HOUSE REPUBLICAN STAFF ANALYSIS ________________________________________________________________________ Bill: SF 446 Committee: Appropriations Date: May 1, 2013 Floor Manager: Representative Heaton Staff: Carrie Kobrinetz (5-2063) ________________________________________________________________________________ FY 2014 HEALTH AND HUMAN SERVICES APPROPRIATIONS The House amendment to Senate File 446 appropriates $1,698,550,336 in General Fund dollars for the Departments on Aging, Public Health, Human Services, and Veterans’ Affairs in Fiscal Year 2014. This is an increase of $30,827,779 over FY 2013. Summary of Action Initial Senate Action – The Senate PASSED Senate File 446 by a vote of 26-22 on April 18, 2013. DIVISION I DEPARTMENT ON AGING SECTION 1 - Department on Aging FY 13 Estimated Net $10, 342, 086
FY 14 Governor’s Request $10,342,086
FY 14 Senate $14,152,732
FY 14 House $10,442,068
Change from FY 13 $100,000
This section allows the Department on Aging to provide citizens of Iowa who are 60 years of age and older with case management, adult day services, respite care, chore services, and for salaries, support, and administration. Of the funds appropriated in this section, $279,946 will be transferred to the Economic Development Authority to be used for the Retired and Senior Volunteer Program (commonly known as “RSVP”). This is an increase of $100,000. Money in this section will also be used to provide for a local longterm care resident’s advocate to administer the certified volunteer long term care advocate program.
DIVISION II DEPARTMENT OF PUBLIC HEALTH SECTION 2 - Department of Public Health 1
Addictive Disorders FY 13 FY 14 Estimated Net Governor’s Request $23,863,690 $23,863,690
FY 14 Senate $29,763,690
FY 14 House $23,863,690
Change from FY 13 $0
This budget unit provides funding for services directed toward reducing the use of tobacco, alcohol and other drugs, and treating Iowans with addictive disorders. The budget unit is funded at the FY 2013 level. For substance abuse services, the bill appropriates $17,103,715. The section provides $3,111,614 million for gambling treatment services. To achieve the state’s maintenance of effort requirement for federal substance abuse funding, the Department is directed to work with other state agencies to identify state funding currently spent on substance abuse treatment services. Healthy Children and Families FY 13 FY 14 Estimated Net Governor’s Request $2,603,559 $2,653,559
FY 14 Senate $6,996,099
FY 14 House $2,653,559
Change from FY 13 $50,000
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) program, assistance for voluntary dental care, childhood obesity prevention, and audiology services to children. Additional funding of $50,000 is provided for youth suicide prevention. The Governor requested the increase and it is included in the budget unit. Chronic Conditions FY 13 FY 14 Estimated Net Governor’s Request $3,905,429 $4,120,692
FY 14 Senate $5,220,411
FY 14 House $2,955,429
Change from FY 13 $50,000
This budget unit funds activities and services that are provided to those Iowans suffering from chronic conditions or special health care needs. This budget unit includes money for the child health specialty clinics, comprehensive cancer control, and cervical and colon cancer screening. The Governor’s budget requested an additional $215,263 for continuation of prevention and chronic care management Health Care Transformation Account which is not included in the budget unit. Funding for Epilepsy support is increased by $50,000. Epilepsy support will provide education, client-centered programs, and client and family support for people living with epilepsy and their families. Community Capacity FY 13 FY 14 Estimated Net Governor’s Request $4,869,980 $4,894,980
FY 14 Senate $7,514,110
FY 14 House $4,673,417
Change from FY 13 $-196,563
This budget unit funds activities by the Department of Public Health that are designed to strengthen the local public health system. The appropriation for the budget unit is revised due to the following changes: Eliminate Direct Care Worker Association $-150,000 (decrease) Eliminate Collaborative Administrative Allocation $-146,563 (decrease) Transfer Direct Care Worker Advisory Council $-147,025 (decrease) Transfer Direct Care Worker Scholarships $-75,000 (decrease)
