the special need
2can be provided within the available payment source or other
3funding, the superintendent of a state resource center may
4authorize opening not more than two units or other facilities
5and begin implementing the service or addressing the special
6need during fiscal year 2021-2022.
76. Notwithstanding section 8.33, and notwithstanding
8the amount limitation specified in section 222.92, moneys
9appropriated in this section that remain unencumbered or
10unobligated at the close of the fiscal year shall not revert
11but shall remain available for expenditure for the purposes
12designated until the close of the succeeding fiscal year.
13 Sec. 26. SEXUALLY VIOLENT PREDATORS.
141. There is appropriated from the general fund of the
15state to the department of human services for the fiscal year
16beginning July 1, 2021, and ending June 30, 2022, the following
17amount, or so much thereof as is necessary, to be used for the
18purpose designated:
19For costs associated with the commitment and treatment of
20sexually violent predators in the unit located at the state
21mental health institute at Cherokee, including costs of legal
22services and other associated costs, including salaries,
23support, maintenance, and miscellaneous purposes, and for not
24more than the following full-time equivalent positions:
.................................................. $2513,643,727
............................................... FTEs26139.00
272. Unless specifically prohibited by law, if the amount
28charged provides for recoupment of at least the entire amount
29of direct and indirect costs, the department of human services
30may contract with other states to provide care and treatment
31of persons placed by the other states at the unit for sexually
32violent predators at Cherokee. The moneys received under
33such a contract shall be considered to be repayment receipts
34and used for the purposes of the appropriation made in this
35section.
-50- 13. Notwithstanding section 8.33, moneys appropriated in
2this section that remain unencumbered or unobligated at the
3close of the fiscal year shall not revert but shall remain
4available for expenditure for the purposes designated until the
5close of the succeeding fiscal year.
6 Sec. 27. FIELD OPERATIONS.
71. There is appropriated from the general fund of the
8state to the department of human services for the fiscal year
9beginning July 1, 2021, and ending June 30, 2022, the following
10amount, or so much thereof as is necessary, to be used for the
11purposes designated:
12For field operations, including salaries, support,
13maintenance, and miscellaneous purposes, and for not more than
14the following full-time equivalent positions:
.................................................. $1560,596,667
............................................... FTEs161,539.00
172. Priority in filling full-time equivalent positions
18shall be given to those positions related to child protection
19services and eligibility determination for low-income families.
20 Sec. 28. GENERAL ADMINISTRATION. There is appropriated
21from the general fund of the state to the department of human
22services for the fiscal year beginning July 1, 2021, and ending
23June 30, 2022, the following amount, or so much thereof as is
24necessary, to be used for the purpose designated:
25For general administration, including salaries, support,
26maintenance, and miscellaneous purposes, and for not more than
27the following full-time equivalent positions:
.................................................. $2815,342,189
............................................... FTEs29294.00
301. The department shall report at least monthly to the
31general assembly concerning the department’s operational and
32program expenditures.
332. Of the funds appropriated in this section, $150,000 shall
34be used for the provision of a program to provide technical
35assistance, support, and consultation to providers of home and
-51-1community-based services under the medical assistance program.
23. Of the funds appropriated in this section, $50,000
3is transferred to the Iowa finance authority to be used
4for administrative support of the council on homelessness
5established in section 16.2D and for the council to fulfill its
6duties in addressing and reducing homelessness in the state.
74. Of the funds appropriated in this section, $200,000 shall
8be transferred to and deposited in the administrative fund of
9the Iowa ABLE savings plan trust created in section 12I.4, to
10be used for implementation and administration activities of the
11Iowa ABLE savings plan trust.
125. Of the funds appropriated in this section, $200,000 is
13transferred to the economic development authority for the Iowa
14commission on volunteer services to continue to be used for the
15RefugeeRISE AmeriCorps program established under section 15H.8
16for member recruitment and training to improve the economic
17well-being and health of economically disadvantaged refugees in
18local communities across Iowa. Funds transferred may be used
19to supplement federal funds under federal regulations.
206. Of the funds appropriated in this section, up to $300,000
21shall be used as follows:
22a. To fund not more than one full-time equivalent position
23to address the department’s responsibility to support the work
24of the children’s behavioral health system state board and
25implementation of the services required pursuant to section
26331.397.
27b. To support the cost of establishing and implementing new
28or additional services required pursuant to sections 331.397
29and 331.397A.
30c. Of the amount allocated, $32,000 shall be transferred
31to the department of public health to support the costs of
32establishing and implementing new or additional services
33required pursuant to sections 331.397 and 331.397A.
347. Of the funds appropriated in this section, $800,000 shall
35be used for the renovation and construction of certain nursing
-52-1facilities, consistent with the provisions of chapter 249K.
2 Sec. 29. DEPARTMENT-WIDE DUTIES. There is appropriated
3from the general fund of the state to the department of human
4services for the fiscal year beginning July 1, 2021, and ending
5June 30, 2022, the following amount, or so much thereof as is
6necessary, to be used for the purposes designated:
7For salaries, support, maintenance, and miscellaneous
8purposes at facilities under the purview of the department of
9human services:
.................................................. $102,879,274
11 Sec. 30. VOLUNTEERS. There is appropriated from the general
12fund of the state to the department of human services for the
13fiscal year beginning July 1, 2021, and ending June 30, 2022,
14the following amount, or so much thereof as is necessary, to be
15used for the purpose designated:
16For development and coordination of volunteer services:
.................................................. $1784,686
18 Sec. 31. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
19ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
20DEPARTMENT OF HUMAN SERVICES.
211. a. (1) (a) Notwithstanding any provision of law to
22the contrary, for the fiscal year beginning July 1, 2021, the
23department shall not rebase case-mix nursing facility rates,
24but shall instead reimburse case-mix nursing facilities by
25adjusting the nursing facility case-mix adjusted rates that
26were effective July 1, 2019, using the mid-points of each of
27the most recent cost reports submitted by the nursing facility
28for the period ending on or before December 31, 2018, and
29inflating these costs forward applying the inflation factor as
30determined using the latest available quarterly publication of
31the HCFA/SNF index, to the extent possible within the state
32funding, including the $20,000,000 provided for this purpose.
