Bill: Committee: Date: Floor Manager: Staff:
HF 2463 Appropriations May 15, 2014 Representative Dave Heaton Carrie Malone (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. Conference Committee Report Adopted – April 29 Passed House (86-11) on April 29 Passed Senate (26-24) on April 29 Sent to Governor on May 9 Item vetoed and signed by Governor on May 30.
DIVISION I DEPARTMENT OF AGING SECTION 1 – Department on Aging FY 14 FY 15 Estimated Net Governor’s Request $10,606,066 $10,931,066
FY 15 House $10,606,066
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FY 15 Conference Report $11,419,732
Conf. vs. FY 14 $813,666
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.
DIVISION II OFFICE OF LONG-TERM CARE OMBUDSMAN SECTION 2 – Office of Long-Term Care Ombudsman FY 14 FY 15 FY 15 Estimated Net Governor’s Request House $1,021,707 $929,315 $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.
DIVISION III DEPARTMENT OF PUBLIC HEALTH SECTION 3 – 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
FY 15
FY 15 2
FY 15
Estimated Net $5,080,692
Governor’s Request $5,040,692
House $5,040,692
Conference Report $5,155,692
Conf. vs. FY 14 $75,000
Conference Report changes include: A $50,000 increase for epilepsy support. 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. The Governor vetoed a part of this section that allocated $1,158,150 to the Iowa Collaborative Safety Net Provider Network for the development and implementation of a statewide regionally based network. The Governor said this is unnecessary and duplicative. 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
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. 3
Public Protection FY 14 Estimated Net $3,278,771
FY 15 Governor’s Request $3,297,127
FY 15 House $3,297,127
FY 15 Conference Report $3,287,127
Conf. vs. FY 14 $8,356
Conference Report changes include: A $75,000 reduction for EMS benchmarks and trauma assessment.
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
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
No change from House appropriation.
DIVISION IV VETERANS AFFAIRS SECTION 4 – Department of Veterans Affairs General Administration FY 14 FY 15 Estimated Net Governor’s Request $1,095,951 $1,095,951 No change from House appropriation. SECTION 5 – Iowa Veterans Home FY 14 FY 15 Estimated Net Governor’s Request $7,594,996 $7,594,996 No change from House appropriation. SECTION 6 This section requires an Iowa Veterans Home expenditure report to be submitted monthly to the Legislative Services Agency. The Governor vetoed this section because it creates a redundant, overly burdensome mandate requiring the Iowa Veterans’ Home to make expenditure reports monthly to LSA. He said this information is already available. SECTION 7 – Home Ownership Assistance Program FY 14 FY 15 FY 15 Estimated Net Governor’s Request House 4
FY 15 Conference Report
Conf. vs. FY 14
$1,600,000
$2,500,000
$2,500,000
$2,500,000
$900,000
No change from House appropriation. SECTION 8 – 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 Conf. vs. FY 14 $990,000 $990,000 $990,000 $990,000 0 No change from House appropriation.
