HOUSE REPUBLICAN STAFF ANALYSIS

Transcription

1 \ gt HOUSE REPUBLICAN STAFF ANALYSIS Bill: House File 2501/Senate File 2418 Committee: Appropriations Floor Manager: Rep. Heaton Date: 5/3/18 Staff: Natalie Ginty (5-2063) House Sub: House Committee: House Floor: Senate Floor: Governor: PASSED 5/3/18 (5-4) PASSED 5/3/18 (14-10) FISCAL YEAR 2019 HEALTH AND HUMAN SERVICES BUDGET The House bill appropriates a total of $ 1.82 billion from the General Fund to the Department on Aging (IDA), the Department of Public Health (DPH), the Department of Human Services (DHS), the Department of Veterans Affairs (IVA), and the Iowa Veterans Home (IVH) in FY This is an increase of $ million when compared to the revised budget for FY Section-by-Section Analysis DIVISION I DEPARTMENT ON AGING Total Department on Aging Appropriation: $ 10,942,924 $ 11,042,924 $ 100,000 This Division allows the Department on Aging to provide citizens of Iowa who are sixty years of age and older with case management, adult day services, respite care, and for salaries, support, and administration. Changes in the bill include: Appropriates $100,000 to be used to design a new Pre-Medicaid Pilot Project. This project will work to keep individuals in the community and out of long-term care facilities following a nursing facility stay. This project is modeled after Minnesota s Return to Community Initiative, which utilizes Community Living Specialists to work with recent nursing home clients to return them back to their home and to avoid spending down their savings and needing Medicaid. Minnesota invested around $1 million into their program per year, and found savings to be at $9.6 million over four years. IDA, in collaboration with DHS, will submit a design plan to the Governor and General Assembly by December 15, 2018, to look towards drawing down federal matching funds for a statewide Project. Eliminates the Office of Substitute Decision Maker suballocation within the Aging and Disability Resource Center (ADRC) appropriation. This provides IDA with more flexibility in using its funds. Eliminates the ability of IDA to transfer funds within or between allocations made in this Division. 1

2 DIVISION II OFFICE OF LONG-TERM CARE OMBUDSMAN $ 1,149,821 $ 1,149,821 $ 0 The Office of the State Long-Term Care Ombudsman works to advocate for the rights and wishes of residents and tenants in long-term care, including those living in nursing facilities, residential care facilities, assisted living programs and elder group homes. The Ombudsmen help answer questions and resolve complaints. The Managed Care Ombudsman Program advocates for the rights and needs of approximately 57,000 Medicaid managed care members who receive care in health care facilities, assisted living programs, and elder group homes in Iowa, as well as members who are enrolled in one of the seven Medicaid HCBS waiver programs. DIVISION III DEPARTMENT OF PUBLIC HEALTH The Division appropriates $54,766,995 to the Department of Public Health. This is an increase of $4,052,436 when compared to the revised FY 2018 budget. Transfer: Last year in the HHS Budget, HF 653 provided DPH with transfer authority to move funds within or between any of the allocations or appropriations made in the HHS Budget for DPH. In June 2017, DPH notified LSA of its plan to implement the FY18 budget reductions by eliminating 10 programs and fund transfers, decreasing funding in 11 other programs, and increasing funding to 7 programs, including one program (Childhood Obesity) that was eliminated in the FY 18 HHS Budget. This bill eliminates IDPH s transfer authority that was provided last year in light of the budget reductions (Section 7 of the bill, page 15). This bill also reinstates funding to many of the areas that DPH eliminated in the June 2017 transfer. This funding is allocated amongst the following budget units: Addictive Disorders $ 24,804,344 $ 24,804,344 $ 0 This budget unit provides funding for services directed toward reducing the use of tobacco, alcohol and other drugs, and treating Iowans with addictive disorders, including problem gambling. Changes in the bill include: Requiring DPH and DHS to create a workgroup to review reimbursement equity of substancerelated disorder services providers. A report is due to the General Assembly by December 15, This is a follow-up to the 2014 study that recommended reimbursement rates be raised and also the recommendation of the Complex Needs report that reimbursement rates be reviewed for substance-related residential rates. 2

