Bill Text: IA HF2698 | 2023-2024 | 90th General Assembly | Enrolled

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Bill Title: A bill for an act relating to and making appropriations for veterans and health and human services, including other related provisions and appropriations including but not limited to the personal needs allowance for certain persons under Medicaid and the state supplementary assistance programs, replacement generation tax revenues, the Medicaid fraud and health care trust funds, the retention of certain revenues by the mental health institutes, the retention of Medicaid eligibility by residents of mental health institutes, the scope of services of the state resource centers, the appropriation of moneys in the juvenile detention home fund, the family investment program account and diversion program, the child support collection services center refund account, the quality assurance assessment payment period, the centers of excellence grant program, an assisted living program revised payment model study, funding for county commissions of veteran affairs, foster care provisions including those relating to a relative or fictive kin, health care employment agencies and health care technology platforms, medical cannabidiol practitioner requirements, nursing facility oversight, and state-funded psychiatry residency and fellowship positions, providing penalties, and including effective date and retroactive applicability provisions. Effective date: 05/09/2024, 07/01/2024. Applicability date: 07/01/2022, 07/01/2023.

Spectrum: Committee Bill

Status: (Passed) 2024-05-10 - NOBA: Final [HF2698 Detail]

Download: Iowa-2023-HF2698-Enrolled.html

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House File 2698 - Enrolled
House File 2698
AN ACT
RELATING TO AND MAKING APPROPRIATIONS FOR VETERANS AND HEALTH
AND HUMAN SERVICES, INCLUDING OTHER RELATED PROVISIONS AND
APPROPRIATIONS INCLUDING BUT NOT LIMITED TO THE PERSONAL
NEEDS ALLOWANCE FOR CERTAIN PERSONS UNDER MEDICAID AND
THE STATE SUPPLEMENTARY ASSISTANCE PROGRAMS, REPLACEMENT
GENERATION TAX REVENUES, THE MEDICAID FRAUD AND HEALTH CARE
TRUST FUNDS, THE RETENTION OF CERTAIN REVENUES BY THE MENTAL
HEALTH INSTITUTES, THE RETENTION OF MEDICAID ELIGIBILITY
BY RESIDENTS OF MENTAL HEALTH INSTITUTES, THE SCOPE OF
SERVICES OF THE STATE RESOURCE CENTERS, THE APPROPRIATION
OF MONEYS IN THE JUVENILE DETENTION HOME FUND, THE FAMILY
INVESTMENT PROGRAM ACCOUNT AND DIVERSION PROGRAM, THE CHILD
SUPPORT COLLECTION SERVICES CENTER REFUND ACCOUNT, THE
QUALITY ASSURANCE ASSESSMENT PAYMENT PERIOD, THE CENTERS
OF EXCELLENCE GRANT PROGRAM, AN ASSISTED LIVING PROGRAM
REVISED PAYMENT MODEL STUDY, FUNDING FOR COUNTY COMMISSIONS
OF VETERAN AFFAIRS, FOSTER CARE PROVISIONS INCLUDING
THOSE RELATING TO A RELATIVE OR FICTIVE KIN, HEALTH CARE
EMPLOYMENT AGENCIES AND HEALTH CARE TECHNOLOGY PLATFORMS,
MEDICAL CANNABIDIOL PRACTITIONER REQUIREMENTS, NURSING
FACILITY OVERSIGHT, AND STATE-FUNDED PSYCHIATRY RESIDENCY
AND FELLOWSHIP POSITIONS, PROVIDING PENALTIES, AND INCLUDING
EFFECTIVE DATE AND RETROACTIVE APPLICABILITY PROVISIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

House File 2698, p. 2
DIVISION I
DEPARTMENT OF VETERANS AFFAIRS —— FY 2024-2025
Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is
appropriated from the general fund of the state to the
department of veterans affairs for the fiscal year beginning
July 1, 2024, and ending June 30, 2025, the following amounts,
or so much thereof as is necessary, to be used for the purposes
designated:
1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION
For salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00
2. IOWA VETERANS HOME
For salaries, support, maintenance, and miscellaneous
purposes:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736
a. The Iowa veterans home billings involving the department
of health and human services shall be submitted to the
department on at least a monthly basis.
b. The Iowa veterans home expenditure report shall be
submitted monthly to the general assembly.
3. HOME OWNERSHIP ASSISTANCE PROGRAM
For transfer to the Iowa finance authority for the
continuation of the home ownership assistance program for
persons who are or were eligible members of the armed forces of
the United States, pursuant to section 16.54:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,200,000
DIVISION II
AGING AND DISABILITY SERVICES —— FY 2024-2025
Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING
AND DISABILITY SERVICES. There is appropriated from the
general fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2024, and ending
June 30, 2025, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
For aging programs for the department of health and human
services and area agencies on aging to provide citizens of

House File 2698, p. 3
Iowa who are 60 years of age and older with case management;
Iowa’s aging and disabilities resource centers; for the
return to community program; for the purposes of chapter 231E,
to administer the prevention of elder abuse, neglect, and
exploitation program pursuant to section 231.56A, in accordance
with the requirements of the federal Older Americans Act of
1965, 42 U.S.C. §3001 et seq., as amended; for the reporting
and evaluation of cases of dependant adult abuse pursuant to
chapter 235B; and for other services which may include but are
not limited to adult day, respite care, chore, information
and assistance, and material aid, for information and options
counseling for persons with disabilities, and for salaries,
support, administration, maintenance, and miscellaneous
purposes:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,088,714
1. Funds appropriated in this section may be used to
supplement federal funds under federal regulations. To
receive funds appropriated in this section, a local area
agency on aging shall match the funds with moneys from other
sources according to rules adopted by the department. Funds
appropriated in this section may be used for services not
specifically enumerated in this section only if approved by the
department as part of an area agency on aging’s area plan.
2. Of the funds appropriated in this section, $949,282
shall be used for the family support center component of the
comprehensive family support program under chapter 225C,
subchapter V.
3. Of the funds appropriated in this section, $33,632 shall
be used to build community capacity through the coordination
and provision of training opportunities in accordance with the
consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D.
Iowa, July 14, 1994).
DIVISION III
BEHAVIORAL HEALTH —— FY 2024-2025
Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES ——
BEHAVIORAL HEALTH. There is appropriated from the general fund
of the state to the department of health and human services for
the fiscal year beginning July 1, 2024, and ending June 30,
2025, the following amount, or so much thereof as is necessary,

House File 2698, p. 4
to be used for the purposes designated:
For behavioral health prevention, treatment, and recovery
efforts to reduce the prevalence of the use of, provide
treatment for, and support recovery from tobacco and substance
use and misuse pursuant to the applicable policy, purpose,
and intent described in sections 125.1 and 142A.1, alcohol,
problem gambling, and other addictive behaviors. Activities
shall align with accepted best practice guidance standards for
behavioral health including those published by the centers for
disease control and prevention and the substance abuse and
mental health services administration of the United States
department of health and human services for health promotion;
universal, selective, and indicated prevention; treatment; and
recovery services and supports; and shall include a 24-hour
helpline, public information resources, professional training,
youth prevention, program evaluation, and efforts at the state
and local levels:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,400,114
1. Of the funds appropriated in this section, $300,000 shall
be used to support the work of the children’s behavioral health
system including evidence-based behavioral health prevention,
treatment, and recovery services and supports for children and
their families pursuant to the intent specified in section
225C.6B, subsection 1.
2. Of the funds appropriated in this section, $950,000
shall be used for an integrated substance use disorder managed
care system. The department shall maintain the level of mental
health and substance use disorder treatment services provided
by the managed care contractors. The department shall take the
steps necessary to continue the federal waivers as needed to
maintain the level of services.
Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS
WAGERING RECEIPTS FUND. There is appropriated from the sports
wagering receipts fund created in section 8.57, subsection 6,
to the department of health and human services for the fiscal
year beginning July 1, 2024, and ending June 30, 2025, the
following amount, or so much thereof as is necessary, to be
used for behavioral health prevention, treatment, and recovery
efforts to reduce the prevalence of the use of, provide

House File 2698, p. 5
treatment for, and support recovery from tobacco and substance
use and misuse pursuant to the applicable policy, purpose, and
intent described in sections 125.1 and 142A.1, alcohol, problem
gambling, and other addictive behaviors:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000
DIVISION IV
PUBLIC HEALTH —— FY 2024-2025
Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC
HEALTH. There is appropriated from the general fund of the
state to the department of health and human services for the
fiscal year beginning July 1, 2024, and ending June 30, 2025,
the following amount, or so much thereof as is necessary, to be
used for the purposes designated:
For programs that support health promotion, protect the
health and safety of the public, conduct disease surveillance
and investigation to reduce the incidence of morbidity and
mortality, serve individuals with chronic conditions including
but not limited to cancer, support the Iowa donor registry as
specified in section 142C.18, and strengthen the health care
delivery system and workforce to improve health outcomes for
all Iowans:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,531,821
1. Of the funds appropriated in this section, $2,100,000
shall be deposited in the medical residency training account
created in section 135.175, subsection 5, paragraph “a”, and is
appropriated from the account to the department to be used for
the purposes of the medical residency training state matching
grants program as specified in section 135.176.
2. Of the funds appropriated in this section, the following
amounts are allocated to be used as follows to support the
goals of increased access, health system integration, and
engagement:
a. $600,000 is allocated to the Iowa prescription
drug corporation for continuation of the pharmaceutical
infrastructure for safety net providers originally established
as described in 2007 Iowa Acts, chapter 218, section 108, and
for the prescription drug donation repository program created
in chapter 135M. Funds allocated under this paragraph shall
be distributed in their entirety for the purpose specified on

House File 2698, p. 6
July 1, 2024.
b. $374,000 is allocated to free clinics and free clinics
of Iowa for necessary infrastructure, statewide coordination,
provider recruitment, service delivery, and provision of
assistance to patients in securing a medical home inclusive
of oral health care. Of the funds allocated, $40,000 shall
be used to cover fees associated with using an electronic
prescribing system. Funds allocated under this paragraph shall
be distributed in their entirety for the purpose specified on
July 1, 2024.
c. $25,000 is allocated to the Iowa association of rural
health clinics for necessary infrastructure and service
delivery transformation. Funds allocated under this paragraph
shall be distributed in their entirety for the purpose
specified on July 1, 2024.
d. $225,000 is allocated to the Polk county medical society
for continuation of the safety net provider patients access
to specialty care initiative as described in 2007 Iowa Acts,
chapter 218, section 109. Funds allocated under this paragraph
shall be distributed in their entirety for the purpose
specified on July 1, 2024.
3. Of the funds appropriated in this section, $800,000
shall be used for rural psychiatric residencies to annually
fund eight psychiatric residents who will provide mental health
services in underserved areas of the state.
4. Of the funds appropriated in this section, $560,000 shall
be deposited in the state-funded family medicine obstetrics
fellowship program fund to be used for the state-funded family
medicine obstetrics fellowship program, in accordance with
section 135.193.
5. The department shall work with the board established
in chapter 135D to develop plans for program enhancements
in the Iowa health information network for the purpose of
empowering Iowa patients to access and direct their health
information utilizing the Iowa health information network.
Program enhancements shall protect data privacy, facilitate the
interchange of health data for the purpose of improving public
health outcomes, and increase participation by health care
providers.