DIVISION V DEPARTMENT OF HUMAN SERVICES SECTION 9 – 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 2015 are: TANF Allocation Family Investment Program Account PROMISE JOBS Family Development and Self-Sufficiency (FaDSS) Field Operations General Administration State Child Care Assistance Mental Health and Disability Services State Cases Child and Family Services Child Abuse Prevention Pregnancy Prevention grants TANF Technology grants Integrated eligibility determination system (FIP)
Amount $9,879,488 $11,091,911 $2,898,980 $31,296,232 $3,744,000 $35,047,110 $4,894,052 $32,084,430 $125,000 $1,930,067 $1,037,186 $6,549,549
SECTION 10 – 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. The Family Investment Program (FIP) is Iowa's TANF program. SECTION 11 – Family Investment Program General Fund FY 14 FY 15 FY 15 Estimated Net Governor’s Request House $48,503,875 $48,503,875 $48,503,875
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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. There is no net change compared to FY 2014. Notable changes include: An increase of $3,502,157 for FIP to shift funding to the General Fund. An increase of $774,528 for Promise Jobs to shift additional funding to the General Fund. An increase of $422,157 for operational and maintenance costs for a new eligibility system. A decrease of $1,196,685 due to a reduction in Promise Jobs caseloads. A decrease of $3,502,157 due to a reduction of FIP caseloads. Conference Report Changes: A $150,000 increase for FaDSS (Family Development and Self Sufficiency). A 40,000 for the fatherhood initiative at the YMCA. SECTION 12 – 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
No change from House appropriation. SECTION 13 – Health Care Trust Fund – Medical Assistance This section states that funds deposited in the Health Care Trust Fund for FY 2015 will be appropriated to DHS to supplement the Medicaid appropriations. SECTION 14 – Medical Assistance FY 14 FY 15 Estimated Net Governor’s Request $1,144,208,805 $962,091,053
FY 15 House $1,250,658,393
FY 15 Conference Report $1,250,658,393
Conf. vs. FY 14 $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. SECTION 15 – DHS Payments This section specifies that $8.3 million will be allocated for disproportionate share hospital payments. SECTION 16 – Cost Containment This section states that DHS shall continue to implement the cost containment strategies for Medicaid that were recommended by the Governor last year (with the exception of the consumer-directed attendant care option). SECTION 17 – Report 6
DHS has to report on the implementation of the cost containment strategies every year. The Governor vetoed this section because it requires DHS to redundantly report on cost containment strategies. He also stated this information is already available within the State’s accounting and budgeting system.
SECTION 18 – Home and Community Based Services Waiver Waiting List Buydown This section appropriates $6 million to reduce the waiting lists of all medical assistance home and community-based services waivers. If federal approval is granted, DHS is directed to expand hospital presumptive eligibility to include Federally Qualified Health Centers. The Governor did NOT veto the $6 million waiver allocation. He did veto a part of this section that required DHS to work with Magellan to perform an analysis on the cost effectiveness of including the pharmacy benefit for enrollees of the managed care plan within the managed care organization contract.
SECTION 19 – Medical Contracts FY 14 FY 15 Estimated Net Governor’s Request $12,320,048 $16,323,366
FY 15 House $17,148,576
FY 15 Conference Report $17,148,576
Conf. vs. FY 14 $4,828,528
No change from House appropriation. The Governor vetoed the item that requires DHS to submit a report regarding implementation of a uniform cost report because this information is already available upon request.
SECTION 20 – State Supplementary Assistance FY 14 FY 15 FY 15 Estimated Net Governor’s Request House $16,516,858 $14,121,154 $14,121,154
FY 15 Conference Report $14,121,154
Conf. vs. FY 14 $-2,395,704
FY 15 Conference Report $45,877,998
Conf. vs. FY 14 $9,060,737
No change from House appropriation. SECTION 21 – Children’s Health Insurance Program (CHIP) FY 14 FY 15 FY 15 Estimated Net Governor’s Request House $36,817,261 $45,877,998 $45,877,998 No change from House appropriation. SECTION 22 – Child Care Assistance 7
FY 14 Estimated Net $62,735,563
FY 15 Governor’s Request $57,925,206
FY 15 House $45,622,828
FY 15 Conference Report $47,132,080
Conf. vs. FY 14 $-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. SECTION 23 – 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. The Governor vetoed the language that requires the maintenance staff be maintained at the Iowa Juvenile Home. According to his veto message, because IJH no longer serves children this item is no longer necessary. 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 assist people who leave foster care and other court-ordered services at age 18 to help them make the transition into self-sufficiency.
SECTION 24 – Children Adjudicated as Delinquent or CINA - Iowa Juvenile Home 8
FY 14 Estimated Net $0
FY 15 Governor’s Request $5,110,534
FY 15 House $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. The Governor vetoed a provision requiring DHS to provide a report that includes a description of the status of both juvenile delinquent girls and boys and CINA boys and girls who are hard to place. The Governor stated that this item creates an unfunded system that is duplicative of the Department’s ongoing efforts. The Governor also vetoed a provision giving DHS transfer authority. The Governor stated that DHS already has transfer authority. SECTION 25 – Child and Family Services FY 14 FY 15 Estimated Net Governor’s Request $91,329,427 $91,762,511
FY 15 House $95,920,906
FY 15 Conference Report $94,857,554
Conf. vs. FY 14 $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. The Governor vetoed a provision requiring DHS to review the child welfare system. He stated a task force conducted a review in 2009 and DHS will proceed to update this study if any changes are needed. SECTION 26 – Adoption Subsidy FY 14 FY 15 Estimated Net Governor’s Request $40,729,282 $42,580,749
FY 15 House $42,580,749
FY 15 Conference Report $42,580,749
Conf. vs. FY 14 $1,851,467
SECTION 27 – Family Support Subsidy Program FY 14 FY 15 FY 15 Estimated Net Governor’s Request House $1,093,288 $1,079,739 $1,079,739
FY 15 Conference Report $1,079,739
Conf. vs. FY 14 $-13,549
No change from House appropriation.
