Bill: Committee: Date: Floor Manager: Staff:
Amendment 1913 to SF 505 Appropriations May 12, 2015 Representative Dave Heaton Carrie Malone (5-2063)
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FISCAL YEAR 2016 HEALTH AND HUMAN SERVICES BUDGET The House bill appropriates $1,843,743,333 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 a reduction of $14,859,686 compared to estimated FY 2015.
DIVISION I DEPARTMENT ON AGING SECTION 1 – Department on Aging Total Department on Aging Appropriation: FY 15 FY 16 Estimated Net Governor’s Request $11,419,732 $11,436,066
FY 16 Senate $11,436,066
FY 16 House $11,111,066
FY 16 House vs. Senate $-325,000
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 Governor, Senate, and House all agreed to eliminate the guardianship and conservatorship pilot project that was funded for the first time last year. The House eliminated the Office of Substitute Decision Maker appropriation of $288,666. The House and Senate agreed to move a $250,000 appropriation for food security for older individuals to the Iowa Food Bank for distribution.
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DIVISION II OFFICE OF LONG-TERM CARE OMBUDSMAN SECTION 2 – Office of Long-Term Care Ombudsman FY 15 FY 16 FY 16 Estimated Net Governor’s Request Senate $929,315 $1,056,783 $1,506,783
FY 16 House $929,315
FY 16 House vs. Senate $-577,468
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. Changes include: The Governor and the Senate funded an increase of $127,468 to maintain current programs and personnel. The House did not fund that increase. The Senate included a $450,000 increase for 8 additional Long Term Care Ombudsmen to assist the Medicaid Program applicants and enrollees. The House did not fund that increase.
DIVISION III DEPARTMENT OF PUBLIC HEALTH SECTION 3 – Department of Public Health Total Public Health Appropriation: FY 15 FY 16 Estimated Net Governor’s Request $58,782,260 $59,782,260
FY 16 Senate $62,247,429
FY 16 House $55,373,046
FY 16 House vs. Senate $-6,874,383
Addictive Disorders FY 15 Estimated Net $27,263,690
FY 16 Senate $27,263,690
FY 16 House $26,588,690
FY 16 House vs. Senate $-675,000
FY 16 Governor’s Request $27,263,690
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: The Governor and Senate funded this budget unit status quo. The House decreased this appropriation by $675,000. Healthy Children and Families FY 15 FY 16 Estimated Net Governor’s Request $4,046,602 $4,046,602
FY 16 Senate $7,331,602
FY 16 House $4,046,602
FY 16 House vs. Senate $-3,285,000
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)
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program, assistance for voluntary dental care, childhood obesity prevention, and audiology services to children. Changes include: The Senate increased this appropriation by $3,285,000 compared to FY 2015. The increase is to expand the First Five Program statewide. The House chose to fund this budget unit the same as FY 2015. Chronic Conditions FY 15 Estimated Net $5,155,692
FY 16 Governor’s Request $4,955,692
FY 16 Senate $5,105,861
FY 16 House $4,470,429
FY 16 House vs. Senate $-365,432
This budget unit funds activities and services that are provided to Iowans suffering from chronic conditions or special health care needs. This includes money for the child health specialty clinics, comprehensive cancer control, and cervical and colon cancer screening. Changes include: The Governor, Senate, and House all agree to decrease the Cervical Cancer Screening Program appropriation by $200,000. The Senate included an increase of $150,169 for the Center for Congenital and Inherited Disorders. The House did not include this increase. The House eliminated the Medical Home Residency Advisory Council appropriation of $215,263. Community Capacity FY 15 Estimated Net $8,737,910
FY 16 Governor’s Request $16,986,858
FY 16 Senate $8,719,716
FY 16 House $6,170,765
FY 16 House vs. Senate $-2,548,951
This budget unit funds activities by the Department of Public Health that are designed to strengthen the local public health system. The House chose to make significant changes to this budget unit for FY 2016. Many of the items funded in this budget unit help to create a health care safety net for people that do not have health insurance. Coverage for these people is now provided through the Iowa Health and Wellness Program or Medicaid. Therefore, many of these items no longer need to be funded by the state. The House chose to eliminate the following programs: Reach Out and Read -50,000 Collaborative Administration Allocation -145,785 Federally Qualified Healthcare Center -75,000 (FQHC) Medical Homes Local Boards of Health for Medical Homes -77,153 Pilots Child and Maternal Health Center Pilots -141,544 Rural Health Clinics -141,544 Direct Care Advisory Council -213,400 Direct Care Worker Association -216,375 Direct Care Worker Scholarships -75,000 Public Health Director’s Wellness Council -25,000 Collaborative Safety Net Integrated -1,158,150 Network Prevent Blindness Iowa -100,000 3
The House chose to decrease the appropriation for the Donor Registry by $100,000. The Senate chose to increase the appropriation for the FIND Dental Education Loan Repayment Program and the Direct Care Worker Mouth Care Matters appropriations. The House did not fund those increases.