House File 2698, p. 7
6. The university of Iowa hospitals and clinics under
the control of the state board of regents shall not receive
indirect costs from the funds appropriated in this section.
The university of Iowa hospitals and clinics billings to the
department shall be on at least a quarterly basis.
DIVISION V
COMMUNITY ACCESS AND ELIGIBILITY —— FY 2024-2025
Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY
ACCESS AND ELIGIBILITY. There is appropriated from the
general fund of the state to the department of health and human
services for the fiscal year beginning July 1, 2024, and ending
June 30, 2025, the following amount, or so much thereof as is
necessary, to be used for the purposes designated:
To be used for salaries, support, maintenance, and
miscellaneous purposes and for family investment program (FIP)
assistance in accordance with chapter 239B, and for other costs
associated with providing needs-based benefits or assistance
including but not limited to maternal and child health, oral
health, obesity prevention, the promoting independence and
self-sufficiency through employment, job opportunities and
basic skills (PROMISE JOBS) program, supplemental nutrition
assistance program (SNAP) employment and training, the FIP
diversion program, family planning, rent reimbursement,
and eligibility determinations for medical assistance, food
assistance, and the children’s health insurance program:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,043,944
1. Of the child support collections assigned under FIP,
the federal share of support collections shall be credited to
the child support services appropriation made in this division
of this Act. Of the remainder of the assigned child support
collections received by child support services, a portion
shall be credited to community access and eligibility, and
the remaining funds may be used to increase recoveries, to
sustain cash flow in the child support payments account, or for
technology needs. If child support collections assigned under
FIP are greater than estimated or are otherwise determined not
to be required for maintenance of effort, the state share of
either amount may be transferred to or retained in the child
support payments account.

House File 2698, p. 8
2. Of the funds appropriated in this section, $3,075,000
shall be used for continuation of the department’s initiative
to provide for adequate developmental surveillance and
screening during a child’s first five years. The funds shall
be used first to fully fund the current participating counties
to ensure that those counties are fully operational, with the
remaining funds to be used for expanding participation to
additional counties. The full implementation and expansion
shall include enhancing the scope of the initiative through
collaboration with the 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. The department shall also collaborate with the Medicaid
program and the child health specialty clinics to assist in
coordinating the activities of the first five initiative into
the establishment of patient-centered medical homes developed
to improve health quality and population health while reducing
health care costs. To the maximum extent possible, funding
allocated in this subsection shall be utilized as matching
funds for Medicaid program reimbursement.
3. Of the funds appropriated in this section, $1,145,102
is allocated to the Iowa commission on volunteer service for
programs and grants.
4. The university of Iowa hospitals and clinics under
the control of the state board of regents shall not receive
indirect costs from the funds appropriated in this section.
The university of Iowa hospitals and clinics billings to the
department shall be on at least a quarterly basis.
CHILD SUPPORT SERVICES
Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from
the general fund of the state to the department of health and
human services for the fiscal year beginning July 1, 2024, and
ending June 30, 2025, the following amount, or so much thereof
as is necessary, to be used for the purposes designated:
For child support services, including salaries, support,

House File 2698, p. 9
maintenance, and miscellaneous purposes:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,434,282
1. Federal 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.
2. The appropriation made to the department for child
support services may be used throughout the fiscal year in the
manner necessary for purposes of cash flow management, and for
cash flow management purposes the department may temporarily
draw more than the amount appropriated, provided the amount
appropriated is not exceeded at the close of the fiscal year.
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK GRANT
Sec. 8. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES BLOCK
GRANT. There is appropriated from the special fund created in
section 8.41 to the department of health and human services
for the fiscal year beginning July 1, 2024, and ending June
30, 2025, from moneys received under the federal temporary
assistance for needy families (TANF) block grant pursuant
to the federal Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, Pub. L. No. 104-193, and successor
legislation, the following amounts, or so much thereof as is
necessary, to be used for the purposes designated:
1. For community access and eligibility, FIP, the PROMISE
JOBS program, implementing family investment agreements in
accordance with chapter 239B, and for continuation of the
program promoting awareness of the benefits of a healthy
marriage:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,988,627
2. For community access and eligibility to provide
pregnancy prevention grants on the condition that family
planning services are funded:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,913,203
Pregnancy prevention grants shall be awarded to programs
in existence on or before July 1, 2024, if the programs have
demonstrated positive outcomes. Grants shall be awarded to
pregnancy prevention programs which are developed after July
1, 2024, if the programs are based on existing models that
have demonstrated positive outcomes. Grants shall comply with

House File 2698, p. 10
the requirements provided in 1997 Iowa Acts, chapter 208,
section 14, subsections 1 and 2, including the requirement that
grant programs must emphasize sexual abstinence. Priority in
the awarding of grants shall be given to programs 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.
3. For community access and eligibility to meet one of the
four core purposes of TANF as specified in 45 C.F.R. §260.20,
including by modernizing the program to promote economic
mobility and self-sufficiency, ensuring that families are able
to overcome benefit cliffs, encouraging healthy families, and
streamlining service delivery to reduce duplication:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000
4. For technology needs related to child support
modernization of the Iowa collections and reporting (ICAR)
system and for a closed loop referral system for the thrive
Iowa program:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,000,000
5. For early intervention and supports for the family
development and self-sufficiency (FaDSS) grant program in
accordance with section 216A.107:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,888,980
Of the funds allocated for the FaDSS grant program in this
subsection, not more than 5 percent of the funds shall be used
for administrative purposes.
6. For early intervention and supports for child abuse
prevention grants:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 125,000
7. For accountability, compliance, program integrity,
technology needs, and other resources necessary to meet federal
and state reporting, tracking, and case management requirements
and other departmental needs:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,533,647
8. For state child care assistance:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 47,166,826
9. For child protective services:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 62,364,100
10. For child protective services for the kinship stipend

House File 2698, p. 11
program:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,000,000
DIVISION VI
MEDICAL ASSISTANCE —— STATE SUPPLEMENTARY ASSISTANCE —— HEALTHY
AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED PROGRAMS
—— FY 2024-2025
Sec. 9. MEDICAL ASSISTANCE, STATE SUPPLEMENTARY
ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There
is appropriated from the general fund of the state to the
department of health and human services for the fiscal year
beginning July 1, 2024, and ending June 30, 2025, the following
amount, or so much thereof as is necessary, to be used for the
purposes designated:
For medical assistance program reimbursement and associated
costs as specifically provided in the reimbursement
methodologies in effect on June 30, 2024, 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 program; for the state
supplementary assistance program; for the health insurance
premium payment program; and for maintenance of the healthy and
well kids in Iowa (Hawki) program pursuant to chapter 514I,
including supplemental dental services, for receipt of federal
financial participation under Tit. XXI of the federal Social
Security Act, which creates the children’s health insurance
program; and for other specified health-related programs:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,650,866,536
1. Of the funds appropriated in this section,
$1,605,063,804 is allocated for medical assistance program
reimbursement and associated costs.
a. Of the funds allocated in this subsection, $800,000 shall
be used for the renovation and construction of certain nursing
facilities, consistent with the provisions of chapter 249K.
b. Of the funds allocated in this subsection, $3,383,880
shall be used for program administration, outreach, and
enrollment activities of the state family planning services
program pursuant to section 217.41B, and of this amount, the
department may use $200,000 for administrative expenses.

House File 2698, p. 12
c. Of the funds allocated in this subsection,
$1,700,000 shall be used to provide for additional home and
community-based services waiver slots for individuals with an
intellectual disability.
2. Iowans support reducing the number of abortions
performed in our state. Funds appropriated under this section
shall not be used for abortions, unless otherwise authorized
under this section.
3. The provisions of this section relating to abortions
shall also apply to the Iowa health and wellness plan created
pursuant to chapter 249N.
4. Of the funds appropriated in this section, $4,479,762 is
allocated for the state supplementary assistance program.
5. Of the funds appropriated in this section, $41,322,970
is allocated for maintenance of the Hawki program pursuant
to chapter 514I, including supplemental dental services, for
receipt of federal financial participation under Tit. XXI of
the federal Social Security Act, which creates the children’s
health insurance program.
HEALTH PROGRAM OPERATIONS
Sec. 10. HEALTH PROGRAM OPERATIONS. There is appropriated
from the general fund of the state to the department of health
and human services for the fiscal year beginning July 1,
2024, and ending June 30, 2025, the following amount, or so
much thereof as is necessary, to be used for the purposes
designated:
For health program operations and the autism support
program:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,597,231
1. The department of inspections, appeals, and licensing
shall provide all state matching funds for survey and
certification activities performed by the department of
inspections, appeals, and licensing. The department of health
and human services is solely responsible for distributing the
federal matching funds for such activities.
2. Of the funds appropriated in this section, a sufficient
amount shall be used for the administration of the health
insurance premium payment program, including salaries, support,
maintenance, and miscellaneous purposes.

House File 2698, p. 13
3. Of the funds appropriated in this section, $750,000 shall
be used for the state poison control center. Pursuant to the
directive under 2014 Iowa Acts, chapter 1140, section 102, the
federal matching funds available to the state poison control
center from the department under the federal Children’s Health
Insurance Program Reauthorization Act of 2009 allotment shall
be subject to the federal administrative cap rule of 10 percent
applicable to funding provided under Tit. XXI of the federal
Social Security Act and included within the department’s
calculations of the cap.
4. Unless otherwise provided, annual increases for services
provided through contracts funded under this section shall
not exceed the amount by which the consumer price index for
all urban consumers increased during the most recently ended
calendar year.
HEALTH CARE ACCOUNTS AND FUNDS
Sec. 11. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT
OF HEALTH AND HUMAN SERVICES. There is appropriated from the
pharmaceutical settlement account created in section 249A.33 to
the department of health and human services for the fiscal year
beginning July 1, 2024, and ending June 30, 2025, the following
amount, or so much thereof as is necessary, to be used for the
purposes designated:
Notwithstanding any provision of law to the contrary, to
supplement the appropriation made in this Act for health
program operations under the medical assistance program for the
same fiscal year:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193
Sec. 12. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF
HEALTH AND HUMAN SERVICES. Notwithstanding any provision to
the contrary and subject to the availability of funds, there is
appropriated from the quality assurance trust fund created in
section 249L.4 to the department of health and human services
for the fiscal year beginning July 1, 2024, and ending June 30,
2025, the following amount, or so much thereof as is necessary,
for the purposes designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of health and human
services for medical assistance for the same fiscal year:

House File 2698, p. 14
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205
Sec. 13. HOSPITAL HEALTH CARE ACCESS TRUST FUND ——
DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding any
provision to the contrary and subject to the availability of
funds, 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, 2024, and ending June 30, 2025, the following amount, or so
much thereof as is necessary, for the purposes designated:
To supplement the appropriation made in this Act from the
general fund of the state to the department of health and human
services for medical assistance for the same fiscal year:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554
REIMBURSEMENT RATES
Sec. 14. REIMBURSEMENT RATES.
1. Reimbursement for medical assistance, state
supplementary assistance, and social service providers and
services reimbursed under the purview of the department of
health and human services shall remain at the reimbursement
rate or shall be determined pursuant to the reimbursement
methodology in effect on June 30, 2024, with the exception of
the following:
a. If reimbursement is otherwise negotiated by contract or
pursuant to an updated fee schedule.
b. As otherwise provided in this section.
2. a. Notwithstanding any provision of law to the contrary,
for the fiscal year beginning July 1, 2024, and ending June
30, 2025, the department of health and human services shall
reimburse case-mix nursing facility rates at the amounts in
effect on June 30, 2024.
b. The department of health and human services shall
calculate each nursing facility’s case-mix index for the period
beginning July 1, 2023, using weighting based on the current
patient driven payment model (PDPM) schedule. Rosters shall be
made to show a separate calculation to determine the average
case-mix index for a nursing-facility-wide case mix index, and
a case-mix index for the residents of a nursing facility who
are Medicaid recipients using all minimum data set reports by
the nursing facility for the previous semi-annual period using

House File 2698, p. 15
a day weighted calculation.
3. For the fiscal year beginning July 1, 2024, Medicaid
provider rates shall be adjusted to 85 percent of the benchmark
rates based on the department’s 2023 Medicaid rate review for
all of the following Medicaid providers:
a. Medical supply providers.
b. Physician assistants.
c. Physical therapists.
d. Occupational therapists.
e. Certified nurse midwives.
4. For the fiscal year beginning July 1, 2024, reimbursement
rates for home and community-based services providers shall be
increased compared to the rates in effect on June 30, 2024, to
the extent possible within the state funding, including the
$14,600,000 provided for this purpose.
5. For the fiscal year beginning July 1, 2024, reimbursement
rates for community mental health centers shall be increased
compared to the rates in effect on June 30, 2024, to the extent
possible within the state funding, including the $276,947
provided for this purpose.
6. For the fiscal year beginning July 1, 2024, enhanced
reimbursement shall be provided within the additional $369,000
appropriated for this purpose for a psychiatric medical
institution for children that meets the selection criteria
specified in 2024 Iowa Acts, House File 2402, or successor
legislation, if enacted.
7. For the fiscal year beginning July 1, 2024, the pharmacy
dispensing fee shall be adjusted within the additional $500,000
appropriated for this purpose.
8. For the fiscal year beginning July 1, 2024, the
reimbursement rates for mental health providers shall be
increased within the additional $2,104,186 appropriated for
this purpose.
9. For the fiscal year beginning July 1, 2024,
residential-based supported community living provider
rates shall be increased within the additional $1,352,750
appropriated for this purpose.
10. For the fiscal year beginning July 1, 2024,
reimbursement rates for home heath agencies shall continue to

House File 2698, p. 16
be based on the Medicare low utilization payment adjustment
(LUPA) methodology with state geographic wage adjustments and
shall be adjusted to increase the rates to the extent possible
within the state funding appropriated. The department shall
continue to update the rates every two years to reflect the
most recent Medicare LUPA rates.
11. For the fiscal year beginning July 1, 2024,
reimbursement rates for air medical services provided by an
entity that has over 40 years of experience and is the largest
community-based provider of air medical services shall be
increased within the additional $250,000 appropriated for this
purpose.
DIVISION VII
FAMILY WELL-BEING AND PROTECTION —— FY 2024-2025
STATE CHILD CARE ASSISTANCE
Sec. 15. STATE CHILD CARE ASSISTANCE. There is appropriated
from the general fund of the state to the department of health
and human services for the fiscal year beginning July 1,
2024, and ending June 30, 2025, the following amount, or so
much thereof as is necessary, to be used for the purposes
designated:
For state child care assistance in accordance with section
237A.13:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34,966,931
1. If the appropriations made for purposes of the state
child care assistance program for the fiscal year are
determined to be insufficient, it is the intent of the general
assembly to appropriate sufficient funding for the fiscal year
in order to avoid establishment of waiting list requirements.
2. A portion of the state match for the federal child care
and development block grant shall be provided as necessary to
meet federal matching funds requirements through the state
general fund appropriation made for child development grants
and other programs for at-risk children in section 279.51.
EARLY INTERVENTION AND SUPPORTS
Sec. 16. EARLY INTERVENTION AND SUPPORTS. There is
appropriated from the general fund of the state to the
department of health and human services for the fiscal year
beginning July 1, 2024, and ending June 30, 2025, the following

House File 2698, p. 17
amount, or so much thereof as is necessary, to be used for the
purposes designated:
For promoting the optimum health status for children
and adolescents from birth through 21 years of age, and for
families:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35,277,739
1. Of the funds 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
(HFI) program established pursuant to section 135.106.
2. Of the funds appropriated in this section, $4,313,854 is
allocated for the FaDSS grant program. Of the funds allocated
for the FaDSS grant program in this subsection, not more than 5
percent of the funds shall be used for administration of the
grant program.
3. Of the funds appropriated in this section, $29,256,799
shall be used for the purposes of the early childhood Iowa fund
created in section 256I.11.
4. Of the funds appropriated in this section, $1,000,000
shall be used for the purposes of program administration and
provision of pregnancy support services through the more
options for maternal support program in accordance with section
217.41C.
CHILD PROTECTIVE SERVICES
Sec. 17. CHILD PROTECTIVE SERVICES. There is appropriated
from the general fund of the state to the department of health
and human services for the fiscal year beginning July 1,
2024, and ending June 30, 2025, the following amount, or so
much thereof as is necessary, to be used for the purposes
designated:
For child, family, and adoption services, and for salaries,
support, maintenance, and miscellaneous purposes:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $166,101,034
1. Of the funds appropriated in this section, $1,717,000
is allocated specifically for expenditure for fiscal year
2024-2025 through the decategorization services funding pools
and governance boards established pursuant to section 232.188.
2. A portion of the funds appropriated in this section
may be used to provide other resources based on client need

House File 2698, p. 18
required to support family preservation, emergency client need,
or family reunification efforts.
3. Of the funds appropriated in this section, a sufficient
amount is allocated for foster family care, group foster care
maintenance and services, shelter care, child welfare emergency
services, and supervised apartment living contracts.
4. Federal funds received by the state during the fiscal
year beginning July 1, 2024, as the result of the expenditure
of state funds appropriated during a previous state fiscal
year for a service or activity funded under this section, are
appropriated to the department to be used as additional funding
for services and purposes provided for under this section.
Notwithstanding section 8.33, moneys received in accordance
with this subsection that remain unencumbered or unobligated at
the close of the fiscal year shall not revert to any fund but
shall remain available for the purposes designated until the
close of the succeeding fiscal year.
5. a. Of the funds appropriated in this section, $748,000
is allocated for the payment of the expenses of court-ordered
services provided to children who are under the supervision
of the department, which expenses are a charge upon the state
pursuant to section 232.141, subsection 4.
b. Notwithstanding chapter 232 or any other provision of
law to the contrary, a district or juvenile court shall not
order any service which is a charge upon the state pursuant
to section 232.141 if the court-ordered services distribution
amount is insufficient to pay for the service.
6. Of the funds appropriated in this section, $1,658,000
shall be used for the child protection center grant program for
child protection centers located in Iowa in accordance with
section 135.118. The grant amounts under the program shall be
equalized so that each center receives a uniform base amount of
$245,000, and so that the remaining funds are awarded through
a funding formula based upon the volume of children served.
To increase access to child protection center services for
children in rural areas, the funding formula for the awarding
of the remaining funds shall provide for the awarding of an
enhanced amount to eligible grantees to develop and maintain
satellite centers in underserved regions of the state.

House File 2698, p. 19
7. Of the funds appropriated in this section, $4,359,500 is
allocated for the preparation for adult living program pursuant
to section 234.46.
8. Of the funds appropriated in this section, up to $227,000
shall be used for the public purpose of continuing a grant to a
nonprofit human services organization, providing services to
individuals and families in multiple locations in southwest
Iowa and Nebraska for support of a project providing immediate,
sensitive support and forensic interviews, medical exams, needs
assessments, and referrals for victims of child abuse and their
nonoffending family members.
9. Of the funds appropriated in this section, a portion may
be used for family-centered services for purposes of complying
with the federal Family First Prevention Services Act of 2018,
Pub. L. No. 115-123, and successor legislation.
10. a. Of the funds appropriated in this section, a
sufficient amount is allocated for adoption subsidy payments
and related costs.
b. Any funds allocated in this subsection remaining after
the allocation under paragraph “a” are designated and allocated
as state savings resulting from implementation of the federal
Fostering Connections to Success and Increasing Adoptions Act
of 2008, Pub. L. No. 110-351, and successor legislation, as
determined in accordance with 42 U.S.C. §673(a)(8), and shall
be used for post-adoption services and for other purposes
allowed under these federal laws, Tit. IV-B or Tit. IV-E of the
federal Social Security Act.
c. Of the funds appropriated in this section, $148,232
shall be used to increase the adoption subsidy paid to a person
pursuant to section 600.17 who adopts a child after July 1,
2024, by five percent over the rates in effect on June 30,
2024.
11. Of the funds appropriated in this section, a sufficient
amount is allocated to support training needs for child welfare
providers and to address disproportionality within the child
welfare system.
12. Of the funds appropriated in this section, $308,765
shall be used to increase the foster care reimbursement rates
paid pursuant to section 234.38, by five percent over the rates

House File 2698, p. 20
in effect on June 30, 2024.
13. Of the funds appropriated in this section, $1,000,000 is
allocated for enhanced training for child protective services
workers and for additional social worker supervisors to
appropriately manage caseloads.
14. If a separate funding source is identified that reduces
the need for state funds within an allocation under this
section, the allocated state funds may be redistributed to
other allocations under this section for the same fiscal year.
DIVISION VIII
STATE SPECIALTY CARE —— FY 2024-2025
Sec. 18. STATE SPECIALTY CARE. There is appropriated from
the general fund of the state to the department of health and
human services for the fiscal year beginning July 1, 2024, and
ending June 30, 2025, the following amount, or so much thereof
as is necessary, to be used for the purposes designated:
For salaries, support, maintenance, and miscellaneous
purposes at institutions under the jurisdiction of the
department of health and human services:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100,006,128
1. The department shall utilize the funds appropriated in
this section as necessary to maximize bed capacity and to most
effectively meet the needs of the individuals served.
2. Of the amount appropriated in this section, the following
amounts are allocated to each institution as follows:
a. For the state mental health institute at Cherokee:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,439,086
b. For the state mental health institute at Independence:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 23,916,279
c. For the civil commitment unit for sexual offenders at
Cherokee:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 17,755,397
d. For the state resource center at Woodward:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 14,018,717
e. For the state resource center at Glenwood:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,255,132
f. For the state training school at Eldora:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,621,517
DIVISION IX