No change from House appropriation. SECTION 28 – 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.
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SECTION 29 – 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
FY 15 Conference Report $6,031,934
Conf. vs. FY 14 $67,197
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. Clarinda Mental Health Institute FY 14 FY 15 Estimated Net Governor’s Request $6,757,689 $6,787,309 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
SECTION 30 – 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
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. 10
SECTION 31 – Sexually Violent Predators FY 14 FY 15 Estimated Net Governor’s Request $9,425,568 $9,923,563
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. SECTION 32 – Field Operations FY 14 FY 15 Estimated Net Governor’s Request $66,670,976 $66,670,976
Conference Committee changes include: A $1.5 million reduction because they had not used funds appropriated in previous years. The Governor vetoed a provision that required DHS to fill their FTE positions. The Governor vetoed this provision, stating that this item prohibits external approvals that are designed to ensure budget integrity, stability, and predictability.
SECTION 33 – 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. SECTION 34 – Volunteers The section sets the FY 2015 appropriation at $84,686 for the development and coordination of volunteer services, which is the same as FY 2014. SECTION 35 – Nursing Home Rebasing This section appropriates $1,250,000 for reimbursement of nursing facilities to supplement shortfalls. SECTION 36 – Pharmacy Dispensing Fee This section says DHS shall continue the current pharmacy dispensing fee until a cost of dispensing survey is completed. SECTION 37 Reimbursement rates for outpatient hospital services shall be rebased effective January 1, 2015 subject to Medicaid upper payment limit rules. Inpatient hospital services shall be rebased effective October 1, 2015, subject to Medicaid upper payment limit rules. SECTION 38 – LUPA Reimbursement 11
Reimbursement rates for home health agencies shall continue to be based on the Medicare low utilization payment adjustment (LUPA) method. Beginning July 1, 2015 DHS is required to updated these rates every two years. SECTION 39 – Inpatient Mental Health Rates Reimbursement rates for inpatient mental health services will be rebased effective October 1, 2015. SECTION 40 – Community Mental Health Centers This language allows CMHCs to choose between two methods of reimbursement. This was formerly a bill that passed the Human Resources committee this year. SECTION 41 – EMS Provider Rate Increase This section Beginning July 1, 2014, EMS providers will get a 10% rate increase. SECTION 42 This is a technical change. SECTION 43 – Group Foster Care Reimbursement Rate Change The report makes changes to Group Foster Care rates. There are no “losers” in this scenario. All rates either increase or remain the same. 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
SECTION 44 – ICF/ID Rates DHS shall calculate reimbursement rates at the 80th percentile. SECTION 45 – Emergency Rules DHS and the Mental Health and Disability Services Commission may adopt emergency rules. SECTION 46 – Reports Reports and other information required to be submitted shall be submitted to the chairpersons and ranking members of the HHS subcommittee, LSA, and caucus staff.
DIVISION VI HEALTH CARE ACCOUNTS AND FUNDS SECTION 47 – 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 $5,467,564. SECTION 48 – Quality Assurance Trust Fund For FY 2015, $29,195,653 will be appropriated from the quality assurance trust fund to DHS for Medicaid. 12
DIVISION VII PERSONNEL SETTLEMENT AGREEMENTS SECTION 49 – Personnel Settlement Agreement Payments As a condition of the appropriations in this Act, the money appropriated and any other moneys available shall not be used for payment of a personnel settlement agreement that contains a confidentiality provision intended to prevent public disclosure of the agreement.