Healthy Aging FY 15 Estimated Net $7,297,142
FY 16 Governor’s Request $0
FY 16 Senate $7,297,142
FY 16 House $7,297,142
FY 16 House vs. Senate $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. The Governor’s budget moved this appropriation into the community capacity appropriation. The Senate and House chose to leave it as a separate budget unit. Environmental Hazards FY 15 FY 16 Estimated Net Governor’s Request $803,870 $0
FY 16 Senate $0
FY 16 House $0
FY 16 House vs. Senate $0
The budget unit funds activities intended to reduce exposure to hazards in the environment, primarily chemical hazards. This appropriation is transferred to the public protection appropriation. Infectious Diseases FY 15 Estimated Net $1,335,155
FY 16 Governor’s Request $1,335,155
FY 16 Senate $1,335,155
FY 16 House $1,335,155
FY 16 House vs. Senate $0
The budget unit funds state activities designed to reduce the incidence of communicable diseases. The Governor, Senate, and House all funded this budget unit at the FY 2015 level. Public Protection FY 15 Estimated Net $3,287,127
FY 16 Governor’s Request $4,339,191
FY 16 Senate $4,339,191
FY 16 House $4,339,191
FY 16 House vs. Senate $0
The public protection budget unit funds activities related to protecting public health and safety through the establishment of standards and enforcement of regulations. Changes include: The Governor, Senate, and House all greed to transfer appropriations from Community Capacity and Environmental Hazards to this appropriation. They also all agreed to increase EMS Services by $200,000.
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Resource Management FY 15 FY 16 Estimated Net Governor’s Request $855,072 $855,072
FY 16 Senate $855,072
FY 16 House $855,072
FY 16 House vs. Senate $0
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. There is no change from the FY 2015 appropriation.
DIVISION IV VETERANS AFFAIRS SECTION 4 – Department of Veterans Affairs Total Department of Veterans Affairs Appropriation: FY 15 FY 16 FY 16 Estimated Net Governor’s Request Senate $4,585,951 $4,690,546 $4,690,546
FY 16 House $4,690,546
FY 16 House vs. Senate $0
General Administration FY 15 FY 16 Estimated Net Governor’s Request $1,095,951 $1,200,546
FY 16 House $1,200,546
FY 16 House vs. Senate $0
FY 16 Senate $1,200,546
This budget unit goes toward salaries, support, and maintenance of the Department of Veterans Affairs. Changes include: The Governor, Senate, and House all agree to an increase of $92,995 and 1 FTE position for a Cemetery Representative and 1 FTE for a maintenance worker. An increase of $11,600 to provide for audit expenses charged by the Auditor of State previously paid for by the Iowa Veterans Home. Iowa Veterans Home FY 15 FY 16 Estimated Net Governor’s Request $7,594,996 $7,594,996
FY 16 Senate $7,594,996
FY 16 House $7,594,996
FY 16 House vs. Senate $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. There is no change compared to FY 2015. Home Ownership Assistance Program FY 15 FY 16 Estimated Net Governor’s Request $2,500,000 $2,500,000
FY 16 Senate $2,500,000
FY 16 House $2,500,000
The section funds the Home Ownership Assistance Program for veterans.
