Iowa House Bill HSB342 Introduced / Bill

                    House Study Bill 342 - Introduced   HOUSE FILE _____   BY (PROPOSED COMMITTEE ON   APPROPRIATIONS BILL BY   CHAIRPERSON MOHR)   A BILL FOR   An Act relating to and making appropriations to the department 1   of veterans affairs and the department of health and human 2   services, and related provisions and appropriations, 3   including aging and disability services; behavioral health, 4   public health, community access and eligibility; the 5   medical assistance program, state supplementary assistance, 6   Hawki, and other health-related programs; reimbursement 7   rates; family well-being and protection; state-operated 8   specialty care, administration and compliance; transfers, 9   cash flows, and nonreversions; prior appropriations; the 10   beer and liquor control fund, and the behavioral health 11   fund; report on nonreversion of moneys; emergency rules; 12   autism spectrum disorder; involuntary commitment hearing 13   testimony; discharge of involuntarily committed persons; 14   medical residency and fellowships; maintenance and costs of 15   juvenile homes; and a hospital directed payment program; 16   and including effective date and retroactive applicability 17   provisions. 18   BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 19   TLSB 1004YC (14) 91   lh/ko

H.F. _____   DIVISION I 1   DEPARTMENT OF VETERANS AFFAIRS  FY 2025-2026 2   Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is 3   appropriated from the general fund of the state to the 4   department of veterans affairs for the fiscal year beginning 5   July 1, 2025, and ending June 30, 2026, the following amounts, 6   or so much thereof as is necessary, to be used for the purposes 7   designated: 8   1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 9   For salaries, support, maintenance, and miscellaneous 10   purposes, and for not more than the following full-time 11   equivalent positions: 12   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,619,205 13   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14   2. IOWA VETERANS HOME 15   For salaries, support, maintenance, and miscellaneous 16   purposes: 17   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,234,502 18   a. The Iowa veterans home billings involving the department 19   of health and human services shall be submitted to the 20   department on at least a monthly basis. 21   b. The Iowa veterans home expenditure report shall be 22   submitted monthly to the general assembly. 23   3. HOME OWNERSHIP ASSISTANCE PROGRAM 24   For transfer to the Iowa finance authority for the 25   continuation of the home ownership assistance program for 26   persons who are or were eligible members of the armed forces 27   of the United States or eligible service members pursuant to 28   section 16.54: 29   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000 30   4. VETERANS SERVICE ORGANIZATION GRANT FUND 31   Of the moneys allocated under subsection 1, $250,000 shall 32   be deposited in the veterans service organization grant fund 33   created in section 35A.23, as enacted by this division of this 34   Act.   35   -1-   LSB 1004YC (14) 91   lh/ko 1/ 47

H.F. _____   Sec. 2. NEW SECTION . 35A.23 Veterans service organization 1   grant program. 2   1. A veterans service organization grant program is 3   established under the administration and control of the 4   department to award grants to veterans service organizations 5   for the purpose of ensuring adequate staff are employed to 6   assist veterans with claims. 7   2. A veterans service organization grant fund is created 8   within the state treasury under the control of the department. 9   The fund shall consist of moneys appropriated to the fund by 10   the general assembly and any other moneys available to and 11   obtained or accepted by the department for deposit in the fund. 12   All moneys in the fund are appropriated to the department for 13   purposes of administering the program and providing grants 14   under the program. Notwithstanding section 8.33, moneys in 15   the fund that remain unencumbered or unobligated at the close 16   of a fiscal year shall not revert but shall remain available 17   for expenditure for the purposes designated. Notwithstanding 18   section 12C.7, subsection 2, interest or earnings on moneys in 19   the fund shall be credited to the fund. 20   3. a. In administering the program, the department shall 21   award matching funds to veterans service organizations for the 22   purpose of employing staff to assist veterans with claims. 23   b. To receive a grant, a veterans service organization shall 24   demonstrate that moneys have been budgeted and will be expended 25   by the veterans service organization in the amount required to 26   provide matching funds for each staff position for which grant 27   moneys are sought. 28   c. For purposes of this section, veterans service 29   organization means an organization recognized by the United 30   States department of veterans affairs pursuant to 38 C.F.R. 31   14.628(c). 32   4. The department shall adopt rules pursuant to chapter 17A 33   as necessary to implement and administer the program. 34   DIVISION II   35   -2-   LSB 1004YC (14) 91   lh/ko 2/ 47

H.F. _____   AGING AND DISABILITY SERVICES  FY 2025-2026 1   Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES  AGING 2   AND DISABILITY SERVICES. There is appropriated from the 3   general fund of the state to the department of health and human 4   services for the fiscal year beginning July 1, 2025, and ending 5   June 30, 2026, the following amount, or so much thereof as is 6   necessary, to be used for the purposes designated: 7   For aging programs for the department of health and human 8   services and area agencies on aging to provide citizens of 9   Iowa who are 60 years of age and older with case management; 10   for Iowas aging and disabilities resource centers; for the 11   return to community program; for the purposes of chapter 231E; 12   to administer the prevention of elder abuse, neglect, and 13   exploitation program pursuant to section 231.56A, in accordance 14   with the requirements of the federal Older Americans Act of 15   1965, 42 U.S.C. 3001 et seq., as amended; for the operation 16   of the dependent adult abuse services program pursuant to 17   chapter 235B; for other services which may include but are not 18   limited to adult day care, respite care, chore, information 19   and assistance, and material aid; for information and options 20   counseling for persons with disabilities; and for salaries, 21   support, administration, maintenance, and miscellaneous 22   purposes, and for not more than the following full-time 23   equivalent positions: 24   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,208,822 25   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 88.00 26   1. Moneys appropriated in this section may be used to 27   supplement federal moneys received under federal regulations. 28   To receive moneys appropriated in this section, a local area 29   agency on aging shall match the moneys with moneys from other 30   sources according to rules adopted by the department. Moneys 31   appropriated in this section may be used for services not 32   specifically enumerated in this section only if approved by the 33   department as part of an area agency on agings area plan. 34   2. Of the moneys appropriated in this section, $949,282 35   -3-   LSB 1004YC (14) 91   lh/ko 3/ 47

H.F. _____   shall be used for the family support center component of the 1   comprehensive family support program under section 225C.47. 2   3. Of the moneys appropriated in this section, $33,632 shall 3   be used to build community capacity through the coordination 4   and provision of training opportunities in accordance with the 5   consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 6   Iowa, July 15, 1994). 7   4. Of the moneys appropriated in this section, $100,000 8   shall be used by the department of health and human services 9   for a dementia services coordinator position. The duties of 10   the dementia services coordinator shall include but are not 11   limited to all of the following: 12   a. Coordinating state-funded and privately funded dementia 13   services within the state. 14   b. Coordinating the implementation of the Alzheimers 15   disease and related dementias state plan. 16   c. Assessing and analyzing dementia-related data collected 17   by the state. 18   d. Evaluating state-funded dementia services. 19   e. Identifying and supporting the development of 20   dementia-specific trainings. 21   f. Performing other duties as may be required to ensure the 22   state is addressing Alzheimers and related dementias. 23   DIVISION III 24   BEHAVIORAL HEALTH  FY 2025-2026 25   Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES  26   BEHAVIORAL HEALTH. There is appropriated from the general fund 27   of the state to the department of health and human services for 28   the fiscal year beginning July 1, 2025, and ending June 30, 29   2026, the following amount, or so much thereof as is necessary, 30   to be used for the purposes designated: 31   For behavioral health prevention, treatment, and recovery 32   efforts to reduce the prevalence of the use of, provide 33   treatment for, and support recovery from alcohol, tobacco, and 34   substance use and misuse, problem gambling, and other addictive 35   -4-   LSB 1004YC (14) 91   lh/ko 4/ 47

H.F. _____   behaviors. Activities shall align with accepted best practice 1   guidance standards for behavioral health including those 2   published by the centers for disease control and prevention of 3   the United States department of health and human services, and 4   the substance abuse and mental health services administration 5   of the United States department of health and human services, 6   for health promotion; universal, selective, and indicated 7   prevention; treatment; and recovery services and supports; and 8   shall include a 24-hour helpline, public information resources, 9   professional training, youth prevention, program evaluation, 10   and efforts at the state and local levels, and for not more 11   than the following full-time equivalent positions: 12   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,400,114 13   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 71.00 14   1. Of the moneys appropriated in this section, $300,000 15   shall be used to support the work of the childrens behavioral 16   health system including evidence-based behavioral health 17   prevention, treatment, and recovery services and supports for 18   children and their families pursuant to the intent specified in 19   section 225C.6B, subsection 1. 20   2. Of the moneys appropriated in this section, $950,000 21   shall be used for an integrated substance use disorder managed 22   care system. The department shall maintain the level of mental 23   health and substance use disorder treatment services provided 24   by the managed care contractors, and shall take the steps 25   necessary to continue the federal waivers as needed to maintain 26   the level of services.   27   Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES  SPORTS   28   WAGERING RECEIPTS FUND. There is appropriated from the 29   sports wagering receipts fund created in section 8.57I, to the 30   department of health and human services for the fiscal year 31   beginning July 1, 2025, and ending June 30, 2026, the following 32   amount, or so much thereof as is necessary, to be used for 33   behavioral health prevention, treatment, and recovery efforts 34   to reduce the prevalence of the use of, provide treatment for, 35   -5-   LSB 1004YC (14) 91   lh/ko 5/ 47

H.F. _____   and support recovery from alcohol, tobacco, and substance use 1   and misuse, problem gambling, and other addictive behaviors: 2   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 3   DIVISION IV 4   PUBLIC HEALTH  FY 2025-2026 5   Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES  PUBLIC 6   HEALTH. There is appropriated from the general fund of the 7   state to the department of health and human services for the 8   fiscal year beginning July 1, 2025, and ending June 30, 2026, 9   the following amount, or so much thereof as is necessary, to be 10   used for the purposes designated: 11   For programs that support health promotion, protect the 12   health and safety of the public, conduct disease surveillance 13   and investigation to reduce the incidence of morbidity and 14   mortality, serve individuals with chronic conditions including 15   but not limited to cancer, support the Iowa donor registry as 16   specified in section 142C.18, and strengthen the health care 17   delivery system and workforce to improve health outcomes for 18   all Iowans, and for not more than the following full-time 19   equivalent positions: 20   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 21,037,821 21   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 286.00 22   1. Of the moneys appropriated in this section, the following 23   amounts are allocated to the department of health and human 24   services to be used as follows to support the goals of 25   increased access, health system integration, and engagement: 26   a. $600,000 for distribution to a nonprofit organization 27   that established the first statewide drug donation repository 28   for continuation of the pharmaceutical infrastructure for 29   safety net providers established as described in 2007 Iowa 30   Acts, chapter 218, section 108, and for the prescription drug 31   donation repository program established in chapter 135M. 32   Moneys under this paragraph shall be distributed in their 33   entirety on July 1, 2025, for the purpose specified. 34   b. $374,000 for distribution to free clinics, as defined in 35   -6-   LSB 1004YC (14) 91   lh/ko 6/ 47