DIVISION VIII IOWA PRODUCTS SECTION 50 – Iowa Products This section states agencies shall give first preference when purchasing a product to an Iowa product or a product produced by an Iowa-based business.
DIVISION IX PRIOR YEAR APPROPRIATIONS AND OTHER PRIOR PROVISIONS SECTION 51 – Safety Net – Care Coordination This section allocates funds to the Iowa Collaborative Safety Net Provider Network to be used to collaborate with DHS and develop an integrated approach to health care delivery through care coordination that supports primary care providers and links patients with community resources. SECTION 52 – Medical Residency This section allows IDPH to use the medical residency training program. It specifies that the grants for new medical residency positions, psychiatric residency positions, and family practice positions have priority. SECTION 53 – Consumer-Directed Attendant Care This is a technical change that removes the law that was passed last year and was subsequently rescinded through the rules process. SECTION 54 – Disproportionate Share Hospital Payments This section requires DHS to implement rules that would not allow hospitals outside of Iowa to receive Iowa DSH payments. It also allows Mercy Children’s Hospital to receive these payments. SECTION 55 – Autism Carryforward This section permits DHS to carryforward any unspent funds from the Autism Treatment Program to FY 2015. SECTION 56 – State Supplementary Assistance Carryforward 13
This section allows unspent funds to carryforward. SECTION 57 – Foster Care Respite Carryforward This language permits DHS to carryforward any unspent funds. SECTION 58 – Field Operations Carryforward This section allows unspent funds to carryforward. The Governor vetoed the carryforward language for field operations. He said the language does not work to advance his goals of returning predictability and sustainability to government budgeting. SECTION 59 – Nursing Facility Open or Unsettled Cost Reports This section mandates that DHS distribute the nursing home rebasing money that was appropriated last year. SECTION 60 – Community Mental Health Center Reimbursement Reimbursement rates for inpatient mental health services provided at hospitals shall be increased by 1%. SECTION 61 – Community Mental Health Centers This language allows CMHCs to choose between two methods of reimbursement. This was formerly a bill that passed the Human Resources committee this year. SECTION 62 – Emergency Rules This section allows DHS to adopt emergency rules. SECTION 63 – Effective Upon Enactment This Division that makes changes to the medical residency program, CDAC, autism, foster care respite, and CMHC reimbursement takes effect upon enactment. SECTION 64 – Retroactive Applicability The sections relating to CDAC are retroactive to July 1, 2013. SECTION 65 – Applicability The rules regarding DHS payments will apply beginning October 1, 2014. SECTION 66 – Retroactive Applicability The section relating to cost reports is retroactively applicable to July 1, 2015. SECTION 67 – Retroactive Applicability
DIVISION X MENTAL HEALTH AND DISABILITY SERVICES SECTION 68 – MHDS Equalization Payments Transfer and Appropriation 14
This section provides a FY 2015 General Fund appropriation to the Property Tax Relief Fund for MHDS equalization payments to counties. This is an increase from last year of $735,345 because of population growth. The money credited to the fund will be distributed by DHS. SECTION 69 – State Payment Program Remittance Appropriation This program was to pay for individuals without a county of legal settlement. County of legal settlement has been eliminated and payment is now based on county of residence. This section allocates funding that was previously appropriated to counties. SECTION 70 – Vocational Rehabilitation Services – Employment This section requires DHS and the Department of Education Vocational Rehabilitation Division to jointly develop protocols and program models to integrate employment services for persons with disabilities through a federal matching fund. The two agencies are to report to LSA and the General Assembly by December 15, 2014. SECTION 71 – Provisional Regionalization Authorization This section authorizes provisional regionalization to Marion and Mahaska counties. The counties must apply to DHS. When DHS receives the application, the Director of DHS may authorize the counties to form and operation a MHDS region on a provisional basis for up to 12 months. If the Director determines the two counties and their region are not in compliance with the requirements, the Director can assign each county to a region. SECTION 72 – Study of Community-Based Service Options for Persons with Serious Mental Illness This section requires DHS to assemble a group to study community-based placement options for persons with serious mental illness to divert them from being placed in an institution. SECTION 73 This section clarifies who is responsible for payment of a person committed to the state hospital. SECTION 74 The population has increased slightly since last year. Therefore, this section defines population so that the additional equalization funds needed by the increase in population would be included. SECTION 75 If a region is meeting its financial obligations for regionalization, the regional administrator shall reserve an adequate amount for cash flow. SECTION 76 Technical change. SECTION 77 This section revises the core services language regarding work activity, by encouraging counties to provide opportunities for employment activities that are an appropriate match with the client’s abilities. SECTION 78 This section specifies that county cash reserves are not to exceed 25% of their expenditures. SECTION 79 15
This section extends the MHDS equalization payment through FY 2016. SECTION 80 This section extends the mental health levy through FY 2016. SECTION 81 This section describes how the equalization payments will be distributed. SECTION 82 This section relates to how the Medicaid Offset will be calculated. 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 16
If the I-HAWP savings are less than this offset calculation then the I-HAWP savings would be used.
