Iowa 2023-2024 Regular Session

Iowa Senate Bill SF561 Latest Draft

Bill / Enrolled Version Filed 05/10/2023

                            Senate File 561 - Enrolled   Senate File 561   AN ACT   RELATING TO APPROPRIATIONS FOR VETERANS AND HEALTH AND HUMAN   SERVICES AND INCLUDING OTHER RELATED PROVISIONS AND   APPROPRIATIONS INCLUDING HEALTH POLICY OVERSIGHT, PUBLIC   ASSISTANCE PROGRAM PROVISIONS AND A PUBLIC ASSISTANCE   MODERNIZATION FUND, SPRINKLER SYSTEMS FOR HOME AND   COMMUNITY-BASED SERVICES WAIVER RECIPIENT RESIDENCES, A   STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM   AND FUND, ADOPTION SUBSIDY PROGRAM NONRECURRING ADOPTION   EXPENSES, REAL ESTATE TRANSACTIONS INVOLVING DEPARTMENTAL   INSTITUTIONS, PROVIDING PENALTIES, AND INCLUDING EFFECTIVE   DATE AND OTHER APPLICABILITY DATE PROVISIONS.   BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:    DIVISION I      DEPARTMENT OF VETERANS AFFAIRS  FY 2023-2024      Section 1. 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, 2023, and ending June 30, 2024, the following amounts,    or so much thereof as is necessary, to be used for the purposes    designated:   

  Senate File 561, p. 2   1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION    For salaries, support, maintenance, and miscellaneous    purposes, and for not more than the following full-time    equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,033,289    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00    2. IOWA VETERANS HOME    For salaries, support, maintenance, and miscellaneous    purposes:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,115,335    a. The Iowa veterans home billings involving the department    of health and 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 :    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000    Sec. 2. 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, 2023, and ending June 30, 2024, 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   

  Senate File 561, p. 3   DIVISION II    DEPARTMENT OF HEALTH AND HUMAN SERVICES  AGING  FY    2023-2024    Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES     AGING. There is appropriated from the general fund of the    state to the department of health and human services for the    fiscal year beginning July 1, 2023, and ending June 30, 2024,    the following amount, or so much thereof as is necessary, to be    used for the purposes designated:    For aging programs for the department of health and human    services and area agencies on aging to provide citizens of    Iowa who are 60 years of age and older with case management,    Iowas 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,799,361    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 31.00    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 Iowa commission on volunteer service to be    used for the retired and senior volunteer program.    3. a. The department of health and human services shall    establish and enforce procedures relating to expenditure    of state and federal funds by area agencies on aging that    require compliance with both state and federal laws, rules, and    regulations, including but not limited to all of the following:   

  Senate File 561, p. 4   (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, $1,312,000    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.    5. Of the funds appropriated in this section, $1,000,000    shall be used to fund continuation of the aging and disability    resource center lifelong links to provide individuals and    caregivers with information and services to plan for and    maintain independence.    6. Of the funds appropriated in this section, $850,000    shall be used by the department of health and human services,    in collaboration with 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; and shall be used by the department to fund home   

  Senate File 561, p. 5   and community-based services to enable older individuals to    avoid more costly utilization of residential or institutional    services and remain in their homes. The department shall    submit a report regarding the outcomes of the pilot initiative    to the governor and the general assembly by December 15, 2023.    DIVISION III    OFFICE OF LONG-TERM CARE OMBUDSMAN  FY 2023-2024    Sec. 4. 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, 2023, and ending June 30, 2024, 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,148,959    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 12.00    DIVISION IV    DEPARTMENT OF HEALTH AND HUMAN SERVICES  PUBLIC HEALTH  FY    2023-2024    Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES  PUBLIC    HEALTH. There is appropriated from the general fund of the    state to the department of health and human services for the    fiscal year beginning July 1, 2023, and ending June 30, 2024,    the following amounts, or so much thereof as is necessary, to    be used for the purposes designated:    1. ADDICTIVE DISORDERS    For reducing the prevalence of the use of tobacco, alcohol,    and other drugs, and treating individuals affected by addictive    behaviors, including gambling, and for not more than the    following full-time equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,656,992    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 12.00      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   

  Senate File 561, p. 6   142A.3 shall advise the director of health and human services    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    department of revenue for enforcement of tobacco laws,    regulations, and ordinances and to engage in tobacco control    activities approved by the departments as specified in    the memorandum of understanding entered into between the    departments.    (b) For the fiscal year beginning July 1, 2023, and ending    June 30, 2024, the terms of the memorandum of understanding,    entered into between the department of revenue and the    department, 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    use 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,   

  Senate File 561, p. 7   $306,000 shall be utilized by the department to maintain    a single statewide 24-hour crisis hotline for the Iowa    childrens behavioral health system that incorporates warmline    services which may be provided through expansion of existing    capabilities 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 use disorder treatment and    addictive disorders for the fiscal year beginning July 1, 2023.    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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,815,491    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 14.00    a. Of the funds appropriated in this subsection, not more    than $734,000 shall be used for the healthy opportunities for    parents to experience success (HOPES)-healthy families Iowa    (HFI) program established pursuant to section 135.106 .    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 departments initiative    to provide for adequate developmental surveillance and    screening during a childs 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   

  Senate File 561, p. 8   through training, education, and evaluation; and by providing    for practitioner consultation particularly for children with    behavioral conditions and needs. The department shall also    collaborate with the Medicaid program and the child health    specialty clinics to integrate the activities of the first five    initiative into the establishment of patient-centered medical    homes, community utilities, accountable care organizations,    and other integrated care models developed to improve health    quality and population health while reducing health care costs.    To the maximum extent possible, funding allocated in this    paragraph shall be utilized as matching funds for Medicaid    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 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   

  Senate File 561, p. 9   the following full-time equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,256,595    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 10.00    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    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, 2023.    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 health and human services for persons with    autism, their families, and providers of services, including   

  Senate File 561, p. 10   delivering regionalized services of care coordination,    family navigation, and integration of services through the    statewide system of regional child health specialty clinics and    fulfilling other requirements as specified in chapter 225D .    The university of Iowa shall not receive funds allocated under    this paragraph for indirect costs associated with the regional    autism assistance program.    f. Of the funds appropriated in this subsection, $577,000    shall be used for the comprehensive cancer control program to    reduce the burden of cancer in Iowa through prevention, early    detection, effective treatment, and ensuring quality of life.    Of the funds allocated in this paragraph f, $150,000 shall    be used to support a melanoma research symposium, a melanoma    biorepository and registry, basic and translational melanoma    research, and clinical trials.    g. Of the funds appropriated in this subsection, $97,000    shall be used for cervical and colon cancer screening, and    $177,000 shall be used to enhance the capacity of the cervical    cancer screening program to include provision of recommended    prevention and early detection measures to a broader range of    low-income women.    h. Of the funds appropriated in this subsection, $506,000    shall be used for the center for congenital and inherited    disorders.    4. COMMUNITY CAPACITY    For strengthening the health care delivery system at the    local level, and for not more than the following full-time    equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,435,682    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 14.00    a. Of the funds appropriated in this subsection, $95,000    is allocated for continuation of the child vision screening    program implemented through the university of Iowa hospitals    and clinics in collaboration with early childhood Iowa areas.    The program shall submit a report to the department regarding    the use of funds allocated under this paragraph a. The    report shall include the objectives and results for the    program year including the target population and how the funds    allocated assisted the program in meeting the objectives; the   

  Senate File 561, p. 11   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 the services    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    psychologists 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 $600,000 is allocated to the Iowa    prescription drug corporation for continuation of the    pharmaceutical infrastructure originally established for safety    net providers as described in 2007 Iowa Acts, chapter 218,    section 108 , and for the prescription drug donation repository    program created in chapter 135M . Funds allocated under this    subparagraph shall be distributed in their entirety for the    purpose specified on July 1, 2023.    (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   

  Senate File 561, p. 12   subparagraph shall be distributed in their entirety for the    purpose specified on July 1, 2023.    (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, 2023.    (4) Not less than $225,000 is allocated to the Polk    county medical society for continuation of the safety net    provider patients 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, 2023.    d. Of the funds appropriated in this subsection, $191,000    is allocated for the purposes of health care and public health    workforce initiatives.    e. Of the funds appropriated in this subsection, $96,000    shall be used for a matching dental education loan repayment    program to be allocated to a dental nonprofit health service    corporation to continue to develop the criteria and implement    the loan repayment program.    f. Of the funds appropriated in this subsection, $100,000    shall be used for the purposes of the Iowa donor registry as    specified in section 142C.18 .    g. Of the funds appropriated in this subsection, $96,000    shall be used for continuation of a grant to a nationally    affiliated volunteer eye organization that has an established    program for children and adults and that is solely dedicated to    preserving sight and preventing blindness through education,    nationally certified vision screening and training, and    community and patient service programs. The contractor shall    submit a report to the 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 the   

  Senate File 561, p. 13   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 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, $800,000    shall be used for rural psychiatric residencies to annually    fund six 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    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 continuation of a center of excellence    program to award two grants 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 grant funds shall    specify how the grant 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 grant funding.    Following the receipt of grant funding, a recipient shall    submit periodic reports as specified by the department to the    governor and the general assembly regarding the recipients   

  Senate File 561, p. 14   expenditure of the grant funds and progress in accomplishing    the programs goals.    m. Of the funds appropriated in this subsection, $560,000    shall be deposited in the family medicine obstetrics fellowship    program fund to be used for the state family medicine    obstetrics fellowship program in accordance with section    135.182, if enacted in this Act, to meet a critical demand for    well-trained family medicine obstetrics practitioners in rural    and underserved areas in the state.    n. Of the funds appropriated in this subsection, $358,201    is allocated for the Iowa commission on volunteer service for    purposes of the Iowa state commission grant program and the    Iowas promise and Iowa mentoring partnership programs.    (1) Of the funds allocated in this paragraph, $75,000 shall    be used for the purposes of the Iowa state commission grant    program and $93,201 shall be used for the purposes of the    Iowas promise and Iowa mentoring partnership programs.    (2) Notwithstanding section 8.33, funds allocated in this    paragraph 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.    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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,795,902    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 6.00      7. PUBLIC PROTECTION    For protecting the health and safety of the public through    establishing standards and enforcing regulations, and for not    more than the following full-time equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,581,792   

  Senate File 561, p. 15   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 57.00    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    departments 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    $750,000 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 under the    federal Childrens 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    departments 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 933,543    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 4.00    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.   