H.F. _____   section 135.24, and a nonprofit organization that facilitates 1   the initiation, operation, and collaboration of free clinics 2   for necessary infrastructure, statewide coordination, provider 3   recruitment, service delivery, e-prescribing capacity, and 4   provision of assistance to patients in securing a medical home. 5   Moneys under this paragraph shall be distributed in their 6   entirety on July 1, 2025, for the purpose specified. 7   c. $25,000 for distribution to an organization that raises 8   awareness about issues related to rural health clinics, and 9   necessary infrastructure and service delivery transformation. 10   Moneys under this paragraph shall be distributed in their 11   entirety on July 1, 2025, for the purpose specified. 12   d. $225,000 for distribution to an organization that is 13   the oldest continuously operating medical society in the state 14   for continuation of safety net provider patients access to 15   specialty care as described in 2007 Iowa Acts, chapter 218, 16   section 109. Moneys under this paragraph shall be distributed 17   in their entirety on July 1, 2025, for the purpose specified. 18   2. Of the moneys appropriated in this section, $600,000 19   shall be used for rural psychiatric residencies for residents 20   selected on or before June 30, 2025. 21   3. The university of Iowa hospitals and clinics under 22   the control of the state board of regents shall not receive 23   indirect costs from the moneys appropriated in this section. 24   The university of Iowa hospitals and clinics billings to the 25   department shall be, at a minimum, on a quarterly basis. 26   4. Of the moneys appropriated in this section, $20,000 shall 27   be used to make radon test kits available, free of charge, to 28   homeowners and renters in the state. The department shall 29   provide a link on the departments internet site for homeowners 30   and renters in the state to order radon test kits.   31   5. Of the moneys appropriated in this section, $1,000,000 32   shall be used to provide grants to support the double up 33   food bucks program administered by the Iowa healthiest state 34   initiative to make fresh fruits and vegetables sold at farmers 35   -7-   LSB 1004YC (14) 91   lh/ko 7/ 47

H.F. _____   markets, grocery stores, and other participating locations 1   accessible to individuals and families who reside in this 2   state and receive assistance through the federal supplemental 3   nutrition assistance program. 4   DIVISION V 5   COMMUNITY ACCESS AND ELIGIBILITY  FY 2025-2026 6   Sec. 7. DEPARTMENT OF HEALTH AND HUMAN SERVICES  COMMUNITY 7   ACCESS AND ELIGIBILITY. There is appropriated from the 8   general fund of the state to the department of health and human 9   services for the fiscal year beginning July 1, 2025, and ending 10   June 30, 2026, the following amount, or so much thereof as is 11   necessary, to be used for the purposes designated: 12   To be used for salaries, support, maintenance, and 13   miscellaneous purposes and for family investment program (FIP) 14   assistance in accordance with chapter 239B, and for other costs 15   associated with providing needs-based benefits or assistance 16   including but not limited to maternal and child health, oral 17   health, obesity prevention, the promotion of independence 18   and self-sufficiency through employment, job opportunities 19   and the basic skills (PROMISE JOBS) program, supplemental 20   nutrition assistance program (SNAP) employment and training, 21   the FIP diversion program, family planning, rent reimbursement, 22   and eligibility determinations for medical assistance, food 23   assistance, and the childrens health insurance program, and 24   for not more than the following full-time equivalent positions: 25   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,043,944 26   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 948.00   27   1. Of the child support collections assigned under FIP, 28   the federal share of the child support collections shall be 29   credited to the child support services appropriation made in 30   this division of this Act. Of the remainder of the child   31   support collections assigned under FIP, a portion shall be 32   credited to community access and eligibility, and the remaining 33   moneys may be used to increase recoveries, to sustain cash flow 34   in the collection services center refund account as provided in 35   -8-   LSB 1004YC (14) 91   lh/ko 8/ 47

H.F. _____   section 252B.13A, or for technology needs. If child support 1   collections assigned under FIP are greater than estimated or 2   are otherwise determined not to be required for maintenance of 3   efforts, the state share of either amount is appropriated to 4   the department for child support services as described in this 5   Act, or may be transferred to or retained in the collection 6   services center refund account. 7   2. Of the moneys appropriated in this section, $3,075,000 8   shall be used for continuation of the departments initiative 9   to provide for adequate developmental surveillance and 10   screening during a childs first five years. The moneys shall 11   be used first to fully fund the current participating counties 12   to ensure that those counties are fully operational, with 13   the remaining moneys to be used for expanding participation 14   to additional counties. Full implementation and expansion 15   shall include enhancing the scope of the initiative through 16   collaboration with child health specialty clinics to promote 17   the use of developmental surveillance and screening to 18   support healthy child development through early identification 19   and response to both biomedical and social determinants of 20   healthy development by providing practitioner consultation 21   and continuous improvement through training and education, 22   particularly for children with behavioral conditions and 23   needs. The department shall also collaborate with the Medicaid 24   program and child health specialty clinics to assist in 25   coordinating the activities of the first five initiative into 26   the establishment of patient-centered medical homes developed 27   to improve health quality and population health while reducing 28   health care costs. To the maximum extent possible, moneys 29   allocated in this subsection shall be utilized as matching 30   moneys for Medicaid program reimbursement. 31   3. Of the moneys appropriated in this section, $1,145,102 32   is allocated to the Iowa commission on volunteer service for 33   programs and grants. 34   4. The university of Iowa hospitals and clinics under 35   -9-   LSB 1004YC (14) 91   lh/ko 9/ 47

H.F. _____   the control of the state board of regents shall not receive 1   indirect costs from the moneys appropriated in this section. 2   The university of Iowa hospitals and clinics billings to the 3   department shall be, at a minimum, on a quarterly basis. 4   CHILD SUPPORT SERVICES 5   Sec. 8. CHILD SUPPORT SERVICES. There is appropriated from 6   the general fund of the state to the department of health and 7   human services for the fiscal year beginning July 1, 2025, and 8   ending June 30, 2026, the following amount, or so much thereof 9   as is necessary, to be used for the purposes designated: 10   For child support services, including salaries, support, 11   maintenance, and miscellaneous purposes, and for not more than 12   the following full-time equivalent positions: 13   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,434,282 14   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 464.00 15   1. Federal access and visitation grant moneys shall be used 16   for services designed to increase compliance with the child 17   access provisions of court orders, including but not limited to 18   neutral visitation sites and mediation services. 19   2. The appropriation made to the department for child 20   support services may be used throughout the fiscal year in the 21   manner necessary for purposes of cash flow management, and for 22   cash flow management purposes the department may temporarily 23   draw more than the amount appropriated provided the amount 24   appropriated is not exceeded at the close of the fiscal year. 25   TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT 26   Sec. 9. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK   27   GRANT. There is appropriated from the special fund created in 28   section 8.41 to the department of health and human services 29   for the fiscal year beginning July 1, 2025, and ending June 30   30, 2026, from moneys received under the federal temporary 31   assistance for needy families (TANF) block grant pursuant 32   to the federal Personal Responsibility and Work Opportunity 33   Reconciliation Act of 1996, Pub. L. No. 104-193, and successor 34   legislation, the following amounts, or so much thereof as is 35   -10-   LSB 1004YC (14) 91   lh/ko 10/ 47

H.F. _____   necessary, to be used for the purposes designated: 1   1. For community access and eligibility, FIP, the PROMISE 2   JOBS program, implementing family investment agreements in 3   accordance with chapter 239B, and for continuation of the 4   program promoting awareness of the benefits of a healthy 5   marriage: 6   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627 7   2. For community access and eligibility to provide 8   pregnancy prevention grants on the condition that family 9   planning services are funded: 10   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203 11   Pregnancy prevention grants shall be awarded to programs 12   in existence on or before July 1, 2025, if the programs have 13   demonstrated positive outcomes. Grants shall be awarded 14   to pregnancy prevention programs developed after July 1, 15   2025, if the programs are based on existing models that have 16   demonstrated positive outcomes. Grants shall comply with the 17   requirements provided in 1997 Iowa Acts, chapter 208, section 18   14, subsections 1 and 2, including the requirement that a 19   program awarded a grant must emphasize sexual abstinence. 20   Priority in the awarding of grants shall be given to programs 21   that serve areas of the state which demonstrate the highest 22   percentage of unplanned pregnancies of females of childbearing 23   age within the geographic area to be served by the grant. 24   3. For community access and eligibility to meet one of 25   the four purposes of TANF as specified in 45 C.F.R. 260.20, 26   including by modernizing the program to promote economic 27   mobility and self-sufficiency, ensuring that families are able 28   to overcome benefit cliffs, encouraging healthy families, and 29   streamlining service delivery to reduce duplication: 30   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 31   4. For technology needs related to child support 32   modernization of the Iowa collections and reporting (ICAR) 33   system and for a closed loop referral system for the thrive 34   Iowa program: 35   -11-   LSB 1004YC (14) 91   lh/ko 11/ 47