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FY 16 House vs. Senate $0
SECTION 5 – Limitation of County Commission of Veterans Affairs Fund Standing Appropriation FY 15 FY 16 FY 16 FY 16 FY 16 Estimated Net Governor’s Request Senate House House vs. Senate $990,000 $990,000 $990,000 $990,000 $0 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 2015 level. The money must be used for the administration and maintenance of the County Commission of Veterans Affairs office. The funds are used for office supplies, office rent, personnel, and state and national training.
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 2016 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 $5,136,995 $10,138,178 $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 $6,654,880
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 FY 15 FY 16 FY 16 Estimated Net Governor’s Request Senate $48,693,875 $48,693,875 $49,093,875
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FY 16 House $48,418,197
FY 16 House vs. Senate $-675,678
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). Changes include: The Senate increased the appropriation for the Boys and Girls Club by $200,000. The House did not make that increase. The Senate increased the appropriation for FaDSS by $200,000. The House did not make that increase. The House eliminated the Tax Preparation Program ($195,678) and the Fatherhood Initiative ($80,000). SECTION 9 – Child Support Recovery FY 15 FY 16 Estimated Net Governor’s Request $14,911,230 $14,663,373
FY 16 Senate $14,663,373
FY 16 House $14,617,119
FY 16 House vs. Senate $-46,254
The section funds child support enforcement efforts in Iowa. Changes include: The Governor, Senate, and House all reallocated $294,111 in SERIP funds to the Medicaid program. The Governor and Senate increased the cost of services by $46,254. The House did not. SECTION 10 – Health Care Trust Fund – Medical Assistance This section states that funds deposited in the Health Care Trust Fund for FY 2016 will be appropriated to DHS to supplement the Medicaid appropriation. SECTION 11 – Medicaid Fraud Fund – Medical Assistance This section states that funds deposited in the Medicaid Fraud Fund for FY 2016 will be appropriated to DHS to supplement the Medicaid appropriation. SECTION 12 – Medical Assistance FY 15 FY 16 Estimated Net Governor’s Request $1,250,658,393 $1,012,355,027
FY 16 Senate $1,346,353,640
FY 16 House $1,320,810,997
FY 16 House vs. Senate $-25,542,643
Medical Assistance provides medically necessary healthcare coverage for financially needy parents with children, children, people with disabilities, elderly people, and pregnant women. The appropriation is approximately $70 million higher in FY 2016 than the previous year’s level, and does include additional funding for nursing homes, supported employment, and Medicaid special needs trusts. Funding for the family planning waiver is eliminated. The Governor, Senate and House have all assumed savings from the Governor’s initiative to expand the use of managed care in Medicaid. The Governor and House have savings of $51 million, while the Senate has assumed savings of $103 million. The Governor, Senate and House have all provided additional General Fund dollars for nursing homes. The House has provided $10 million, while the Governor and Senate have provided $32.5 million. The Governor and Senate have included a $5.4 million increase for hospital rate rebasing. The House did not include that increase.
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The Governor and Senate have included a $3.9 million increase for home health rebasing. The House did not include that increase. The Governor and Senate have included a $1 million increase for a hospital psychiatric care rate adjustment. The House did not include that increase. The Senate included $4.2 million for a general Medicaid provider rate increase of 1.5%. The House and the Governor did not include that increase.
SECTION 13 – Medical Contracts FY 15 FY 16 Estimated Net Governor’s Request $17,148,576 $22,903,584
FY 16 Senate $22,153,584
FY 16 House $20,613,964
FY 16 House vs. Senate $-1,539,620
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. Changes include: The Governor and Senate increased contract, IT, and operational costs by $1,037,444. The House did not fund this increase. The Governor and Senate decreased the Autism Support Program allocation by $1,000,000. The House left the appropriation at the FY 2015 level ($3,000,000). SECTION 14 – State Supplementary Assistance FY 15 FY 16 FY 16 Estimated Net Governor’s Request Senate $14,121,154 $12,997,187 $12,997,187
FY 16 House $11,841,351
FY 16 House vs. Senate $-1,155,836
State Supplementary Assistance helps low-income elderly or disabled Iowans meet basic needs and reduces state spending for Medicaid. Changes include: The Governor, Senate, and House all agreed to decrease the appropriation by $1,123,697 due to a declining caseload. The House reduced the appropriation by $1,155,836 due to FY 2015 carryforward. SECTION 15 – Children’s Health Insurance Program (CHIP) FY 15 FY 16 FY 16 Estimated Net Governor’s Request Senate $45,877,998 $21,163,844 $21,163,844
FY 16 House $20,010,344
FY 16 House vs. Senate $-1,153,500
This section appropriates money for the Healthy and Well Kids in Iowa (HAWK-i) program. Changes include: The House made a $1,110,700 general reduction to the program. The House eliminated the CHIP Outreach appropriation of $42,800. The federal government increased the amount of funds they give Iowa temporarily due to the Affordable Care Act. This 23% federal increase reduced the state costs in this program by about $30,000,000 for FY 2016.