3 Healthy Children and Families $ 5,284,599 $ 5,802,625 $ 536,026 This budget unit provides funding for programs that assure access to preventive child health services and link children and families with community-based preventive health and family support services. Changes in the bill include: An increase of $156,482 to restore the Audiological Services for Children Program eliminated in the DPH Transfer. This program provides funding for hearing aids and/or audiological services for children who otherwise would not be able to afford these services. An increase of $23,000 to restore the Dental Services Program at the University of Iowa eliminated in the DPH Transfer. This program provides dental care for underserved children on a fee-for-service basis. Funds must be matched on a dollar-for-dollar basis by the University. The University is required to serve a minimum of 100 children during the contract period. An increase of $15,511 to the Adverse Childhood Experiences allocation eliminated in the DPH Transfer. An increase of $300,000 for the Childhood Obesity Program. The Governor had requested an increase of $450,000 to this program. An increase of $41,033 to backfill the FY 2018 deappropriation. Chronic Conditions $ 3,546,757 $ 4,528,109 $ 981,352 This budget unit funds activities and services that are provided to Iowans suffering from chronic conditions or special health care needs. This includes money for the child health specialty clinics, comprehensive cancer control, and cervical and colon cancer screening. Changes in the bill include: An increase of $64,387 to Child Health Specialty Clinics that was eliminated in the DPH Transfer. This program facilitates the development of family-centered, community-based, coordinated systems of care for children and youth with special health care needs. An increase of $144,097 to the Epilepsy Foundation that was eliminated in the DPH Transfer. Funding provides for education, client-centered programs, and client and family support for people living with epilepsy and their families. The allocation language for this program requires a one-to-one match for all State funds provided in excess of $100,000. An increase of $150,000 to the Melanoma Research and Clinical Trials allocation that was eliminated in the DPH Transfer. An increase of $384,552 to restore the Regional Autism Assistance Program eliminated in the DPH Transfer. The Child Health Specialty Clinics uses these funds to coordinate educational, medical, and other services and supports for children and youth with autism spectrum disorder, their families, and providers. An increase of $153,755 to the Inherited Metabolic Disorders Program that was eliminated in the DPH Transfer. This program assists with the costs of necessary special foods and supplements for individual patients with PKU or other inherited metabolic disorders. Funds are provided to individuals only after they have shown that all benefits from third-party payors and other government assistance programs have been exhausted. An increase of $20,850 to the Brain Injury Services Program that was eliminated in the DPH Transfer. An increase of $63,711 to backfill the FY 2018 deappropriation. 3

4 This section also includes a $322,100 appropriation to administer the Medical Cannabidiol Act. This amount was built into the base because of the $300,000 DPH Transfer in June Community Capacity $ 2,351,879 $ 4,865,152 $ 2,513,273 This budget unit provides funding intended to strengthen the public health system at the local level. Changes in the bill include: An increase of $250,000 for Des Moines University for psychiatric training for physicians. This is a new allocation that was recommended by the Governor. The program will provide 15 hours of didactic and experiential learning to DMU s third-year osteopathic medical students. NAMI will provide program facilitators, materials and certification; DMU will provide the physicians, space and research in the program implementation. The State funding represents half of the program s budgeted need. An increase of $2,000,000 to resume funding the Medical Residency Program as recommended by the Governor. The program is a matching grants program to provide State funding to sponsors of accredited graduate medical education residency programs in Iowa to establish, expand, or support medical residency training programs. Priority is given to family practice or psychiatric residency programs. An increase of $96,138 to restore the Prevent Blindness Iowa Initiative eliminated in the DPH Transfer. The Program seeks to increase statewide vision screening programs provided to children by volunteers and nurses, and it must specifically target children in child care centers and schools. An increase of $86,548 for the Free Clinics of Iowa that was eliminated in the DPH Transfer. An increase of $41,745 for Specialty Health Care that was eliminated in the DPH Transfer. An increase of $38,842 to partially backfill FY 2018 deappropriations. Eliminates an allocation for a UI initiative to expand and improve the mental health treatment and services workforce. This is no change compared to the estimated net FY 2018 allocation because it was eliminated in the DPH Transfer. Eliminates an allocation transferring funds to the Governmental Public Health System Fund for activities related to the DPH modernization initiative. This is no change compared to the estimated net FY 2018 allocation because it was eliminated in the DPH Transfer. Eliminates the transfer to the College Student Aid Commission for deposit in the Primary Care Trust. This is no change compared to the estimated net FY 2018 allocation because it was eliminated in the DPH Transfer. Essential Public Health Services $ 7,660,942 $ 7,662,464 $ 1,522 The budget unit funds activities and services provided to persons over the age of 55 which are intended to optimize the health status of Iowa seniors. The slight increase is to backfill the FY 2018 deappropriation. Infectious Diseases $ 1,752,786 $ 1,796,426 $ 43,640 4

5 The budget unit funds state activities designed to reduce the incidence of communicable diseases. The slight increase of $43,640 is to backfill the FY 2018 deappropriation. Public Protection $ 4,083,887 $ 4,095,139 $ 11,252 The public protection budget unit funds activities related to protecting public health and safety through the establishment of standards and enforcement of regulations. The increase of $11,252 is to backfill the FY 2018 deappropriation. Resource Management $971,215 $971,215 $0 This budget unit pays for the Director s Office, Department-Wide Activities, the Human Resources Office, and utilities. There is no change from the FY 2018 appropriation. Congenital & Inherited Disorders Registry $258,150 $223,521 -$ 34,629 This is a standing unlimited appropriation from the General Fund in Iowa Code section A(4)(b) that permits the DPH to retain $10 of the $20 Birth Certificate Registration Fee for the Registry. DIVISION IV VETERANS AFFAIRS The section appropriates $11,216,581 to the Department of Veterans Affairs and the Iowa Veterans Home for FY This is an increase of $86,895 when compared to the revised budget for FY Funding is allocated to the following budget units: General Administration $ 1,115,580 $ 1,150,500 $ 34,920 This budget unit goes toward salaries, support, and maintenance of the Department of Veterans Affairs. The increase in funding is for reclassifying the pay grade of the Director (Division XI) and for providing additional funding for cemetery maintenance. Iowa Veterans Home $ 7,162,976 $ 7,162,976 $ 0 The section provides funding for the operation of the Iowa Veterans Home, which operates on net budgeting. Thus, the appropriation provides only the state funds required to operate the facility. 5