House File 2698, p. 21
ADMINISTRATION AND COMPLIANCE —— FY 2024-2025
Sec. 19. ACCOUNTABILITY, COMPLIANCE, AND PROGRAM
INTEGRITY. There is appropriated from the general fund of the
state to the department of health and human services for the
fiscal year beginning July 1, 2024, and ending June 30, 2025,
the following amount, or so much thereof as is necessary, to be
used for the purposes designated:
For accountability, compliance, and program integrity,
including salaries, support, maintenance, and miscellaneous
purposes:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,356,598
1. Of the funds appropriated in this section, $200,000 shall
be transferred to and deposited in the Iowa ABLE savings plan
trust administrative fund created in section 12I.4, to be used
for implementation and administration activities of the Iowa
ABLE savings plan trust.
2. Of the funds appropriated in this section, $2,602,312
shall be used for foster care review and the court appointed
special advocate program, including for salaries, support,
maintenance, and miscellaneous purposes.
3. Of the funds appropriated in this section, $1,148,959
shall be used for the office of long-term care ombudsman
for salaries, support, administration, maintenance, and
miscellaneous purposes.
4. For the fiscal year beginning July 1, 2024, and ending
June 30, 2025, the department of health and human services
may utilize the funds appropriated from the general fund of
the state to the department under this Act for up to 4,156.00
full-time equivalent positions. The department shall report to
the general assembly by December 15, 2024, the distribution of
the approved number of full-time equivalent positions across
the organizational divisions of the department.
DIVISION X
AUTISM SUPPORT FUND
Sec. 20. AUTISM SUPPORT FUND —— APPROPRIATION.
Notwithstanding any provision to the contrary under section
225D.2, there is appropriated from the autism support fund
created in section 225D.2 to the department of health and human
services for the fiscal year beginning July 1, 2024, and ending

House File 2698, p. 22
June 30, 2025, the following amount, or so much thereof as is
necessary, for the purposes designated:
For allocation to a nonprofit agency that provides expert
care for children with medical complexity as infrastructure
funding to expand its facilities to provide behavioral analysis
treatment for eligible individuals:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 750,000
DIVISION XI
DEPARTMENT OF HEALTH AND HUMAN SERVICES TRANSFERS, CASHFLOW,
AND NONREVERSIONS
Sec. 21. DEPARTMENT OF HEALTH AND HUMAN SERVICES TRANSFERS
AND CASHFLOW.
1. The department of health and human services may transfer
funds 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
funds are provided. The department shall report any transfers
made pursuant to this subsection to the general assembly.
2. If the savings to the appropriations made for the
Medicaid program from ongoing cost management efforts exceed
the associated costs for the fiscal year, the department may
transfer any savings generated for the fiscal year due to cost
management efforts to the appropriations made in this Act for
health program operations or for accountability, compliance,
and program integrity to defray the costs associated with
implementation of the cost management efforts.
3. The department may transfer funds appropriated for
child protective services to pay the nonfederal share costs of
services reimbursed under the medical assistance program, state
child care assistance program, or the family investment program
which are provided to children who would otherwise receive
services paid under the appropriation for child protective
services.
4. The department may transfer funds from the temporary
assistance for needy families block grant to the federal social
services block grant appropriation, and to the child care and
development block grant appropriation, in accordance with
federal law.

House File 2698, p. 23
5. To the extent the department determines that moneys
appropriated under this Act or allocated for a specific purpose
under the Act will remain unencumbered or unobligated at the
close of the fiscal year, such unencumbered or unobligated
moneys may be used in the same fiscal year for any other
purpose for which the moneys appropriated may be used, or for
any other allocation within the same appropriation.
6. To the extent the department determines that moneys
appropriated under this Act will remain unencumbered or
unobligated at the close of the fiscal year or that services
will not be impacted, the department may utilize up to
$3,000,000 of such unencumbered or unobligated moneys
appropriated to develop and support the thrive Iowa program,
a closed-loop referral system utilizing a navigator model,
that acts as the connection point to link Iowans on an
individualized path to prosperity and self-sufficiency to
available resources in all sectors of the community.
Sec. 22. DEPARTMENT OF HEALTH AND HUMAN SERVICES
NONREVERSIONS.
1. Notwithstanding section 8.33, moneys appropriated 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, 2024,
and ending June 30, 2025, for the purposes of the FaDSS grant
program 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.
2. Notwithstanding section 8.33, of the moneys appropriated
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, 2024, and ending June 30, 2025, for the
purposes of the medical assistance program, the amount that is
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.

House File 2698, p. 24
3. Notwithstanding section 8.33, and notwithstanding the
nonreversion amount limitation specified in section 222.92,
moneys appropriated from the general fund of the state to the
department of health and human services for the fiscal year
beginning July 1, 2024, and ending June 30, 2025, for the
purposes of state specialty care 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 for subsequent fiscal years.
4. Notwithstanding section 8.33, moneys appropriated from
the general fund of the state to the department of health and
human services for the fiscal year beginning July 1, 2024,
and ending June 30, 2025, for the commission on volunteer
service for purposes of the Iowa state commission grant program
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 for subsequent fiscal
years.
5. Notwithstanding section 8.33, moneys appropriated from
the general fund of the state to the department of health and
human services for the fiscal year beginning July 1, 2024,
and ending June 30, 2025, and allocated for rural psychiatric
residencies to annually fund eight psychiatric residents who
will provide mental health services to underserved areas of the
state 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.
6. Notwithstanding section 8.33, moneys appropriated from
the general fund of the state to the department of health and
human services for the fiscal year beginning July 1, 2024,
and ending June 30, 2025, and allocated for adoption subsidy
payments and related costs or for post-adoption services
and related allowable purposes 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.
DIVISION XII
HEALTH AND HUMAN SERVICES —— PRIOR APPROPRIATIONS AND OTHER

House File 2698, p. 25
PROVISIONS —— FY 2022-2023
RURAL PSYCHIATRIC RESIDENCIES
Sec. 23. 2022 Iowa Acts, chapter 1131, section 3, subsection
4, paragraph j, is amended to read as follows:
j. Of the funds appropriated in this subsection, $800,000
shall be used for rural psychiatric residencies to support the
annual creation and training of six eight psychiatric residents
who will provide mental health services in underserved areas of
the state. Notwithstanding section 8.33 , moneys 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 for subsequent fiscal years.
FAMILY INVESTMENT PROGRAM
Sec. 24. 2022 Iowa Acts, chapter 1131, section 9, subsection
7, as enacted by 2023 Iowa Acts, chapter 112, section 41, is
amended to read as follows:
7. Notwithstanding section 8.33 , moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for the purposes designated , or may be transferred to
other appropriations in this division of this Act or used as
necessary to enhance agency accountability, program integrity,
compliance, and efficiency, until the close of the succeeding
fiscal year.
Sec. 25. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 26. RETROACTIVE APPLICABILITY. This division of this
Act applies retroactively to July 1, 2022.
DIVISION XIII
HEALTH AND HUMAN SERVICES —— PRIOR APPROPRIATIONS AND OTHER
PROVISIONS —— FY 2023-2024
OFFICE OF PUBLIC GUARDIAN
Sec. 27. 2023 Iowa Acts, chapter 112, section 3, is amended
by adding the following new subsection:
NEW SUBSECTION . 7. Notwithstanding section 8.33,
moneys appropriated in this section for the state office of
public guardian established under chapter 231E that remain
unencumbered or unobligated at the close of the fiscal year
shall not revert but shall remain available for the purposes

House File 2698, p. 26
designated until the close of the succeeding fiscal year.
AUDIOLOGICAL SERVICES
Sec. 28. 2023 Iowa Acts, chapter 112, section 5, subsection
2, paragraph e, is amended to read as follows:
e. Of the funds appropriated in this subsection, $156,000
shall be used to provide audiological services and hearing aids
for children. Notwithstanding section 8.33, moneys allocated
in this paragraph that remain unencumbered or unobligated at
the close of the fiscal year shall not revert but shall remain
available for the purposes designated until the close of the
succeeding fiscal year.
RURAL PSYCHIATRIC RESIDENCIES
Sec. 29. 2023 Iowa Acts, chapter 112, section 5, subsection
4, paragraph j, is amended to read as follows:
j. Of the funds appropriated in this subsection, $800,000
shall be used for rural psychiatric residencies to annually
fund six eight psychiatric residents who will provide
mental health services in underserved areas of the state.
Notwithstanding section 8.33 , moneys 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 for subsequent fiscal years.
CHILD AND FAMILY SERVICES —— CHILD PROTECTIVE SERVICES
Sec. 30. 2023 Iowa Acts, chapter 112, section 7, subsection
7, is amended to read as follows:
7. For child and family protective services:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 32,380,654
35,380,654
Of the funds appropriated in this subsection, up to
$3,000,000 shall be used for the kinship caregiver stipend
program.
FAMILY INVESTMENT PROGRAM
Sec. 31. 2023 Iowa Acts, chapter 112, section 9, is amended
by adding the following new subsection:
NEW SUBSECTION . 7. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for the purposes designated, or may
be transferred to other appropriations in this division of this

House File 2698, p. 27
Act or used as necessary to enhance agency accountability,
program integrity, compliance, and efficiency, until the close
of the succeeding fiscal year.
CHILD CARE ASSISTANCE
Sec. 32. 2023 Iowa Acts, chapter 112, section 17, subsection
8, is amended to read as follows:
8. Notwithstanding section 8.33 , moneys advanced for
purposes of the programs developed by early childhood Iowa
areas, advanced for purposes of wraparound child care, or
received from the federal appropriations made for the purposes
of appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
to any fund but shall remain available for expenditure for the
purposes designated until the close of the succeeding fiscal
year.
CHILD AND FAMILY SERVICES
Sec. 33. 2023 Iowa Acts, chapter 112, section 19, is amended
by adding the following new subsection:
NEW SUBSECTION . 23. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for the purposes designated until
the close of the succeeding fiscal year.
ADOPTION SUBSIDY —— QUALIFIED RESIDENTIAL TREATMENT PROVIDERS
—— PMIC PROVIDER
Sec. 34. 2023 Iowa Acts, chapter 112, section 20, subsection
4, is amended to read as follows:
4. Notwithstanding section 8.33 , moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for the purposes designated ; and may be used for
child protective services qualified residential treatment
provider rates and security enhancements; and up to $3,000,000
may be used by the department, notwithstanding any provision
of law to the contrary regarding competitive bidding, to enter
into a sole source contract with a nonprofit provider founded
in 1912, with centers in 11 states that provide a comprehensive
behavioral health network of clinical, therapeutic, education,
and employment programs and services, for renovation or

