House File 2463 Health and Human Services Appropriations CC

Bill: Committee: Date: Floor Manager: Staff: HF 2463 Appropriations April 28, 2014 Representative Dave Heaton Carrie Ko...

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Bill: Committee: Date: Floor Manager: Staff:

HF 2463 Appropriations April 28, 2014 Representative Dave Heaton Carrie Kobrinetz (5-2063)

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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 2014.

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 FY 14 FY 15 Estimated Net Governor’s Request $10,606,066 $10,931,066

FY 15 House $10,606,066

FY 15 Conference Report $11,419,732

Conference Report changes include:  An increase of $288,666 for the Office of Substitute Decision Maker.  An increase of $525,000 for the Aging and Disability Resource Centers.

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Conf. vs. FY 14 $813,666

OFFICE OF LONG-TERM CARE OMBUDSMAN Office of Long-Term Care Ombudsman FY 14 FY 15 Estimated Net Governor’s Request $1,021,707 $929,315

FY 15 House $821,707

FY 15 Conference Report $929,315

Conf. vs. FY 14 $-92,392

Conference Report changes include:  The addition of $107,608 to add a discharge specialist.

DEPARTMENT OF PUBLIC HEALTH Department of Public Health FY 14 FY 15 Estimated Net Governor’s Request $58,030,568 $58,973,924

FY 15 House $58,696,686

FY 15 Conference Report $58,782,260

Conf. vs. FY 14 $751,692

Addictive Disorders FY 14 Estimated Net $27,163,690

FY 15 House $27,088,690

FY 15 Conference Report $27,263,690

Conf. vs. FY 14 $100,000

FY 15 Conference Report $4,046,602

Conf. vs. FY 14 $393,043

FY 15 Governor’s Request $27,088,690

Conference Report changes include:  A net increase of $100,000 in tobacco funding. Healthy Children and Families FY 14 FY 15 Estimated Net Governor’s Request $3,653,559 $3,628,559

FY 15 House $3,671,602

Conference Report changes include:  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 FY 14 Estimated Net $5,080,692

FY 15 Governor’s Request $5,040,692

FY 15 House $5,040,692

Conference Report changes include:  A $50,000 increase for epilepsy support.

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FY 15 Conference Report $5,155,692

Conf. vs. FY 14 $75,000



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 FY 14 Estimated Net $8,562,617

FY 15 Governor’s Request $9,562,617

FY 15 House $9,192,336

FY 15 Conference Report $8,737,910

Conf. vs. FY 14 $175,293

Conference Report changes include:  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 FY 14 Estimated Net $7,297,142

FY 15 Governor’s Request $7,297,142

FY 15 House $7,297,142

FY 15 Conference Report $7,297,142

Conf. vs. FY 14 0

FY 15 House $853,870

FY 15 Conference Report $853,870

Conf. vs. FY 14 0

FY 15 House $1,335,155

FY 15 Conference Report $1,335,155

Conf. vs. FY 14 0

FY 15 House $3,297,127

FY 15 Conference Report $3,287,127

Conf. vs. FY 14 $8,356

No change from House appropriation. Environmental Hazards FY 14 FY 15 Estimated Net Governor’s Request $803,870 $803,870 No change from House appropriation. Infectious Diseases FY 14 Estimated Net $1,335,155

FY 15 Governor’s Request $1,335,155

No change from House appropriation. Public Protection FY 14 Estimated Net $3,278,771

FY 15 Governor’s Request $3,297,127

Conference Report changes include:  A $75,000 reduction for EMS benchmarks and trauma assessment.

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Resource Management FY 14 FY 15 Estimated Net Governor’s Request $855,072 $920,072

FY 15 House $920,072

FY 15 Conference Report $920,072

Conf. vs. FY 14 0

Department of Veterans Affairs and Iowa Veterans Home FY 14 FY 15 FY 15 Estimated Net Governor’s Request House $11,280,947 $12,180,947 $12,180,947

FY 15 Conference Report $12,180,947

Conf. vs. FY 14 $900,000

General Administration FY 14 FY 15 Estimated Net Governor’s Request $1,095,951 $1,095,951

FY 15 House $1,095,951

FY 15 Conference Report $1,095,951

Conf. vs. FY 14 0

FY 15 House $7,594,996

FY 15 Conference Report $7,594,996

Conf. vs. FY 14 0

FY 15 House $2,500,000

FY 15 Conference Report $2,500,000

Conf. vs. FY 14 $900,000

Limitation of County Commission of Veterans Affairs Fund Standing Appropriation FY 14 FY 15 FY 15 FY 15 Estimated Net Governor’s Request House Conference Report $990,000 $990,000 $990,000 $990,000

Conf. vs. FY 14 0

No change from House appropriation.

VETERANS AFFAIRS

No change from House appropriation. Iowa Veterans Home FY 14 FY 15 Estimated Net Governor’s Request $7,594,996 $7,594,996 No change from House appropriation. Home Ownership Assistance Program FY 14 FY 15 Estimated Net Governor’s Request $1,600,000 $2,500,000 No change from House appropriation.

No change from House appropriation.