  Senate File 561, p. 16   The university of Iowa hospitals and clinics billings to the    department shall be on at least a quarterly basis.    10. IOWA HEALTH INFORMATION NETWORK ENHANCEMENTS    The department shall work with the board established    in chapter 135D to develop plans for program enhancements    in the Iowa health information network, for the purpose of    empowering Iowa patients to access and direct their health    information utilizing the Iowa health information network.    Program enhancements shall protect data privacy, facilitate the    interchange of health data for the purpose of improving public    health outcomes, and increase participation by health care    providers.    Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES  SPORTS    WAGERING RECEIPTS FUND. There is appropriated from the sports    wagering receipts fund created in section 8.57, subsection 6,    to the department of health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, the    following amount, or so much thereof as is necessary, to be    used for the purposes designated:    For problem gambling and substance use 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 V    DEPARTMENT OF HEALTH AND HUMAN SERVICES  HUMAN SERVICES     FY 2023-2024    Sec. 7. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK    GRANT. There is appropriated from the fund created in section    8.41 to the department of health and human services for the    fiscal year beginning July 1, 2023, and ending June 30, 2024,    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 (FIP)    account and used for assistance under FIP in accordance with   

  Senate File 561, p. 17   chapter 239B :    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,002,006    2. To be credited to the FIP 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, 2024, the    moneys shall revert.    4. For field operations:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 31,296,232    5. For general administration:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,744,000    6. For state child care assistance:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826    a. Of the funds appropriated in this subsection,    $26,205,412 is transferred to the child care and development    block grant appropriation made by the Ninetieth General    Assembly, 2023 session, for the federal fiscal year beginning    October 1, 2023, and ending September 30, 2024. 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     

  Senate File 561, p. 18   payments for families who are employed including but not    limited to individuals enrolled in FIP.    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, 2023, if the programs have    demonstrated positive outcomes. Grants shall be awarded to    pregnancy prevention programs which are developed after July    1, 2023, if the programs are based on existing models that    have demonstrated positive outcomes. Grants shall comply with    the requirements provided in 1997 Iowa Acts, chapter 208,    section 14, subsections 1 and 2 , including the requirement that    grant programs must emphasize sexual abstinence. Priority in    the awarding of grants shall be given to programs that serve    areas of the state which demonstrate the highest percentage of    unplanned pregnancies of females of childbearing age within the    geographic area to be served by the grant.    10. For technology needs and other resources necessary to    meet federal and state 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 2022 Iowa Acts or 2023 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, 2023, are appropriated to the department of    health and human services to the extent as may be necessary    to be used in the following priority order: for FIP, for    state child care assistance program payments for families    who are employed, and for the FIP share of system costs for    eligibility determination and related functions. The federal   

  Senate File 561, p. 19   funds appropriated in this paragraph a shall be expended    only after all other funds appropriated in subsection l for    assistance under FIP, in subsection 6 for state child care    assistance, or in subsection 10 for technology needs and other    resources necessary to meet departmental needs, 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,    $12,962,008 for the fiscal year beginning July 1, 2023, is    transferred to the appropriation of the federal social services    block grant made to the department of health and human services    for that fiscal year.    13. For continuation of the program providing categorical    eligibility for the supplemental nutrition assistance program    (SNAP) as specified in section 239.2, if enacted by 2023 Iowa    Acts, Senate File 494:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 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 FIP 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 FIP account. If there are conflicting   

  Senate File 561, p. 20   needs, priority shall first be given to the FIP account as    specified under subsection 1 of this section and used for the    purposes of assistance under FIP 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 FIP account for the fiscal year    beginning July 1, 2023, and ending June 30, 2024, 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,    including administrative and information technology costs    associated with rent reimbursement and other income assistance    programs administered by the department.    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 FIP 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, 2023, and ending June 30, 2024, are allocated as follows:    a. To be used by the department of health and human services    to more effectively serve participants in FIP and other clients    and to meet federal reporting requirements under the federal    temporary assistance for needy families block grant:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,000    b. To the department of health and human services for    staffing, administration, and implementation of the family    development and self-sufficiency grant program in accordance    with section 216A.107 :    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7,192,834   

  Senate File 561, p. 21   (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 health and human services may continue    to implement the family development and self-sufficiency grant    program statewide during fiscal year 2023-2024.    (3) The department of health and human services 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 health and 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 FIP participants in work, education,    or training activities, or for the purposes of assistance under    FIP in accordance with chapter 239B .    d. For the SNAP employment and training program:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 66,588    (1) The department shall apply the federal 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 SNAP participants, including    but not limited to related dependent care and transportation    expenses.    (2) The department shall continue categorical federal    SNAP eligibility as specified in section 239.2, if enacted    by 2023 Iowa Acts, Senate File 494, consistent with federal   

  Senate File 561, p. 22   SNAP requirements. The eligibility provisions shall conform    to all federal requirements including requirements addressing    individuals who are disqualified for committing an intentional    program violation or are 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 services appropriation made    in this division of this Act. Of the remainder of the assigned    child support collections received by child support services,    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 health and human services for the fiscal year    beginning July 1, 2023, and ending June 30, 2024, the following    amount, or so much thereof as is necessary, to be used for the    purpose designated:    To be credited to the FIP account and used for FIP assistance    in accordance with chapter 239B and for other costs associated    with providing needs-based benefits or assistance:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 41,003,575    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   

  Senate File 561, p. 23   year beginning July 1, 2023, 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 health and 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 FIP.    (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.    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 child support services participates, to support the    efforts of a nonprofit organization committed to strengthening   

  Senate File 561, p. 24   the community through youth development, healthy living,    and social responsibility headquartered in a county with    a population over 450,000 according to the 2020 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 FIP account.    Sec. 10. CHILD SUPPORT SERVICES. There is appropriated from    the general fund of the state to the department of health and    human services for the fiscal year beginning July 1, 2023, and    ending June 30, 2024, the following amount, or so much thereof    as is necessary, to be used for the purposes designated:    For child support services, including salaries, support,    maintenance, and miscellaneous purposes, and for not more than    the following full-time equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,914,329    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 459.00    1. The department shall expend up to $24,000, including    federal financial participation, for the fiscal year beginning    July 1, 2023, 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   

  Senate File 561, p. 25   neutral visitation sites and mediation services.    3. The appropriation made to the department for child    support services 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 2023-2024. Any funds remaining in the health care trust    fund created in section 453A.35A for the fiscal year beginning    July 1, 2023, and ending June 30, 2024, are appropriated to    the department of health and 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    2023-2024. Any funds remaining in the Medicaid fraud fund    created in section 249A.50 for the fiscal year beginning July    1, 2023, and ending June 30, 2024, are appropriated to the    department of health and 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 health and human    services for the fiscal year beginning July 1, 2023, and ending    June 30, 2024, 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, 2023, 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,543,626,779    1. Iowans support reducing the number of abortions   

  Senate File 561, p. 26   performed in our state. Funds appropriated under this section    shall not be used for abortions, unless otherwise authorized    under this section.    2. The provisions of this section relating to abortions    shall also apply to the Iowa health and wellness plan created    pursuant to chapter 249N .    3. The department shall utilize not more than $60,000 of    the funds appropriated in this section to continue the AIDS/HIV    health insurance premium payment program as established in 1992    Iowa Acts, Second Extraordinary Session, chapter 1001, section    409, subsection 6 . Of the funds allocated in this subsection,    not more than $5,000 may be expended for administrative    purposes.    4. Of the funds appropriated in this Act to the department    of health and human services for addictive disorders, $950,000    shall be used for an integrated substance use disorder managed    care system. The department shall maintain the level of mental    health and substance use disorder treatment services provided    by the managed care contractors. The 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 departments 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   

  Senate File 561, p. 27   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    childrens health insurance program, or field operations to be    used for the state match cost to comply with the payment error    rate measurement (PERM) program for both the medical assistance    and childrens 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. 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.    11. 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.    12. 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.    13. a. The department may increase the amounts allocated    for salaries, support, maintenance, and miscellaneous purposes    associated with the medical assistance program, as necessary,   

  Senate File 561, p. 28   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, 2023, 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.    14. For the fiscal year beginning July 1, 2023, and ending    June 30, 2024, the replacement generation tax revenues required    to be deposited in the property tax relief fund pursuant to    section 437A.8, subsection 4 , paragraph d, and section    437A.15, subsection 3 , paragraph f, shall instead be credited    to and supplement the appropriation made in this section and    used for the allocations made in this section.    15. 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 childrens 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   