Transfer DCW Council and Scholarships to IWD $222,025 Prevent Blindness Iowa $50,000 (increase) Reach Out and Read $50,000 (increase) $222,025 of the money appropriated in this section will be transferred to the Iowa Department of Workforce Development to implement the recommendations of the Direct Care Worker Advisory Council. The Direct Care Worker Advisory Council will be eliminated. Prevent Blindness Iowa is getting an increase of $50,000. The money is dedicated to preserving sight and preventing blindness through education, nationally certified vision screening and training, and community and patient service programs. Reach Out and Read is also getting an increase of $50,000 that will be distributed to a statewide nonprofit organization to be used to support a partnership between medical providers and parents through community health centers to promote reading. Healthy Aging FY 13 Estimated Net $7,297,142
FY 14 Governor’s Request $7,297,142
FY 14 Senate $7,297,142
FY 14 House $7,297,142
Change from FY 13 $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 budget unit is funded at the FY 2013 level. Environmental Hazards FY 13 FY 14 Estimated Net Governor’s Request $803,870 $803,870
FY 14 Senate $803,870
FY 14 House $803,870
Change from FY 13 $0
The budget unit funds activities intended to reduce exposure to hazards in the environment, primarily chemical hazards. The budget unit is funded at the FY 2013 level. Infectious Diseases FY 13 FY 14 Estimated Net Governor’s Request $1,335,155 $1,335,155
FY 14 Senate $1,335,155
FY 14 House $1,335,155
Change from FY 13 $0
The budget unit funds state activities designed to reduce the incidence of communicable diseases. The budget unit is funded at the FY 2013 level. Public Protection FY 13 FY 14 Estimated Net Governor’s Request $2,779,127 $3,175,127
FY 14 Senate $3,334,571
FY 14 House $3,259,571
Change from FY 13 $480,444
The public protection budget unit funds activities related to protecting public health and safety through the establishment of standards and enforcement of regulations. This budget unit is increased by $480,444 from the FY 2013 level by making the following changes:
Creation of a Substance Abuse Board (HF 569) Maintain the Environmental Health Program Orthotists, Prosthetics, Pedorthists fee model EMS Task Force
$55,800 (one time money) $368,000 (increase) $28,000 (one time money) $28,644 (increase)
The budget unit allocates $55,800 to create Substance Abuse and Addictive Disorder Counseling Licensure pursuant to House File 569 that was passed this session. $368,000 will go toward maintenance of environmental health programs to ensure public safety. $28,000 will be used as one-time funding to transition the licensing of orthotists, prosthetists, and pedorthists to a fee-supported licensing model. $28,644 will be used for the costs of the emergency medical services task force. Resource Management FY 13 FY 14 Estimated Net Governor’s Request $804,054 $804,054
FY 14 Senate $804,054
FY 14 House $804,054
Change from FY 13 $0
This budget unit is the administrative arm of the Department. The University of Iowa Hospitals and Clinics shall not receive indirect costs from the funds appropriated in this section. DIVISION III VETERANS AFFAIRS SECTION 3 - Department of Veterans Affairs Department on Veteran Affairs Administration FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $1,025,819 $1,093,508 $1,093,508
FY 14 House $1,093,508
Change from FY 13 $67,689
This budget unit goes toward salaries, support, and maintenance of the Department of Veterans Affairs. The funding in this section is increased by $67,689 from its FY 2013 levels by increasing the allocation for rent costs at Camp Dodge and an increase for accounting, budget, and IT services. Iowa Veterans Home FY 13 FY 14 Estimated Net Governor’s Request $8,025,714 $8,025,714
FY 14 Senate $8,025,714
FY 14 House $7,525,714
Change from FY 13 $-500,000
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. The funding is reduced from the FY 2013 level by $500,000. This reduction is due to available carryforward. Language is added to the section requiring the Veterans Home to submit its expenditure report to the Legislative Services Agency on a monthly basis. This requirement was line-item vetoed by the Governor last year: “While I strongly support transparency efforts that publicly disclose how departments spend their resources, this information is already available within the State’s accounting and budgeting systems.” State Education Assistance – Children of Deceased Veterans FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $12,416 $12,416 $12,416
FY 14 House $0
Change from FY 13 $-12,416
The section provides funding for educational grants to children of veterans killed in action. Pursuant to House File 613, the appropriation is being removed because it has not been used since FY 2009.
