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House File 891 - EnrolledAn Actrelating to appropriations for health and human
services and veterans and including other related provisions
and appropriations, providing penalties, and including
effective date and retroactive and other applicability date
provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I
DEPARTMENT ON AGING — FY 2021-2022
Section 1. DEPARTMENT ON AGING. There is appropriated from
the general fund of the state to the department on aging for
the fiscal year beginning July 1, 2021, and ending June 30,
2022, the following amount, or so much thereof as is necessary,
to be used for the purposes designated:
For aging programs for the department on aging and area
agencies on aging to provide citizens of Iowa who are 60
years of age and older with case management, Iowa’s aging and
disabilities resource center, and other services which may
include but are not limited to adult day, respite care, chore,
information and assistance, and material aid, for information
and options counseling for persons with disabilities who
are 18 years of age or older, and for salaries, support,
administration, maintenance, and miscellaneous purposes, and
for not more than the following full-time equivalent positions:
.................................................. $11,304,082
............................................... FTEs27.00
1. Funds appropriated in this section may be used to
supplement federal funds under federal regulations. To
receive funds appropriated in this section, a local area
agency on aging shall match the funds with moneys from other
sources according to rules adopted by the department. Funds
appropriated in this section may be used for elderly services
not specifically enumerated in this section only if approved
by an area agency on aging for provision of the service within
the area.
2. Of the funds appropriated in this section, $418,700 is
transferred to the economic development authority for the Iowa
commission on volunteer services to be used for the retired and
senior volunteer program.
3. a. The department on aging shall establish and enforce
procedures relating to expenditure of state and federal funds
by area agencies on aging that require compliance with both
-1-state and federal laws, rules, and regulations, including but
not limited to all of the following:
(1) Requiring that expenditures are incurred only for goods
or services received or performed prior to the end of the
fiscal period designated for use of the funds.
(2) Prohibiting prepayment for goods or services not
received or performed prior to the end of the fiscal period
designated for use of the funds.
(3) Prohibiting prepayment for goods or services not
defined specifically by good or service, time period, or
recipient.
(4) Prohibiting the establishment of accounts from which
future goods or services which are not defined specifically by
good or service, time period, or recipient, may be purchased.
b. The procedures shall provide that if any funds are
expended in a manner that is not in compliance with the
procedures and applicable federal and state laws, rules, and
regulations, and are subsequently subject to repayment, the
area agency on aging expending such funds in contravention of
such procedures, laws, rules and regulations, not the state,
shall be liable for such repayment.
4. Of the funds appropriated in this section, at least
$600,000 shall be used to fund home and community-based
services through the area agencies on aging that enable older
individuals to avoid more costly utilization of residential or
institutional services and remain in their own homes.
5. Of the funds appropriated in this section, $812,000 shall
be used for the purposes of chapter 231E and to administer
the prevention of elder abuse, neglect, and exploitation
program pursuant to section 231.56A, in accordance with the
requirements of the federal Older Americans Act of 1965, 42
U.S.C.§3001 et seq., as amended.
6. Of the funds appropriated in this section, $1,000,000
shall be used to fund continuation of the aging and disability
resource center lifelong links to provide individuals and
-2-caregivers with information and services to plan for and
maintain independence.
7. Of the funds appropriated in this section, $250,000
shall be used by the department on aging, in collaboration with
the department of human services and affected stakeholders,
to continue to expand the pilot initiative to provide
long-term care options counseling utilizing support planning
protocols, to assist non-Medicaid eligible consumers who
indicate a preference to return to the community and are
deemed appropriate for discharge, to return to their community
following a nursing facility stay. The department on aging
shall submit a report regarding the outcomes of the pilot
initiative to the governor and the general assembly by December
15, 2021.
DIVISION II
OFFICE OF LONG-TERM CARE oMBUDSMAN — FY 2021-2022
Sec. 2. OFFICE OF LONG-TERM CARE OMBUDSMAN. There is
appropriated from the general fund of the state to the office
of long-term care ombudsman for the fiscal year beginning July
1, 2021, and ending June 30, 2022, the following amount, or
so much thereof as is necessary, to be used for the purposes
designated:
For salaries, support, administration, maintenance, and
miscellaneous purposes, and for not more than the following
full-time equivalent positions:
.................................................. $1,149,821
............................................... FTEs16.00
DIVISION III
DEPARTMENT OF PUBLIC HEALTH — FY 2021-2022
Sec. 3. DEPARTMENT OF PUBLIC HEALTH. There is appropriated
from the general fund of the state to the department of public
health for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amounts, or so much thereof as is
necessary, to be used for the purposes designated:
1. ADDICTIVE DISORDERS
-3- For reducing the prevalence of the use of tobacco, alcohol,
and other drugs, and treating individuals affected by addictive
behaviors, including gambling, and for not more than the
following full-time equivalent positions:
.................................................. $23,659,379
............................................... FTEs12.00
a. (1) Of the funds appropriated in this subsection,
$4,020,894 shall be used for the tobacco use prevention
and control initiative, including efforts at the state and
local levels, as provided in chapter 142A. The commission
on tobacco use prevention and control established pursuant
to section 142A.3 shall advise the director of public health
in prioritizing funding needs and the allocation of moneys
appropriated for the programs and initiatives. Activities
of the programs and initiatives shall be in alignment with
the United States centers for disease control and prevention
best practices for comprehensive tobacco control programs
that include the goals of preventing youth initiation of
tobacco usage, reducing exposure to secondhand smoke, and
promotion of tobacco cessation. To maximize resources,
the department shall determine if third-party sources are
available to instead provide nicotine replacement products
to an applicant prior to provision of such products to an
applicant under the initiative. The department shall track and
report to the governor and the general assembly any reduction
in the provision of nicotine replacement products realized
by the initiative through implementation of the prerequisite
screening.
(2) (a) The department shall collaborate with the
alcoholic beverages division of the department of commerce for
enforcement of tobacco laws, regulations, and ordinances and to
engage in tobacco control activities approved by the division
of tobacco use prevention and control of the department of
public health as specified in the memorandum of understanding
entered into between the divisions.
-4- (b) For the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the terms of the memorandum of understanding,
entered into between the division of tobacco use prevention
and control of the department of public health and the
alcoholic beverages division of the department of commerce,
governing compliance checks conducted to ensure licensed retail
tobacco outlet conformity with tobacco laws, regulations, and
ordinances relating to persons under 21 years of age, shall
continue to restrict the number of such checks to one check per
retail outlet, and one additional check for any retail outlet
found to be in violation during the first check.
b. (1) Of the funds appropriated in this subsection,
$19,638,485 shall be used for problem gambling and
substance-related disorder prevention, treatment, and recovery
services, including a 24-hour helpline, public information
resources, professional training, youth prevention, and program
evaluation.
(2) Of the amount allocated under this paragraph, $306,000
shall be utilized by the department of public health, in
collaboration with the department of human services, to
maintain a single statewide 24-hour crisis hotline for the Iowa
children’s behavioral health system that incorporates warmline
services which may be provided through expansion of existing
capabilities maintained by the department of public health as
required pursuant to 2018 Iowa Acts, chapter 1056, section 16.
c. The requirement of section 123.17, subsection 5, is met
by the appropriations and allocations made in this division of
this Act for purposes of substance-related disorder treatment
and addictive disorders for the fiscal year beginning July 1,
2021.
2. HEALTHY CHILDREN AND FAMILIES
For promoting the optimum health status for children and
adolescents from birth through 21 years of age, and families,
and for not more than the following full-time equivalent
positions:
-5-.................................................. $5,816,681
............................................... FTEs14.00
a. Of the funds appropriated in this subsection, not more
than $734,000 shall be used for the healthy opportunities for
parents to experience success (HOPES)-healthy families Iowa
(HFI) program established pursuant to section 135.106.
b. In order to implement the legislative intent stated
in sections 135.106 and 256I.9, priority for home visitation
program funding shall be given to programs using evidence-based
or promising models for home visitation.
c. Of the funds appropriated in this subsection, $3,075,000
shall be used for continuation of the department’s initiative
to provide for adequate developmental surveillance and
screening during a child’s first five years. The funds shall
be used first to fully fund the current sites to ensure that
the sites are fully operational, with the remaining funds
to be used for expansion to additional sites. The full
implementation and expansion shall include enhancing the scope
of the initiative through collaboration with the child health
specialty clinics to promote healthy child development through
early identification and response to both biomedical and social
determinants of healthy development; by monitoring child
health metrics to inform practice, document long-term health
impacts and savings, and provide for continuous improvement
through training, education, and evaluation; and by providing
for practitioner consultation particularly for children with
behavioral conditions and needs. The department of public
health shall also collaborate with the Iowa Medicaid enterprise
and the child health specialty clinics to integrate the
activities of the first five initiative into the establishment
of patient-centered medical homes, community utilities,
accountable care organizations, and other integrated care
models developed to improve health quality and population
health while reducing health care costs. To the maximum extent
possible, funding allocated in this paragraph shall be utilized
-6-as matching funds for medical assistance program reimbursement.
d. Of the funds appropriated in this subsection, $64,000
shall be distributed to a statewide dental carrier to provide
funds to continue the donated dental services program patterned
after the projects developed by the dental lifeline network to
provide dental services to indigent individuals who are elderly
or with disabilities.
e. Of the funds appropriated in this subsection, $156,000
shall be used to provide audiological services and hearing aids
for children.
f. Of the funds appropriated in this subsection, $23,000 is
transferred to the university of Iowa college of dentistry for
provision of primary dental services to children. State funds
shall be matched on a dollar-for-dollar basis. The university
of Iowa college of dentistry shall coordinate efforts with the
department of public health, oral and health delivery system
bureau, to provide dental care to underserved populations
throughout the state.
g. Of the funds appropriated in this subsection, $50,000
shall be used to address youth suicide prevention.
h. Of the funds appropriated in this subsection, $40,000
shall be used to support the Iowa effort to address the survey
of children who experience adverse childhood experiences known
as ACEs.
i. Of the funds appropriated in this subsection, up to
$494,000 shall be used for childhood obesity prevention.
3. CHRONIC CONDITIONS
For serving individuals identified as having chronic
conditions or special health care needs, and for not more than
the following full-time equivalent positions:
.................................................. $4,258,373
............................................... FTEs10.00
a. Of the funds appropriated in this subsection, $188,000
shall be used for grants to individual patients who have an
inherited metabolic disorder to assist with the costs of
-7-medically necessary foods and formula.
b. Of the funds appropriated in this subsection, $1,055,000
shall be used for the brain injury services program pursuant
to section 135.22B, including $861,000 for contracting with an
existing nationally affiliated and statewide organization whose
purpose is to educate, serve, and support Iowans with brain
injury and their families, for resource facilitator services
in accordance with section 135.22B, subsection 9, and for
contracting to enhance brain injury training and recruitment
of service providers on a statewide basis. Of the amount
allocated in this paragraph, $95,000 shall be used to fund
1.00 full-time equivalent position to serve as the state brain
injury services program manager.
c. Of the funds appropriated in this subsection, $144,000
shall be used for the public purpose of continuing to contract
with an existing nationally affiliated organization to provide
education, client-centered programs, and client and family
support for people living with epilepsy and their families.
The amount allocated in this paragraph in excess of $50,000
shall be matched dollar-for-dollar by the organization
specified. Funds allocated under this paragraph shall be
distributed in their entirety for the purpose specified on July
1, 2021.
d. Of the funds appropriated in this subsection, $809,000
shall be used for child health specialty clinics.
e. Of the funds appropriated in this subsection, $384,000
shall be used by the regional autism assistance program
established pursuant to section 256.35, and administered by
the child health specialty clinic located at the university of
Iowa hospitals and clinics. The funds shall be used to enhance
interagency collaboration and coordination of educational,
medical, and other human services for persons with autism,
their families, and providers of services, including delivering
regionalized services of care coordination, family navigation,
and integration of services through the statewide system of
-8-regional child health specialty clinics and fulfilling other
requirements as specified in chapter 225D. The university of
Iowa shall not receive funds allocated under this paragraph for
indirect costs associated with the regional autism assistance
program.
f. Of the funds appropriated in this subsection, $577,000
shall be used for the comprehensive cancer control program to
reduce the burden of cancer in Iowa through prevention, early
detection, effective treatment, and ensuring quality of life.
Of the funds allocated in this paragraph “f”, $150,000 shall
be used to support a melanoma research symposium, a melanoma
biorepository and registry, basic and translational melanoma
research, and clinical trials.
g. Of the funds appropriated in this subsection, $97,000
shall be used for cervical and colon cancer screening, and
$177,000 shall be used to enhance the capacity of the cervical
cancer screening program to include provision of recommended
prevention and early detection measures to a broader range of
low-income women.
h. Of the funds appropriated in this subsection, $506,000
shall be used for the center for congenital and inherited
disorders.
4. COMMUNITY CAPACITY
For strengthening the health care delivery system at the
local level, and for not more than the following full-time
equivalent positions:
.................................................. $7,319,306
............................................... FTEs13.00
a. Of the funds appropriated in this subsection, $95,000
is allocated for continuation of the child vision screening
program implemented through the university of Iowa hospitals
and clinics in collaboration with early childhood Iowa areas.
The program shall submit a report to the department regarding
the use of funds allocated under this paragraph “a”. The
report shall include the objectives and results for the
-9-program year including the target population and how the funds
allocated assisted the program in meeting the objectives; the
number, age, and location within the state of individuals
served; the type of services provided to the individuals
served; the distribution of funds based on service provided;
and the continuing needs of the program.
b. Of the funds appropriated in this subsection,
$48,000 shall be used for a grant to a statewide association
of psychologists, that is affiliated with the American
psychological association, to be used for continuation of a
program to rotate intern psychologists in placements that
serve urban and rural mental health professional shortage
areas. Once an intern psychologist begins service, the intern
psychologist may continue serving in the location of the intern
psychologist’s placement, notwithstanding any change in the
mental health professional shortage area designation of such
location. The intern psychologist may also provide services
via telehealth, to underserved populations, and to Medicaid
members. For the purposes of this paragraph “b”, “mental
health professional shortage area” means a geographic area
in this state that has been designated by the United States
department of health and human services, health resources and
services administration, bureau of health professionals, as
having a shortage of mental health professionals.
c. Of the funds appropriated in this subsection, the
following amounts are allocated to be used as follows
to support the goals of increased access, health system
integration, and engagement:
(1) Not less than $1,600,000 is allocated to the Iowa
prescription drug corporation for continuation of the
pharmaceutical infrastructure for safety net providers as
described in 2007 Iowa Acts, chapter 218, section 108, and for
the prescription drug donation repository program created in
chapter 135M. Of the amount allocated in this subparagraph,
$1,000,000 shall be used as one-time funding to support
-10-program expansion and to implement an automated multi-dose
prescription packaging system. Funds allocated under this
subparagraph shall be distributed in their entirety for the
purpose specified on July 1, 2021.
(2) Not less than $334,000 is allocated to free clinics and
free clinics of Iowa for necessary infrastructure, statewide
coordination, provider recruitment, service delivery, and
provision of assistance to patients in securing a medical home
inclusive of oral health care. Funds allocated under this
subparagraph shall be distributed in their entirety for the
purpose specified on July 1, 2021.
(3) Not less than $25,000 is allocated to the Iowa
association of rural health clinics for necessary
infrastructure and service delivery transformation. Funds
allocated under this subparagraph shall be distributed in their
entirety for the purpose specified on July 1, 2021.
(4) Not less than $225,000 is allocated to the Polk county
medical society for continuation of the safety net provider
patient access to specialty health care initiative as described
in 2007 Iowa Acts, chapter 218, section 109. Funds allocated
under this subparagraph shall be distributed in their entirety
for the purpose specified on July 1, 2021.
d. Of the funds appropriated in this subsection, $191,000
is allocated for the purposes of health care and public health
workforce initiatives.
e. Of the funds appropriated in this subsection, $96,000
shall be used for a matching dental education loan repayment
program to be allocated to a dental nonprofit health service
corporation to continue to develop the criteria and implement
the loan repayment program.
f. Of the funds appropriated in this subsection, $100,000
shall be used for the purposes of the Iowa donor registry as
specified in section 142C.18.
g. Of the funds appropriated in this subsection, $96,000
shall be used for continuation of a grant to a nationally
-11-affiliated volunteer eye organization that has an established
program for children and adults and that is solely dedicated to
preserving sight and preventing blindness through education,
nationally certified vision screening and training, and
community and patient service programs. The contractor shall
submit a report to the general assembly regarding the use
of funds allocated under this paragraph “g”. The report
shall include the objectives and results for the program year
including the target population and how the funds allocated
assisted the program in meeting the objectives; the number,
age, grade level if appropriate, and location within the state
of individuals served; the type of services provided to the
individuals served; the distribution of funds based on services
provided; and the continuing needs of the program.
h. Of the funds appropriated in this subsection, $2,100,000
shall be deposited in the medical residency training account
created in section 135.175, subsection 5, paragraph “a”, and
is appropriated from the account to the department of public
health to be used for the purposes of the medical residency
training state matching grants program as specified in section
135.176.
i. Of the funds appropriated in this subsection, $250,000
shall be used for the public purpose of providing funding to
Des Moines university to continue a provider education project
to provide primary care physicians with the training and skills
necessary to recognize the signs of mental illness in patients.
j. Of the funds appropriated in this subsection, $600,000
shall be used for rural psychiatric residencies to support the
annual creation and training of four psychiatric residents who
will provide mental health services in underserved areas of
the state. Notwithstanding section 8.33, moneys that remain
unencumbered or unobligated at the close of the fiscal year
shall not revert but shall remain available for expenditure for
the purposes designated for subsequent fiscal years.
k. Of the funds appropriated in this subsection, $150,000
-12-shall be used for psychiatric training to increase access to
mental health care services by expanding the mental health
workforce via training of additional physician assistants and
nurse practitioners.
1. Of the funds appropriated in this subsection, $425,000
shall be used for the creation of a center of excellence
program to encourage innovation and collaboration among
regional health care providers in a rural area based upon the
results of a regional community needs assessment to transform
health care delivery in order to provide quality, sustainable
care that meets the needs of the local communities. An
applicant for the funds shall specify how the funds will be
expended to accomplish the goals of the program and shall
provide a detailed five-year sustainability plan prior to
being awarded any funding. Following the receipt of funding,
a recipient shall submit periodic reports as specified by the
department to the governor and the general assembly regarding
the recipient’s expenditure of the funds and progress in
accomplishing the program goals.
5. ESSENTIAL PUBLIC HEALTH SERVICES
To provide public health services that reduce risks and
invest in promoting and protecting good health over the
course of a lifetime with a priority given to older Iowans and
vulnerable populations:
.................................................. $7,662,464
6. INFECTIOUS DISEASES
For reducing the incidence and prevalence of communicable
diseases, and for not more than the following full-time
equivalent positions:
.................................................. $1,796,206
............................................... FTEs6.00
7. PUBLIC PROTECTION
For protecting the health and safety of the public through
establishing standards and enforcing regulations, and for not
more than the following full-time equivalent positions:
-13-.................................................. $4,466,601
............................................... FTEs142.00
a. Of the funds appropriated in this subsection, not more
than $304,000 shall be credited to the emergency medical
services fund created in section 135.25. Moneys in the
emergency medical services fund are appropriated to the
department to be used for the purposes of the fund.
b. Of the funds appropriated in this subsection, up
to $243,000 shall be used for sexual violence prevention
programming through a statewide organization representing
programs serving victims of sexual violence through the
department’s sexual violence prevention program, and for
continuation of a training program for sexual assault
response team (SART) members, including representatives of
law enforcement, victim advocates, prosecutors, and certified
medical personnel. The amount allocated in this paragraph “b”
shall not be used to supplant funding administered for other
sexual violence prevention or victims assistance programs.
c. Of the funds appropriated in this subsection, up to
$500,000 shall be used for the state poison control center.
Pursuant to the directive under 2014 Iowa Acts, chapter
1140, section 102, the federal matching funds available to
the state poison control center from the department of human
services under the federal Children’s Health Insurance Program
Reauthorization Act allotment shall be subject to the federal
administrative cap rule of 10 percent applicable to funding
provided under Tit.XXI of the federal Social Security Act and
included within the department’s calculations of the cap.
d. Of the funds appropriated in this subsection, up to
$504,000 shall be used for childhood lead poisoning provisions.
8. RESOURCE MANAGEMENT
For establishing and sustaining the overall ability of the
department to deliver services to the public, and for not more
than the following full-time equivalent positions:
.................................................. $933,871
-14-............................................... FTEs4.00
9. MISCELLANEOUS PROVISIONS
The university of Iowa hospitals and clinics under the
control of the state board of regents shall not receive
indirect costs from the funds appropriated in this section.
The university of Iowa hospitals and clinics billings to the
department shall be on at least a quarterly basis.
Sec. 4. DEPARTMENT OF PUBLIC HEALTH — SPORTS WAGERING
RECEIPTS FUND. There is appropriated from the sports wagering
receipts fund created in section 8.57, subsection 6, to the
department of public health for the fiscal year beginning July
1, 2021, and ending June 30, 2022, the following amount, or
so much thereof as is necessary, to be used for the purposes
designated:
For problem gambling and substance-related disorder
prevention, treatment, and recovery services, including a
24-hour helpline, public information resources, professional
training, youth prevention, and program evaluation:
.................................................. $1,750,000
DIVISION IV
DEPARTMENT OF VETERANS AFFAIRS — FY 2021-2022
Sec. 5. DEPARTMENT OF VETERANS AFFAIRS. There is
appropriated from the general fund of the state to the
department of veterans affairs for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, the following amounts,
or so much thereof as is necessary, to be used for the purposes
designated:
1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
For salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
.................................................. $1,229,763
............................................... FTEs15.00
2. IOWA VETERANS HOME
For salaries, support, maintenance, and miscellaneous
-15-purposes:
.................................................. $7,131,552
a. The Iowa veterans home billings involving the department
of human services shall be submitted to the department on at
least a monthly basis.
b. The Iowa veterans home expenditure report shall be
submitted monthly to the general assembly.
c. The Iowa veterans home shall continue to include in the
annual discharge report applicant information to provide for
the collection of demographic information including but not
limited to the number of individuals applying for admission and
admitted or denied admittance and the basis for the admission
or denial; the age, gender, and race of such individuals;
and the level of care for which such individuals applied for
admission including residential or nursing level of care.
3. HOME OWNERSHIP ASSISTANCE PROGRAM
For transfer to the Iowa finance authority for the
continuation of the home ownership assistance program for
persons who are or were eligible members of the armed forces of
the United States, pursuant to section 16.54:
.................................................. $2,000,000
Sec. 6. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS
FUND STANDING APPROPRIATIONS. Notwithstanding the standing
appropriation in section 35A.16 for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, the amount appropriated
from the general fund of the state pursuant to that section
for the following designated purposes shall not exceed the
following amount:
For the county commissions of veteran affairs fund under
section 35A.16:
.................................................. $990,000
DIVISION V
DEPARTMENT OF HUMAN SERVICES — FY 2021-2022
Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
GRANT. There is appropriated from the fund created in section
-16-8.41 to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, from moneys
received under the federal temporary assistance for needy
families (TANF) block grant pursuant to the federal Personal
Responsibility and Work Opportunity Reconciliation Act of 1996,
Pub.L.No.104-193, and successor legislation, the following
amounts, or so much thereof as is necessary, to be used for the
purposes designated:
1. To be credited to the family investment program account
and used for assistance under the family investment program
under chapter 239B:
.................................................. $5,002,006
2. To be credited to the family investment program account
and used for the job opportunities and basic skills (JOBS)
program and implementing family investment agreements in
accordance with chapter 239B:
.................................................. $5,412,060
3. To be used for the family development and
self-sufficiency grant program in accordance with section
216A.107:
.................................................. $2,888,980
Notwithstanding section 8.33, moneys appropriated in this
subsection that remain unencumbered or unobligated at the close
of the fiscal year shall not revert but shall remain available
for expenditure for the purposes designated until the close of
the succeeding fiscal year. However, unless such moneys are
encumbered or obligated on or before September 30, 2022, the
moneys shall revert.
4. For field operations:
.................................................. $31,296,232
5. For general administration:
.................................................. $3,744,000
6. For state child care assistance:
.................................................. $47,166,826
a. Of the funds appropriated in this subsection,
-17-$26,205,412 is transferred to the child care and development
block grant appropriation made by the Eighty-ninth General
Assembly, 2021 session, for the federal fiscal year beginning
October 1, 2021, and ending September 30, 2022. Of this
amount, $200,000 shall be used for provision of educational
opportunities to registered child care home providers in order
to improve services and programs offered by this category
of providers and to increase the number of providers. The
department may contract with institutions of higher education
or child care resource and referral centers to provide
the educational opportunities. Allowable administrative
costs under the contracts shall not exceed 5 percent. The
application for a grant shall not exceed two pages in length.
b. Any funds appropriated in this subsection remaining
unallocated shall be used for state child care assistance
payments for families who are employed including but not
limited to individuals enrolled in the family investment
program.
7. For child and family services:
.................................................. $32,380,654
8. For child abuse prevention grants:
.................................................. $125,000
9. For pregnancy prevention grants on the condition that
family planning services are funded:
.................................................. $1,913,203
Pregnancy prevention grants shall be awarded to programs
in existence on or before July 1, 2021, if the programs have
demonstrated positive outcomes. Grants shall be awarded to
pregnancy prevention programs which are developed after July
1, 2021, if the programs are based on existing models that
have demonstrated positive outcomes. Grants shall comply with
the requirements provided in 1997 Iowa Acts, chapter 208,
section 14, subsections 1 and 2, including the requirement that
grant programs must emphasize sexual abstinence. Priority in
the awarding of grants shall be given to programs that serve
-18-areas of the state which demonstrate the highest percentage of
unplanned pregnancies of females of childbearing age within the
geographic area to be served by the grant.