33(b) For the fiscal year beginning July 1, 2021, non-case-mix
34and special population nursing facilities shall be reimbursed
35in accordance with the methodology in effect on June 30 of the
-53-1prior fiscal year.
2(c) For managed care claims, the department of human
3services shall adjust the payment rate floor for nursing
4facilities, annually, to maintain a rate floor that is no
5lower than the Medicaid fee-for-service case-mix adjusted rate
6calculated in accordance with subparagraph division (a) and
7441 IAC 81.6. The department shall then calculate adjusted
8reimbursement rates, including but not limited to add-on
9payments, annually, and shall notify Medicaid managed care
10organizations of the adjusted reimbursement rates within 30
11days of determining the adjusted reimbursement rates. Any
12adjustment of reimbursement rates under this subparagraph
13division shall be budget neutral to the state budget.
14(d) For the fiscal year beginning July 1, 2021, Medicaid
15managed care long-term services and supports capitation rates
16shall be adjusted to reflect the case-mix adjusted rates
17specified pursuant to subparagraph division (a) for the patient
18populations residing in Medicaid-certified nursing facilities.
19(2) Medicaid managed care organizations shall adjust
20facility-specific rates based upon payment rate listings issued
21by the department. The rate adjustments shall be applied
22prospectively from the effective date of the rate letter issued
23by the department.
24b. (1) For the fiscal year beginning July 1, 2021, the
25department shall establish the fee-for-service pharmacy
26dispensing fee reimbursement at $10.38 per prescription,
27until a cost of dispensing survey is completed. The actual
28dispensing fee shall be determined by a cost of dispensing
29survey performed by the department and required to be completed
30by all medical assistance program participating pharmacies
31every two years.
32(2) The department shall utilize an average acquisition
33cost reimbursement methodology for all drugs covered under the
34medical assistance program in accordance with 2012 Iowa Acts,
35chapter 1133, section 33.
-54- 1c. (1) For the fiscal year beginning July 1, 2021,
2reimbursement rates for outpatient hospital services shall
3remain at the rates in effect on June 30, 2021, subject to
4Medicaid program upper payment limit rules, and adjusted
5as necessary to maintain expenditures within the amount
6appropriated to the department for this purpose for the fiscal
7year.
8(2) For the fiscal year beginning July 1, 2021,
9reimbursement rates for inpatient hospital services shall
10be rebased effective October 1, 2021, subject to Medicaid
11program upper payment limit rules, and adjusted as necessary
12to maintain expenditures within the amount appropriated to the
13department for this purpose for the fiscal year.
14(3) For the fiscal year beginning July 1, 2021, under
15both fee-for-service and managed care administration of
16the Medicaid program, critical access hospitals shall be
17reimbursed for inpatient and outpatient services based on the
18hospital-specific critical access hospital cost adjustment
19factor methodology utilizing the most recent and complete cost
20reporting period as applied prospectively within the funds
21appropriated for such purpose for the fiscal year.
22(4) For the fiscal year beginning July 1, 2021, the graduate
23medical education and disproportionate share hospital fund
24shall remain at the amount in effect on June 30, 2021, except
25that the portion of the fund attributable to graduate medical
26education shall be reduced in an amount that reflects the
27elimination of graduate medical education payments made to
28out-of-state hospitals.
29(5) In order to ensure the efficient use of limited state
30funds in procuring health care services for low-income Iowans,
31funds appropriated in this Act for hospital services shall
32not be used for activities which would be excluded from a
33determination of reasonable costs under the federal Medicare
34program pursuant to 42 U.S.C.§1395x(v)(1)(N).
35d. For the fiscal year beginning July 1, 2021, reimbursement
-55-1rates for hospices and acute psychiatric hospitals shall be
2increased in accordance with increases under the federal
3Medicare program or as supported by their Medicare audited
4costs.
5e. For the fiscal year beginning July 1, 2021, independent
6laboratories and rehabilitation agencies shall be reimbursed
7using the same methodology in effect on June 30, 2021.
8f. (1) For the fiscal year beginning July 1, 2021,
9reimbursement rates for home health agencies shall continue to
10be based on the Medicare low utilization payment adjustment
11(LUPA) methodology with state geographic wage adjustments and
12shall be adjusted to increase the rates to the extent possible
13within the state funding, including the $2,000,000 appropriated
14for this purpose. The department shall continue to update the
15rates every two years to reflect the most recent Medicare LUPA
16rates.
17(2) For the fiscal year beginning July 1, 2021, rates for
18private duty nursing and personal care services under the early
19and periodic screening, diagnostic, and treatment program
20benefit shall be calculated based on the methodology in effect
21on June 30, 2021.
22g. For the fiscal year beginning July 1, 2021, federally
23qualified health centers and rural health clinics shall receive
24cost-based reimbursement for 100 percent of the reasonable
25costs for the provision of services to recipients of medical
26assistance.
27h. For the fiscal year beginning July 1, 2021, the
28reimbursement rates for dental services shall remain at the
29rates in effect on June 30, 2021.
30i. (1) For the fiscal year beginning July 1, 2021,
31reimbursement rates for non-state-owned psychiatric medical
32institutions for children shall be increased to the extent
33possible within the $3,900,000 appropriated for this purpose.
34(2) As a condition of participation in the medical
35assistance program, enrolled providers shall accept the medical
-56-1assistance reimbursement rate for any covered goods or services
2provided to recipients of medical assistance who are children
3under the custody of a psychiatric medical institution for
4children.
5j. For the fiscal year beginning July 1, 2021, unless
6otherwise specified in this Act, all noninstitutional medical
7assistance provider reimbursement rates shall remain at the
8rates in effect on June 30, 2021, except for area education
9agencies, local education agencies, infant and toddler
10services providers, home and community-based services providers
11including consumer-directed attendant care providers under a
12section 1915(c) or 1915(i) waiver, targeted case management
13providers, and those providers whose rates are required to be
14determined pursuant to section 249A.20, or to meet federal
15mental health parity requirements.
16k. Notwithstanding any provision to the contrary, for the
17fiscal year beginning July 1, 2021, the reimbursement rate for
18anesthesiologists shall remain at the rates in effect on June
1930, 2021, and updated on January 1, 2022, to align with the
20most current Iowa Medicare anesthesia rate.