6 Home Ownership Assistance Program $ 2,000,000 $2,000,000 $ 0 This section is administered by the Iowa Finance Authority. A $5,000 grant is available to a service member for a down payment and closing costs toward the purchase of a new home in the state. Veterans County Grants $ 938,025 $ 990,000 $ 51,975 The section provides county veteran programs with a matching grant. The money must be used for the administration and maintenance of the County Commission of Veterans Affairs office. The funds are used for office supplies, office rent, personnel, and state and national training. This is an increase of $51,975 compared to estimated net FY DIVISION V DEPARTMENT OF HUMAN SERVICES SECTION 10 Temporary Assistance for Needy Families Block Grant This section appropriates the TANF money received by the state and unused TANF funds from previous years. TANF is a federal block grant that allows states flexibility in using funds to: help needy families care for children, end dependence on public benefits by promoting work, reduce out-of-wedlock pregnancies, and encourage the formation of two parent families. Iowa s federal grant remains the same each year: $131,028,542. The allocations for FY 2019 are: TANF Allocation Amount Family Investment Program Account $4,539,006 PROMISE JOBS $5,412,060 Family Development and Self-Sufficiency (FaDSS) $2,883,980 Field Operations $31,296,232 General Administration $3,744,000 State Child Care Assistance $47,166,826 Child and Family Services $32,380,654 Child Abuse Prevention $125,000 Pregnancy Prevention grants $1,913,203 TANF Technology grants $1,037,186 Expanded Categorical Eligibility for SNAP $14,236 This section also permits DHS to transfer excess funds from the TANF Block Grant appropriation to the FIP Account to be used for assistance through the FIP within the same fiscal year and adds the Child Care Assistance Program to the list of programs to which the DHS can transfer available TANF funds. 6

7 Family Investment Program Account This section describes how funds deposited in the Family Investment Program (FIP) account will be allocated and disbursed by the Department of Human Services. $ 42,634,480 $ 40,365,715 -$ 2,268,765 Iowa s Family Investment Program is a cash assistance program to support low income families with children and to provide services for them to become self-sufficient. The FIP appropriation funds the Promise Jobs Program and the Family Development and Self-Sufficiency Program (FaDSS). It also allows DHS to transfer funds as necessary to meet federal MOE requirements. Changes include: An increase of $10,000 towards the Parenthood Program, formerly known as the Fatherhood Initiative. This program is designed to strengthen parental skills and involvement of men who are living apart from their children. The program offers classes in health and nutrition, effective communication, co-parenting, financial education, and community resources. A decrease of $370,000 to reflect the FY 2018 Deappropriation in FY 2019 A decrease of $1,467,303 based on a general reduction re-adjustment from HF 653 A decrease of $811,462 due to caseload reduction Section 12 SNAP Employment and Training Workgroup This section requires DHS to convene a workgroup to review opportunities to increase State engagement in the Supplemental Nutrition and Assistance Program. Recipients of SNAP benefits can be converted to SNAP Employment and Training, allowing participation in education and training programs in advancement of their skills toward better employment and self-sufficiency. Program costs for SNAP E&T participants are eligible for a federal match. The workgroup is required to submit a report to the Governor and General Assembly by December 15, Section 15 Child Support Recovery $ 12,586,635 $ 14,586,635 $2,000,000 The section funds child support enforcement efforts in Iowa. The increase of $2 million is to replace onetime funding used in FY Medical Assistance $ 1,282,992,417 $ 1,337,946,375 $ 54,953,958 Medical Assistance is a joint federal/state-funded entitlement program that provides medical assistance to certain low-income individuals that are aged, blind, disabled, or pregnant and to children or members of families with dependent children. Funding for Medicaid is based on the Federal Medical Assistance Percentage (FMAP). Changes include: An increase of $54,360,743 to fund the Program at the Medicaid Forecasting Group s March 2018 estimate. An increase of $3,000,000 to increase tiered rates beginning July 1, DHS is required to work with an actuary to evaluate the tiered rates for supported community living and distribute the funds provided for tiered rates. In addition, DHS is required to convene a Tiered Rate Workgroup 7

