HF 1049 — A bill for an act relating to and making appropriations to the department of veterans affairs and the department of health and human services, and related provisions and appropriations, including aging and disability services; behavioral health, public health, community access and eligibility; the medical assistance program, state supplementary assistance, Hawki, and other health-related programs; sex reassignment surgeries or associated procedures; family well-being and protection; state-operated specialty care, administration and compliance; transfers, cash flows, and nonreversions; prior appropriations; the beer and liquor control fund, and the behavioral health fund; report on nonreversion of moneys; emergency rules; and a hospital directed payment program; and including effective date and retroactive applicability provisions.

1049Full implementation and expansion shall include enhancing the scope of the initiative through collaboration with child health specialty clinics to promote the use of developmental surveillance and screening to support healthy child development through early identification and response to both biomedical and social determinants of healthy development by providing practitioner consultation and continuous improvement through training and education, particularly for children with behavioral conditions and needs.

FTEs 464.00 LSB1. 1004HV (1) 91 -8- lh/ko 8/35 H.F.

1049Federal 1.access and visitation grant moneys shall be used House File 1049, p.

Federal9 access and visitation grant moneys shall be used for services designed to increase compliance with the child access provisions of court orders, including but not limited to neutral visitation sites and mediation services.

Grants shall be awarded to pregnancy prevention programs developed after July 1, 2025, if the programs are based on existing models that have LSBdemonstrated 1004HVpositive (1)outcomes. 91 -9- lh/ko 9/35 H.F.

1049 demonstrated positive outcomes.

Priority in the awarding of grants shall be given to programs thatHouse serveFile areas1049, ofp. the state which demonstrate the highest percentage of unplanned pregnancies of females of childbearing age within the geographic area to be served by the grant.

10 that serve areas of the state which demonstrate the highest percentage of unplanned pregnancies of females of childbearing age within the geographic area to be served by the grant.

There LSBis 1004HVappropriated (1)from 91the -10-general lh/kofund 10/35of H.F.the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated:

1049For ismedical appropriatedassistance fromprogram thereimbursement generaland fundassociated ofcosts theas statespecifically toprovided thein department of health and human services for the fiscalreimbursement yearmethodologies beginningin Julyeffect 1,on 2025, and ending June 30, 2026,2025, theexcept followingas amount,otherwise orexpressly soauthorized muchby thereoflaw, asconsistent iswith necessary,options tounder beHouse usedFile for1049, thep. purposes designated:

For11 medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies in effect on June 30, 2025, except as otherwise expressly authorized by law, consistent with options under federal law and regulations, and contingent upon receipt of approval from the office of the governor of reimbursement for each abortion performed under the medical assistance program;

Of the moneys allocated in this subsection, $3,050,000 shall be used to expand the capacity of intermittent community-based services that allow an individual to remain in the community and that provide support to the individual, including employment services, hourly supported community living services, respite services, and day habilitation LSBservices. 1004HV (1) 91 -11- lh/ko 11/35 H.F.

1049 services.

Of the moneys appropriated in this section, $61,266,871 is allocated for maintenance of the Hawki program pursuant to chapter 514I, including supplemental dental services, for receiptHouse ofFile federal1049, financialp. participation under Tit.

12 receipt of federal financial participation under Tit.

Of the moneys appropriated in this section, a sufficient LSBamount 1004HVshall (1)be 91allocated -12-for lh/kothe 12/35administration H.F.of the health insurance premium payment program, including salaries, support, maintenance, and miscellaneous purposes.

1049 amount shall be allocated for the administration of the health insurance premium payment program, including salaries, support, maintenance, and miscellaneous purposes.

Unless otherwise provided by law, if a contract for services provided under this section initially entered into during the fiscal year beginning July 1, 2025, and ending JuneHouse 30,File 2026,1049, providesp. for an annual increase of the cost of services provided under the contract, the annual increase shall not exceed the amount by which the consumer price index for all urban consumers increased during the immediately preceding calendar year.

13 June 30, 2026, provides for an annual increase of the cost of services provided under the contract, the annual increase shall not exceed the amount by which the consumer price index for all urban consumers increased during the immediately preceding calendar year.