21l. Notwithstanding section 249A.20, for the fiscal year
22beginning July 1, 2021, the average reimbursement rate for
23health care providers eligible for use of the federal Medicare
24resource-based relative value scale reimbursement methodology
25under section 249A.20 shall remain at the rate in effect on
26June 30, 2021; however, this rate shall not exceed the maximum
27level authorized by the federal government.
28m. For the fiscal year beginning July 1, 2021, the
29reimbursement rate for residential care facilities shall not
30be less than the minimum payment level as established by the
31federal government to meet the federally mandated maintenance
32of effort requirement. The flat reimbursement rate for
33facilities electing not to file annual cost reports shall not
34be less than the minimum payment level as established by the
35federal government to meet the federally mandated maintenance
-57-1of effort requirement.
2n. For the fiscal year beginning July 1, 2021, the
3reimbursement rates for inpatient mental health services
4provided at hospitals shall be rebased effective October 1,
52021, subject to Medicaid program upper payment limit rules
6and adjusted as necessary to maintain expenditures within the
7amount appropriated to the department for this purpose for
8the fiscal year; and psychiatrists shall be reimbursed at the
9medical assistance program fee-for-service rate in effect on
10June 30, 2021.
11o. For the fiscal year beginning July 1, 2021, community
12mental health centers may choose to be reimbursed for the
13services provided to recipients of medical assistance through
14either of the following options:
15(1) For 100 percent of the reasonable costs of the services.
16(2) In accordance with the alternative reimbursement rate
17methodology approved by the department of human services in
18effect on June 30, 2021.
19p. For the fiscal year beginning July 1, 2021, the
20reimbursement rate for providers of family planning services
21that are eligible to receive a 90 percent federal match shall
22remain at the rates in effect on June 30, 2021.
23q. (1) For the fiscal year beginning July 1, 2021,
24reimbursement rates for providers of home and community-based
25services waiver and habilitation services shall be increased by
265.25 percent over the rates in effect on June 30, 2021.
27(2) For the fiscal year beginning July 1, 2021,
28reimbursement rates for providers of state plan home and
29community-based services home-based habilitation services
30shall be increased with the $7,134,214 appropriated for this
31purpose. The reimbursement rates for home-based habilitation
32services shall be based on a fee schedule that incorporates the
33acuity-based tiers.
34r. For the fiscal year beginning July 1, 2021, the
35reimbursement rates for emergency medical service providers
-58-1shall remain at the rates in effect on June 30, 2021, or as
2approved by the centers for Medicare and Medicaid services of
3the United States department of health and human services.
4s. For the fiscal year beginning July 1, 2021, reimbursement
5rates for substance-related disorder treatment programs
6licensed under section 125.13 shall remain at the rates in
7effect on June 30, 2021.
8t. For the fiscal year beginning July 1, 2021, assertive
9community treatment per diem rates shall remain at the rates in
10effect on June 30, 2021.
11u. For the fiscal year beginning July 1, 2021, the
12reimbursement rate for family-centered services providers shall
13be established by contract.
142. For the fiscal year beginning July 1, 2021, the
15reimbursement rate for providers reimbursed under the
16in-home-related care program shall not be less than the minimum
17payment level as established by the federal government to meet
18the federally mandated maintenance of effort requirement.
193. Unless otherwise directed in this section, when the
20department’s reimbursement methodology for any provider
21reimbursed in accordance with this section includes an
22inflation factor, this factor shall not exceed the amount
23by which the consumer price index for all urban consumers
24increased during the calendar year ending December 31, 2002.
254. Notwithstanding section 234.38, for the fiscal
26year beginning July 1, 2021, the foster family basic daily
27maintenance rate and the maximum adoption subsidy rate for
28children ages 0 through 5 years shall be $16.78, the rate for
29children ages 6 through 11 years shall be $17.45, the rate for
30children ages 12 through 15 years shall be $19.10, and the
31rate for children and young adults ages 16 and older shall
32be $19.35. For youth ages 18 to 23 who have exited foster
33care, the preparation for adult living program maintenance
34rate shall be up to $602.70 per month as calculated based on
35the age of the participant. The maximum payment for adoption
-59-1subsidy nonrecurring expenses shall be limited to $500 and the
2disallowance of additional amounts for court costs and other
3related legal expenses implemented pursuant to 2010 Iowa Acts,
4chapter 1031, section 408, shall be continued.
55. For the fiscal year beginning July 1, 2021, the maximum
6reimbursement rates for social services providers under
7contract shall remain at the rates in effect on June 30, 2021,
8or the provider’s actual and allowable cost plus inflation for
9each service, whichever is less. However, if a new service
10or service provider is added after June 30, 2021, the initial
11reimbursement rate for the service or provider shall be based
12upon a weighted average of provider rates for similar services.
136. a. For the fiscal year beginning July 1, 2021, the
14reimbursement rates for resource family recruitment and
15retention contractors shall be established by contract.
16b. For the fiscal year beginning July 1, 2021, the
17reimbursement rates for supervised apartment living foster care
18providers shall be established by contract.
197. For the fiscal year beginning July 1, 2021, the
20reimbursement rate for group foster care providers shall be the
21combined service and maintenance reimbursement rate established
22by contract.
238. The group foster care reimbursement rates paid for
24placement of children out of state shall be calculated
25according to the same rate-setting principles as those used for
26in-state providers, unless the director of human services or
27the director’s designee determines that appropriate care cannot
28be provided within the state. The payment of the daily rate
29shall be based on the number of days in the calendar month in
30which service is provided.
319. a. For the fiscal year beginning July 1, 2021, the
32reimbursement rate paid for shelter care and the child welfare
33emergency services implemented to provide or prevent the need
34for shelter care shall be established by contract.
35b. For the fiscal year beginning July 1, 2021, the combined
-60-1service and maintenance components of the reimbursement rate
2paid for shelter care services shall be based on the financial
3and statistical report submitted to the department. The
4maximum reimbursement rate shall be $101.83 per day. The
5department shall reimburse a shelter care provider at the
6provider’s actual and allowable unit cost, plus inflation, not
7to exceed the maximum reimbursement rate.