H.F. _____   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000 1   5. For early intervention and supports for the family 2   development and self-sufficiency (FaDSS) grant program in 3   accordance with section 216A.107: 4   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,888,980 5   Of the moneys allocated for the FaDSS grant program in this 6   subsection, not more than 5 percent of the moneys shall be used 7   for administrative purposes. 8   6. For early intervention and supports for child abuse 9   prevention grants: 10   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 125,000 11   7. For accountability, compliance, program integrity, 12   technology needs, and other resources necessary to meet 13   federal and state reporting, tracking, and case management 14   requirements, and other departmental needs: 15   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647 16   8. For state child care assistance: 17   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826 18   9. For child protective services: 19   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 62,364,100 20   10. For child protective services for the kinship caregiver 21   payment program: 22   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,000,000 23   DIVISION VI 24   MEDICAL ASSISTANCE PROGRAM  STATE SUPPLEMENTARY ASSISTANCE  25   HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 26   PROGRAMS  FY 2025-2026   27   Sec. 10. MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY 28   ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There   29   is appropriated from the general fund of the state to the 30   department of health and human services for the fiscal year 31   beginning July 1, 2025, and ending June 30, 2026, the following 32   amount, or so much thereof as is necessary, to be used for the 33   purposes designated: 34   For medical assistance program reimbursement and associated 35   -12-   LSB 1004YC (14) 91   lh/ko 12/ 47

H.F. _____   costs as specifically provided in the reimbursement 1   methodologies in effect on June 30, 2025, except as otherwise 2   expressly authorized by law, consistent with federal law and 3   regulations, and contingent upon receipt of approval from the 4   office of the governor of reimbursement for each abortion 5   performed under the medical assistance program; for the state 6   supplementary assistance program; for the health insurance 7   premium payment program; and for maintenance of the healthy and 8   well kids in Iowa (Hawki) program pursuant to chapter 514I, 9   including supplemental dental services, for receipt of federal 10   financial participation under Tit. XXI of the federal Social 11   Security Act, which creates the childrens health insurance 12   program; and for other specified health-related programs: 13   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,899,238,628 14   1. Of the moneys appropriated in this section, 15   $1,833,843,866 is allocated for medical assistance program 16   reimbursement and associated costs. 17   a. Of the moneys allocated in this subsection, $794,859 18   shall be used for the renovation and construction of certain 19   nursing facilities, consistent with chapter 249K. 20   b. Of the moneys allocated in this subsection, $3,383,880 21   shall be used for program administration, outreach, and 22   enrollment activities of the state family planning services 23   program pursuant to section 217.41B, and of this amount, the 24   department may use $200,000 for administrative expenses. 25   2. Iowans support reducing the number of abortions 26   performed in our state. Moneys appropriated under this section 27   shall not be used for abortions, unless otherwise authorized   28   under this section.   29   3. The provisions of this section relating to abortions 30   shall also apply to the Iowa health and wellness plan created 31   pursuant to chapter 249N. 32   4. Of the moneys appropriated in this section, $4,479,762 is 33   allocated for the state supplementary assistance program. 34   5. Of the moneys appropriated in this section, $61,275,000 35   -13-   LSB 1004YC (14) 91   lh/ko 13/ 47

H.F. _____   is allocated for maintenance of the Hawki program pursuant 1   to chapter 514I, including supplemental dental services, for 2   receipt of federal financial participation under Tit. XXI of 3   the federal Social Security Act, which creates the childrens 4   health insurance program. 5   HEALTH PROGRAM OPERATIONS 6   Sec. 11. HEALTH PROGRAM OPERATIONS. There is appropriated 7   from the general fund of the state to the department of health 8   and human services for the fiscal year beginning July 1, 9   2025, and ending June 30, 2026, the following amount, or so 10   much thereof as is necessary, to be used for the purposes 11   designated: 12   For health program operations, and the autism support 13   program under section 225D.2, and for not more than the 14   following full-time equivalent positions: 15   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,652,231 16   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 82.00 17   1. The department of inspections, appeals, and licensing 18   shall provide all state matching moneys for survey and 19   certification activities performed by the department of 20   inspections, appeals, and licensing. The department of health 21   and human services shall be solely responsible for distributing 22   the federal matching moneys for such activities. 23   2. Of the moneys appropriated in this section, a sufficient 24   amount shall be allocated for the administration of the health 25   insurance premium payment program, including salaries, support, 26   maintenance, and miscellaneous purposes. 27   3. Of the moneys appropriated in this section, $750,000 28   shall be allocated for a nonprofit organization that provides 29   access to emergency poison information and treatment. Pursuant 30   to the directive under 2014 Iowa Acts, chapter 1140, section 31   102, the federal matching moneys available to the nonprofit 32   organization from the department under the federal Childrens 33   Health Insurance Program Reauthorization Act of 2009 shall be 34   subject to the federal administrative cap rule of 10 percent 35   -14-   LSB 1004YC (14) 91   lh/ko 14/ 47

H.F. _____   applicable to moneys provided under Tit. XXI of the federal 1   Social Security Act and shall be included in the departments 2   calculations of the cap. 3   4. Of the moneys appropriated in this section, $55,000 4   shall be allocated to expand enrollment in the ground emergency 5   medical transportation program pursuant to section 249A.5, if 6   enacted by 2025 Iowa Acts, House File 977. 7   5. Unless otherwise provided by law, if a contract for 8   services provided under this section initially entered into 9   during the fiscal year beginning July 1, 2025, and ending 10   June 30, 2026, provides for an annual increase of the cost of 11   services provided under the contract, the annual increase shall 12   not exceed the amount by which the consumer price index for 13   all urban consumers increased during the immediately preceding 14   calendar year. This subsection shall not affect a contract 15   entered into on or before June 30, 2025, that is for a term of 16   more than one year. 17   HEALTH CARE ACCOUNTS AND FUNDS 18   Sec. 12. PHARMACEUTICAL SETTLEMENT ACCOUNT  DEPARTMENT 19   OF HEALTH AND HUMAN SERVICES. There is appropriated from the 20   pharmaceutical settlement account created in section 249A.33 to 21   the department of health and human services for the fiscal year 22   beginning July 1, 2025, and ending June 30, 2026, the following 23   amount, or so much thereof as is necessary, to be used for the 24   purposes designated: 25   Notwithstanding any provision of law to the contrary, to 26   supplement the appropriation made in this Act from the general 27   fund of the state for health program operations under the 28   medical assistance program for the same fiscal year: 29   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 30   Sec. 13. QUALITY ASSURANCE TRUST FUND  DEPARTMENT OF 31   HEALTH AND HUMAN SERVICES. Notwithstanding any provision of 32   law to the contrary, and subject to the availability of moneys, 33   there is appropriated from the quality assurance trust fund 34   created in section 249L.4 to the department of health and human 35   -15-   LSB 1004YC (14) 91   lh/ko 15/ 47

H.F. _____   services for the fiscal year beginning July 1, 2025, and ending 1   June 30, 2026, the following amount, or so much thereof as is 2   necessary, for the purposes designated: 3   To supplement the appropriation made in this Act from the 4   general fund of the state to the department of health and human 5   services for medical assistance for the same fiscal year: 6   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 7   Sec. 14. HOSPITAL HEALTH CARE ACCESS TRUST FUND  8   DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding 9   any provision of law to the contrary, and subject to the 10   availability of moneys, there is appropriated from the hospital 11   health care access trust fund created in section 249M.4 to the 12   department of health and human services for the fiscal year 13   beginning July 1, 2025, and ending June 30, 2026, the following 14   amount, or so much thereof as is necessary, for the purposes 15   designated: 16   To supplement the appropriation made in this Act from the 17   general fund of the state to the department of health and human 18   services for medical assistance for the same fiscal year: 19   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 20   NURSING FACILITIES  MEDICAID REIMBURSEMENT METHODOLOGY 21   PROPOSAL 22   Sec. 15. NURSING FACILITIES  MEDICAID REIMBURSEMENT 23   METHODOLOGY PROPOSAL. 24   1. By April 1, 2026, the department of health and human 25   services shall develop a reimbursement methodology proposal for 26   reimbursement of nursing facilities under the Medicaid program 27   that includes all of the following: 28   a. A base-rate payment component. 29   b. A quality assurance assessment pass-through component. 30   c. A quality assurance add-on component, which includes a 31   fixed fee payment and a quality-based payment. 32   2. The reimbursement methodology proposal shall include 33   recommendations developed by the department of health and human 34   services, in consultation with stakeholders including the Iowa 35   -16-   LSB 1004YC (14) 91   lh/ko 16/ 47

H.F. _____   health care association and leadingage Iowa, for specific 1   metrics the department of health and human services will use 2   to determine whether a nursing facility is eligible to receive 3   all or a portion of the quality-based payment portion of the 4   reimbursement to the nursing facility. 5   3. The total state expenditures for reimbursement of 6   nursing facilities under the Medicaid program using the 7   reimbursement methodology proposed in this section shall 8   not exceed the amount appropriated for this purpose for the 9   applicable fiscal year. 10   NURSING FACILITY BED FORECASTING FORMULA 11   Sec. 16. NURSING FACILITY BED FORECASTING FORMULA  WORK 12   GROUP. 13   1. The department of health and human services shall 14   establish a work group to make recommendations for a 15   forecasting formula to ensure a sufficient number of nursing 16   facility beds are available to meet the future demand for 17   nursing facility beds. 18   2. The work group shall include all of the following 19   members: 20   a. The director of health and human services, or the 21   directors designee. 22   b. The director of the department of inspections, appeals, 23   and licensing, or the directors designee. 24   c. Multiple representatives of nursing facilities located 25   in this state. 26   d. A representative from each managed care organization 27   acting pursuant to a contract with the department of health and 28   human services to administer the medical assistance program 29   under chapter 249A. 30   e. A representative of appropriate stakeholders as 31   determined by the director of health and human services. 32   3. On or before July 1, 2026, the department of health and 33   human services shall use the recommendations from the work   34   group to develop and implement a forecasting formula to ensure 35   -17-   LSB 1004YC (14) 91   lh/ko 17/ 47