8 to review actuarial findings and recommendation, and submit a report of the findings to the Governor and General Assembly by December 15, A $3 million increase in state funding amounts to about $7.5 million when combined with federal funding. An increase of $1,545,530 due to the Medicaid oversight language in Division XXVI of this Bill, and as passed unanimously by the House in HF An increase of $1,000,000 for Home Health Low Utilization Payment Adjustment (LUPA) rates compared to the rates in effect in FY 2018 (Section 38 of the bill) An increase of $876,015 to fund HF 2456, comprehensive mental health legislation An increase of $488,033 to increase the age of eligibility for special population nursing facilities to include young adults up to age 30. Currently, facilities like Childserve, can only admit individuals with complex medical conditions up to the age of 21. An increase of $300,000 to fund a partnership between the University of Iowa Hospitals and Clinics and a nonprofit entity to provide new, refurbished, or repaired durable medical equipment. DHS will issue an RFP to establish this partnership. An increase of $140,314 to restore retroactive eligibility for resident of long-term care facilities. A decrease of $6,756,677 to annualize the elimination of the State match for the Disproportionate Share Hospital Program and the Graduate Medical Education Program for the UIHC and Broadlawns Hospital. Those hospitals will be required to provide the State match to draw down federal funds for both Programs. Section 18 Permits DHS to use a portion of the funds appropriated to carry out the Payment Error Rate Measurement (PERM) Program and other reviews and quality control activities. Section 19 Subsection 24: Requires the DHS to delay implementation of federal guidelines related to home and community-based setting criteria until March 17, 2022, to match the delay in the changes to federal law. Subsection 26: Requires DHS to review all current Medicaid fee schedules regarding how the current rates compare to the equivalent Medicare fee schedules and other appropriate reimbursement methodologies and submit a report to the Governor and General Assembly by January 15, Medical Contracts $ 17,312,207 $ 16,603,198 -$ 709,009 This provides the money for DHS to contract out with several entities to carry out programs to support the Medicaid program. Staff performs policy functions; they also manage Medicaid vendors to assure member access, cost effectiveness, and value. Changes include: A decrease of $202,000 to reflect the Governor s FY 2018 veto of funding for a Drake University Autism Program A decrease of $646,266 due to additional funding from the Pharmaceutical Settlement Account A decrease of $175,000 due to surplus funds An increase of $314,257 to backfill the FY 2018 deappropriation Eliminates the allocation for board-certified behavioral analyst and board-certified assistant behavioral analyst grants since it hasn t been funded since FY Eliminates the allocation for a grant for a hospital-based provider in Dubuque County for support services for children with autism spectrum disorder and their families. The hospital discontinued the project. 8

9 State Supplementary Assistance $ 9,872,658 $ 10,250,873 $ 378,215 State Supplementary Assistance helps low-income elderly or disabled Iowans meet basic needs and reduces state spending for Medicaid. The increase is to partially backfill the FY 2018 deappropriation. Section 22 allows DHS to carry forward SSA funds to be used by the Program in FY Children s Health Insurance Program (CHIP) $ 8,418,452 $ 7,064,057 -$ 1,354,395 This section appropriates money for the Healthy and Well Kids in Iowa (hawk-i) program. Changes include: An increase of $41,286 to reflect the current hawk-i Program forecasted need A decrease of $1,395,681 due to an adjustment to the FMAP rate Child Care Assistance $ 39,343,616 $ 40,816,831 $ 1,473,215 The Child Care Assistance program supports low income families with working parents, parents gaining working skills, or parents going to school. In addition to paying for child care, this appropriation supports the regulation of child care providers. Changes include: An increase of $14,476,959 to reflect the current CCA Program forecasted need A decrease of $16,703,744 to use additional Child Care Development Fund An increase of $700,000 to use more General Fund dollars instead of TANF funds to cover the Program An increase of $3,000,000 to increase certain provider rates (discussed in Section 40 of the bill) Juvenile Institutions State Training School at Eldora $ 11,350,443 $ 12,762,443 $ 1,412,000 The State Training School at Eldora provides treatment and educational services to assist youth who are adjudicated delinquent. The changes include: An increase of $212,000 for a Substance Use Disorder Program. There are currently about 50 students currently at the facility that could immediately benefit from substance use disorder treatment. This program was eliminated in FY 2016 after federal funding was no longer available. An increase of $1,200,000 to meet staffing level needs of the federal Prison Rape Elimination Act. Maintaining PREA minimum staffing ratios at the current population cap of 130 students requires an additional 21 FTEs for direct care/security staff. Child and Family Services $ 84,413,610 $ 84,939,774 $ 526,164 9

10 The section appropriates money for various child welfare and juvenile justice programs. Changes include: An increase of $1,467,303 to adjust for an internal transfer within the Department. A decrease of $254,601 due to the FMAP rate adjustment. A decrease of $600,000 to be replaced with federal Social Services Block Grant funds. A decrease of $1,200,000 to reduce the number of guaranteed group care beds from 650 to 600. The average use in February 2018 was 517. A decrease of $285,000 for the Community Circle of Care Grant in northeast Iowa. An increase of $1,398,462 to backfill the FY 2018 deappropriation Adoption Subsidy $ 40,77,910 $40,445,137 -$332,773 This section appropriates funding to provide financial support to families that adopt special needs children. This is a decrease of $332,773 to cover changes in the Iowa FMAP rate and Title IV-E eligibility, but allows funding to also remain in the Program to account for eligibility savings. Family Support Subsidy Program $ 969,282 $ 949,282 -$ 20,000 The Family Support Subsidy appropriation includes two programs: Family Support Subsidy (FSS) and Children at Home (CAH). These programs assist families of children with developmental disabilities to meet the special needs of their disabled children and are administered by the Department of Human Services. SECTION 30 Conner Training The section states that the Department of Human Services is to provide training in accord with the consent decree in Conner v. Branstad mandating placement of persons with developmental disabilities in the least restrictive setting possible. The money is used for building community capacity. The appropriation is the same as last year at $ 33,632. SECTION 31 Mental Health Institutes This section sets out the funding for the state s two mental health institutes. Cherokee Mental Health Institute $ 13,870,254 $ 13,870,254 $ 0 Independence Mental Health Institute $ 17,513,621 $ 17,513,621 $ 0 SECTION 32 State Resource Centers The section appropriates money to the State Resources Centers in Glenwood and Woodward. Both facilities had a decrease compared to estimated net FY 2018 due to an adjustment in the FMAP rate. 10