Home Ownership Assistance Program FY 13 FY 14 Estimated Net Governor’s Request $1,600,000 $1,600,000
FY 14 Senate $1,600,000
FY 14 House $1,600,000
Change from FY 13 $0
The section funds the Home Ownership Assistance Program for veterans. SECTION 4 – Limitation of County Commission of Veterans Affairs Fund Standing Appropriation FY 13 FY 14 FY 14 FY 14 Estimated Net Governor’s Request Senate House Change from FY 13 $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 2013 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 IV DEPARTMENT OF HUMAN SERVICES SECTION 5 - Temporary Assistance for Needy Families Block Grant - The 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. The allocations are:
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 Food Assistance Program support
$ 18,116,948 $ 11,866,439 $ 2,898,980 $ 31,296,232 $ 3,744,000 $ 25,732,687 $ 4,894,052 $ 32,084,430 $ 125,000 $ 1,930,067 $ 1,037,186 $ 25,000
SECTION 6 - 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 section also includes language concerning the funding of the Family Development and Self-Sufficiency program (FaDSS), the FIP Diversion program, and the Food Assistance employment and training program.
SECTION 7 - Family Investment Program General Fund FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $48,397,214 $47,897,214 $48,894,380
FY 14 House $47,897,214
Change from FY 13 $-500,000
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 following: Cash benefits on a monthly basis. PROMISE JOBS Program – Promoting Independence and Self-Sufficiency through Employment, Job Opportunities, and Basic Skills. The program provides training and employment services. Family Self-Sufficiency Grant – Provides up to $1,000 per year to pay for work related goods and services. Family Development and Self Sufficiency (FaDSS) – Intensive home-based case management. The FY 2014 level is below FY 2013 by $500,000 because the Governor vetoed a one-time appropriation to the food bank. SECTION 8 - Child Support Recovery Unit FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $13,149,541 $14,173,770 $14,173,770
FY 14 House $14,173,770
Change from FY 13 $1,024,229
The section funds child support enforcement efforts in Iowa. The FY 2013 appropriation is increased by $1,024,229, to replace the loss of federal incentives and one-time funding, and to increase the costs of services. SECTION 9 – Health Care Trust Fund – Medical Assistance This section states that funds deposited in the Health Care Trust Fund for FY 2014 will be appropriated to DHS to supplement the Medicaid appropriations. Under the House Republican Budget plan, all tobacco tax revenue will be deposited in the Health Care Trust Fund to pay for the state’s share of Medicaid. SECTION 10 – Medicaid Fraud Fund Money recovered by the Department of Inspections & Appeals in the Medicaid fraud fund for FY 2014 is appropriated to DHS to supplement Medicaid. These funds had previously been used to pay for certain operations in the Department of Inspections and Appeals. SECTION 11 – Medical Assistance FY 13 FY 14 Estimated Net Governor’s Request $914,993,421 $1,024,388,866
FY 14 Senate $1,301,686,445
FY 14 House $1,125,800,162
Change from FY 13 $210,806,741
The chart below shows Iowa Medicaid enrollment and spending by enrollment category:
Medical Assistance provides medically necessary healthcare coverage for financially needy parents with children, children, people with disabilities, elderly people, and pregnant women. The FY 2014 appropriation is $210,806,741 above the FY 2013 level. A majority of the increase is due to the transfer of mental health funding into the Medicaid budget. With the implementation of mental health redesign, the state is no longer distributing funds to the counties so they can pay the Medicaid program. Those funds are now in the Medicaid budget. The section maintains the monthly personal needs allowance level at $50 for Medicaid enrollees residing in nursing homes, Intermediate Care Facilities for those with Mental Retardation (ICF/MR) and Intermediate Care Facilities for those with Mental Illness (ICF/MI). The section provides appropriations to the four state Mental Health Institutes to make up for reduced federal funding through the IowaCare program. The section retains language that would allow the University of Iowa Hospitals and Clinics to utilize the certified public expenditure process to draw down federal Medicaid match. The section also states for third party contracts under Medicaid, any interest earned on the payments for these contracts will be