HF2698: Health/Human Services (HHS) Budget

Appropriates $2.2 billion for health and human services programs (including Medicaid) for the fiscal year beginning July 1, 2024 (FY 2025).  This is a 4% increase ($88.6 million). Appropriates $468.5 million from other funds (an increase of $360,000). Aging & Disability Services ($19,088,714): Increases funding for department duties by $155,157. Eliminates line items but not the responsibility for the work. Codifies area agency on aging language that has been in the budget for more than a decade. Because of budget restructuring, this includes aging programs, state supplementary assistance, health program operations, Conner decree training, and the family support subsidy/child at home pilot. Behavioral Health ($24,400,114):  No change in funding. Continues two line items at current levels (Children's Behavioral Health System - $300,000; managed care substance use treatment transfer - $950,000). Maintains $1.75 million transfer from sports wagering receipts fund. Because of budget restructuring, this includes addictive disorders and some funding from healthy children/families. Public Health ($22,513,821): Cut of $385,000 due to moving Centers of Excellence funding to a standing (automatic) appropriation. Eliminates earmarks (but does not cut the money) for: brain injury facilitators and training ($1.055 million), epilepsy education and support ($144,000), psychology postdoctoral internships ($48,000), and psychiatric training for PAs & nurse practitioners ($150,000). Retains earmarks and funding for SafeNetRx prescription drug donation program ($600,000), rural health clinics ($25,000), specialty care access ($225,000), medical residencies ($2.1 million), rural psychiatric residencies ($800,000), and family medicine/obstetrics fellowship ($560,000). Increases earmark for free clinics by $40,000 ($374,000) to help with e-prescribing. Requires HHS to work with the Iowa Health Information Network (IHIN) to plan for program enhancements that empower Iowans with access to their health information. Because of budget restructuring, this includes healthy children/families, chronic conditions, community capacity, essential public health services, infectious diseases, public protection, congenital & inherited disorders registry, and psychiatric residency funding. Community Access ($68,043,944): This is a decrease of $2.1 million (primarily due to decreased enrollment in PROMISE JOBS and Family Investment Program/FIP). Because of budget restructuring, this includes some aging programs, human rights administration, general administration, field operations, FIP/Promise Jobs, Medicaid, children's health insurance (hawk-I), volunteer programs, chronic conditions, community capacity, and public protection).  No change for First Five Health Mental Development programs ($3.1 million), pregnancy prevention grants ($1.9 million), childcare assistance ($47.2 million), and child protective services ($62.4 million). Adds new $3 million appropriation for a new kinship stipend program (paying family members or fictive kin as foster parents for relative children placed in their care). Medicaid ($1.65 billion): Increases Medicaid by $107.2 million. This includes increases of $40.9 million increase to meet expected need, $16.5 million to replace federal funds used to increase HCBS waiver rates (aka "ARPA backfill"), $5 million for enhanced case management, $1.7 million to open more HCBS ID waiver slots, and $2.7 million for children's health insurance program to meet expected need. No change in funding for nursing home facility improvements ($900,000), and state family planning services ($3.4 million).  Reimbursement Rates: Increases reimbursement rates for HCBS waiver providers by 5% ($14.6 million), residential supported community living services ($1.4 million), home health providers ($3 million), mental health providers ($2.1 million), community mental health centers ($276,947), psychiatric medical institutions for children (PMIC) tiered rates ($369,000), physical therapists ($418,121), occupational therapists ($64,692), physician assistants ($29,691), certified nurse midwives ($3,122), air medical services ($250,000), medical equipment ($144,014), and pharmacy dispensing fees ($500,000). Health Program Operations ($39,597,231): This is an increase of $1.2 million due to contract increases. No change for state poison control center ($750,000).  Childcare Assistance ($34,966,931): No change in funding. Early Intervention & Supports ($35,277,739): No change in funding for human rights administration, community advocacy and services, early childhood Iowa ($29,256,799), More Options for Maternal Support ($1 million), and child abuse prevention (no longer line item but funding still there).  Child Protective Services ($164,101,034): This is a $2.1 million increase for programs that include child and family services and the adoption subsidy.  No change in funding for decategorization ($1,717,000), group foster care ($40.5 million), court-ordered services ($748,000), child protection center grants ($1,658,000), and Project Harmony for child abuse victims ($227,000). Increases funding for Preparation for Adult Living by $334,000 (total $4,359,500), adoption subsidies by 5% ($148,232), and foster care reimbursement rates by 5% ($308,765). State Specialty Care Services ($100,006,128): This is a small increase ($35,259) for state-owned institutions. Increases Cherokee MHI by $2.6 million, Independence MHI by $3.1 million, sex offender civil commitment at Cherokee MHI by $1.9 million, and Eldora State Training School by $961,124. No change in funding for Woodward State Resource Center ($13.4 million) and reduces funding for the Glenwood State Resource Center by $11 million ($5.3 million). Administration & Compliance ($21,194,894): Increases funding by $1.3 million.  