Bill: Date: Floor Manager: Staff:
House File 2460 Health and Human Services FY 2017 Budget April 18, 2016 Representative Dave Heaton Carrie Malone (5-2063)
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FISCAL YEAR 2017 HEALTH AND HUMAN SERVICES BUDGET The House bill appropriates $1,836,364,265 from the General Fund to the Department on Aging, the Department of Public Health, the Department of Human Services, the Department of Veterans Affairs, and the Iowa Veterans Home. 2016 Estimated Net $1,832,865,612
2017 Governor $1,859,923,155
2017 House $1,836,364,265
House 17 vs. Estimated FY 16 $3,498,653
Major funding changes include: $3,000,000 to increase the number of slots available for the HCBS waivers. $2,200,000 for a 1% provider rate increase for Community Based providers. $4,000,000 decrease to require the U of I to provide matching funds for the Disproportionate Share Hospital (DSH) payment. $16,772,391 decrease due to process improvement changes by DHS. $3 million for Polk County and the Eastern Iowa MHDS region for mental health grants. $300,000 for children’s mental health. $976,231 for further implementation of the First Five program. Major policy changes include: House Medicaid Oversight Proposal - Sets up a structure for oversight of Managed Care related to consumer protection, outcome achievement, and program integrity. Autism Support Program - Expands eligibility from 9 to 14 years of age and from 400% to 500% of the federal poverty level. Mental Health Redesign - Requires DHS to report on the progress and make recommendations. State Family Planning Services Program - Requires DHS to discontinue the Medicaid Family Planning Network Waiver effective July 1, 2016 and create a new State Family Planning Program. Children’s Mental Health and Well-Being Workgroup - Directs the DHS to establish a process to contract for two planning grants for the development of children’s mental health crisis services. Nursing Facility Supplemental Payment Program - Provides a supplemental payment to nursing facilities in a budget-neutral way. Care Provider - Provides a patient with the opportunity to designate a family member as their caregiver and who the provider can discuss the patient’s health information with. Hospital Assessment - Repeals assessment and requires DHS to explore alternatives. 1
DIVISION I DEPARTMENT ON AGING SECTION 1 – Department on Aging Total Department on Aging Appropriation: 2016 2017 Estimated Net Governor $11,399,732 $11,436,066
2017 House $11,436,066
House 17 vs. Estimated FY 16 $36,334
This section 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 include: The house took the Governor’s recommendation to add $36,334 to fully fund the Office of Substitute Decision Maker.
DIVISION II OFFICE OF LONG-TERM CARE OMBUDSMAN SECTION 2 – Office of Long-Term Care Ombudsman 2016 2017 2017 Estimated Net Governor House $1,276,783 $1,276,783 $1,276,783
House 17 vs. Estimated FY 16 $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 House did not increase funding for this office.
DIVISION III DEPARTMENT OF PUBLIC HEALTH SECTION 3 – Department of Public Health Total Public Health Appropriation: 2016 2017 Estimated Net Governor $59,484,820 $57,812,621
2017 House $59,288,852
House 17 vs. Estimated FY 16 $-195,968
Addictive Disorders 2016 Estimated Net $27,263,690
2017 House $26,988,690
House 17 vs. Estimated FY 16 $-275,000
2017 Governor $26,988,690
This budget unit provides funding for services directed toward reducing the use of tobacco, alcohol and other drugs, and treating Iowans with addictive disorders. Changes include:
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The House took the Governor’s recommendation to take $275,000 that usually reverts to the general fund from the Gambling Prevention Program and use that money elsewhere in the Department of Public Health. This will not cut services. The House requires DPH to collaborate with the Alcoholic Beverages Division. This section allows Public Health to have more flexibility in the funding of substance abuse.