returned to the state for Medicaid. Medicaid Cost Containment Strategies The bill adds new cost containment strategies that will save Medicaid approximately $29,885,000 for FY 2014. They include: Integrating Medicaid habilitation services into the Iowa Plan contract Require prior authorization for home health services for adults with over 100 visits per year Prohibit coverage for elective, non-medically necessary cesarean sections Require prior authorization before reimbursement for hospital swing bed placements Align payment methods and rates between medical and non-medical transportation Require all fees for employee record checks be paid by HCBS consumer directed attendant care Require transition of personal care Require people with an intellectual disability receiving Medicaid to receive a functional assessment Develop a new reimbursement method for targeted case management Implement an integrated health home approach Expand categories of diabetic supplies for which a rebate may be received Limit initial authorization for institutional based care to 30 days for members following discharge from a hospital SECTION 12 - Medical Contracts FY 13 FY 14 Estimated Net Governor’s Request $5,791,994 $9,562,544
FY 14 Senate $14,225,569
FY 14 House $8,620,749
Change from FY 13 $2,828,755
This provides the money for DHS to contract out with several entities to carry out programs to support the Medicaid program. Staff performs policy functions; they also manage Medicaid vendors to assure member access, cost effectiveness, and value. Additional funding is provided to replace IowaCare funds used in FY 2013. SECTION 13 - State Supplementary Assistance FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $15,450,747 $16,512,174 $16,512,74
FY 14 House $16,512,174
Change from FY 13 $1,061,427
State Supplementary Assistance helps low-income elderly or disabled Iowans meet basic needs and reduces state spending for Medicaid. The amount is $1,061,427 above the FY2013 level due to expected FY2014 caseload growth. SECTION 14 - Children’s Health Insurance Program FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $36,806,102 $36,806,102 $36,806,102
FY 14 House $36,806,102
Change from FY 13 $0
This section appropriates money for the Healthy and Well Kids in Iowa (HAWK-I) program. The House and Senate bills are the same and there is no increase from last year’s appropriation. SECTION 15 - Child Care Assistance FY 13 FY 14 Estimated Net Governor’s Request $62,264,342 $61,222,955
FY 14 Senate $69,282,163
FY 14 House $59,264,342
Change from FY 13 $-3,000,000
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. The decrease in the FY2014 appropriation is due to increase the amount of TANF funding used for this appropriation. This section also funds the federal fingerprint record check requirement and provides funding for projected caseload growth. One adjustment in child care funding is changing how Early Childhood Iowa areas receive their funding. In previous years, this budget provided funds from the TANF block grant. This year this is being switched to general fund dollars so that local ECI groups do not have to fill out the significant paperwork requirements associated with using TANF funds.
SECTION 16 - Juvenile Institutions Iowa Juvenile Home at Toledo FY 13 FY 14 Estimated Net Governor’s Request $8,297,765 $8,859,355
FY 14 Senate $8,859,355
FY 14 House $8,859,355
Change from FY 13 $561,590
The Iowa Juvenile Home and the State Training School for Girls at Toledo provide treatment and educational services within a structured setting to assist girls who are adjudicated delinquent and children in need of assistance. The section is increased due to an increase in food, transportation, and utilities costs that was recommended by the Governor. This appropriation sustains the funding level approved in FY 2013. State Training School at Eldora FY 13 FY 14 Estimated Net Governor’s Request $10,680,143 $11,256,969
FY 14 Senate $11,256,969
FY 14 House $11,256,969
Change from FY 13 $576,826
The State Training School at Eldora provides treatment and educational services to assist youth who are adjudicated delinquent. The section is increased due to an increase in food, transportation, and utilities costs that was recommended by the Governor. This appropriation sustains the funding level approved in FY 2013. SECTION 17 - Child and Family Services FY 13 FY 14 Estimated Net Governor’s Request $81,231,561 $81,274,946
FY 14 Senate $96,613,770
FY 14 House $81,274,946
Change from FY 13 $43,385