House File 2698, p. 28
purchase of a facility for use as a psychiatric medical
institution for children, until the close of the succeeding
fiscal year.
FIELD OPERATIONS
Sec. 35. 2023 Iowa Acts, chapter 112, section 26, is amended
by adding the following new subsection:
NEW SUBSECTION . 4. Notwithstanding section 8.33, moneys
appropriated in this section that remain unencumbered or
unobligated at the close of the fiscal year shall not revert
but shall remain available for the purposes designated until
the close of the succeeding fiscal year.
GENERAL ADMINISTRATION —— MORE OPTIONS FOR MATERNAL SUPPORT
PROGRAM
Sec. 36. 2023 Iowa Acts, chapter 112, section 27, subsection
8, is amended to read as follows:
8. Of the funds appropriated under this section, $1,000,000
shall be used for the purposes of program administration and
provision of pregnancy support services through the more
options for maternal support program in accordance with section
217.41C . Notwithstanding section 8.33, moneys allocated in
this subsection that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for the purposes designated until the close of the
succeeding fiscal year.
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM ADMINISTRATIVE
ALLOCATION —— FEDERAL BLOCK GRANT
Sec. 37. 2023 Iowa Acts, chapter 161, section 10, subsection
3, is amended to read as follows:
3. After subtracting the allocation in subsection 2, up to
10 no less than 8.4 percent of the remaining moneys for each
federal fiscal year are allocated for administrative expenses
of low-income home energy assistance program contractors and
up to 1.6 percent of the remaining moneys for each fiscal year
are allocated for the administrative expenses of the department
of health and human services under the low-income home energy
assistance program of which $377,000 is allocated each federal
fiscal year for administrative expenses of the department of
health and human services . The costs of auditing the use and
administration of the portion of the appropriation in this

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section that is retained by the state shall be paid from the
amount allocated in this subsection each federal fiscal year to
the department of health and human services. The auditor of
state shall bill the department of health and human services
for the audit costs.
Sec. 38. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 39. RETROACTIVE APPLICABILITY. This division of this
Act applies retroactively to July 1, 2023.
DIVISION XIV
REPORT ON NONREVERSION OF FUNDS
Sec. 40. REPORT ON NONREVERSION OF FUNDS. The department
of health and human services shall report the expenditure of
any moneys for which nonreversion authorization was provided
for the fiscal year beginning July 1, 2023, and ending June 30,
2024, to the general assembly on a quarterly basis beginning
October 1, 2024.
DIVISION XV
EMERGENCY RULES AND REPORTS
Sec. 41. EMERGENCY RULES.
1. If necessary to comply with federal requirements
including time frames, or if specifically authorized by a
provision of this Act, the department of health and human
services or the mental health and disability services
commission shall adopt administrative rules under section
17A.4, subsection 3, and section 17A.5, subsection 2, paragraph
“b”, to implement the applicable provisions of this Act. The
rules shall be effective immediately upon filing unless a
later date is specified in the rules. Any rules adopted in
accordance with this section shall also be published as a
notice of intended action as provided in section 17A.4.
2. If during a fiscal year, the department of health and
human services is adopting rules in accordance with this
section or as otherwise directed or authorized by state
law, and the rules will result in an expenditure increase
beyond the amount anticipated in the budget process or if the
expenditure was not addressed in the budget process for the
fiscal year, the department shall notify the general assembly
and the department of management concerning the rules and the

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expenditure increase. The notification shall be provided at
least thirty calendar days prior to the date notice of the
rules is submitted to the administrative rules coordinator and
the administrative code editor.
Sec. 42. REPORTS. Unless otherwise provided, any reports or
other information required to be compiled and submitted under
this Act during the fiscal year beginning July 1, 2024, shall
be submitted on or before the date specified for submission of
the reports or information.
DIVISION XVI
CODIFIED PROVISIONS
PERSONAL NEEDS ALLOWANCE FOR FACILITIES UNDER MEDICAID
Sec. 43. Section 249A.30A, Code 2024, is amended to read as
follows:
249A.30A Medical assistance —— personal needs allowance.
1. The personal needs allowance under the medical
assistance program, which may be retained by a person who is a
resident of a nursing facility, an intermediate care facility
for persons with an intellectual disability, or an intermediate
care facility for persons with mental illness, as defined in
section 135C.1 , or a person who is a resident of a psychiatric
medical institution for children as defined in section 135H.1 ,
shall be fifty dollars per month.
2. A resident who has income of less than fifty dollars
per month shall receive a supplement from the state in the
amount necessary to receive a personal needs allowance of fifty
dollars per month , if funding is specifically appropriated for
this purpose . The general assembly shall annually appropriate
a sufficient amount from the general fund of the state to the
department of health and human services for this purpose.
REPLACEMENT GENERATION TAX REVENUES
Sec. 44. Section 437A.8, subsection 4, paragraph d, Code
2024, is amended to read as follows:
d. Notwithstanding paragraph “a” , a taxpayer who owns
or leases a new electric power generating plant and who has
no other operating property in the state of Iowa except for
operating property directly serving the new electric power
generating plant as described in section 437A.16 shall pay
the replacement generation tax associated with the allocation

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of the local amount to the county treasurer of the county in
which the local amount is located and shall remit the remaining
replacement generation tax, if any, to the director according
to paragraph “a” for remittance of the tax to county treasurers.
The director shall notify each taxpayer on or before August 31
following a tax year of its remaining replacement generation
tax to be remitted to the director. All remaining replacement
generation tax revenues received by the director shall be
deposited in the property tax relief fund created in section
426B.1 , and shall be distributed as provided in section 426B.2
appropriated annually to the department of health and human
services to supplement any appropriation made for medical
assistance .
If a taxpayer has paid an amount of replacement tax,
penalty, or interest which was deposited into the property
tax relief fund appropriated to the department of health and
human services under this paragraph and which was not due, all
of the provisions of section 437A.14, subsection 1 , paragraph
“b” , shall apply with regard to any claim for refund or credit
filed by the taxpayer. The director shall have sole discretion
as to whether the erroneous payment will be refunded to the
taxpayer or credited against any replacement tax due, or to
become due, from the taxpayer that would be subject to deposit
in the property tax relief fund appropriated to the department
of health and human services under this paragraph .
Sec. 45. Section 437A.15, subsection 3, paragraph f, Code
2024, is amended to read as follows:
f. Notwithstanding the provisions of this section , if
a taxpayer is a municipal utility or a municipal owner of
an electric power facility financed under the provisions
of chapter 28F or 476A , the assessed value, other than the
local amount, of a new electric power generating plant shall
be allocated to each taxing district in which the municipal
utility or municipal owner is serving customers and has
electric meters in operation in the ratio that the number of
operating electric meters of the municipal utility or municipal
owner located in the taxing district bears to the total number
of operating electric meters of the municipal utility or
municipal owner in the state as of January 1 of the tax year.

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If the municipal utility or municipal owner of an electric
power facility financed under the provisions of chapter 28F
or 476A has a new electric power generating plant but the
municipal utility or municipal owner has no operating electric
meters in this state, the municipal utility or municipal owner
shall pay the replacement generation tax associated with the
new electric power generating plant allocation of the local
amount to the county treasurer of the county in which the local
amount is located and shall remit the remaining replacement
generation tax, if any, to the director at the times contained
in section 437A.8, subsection 4 , for remittance of the tax to
the county treasurers. All remaining replacement generation
tax revenues received by the director shall be deposited in
the property tax relief fund created in section 426B.1 , and
shall be distributed as provided in section 426B.2 appropriated
annually to the department of health and human services to
supplement any appropriation made for medical assistance .
PERSONAL NEEDS ALLOWANCE FOR STATE SUPPLEMENTARY ASSISTANCE
Sec. 46. NEW SECTION . 249.9A Personal needs allowance.
1. The department shall increase the personal needs
allowance for residents of residential care facilities by the
same percentage and at the same time as federal supplemental
security income and federal social security benefits are
increased due to a recognized increase in the cost of living.
2. If during a fiscal year, the department projects that
state supplementary assistance expenditures for a calendar year
will not meet the federal pass-through requirement specified
in Tit. XVI of the federal Social Security Act, section 1618,
as codified in 42 U.S.C. §1382g, the department may take
actions including but not limited to increasing the personal
needs allowance for residential care facility residents
and making programmatic adjustments or upward adjustments
of the residential care facility or in-home health-related
care reimbursement rates to ensure compliance with federal
requirements. In addition, the department may make other
programmatic and rate adjustments necessary to remain within
the funds appropriated for a fiscal year while ensuring
compliance with federal requirements.
3. The department may adopt emergency rules under section

House File 2698, p. 33
17A.4, subsection 3, and section 17A.5, subsection 2, paragraph
“b” , to implement the provisions of this section and the rules
shall be effective immediately upon filing unless a later date
is specified in the rules. Any rules adopted in accordance
with this section shall also be published as a notice of
intended action as provided in section 17A.4.
MEDICAID FRAUD FUND AND HEALTH CARE TRUST FUND
Sec. 47. Section 249A.50, subsection 3, Code 2024, is
amended to read as follows:
3. a. A Medicaid fraud fund is created in the state
treasury under the authority of the department of inspections,
appeals, and licensing. Moneys from penalties, investigative
costs recouped by the Medicaid fraud control unit, and other
amounts received as a result of prosecutions involving
the department of inspections, appeals, and licensing
investigations and audits to ensure compliance with the medical
assistance program that are not credited to the program shall
be credited to the fund.
b. Notwithstanding section 8.33 , moneys credited to the
fund from any other account or fund shall not revert to the
other account or fund. Moneys in the fund shall only be used as
provided in appropriations from the fund and shall be used in
accordance with applicable laws, regulations, and the policies
of the office of inspector general of the United States
department of health and human services.
c. Any funds remaining in the Medicaid fraud fund at the
close of a fiscal year are appropriated to the department of
health and human services to supplement any medical assistance
program appropriation for the same fiscal year to be used
for medical assistance reimbursement and associated costs,
including program administration and costs associated with
program implementation.
c. d. For the purposes of this subsection , “investigative
costs” means the reasonable value of a Medicaid fraud control
unit investigator’s, auditor’s or employee’s time, any moneys
expended by the Medicaid fraud control unit, and the reasonable
fair market value of resources used or expended by the Medicaid
fraud control unit in a case resulting in a criminal conviction
of a provider under this chapter or chapter 714 or 715A .

