Appropriations Committee – Week 15, 2021


HF 839 – Financial exploitation of older adults

HF 839 is an Iowa Insurance Division (IID) recommendation to address the financial exploitation of adults 65 or older, or dependent adults age 18 or older who are unable to protect their own interests, or unable to adequately perform or obtain services necessary to meet essential needs. It is based on model law from the North American Securities Administrators Association. The new Code sections deal with confidentiality of records, governmental and third-party disclosures and immunity, and training requirements brokers-dealers and investment advisers must provide to their employees focusing on identifying and reporting financial exploitation. The IID must submit an annual report to the Governor and the Legislature that includes the number of notifications related to the potential financial exploitation, the amount of time IID employees spent investigating the notifications, and the number of founded cases of financial exploitation of eligible adults. Supporters include the Older Iowans Legislature, Principal Financial, Area Agencies on Aging, Hope Haven, Mosaic, Iowa Attorney General, Iowa CareGivers, Iowa Health Care Association, Iowa State Bar Association, and Wells Fargo.

The original proposal allocated $75,000 annually from the Commerce Revolving Fund for one FTE (complaint analyst level) to investigate complaints. The Senate took out that provision with the understanding that the language will be included in the Administration and Regulation Appropriations bills in both the Senate and House. The bill passed the House on a vote of 95-0, and returns to the House for consideration of the Senate amendment.
[4/21: 46-0 (Excused: Mathis, Nunn, Schultz, Whiting)]


SF 606/SSB 1267—FY22 Health and Human Service Budget

SF 606/SSB 1267, as amended, provides funding for the Department of Aging (IDA), including the Long-Term Care Ombudsman’s Office; Department of Human Services (DHS), including Medicaid; Department of Public Health (IDPH); and Veteran’s Affairs, including the Veteran’s Home. It is an increase of $37.05 million compared to FY21, plus $60 million for Mental Health and Disability Services regions that is not in this bill but was passed as part of SF 587.

No supplemental appropriation was necessary for Medicaid due to the enhanced FMAP rate provided during the Public Health Emergency.

  • Senate Republican Target:  $2,085,354,651
  • Governor:  $2,043,504,651
General FundActual     FY 20  Est. FY 21Gov FY 22Senate Repub FY 22DIFF Senate Repub Vs FY 21
   Aging$12,314,203$12,314,203$12,314,20312,453,903  $139,700
   IDPH$55,409,928$53,995,021$55,576,40256,826,402  $2,831,381
Vet’s Home7,131,5527,131,5527,131,5527,131,5520


Department on Aging

  • Department on Aging and the Office of Long-Term Care Ombudsman receive no increases and are funded at the FY21 level.
  • An increase of $137,900 is provided to the Retired Senior Volunteer Program (RSVP) that goes to the Iowa Commission on Volunteer Services at the Economic Development Authority.

Department of Public Health

  • $1 million to create two Centers of Excellence programs to encourage innovation and collaboration among regional health care providers. Two $500,000 grants go to rural areas to improve access through collaboration.  Governor also had this in her budget.
  • $1 million (for a total of $1.6 million) to Iowa Prescription Drug Corporation for one-time funding to support program expansion and implementation of an automated multi-dose packaging system using unused and donated drugs.
  • $200,000 (for a total of $600,000) to the Rural Psychiatric Residency Program.
  • $200,000 (for a total of $296,000) to FIND for matching Dental Education Loan Repayment Program.
  • $50,000 (for a total of $150,000) to the Iowa Donor Registry.
  • $381,381 for three additional FTEs at the State Medical Examiner’s Office: one physician, one investigator, one support staff.

Veteran’s Affairs

  • Veteran’s Affairs including the Home Ownership Assistance Program, Veteran’s County Grants and the Iowa Veteran’s Home receive no increases for FY22 and remain at FY21 funding level.

Department of Human Services

  • $1,075,072 for Child Support Recovery Unit for administrative cost increases and replacing federal incentive funds
  • $358,659 for Children’s Health Insurance to fully fund the program at the March forecast estimate (Governor used the December estimate)
  • $1,367,580 for the Boys State Training School in Eldora for a Youth Services Worker Recruitment and Retention program ($670,203); carryforward replacement (326,679); and administration (290,520) and salary costs (80,178)
  • $1,812,388 for Cherokee Mental Health Institute to replace carryforward ($1,046,132); replace provider relief funds ($600,759); Administrative increases ($102,093); and Salary costs ($63,404)
  • $1,426,433 for Independence Mental Health Institute to replace provider relief funds ($975,698); replace carryforward ($367,740) Administrative increases (61,218); and salary costs (41,210)
  • $2,784,734 increase for Woodward Resource Center, along with a $1,897,994 decrease for Glenwood Resource Center, that includes increases for administration, salary and replacing funds, as well as a shift of patients and staff from Glenwood to Woodward
  • $1,573,162 for the Civil Commitment Unit for Sexual Offenders (CCUSO) to replace carryforward ($1,718,762); annualize salaries
  • $4,996,269 for Field Operations to replace carryforward ($2,245,801); replace one-time revenue for new FTEs in FY21 ($1,301,137); 53 new FTEs over two years ($765,685); salary costs ($382,899); and administrative increases ($300,747)
  • $769,656 for General Administration
  • $60 million for MHDS Regions [not in this bill—see SF 587]

Medicaid (Balance Sheet attached)

  • $8,002,912 increase for Nursing Facilities (Governor had $10 million)
  • $8 million for Home and Community Based Services provider rate increases. This is approximately a 3.5% increase. (Same as Governor)
  • $3.9 million for Psychiatric Medical Institute for Children (PMIC) provider rate increases, which is over 27% increase. (Same as Governor)
  • $100,000 for air ambulance provider rate increase. Medicaid rates are much lower than Medicare and Commercial.
  • $14.5 million is built in for MCO capitation rates, which is the six-month increase they got last year annualized, so it’s just an estimate.

New Policy Included in Budget Bill

  • Division VII, Nursing Facility Rebasing: There will be no typical rebasing for FY22/FY23 due to the pandemic and low occupancy, etc. FY22 will only be an inflationary increase based on FY20. The rebasing for FY24-FY25 will use a 70% occupancy instead of 85% and then go back to normal rebasing after that.
  • Division VIII directs DHS to convene a workgroup to study and make recommendations on the case-mix reimbursement methodology and process for nursing facilities.
  • Division IX directs DHS to review and report on laws and rules related to the telehealth provision of PT, OT, SpT, ABA and other services for Medicaid kids to determine necessary change to maintain consistency with Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Report due October 1, 2021.
  • Division XIII is the Public Assistance Program Oversight (SF 389) bill that the Senate passed, with the exception regarding cooperating with CSRU. 
  • Division XIII creates additional oversight and restrictions, including eligibility determination and redeterminations, identity authentication and asset identification for all public assistance programs. The definition of public assistance includes children’s health insurance programs, Medicaid, SNAP and the Family Investment Program (FIP). DHS may contract with third-party vendors as defined by the federal Fair Credit Reporting Act to do multiple data matches on all applicants. The bill lists many sources of possible data matches and databases that must be checked from federal, state and other public sources. A contract for the services must save more money than the contract costs. The bill requires real-time verification, and sets up a process for recipients to dispute a discrepancy or change in circumstances.
    [4/20: 12-7, party line (No: Democrats; Excused: Lofgren, Mathis)]