H.F. _____   a sufficient number of nursing facility beds are available to 1   meet the future demand for nursing facility beds. 2   4. The department of health and human services shall 3   consider the forecasting formula developed and implemented 4   under subsection 3 to complete the formal review of an 5   application for a certificate of need under section 10A.719. 6   PERSONAL NEEDS ALLOWANCE 7   Sec. 17. PERSONAL NEEDS ALLOWANCE. Of the moneys 8   appropriated for the medical assistance program reimbursement 9   and associated costs as specifically provided in the 10   reimbursement methodologies in effect on June 30, 2025, 11   $991,540 shall be allocated to provide for the increased 12   monthly personal needs allowance under section 249A.30A. 13   Sec. 18. Section 249A.30A, Code 2025, is amended to read as 14   follows: 15   249A.30A Medical assistance  personal needs allowance. 16   1. The personal needs allowance under the medical 17   assistance program, which may be retained by a person who is a 18   resident of a nursing facility, an intermediate care facility 19   for persons with an intellectual disability, or an intermediate 20   care facility for persons with mental illness, as defined in 21   section 135C.1 , or a person who is a resident of a psychiatric 22   medical institution for children as defined in section 135H.1 , 23   shall be fifty   sixty-five dollars per month. 24   2. A resident who has income of less than fifty sixty-five 25   dollars per month shall receive a supplement from the state in 26   the amount necessary to receive a personal needs allowance of 27   fifty dollars per month. The general assembly shall annually 28   appropriate a sufficient amount from the general fund of the 29   state to the department of health and human services for this 30   purpose. 31   DIVISION VII   32   REIMBURSEMENT RATES   33   Sec. 19. REIMBURSEMENT METHODOLOGY. Reimbursement for   34   medical assistance, state supplementary assistance, and social 35   -18-   LSB 1004YC (14) 91   lh/ko 18/ 47

H.F. _____   service providers and services reimbursed under the purview of 1   the department of health and human services shall remain at the 2   current reimbursement rate, or shall be determined pursuant to 3   the reimbursement methodology in effect on June 30, 2025, with 4   the exception of the following: 5   1. If reimbursement is otherwise negotiated by contract or 6   pursuant to an updated fee schedule. 7   2. As otherwise provided in this division of this Act. 8   Sec. 20. REIMBURSEMENT RATES  MEDICAL ASSISTANCE PROGRAM, 9   STATE SUPPLEMENTARY ASSISTANCE, HEALTHY AND WELL KIDS IN 10   IOWA, AND OTHER HEALTH-RELATED PROGRAMS. Of the moneys 11   appropriated for medical assistance program reimbursement and 12   associated costs as specifically provided in the reimbursement 13   methodologies June 30, 2025, the following amounts, or so 14   much thereof as is necessary, are allocated to the department 15   of health and human services to be used for the following 16   purposes: 17   1. a. Notwithstanding any provision of law to the contrary, 18   for the fiscal year beginning July 1, 2025, and ending June 19   30, 2026, the department of health and human services shall 20   rebase case-mix nursing facility rates beginning July 1, 2025, 21   using the Medicaid cost reports on file for the period ending 22   December 31, 2024, to the extent possible within state funding, 23   including no more than $25,000,000 from the allocation provided 24   for medical assistance program reimbursement and associated 25   costs. 26   b. The department of health and human services shall 27   calculate each nursing facilitys case-mix index for the period 28   beginning July 1, 2024, using weighting based on the current 29   patient-driven payment model schedule. Rosters shall be 30   made to show a separate calculation to determine the average 31   case-mix index for a nursing-facility-wide case-mix index, and 32   a case-mix index for the residents of a nursing facility who 33   are Medicaid recipients using all minimum data set reports by 34   the nursing facility for the previous semiannual period using a 35   -19-   LSB 1004YC (14) 91   lh/ko 19/ 47

H.F. _____   day weighted calculation. 1   2. For the fiscal year beginning July 1, 2025, Medicaid 2   provider and service rates shall be adjusted to 85 percent of 3   the benchmark rates based on the departments 2024 Medicaid 4   rate review for dentists, excluding orthodontic services. 5   3. For the fiscal year beginning July 1, 2025, $420,000 6   shall be used to increase to the extent possible reimbursement 7   rates for maternal health providers compared to the rates in 8   effect on June 30, 2025. 9   4. For the fiscal year beginning July 1, 2025, the pharmacy 10   dispensing fee shall be adjusted to $11.10. The change 11   in dispensing fee shall become effective following federal 12   approval of the Medicaid state plan. 13   5. a. For the fiscal year beginning July 1, 2025, 14   reimbursement rates for home health agencies shall continue to 15   be based on the Medicare low utilization payment adjustment 16   (LUPA) methodology with state geographic wage adjustments, and 17   shall be adjusted to increase the rates to the extent possible. 18   b. For the fiscal year beginning July 1, 2026, and for 19   each fiscal year thereafter, the department shall review the 20   reimbursement rates for home health agencies and pharmacy 21   dispensing fees. 22   6. On or before December 15, 2025, the department shall 23   review the current rate limit calculation and application for 24   special population nursing facility rates. 25   Sec. 21. REIMBURSEMENT RATES  CHILD PROTECTIVE 26   SERVICES. Of the moneys appropriated for child, family, and 27   adoption services, the following amounts, or so much thereof 28   as is necessary, are allocated to the department of health and 29   human services for the following purposes: 30   1. For the fiscal year beginning July 1, 2025, $3,245,594 31   shall be used to increase to the extent possible reimbursement 32   rates for qualified residential treatment program providers 33   compared to rates in effect June 30, 2025. 34   2. For the fiscal year beginning July 1, 2025, $1,590,842 35   -20-   LSB 1004YC (14) 91   lh/ko 20/ 47

H.F. _____   shall be used to increase to the extent possible reimbursement 1   rates for shelter care providers compared to rates in effect 2   June 30, 2025. 3   DIVISION VIII 4   FAMILY WELL-BEING AND PROTECTION  FY 2025-2026 5   STATE CHILD CARE ASSISTANCE 6   Sec. 22. STATE CHILD CARE ASSISTANCE. There is appropriated 7   from the general fund of the state to the department of health 8   and human services for the fiscal year beginning July 1, 9   2025, and ending June 30, 2026, the following amount, or so 10   much thereof as is necessary, to be used for the purposes 11   designated: 12   For state child care assistance in accordance with sections 13   237A.13 and 237A.14, and for not more than the following 14   full-time equivalent positions: 15   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34,966,931 16   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 38.00 17   1. If the appropriation made for purposes of the state child 18   care assistance program for the fiscal year is determined to 19   be insufficient, it is the intent of the general assembly to 20   appropriate sufficient moneys for the fiscal year to avoid 21   application of waiting list requirements. 22   2. A portion of the state match for the federal child care 23   and development block grant shall be provided as necessary to 24   meet federal matching moneys requirements through the state 25   general fund appropriation made for child development grants 26   and other programs for at-risk children in section 279.51. 27   EARLY INTERVENTION AND SUPPORTS   28   Sec. 23. EARLY INTERVENTION AND SUPPORTS. There is   29   appropriated from the general fund of the state to the 30   department of health and human services for the fiscal year 31   beginning July 1, 2025, and ending June 30, 2026, the following 32   amount, or so much thereof as is necessary, to be used for the 33   purposes designated: 34   For promoting optimum health status for children and 35   -21-   LSB 1004YC (14) 91   lh/ko 21/ 47

H.F. _____   adolescents from birth through 21 years of age, and for 1   families, and for not more than the following full-time 2   equivalent positions: 3   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 36,277,739 4   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 25.00 5   1. Of the moneys appropriated in this section, not more 6   than $734,000 shall be used for the healthy opportunities for 7   parents to experience success (HOPES)-healthy families Iowa 8   (HFI) program established pursuant to section 135.106. 9   2. Of the moneys appropriated in this section, $4,313,854 10   is allocated for the FaDSS grant program, and not more than 5 11   percent of the moneys shall be used for administration of the 12   grant program. 13   3. Of the moneys appropriated in this section, $29,256,799 14   shall be deposited in the early childhood Iowa fund created in 15   section 256I.11. 16   4. Of the moneys appropriated in this section, $1,000,000 17   shall be used for the purposes of program administration and 18   provision of pregnancy support services through the more 19   options for maternal support program in accordance with section 20   217.41C. 21   CHILD PROTECTIVE SERVICES 22   Sec. 24. CHILD PROTECTIVE SERVICES. There is appropriated 23   from the general fund of the state to the department of health 24   and human services for the fiscal year beginning July 1, 25   2025, and ending June 30, 2026, the following amount, or so 26   much thereof as is necessary, to be used for the purposes 27   designated: 28   For child, family, and adoption services, and for salaries, 29   support, maintenance, and miscellaneous purposes, and for not 30   more than the following full-time equivalent positions: 31   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $170,398,711 32   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 977.00 33   1. Of the moneys appropriated in this section, $1,717,000 34   is allocated specifically for expenditure for the fiscal 35   -22-   LSB 1004YC (14) 91   lh/ko 22/ 47

H.F. _____   year beginning July 1, 2025, through the decategorization 1   services funding pools and decategorization governance boards 2   established pursuant to section 232.188. 3   2. A portion of the moneys appropriated in this section 4   may be used to provide other resources, based on client need, 5   required to support family preservation, emergency client need, 6   or family reunification efforts. 7   3. Of the moneys appropriated in this section, a sufficient 8   amount is allocated for foster family care, group foster care 9   maintenance and services, shelter care, child welfare emergency 10   services, qualified residential treatment programs, supervised 11   apartment living contracts, and for medical assistance program 12   reimbursement and associated costs. 13   4. Federal moneys received by the state during the fiscal 14   year beginning July 1, 2025, as the result of the expenditure 15   of state moneys appropriated during a previous state fiscal 16   year for a service or activity funded under this section, are 17   appropriated to the department to be used as additional moneys 18   for services and purposes provided for under this section. 19   Notwithstanding section 8.33, moneys appropriated under this 20   subsection that remain unencumbered or unobligated at the close 21   of the fiscal year shall not revert but shall remain available 22   for the purposes designated until the close of the succeeding 23   fiscal year. 24   5. a. Of the moneys appropriated in this section, $748,000 25   is allocated for the payment of the expenses of court-ordered 26   services provided to children who are under the supervision 27   of the department, which expenses are a charge upon the state 28   pursuant to section 232.141, subsection 4. 29   b. Notwithstanding chapter 232 or any other provision of 30   law to the contrary, a district or juvenile court shall not 31   order any service which is a charge upon the state pursuant to 32   section 232.141, subsection 4, if the moneys allocated under 33   paragraph a for court-ordered services are insufficient to 34   pay for the service. 35   -23-   LSB 1004YC (14) 91   lh/ko 23/ 47