11 Glenwood State Resource Center $ 17,887,781 $ 16,858,523 -$ 1,029,258 Woodward State Resource Center $ 12,077,034 $ 11,386,679 - $ 690,355 SECTION 33 Civil Commitment Unit for Sexual Offenders $ 9,464,747 $ 10,864,747 $ 1,400,000 This is an increase of $1,400,000 and FTE positions compared to estimated net FY 2018 due to an additional 27 offenders anticipated at the facility due to Iowa vs. Iowa District Court for Jones County. SECTION 34 Field Operations $ 48,484,435 $ 49,074,517 $ 590,082 The section sets the FY 2019 appropriation for local DHS offices and service area offices. Changes include an increase of $590,082 to replace Child Care Facility Fund dollars. SECTION 35 General Administration $ 14,033,040 $ 13,833,040 -$ 200,000 This section funds the central office activities of DHS. The $200,000 decrease is to reflect the item veto of college of direct support Internet training. This section also allocates $300,000 to the DHS for the purpose of continuing the development and implementation of children s mental health crisis services. This section also requires DHS to submit a copy of the strategic plan developed by the state board, as outlined in the Governor s Executive Order, on children s mental health to the General Assembly by November 15, SECTION 36 - Department-Wide Duties $2,879,274 $2,879,274 $0 This appropriation is to ensure adequate staffing among DHS facilities and transfer staff as needed, while remaining within the set number of authorized positions. SECTION 37 Volunteers The section sets the FY 2019 appropriation at $84,686 for the development and coordination of volunteer services, which is the same as FY Child Abuse Prevention $232,570 $232,570 $0 11

12 Commission of Inquiry $1,394 $1,394 $0 Nonresident Commitment Mental Illness $142,802 $142,802 $0 This section reinstates the $120,000 from the FY 2018 deappropriation. Section 39 Rates Requires the reimbursement rates for all noninstitutional Medicaid providers, with specified exceptions, to remain at the rates in effect in FY 2018 or to meet federal mental health parity requirements Requires the reimbursement rate for anesthesiologists to remain at the rate in effect in FY 2018 and updated on January 1, 2019, to align with the most current Iowa Medicare anesthesia rate. Section 40 Child Care Assistance This section maintains the FY 2018 child care provider reimbursement rate from July 1, 2018 to December 31, Effective January 1, 2019, reimbursement rates for providers will increase, within $3 million of funds available, starting at the rate furthest from the 50 th percentile of the 2014 Market Rate Survey (MRS) up to the relative percentage of the second lowest rate as compared to the 50 th percentile of the 2014 MRS. If funds are projected to remain available, the lowest rates will continue to increase in a similar manner. The total cost of moving to the 50 th MRS is estimated at about $8.6 million with state and federal funds. Also effective January 1, 2019, the infant and toddler care reimbursement rate for providers participating in the Quality Rating System will move to the 75 th percentile of the 2014 MRS, to the extent that the expenditures fit within the expected increase of funding in the federal Consolidated Appropriations Act of 2018 for the Program. Section 41 Eliminates language allowing DHS to adjust rates due to cost containment. Section 42 Eliminates the General Fund reduction of $733,651 to all appropriations under DHS. DIVISION VI HEALTH CARE ACCOUNTS AND FUNDS SECTION 43 Pharmaceutical Settlement Account The section appropriates the funds received in the pharmaceutical settlement account to the Department of Human Services for the Medical Contracts line item. This year s amount has an increase of $582,009 compared to estimated net FY 2018 due to additional funds available in the Account. 12

13 SECTION 44 Quality Assurance Trust Fund For FY 2019, $36,705,208 will be appropriated from the quality assurance trust fund to DHS for Medicaid. This is no change from last year. This fund is used to supplement nursing facilities under the Medicaid program. The 3% nursing facility assessment fee for this fund is increased in section of the bill. SECTION 45 Hospital Health Care Access Trust Fund Department of Human Services $33,920,554 will be appropriated from the Hospital Health Care Access Trust Fund to DHS for Medicaid in FY DIVISION VII PRIOR YEAR APPROPRIATIONS AND OTHER PROVISIONS Amends the Social Services Block Grant State Cases appropriate for FY 2018 and eliminates the appropriation in FY Adds the Child Care Assistance Program to the list of programs to which DHS can transfer available TANF funds. First priority will be given to the FIP, followed by the Child Care Assistance Program payments for employed families, followed by other priorities specified by DHS. Amends FY 2019 language related to the PERM program to allow for funds to be used to support other reviews and quality control activities. Sections Allow any unexpended funds appropriated to SSA, Eldora State Training School, the MHIs, the Resource Centers, or CCUSO from FY 2018 to remain available for FY This Division is effective upon enactment and retroactive to July 1, DIVISION VIII DECATEGORIZATION This Division transfers to Medicaid decategorization funds that would have previously reverted to the General Fund. It is estimated that $500,000 will be transferred to Medicaid in FY This Division is effective upon enactment and retroactive to July 1, DIVISION IX STATE CASES This Division removes references to state cases for mental health services provided to individuals with no counties of legal settlement. Counties will now be responsible for paying for services of individuals within a MHDS Region. This will decrease annual expenditures from the Social Services Block Grant by $600,000 beginning in FY