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SECTION 16 – Child Care Assistance FY 15 FY 16 Estimated Net Governor’s Request $47,132,080 $52,553,279
FY 16 Senate $56,638,030
FY 16 House $48,608,668
FY 16 House vs. Senate $-8,029,362
The Child Care Assistance program supports low income families with working parents, parents gaining working skills, or parents going to school. In addition to paying for child care, this appropriation supports the regulation of child care providers. Changes include: The Senate increase eligibility to 160% of the federal poverty level. This is an increase of $7,929,362. The House did not fund that increase. The House eliminated the Child Burial Program appropriation (100,000). The fund still has $90,000 in it from last year that has yet to be spent. SECTION 17 – Juvenile Institutions State Training School at Eldora FY 15 FY 16 Estimated Net Governor’s Request $12,358,285 $12,445,552
FY 16 Senate $12,445,552
FY 16 House $11,941,330
FY 16 House vs. Senate $-504,222
The State Training School at Eldora provides treatment and educational services to assist youth who are adjudicated delinquent. Changes include: The Governor, Senate, and House all agree to reallocate $251,936 of SERIP funds to Medicaid. The Governor, Senate, and House all added $693,168 to replace lost funds from the Department of Education. The Governor and Senate increased the appropriation by $212,132 to replace the loss of grant funding for a substance use disorder program. The House did not fund that increase. The Governor and Senate added $292,090 for an additional special education position and four additional education aides. The House did not fund these changes. Iowa Juvenile Home at Toledo FY 15 FY 16 Estimated Net Governor’s Request $507,766 $507,766
FY 16 Senate $372,766
FY 16 House $372,766
FY 16 House vs. Senate $0
Prior to its closure, the Iowa Juvenile Home and the State Training School for Girls at Toledo provided treatment and educational services within a structured setting to assist girls who are adjudicated delinquent and children in need of assistance (CINA). Changes include: The $135,000 of SERIP dollars in this budget unit are being reallocated. SECTION 18 – Child and Family Services FY 15 FY 16 Estimated Net Governor’s Request $94,857,554 $94,967,179
FY 16 Senate $98,182,179
FY 16 House $86,128,726
FY 16 House vs. Senate $-12,053,453
The section appropriates money for various child welfare and juvenile justice programs. Changes include: The Senate increased provider rates by 5%. The House did not fund this $2,100,000 increase.
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The Senate increased the Systems of Care appropriation by $115,000 to fund the Total Child Initiative. The House did not fund this increase. A $50,000 decrease by the House for Autism. This will now be funded by the medical contracts appropriation. A $76,648 decrease by the House for the Systems of Care Grants. A $8,711,805 decrease in general fund money by the House. The Social Services Block Grant will be used instead of general fund money.
SECTION 19 – Adoption Subsidy FY 15 FY 16 Estimated Net Governor’s Request $42,580,749 $42,888,386
FY 16 Senate $42,998,286
FY 16 House $42,998,286
FY 16 House vs. Senate $0
This section provides the FY 2016 funding for the subsidized adoption program. Changes include: The Senate and House agreed to a $145,818 increase for caseload growth. SECTION 20 – Juvenile Detention Home Fund This section requires funds deposited in the Juvenile Detention Fund to be distributed to the eligible juvenile detention centers. SECTION 21 – Family Support Subsidy Program FY 15 FY 16 FY 16 Estimated Net Governor’s Request Senate $1,079,739 $1,073,932 $1,073,932
FY 16 House $1,073,932
FY 16 House vs. Senate $0
SECTION 22 – 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 23 – Mental Health Institutes This section sets out the funding for the state’s four mental health institutes. Cherokee Mental Health Institute FY 15 FY 16 Estimated Net Governor’s Request $6,031,934 $14,644,041
FY 16 Senate $5,545,616
FY 16 House $5,545,616
FY 16 House vs. Senate $0
Clarinda Mental Health Institute FY 15 FY 16 Estimated Net Governor’s Request $6,787,309 $0
FY 16 Senate $1,812,899
FY 16 House $1,810,000
FY 16 House vs. Senate $-2,899
Changes include: The Senate reduced this general fund appropriation by $4,836,507 and replaced it with social services block grant funds.