H.F. _____   6. Of the moneys appropriated in this section, $1,658,000 1   shall be allocated for child protection centers located in Iowa 2   pursuant to the child protection center grant program under 3   section 135.118. The grant amounts under the program shall be 4   equalized so that each center receives a uniform base amount 5   of $245,000, and the remaining moneys are awarded through a 6   funding formula based upon the volume of children served by a 7   center. To increase access to child protection center services 8   for children in rural areas, the funding formula for awarding 9   the remaining moneys shall provide for awarding an enhanced 10   amount to eligible grantees to develop and maintain satellite 11   centers in underserved regions of the state. 12   7. Of the moneys appropriated in this section, $4,359,500 13   is allocated for the preparation for adult living program 14   established pursuant to section 234.46. 15   8. Of the moneys appropriated in this section, up to 16   $227,000 shall be used for the public purpose of continuing a 17   grant to a nonprofit human services organization that provides 18   services to individuals and families in multiple locations in 19   southwest Iowa and Nebraska, for support of a project providing 20   immediate, sensitive support and forensic interviews, medical 21   exams, needs assessments, and referrals for victims of child 22   abuse and their nonoffending family members. 23   9. Of the moneys appropriated in this section, a portion may 24   be used for family-centered services for purposes of complying 25   with the federal Family First Prevention Services Act of 2018, 26   Pub. L. No. 115-123, and successor legislation. 27   10. a. Of the moneys appropriated in this section, 28   $39,673,470 is allocated for adoption subsidy payments and 29   related costs. 30   b. Of the moneys allocated in this subsection, $148,232 31   shall be used to increase the adoption subsidy pursuant to 32   section 600.17 by 5 percent compared to the rates in effect on 33   June 30, 2025, for a child adopted after July 1, 2025. 34   c. Any moneys remaining after the allocations under 35   -24-   LSB 1004YC (14) 91   lh/ko 24/ 47

H.F. _____   paragraphs a and b are designated and allocated as state 1   savings resulting from implementation of the federal Fostering 2   Connections to Success and Increasing Adoptions Act of 2008, 3   Pub. L. No. 110-351, and successor legislation, as determined 4   in accordance with 42 U.S.C. 673(a)(8), and shall be used for 5   post-adoption services and for other purposes allowed under 6   those federal laws, Tit. IV-B or Tit. IV-E of the federal 7   Social Security Act. 8   11. Of the moneys appropriated in this section, a sufficient 9   amount is allocated to support training needs for child welfare 10   providers and to address disproportionality within the child 11   welfare system. 12   12. Of the moneys appropriated in this section, $308,756 13   shall be allocated to increase the foster care reimbursement 14   rates pursuant to section 234.38 by 5 percent compared to the 15   rates in effect on June 30, 2025, not to exceed the maximum 16   reimbursement rate established in section 234.38. 17   13. If a separate funding source is available that reduces 18   the need for state moneys within an allocation under this 19   section, the allocated state moneys may be redistributed to 20   other allocations under this section for the same fiscal year. 21   DIVISION IX 22   STATE-OPERATED SPECIALTY CARE  FY 2025-2026 23   Sec. 25. STATE-OPERATED SPECIALTY CARE. There is 24   appropriated from the general fund of the state to the 25   department of health and human services for the fiscal year 26   beginning July 1, 2025, and ending June 30, 2026, the following 27   amount, or so much thereof as is necessary, to be used for the 28   purposes designated: 29   For salaries, support, maintenance, and miscellaneous 30   purposes at institutions under the jurisdiction of the 31   department of health and human services, and for not more than 32   the following full-time equivalent positions: 33   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $102,343,507 34   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 756.00 35   -25-   LSB 1004YC (14) 91   lh/ko 25/ 47

H.F. _____   1. The department shall utilize the moneys appropriated in 1   this section as necessary to maximize bed capacity and to most 2   effectively meet the needs of the individuals served. 3   2. Of the moneys appropriated in this section, the following 4   amounts are allocated to each institution as follows: 5   a. For the state mental health institute at Cherokee: 6   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,738,275 7   b. For the state mental health institute at Independence: 8   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,215,468 9   c. For the civil commitment unit for sexual offenders at 10   Cherokee: 11   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 18,898,416 12   d. For the state resource center at Woodward: 13   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 14,217,377 14   e. For the state resource center at Glenwood: 15   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,453,792 16   f. For the state training school at Eldora: 17   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,820,177 18   DIVISION X 19   ADMINISTRATION AND COMPLIANCE  FY 2025-2026 20   Sec. 26. ACCOUNTABILITY, COMPLIANCE, AND PROGRAM 21   INTEGRITY. There is appropriated from the general fund of the 22   state to the department of health and human services for the 23   fiscal year beginning July 1, 2025, and ending June 30, 2026, 24   the following amount, or so much thereof as is necessary, to be 25   used for the purposes designated: 26   For accountability, compliance, and program integrity, 27   including salaries, support, maintenance, and miscellaneous 28   purposes, and for not more than the following full-time 29   equivalent positions: 30   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 21,242,539 31   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 411.00   32   1. Of the moneys appropriated in this section, $200,000 33   shall be transferred to and deposited in the Iowa ABLE savings 34   plan trust administrative fund created in section 12I.4, to be 35   -26-   LSB 1004YC (14) 91   lh/ko 26/ 47

H.F. _____   used for implementation and administration activities of the 1   Iowa ABLE savings plan trust. 2   2. Of the moneys appropriated in this section, $2,602,312 3   shall be allocated for foster care review and the court 4   appointed special advocate program, including for salaries, 5   support, maintenance, and miscellaneous purposes. 6   3. Of the moneys appropriated in this section, $1,148,959 7   shall be allocated for the office of long-term care ombudsman 8   for salaries, support, administration, maintenance, and 9   miscellaneous purposes. 10   DIVISION XI 11   DEPARTMENT OF HEALTH AND HUMAN SERVICES TRANSFERS, CASH FLOW, 12   AND NONREVERSIONS  FY 2025-2026 13   Sec. 27. DEPARTMENT OF HEALTH AND HUMAN SERVICES TRANSFERS 14   AND CASH FLOW. 15   1. Notwithstanding any provision of law to the contrary, 16   the department of health and human services may transfer moneys 17   appropriated in this Act to support continuing alignment 18   efforts, to maximize federal support in accordance with the 19   departments federal costs allocation plan, and for resources 20   necessary to implement and administer the services for which 21   moneys are appropriated. The department shall report any 22   transfers made pursuant to this subsection to the general 23   assembly. 24   2. If, due to ongoing cost management efforts, the 25   appropriations under this Act for the Medicaid program 26   exceed the associated costs for the Medicaid program for the 27   fiscal year, the department may transfer any savings to the 28   appropriations made in this Act for health program operations, 29   or for accountability, compliance, and program integrity, 30   to defray the costs associated with ongoing cost management 31   efforts.   32   3. Notwithstanding any provision of law to the contrary, 33   the department may transfer moneys appropriated under this Act 34   for child protective services to pay the nonfederal share costs 35   -27-   LSB 1004YC (14) 91   lh/ko 27/ 47

H.F. _____   of services reimbursed under the medical assistance program, 1   state child care assistance program, or the family investment 2   program which are provided to children who would otherwise 3   receive services paid by the appropriation for child protective 4   services. 5   4. The department may transfer moneys from the temporary 6   assistance for needy families block grant to the federal social 7   services block grant appropriation, and to the child care and 8   development block grant appropriation, in accordance with 9   federal law. 10   5. To the extent the department determines that moneys 11   appropriated under this Act, or allocated for a specific 12   purpose under this Act, will remain unencumbered or unobligated 13   at the close of the fiscal year, such unencumbered or 14   unobligated moneys may be used in the same fiscal year for any 15   other purpose for which the appropriated moneys may be used, or 16   for any other allocation within the same appropriation. 17   6. To the extent the department determines that moneys 18   appropriated under this Act will remain unencumbered or 19   unobligated at the close of the fiscal year, and that services 20   will not be impacted, the department may utilize up to 21   $3,000,000 of such unencumbered or unobligated moneys to 22   develop and support the thrive Iowa program, a closed-loop 23   referral system utilizing a navigator model, that acts as the 24   connection point to link Iowans on an individualized path to 25   prosperity and self-sufficiency to available resources in all 26   sectors of the community. 27   Sec. 28. DEPARTMENT OF HEALTH AND HUMAN SERVICES   28   NONREVERSIONS.   29   1. Notwithstanding section 8.33, moneys appropriated under 30   this Act from the general fund of the state and the temporary 31   assistance for needy families block grant to the department of 32   health and human services for the fiscal year beginning July 1, 33   2025, and ending June 30, 2026, for the purposes of the FaDSS 34   grant program that remain unencumbered or unobligated at the 35   -28-   LSB 1004YC (14) 91   lh/ko 28/ 47

H.F. _____   close of the fiscal year shall not revert, but shall remain 1   available for expenditure for the purposes designated until the 2   close of the succeeding fiscal year. 3   2. Notwithstanding section 8.33, of the moneys appropriated 4   under this Act from the general fund of the state, the quality 5   assurance trust fund, and the hospital health care access trust 6   fund to the department of health and human services for the 7   fiscal year beginning July 1, 2025, and ending June 30, 2026, 8   for the purposes of the medical assistance program, the amount 9   in excess of actual expenditures for the medical assistance 10   program that remains unencumbered or unobligated at the close 11   of the fiscal year shall not revert, but shall remain available 12   for expenditure for the medical assistance program until the 13   close of the succeeding fiscal year. 14   3. Notwithstanding section 8.33, and notwithstanding the 15   nonreversion amount limitation specified for state resource 16   centers in section 222.92, subsection 4, moneys appropriated 17   under this Act from the general fund of the state to the 18   department of health and human services for the fiscal 19   year beginning July 1, 2025, and ending June 30, 2026, for 20   the purposes of state-operated specialty care that remain 21   unencumbered or unobligated at the close of the fiscal year 22   shall not revert, but shall remain available for expenditure 23   for the purposes designated for subsequent fiscal years. 24   4. Notwithstanding section 8.33, moneys appropriated in 25   this Act from the general fund of the state to the department 26   of health and human services for the fiscal year beginning July 27   1, 2025, and ending June 30, 2026, for the Iowa commission 28   on volunteer service for programs and grants that remain 29   unencumbered or unobligated at the close of the fiscal year 30   shall not revert, but shall remain available for expenditure 31   for the purposes designated for subsequent fiscal years. 32   5. Notwithstanding section 8.33, moneys appropriated under 33   this Act from the general fund of the state to the department 34   of health and human services for the fiscal year beginning July 35   -29-   LSB 1004YC (14) 91   lh/ko 29/ 47