Healthy Children and Families 2016 2017 Estimated Net Governor $4,617,543 $4,617,543
2017 House $5,593,774
House 17 vs. Estimated FY 16 $976,231
This budget unit provides funding for programs that promote the health status of children and adults. Among the services funded by this area is the Healthy Opportunities to Experience Success (HOPES) program, assistance for voluntary dental care, childhood obesity prevention, and audiology services to children. The House chose to appropriate almost a million dollars to fully implement First Five in an additional 13 counties. Chronic Conditions 2016 Estimated Net $4,955,692
2017 Governor $4,930,692
2017 House $4,930,692
House 17 vs. Estimated FY 16 $-25,000
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. The House took the Governor’s recommendation to decrease funding in this area due to historical reversions and move the money to another program in Public Health. Community Capacity 2016 Estimated Net $8,821,335
2017 Governor $7,239,136
2017 House $7,739,136
House 17 vs. Estimated FY 16 $-1,082,199
This budget unit funds activities by the Department of Public Health that are designed to strengthen the local public health system. Last year, the Governor item-vetoed the Collaborative Safety Net Provider Network funding which was $1,672,199. This appropriation also includes increases suggested by the Governor’s office that we accepted from money that was moved from the addictive disorders and chronic conditions appropriations. Healthy Aging 2016 Estimated Net $7,297,142
2017 Governor $7,297,142
2017 House $7,297,142
House 17 vs. Estimated FY 16 $0
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. Infectious Diseases 3
2016 Estimated Net $1,335,155
2017 Governor $1,335,155
2017 House $1,335,155
House 17 vs. Estimated FY 16 $0
The budget unit funds state activities designed to reduce the incidence of communicable diseases. Public Protection 2016 Estimated Net $4,339,191
2017 Governor $4,399,191
2017 House $4,399,191
House 17 vs. Estimated FY 16 $60,000
The public protection budget unit funds activities related to protecting public health and safety through the establishment of standards and enforcement of regulations. The House accepted the Governor’s suggestion to fund 60,000 for an increased need in the Certificate of Need program. Resource Management 2016 Estimated Net $855,072
2017 Governor $1,005,072
2017 House $1,005,072
House 17 vs. Estimated FY 16 $150,000
This budget unit prohibits the UIHC from receiving indirect cost reimbursement from General Fund appropriations to DPH. It also requires the UIHC to submit billings to the Department of Public Health on a quarterly basis each year. The House took the Governor’s suggestion to increase this budget unit by 150,000 for the Office of Chief Information Officer monthly service charges. Miscellaneous Provisions This section of the bill requires all groups that receive funds from Public Health to submit a report to Public Health that details the objectives and results of their programs, how the funds are used, and how the programs will evolve in the future. Then Public Health is required to make recommendations to the Governor and General Assembly about realigning, bundling, or changing the way funds are distributed to meet the service needs the following year.
DIVISION IV VETERANS AFFAIRS SECTION 4 – Department of Veterans Affairs Total Department of Veterans Affairs Appropriation: 2016 2017 2017 Estimated Net Governor House $4,690,546 $4,690,546 $4,690,546
House 17 vs. Estimated FY 16 $0
General Administration 2016 Estimated Net $1,200,546
House 17 vs. Estimated FY 16 $0
2017 Governor $1,200,546
2017 House $1,200,546
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This budget unit goes toward salaries, support, and maintenance of the Department of Veterans Affairs. Iowa Veterans Home 2016 Estimated Net $7,594,996
2017 Governor $7,594,996
2017 House $7,594,996
House 17 vs. Estimated FY 16 $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. Home Ownership Assistance Program 2016 2017 Estimated Net Governor $2,500,000 $2,500,000
2017 House $2,500,000
House 17 vs. Estimated FY 16 $0
The section funds the Home Ownership Assistance Program for veterans. SECTION 5 – Limitation of County Commission of Veterans Affairs Fund Standing Appropriation 2016 2017 2017 House 17 vs. Estimated Net Governor House Estimated FY 16 $990,000 $990,000 $990,000 $990,000 The section provides county veteran programs with a matching grant. This year, the funding for the grant is $10,000 per county, which is same as the FY 2016 level. The money must be used for the administration and maintenance of the County Commission of Veterans Affairs office.