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The House appropriated $1,810,000 as a part of the agreement reached between Reps. Heaton, Dolecheck, and the Governor. The agreement includes: o The $1.8 million will be used to operate a 15 bed acute inpatient psychiatric program and a six bed gero-psychiatric program. It will operate through December 15, 2015. o After December 15, the Department of Human Services will work to find a mental health provider to take over the MHI on a private basis.
Independence Mental Health Institute FY 15 FY 16 Estimated Net Governor’s Request $10,484,386 $23,963,370
FY 16 Senate $10,390,773
FY 16 House $10,324,209
FY 16 House vs. Senate $-66,564
Changes include: The Governor, Senate, and House all appropriated an additional $472,409 for education expenses due to a decrease from the Department of Education. Mount Pleasant Mental Health Institute FY 15 FY 16 Estimated Net Governor’s Request $1,417,796 $0
FY 16 Senate $0
FY 16 House $1,040,000
FY 16 House vs. Senate $1,040,000
Changes include: The Senate funds ongoing operations of the MHI at Miunt Pleasant using Social Services Block Grant funds and no general funds. The House appropriated $1,040,000 as a part of the agreement reached between Reps. Heaton, Dolecheck, and the Governor. The agreement includes: o The $1,040,000 will be used to operate a 50 bed substance abuse residential treatment program. It will operate through December 15, 2015. o After December 15, the Department of Public Health will work with stakeholders to select a private provider to operate a dual diagnosis and residential treatment program. SECTION 24 – 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 15 FY 16 Estimated Net Governor’s Request $21,695,266 $22,024,482
FY 16 Senate $22,024,482
FY 16 House $21,524,482
FY 16 House vs. Senate $-500,000
FY 16 House $14,583,806
FY 16 House vs. Senate $-350,000
Changes include: The House included a general reduction of $500,000. Woodward State Resource Center FY 15 FY 16 Estimated Net Governor’s Request $14,855,693 $14,933,806
FY 16 Senate $14,933,806
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Changes include: The House included a general reduction of $350,000. SECTION 25 – Sexually Violent Predators FY 15 FY 16 Estimated Net Governor’s Request $9,923,563 $9,893,079
FY 16 Senate $9,893,079
FY 16 House $9,893,079
FY 16 House vs. Senate $0
The section makes the FY 2016 appropriation to the Civil Commitment Unit for Sexual Offenders. SECTION 26 – Field Operations FY 15 FY 16 Estimated Net Governor’s Request $65,170,976 $58,920,976
FY 16 Senate $58,920,976
FY 16 House $58,920,976
FY 16 House vs. Senate $0
The section sets the FY 2016 appropriation for local DHS offices and service area offices. There is a general decrease of $4,000,000 requested by the Governor that the House and Senate agree to. SECTION 27 – General Administration FY 15 FY 16 Estimated Net Governor’s Request $16,072,302 $14,661,741
FY 16 Senate $15,161,741
FY 16 House $12,848,198
FY 16 House vs. Senate $-2,313,543
This section funds the central office activities of DHS. Changes include: The Senate included an increase of $250,000 for the Able Act. The House did not include this new policy or appropriation. The House eliminates the $38,543 appropriation for the Prevention of Disabilities Council. The Senate and House both transfer $250,000 from the Department of Aging to General Administration to go to the Iowa Food Bank. The House decreases the Council on Homelessness allocation by $25,000. The House reduces the general fund appropriation by $2,000,000 and backfills it with a Food Assistance Bonus from the federal government that has to be used by next year. SECTION 28 – 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 2015. SECTION 29 – 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 2016 shall be the same as were in place in the previous fiscal year. SECTION 30 – Emergency Rules This section permits DHS and the Mental Health and Disability Services Commission to adopt emergency rules when authorized. If the rules result in an expenditure increase beyond the amount anticipated in
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the appropriations process, the Department shall notify the chairpersons and ranking members of the appropriations committees and the Department of Management. SECTION 31 – 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. SECTION 32 – Effective Upon Enactment The section of the bill that requires allocations to the judicial districts, as determined by the Court Administrator, and to the DHS districts, as determined by the Division of Child and Family Services Administrator, is effective on enactment. In this section of the Senate bill, the Senate prohibits DHS from utilizing emergency rules to implement managed care. The Governor and House proposal assumes $51 million in savings can be realized for 6 months of FY 2016. The Senate doubles that amount to $102 million. If emergency rules cannot be used, the Senate is clearly setting the Medicaid Modernization up to fail.