8c. Notwithstanding section 232.141, subsection 8, for the
9fiscal year beginning July 1, 2021, the amount of the statewide
10average of the actual and allowable rates for reimbursement of
11juvenile shelter care homes that is utilized for the limitation
12on recovery of unpaid costs shall remain at the amount in
13effect for this purpose in the fiscal year beginning July 1,
142020.
1510. For the fiscal year beginning July 1, 2021, the
16department shall calculate reimbursement rates for intermediate
17care facilities for persons with an intellectual disability
18at the 80th percentile. Beginning July 1, 2021, the rate
19calculation methodology shall utilize the consumer price index
20inflation factor applicable to the fiscal year beginning July
211, 2021.
2211. Effective July 1, 2021, the department of human services
23shall set the reimbursement rate of child care providers whose
24reimbursement rates are below the fiftieth percentile of the
25most recent market rate survey at the fiftieth percentile of
26the most recent market rate survey. Reimbursement rates of
27child care providers whose reimbursement rates are at or above
28the fiftieth percentile of the most recent market rate survey
29shall remain at the rates in effect on June 30, 2021. The
30department shall also adjust quality rating system bonuses to
31reflect increased child care provider reimbursement rates as
32appropriate. The department shall set rates in a manner so as
33to provide incentives for a nonregistered provider to become
34registered by applying any increase only to registered and
35licensed providers.
-61- 112. The department may adopt emergency rules to implement
2this section.
3 Sec. 32. EMERGENCY RULES.
41. If necessary to comply with federal requirements
5including time frames, or if specifically authorized by a
6provision of this division of this Act, the department of
7human services or the mental health and disability services
8commission may adopt administrative rules under section 17A.4,
9subsection 3, and section 17A.5, subsection 2, paragraph “b”,
10to implement the provisions of this division of this Act and
11the rules shall become effective immediately upon filing or
12on a later effective date specified in the rules, unless the
13effective date of the rules is delayed or the applicability
14of the rules is suspended by the administrative rules review
15committee. Any rules adopted in accordance with this section
16shall not take effect before the rules are reviewed by the
17administrative rules review committee. The delay authority
18provided to the administrative rules review committee under
19section 17A.4, subsection 7, and section 17A.8, subsections
209 and 10, shall be applicable to a delay imposed under this
21section, notwithstanding a provision in those subsections
22making them inapplicable to section 17A.5, subsection 2,
23paragraph “b”. Any rules adopted in accordance with the
24provisions of this section shall also be published as a notice
25of intended action as provided in section 17A.4.
262. If during a fiscal year, the department of human
27services is adopting rules in accordance with this section
28or as otherwise directed or authorized by state law, and
29the rules will result in an expenditure increase beyond the
30amount anticipated in the budget process or if the expenditure
31was not addressed in the budget process for the fiscal
32year, the department shall notify the general assembly and
33the department of management concerning the rules and the
34expenditure increase. The notification shall be provided at
35least 30 calendar days prior to the date notice of the rules
-62-1is submitted to the administrative rules coordinator and the
2administrative code editor.
3 Sec. 33. REPORTS. Unless otherwise provided, any reports or
4other information required to be compiled and submitted under
5this Act during the fiscal year beginning July 1, 2021, shall
6be submitted on or before the dates specified for submission
7of the reports or information.
8 Sec. 34. EFFECTIVE UPON ENACTMENT. The following provision
9of this division of this Act, being deemed of immediate
10importance, takes effect upon enactment:
111. The provision relating to section 232.141 and directing
12the state court administrator and the division administrator of
13the department of human services division of child and family
14services to make the determination, by June 15, 2021, of the
15distribution of funds allocated for the payment of the expenses
16of court-ordered services provided to juveniles which are a
17charge upon the state.
18DIVISION VI
19HEALTH CARE ACCOUNTS AND FUNDS — FY 2021-2022
20 Sec. 35. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is
21appropriated from the pharmaceutical settlement account created
22in section 249A.33 to the department of human services for the
23fiscal year beginning July 1, 2021, and ending June 30, 2022,
24the following amount, or so much thereof as is necessary, to be
25used for the purpose designated:
26Notwithstanding any provision of law to the contrary, to
27supplement the appropriations made in this Act for health
28program operations under the medical assistance program for the
29fiscal year beginning July 1, 2021, and ending June 30, 2022:
.................................................. $30234,193
31 Sec. 36. QUALITY ASSURANCE TRUST FUND — DEPARTMENT OF HUMAN
32SERVICES. Notwithstanding any provision to the contrary and
33subject to the availability of funds, there is appropriated
34from the quality assurance trust fund created in section
35249L.4 to the department of human services for the fiscal year
-63-1beginning July 1, 2021, and ending June 30, 2022, the following
2amounts, or so much thereof as is necessary, for the purposes
3designated:
4To supplement the appropriation made in this Act from the
5general fund of the state to the department of human services
6for medical assistance for the same fiscal year:
.................................................. $756,305,139
8 Sec. 37. HOSPITAL HEALTH CARE ACCESS TRUST FUND —
9DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to
10the contrary and subject to the availability of funds, there is
11appropriated from the hospital health care access trust fund
12created in section 249M.4 to the department of human services
13for the fiscal year beginning July 1, 2021, and ending June
1430, 2022, the following amounts, or so much thereof as is
15necessary, for the purposes designated:
16To supplement the appropriation made in this Act from the
17general fund of the state to the department of human services
18for medical assistance for the same fiscal year:
.................................................. $1933,920,554
20 Sec. 38. MEDICAL ASSISTANCE PROGRAM — NONREVERSION
21FOR FY 2021-2022. Notwithstanding section 8.33, if moneys
22appropriated for purposes of the medical assistance program for
23the fiscal year beginning July 1, 2021, and ending June 30,
242022, from the general fund of the state, the quality assurance
25trust fund, and the hospital health care access trust fund, are
26in excess of actual expenditures for the medical assistance
27program and remain unencumbered or unobligated at the close
28of the fiscal year, the excess moneys shall not revert but
29shall remain available for expenditure for the purposes of the
30medical assistance program until the close of the succeeding
31fiscal year.