House File 2698, p. 34
Sec. 48. Section 453A.35A, Code 2024, is amended to read as
follows:
453A.35A Health care trust fund —— appropriation to Medicaid
program .
1. A health care trust fund is created in the office of
the treasurer of state. The fund consists of the revenues
generated from the tax on cigarettes pursuant to section
453A.6, subsection 1 , and from the tax on tobacco products
as specified in section 453A.43, subsections 1, 2, 3, and 4 ,
that are credited to the health care trust fund, annually,
pursuant to section 453A.35 . Moneys in the fund shall be
separate from the general fund of the state and shall not be
considered part of the general fund of the state. However, the
fund shall be considered a special account for the purposes
of section 8.53 relating to generally accepted accounting
principles. Moneys in the fund shall be used only as specified
in this section and shall be appropriated only for the uses
specified. Moneys in the fund are not subject to section 8.33
and shall not be transferred, used, obligated, appropriated,
or otherwise encumbered, except as provided in this section .
Notwithstanding section 12C.7, subsection 2 , interest or
earnings on moneys deposited in the fund shall be credited to
the fund.
2. Moneys in the fund shall be used only for purposes
related to health care, substance use disorder treatment and
prevention, and tobacco use prevention, cessation, and control.
3. Any funds remaining in the health care trust fund at the
close of a fiscal year are appropriated to the department of
health and human services to supplement any medical assistance
program appropriation for the same fiscal year to be used
for medical assistance reimbursement and associated costs,
including program administration and costs associated with
program implementation.
MENTAL HEALTH INSTITUTES —— RETAINING OF REVENUE
Sec. 49. NEW SECTION . 218.97 Retaining of revenue by mental
health institutes.
Notwithstanding sections 218.78 and 249A.11, any revenue
received from the state mental health institute at Cherokee or
the state mental health institute at Independence pursuant to

House File 2698, p. 35
42 C.F.R. §438.6(e) may be retained and expended by the mental
health institute.
RESIDENTS OF MENTAL HEALTH INSTITUTES —— RETAINING MEDICAID
ELIGIBILITY
Sec. 50. NEW SECTION . 249A.38A Residents of mental health
institutes —— retaining of Medicaid eligibility.
Notwithstanding any provision of law to the contrary,
a Medicaid recipient residing at the state mental health
institute at Cherokee or the state mental health institute
at Independence shall retain Medicaid eligibility during the
period of the Medicaid recipient’s stay for which federal
financial participation is available.
STATE RESOURCE CENTERS —— SCOPE OF SERVICES
Sec. 51. NEW SECTION . 218.97A State resource centers ——
scope of services approach —— time-limited assessment and respite
services.
1. The department may continue to bill for state resource
center services utilizing a scope of services approach used for
private providers of intermediate care facilities for persons
with an intellectual disability services, in a manner which
does not shift costs between the medical assistance program,
mental health and disability services regions, or other sources
of funding for the state resource centers.
2. The state resource centers may expand the time-limited
assessment and respite services during a fiscal year.
JUVENILE DETENTION HOME FUND —— APPROPRIATION
Sec. 52. Section 232.142, Code 2024, is amended to read as
follows:
232.142 Maintenance and cost of juvenile homes —— fund ——
appropriation of moneys in fund .
1. County boards of supervisors which singly or in
conjunction with one or more other counties provide and
maintain juvenile detention and juvenile shelter care homes are
subject to this section .
2. For the purpose of providing and maintaining a county
or multicounty home, the board of supervisors of any county
may issue general county purpose bonds in accordance with
sections 331.441 through 331.449 . Expenses for providing and
maintaining a multicounty home shall be paid by the counties

House File 2698, p. 36
participating in a manner to be determined by the boards of
supervisors.
3. A county or multicounty juvenile detention home approved
pursuant to this section shall receive financial aid from the
state in a manner approved by the director. Aid paid by the
state shall be at least ten percent and not more than fifty
percent of the total cost of the establishment, improvements,
operation, and maintenance of the home.
4. The director shall adopt minimal rules and standards for
the establishment, maintenance, and operation of such homes as
shall be necessary to effect the purposes of this chapter . The
rules shall apply the requirements of section 237.8 , concerning
employment and evaluation of persons with direct responsibility
for a child or with access to a child when the child is
alone and persons residing in a child foster care facility,
to persons employed by, residing in, or volunteering for a
home approved under this section . The director shall, upon
request, give guidance and consultation in the establishment
and administration of the homes and programs for the homes.
5. The director shall approve annually all such homes
established and maintained under the provisions of this
chapter . A home shall not be approved unless it complies with
minimal rules and standards adopted by the director and has
been inspected by the department of inspections, appeals, and
licensing. The statewide number of beds in the homes approved
by the director shall not exceed two hundred seventy-two beds
beginning July 1, 2017.
6. a. A juvenile detention home fund is created in the
state treasury under the authority of the department. The
fund shall consist of moneys deposited in the fund pursuant to
section 602.8108 . The moneys in the fund shall be used for
the costs of the establishment, improvement, operation, and
maintenance of county or multicounty juvenile detention homes
in accordance with annual appropriations made by the general
assembly from the fund for these purposes this subsection .
b. (1) Moneys deposited in the juvenile detention home
fund during a fiscal year are appropriated to the department
for the same fiscal year for distribution of an amount equal to
a percentage of the costs of the establishment, improvement,

House File 2698, p. 37
operation, and maintenance of county or multicounty juvenile
detention homes in the prior fiscal year. Such percentage
shall be determined by the department based on the amount
available for distribution from the fund.
(2) Moneys appropriated for distribution in accordance with
this subsection shall be allocated among eligible detention
homes, prorated on the basis of an eligible detention home’s
proportion of the costs of all eligible detention homes in the
prior fiscal year.
FAMILY INVESTMENT PROGRAM ACCOUNT ELIMINATION
Sec. 53. Section 239B.11, Code 2024, is amended to read as
follows:
239B.11 Family investment program account —— diversion
program subaccount —— diversion program.
1. An account is established in the state treasury to
be known as the family investment program account under
control of the department to which shall be credited all funds
appropriated by the state for the payment of assistance and
JOBS program expenditures. All other moneys received at any
time for these purposes, including child support revenues,
shall be deposited into the account as provided by law. All
assistance and JOBS program expenditures under this chapter
shall be paid from the account.
2. a. A diversion program subaccount is created within
the family investment program account. The subaccount may be
used to provide incentives to divert a family’s participation
in the family investment program if the family meets the
department’s income eligibility requirements for the diversion
program. Incentives may be provided in the form of payment or
services to help a family to obtain or retain employment. The
diversion program subaccount may also be used for payments to
participants as necessary to cover the expenses of removing
barriers to employment and to assist in stabilizing employment.
In addition, the diversion program subaccount may be used for
funding of services and payments for persons whose family
investment program eligibility has ended, in order to help the
persons to stabilize or improve their employment status.
b. The A diversion program is created under the family
investment program. The program shall provide incentives

House File 2698, p. 38
to divert a family’s participation in or transition of
a family from the family investment program by helping a
participant obtain or retain employment, by removing barriers
to employment, by stabilizing a participant’s employment, or
by improving a participant’s employment status. The program
shall be implemented statewide in a manner that preserves local
flexibility in program design. The department shall assess and
screen individuals who would most likely benefit from diversion
program assistance. The department may shall adopt income
eligibility requirements and additional eligibility criteria
for the diversion program as necessary for compliance with
federal law and for screening those families who would be most
likely to become eligible for the family investment program if
diversion program incentives would were not be provided to the
families .
Sec. 54. Section 239B.14, subsection 2, Code 2024, is
amended to read as follows:
2. An individual who commits a fraudulent practice under
this section is personally liable for the amount of assistance
or other benefits fraudulently obtained. The amount of the
assistance or other benefits may be recovered from the offender
or the offender’s estate in an action brought or by claim
filed in the name of the state and the recovered funds shall
be deposited in the family investment program account credited
to the appropriation to the department for community access
and eligibility to be used for the purposes of the family
investment program . The action or claim filed in the name of
the state shall not be considered an election of remedies to
the exclusion of other remedies.
Sec. 55. Section 252B.27, subsection 1, Code 2024, is
amended to read as follows:
1. The director, within the limitations of the amount
appropriated for child support services, or moneys transferred
for this purpose from the family investment program account
created in section 239B.11 appropriation to the department for
community access and eligibility , may establish new positions
and add employees to child support services if the director
determines that both the current and additional employees
together can reasonably be expected to maintain or increase net

House File 2698, p. 39
state revenue at or beyond the budgeted level for the fiscal
year.
Sec. 56. TRANSITION PROVISION. All unencumbered and
unobligated moneys remaining on June 30, 2024, in the family
investment program account created in section 239B.11, are
appropriated to the department of health and human services for
community access and eligibility.
CHILD SUPPORT COLLECTION SERVICES CENTER REFUND ACCOUNT
Sec. 57. Section 252B.13A, Code 2024, is amended by adding
the following new subsection:
NEW SUBSECTION . 3. Support payments received by the
collection services center shall be deposited in the collection
services center refund account. The account shall be separate
from the general fund of the state and shall not be considered
part of the general fund of the state. The moneys deposited
in the account are not subject to section 8.33 and shall not
be transferred, used, obligated, appropriated, or otherwise
encumbered except as provided for the purposes of this chapter.
Notwithstanding section 12C.7, subsection 2, interest or
earnings on moneys deposited in the account shall be credited
to the account.
QUALITY ASSURANCE ASSESSMENT —— PAYMENT PERIOD BASIS
Sec. 58. Section 249L.3, subsection 2, Code 2024, is amended
to read as follows:
2. The quality assurance assessment shall be paid by each
nursing facility to the department on a quarterly basis , or
other schedule as determined by the department due to a nursing
facility’s noncompliance or based on an indication of a nursing
facility’s financial instability, after the nursing facility’s
medical assistance payment rates are adjusted to include
funds appropriated from the quality assurance trust fund for
that purpose. The department shall prepare and distribute a
form upon which nursing facilities shall calculate and report
the quality assurance assessment. A nursing facility shall
submit the completed form with the assessment amount no later
than thirty days following the end of each calendar quarter
assessment period .
CENTERS OF EXCELLENCE GRANT PROGRAM
Sec. 59. NEW SECTION . 135.194 Centers of excellence grant

House File 2698, p. 40
program.
1. The department shall administer a centers of excellence
grant program to encourage innovation and collaboration among
regional health care providers in rural areas, based upon the
results of a regional community needs assessment, in order
to transform health care delivery that provides quality,
sustainable care in meeting the needs of the local community.
2. There is appropriated from the general fund of the
state to the department, beginning July 1, 2024, and for each
subsequent fiscal year, the sum of four hundred twenty-five
thousand dollars to award two program grants.
3. An applicant for a grant shall specify how the grant will
be expended to accomplish the goals of the program and shall
provide a detailed five-year sustainability plan prior to being
awarded the grant.
4. Following receipt of a grant, a recipient shall submit
periodic reports as specified by the department to the governor
and the general assembly regarding the recipient’s expenditure
of the grant and progress in accomplishing the program’s goals.
ASSISTED LIVING PROGRAM —— REVISED PAYMENT MODEL STUDY
Sec. 60. ASSISTED LIVING PROGRAM —— REVISED PAYMENT
MODEL STUDY. The department of health and human services,
in consultation with Medicaid provider associations and
stakeholders, shall explore options for a revised payment model
for reimbursement of assisted living programs that provide
services to Medicaid recipients. The study shall include
consideration of all sources of funding utilized by residents
of assisted living programs. The department of health and
human services shall report all options identified to the
general assembly by December 1, 2024.
COUNTY COMMISSIONS OF VETERAN AFFAIRS —— APPROPRIATION
Sec. 61. Section 35A.16, subsection 1, paragraph b, Code
2024, is amended to read as follows:
b. There is appropriated from the general fund of the state
to the department, for the fiscal year beginning July 1, 2009,
and for each subsequent fiscal year, the sum of one million
nine hundred ninety thousand dollars to be credited to the
county commissions of veteran affairs fund.
FOSTER CARE —— RELATIVE OR FICTIVE KIN