DIVISION V DEPARTMENT OF HUMAN SERVICES SECTION 6 – 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: $131,524,959. The allocations for FY 2017 are: TANF Allocation Family Investment Program Account PROMISE JOBS Family Development and Self-Sufficiency (FaDSS) Field Operations General Administration State Child Care Assistance Child and Family Services Child Abuse Prevention Pregnancy Prevention grants TANF Technology grants
Amount $5,112,462 $5,575,693 $2,898,980 $35,774,330 $3,744,000 $46,866,826 $36,256,581 $125,000 $1,930,067 $1,037,186 5
Integrated eligibility determination system (FIP)
$6,654,880
SECTION 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. FIP is Iowa's Temporary Assistance for Needy People program. SECTION 8 – Family Investment Program General Fund 2016 2017 2017 Estimated Net Governor House $48,673,875 $48,673,875 $48,673,875
House 17 vs. Estimated FY 16 $0
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). SECTION 9 – Child Support Recovery 2016 2017 Estimated Net Governor $14,663,373 $14,663,373
2017 House $14,663,373
House 17 vs. Estimated FY 16 $0
The section funds child support enforcement efforts in Iowa. SECTION 10 – Medical Assistance 2016 2017 Estimated Net Governor $1,303,191,564 $1,326,546,446
2017 House $1,315,246,446
House 17 vs. Estimated FY 16 $12,054,882
Medical Assistance provides medically necessary healthcare coverage for financially needy parents with children, children, people with disabilities, elderly people, and pregnant women. The House made the following changes: An increase of $88,500,000 to fund Medicaid at the Forecasting Group estimate. An increase of $9,000,000 due to an adjustment to the estimates for drug rebate savings. An increase of $3,000,000 to increase the number of slots available for the Home and Community Based Services (HCBS) waivers. An increase of $2,200,000 for a 1% provider rate increase for Community Based providers. A decrease of $4,000,000 to require the U of I to provide matching funds for the Disproportionate Share Hospital (DSH) payment. A decrease of $10,000,000 for a timing adjustment for the 2% incentive payment to the MCOs. A decrease of $16,772,391 due to process improvement changes by DHS. The House bill prevents DHS from implementing some cost containment initiatives that the Governor suggested. Those include reducing Medicaid reimbursement rates for physicians and changes to crossover claims. SECTION 11 – Medical Contracts 2016 2017 Estimated Net Governor $19,613,964 $19,113,964
2017 House $17,045,964 6
House 17 vs. Estimated FY 16 $-2,568,000
This provides the money for DHS to contract out with several entities to carry out programs to support the Medicaid program. Staff perform policy functions; they also manage Medicaid vendors to assure member access, cost effectiveness, and value. This is a decrease compared to FY 16 due to the following changes: An increase of $702,176 to replace one-time funding from the Pharmaceutical Settlement Account. A decrease of $1,268,000 due to a transfer of leftover funds from the Autism Support Program Fund. A decrease of $2,002,176 due to savings related to the implementation of managed care. SECTION 12 – State Supplementary Assistance 2016 2017 2017 Estimated Net Governor House $12,997,187 $11,611,442 $11,611,442
House 17 vs. Estimated FY 16 $-1,385,745
State Supplementary Assistance helps low-income elderly or disabled Iowans meet basic needs and reduces state spending for Medicaid. This decrease is due to declining caseloads. SECTION 13 – Children’s Health Insurance Program (CHIP) 2016 2017 2017 Estimated Net Governor House $20,413,844 $9,176,652 $9,176,652
House 17 vs. Estimated FY 16 $-11,237,192
This section appropriates money for the Healthy and Well Kids in Iowa (HAWK-i) program. Changes for this year include: An increase of $371,949 due to increased cost of services and program growth. A decrease of $3,768,657 due to savings related to managed care. A decrease of $7,840,484 due to a 23% FMAP increase provided under the Affordable Care Act. SECTION 14 – Child Care Assistance 2016 2017 Estimated Net Governor $51,408,668 $49,889,790
2017 House $36,389,561
House 17 vs. Estimated FY 16 $-15,019,107
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. There are many changes in funds in this budget unit due to lower estimated child care expenditures, using carryforward dollars, and moving TANF fund. SECTION 15 – Juvenile Institution State Training School at Eldora 2016 2017 Estimated Net Governor $12,233,420 $12,233,420
2017 House $12,233,420
House 17 vs. Estimated FY 16 $0
The State Training School at Eldora provides treatment and educational services to assist youth who are adjudicated delinquent. 7
SECTION 16 – Child and Family Services 2016 2017 Estimated Net Governor $85,341,938 $86,133,749