DIVISION VI HEALTH CARE ACCOUNTS AND FUNDS SECTION 33 – 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 $2,002,176. SECTION 34 – Quality Assurance Trust Fund For FY 2016, $36,705,208 will be appropriated from the Quality Assurance Trust Fund to DHS for Medicaid. This is an increase of $7,509,555 compared to FY 2015. The increase is due to raising the assessment. This fund is used to supplement nursing facilities under the Medicaid program. SECTION 35 – 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 2016. SECTION 36 – Medical Assistance Program – Nonreversion This section requires nonreversion of funds from the Medicaid Program. The funds will remain within the appropriation to be used in the succeeding fiscal year.
DIVISION VII PRIOR YEAR APPROPRIATIONS AND OTHER PRIOR PROVISIONS MEDICAID OFFSET PAID BY COUNTIES IN FY 2015 This division lays out the House proposal for additional funding for Medicaid in FY 2015. The current estimate is that there is a $76,000,000 need in Medicaid for FY 2015. DHS and the Governor’s office has identified areas within the DHS budget where funding can be moved to Medicaid. Therefore, this bill makes de-appropriations from a number of programs and increases the Medicaid line item for FY 2015.
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The House proposal moves $49.4 million from various parts of DHS to Medicaid. The Senate moved almost $37 million within the FY 2015 DHS budget to Medicaid, and also provided a $32 million supplemental appropriation. The House proposal does not include a supplemental. SECTION 37 – Medicaid Offset Any payment received back from the counties as a part of the Medicaid Offset will be transferred to DHS to be used for the FY 2015 Medicaid shortfall. This is approximately $9,986,651. Both the House and the Governor use these funds for the FY 2015 Medicaid shortfall. The Senate uses these funds to increase the following:
Fund FY 15 Medicaid Shortfall Reduce HCBS Waiver Waiting List Return Funds to Counties with less than 25% fund balance Alzheimer’s Education Program Certified Behavioral Health clinics
Senate Uses Money for FY 2016 Increases No $5,092,000 $4,554,651
House Uses Money for FY 2015 Medicaid Shortfall $9,986,651 $0 $0
$100,000 $240,000
$0 $0
SECTION 38 – Decategorization Carryover Funding – Transfer to Medicaid Program This section reduces the DCAT appropriation by $3,000,000 million, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 39 – Community Mental Health Services Appropriation This section moves block grant funds to the Systems of Care appropriation, which frees up $1,643,467 to be used for the FY 2015 Medicaid appropriation. SECTION 40 – Temporary Assistance for Needy Families This section increases funding for TANF by $6,281,222. This frees up $6,281,222 in general funds to be used for the FY 2015 Medicaid appropriation. SECTION 41 – Child Support Recovery Unit This section reduces the Child Support Recovery appropriation by $175,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 42 – Medical Assistance This section includes the total amount of money we are de-appropriating that will be used to fund FY 2015 Medicaid. The total amount of money we are moving is $29,000,000 that was previously appropriated for FY 2015 but did not get spent. SECTION 43 – Disproportionate Share Hospital This section requires the University of Iowa to fund $2,800,000 of their disproportionate share, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 44 – Medical Contracts This section reduces the Medical Contracts appropriation by $750,000, which allows these funds to be used for the FY 2015 Medicaid appropriation.