10. For technology needs and other resources necessary to
meet federal, state, and welfare reform reporting, tracking,
and case management requirements and other departmental needs:
.................................................. $1,037,186
11. a. Notwithstanding any provision to the contrary,
including but not limited to requirements in section 8.41 or
provisions in 2020 Iowa Acts or 2021 Iowa Acts regarding the
receipt and appropriation of federal block grants, federal
funds from the temporary assistance for needy families block
grant received by the state and not otherwise appropriated
in this section and remaining available for the fiscal year
beginning July 1, 2021, are appropriated to the department of
human services to the extent as may be necessary to be used in
the following priority order: the family investment program,
for state child care assistance program payments for families
who are employed, and for the family investment program share
of system costs for eligibility determination and related
functions. The federal funds appropriated in this paragraph
“a” shall be expended only after all other funds appropriated
in subsection 1 for assistance under the family investment
program, in subsection 6 for state child care assistance, or
in subsection 10 for technology costs related to the family
investment program, as applicable, have been expended. For
the purposes of this subsection, the funds appropriated in
subsection 6, paragraph “a”, for transfer to the child care
and development block grant appropriation are considered fully
expended when the full amount has been transferred.
b. The department shall, on a quarterly basis, advise the
general assembly and department of management of the amount of
funds appropriated in this subsection that was expended in the
prior quarter.
12. Of the amounts appropriated in this section,
-19-$12,962,008 for the fiscal year beginning July 1, 2021, is
transferred to the appropriation of the federal social services
block grant made to the department of human services for that
fiscal year.
13. For continuation of the program providing categorical
eligibility for the food assistance program as specified
for the program in the section of this division of this Act
relating to the family investment program account:
.................................................. $14,236
14. The department may transfer funds allocated in this
section to the appropriations made in this division of this Act
for the same fiscal year for general administration and field
operations for resources necessary to implement and operate the
services referred to in this section and those funded in the
appropriation made in this division of this Act for the same
fiscal year for the family investment program from the general
fund of the state.
15. With the exception of moneys allocated under this
section for the family development and self-sufficiency grant
program, to the extent moneys allocated in this section are
deemed by the department not to be necessary to support the
purposes for which they are allocated, such moneys may be used
in the same fiscal year for any other purpose for which funds
are allocated in this section or in section 8 of this division
of this Act for the family investment program account. If
there are conflicting needs, priority shall first be given
to the family investment program account as specified under
subsection 1 of this section and used for the purposes of
assistance under the family investment program in accordance
with chapter 239B, followed by state child care assistance
program payments for families who are employed, followed by
other priorities as specified by the department.
Sec. 8. FAMILY INVESTMENT PROGRAM ACCOUNT.
1. Moneys credited to the family investment program (FIP)
account for the fiscal year beginning July 1, 2021, and
-20-ending June 30, 2022, shall be used to provide assistance in
accordance with chapter 239B.
2. The department may use a portion of the moneys credited
to the FIP account under this section as necessary for
salaries, support, maintenance, and miscellaneous purposes.
3. The department may transfer funds allocated in
subsection 4, excluding the allocation under subsection 4,
paragraph “b”, to the appropriations made in this division of
this Act for the same fiscal year for general administration
and field operations for resources necessary to implement
and operate the services referred to in this section and
those funded in the appropriations made in section 7 for the
temporary assistance for needy families block grant and in
section 9 for the family investment program from the general
fund of the state in this division of this Act for the same
fiscal year.
4. Moneys appropriated in this division of this Act and
credited to the FIP account for the fiscal year beginning July
1, 2021, and ending June 30, 2022, are allocated as follows:
a. To be retained by the department of human services to
be used for coordinating with the department of human rights
to more effectively serve participants in FIP and other shared
clients and to meet federal reporting requirements under the
federal temporary assistance for needy families block grant:
.................................................. $10,000
b. To the department of human rights for staffing,
administration, and implementation of the family development
and self-sufficiency grant program in accordance with section
216A.107:
.................................................. $7,192,834
(1) Of the funds allocated for the family development
and self-sufficiency grant program in this paragraph “b”,
not more than 5 percent of the funds shall be used for the
administration of the grant program.
(2) The department of human rights may continue to implement
-21-the family development and self-sufficiency grant program
statewide during fiscal year 2021-2022.
(3) The department of human rights may engage in activities
to strengthen and improve family outcomes measures and
data collection systems under the family development and
self-sufficiency grant program.
c. For the diversion subaccount of the FIP account:
.................................................. $1,293,000
A portion of the moneys allocated for the diversion
subaccount may be used for field operations, salaries, data
management system development, and implementation costs and
support deemed necessary by the director of human services
in order to administer the FIP diversion program. To the
extent moneys allocated in this paragraph “c” are deemed by the
department not to be necessary to support diversion activities,
such moneys may be used for other efforts intended to increase
engagement by family investment program participants in work,
education, or training activities, or for the purposes of
assistance under the family investment program in accordance
with chapter 239B.
d. For the food assistance employment and training program:
.................................................. $66,588
(1) The department shall apply the federal supplemental
nutrition assistance program (SNAP) employment and training
state plan in order to maximize to the fullest extent permitted
by federal law the use of the 50 percent federal reimbursement
provisions for the claiming of allowable federal reimbursement
funds from the United States department of agriculture
pursuant to the federal SNAP employment and training program
for providing education, employment, and training services
for eligible food assistance program participants, including
but not limited to related dependent care and transportation
expenses.
(2) The department shall continue the categorical federal
food assistance program eligibility at 160 percent of the
-22-federal poverty level and continue to eliminate the asset test
from eligibility requirements, consistent with federal food
assistance program requirements. The department shall include
as many food assistance households as is allowed by federal
law. The eligibility provisions shall conform to all federal
requirements including requirements addressing individuals who
are incarcerated or otherwise ineligible.
e. For the JOBS program, not more than:
.................................................. $12,018,258
5. Of the child support collections assigned under FIP,
an amount equal to the federal share of support collections
shall be credited to the child support recovery appropriation
made in this division of this Act. Of the remainder of the
assigned child support collections received by the child
support recovery unit, a portion shall be credited to the FIP
account, a portion may be used to increase recoveries, and a
portion may be used to sustain cash flow in the child support
payments account. If as a consequence of the appropriations
and allocations made in this section the resulting amounts
are insufficient to sustain cash assistance payments and meet
federal maintenance of effort requirements, the department
shall seek supplemental funding. If child support collections
assigned under FIP are greater than estimated or are otherwise
determined not to be required for maintenance of effort, the
state share of either amount may be transferred to or retained
in the child support payments account.
Sec. 9. FAMILY INVESTMENT PROGRAM GENERAL FUND. There
is appropriated from the general fund of the state to the
department of human services for the fiscal year beginning July
1, 2021, and ending June 30, 2022, the following amount, or
so much thereof as is necessary, to be used for the purpose
designated:
To be credited to the family investment program (FIP)
account and used for family investment program assistance
under chapter 239B and other costs associated with providing
-23-needs-based benefits or assistance:
.................................................. $41,003,978
1. Of the funds appropriated in this section, $6,606,198 is
allocated for the JOBS program.
2. Of the funds appropriated in this section, $4,313,854 is
allocated for the family development and self-sufficiency grant
program.
3. a. Notwithstanding section 8.39, for the fiscal
year beginning July 1, 2021, if necessary to meet federal
maintenance of effort requirements or to transfer federal
temporary assistance for needy families block grant funding
to be used for purposes of the federal social services block
grant or to meet cash flow needs resulting from delays in
receiving federal funding or to implement, in accordance with
this division of this Act, activities currently funded with
juvenile court services, county, or community moneys and state
moneys used in combination with such moneys; to comply with
federal requirements; or to maximize the use of federal funds;
the department of human services may transfer funds within or
between any of the appropriations made in this division of this
Act and appropriations in law for the federal social services
block grant to the department for the following purposes,
provided that the combined amount of state and federal
temporary assistance for needy families block grant funding
for each appropriation remains the same before and after the
transfer:
(1) For the family investment program.
(2) For state child care assistance.
(3) For child and family services.
(4) For field operations.
(5) For general administration.
b. This subsection shall not be construed to prohibit the
use of existing state transfer authority for other purposes.
The department shall report any transfers made pursuant to this
subsection to the general assembly.
-24- 4. Of the funds appropriated in this section, $195,000
shall be used for a contract for tax preparation assistance
to low-income Iowans to expand the usage of the earned income
tax credit. The purpose of the contract is to supply this
assistance to underserved areas of the state. The department
shall not retain any portion of the allocation under this
subsection for administrative costs.
5. Of the funds appropriated in this section, $70,000 shall
be used for the continuation of the parenting program, as
specified in 441 IAC ch.100, relating to parental obligations,
in which the child support recovery unit participates, to
support the efforts of a nonprofit organization committed to
strengthening the community through youth development, healthy
living, and social responsibility headquartered in a county
with a population over 350,000 according to the 2010 certified
federal census. The funds allocated in this subsection shall
be used by the recipient organization to develop a larger
community effort, through public and private partnerships, to
support a broad-based multi-county parenthood initiative that
promotes payment of child support obligations, improved family
relationships, and full-time employment.
6. The department may transfer funds appropriated in this
section, excluding the allocation in subsection 2 for the
family development and self-sufficiency grant program, to the
appropriations made in this division of this Act for general
administration and field operations as necessary to administer
this section, section 7 for the temporary assistance for needy
families block grant, and section 8 for the family investment
program account.
Sec. 10. CHILD SUPPORT RECOVERY. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For child support recovery, including salaries, support,
-25-maintenance, and miscellaneous purposes, and for not more than
the following full-time equivalent positions:
.................................................. $15,942,885
............................................... FTEs459.00
1. The department shall expend up to $24,000, including
federal financial participation, for the fiscal year beginning
July 1, 2021, for a child support public awareness campaign.
The department and the office of the attorney general shall
cooperate in continuation of the campaign. The public
awareness campaign shall emphasize, through a variety of
media activities, the importance of maximum involvement of
both parents in the lives of their children as well as the
importance of payment of child support obligations.
2. Federal access and visitation grant moneys shall be
issued directly to private not-for-profit agencies that provide
services designed to increase compliance with the child access
provisions of court orders, including but not limited to
neutral visitation sites and mediation services.
3. The appropriation made to the department for child
support recovery may be used throughout the fiscal year in the
manner necessary for purposes of cash flow management, and for
cash flow management purposes the department may temporarily
draw more than the amount appropriated, provided the amount
appropriated is not exceeded at the close of the fiscal year.
Sec. 11. HEALTH CARE TRUST FUND — MEDICAL ASSISTANCE —
FY 2021-2022. Any funds remaining in the health care trust
fund created in section 453A.35A for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, are appropriated to
the department of human services to supplement the medical
assistance program appropriations made in this division of this
Act, for medical assistance reimbursement and associated costs,
including program administration and costs associated with
program implementation.
Sec. 12. MEDICAID FRAUD FUND — MEDICAL ASSISTANCE — FY
2021-2022. Any funds remaining in the Medicaid fraud fund
-26-created in section 249A.50 for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, are appropriated to
the department of human services to supplement the medical
assistance appropriations made in this division of this Act,
for medical assistance reimbursement and associated costs,
including program administration and costs associated with
program implementation.
Sec. 13. MEDICAL ASSISTANCE. There is appropriated from the
general fund of the state to the department of human services
for the fiscal year beginning July 1, 2021, and ending June 30,
2022, the following amount, or so much thereof as is necessary,
to be used for the purpose designated:
For medical assistance program reimbursement and associated
costs as specifically provided in the reimbursement
methodologies in effect on June 30, 2021, except as otherwise
expressly authorized by law, consistent with options under
federal law and regulations, and contingent upon receipt of
approval from the office of the governor of reimbursement for
each abortion performed under the program:
.................................................. $1,503,848,253
1. Iowans support reducing the number of abortions
performed in our state. Funds appropriated under this section
shall not be used for abortions, unless otherwise authorized
under this section.
2. The provisions of this section relating to abortions
shall also apply to the Iowa health and wellness plan created
pursuant to chapter 249N.
3. The department shall utilize not more than $60,000 of
the funds appropriated in this section to continue the AIDS/HIV
health insurance premium payment program as established in 1992
Iowa Acts, Second Extraordinary Session, chapter 1001, section
409, subsection 6. Of the funds allocated in this subsection,
not more than $5,000 may be expended for administrative
purposes.
4. Of the funds appropriated in this Act to the department
-27-of public health for addictive disorders, $950,000 for
the fiscal year beginning July 1, 2021, is transferred
to the department of human services for an integrated
substance-related disorder managed care system. The
departments of human services and public health shall
work together to maintain the level of mental health and
substance-related disorder treatment services provided by the
managed care contractors. Each department shall take the steps
necessary to continue the federal waivers as necessary to
maintain the level of services.
5. The department shall aggressively pursue options for
providing medical assistance or other assistance to individuals
with special needs who become ineligible to continue receiving
services under the early and periodic screening, diagnostic,
and treatment program under the medical assistance program
due to becoming 21 years of age who have been approved for
additional assistance through the department’s exception to
policy provisions, but who have health care needs in excess
of the funding available through the exception to policy
provisions.
6. Of the funds appropriated in this section, up to
$3,050,082 may be transferred to the field operations or
general administration appropriations in this division of this
Act for operational costs associated with Part D of the federal
Medicare Prescription Drug Improvement and Modernization Act
of 2003, Pub.L.No.108-173.
7. Of the funds appropriated in this section, up to $442,100
may be transferred to the appropriation in this division of
this Act for health program operations to be used for clinical
assessment services and prior authorization of services.
8. A portion of the funds appropriated in this section may
be transferred to the appropriations in this division of this
Act for general administration, health program operations, the
children’s health insurance program, or field operations to be
used for the state match cost to comply with the payment error
-28-rate measurement (PERM) program for both the medical assistance
and children’s health insurance programs as developed by the
centers for Medicare and Medicaid services of the United States
department of health and human services to comply with the
federal Improper Payments Information Act of 2002, Pub.L.
No.107-300, and to support other reviews and quality control
activities to improve the integrity of these programs.
9. Of the funds appropriated in this section, a sufficient
amount is allocated to supplement the incomes of residents of
nursing facilities, intermediate care facilities for persons
with mental illness, and intermediate care facilities for
persons with an intellectual disability, with incomes of less
than $50 in the amount necessary for the residents to receive a
personal needs allowance of $50 per month pursuant to section
249A.30A.
10. a. Hospitals that meet the conditions specified
in subparagraphs (1) and (2) shall either certify public
expenditures or transfer to the medical assistance program
an amount equal to provide the nonfederal share for a
disproportionate share hospital payment in an amount up to the
hospital-specific limit as approved in the Medicaid state plan.
The hospitals that meet the conditions specified shall receive
and retain 100 percent of the total disproportionate share
hospital payment in an amount up to the hospital-specific limit
as approved in the Medicaid state plan.
(1) The hospital qualifies for disproportionate share and
graduate medical education payments.
(2) The hospital is an Iowa state-owned hospital with more
than 500 beds and eight or more distinct residency specialty
or subspecialty programs recognized by the American college of
graduate medical education.
b. Distribution of the disproportionate share payments
shall be made on a monthly basis. The total amount of
disproportionate share payments including graduate medical
education, enhanced disproportionate share, and Iowa
-29-state-owned teaching hospital payments shall not exceed the
amount of the state’s allotment under Pub.L.No.102-234.
In addition, the total amount of all disproportionate
share payments shall not exceed the hospital-specific
disproportionate share limits under Pub.L.No.103-66.
11. One hundred percent of the nonfederal share of payments
to area education agencies that are medical assistance
providers for medical assistance-covered services provided to
medical assistance-covered children, shall be made from the
appropriation made in this section.
12. A portion of the funds appropriated in this section may
be transferred to the appropriation in this division of this
Act for health program operations to be used for administrative
activities associated with the money follows the person
demonstration project.
13. Of the funds appropriated in this section, $349,011
shall be used for the administration of the health insurance
premium payment program, including salaries, support,
maintenance, and miscellaneous purposes.
14. a. The department may increase the amounts allocated
for salaries, support, maintenance, and miscellaneous purposes
associated with the medical assistance program, as necessary,
to sustain cost management efforts. The department shall
report any such increase to the general assembly and the
department of management.
b. If the savings to the medical assistance program from
ongoing cost management efforts exceed the associated cost
for the fiscal year beginning July 1, 2021, the department
may transfer any savings generated for the fiscal year due
to medical assistance program cost management efforts to the
appropriation made in this division of this Act for health
program operations or general administration to defray the
costs associated with implementing the efforts.
15. For the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the replacement generation tax revenues required
-30-to be deposited in the property tax relief fund pursuant to
section 437A.8, subsection 4, paragraph “d”, and section
437A.15, subsection 3, paragraph “f”, shall instead be credited
to and supplement the appropriation made in this section and
used for the allocations made in this section.
16. a. Of the funds appropriated in this section, up
to $50,000 may be transferred by the department to the
appropriation made in this division of this Act to the
department for the same fiscal year for general administration
to be used for associated administrative expenses and for not
more than 1.00 full-time equivalent position, in addition to
those authorized for the same fiscal year, to be assigned to
implementing the children’s mental health home project.
b. Of the funds appropriated in this section, up to $400,000
may be transferred by the department to the appropriation made
to the department in this division of this Act for the same
fiscal year for Medicaid program-related general administration
planning and implementation activities. The funds may be used
for contracts or for personnel in addition to the amounts
appropriated for and the positions authorized for general
administration for the fiscal year.
c. Of the funds appropriated in this section, up to
$3,000,000 may be transferred by the department to the
appropriations made in this division of this Act for the
same fiscal year for general administration or health
program operations to be used to support the development
and implementation of standardized assessment tools for
persons with mental illness, an intellectual disability, a
developmental disability, or a brain injury.
17. Of the funds appropriated in this section, $150,000
shall be used for lodging expenses associated with care
provided at the university of Iowa hospitals and clinics for
patients with cancer whose travel distance is 30 miles or more
and whose income is at or below 200 percent of the federal
poverty level as defined by the most recently revised poverty
-31-income guidelines published by the United States department of
health and human services. The department of human services
shall establish the maximum number of overnight stays and the
maximum rate reimbursed for overnight lodging, which may be
based on the state employee rate established by the department
of administrative services. The funds allocated in this
subsection shall not be used as nonfederal share matching
funds.
18. Of the funds appropriated in this section, up to
$3,383,880 shall be used for administration of the state family
planning services program pursuant to section 217.41B, and
of this amount, the department may use up to $200,000 for
administrative expenses.
19. Of the funds appropriated in this section, $1,545,530
shall be used and may be transferred to other appropriations
in this division of this Act as necessary to administer the
provisions in the division of this Act relating to Medicaid
program administration.
20. The department shall comply with the centers for
Medicare and Medicaid services’ guidance related to Medicaid
program and children’s health insurance program maintenance
of effort provisions, including eligibility standards,
methodologies, procedures, and continuous enrollment, to
receive the enhanced federal medical assistance percentage
under section 6008(b) of the federal Families First Coronavirus
Response Act, Pub.L. No.116-127. The department shall
utilize and implement all tools, processes, and resources
available to expediently return to normal eligibility and
enrollment operations in compliance with federal guidance and
expectations.
21. Of the funds appropriated in this section, up to
$1,031,530 shall be used to implement reductions in the waiting
list for the children’s mental health home and community-based
services waiver.
22. Of the funds appropriated in this section, a sufficient
-32-amount is allocated to fund up to three full-time equivalent
positions to support the administrative work associated with
existing and potential supplemental payment programs.
Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purpose designated:
For health program operations:
.................................................. $17,831,343
1. The department of inspections and appeals shall
provide all state matching funds for survey and certification
activities performed by the department of inspections
and appeals. The department of human services is solely
responsible for distributing the federal matching funds for
such activities.
2. Of the funds appropriated in this section, $50,000 shall
be used for continuation of home and community-based services
waiver quality assurance programs, including the review and
streamlining of processes and policies related to oversight and
quality management to meet state and federal requirements.
3. Of the amount appropriated in this section, up to
$200,000 may be transferred to the appropriation for general
administration in this division of this Act to be used for
additional full-time equivalent positions in the development
of key health initiatives such as development and oversight
of managed care programs and development of health strategies
targeted toward improved quality and reduced costs in the
Medicaid program.
4. Of the funds appropriated in this section, $1,000,000
shall be used for planning and development, in cooperation with
the department of public health, of a phased-in program to
provide a dental home for children.
5. a. Of the funds appropriated in this section, $573,000
shall be credited to the autism support program fund created
-33-in section 225D.2 to be used for the autism support program
created in chapter 225D, with the exception of the following
amount of this allocation which shall be used as follows:
b. Of the funds allocated in this subsection, $25,000 shall
be used for the public purpose of continuation of a grant to
a nonprofit provider of child welfare services that has been
in existence for more than 115 years, is located in a county
with a population between 200,000 and 220,000 according to the
2010 federal decennial census, is licensed as a psychiatric
medical institution for children, and provides school-based
programming, to be used for support services for children with
autism spectrum disorder and their families.
Sec. 15. STATE SUPPLEMENTARY ASSISTANCE.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For the state supplementary assistance program:
.................................................. $7,349,002
2. The department shall increase the personal needs
allowance for residents of residential care facilities by the
same percentage and at the same time as federal supplemental
security income and federal social security benefits are
increased due to a recognized increase in the cost of living.
The department may adopt emergency rules to implement this
subsection.
3. If during the fiscal year beginning July 1, 2021,
the department projects that state supplementary assistance
expenditures for a calendar year will not meet the federal
pass-through requirement specified in Tit.XVI of the federal
Social Security Act, section 1618, as codified in 42 U.S.C.
§1382g, the department may take actions including but not
limited to increasing the personal needs allowance for
residential care facility residents and making programmatic
-34-adjustments or upward adjustments of the residential care
facility or in-home health-related care reimbursement rates
prescribed in this division of this Act to ensure that federal
requirements are met. In addition, the department may make
other programmatic and rate adjustments necessary to remain
within the amount appropriated in this section while ensuring
compliance with federal requirements. The department may adopt
emergency rules to implement the provisions of this subsection.
4. Notwithstanding section 8.33, moneys appropriated
in this section that remain unencumbered or unobligated
at the close of the fiscal year shall not revert but
shall remain available for expenditure for the purposes
designated, including for liability amounts associated with the
supplemental nutrition assistance program payment error rate,
until the close of the succeeding fiscal year.
Sec. 16. CHILDREN’S HEALTH INSURANCE PROGRAM.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For maintenance of the healthy and well kids in Iowa (hawk-i)
program pursuant to chapter 514I, including supplemental dental
services, for receipt of federal financial participation under
Tit.XXI of the federal Social Security Act, which creates the
children’s health insurance program:
.................................................. $37,957,643
2. Of the funds appropriated in this section, $149,189 is
allocated for continuation of the contract for outreach with
the department of public health.
3. A portion of the funds appropriated in this section may
be transferred to the appropriations made in this division of
this Act for field operations or health program operations to
be used for the integration of hawk-i program eligibility,
payment, and administrative functions under the purview of
-35-the department of human services, including for the Medicaid
management information system upgrade.
Sec. 17. CHILD CARE ASSISTANCE. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purpose designated:
For child care programs:
.................................................. $40,816,931
1. Of the funds appropriated in this section, $34,966,931
shall be used for state child care assistance in accordance
with section 237A.13.
2. Nothing in this section shall be construed or is
intended as or shall imply a grant of entitlement for services
to persons who are eligible for assistance due to an income
level consistent with the waiting list requirements of section
237A.13. Any state obligation to provide services pursuant to
this section is limited to the extent of the funds appropriated
in this section.
3. A list of the registered and licensed child care
facilities operating in the area served by a child care
resource and referral service shall be made available to the
families receiving state child care assistance in that area.
4. Of the funds appropriated in this section, $5,850,000
shall be credited to the early childhood programs grants
account in the early childhood Iowa fund created in section
256I.11. The moneys shall be distributed for funding of
community-based early childhood programs targeted to children
from birth through five years of age developed by early
childhood Iowa areas in accordance with approved community
plans as provided in section 256I.8.
5. The department may use any of the funds appropriated
in this section as a match to obtain federal funds for use in
expanding child care assistance and related programs. For
the purpose of expenditures of state and federal child care
-36-funding, funds shall be considered obligated at the time
expenditures are projected or are allocated to the department’s
service areas. Projections shall be based on current and
projected caseload growth, current and projected provider
rates, staffing requirements for eligibility determination
and management of program requirements including data systems
management, staffing requirements for administration of the
program, contractual and grant obligations and any transfers
to other state agencies, and obligations for decategorization
or innovation projects.
6. A portion of the state match for the federal child care
and development block grant shall be provided as necessary to
meet federal matching funds requirements through the state
general fund appropriation made for child development grants
and other programs for at-risk children in section 279.51.
7. If a uniform reduction ordered by the governor under
section 8.31 or other operation of law, transfer, or federal
funding reduction reduces the appropriation made in this
section for the fiscal year, the percentage reduction in the
amount paid out to or on behalf of the families participating
in the state child care assistance program shall be equal to or
less than the percentage reduction made for any other purpose
payable from the appropriation made in this section and the
federal funding relating to it. The percentage reduction to
the other allocations made in this section shall be the same as
the uniform reduction ordered by the governor or the percentage
change of the federal funding reduction, as applicable. If
there is an unanticipated increase in federal funding provided
for state child care services, the entire amount of the
increase, except as necessary to meet federal requirements
including quality set asides, shall be used for state child
care assistance payments. If the appropriations made for
purposes of the state child care assistance program for the
fiscal year are determined to be insufficient, it is the intent
of the general assembly to appropriate sufficient funding for
-37-the fiscal year in order to avoid establishment of waiting list
requirements.
8. Notwithstanding section 8.33, moneys advanced for
purposes of the programs developed by early childhood Iowa
areas, advanced for purposes of wraparound child care, or
received from the federal appropriations made for the purposes
of this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert to any fund but shall
remain available for expenditure for the purposes designated
until the close of the succeeding fiscal year.
Sec. 18. JUVENILE INSTITUTION. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amounts, or so much thereof as is
necessary, to be used for the purposes designated:
1. a. For operation of the state training school at Eldora
and for salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
.................................................. $17,397,068
............................................... FTEs207.00
b. Of the funds appropriated in this subsection, $91,000
shall be used for distribution to licensed classroom teachers
at this and other institutions under the control of the
department of human services based upon the average student
yearly enrollment at each institution as determined by the
department.