The section appropriates money for various child welfare and juvenile justice programs. The section is increased by $43,385 from FY 2013. The main programmatic adjustment in this section is a reduction in funding for shelter care by $438,248. SECTION 18 - Adoption Subsidy FY 13 FY 14 Estimated Net Governor’s Request $36,788,567 $39,156,832
FY 14 Senate $35,644,083
FY 14 House $39,156,832
Change from FY 13 $2,368,256
This section provides the FY 2014 funding for the subsidized adoption program. The FY 2013 appropriation is increased by $2,368,256 to replace the loss of $780,576 in federal funding, to fund $790,660 in caseload growth, and to fund $998,628 for the FY 2013 shortfall. SECTION 19 – Juvenile Detention Home Fund Money deposited in the juvenile detention home fund are appropriated to DHS for distribution. Money will be allocated among eligible detention homes, prorated on the basis of the proportion of the costs of all eligible detention homes. This language is status quo. Nothing is being changed to the existing formula of how detention centers get their funds. SECTION 20 - Family Support Subsidy Program FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $1,096,784 $994,955 $1,092,955
FY 14 House $994,955
Change from FY 13 $-101,829
This program helps keep families together by defraying some of the special costs of caring at home for a child with disabilities. Funding for the Family Support Subsidy is reduced by $101,829, due to children aging out of the system. SECTION 21 - 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 for this year is $33,622. SECTION 22 - Mental Health Institutes This section sets out the funding for the state’s four mental health institutes. All four MHI’s are increased by approximately $20,000 for increases in food, transportation, and utilities costs. All four MHI’s also get money to sustain the funding level approved in FY 2013 and a transfer from general administration. Mt. Pleasant gets an additional $82,485 for a pharmacist. Cherokee Mental Health Institute FY 13 FY 14 Estimated Net Governor’s Request $5,535,738 $5,954,464
FY 14 Senate $5,954,464
FY 14 House $5,975,057
Change from FY 13 $439,319
Clarinda Mental Health Institute FY 13 FY 14 Estimated Net Governor’s Request $6,442,688 $6,751,868
FY 14 Senate $6,751,868
FY 14 House $6,772,460
Change from FY 13 $329,772
Independence Mental Health Institute FY 13 FY 14 Estimated Net Governor’s Request $9,738,520 $10,318,778
FY 14 Senate $10,318,778
FY 14 House $10,339,371
Change from FY 13 $600,851
FY 14 House $1,387,278
Change from FY 13 $501,819
Mount Pleasant Mental Health Institute FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $885,459 $1,366,686 $1,366,686
SECTION 23 - State Resource Centers The section makes the appropriation to the State Resources Centers in Glenwood and Woodward. Additional funds are provided to cover changes in the federal Medicaid matching rate. The appropriations for both facilities are increased for food transportation and utilities costs. Glenwood State Resource Center FY 13 FY 14 Estimated Net Governor’s Request $18,866,116 $20,046,519
FY 14 Senate $20,502,425
FY 14 House $20,046,519
Change from FY 13 $1,180,403
Woodward State Resource Center FY 13 FY 14 Estimated Net Governor’s Request $13,033,115 $13,809,566
FY 14 Senate $14,631,359
FY 14 House $13,809,566
Change from FY 13 $776,451
SECTION 24 - Sexually Violent Predators FY 13 FY 14 FY 14 Estimated Net Governor’s Request Senate $8,899,686 $9,416,969 $11,142,979
FY 14 House $10,916,969
Change from FY 13 $2,017,283
The section makes the FY 2013 appropriation to the Civil Commitment Unit for Sexual Offenders. The FY 2014 funding level is $2 million above FY 2013, with the increase coming from a transfer from general administration, funding an additional 10 court ordered offenders, and annualizing the cost of the FY 2013 enrollment increases. SECTION 25 - Field Operations FY 13 FY 14 Estimated Net Governor’s Request $61,636,313 $63,409,538
FY 14 Senate $67,008,683
FY 14 House $62,731,674
Change from FY 13 $1,095,361
The section sets the FY 2014 appropriation for local DHS offices and service area offices. The appropriation is increased to maintain the FY 12 field staff level . Funding is increased by $1,095,361 to maintain the FY 2013 case per worker level. SECTION 26 - General Administration FY 13 FY 14 Estimated Net Governor’s Request $16,100,685 $15,672,744
FY 14 Senate $16,231,171
FY 14 House $15,300,045
Change from FY 13 $-800,640