32DIVISION VII
33NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
34JULY 1, 2023, THROUGH JUNE 30, 2025
35 Sec. 39. NURSING FACILITY REIMBURSEMENT METHODOLOGY —
-64-1FISCAL PERIOD JULY 1, 2023, THROUGH JUNE 30, 2025.
2Notwithstanding any provision of law to the contrary, for the
3fiscal period beginning July 1, 2023, and ending June 30, 2025,
4the department of human services shall rebase case-mix nursing
5facility rates beginning July 1, 2023, using the Medicaid cost
6reports on file for the period ending December 31, 2022, and
7applying a minimum occupancy factor of 70 percent.
8DIVISION VIII
9DECATEGORIZATION CARRYOVER FUNDING
10 Sec. 40. DECATEGORIZATION CARRYOVER FUNDING FY 2019 —
11TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188,
12subsection 5, paragraph “b”, any state-appropriated moneys in
13the funding pool that remained unencumbered or unobligated
14at the close of the fiscal year beginning July 1, 2018, and
15were deemed carryover funding to remain available for the two
16succeeding fiscal years that still remain unencumbered or
17unobligated at the close of the fiscal year beginning July 1,
182020, shall not revert but shall be transferred to the medical
19assistance program for the fiscal year beginning July 1, 2021.
20 Sec. 41. EFFECTIVE DATE. This division of this Act, being
21deemed of immediate importance, takes effect upon enactment.
22 Sec. 42. RETROACTIVE APPLICABILITY. This division of this
23Act applies retroactively to July 1, 2020.
24DIVISION IX
25PRIOR APPROPRIATIONS AND OTHER PROVISIONS
26FAMILY INVESTMENT PROGRAM ACCOUNT
27 Sec. 43. 2019 Iowa Acts, chapter 85, section 9, as amended
28by 2020 Iowa Acts, chapter 1121, section 20, is amended by
29adding the following new subsection:
30 NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
31appropriated in this section that remain unencumbered or
32unobligated at the close of the fiscal year shall not revert
33but shall remain available for expenditure for the purposes
34designated, and may be transferred to other appropriations made
35in this division of this Act as necessary to carry out the
-65-1initiatives included in the report submitted on nonreversion
2of funds required pursuant to 2020 Iowa Acts, chapter 1121,
3section 43, until the close of the succeeding fiscal year.
4Child and family services
5 Sec. 44. 2019 Iowa Acts, chapter 85, section 19, as amended
6by 2020 Iowa Acts, chapter 1121, section 23, is amended by
7adding the following new subsection:
8 NEW SUBSECTION. 25. Notwithstanding section 8.33, moneys
9appropriated in this section that remain unencumbered or
10unobligated at the close of the fiscal year shall not revert
11but shall remain available for expenditure for the purpose of
12the redesign of the child welfare system, until the close of
13the succeeding fiscal year.
14FIELD OPERATIONS
15 Sec. 45. 2019 Iowa Acts, chapter 85, section 27, as amended
16by 2020 Iowa Acts, chapter 1121, section 25, is amended by
17adding the following new subsection:
18 NEW SUBSECTION. 5. Notwithstanding section 8.33, moneys
19appropriated in this section that remain unencumbered or
20unobligated at the close of the fiscal year shall not revert
21but shall remain available for expenditure for the purposes
22designated until the close of the succeeding fiscal year.
23GENERAL ADMINISTRATION
24 Sec. 46. 2019 Iowa Acts, chapter 85, section 28, as amended
25by 2020 Iowa Acts, chapter 1121, section 26, is amended by
26adding the following new subsection:
27 NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
28appropriated in this section that remain unencumbered or
29unobligated at the close of the fiscal year shall not revert
30but shall remain available for expenditure for the purposes
31designated until the close of the succeeding fiscal year.
32 Sec. 47. EFFECTIVE DATE. This division of this Act, being
33deemed of immediate importance, takes effect upon enactment.
34DIVISION X
35EXTENSION OF FUTURE REPEAL — HOSPITAL HEALTH CARE ACCESS
-66-1ASSESSMENT PROGRAM
2 Sec. 48. Section 249M.5, Code 2021, is amended to read as
3follows:
4249M.5 Future repeal.
5This chapter is repealed July 1, 2021 2023.
6 Sec. 49. EFFECTIVE DATE. This division of this Act, being
7deemed of immediate importance, takes effect upon enactment.
8DIVISION XI
9MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS
10 Sec. 50. MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER
11OF FUNDS. Notwithstanding section 331.432, a county with a
12population of over 300,000 based on the 2010 federal decennial
13census may transfer funds from any other fund of the county to
14the mental health and disability regional services fund for the
15purposes of providing mental health and disability services for
16the fiscal year beginning July 1, 2021, and ending June 30,
172022. The county shall submit a report to the governor and the
18general assembly by September 1, 2022, including the source of
19any funds transferred, the amount of the funds transferred, and
20the mental health and disability services provided with the
21transferred funds. The county shall work with the department
22to maximize the use of the medical assistance program and other
23third-party payment sources, including but not limited to
24identifying individuals enrolled with or eligible for Medicaid
25whose Medicaid-covered services are being paid by the county or
26could be converted to Medicaid-covered services.
27DIVISION XII
28TELEHEALTH — MENTAL HEALTH — REIMBURSEMENT PARITY
29 Sec. 51. Section 514C.34, subsection 1, Code 2021, is
30amended by adding the following new paragraphs:
31 NEW PARAGRAPH. 0a. “Covered person” means the same as
32defined in section 514J.102.
33 NEW PARAGRAPH. 00a. “Facility” means the same as defined in
34section 514J.102.
35 NEW PARAGRAPH. 0c. “Health carrier” means the same as
-67-1defined in section 514J.102.
2 Sec. 52. Section 514C.34, subsection 1, paragraph c, Code
32021, is amended to read as follows:
4c. “Telehealth” means the delivery of health care services
5through the use of real-time interactive audio and video, or
6other real-time interactive electronic media, regardless of
7where the health care professional and the covered person are
8each located. “Telehealth” does not include the delivery of
9health care services delivered solely through an audio-only
10telephone, electronic mail message, or facsimile transmission.