House File 2698, p. 41
Sec. 62. Section 234.39, subsection 2, Code 2024, is amended
to read as follows:
2. a. A person entitled to periodic support payments
pursuant to an order or judgment entered in any action for
support, who also is or has a child receiving foster care
services, is deemed to have assigned to the department
current and accruing support payments attributable to the
child effective as of the date the child enters foster care
placement, to the extent of expenditure of foster care funds.
The department shall notify the clerk of the district court
when a child entitled to support payments is receiving foster
care services pursuant to chapter 234 . Upon notification
by the department that a child entitled to periodic support
payments is receiving foster care services, the clerk of
the district court shall make a notation of the automatic
assignment in the judgment docket and lien index. The notation
constitutes constructive notice of assignment. The clerk of
court shall furnish the department with copies of all orders
and decrees awarding support when the child is receiving
foster care services. At the time the child ceases to receive
foster care services, the assignment of support shall be
automatically terminated. Unpaid support accrued under the
assignment of support rights during the time that the child was
in foster care remains due to the department up to the amount
of unreimbursed foster care funds expended. The department
shall notify the clerk of court of the automatic termination
of the assignment. Unless otherwise specified in the support
order, an equal and proportionate share of any child support
awarded shall be presumed to be payable on behalf of each child
subject to the order or judgment for purposes of an assignment
under this section .
b. This subsection shall not apply when a child is placed
with a relative or fictive kin as those terms are defined in
section 232.2, who is not licensed under chapter 237 to provide
child foster care.
DIVISION XVII
HEALTH CARE EMPLOYMENT AGENCIES AND HEALTH CARE TECHNOLOGY
PLATFORMS
Sec. 63. Section 135Q.1, Code 2024, is amended to read as

House File 2698, p. 42
follows:
135Q.1 Definitions.
As used in this chapter , unless the context otherwise
requires:
1. “Affiliate” means an entity that directly or indirectly
is controlled with or by, or is under the common control with,
a health care entity. For the purposes of this subsection,
“control” means the same as defined in section 423.3, subsection
92, paragraph “e” .
1. 2. “Department” means the department of inspections,
appeals, and licensing.
2. 3. a. “Health care employment agency” or “agency”
means an agency that contracts with a health care entity
in this state to provide agency workers for temporary or
temporary-to-hire employee placements.
b. “Health care employment agency” does not include a health
care entity or an affiliate of a health care entity when acting
as a health care employment agency for the sole purpose of
providing agency workers to the health care entity itself or to
an affiliate of the health care entity.
c. “Health care employment agency” does not include a health
care technology platform.
3. 4. “Health care employment agency worker” or “agency
worker” means an individual who contracts with or is employed by
a health care employment agency to provide nursing services to
health care entity consumers.
4. 5. “Health care entity” means a facility, agency, or
program licensed or certified by the department or by the
centers for Medicare and Medicaid services of the United States
department of health and human services.
6. “Health care technology platform” or “platform” includes
an individual, a trust, a partnership, a corporation, a limited
liability partnership or company, or any other business entity
that develops and operates, offers, or maintains a system or
technology that provides an internet-based or application-based
marketplace through which an independent nursing services
professional bids on open shifts posted by a health care entity
to provide nursing services for the health care entity.
7. “Independent nursing services professional” means a person

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engaged as an independent contractor through a health care
technology platform to provide nursing services for a health
care entity. An independent nursing services professional
shall be considered an independent contractor provided the
independent nursing services professional in the independent
nursing services professional’s sole discretion bids on open
shifts and chooses where, when, and how often to work.
8. “Individual agency worker category” includes registered
nurses, licensed practical nurses, certified nurse aides,
certified medication aides, home health aides, medication
managers, and noncertified or nonlicensed staff providing
personal care as defined in section 231C.2 who are health care
employment agency workers.
5. 9. “Managing entity” means a business entity,
owner, ownership group, chief executive officer, program
administrator, director, or other decision maker whose
responsibilities include directing the management or policies
of a health care employment agency or a health care technology
platform . “Managing entity” includes an individual who,
directly or indirectly, holds a beneficial interest in a
corporation, partnership, or other business entity that
constitutes a managing entity.
6.
10. “Nursing services” means those services which may be
provided only by or under the supervision of a nurse. “Nursing
services” includes services performed by a registered nurse, a
licensed practical nurse, a certified nurse aide, a certified
medication aide, a home health aide, a medication manager, or
by noncertified or nonlicensed staff providing personal care
as defined in section 231C.2 . “Nursing services” does not
include the practice of nursing by an advanced registered nurse
practitioner or an advanced practice registered nurse licensed
under chapter 152 or 152E .
11. “Nursing services professionals” includes registered
nurses, licensed practical nurses, certified nurse aides,
certified medication aides, home health aides, medication
managers, and noncertified or nonlicensed staff providing
personal care as defined in section 231C.2, who are not
health care employment agency workers but instead are employed
directly by or contract directly with a health care entity.

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Sec. 64. Section 135Q.2, Code 2024, is amended to read as
follows:
135Q.2 Health care employment agency requirements ——
registration —— liability —— penalties .
1. a. A health care employment agency operating in the
state shall register annually with the department. Each
separate location of a health care employment agency shall
register annually with and pay an annual registration fee of
five hundred dollars to the department. The department shall
issue each location a separate certification of registration
upon approval of registration and payment of the fee. The
annual registration fees shall be retained by the department as
repayment receipts as defined in section 8.2 .
b. A health care employment agency that fails to register
with the department as required under this subsection shall be
prohibited from contracting with any health care entity in this
state.
2. A health care employment agency shall do all of the
following:
a. Ensure that agency workers comply with all applicable
requirements relating to the health requirements and
qualifications of personnel in health care entity settings.
b. Document that each agency worker meets the minimum
licensing, certification, training, and health requirements
and the continuing education standards for the agency worker’s
position in the health care entity setting.
c. Maintain records for each agency worker and report,
file, or otherwise provide any required documentation to
external parties or regulators which would otherwise be the
responsibility of the health care entity if the agency worker
was directly employed by the health care entity.
d. Maintain professional and general liability insurance
coverage with minimum per occurrence coverage of one million
dollars and aggregate coverage of three million dollars to
insure against loss, damage, or expense incident to a claim
arising out of the death or injury of any person as the result
of negligence or malpractice in the provision of services by
the agency or an agency worker.
3. a. A health care employment agency shall not do any of

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the following:
(1) Restrict in any manner the employment opportunities
of an agency worker by including a noncompete clause in any
contract with an agency worker or health care entity.
(2) In any contract with an agency worker or health care
entity, require payment of liquidated damages, employment fees,
or other compensation if the agency worker is subsequently
hired as a permanent employee of the health care entity.
b. This subsection shall not apply to a contract between
a health care employment agency and an agency worker or a
health care entity if the contract meets all of the following
criteria:
(1) The contract is entered into for the purpose of placing
an agency worker the health care employment agency assisted in
obtaining authorization to work in the United States.
(2) The contract contains an initial duration term of
not less than twenty-four months and a total duration term,
including any renewals or extensions, of not more than
thirty-six months.
(3) The contract requires the agency worker to work for
a single health care entity for the entire duration of the
contract.
c. Any contract that violates this subsection shall be
unenforceable in court.
4. A health care employment agency shall submit a report to
the department on a quarterly basis for each health care entity
participating in Medicare or Medicaid with whom the agency
contracts that includes all of the following by provider type:
a. A detailed list of the average amount charged to the
health care entity for each individual agency worker category.
b. A detailed list of the average amount paid by the agency
to agency workers in each individual agency worker category.
5. a. A health care employment agency that violates
subsection 1 or subsection 2 is subject to denial or revocation
of registration for a period of one year and a monetary penalty
of five hundred dollars for a first offense and five thousand
dollars for each offense thereafter.
b. A health care employment agency that violates subsection
3 or that knowingly provides an agency worker who has an

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illegally or fraudulently obtained or issued diploma,
registration, license, certification, or background check to
a health care entity is subject to immediate revocation of
registration. The department shall notify the agency thirty
days in advance of the date of such revocation.
c. (1) The managing entity of an agency for which
registration has been denied or revoked under this subsection
shall not be eligible to apply for or be granted registration
for another agency during the two-year period following the
date of the denial or revocation.
(2) The department shall not approve a new registration
or renew an existing registration for any agency for which
the managing entity is also the managing entity of an agency
for which registration has been denied or revoked during the
two-year period in which registration of the violating agency
is denied or revoked.
6. 5. The department shall establish a system for members
of the public to report complaints against an agency or
agency worker. The department shall investigate any complaint
received and shall report the department’s findings to the
complaining party and the agency involved.
Sec. 65. NEW SECTION . 135Q.3 Health care technology
platform requirements —— registration —— liability.
1. a. A health care technology platform operating in
the state shall register annually with the department and
pay an annual registration fee of five hundred dollars to
the department. The department shall issue each health
care technology platform a certificate of registration upon
approval of registration and payment of the fee. The annual
registration fees shall be retained by the department as
repayment receipts as defined in section 8.2.
b. A health care technology platform that fails to register
with the department as required under this subsection shall be
prohibited from contracting with any health care entity in this
state.
c. A health care technology platform that allows independent
nursing services professionals to utilize the platform to bid
on open shifts is an authorized agency for purposes of access
to the single contact repository. A health care technology

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platform shall rerun background checks for an independent
nursing services professional following two consecutive years
of inactivity on the platform by the independent nursing
services professional.
2. A health care technology platform shall verify that
an independent nursing services professional utilizing the
platform does all of the following:
a. Supplies documentation demonstrating that the independent
nursing services professional meets all applicable state
requirements and qualifications of personnel in a health care
entity setting.
b. Meets all applicable minimum state licensing and
certification requirements.
c. Maintains professional liability insurance coverage with
the minimum per occurrence coverage of one million dollars and
aggregate coverage of three million dollars to insure against
loss, damage, or expense incident to a claim arising out of
the death or injury of any person as the result of negligence
or malpractice in the provision of services by the independent
nursing services professional.
3. a. A health care technology platform shall not do any
of the following:
(1) Restrict in any manner the employment opportunities of
an independent nursing services professional by including a
noncompete clause in any contract with an independent nursing
services professional or health care entity.
(2) In any contract with an independent nursing services
professional or health care entity, require payment of
liquidated damages, employment fees, or other compensation if
the independent nursing services professional is subsequently
hired as a permanent employee or is engaged directly as a
contractor of the health care entity.
b. Any contract that violates this subsection shall be
unenforceable in court.
4. The department shall establish a system for members
of the public to report complaints against a health care
technology platform or an independent nursing services
professional. The department shall investigate any complaint
received and shall report the department’s findings to the