This section funds the central office activities of DHS. The section provides that any funds not spent shall be carried forward for use in FY 2015. The College of Direct Support and HCBS Tech Assistance allocations are both moving to Medicaid. Additional funding included is: Reduction of sex offender transition earmark $-463,000 Transfer funds to institutions $-653,940 Sustain FY 2013 funding level via carryforward $600,000 Prevention of Disabilities Council $25,000 SECTION 27 - Volunteers The section sets the FY 2013 appropriation at $84,660 for the development and coordination of volunteer services, which is the same as FY 2013. SECTION 28 – Medical Assistance, State Supplementary Assistance, and Social Service Providers Reimbursed Under DHS This section sets forth the reimbursement rates for DHS service providers in FY 2014. Virtually all of the rates will be the same as in FY 2013. The section establishes the expenditure cap for Medicaid nursing home services and instructs the Department to undertake nursing facility case-mix rebasing within this amount. This section provides a $14,268,148 increase to re-base nursing homes. There is also a 1.5% provider rate increase for pharmacists that totals $218,000. SECTION 29 – Emergency Rules DHS may adopt emergency rules. Any rules adopted in accordance with this section will not take effect before the rules are reviewed by the administrative rules review committee. This section ensures that the rules review committee gets two opportunities to review any rules DHS promulgates as emergency. This is different from the normal emergency rules process, where the rules review committee cannot stop the rule. SECTION 30 – Reports This section requires reports to be submitted to the members of the joint appropriations subcommittee on Health and Human Services.
DIVISION V HEALTH CARE ACCOUNTS AND FUNDS SECTION 31 – 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 $6,650,000. SECTION 32 – Appropriations from IowaCare Account The section makes the appropriations to the various providers serving clients of the IowaCare program for the first 6 months of FY 2014, as the program sunsets on December 31, 2013. The funds are appropriated as follows:
University of Iowa Hospitals and Clinics University of Iowa Hospitals and Clinics University of Iowa Hospitals and Clinics Broadlawns Medical Center DHS – Regional Provider Network DHS – Care Coordination Pool DHS – Regional Provider Network Lab and Radiology
$13,642,292 $26,284,600 $ 9,903,183 $33,750,000 $ 2,993,183 $ 1,500,000 $ 371,552
SECTION 33 – Appropriations from Nonparticipating Provider Reimbursement Fund For FY 2014 $1,000,000 will be appropriated from the nonparticipating provider reimbursement fund to DHS to reimburse nonparticipating providers. SECTION 34 – Quality Assurance Trust Fund For FY 2014 $28,788,917 will be appropriated from the quality assurance trust fund to DHS for Medicaid. SECTION 35 – Hospital Health Care Access Trust Fund For FY 2014 $34,288,000 will be appropriated from the hospital health care access trust fund to DHS for Medicaid. SECTION 36 – Medial Assistance Program – Nonreversion If the money appropriated for Medicaid is not spent, the excess money will not revert back to the state but it will remain available for expenditure for Medicaid until the close of FY 2015. DIVISION VI PRIOR YEAR APPROPRIATIONS SECTION 37 – Respite At least $25,000 shall be used to continue the foster care respite pilot program. This encourages postsecondary students in human services related programs to receive experience. Money in this section will not revert, but will remain available to spend in FY 2015. SECTION 38 – Medical Assistance (General Fund) The section revises the FY 13 General Fund appropriation for Medicaid by increasing it by $61 million. SECTION 39 – Adoption Subsidy (General Fund) The section revises the FY 13 General Fund appropriation for Adoption Subsidy by increasing it by $954,673. SECTION 40 – Nursing Facility Reimbursement
The section revises the cap on Medicaid nursing home expenditures by increasing it $2 million. Section 41 – Replacement Generation Tax Revenues – Levy Rates for FY 12 and FY 13 The section corrects language from last year’s bill by adding that the utility replacement generation tax (paid by the Duane Arnold nuclear facility) is to be deposited in the mental health property tax relief fund in both fiscal years. Section 42 – Effective Upon Enactment The section makes Division VI effective upon signature by the Governor. Section 43 – Retroactive Applicability The section makes section 41 – dealing with the Replacement Generation Tax Revenues – effective retroactively to FY 2012 DIVISION VII Aging SECTION 44 – Area Agencies on