2. A portion of the moneys appropriated in this section
shall be used by the state training school at Eldora for
grants for adolescent pregnancy prevention activities at the
institution in the fiscal year beginning July 1, 2021.
3. Of the funds appropriated in this subsection, $212,000
shall be used by the state training school at Eldora for a
substance use disorder treatment program at the institution for
the fiscal year beginning July 1, 2021.
-38- 4. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated until the
close of the succeeding fiscal year.
Sec. 19. CHILD AND FAMILY SERVICES.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For child and family services:
.................................................. $89,071,930
2. The department may transfer funds appropriated in this
section as necessary to pay the nonfederal costs of services
reimbursed under the medical assistance program, state child
care assistance program, or the family investment program which
are provided to children who would otherwise receive services
paid under the appropriation in this section. The department
may transfer funds appropriated in this section to the
appropriations made in this division of this Act for general
administration and for field operations for resources necessary
to implement and operate the services funded in this section.
3. a. Of the funds appropriated in this section, up to
$31,500,000 is allocated as the statewide expenditure target
under section 232.143 for group foster care maintenance and
services. If the department projects that such expenditures
for the fiscal year will be less than the target amount
allocated in this paragraph “a”, the department may reallocate
the excess to provide additional funding for family foster
care, independent living, family-centered services, shelter
care, or the child welfare emergency services addressed with
the allocation for shelter care.
b. If at any time after September 30, 2021, annualization
of a service area’s current expenditures indicates a service
-39-area is at risk of exceeding its group foster care expenditure
target under section 232.143 by more than 5 percent, the
department and juvenile court services shall examine all
group foster care placements in that service area in order to
identify those which might be appropriate for termination.
In addition, any aftercare services believed to be needed
for the children whose placements may be terminated shall be
identified. The department and juvenile court services shall
initiate action to set dispositional review hearings for the
placements identified. In such a dispositional review hearing,
the juvenile court shall determine whether needed aftercare
services are available and whether termination of the placement
is in the best interest of the child and the community.
4. In accordance with the provisions of section 232.188,
the department shall continue the child welfare and juvenile
justice funding initiative during fiscal year 2021-2022. Of
the funds appropriated in this section, $1,717,000 is allocated
specifically for expenditure for fiscal year 2021-2022 through
the decategorization services funding pools and governance
boards established pursuant to section 232.188.
5. A portion of the funds appropriated in this section
may be used for emergency family assistance to provide other
resources required for a family participating in a family
preservation or reunification project or successor project to
stay together or to be reunified.
6. Of the funds appropriated in this section, a sufficient
amount is allocated for shelter care and the child welfare
emergency services contracting implemented to provide for or
prevent the need for shelter care.
7. Federal funds received by the state during the fiscal
year beginning July 1, 2021, as the result of the expenditure
of state funds appropriated during a previous state fiscal
year for a service or activity funded under this section are
appropriated to the department to be used as additional funding
for services and purposes provided for under this section.
-40-Notwithstanding section 8.33, moneys received in accordance
with this subsection that remain unencumbered or unobligated at
the close of the fiscal year shall not revert to any fund but
shall remain available for the purposes designated until the
close of the succeeding fiscal year.
8. a. Of the funds appropriated in this section, up to
$3,290,000 is allocated for the payment of the expenses of
court-ordered services provided to juveniles who are under the
supervision of juvenile court services, which expenses are a
charge upon the state pursuant to section 232.141, subsection
4. Of the amount allocated in this paragraph “a”, up to
$1,556,000 shall be made available to provide school-based
supervision of children adjudicated under chapter 232, of which
not more than $15,000 may be used for the purpose of training.
A portion of the cost of each school-based liaison officer
shall be paid by the school district or other funding source as
approved by the chief juvenile court officer.
b. Of the funds appropriated in this section, up to $748,000
is allocated for the payment of the expenses of court-ordered
services provided to children who are under the supervision
of the department, which expenses are a charge upon the state
pursuant to section 232.141, subsection 4.
c. Notwithstanding section 232.141 or any other provision
of law to the contrary, the amounts allocated in this
subsection shall be distributed to the judicial districts
as determined by the state court administrator and to the
department’s service areas as determined by the administrator
of the department of human services’ division of child and
family services. The state court administrator and the
division administrator shall make the determination of the
distribution amounts on or before June 15, 2021.
d. Notwithstanding chapter 232 or any other provision of
law to the contrary, a district or juvenile court shall not
order any service which is a charge upon the state pursuant
to section 232.141 if there are insufficient court-ordered
-41-services funds available in the district court or departmental
service area distribution amounts to pay for the service. The
chief juvenile court officer and the departmental service area
manager shall encourage use of the funds allocated in this
subsection such that there are sufficient funds to pay for
all court-related services during the entire year. The chief
juvenile court officers and departmental service area managers
shall attempt to anticipate potential surpluses and shortfalls
in the distribution amounts and shall cooperatively request the
state court administrator or division administrator to transfer
funds between the judicial districts’ or departmental service
areas’ distribution amounts as prudent.
e. Notwithstanding any provision of law to the contrary,
a district or juvenile court shall not order a county to pay
for any service provided to a juvenile pursuant to an order
entered under chapter 232 which is a charge upon the state
under section 232.141, subsection 4.
f. Of the funds allocated in this subsection, not more than
$83,000 may be used by the judicial branch for administration
of the requirements under this subsection.
g. Of the funds allocated in this subsection, $17,000
shall be used by the department of human services to support
the interstate commission for juveniles in accordance with
the interstate compact for juveniles as provided in section
232.173.
9. Of the funds appropriated in this section, $12,253,000 is
allocated for juvenile delinquent graduated sanctions services.
Any state funds saved as a result of efforts by juvenile court
services to earn a federal Tit.IV-E match for juvenile court
services administration may be used for the juvenile delinquent
graduated sanctions services.
10. Of the funds appropriated in this section, $1,658,000 is
transferred to the department of public health to be used for
the child protection center grant program for child protection
centers located in Iowa in accordance with section 135.118.
-42-The grant amounts under the program shall be equalized so that
each center receives a uniform base amount of $245,000, and so
that the remaining funds are awarded through a funding formula
based upon the volume of children served. To increase access
to child protection center services for children in rural
areas, the funding formula for the awarding of the remaining
funds shall provide for the awarding of an enhanced amount to
eligible grantees to develop and maintain satellite centers in
underserved regions of the state.
11. Of the funds appropriated in this section, $4,025,000 is
allocated for the preparation for adult living program pursuant
to section 234.46.
12. Of the funds appropriated in this section, $227,000
shall be used for the public purpose of continuing a grant to a
nonprofit human services organization, providing services to
individuals and families in multiple locations in southwest
Iowa and Nebraska for support of a project providing immediate,
sensitive support and forensic interviews, medical exams, needs
assessments, and referrals for victims of child abuse and their
nonoffending family members.
13. Of the funds appropriated in this section, $300,000
is allocated for the foster care youth council approach of
providing a support network to children placed in foster care.
14. Of the funds appropriated in this section, $202,000 is
allocated for use pursuant to section 235A.1 for continuation
of the initiative to address child sexual abuse implemented
pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection
21.
15. Of the funds appropriated in this section, $630,000 is
allocated for the community partnership for child protection
sites.
16. Of the funds appropriated in this section, $371,000
is allocated for the department’s minority youth and family
projects under the redesign of the child welfare system.
17. Of the funds appropriated in this section, $851,000
-43-is allocated for funding of the community circle of care
collaboration for children and youth in northeast Iowa.
18. Of the funds appropriated in this section, at least
$147,000 shall be used for the continuation of the child
welfare provider training academy, a collaboration between the
coalition for family and children’s services in Iowa and the
department.
19. Of the funds appropriated in this section, $211,000
shall be used for continuation of the central Iowa system of
care program grant for the purposes of funding community-based
services and other supports with a system of care approach for
children with serious emotional disturbance and their families
through a nonprofit provider that is located in a county
with a population of more than 420,000 but less than 450,000
according to the 2010 certified federal census, is licensed
as a psychiatric medical institution for children, and was a
system of care grantee prior to July 1, 2021.
20. Of the funds appropriated in this section, $235,000
shall be used for the public purpose of the continuation
and expansion of a system of care program grant implemented
in Cerro Gordo and Linn counties to utilize a comprehensive
and long-term approach for helping children and families by
addressing the key areas in a child’s life of childhood basic
needs, education and work, family, and community.
21. Of the funds appropriated in this section, $110,000
shall be used for the public purpose of funding community-based
services and other supports with a system of care approach
for children with a serious emotional disturbance and their
families through a nonprofit provider of child welfare services
that has been in existence for more than 115 years, is located
in a county with a population of more than 200,000 but less
than 220,000 according to the 2010 certified federal census, is
licensed as a psychiatric medical institution for children, and
was a system of care grantee prior to July 1, 2021.
22. If a separate funding source is identified that reduces
-44-the need for state funds within an allocation under this
section, the allocated state funds may be redistributed to
other allocations under this section for the same fiscal year.
23. Of the funds appropriated in this section, a portion may
be used for family-centered services for purposes of complying
with the federal Family First Prevention Services Act of 2018,
Pub.L. No.115-123, and successor legislation.
Sec. 20. ADOPTION SUBSIDY.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
a. For adoption subsidy payments and related costs and for
other services provided for under paragraph “b”, subparagraph
(2):
.................................................. $40,596,007
b. (1) Of the funds appropriated in this section, a
sufficient amount is allocated for adoption subsidy payments
and related costs.
(2) Any funds appropriated in this section remaining after
the allocation under subparagraph (1) are designated and
allocated as state savings resulting from implementation of
the federal Fostering Connections to Success and Increasing
Adoptions Act of 2008, Pub.L. No.110-351, and successor
legislation, as determined in accordance with 42 U.S.C.
§673(a)(8), and shall be used for post-adoption services and
for other purposes allowed under these federal laws, Tit.IV-B
or Tit.IV-E of the federal Social Security Act.
(a) The department of human services may transfer funds
allocated in this subparagraph (2) to the appropriation for
child and family services in this division of this Act for the
purposes designated in this subparagraph (2).
(b) Notwithstanding section 8.33, moneys allocated
under this subparagraph (2) shall not revert to any fund but
-45-shall remain available for the purposes designated in this
subparagraph (2) until expended.
2. The department may transfer funds appropriated in
this section to the appropriation made in this division of
this Act for general administration for costs paid from the
appropriation relating to adoption subsidy.
3. Federal funds received by the state during the
fiscal year beginning July 1, 2021, as the result of the
expenditure of state funds during a previous state fiscal
year for a service or activity funded under this section are
appropriated to the department to be used as additional funding
for the services and activities funded under this section.
Notwithstanding section 8.33, moneys received in accordance
with this subsection that remain unencumbered or unobligated
at the close of the fiscal year shall not revert to any fund
but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
Sec. 21. JUVENILE DETENTION HOME FUND. Moneys deposited
in the juvenile detention home fund created in section 232.142
during the fiscal year beginning July 1, 2021, and ending June
30, 2022, are appropriated to the department of human services
for the fiscal year beginning July 1, 2021, and ending June 30,
2022, for distribution of an amount equal to a percentage of
the costs of the establishment, improvement, operation, and
maintenance of county or multicounty juvenile detention homes
in the fiscal year beginning July 1, 2020. Moneys appropriated
for distribution in accordance with this section shall be
allocated among eligible detention homes, prorated on the basis
of an eligible detention home’s proportion of the costs of all
eligible detention homes in the fiscal year beginning July
1, 2020. The percentage figure shall be determined by the
department based on the amount available for distribution for
the fund. Notwithstanding section 232.142, subsection 3, the
financial aid payable by the state under that provision for the
fiscal year beginning July 1, 2021, shall be limited to the
-46-amount appropriated for the purposes of this section.
Sec. 22. FAMILY SUPPORT SUBSIDY PROGRAM.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For the family support subsidy program subject to the
enrollment restrictions in section 225C.37, subsection 3:
.................................................. $949,282
2. At least $899,291 of the moneys appropriated in this
section is transferred to the department of public health for
the family support center component of the comprehensive family
support program under chapter 225C, subchapter V.
3. If at any time during the fiscal year, the amount of
funding available for the family support subsidy program
is reduced from the amount initially used to establish the
figure for the number of family members for whom a subsidy
is to be provided at any one time during the fiscal year,
notwithstanding section 225C.38, subsection 2, the department
shall revise the figure as necessary to conform to the amount
of funding available.
Sec. 23. CONNER DECREE. There is appropriated from the
general fund of the state to the department of human services
for the fiscal year beginning July 1, 2021, and ending June 30,
2022, the following amount, or so much thereof as is necessary,
to be used for the purpose designated:
For building community capacity through the coordination
and provision of training opportunities in accordance with the
consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D.
Iowa, July 14, 1994):
.................................................. $33,632
Sec. 24. MENTAL HEALTH INSTITUTES.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
-47-beginning July 1, 2021, and ending June 30, 2022, the following
amounts, or so much thereof as is necessary, to be used for the
purposes designated:
a. For operation of the state mental health institute at
Cherokee as required by chapters 218 and 226 for salaries,
support, maintenance, and miscellaneous purposes, and for not
more than the following full-time equivalent positions:
.................................................. $15,457,597
............................................... FTEs169.00
b. For operation of the state mental health institute at
Independence as required by chapters 218 and 226 for salaries,
support, maintenance, and miscellaneous purposes, and for not
more than the following full-time equivalent positions:
.................................................. $19,652,379
............................................... FTEs208.00
2. a. Notwithstanding sections 218.78 and 249A.11, any
revenue received from the state mental health institute at
Cherokee or the state mental health institute at Independence
pursuant to 42 C.F.R§438.6(e) may be retained and expended by
the mental health institute.
b. Notwithstanding sections 218.78 and 249A.11, any
COVID-19 related funding received through federal funding
sources by the state mental health institute at Cherokee or the
state mental health institute at Independence may be retained
and expended by the mental health institute.
3. Notwithstanding any provision of law to the contrary,
a Medicaid member residing at the state mental health
institute at Cherokee or the state mental health institute
at Independence shall retain Medicaid eligibility during
the period of the Medicaid member’s stay for which federal
financial participation is available.
4. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated until the
-48-close of the succeeding fiscal year.
Sec. 25. STATE RESOURCE CENTERS.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amounts, or so much thereof as is necessary, to be used for the
purposes designated:
a. For the state resource center at Glenwood for salaries,
support, maintenance, and miscellaneous purposes:
.................................................. $14,802,873
b. For the state resource center at Woodward for salaries,
support, maintenance, and miscellaneous purposes:
.................................................. $12,237,937
2. The department may continue to bill for state resource
center services utilizing a scope of services approach used for
private providers of intermediate care facilities for persons
with an intellectual disability services, in a manner which
does not shift costs between the medical assistance program,
counties, or other sources of funding for the state resource
centers.
3. The state resource centers may expand the time-limited
assessment and respite services during the fiscal year.
4. If the department’s administration and the department
of management concur with a finding by a state resource
center’s superintendent that projected revenues can reasonably
be expected to pay the salary and support costs for a new
employee position, or that such costs for adding a particular
number of new positions for the fiscal year would be less
than the overtime costs if new positions would not be added,
the superintendent may add the new position or positions. If
the vacant positions available to a resource center do not
include the position classification desired to be filled, the
state resource center’s superintendent may reclassify any
vacant position as necessary to fill the desired position. The
superintendents of the state resource centers may, by mutual
-49-agreement, pool vacant positions and position classifications
during the course of the fiscal year in order to assist one
another in filling necessary positions.
5. If existing capacity limitations are reached in
operating units, a waiting list is in effect for a service or
a special need for which a payment source or other funding
is available for the service or to address the special need,
and facilities for the service or to address the special need
can be provided within the available payment source or other
funding, the superintendent of a state resource center may
authorize opening not more than two units or other facilities
and begin implementing the service or addressing the special
need during fiscal year 2021-2022.
6. Notwithstanding section 8.33, and notwithstanding
the amount limitation specified in section 222.92, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
Sec. 26. SEXUALLY VIOLENT PREDATORS.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For costs associated with the commitment and treatment of
sexually violent predators in the unit located at the state
mental health institute at Cherokee, including costs of legal
services and other associated costs, including salaries,
support, maintenance, and miscellaneous purposes, and for not
more than the following full-time equivalent positions:
.................................................. $13,643,727
............................................... FTEs139.00
2. Unless specifically prohibited by law, if the amount
charged provides for recoupment of at least the entire amount
-50-of direct and indirect costs, the department of human services
may contract with other states to provide care and treatment
of persons placed by the other states at the unit for sexually
violent predators at Cherokee. The moneys received under
such a contract shall be considered to be repayment receipts
and used for the purposes of the appropriation made in this
section.
3. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated until the
close of the succeeding fiscal year.
Sec. 27. FIELD OPERATIONS.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purposes designated:
For field operations, including salaries, support,
maintenance, and miscellaneous purposes, and for not more than
the following full-time equivalent positions:
.................................................. $60,596,667
............................................... FTEs1,539.00
2. Priority in filling full-time equivalent positions
shall be given to those positions related to child protection
services and eligibility determination for low-income families.
Sec. 28. GENERAL ADMINISTRATION. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purpose designated:
For general administration, including salaries, support,
maintenance, and miscellaneous purposes, and for not more than
the following full-time equivalent positions:
.................................................. $15,342,189
-51-............................................... FTEs294.00
1. The department shall report at least monthly to the
general assembly concerning the department’s operational and
program expenditures.
2. Of the funds appropriated in this section, $150,000 shall
be used for the provision of a program to provide technical
assistance, support, and consultation to providers of home and
community-based services under the medical assistance program.
3. Of the funds appropriated in this section, $50,000
is transferred to the Iowa finance authority to be used
for administrative support of the council on homelessness
established in section 16.2D and for the council to fulfill its
duties in addressing and reducing homelessness in the state.
4. Of the funds appropriated in this section, $200,000 shall
be transferred to and deposited in the administrative fund of
the Iowa ABLE savings plan trust created in section 12I.4, to
be used for implementation and administration activities of the
Iowa ABLE savings plan trust.
5. Of the funds appropriated in this section, $200,000 is
transferred to the economic development authority for the Iowa
commission on volunteer services to continue to be used for the
RefugeeRISE AmeriCorps program established under section 15H.8
for member recruitment and training to improve the economic
well-being and health of economically disadvantaged refugees in
local communities across Iowa. Funds transferred may be used
to supplement federal funds under federal regulations.
6. Of the funds appropriated in this section, up to $300,000
shall be used as follows:
a. To fund not more than one full-time equivalent position
to address the department’s responsibility to support the work
of the children’s behavioral health system state board and
implementation of the services required pursuant to section
331.397.
b. To support the cost of establishing and implementing new
or additional services required pursuant to sections 331.397
-52-and 331.397A.
c. Of the amount allocated, $32,000 shall be transferred
to the department of public health to support the costs of
establishing and implementing new or additional services
required pursuant to sections 331.397 and 331.397A.
7. Of the funds appropriated in this section, $800,000 shall
be used for the renovation and construction of certain nursing
facilities, consistent with the provisions of chapter 249K.
Sec. 29. DEPARTMENT-WIDE DUTIES. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For salaries, support, maintenance, and miscellaneous
purposes at facilities under the purview of the department of
human services:
.................................................. $2,879,274
Sec. 30. VOLUNTEERS. There is appropriated from the general
fund of the state to the department of human services for the
fiscal year beginning July 1, 2021, and ending June 30, 2022,
the following amount, or so much thereof as is necessary, to be
used for the purpose designated:
For development and coordination of volunteer services:
.................................................. $84,686
Sec. 31. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
DEPARTMENT OF HUMAN SERVICES.
1. a. (1) (a) Notwithstanding any provision of law to
the contrary, for the fiscal year beginning July 1, 2021, the
department shall not rebase case-mix nursing facility rates,
but shall instead reimburse case-mix nursing facilities by
adjusting the nursing facility case-mix adjusted rates that
were effective July 1, 2019, using the mid-points of each of
the most recent cost reports submitted by the nursing facility
for the period ending on or before December 31, 2018, and
-53-inflating these costs forward applying the inflation factor as
determined using the latest available quarterly publication of
the HCFA/SNF index, to the extent possible within the state
funding, including the $19,080,860 provided for this purpose.
(b) For the fiscal year beginning July 1, 2021, non-case-mix
and special population nursing facilities shall be reimbursed
in accordance with the methodology in effect on June 30 of the
prior fiscal year.
(c) For managed care claims, the department of human
services shall adjust the payment rate floor for nursing
facilities, annually, to maintain a rate floor that is no
lower than the Medicaid fee-for-service case-mix adjusted rate
calculated in accordance with subparagraph division (a) and
441 IAC 81.6. The department shall then calculate adjusted
reimbursement rates, including but not limited to add-on
payments, annually, and shall notify Medicaid managed care
organizations of the adjusted reimbursement rates within 30
days of determining the adjusted reimbursement rates. Any
adjustment of reimbursement rates under this subparagraph
division shall be budget neutral to the state budget.
(d) For the fiscal year beginning July 1, 2021, Medicaid
managed care long-term services and supports capitation rates
shall be adjusted to reflect the case-mix adjusted rates
specified pursuant to subparagraph division (a) for the patient
populations residing in Medicaid-certified nursing facilities.
(2) Medicaid managed care organizations shall adjust
facility-specific rates based upon payment rate listings issued
by the department. The rate adjustments shall be applied
prospectively from the effective date of the rate letter issued
by the department.
b. (1) For the fiscal year beginning July 1, 2021,
contingent upon implementation of the contractual agreements
with Medicaid managed care organizations as described pursuant
to subparagraph (2), the department shall establish the
fee-for-service pharmacy dispensing fee reimbursement at
-54-$10.38 per prescription, until a cost of dispensing survey is
completed. The actual dispensing fee shall be determined by
a cost of dispensing survey performed by the department and
required to be completed by all medical assistance program
participating pharmacies every two years. A change in the
dispensing fee shall become effective following federal
approval of the Medicaid state plan.
(2) The department shall amend Medicaid managed care
organization contracts to authorize establishment of a managed
care pharmacy dispensing fee reimbursement in accordance with
either of the following:
(a) The established fee-for-service pharmacy dispensing
fee reimbursement per prescription as specified pursuant to
subparagraph (1).
(b) A dispensing fee determined contractually by mutual
agreement between the managed care organization and a
participating pharmacy with more than thirty locations in
the state and headquarters located outside the state, not to
exceed the established fee-for-service pharmacy dispensing
fee reimbursement per prescription as specified pursuant to
subparagraph (1).
(3) The department shall utilize an average acquisition
cost reimbursement methodology for all drugs covered under the
medical assistance program in accordance with 2012 Iowa Acts,
chapter 1133, section 33.
c. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for outpatient hospital services shall
remain at the rates in effect on June 30, 2021, subject to
Medicaid program upper payment limit rules, and adjusted
as necessary to maintain expenditures within the amount
appropriated to the department for this purpose for the fiscal
year.
(2) For the fiscal year beginning July 1, 2021,
reimbursement rates for inpatient hospital services shall
be rebased effective October 1, 2021, subject to Medicaid
-55-program upper payment limit rules, and adjusted as necessary
to maintain expenditures within the amount appropriated to the
department for this purpose for the fiscal year.
(3) For the fiscal year beginning July 1, 2021, under
both fee-for-service and managed care administration of
the Medicaid program, critical access hospitals shall be
reimbursed for inpatient and outpatient services based on the
hospital-specific critical access hospital cost adjustment
factor methodology utilizing the most recent and complete cost
reporting period as applied prospectively within the funds
appropriated for such purpose for the fiscal year.
(4) For the fiscal year beginning July 1, 2021, the graduate
medical education and disproportionate share hospital fund
shall remain at the amount in effect on June 30, 2021, except
that the portion of the fund attributable to graduate medical
education shall be reduced in an amount that reflects the
elimination of graduate medical education payments made to
out-of-state hospitals.
(5) In order to ensure the efficient use of limited state
funds in procuring health care services for low-income Iowans,
funds appropriated in this Act for hospital services shall
not be used for activities which would be excluded from a
determination of reasonable costs under the federal Medicare
program pursuant to 42 U.S.C.§1395x(v)(1)(N).
d. For the fiscal year beginning July 1, 2021, reimbursement
rates for hospices and acute psychiatric hospitals shall be
increased in accordance with increases under the federal
Medicare program or as supported by their Medicare audited
costs.
e. For the fiscal year beginning July 1, 2021, independent
laboratories and rehabilitation agencies shall be reimbursed
using the same methodology in effect on June 30, 2021.
f. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for home health agencies shall continue to
be based on the Medicare low utilization payment adjustment
-56-(LUPA) methodology with state geographic wage adjustments and
shall be adjusted to increase the rates to the extent possible
within the state funding, including the $2,000,000 appropriated
for this purpose. The department shall continue to update the
rates every two years to reflect the most recent Medicare LUPA
rates.
(2) For the fiscal year beginning July 1, 2021, rates for
private duty nursing and personal care services under the early
and periodic screening, diagnostic, and treatment program
benefit shall be calculated based on the methodology in effect
on June 30, 2021.
g. For the fiscal year beginning July 1, 2021, federally
qualified health centers and rural health clinics shall receive
cost-based reimbursement for 100 percent of the reasonable
costs for the provision of services to recipients of medical
assistance.
h. For the fiscal year beginning July 1, 2021, the
reimbursement rates for dental services shall remain at the
rates in effect on June 30, 2021.
i. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for non-state-owned psychiatric medical
institutions for children shall be increased to the extent
possible within the $3,900,000 appropriated for this purpose.