DEPARTMENT OF HUMAN SERVICES Family Investment Program General Fund 4

FY 14 Estimated Net $48,503,875

FY 15 Governor’s Request $48,503,875

FY 15 House $48,503,875

FY 15 Conference Report $48,693,875

Conf. vs. FY 14 $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 FY 14 FY 15 Estimated Net Governor’s Request $14,215,081 $14,911,230

FY 15 House $14,911,230

FY 15 Conference Report $14,911,230

Conf. vs. FY 14 $696,149

FY 15 House $1,250,658,393

FY 15 Conference Report $1,250,658,393

Conf. vs. FY 14 $106,449,588

No change from House appropriation. Medical Assistance FY 14 Estimated Net $1,144,208,805

FY 15 Governor’s Request $962,091,053

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 FY 14 Estimated Net $12,320,048

FY 15 Governor’s Request $16,323,366

FY 15 House $17,148,576

FY 15 Conference Report $17,148,576

Conf. vs. FY 14 $4,828,528

FY 15 House $14,121,154

FY 15 Conference Report $14,121,154

Conf. vs. FY 14 $-2,395,704

No change from House appropriation. State Supplementary Assistance FY 14 FY 15 Estimated Net Governor’s Request $16,516,858 $14,121,154 No change from House appropriation. Children’s Health Insurance Program (CHIP) 5

FY 14 Estimated Net $36,817,261

FY 15 Governor’s Request $45,877,998

FY 15 House $45,877,998

FY 15 Conference Report $45,877,998

Conf. vs. FY 14 $9,060,737

FY 15 House $45,622,828

FY 15 Conference Report $47,132,080

Conf. vs. FY 14 $-15,603,483

No change from House appropriation. Child Care Assistance FY 14 FY 15 Estimated Net Governor’s Request $62,735,563 $57,925,206

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 FY 14 FY 15 Estimated Net Governor’s Request $11,268,202 $11,500,098

FY 15 House $11,500,098

FY 15 Conference Report $12,358,285

Conf. vs. FY 14 $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 FY 14 FY 15 Estimated Net Governor’s Request $8,867,121 $788,531

FY 15 House $788,531

FY 15 Conference Report $507,766

Conf. vs. FY 14 $-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

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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 FY 14 FY 15 FY 15 Estimated Net Governor’s Request House $0 $5,110,534 $5,110,534

FY 15 Conference Report $2,000,000

Conf. vs. FY 14 $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 FY 14 FY 15 FY 15 FY 15 Estimated Net Governor’s Request House Conference Report Conf. vs. FY 14 $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 FY 14 Estimated Net $40,729,282

FY 15 Governor’s Request $42,580,749

FY 15 House $42,580,749

FY 15 Conference Report $42,580,749

Conf. vs. FY 14 $1,851,467

FY 15 House $1,079,739

FY 15 Conference Report $1,079,739

Conf. vs. FY 14 $-13,549

No change from House appropriation. Family Support Subsidy Program FY 14 FY 15 Estimated Net Governor’s Request $1,093,288 $1,079,739 No change from House appropriation. 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 FY 14 FY 15 Estimated Net Governor’s Request $5,964,737 $6,031,934

FY 15 House $6,031,934

No change from House appropriation. Clarinda Mental Health Institute 7

FY 15 Conference Report $6,031,934

Conf. vs. FY 14 $67,197

FY 14 Estimated Net $6,757,689

FY 15 Governor’s Request $6,787,309

FY 15 House $6,787,309

FY 15 Conference Report $6,787,309

Conf. vs. FY 14 $29,620

FY 15 House $10,484,386

FY 15 Conference Report $10,484,386

Conf. vs. FY 14 $150,304

FY 15 House $1,417,796

FY 15 Conference Report $1,417,796

Conf. vs. FY 14 $43,735

No change from House appropriation. Independence Mental Health Institute FY 14 FY 15 Estimated Net Governor’s Request $10,334,082 $10,484,386 No change from House appropriation. Mount Pleasant Mental Health Institute FY 14 FY 15 Estimated Net Governor’s Request $1,374,061 $1,417,796

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 FY 14 FY 15 Estimated Net Governor’s Request $20,349,122 $21,695,266

FY 15 House $21,695,266

FY 15 Conference Report $21,695,266

Conf. vs. FY 14 $1,346,144

FY 15 House $14,855,693

FY 15 Conference Report $14,855,693

Conf. vs. FY 14 $569,502

FY 15 House $9,923,563

FY 15 Conference Report $9,923,563

Conf. vs. FY 14 $497,995

FY 15 House $66,670,976

FY 15 Conference Report $65,170,976

Conf. vs. FY 14 $-1,500,000

No change from House appropriation. Woodward State Resource Center FY 14 FY 15 Estimated Net Governor’s Request $14,286,191 $14,855,693 No change from House appropriation. Sexually Violent Predators FY 14 FY 15 Estimated Net Governor’s Request $9,425,568 $9,923,563 No change from House appropriation. Field Operations FY 14 Estimated Net $66,670,976

FY 15 Governor’s Request $66,670,976

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Conference Committee changes include:  A $1.5 million reduction because they had not used funds appropriated in previous years. General Administration FY 14 FY 15 Estimated Net Governor’s Request $16,329,602 $16,079,602

FY 15 House $16,304,602

FY 15 Conference Report $16,072,302

Conf. vs. FY 14 $-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, 2020. 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



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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 D1 D2 D3

House Percentage 71% of cost 78% of cost 93% of cost

Conference Report Percentage 64.53% of cost 78% of cost 93% of cost

Conference Report Per Diem $84.17 per day $119.09 per day $131.09 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.

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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 2475. The $47.28 levy is set to sunset in FY15. The bill pushes the sunset date to FY16. 2. 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 FY16. 3. 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, 2014.  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 7/1/2013- 12/31/13

Actual Aggregate County Expenditures ICD-9 and CPT Codes 1/1/2014- 6/30/14

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If the I-HAWP savings are less than this offset calculation then the I-HAWP savings would be used.

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