14 DIVISION X IOWA DEPARTMENT ON AGING MEDICAID CLAIMING This Division requires IDA and DHS to develop a cost allocation plan requesting federal Medicaid administrative funds for the Aging and Disability Resource Center. Administrative claiming provides federal financial participation to cover activities that contribute to the efficient and effective administration of the Medicaid program. Many states have applied or are preparing to apply for a Medicaid state plan amendments on this topic since CMS and ACL have endorsed this cost allocation plan. This concept was presented to the HHS Budget Subcommittee on January 18, This Division is effective upon enactment. DIVISION XI EXECUTIVE DIRECTOR DEPARTMENT OF VETERANS AFFAIRS Reclassifies the Director of the Department of Veterans Affairs from a salary Range 3 (salary between $55,380 and $84,750) position to a Range 5 position (salary between $73,250 and $112,070). Additional funding was provided in Division IV for this change. Director level positions with similarly sized state agencies are also at salary Range 5. This Division is effective upon enactment. DIVISION XII FAMILY PLANNING SERVICES PROGRAM Amends the Family Planning Services Program to allow for the UnityPoint Health Care Group to participate. This is in response to the Attorney General s interpretation of entity within the state family planning program. The distinct location that is providing the family planning services cannot perform abortions. This Division requires DHS to adopt rules to require that as a condition of eligibility as a provider under this Division, that each distinct location shall enroll in the program as a separate provider, be assigned a distinct provider identification number, and complete an attestation that abortions are not performed at the distinct location. UnityPoint hospitals do not provide elective abortions. This change allows UPH facilities like Allen Hospital, the UPH facility in Muscatine and others that do not perform any abortion procedures to participate in the Family Planning Services Program. This Division is identical to House File

15 DIVISION XIII PROVISION REGIONALIZATION AUTHORIZATION Section 82 Specifies that Polk County is exempt from the requirement to enter into a regional service system, but the Board of Supervisors must meet all requirements of a region. Section 83 Specifies that the Director of DHS is to approve any region meeting the requirements of Iowa Code section , subsection 3. Section 84 Eliminates exceptions to counties joining regions that are not contiguous. Section 87 Beginning FY 2020, the MHDS regions per capita expenditure target amount is the sum of the base expenditure amount for all counties in the region divided by the population of the region, not to exceed the statewide per capita expenditure target of $47.28 per capita. Section 88 Allows the Director of DHS to authorize counties in the County Social Services Region to join with other counties requesting to be removed from the Region to form a new region. This section also requires the counties forming a new region to have a total combined population of more than 100,000 and a city with a population of more than 24,000. In addition the new region must meet the following requirements: The board of supervisors of each county forming the region has voted to approve a chapter 28E agreement and those authorized from the counties have signed The region s governing board is appointed Executive staff for the region is identified or engaged The regional service management plan is developed and submitted to the DHS A service provider network for the region must be identified Each county must submit information to DHS by February 1, 2019 and DHS shall determine if the region is in full compliance. By February 1, 2019, the DHS Director shall assign a county making a request that has not reached an agreement to be part of the proposed new region to an existing region or to the new proposed region. If the new region is approved by DHS, they are required to be in full operation by July 1, DHS has approved the language in this Division. This Division is effective upon enactment. DIVISION XIV MANDATORY REPORTER TRAINING AND CERTIFICATION WORKGROUP Establishes a workgroup to make recommendations related to mandatory child abuse and dependent adult abuse reporter training and certification. The workgroup will consist of representatives from DHS, DOE, DPH, DPS, DHR, IDA, and the AGs office. The report is due to the Governor and General Assembly by December 15, This division is identical to Senate File 2300, and it passed the Senate unanimously on March

16 DIVISION XV NURSING FACILITY QUALITY ASSURANCE ASSESSMENT This Division eliminates the 3% cap on the nursing facility provider assessment and sets the cap at the maximum amount allowed by the federal government (6%). The current 3% assessment raises $36,705,208 annually. The new assessment may generate up to $73,410,416 annually for the Quality Assurance Trust Fund which is intended to be increased Medicaid reimbursement for nursing facilities. The industry has indicated that it will seek a new assessment rate of 4%. DHS must request approval from CMS to increase the provider tax for nursing facilities. Any change is required to take effect on the first day of the calendar quarter following the date of approval by CMS. DIVISION XVI SEXUAL OFFENSES AND SEX OFFENDERS This Division was part of House File 2401 and Senate File 2356, which passed the House 96-1 and the Senate 50-0 in non-identical bills. That bill eliminated provisions permitting a person committed as a sexually violent predator under Iowa Code chapter 229A to be released from a secure facility or a transitional release program without supervision. In addition, the Division eliminates the requirement that a hearing be held within five days of the committed person s return to a secure facility after the person leaves a transitional release program. The hearing will now be held after an evaluation has been performed. This Division also modifies the criteria for commission of a sexual offense against a child to establish that the offense only applies to a person who is 14 years old or older that residence in a home with the child. Under current law, the offense applies regardless of age. In addition, this Division modifies the criteria for allowing access to a registered sex offender to establish that the offense applies to a person responsible for the care of a child who knowingly allows access to a person who is required to register on the sex offender registry, and provides some exceptions. DIVISION XVII MEDICAID RETROACTIVE ELIGIBILITY This Division reinstates the three-month retroactive coverage benefit under Medicaid for individuals residing in long-term care facilities. This change is estimated to increase General Fund expenditures for Medicaid by $140,314 in FY This provision was in the House version of the FY 2018 budget adjustment (HSB 648, Division IV). 16