  Senate File 561, p. 29   and implementation of standardized assessment tools for    persons with mental illness, an intellectual disability, a    developmental disability, or a brain injury.    16. Of the funds appropriated in this section, $150,000    shall be used for lodging expenses associated with care    provided at the university of Iowa hospitals and clinics for    patients with cancer whose travel distance is 30 miles or more    and whose income is at or below 200 percent of the federal    poverty level as defined by the most recently revised poverty    income guidelines published by the United States department of    health and human services. The department of health and 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.    17. 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.    18. 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.    19. The department shall comply with the centers for    Medicare and Medicaid services guidance related to Medicaid    program and childrens 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 and section 5131 of the    federal Consolidated Appropriations Act, 2023, Pub. L. No.    117-328. The department shall utilize and implement all tools,    processes, and resources available to expediently return to    normal eligibility and enrollment operations in compliance with   

  Senate File 561, p. 30   federal guidance and expectations.    20. A portion of the funds appropriated in this section    may be transferred to the appropriation made in this division    of this Act for the childrens health insurance program,    if the childrens health insurance program appropriation    is insufficient to cover the designated purposes of that    appropriation.    21. Notwithstanding any provision to the contrary, of the    funds appropriated in this section, $13,000,000 shall be used    to increase reimbursement rates for mental health and substance    use disorder providers in accordance with a methodology    determined by the department. Of the amount allocated    under this subsection, $7,000,000 shall be used to increase    reimbursement rates for individual mental health therapy    providers, $3,000,000 shall be used to increase reimbursement    rates for mental health providers, and $3,000,000 shall be used    to increase reimbursement rates for substance use disorder    providers.    22. Of the funds appropriated in this section, $5,500,000    shall be used to maintain the reimbursement rates of eligible    home and community-based services providers at the rates    in effect on June 30, 2023, and to reduce the home and    community-based services intellectual disabilities waiver    waiting list to the extent possible.    Sec. 14. HEALTH PROGRAM OPERATIONS. There is appropriated    from the general fund of the state to the department of health    and human services for the fiscal year beginning July 1, 2023,    and ending June 30, 2024, the following amount, or so much    thereof as is necessary, to be used for the purpose designated:    For health program operations:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 17,446,067      1. The department of inspections, appeals, and licensing    shall provide all state matching funds for survey and    certification activities performed by the department of    inspections, appeals, and licensing. The department of health    and 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   

  Senate File 561, p. 31   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 of a phased-in    program to provide a dental home for children.    5. a. Of the funds appropriated in this section, $188,000    shall be credited to the autism support program fund created    in section 225D.2 to be used for the autism support program    created in chapter 225D , with the exception of the following    amount of this allocation which shall be used as follows:    b. Of the funds allocated in this subsection, $25,000 shall    be used for the public purpose of continuation of a grant to    a nonprofit provider of child welfare services that has been    in existence for more than 115 years, is located in a county    with a population between 220,000 and 250,000 according to the    2020 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 health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, 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   

  Senate File 561, p. 32   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, 2023,    the department projects that state supplementary assistance    expenditures for a calendar year will not meet the federal    pass-through requirement specified in Tit. XVI of the federal    Social Security Act, section 1618, as codified in 42 U.S.C.    1382g, the department may take actions including but not    limited to increasing the personal needs allowance for    residential care facility residents and making programmatic    adjustments or upward adjustments of the residential care    facility or in-home health-related care reimbursement rates    prescribed in this division of this Act to ensure that federal    requirements are met. In addition, the department may make    other programmatic and rate adjustments necessary to remain    within the amount appropriated in this section while ensuring    compliance with federal requirements. The department may adopt    emergency rules to implement the provisions of this subsection.    4. Notwithstanding section 8.33 , moneys appropriated in    this section that remain unencumbered or unobligated at the    close of the fiscal year shall not revert but shall remain    available for expenditure for the purposes designated,    including for liability amounts associated with the SNAP    payment error rate, until the close of the succeeding fiscal    year.    Sec. 16. CHILDRENS HEALTH INSURANCE PROGRAM.    1. There is appropriated from the general fund of the state    to the department of health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, 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 (Hawki)    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    childrens health insurance program:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 38,661,688   

  Senate File 561, p. 33   2. Of the funds appropriated in this section, a sufficient    amount is allocated for continuation of the contract for    outreach.    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 Hawki program eligibility,    payment, and administrative functions under the purview of the    department of health and 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 health and    human services for the fiscal year beginning July 1, 2023, and    ending June 30, 2024, the following amount, or so much thereof    as is necessary, to be used for the purpose designated:    For child care programs:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 64,223,730    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, $29,256,799    shall be deposited in the school ready children grants account    of the early childhood Iowa fund created in section 256I.11,    and shall be allocated as follows for the fiscal year beginning    July 1, 2023:    a. Of the amount deposited under this subsection, not    more than $265,950 is allocated for the early childhood Iowa    program and other technical assistance activities. Moneys   

  Senate File 561, p. 34   allocated under this lettered paragraph may be used by the    early childhood Iowa state board for the purpose of skills    development and support for ongoing training of staff. The    early childhood Iowa state board may reserve a portion of the    allocation under paragraph b, not to exceed $88,650, for    the technical assistance expenses of the early childhood Iowa    program, including the reimbursement of staff. However, except    as otherwise provided in this subsection, moneys shall not be    used for additional staff or for the reimbursement of staff.    b. Of the amount deposited under this subsection,    $2,318,018 shall be used for efforts to improve the quality    of early care, health, and education programs. Moneys    allocated pursuant to this lettered paragraph may be used    for additional staff and for the reimbursement of staff in    early childhood Iowa areas and for local quality improvement    efforts. The early childhood Iowa state board shall determine    the methodology to make the most productive use of the funding,    which may include use of the distribution formula, grants, or    other means.    c. Of the amount deposited under this subsection, $825,030    shall be used for support of professional development and    training activities for persons working in early care,    health, and education by the early childhood Iowa state    board in collaboration with the professional development    component group maintained by the early childhood Iowa    stakeholders alliance pursuant to section 256I.12, and the    early childhood Iowa area boards. Expenditures shall be    limited to professional development and training activities,    and strategic plan implementation staff as agreed upon by the    parties participating in the collaboration as approved by the    early childhood Iowa state board.    d. Of the amount deposited under this subsection, $200,000    shall be used to invest in the states early childhood database    system that integrates state administrative data to provide    results that inform and improve the early childhood system of    programs and services in the state.    e. Of the amount deposited under this subsection,    $5,850,000 shall be distributed for funding of community-based    early childhood programs targeted to children from birth   

  Senate File 561, p. 35   through five years of age developed by early childhood Iowa    areas in accordance with approved community plans as provided    in section 256I.8. Up to $65,000 of the funds allocated in    this paragraph may be used for additional technical assistance    staff.    5. The department may use any of the funds appropriated    in this section as a match to obtain federal funds for use in    expanding child care assistance and related programs. For    the purpose of expenditures of state and federal child care    funding, funds shall be considered obligated at the time    expenditures are projected or are allocated to the departments    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   

  Senate File 561, p. 36   including quality set asides, shall be used for state child    care assistance payments. If the appropriations made for    purposes of the state child care assistance program for the    fiscal year are determined to be insufficient, it is the intent    of the general assembly to appropriate sufficient funding for    the fiscal year in order to avoid establishment of waiting list    requirements.    8. Notwithstanding section 8.33 , moneys advanced for    purposes of the programs developed by early childhood Iowa    areas, advanced for purposes of wraparound child care, or    received from the federal appropriations made for the purposes    of this section that remain unencumbered or unobligated at the    close of the fiscal year shall not revert to any fund but shall    remain available for expenditure for the purposes designated    until the close of the succeeding fiscal year.    Sec. 18. JUVENILE INSTITUTION. There is appropriated from    the general fund of the state to the department of health and    human services for the fiscal year beginning July 1, 2023, and    ending June 30, 2024, 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 17,568,511    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 207.00    b. Of the funds appropriated in this subsection, $91,000    shall be used for distribution to licensed classroom teachers    at this and other institutions under the control of the    department of health and 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, 2023.    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   

  Senate File 561, p. 37   the fiscal year beginning July 1, 2023.    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 health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, the    following amount, or so much thereof as is necessary, to be    used for the purpose designated:    For child and family services:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 79,027,794    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, the state    child care assistance program, or FIP 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. Of the funds appropriated in this section, up to    $40,500,000 is allocated for group foster care maintenance and    services.    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 2023-2024. Of    the funds appropriated in this section, $1,717,000 is allocated    specifically for expenditure for fiscal year 2023-2024 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.   

  Senate File 561, p. 38   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, 2023, as the result of the expenditure    of state funds appropriated during a previous state fiscal    year for a service or activity funded under this section are    appropriated to the department to be used as additional funding    for services and purposes provided for under this section.    Notwithstanding section 8.33 , moneys received in accordance    with this subsection that remain unencumbered or unobligated at    the close of the fiscal year shall not revert to any fund but    shall remain available for the purposes designated until the    close of the succeeding fiscal year.    8. a. Of the funds appropriated in this section, up to    $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 .    b. Notwithstanding section 232.141 or any other    provision of law to the contrary, the amounts allocated in    this subsection shall be distributed as determined by the    department. The department shall make the determination of the    distribution amounts on or before June 15, 2023.    c. 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 the court-ordered services    distribution amount is insufficient to pay for the service.    The department 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    department shall attempt to anticipate potential surpluses    and shortfalls in the distribution amounts and shall transfer    distribution amounts as prudent.    d. 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   

  Senate File 561, p. 39   entered under chapter 232 which is a charge upon the state    under section 232.141, subsection 4 .    9. Of the funds appropriated in this section, $1,658,000    shall be used for the child protection center grant program for    child protection centers located in Iowa in accordance with    section 135.118 . The grant amounts under the program shall be    equalized so that each center receives a uniform base amount of    $245,000, and so that the remaining funds are awarded through    a funding formula based upon the volume of children served.    To increase access to child protection center services for    children in rural areas, the funding formula for the awarding    of the remaining funds shall provide for the awarding of an    enhanced amount to eligible grantees to develop and maintain    satellite centers in underserved regions of the state.    10. Of the funds appropriated in this section, up to    $4,025,000 is allocated for the preparation for adult living    program pursuant to section 234.46 .    11. 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.    12. 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.    13. 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 .    14. Of the funds appropriated in this section, $630,000 is    allocated for the community partnership for child protection    sites.      15. Of the funds appropriated in this section, up to    $371,000 is allocated for the departments minority youth and    family projects under the redesign of the child welfare system.   