2017 House $88,944,956
House 17 vs. Estimated FY 16 $3,603,018
The section appropriates money for various child welfare and juvenile justice programs. Changes include: An increase of $5,200,000 for Juvenile Court Services. This was previously funded with TANF money but the federal law changed so we had to find another funding source. An increase of $50,000 for a new Child Protection Center satellite office. SECTION 17 – Adoption Subsidy 2016 2017 Estimated Net Governor $42,998,286 $43,046,664
2017 House $43,046,664
House 17 vs. Estimated FY 16 $48,378
The changes in this program are due to a federal mandate requiring state savings to be spent on child welfare services. SECTION 18 – Family Support Subsidy Program 2016 2017 2017 Estimated Net Governor House $1,073,932 $1,069,282 $1,069,282
House 17 vs. Estimated FY 16 $-4,650
Changes include a decrease of $85,650 due to a reduction in expenses and an increase of $81,000 to expand the Children-at-Home program to new service areas. SECTION 19 – Conner Decree The section states that the Department of Human Services is to provide training in accord with the consent decree in Conner v. Branstad. The money is used for building community capacity. The appropriation is the same as last year. SECTION 20 – Mental Health Institutes This section sets out the funding for the state’s four mental health institutes. Cherokee Mental Health Institute 2016 2017 Estimated Net Governor $5,545,616 $14,644,041
2017 House $14,644,041
House 17 vs. Estimated FY 16 $9,098,425
This is an increase and no change in FTE positions compared to FY 16. We are re-allocating dollars previously transferred from Medicaid directly to the MHI. Independence Mental Health Institute 2016 2017 Estimated Net Governor $10,324,209 $18,552,103
2017 House $18,552,103
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House 17 vs. Estimated FY 16 $8,227,894
This is an increase to reallocate money previously transferred from Medicaid directly to the MHI. SECTION 21 – State Resource Centers The section appropriates money to the State Resources Centers in Glenwood and Woodward. Glenwood State Resource Center 2016 2017 Estimated Net Governor $21,524,482 $20,719,486
2017 House $20,719,486
House 17 vs. Estimated FY 16 $-804,996
This is a decrease due to an adjustment in the FMAP rate. Woodward State Resource Center 2016 2017 Estimated Net Governor $14,583,806 $14,053,011
2017 House $14,053,011
House 17 vs. Estimated FY 16 $-530,795
This is a decrease due to an adjustment in the FMAP rate. SECTION 22 – Sexually Violent Predators 2016 2017 Estimated Net Governor $9,893,079 $10,193,079
2017 House $10,193,079
House 17 vs. Estimated FY 16 $300,000
The House agreed with the Governor’s recommendation to increase funds by $300,000 to increase treatment services. SECTION 23 – Field Operations 2016 2017 Estimated Net Governor $58,920,976 $58,920,976
2017 House $54,442,877
House 17 vs. Estimated FY 16 $-4,478,099
SECTION 24 – General Administration 2016 2017 Estimated Net Governor $14,898,198 $14,873,198
2017 House $15,373,198
House 17 vs. Estimated FY 16 $475,000
This section funds the central office activities of DHS. Changes include: A decrease of $25,000 due to the repeal of the Prevention of Disabilities Council. An increase of $200,000 for the College of Direct Support. An increase of $300,000 to implement the recommendations of the Children’s Mental Health and Well Being Workgroup. SECTION 25 – Department-Wide Duties This is a new appropriation that was requested by the Governor that the House agreed to. There will be $2.8 million appropriated to maintain the staffing levels at DHS facilities.
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SECTION 26 – Volunteers The section sets the FY 2016 appropriation at $84,686 for the development and coordination of volunteer services, which is the same as FY 2016. SECTION 27 – Medical Assistance, State Supplementary Assistance, and Social Service Providers Reimbursed Under the Department of Human Services This section establishes the provider reimbursement rates for services provided by DHS. Unless additional funding has been provided, the rates for FY 2017 shall be the same as were in place in the previous fiscal year. The House version eliminates language relating to the nursing facility cap. This language is no longer necessary under managed care. The only rate the House increased was a 1% increase for Community Providers. This change costs $2,200,000. The Department may adopt emergency rules to implement this section related to provider rates. SECTION 28 – New Section - Transfer of Medicaid Modernization Savings Between Appropriations FY16 - 17 This section allows the DHS to transfer funds between appropriations to account for savings from the Managed Care initiative.