11 Sec. 53. Section 514C.34, Code 2021, is amended by adding
12the following new subsection:
13 NEW SUBSECTION. 3A. a. A health carrier shall reimburse
14a health care professional and a facility for health care
15services provided by telehealth to a covered person for a
16mental health condition, illness, injury, or disease on the
17same basis and at the same rate as the health carrier would
18apply to the same health care services for a mental health
19condition, illness, injury, or disease provided in person to a
20covered person by the health care professional or the facility.
21b. As a condition of reimbursement pursuant to paragraph
22“a”, a health carrier shall not require that an additional
23health care professional be located in the same room as a
24covered person while health care services for a mental health
25condition, illness, injury, or disease are provided via
26telehealth by another health care professional to the covered
27person.
28 Sec. 54. EFFECTIVE DATE. This division of this Act, being
29deemed of immediate importance, takes effect upon enactment.
30 Sec. 55. RETROACTIVE APPLICABILITY. This division of
31this Act applies to health care services for a mental health
32condition, illness, injury, or disease provided by a health
33care professional or a facility to a covered person by
34telehealth on or after January 1, 2021.
35DIVISION XIII
-68-1IN-PERSON SUPERVISION REQUIREMENTS FOR LICENSURE — CERTAIN
2PROFESSIONALS
3 Sec. 56. Section 154C.3, subsection 1, paragraph c,
4subparagraph (5), subparagraph division (a), Code 2021, is
5amended by adding the following new subparagraph subdivision:
6 NEW SUBPARAGRAPH SUBDIVISION. (0ii) By a person licensed
7under section 154D.2 to practice marital and family therapy
8without supervision or mental health counseling without
9supervision.
10 Sec. 57. Section 154C.3, Code 2021, is amended by adding the
11following new subsection:
12 NEW SUBSECTION. 4. Supervision. The board shall not, by
13rule or other means, require that supervision be completed
14in-person as a condition for an applicant to receive a license,
15a reciprocal license, or a renewed license under this chapter.
16 Sec. 58. Section 154D.2, Code 2021, is amended to read as
17follows:
18154D.2 Licensure — marital and family therapy — mental
19health counseling.
201. An applicant for a license to practice marital and family
21therapy or mental health counseling shall be granted a license
22by the board when the applicant satisfies all of the following
23requirements:
241. a. Possesses a master’s degree in marital and family
25therapy or mental health counseling, as applicable, consisting
26of at least sixty semester hours, or its equivalent, from a
27nationally accredited institution or from a program approved
28by the board.
292. b. Has at least two years of supervised clinical
30experience or its equivalent as approved by the board.
31Standards for supervision, including the required
32qualifications for supervisors, shall be determined pursuant
33to the requirements in subsection 2 and by the board by rule,
34provided that a supervisor may be a person licensed under this
35section to practice marital and family therapy or mental health
-69-1counseling without supervision or a licensed independent social
2worker licensed under chapter 154C.
33. c. Passes an examination approved by the board.
42. The board shall not, by rule or other means, require any
5in-person supervised clinical experience.
6 Sec. 59. Section 154D.4, subsection 2, paragraph b, Code
72021, is amended to read as follows:
8b. A person who practices marital and family therapy or
9mental health counseling under the supervision of a person
10licensed under this chapter as part of a clinical experience as
11described in section 154D.2, subsection 2 1, paragraph “b”.
12 Sec. 60. BOARD OF SOCIAL WORK AND BOARD OF BEHAVIORAL
13SCIENCE — RULES. The board of social work and the board
14of behavioral science shall amend their administrative
15rules pursuant to chapter 17A to remove any requirement for
16supervised clinical experience and supervised professional
17practice to be completed in-person as a condition for the
18licensure of marital and family therapists, mental health
19counselors, and social workers pursuant to chapters 154C and
20154D. The board of social work and the board of behavioral
21science shall replace all licensing requirements for in-person
22supervision with the ability to have supervision requirements
23completed electronically.
24 Sec. 61. EMERGENCY RULES.
251. The board of social work and the board of behavioral
26science shall adopt emergency rules under section 17A.4,
27subsection 3, and section 17A.5, subsection 2, to implement
28the sections of this division of this Act amending section
29154C.3 and section 154D.2, and the rules shall be effective
30immediately upon filing unless a later date is specified in the
31rules. Any emergency rules adopted in accordance with this
32section shall also be published as a notice of intended action
33as provided in section 17A.4, subsection 1.
342. The board of social work and the board of behavioral
35science shall jointly develop rules adopted pursuant to this
-70-1subsection through a collaborative process. The respective
2boards may establish subcommittees or designate other personnel
3to facilitate such a process. Such rules shall consist of
4substantively identical standards applicable to the professions
5regulated by the respective boards and shall, to the greatest
6extent possible, consist of substantially similar language
7in a substantially similar format. Prior to a vote to adopt
8such rules by either board, each board shall, by a separate
9vote, approve the language to be adopted by the other board.
10Neither board shall vote to adopt such rules until the rules
11to be adopted by both boards have been so approved. Such rules
12shall have the same effective date and shall be submitted to
13the administrative rules coordinator and the administrative
14code editor for publication in the same issue of the Iowa
15administrative bulletin pursuant to sections 17A.4 and 17A.5.
16 Sec. 62. EFFECTIVE DATE. This division of this Act, being
17deemed of immediate importance, takes effect upon enactment.
18DIVISION XIV
19CHILD CARE ASSISTANCE — ELIGIBILITY PHASE-OUT
20 Sec. 63. NEW SECTION. 237A.14 Child care assistance —
21graduated eligibility phase-out.
221. At the time of a twelve-month eligibility
23redetermination for a family receiving state child care
24assistance, the family shall remain eligible to receive
25child care assistance, subject to the graduated eligibility
26phase-out program as specified in subsection 2, if either of
27the following conditions are met:
28a. The family’s nonexempt gross monthly income is determined
29to be at least two hundred twenty-five percent but less
30than two hundred fifty percent of the federal poverty level
31applicable to the family size for children needing basic care.