  Senate File 561, p. 40   16. Of the funds appropriated in this section, $851,000    is allocated for funding of the community circle of care    collaboration for children and youth in northeast Iowa.    17. Of the funds appropriated in this section, at least    $147,000 shall be used for the continuation of the child    welfare provider training program.    18. 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 450,000 according to the 2020    certified federal census, is licensed as a psychiatric medical    institution for children, and was a system of care grantee    prior to July 1, 2023.    19. 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 childs life of childhood basic    needs, education and work, family, and community.    20. 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 230,000 according to    the 2020 certified federal census, is licensed as a psychiatric    medical institution for children, and was a system of care    grantee prior to July 1, 2023.    21. If a separate funding source is identified that reduces    the need for state funds within an allocation under this    section, the allocated state funds may be redistributed to    other allocations under this section for the same fiscal year.    22. Of the funds appropriated in this section, a portion may    be used for family-centered services for purposes of complying   

  Senate File 561, p. 41   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 health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, 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 operations and services provided for under paragraph b:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 40,883,507    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 health and 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    shall remain available for the purposes designated in this    subparagraph (2) until expended.    2. The department may transfer funds appropriated in this    section remaining after the transfer of funds under subsection    1, paragraph b, 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, 2023, as the result of the    expenditure of state funds during a previous state fiscal   

  Senate File 561, p. 42   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.    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 the purposes designated until the close of the    succeeding fiscal year.    Sec. 21. FAMILY SUPPORT SUBSIDY PROGRAM.    1. There is appropriated from the general fund of the state    to the department of health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, 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 $931,536 of the moneys appropriated in this    section shall be used 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. 22. CONNER DECREE. There is appropriated from the    general fund of the state to the department of health and human    services for the fiscal year beginning July 1, 2023, and ending    June 30, 2024, the following amount, or so much thereof as is    necessary, to be used for the purpose designated:   

  Senate File 561, p. 43   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. 23. MENTAL HEALTH INSTITUTES.    1. There is appropriated from the general fund of the state    to the department of health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,923,252    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 188.00    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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,811,470    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 211.00    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 members stay for which federal    financial participation is available.   

  Senate File 561, p. 44   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. 24. STATE RESOURCE CENTERS.    1. There is appropriated from the general fund of the state    to the department of health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, the    following amounts, or so much thereof as is necessary, to be    used for the purposes designated:    a. For the state resource center at Glenwood for salaries,    support, maintenance, and miscellaneous purposes:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 16,255,132    b. For the state resource center at Woodward for salaries,    support, maintenance, and miscellaneous purposes:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13,389,577    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,    mental health and disability services regions, 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 departments administration and the department    of management concur with a finding by a state resource    centers 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 centers superintendent may reclassify any    vacant position as necessary to fill the desired position. The    superintendents of the state resource centers may, by mutual   

  Senate File 561, p. 45   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 2023-2024.    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. 25. SEXUALLY VIOLENT PREDATORS.    1. There is appropriated from the general fund of the state    to the department of health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 14,865,337    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 167.00    2. Unless specifically prohibited by law, if the amount    charged provides for recoupment of at least the entire amount    of direct and indirect costs, the department of health and    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   

  Senate File 561, p. 46   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. 26. FIELD OPERATIONS.    1. There is appropriated from the general fund of the state    to the department of health and human services for the fiscal    year beginning July 1, 2023, and ending June 30, 2024, 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 72,056,945    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 1,589.00    2. Of the funds appropriated in this section, $1,370,436    shall be used for the purpose of increasing compensation for    child welfare case workers and to support case workers with    complex cases in all service areas.    3. In addition to subsection 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. 27. GENERAL ADMINISTRATION. There is appropriated    from the general fund of the state to the department of health    and human services for the fiscal year beginning July 1, 2023,    and ending June 30, 2024, 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:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 18,913,662    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 341.86    1. The department shall report at least monthly to the    general assembly concerning the departments operational and   

  Senate File 561, p. 47   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 Iowa commission on volunteer service 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 1.00 full-time equivalent position    to address the departments responsibility to support the work    of the childrens 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    and 331.397A.    c. Of the amount allocated, $32,000 shall be used 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.   

  Senate File 561, p. 48   8. Of the funds appropriated under this section, $1,000,000    shall be used for the purposes of program administration and    provision of pregnancy support services through the more    options for maternal support program in accordance with section    217.41C.    9. Of the funds appropriated under this section, $2,602,312    shall be used for the child advocacy board for foster care    review and the court appointed special advocate program,    including for salaries, support, maintenance, and miscellaneous    purposes.    a. The department, in coordination with the child advocacy    board, shall submit an application for funding available    pursuant to Tit. IV-E of the federal Social Security Act for    claims for child advocacy board administrative review costs.    b. The court appointed special advocate program shall    investigate and develop opportunities for expanding fundraising    for the program.    c. Administrative costs charged by the department for items    funded under this subsection shall not exceed 4 percent of the    amount appropriated in this subsection.    Sec. 28. DEPARTMENT-WIDE DUTIES.    There is appropriated from the general fund of the state to    the department of health and human services for the fiscal year    beginning July 1, 2023, and ending June 30, 2024, 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    health and human services:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,157,590    The department shall submit a report to the general assembly    detailing the expenditure of the funds appropriated under this    section.    Sec. 29. VOLUNTEERS. There is appropriated from the    general fund of the state to the department of health and human    services for the fiscal year beginning July 1, 2023, and ending    June 30, 2024, the following amount, or so much thereof as is    necessary, to be used for the purpose designated:    For development and coordination of volunteer services:   

  Senate File 561, p. 49   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 84,686    Sec. 30. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY    ASSISTANCE, AND SOCIAL SERVICE PROVIDERS REIMBURSED UNDER THE    DEPARTMENT OF HEALTH AND HUMAN SERVICES.    1. a. (1) (a) (i) Notwithstanding any provision of    law to the contrary, for the fiscal period beginning July 1,    2023, and ending June 30, 2025, the department of health and    human services shall rebase case-mix nursing facility rates    beginning July 1, 2023, using the Medicaid cost reports on file    for the period ending December 31, 2022, and applying a minimum    occupancy factor of 70 percent, as provided pursuant to 2021    Iowa Acts, chapter 182, section 39, to the extent possible    within the state funding, including the $15,000,000 provided    for this purpose.    (ii) For the fiscal year beginning July 1, 2023, the    department of health and human services shall determine and    adjust each nursing facilitys case-mix index on a semiannual    basis. A separate calculation shall be made to determine the    average case-mix index for a nursing facility-wide case-mix    index, and a case-mix index for the residents of a nursing    facility who are medical assistance program recipients using    all of the minimum data set reports by the nursing facility for    the previous semiannual period of the state fiscal year using a    day weighted calculation.    (b) For the fiscal year beginning July 1, 2023, non-case-mix    and special population nursing facilities shall be reimbursed    in accordance with the methodology in effect on June 30, 2023.    (c) For managed care claims, the department of health    and 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.   

  Senate File 561, p. 50   (d) For the fiscal year beginning July 1, 2023, 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, 2023, the    department shall establish the fee-for-service pharmacy    dispensing fee reimbursement at $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, adjusted as necessary to maintain expenditures    within the amount appropriated to the department for this    purpose for the fiscal year. A change in the dispensing    fee shall become effective following federal approval of the    Medicaid state plan.    (2) The department shall utilize an average acquisition    cost reimbursement methodology for all drugs covered under the    medical assistance program in accordance with 2012 Iowa Acts,    chapter 1133, section 33.    c. (1) For the fiscal year beginning July 1, 2023,    reimbursement rates for outpatient hospital services shall    be rebased effective January 1, 2024, 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, 2023,    reimbursement rates for inpatient hospital services shall    remain at the rates in effect on June 30, 2023, 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.   