DIVISION VI HEALTH CARE ACCOUNTS AND FUNDS SECTION 29 – 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 is $1,300,000. SECTION 30 – Quality Assurance Trust Fund This is a decrease of $500,000 compared to FY 2016. The decrease is due to less revenue available in the fund. This fund is used to supplement nursing facilities under the Medicaid program. SECTION 31 – Hospital Health Care Access Trust Fund – Department of Human Services $34,700,000 will be appropriated from the Hospital Health Care Access Trust Fund to DHS for Medicaid in FY 2017.
DIVISION VII PROPERTY TAX RELIEF FUND BLOCK GRANT MONEY SECTION 32 – Property Tax Relief Fund This section appropriates $2,999,305 from the Social Services Block Grant to the DHS for a state-only family planning program. This is a new appropriation for FY 2017. The Governor also had this amount specified for this purpose in his bill. The policy for this program is in section 56 of this bill.
DIVISION VIII PRIOR YEAR APPROPRIATIONS AND OTHER PRIOR PROVISIONS This division lays out the House proposal for additional funding for Medicaid in FY 2016. DHS and the Governor’s office have identified areas within the DHS budget where the need for funding is less than the 10
FY 2016 appropriation, and the difference can be moved to Medicaid. Therefore, this bill makes deappropriations from a number of programs to re-direct funds to the FY 2016 Medicaid shortfall. This is in addition to the supplemental appropriation provided in SF 2109. SECTION 33 – Family Investment Program This section de-appropriates $400,000 in FY16 from the FIP allocation to be used for the FY 16 Medicaid shortfall. SECTION 34 – FIP General Fund This section de-appropriates $3,900,000 in FY 16 and re-directs funds for the FY 16 Medicaid shortfall. SECTION 35 – Promise Jobs This section is a conforming change. SECTION 36 – Medical Assistance Appropriation FY 2015-2016 This section includes the general fund supplemental of $15,000,000 for the Medicaid program in FY 2016. The supplemental, in addition to the $2,000,000 transfer from Decategorization funds and a $67,000,000 supplemental appropriation from an appropriations bill provides a total of $84,000,000 for the Medicaid program in FY 2016. SECTION 37 – Modernization Emergency Rules FY 2015-2016 This section delays the DHS’s authority to adopt emergency rules for the managed care program until it is implemented. SECTION 38 – State Supplementary Assistance FY 2015-2016 This section de-appropriates $1,100,000 in FY 2016 to be used for the FY 2016 Medicaid shortfall. SECTION 39 – Child Care Assistance FY 2015-2016 This section de-appropriates $10,000,000 in FY 2016 from the child care assistance appropriation to be used for the FY 2016 Medicaid shortfall. SECTION 40 This section is a conforming change. SECTION 41 This section is a conforming change. SECTION 42 – Nursing Facility Budget FY 2015-2016 This section changes the nursing facility cap to account for the new implementation date of managed care. SECTION 43 – Effective Upon Enactment This Division is effective upon enactment. SECTION 44 – Retroactive Applicability This Division applies retroactively to July 1, 2015.
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DIVISION IX DECATEGORIZATION Child Welfare Decategorization is an effort to change the child welfare system to one that is needs based, family focused, and easily accessible by “decategorizing” services from a state level to a local level. SECTION 45 – Decategorization Carryover Funding - Transfer to Medicaid Program This section transfers funds that would revert to the general fund in FY 2016 to be used for the Medicaid appropriation for the same fiscal year. The carryforward amount is $2,000,000. SECTION 46 – Effective Upon Enactment This Division is effective on enactment. SECTION 47 – Retroactive Applicability This Division applies retroactively to July 1, 2015.
DIVISION X CODE CHANGES SECTION 48 – Local Offices of Substitute Decision Maker This section extends the establishment date for local Office of Substitute Decision Maker offices to July 1, 2018. SECTIONS 49 – 51 Institutions for Persons with an Intellectual Disability - Assessment This section amends language related to the assessment for ICF/IDs to conform to the transition to managed care.