(2) As a condition of participation in the medical
assistance program, enrolled providers shall accept the medical
assistance reimbursement rate for any covered goods or services
provided to recipients of medical assistance who are children
under the custody of a psychiatric medical institution for
children.
j. For the fiscal year beginning July 1, 2021, unless
otherwise specified in this Act, all noninstitutional medical
assistance provider reimbursement rates shall remain at the
rates in effect on June 30, 2021, except for area education
agencies, local education agencies, infant and toddler
services providers, home and community-based services providers
-57-including consumer-directed attendant care providers under a
section 1915(c) or 1915(i) waiver, targeted case management
providers, and those providers whose rates are required to be
determined pursuant to section 249A.20, or to meet federal
mental health parity requirements.
k. Notwithstanding any provision to the contrary, for the
fiscal year beginning July 1, 2021, the reimbursement rate for
anesthesiologists shall remain at the rates in effect on June
30, 2021, and updated on January 1, 2022, to align with the
most current Iowa Medicare anesthesia rate.
l. Notwithstanding section 249A.20, for the fiscal year
beginning July 1, 2021, the average reimbursement rate for
health care providers eligible for use of the federal Medicare
resource-based relative value scale reimbursement methodology
under section 249A.20 shall remain at the rate in effect on
June 30, 2021; however, this rate shall not exceed the maximum
level authorized by the federal government.
m. For the fiscal year beginning July 1, 2021, the
reimbursement rate for residential care facilities shall not
be less than the minimum payment level as established by the
federal government to meet the federally mandated maintenance
of effort requirement. The flat reimbursement rate for
facilities electing not to file annual cost reports shall not
be less than the minimum payment level as established by the
federal government to meet the federally mandated maintenance
of effort requirement.
n. For the fiscal year beginning July 1, 2021, the
reimbursement rates for inpatient mental health services
provided at hospitals shall be rebased effective October 1,
2021, subject to Medicaid program upper payment limit rules
and adjusted as necessary to maintain expenditures within the
amount appropriated to the department for this purpose for
the fiscal year; and psychiatrists shall be reimbursed at the
medical assistance program fee-for-service rate in effect on
June 30, 2021.
-58- o. For the fiscal year beginning July 1, 2021, community
mental health centers may choose to be reimbursed for the
services provided to recipients of medical assistance through
either of the following options:
(1) For 100 percent of the reasonable costs of the services.
(2) In accordance with the alternative reimbursement rate
methodology approved by the department of human services in
effect on June 30, 2021.
p. For the fiscal year beginning July 1, 2021, the
reimbursement rate for providers of family planning services
that are eligible to receive a 90 percent federal match shall
remain at the rates in effect on June 30, 2021.
q. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for providers of home and community-based
services waiver and habilitation services shall be increased
to the extent possible within the $11,002,240 appropriated for
this purpose.
(2) For the fiscal year beginning July 1, 2021,
reimbursement rates for providers of state plan home and
community-based services home-based habilitation services
shall be increased with the $7,134,214 appropriated for this
purpose. The reimbursement rates for home-based habilitation
services shall be based on a fee schedule that incorporates the
acuity-based tiers.
r. For the fiscal year beginning July 1, 2021, the
reimbursement rates for emergency medical service providers
shall remain at the rates in effect on June 30, 2021, or as
approved by the centers for Medicare and Medicaid services of
the United States department of health and human services.
s. For the fiscal year beginning July 1, 2021, reimbursement
rates for substance-related disorder treatment programs
licensed under section 125.13 shall remain at the rates in
effect on June 30, 2021.
t. For the fiscal year beginning July 1, 2021, assertive
community treatment per diem rates shall remain at the rates in
-59-effect on June 30, 2021.
u. For the fiscal year beginning July 1, 2021, the
reimbursement rate for family-centered services providers shall
be established by contract.
v. For the fiscal year beginning July 1, 2021, the
reimbursement rate for air ambulance services shall be
increased to the extent possible within the additional $100,000
appropriated for this purpose.
2. For the fiscal year beginning July 1, 2021, the
reimbursement rate for providers reimbursed under the
in-home-related care program shall not be less than the minimum
payment level as established by the federal government to meet
the federally mandated maintenance of effort requirement.
3. Unless otherwise directed in this section, when the
department’s reimbursement methodology for any provider
reimbursed in accordance with this section includes an
inflation factor, this factor shall not exceed the amount
by which the consumer price index for all urban consumers
increased during the calendar year ending December 31, 2002.
4. Notwithstanding section 234.38, for the fiscal
year beginning July 1, 2021, the foster family basic daily
maintenance rate and the maximum adoption subsidy rate for
children ages 0 through 5 years shall be $16.78, the rate for
children ages 6 through 11 years shall be $17.45, the rate for
children ages 12 through 15 years shall be $19.10, and the
rate for children and young adults ages 16 and older shall
be $19.35. For youth ages 18 to 23 who have exited foster
care, the preparation for adult living program maintenance
rate shall be up to $602.70 per month as calculated based on
the age of the participant. The maximum payment for adoption
subsidy nonrecurring expenses shall be limited to $500 and the
disallowance of additional amounts for court costs and other
related legal expenses implemented pursuant to 2010 Iowa Acts,
chapter 1031, section 408, shall be continued.
5. For the fiscal year beginning July 1, 2021, the maximum
-60-reimbursement rates for social services providers under
contract shall remain at the rates in effect on June 30, 2021,
or the provider’s actual and allowable cost plus inflation for
each service, whichever is less. However, if a new service
or service provider is added after June 30, 2021, the initial
reimbursement rate for the service or provider shall be based
upon a weighted average of provider rates for similar services.
6. a. For the fiscal year beginning July 1, 2021, the
reimbursement rates for resource family recruitment and
retention contractors shall be established by contract.
b. For the fiscal year beginning July 1, 2021, the
reimbursement rates for supervised apartment living foster care
providers shall be established by contract.
7. For the fiscal year beginning July 1, 2021, the
reimbursement rate for group foster care providers shall be the
combined service and maintenance reimbursement rate established
by contract.
8. The group foster care reimbursement rates paid for
placement of children out of state shall be calculated
according to the same rate-setting principles as those used for
in-state providers, unless the director of human services or
the director’s designee determines that appropriate care cannot
be provided within the state. The payment of the daily rate
shall be based on the number of days in the calendar month in
which service is provided.
9. a. For the fiscal year beginning July 1, 2021, the
reimbursement rate paid for shelter care and the child welfare
emergency services implemented to provide or prevent the need
for shelter care shall be established by contract.
b. For the fiscal year beginning July 1, 2021, the combined
service and maintenance components of the reimbursement rate
paid for shelter care services shall be based on the financial
and statistical report submitted to the department. The
maximum reimbursement rate shall be $101.83 per day. The
department shall reimburse a shelter care provider at the
-61-provider’s actual and allowable unit cost, plus inflation, not
to exceed the maximum reimbursement rate.
c. Notwithstanding section 232.141, subsection 8, for the
fiscal year beginning July 1, 2021, the amount of the statewide
average of the actual and allowable rates for reimbursement of
juvenile shelter care homes that is utilized for the limitation
on recovery of unpaid costs shall remain at the amount in
effect for this purpose in the fiscal year beginning July 1,
2020.
10. For the fiscal year beginning July 1, 2021, the
department shall calculate reimbursement rates for intermediate
care facilities for persons with an intellectual disability
at the 80th percentile. Beginning July 1, 2021, the rate
calculation methodology shall utilize the consumer price index
inflation factor applicable to the fiscal year beginning July
1, 2021.
11. Effective July 1, 2021, the department of human services
shall set the reimbursement rate of child care providers whose
reimbursement rates are below the fiftieth percentile of the
most recent market rate survey at the fiftieth percentile of
the most recent market rate survey. Reimbursement rates of
child care providers whose reimbursement rates are at or above
the fiftieth percentile of the most recent market rate survey
shall remain at the rates in effect on June 30, 2021. The
department shall also adjust quality rating system bonuses to
reflect increased child care provider reimbursement rates as
appropriate. The department shall set rates in a manner so as
to provide incentives for a nonregistered provider to become
registered by applying any increase only to registered and
licensed providers.
12. The department may adopt emergency rules to implement
this section.
Sec. 32. EMERGENCY RULES.
1. If necessary to comply with federal requirements
including time frames, or if specifically authorized by a
-62-provision of this division of this Act, the department of
human services or the mental health and disability services
commission may adopt administrative rules under section 17A.4,
subsection 3, and section 17A.5, subsection 2, paragraph “b”,
to implement the provisions of this division of this Act and
the rules shall become effective immediately upon filing or
on a later effective date specified in the rules, unless the
effective date of the rules is delayed or the applicability
of the rules is suspended by the administrative rules review
committee. Any rules adopted in accordance with this section
shall not take effect before the rules are reviewed by the
administrative rules review committee. The delay authority
provided to the administrative rules review committee under
section 17A.4, subsection 7, and section 17A.8, subsections
9 and 10, shall be applicable to a delay imposed under this
section, notwithstanding a provision in those subsections
making them inapplicable to section 17A.5, subsection 2,
paragraph “b”. Any rules adopted in accordance with the
provisions of this section shall also be published as a notice
of intended action as provided in section 17A.4.
2. If during a fiscal year, the department of human
services is adopting rules in accordance with this section
or as otherwise directed or authorized by state law, and
the rules will result in an expenditure increase beyond the
amount anticipated in the budget process or if the expenditure
was not addressed in the budget process for the fiscal
year, the department shall notify the general assembly and
the department of management concerning the rules and the
expenditure increase. The notification shall be provided at
least 30 calendar days prior to the date notice of the rules
is submitted to the administrative rules coordinator and the
administrative code editor.
Sec. 33. REPORTS. Unless otherwise provided, any reports or
other information required to be compiled and submitted under
this Act during the fiscal year beginning July 1, 2021, shall
-63-be submitted on or before the dates specified for submission
of the reports or information.
Sec. 34. EFFECTIVE UPON ENACTMENT. The following provision
of this division of this Act, being deemed of immediate
importance, takes effect upon enactment:
1. The provision relating to section 232.141 and directing
the state court administrator and the division administrator of
the department of human services division of child and family
services to make the determination, by June 15, 2021, of the
distribution of funds allocated for the payment of the expenses
of court-ordered services provided to juveniles which are a
charge upon the state.
DIVISION VI
HEALTH CARE ACCOUNTS AND FUNDS — FY 2021-2022
Sec. 35. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is
appropriated from the pharmaceutical settlement account created
in section 249A.33 to the department of human services for the
fiscal year beginning July 1, 2021, and ending June 30, 2022,
the following amount, or so much thereof as is necessary, to be
used for the purpose designated:
Notwithstanding any provision of law to the contrary, to
supplement the appropriations made in this Act for health
program operations under the medical assistance program for the
fiscal year beginning July 1, 2021, and ending June 30, 2022:
.................................................. $234,193
Sec. 36. QUALITY ASSURANCE TRUST FUND — DEPARTMENT OF HUMAN
SERVICES. Notwithstanding any provision to the contrary and
subject to the availability of funds, there is appropriated
from the quality assurance trust fund created in section
249L.4 to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amounts, or so much thereof as is necessary, for the purposes
designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of human services
-64-for medical assistance for the same fiscal year:
.................................................. $56,305,139
Sec. 37. HOSPITAL HEALTH CARE ACCESS TRUST FUND —
DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to
the contrary and subject to the availability of funds, there is
appropriated from the hospital health care access trust fund
created in section 249M.4 to the department of human services
for the fiscal year beginning July 1, 2021, and ending June
30, 2022, the following amounts, or so much thereof as is
necessary, for the purposes designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of human services
for medical assistance for the same fiscal year:
.................................................. $33,920,554
Sec. 38. MEDICAL ASSISTANCE PROGRAM — NONREVERSION
FOR FY 2021-2022. Notwithstanding section 8.33, if moneys
appropriated for purposes of the medical assistance program for
the fiscal year beginning July 1, 2021, and ending June 30,
2022, from the general fund of the state, the quality assurance
trust fund, and the hospital health care access trust fund, are
in excess of actual expenditures for the medical assistance
program and remain unencumbered or unobligated at the close
of the fiscal year, the excess moneys shall not revert but
shall remain available for expenditure for the purposes of the
medical assistance program until the close of the succeeding
fiscal year.
DIVISION VII
NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
JULY 1, 2023, THROUGH JUNE 30, 2025
Sec. 39. NURSING FACILITY REIMBURSEMENT METHODOLOGY —
FISCAL PERIOD JULY 1, 2023, THROUGH JUNE 30, 2025.
Notwithstanding any provision of law to the contrary, for the
fiscal period beginning July 1, 2023, and ending June 30, 2025,
the department of human services shall rebase case-mix nursing
facility rates beginning July 1, 2023, using the Medicaid cost
-65-reports on file for the period ending December 31, 2022, and
applying a minimum occupancy factor of 70 percent.
DIVISION VIII
NURSING FACILITY REIMBURSEMENT STUDY
Sec. 40. NURSING FACILITY CASE-MIX REIMBURSEMENT — STUDY
AND RECOMMENDATIONS. The department of human services shall
convene a workgroup including representatives of nursing
facilities, managed care organizations, and other appropriate
stakeholders to review the case-mix reimbursement methodology
and process for nursing facilities, including but not limited
to rebasing, the use of cost reports, and the application
of quarterly case-mix index adjustments, and shall submit
recommendations to the governor and the general assembly by
December 1, 2021, for improvements including those related to
the methodology, the process, the use of prospective payments,
and the applicable time frames to increase efficiencies
and accuracy in the determination of reimbursements, reduce
duplication of effort, more adequately reflect the actual costs
of care, address changes in patient acuity levels without
reliance on retroactive rate adjustments, and incentivize
quality outcomes.
DIVISION IX
MEDICAID-ELIGIBLE CHILDREN — PEDIATRIC HEALTH CARE SERVICES
Sec. 41. MEDICAID-ELIGIBLE CHILDREN — PROVISION OF
PEDIATRIC HEALTH CARE SERVICES — REVIEW AND REPORT. The
department of human services shall review federal Medicare
and state law and administrative rule restrictions related
to the provision of physical therapy, occupational therapy,
speech-language pathology, applied behavior analysis, and other
pediatric health care services to Medicaid-eligible children
to determine necessary changes in law and policy to ensure
that these services are provided consistent with the early and
periodic screening, diagnostic, and treatment program. The
department shall submit a report including the findings of the
review and recommendations to the governor and the general
-66-assembly by October 1, 2021.
DIVISION X
DECATEGORIZATION CARRYOVER FUNDING
Sec. 42. DECATEGORIZATION CARRYOVER FUNDING FY 2019 —
TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188,
subsection 5, paragraph “b”, any state-appropriated moneys in
the funding pool that remained unencumbered or unobligated
at the close of the fiscal year beginning July 1, 2018, and
were deemed carryover funding to remain available for the two
succeeding fiscal years that still remain unencumbered or
unobligated at the close of the fiscal year beginning July 1,
2020, shall not revert but shall be transferred to the medical
assistance program for the fiscal year beginning July 1, 2021.
Sec. 43. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 44. RETROACTIVE APPLICABILITY. This division of this
Act applies retroactively to July 1, 2020.
DIVISION XI
PRIOR APPROPRIATIONS AND OTHER PROVISIONS
COURT-ORDERED SERVICES REIMBURSEMENT BY MANAGED CARE
ORGANIZATIONS
Sec. 45. 2018 Iowa Acts, chapter 1165, section 128,
subsection 2, paragraph a, is amended to read as follows:
a. If a Medicaid member is receiving court-ordered services
or treatment for a substance-related disorder pursuant to
chapter 125 or for a mental illness pursuant to chapter 229,
such services or treatment shall be provided and reimbursed
for an initial period of three days before a managed care
organization may apply medical necessity criteria to determine
the most appropriate services, treatment, or placement for the
Medicaid member.
FAMILY INVESTMENT PROGRAM ACCOUNT
Sec. 46. 2019 Iowa Acts, chapter 85, section 9, as amended
by 2020 Iowa Acts, chapter 1121, section 20, is amended by
adding the following new subsection:
-67- NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purposes
designated, and may be transferred to other appropriations made
in this division of this Act as necessary to carry out the
initiatives included in the report submitted on nonreversion
of funds required pursuant to 2020 Iowa Acts, chapter 1121,
section 43, until the close of the succeeding fiscal year.
Child and family services
Sec. 47. 2019 Iowa Acts, chapter 85, section 19, as amended
by 2020 Iowa Acts, chapter 1121, section 23, is amended by
adding the following new subsection:
NEW SUBSECTION. 25. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purpose of
the redesign of the child welfare system, until the close of
the succeeding fiscal year.
FIELD OPERATIONS
Sec. 48. 2019 Iowa Acts, chapter 85, section 27, as amended
by 2020 Iowa Acts, chapter 1121, section 25, is amended by
adding the following new subsection:
NEW SUBSECTION. 5. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
GENERAL ADMINISTRATION
Sec. 49. 2019 Iowa Acts, chapter 85, section 28, as amended
by 2020 Iowa Acts, chapter 1121, section 26, is amended by
adding the following new subsection:
NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
-68-but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
Sec. 50. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION XII
EXTENSION OF FUTURE REPEAL — HOSPITAL HEALTH CARE ACCESS
ASSESSMENT PROGRAM
Sec. 51. Section 249M.5, Code 2021, is amended to read as
follows:
249M.5 Future repeal.
This chapter is repealed July 1, 2021 2023.
Sec. 52. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION XIII
PUBLIC HEALTH EMERGENCY PROVISIONS COVID-19 REGULATIONS
Sec. 53. COVID-19 FEDERAL REGULATIONS. For the time
period beginning on the effective date of this division of
this Act, and ending June 30, 2022, notwithstanding state
administrative rules to the contrary, to the extent federal
regulations relating to the COVID-19 pandemic differ from state
administrative rules, including applicable federal waivers,
the federal regulations are controlling during the pendency of
the federally declared state of emergency and for such period
of time following the end of the federally declared state of
emergency applicable to the respective federal regulations.
DIVISION XIV
FOSTER HOME INSURANCE FUND
Sec. 54. Section 237.13, subsection 2, Code 2021, is amended
to read as follows:
2. The foster home insurance fund shall be administered by
the department of human services. The fund shall consist of
all moneys appropriated by the general assembly for deposit
in the fund. The department shall use moneys in the fund to
provide home and property coverage for foster parents to cover
damages to property resulting from the actions of a foster
-69-child residing in a foster home or to reimburse foster parents
for the cost of purchasing foster care liability insurance and
to perform the administrative functions necessary to carry out
this section. The department may establish limitations of
liability for individual claims as deemed reasonable by the
department.
DIVISION XV
MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS
Sec. 55. MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER
OF FUNDS. Notwithstanding section 331.432, a county with a
population of over 300,000 based on the 2010 federal decennial
census may transfer funds from any other fund of the county to
the mental health and disability regional services fund for the
purposes of providing mental health and disability services for
the fiscal year beginning July 1, 2021, and ending June 30,
2022. The county shall submit a report to the governor and the
general assembly by September 1, 2022, including the source of
any funds transferred, the amount of the funds transferred, and
the mental health and disability services provided with the
transferred funds. The county shall work with the department
to maximize the use of the medical assistance program and other
third-party payment sources, including but not limited to
identifying individuals enrolled with or eligible for Medicaid
whose Medicaid-covered services are being paid by the county or
could be converted to Medicaid-covered services.
DIVISION XVI
IN-PERSON SUPERVISION REQUIREMENTS FOR LICENSURE — CERTAIN
PROFESSIONALS
Sec. 56. Section 154C.3, subsection 1, paragraph c,
subparagraph (5), subparagraph division (a), Code 2021, is
amended by adding the following new subparagraph subdivision:
NEW SUBPARAGRAPH SUBDIVISION. (0ii) By a person licensed
under section 154D.2 to practice marital and family therapy
without supervision or mental health counseling without
supervision.
-70- Sec. 57. Section 154C.3, Code 2021, is amended by adding the
following new subsection:
NEW SUBSECTION. 4. Supervision. The board shall not, by
rule or other means, require that supervision be completed in
person as a condition for an applicant to receive a license, a
reciprocal license, or a renewed license under this chapter.
Sec. 58. Section 154D.2, Code 2021, is amended to read as
follows:
154D.2 Licensure — marital and family therapy — mental
health counseling.
1. An applicant for a license to practice marital and family
therapy or mental health counseling shall be granted a license
by the board when the applicant satisfies all of the following
requirements:
1. a. Possesses a master’s degree in marital and family
therapy or mental health counseling, as applicable, consisting
of at least sixty semester hours, or its equivalent, from a
nationally accredited institution or from a program approved
by the board.
2. b. Has at least two years of supervised clinical
experience or its equivalent as approved by the board.
Standards for supervision, including the required
qualifications for supervisors, shall be determined in
accordance with subsection 2 and by the board by rule, provided
that a supervisor may be a person licensed under this section
to practice marital and family therapy or mental health
counseling without supervision or a licensed independent social
worker licensed under chapter 154C.
3. c. Passes an examination approved by the board.
2. The board shall not, by rule or other means, require any
in-person supervised clinical experience.
Sec. 59. Section 154D.4, subsection 2, paragraph b, Code
2021, is amended to read as follows:
b. A person who practices marital and family therapy or
mental health counseling under the supervision of a person
-71-licensed under this chapter as part of a clinical experience as
described in section 154D.2, subsection 2 1, paragraph “b”.
Sec. 60. BOARD OF SOCIAL WORK AND BOARD OF BEHAVIORAL
SCIENCE — RULES. The board of social work and the board
of behavioral science shall amend their administrative
rules pursuant to chapter 17A to remove any requirement for
supervised clinical experience and supervised professional
practice to be completed in person as a condition for the
licensure of marital and family therapists, mental health
counselors, and social workers pursuant to chapters 154C and
154D. The board of social work and the board of behavioral
science shall replace all licensing requirements for in-person
supervision with the ability to have supervision requirements
completed electronically.
Sec. 61. EMERGENCY RULES.
1. The board of social work and the board of behavioral
science shall adopt emergency rules under section 17A.4,
subsection 3, and section 17A.5, subsection 2, to implement
the sections of this division of this Act amending section
154C.3 and section 154D.2, and the rules shall be effective
immediately upon filing unless a later date is specified in the
rules. Any emergency rules adopted in accordance with this
section shall also be published as a notice of intended action
as provided in section 17A.4, subsection 1.
2. The board of social work and the board of behavioral
science shall jointly develop rules adopted pursuant to this
subsection through a collaborative process. The respective
boards may establish subcommittees or designate other personnel
to facilitate such a process. Such rules shall consist of
substantively identical standards applicable to the professions
regulated by the respective boards and shall, to the greatest
extent possible, consist of substantially similar language
in a substantially similar format. Prior to a vote to adopt
such rules by either board, each board shall, by a separate
vote, approve the language to be adopted by the other board.
-72-Neither board shall vote to adopt such rules until the rules
to be adopted by both boards have been so approved. Such rules
shall have the same effective date and shall be submitted to
the administrative rules coordinator and the administrative
code editor for publication in the same issue of the Iowa
administrative bulletin pursuant to sections 17A.4 and 17A.5.
Sec. 62. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION XVII
MEDICAL RESIDENCY LIABILITY COSTS
Sec. 63. Section 135.176, subsection 1, Code 2021, is
amended by adding the following new paragraph:
NEW PARAGRAPH. d. For the period beginning July 1, 2021,
and ending June 30, 2026, the payment by the sponsor of medical
residency program liability costs subject to provision by the
sponsor of dollar-for-dollar matching funds used for payment
of such costs. This paragraph shall not apply to medical
residency programs to which chapter 669 applies.
Sec. 64. Section 135.176, subsection 2, paragraphs e and f,
Code 2021, are amended to read as follows:
e. The maximum award of grant funds to a particular
individual sponsor per year. An individual sponsor that
establishes a new or alternative campus accredited medical
residency training program as defined in subsection 1,
paragraph “a”, shall not receive more than fifty percent
of the state matching funds available each year to support
the program. An individual sponsor proposing the provision
of a new residency position within an existing accredited
medical residency or fellowship training program as specified
in subsection 1, paragraph “b”, or the funding of residency
positions which are in excess of the federal residency cap as
defined in subsection 1, paragraph “c”, or the funding of the
payment by the sponsor of medical residency program liability
costs subject to provision by the sponsor of dollar-for-dollar
matching funds used for payment of such costs as specified
-73-in subsection 1, paragraph “d”, shall not receive more than
twenty-five percent of the state matching funds available each
year to support the program.
f. Use of the funds awarded. Funds may be used to pay the
costs of establishing, expanding, or supporting an accredited
graduate medical education program as specified in this
section, including but not limited to the costs associated
with residency stipends and physician faculty stipends. For
the period beginning July 1, 2021, and ending June 30, 2026,
use of the funds awarded may include payment by the sponsor of
medical residency program liability costs in accordance with
subsection 1, paragraph “d”, and subject to provision by the
sponsor of dollar-for-dollar matching funds used for payment
of such costs.
DIVISION XVIII
REPORT ON NONREVERSION OF FUNDS
Sec. 65. REPORT ON NONREVERSION OF FUNDS. The department
of human services shall report the expenditure of any moneys
for which nonreversion authorization was provided for the
fiscal year beginning July 1, 2020, and ending June 30, 2021,
for field operations or general administration to the general
assembly on a quarterly basis beginning October 1, 2021.
DIVISION XIX
PHYSICIAN ORDERS FOR SCOPE OF TREATMENT
Sec. 66. Section 144D.2, subsection 1, paragraph e,
subparagraph (4), Code 2021, is amended by striking the
subparagraph.
______________________________
PAT GRASSLEYSpeaker of the House______________________________
JAKE CHAPMANPresident of the Senate I hereby certify that this bill originated in the House and is known as House File 891, Eighty-ninth General Assembly.______________________________
MEGHAN NELSONChief Clerk of the HouseApproved _______________, 2021______________________________
KIM REYNOLDSGovernorpf/rn/md
services and veterans and including other related provisions
and appropriations, providing penalties, and including
effective date and retroactive and other applicability date
provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I
DEPARTMENT ON AGING — FY 2021-2022
Section 1. DEPARTMENT ON AGING. There is appropriated from
the general fund of the state to the department on aging for
the fiscal year beginning July 1, 2021, and ending June 30,
2022, the following amount, or so much thereof as is necessary,
to be used for the purposes designated:
For aging programs for the department on aging and area
agencies on aging to provide citizens of Iowa who are 60
years of age and older with case management, Iowa’s aging and
disabilities resource center, and other services which may
include but are not limited to adult day, respite care, chore,
information and assistance, and material aid, for information
and options counseling for persons with disabilities who
are 18 years of age or older, and for salaries, support,
administration, maintenance, and miscellaneous purposes, and
for not more than the following full-time equivalent positions:
.................................................. $11,304,082
............................................... FTEs27.00
1. Funds appropriated in this section may be used to
supplement federal funds under federal regulations. To
receive funds appropriated in this section, a local area
agency on aging shall match the funds with moneys from other
sources according to rules adopted by the department. Funds
appropriated in this section may be used for elderly services
not specifically enumerated in this section only if approved
by an area agency on aging for provision of the service within
the area.