  Senate File 561, p. 51   (3) For the fiscal year beginning July 1, 2023, 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, 2023, the graduate    medical education and disproportionate share hospital fund    shall remain at the amount in effect on June 30, 2023, 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, 2023, 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, 2023, independent    laboratories and rehabilitation agencies shall be reimbursed    using the same methodology in effect on June 30, 2023.    f. (1) For the fiscal year beginning July 1, 2023,    reimbursement rates for home health agencies shall continue to    be based on the Medicare low utilization payment adjustment    (LUPA) methodology with state geographic wage adjustments.    The department shall continue to update the rates every two    years to reflect the most recent Medicare LUPA rates to the    extent possible within the state funding appropriated for this    purpose.    (2) For the fiscal year beginning July 1, 2023, the    department shall continue the reimbursement rate structure that   

  Senate File 561, p. 52   provides incentives to home health care providers located in    rural areas and providing home health care to Medicaid members.    The rate structure shall include a telehealth component to    incentivize the provision of necessary supervision for skilled    care without requiring travel time. For the purposes of this    subparagraph (2), rural area means an area that is not an    Iowa core based statistical area as defined by the federal    office of management and budget.    (3) For the fiscal year beginning July 1, 2023, 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, 2023.    g. For the fiscal year beginning July 1, 2023, 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, 2023, the    reimbursement rates for dental services shall remain at the    rates in effect on June 30, 2023, unless the department is    able to adjust rates in a budget neutral manner within overall    dental program expenditures.    i. (1) For the fiscal year beginning July 1, 2023,    reimbursement rates for non-state-owned psychiatric medical    institutions for children shall be based on the reimbursement    methodology in effect on June 30, 2023.    (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, 2023, unless    otherwise specified in this Act, all noninstitutional medical    assistance provider reimbursement rates shall remain at the    rates in effect on June 30, 2023, except for area education    agencies, local education agencies, infant and toddler    services providers, home and community-based services providers   

  Senate File 561, p. 53   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, 2023, the reimbursement rate for    anesthesiologists shall remain at the rates in effect on June    30, 2023, and updated on January 1, 2024, to align with the    most current Iowa Medicare anesthesia rate.    l. Notwithstanding section 249A.20 , for the fiscal year    beginning July 1, 2023, 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, 2023; however, this rate shall not exceed the maximum    level authorized by the federal government.    m. For the fiscal year beginning July 1, 2023, 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. (1) For the fiscal year beginning July 1, 2023, the    reimbursement rates for inpatient mental health services    provided at hospitals shall remain at the rates in effect on    June 30, 2023, 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, 2023.    (2) The department of health and human services shall    continue the tiered rate reimbursement methodology for    psychiatric intensive inpatient care.    o. For the fiscal year beginning July 1, 2023, community   

  Senate File 561, p. 54   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 health and human    services in effect on June 30, 2023.    p. For the fiscal year beginning July 1, 2023, 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, 2023.    q. For the fiscal year beginning July 1, 2023, the    reimbursement rates for emergency medical service providers    shall remain at the rates in effect on June 30, 2023, or as    approved by the centers for Medicare and Medicaid services of    the United States department of health and human services.    r. For the fiscal year beginning July 1, 2023, reimbursement    rates for substance use disorder treatment programs licensed    under section 125.13 shall remain at the rates in effect on    June 30, 2023.    s. For the fiscal year beginning July 1, 2023, assertive    community treatment per diem rates shall remain at the rates in    effect on June 30, 2023.    t. For the fiscal year beginning July 1, 2023, the    reimbursement rate for family-centered services providers shall    be established by contract.    u. For the fiscal year beginning July 1, 2023, the    reimbursement rate for air ambulance services shall remain at    the rate in effect on June 30, 2023.    v. For the fiscal year beginning July 1, 2023, all applied    behavioral analysis services reimbursement rates shall remain    at the rates in effect on June 30, 2023.      w. For the fiscal year beginning July 1, 2023, all    behavioral health intervention services reimbursement rates    shall remain at the rates in effect on June 30, 2023.      2. For the fiscal year beginning July 1, 2023, 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   

  Senate File 561, p. 55   the federally mandated maintenance of effort requirement.    3. Unless otherwise directed in this section, when the    departments 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 most recently ended calendar year.    4. Notwithstanding section 234.38 , for the fiscal    year beginning July 1, 2023, 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.    5. For the fiscal year beginning July 1, 2023, the maximum    reimbursement rates for social services providers under    contract shall remain at the rates in effect on June 30, 2023,    or the providers 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, 2023, 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, 2023, the    reimbursement rates for resource family recruitment and    retention contractors shall be established by contract.    b. For the fiscal year beginning July 1, 2023, the    reimbursement rates for supervised apartment living foster care    providers shall be established by contract.    7. For the fiscal year beginning July 1, 2023, 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   

  Senate File 561, p. 56   in-state providers, unless the director of health and human    services or the directors 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, 2023, 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, 2023, the combined    service and maintenance components of the per day reimbursement    rate paid for shelter care services shall be based on the    financial and statistical report submitted to the department.    The maximum per day reimbursement rate shall be the maximum    per day reimbursement rate in effect on June 30, 2023. The    department shall reimburse a shelter care provider at the    providers actual and allowable unit cost, plus inflation, not    to exceed the maximum reimbursement rate.    10. For the fiscal year beginning July 1, 2023, the    department shall calculate reimbursement rates for intermediate    care facilities for persons with an intellectual disability    at the 80th percentile. Beginning July 1, 2023, the rate    calculation methodology shall utilize the consumer price index    inflation factor applicable to the fiscal year beginning July    1, 2023.    11. The department may adopt emergency rules to implement    this section.    Sec. 31. EMERGENCY RULES.    1. If necessary to comply with federal requirements    including time frames, or if specifically authorized by a    provision of this division of this Act, the department of    health and human services or the mental health and disability    services commission shall 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 shall submit such rules to the administrative      rules coordinator and the administrative code editor pursuant    to section 17A.5, subsection 1. The rules shall be effective    immediately upon filing unless a later date is specified in the   

  Senate File 561, p. 57   rules. Any rules adopted in accordance with 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 health and    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 thirty calendar days prior to the date notice of the    rules is submitted to the administrative rules coordinator and    the administrative code editor.    Sec. 32. 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, 2023, shall    be submitted on or before the dates specified for submission    of the reports or information.    Sec. 33. EFFECTIVE UPON ENACTMENT. The following provision    of this division of this Act, being deemed of immediate    importance, takes effect upon enactment:    The provision relating to section 232.141 and directing    the department of health and human services to make the    determination, by June 15, 2023, 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    DEPARTMENT OF HEALTH AND HUMAN SERVICES  HUMAN RIGHTS      Sec. 34. DEPARTMENT OF HEALTH AND HUMAN SERVICES  HUMAN      RIGHTS. There is appropriated from the general fund of the    state to the department of health and human services for the    fiscal year beginning July 1, 2023, and ending June 30, 2024,    the following amounts, or so much thereof as is necessary, to    be used for the purposes designated:    1. HUMAN RIGHTS CENTRAL ADMINISTRATION      For salaries, support, maintenance, and miscellaneous   

  Senate File 561, p. 58   purposes, and for not more than the following full-time    equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 186,913    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 5.54    2. COMMUNITY ADVOCACY AND SERVICES    For salaries, support, maintenance, and miscellaneous    purposes, and for not more than the following full-time    equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 956,894    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 7.55    3. CRIMINAL AND JUVENILE JUSTICE PLANNING    a. For salaries, support, maintenance, and miscellaneous    purposes, and for not more than the following full-time    equivalent positions:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,318,547    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 9.00    b. (1) For a single grant to a program located in a city    with a higher than average juvenile crime rate as determined by    the department of health and human services and a population    greater than 80,000 as determined by the 2020 federal decennial    census, which may be used for studying, planning, programming,    and capital, that is committed to deterring juvenile    delinquency through early intervention in the criminal justice    system by providing a comprehensive, multifaceted delivery of    social services and which shall meet the guiding principles    and standards for assessment centers set forth by the national    assessment center association:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 140,000    (2) The program shall use no more than 5 percent of the    grant for administrative costs.    (3) A city shall not receive a grant under this paragraph,    or a similar grant from the state, for more than two    consecutive fiscal years unless no other city meets the    requirements specified in subparagraph (1).    c. The justice advisory board and the juvenile justice    advisory council shall coordinate their efforts in carrying out    their respective duties relative to juvenile justice.    Sec. 35. JUVENILE DETENTION HOME FUND. Moneys deposited    in the juvenile detention home fund created in section 232.142   

  Senate File 561, p. 59   during the fiscal year beginning July 1, 2023, and ending June    30, 2024, are appropriated to the department of health and    human services for the fiscal year beginning July 1, 2023, and    ending June 30, 2024, 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, 2022.    Moneys appropriated for distribution in accordance with    this section shall be allocated among eligible detention    homes, prorated on the basis of an eligible detention homes    proportion of the costs of all eligible detention homes in the    fiscal year beginning July 1, 2022. The percentage figure    shall be determined by the department of health and human    services based on the amount available for distribution for    the fund. Notwithstanding section 232.142, the financial aid    percentage of total costs payable by the state under that    provision for the fiscal year beginning July 1, 2023, shall be    limited to the amount appropriated for the purposes of this    section.    DIVISION VII    HEALTH AND HUMAN SERVICES  HEALTH CARE ACCOUNTS AND FUNDS     FY 2023-2024    Sec. 36. PHARMACEUTICAL SETTLEMENT ACCOUNT  DEPARTMENT    OF HEALTH AND HUMAN SERVICES. There is appropriated from the    pharmaceutical settlement account created in section 249A.33 to    the department of health and human services for the fiscal year    beginning July 1, 2023, and ending June 30, 2024, 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, 2023, and ending June 30, 2024:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193    Sec. 37. QUALITY ASSURANCE TRUST FUND  DEPARTMENT OF    HEALTH AND 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 health and human services   

  Senate File 561, p. 60   for the fiscal year beginning July 1, 2023, and ending June    30, 2024, 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 health and human    services for medical assistance for the same fiscal year:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205    Sec. 38. HOSPITAL HEALTH CARE ACCESS TRUST FUND     DEPARTMENT OF HEALTH AND 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 health and human services for the fiscal year beginning July    1, 2023, and ending June 30, 2024, 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 health and human    services for medical assistance for the same fiscal year:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554    Sec. 39. MEDICAL ASSISTANCE PROGRAM  NONREVERSION    FOR FY 2023-2024. Notwithstanding section 8.33 , if moneys    appropriated for purposes of the medical assistance program for    the fiscal year beginning July 1, 2023, and ending June 30,    2024, 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 VIII      DECATEGORIZATION CARRYOVER FUNDING  TRANSFER TO MEDICAID      PROGRAM    Sec. 40. DECATEGORIZATION CARRYOVER FUNDING FY 2021     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, 2020, and were   