DIVISION XI HOSPITAL HEALTH CARE ACCESS ASSESSMENT The hospital assessment is an assessment that hospitals voluntarily pay to the state. The state is then able to draw down additional federal funds that go back to the hospitals on an annual basis. The Medicaid budget receives $3,782,554 each year from the hospital assessment. The hospitals have a net gain of $34,035,985 per year from the assessment. This money is used to increase hospital reimbursement rates. To ensure the assessment continues, below the sunset date of the assessment has been repealed. Section 53 requires DHS to study the hospital assessment. SECTION 52 – Repeal This section repeals the sunset of the hospital assessment. This means that the assessment will not sunset in the future. SECTION 53 – Review of Alternative Assessment Method This requires DHS to study alternatives to the current hospital assessment method and make recommendations. SECTION 54 – Effective Upon Enactment This Division is effective on enactment. 12
SECTION 55 – Retroactive Applicability This Division applies retroactively to June 30, 2016.
DIVISION XII STATE FAMILY PLANNING SERVICES PROGRAM SECTION 56 – Discontinuation of Medicaid Family Planning Network Waiver – Establishment of State Program This section requires DHS to discontinue the Medicaid family planning waiver effective July 1, 2016. Instead, it will establish a state family planning program. The state program will have the same eligibility requirements and the same services as the federal program did. However, the state program will distribute family planning funds by a provider prioritization list. Distribution of family planning funds shall be made to eligible provider applicants in the following order of priority: 1. Public entities that provide family planning services. These would include state, county, or local health clinics and FQHCs. 2. Nonpublic entities that provide primary health services. 3. Nonpublic entities that provide family planning services but do not provide primary health services. Distribution of family planning funds shall be made in a manner that continues access to family planning services. Distribution of family planning funds shall not be made to any entity that performs abortions or that maintains or operates a facility where abortions are performed. Abortion does not include any of the following: The treatment of a woman for a physical disorder or illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would place the woman in danger of death. The treatment of a woman for a miscarriage when not all the products of conception are expelled. Family planning funds shall not be used for direct or indirect costs related to providing abortions. DHS is required to submit a report to the Governor and Legislature annually listing any entities that received funds pursuant to this section.
DIVISION XIII AUTISM SUPPORT PROGRAM The Autism Support Program (ASP) was created by the Legislature in 2013 to provide funding for Applied Behavioral Analysis (ABA) treatment for children under 9 who are not eligible for services through Medicaid or private health insurance. This year, changes were made to allow more children to be served and to encourage more providers to come into the state. SECTION 57 – Applied Behavioral Analyst Grant Program This section amends the Autism Support Program grant program. This section expands the grant program to include any accredited university, community college, or accredited private institution within 13
or outside Iowa. This allows students in Iowa to take a popular online class and still utilize these grant funds. The grant program will require students to agree to practice in Iowa and supervise other people working towards their board certification. SECTION 58 – DHS Report on Grant Program This section requires the Department to submit an annual report to show the legislature the number of applications received, approved, and the cost of administering the grant program. SECTION 59 – Eligibility for the Autism Support Program This section increases eligibility for children up to age 14. It also expends eligibility to 500% of the federal poverty level for families to qualify for the program. 500% of the federal poverty level for a family of 4 is $121,500. SECTION 60 - Age Eligibility This section increases eligibility for children from age 9 to age 14. SECTION 61 – Autism Support Fund Carryforward This section says any funds remaining in the Autism Services Fund at the end of FY 2016 shall be used to fund medical contracts in FY 2017. SECTION 62 – Effective Date The Autism Support Program carryforward funds is effective on enactment. SECTION 63 – Retroactive Applicability The Autism Support Program carryforward is retroactive to July 1, 2015.