SECTION 83 This section appropriates money for the state case services. SECTION 84 - Emergency Rules This section allows DHS to adopt emergency administrative rules. SECTION 85 - Effective Upon Enactment SECTION 86 - Retroactive Applicability
DIVISION XI FAMILY SUPPLEMENTATION SECTION 87 This section lowers the nursing facility occupancy rate to 50% to allow families to supplement Medicaid money to allow their loved one to have a private room. SECTION 88 This section requires nursing homes that use the supplementation option to report the following information to DHS: Their average occupancy rate The total number of residents that utilize supplementation The average private pay charge for a private room The total charge to the resident for the private room DHS has to report the above information to the general assembly by May 1 each year.
DIVISION XII MISCELLANEOUS SECTION 89 - Preparation for Adult Living Services (PALS) This section sets the qualifications for the children that will receive assistance under the PALS program. At the time the person becomes 18, the person either received foster care services paid for by the state, services at a state training school, services at a juvenile care home, or services at a juvenile detention home. SECTION 90 This section requires the creation of a PALS program for young adults. The purpose is to assist persons leaving foster care in making a self-sufficient transition. This section gives DHS the authority to adopt rules. SECTION 91 Medicaid and Hawk-i State Plan Amendments and Waivers This section requires DHS to inform the General Assembly prior to submission of any Medicaid or Hawk-i state plan amendments. 17
The Governor vetoed this entire section. This section requires DHS to report to the Legislature prior to the submission of any state plan amendments or waivers. The Governor stated this information is already provided to the Legislature. SECTION 92 - Child Welfare Services Committee The legislative council is requested to establish a child welfare services committee. The purpose of the group is to review child welfare services in the state, identify options for improving coordination and collaboration, direct special attention to children’s mental health and behavioral health services, and submit a report with findings to the General Assembly.
DIVISION XIII ASSET VERIFICATION SECTION 93 - Medicaid Asset Verification This section requires DHS to contract with a third party vendor to establish an electronic asset, income, and identity eligibility verification system. This will cost money in FY 2015 but cost savings will begin in the second year. This bill passed the House but failed to pass in the Senate. SECTION 94 - Effective Upon Enactment This section makes Medicaid asset verification effective upon enactment. The Governor vetoed this entire Division of the bill. His reason was that the money to implement this program was in the Debt Reduction bill, which he vetoed. Therefore, it would be an unfunded mandate so he vetoed the division.
DIVISION XIV INTERDEPARTMENTAL COORDINATION - INDIVIDUALS RELEASED FROM CORRECTIONAL SYSTEM SECTION 95 This section requires DHS, DPH, and DOC to implement an interagency collaborative effort to provide an integrated approach to address the medical and psychosocial needs of people released from correctional facilities. The Departments will submit a report to the Legislature.
DIVISION XV STATE CHILD CARE ASSISTANCE SECTION 96 Currently, to receive child care assistance, a person has to either work 28 hours per week or participate in an education program for 28 hours per week. This means that people cannot receive child care 18
assistance if they both work and go to school for a combination of 28 hours per week. This section implements the combination of work or school across the whole state. This means that low income families can receive child care assistance if they both work and go to school for a combination of 28 hours per week. SECTION 97 - Implementation DHS shall adopt rules to implement the above program.