  Senate File 561, p. 61   deemed carryover funding to remain available for the three    succeeding fiscal years that still remain unencumbered or    unobligated at the close of the fiscal year beginning July 1,    2023, shall not revert but shall be transferred to the medical    assistance program for the fiscal year beginning July 1, 2024.    DIVISION IX    HEALTH AND HUMAN SERVICES  PRIOR APPROPRIATIONS AND OTHER    PROVISIONS    FAMILY INVESTMENT PROGRAM GENERAL FUND    Sec. 41. 2022 Iowa Acts, chapter 1131, section 9, is amended    by adding the following new subsection:    NEW SUBSECTION   . 7. Notwithstanding section 8.33, moneys    appropriated in this section that remain unencumbered or    unobligated at the close of the fiscal year shall not revert    but shall remain available for the purposes designated until    the close of the succeeding fiscal year.    STATE CHILD CARE ASSISTANCE    Sec. 42. 2022 Iowa Acts, chapter 1131, section 17,    subsection 8, is amended to read as follows:    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   appropriated in 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.    CHILD AND FAMILY SERVICES    Sec. 43. 2022 Iowa Acts, chapter 1131, section 19, 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 the purposes designated until    the close of the succeeding fiscal year.    FIELD OPERATIONS      Sec. 44. 2022 Iowa Acts, chapter 1131, section 27, is    amended by adding the following new subsection:           

  Senate File 561, p. 62   NEW SUBSECTION   . 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 the purposes designated until    the close of the succeeding fiscal year.    MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM    Sec. 45. 2022 Iowa Acts, chapter 1131, section 28,    subsection 8, is amended to read as follows:    8. Of the funds appropriated under this section, $500,000    shall be used for the purposes of program administration    and provision of pregnancy support services through the    more options for maternal support program created in this    Act. Notwithstanding section 8.33, moneys allocated in this      subsection that remain unencumbered or unobligated at the close      of the fiscal year shall not revert but shall remain available    for the purposes designated until the close of the succeeding      fiscal year.    GENERAL ADMINISTRATION    Sec. 46. 2022 Iowa Acts, chapter 1131, section 28, is    amended by adding the following new subsection:    NEW SUBSECTION   . 9. Notwithstanding section 8.33, moneys    appropriated in this section that remain unencumbered or    unobligated at the close of the fiscal year shall not revert    but shall remain available for the purposes designated until    the close of the succeeding fiscal year.    QUALITY ASSURANCE TRUST FUND    Sec. 47. 2022 Iowa Acts, chapter 1131, section 36,    unnumbered paragraph 2, is amended to read as follows:    To supplement the appropriation made in this Act from the    general fund of the state to the department of health and   human    services for medical assistance for the same fiscal year:    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 56,305,139      66,282,906      Sec. 48. EFFECTIVE DATE. This division of this Act, being    deemed of immediate importance, takes effect upon enactment.    DIVISION X      HEALTH AND HUMAN SERVICES  REPORT ON NONREVERSION OF FUNDS      Sec. 49. REPORT ON NONREVERSION OF FUNDS. The department    of health and human services shall report the expenditure of             

  Senate File 561, p. 63   any moneys for which nonreversion authorization was provided    for the fiscal year beginning July 1, 2022, and ending June 30,    2023, to the general assembly on a quarterly basis beginning    October 1, 2023.    DIVISION XI    ELIMINATION OF REPEAL OF HOSPITAL HEALTH CARE ACCESS ASSESSMENT    PROGRAM    Sec. 50. REPEAL. Section 249M.5, Code 2023, is repealed.    Sec. 51. EFFECTIVE DATE. This division of this Act, being    deemed of immediate importance, takes effect upon enactment.    DIVISION XII    HEALTH AND HUMAN SERVICES  REALIGNMENT PROVISIONS    DIRECTOR OF HEALTH AND HUMAN SERVICES  INSTITUTIONS  BUYING    AND SELLING OF REAL ESTATE  FUND    Sec. 52. Section 218.94, as amended by 2023 Iowa Acts,    Senate File 514, section 411, as enacted is amended to read as    follows:    218.94 Director may buy and sell real estate  options     fund   .      1. a.   The director may secure options to purchase real    estate, to acquire and sell real estate, and to grant utility    easements, for the proper uses of the institutions. Real    estate shall be acquired and sold and utility easements    granted, upon such terms and conditions as the director may    determine. Upon sale of the real estate, the proceeds shall    be deposited with the treasurer of state and credited to the      general fund of the state in a health and human services    capital reinvestment fund created in the state treasury under    the control of the department   . There is appropriated from the    general such capital reinvestment fund of the state a sum equal    to the proceeds deposited and credited to the general   capital    reinvestment fund of the state to the department, which may be    used to purchase other real estate ,   or for capital improvements    upon property under the directors control , or for improvements      to property which is owned by the state and utilized by the      department .    b.   Notwithstanding section 8.33, moneys in the capital    reinvestment fund shall not revert at the close of a fiscal    year, and shall not be transferred, used, obligated,                             

  Senate File 561, p. 64   appropriated, or otherwise encumbered, except as provided in      this section. Notwithstanding section 12C.7, subsection 2,    interest or earnings on moneys deposited in the fund shall be      credited to the fund.      c. Any proceeds from the sale of real estate that were    credited to the general fund of the state pursuant to section      218.94, Code 2022, and that remain available on June 30, 2023,      are transferred to the capital reinvestment fund to be used for    the purposes of the fund.      2. The costs incident to securing of options, acquisition    and sale of real estate and granting of utility easements,    including but not limited to appraisals, invitations for    offers, abstracts, and other necessary costs, may be paid    from moneys appropriated for support and maintenance to the    institution at which the real estate is located . Such costs      shall be   and the source from which the moneys were appropriated    shall be reimbursed from the proceeds of the sale.    SCHOOL READY CHILDREN GRANTS ACCOUNT    Sec. 53. Section 256I.11, subsection 2, unnumbered    paragraph 1, as amended by 2023 Iowa Acts, Senate File 514,    section 1005, is amended to read as follows:    A school ready children grants account is created in the    fund under the authority of the director of the department of      education   . Moneys credited to the account are appropriated    to and shall be distributed by the department of education in    the form of grants to early childhood Iowa areas pursuant to    criteria established by the state board in accordance with law.    DIVISION XIII    ADMINISTRATOR OF CHILD AND FAMILY SERVICES CONFORMING REPEAL    Sec. 54. 2023 Iowa Acts, Senate File 514, section 1357, as    enacted, is amended to read as follows:    SEC. 1357. REPEAL. Sections 135.2 , 135.3 , 135.6 , 135.7 ,      135.8 , 135.9 , 135.10 , 216A.2 , 217.7 , 217.8,   217.9 , 217.10 ,      217.15 , 217.16 , 217.17 , 218.19 , 218.20 , 218.40 , 218.53 , 218.54 ,      222.6 , 227.19 , 231.22 , and 234.2 , Code 2023, are repealed.    DIVISION XIV      HEALTH POLICY OVERSIGHT COMMITTEE  MEDICAID PROGRAM      Sec. 55. Section 2.45, subsection 5, Code 2023, is amended      to read as follows:                      

  Senate File 561, p. 65   5. The legislative health policy oversight committee,    which shall be composed of ten members of the general    assembly, consisting of five members from each house, to    be appointed by the legislative council. The legislative    health policy oversight committee shall   may meet at least two    times,   annually , during the legislative interim to provide    continuing oversight for Medicaid managed care, and to ensure    effective and efficient administration of the program, address    stakeholder concerns, monitor program costs and expenditures,    and make recommendations.    DIVISION XV    PUBLIC ASSISTANCE PROGRAM PROVISIONS    Sec. 56. Section 234.1, subsection 6, as enacted by 2023    Iowa Acts, Senate File 514, section 669, is amended to read as    follows:    6. Supplemental nutrition assistance program or SNAP    means benefits provided by the federal program administered    through 7 C.F.R. pts. 270  280 283 , as amended.    Sec. 57. Section 239.1, subsections 2 and 3, if enacted by    2023 Iowa Acts, Senate File 494, are amended by striking the    subsections and inserting in lieu thereof the following:    2. Asset for the purposes of the asset test for the    supplemental nutrition assistance program under section 239.4    means all of the following resources countable toward the    maximum allowed household asset limit of fifteen thousand    dollars:    a. All liquid resources.    b. All other personal property excluding one vehicle and    the fair market value in excess of ten thousand dollars of an    additional vehicle.    3. Asset test for the purposes of the asset test for    the supplemental nutrition assistance program under section    239.4 means the comparison of the collective value of all    countable assets of the members of the applicants household to    the maximum allowed household asset limit of fifteen thousand      dollars.    Sec. 58. Section 239.4, subsection 1, if enacted by 2023    Iowa Acts, Senate File 494, is amended to read as follows:    1. For the purposes of determining eligibility for receipt          