DIVISION XIV IOWA HIGH QUALITY HEALTH CARE INITIATIVE CONSUMER PROTECTION OUTCOME ACHIEVEMENT AND PROGRAM INTEGRITY SECTION 64 – Legislative Goals of Managed Care This section says the legislative goals of managed care are to improve quality of and access to care for Medicaid members, promote accountability for outcomes, and create a more predictable and sustainable Medicaid budget. SECTION 65 – Managed Care Reports The DHS is required to submit to the chairs and ranking members of the Human Resources Committees of the House and Senate and to the chairs and ranking members of the HHS Budget Subcommittee an annual report regarding consumer protection, outcome achievement, and program integrity in the Medicaid program. The HHS budget sub is required to dedicate one meeting per year to review this data. Consumer Protection - The consumer protection report to the legislature shall be based on the following reports on provider and member services: Member enrollment and disenrollment Member grievances and appeals Member call center performance
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Outcome Achievement - The focus of the legislature in moving to managed care is to improve the quality of care and outcomes for Medicaid members. The outcome achievement reports to the legislature have to include the following reports related to health outcomes and contract management: Percentage of claims paid and denied Managed Care Organization capitation payments The medical loss ration Managed care savings Program Integrity - Under managed care, federal, state, and contractual safeguards will continue to be incorporated to prevent and eliminate fraud, waste abuse in the Medicaid program. The program integrity report given to the legislature will include information on the following: The level of fraud, waste, and abuse identified by the MCOs A summary report by the Insurance Division related to the MCO licensure status and audit. Other Oversight Entities - The DHS Council, Medical Assistance Advisory Council, the Hawk-I Board, the MHDS Commission, and the Office of Long-Term Care Ombudsman shall regularly review managed care and how it impacts their groups and submit summaries of pertinent information to DHS to be included in the legislative report. SECTION 66 – Additional Oversight The DHS Council, MAAC, and Hawk-i Board are required to submit to the chairs and ranking members the minutes of their meetings related to managed care. The DHS Director shall submit the compilation of recommendations from stakeholders and Medicaid members to the chairs and ranking members of the House and Senate Human Resources Committee and the HHS Budget Sub. SECTION 67 – Posting of Public Information Summaries of all the reports listed above will be available for the public to view on the Iowa Medicaid Modernization website. This is an unprecedented amount of information available to the public.
DIVISION XV CHILDREN’S MENTAL HEALTH AND WELL-BEING SECTION 68 – Children’s Mental Health Planning Grants DHS and Public Health and the Department of Education have to establish an RFP process to contract for two planning grants for the development of children’s mental health services. The grant awardees must develop a plan for children’s mental health crisis services. SECTION 69 – Children’s Learning Labs The DHS has to study and collect data on existing children’s programs across the state that address wellbeing for children with complex needs. DHS will select three to five programs to serve as learning labs. Then, DHS will submit a report including recommendations to the General Assembly next year. SECTION 70 – DHS Report on the Statewide Children’s Mental Health System This section requires DHS to consult with other groups and agencies and to submit a legislative report with recommendations for a statewide children’s mental health crisis service system. SECTION 71 – Children’s Mental Health Advisory Committee
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This section creates the Children’s Mental Health and Well-Being Advisory Committee to continue the efforts of the Children’s Mental Health and Well-Being Workgroup that met last year. This committee will select the learning labs and facilitate recommendations.
DIVISION XVI OPIOID ANTAGONIST REVISION Senate File 2218 (Opioid Antagonist Authorization Act) was passed this session. The bill authorized first responders to obtain a supply of opioid antagonists and administer them to drug overdose victims. It also allowed persons in a position to assist to have access to the opioid antagonists and to administer them to a drug overdose victim. The below sections amend Senate File 2218. SECTION 72 – Opioid Antagonist Revision This section amends Senate File 2218 to permit, rather than require, Public Health to adopt rules to administer the Act. SECTION 73 – Opioid Antagonist Implementation This strikes the section that implements the act on the contingency of funding available.
DIVISION XVII NURSING GRANT PROGRAMS SECTION 74-77 – Nurse Residency State Matching Grants Program These sections eliminate the sunset date for the Nurse Residency State Matching Grant Program and the Iowa Needs Nurses Now program. There are no funds appropriated with these programs.