Notwithstanding any provision of law to the contrary, to supplement the appropriation made in this Act from the general fund of the state for health program operations under the LSBmedical 1004HVassistance (1)program 91for -13-the lh/kosame 13/35fiscal H.F.year:

1049 medical assistance program for the same fiscal year:

Notwithstanding any provision of law to the contrary, and subject to the availability of moneys, there is appropriated from the hospital health care access trust fund created in section 249M.4 to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount,House orFile so1049, muchp. thereof as is necessary, for the purposes designated:

14 amount, or so much thereof as is necessary, for the purposes designated:

Moneys appropriated from the general fund of the state to the department for the medical assistance program shall not be used for reimbursement for sex reassignment surgery or associated procedures, including hormone therapy or other medical interventions intended to alter primary or secondary LSBsex 1004HVcharacteristics (1)related 91to -14-an lh/koindividual’s 14/35gender H.F.dysphoria diagnosis.

1049 sex characteristics related to an individual’s gender dysphoria diagnosis.

Of the moneys appropriated for medical assistance program reimbursement and associated costs as specifically provided in the reimbursement methodologies June 30, 2025, the following amounts, or so much thereof as is necessary, are allocated to the department of health and human services to be usedHouse forFile the1049, followingp. purposes:

15 used for the following purposes:

LSB(2) 1004HVThe (1)department 91of -15-health lh/koand 15/35human H.F.services shall calculate each nursing facility’s case-mix index for the period beginning July 1, 2024, using weighting based on the current patient-driven payment model schedule.

1049 (2) The department of health and human services shall calculate each nursing facility’s case-mix index for the period beginning July 1, 2024, using weighting based on the current patient-driven payment model schedule.

For the fiscal year beginning July 1, 2026, and for each fiscal year thereafter, the department shall review the reimbursementHouse ratesFile for1049, homep. health agencies and pharmacy dispensing fees.

16 reimbursement rates for home health agencies and pharmacy dispensing fees.

LSBNURSING 1004HVFACILITIES (1)—— 91MEDICAID -16-REIMBURSEMENT lh/koMETHODOLOGY 16/35PROPOSAL H.F.Sec.

1049 NURSING FACILITIES —— MEDICAID REIMBURSEMENT METHODOLOGY PROPOSAL Sec.

On or before July 1, 2026, the department of health and human services, in consultation with appropriate stakeholders, shall develop and implement a nursing bed facility forecasting formula utilizing the recommendations for improvement to the nursing facility bed need formula developed by the workgroup convened pursuant to 2023 Iowa Acts, chapter 158, section 11, to ensure the availability of sufficient nursing facility beds toHouse meetFile future1049, demandp. for nursing facility beds.

LSB17 1004HVto (1)meet 91future -17-demand lh/kofor 17/35nursing H.F.facility beds.

1049 2.

There is appropriated from the general fund of the state to the department of health LSBand 1004HVhuman (1)services 91for -18-the lh/kofiscal 18/35year H.F.beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes House File 1049, p.

104918 and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, the following amount, or so much thereof as is necessary, to be used for the purposes designated:

Of the moneys appropriated in this section, not more than $734,000 shall be used for the healthy opportunities for parents to experience success (HOPES)-healthy families Iowa LSB(HFI) 1004HVprogram (1)established 91pursuant -19-to lh/kosection 19/35135.106. H.F.

1049 (HFI) program established pursuant to section 135.106.

Of the moneys appropriated in this section, $29,256,799 shall be deposited in the early childhood Iowa fund created in sectionHouse 256I.11.File 1049, p.

19 section 256I.11.

LSB4. 1004HV (1) 91 -20- lh/ko 20/35 H.F.

1049 4.

5.House File 1049, p.

20 5.

Of the moneys appropriated in this section, $4,359,500 LSBis 1004HVallocated (1)for 91the -21-preparation lh/kofor 21/35adult H.F.living program established pursuant to section 234.46.

1049 is allocated for the preparation for adult living program established pursuant to section 234.46.

Of the moneys appropriated in this section, $39,823,955House isFile allocated1049, forp. adoption subsidy payments and related costs.

21 $39,823,955 is allocated for adoption subsidy payments and related costs.

Of the moneys appropriated in this section, $308,765 shall be allocated to increase the foster care reimbursement LSBrates 1004HVpursuant (1)to 91section -22-234.38, lh/konot 22/35to H.F.exceed the maximum reimbursement rate established in section 234.38.