  Senate File 561, p. 66   of SNAP benefits, the department shall conduct an asset test    on all members of the applicants household. The allowable    financial resources to be included in or excluded from a    determination of eligibility for SNAP shall be those specified    in 7 U.S.C. 2014(g)(1)   7 U.S.C. 2014(g) , to the extent    consistent with the term asset as defined in this chapter.    Sec. 59. Section 239.9, subsection 1, if enacted by 2023    Iowa Acts, Senate File 494, is amended to read as follows:    1. Following a review of an applicants or recipients    eligibility under this chapter, the department may refer cases    of suspected fraud along with any supportive information to    the department of inspections ,   and appeals , and licensing for    review.    Sec. 60. Section 239.10, subsection 1, if enacted by 2023    Iowa Acts, Senate File 494, is amended to read as follows:    1. The department of health and human services   shall adopt    rules pursuant to chapter 17A to administer this chapter.    Sec. 61. 2023 Iowa Acts, Senate File 494, if enacted, is    amended by adding the following new section:    NEW SECTION   . SEC. 10A. NEW SECTION . 239.11 Public    assistance modernization fund.    1. A public assistance modernization fund is created in    the state treasury under the control of the department. The    fund shall consist of moneys appropriated or transferred to, or    deposited in, the fund as provided by law.    2. The moneys in the fund shall be used and shall be    appropriated only for the purposes of modernizing information    technology systems and for other modernization initiatives    related to delivery of public assistance programs.    3. The moneys deposited in the fund are not subject to    section 8.33 and shall not be transferred, used, obligated,    appropriated, or otherwise encumbered except as provided in    this section. Notwithstanding section 12C.7, subsection 2,    interest or earnings on moneys deposited in the state capitol    maintenance fund shall be credited to the fund.    4. This section is repealed July 1, 2028.    Sec. 62. 2023 Iowa Acts, Senate File 494, section 12,    subsection 6, if enacted, is amended to read as follows:      6. The department of health and human services   may contract            

  Senate File 561, p. 67   with multiple third-party vendors to administer this Act.    Sec. 63. ONE-TIME SETTLEMENT FUNDS  DEPOSIT IN PUBLIC    ASSISTANCE MODERNIZATION FUND. For the fiscal year beginning    July 1, 2023, and ending June 30, 2024, the department of    health and human services shall deposit up to $8,000,000    received from one-time medical assistance settlement funds in    the public assistance modernization fund, if enacted in this    division of this Act.    DIVISION XVI    HOME AND COMMUNITY-BASED SERVICES WAIVER RECIPIENT RESIDENCES     SPRINKLER SYSTEMS    Sec. 64. Section 335.34, Code 2023, is amended to read as    follows:    335.34 Home and community-based services waiver recipient    residence.    1. A county, county board of supervisors, or county zoning    commission shall consider the residence of the recipient of    services under a home and community-based services waiver as    a residential use of property for the purposes of zoning and    shall treat the use of the residence as a permitted use in all    residential zones or districts, including all single-family    residential zones or districts, of the county.    2. A county, county board of supervisors, or a county zoning    commission shall not require that the recipient, or the owner    of such a residence if other than the recipient, obtain a    conditional use permit, special use permit, special exception,    or variance. A county, county board of supervisors, or county    zoning commission shall not establish limitations regarding the    proximity of one such residence to another.    3.   A county, county board of supervisors, or a county    zoning commission shall not classify such a residence as a      residential group R-3 occupancy or as a care facility within    a dwelling for the purposes of enforcement of compliance      with the sprinkler systems provisions specified in section    903.3.1.3 of the international building code or section P2904      of the international residential code, if adopted, or if such    residence is inspected by the county.      3. 4. This section applies to the residence of a recipient    of services under a home and community-based services waiver if               

  Senate File 561, p. 68   the residence meets any of the following conditions:    a. The residence is a single-family dwelling owned or rented    by the recipient.    b. The residence is a multifamily dwelling which does not    hold itself out to the public as a community-based residential    provider otherwise regulated by law, including but not limited    to a residential care facility, and which provides dwelling    units to no more than four recipients of services under a home    and community-based services waiver at any one time.    4.   5. For the purposes of this section , home and    community-based services waiver means waiver as defined in    section 249A.29 .    Sec. 65. Section 414.32, Code 2023, is amended to read as    follows:    414.32 Home and community-based services waiver recipient    residence.    1. A city, city council, or city zoning commission shall    consider the residence of the recipient of services under a    home and community-based services waiver as a residential use    of property for the purposes of zoning and shall treat the use    of the residence as a permitted use in all residential zones    or districts, including all single-family residential zones or    districts, of the city.    2. A city, city council, or city zoning commission shall    not require that the recipient, or owner of such residence if    other than the recipient, obtain a conditional use permit,    special use permit, special exception, or variance. A city,    city council, or city zoning commission shall not establish    limitations regarding the proximity of one such residence to    another.    3.   A city, city council, or city zoning commission shall not    classify such a residence as a residential group R-3 occupancy    or as a care facility within a dwelling for the purposes of      enforcement of compliance with the sprinkler systems provisions    specified in section 903.3.1.3 of the international building      code or section P2904 of the international residential code, if    adopted, or if such residence is inspected by the city.      3. 4. This section applies to the residence of a recipient    of services under a home and community-based services waiver if                

  Senate File 561, p. 69   the residence meets any of the following conditions:    a. The residence is a single-family dwelling owned or rented    by the recipient.    b. The residence is a multifamily dwelling which does not    hold itself out to the public as a community-based residential    provider otherwise regulated by law, including but not limited    to a residential care facility, and which provides dwelling    units to no more than four recipients of services under a home    and community-based services waiver at any one time.    4.   5. For the purposes of this section , home and    community-based services waiver means waiver as defined in    section 249A.29 .    Sec. 66. EFFECTIVE DATE. This division of this Act, being    deemed of immediate importance, takes effect upon enactment.    DIVISION XVII    STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM    Sec. 67. NEW SECTION   . 135.182 State-funded family medicine    obstetrics fellowship program  fund.    1. The department shall establish a state-funded family    medicine obstetrics fellowship program to increase access    to family medicine obstetrics practitioners in rural and    underserved areas of the state. A person who has completed an    accreditation council for graduate medical education residency    program in family medicine is eligible for participation    in the fellowship program. Participating fellows shall    enter into a program agreement with a participating teaching    hospital which, at a minimum, requires the fellow to complete a    one-year fellowship and to engage in full-time family medicine    obstetrics practice in a rural or underserved area of the    state for a period of at least five years within nine months    following completion of the fellowship and receipt of a license    to practice medicine in the state.    2. Each fellow participating in the program shall be    eligible for a salary and benefits including a stipend as    determined by the participating teaching hospital which shall    be funded through the family medicine obstetrics fellowship    program fund.    3. The department shall adopt rules pursuant to chapter    17A to administer the program, including defining rural and      

  Senate File 561, p. 70   underserved areas for the purpose of the required full-time    practice of a person following completion of the fellowship.    4. a. A family medicine obstetrics fellowship program    fund is created in the state treasury consisting of the moneys    appropriated or credited to the fund by law. Notwithstanding    section 8.33, moneys in the fund at the end of each fiscal year    shall not revert to any other fund but shall remain in the fund    for use in subsequent fiscal years. Moneys in the fund are    appropriated to the department to be used to fund fellowship    positions as provided in this section.    b. For the fiscal year beginning July 1, 2023, and each    fiscal year beginning July 1 thereafter, there is appropriated    from the general fund of the state for deposit in the family    medicine obstetrics fellowship program fund an amount    sufficient to support the creation of four fellowship positions    as provided in this section.    5. The department and the participating teaching hospitals    shall regularly evaluate and document their experiences    including identifying ways the program may be modified or    expanded to facilitate increased access to family medicine    obstetrics practitioners in rural and underserved areas of the    state. The department shall submit an annual report to the    general assembly by January 1. The report shall include the    number of fellowships funded to date and any other information    identified by the department and the participating teaching    hospitals as indicators of outcomes and the effectiveness of    the program.    6. For the purposes of this section, teaching hospital    means a hospital or medical center that provides medical    education to prospective and current health professionals.    DIVISION XVIII      ADOPTION SUBSIDY PROGRAM  NONRECURRING ADOPTION EXPENSES      Sec. 68. NEW SECTION   . 234.48 Adoption subsidy     nonrecurring adoption expenses.    Notwithstanding any provision to the contrary, the maximum    reimbursement provided to an adoptive parent under the    adoption subsidy program for nonrecurring adoption expenses    is one thousand dollars. For the purposes of this section,    nonrecurring adoption expenses means the same as defined in 45    

  Senate File 561, p. 71   C.F.R. 1356.41. The department shall adopt rules pursuant to    chapter 17A to administer this section.    Sec. 69. REPEAL. 2010 Iowa Acts, chapter 1031, section 408,    is repealed.    DIVISION XIX    SAFE HAVEN ACT HARMONIZATION    Sec. 70. Section 233.2, Code 2023, is amended to read as    follows:    233.2 Newborn infant custody release procedures.    1. a. A parent of a newborn infant may voluntarily release    custody of the newborn infant by   as follows:    (1) By relinquishing physical custody of the newborn    infant, without expressing an intent to again assume physical    custody, at an institutional health facility or a fire station,      to an adoption service provider, or by authorizing another    person to relinquish physical custody on the parents behalf.    If physical custody of the newborn infant is not relinquished    directly to an individual on duty at the   an institutional    health facility or a fire station   , or to an adoption service    provider, the parent may take other actions to be reasonably    sure that an the individual on duty or the adoption service    provider   is aware that the newborn infant has been left at    the institutional health facility , the fire station, or the    location of the adoption service provider   . The actions may    include but are not limited to making telephone contact with    the institutional health facility , the fire station, or the    adoption service provider, or a 911 service.    (2) By relinquishing physical custody of the newborn infant    to medical staff at a hospital or other facility following      delivery of the newborn infant in the hospital or other    facility when the parent notifies the medical staff that the      parent is voluntarily relinquishing physical custody of the    newborn infant without expressing an intent to again assume      physical custody.    (3)   By relinquishing physical custody of the newborn infant    at a hospital, a fire station, or an emergency medical care    provider location, through a newborn safety device, without      expressing an intent to again assume physical custody.    b. In lieu of the procedure described in paragraph a ,                                      

