FISCAL YEAR 2015 HEALTH AND HUMAN SERVICES BUDGET

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1 Bill: HF 2463 Committee: Appropriations Date: April 28, 2014 Floor Manager: Representative Dave Heaton Staff: Carrie Kobrinetz (5-2063) FISCAL YEAR 2015 HEALTH AND HUMAN SERVICES BUDGET The House bill appropriates a total of $1,858.4 million 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). This is an increase of $107.4 million compared to estimated FY Summary of Action House HHS Budget Subcommittee Passed HSB 685 on April 2 (5-4). House Appropriations Committee Passed HSB 685 on April 3 (14-11). House Floor Passed House File 2463 on April 10 (51-47). Senate Appropriations Committee Passed April 17 (13-6). Senate Floor Passed April 21 (26-22). House Refused to Concur April 22. Senate Insisted April 22. House and Senate Conference Committee Appointed April 22. DEPARTMENT OF AGING Department on Aging $10,606,066 $10,931,066 $10,606,066 $11,419,732 $813,666 An increase of $288,666 for the Office of Substitute Decision Maker. An increase of $525,000 for the Aging and Disability Resource Centers. 1

2 OFFICE OF LONG-TERM CARE OMBUDSMAN Office of Long-Term Care Ombudsman $1,021,707 $929,315 $821,707 $929,315 $-92,392 The addition of $107,608 to add a discharge specialist. DEPARTMENT OF PUBLIC HEALTH Department of Public Health $58,030,568 $58,973,924 $58,696,686 $58,782,260 $751,692 Addictive Disorders $27,163,690 $27,088,690 $27,088,690 $27,263,690 $100,000 A net increase of $100,000 in tobacco funding. Healthy Children and Families $3,653,559 $3,628,559 $3,671,602 $4,046,602 $393,043 A status quo budget for children s hearing aids. The House budget removed $25,000 for this because the funds had not yet been spent but the Conference Committee chose to add it back. A $50,000 increase for Adverse Childhood Experiences (ACEs). An $300,000 increase to expand the First Five program. This expansion is not state-wide. Chronic Conditions $5,080,692 $5,040,692 $5,040,692 $5,155,692 $75,000 A $50,000 increase for epilepsy support. 2

3 A $25,000 increase for the Medical Cannabidiol Act Administration. NOTE - there is only an appropriation in the bill for this, there is no policy language. Therefore, if the policy bill does not pass both chambers this money will go into the Medicaid Waiver Waiting List Buydown. Community Capacity $8,562,617 $9,562,617 $9,192,336 $8,737,910 $175,293 A $75,000 increase for Direct Caregivers. A $100,000 increase for the Organ Donor Registry. A $293 increase for the FIND dental program. A $1,000,000 decrease for the Medical Residency Program. There is $2 million in the base for this appropriation that has not been utilized by the Department of Public Health yet. Healthy Aging $7,297,142 $7,297,142 $7,297,142 $7,297,142 0 Environmental Hazards $803,870 $803,870 $853,870 $853,870 0 Infectious Diseases $1,335,155 $1,335,155 $1,335,155 $1,335,155 0 Public Protection $3,278,771 $3,297,127 $3,297,127 $3,287,127 $8,356 A $75,000 reduction for EMS benchmarks and trauma assessment. 3

4 Resource Management $855,072 $920,072 $920,072 $920,072 0 VETERANS AFFAIRS Department of Veterans Affairs and Iowa Veterans Home $11,280,947 $12,180,947 $12,180,947 $12,180,947 $900,000 General Administration $1,095,951 $1,095,951 $1,095,951 $1,095,951 0 Iowa Veterans Home $7,594,996 $7,594,996 $7,594,996 $7,594,996 0 Home Ownership Assistance Program $1,600,000 $2,500,000 $2,500,000 $2,500,000 $900,000 Limitation of County Commission of Veterans Affairs Fund Standing Appropriation $990,000 $990,000 $990,000 $990,000 0 DEPARTMENT OF HUMAN SERVICES Family Investment Program General Fund 4

5 $48,503,875 $48,503,875 $48,503,875 $48,693,875 $190,000 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, the Family Self-Sufficiency Grant, and FaDSS. Conference Report Changes: A $150,000 increase for FaDSS (Family Development and Self Sufficiency). A 40,000 for the fatherhood initiative at the YMCA. Child Support Recovery $14,215,081 $14,911,230 $14,911,230 $14,911,230 $696,149 Medical Assistance $1,144,208,805 $962,091,053 $1,250,658,393 $1,250,658,393 $106,449,588 Conference Committee changes include: A $252,000 increase to fund the increase in the statewide average of care for the Miller Trust bill. A $1,000,000 increase to get Medicaid to the midpoint. $1,250,000 for nursing home rebasing. $6,000,000 for the Medicaid Waiver Waiting List Buydown (this is an increase of $2 million from the House bill). $238,938 for a 10% EMS provider rate increase. Medical Contracts $12,320,048 $16,323,366 $17,148,576 $17,148,576 $4,828,528 State Supplementary Assistance $16,516,858 $14,121,154 $14,121,154 $14,121,154 $-2,395,704 Children s Health Insurance Program (CHIP) 5