Aging Duties An employee of an Area Agency on Aging that was enrolled in a qualified plan prior to July 1, 2012 can continue using that plan in lieu of participation in the Iowa public employees’ retirement plan. SECTION 45 – Duties of the Long-Term Resident’s Advocate Currently, if an employee of a long-term care facility interferes with the work of the long-term care resident’s advocate and pays a monetary fine, the money goes into the general fund. This changes that policy so the money now will go back to the office of long-term care resident’s advocate to be used for the duties of the office. DIVISION VIII EMS Task Force SECTION 46 – Emergency Medical Services Task Force and Report This section allows the Department of Public Health to establish a task force to ensure the availability of emergency medical services in the state. The members will be appointed by the Director of IDPH. The task force will submit a final report of its findings by April 30, 2014. Members include: A manager of a rural volunteer EMT service A manager of a rural paid EMT service A manager of an urban EMT service A manager of a non-transport emergency medical service A representative of a fire department based emergency medical service A representative of a hospital-based emergency medical service A representative of a private, for-profit EMT service A representative of a not-for-profit EMT service A representative of the Iowa emergency medical services association board of directors A representative of an emergency medical services training agency An urban emergency department physician A rural emergency department physician A representative of the Iowa emergency nurses association A representative of the Iowa alliance in home care A representative of an emergency medical service air ambulance
A representative of the Iowa Hospital Association A representative of the private insurance industry A representative of the Iowa Medicaid Enterprise A representative of city government A representative of county government A representative of the nursing facility industry A representative of the Iowa Behavioral Health Association A consumer of emergency medical services An ARNP
DIVISION IV Hospital Provider Tax SECTION 47 – Hospital Health Care Access Assessment Program This section extends the sunset of this program from June 30, 2013 to June 30, 2016. SECTION 48 – Effective Upon Enactment The section makes Division IV effective upon signature by the Governor. DIVISION X Ill and Handicapped Waiver Name Change SECTION 49 – Ill and Handicapped Waiver The Ill and Handicapped Waiver will become the Health and Disability Waiver. DIVISION XI Autism Support Program SECTION 50 – Definitions This section lists the definitions that will be used in the new autism support program. SECTION 51 – Autism Support Program This section gives DHS the authority to implement an autism support program beginning January 1, 2014 to provide payment for applied behavioral analysis treatment for eligible individuals. DHS will adopt rules to implement and administer the program. DHS shall consult with and incorporate the recommendations of an expert panel convened by the regional autism assistance program to provide expert opinion on clinically relevant practices. The rules and guidelines established by DHS must address all of the following: Individuals will receive a maximum annual benefit of $36,000 per year A maximum of 24 months of Applied Behavioral Analysis treatment If an eligible person reaches the age of 9 before their allowed 24 months of treatment is completed, they can continue getting the benefit until the expiration of 24 months. There will be cost sharing for families with a household income at or above 200% of the federal poverty level with a maximum cost sharing of 10%. Application and appeal processes Enrollment, renewal, and reimbursement of claims A requirement of family engagement A requirement that the autism service provider coordinate with the child’s school
A requirement that the administrator of the program utilize the regional autism assistance program to coordinate interventions between eligible children and their families receiving support through the autism support program with appropriate medical educational, and treatment providers. Payment of funds will be limited to Applied Behavioral Analysis treatment. Payment of funds is limited to the funds appropriated. An autism support fund will be created in the state treasury under the authority of DHS. DHS has to submit an annual report to the Governor and General Assembly about the program.