2. Of the funds appropriated in this section, $418,700 is
transferred to the economic development authority for the Iowa
commission on volunteer services to be used for the retired and
senior volunteer program.
3. a. The department on aging shall establish and enforce
procedures relating to expenditure of state and federal funds
by area agencies on aging that require compliance with both
-1-state and federal laws, rules, and regulations, including but
not limited to all of the following:
(1) Requiring that expenditures are incurred only for goods
or services received or performed prior to the end of the
fiscal period designated for use of the funds.
(2) Prohibiting prepayment for goods or services not
received or performed prior to the end of the fiscal period
designated for use of the funds.
(3) Prohibiting prepayment for goods or services not
defined specifically by good or service, time period, or
recipient.
(4) Prohibiting the establishment of accounts from which
future goods or services which are not defined specifically by
good or service, time period, or recipient, may be purchased.
b. The procedures shall provide that if any funds are
expended in a manner that is not in compliance with the
procedures and applicable federal and state laws, rules, and
regulations, and are subsequently subject to repayment, the
area agency on aging expending such funds in contravention of
such procedures, laws, rules and regulations, not the state,
shall be liable for such repayment.
4. Of the funds appropriated in this section, at least
$600,000 shall be used to fund home and community-based
services through the area agencies on aging that enable older
individuals to avoid more costly utilization of residential or
institutional services and remain in their own homes.
5. Of the funds appropriated in this section, $812,000 shall
be used for the purposes of chapter 231E and to administer
the prevention of elder abuse, neglect, and exploitation
program pursuant to section 231.56A, in accordance with the
requirements of the federal Older Americans Act of 1965, 42
U.S.C.§3001 et seq., as amended.
6. Of the funds appropriated in this section, $1,000,000
shall be used to fund continuation of the aging and disability
resource center lifelong links to provide individuals and
-2-caregivers with information and services to plan for and
maintain independence.
7. Of the funds appropriated in this section, $250,000
shall be used by the department on aging, in collaboration with
the department of human services and affected stakeholders,
to continue to expand the pilot initiative to provide
long-term care options counseling utilizing support planning
protocols, to assist non-Medicaid eligible consumers who
indicate a preference to return to the community and are
deemed appropriate for discharge, to return to their community
following a nursing facility stay. The department on aging
shall submit a report regarding the outcomes of the pilot
initiative to the governor and the general assembly by December
15, 2021.
DIVISION II
OFFICE OF LONG-TERM CARE oMBUDSMAN — FY 2021-2022
Sec. 2. OFFICE OF LONG-TERM CARE OMBUDSMAN. There is
appropriated from the general fund of the state to the office
of long-term care ombudsman for the fiscal year beginning July
1, 2021, and ending June 30, 2022, the following amount, or
so much thereof as is necessary, to be used for the purposes
designated:
For salaries, support, administration, maintenance, and
miscellaneous purposes, and for not more than the following
full-time equivalent positions:
.................................................. $1,149,821
............................................... FTEs16.00
DIVISION III
DEPARTMENT OF PUBLIC HEALTH — FY 2021-2022
Sec. 3. DEPARTMENT OF PUBLIC HEALTH. There is appropriated
from the general fund of the state to the department of public
health for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amounts, or so much thereof as is
necessary, to be used for the purposes designated:
1. ADDICTIVE DISORDERS
-3- For reducing the prevalence of the use of tobacco, alcohol,
and other drugs, and treating individuals affected by addictive
behaviors, including gambling, and for not more than the
following full-time equivalent positions:
.................................................. $23,659,379
............................................... FTEs12.00
a. (1) Of the funds appropriated in this subsection,
$4,020,894 shall be used for the tobacco use prevention
and control initiative, including efforts at the state and
local levels, as provided in chapter 142A. The commission
on tobacco use prevention and control established pursuant
to section 142A.3 shall advise the director of public health
in prioritizing funding needs and the allocation of moneys
appropriated for the programs and initiatives. Activities
of the programs and initiatives shall be in alignment with
the United States centers for disease control and prevention
best practices for comprehensive tobacco control programs
that include the goals of preventing youth initiation of
tobacco usage, reducing exposure to secondhand smoke, and
promotion of tobacco cessation. To maximize resources,
the department shall determine if third-party sources are
available to instead provide nicotine replacement products
to an applicant prior to provision of such products to an
applicant under the initiative. The department shall track and
report to the governor and the general assembly any reduction
in the provision of nicotine replacement products realized
by the initiative through implementation of the prerequisite
screening.
(2) (a) The department shall collaborate with the
alcoholic beverages division of the department of commerce for
enforcement of tobacco laws, regulations, and ordinances and to
engage in tobacco control activities approved by the division
of tobacco use prevention and control of the department of
public health as specified in the memorandum of understanding
entered into between the divisions.
-4- (b) For the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the terms of the memorandum of understanding,
entered into between the division of tobacco use prevention
and control of the department of public health and the
alcoholic beverages division of the department of commerce,
governing compliance checks conducted to ensure licensed retail
tobacco outlet conformity with tobacco laws, regulations, and
ordinances relating to persons under 21 years of age, shall
continue to restrict the number of such checks to one check per
retail outlet, and one additional check for any retail outlet
found to be in violation during the first check.
b. (1) Of the funds appropriated in this subsection,
$19,638,485 shall be used for problem gambling and
substance-related disorder prevention, treatment, and recovery
services, including a 24-hour helpline, public information
resources, professional training, youth prevention, and program
evaluation.
(2) Of the amount allocated under this paragraph, $306,000
shall be utilized by the department of public health, in
collaboration with the department of human services, to
maintain a single statewide 24-hour crisis hotline for the Iowa
children’s behavioral health system that incorporates warmline
services which may be provided through expansion of existing
capabilities maintained by the department of public health as
required pursuant to 2018 Iowa Acts, chapter 1056, section 16.
c. The requirement of section 123.17, subsection 5, is met
by the appropriations and allocations made in this division of
this Act for purposes of substance-related disorder treatment
and addictive disorders for the fiscal year beginning July 1,
2021.
2. HEALTHY CHILDREN AND FAMILIES
For promoting the optimum health status for children and
adolescents from birth through 21 years of age, and families,
and for not more than the following full-time equivalent
positions:
-5-.................................................. $5,816,681
............................................... FTEs14.00
a. Of the funds appropriated in this subsection, not more
than $734,000 shall be used for the healthy opportunities for
parents to experience success (HOPES)-healthy families Iowa
(HFI) program established pursuant to section 135.106.
b. In order to implement the legislative intent stated
in sections 135.106 and 256I.9, priority for home visitation
program funding shall be given to programs using evidence-based
or promising models for home visitation.
c. Of the funds appropriated in this subsection, $3,075,000
shall be used for continuation of the department’s initiative
to provide for adequate developmental surveillance and
screening during a child’s first five years. The funds shall
be used first to fully fund the current sites to ensure that
the sites are fully operational, with the remaining funds
to be used for expansion to additional sites. The full
implementation and expansion shall include enhancing the scope
of the initiative through collaboration with the child health
specialty clinics to promote healthy child development through
early identification and response to both biomedical and social
determinants of healthy development; by monitoring child
health metrics to inform practice, document long-term health
impacts and savings, and provide for continuous improvement
through training, education, and evaluation; and by providing
for practitioner consultation particularly for children with
behavioral conditions and needs. The department of public
health shall also collaborate with the Iowa Medicaid enterprise
and the child health specialty clinics to integrate the
activities of the first five initiative into the establishment
of patient-centered medical homes, community utilities,
accountable care organizations, and other integrated care
models developed to improve health quality and population
health while reducing health care costs. To the maximum extent
possible, funding allocated in this paragraph shall be utilized
-6-as matching funds for medical assistance program reimbursement.
d. Of the funds appropriated in this subsection, $64,000
shall be distributed to a statewide dental carrier to provide
funds to continue the donated dental services program patterned
after the projects developed by the dental lifeline network to
provide dental services to indigent individuals who are elderly
or with disabilities.
e. Of the funds appropriated in this subsection, $156,000
shall be used to provide audiological services and hearing aids
for children.
f. Of the funds appropriated in this subsection, $23,000 is
transferred to the university of Iowa college of dentistry for
provision of primary dental services to children. State funds
shall be matched on a dollar-for-dollar basis. The university
of Iowa college of dentistry shall coordinate efforts with the
department of public health, oral and health delivery system
bureau, to provide dental care to underserved populations
throughout the state.
g. Of the funds appropriated in this subsection, $50,000
shall be used to address youth suicide prevention.
h. Of the funds appropriated in this subsection, $40,000
shall be used to support the Iowa effort to address the survey
of children who experience adverse childhood experiences known
as ACEs.
i. Of the funds appropriated in this subsection, up to
$494,000 shall be used for childhood obesity prevention.
3. CHRONIC CONDITIONS
For serving individuals identified as having chronic
conditions or special health care needs, and for not more than
the following full-time equivalent positions:
.................................................. $4,258,373
............................................... FTEs10.00
a. Of the funds appropriated in this subsection, $188,000
shall be used for grants to individual patients who have an
inherited metabolic disorder to assist with the costs of
-7-medically necessary foods and formula.
b. Of the funds appropriated in this subsection, $1,055,000
shall be used for the brain injury services program pursuant
to section 135.22B, including $861,000 for contracting with an
existing nationally affiliated and statewide organization whose
purpose is to educate, serve, and support Iowans with brain
injury and their families, for resource facilitator services
in accordance with section 135.22B, subsection 9, and for
contracting to enhance brain injury training and recruitment
of service providers on a statewide basis. Of the amount
allocated in this paragraph, $95,000 shall be used to fund
1.00 full-time equivalent position to serve as the state brain
injury services program manager.
c. Of the funds appropriated in this subsection, $144,000
shall be used for the public purpose of continuing to contract
with an existing nationally affiliated organization to provide
education, client-centered programs, and client and family
support for people living with epilepsy and their families.
The amount allocated in this paragraph in excess of $50,000
shall be matched dollar-for-dollar by the organization
specified. Funds allocated under this paragraph shall be
distributed in their entirety for the purpose specified on July
1, 2021.
d. Of the funds appropriated in this subsection, $809,000
shall be used for child health specialty clinics.
e. Of the funds appropriated in this subsection, $384,000
shall be used by the regional autism assistance program
established pursuant to section 256.35, and administered by
the child health specialty clinic located at the university of
Iowa hospitals and clinics. The funds shall be used to enhance
interagency collaboration and coordination of educational,
medical, and other human services for persons with autism,
their families, and providers of services, including delivering
regionalized services of care coordination, family navigation,
and integration of services through the statewide system of
-8-regional child health specialty clinics and fulfilling other
requirements as specified in chapter 225D. The university of
Iowa shall not receive funds allocated under this paragraph for
indirect costs associated with the regional autism assistance
program.
f. Of the funds appropriated in this subsection, $577,000
shall be used for the comprehensive cancer control program to
reduce the burden of cancer in Iowa through prevention, early
detection, effective treatment, and ensuring quality of life.
Of the funds allocated in this paragraph “f”, $150,000 shall
be used to support a melanoma research symposium, a melanoma
biorepository and registry, basic and translational melanoma
research, and clinical trials.
g. Of the funds appropriated in this subsection, $97,000
shall be used for cervical and colon cancer screening, and
$177,000 shall be used to enhance the capacity of the cervical
cancer screening program to include provision of recommended
prevention and early detection measures to a broader range of
low-income women.
h. Of the funds appropriated in this subsection, $506,000
shall be used for the center for congenital and inherited
disorders.
4. COMMUNITY CAPACITY
For strengthening the health care delivery system at the
local level, and for not more than the following full-time
equivalent positions:
.................................................. $7,319,306
............................................... FTEs13.00
a. Of the funds appropriated in this subsection, $95,000
is allocated for continuation of the child vision screening
program implemented through the university of Iowa hospitals
and clinics in collaboration with early childhood Iowa areas.
The program shall submit a report to the department regarding
the use of funds allocated under this paragraph “a”. The
report shall include the objectives and results for the
-9-program year including the target population and how the funds
allocated assisted the program in meeting the objectives; the
number, age, and location within the state of individuals
served; the type of services provided to the individuals
served; the distribution of funds based on service provided;
and the continuing needs of the program.
b. Of the funds appropriated in this subsection,
$48,000 shall be used for a grant to a statewide association
of psychologists, that is affiliated with the American
psychological association, to be used for continuation of a
program to rotate intern psychologists in placements that
serve urban and rural mental health professional shortage
areas. Once an intern psychologist begins service, the intern
psychologist may continue serving in the location of the intern
psychologist’s placement, notwithstanding any change in the
mental health professional shortage area designation of such
location. The intern psychologist may also provide services
via telehealth, to underserved populations, and to Medicaid
members. For the purposes of this paragraph “b”, “mental
health professional shortage area” means a geographic area
in this state that has been designated by the United States
department of health and human services, health resources and
services administration, bureau of health professionals, as
having a shortage of mental health professionals.
c. Of the funds appropriated in this subsection, the
following amounts are allocated to be used as follows
to support the goals of increased access, health system
integration, and engagement:
(1) Not less than $1,600,000 is allocated to the Iowa
prescription drug corporation for continuation of the
pharmaceutical infrastructure for safety net providers as
described in 2007 Iowa Acts, chapter 218, section 108, and for
the prescription drug donation repository program created in
chapter 135M. Of the amount allocated in this subparagraph,
$1,000,000 shall be used as one-time funding to support
-10-program expansion and to implement an automated multi-dose
prescription packaging system. Funds allocated under this
subparagraph shall be distributed in their entirety for the
purpose specified on July 1, 2021.
(2) Not less than $334,000 is allocated to free clinics and
free clinics of Iowa for necessary infrastructure, statewide
coordination, provider recruitment, service delivery, and
provision of assistance to patients in securing a medical home
inclusive of oral health care. Funds allocated under this
subparagraph shall be distributed in their entirety for the
purpose specified on July 1, 2021.
(3) Not less than $25,000 is allocated to the Iowa
association of rural health clinics for necessary
infrastructure and service delivery transformation. Funds
allocated under this subparagraph shall be distributed in their
entirety for the purpose specified on July 1, 2021.
(4) Not less than $225,000 is allocated to the Polk county
medical society for continuation of the safety net provider
patient access to specialty health care initiative as described
in 2007 Iowa Acts, chapter 218, section 109. Funds allocated
under this subparagraph shall be distributed in their entirety
for the purpose specified on July 1, 2021.
d. Of the funds appropriated in this subsection, $191,000
is allocated for the purposes of health care and public health
workforce initiatives.
e. Of the funds appropriated in this subsection, $96,000
shall be used for a matching dental education loan repayment
program to be allocated to a dental nonprofit health service
corporation to continue to develop the criteria and implement
the loan repayment program.
f. Of the funds appropriated in this subsection, $100,000
shall be used for the purposes of the Iowa donor registry as
specified in section 142C.18.
g. Of the funds appropriated in this subsection, $96,000
shall be used for continuation of a grant to a nationally
-11-affiliated volunteer eye organization that has an established
program for children and adults and that is solely dedicated to
preserving sight and preventing blindness through education,
nationally certified vision screening and training, and
community and patient service programs. The contractor shall
submit a report to the general assembly regarding the use
of funds allocated under this paragraph “g”. The report
shall include the objectives and results for the program year
including the target population and how the funds allocated
assisted the program in meeting the objectives; the number,
age, grade level if appropriate, and location within the state
of individuals served; the type of services provided to the
individuals served; the distribution of funds based on services
provided; and the continuing needs of the program.
h. Of the funds appropriated in this subsection, $2,100,000
shall be deposited in the medical residency training account
created in section 135.175, subsection 5, paragraph “a”, and
is appropriated from the account to the department of public
health to be used for the purposes of the medical residency
training state matching grants program as specified in section
135.176.
i. Of the funds appropriated in this subsection, $250,000
shall be used for the public purpose of providing funding to
Des Moines university to continue a provider education project
to provide primary care physicians with the training and skills
necessary to recognize the signs of mental illness in patients.
j. Of the funds appropriated in this subsection, $600,000
shall be used for rural psychiatric residencies to support the
annual creation and training of four psychiatric residents who
will provide mental health services in underserved areas of
the state. Notwithstanding section 8.33, moneys that remain
unencumbered or unobligated at the close of the fiscal year
shall not revert but shall remain available for expenditure for
the purposes designated for subsequent fiscal years.
k. Of the funds appropriated in this subsection, $150,000
-12-shall be used for psychiatric training to increase access to
mental health care services by expanding the mental health
workforce via training of additional physician assistants and
nurse practitioners.
1. Of the funds appropriated in this subsection, $425,000
shall be used for the creation of a center of excellence
program to encourage innovation and collaboration among
regional health care providers in a rural area based upon the
results of a regional community needs assessment to transform
health care delivery in order to provide quality, sustainable
care that meets the needs of the local communities. An
applicant for the funds shall specify how the funds will be
expended to accomplish the goals of the program and shall
provide a detailed five-year sustainability plan prior to
being awarded any funding. Following the receipt of funding,
a recipient shall submit periodic reports as specified by the
department to the governor and the general assembly regarding
the recipient’s expenditure of the funds and progress in
accomplishing the program goals.
5. ESSENTIAL PUBLIC HEALTH SERVICES
To provide public health services that reduce risks and
invest in promoting and protecting good health over the
course of a lifetime with a priority given to older Iowans and
vulnerable populations:
.................................................. $7,662,464
6. INFECTIOUS DISEASES
For reducing the incidence and prevalence of communicable
diseases, and for not more than the following full-time
equivalent positions:
.................................................. $1,796,206
............................................... FTEs6.00
7. PUBLIC PROTECTION
For protecting the health and safety of the public through
establishing standards and enforcing regulations, and for not
more than the following full-time equivalent positions:
-13-.................................................. $4,466,601
............................................... FTEs142.00
a. Of the funds appropriated in this subsection, not more
than $304,000 shall be credited to the emergency medical
services fund created in section 135.25. Moneys in the
emergency medical services fund are appropriated to the
department to be used for the purposes of the fund.
b. Of the funds appropriated in this subsection, up
to $243,000 shall be used for sexual violence prevention
programming through a statewide organization representing
programs serving victims of sexual violence through the
department’s sexual violence prevention program, and for
continuation of a training program for sexual assault
response team (SART) members, including representatives of
law enforcement, victim advocates, prosecutors, and certified
medical personnel. The amount allocated in this paragraph “b”
shall not be used to supplant funding administered for other
sexual violence prevention or victims assistance programs.
c. Of the funds appropriated in this subsection, up to
$500,000 shall be used for the state poison control center.
Pursuant to the directive under 2014 Iowa Acts, chapter
1140, section 102, the federal matching funds available to
the state poison control center from the department of human
services under the federal Children’s Health Insurance Program
Reauthorization Act allotment shall be subject to the federal
administrative cap rule of 10 percent applicable to funding
provided under Tit.XXI of the federal Social Security Act and
included within the department’s calculations of the cap.
d. Of the funds appropriated in this subsection, up to
$504,000 shall be used for childhood lead poisoning provisions.
8. RESOURCE MANAGEMENT
For establishing and sustaining the overall ability of the
department to deliver services to the public, and for not more
than the following full-time equivalent positions:
.................................................. $933,871
-14-............................................... FTEs4.00
9. MISCELLANEOUS PROVISIONS
The university of Iowa hospitals and clinics under the
control of the state board of regents shall not receive
indirect costs from the funds appropriated in this section.
The university of Iowa hospitals and clinics billings to the
department shall be on at least a quarterly basis.
Sec. 4. DEPARTMENT OF PUBLIC HEALTH — SPORTS WAGERING
RECEIPTS FUND. There is appropriated from the sports wagering
receipts fund created in section 8.57, subsection 6, to the
department of public health for the fiscal year beginning July
1, 2021, and ending June 30, 2022, the following amount, or
so much thereof as is necessary, to be used for the purposes
designated:
For problem gambling and substance-related disorder
prevention, treatment, and recovery services, including a
24-hour helpline, public information resources, professional
training, youth prevention, and program evaluation:
.................................................. $1,750,000
DIVISION IV
DEPARTMENT OF VETERANS AFFAIRS — FY 2021-2022
Sec. 5. DEPARTMENT OF VETERANS AFFAIRS. There is
appropriated from the general fund of the state to the
department of veterans affairs for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, the following amounts,
or so much thereof as is necessary, to be used for the purposes
designated:
1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
For salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
.................................................. $1,229,763
............................................... FTEs15.00
2. IOWA VETERANS HOME
For salaries, support, maintenance, and miscellaneous
-15-purposes:
.................................................. $7,131,552
a. The Iowa veterans home billings involving the department
of human services shall be submitted to the department on at
least a monthly basis.
b. The Iowa veterans home expenditure report shall be
submitted monthly to the general assembly.
c. The Iowa veterans home shall continue to include in the
annual discharge report applicant information to provide for
the collection of demographic information including but not
limited to the number of individuals applying for admission and
admitted or denied admittance and the basis for the admission
or denial; the age, gender, and race of such individuals;
and the level of care for which such individuals applied for
admission including residential or nursing level of care.
3. HOME OWNERSHIP ASSISTANCE PROGRAM
For transfer to the Iowa finance authority for the
continuation of the home ownership assistance program for
persons who are or were eligible members of the armed forces of
the United States, pursuant to section 16.54:
.................................................. $2,000,000
Sec. 6. LIMITATION OF COUNTY COMMISSIONS OF VETERAN AFFAIRS
FUND STANDING APPROPRIATIONS. Notwithstanding the standing
appropriation in section 35A.16 for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, the amount appropriated
from the general fund of the state pursuant to that section
for the following designated purposes shall not exceed the
following amount:
For the county commissions of veteran affairs fund under
section 35A.16:
.................................................. $990,000
DIVISION V
DEPARTMENT OF HUMAN SERVICES — FY 2021-2022
Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
GRANT. There is appropriated from the fund created in section
-16-8.41 to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, from moneys
received under the federal temporary assistance for needy
families (TANF) block grant pursuant to the federal Personal
Responsibility and Work Opportunity Reconciliation Act of 1996,
Pub.L.No.104-193, and successor legislation, the following
amounts, or so much thereof as is necessary, to be used for the
purposes designated:
1. To be credited to the family investment program account
and used for assistance under the family investment program
under chapter 239B:
.................................................. $5,002,006
2. To be credited to the family investment program account
and used for the job opportunities and basic skills (JOBS)
program and implementing family investment agreements in
accordance with chapter 239B:
.................................................. $5,412,060
3. To be used for the family development and
self-sufficiency grant program in accordance with section
216A.107:
.................................................. $2,888,980
Notwithstanding section 8.33, moneys appropriated in this
subsection that remain unencumbered or unobligated at the close
of the fiscal year shall not revert but shall remain available
for expenditure for the purposes designated until the close of
the succeeding fiscal year. However, unless such moneys are
encumbered or obligated on or before September 30, 2022, the
moneys shall revert.
4. For field operations:
.................................................. $31,296,232
5. For general administration:
.................................................. $3,744,000
6. For state child care assistance:
.................................................. $47,166,826
a. Of the funds appropriated in this subsection,
-17-$26,205,412 is transferred to the child care and development
block grant appropriation made by the Eighty-ninth General
Assembly, 2021 session, for the federal fiscal year beginning
October 1, 2021, and ending September 30, 2022. Of this
amount, $200,000 shall be used for provision of educational
opportunities to registered child care home providers in order
to improve services and programs offered by this category
of providers and to increase the number of providers. The
department may contract with institutions of higher education
or child care resource and referral centers to provide
the educational opportunities. Allowable administrative
costs under the contracts shall not exceed 5 percent. The
application for a grant shall not exceed two pages in length.
b. Any funds appropriated in this subsection remaining
unallocated shall be used for state child care assistance
payments for families who are employed including but not
limited to individuals enrolled in the family investment
program.
7. For child and family services:
.................................................. $32,380,654
8. For child abuse prevention grants:
.................................................. $125,000
9. For pregnancy prevention grants on the condition that
family planning services are funded:
.................................................. $1,913,203
Pregnancy prevention grants shall be awarded to programs
in existence on or before July 1, 2021, if the programs have
demonstrated positive outcomes. Grants shall be awarded to
pregnancy prevention programs which are developed after July
1, 2021, if the programs are based on existing models that
have demonstrated positive outcomes. Grants shall comply with
the requirements provided in 1997 Iowa Acts, chapter 208,
section 14, subsections 1 and 2, including the requirement that
grant programs must emphasize sexual abstinence. Priority in
the awarding of grants shall be given to programs that serve
-18-areas of the state which demonstrate the highest percentage of
unplanned pregnancies of females of childbearing age within the
geographic area to be served by the grant.
10. For technology needs and other resources necessary to
meet federal, state, and welfare reform reporting, tracking,
and case management requirements and other departmental needs:
.................................................. $1,037,186
11. a. Notwithstanding any provision to the contrary,
including but not limited to requirements in section 8.41 or
provisions in 2020 Iowa Acts or 2021 Iowa Acts regarding the
receipt and appropriation of federal block grants, federal
funds from the temporary assistance for needy families block
grant received by the state and not otherwise appropriated
in this section and remaining available for the fiscal year
beginning July 1, 2021, are appropriated to the department of
human services to the extent as may be necessary to be used in
the following priority order: the family investment program,
for state child care assistance program payments for families
who are employed, and for the family investment program share
of system costs for eligibility determination and related
functions. The federal funds appropriated in this paragraph
“a” shall be expended only after all other funds appropriated
in subsection 1 for assistance under the family investment
program, in subsection 6 for state child care assistance, or
in subsection 10 for technology costs related to the family
investment program, as applicable, have been expended. For
the purposes of this subsection, the funds appropriated in
subsection 6, paragraph “a”, for transfer to the child care
and development block grant appropriation are considered fully
expended when the full amount has been transferred.
b. The department shall, on a quarterly basis, advise the
general assembly and department of management of the amount of
funds appropriated in this subsection that was expended in the
prior quarter.