1049 rates pursuant to section 234.38, not to exceed the maximum reimbursement rate established in section 234.38.

2.House File 1049, p.

22 2.

LSBFor 1004HVsalaries, (1)support, 91maintenance, -23-and lh/komiscellaneous 23/35purposes H.F.at institutions under the jurisdiction of the department of health and human services, and for not more than the following full-time equivalent positions:

1049 For salaries, support, maintenance, and miscellaneous purposes at institutions under the jurisdiction of the department of health and human services, and for not more than the following full-time equivalent positions:

..................................................House File 1049, p.

23 ..................................................

For accountability, compliance, and program integrity, including salaries, support, maintenance, and miscellaneous purposes, and for not more than the following full-time LSBequivalent 1004HVpositions: (1) 91 -24- lh/ko 24/35 H.F.

1049 equivalent positions:

Notwithstanding any provision of law to the contrary, the department of health and human services may transfer moneys appropriated in this Act to support continuing alignment efforts, to maximize federal support in accordance with the department’s federal costs allocation plan, and for resources necessary to implement and administer the services for which moneysHouse areFile appropriated.1049, p.

24 moneys are appropriated.

If, due to ongoing cost management efforts, the appropriations under this Act for the Medicaid program exceed the associated costs for the Medicaid program for the fiscal year, the department may transfer any savings to the appropriations made in this Act for health program operations, LSBor 1004HVfor (1)accountability, 91compliance, -25-and lh/koprogram 25/35integrity, H.F.to defray the costs associated with ongoing cost management efforts.

1049 or for accountability, compliance, and program integrity, to defray the costs associated with ongoing cost management efforts.

Notwithstanding section 8.33, moneys appropriated under this Act from the general fund of the state and the temporary assistance for needy families block grant to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, for the purposes of the FaDSS grant program that remain unencumbered or unobligated at the closeHouse ofFile the1049, fiscalp. year shall not revert, but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.

25 close of the fiscal year shall not revert, but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.

Notwithstanding section 8.33, of the moneys appropriated LSBunder 1004HVthis (1)Act 91from -26-the lh/kogeneral 26/35fund H.F.of the state, the quality assurance trust fund, and the hospital health care access trust fund to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, for the purposes of the medical assistance program, the amount in excess of actual expenditures for the medical assistance program that remains unencumbered or unobligated at the close of the fiscal year shall not revert, but shall remain available for expenditure for the medical assistance program until the close of the succeeding fiscal year.

1049 under this Act from the general fund of the state, the quality assurance trust fund, and the hospital health care access trust fund to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, for the purposes of the medical assistance program, the amount in excess of actual expenditures for the medical assistance program that remains unencumbered or unobligated at the close of the fiscal year shall not revert, but shall remain available for expenditure for the medical assistance program until the close of the succeeding fiscal year.

Notwithstanding section 8.33, moneys appropriated under this Act from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2025, and ending June 30, 2026, and allocated for rural psychiatric residencies that remain unencumbered or unobligated at the close of the fiscal year shall not revert, but shall remain available for expenditure for the purposes designated LSBHouse 1004HVFile (1)1049, 91p. -27- lh/ko 27/35 H.F.

104926 until the close of the succeeding fiscal year.

LSBNotwithstanding 1004HVsection (1)8.33, 91any -28-moneys lh/koutilized 28/35for H.F.this purpose shall not revert but shall remain available for expenditure for the purposes designated.

1049COMMUNITY NotwithstandingACCESS sectionAND 8.33,ELIGIBILITY anyHouse moneysFile utilized1049, forp. this purpose shall not revert but shall remain available for expenditure for the purposes designated.

COMMUNITY27 ACCESS AND ELIGIBILITY Sec.

NEW SUBSECTION.SUBSECTION .

Notwithstanding section 8.33, moneys appropriated under this 2024 Iowa Act from the general fund of LSBthe 1004HVstate (1)to 91the -29-department lh/koof 29/35health H.F.and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, for child protective services that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.

1049 the state to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, for child protective services that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purposes designated until the close of the succeeding fiscal year.

Sec.House File 1049, p.