H.F. _____   1, 2025, and ending June 30, 2026, and allocated for rural 1   psychiatric residencies that remain unencumbered or unobligated 2   at the close of the fiscal year shall not revert, but shall 3   remain available for expenditure for the purposes designated 4   until the close of the succeeding fiscal year. 5   6. Notwithstanding section 8.33, moneys appropriated 6   under this Act from the general fund of the state to the 7   department of health and human services for the fiscal 8   year beginning July 1, 2025, and ending June 30, 2026, and 9   allocated for adoption subsidy payments and related costs, or 10   for post-adoption services and related allowable purposes, 11   that remain unencumbered or unobligated at the close of the 12   fiscal year shall not revert, but shall remain available for 13   expenditure for the purposes designated until the close of the 14   succeeding fiscal year. 15   DIVISION XII 16   DEPARTMENT OF HEALTH AND HUMAN SERVICES PRIOR APPROPRIATIONS 17   AND OTHER PROVISIONS 18   THRIVE IOWA PROGRAM CLOSED-LOOP REFERRAL SYSTEM 19   Sec. 29. 2024 Iowa Acts, chapter 1157, section 21, 20   subsection 6, is amended to read as follows: 21   6. To the extent the department determines that moneys 22   appropriated under this Act will remain unencumbered or 23   unobligated at the close of the fiscal year or that services 24   will not be impacted, the department may utilize up to 25   $3,000,000 of such unencumbered or unobligated moneys 26   appropriated to develop and support the thrive Iowa program, 27   a closed-loop referral system utilizing a navigator model, 28   that acts as the connection point to link Iowans on an 29   individualized path to prosperity and self-sufficiency 30   to available resources in all sectors of the community. 31   Notwithstanding section 8.33, any moneys utilized for this   32   purpose shall not revert but shall remain available for 33   expenditure for the purposes designated.   34   COMMUNITY ACCESS AND ELIGIBILITY   35   -30-   LSB 1004YC (14) 91   lh/ko 30/ 47

H.F. _____   Sec. 30. 2024 Iowa Acts, chapter 1157, section 22, is 1   amended by adding the following new subsection: 2   NEW SUBSECTION   . 7. Notwithstanding section 8.33, moneys 3   appropriated under this Act from the general fund of the state 4   to the department of health and human services for the fiscal 5   year beginning July 1, 2024, and ending June 30, 2025, and 6   allocated for community access and eligibility that remain 7   unencumbered or unobligated at the close of the fiscal year 8   shall not revert but shall remain available for expenditure for 9   the purposes designated, or are appropriated to the department 10   for any purpose described in this division of this Act or to be 11   used as necessary to enhance the departments accountability, 12   compliance, program integrity, and efficiency, until the close 13   of the succeeding fiscal year. 14   Sec. 31. EFFECTIVE DATE. This division of this Act, being 15   deemed of immediate importance, takes effect upon enactment. 16   Sec. 32. RETROACTIVE APPLICABILITY. This division of this 17   Act applies retroactively to July 1, 2024. 18   DIVISION XIII 19   BEER AND LIQUOR CONTROL FUND  BEHAVIORAL HEALTH FUND 20   Sec. 33. 2024 Iowa Acts, chapter 1157, is amended by adding 21   the following new section: 22   NEW SECTION   . SEC. 4A. IN LIEU OF STANDING 23   APPROPRIATION. The moneys appropriated and allocated in this 24   division of this Act for purposes of treatment and prevention 25   of substance use and misuse and addictive behaviors are in lieu 26   of the standing appropriation to the department of health and 27   human services pursuant to section 123.17, subsection 5, for 28   the fiscal year beginning July 1, 2024. 29   Sec. 34. 2024 Iowa Acts, chapter 1161, section 14, is 30   amended by striking the section and inserting in lieu thereof 31   the following: 32   SEC. 14. Section 123.17, subsection 5 , Code 2024, is amended 33   to read as follows: 34   5. After any transfer provided for in subsection 3 is 35   -31-   LSB 1004YC (14) 91   lh/ko 31/ 47

H.F. _____   made, the department shall transfer into a special revenue 1   account in the general fund of the state, a sum of money at 2   least equal to seven percent of the gross amount of sales made 3   by the department from the beer and liquor control fund on a 4   monthly basis but not less than nine million dollars annually. 5   Of the amounts transferred, two   one million dollars, plus an 6   additional amount determined by the general assembly, shall be 7   appropriated to the department of health and human services for 8   use by the staff who administer the comprehensive substance use   9   disorder program under chapter 125 for substance use disorder 10   treatment and prevention programs   shall be transferred to the 11   behavioral health fund established under section 225A.7 . Any 12   amounts received in excess of the amounts appropriated to the 13   department of health and human services for use by the staff   14   who administer the comprehensive substance use disorder program 15   under chapter 125 transferred to the behavioral health fund 16   shall be considered part of the general fund balance. 17   Sec. 35. EFFECTIVE DATE. This division of this Act, being 18   deemed of immediate importance, takes effect upon enactment. 19   Sec. 36. RETROACTIVE APPLICABILITY. This division of this 20   Act applies retroactively to July 1, 2024. 21   DIVISION XIV 22   REPORT ON NONREVERSION OF MONEYS 23   Sec. 37. REPORT ON NONREVERSION OF MONEYS. The department 24   of health and human services shall report the expenditure of 25   any moneys for which nonreversion authorization was provided 26   for the fiscal year beginning July 1, 2024, and ending June 30, 27   2025, to the general assembly on a quarterly basis beginning 28   October 1, 2025. 29   DIVISION XV   30   EMERGENCY RULES   31   Sec. 38. EMERGENCY RULES.   32   1. If necessary to comply with federal requirements, 33   including time frames, the department of health and human 34   services or the mental health and disability services 35   -32-   LSB 1004YC (14) 91   lh/ko 32/ 47

H.F. _____   commission shall adopt administrative rules under section 1   17A.4, subsection 3, and section 17A.5, subsection 2, paragraph 2   b, to implement the applicable provisions of this Act. The 3   rules shall be effective immediately upon filing unless a 4   later date is specified in the rules. Any rules adopted in 5   accordance with this section shall also be published as a 6   notice of intended action as provided in section 17A.4. 7   2. If the department of health and human services adopts 8   emergency rules in accordance with this section, or as 9   otherwise directed or authorized by state law, and the rules 10   will result in an increase in expenditures beyond the amount 11   anticipated in the budget for the fiscal year, or if the 12   expenditures were not addressed in the budget for the fiscal 13   year, the department shall notify the general assembly and the 14   department of management concerning the rules and the increase 15   in expenditures. The notification shall be provided at least 16   thirty calendar days prior to the date notice of the rules 17   is submitted to the administrative rules coordinator and the 18   administrative code editor. 19   DIVISION XVI 20   MATTERS RELATED TO AUTISM SPECTRUM DISORDER 21   Sec. 39. Section 225D.2, Code 2025, is amended by adding the 22   following new subsection: 23   NEW SUBSECTION   . 4A. The department shall not approve a new 24   application for the autism support program on or after July 25   1, 2025. The department shall continue to provide treatment 26   and make payments pursuant to the program for an eligible 27   individual whose application is approved on or before June 30, 28   2025, if the individual remains eligible for the program. 29   Sec. 40. NEW SECTION   . 225D.3 Future repeal. 30   This chapter is repealed July 1, 2027. 31   Sec. 41. Section 514I.5, subsection 4, paragraph c, Code 32   2025, is amended by adding the following new subparagraph: 33   NEW SUBPARAGRAPH   . (18) Applied behavior analysis services 34   for the treatment of autism spectrum disorder. 35   -33-   LSB 1004YC (14) 91   lh/ko 33/ 47

H.F. _____   Sec. 42. TRANSFER OF MONEYS. Upon repeal of chapter 225D on 1   July 1, 2027, any unencumbered and unobligated moneys remaining 2   in the autism support fund created in section 225D.2, are 3   transferred to the Hawki trust fund created in section 514I.11. 4   DIVISION XVII 5   INVOLUNTARY COMMITMENT HEARING TESTIMONY 6   Sec. 43. Section 125.82, subsection 3, Code 2025, is amended 7   to read as follows: 8   3. a.   The person who filed the application , and a the 9   licensed physician and surgeon , or osteopathic physician and 10   surgeon, mental health professional, or certified   alcohol and 11   drug counselor certified by the nongovernmental Iowa board of 12   certification who has examined the respondent in connection 13   with the commitment hearing ,   shall be present at the hearing, 14   unless the court for good cause finds that their presence or 15   testimony is not necessary any of the following apply: 16   (1) The court finds for good cause that the presence or 17   testimony of the person who examined the respondent is not   18   necessary.   Good cause may include but is not limited to a 19   waiver under subparagraph (3) . 20   (2)   The court grants an application to allow a physician 21   assistant licensed under chapter 148C or an advanced registered 22   nurse practitioner licensed under chapter 152 to be present   23   and testify at the hearing on behalf of the licensed physician 24   and surgeon, osteopathic physician and surgeon, mental health 25   professional, or certified alcohol and drug counselor who 26   examined the respondent in connection with the commitment 27   hearing. An application under this subparagraph shall contain 28   all of the following: 29   (a)   A sworn statement that the physician assistant or 30   advanced registered nurse practitioner witnessed the physician 31   and surgeon, osteopathic physician and surgeon, mental health   32   professional, or certified alcohol and drug counselor examine 33   the respondent in connection with the commitment hearing.   34   (b) A sworn statement that the physician assistant or 35   -34-   LSB 1004YC (14) 91   lh/ko 34/ 47