12. Of the amounts appropriated in this section,
-19-$12,962,008 for the fiscal year beginning July 1, 2021, is
transferred to the appropriation of the federal social services
block grant made to the department of human services for that
fiscal year.
13. For continuation of the program providing categorical
eligibility for the food assistance program as specified
for the program in the section of this division of this Act
relating to the family investment program account:
.................................................. $14,236
14. The department may transfer funds allocated in this
section to the appropriations made in this division of this Act
for the same fiscal year for general administration and field
operations for resources necessary to implement and operate the
services referred to in this section and those funded in the
appropriation made in this division of this Act for the same
fiscal year for the family investment program from the general
fund of the state.
15. With the exception of moneys allocated under this
section for the family development and self-sufficiency grant
program, to the extent moneys allocated in this section are
deemed by the department not to be necessary to support the
purposes for which they are allocated, such moneys may be used
in the same fiscal year for any other purpose for which funds
are allocated in this section or in section 8 of this division
of this Act for the family investment program account. If
there are conflicting needs, priority shall first be given
to the family investment program account as specified under
subsection 1 of this section and used for the purposes of
assistance under the family investment program in accordance
with chapter 239B, followed by state child care assistance
program payments for families who are employed, followed by
other priorities as specified by the department.
Sec. 8. FAMILY INVESTMENT PROGRAM ACCOUNT.
1. Moneys credited to the family investment program (FIP)
account for the fiscal year beginning July 1, 2021, and
-20-ending June 30, 2022, shall be used to provide assistance in
accordance with chapter 239B.
2. The department may use a portion of the moneys credited
to the FIP account under this section as necessary for
salaries, support, maintenance, and miscellaneous purposes.
3. The department may transfer funds allocated in
subsection 4, excluding the allocation under subsection 4,
paragraph “b”, to the appropriations made in this division of
this Act for the same fiscal year for general administration
and field operations for resources necessary to implement
and operate the services referred to in this section and
those funded in the appropriations made in section 7 for the
temporary assistance for needy families block grant and in
section 9 for the family investment program from the general
fund of the state in this division of this Act for the same
fiscal year.
4. Moneys appropriated in this division of this Act and
credited to the FIP account for the fiscal year beginning July
1, 2021, and ending June 30, 2022, are allocated as follows:
a. To be retained by the department of human services to
be used for coordinating with the department of human rights
to more effectively serve participants in FIP and other shared
clients and to meet federal reporting requirements under the
federal temporary assistance for needy families block grant:
.................................................. $10,000
b. To the department of human rights for staffing,
administration, and implementation of the family development
and self-sufficiency grant program in accordance with section
216A.107:
.................................................. $7,192,834
(1) Of the funds allocated for the family development
and self-sufficiency grant program in this paragraph “b”,
not more than 5 percent of the funds shall be used for the
administration of the grant program.
(2) The department of human rights may continue to implement
-21-the family development and self-sufficiency grant program
statewide during fiscal year 2021-2022.
(3) The department of human rights may engage in activities
to strengthen and improve family outcomes measures and
data collection systems under the family development and
self-sufficiency grant program.
c. For the diversion subaccount of the FIP account:
.................................................. $1,293,000
A portion of the moneys allocated for the diversion
subaccount may be used for field operations, salaries, data
management system development, and implementation costs and
support deemed necessary by the director of human services
in order to administer the FIP diversion program. To the
extent moneys allocated in this paragraph “c” are deemed by the
department not to be necessary to support diversion activities,
such moneys may be used for other efforts intended to increase
engagement by family investment program participants in work,
education, or training activities, or for the purposes of
assistance under the family investment program in accordance
with chapter 239B.
d. For the food assistance employment and training program:
.................................................. $66,588
(1) The department shall apply the federal supplemental
nutrition assistance program (SNAP) employment and training
state plan in order to maximize to the fullest extent permitted
by federal law the use of the 50 percent federal reimbursement
provisions for the claiming of allowable federal reimbursement
funds from the United States department of agriculture
pursuant to the federal SNAP employment and training program
for providing education, employment, and training services
for eligible food assistance program participants, including
but not limited to related dependent care and transportation
expenses.
(2) The department shall continue the categorical federal
food assistance program eligibility at 160 percent of the
-22-federal poverty level and continue to eliminate the asset test
from eligibility requirements, consistent with federal food
assistance program requirements. The department shall include
as many food assistance households as is allowed by federal
law. The eligibility provisions shall conform to all federal
requirements including requirements addressing individuals who
are incarcerated or otherwise ineligible.
e. For the JOBS program, not more than:
.................................................. $12,018,258
5. Of the child support collections assigned under FIP,
an amount equal to the federal share of support collections
shall be credited to the child support recovery appropriation
made in this division of this Act. Of the remainder of the
assigned child support collections received by the child
support recovery unit, a portion shall be credited to the FIP
account, a portion may be used to increase recoveries, and a
portion may be used to sustain cash flow in the child support
payments account. If as a consequence of the appropriations
and allocations made in this section the resulting amounts
are insufficient to sustain cash assistance payments and meet
federal maintenance of effort requirements, the department
shall seek supplemental funding. If child support collections
assigned under FIP are greater than estimated or are otherwise
determined not to be required for maintenance of effort, the
state share of either amount may be transferred to or retained
in the child support payments account.
Sec. 9. FAMILY INVESTMENT PROGRAM GENERAL FUND. There
is appropriated from the general fund of the state to the
department of human services for the fiscal year beginning July
1, 2021, and ending June 30, 2022, the following amount, or
so much thereof as is necessary, to be used for the purpose
designated:
To be credited to the family investment program (FIP)
account and used for family investment program assistance
under chapter 239B and other costs associated with providing
-23-needs-based benefits or assistance:
.................................................. $41,003,978
1. Of the funds appropriated in this section, $6,606,198 is
allocated for the JOBS program.
2. Of the funds appropriated in this section, $4,313,854 is
allocated for the family development and self-sufficiency grant
program.
3. a. Notwithstanding section 8.39, for the fiscal
year beginning July 1, 2021, if necessary to meet federal
maintenance of effort requirements or to transfer federal
temporary assistance for needy families block grant funding
to be used for purposes of the federal social services block
grant or to meet cash flow needs resulting from delays in
receiving federal funding or to implement, in accordance with
this division of this Act, activities currently funded with
juvenile court services, county, or community moneys and state
moneys used in combination with such moneys; to comply with
federal requirements; or to maximize the use of federal funds;
the department of human services may transfer funds within or
between any of the appropriations made in this division of this
Act and appropriations in law for the federal social services
block grant to the department for the following purposes,
provided that the combined amount of state and federal
temporary assistance for needy families block grant funding
for each appropriation remains the same before and after the
transfer:
(1) For the family investment program.
(2) For state child care assistance.
(3) For child and family services.
(4) For field operations.
(5) For general administration.
b. This subsection shall not be construed to prohibit the
use of existing state transfer authority for other purposes.
The department shall report any transfers made pursuant to this
subsection to the general assembly.
-24- 4. Of the funds appropriated in this section, $195,000
shall be used for a contract for tax preparation assistance
to low-income Iowans to expand the usage of the earned income
tax credit. The purpose of the contract is to supply this
assistance to underserved areas of the state. The department
shall not retain any portion of the allocation under this
subsection for administrative costs.
5. Of the funds appropriated in this section, $70,000 shall
be used for the continuation of the parenting program, as
specified in 441 IAC ch.100, relating to parental obligations,
in which the child support recovery unit participates, to
support the efforts of a nonprofit organization committed to
strengthening the community through youth development, healthy
living, and social responsibility headquartered in a county
with a population over 350,000 according to the 2010 certified
federal census. The funds allocated in this subsection shall
be used by the recipient organization to develop a larger
community effort, through public and private partnerships, to
support a broad-based multi-county parenthood initiative that
promotes payment of child support obligations, improved family
relationships, and full-time employment.
6. The department may transfer funds appropriated in this
section, excluding the allocation in subsection 2 for the
family development and self-sufficiency grant program, to the
appropriations made in this division of this Act for general
administration and field operations as necessary to administer
this section, section 7 for the temporary assistance for needy
families block grant, and section 8 for the family investment
program account.
Sec. 10. CHILD SUPPORT RECOVERY. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For child support recovery, including salaries, support,
-25-maintenance, and miscellaneous purposes, and for not more than
the following full-time equivalent positions:
.................................................. $15,942,885
............................................... FTEs459.00
1. The department shall expend up to $24,000, including
federal financial participation, for the fiscal year beginning
July 1, 2021, for a child support public awareness campaign.
The department and the office of the attorney general shall
cooperate in continuation of the campaign. The public
awareness campaign shall emphasize, through a variety of
media activities, the importance of maximum involvement of
both parents in the lives of their children as well as the
importance of payment of child support obligations.
2. Federal access and visitation grant moneys shall be
issued directly to private not-for-profit agencies that provide
services designed to increase compliance with the child access
provisions of court orders, including but not limited to
neutral visitation sites and mediation services.
3. The appropriation made to the department for child
support recovery may be used throughout the fiscal year in the
manner necessary for purposes of cash flow management, and for
cash flow management purposes the department may temporarily
draw more than the amount appropriated, provided the amount
appropriated is not exceeded at the close of the fiscal year.
Sec. 11. HEALTH CARE TRUST FUND — MEDICAL ASSISTANCE —
FY 2021-2022. Any funds remaining in the health care trust
fund created in section 453A.35A for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, are appropriated to
the department of human services to supplement the medical
assistance program appropriations made in this division of this
Act, for medical assistance reimbursement and associated costs,
including program administration and costs associated with
program implementation.
Sec. 12. MEDICAID FRAUD FUND — MEDICAL ASSISTANCE — FY
2021-2022. Any funds remaining in the Medicaid fraud fund
-26-created in section 249A.50 for the fiscal year beginning
July 1, 2021, and ending June 30, 2022, are appropriated to
the department of human services to supplement the medical
assistance appropriations made in this division of this Act,
for medical assistance reimbursement and associated costs,
including program administration and costs associated with
program implementation.
Sec. 13. MEDICAL ASSISTANCE. There is appropriated from the
general fund of the state to the department of human services
for the fiscal year beginning July 1, 2021, and ending June 30,
2022, the following amount, or so much thereof as is necessary,
to be used for the purpose designated:
For medical assistance program reimbursement and associated
costs as specifically provided in the reimbursement
methodologies in effect on June 30, 2021, except as otherwise
expressly authorized by law, consistent with options under
federal law and regulations, and contingent upon receipt of
approval from the office of the governor of reimbursement for
each abortion performed under the program:
.................................................. $1,503,848,253
1. Iowans support reducing the number of abortions
performed in our state. Funds appropriated under this section
shall not be used for abortions, unless otherwise authorized
under this section.
2. The provisions of this section relating to abortions
shall also apply to the Iowa health and wellness plan created
pursuant to chapter 249N.
3. The department shall utilize not more than $60,000 of
the funds appropriated in this section to continue the AIDS/HIV
health insurance premium payment program as established in 1992
Iowa Acts, Second Extraordinary Session, chapter 1001, section
409, subsection 6. Of the funds allocated in this subsection,
not more than $5,000 may be expended for administrative
purposes.
4. Of the funds appropriated in this Act to the department
-27-of public health for addictive disorders, $950,000 for
the fiscal year beginning July 1, 2021, is transferred
to the department of human services for an integrated
substance-related disorder managed care system. The
departments of human services and public health shall
work together to maintain the level of mental health and
substance-related disorder treatment services provided by the
managed care contractors. Each department shall take the steps
necessary to continue the federal waivers as necessary to
maintain the level of services.
5. The department shall aggressively pursue options for
providing medical assistance or other assistance to individuals
with special needs who become ineligible to continue receiving
services under the early and periodic screening, diagnostic,
and treatment program under the medical assistance program
due to becoming 21 years of age who have been approved for
additional assistance through the department’s exception to
policy provisions, but who have health care needs in excess
of the funding available through the exception to policy
provisions.
6. Of the funds appropriated in this section, up to
$3,050,082 may be transferred to the field operations or
general administration appropriations in this division of this
Act for operational costs associated with Part D of the federal
Medicare Prescription Drug Improvement and Modernization Act
of 2003, Pub.L.No.108-173.
7. Of the funds appropriated in this section, up to $442,100
may be transferred to the appropriation in this division of
this Act for health program operations to be used for clinical
assessment services and prior authorization of services.
8. A portion of the funds appropriated in this section may
be transferred to the appropriations in this division of this
Act for general administration, health program operations, the
children’s health insurance program, or field operations to be
used for the state match cost to comply with the payment error
-28-rate measurement (PERM) program for both the medical assistance
and children’s health insurance programs as developed by the
centers for Medicare and Medicaid services of the United States
department of health and human services to comply with the
federal Improper Payments Information Act of 2002, Pub.L.
No.107-300, and to support other reviews and quality control
activities to improve the integrity of these programs.
9. Of the funds appropriated in this section, a sufficient
amount is allocated to supplement the incomes of residents of
nursing facilities, intermediate care facilities for persons
with mental illness, and intermediate care facilities for
persons with an intellectual disability, with incomes of less
than $50 in the amount necessary for the residents to receive a
personal needs allowance of $50 per month pursuant to section
249A.30A.
10. a. Hospitals that meet the conditions specified
in subparagraphs (1) and (2) shall either certify public
expenditures or transfer to the medical assistance program
an amount equal to provide the nonfederal share for a
disproportionate share hospital payment in an amount up to the
hospital-specific limit as approved in the Medicaid state plan.
The hospitals that meet the conditions specified shall receive
and retain 100 percent of the total disproportionate share
hospital payment in an amount up to the hospital-specific limit
as approved in the Medicaid state plan.
(1) The hospital qualifies for disproportionate share and
graduate medical education payments.
(2) The hospital is an Iowa state-owned hospital with more
than 500 beds and eight or more distinct residency specialty
or subspecialty programs recognized by the American college of
graduate medical education.
b. Distribution of the disproportionate share payments
shall be made on a monthly basis. The total amount of
disproportionate share payments including graduate medical
education, enhanced disproportionate share, and Iowa
-29-state-owned teaching hospital payments shall not exceed the
amount of the state’s allotment under Pub.L.No.102-234.
In addition, the total amount of all disproportionate
share payments shall not exceed the hospital-specific
disproportionate share limits under Pub.L.No.103-66.
11. One hundred percent of the nonfederal share of payments
to area education agencies that are medical assistance
providers for medical assistance-covered services provided to
medical assistance-covered children, shall be made from the
appropriation made in this section.
12. A portion of the funds appropriated in this section may
be transferred to the appropriation in this division of this
Act for health program operations to be used for administrative
activities associated with the money follows the person
demonstration project.
13. Of the funds appropriated in this section, $349,011
shall be used for the administration of the health insurance
premium payment program, including salaries, support,
maintenance, and miscellaneous purposes.
14. a. The department may increase the amounts allocated
for salaries, support, maintenance, and miscellaneous purposes
associated with the medical assistance program, as necessary,
to sustain cost management efforts. The department shall
report any such increase to the general assembly and the
department of management.
b. If the savings to the medical assistance program from
ongoing cost management efforts exceed the associated cost
for the fiscal year beginning July 1, 2021, the department
may transfer any savings generated for the fiscal year due
to medical assistance program cost management efforts to the
appropriation made in this division of this Act for health
program operations or general administration to defray the
costs associated with implementing the efforts.
15. For the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the replacement generation tax revenues required
-30-to be deposited in the property tax relief fund pursuant to
section 437A.8, subsection 4, paragraph “d”, and section
437A.15, subsection 3, paragraph “f”, shall instead be credited
to and supplement the appropriation made in this section and
used for the allocations made in this section.
16. a. Of the funds appropriated in this section, up
to $50,000 may be transferred by the department to the
appropriation made in this division of this Act to the
department for the same fiscal year for general administration
to be used for associated administrative expenses and for not
more than 1.00 full-time equivalent position, in addition to
those authorized for the same fiscal year, to be assigned to
implementing the children’s mental health home project.
b. Of the funds appropriated in this section, up to $400,000
may be transferred by the department to the appropriation made
to the department in this division of this Act for the same
fiscal year for Medicaid program-related general administration
planning and implementation activities. The funds may be used
for contracts or for personnel in addition to the amounts
appropriated for and the positions authorized for general
administration for the fiscal year.
c. Of the funds appropriated in this section, up to
$3,000,000 may be transferred by the department to the
appropriations made in this division of this Act for the
same fiscal year for general administration or health
program operations to be used to support the development
and implementation of standardized assessment tools for
persons with mental illness, an intellectual disability, a
developmental disability, or a brain injury.
17. Of the funds appropriated in this section, $150,000
shall be used for lodging expenses associated with care
provided at the university of Iowa hospitals and clinics for
patients with cancer whose travel distance is 30 miles or more
and whose income is at or below 200 percent of the federal
poverty level as defined by the most recently revised poverty
-31-income guidelines published by the United States department of
health and human services. The department of human services
shall establish the maximum number of overnight stays and the
maximum rate reimbursed for overnight lodging, which may be
based on the state employee rate established by the department
of administrative services. The funds allocated in this
subsection shall not be used as nonfederal share matching
funds.
18. Of the funds appropriated in this section, up to
$3,383,880 shall be used for administration of the state family
planning services program pursuant to section 217.41B, and
of this amount, the department may use up to $200,000 for
administrative expenses.
19. Of the funds appropriated in this section, $1,545,530
shall be used and may be transferred to other appropriations
in this division of this Act as necessary to administer the
provisions in the division of this Act relating to Medicaid
program administration.
20. The department shall comply with the centers for
Medicare and Medicaid services’ guidance related to Medicaid
program and children’s health insurance program maintenance
of effort provisions, including eligibility standards,
methodologies, procedures, and continuous enrollment, to
receive the enhanced federal medical assistance percentage
under section 6008(b) of the federal Families First Coronavirus
Response Act, Pub.L. No.116-127. The department shall
utilize and implement all tools, processes, and resources
available to expediently return to normal eligibility and
enrollment operations in compliance with federal guidance and
expectations.
21. Of the funds appropriated in this section, up to
$1,031,530 shall be used to implement reductions in the waiting
list for the children’s mental health home and community-based
services waiver.
22. Of the funds appropriated in this section, a sufficient
-32-amount is allocated to fund up to three full-time equivalent
positions to support the administrative work associated with
existing and potential supplemental payment programs.
Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purpose designated:
For health program operations:
.................................................. $17,831,343
1. The department of inspections and appeals shall
provide all state matching funds for survey and certification
activities performed by the department of inspections
and appeals. The department of human services is solely
responsible for distributing the federal matching funds for
such activities.
2. Of the funds appropriated in this section, $50,000 shall
be used for continuation of home and community-based services
waiver quality assurance programs, including the review and
streamlining of processes and policies related to oversight and
quality management to meet state and federal requirements.
3. Of the amount appropriated in this section, up to
$200,000 may be transferred to the appropriation for general
administration in this division of this Act to be used for
additional full-time equivalent positions in the development
of key health initiatives such as development and oversight
of managed care programs and development of health strategies
targeted toward improved quality and reduced costs in the
Medicaid program.
4. Of the funds appropriated in this section, $1,000,000
shall be used for planning and development, in cooperation with
the department of public health, of a phased-in program to
provide a dental home for children.
5. a. Of the funds appropriated in this section, $573,000
shall be credited to the autism support program fund created
-33-in section 225D.2 to be used for the autism support program
created in chapter 225D, with the exception of the following
amount of this allocation which shall be used as follows:
b. Of the funds allocated in this subsection, $25,000 shall
be used for the public purpose of continuation of a grant to
a nonprofit provider of child welfare services that has been
in existence for more than 115 years, is located in a county
with a population between 200,000 and 220,000 according to the
2010 federal decennial census, is licensed as a psychiatric
medical institution for children, and provides school-based
programming, to be used for support services for children with
autism spectrum disorder and their families.
Sec. 15. STATE SUPPLEMENTARY ASSISTANCE.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For the state supplementary assistance program:
.................................................. $7,349,002
2. The department shall increase the personal needs
allowance for residents of residential care facilities by the
same percentage and at the same time as federal supplemental
security income and federal social security benefits are
increased due to a recognized increase in the cost of living.
The department may adopt emergency rules to implement this
subsection.
3. If during the fiscal year beginning July 1, 2021,
the department projects that state supplementary assistance
expenditures for a calendar year will not meet the federal
pass-through requirement specified in Tit.XVI of the federal
Social Security Act, section 1618, as codified in 42 U.S.C.
§1382g, the department may take actions including but not
limited to increasing the personal needs allowance for
residential care facility residents and making programmatic
-34-adjustments or upward adjustments of the residential care
facility or in-home health-related care reimbursement rates
prescribed in this division of this Act to ensure that federal
requirements are met. In addition, the department may make
other programmatic and rate adjustments necessary to remain
within the amount appropriated in this section while ensuring
compliance with federal requirements. The department may adopt
emergency rules to implement the provisions of this subsection.
4. Notwithstanding section 8.33, moneys appropriated
in this section that remain unencumbered or unobligated
at the close of the fiscal year shall not revert but
shall remain available for expenditure for the purposes
designated, including for liability amounts associated with the
supplemental nutrition assistance program payment error rate,
until the close of the succeeding fiscal year.
Sec. 16. CHILDREN’S HEALTH INSURANCE PROGRAM.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For maintenance of the healthy and well kids in Iowa (hawk-i)
program pursuant to chapter 514I, including supplemental dental
services, for receipt of federal financial participation under
Tit.XXI of the federal Social Security Act, which creates the
children’s health insurance program:
.................................................. $37,957,643
2. Of the funds appropriated in this section, $149,189 is
allocated for continuation of the contract for outreach with
the department of public health.
3. A portion of the funds appropriated in this section may
be transferred to the appropriations made in this division of
this Act for field operations or health program operations to
be used for the integration of hawk-i program eligibility,
payment, and administrative functions under the purview of
-35-the department of human services, including for the Medicaid
management information system upgrade.
Sec. 17. CHILD CARE ASSISTANCE. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purpose designated:
For child care programs:
.................................................. $40,816,931
1. Of the funds appropriated in this section, $34,966,931
shall be used for state child care assistance in accordance
with section 237A.13.
2. Nothing in this section shall be construed or is
intended as or shall imply a grant of entitlement for services
to persons who are eligible for assistance due to an income
level consistent with the waiting list requirements of section
237A.13. Any state obligation to provide services pursuant to
this section is limited to the extent of the funds appropriated
in this section.
3. A list of the registered and licensed child care
facilities operating in the area served by a child care
resource and referral service shall be made available to the
families receiving state child care assistance in that area.
4. Of the funds appropriated in this section, $5,850,000
shall be credited to the early childhood programs grants
account in the early childhood Iowa fund created in section
256I.11. The moneys shall be distributed for funding of
community-based early childhood programs targeted to children
from birth through five years of age developed by early
childhood Iowa areas in accordance with approved community
plans as provided in section 256I.8.
5. The department may use any of the funds appropriated
in this section as a match to obtain federal funds for use in
expanding child care assistance and related programs. For
the purpose of expenditures of state and federal child care
-36-funding, funds shall be considered obligated at the time
expenditures are projected or are allocated to the department’s
service areas. Projections shall be based on current and
projected caseload growth, current and projected provider
rates, staffing requirements for eligibility determination
and management of program requirements including data systems
management, staffing requirements for administration of the
program, contractual and grant obligations and any transfers
to other state agencies, and obligations for decategorization
or innovation projects.
6. A portion of the state match for the federal child care
and development block grant shall be provided as necessary to
meet federal matching funds requirements through the state
general fund appropriation made for child development grants
and other programs for at-risk children in section 279.51.
7. If a uniform reduction ordered by the governor under
section 8.31 or other operation of law, transfer, or federal
funding reduction reduces the appropriation made in this
section for the fiscal year, the percentage reduction in the
amount paid out to or on behalf of the families participating
in the state child care assistance program shall be equal to or
less than the percentage reduction made for any other purpose
payable from the appropriation made in this section and the
federal funding relating to it. The percentage reduction to
the other allocations made in this section shall be the same as
the uniform reduction ordered by the governor or the percentage
change of the federal funding reduction, as applicable. If
there is an unanticipated increase in federal funding provided
for state child care services, the entire amount of the
increase, except as necessary to meet federal requirements
including quality set asides, shall be used for state child
care assistance payments. If the appropriations made for
purposes of the state child care assistance program for the
fiscal year are determined to be insufficient, it is the intent
of the general assembly to appropriate sufficient funding for
-37-the fiscal year in order to avoid establishment of waiting list
requirements.
8. Notwithstanding section 8.33, moneys advanced for
purposes of the programs developed by early childhood Iowa
areas, advanced for purposes of wraparound child care, or
received from the federal appropriations made for the purposes
of this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert to any fund but shall
remain available for expenditure for the purposes designated
until the close of the succeeding fiscal year.
Sec. 18. JUVENILE INSTITUTION. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amounts, or so much thereof as is
necessary, to be used for the purposes designated:
1. a. For operation of the state training school at Eldora
and for salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
.................................................. $17,397,068
............................................... FTEs207.00
b. Of the funds appropriated in this subsection, $91,000
shall be used for distribution to licensed classroom teachers
at this and other institutions under the control of the
department of human services based upon the average student
yearly enrollment at each institution as determined by the
department.
2. A portion of the moneys appropriated in this section
shall be used by the state training school at Eldora for
grants for adolescent pregnancy prevention activities at the
institution in the fiscal year beginning July 1, 2021.
3. Of the funds appropriated in this subsection, $212,000
shall be used by the state training school at Eldora for a
substance use disorder treatment program at the institution for
the fiscal year beginning July 1, 2021.