6 $36,817,261 $45,877,998 $45,877,998 $45,877,998 $9,060,737 Child Care Assistance $62,735,563 $57,925,206 $45,622,828 $47,132,080 $-15,603,483 Notable Conference Committee changes include: A $1,509,252 increase to allow people to work and go to school a combination of 28 hours per week and still get child care assistance. Juvenile Institutions State Training School at Eldora $11,268,202 $11,500,098 $11,500,098 $12,358,285 $1,090,083 Conference Committee changes include: A new $858,187 appropriation to have an after care/ PALS program for post-state training school youth. This will help the kids transition into the community after they are 18. Iowa Juvenile Home at Toledo $8,867,121 $788,531 $788,531 $507,766 $-8,359,355 Conference Committee: The Senate agreed that the Iowa Juvenile Home should remain closed. The conference committee appropriated $500,000 to maintain the facility. The report makes a $2 million appropriation to help place Children In Need of Assistance (CINA) in private placements. The conference committee removed the Governor s recommended $1.2 million appropriation for the remedial education of CINA and juvenile delinquent girls who may have received interrupted educational services when transitioning the juvenile home. The committee recommended this be placed in the Debt Reduction bill. The report directs DHS to engage with the Chief Juvenile Court Officers and others to develop and implement a tracking system to keep track of children adjudicated as delinquent or CINA. The purpose of this is to identify the outcomes experienced by these children following placement and for the two year period following their last placement. The report appropriates money for Preparation for Adult Living Services (PALS). This requires DHS to establish a program directed toward young adults. The purpose of the program is to 6

7 assist people who leave foster care and other court-ordered services at age 18 to help them make the transition into self-sufficiency. Children Adjudicated as Delinquent or CINA Placements $0 $5,110,534 $5,110,534 $2,000,000 $2,000,000 Conference committee changes include: A decrease of $1,218,000 for remedial education for the children that were previously placed at Toledo. The committee recommended that appropriation be placed in the Debt Reduction bill. A decrease of around $2 million for placement of CINA and juvenile delinquents. Child and Family Services $91,329,427 $91,762,511 $95,920,906 $94,857,554 $3,528,127 Conference committee changes include: A decrease of $700,000 for the rebase of group foster care rates. There are no losers in this scenario. Adoption Subsidy $40,729,282 $42,580,749 $42,580,749 $42,580,749 $1,851,467 Family Support Subsidy Program $1,093,288 $1,079,739 $1,079,739 $1,079,739 $-13,549 Mental Health Institutes This section sets out the funding for the state s four mental health institutes. All facilities received an increase due to higher costs of food, pharmaceuticals, transportation, and utilities. Cherokee Mental Health Institute $5,964,737 $6,031,934 $6,031,934 $6,031,934 $67,197 Clarinda Mental Health Institute 7

8 $6,757,689 $6,787,309 $6,787,309 $6,787,309 $29,620 Independence Mental Health Institute $10,334,082 $10,484,386 $10,484,386 $10,484,386 $150,304 Mount Pleasant Mental Health Institute $1,374,061 $1,417,796 $1,417,796 $1,417,796 $43,735 State Resource Centers The section appropriates money to the State Resources Centers in Glenwood and Woodward. Additional funds are provided to cover the reduction in the federal FMAP rate. Glenwood State Resource Center $20,349,122 $21,695,266 $21,695,266 $21,695,266 $1,346,144 Woodward State Resource Center $14,286,191 $14,855,693 $14,855,693 $14,855,693 $569,502 Sexually Violent Predators $9,425,568 $9,923,563 $9,923,563 $9,923,563 $497,995 Field Operations $66,670,976 $66,670,976 $66,670,976 $65,170,976 $-1,500,000 8