17 DIVISION XVIII MHDS TRANSFER OF FUNDS BY POLK COUNTY Allows Polk County to transfer any funds not raised through county property tax levies to the County Mental Health and Disability Services Fund for 1 year. The county must submit a report to the governor and general assembly by September 1, 2019 that includes the source of any funds transferred, the amount of the funds transferred, and the mental health and disability services provided with the transferred funds. DIVISION XIX MISCELLANEOUS TECHNICAL PROVISIONS Makes a technical change to the Oral and Health Delivery System Bureau s name and adds language to utilize a defined term, as recommended by the Code Editor. The Code Editor also recommended the insertion of the nurse residency state matching grants program after it was unintentionally not inserted back into Code in a previous year. DIVISION XX STATE TRAINING SCHOOL ELDORA States that the Eldora State Training School is for court-committed male juvenile delinquents and eliminates references to the Toledo State Training School. These were non-controversial components of HF 2399, which passed the House on March 7. DIVISION XXI GERIATRIC PATIENT HOUSING REVIEW Requires IDA, DHS, DIA, and DOC to review issues and develop policy recommendations relating to housing for geriatric persons who are registered sex offenders or are sexually aggressive. The Departments are to study the feasibility of utilizing the facilities at Mount Pleasant, Clarinda, or other vacant state-owned facilities, while taking into consideration Medicaid reimbursement rules. The Departments are required to submit a report to the Governor and the General Assembly by December 15, DIVISION XXII DISTRIBUTION OF FEDERAL FUNDS RESTRICTIONS ABORTION SECTION 116 Distribution of Federal Public Health Services Act Funds for Family Planning Directs DPH to distribute all grant funding received through Title X of the federal Public Health Services Act on the basis of a prioritized schedule of applicants. Funds cannot be made to any entity that performs abortions or that maintains or operates a facility where abortions are performed. DPH is required to submit 17

18 an annual report listing any entities that received funds under this section and a detailed explanation of how the department determined that distribution of funds to such an entity was necessary to prevent severe limitation of elimination of access to family planning services in the region of the state where the entity is located. SECTION 117 Administration of Personal Responsibility Education Program and Abstinence Education Grant Program Funds Directs DPH, beginning with any contract entered into on or after July 1, 2018, to administer the State Abstinence Education Grant Program, and to exclude as an eligible applicant any applicant entity that provides abortions, maintains or operates facilities where abortions are performed, or regularly makes referrals to an entity that provides abortions or maintains or operates a facility where abortions are performed. SECTION 118 Award of Community Adolescent Pregnancy Prevention and Services Program Grant Funds Directs DHS, beginning with any contract entered into on or after July 1, 2018, to exclude from the award of federal TANF block grant funds appropriated to the Department for the Community Adolescent Pregnancy Prevention and Services Program any applicant entity that provides abortions, maintains or operates a facility where abortions are performed, or regularly makes referrals to an entity that provides abortions or maintains or operates a facility where abortions are performed. DIVISION XXIII WRONGFUL BIRTH OR WRONGFUL LIFE CAUSE OF ACTION This Division is in response to an Iowa Supreme Court Case, Plowman v Ft. Madison Community Hospital. The case created a claim for wrongful birth. This cause of action has not ever existed in Iowa law. Wrongful birth is a lawsuit brought by parents claiming they would have aborted the child if they had known the child had certain disabilities. Multiple courts across the country have recognized a right to sue for wrongful birth. At least 9 states have passed laws to ban these suits after court decisions, and at least 1 state (Maine) has a law allowing wrongful birth lawsuits to proceed. This Division bans a person from brining a wrongful birth or wrongful life lawsuit. The Division does not stop a lawsuit for intentional or gross negligence, or omission. A doctor cannot willingly hide information from a mother to prevent her from having an abortion. This Division is identical to House File 2405, which passed the House on February 27 with a vote of This Division is effective upon enactment and applies only to cause of action that accrue on or after the effective date. DIVISION XXIV TRANSFER OF FUNDS BETWEEN DHS INSTITUTIONS Requires DHS to report to LSA any transfers made between the appropriations for the State Resource Centers, the MHIs, the State Training School, and the CCUSO within 30 days of the beginning of each fiscal quarter. 18