-38- 4. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated until the
close of the succeeding fiscal year.
Sec. 19. CHILD AND FAMILY SERVICES.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For child and family services:
.................................................. $89,071,930
2. The department may transfer funds appropriated in this
section as necessary to pay the nonfederal costs of services
reimbursed under the medical assistance program, state child
care assistance program, or the family investment program which
are provided to children who would otherwise receive services
paid under the appropriation in this section. The department
may transfer funds appropriated in this section to the
appropriations made in this division of this Act for general
administration and for field operations for resources necessary
to implement and operate the services funded in this section.
3. a. Of the funds appropriated in this section, up to
$31,500,000 is allocated as the statewide expenditure target
under section 232.143 for group foster care maintenance and
services. If the department projects that such expenditures
for the fiscal year will be less than the target amount
allocated in this paragraph “a”, the department may reallocate
the excess to provide additional funding for family foster
care, independent living, family-centered services, shelter
care, or the child welfare emergency services addressed with
the allocation for shelter care.
b. If at any time after September 30, 2021, annualization
of a service area’s current expenditures indicates a service
-39-area is at risk of exceeding its group foster care expenditure
target under section 232.143 by more than 5 percent, the
department and juvenile court services shall examine all
group foster care placements in that service area in order to
identify those which might be appropriate for termination.
In addition, any aftercare services believed to be needed
for the children whose placements may be terminated shall be
identified. The department and juvenile court services shall
initiate action to set dispositional review hearings for the
placements identified. In such a dispositional review hearing,
the juvenile court shall determine whether needed aftercare
services are available and whether termination of the placement
is in the best interest of the child and the community.
4. In accordance with the provisions of section 232.188,
the department shall continue the child welfare and juvenile
justice funding initiative during fiscal year 2021-2022. Of
the funds appropriated in this section, $1,717,000 is allocated
specifically for expenditure for fiscal year 2021-2022 through
the decategorization services funding pools and governance
boards established pursuant to section 232.188.
5. A portion of the funds appropriated in this section
may be used for emergency family assistance to provide other
resources required for a family participating in a family
preservation or reunification project or successor project to
stay together or to be reunified.
6. Of the funds appropriated in this section, a sufficient
amount is allocated for shelter care and the child welfare
emergency services contracting implemented to provide for or
prevent the need for shelter care.
7. Federal funds received by the state during the fiscal
year beginning July 1, 2021, as the result of the expenditure
of state funds appropriated during a previous state fiscal
year for a service or activity funded under this section are
appropriated to the department to be used as additional funding
for services and purposes provided for under this section.
-40-Notwithstanding section 8.33, moneys received in accordance
with this subsection that remain unencumbered or unobligated at
the close of the fiscal year shall not revert to any fund but
shall remain available for the purposes designated until the
close of the succeeding fiscal year.
8. a. Of the funds appropriated in this section, up to
$3,290,000 is allocated for the payment of the expenses of
court-ordered services provided to juveniles who are under the
supervision of juvenile court services, which expenses are a
charge upon the state pursuant to section 232.141, subsection
4. Of the amount allocated in this paragraph “a”, up to
$1,556,000 shall be made available to provide school-based
supervision of children adjudicated under chapter 232, of which
not more than $15,000 may be used for the purpose of training.
A portion of the cost of each school-based liaison officer
shall be paid by the school district or other funding source as
approved by the chief juvenile court officer.
b. Of the funds appropriated in this section, up to $748,000
is allocated for the payment of the expenses of court-ordered
services provided to children who are under the supervision
of the department, which expenses are a charge upon the state
pursuant to section 232.141, subsection 4.
c. Notwithstanding section 232.141 or any other provision
of law to the contrary, the amounts allocated in this
subsection shall be distributed to the judicial districts
as determined by the state court administrator and to the
department’s service areas as determined by the administrator
of the department of human services’ division of child and
family services. The state court administrator and the
division administrator shall make the determination of the
distribution amounts on or before June 15, 2021.
d. Notwithstanding chapter 232 or any other provision of
law to the contrary, a district or juvenile court shall not
order any service which is a charge upon the state pursuant
to section 232.141 if there are insufficient court-ordered
-41-services funds available in the district court or departmental
service area distribution amounts to pay for the service. The
chief juvenile court officer and the departmental service area
manager shall encourage use of the funds allocated in this
subsection such that there are sufficient funds to pay for
all court-related services during the entire year. The chief
juvenile court officers and departmental service area managers
shall attempt to anticipate potential surpluses and shortfalls
in the distribution amounts and shall cooperatively request the
state court administrator or division administrator to transfer
funds between the judicial districts’ or departmental service
areas’ distribution amounts as prudent.
e. Notwithstanding any provision of law to the contrary,
a district or juvenile court shall not order a county to pay
for any service provided to a juvenile pursuant to an order
entered under chapter 232 which is a charge upon the state
under section 232.141, subsection 4.
f. Of the funds allocated in this subsection, not more than
$83,000 may be used by the judicial branch for administration
of the requirements under this subsection.
g. Of the funds allocated in this subsection, $17,000
shall be used by the department of human services to support
the interstate commission for juveniles in accordance with
the interstate compact for juveniles as provided in section
232.173.
9. Of the funds appropriated in this section, $12,253,000 is
allocated for juvenile delinquent graduated sanctions services.
Any state funds saved as a result of efforts by juvenile court
services to earn a federal Tit.IV-E match for juvenile court
services administration may be used for the juvenile delinquent
graduated sanctions services.
10. Of the funds appropriated in this section, $1,658,000 is
transferred to the department of public health to be used for
the child protection center grant program for child protection
centers located in Iowa in accordance with section 135.118.
-42-The grant amounts under the program shall be equalized so that
each center receives a uniform base amount of $245,000, and so
that the remaining funds are awarded through a funding formula
based upon the volume of children served. To increase access
to child protection center services for children in rural
areas, the funding formula for the awarding of the remaining
funds shall provide for the awarding of an enhanced amount to
eligible grantees to develop and maintain satellite centers in
underserved regions of the state.
11. Of the funds appropriated in this section, $4,025,000 is
allocated for the preparation for adult living program pursuant
to section 234.46.
12. Of the funds appropriated in this section, $227,000
shall be used for the public purpose of continuing a grant to a
nonprofit human services organization, providing services to
individuals and families in multiple locations in southwest
Iowa and Nebraska for support of a project providing immediate,
sensitive support and forensic interviews, medical exams, needs
assessments, and referrals for victims of child abuse and their
nonoffending family members.
13. Of the funds appropriated in this section, $300,000
is allocated for the foster care youth council approach of
providing a support network to children placed in foster care.
14. Of the funds appropriated in this section, $202,000 is
allocated for use pursuant to section 235A.1 for continuation
of the initiative to address child sexual abuse implemented
pursuant to 2007 Iowa Acts, chapter 218, section 18, subsection
21.
15. Of the funds appropriated in this section, $630,000 is
allocated for the community partnership for child protection
sites.
16. Of the funds appropriated in this section, $371,000
is allocated for the department’s minority youth and family
projects under the redesign of the child welfare system.
17. Of the funds appropriated in this section, $851,000
-43-is allocated for funding of the community circle of care
collaboration for children and youth in northeast Iowa.
18. Of the funds appropriated in this section, at least
$147,000 shall be used for the continuation of the child
welfare provider training academy, a collaboration between the
coalition for family and children’s services in Iowa and the
department.
19. Of the funds appropriated in this section, $211,000
shall be used for continuation of the central Iowa system of
care program grant for the purposes of funding community-based
services and other supports with a system of care approach for
children with serious emotional disturbance and their families
through a nonprofit provider that is located in a county
with a population of more than 420,000 but less than 450,000
according to the 2010 certified federal census, is licensed
as a psychiatric medical institution for children, and was a
system of care grantee prior to July 1, 2021.
20. Of the funds appropriated in this section, $235,000
shall be used for the public purpose of the continuation
and expansion of a system of care program grant implemented
in Cerro Gordo and Linn counties to utilize a comprehensive
and long-term approach for helping children and families by
addressing the key areas in a child’s life of childhood basic
needs, education and work, family, and community.
21. Of the funds appropriated in this section, $110,000
shall be used for the public purpose of funding community-based
services and other supports with a system of care approach
for children with a serious emotional disturbance and their
families through a nonprofit provider of child welfare services
that has been in existence for more than 115 years, is located
in a county with a population of more than 200,000 but less
than 220,000 according to the 2010 certified federal census, is
licensed as a psychiatric medical institution for children, and
was a system of care grantee prior to July 1, 2021.
22. If a separate funding source is identified that reduces
-44-the need for state funds within an allocation under this
section, the allocated state funds may be redistributed to
other allocations under this section for the same fiscal year.
23. Of the funds appropriated in this section, a portion may
be used for family-centered services for purposes of complying
with the federal Family First Prevention Services Act of 2018,
Pub.L. No.115-123, and successor legislation.
Sec. 20. ADOPTION SUBSIDY.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
a. For adoption subsidy payments and related costs and for
other services provided for under paragraph “b”, subparagraph
(2):
.................................................. $40,596,007
b. (1) Of the funds appropriated in this section, a
sufficient amount is allocated for adoption subsidy payments
and related costs.
(2) Any funds appropriated in this section remaining after
the allocation under subparagraph (1) are designated and
allocated as state savings resulting from implementation of
the federal Fostering Connections to Success and Increasing
Adoptions Act of 2008, Pub.L. No.110-351, and successor
legislation, as determined in accordance with 42 U.S.C.
§673(a)(8), and shall be used for post-adoption services and
for other purposes allowed under these federal laws, Tit.IV-B
or Tit.IV-E of the federal Social Security Act.
(a) The department of human services may transfer funds
allocated in this subparagraph (2) to the appropriation for
child and family services in this division of this Act for the
purposes designated in this subparagraph (2).
(b) Notwithstanding section 8.33, moneys allocated
under this subparagraph (2) shall not revert to any fund but
-45-shall remain available for the purposes designated in this
subparagraph (2) until expended.
2. The department may transfer funds appropriated in
this section to the appropriation made in this division of
this Act for general administration for costs paid from the
appropriation relating to adoption subsidy.
3. Federal funds received by the state during the
fiscal year beginning July 1, 2021, as the result of the
expenditure of state funds during a previous state fiscal
year for a service or activity funded under this section are
appropriated to the department to be used as additional funding
for the services and activities funded under this section.
Notwithstanding section 8.33, moneys received in accordance
with this subsection that remain unencumbered or unobligated
at the close of the fiscal year shall not revert to any fund
but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
Sec. 21. JUVENILE DETENTION HOME FUND. Moneys deposited
in the juvenile detention home fund created in section 232.142
during the fiscal year beginning July 1, 2021, and ending June
30, 2022, are appropriated to the department of human services
for the fiscal year beginning July 1, 2021, and ending June 30,
2022, for distribution of an amount equal to a percentage of
the costs of the establishment, improvement, operation, and
maintenance of county or multicounty juvenile detention homes
in the fiscal year beginning July 1, 2020. Moneys appropriated
for distribution in accordance with this section shall be
allocated among eligible detention homes, prorated on the basis
of an eligible detention home’s proportion of the costs of all
eligible detention homes in the fiscal year beginning July
1, 2020. The percentage figure shall be determined by the
department based on the amount available for distribution for
the fund. Notwithstanding section 232.142, subsection 3, the
financial aid payable by the state under that provision for the
fiscal year beginning July 1, 2021, shall be limited to the
-46-amount appropriated for the purposes of this section.
Sec. 22. FAMILY SUPPORT SUBSIDY PROGRAM.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For the family support subsidy program subject to the
enrollment restrictions in section 225C.37, subsection 3:
.................................................. $949,282
2. At least $899,291 of the moneys appropriated in this
section is transferred to the department of public health for
the family support center component of the comprehensive family
support program under chapter 225C, subchapter V.
3. If at any time during the fiscal year, the amount of
funding available for the family support subsidy program
is reduced from the amount initially used to establish the
figure for the number of family members for whom a subsidy
is to be provided at any one time during the fiscal year,
notwithstanding section 225C.38, subsection 2, the department
shall revise the figure as necessary to conform to the amount
of funding available.
Sec. 23. CONNER DECREE. There is appropriated from the
general fund of the state to the department of human services
for the fiscal year beginning July 1, 2021, and ending June 30,
2022, the following amount, or so much thereof as is necessary,
to be used for the purpose designated:
For building community capacity through the coordination
and provision of training opportunities in accordance with the
consent decree of Conner v.Branstad, No.4-86-CV-30871(S.D.
Iowa, July 14, 1994):
.................................................. $33,632
Sec. 24. MENTAL HEALTH INSTITUTES.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
-47-beginning July 1, 2021, and ending June 30, 2022, the following
amounts, or so much thereof as is necessary, to be used for the
purposes designated:
a. For operation of the state mental health institute at
Cherokee as required by chapters 218 and 226 for salaries,
support, maintenance, and miscellaneous purposes, and for not
more than the following full-time equivalent positions:
.................................................. $15,457,597
............................................... FTEs169.00
b. For operation of the state mental health institute at
Independence as required by chapters 218 and 226 for salaries,
support, maintenance, and miscellaneous purposes, and for not
more than the following full-time equivalent positions:
.................................................. $19,652,379
............................................... FTEs208.00
2. a. Notwithstanding sections 218.78 and 249A.11, any
revenue received from the state mental health institute at
Cherokee or the state mental health institute at Independence
pursuant to 42 C.F.R§438.6(e) may be retained and expended by
the mental health institute.
b. Notwithstanding sections 218.78 and 249A.11, any
COVID-19 related funding received through federal funding
sources by the state mental health institute at Cherokee or the
state mental health institute at Independence may be retained
and expended by the mental health institute.
3. Notwithstanding any provision of law to the contrary,
a Medicaid member residing at the state mental health
institute at Cherokee or the state mental health institute
at Independence shall retain Medicaid eligibility during
the period of the Medicaid member’s stay for which federal
financial participation is available.
4. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated until the
-48-close of the succeeding fiscal year.
Sec. 25. STATE RESOURCE CENTERS.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amounts, or so much thereof as is necessary, to be used for the
purposes designated:
a. For the state resource center at Glenwood for salaries,
support, maintenance, and miscellaneous purposes:
.................................................. $14,802,873
b. For the state resource center at Woodward for salaries,
support, maintenance, and miscellaneous purposes:
.................................................. $12,237,937
2. The department may continue to bill for state resource
center services utilizing a scope of services approach used for
private providers of intermediate care facilities for persons
with an intellectual disability services, in a manner which
does not shift costs between the medical assistance program,
counties, or other sources of funding for the state resource
centers.
3. The state resource centers may expand the time-limited
assessment and respite services during the fiscal year.
4. If the department’s administration and the department
of management concur with a finding by a state resource
center’s superintendent that projected revenues can reasonably
be expected to pay the salary and support costs for a new
employee position, or that such costs for adding a particular
number of new positions for the fiscal year would be less
than the overtime costs if new positions would not be added,
the superintendent may add the new position or positions. If
the vacant positions available to a resource center do not
include the position classification desired to be filled, the
state resource center’s superintendent may reclassify any
vacant position as necessary to fill the desired position. The
superintendents of the state resource centers may, by mutual
-49-agreement, pool vacant positions and position classifications
during the course of the fiscal year in order to assist one
another in filling necessary positions.
5. If existing capacity limitations are reached in
operating units, a waiting list is in effect for a service or
a special need for which a payment source or other funding
is available for the service or to address the special need,
and facilities for the service or to address the special need
can be provided within the available payment source or other
funding, the superintendent of a state resource center may
authorize opening not more than two units or other facilities
and begin implementing the service or addressing the special
need during fiscal year 2021-2022.
6. Notwithstanding section 8.33, and notwithstanding
the amount limitation specified in section 222.92, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
Sec. 26. SEXUALLY VIOLENT PREDATORS.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purpose designated:
For costs associated with the commitment and treatment of
sexually violent predators in the unit located at the state
mental health institute at Cherokee, including costs of legal
services and other associated costs, including salaries,
support, maintenance, and miscellaneous purposes, and for not
more than the following full-time equivalent positions:
.................................................. $13,643,727
............................................... FTEs139.00
2. Unless specifically prohibited by law, if the amount
charged provides for recoupment of at least the entire amount
-50-of direct and indirect costs, the department of human services
may contract with other states to provide care and treatment
of persons placed by the other states at the unit for sexually
violent predators at Cherokee. The moneys received under
such a contract shall be considered to be repayment receipts
and used for the purposes of the appropriation made in this
section.
3. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated until the
close of the succeeding fiscal year.
Sec. 27. FIELD OPERATIONS.
1. There is appropriated from the general fund of the
state to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amount, or so much thereof as is necessary, to be used for the
purposes designated:
For field operations, including salaries, support,
maintenance, and miscellaneous purposes, and for not more than
the following full-time equivalent positions:
.................................................. $60,596,667
............................................... FTEs1,539.00
2. Priority in filling full-time equivalent positions
shall be given to those positions related to child protection
services and eligibility determination for low-income families.
Sec. 28. GENERAL ADMINISTRATION. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purpose designated:
For general administration, including salaries, support,
maintenance, and miscellaneous purposes, and for not more than
the following full-time equivalent positions:
.................................................. $15,342,189
-51-............................................... FTEs294.00
1. The department shall report at least monthly to the
general assembly concerning the department’s operational and
program expenditures.
2. Of the funds appropriated in this section, $150,000 shall
be used for the provision of a program to provide technical
assistance, support, and consultation to providers of home and
community-based services under the medical assistance program.
3. Of the funds appropriated in this section, $50,000
is transferred to the Iowa finance authority to be used
for administrative support of the council on homelessness
established in section 16.2D and for the council to fulfill its
duties in addressing and reducing homelessness in the state.
4. Of the funds appropriated in this section, $200,000 shall
be transferred to and deposited in the administrative fund of
the Iowa ABLE savings plan trust created in section 12I.4, to
be used for implementation and administration activities of the
Iowa ABLE savings plan trust.
5. Of the funds appropriated in this section, $200,000 is
transferred to the economic development authority for the Iowa
commission on volunteer services to continue to be used for the
RefugeeRISE AmeriCorps program established under section 15H.8
for member recruitment and training to improve the economic
well-being and health of economically disadvantaged refugees in
local communities across Iowa. Funds transferred may be used
to supplement federal funds under federal regulations.
6. Of the funds appropriated in this section, up to $300,000
shall be used as follows:
a. To fund not more than one full-time equivalent position
to address the department’s responsibility to support the work
of the children’s behavioral health system state board and
implementation of the services required pursuant to section
331.397.
b. To support the cost of establishing and implementing new
or additional services required pursuant to sections 331.397
-52-and 331.397A.
c. Of the amount allocated, $32,000 shall be transferred
to the department of public health to support the costs of
establishing and implementing new or additional services
required pursuant to sections 331.397 and 331.397A.
7. Of the funds appropriated in this section, $800,000 shall
be used for the renovation and construction of certain nursing
facilities, consistent with the provisions of chapter 249K.
Sec. 29. DEPARTMENT-WIDE DUTIES. There is appropriated
from the general fund of the state to the department of human
services for the fiscal year beginning July 1, 2021, and ending
June 30, 2022, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For salaries, support, maintenance, and miscellaneous
purposes at facilities under the purview of the department of
human services:
.................................................. $2,879,274
Sec. 30. VOLUNTEERS. There is appropriated from the general
fund of the state to the department of human services for the
fiscal year beginning July 1, 2021, and ending June 30, 2022,
the following amount, or so much thereof as is necessary, to be
used for the purpose designated:
For development and coordination of volunteer services:
.................................................. $84,686
Sec. 31. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE
DEPARTMENT OF HUMAN SERVICES.
1. a. (1) (a) Notwithstanding any provision of law to
the contrary, for the fiscal year beginning July 1, 2021, the
department shall not rebase case-mix nursing facility rates,
but shall instead reimburse case-mix nursing facilities by
adjusting the nursing facility case-mix adjusted rates that
were effective July 1, 2019, using the mid-points of each of
the most recent cost reports submitted by the nursing facility
for the period ending on or before December 31, 2018, and
-53-inflating these costs forward applying the inflation factor as
determined using the latest available quarterly publication of
the HCFA/SNF index, to the extent possible within the state
funding, including the $19,080,860 provided for this purpose.
(b) For the fiscal year beginning July 1, 2021, non-case-mix
and special population nursing facilities shall be reimbursed
in accordance with the methodology in effect on June 30 of the
prior fiscal year.
(c) For managed care claims, the department of human
services shall adjust the payment rate floor for nursing
facilities, annually, to maintain a rate floor that is no
lower than the Medicaid fee-for-service case-mix adjusted rate
calculated in accordance with subparagraph division (a) and
441 IAC 81.6. The department shall then calculate adjusted
reimbursement rates, including but not limited to add-on
payments, annually, and shall notify Medicaid managed care
organizations of the adjusted reimbursement rates within 30
days of determining the adjusted reimbursement rates. Any
adjustment of reimbursement rates under this subparagraph
division shall be budget neutral to the state budget.
(d) For the fiscal year beginning July 1, 2021, Medicaid
managed care long-term services and supports capitation rates
shall be adjusted to reflect the case-mix adjusted rates
specified pursuant to subparagraph division (a) for the patient
populations residing in Medicaid-certified nursing facilities.
(2) Medicaid managed care organizations shall adjust
facility-specific rates based upon payment rate listings issued
by the department. The rate adjustments shall be applied
prospectively from the effective date of the rate letter issued
by the department.
b. (1) For the fiscal year beginning July 1, 2021,
contingent upon implementation of the contractual agreements
with Medicaid managed care organizations as described pursuant
to subparagraph (2), the department shall establish the
fee-for-service pharmacy dispensing fee reimbursement at
-54-$10.38 per prescription, until a cost of dispensing survey is
completed. The actual dispensing fee shall be determined by
a cost of dispensing survey performed by the department and
required to be completed by all medical assistance program
participating pharmacies every two years. A change in the
dispensing fee shall become effective following federal
approval of the Medicaid state plan.
(2) The department shall amend Medicaid managed care
organization contracts to authorize establishment of a managed
care pharmacy dispensing fee reimbursement in accordance with
either of the following:
(a) The established fee-for-service pharmacy dispensing
fee reimbursement per prescription as specified pursuant to
subparagraph (1).
(b) A dispensing fee determined contractually by mutual
agreement between the managed care organization and a
participating pharmacy with more than thirty locations in
the state and headquarters located outside the state, not to
exceed the established fee-for-service pharmacy dispensing
fee reimbursement per prescription as specified pursuant to
subparagraph (1).
(3) The department shall utilize an average acquisition
cost reimbursement methodology for all drugs covered under the
medical assistance program in accordance with 2012 Iowa Acts,
chapter 1133, section 33.
c. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for outpatient hospital services shall
remain at the rates in effect on June 30, 2021, subject to
Medicaid program upper payment limit rules, and adjusted
as necessary to maintain expenditures within the amount
appropriated to the department for this purpose for the fiscal
year.
(2) For the fiscal year beginning July 1, 2021,
reimbursement rates for inpatient hospital services shall
be rebased effective October 1, 2021, subject to Medicaid
-55-program upper payment limit rules, and adjusted as necessary
to maintain expenditures within the amount appropriated to the
department for this purpose for the fiscal year.
(3) For the fiscal year beginning July 1, 2021, under
both fee-for-service and managed care administration of
the Medicaid program, critical access hospitals shall be
reimbursed for inpatient and outpatient services based on the
hospital-specific critical access hospital cost adjustment
factor methodology utilizing the most recent and complete cost
reporting period as applied prospectively within the funds
appropriated for such purpose for the fiscal year.
(4) For the fiscal year beginning July 1, 2021, the graduate
medical education and disproportionate share hospital fund
shall remain at the amount in effect on June 30, 2021, except
that the portion of the fund attributable to graduate medical
education shall be reduced in an amount that reflects the
elimination of graduate medical education payments made to
out-of-state hospitals.
(5) In order to ensure the efficient use of limited state
funds in procuring health care services for low-income Iowans,
funds appropriated in this Act for hospital services shall
not be used for activities which would be excluded from a
determination of reasonable costs under the federal Medicare
program pursuant to 42 U.S.C.§1395x(v)(1)(N).
d. For the fiscal year beginning July 1, 2021, reimbursement
rates for hospices and acute psychiatric hospitals shall be
increased in accordance with increases under the federal
Medicare program or as supported by their Medicare audited
costs.
e. For the fiscal year beginning July 1, 2021, independent
laboratories and rehabilitation agencies shall be reimbursed
using the same methodology in effect on June 30, 2021.
f. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for home health agencies shall continue to
be based on the Medicare low utilization payment adjustment
-56-(LUPA) methodology with state geographic wage adjustments and
shall be adjusted to increase the rates to the extent possible
within the state funding, including the $2,000,000 appropriated
for this purpose. The department shall continue to update the
rates every two years to reflect the most recent Medicare LUPA
rates.
(2) For the fiscal year beginning July 1, 2021, rates for
private duty nursing and personal care services under the early
and periodic screening, diagnostic, and treatment program
benefit shall be calculated based on the methodology in effect
on June 30, 2021.
g. For the fiscal year beginning July 1, 2021, federally
qualified health centers and rural health clinics shall receive
cost-based reimbursement for 100 percent of the reasonable
costs for the provision of services to recipients of medical
assistance.
h. For the fiscal year beginning July 1, 2021, the
reimbursement rates for dental services shall remain at the
rates in effect on June 30, 2021.
i. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for non-state-owned psychiatric medical
institutions for children shall be increased to the extent
possible within the $3,900,000 appropriated for this purpose.