  Senate File 561, p. 72   a parent of a newborn infant may make telephone contact with    a 911 service and relinquish physical custody of the newborn    infant, without expressing an intent to again assume physical    custody, to a first responder who responds to the 911 telephone    call.    c. For the purposes of this chapter and for any judicial    proceedings associated with the newborn infant, a rebuttable    presumption arises that the person who relinquishes physical    custody at an institutional health facility or to a first      responder in accordance with this section is the newborn    infants parent or has relinquished physical custody with the    parents authorization.    2. a. Unless the parent or other person relinquishing    physical custody of a newborn infant clearly expresses an    intent to return to again assume physical custody of the    newborn infant, an   the individual on duty or the medical staff    at the institutional health facility , the emergency medical    care provider location, or the fire station at which physical    custody of the newborn infant was relinquished, the adoption      service provider to whom physical custody of the newborn infant    was relinquished, or a the first responder to whom physical    custody of the newborn infant was relinquished, pursuant    to subsection 1 shall take physical custody of the newborn    infant. The individual on duty or the medical staff, the      adoption service provider, or the first responder who takes    physical custody of the newborn infant may request the parent    or other person to provide the name of the parent or parents    and information on the medical history of the newborn infant    and the newborn infants parent or parents. However, the    parent or other person is not required to provide the names or    medical history information to comply with this section . The    individual on duty or the medical staff, the adoption service      provider,   or the first responder who takes physical custody of    the newborn infant may perform reasonable acts necessary to    protect the physical health or safety of the newborn infant.    The individual on duty and   or the medical staff, the adoption    service provider, and the first responder to whom physical      custody of the newborn infant was relinquished, and the    institutional health facility in , the emergency medical care                               

  Senate File 561, p. 73   provider location, and the fire station at   which the individual    was on duty and the first responder physical custody of the    newborn infant was relinquished   are immune from criminal or    civil liability for any acts or omissions made in good faith to    comply with this section .    b. If the physical custody of a newborn infant is    relinquished at an emergency medical care provider location or      a fire station, to an adoption service provider, or to a first    responder, the individual on duty at the emergency medical      care provider location or the fire station, the adoption    service provider, or the   first responder who responded to the    911 telephone call shall transport the newborn infant to the    nearest institutional health facility. The individual on duty    at the emergency medical care provider location or the fire      station, the adoption service provider, or the first responder    who took physical custody of the newborn infant   shall provide    any parental identification or medical history information to    the institutional health facility.    c. If the physical custody of the newborn infant is    relinquished at an institutional health facility, the state    shall reimburse the institutional health facility for the    institutional health facilitys actual expenses in providing    care to the newborn infant and in performing acts necessary to    protect the physical health or safety of the newborn infant.    The reimbursement shall be paid from moneys appropriated for    this purpose to the department of human services   .    d. If the name of the parent is unknown to the institutional    health facility, the individual on duty at the institutional    health facility   or other person designated by the institutional    health facility at which physical custody of the newborn infant    was relinquished shall submit the certificate of birth report    as required pursuant to section 144.14 . If the name of the    parent is disclosed to the institutional health facility,    the facility shall submit the certificate of birth report as    required pursuant to section 144.13 . The department of public      health shall not file the certificate of birth with the county    of birth and shall otherwise maintain the confidentiality of    the birth certificate in accordance with section 144.43 .      3. a.   As soon as possible after the individual on duty                         

  Senate File 561, p. 74   or the medical staff, the adoption service provider,   or the    first responder assumes physical custody of a newborn infant    released under subsection 1 , and, if applicable, the individual      on duty at the emergency medical care provider location      or the fire station, the adoption service provider, or the    first responder transports the newborn infant to the nearest      institutional health facility under subsection 2, paragraph      b , the individual or on duty or the medical staff shall notify    either the department or an adoption service provider and the      first responder shall notify the department of human services    and the   . The department or the adoption service provider shall    take the actions necessary to assume the care, control, and    custody of the newborn infant . The as follows:    (1)   If physical custody of the newborn infant was not    initially relinquished to an adoption service provider,    the   department shall immediately notify the juvenile court    and the county attorney of the departments action and the    circumstances surrounding the action and request an ex parte    order from the juvenile court ordering, in accordance with the    requirements of section 232.78 , subsection 9,   the department    to take custody of the newborn infant. Upon receiving the    order, the department shall take custody of the newborn    infant. After the department takes custody of the newborn      infant, notwithstanding any provision to the contrary relating      to priority placement of the child under section 232.78, the    department shall, if feasible, place the newborn infant in    a prospective adoptive home. The department shall maintain    a list of prospective adoptive homes that have completed    placement investigations and have been preapproved by the      department or a certified adoption investigator.    (2)   If physical custody of the newborn infant was initially    relinquished to an adoption service provider, the adoption    service provider shall immediately notify the juvenile court      and the county attorney of the adoption service providers      action and the circumstances surrounding the action and      request an ex parte order from the juvenile court ordering, in    accordance with the requirements of section 232.78, subsection      9, the adoption service provider to take custody of the    newborn infant. Upon receiving the order, the adoption service                                              

  Senate File 561, p. 75   provider shall take custody of the newborn infant.      b. Within twenty-four hours of the department or the    adoption service provider   taking custody of the newborn infant,    the department or the adoption service provider   shall notify    the juvenile court and the county attorney in writing of the    departments or adoption service providers   action and the    circumstances surrounding the action.    c.   Within twenty-four hours of the adoption service provider    taking custody of the newborn infant, the adoption service      provider shall notify the department in writing that the    adoption service provider has taken custody of the newborn      infant and will comply with the requirements of chapter 233.    4. a. Upon being notified in writing by the department or    the adoption service provider   under subsection 3 , the county    attorney shall file a petition alleging the newborn infant to    be a child in need of assistance in accordance with section    232.87 and a petition for termination of parental rights with    respect to the newborn infant in accordance with section    232.111, subsection 2 , paragraph a . A hearing on a child in    need of assistance petition filed pursuant to this subsection    shall be held at the earliest practicable time. A hearing on a    termination of parental rights petition filed pursuant to this    subsection shall be held no later than thirty days after the    day the physical custody of the newborn child was relinquished    in accordance with subsection 1 unless the juvenile court    continues the hearing beyond the thirty days for good cause    shown.    b. Notice of a petition filed pursuant to this subsection by      either the department or the adoption service provider   shall    be provided to any known parent and others in accordance with    the provisions of chapter 232 and shall be served upon any    putative father registered with the state registrar of vital    statistics pursuant to section 144.12A . In addition, prior to    holding a termination of parental rights hearing with respect    to the newborn infant, notice by publication shall be provided    as described in section 600A.6, subsection 5 .      5. Reasonable efforts, as defined in section 232.102 , that      are made in regard to the newborn infant shall be limited to    the efforts made in a timely manner to finalize a permanency                    

  Senate File 561, p. 76   plan for the newborn infant.    6. An   The individual on duty or the medical staff at an    institutional health facility , emergency medical care provider      location, or fire station, the adoption service provider,   or    the first responder who assumes physical custody of a newborn    infant upon the release of the newborn infant under subsection    1 shall be provided notice of any hearing held concerning    the newborn infant at the same time notice is provided to    other parties to the hearing and the individual on duty or the      medical staff, the adoption service provider, or the first    responder may provide testimony at the hearing.    Sec. 71. Section 233.6, Code 2023, is amended to read as    follows:    233.6 Educational and public information.    The department of human services, in consultation with the      Iowa department of public health   and the department of justice,    shall develop and distribute the following:    1. An information card or other publication for    distribution by an institutional health facility , an emergency      medical care provider location, a fire station, an adoption    service provider, or a first responder to a parent who releases    custody of a newborn infant in accordance with this chapter .    The publication shall inform the parent of a parents rights    under section 233.4 , explain the request for medical history    information under section 233.2, subsection 2 , and provide    other information deemed pertinent by the departments.    2. Educational materials, public information announcements,    and other resources to develop awareness of the availability    of the newborn safe haven Act and the involvement of adoption      service providers among adolescents, young parents, and others    who might avail themselves of this chapter .    3. Signage that may be used to identify the institutional    health facilities , emergency medical care provider locations,      fire stations, and adoption service provider locations at which    physical custody of a newborn infant may be relinquished in    accordance with this chapter .    Sec. 72. 2023 Iowa Acts, Senate File 514, section 656,    amending section 233.6, unnumbered paragraph 1, Code 2023, as    enacted, is amended by striking the section.                      

  Senate File 561, p. 77   Sec. 73. 2023 Iowa Acts, House File 425, section 2, amending    section 233.2, Code 2023, if enacted, is amended by striking    the section.    Sec. 74. 2023 Iowa Acts, House File 425, section 4, amending    section 233.6, Code 2023, if enacted, is amended by striking    the section.    Sec. 75. 2023 Iowa Acts, House File 474, section 8, amending    section 233.2, Code 2023, if enacted, is amended by striking    the section.    Sec. 76. 2023 Iowa Acts, House File 474, section 10,    amending section 233.6, Code 2023, if enacted, is amended by    striking the section.    ______________________________   AMY SINCLAIR   President of the Senate   ______________________________   PAT GRASSLEY   Speaker of the House   I hereby certify that this bill originated in the Senate and   is known as Senate File 561, Ninetieth General Assembly.   ______________________________   W. CHARLES SMITHSON   Secretary of the Senate   Approved _______________, 2023 ______________________________   KIM REYNOLDS   Governor