H.F. _____   advanced registered nurse practitioner has reviewed the written 1   report of the examination prepared pursuant to section 125.80.   2   (c) A sworn statement that the physician and surgeon, 3   osteopathic physician and surgeon, mental health professional, 4   or certified alcohol and drug counselor is unable to attend the   5   hearing.   6   (3) The applicant, respondent, and the respondents 7   attorney may waive the presence, televised appearance, or 8   telephonic appearance of the licensed physician and surgeon ,   or 9   osteopathic physician and surgeon, mental health professional, 10   or certified alcohol and drug counselor who examined the 11   respondent and agree to submit as evidence the written report 12   of the licensed physician and surgeon or osteopathic physician   13   and surgeon, mental health professional, or certified alcohol   14   and drug counselor of examination prepared pursuant to 15   section 125.80 . The respondents attorney shall inform the 16   court if the respondents attorney reasonably believes that 17   the respondent, due to diminished capacity, cannot make an 18   adequately considered waiver decision. Good cause   for finding 19   that the testimony of the licensed physician and surgeon or 20   osteopathic physician and surgeon, mental health professional,   21   or certified alcohol and drug counselor who examined the 22   respondent is not necessary may include but is not limited to   23   such a waiver. 24   b. If the court determines that the testimony of the 25   licensed physician and surgeon , or osteopathic physician and 26   surgeon, mental health professional, or certified alcohol and 27   drug counselor is necessary, the court may allow the licensed 28   physician and surgeon , or osteopathic physician and surgeon, 29   mental health professional, or certified alcohol and drug 30   counselor to testify by telephone or televised means. 31   c.   The respondent shall be present at the hearing unless 32   prior to the hearing the respondents attorney stipulates in 33   writing that the attorney has conversed with the respondent, 34   and that in the attorneys judgment either   the respondent 35   -35-   LSB 1004YC (14) 91   lh/ko 35/ 47

H.F. _____   cannot make a meaningful contribution to the hearing , or that 1   the respondent has waived the right to be present, and the 2   basis for the attorneys conclusions. A stipulation to the 3   respondents absence shall be reviewed by the court before the 4   hearing, and may be rejected if it appears that insufficient 5   grounds are stated or that the respondents interests would not 6   be served by the respondents absence. 7   Sec. 44. Section 229.12, subsection 3, paragraph b, Code 8   2025, is amended to read as follows: 9   b. (1)   The licensed physician or mental health professional 10   who examined the respondent shall be present at the hearing 11   unless the court for good cause finds that the licensed   12   physicians or mental health professionals presence or 13   testimony is not necessary   any of the following apply: 14   (a) The court finds for good cause that the licensed 15   physicians or mental health professionals presence is not 16   necessary . Good cause may include but is not limited to a 17   waiver under subparagraph division (c).   18   (b)   The court grants an application to allow a physician 19   assistant licensed under chapter 148C or an advanced registered 20   nurse practitioner licensed under chapter 152 to be present   21   and testify at the hearing on behalf of the licensed physician 22   or mental health professional who examined the respondent in   23   connection with the commitment hearing. An application under 24   this subparagraph division shall contain all of the following: 25   (i) A sworn statement that the physician assistant or 26   advanced registered nurse practitioner witnessed the licensed 27   physician or mental health professional examine the respondent. 28   (ii) A sworn statement that the physician assistant or 29   advanced registered nurse practitioner has reviewed the written   30   report of the examination prepared pursuant to section 229.10. 31   (iii)   A sworn statement that the licensed physician or 32   mental health professional who examined the respondent is 33   unable to attend the hearing.   34   (c) The applicant, respondent, and the respondents 35   -36-   LSB 1004YC (14) 91   lh/ko 36/ 47

H.F. _____   attorney may waive the presence, televised appearance, or the 1   telephonic appearance of the licensed physician or mental 2   health professional who examined the respondent and agree to 3   submit as evidence the written report of the licensed physician   4   or mental health professional   of the examination prepared 5   pursuant to section 229.10   . The respondents attorney shall 6   inform the court if the respondents attorney reasonably 7   believes that the respondent, due to diminished capacity, 8   cannot make an adequately considered waiver decision. Good   9   cause for finding that the testimony of the licensed physician 10   or mental health professional who examined the respondent is   11   not necessary may include but is not limited to such a waiver. 12   (2) If the court determines that the testimony of the 13   licensed physician or mental health professional is necessary, 14   the court may allow the licensed physician or the mental health 15   professional to testify by telephone or televised means. 16   DIVISION XVIII 17   DISCHARGE OF INVOLUNTARILY COMMITTED PERSONS 18   Sec. 45. Section 125.2, Code 2025, is amended by adding the 19   following new subsections: 20   NEW SUBSECTION   . 01. Administrative services organization 21   means the same as defined in section 225A.1. 22   NEW SUBSECTION   . 001. Behavioral health district means the 23   same as defined in section 225A.1. 24   Sec. 46. Section 125.85, subsection 4, Code 2025, is amended 25   by striking the subsection. 26   Sec. 47. Section 125.85, Code 2025, is amended by adding the 27   following new subsections: 28   NEW SUBSECTION . 6. Prior to a discharge of a respondent 29   under this section, the facility treating the respondent shall 30   do all of the following: 31   a. Refer the respondent to an administrative services 32   organization for evaluation, system navigation, and 33   postdischarge services. 34   b. Assess the respondent for suicide risk. 35   -37-   LSB 1004YC (14) 91   lh/ko 37/ 47

H.F. _____   c. Provide the respondent or the respondents legal 1   representative with a discharge report. The discharge report 2   shall include all of the following: 3   (1) The respondents name and address. 4   (2) The dates, times, and locations of all postdischarge 5   appointments scheduled for the respondent. 6   (3) A list of each medication prescribed for the respondent 7   before or during the respondents treatment, including 8   psychiatric and nonpsychiatric medications. 9   (4) Contact information for the administrative services 10   organization to which the respondent was referred under 11   paragraph a . 12   (5) A written patient-centered aftercare plan, including 13   crisis prevention and steps to address the respondents ongoing 14   care needs. 15   (6) (a) Educational materials for the respondent and 16   individuals who are willing to support the respondent after the 17   respondents discharge. 18   (b) Educational materials shall be developed by the 19   department for distribution to facilities. Educational 20   materials shall include but not be limited to all of the 21   following: 22   (i) Descriptions of the symptoms of a substance use 23   disorder. 24   (ii) Warning signs of decompensation. 25   (iii) Information regarding the availability of other 26   educational services, services offered in the respondents 27   community, and services offered statewide. 28   d. Notify all of the following persons: 29   (1) The administrative services organization to which the 30   respondent was referred under paragraph a . 31   (2) The respondents legal guardian, parent, spouse, 32   attorney in fact under chapter 144B, or adult siblings, as 33   applicable. 34   NEW SUBSECTION   . 7. a. The administrative services 35   -38-   LSB 1004YC (14) 91   lh/ko 38/ 47

H.F. _____   organization to which a respondent was referred under 1   subsection 6, paragraph a , shall do all of the following in 2   relation to the discharged respondent: 3   (1) Coordinate postdischarge care, including but not 4   limited to contacting the respondent to ensure the respondent 5   attends scheduled appointments and receives necessary care and 6   services. 7   (2) Follow up with the respondent in a timely manner. 8   Follow-ups shall include but not be limited to home visits, 9   telephone calls, and other means of contacting the respondent. 10   b. An administrative services organization may delegate 11   duties required under this subsection to a managed care 12   organization acting pursuant to a contract with the department 13   to administer the Medicaid program under chapter 249A, if the 14   respondent referred to the administrative services organization 15   qualifies for Medicaid. 16   NEW SUBSECTION   . 8. a. Each administrative services 17   organization shall make a quarterly report to the department, 18   and the report shall include all of the following: 19   (1) The number of respondents discharged and referred to 20   the administrative services organization during the reporting 21   period. 22   (2) The outcome of each discharged respondent. 23   (3) Any issues encountered while ensuring each respondents 24   postdischarge continuity of care. 25   b. A report under this section shall be considered a 26   confidential record under section 22.7. 27   c. A report under this section shall comply with the federal 28   Health Insurance Portability and Accountability Act of 1996, 29   Pub. L. No. 104-191. 30   NEW SUBSECTION   . 9. Following a respondents discharge from 31   a facility or from treatment, the administrator of the facility 32   shall immediately report the discharge to the court which 33   ordered the respondents commitment or treatment. The court 34   shall issue an order confirming the respondents discharge 35   -39-   LSB 1004YC (14) 91   lh/ko 39/ 47

H.F. _____   and terminating the proceedings in which the respondents 1   commitment or treatment was ordered. Copies of the order 2   confirming the discharge and terminating the proceedings shall 3   be sent by regular mail to the facility and the respondent. 4   NEW SUBSECTION . 10. The department shall adopt rules 5   pursuant to chapter 17A to implement and administer this 6   section. 7   Sec. 48. Section 229.1, Code 2025, is amended by adding the 8   following new subsections: 9   NEW SUBSECTION   . 01. Administrative services organization 10   means the same as defined in section 225A.1. 11   NEW SUBSECTION   . 001. Behavioral health district means the 12   same as defined in section 225A.1. 13   Sec. 49. Section 229.16, Code 2025, is amended to read as 14   follows: 15   229.16 Discharge and termination of proceeding. 16   1.   When the condition of , in the opinion of the chief 17   medical officer,   a patient who is hospitalized pursuant to a 18   report issued   whose treatment was recommended under section 19   229.14, subsection 1 , paragraph b , or is receiving treatment 20   pursuant to a report issued under   section 229.14, subsection 21   1 , paragraph c , or is in full-time care and custody pursuant 22   to a report issued under   section 229.14, subsection 1 , 23   paragraph d , is such that in the opinion of the chief medical 24   officer the patient no longer requires treatment or care for 25   serious mental impairment, the chief medical officer shall 26   tentatively discharge the patient and immediately report that 27   fact   the discharge to the court which ordered the patients 28   hospitalization or care and custody treatment . Upon receiving 29   the report, the court shall issue an order confirming the 30   patients discharge from the hospital or from care and custody,   31   as the case may be,   and shall terminate terminating the 32   proceedings pursuant to in which the order patients treatment 33   was issued   ordered . Copies of the order shall be sent by 34   regular mail to the hospital, the patient, and the applicant if 35   -40-   LSB 1004YC (14) 91   lh/ko 40/ 47