19 DIVISION XXV MEDICAL CANNABIDIOL This Division allows fee revenue generated by the Medical Cannabidiol Program to not revert to the General Fund at the end of the fiscal year, but remain available for successive years for the purposes of the Program. This Division also directs DPS to conduct background investigations of applicants for medical cannabidiol manufacturer and medical cannabidiol dispensary licenses, including employees, owners of, and investors in, any such applicants. This Division also permits DPS to establish what required information should be provided and a fee, as well as makes conforming changes to background checks for employees of manufacturers and dispensaries of medical cannabidiol. This Division takes effect upon enactment. DIVISION XXVI DEPARTMENT OF HUMAN SERVICES PROGRAMS AND ACTIVITIES This Division is modeled after HF 2483, as passed by the House unanimously on April 23. Section 128 Sharing of Incarceration Data This section requires DHS to suspend Medicaid eligibility of an individual following the first 30 days of the individual s commitment to a public institution. Public institutions (county jails) must share incarceration data with Iowa Medicaid through a monthly report. Section 129 Medicaid Program Administration Provider Processes and Procedures: Requires the MCOs to pay providers within the timelines specified in their contract and to provide reasons for denials of claims. Requires the MCOs to correct any errors it finds due to system configuration and fully reprocess the claims affected by the error within 30 days of the discovery. Requires the MCOs to provide written notice to affected individuals at least 60 days prior to making any program or procedural changes as determined by DHS. Requires DHS to engage dedicated provider relations staff to assist Medicaid providers in resolving billing conflicts with MCOs, including conflicts involving denied claims, technical omissions, or incomplete information. Requires DHS to adopt rules to require the inclusion of advanced registered nurse practitioners and physician assistants as primary care providers by MCOs. Requires DHS to develop and require the MCOs to use a standardized provider enrollment form to be used for credentialing. 19

20 Member Services and Processes: Requires the MCOs to reimburse for court-ordered services or treatment for the first 3 days. After that time period, the MCO can apply medical necessity criteria to determine if the services are appropriate. Requires DHS to update eligibility files in a timely manner. Requires DHS to utilize an independent external quality review vendor to complete a review of a random case sample of decreased level of care determinations and report the findings to the Governor and Legislature by December 15, Requires DHS to conduct an annual analysis of member appeals that have been dismissed, withdrawn or overturned and determine if there are any negative patterns. DHS is required to submit a report to the Governor and General Assembly on a biannual basis. Medicaid Program Review and Oversight Requires DHS to facilitate a workgroup with the MCOs and health home providers to review the health home program. The review must include an analysis of the State Plan Amendment and the current health home system, the development of a clear and consistent delivery model linked to program-determined outcomes and data reporting requirements, and a work plan to communicate with stakeholders. The workgroup must submit a report to the legislature and governor by December 15, Requires DHS, along with providers and MCOs, to initiate a review of prior authorizations with the goal of making adjustments based on relevant costs and member outcomes data. Requires DHS to contract with an external review organization to perform an audit of small dollar claims ($2,500 or less) from 2018 paid to or denied to Medicaid long-term services and supports providers. This section also requires a report to the legislature in December with the results of the audit. Section 130 Medicaid Program Pharmacy Copayment This section changes the pharmacy copayment to a flat copayment ($1.00) and no longer bases it on preferred/nonpreferred status on the Preferred Drug List to be consistent with federal regulations. Sections 131 and 132 Medical Assistance Advisory Council (MAAC) These sections remove the Iowa coalition of home and community-based services for seniors and the Iowa adult day services association from the MAAC membership roster since they both have dissolved. These sections also add in a requirement that the MAAC Executive Committee review data collected and analyzed for inclusion in periodic reports to the legislature, as specified in code, to determine which data points and information should be included and analyzed to more accurately identify trends and issues with the managed care program. The MAAC Exec Committee will then report their recommendations to the entire MAAC, and then report final recommendations to the legislature and governor by December 31, Section 133 Elimination of Cost-Based Reimbursement This Division eliminates cost-based reimbursement for targeted case management services and psychiatric medical institutions for children (PMICs) beginning July 1, DHS will develop a fee schedule for these providers. 20

21 DIVISION XXVII PREAPPLICATION SCREENING ASSESSMENT Eliminates the requirement that the State Court Administrator develop the practices and procedures for preapplication screening for the hospitalization of persons with mental illness. The Mental Health bill passed this year, HF 2456, requires DHS to develop rules regarding pre-commitment screenings. This division still maintains the requirement that the clerk of the district court shall inform any interested person about the option of requesting a preapplication screening assessment. DIVISION XXVIII COVERAGE OF BEHAVIORAL HEALTH SERVICES PROVIDED BY CERTAIN PROVIDERS This Division adds language for behavioral health service providers (Psychologists, Licensed Marital and Family Therapists, Licensed Master Social Workers, Licensed Mental Health Counselors) to allow individuals practicing under a temporary license to bill to Medicaid and private insurance for services provided under the supervision of a licensed practitioner. This Division is effective upon enactment. DIVISION XXIX PHARMACY BENEFITS MANAGER RIGHTS OF COVERED INDIVIDUALS This Division amends Iowa Code chapter on Regulation of Pharmacy Benefits Managers (PBMs) to add certain rights related to individuals, including: Prohibiting a PBM from barring a pharmacy or pharmacist from advising an individual about other inexpensive alternative prescription drugs available. Prohibiting a health benefit plan from requiring a copayment for pharmacy benefits that exceed the pharmacy or pharmacist s submitted charges. Requiring that any amount paid for covered prescription drugs to be applied to any deductible imposed by the individual s health benefit plan. Establishing that any federal law, rule, or regulation supersedes this law to the extent necessary to eliminate the inconsistency or conflict. House Government Oversight had a public hearing investigating PBMs on April 18,