9 Conference Committee changes include: A $1.5 million reduction because they had not used funds appropriated in previous years. General Administration $16,329,602 $16,079,602 $16,304,602 $16,072,302 $-257,300 Conference Committee changes include: A $250,000 decrease for the Mental Health Advocate program. The committee removed the entire mental health advocate portion of the bill. LANGUAGE CHANGES Department on Aging The conference report re-establishes the Office of Substitute Decision Maker. Substitute Decision Makers serve as guardians, conservators, representative payees, and attorney-in-facts under powers of attorney. A discharge specialist was added. They will assist residents and tenants with voluntary and involuntary discharges and evictions from health care facilities, elder group homes, and assisted living programs. Department of Public Health The report directs IDPH to engage stakeholders to review reimbursement provisions for substance abuse providers and report back to the General Assembly. The report directs IDPH and the Department of Education to submit recommendations to the General Assembly about options for continuing the work of the Young Adult Suicide Prevention Program (Y-YASP). The report appropriates $25,000 for the implementation of the Medical Cannabidiol Act, if it is enacted. If it is not enacted, this money will be moved to the HCBS Waiver Waiting List Buydown. The report directs the Department of Human Services to work with the Iowa Collaborative Safety Net Provider Network and the Iowa Primary Care Association to develop a plan for a statewide network to provide an integrated approach to health care delivery. The report states that priority will be given to psychiatric and family practice residency positions for the medical residency grant program. The hope is that this will encourage new residency slots to open up in Iowa. The report establishes a Healthiest Children Initiative in the Department. The purpose is to develop and implement a plan for Iowa children to become the Healthiest Children in the nation by January 1, Department of Human Services If federal approval is granted, DHS is directed to expand hospital presumptive eligibility to include Federally Qualified Health Centers. The report directs DHS to transfer $100,000 to IDPH to be used for a program to assist parents in Iowa with costs resulting from the death of a child. 9

10 The report directs DHS to engage with the Chief Juvenile Court Officers and others to develop and implement a tracking system to keep track of children adjudicated as delinquent or CINA. The purpose of this is to identify the outcomes experienced by these children following placement and for the two year period following their last placement. The report directs DHS to review the feasibility of expanding foster care and subsidized adoptions to be available on a voluntary basis to young adults who become 18 while in the child welfare system. The report specifies that only hospitals located in the state of Iowa may qualify for disproportionate share hospital payments. Currently, some money that Iowa hospitals should receive is going to adjacent states, like Nebraska, for border hospitals. The report directs DHS to distribute the nursing facility rebase payments from last year immediately. The report appropriates money for Preparation for Adult Living Services (PALS). This requires DHS to establish a program directed toward young adults. The purpose of the program is to assist people who leave foster care and other court-ordered services at age 18 to help them make the transition into self-sufficiency. The report requires DHS to notify the legislature when they apply for a State Plan Amendment to Medicaid. The report allows a combination of work and education for people trying to obtain child care assistance. The report makes the Poison Control center appropriation effective upon enactment so that DHS can ask for CHIP funds immediately upon passage of the bill. The report requires the Insurance Commissioner to develop a single prior authorization form. The report requires the Insurance Commissioner to engage stakeholders to review differences in external review of adverse determinations. The report makes changes to Group Foster Care rates. The percentages were changed to the following: Classification House Percentage Conference Report Percentage Conference Report Per Diem D1 71% of cost 64.53% of cost $84.17 per day D2 78% of cost 78% of cost $ per day D3 93% of cost 93% of cost $ per day Committees The report requests a Long Term Care Delivery Interim Committee be established. This committee would examine issues relating to aging Iowans and long-term care. The report requests a Child Welfare Services Committee be established. The group would include a number of stakeholders and would require a report to the General Assembly. The bill directs DHS to engage stakeholders to review the potential for development and submission of a Medicaid state plan amendment for elders. 10

11 Mental Health and Disability Services The conference report makes an effort to align the three major components of Mental Health Redesign: 1. The $47.28 county mental health levy The conference report includes House File The $47.28 levy is set to sunset in FY15. The bill pushes the sunset date to FY The Clawback or Medicaid Offset 80% of the Medicaid Offset amount will return to the state while the counties will retain 20% of this amount (this amount was in the law passed last year). The bill extends the clawback to FY Equalization payments Equalization payments are set to expire in FY16 under current law. With the passage of this conference report, the three major components of mental health redesign will all be in alignment and will sunset in FY16. The conference report also establishes how the Medicaid Offset amount will be calculated by the Department of Human Services. Medicaid Offset Calculation DHS and the counties will get together and agree to a code set for the services and supports provided under the regional system for people that qualify for the Iowa Health and Wellness Plan. They must do this by June 30, Below is an illustration of how the Offset will be calculated. 80% of the savings amount will be given back to the state by the counties. 20% of the savings amount will be retained by the counties. The 80% that comes back to the state will go into a fund that will be utilized by future legislatures to distribute money back into the MHDS system for services. Counties that do not get equalization or counties whose offset is more than the equalization amount will have property tax relief. Savings Actual Aggregate County Expenditures ICD-9 and CPT Codes 7/1/ /31/13 Actual Aggregate County Expenditures ICD-9 and CPT Codes 1/1/2014-6/30/14 If the I-HAWP savings are less than this offset calculation then the I-HAWP savings would be used. 11

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