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SECTION 45 – State Supplementary Assistance This section reduces the State Supplementary Assistance appropriation by $1,100,000, which allows these funds to be carried forward for the FY 2016 Medicaid appropriation. SECTION 46 – Children’s Health Insurance Program/ HAWK-i This section reduces the Children’s Health Insurance Program by $780,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 47 – Child Care Assistance This section reduces the Child Care Assistance appropriation by $11,000,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. Child Care Assistance will not be underfunded because it is backfilled with federal TANF money. SECTION 48 – Children Adjudicated as Delinquent and Child in Need of Assistance This section reduces the CINA appropriation by $600,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 49 – Child and Family Services This section reduces the Child and Family Services appropriation by $8,200,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 50 – Adoption Subsidy This section reduces the Adoption Subsidy appropriation by $836,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 51 – Family Support Subsidy This section reduces the Family Support Subsidy appropriation by $500,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 52 – Clarinda and Independence Mental Health Institutes This section reduces the Clarinda appropriation by $548,000 and the Independence appropriation by $141,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 53 – Glenwood and Woodward State Resource Centers This section reduces the Glenwood appropriation by $500,000 and the Woodward appropriation by $350,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 54 – Field Operations This section reduces the field operations appropriation by $4,000,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. Currently, there are numerous FTE vacancies that are causing this large amount of excess money. SECTION 55 – General Administration This section reduces the General Administration appropriation by $1,000,000, which allows these funds to be used for the FY 2015 Medicaid appropriation. SECTION 56 – Quality Assurance Trust Fund 15
This section utilizes $500,000 from the Quality Assurance Trust Fund for the FY 2015 Medicaid appropriation. SECTION 57 – Effective Upon Enactment This division takes effect upon enactment. SECTION 58 – Retroactive Applicability This division is retroactively applicable to July 1, 2014.
DIVISION VIII QUALITY ASSURANCE ASSESSMENT SECTION 59 – This section requires the Nursing Facility Quality Assurance Assessment to be set at 3%.
DIVISION IX AUTISM SECTION 60 – New Section. Behavior Analyst and Board Certified Assistant Behavior Analyst Grants Program and Fund The Autism Support Program was created to help families whose health insurance did not cover autism services. The appropriation for this budget unit is $3,000,000. Over the last year, not much of this fund has been spent due to a lack of providers in the state. This section seeks to remedy the situation by providing a financial incentive for behavioral analysts to study in the state. This section requires the Department establish a board-certified behavior analyst and board-certified assistant behavior analyst grant program to provide grants to Iowa resident and non-resident applicants who have been accepted to a regents university, community college, or other accredited private institution. They also have to be enrolled in a program to be eligible for board certification and demonstrate financial need. This section creates a board-certified behavior analyst and a board-certified assistant behavior analyst grant program fund in the treasury. SECTION 61 This section changes the current definition of “autism service provider.” In the current law, only certified behavioral analysts can get reimbursed through the Autism Support Program. This section opens this strict criteria to include board-certified assistant behavior analysts. SECTION 62 This section clarifies that a written denial of coverage is sufficient to indicate that autism services are not a covered benefit.
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DIVISION X OFFICE OF SUBSTITUTE DECISION MAKER SECTION 63 This section extends the time period for which the Office of Substitute Decision Maker can establish local offices and become a statewide operation. This change is needed so that the Office does not get audited by the State Auditor for non-compliance (we currently do not fund this office in our amendment).
DIVISION XI PHARMACEUTICAL COLLECTION AND DISPOSAL PROGRAM SECTION 64 This section permits the Board of Pharmacy to allocate up to $175,000 of the fees available to the Board for the Pharmaceutical Collection and Disposal Program. This is an increase of $50,000.