SECTION 52 – Implementation DHS shall implement the autism support program beginning January 1, 2014. DHS can utilize sole-source contracting and utilize the managed care entity under contract with DHS. Total administrative costs shall not exceed 10% of the funds for the program. SECTION 53 – Effective Upon Enactment The section makes Division XI effective upon signature by the Governor. DIVISION XII Department of Human Service – Child, Adult, and Family Services SECTION 54 This section removes reference to the comprehensive family support council in the code. SECTION 55 This section removes reference to the comprehensive family support council in the code. SECTION 56 This section removes reference to the comprehensive family support council in the code. SECTION 57 This section removes reference to the comprehensive family support council in the code. SECTION 58 – New Subsection This section relates to using Family Investment Program (FIP) assistance in gaming establishments. DHS is required to implement policies and procedures to comply with the federal Middle Class Tax Relief and Job Creation Act to prevent assistance from being used in liquor stores, casinos, gaming establishments, or any retain establishments that provide adult-oriented entertainment. SECTION 59 – Fraudulent Practices A person who accesses benefits provided under the FIP program in violation of this chapter commits a fraudulent practice. SECTION 60 – Eligibility for Medical Assistance Beginning January 1, 2014, a person that is under 26, was in foster care, and was enrolled in Medicaid while in foster care will be eligible for Medicaid. SECTION 61 – Eligibility for Medical Assistance This section strikes the current code which states that children in foster care only get Medicaid until the age of 21.
SECTION 62 – IowaCare Extends the sunset of IowaCare to December 31, 2013 so there is no lapse in coverage for this population. SECTIONS 63 – 68 HAWK-I Program These sections require DHS to review and improve their eligibility systems so that they interact with each other. For example, instead of people having to apply for Medicaid and completing a separate application for Hawk-i, these sections mandate DHS coordinate the two eligibility systems. Since this has been placed in the code, DHS has coordinated eligibility systems. Therefore, these sections are being stricken from the code. SECTION 69 – HAWK-I Eligibility This section brings Iowa law into compliance with federal law. We are now required to use the modified adjusted gross income methodology to determine family income under this section. SECTION 70 – HAWK-I Eligibility Once a child is enrolled, the enrollee may request to change plans within 90 days of initial enrollment at any time. Otherwise, they can change plan enrollment once per year. SECTION 71 – HAWK-I Eligibility This section strikes 2 code sections regarding the level of family income which is appropriate for eligibility in the program. Federal law now determines this. SECTION 72 – Program Benefits This section allows the benefits of the program to be determined by rule. This is being changed so that the Hawk-i Board will determine the benefits package annually. SECTION 73 – Repeal Comprehensive Family Support Council This section repeals the comprehensive family support council. SECTION 74 Section 249A.3 relating to foster children being able to get Medicaid until the age of 26 is effective upon enactment. DIVISION XIII Medicaid Cost Containment SECTION 75 In the previous General Assembly, the Legislature approved a Medicaid cost containment effort that reduced payment for services provided in hospital settings. Previously, these had been paid at the rate set for providing the care in a doctor’s office. This meant the rate included a portion for overhead expenses. Those expenses were not incurred in the hospital setting. Thus, it was called the Site of Service rule. The provision was to save $1 million, but after implementation it was projected to save $2.6 million. The Legislature objected last year, and limited the savings to $1 million. These savings happened in less than 6 months, and tend to impact only a few types of services. Because DHS is limited in how much it can save through this measure, they are envisioning a process where the state’s Medicaid plan would be amended every six months to either start or stop the cost containment initiative. Rather than deal with that bureaucratic situation or raise the impact on providers, the section repeals the cost containment measure starting in FY 14.
DIVISION XIV Cigarette and Tobacco Tax Proceeds – Health Care Trust Fund SECTION 76 – Proceeds Paid to the General Fund This section relates to the standing appropriation to the health care trust fund. All of the revenues generated from the tax on cigarettes and tobacco products will be credited to the Health Care Trust Fund. Previously, only the first $106,016,400 was credited to the account. It is projected that an additional $118.4 million will be deposited in the Fund, which is used for Medicaid. DIVISION XV IowaCare – Account for Health Care Transformation SECTION 77 This section states that premiums collected for IowaCare will be deposited in the IowaCare account. Previously, this money went into a “premiums subaccount.” SECTION 78 This section removes the “premiums subaccount” from the Code so that money from IowaCare will go into the state treasury. SECTION 79 This section states that revenue generated though IowaCare premiums will go into the IowaCare account in the state treasury. FY 2015 SECTIONS 81-114 For FY 15 each line item is funded at 50% of their FY 14 appropriation except Medicaid, which is funded at 100%.