28 Sec.

Of the amounts transferred, two one million dollars, plus an additional amount determined by the general assembly, shall be appropriated to the department of health and human services for LSBuse 1004HVby (1)the 91staff -30-who lh/koadminister 30/35the H.F.comprehensive substance use disorder program under chapter 125 for substance use disorder treatment and prevention programs shall be transferred to the behavioral health fund established under section 225A.7.

1049 use by the staff who administer the comprehensive substance use disorder program under chapter 125 for substance use disorder treatment and prevention programs shall be transferred to the behavioral health fund established under section 225A.7.

This division of this ActHouse appliesFile retroactively1049, top. July 1, 2024.

29 Act applies retroactively to July 1, 2024.

If the department of health and human services adopts emergency rules in accordance with this section, or as LSBotherwise 1004HVdirected (1)or 91authorized -31-by lh/kostate 31/35law, H.F.and the rules will result in an increase in expenditures beyond the amount anticipated in the budget for the fiscal year, or if the expenditures were not addressed in the budget for the fiscal year, the department shall notify the general assembly and the department of management concerning the rules and the increase in expenditures.

1049 otherwise directed or authorized by state law, and the rules will result in an increase in expenditures beyond the amount anticipated in the budget for the fiscal year, or if the expenditures were not addressed in the budget for the fiscal year, the department shall notify the general assembly and the department of management concerning the rules and the increase in expenditures.

“Centers for Medicare and Medicaid services” means the centersHouse forFile Medicare1049, andp. Medicaid services of the United States department of health and human services.

30 centers for Medicare and Medicaid services of the United States department of health and human services.

Upon receipt of approval from the centers for Medicare and Medicaid services, the department LSBshall 1004HVadminister (1)the 91hospital -32-directed lh/kopayment 32/35program H.F.during the specified fiscal year.

1049 shall administer the hospital directed payment program during the specified fiscal year.

4.House File 1049, p.

31 4.

EXPLANATION______________________________ The______________________________ inclusionPAT ofGRASSLEY thisAMY explanationSINCLAIR doesSpeaker notof constitutethe agreementHouse withPresident of the explanation’sSenate substanceI byhereby thecertify membersthat ofthis bill originated in the generalHouse assembly.and is known as House File 1049, Ninety-first General Assembly.

LSB______________________________ 1004HVMEGHAN (1)NELSON 91Chief -33-Clerk lh/koof 33/35the H.F.House Approved _______________, 2025 ______________________________ KIM REYNOLDS Governor

1049 This bill makes appropriations from the general fund of the state to the department of veterans affairs and to the department of health and human services (HHS) for fiscal year 2025-2026.

The appropriations from the general fund of the state to the department of veterans affairs include appropriations for administration, the Iowa veterans home, and the home ownership assistance program.

The appropriations from the general fund of the state to HHS include appropriations for aging and disability services;

behavioral health;

public health;

community access and eligibility including for child support services;

the medical assistance program, state supplementary assistance, the healthy and well kids in Iowa (Hawki) program, and other specified health-related programs including health program operations;

reimbursement rates;

family well-being and protection including state child care assistance, early intervention and supports, and child protective services;

state-operated specialty care;

and administration and compliance.

The bill also makes appropriations to HHS from the sports wagering receipts fund, the pharmaceutical settlement account, the quality assurance trust fund, and the hospital health care access trust fund.

The bill transfers money from the beer and liquor control fund to the behavioral health fund.

The bill requires HHS to develop a reimbursement methodology proposal for reimbursement of nursing facilities under the medical assistance program.

The bill prohibits HHS from using moneys appropriated for the medical assistance program to reimburse sex reassignment surgery or associated procedures, including hormone therapy or other medical interventions intended to alter primary or secondary sex characteristics related to an individual’s gender dysphoria diagnosis.

The bill requires HHS to submit documentation to the federal centers for Medicare and Medicaid services for approval to LSB 1004HV (1) 91 -34- lh/ko 34/35 H.F.

1049 administer a hospital directed payment program.

Upon receipt of approval, the bill permits HHS to administer a hospital directed payment program.

HHS may impose an assessment on a hospital.

The bill includes transfer, cash flow, and nonreversion provisions, emergency rulemaking authority, and reporting requirements.

LSB 1004HV (1) 91 -35- lh/ko 35/35