H.F. _____   the applicant has filed a written waiver signed by the patient. 1   2.   If a patient is receiving inpatient care, prior to a 2   discharge of the patient under subsection 1, the facility or 3   hospital treating the patient shall do all of the following: 4   a.   Refer the patient to an administrative services 5   organization for evaluation, system navigation, and   6   postdischarge services. 7   b. Assess the patient for suicide risk. 8   c.   Provide the patient or the patients legal representative 9   with a discharge report. The discharge report shall include 10   all of the following:   11   (1) The patients name and address. 12   (2) The dates, times, and locations of all postdischarge 13   appointments scheduled for the patient.   14   (3) A list of each medication prescribed for the patient 15   before or during the patients treatment, including psychiatric 16   and nonpsychiatric medications. 17   (4)   Contact information for the administrative services 18   organization to which the patient was referred under paragraph   19   a . 20   (5)   A written patient-centered aftercare plan, including 21   crisis prevention and steps to address the patients ongoing 22   care needs.   23   (6) (a) Educational materials for the patient and 24   individuals who are willing to support the patient after the 25   patients discharge. 26   (b) Educational materials shall be developed by the 27   department for distribution to facilities and hospitals 28   treating persons with a mental illness. Educational materials 29   shall include but not be limited to all of the following:   30   (i) Descriptions of the symptoms of mental illness. 31   (ii)   Warning signs of decompensation. 32   (iii) Information regarding the availability of other 33   educational services, services offered in the patients   34   community, and services offered statewide. 35   -41-   LSB 1004YC (14) 91   lh/ko 41/ 47

H.F. _____   d. Notify all of the following persons: 1   (1)   The administrative services organization to which the 2   patient was referred under paragraph a . 3   (2) The patients legal guardian, parent, spouse, attorney 4   in fact under chapter 144B, or adult siblings, as applicable.   5   3.   a. The administrative services organization to which a 6   patient was referred under subsection 2, paragraph a , shall do 7   all of the following in relation to the discharged patient: 8   (1)   Coordinate postdischarge care, including but not 9   limited to contacting the patient to ensure the patient 10   attends scheduled appointments and receives necessary care and   11   services. 12   (2) Follow up with the patient in a timely manner. 13   Follow-ups shall include but not be limited to home visits,   14   telephone calls, and other means of contacting the patient. 15   b. An administrative services organization may delegate 16   duties required under this subsection to a managed care 17   organization acting pursuant to a contract with the department   18   to administer the Medicaid program under chapter 249A, if the   19   patient referred to the administrative services organization 20   qualifies for Medicaid.   21   4. a. Each administrative services organization shall make 22   a quarterly report to the department, and the report shall   23   include all of the following: 24   (1) The number of patients discharged and referred to the 25   administrative services organization during the reporting 26   period. 27   (2) The outcomes of each discharged patient. 28   (3) Any issue encountered while ensuring each patients 29   postdischarge continuity of care.   30   b. A report under this section shall be considered a 31   confidential record under section 22.7.   32   c. A report under this section shall comply with the federal 33   Health Insurance Portability and Accountability Act of 1996,   34   Pub. L. No. 104-191. 35   -42-   LSB 1004YC (14) 91   lh/ko 42/ 47

H.F. _____   5. The department shall adopt rules pursuant to chapter 17A 1   to implement this section.   2   DIVISION XIX 3   MEDICAL RESIDENCY AND FELLOWSHIP POSITIONS  RESIDENTS OF IOWA 4   Sec. 50. Section 262.9, subsection 39, paragraph e, 5   subparagraph (2), if enacted by 2025 Iowa Acts, House File 516, 6   section 1, is amended to read as follows: 7   (2) An individual who has lived in Iowa for at least four 8   consecutive years immediately preceding the date the individual 9   applies for admission to   begins classes at the college of 10   medicine in the doctor of medicine program or the college of 11   dentistry at the state university of Iowa, or for   begins a 12   residency at the university of Iowa hospitals and clinics. 13   DIVISION XX 14   MAINTENANCE AND COSTS OF JUVENILE HOMES 15   Sec. 51. Section 232.142, subsection 6, paragraph b, Code 16   2025, is amended to read as follows: 17   b. (1) Moneys deposited in the juvenile detention home 18   fund during a fiscal year are appropriated to the department 19   for the same fiscal year for distribution of an amount equal to 20   a percentage of the costs of the establishment, improvement, 21   operation, and maintenance of county or multicounty juvenile 22   detention homes in the prior   immediately preceding fiscal year. 23   Such percentage shall be determined by the department based on 24   the amount available for distribution from the fund. 25   (2) Moneys appropriated for distribution in accordance with 26   this subsection shall be allocated among eligible detention 27   homes, as follows: 28   (a) One hundred twenty-five thousand dollars shall be 29   distributed to each eligible county or multicounty juvenile   30   detention home. 31   (b)   Appropriated moneys remaining after the distribution 32   in subparagraph division (a) shall be prorated and distributed 33   on the basis of an eligible county or multicounty juvenile   34   detention homes proportion of the costs of all eligible 35   -43-   LSB 1004YC (14) 91   lh/ko 43/ 47

H.F. _____   county or multicounty juvenile detention homes in the prior 1   immediately preceding   fiscal year. 2   DIVISION XXI 3   HOSPITAL DIRECTED PAYMENT PROGRAM 4   Sec. 52. NEW SECTION   . 249O.1 Definitions. 5   As used in this chapter, unless the context otherwise 6   requires: 7   1. Centers for Medicare and Medicaid services means the 8   centers for Medicare and Medicaid services of the United States 9   department of health and human services. 10   2. Department means the department of health and human 11   services. 12   3. Hospital means a nonstate-owned hospital licensed by 13   the state. 14   4. Hospital directed payment program means a program that 15   provides a state directed payment to a hospital for inpatient 16   and outpatient hospital services. 17   5. State directed payment means the same as defined in 42 18   C.F.R. 438.2. 19   Sec. 53. NEW SECTION   . 249O.2 Hospital directed payment 20   program. 21   1. Prior to the department administering a hospital 22   directed payment program under this chapter for any specific 23   fiscal year, the department shall submit any authorizing 24   documentation necessary to the centers for Medicare and 25   Medicaid services for approval. Upon receipt of approval from 26   the centers for Medicare and Medicaid services, the department 27   shall administer the hospital directed payment program during 28   the specified fiscal year. 29   2. a. For the sole purpose of the hospital directed payment 30   program, the department may impose an assessment on a hospital. 31   The total amount of assessments collected by the department 32   shall not exceed the amount necessary to fully fund the 33   nonfederal share of the maximum state directed payment allowed 34   under federal regulations. 35   -44-   LSB 1004YC (14) 91   lh/ko 44/ 47

H.F. _____   b. The department shall establish requirements for timely 1   payment of an assessment, and any penalties for late payment 2   or nonpayment of an assessment. Any assessment imposed under 3   this section shall constitute a debt due the state and may be 4   collected by civil action under any method provided by law. 5   c. The department and a third-party administrator contracted 6   with the department may collectively assess and collect an 7   administrative fee of no more than four percent of the amount 8   of each assessment imposed. 9   3. Any assessments and penalties collected under this 10   section shall be used for the purposes of the hospital directed 11   payment program. 12   4. a. The hospital directed payment program shall not 13   be administered, an assessment shall not be imposed, and a 14   hospital shall not be required to pay an assessment if federal 15   financial participation is not available, or if the hospital 16   directed payment program and imposition of an assessment are 17   not approved by the centers for Medicare and Medicaid services. 18   b. If federal law or policy significantly impacts the 19   hospital directed payment program as determined by the 20   department, the department, in collaboration with stakeholders, 21   may terminate the hospital directed payment program. 22   5. The department shall adopt rules pursuant to chapter 17A 23   as necessary to administer this chapter. 24   EXPLANATION 25   The inclusion of this explanation does not constitute agreement with 26   the explanations substance by the members of the general assembly. 27   This bill makes appropriations from the general fund of 28   the state to the department of veterans affairs and to the 29   department of health and human services (HHS) for fiscal 30   year 2025-2026. The appropriations from the general fund 31   of the state to the department of veterans affairs include 32   appropriations for administration, the Iowa veterans home, and 33   the home ownership assistance program. The appropriations from 34   the general fund of the state to HHS include appropriations 35   -45-   LSB 1004YC (14) 91   lh/ko 45/ 47

H.F. _____   for aging and disability services; behavioral health; public 1   health; community access and eligibility including for child 2   support services; the medical assistance program, state 3   supplementary assistance, the healthy and well kids in Iowa 4   (Hawki) program, and other specified health-related programs 5   including health program operations; reimbursement rates; 6   family well-being and protection including state child 7   care assistance, early intervention and supports, and child 8   protective services; state-operated specialty care; and 9   administration and compliance. 10   The bill also makes appropriations to HHS from the sports 11   wagering receipts fund, the pharmaceutical settlement account, 12   the quality assurance trust fund, and the hospital health care 13   access trust fund. 14   The bill transfers money from the beer and liquor control 15   fund to the behavioral health fund. 16   The bill requires HHS to develop a reimbursement methodology 17   proposal for reimbursement of nursing facilities under the 18   medical assistance program. 19   The bill limits how moneys appropriated to the early 20   childhood Iowa fund shall be used by HHS. 21   The bill repeals the autism support program, requires the 22   Hawki program to cover applied behavior analysis services for 23   the treatment of autism spectrum disorder, and transfers any 24   unencumbered and unobligated moneys remaining in the autism 25   support fund to the Hawki trust fund upon the repeal of the 26   autism support program. 27   The bill allows an assistant or an advanced registered nurse 28   practitioner to testify in an involuntary commitment hearing 29   for a substance abuse disorder or a serious mental impairment. 30   The bill requires a facility or a hospital treating an 31   involuntarily committed person to perform certain actions prior 32   to the discharge of the person, and the referred administrative 33   services organization to coordinate the discharged persons 34   care and provide quarterly reports to HHS. 35   -46-   LSB 1004YC (14) 91   lh/ko 46/ 47

H.F. _____   The bill amends the definition of resident of Iowa in 2025 1   Iowa Acts, House File 516. 2   The bill amends how moneys in the juvenile detention home 3   fund are allocated under Code section 232.142(6)(b). 4   The bill requires HHS to submit documentation to the federal 5   centers for Medicare and Medicaid services for approval to 6   administer a hospital directed payment program. Upon receipt 7   of approval, the bill permits HHS to administer a hospital 8   directed payment program. HHS may impose an assessment on a 9   hospital. 10   The bill includes transfer, cash flow, and nonreversion 11   provisions, emergency rulemaking authority, and reporting 12   requirements. 13   -47-   LSB 1004YC (14) 91   lh/ko 47/ 47