32b. The family’s nonexempt gross monthly income is determined
33to be at least two hundred twenty-five percent but less than
34two hundred seventy-five percent of the federal poverty level
35applicable to the family size for children needing special
-71-1needs care.
22. a. A family with an income at the following percentages
3of the federal poverty level applicable to the family size
4for children needing basic care shall be responsible for the
5following share of child care costs:
6(1) A family with an income above two hundred twenty-five
7percent of the federal poverty level but less than two hundred
8thirty-five percent of the federal poverty level shall pay for
9thirty-three percent of the family child care costs.
10(2) A family with an income at or above two hundred
11thirty-five percent of the federal poverty level but less than
12two hundred forty-five percent of the federal poverty level
13shall pay for forty-five percent of the family child care
14costs.
15(3) A family with an income at or above two hundred
16forty-five percent of the federal poverty level but at or less
17than two hundred fifty percent of the federal poverty level
18shall pay for sixty percent of the family child care costs.
19b. A family with an income at the following percentages of
20the federal poverty level applicable to the family size for
21children needing special needs care shall be responsible for
22the following share of child care costs:
23(1) A family with an income above two hundred twenty-five
24percent of the federal poverty level but less than two hundred
25forty-five percent of the federal poverty level shall pay for
26thirty-three percent of the family child care costs.
27(2) A family with an income at or above two hundred
28forty-five percent of the federal poverty level but less than
29two hundred sixty-five percent of the federal poverty level
30shall pay for forty-five percent of the family child care
31costs.
32(3) A family with an income at or above two hundred
33sixty-five percent of the federal poverty level but at or less
34than two hundred seventy-five percent of the federal poverty
35level shall pay for sixty percent of the family child care
-72-1costs.
2c. The graduated eligibility phase-out as provided in
3paragraphs “a” and “b” shall be implemented no later than July
41, 2022.
53. Child care provider reimbursement rates under the
6graduated eligibility phase-out program shall be the same rates
7as the child care provider reimbursement rates.
84. The department of human services shall adopt rules
9pursuant to chapter 17A in accordance with this section.
10DIVISION XV
11MEDICAL RESIDENCY LIABILITY COSTS
12 Sec. 64. Section 135.176, subsection 1, Code 2021, is
13amended by adding the following new paragraph:
14 NEW PARAGRAPH. d. For the period beginning July 1, 2021,
15and ending June 30, 2026, the payment by the sponsor of medical
16residency program liability costs subject to provision by the
17sponsor of dollar-for-dollar matching funds used for payment
18of such costs. This paragraph shall not apply to medical
19residency programs to which chapter 669 applies.
20 Sec. 65. Section 135.176, subsection 2, paragraphs e and f,
21Code 2021, are amended to read as follows:
22e. The maximum award of grant funds to a particular
23individual sponsor per year. An individual sponsor that
24establishes a new or alternative campus accredited medical
25residency training program as defined in subsection 1,
26paragraph “a”, shall not receive more than fifty percent
27of the state matching funds available each year to support
28the program. An individual sponsor proposing the provision
29of a new residency position within an existing accredited
30medical residency or fellowship training program as specified
31in subsection 1, paragraph “b”, or the funding of residency
32positions which are in excess of the federal residency cap as
33defined in subsection 1, paragraph “c”, or the funding of the
34payment by the sponsor of medical residency program liability
35costs subject to provision by the sponsor of dollar-for-dollar
-73-1matching funds used for payment of such costs as specified
2in subsection 1, paragraph “d”, shall not receive more than
3twenty-five percent of the state matching funds available each
4year to support the program.
5f. Use of the funds awarded. Funds may be used to pay the
6costs of establishing, expanding, or supporting an accredited
7graduate medical education program as specified in this
8section, including but not limited to the costs associated
9with residency stipends and physician faculty stipends. For
10the period beginning July 1, 2021, and ending June 30, 2026,
11use of the funds awarded may include payment by the sponsor of
12medical residency program liability costs in accordance with
13subsection 1, paragraph “d”, and subject to provision by the
14sponsor of dollar-for-dollar matching funds used for payment
15of such costs.
16DIVISION XVI
17PUBLIC HEALTH EMERGENCY PROVISIONS
18COVID-19 REGULATIONS
19 Sec. 66. COVID-19 FEDERAL REGULATIONS. For the time
20period beginning on the effective date of this division of
21this Act, and ending June 30, 2022, notwithstanding state
22administrative rules to the contrary, to the extent federal
23regulations relating to the COVID-19 pandemic differ from state
24administrative rules, including applicable federal waivers,
25the federal regulations are controlling during the pendency of
26the federally declared state of emergency and for such period
27of time following the end of the federally declared state of
28emergency applicable to the respective federal regulations.
29DIVISION XVII
30REPORT ON NONREVERSION OF FUNDS
31 Sec. 67. REPORT ON NONREVERSION OF FUNDS. The department
32of human services shall report the expenditure of any moneys
33for which nonreversion authorization was provided for the
34fiscal year beginning July 1, 2020, and ending June 30, 2021,
35for field operations or general administration to the general
-74-1assembly on a quarterly basis beginning October 1, 2021.
2DIVISION XVIII
3FOSTER HOME INSURANCE FUND
4 Sec. 68. Section 237.13, subsection 2, Code 2021, is amended
5to read as follows:
62. The foster home insurance fund shall be administered by
7the department of human services. The fund shall consist of
8all moneys appropriated by the general assembly for deposit
9in the fund. The department shall use moneys in the fund to
10provide home and property coverage for foster parents to cover
11damages to property resulting from the actions of a foster
12child residing in a foster home or to reimburse foster parents
13for the cost of purchasing foster care liability insurance and
14to perform the administrative functions necessary to carry out
15this section. The department may establish limitations of
16liability for individual claims as deemed reasonable by the
17department.
18EXPLANATION
19The inclusion of this explanation does not constitute agreement with
20the explanation’s substance by the members of the general assembly.
21This bill relates to appropriations for health and human
22services for fiscal year 2021-2022 to the department of
23veterans affairs, Iowa veterans home, department on aging
24(IDA), office of long-term care ombudsman, department of public
25health (DPH), Iowa finance authority, department of human
26rights, and department of human services (DHS). The bill is
27organized into divisions for each fiscal year.