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complaining party and the health care technology platform
involved.
Sec. 66. NEW SECTION . 135Q.4 Penalties —— enforcement.
1. a. A health care employment agency that violates
section 135Q.2, subsection 1 or 4, is subject to an initial
monetary penalty of five thousand dollars and shall be provided
notification by the department and given a thirty-day grace
period in which to comply.
b. A health care employment agency that fails to comply
following the notification and within the thirty-day grace
period under paragraph “a” , shall be subject to a monetary
penalty of twenty-five thousand dollars.
c. If a health care employment agency fails to comply
with paragraph “b” , the health care employment agency shall
be subject to an additional monetary penalty of twenty-five
thousand dollars, revocation of registration, and denial of
subsequent registration for up to three years.
2. a. A health care employment agency that violates section
135Q.2, subsection 2, or that knowingly provides an agency
worker who has an illegally or fraudulently obtained or issued
diploma, registration, license, certification, or background
check to a health care entity is subject to a monetary penalty
of five thousand dollars for each violation.
b. If a health care employment agency commits a second or
subsequent violation of section 135Q.2, subsection 2, within
any three-year period, the health care employment agency shall
be subject to immediate revocation of registration. The
department shall notify the agency thirty days in advance of
the date of such revocation.
3. A health care employment agency that violates section
135Q.2, subsection 3, is subject to a monetary penalty of
twenty-five thousand dollars for the first violation. If
a health care employment agency violates section 135Q.2,
subsection 3, a second or subsequent time, the health care
employment agency shall be subject to immediate revocation of
registration, and shall not be eligible to apply for or be
granted registration for the three-year period immediately
following the date of revocation.
4. a. (1) A health care technology platform that violates

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section 135Q.3, subsection 1, is subject to an initial
monetary penalty of five thousand dollars and shall be provided
notification by the department and given a thirty-day grace
period in which to comply.
(2) A health care technology platform that fails to comply
with the notification and within the thirty-day grace period
under subparagraph (1) shall be subject to a monetary penalty
of twenty-five thousand dollars.
(3) If a health care technology platform knowingly fails
to comply with subparagraph (2), the health care technology
platform shall be subject to an additional monetary penalty of
twenty-five thousand dollars, revocation of registration, and
denial of subsequent registration for up to three years.
b. (1) A health care technology platform that violates
section 135Q.3, subsection 2, or that knowingly allows
an independent nursing services professional who has an
illegally obtained or issued diploma, registration, license,
certification, or background check to utilize the platform to
bid on a shift for a health care entity is subject to a monetary
penalty of five thousand dollars for each violation.
(2) If a health care technology platform commits a second or
subsequent violation of section 135Q.3, subsection 2, within
any three-year period, the health care technology platform
shall be subject to immediate revocation of registration. The
department shall notify the health care technology platform
thirty days in advance of the date of such revocation.
c. (1) A health care technology platform that violates
section 135Q.3, subsection 3, is subject to a monetary penalty
of twenty-five thousand dollars for the first violation.
(2) If a health care technology platform violates section
135Q.3, subsection 3, a second or subsequent time, the health
care technology platform shall be subject to immediate
revocation of registration, and shall not be eligible to apply
for or be granted registration for the three-year period
immediately following the date of revocation.
5. a. The managing entity of an agency for which
registration has been denied or revoked under this section
shall not be eligible to apply for or be granted registration
for another agency during the three-year period following the

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date of the denial or revocation.
b. The department shall not approve a new registration
or renew an existing registration for any agency for which
the managing entity is also the managing entity of an agency
for which registration has been denied or revoked during the
three-year period in which registration of the violating agency
is denied or revoked.
6. a. The managing entity of a health care technology
platform for which registration has been denied or revoked
under this section shall not be eligible to apply for or
be granted registration for another health care technology
platform during the two-year period following the date of the
denial or revocation.
b. The department shall not approve a new registration or
renew an existing registration for any health care technology
platform for which the managing entity is also the managing
entity of a health care technology platform for which
registration has been denied or revoked during the two-year
period in which registration of the violating health care
technology platform is denied or revoked.
7. Any monetary penalties collected under this section
shall be retained by the department as repayment receipts as
defined in section 8.2.
8. The attorney general shall enforce this chapter.
Sec. 67. NEW SECTION . 135Q.5 Department annual report.
The department shall submit an annual report to the general
assembly by January 15, for the immediately preceding fiscal
year, that includes a summary of the number of registrations
issued and the amount of registration fees collected, the
violations of this chapter, the amount of monetary penalties
collected, the number of health care employment agencies,
health care technology platforms, and managing entities
for whom a registration was revoked or denied, and any
recommendations for changes to the chapter.
Sec. 68. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION XVIII
MEDICAL CANNABIDIOL REGISTRATION CARD —— TELEMEDICINE ——
PRACTITIONER REQUIREMENTS

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Sec. 69. Section 124E.3, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 4. A health care practitioner that
establishes or maintains a relationship with a patient through
the use of telemedicine shall comply with the requirements of
653 IAC 13.11(7).
DIVISION XIX
NURSING FACILITY OVERSIGHT
Sec. 70. NEW SECTION . 135C.35C Nursing facilities —— joint
training sessions.
The department shall semiannually provide joint training
sessions for inspectors and nursing facilities to review at
least three of the ten most frequently issued federal citations
in the state during the immediately preceding calendar year.
The department shall develop a protocol to identify regional
citation patterns relating to complaints, standards, and
outcomes in the nursing facility inspection process. The
department shall include the state long-term care ombudsman,
or the state long-term care ombudsman’s designee, and
representatives of each nursing facility provider association
in the state in the planning process for the joint training
sessions.
Sec. 71. Section 135C.40, subsection 1, Code 2024, is
amended by adding the following new paragraph:
NEW PARAGRAPH . d. (1) The department shall establish and
maintain a process to review each citation issued for immediate
jeopardy or substandard quality of care prior to issuance of
final findings under section 135C.40A. Representatives of the
nursing facility issued such a citation may participate in
the review to provide context and evidence for the department
to consider in determining if a final finding of immediate
jeopardy or substandard quality of care should be issued. The
review shall ensure consistent and accurate application of
federal and state inspection protocols and defined regulatory
standards.
(2) For the purposes of this paragraph:
(a) “Immediate jeopardy” means a situation in which the
provider’s noncompliance with one or more requirements of
participation has caused, or is likely to cause, serious

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injury, harm, impairment, or death to a resident.
(b) “Likely” means probable and reasonably to be expected,
and suggests a greater degree of probability than a mere risk,
potential, or possibility that a particular event will cause
serious injury, harm, impairment, or death to a resident.
(c) “Substandard quality of care” means the same as defined
in 42 C.F.R. §488.301.
DIVISION XX
STATE-FUNDED PSYCHIATRY RESIDENCY AND FELLOWSHIP POSITIONS
Sec. 72. Section 135.180, Code 2024, is amended to read as
follows:
135.180 State-funded psychiatry residency and fellowship
program positions —— fund —— appropriations.
1. a. The university of Iowa hospitals and clinics shall
administer a state-funded psychiatry residency and fellowship
program positions for up to nine seven residents and up to two
fellows, annually. In addition, a county medical center, and
a medical center operating for more than one hundred forty
years, that are members of separate health systems, administer
psychiatry residency programs, and are located in a county with
a population over five hundred thousand shall each administer
state-funded psychiatry residency positions for one resident,
annually. The university of Iowa hospitals and clinics and the
specified medical centers shall expand the their psychiatry
residency program programs to provide additional residency
positions by providing financial support for residency
positions which are in excess of the federal residency cap
established by the federal Balanced Budget Act of 1997, Pub.
L. No. 105-33.
b. The university of Iowa hospitals and clinics and the
specified medical centers shall cooperate with the state
mental health institutes at Independence and Cherokee, the
state resource center at Woodward, the state training school
at Eldora, and the Iowa medical and classification center
at Oakdale in administering the program the positions .
Participating residents and fellows shall complete a portion
of their psychiatry training at one of the state mental health
institutes, the state resource center, the state training
school, or the Iowa medical and classification center at

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Oakdale. For accreditation-required clinical experiences
not available at the state mental health institutes, the
state resource center, the state training school, or the Iowa
medical and classification center at Oakdale, the residents of
the psychiatry residency and fellowship program awarded the
residency positions administered by the university of Iowa
hospitals and clinics may utilize clinical rotations at the
university of Iowa hospitals and clinics and its affiliates
across the state and the residents awarded the residency
positions administered by the specified medical centers may
utilize clinical rotations at affiliates of such medical
centers across the state .
2. The university of Iowa hospitals and clinics shall apply
to the accreditation council for graduate medical education
for approval of nine seven additional residency positions
for each class of residents and the psychiatry residency and
fellowship program shall award the total number of residency
positions approved for each class of residents. The university
of Iowa hospitals and clinics shall approve and award up to
two fellowship positions annually. The specified medical
centers shall apply to the accreditation council for graduate
medical education for approval of one additional residency
position each for each class of residents and shall award the
total number of residency positions approved for each class
of residents. Preference in the awarding of residency and
fellowship positions shall be given to candidates who are
residents of Iowa, attended and earned an undergraduate degree
from an Iowa college or university, or attended and earned a
medical degree from a medical school in Iowa.
3. A psychiatry residency and fellowship program positions
fund is created in the state treasury consisting of the moneys
appropriated or credited to the fund by law. Notwithstanding
section 8.33 , moneys in the fund at the end of each fiscal
year shall not revert to any other fund but shall remain in
the psychiatry residency and fellowship program positions fund
for use in subsequent fiscal years. Moneys in the fund are
appropriated to the university of Iowa hospitals and clinics
to be used for the purposes of the program this section . For
the fiscal years beginning on or after July 1, 2023, there

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is appropriated from the general fund of the state to the
psychiatry residency and fellowship program positions fund one
hundred thousand dollars for each residency position approved
and awarded under the program and one hundred fifty thousand
dollars for each fellowship position approved and awarded under
the program this section . Of the amount appropriated annually
from the fund to the university of Iowa hospitals and clinics,
the university of Iowa hospitals and clinics shall distribute
one hundred thousand dollars to each of the specified medical
centers for each residency position approved and awarded.
______________________________ ______________________________
PAT GRASSLEY AMY SINCLAIR
Speaker of the House President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 2698, Ninetieth General Assembly.
______________________________
MEGHAN NELSON
Chief Clerk of the House
Approved _______________, 2024 ______________________________
KIM REYNOLDS
Governor