(2) As a condition of participation in the medical
assistance program, enrolled providers shall accept the medical
assistance reimbursement rate for any covered goods or services
provided to recipients of medical assistance who are children
under the custody of a psychiatric medical institution for
children.
j. For the fiscal year beginning July 1, 2021, unless
otherwise specified in this Act, all noninstitutional medical
assistance provider reimbursement rates shall remain at the
rates in effect on June 30, 2021, except for area education
agencies, local education agencies, infant and toddler
services providers, home and community-based services providers
-57-including consumer-directed attendant care providers under a
section 1915(c) or 1915(i) waiver, targeted case management
providers, and those providers whose rates are required to be
determined pursuant to section 249A.20, or to meet federal
mental health parity requirements.
k. Notwithstanding any provision to the contrary, for the
fiscal year beginning July 1, 2021, the reimbursement rate for
anesthesiologists shall remain at the rates in effect on June
30, 2021, and updated on January 1, 2022, to align with the
most current Iowa Medicare anesthesia rate.
l. Notwithstanding section 249A.20, for the fiscal year
beginning July 1, 2021, the average reimbursement rate for
health care providers eligible for use of the federal Medicare
resource-based relative value scale reimbursement methodology
under section 249A.20 shall remain at the rate in effect on
June 30, 2021; however, this rate shall not exceed the maximum
level authorized by the federal government.
m. For the fiscal year beginning July 1, 2021, the
reimbursement rate for residential care facilities shall not
be less than the minimum payment level as established by the
federal government to meet the federally mandated maintenance
of effort requirement. The flat reimbursement rate for
facilities electing not to file annual cost reports shall not
be less than the minimum payment level as established by the
federal government to meet the federally mandated maintenance
of effort requirement.
n. For the fiscal year beginning July 1, 2021, the
reimbursement rates for inpatient mental health services
provided at hospitals shall be rebased effective October 1,
2021, subject to Medicaid program upper payment limit rules
and adjusted as necessary to maintain expenditures within the
amount appropriated to the department for this purpose for
the fiscal year; and psychiatrists shall be reimbursed at the
medical assistance program fee-for-service rate in effect on
June 30, 2021.
-58- o. For the fiscal year beginning July 1, 2021, community
mental health centers may choose to be reimbursed for the
services provided to recipients of medical assistance through
either of the following options:
(1) For 100 percent of the reasonable costs of the services.
(2) In accordance with the alternative reimbursement rate
methodology approved by the department of human services in
effect on June 30, 2021.
p. For the fiscal year beginning July 1, 2021, the
reimbursement rate for providers of family planning services
that are eligible to receive a 90 percent federal match shall
remain at the rates in effect on June 30, 2021.
q. (1) For the fiscal year beginning July 1, 2021,
reimbursement rates for providers of home and community-based
services waiver and habilitation services shall be increased
to the extent possible within the $11,002,240 appropriated for
this purpose.
(2) For the fiscal year beginning July 1, 2021,
reimbursement rates for providers of state plan home and
community-based services home-based habilitation services
shall be increased with the $7,134,214 appropriated for this
purpose. The reimbursement rates for home-based habilitation
services shall be based on a fee schedule that incorporates the
acuity-based tiers.
r. For the fiscal year beginning July 1, 2021, the
reimbursement rates for emergency medical service providers
shall remain at the rates in effect on June 30, 2021, or as
approved by the centers for Medicare and Medicaid services of
the United States department of health and human services.
s. For the fiscal year beginning July 1, 2021, reimbursement
rates for substance-related disorder treatment programs
licensed under section 125.13 shall remain at the rates in
effect on June 30, 2021.
t. For the fiscal year beginning July 1, 2021, assertive
community treatment per diem rates shall remain at the rates in
-59-effect on June 30, 2021.
u. For the fiscal year beginning July 1, 2021, the
reimbursement rate for family-centered services providers shall
be established by contract.
v. For the fiscal year beginning July 1, 2021, the
reimbursement rate for air ambulance services shall be
increased to the extent possible within the additional $100,000
appropriated for this purpose.
2. For the fiscal year beginning July 1, 2021, the
reimbursement rate for providers reimbursed under the
in-home-related care program shall not be less than the minimum
payment level as established by the federal government to meet
the federally mandated maintenance of effort requirement.
3. Unless otherwise directed in this section, when the
department’s reimbursement methodology for any provider
reimbursed in accordance with this section includes an
inflation factor, this factor shall not exceed the amount
by which the consumer price index for all urban consumers
increased during the calendar year ending December 31, 2002.
4. Notwithstanding section 234.38, for the fiscal
year beginning July 1, 2021, the foster family basic daily
maintenance rate and the maximum adoption subsidy rate for
children ages 0 through 5 years shall be $16.78, the rate for
children ages 6 through 11 years shall be $17.45, the rate for
children ages 12 through 15 years shall be $19.10, and the
rate for children and young adults ages 16 and older shall
be $19.35. For youth ages 18 to 23 who have exited foster
care, the preparation for adult living program maintenance
rate shall be up to $602.70 per month as calculated based on
the age of the participant. The maximum payment for adoption
subsidy nonrecurring expenses shall be limited to $500 and the
disallowance of additional amounts for court costs and other
related legal expenses implemented pursuant to 2010 Iowa Acts,
chapter 1031, section 408, shall be continued.
5. For the fiscal year beginning July 1, 2021, the maximum
-60-reimbursement rates for social services providers under
contract shall remain at the rates in effect on June 30, 2021,
or the provider’s actual and allowable cost plus inflation for
each service, whichever is less. However, if a new service
or service provider is added after June 30, 2021, the initial
reimbursement rate for the service or provider shall be based
upon a weighted average of provider rates for similar services.
6. a. For the fiscal year beginning July 1, 2021, the
reimbursement rates for resource family recruitment and
retention contractors shall be established by contract.
b. For the fiscal year beginning July 1, 2021, the
reimbursement rates for supervised apartment living foster care
providers shall be established by contract.
7. For the fiscal year beginning July 1, 2021, the
reimbursement rate for group foster care providers shall be the
combined service and maintenance reimbursement rate established
by contract.
8. The group foster care reimbursement rates paid for
placement of children out of state shall be calculated
according to the same rate-setting principles as those used for
in-state providers, unless the director of human services or
the director’s designee determines that appropriate care cannot
be provided within the state. The payment of the daily rate
shall be based on the number of days in the calendar month in
which service is provided.
9. a. For the fiscal year beginning July 1, 2021, the
reimbursement rate paid for shelter care and the child welfare
emergency services implemented to provide or prevent the need
for shelter care shall be established by contract.
b. For the fiscal year beginning July 1, 2021, the combined
service and maintenance components of the reimbursement rate
paid for shelter care services shall be based on the financial
and statistical report submitted to the department. The
maximum reimbursement rate shall be $101.83 per day. The
department shall reimburse a shelter care provider at the
-61-provider’s actual and allowable unit cost, plus inflation, not
to exceed the maximum reimbursement rate.
c. Notwithstanding section 232.141, subsection 8, for the
fiscal year beginning July 1, 2021, the amount of the statewide
average of the actual and allowable rates for reimbursement of
juvenile shelter care homes that is utilized for the limitation
on recovery of unpaid costs shall remain at the amount in
effect for this purpose in the fiscal year beginning July 1,
2020.
10. For the fiscal year beginning July 1, 2021, the
department shall calculate reimbursement rates for intermediate
care facilities for persons with an intellectual disability
at the 80th percentile. Beginning July 1, 2021, the rate
calculation methodology shall utilize the consumer price index
inflation factor applicable to the fiscal year beginning July
1, 2021.
11. Effective July 1, 2021, the department of human services
shall set the reimbursement rate of child care providers whose
reimbursement rates are below the fiftieth percentile of the
most recent market rate survey at the fiftieth percentile of
the most recent market rate survey. Reimbursement rates of
child care providers whose reimbursement rates are at or above
the fiftieth percentile of the most recent market rate survey
shall remain at the rates in effect on June 30, 2021. The
department shall also adjust quality rating system bonuses to
reflect increased child care provider reimbursement rates as
appropriate. The department shall set rates in a manner so as
to provide incentives for a nonregistered provider to become
registered by applying any increase only to registered and
licensed providers.
12. The department may adopt emergency rules to implement
this section.
Sec. 32. EMERGENCY RULES.
1. If necessary to comply with federal requirements
including time frames, or if specifically authorized by a
-62-provision of this division of this Act, the department of
human services or the mental health and disability services
commission may adopt administrative rules under section 17A.4,
subsection 3, and section 17A.5, subsection 2, paragraph “b”,
to implement the provisions of this division of this Act and
the rules shall become effective immediately upon filing or
on a later effective date specified in the rules, unless the
effective date of the rules is delayed or the applicability
of the rules is suspended by the administrative rules review
committee. Any rules adopted in accordance with this section
shall not take effect before the rules are reviewed by the
administrative rules review committee. The delay authority
provided to the administrative rules review committee under
section 17A.4, subsection 7, and section 17A.8, subsections
9 and 10, shall be applicable to a delay imposed under this
section, notwithstanding a provision in those subsections
making them inapplicable to section 17A.5, subsection 2,
paragraph “b”. Any rules adopted in accordance with the
provisions of this section shall also be published as a notice
of intended action as provided in section 17A.4.
2. If during a fiscal year, the department of human
services is adopting rules in accordance with this section
or as otherwise directed or authorized by state law, and
the rules will result in an expenditure increase beyond the
amount anticipated in the budget process or if the expenditure
was not addressed in the budget process for the fiscal
year, the department shall notify the general assembly and
the department of management concerning the rules and the
expenditure increase. The notification shall be provided at
least 30 calendar days prior to the date notice of the rules
is submitted to the administrative rules coordinator and the
administrative code editor.
Sec. 33. REPORTS. Unless otherwise provided, any reports or
other information required to be compiled and submitted under
this Act during the fiscal year beginning July 1, 2021, shall
-63-be submitted on or before the dates specified for submission
of the reports or information.
Sec. 34. EFFECTIVE UPON ENACTMENT. The following provision
of this division of this Act, being deemed of immediate
importance, takes effect upon enactment:
1. The provision relating to section 232.141 and directing
the state court administrator and the division administrator of
the department of human services division of child and family
services to make the determination, by June 15, 2021, of the
distribution of funds allocated for the payment of the expenses
of court-ordered services provided to juveniles which are a
charge upon the state.
DIVISION VI
HEALTH CARE ACCOUNTS AND FUNDS — FY 2021-2022
Sec. 35. PHARMACEUTICAL SETTLEMENT ACCOUNT. There is
appropriated from the pharmaceutical settlement account created
in section 249A.33 to the department of human services for the
fiscal year beginning July 1, 2021, and ending June 30, 2022,
the following amount, or so much thereof as is necessary, to be
used for the purpose designated:
Notwithstanding any provision of law to the contrary, to
supplement the appropriations made in this Act for health
program operations under the medical assistance program for the
fiscal year beginning July 1, 2021, and ending June 30, 2022:
.................................................. $234,193
Sec. 36. QUALITY ASSURANCE TRUST FUND — DEPARTMENT OF HUMAN
SERVICES. Notwithstanding any provision to the contrary and
subject to the availability of funds, there is appropriated
from the quality assurance trust fund created in section
249L.4 to the department of human services for the fiscal year
beginning July 1, 2021, and ending June 30, 2022, the following
amounts, or so much thereof as is necessary, for the purposes
designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of human services
-64-for medical assistance for the same fiscal year:
.................................................. $56,305,139
Sec. 37. HOSPITAL HEALTH CARE ACCESS TRUST FUND —
DEPARTMENT OF HUMAN SERVICES. Notwithstanding any provision to
the contrary and subject to the availability of funds, there is
appropriated from the hospital health care access trust fund
created in section 249M.4 to the department of human services
for the fiscal year beginning July 1, 2021, and ending June
30, 2022, the following amounts, or so much thereof as is
necessary, for the purposes designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of human services
for medical assistance for the same fiscal year:
.................................................. $33,920,554
Sec. 38. MEDICAL ASSISTANCE PROGRAM — NONREVERSION
FOR FY 2021-2022. Notwithstanding section 8.33, if moneys
appropriated for purposes of the medical assistance program for
the fiscal year beginning July 1, 2021, and ending June 30,
2022, from the general fund of the state, the quality assurance
trust fund, and the hospital health care access trust fund, are
in excess of actual expenditures for the medical assistance
program and remain unencumbered or unobligated at the close
of the fiscal year, the excess moneys shall not revert but
shall remain available for expenditure for the purposes of the
medical assistance program until the close of the succeeding
fiscal year.
DIVISION VII
NURSING FACILITY REIMBURSEMENT METHODOLOGY — FISCAL PERIOD
JULY 1, 2023, THROUGH JUNE 30, 2025
Sec. 39. NURSING FACILITY REIMBURSEMENT METHODOLOGY —
FISCAL PERIOD JULY 1, 2023, THROUGH JUNE 30, 2025.
Notwithstanding any provision of law to the contrary, for the
fiscal period beginning July 1, 2023, and ending June 30, 2025,
the department of human services shall rebase case-mix nursing
facility rates beginning July 1, 2023, using the Medicaid cost
-65-reports on file for the period ending December 31, 2022, and
applying a minimum occupancy factor of 70 percent.
DIVISION VIII
NURSING FACILITY REIMBURSEMENT STUDY
Sec. 40. NURSING FACILITY CASE-MIX REIMBURSEMENT — STUDY
AND RECOMMENDATIONS. The department of human services shall
convene a workgroup including representatives of nursing
facilities, managed care organizations, and other appropriate
stakeholders to review the case-mix reimbursement methodology
and process for nursing facilities, including but not limited
to rebasing, the use of cost reports, and the application
of quarterly case-mix index adjustments, and shall submit
recommendations to the governor and the general assembly by
December 1, 2021, for improvements including those related to
the methodology, the process, the use of prospective payments,
and the applicable time frames to increase efficiencies
and accuracy in the determination of reimbursements, reduce
duplication of effort, more adequately reflect the actual costs
of care, address changes in patient acuity levels without
reliance on retroactive rate adjustments, and incentivize
quality outcomes.
DIVISION IX
MEDICAID-ELIGIBLE CHILDREN — PEDIATRIC HEALTH CARE SERVICES
Sec. 41. MEDICAID-ELIGIBLE CHILDREN — PROVISION OF
PEDIATRIC HEALTH CARE SERVICES — REVIEW AND REPORT. The
department of human services shall review federal Medicare
and state law and administrative rule restrictions related
to the provision of physical therapy, occupational therapy,
speech-language pathology, applied behavior analysis, and other
pediatric health care services to Medicaid-eligible children
to determine necessary changes in law and policy to ensure
that these services are provided consistent with the early and
periodic screening, diagnostic, and treatment program. The
department shall submit a report including the findings of the
review and recommendations to the governor and the general
-66-assembly by October 1, 2021.
DIVISION X
DECATEGORIZATION CARRYOVER FUNDING
Sec. 42. DECATEGORIZATION CARRYOVER FUNDING FY 2019 —
TRANSFER TO MEDICAID PROGRAM. Notwithstanding section 232.188,
subsection 5, paragraph “b”, any state-appropriated moneys in
the funding pool that remained unencumbered or unobligated
at the close of the fiscal year beginning July 1, 2018, and
were deemed carryover funding to remain available for the two
succeeding fiscal years that still remain unencumbered or
unobligated at the close of the fiscal year beginning July 1,
2020, shall not revert but shall be transferred to the medical
assistance program for the fiscal year beginning July 1, 2021.
Sec. 43. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 44. RETROACTIVE APPLICABILITY. This division of this
Act applies retroactively to July 1, 2020.
DIVISION XI
PRIOR APPROPRIATIONS AND OTHER PROVISIONS
COURT-ORDERED SERVICES REIMBURSEMENT BY MANAGED CARE
ORGANIZATIONS
Sec. 45. 2018 Iowa Acts, chapter 1165, section 128,
subsection 2, paragraph a, is amended to read as follows:
a. If a Medicaid member is receiving court-ordered services
or treatment for a substance-related disorder pursuant to
chapter 125 or for a mental illness pursuant to chapter 229,
such services or treatment shall be provided and reimbursed
for an initial period of three days before a managed care
organization may apply medical necessity criteria to determine
the most appropriate services, treatment, or placement for the
Medicaid member.
FAMILY INVESTMENT PROGRAM ACCOUNT
Sec. 46. 2019 Iowa Acts, chapter 85, section 9, as amended
by 2020 Iowa Acts, chapter 1121, section 20, is amended by
adding the following new subsection:
-67- NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purposes
designated, and may be transferred to other appropriations made
in this division of this Act as necessary to carry out the
initiatives included in the report submitted on nonreversion
of funds required pursuant to 2020 Iowa Acts, chapter 1121,
section 43, until the close of the succeeding fiscal year.
Child and family services
Sec. 47. 2019 Iowa Acts, chapter 85, section 19, as amended
by 2020 Iowa Acts, chapter 1121, section 23, is amended by
adding the following new subsection:
NEW SUBSECTION. 25. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purpose of
the redesign of the child welfare system, until the close of
the succeeding fiscal year.
FIELD OPERATIONS
Sec. 48. 2019 Iowa Acts, chapter 85, section 27, as amended
by 2020 Iowa Acts, chapter 1121, section 25, is amended by
adding the following new subsection:
NEW SUBSECTION. 5. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
GENERAL ADMINISTRATION
Sec. 49. 2019 Iowa Acts, chapter 85, section 28, as amended
by 2020 Iowa Acts, chapter 1121, section 26, is amended by
adding the following new subsection:
NEW SUBSECTION. 8. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
-68-but shall remain available for expenditure for the purposes
designated until the close of the succeeding fiscal year.
Sec. 50. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION XII
EXTENSION OF FUTURE REPEAL — HOSPITAL HEALTH CARE ACCESS
ASSESSMENT PROGRAM
Sec. 51. Section 249M.5, Code 2021, is amended to read as
follows:
249M.5 Future repeal.
This chapter is repealed July 1, 2021 2023.
Sec. 52. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION XIII
PUBLIC HEALTH EMERGENCY PROVISIONS COVID-19 REGULATIONS
Sec. 53. COVID-19 FEDERAL REGULATIONS. For the time
period beginning on the effective date of this division of
this Act, and ending June 30, 2022, notwithstanding state
administrative rules to the contrary, to the extent federal
regulations relating to the COVID-19 pandemic differ from state
administrative rules, including applicable federal waivers,
the federal regulations are controlling during the pendency of
the federally declared state of emergency and for such period
of time following the end of the federally declared state of
emergency applicable to the respective federal regulations.
DIVISION XIV
FOSTER HOME INSURANCE FUND
Sec. 54. Section 237.13, subsection 2, Code 2021, is amended
to read as follows:
2. The foster home insurance fund shall be administered by
the department of human services. The fund shall consist of
all moneys appropriated by the general assembly for deposit
in the fund. The department shall use moneys in the fund to
provide home and property coverage for foster parents to cover
damages to property resulting from the actions of a foster
-69-child residing in a foster home or to reimburse foster parents
for the cost of purchasing foster care liability insurance and
to perform the administrative functions necessary to carry out
this section. The department may establish limitations of
liability for individual claims as deemed reasonable by the
department.
DIVISION XV
MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER OF FUNDS
Sec. 55. MENTAL HEALTH AND DISABILITY SERVICES — TRANSFER
OF FUNDS. Notwithstanding section 331.432, a county with a
population of over 300,000 based on the 2010 federal decennial
census may transfer funds from any other fund of the county to
the mental health and disability regional services fund for the
purposes of providing mental health and disability services for
the fiscal year beginning July 1, 2021, and ending June 30,
2022. The county shall submit a report to the governor and the
general assembly by September 1, 2022, including the source of
any funds transferred, the amount of the funds transferred, and
the mental health and disability services provided with the
transferred funds. The county shall work with the department
to maximize the use of the medical assistance program and other
third-party payment sources, including but not limited to
identifying individuals enrolled with or eligible for Medicaid
whose Medicaid-covered services are being paid by the county or
could be converted to Medicaid-covered services.
DIVISION XVI
IN-PERSON SUPERVISION REQUIREMENTS FOR LICENSURE — CERTAIN
PROFESSIONALS
Sec. 56. Section 154C.3, subsection 1, paragraph c,
subparagraph (5), subparagraph division (a), Code 2021, is
amended by adding the following new subparagraph subdivision:
NEW SUBPARAGRAPH SUBDIVISION. (0ii) By a person licensed
under section 154D.2 to practice marital and family therapy
without supervision or mental health counseling without
supervision.
-70- Sec. 57. Section 154C.3, Code 2021, is amended by adding the
following new subsection:
NEW SUBSECTION. 4. Supervision. The board shall not, by
rule or other means, require that supervision be completed in
person as a condition for an applicant to receive a license, a
reciprocal license, or a renewed license under this chapter.
Sec. 58. Section 154D.2, Code 2021, is amended to read as
follows:
154D.2 Licensure — marital and family therapy — mental
health counseling.
1. An applicant for a license to practice marital and family
therapy or mental health counseling shall be granted a license
by the board when the applicant satisfies all of the following
requirements:
1. a. Possesses a master’s degree in marital and family
therapy or mental health counseling, as applicable, consisting
of at least sixty semester hours, or its equivalent, from a
nationally accredited institution or from a program approved
by the board.
2. b. Has at least two years of supervised clinical
experience or its equivalent as approved by the board.
Standards for supervision, including the required
qualifications for supervisors, shall be determined in
accordance with subsection 2 and by the board by rule, provided
that a supervisor may be a person licensed under this section
to practice marital and family therapy or mental health
counseling without supervision or a licensed independent social
worker licensed under chapter 154C.
3. c. Passes an examination approved by the board.
2. The board shall not, by rule or other means, require any
in-person supervised clinical experience.
Sec. 59. Section 154D.4, subsection 2, paragraph b, Code
2021, is amended to read as follows:
b. A person who practices marital and family therapy or
mental health counseling under the supervision of a person
-71-licensed under this chapter as part of a clinical experience as
described in section 154D.2, subsection 2 1, paragraph “b”.
Sec. 60. BOARD OF SOCIAL WORK AND BOARD OF BEHAVIORAL
SCIENCE — RULES. The board of social work and the board
of behavioral science shall amend their administrative
rules pursuant to chapter 17A to remove any requirement for
supervised clinical experience and supervised professional
practice to be completed in person as a condition for the
licensure of marital and family therapists, mental health
counselors, and social workers pursuant to chapters 154C and
154D. The board of social work and the board of behavioral
science shall replace all licensing requirements for in-person
supervision with the ability to have supervision requirements
completed electronically.
Sec. 61. EMERGENCY RULES.
1. The board of social work and the board of behavioral
science shall adopt emergency rules under section 17A.4,
subsection 3, and section 17A.5, subsection 2, to implement
the sections of this division of this Act amending section
154C.3 and section 154D.2, and the rules shall be effective
immediately upon filing unless a later date is specified in the
rules. Any emergency rules adopted in accordance with this
section shall also be published as a notice of intended action
as provided in section 17A.4, subsection 1.
2. The board of social work and the board of behavioral
science shall jointly develop rules adopted pursuant to this
subsection through a collaborative process. The respective
boards may establish subcommittees or designate other personnel
to facilitate such a process. Such rules shall consist of
substantively identical standards applicable to the professions
regulated by the respective boards and shall, to the greatest
extent possible, consist of substantially similar language
in a substantially similar format. Prior to a vote to adopt
such rules by either board, each board shall, by a separate
vote, approve the language to be adopted by the other board.
-72-Neither board shall vote to adopt such rules until the rules
to be adopted by both boards have been so approved. Such rules
shall have the same effective date and shall be submitted to
the administrative rules coordinator and the administrative
code editor for publication in the same issue of the Iowa
administrative bulletin pursuant to sections 17A.4 and 17A.5.
Sec. 62. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION XVII
MEDICAL RESIDENCY LIABILITY COSTS
Sec. 63. Section 135.176, subsection 1, Code 2021, is
amended by adding the following new paragraph:
NEW PARAGRAPH. d. For the period beginning July 1, 2021,
and ending June 30, 2026, the payment by the sponsor of medical
residency program liability costs subject to provision by the
sponsor of dollar-for-dollar matching funds used for payment
of such costs. This paragraph shall not apply to medical
residency programs to which chapter 669 applies.
Sec. 64. Section 135.176, subsection 2, paragraphs e and f,
Code 2021, are amended to read as follows:
e. The maximum award of grant funds to a particular
individual sponsor per year. An individual sponsor that
establishes a new or alternative campus accredited medical
residency training program as defined in subsection 1,
paragraph “a”, shall not receive more than fifty percent
of the state matching funds available each year to support
the program. An individual sponsor proposing the provision
of a new residency position within an existing accredited
medical residency or fellowship training program as specified
in subsection 1, paragraph “b”, or the funding of residency
positions which are in excess of the federal residency cap as
defined in subsection 1, paragraph “c”, or the funding of the
payment by the sponsor of medical residency program liability
costs subject to provision by the sponsor of dollar-for-dollar
matching funds used for payment of such costs as specified
-73-in subsection 1, paragraph “d”, shall not receive more than
twenty-five percent of the state matching funds available each
year to support the program.
f. Use of the funds awarded. Funds may be used to pay the
costs of establishing, expanding, or supporting an accredited
graduate medical education program as specified in this
section, including but not limited to the costs associated
with residency stipends and physician faculty stipends. For
the period beginning July 1, 2021, and ending June 30, 2026,
use of the funds awarded may include payment by the sponsor of
medical residency program liability costs in accordance with
subsection 1, paragraph “d”, and subject to provision by the
sponsor of dollar-for-dollar matching funds used for payment
of such costs.
DIVISION XVIII
REPORT ON NONREVERSION OF FUNDS
Sec. 65. REPORT ON NONREVERSION OF FUNDS. The department
of human services shall report the expenditure of any moneys
for which nonreversion authorization was provided for the
fiscal year beginning July 1, 2020, and ending June 30, 2021,
for field operations or general administration to the general
assembly on a quarterly basis beginning October 1, 2021.
DIVISION XIX
PHYSICIAN ORDERS FOR SCOPE OF TREATMENT
Sec. 66. Section 144D.2, subsection 1, paragraph e,
subparagraph (4), Code 2021, is amended by striking the
subparagraph.
______________________________
PAT GRASSLEYSpeaker of the House______________________________
JAKE CHAPMANPresident of the Senate I hereby certify that this bill originated in the House and is known as House File 891, Eighty-ninth General Assembly.______________________________
MEGHAN NELSONChief Clerk of the HouseApproved _______________, 2021______________________________
KIM REYNOLDSGovernorpf/rn/md