DIVISION XVI PRIOR AUTHORIZATION SECTION 98 - Prior Authorization for Prescription Drugs This section empowers the Iowa insurance commissioner to develop a single prior authorization form that each health carrier or pharmacy benefit manager shall be required to use by July 1, 2015. The commissioner is tasked with developing a standard prior authorization process which meets specified criteria. Some notable, specific criterion include: the prior authorizations must include a list of drugs that require prior authorization, standards for submitting and considering requests and an appeal process for both PBMs and carriers to contest a prior authorization determination. The forms cannot exceed two pages in length, must be in electronic format and be electronically transmissible. Health carriers and PBMs are obligated to accept the approved forms that are submitted to them when a prior authorization is required by a health plan. The Governor vetoed a portion of this section. He removed all of the time requirements and said those should be implemented through the rules process.
SECTION 99 The section requires pharmacy benefit managers to file with, and have approved by the insurance commissioner, a single prior authorization form as provided under Section 98. SECTION 100 - Submission, Approval, and Use of Prior Authorization Form A PBM shall file with and have approved by the commissioner a single prior authorization form. SECTION 101 This division of the bill is effective upon enactment.
DIVISION XVII POISON CONTROL CENTER SECTION 102 DHS shall request approval from the Centers for Medicare and Medicaid Services (CMS) to utilize administrative funding under the federal CHIP program. SECTION 103 - Effective Upon Enactment 19
This division takes effect upon enactment.
DIVISION XVIII AGING AND LONG-TERM CARE DELIVERY INTERIM COMMITTEE SECTION 104 - Interim Committee on Aging and Long-term Care Delivery The legislative council is requested to establish a study committee for the 2014 interim to examine issues relating to aging Iowans and long-term care. The interim committee will review the existing long-term care delivery system and make recommendations to create a sustainable approach that increases health and life outcomes, supports independence, and addresses medical and social needs. The interim committee shall provide a forum for open dialogue among stakeholders representing people involved in the delivery and financing of long-term care services and supports. The interim committee shall address the cost and financing of long-term care and services and the availability of workforce. The interim committee shall submit its findings and recommendations to the General Assembly for consideration during the 2015 legislative session.
DIVISION XIX HEALTHIEST CHILDREN INITIATIVE SECTION 105 - Iowa Healthiest Children Initiative The Iowa Healthiest Children Initiative is established in the Department of Public Health. The purpose of the initiative is to develop and implement a plan for Iowa children to become the healthiest children in the nation by 2020. The areas of focus shall include: improvement of physical, dental, emotional, behavioral, and mental health and wellness; access to basic needs; and promotion of healthy, active lifestyles. The Department shall create a task force and submit a plan to the Governor and General Assembly on or before December 15, 2014. SECTION 106 - Effective Upon Enactment This Division takes effect upon enactment. The Governor vetoed this entire division. He believes it duplicates the work of the Healthiest State Initiative. His veto message states that there is no need to duplicate programs or grow bureaucracy when a private sector led initiative is working.
DIVISION XX POTENTIAL MEDICAID STATE PLAN AMENDMENT - ELDERS SECTION 107 - Medicaid - Potential State Plan Amendment - HCBS for Elders DHS shall engage stakeholders to review the potential for development and submission of a Medicaid program state plan amendment to cover home and community-based services for eligible elders 65 or older. DHS shall make recommendations on or before December 15, 2014 to the Governor and General Assembly. 20
The Governor vetoed this entire division. He said that this effort is already being conducted on a regular basis and there is no need to duplicate government services.
DIVISION XXI DENTAL COVERAGE - EXTERNAL REVIEW Section 108 - 110 - Dental Coverage, External Review The sections create a “dental care service” classification to the code’s “adverse determination” definition. The sections go on to clarify that diagnostic, preventive, maintenance and therapeutic dental care are considered services subject to external review coverage determinations. Section 111 - Decisions Subject to Review The section amends §514J.103 to remove “dental care” from the code’s external review exemption. Section 112 - Commissioner Review The insurance commissioner is obligated to engage stakeholders and review the differences in the bases used for external review in health services relative to dental services. The commissioner shall report his findings to the governor and general assembly by December 15, 2014.
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