DIVISION XVIII NON-STATE GOVERNMENT-OWNED NURSING FACILITY UPPER PAYMENT LIMIT SUPPLEMENTAL PAYMENT PROGRAM Background - Iowa has many aging nursing homes that need renovation. Funding to update these facilities could be provided through an Intergovernmental Transfer (IGT). An IGT allows the state to draw down additional federal funds. If approved by the federal government, the IGT would allow a merger between participating non state-owned hospitals and nursing facilities. The nursing home/hospital partnership would enable both to take advantage of the higher hospital-based Medicaid reimbursement rate to be split between the nursing home and hospital per their agreement. The supplemental reimbursement rate could only be used for: nursing facility replacement or renovation, health information technology, hospital endowments, and quality measures. The supplemental reimbursement could not be used for day-to-day operations and could not be put on a Medicaid cost report. Therefore, if the federal government terminates the program, there will be no fiscal hole for the state to backfill. The proposal also includes funding from the IGT to DHS for program administration so there is no additional cost to the state. SECTION 78 16
This section redefines nursing facility as required to allow an intergovernmental transfer. SECTION 79 – Non-State Government-Owned Nursing Facility Upper Payment Limit Supplemental Payment Program This section directs DHS to submit a Medicaid state plan amendment to the federal government to allow non-state government owned nursing facilities to receive a supplemental payment. SECTION 80 – Effective Upon Enactment This division is effective on enactment. SECTION 81 – Contingent Implementation If the federal government does not approve the changes in this division, it will not be implemented.
DIVISION XIX CAREGIVER DESIGNATION This Division creates a new chapter of the Iowa Code to better support family caregivers as they help Iowa seniors stay at home and transition from an inpatient hospital stay to their home. The CARE Act requires hospitals to record the name of the family caregiver when a person is admitted to a hospital. The designated caregiver is notified when the loved one is to be discharged. Finally, this Act requires the hospital to discuss with the caregiver the patient’s care needs at home and provide an explanation of medical tasks that the family caregiver will perform at home. SECTION 82 – Definitions This section sets out the definitions for the Caregiver Act. SECTION 83 – Opportunity to Designate a Caregiver This section requires a hospital to provide each patient or their legal guardian with the opportunity to designate at least one caregiver within 24 hours following a patient’s entry into the hospital. If the patient designates a caregiver, the hospital must do the following: (1) The hospital shall request the written consent of the patient to release medical information to the caregiver and (2) the hospital shall record who the caregiver is. SECTION 84 – Notification of Caregiver A hospital shall notify a caregiver of the patient’s discharge. SECTION 85 – Instructions to Caregiver Prior to the patient’s discharge, the hospital shall consult with the caregiver and the patient regarding their care after they are discharged. SECTION 86 – Adoption of Rules DIA and Public Health may adopt rules related to this Division. SECTION 87 – Construction of Chapter Relative to Other Health Care Directive Nothing in this chapter shall interfere with the rights of a durable power of attorney. SECTION 88 – Limitations
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The chapter can’t be used to create a private right of action against a hospital. This chapter can’t delay the discharge of a patient.
DIVISION XX TRAUMA CARE SYSTEM SECTIONS 89 - 91 This Division lets a hospital continue their trauma care services categorization level for which the hospital was issued a certificate of verification prior to July 1, 2015, unless the hospital subsequently fails to maintain the requirements existing at the time of the issuance.
DIVISION XXI MENTAL HEALTH AND DISABILITY SERVICES REGIONS - FUNDING SECTION 92 –MHDS Regions Funding This section appropriates $1,000,000 to the Eastern Iowa Mental Health and Disability Services Region. The funds are intended to help maintain stability in the region. In order to receive the money, the region has to continue their current regional structure. This will prevent the region from dissolving. This section appropriates $2,000,000 to Polk County. Before the money is distributed, Polk County is required to work with DHS on a three year funding plan for sustainable services. In addition, the Department has to work with the region to complete a three year sustainable cash flow funding plan to be submitted by November 15, 2016. DHS and Polk will enter into a memorandum of understanding regarding the use of this money. DHS is required to distribute the money to Polk County within 60 days of the signed memo of understanding. SECTION 93 – MHDS Redesign Progress Report This section requires the DHS to review and report progress on the implementation of the adult mental health redesign system. DHS has to study any challenges to the redesign process. The progress report shall include information related to the MHDS system including management, administration, the implementation of best practices, the availability of core services and the fiscal viability of the system. DHS shall report to the General Assembly no later than November 15, 2016.
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