28DEPARTMENT ON AGING. This division makes appropriations
29from the general fund of the state to the department on aging.
30OFFICE OF LONG-TERM CARE OMBUDSMAN. This division makes
31appropriations from the general fund of the state to the office
32of long-term care ombudsman.
33DEPARTMENT OF PUBLIC HEALTH. This division makes
34appropriations from the general fund of the state and from
35the sports wagering receipts fund to the department of public
-75-1health.
2DEPARTMENT OF VETERANS AFFAIRS AND IOWA VETERANS HOME. This
3division makes appropriations from the general fund of the
4state to the department of veterans affairs for administration,
5the Iowa veterans home, for transfer to the Iowa finance
6authority for the home ownership assistance program and for the
7county commissions of veteran affairs.
8DEPARTMENT OF HUMAN SERVICES. This division makes
9appropriations from the general fund of the state and the
10federal temporary assistance for needy families block
11grant to DHS. The allocation for the family development
12and self-sufficiency grant program is made directly to
13the department of human rights. The reimbursement section
14addresses reimbursement for providers reimbursed by the
15department of human services.
16HEALTH CARE ACCOUNTS AND FUNDS. This division makes certain
17health-related appropriations. A number of the appropriations
18are made for purposes of the Medicaid program in addition to
19the general fund appropriations made for this purpose for the
20same fiscal year.
21NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
22JULY 1, 2023, THROUGH JUNE 30, 2025. This division provides
23that notwithstanding any provision of law to the contrary,
24for the fiscal period beginning July 1, 2023, and ending June
2530, 2025, DHS shall rebase case-mix nursing facility rates
26beginning July 1, 2023, using the Medicaid cost reports on file
27for the period ending December 31, 2022, and applying a minimum
28occupancy factor of 70 percent.
29DECATEGORIZATION CARRYOVER FUNDING. This division provides
30for the transfer of carryover decategorization funds that
31remained unencumbered or unobligated at the close of the fiscal
32year beginning July 1, 2020, to the Medicaid program for
33FY 2021-2022. The division takes effect upon enactment and is
34retroactively applicable to July 1, 2020.
35PRIOR APPROPRIATIONS AND OTHER PROVISIONS. This division
-76-1provides that funds appropriated to the department of human
2services and credited to the family investment program account
3that remain unencumbered or unobligated at the close of FY
42020-2021 shall not revert but shall remain available for
5expenditure for the purposes designated, and may be transferred
6to other appropriations as necessary to carry out the
7initiatives included in the report submitted on nonreversion
8of funds required pursuant to 2020 Iowa Acts, chapter 1121,
9section 43, until the close of the succeeding fiscal year.
10The division provides that funds appropriated to the
11department of human services for child and family services that
12remain unencumbered or unobligated at the close of FY 2020-2021
13shall not revert but shall remain available for expenditure for
14the purpose of the redesign of the child welfare system, until
15the close of the succeeding fiscal year.
16The division also provides that funds appropriated to the
17department of human services for field operations and general
18administration that remain unencumbered or unobligated at
19the close of FY 2020-2021 shall not revert but shall remain
20available for expenditure for the purposes designated until the
21close of the succeeding fiscal year.
22The division takes effect upon enactment.
23EXTENSION OF REPEAL FOR HOSPITAL HEALTH CARE ACCESS
24ASSESSMENT PROGRAM. This division extends the repeal of
25the hospital health care access assessment program chapter,
26Code chapter 249M, from July 1, 2021, to July 1, 2023. This
27provision takes effect upon enactment.
28MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS.
29 The division authorizes a county with a population of over
30300,000 to transfer funds from any other fund of the county to
31the mental health and disability regional services fund for the
32purposes of providing mental health and disability services for
33the fiscal year beginning July 1, 2021, and ending June 30,
342022.
35TELEHEALTH — MENTAL HEALTH — REIMBURSEMENT PARITY. This
-77-1division requires a health carrier to reimburse a health care
2professional or a facility for health care services for a
3mental health condition, illness, injury, or disease provided
4to a covered person via telehealth on the same basis and at the
5same rate as the health carrier would apply to the same health
6care services provided to the covered person by the health care
7professional or facility in person.
8The division takes effect upon enactment and applies
9retroactively to health care services for a mental health
10condition, illness, injury, or disease provided to a covered
11person via telehealth on or after January 1, 2021.
12IN-PERSON SUPERVISION REQUIREMENTS. This division relates
13to supervision requirements for licensed marital and family
14therapists, mental health counselors, and social workers. The
15division takes effect upon enactment.
16CHILD CARE ELIGIBILITY PHASE-OUT. This division establishes
17a graduated eligibility phase-out program for state child care
18assistance.
19MEDICAL RESIDENCY LIABILITY COSTS. This division provides
20for the use of medical residency training state matching
21grants program funds toward payment by the sponsor of program
22liability costs subject to provision of dollar-for-dollar
23matching funds.
24PUBLIC HEALTH EMERGENCY PROVISIONS. This division provides
25that for the time period beginning on the effective date of
26the bill, and ending June 30, 2022, notwithstanding state
27administrative rules to the contrary, to the extent federal
28regulations relating to the COVID-19 pandemic differ from state
29administrative rules, including applicable federal waivers,
30the federal regulations are controlling during the pendency of
31the federally declared state of emergency and for such period
32of time following the end of the federally declared state of
33emergency applicable to the respective federal regulations.
34REPORT ON NONREVERSION OF FUNDS. This division requires the
35department of human services to report the expenditure of any
-78-1moneys for which nonreversion authorization was provided for
2FY 2021-2022 for field operations or general administration to
3the general assembly on a quarterly basis beginning October 1,
42021.
5FOSTER HOME INSURANCE FUND. This division amends the foster
6home insurance fund provisions under Code section 237.13 to
7authorize the department of human services to use the moneys in
8the fund, in addition to the current authorization to reimburse
9foster parents for the cost of purchasing foster care liability
10insurance, to provide home and property coverage for foster
11parents to cover damages to property resulting from actions
12of a foster child residing in a foster home. The division
13also authorizes the department of human services to establish
14limitations of liability for individual claims as deemed
15reasonable by the department of human services.
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