No change in funding for ABLE Savings Account administration ($200,000), court appointed special advocate ($2.6 million), and long-term care ombudsman ($1,148,959). New $750,000 appropriation from the Autism Support Fund to non-profit provider to expand behavioral analysis (ChildServe).  Other: Gives HHS the ability to transfer funds as needed to continue realignment and maximize federal support.  Allows HHS to use up to $3 million in funds that are not used for their original purpose to pay for the Thrive Iowa Program. Increases the number of rural psychiatric residencies from six to eight annually. Allows the Office of Public Guardian to carry over unused funds into the next fiscal year. Allows up to $3 million of unused PMIC funding from the current fiscal year to be used to purchase a facility for use as a PMIC by a new out-of-state provider who will provide comprehensive services to children with sexualized and other difficult behaviors (and waives competitive bidding). Splits LIHEAP (Low Income Home Energy Assistance Program) administration between contractors (no less than 8.4%) and HHS (1.6%); currently there is a 10% cap on administration, with $377,000 going to HHS.  Removes language about an additional amount money to be transferred from the beer & liquor control fund for substance use disorder treatment (legislators have never transferred more than the base $2 million). Requires HHS to collaborate with the Department of Revenue on tobacco control enforcement. Requires the legislature to appropriate enough money each year to fully fund personal needs allowance (which is currently $50/month) and requires the allowance to be increased at the same percentage and at same time federal SSI benefits are increased. Transfers the replacement generation tax that had been going to mental health property tax relief to Medicaid (remaining funds were minimal = $12,954). Transfers remaining funds in the Medicaid Fraud Fund ($150,000) to Medicaid. Allows Medicaid recipients residing in a State MHI to keep their Medicaid eligibility during their stay at the MHI. Permits the HHS to bill for State Resource Center services utilizing a scope of services approach in a manner that does not shift costs between the Medicaid program, the MHDS regions, or other State Resource Center funding sources. Moves juvenile detention funding and current formula into Code (so it doesn't have to be in the budget each year).  States that child support recovery for state foster care payments does not apply when a child is placed with a relative or fictive kin who is not licensed as a child foster care provider. Requires nursing home quality assurance assessments to be paid monthly (rather than quarterly). Removes the requirement that quality assurance assessment forms be submitted within 30 days of the end of each calendar quarter. Requires HHS (in consultation with Medicaid provider association and stakeholders) to study options for a revised Medicaid payment model for reimbursing assisted living facilities (due 12/1/24). Reduces the number of state-funded University of Iowa psychiatric residencies from nine to seven.  Nurse Staffing Agency/Technology Platforms: Sets separate regulatory structure for a health care technology platforms that allows independent contractor nurses to bid on open shifts.  Applies to LPNs, RNs, CNAs, CMAs, home health aides, medication managers, and "non certified or unlicensed staff providing personal care).  Prohibits a health care employment agency from contracting with a health care entity if the employment agency has not registered with the Department of Inspections, Appeals & Licensing (DIAL). Eliminates fines for non-registration (was $500 for first offense, $5,000 for each subsequent offense). Requires health care technology platforms to register with DIAL ($500 annual fee). Prohibits contracting with health care providers if the platform is not registered in the state. Platforms are required to rerun background checks after two years of inactivity on the platform.  Requires the platform to make sure that professionals using the system 1) show they meet all required state qualifications for their licensure level; 2) meets minimum state licensing and certification requirements; and 3) maintain professional liability insurance ($1 million per incidence, $3 million aggregate). Prohibits the health care technology platform from restricting employment opportunities (including bans on non-competes) and from requiring payment of liquidated damages or employment fees if the person is subsequently hired by the contracting entity.  DIAL is required to set up a system to take complaints against the health care technology platform. Adds new civil penalties for any violations of the law ($25,000 after 30-day grace period).  Medical CBD Card: Allows telemedicine use for physician-patient relationship in getting a medical cannabidiol card.  Nursing Facility Oversight: Requires DIAL to host semi-annual joint trainings for inspectors and nursing facility staff reviewing at least 3 of the 10 most commonly issued federal citations during the last year (and requires inclusion of state long term care ombudsman). Requires DIAL to establish and review each citation for immediate jeopardy or substandard of care prior to issuing their final findings. Standing (Automatic) Appropriations: Includes standing appropriations for child abuse prevention ($233,000), psychiatry residencies ($1.1 million), and the congenital and inherited disorders registry ($224,000). Adds a new standing appropriation for the Centers of Excellence Grant Program ($425,000). Reduces the standing appropriation for county VA commissions by $10,000 ($990,000 total). Effective July 1, 2024. You can find the final nonpartisan staff review at: legis.iowa.gov/docs/publications/NOBA/1449788.pdf.