DIVISION XII COUNTY MENTAL HEALTH AND DISABILITIES SERVICES FUNDING - EQUALIZATION AND MEDICAID OFFSET SECTION 65 This section extends the Mental Health and Disability Services Property Tax Levy for an additional year through FY 2017. The system levies funding based on either a per capita formula or where property taxes were capped in 1996, whichever is lower. SECTION 66 This section extends the per capita distribution formula for MHDS for an additional year through FY 2017. SECTION 67 This section extends the MHDS equalization payment through FY 2017. SECTION 68 This section strikes the code subsection related to the Medicaid Offset that required counties to return a portion of the savings related to the Iowa Health and Wellness Program. There will no longer be a “Medicaid Offset” or “Clawback.” This money (around $10,000,000) will now remain with the counties.
DIVISION XIII PROPERTY TAX RELIEF FUND - BLOCK GRANT MONEYS APPROPRIATIONS FOR FY 2015-2016 SECTION 69 – Property Tax Relief Fund – Block Grant The state receives $11,774,275 from the federal government for the TANF block grant. This section transfers $8,711,805 from the block grant to the Child and Family Services appropriation. It also transfers $3,062,470 to be used to create a state Family Planning Services program.
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DIVISION XIV HOSPITAL AND LONG-TERM CARE PHARMACY PRACTICE - PNEUMOCOCCAL VACCINES - BOARD OF PHARMACY RULES SECTION 70 This section directs the Board of Pharmacy to adopt administrative rules that permit a written or verbal patient-specific medication administration order not be required prior to administration to an adult patient of pneumococcal conjugate vaccine pursuant to physician-approved hospital or facility policy.
DIVISION XV HEALTHY AND WELL KIDS IN IOWA PROGRAM - CONTINUED ENROLLMENT SECTION 71 This section requires DHS to continue to provide coverage for children under the hawk-i Program during eligibility re-determination.
DIVISION XVI PERSONNEL SETTLEMENT AGREEMENTS SECTION 72 – 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 XVII MEDICAID PROGRAM ELIGIBILITY VERIFICATION SECTION 73 – Medicaid Program – Eligibility Verification This section requires DHS to contract with a third party vendor to establish an electronic asset, income, and identity eligibility verification system for the blind, disabled, and aged population. Currently, federal law requires we do this and Iowa is not in compliance. SECTION 74 – Effective Upon Enactment Asset verification takes effect on enactment of this bill.
DIVISION XVIII CODE CHANGES - CLARINDA AND MOUNT PLEASANT MENTAL HEALTH INSTITUTES AND IOWA JUVENILE HOME SECTIONS 75 – 93 These sections remove all references of the Juvenile Home at Toledo, the Mental Health Institute at Mount Pleasant, and the Mental Health Institute at Clarinda from Iowa Code effective December 16, 2015. Removing these items from the Code was a part of the compromise plan our members reached 18
with the Governor. The MHIs at Mount Pleasant and Clarinda will remain open until December 15, 2015 to allow for a transition time. After that time, DHS and IDPH will work to find private providers to take over the facilities.
DIVISION XIX DISTRIBUTION OF MEDICAID FAMILY PLANNING NETWORK WAIVER ESTABLISHMENT OF STATE FAMILY PLANNING SERVICES PROGRAM SECTION 94 – 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, 2015. 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: a) Public entities that provide family planning services. These would include state, county, or local health clinics and FQHCs. b) Nonpublic entities that provide primary health services. c) 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. SECTION 95 – Effective Upon Enactment This division takes effect upon enactment.
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DIVISION XX BOARD OF RESPIRATORY CARE AND POLYSOMNOGRAPHY SECTION 96 – Board of Respiratory Care and Polysomnography If general funds are used to create this board, the board is required to repay those funds to the state by June 30, 2017.
DIVISION XXI PHYSICIAN ASSISTANT SUPERVISION SECTION 97 This section requires the Board of Medicine to establish minimum standards for appropriate physician supervision of physician assistants. The Board of Medicine shall consult with the Board of Physician Assistants related to these rules.
DIVISION XXII FOOD ASSISTANCE PROGRAM BONUS - GENERAL ADMINISTRATION SECTION 98 Any funds available to DHS for FY 2015 received from the federal government as a bonus for achieving a low error rate shall be used by DHS for general administration.
DIVISION XXIII - DIVISION XXX FY 2017 APPROPRIATIONS Appropriations for FY 2017 are funded at 50% of the FY 2016 level.
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