Appropriations Committee – Week 15, 2021

HF 839 – Financial exploitation of older adults

HF 839 is an Iowa Insurance Division (IID) recommendation to combat financial exploitation of adults 65 years of age or older or dependent adults 18 and over who are unable to protect their own interests or provide the services necessary to meet essential requirements unable to adequately provide or sustain needs. It is based on the North American Securities Administrators Association’s Model Law. The new sections of the Code address record confidentiality, disclosures, and immunity from government agencies and third parties, as well as training requirements broker-dealers and investment advisers must provide to their employees in order to identify and report financial exploitation. The IID is required to provide the governor and legislature with an annual report detailing the number of reports related to potential financial exploitation, the time IID staff spent investigating the reports, and the number of legitimate incidents of financial exploitation Includes adult. Supporters include the Iowans Elderly Legislature, Chief Financial Officer, Regional Aging Agencies, Hope Haven, Mosaic, Iowa Attorney General, Iowa CareGivers, Iowa Health Care Association, Iowa State Bar Association, and Wells Fargo.

The original proposal was for the Commerce Revolving Fund to allocate $ 75,000 annually for a full-time employee (complaint analyst level) to investigate complaints. The Senate removed this provision with the understanding that language will be included in draft bills for administrative and regulatory means in both the Senate and the House of Representatives. The bill was passed with a 95-0 vote by the House of Representatives and sent back to the House of Representatives for consideration of the Senate amendment.
[4/21: 46-0 (Excused: Mathis, Nunn, Schultz, Whiting)]

SF 606 / SSB 1267 – Health and Social Services Budget for Fiscal Year 22

SF 606 / SSB 1267, as amended, provides funding for the Department of Aging (IDA), including the Ombudsman’s Office for Long-Term Care. Department of Human Services (DHS), including Medicaid; Public Health Department (IDPH); and veterans affairs, including the veterans home. It is a $ 37.05 million increase Compared to FY 21 plus $ 60 million for mental health and disability service regions not included in this bill but passed as part of SF 587.

Medicaid did not require additional funding due to the increased rate of FMAP delivered during the public health emergency.

• Senate Republican Target: $ 2,085,354,651
• Governor: $ 2,043,504,651

Increases

Department of Aging

• The Aging Department and Long Term Care Ombudsman’s Office do not receive any increases and are funded at the Fiscal Year 21 level.
• A $ 137,900 increase is provided for the Retired Senior Volunteer Program (RSVP), which goes to the Iowa Commission on Volunteer Services at the Economic Development Authority.

Public Health Department

• $ 1 million to establish two Centers of Excellence programs to promote innovation and collaboration among regional health care providers. Two US $ 500,000 grants go to rural areas to improve access through collaboration. Governor had this in their budget too.
• $ 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) for the Rural Psychiatric Residency Program.
• $ 200,000 (for a total of $ 296,000) to FIND for the appropriate dental education loan repayment program.
• $ 50,000 (for a total of $ 150,000) to the Iowa Donor Registry.
• $ 381,381 for three additional full-time positions in the State Medical Examiner’s Office: one doctor, one investigator, one support staff.

Veterans affairs

• Veteran’s Affairs, including the Home Ownership Assistance Program, Veteran’s County Grants, and Iowa Veteran’s Home, will not receive any increases for FY 22 and will remain at FY 21 funding levels.

Human Services Department

• $ 1,075,072 for the Child Support Recovery Unit for administrative cost increases and federal incentive fund replacement
• $ 358,659 for children’s health insurance to fully fund the program on the March forecast (Governor used the December estimate)
• $ 1,367,580 for Boys State Training School, Eldora for a youth worker recruitment and retention program ($ 670,203); Carry set (326,679); and administration (290,520) and salary costs (80,178)
• $ 1,812,388 for the Cherokee Mental Health Institute to replace the talk ($ 1,046,132); Replace the providers’ aid funds ($ 600,759). Administrative Elevations ($ 102,093); and salary expenses ($ 63,404)
• $ 1,426,433 for the Independence Mental Health Institute to replace provider aid funds ($ 975,698); Replace Carryforward ($ 367,740) Administration increases ($ 61,218); and salary costs (41,210)
• Woodward Resource Center increased by $ 2,784,734 and decreased Glenwood Resource Center by $ 1,897,994, which includes increases in administration, salary and reimbursement of funds, and patient and staff relocation from Glenwood to Woodward
• $ 1,573,162 for the Sex Offender Civil Commitment Unit (CCUSO) to replace the talk ($ 1,718,762); Annualize salaries
• $ 4,996,269 for field operations to replace the carryforward ($ 2,245,801); Replace one-time earnings for new full-time positions in FY 21 ($ 1,301,137). 53 new full-time positions over two years ($ 765,685); Salary Expenses ($ 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)

• Care facilities increase by $ 8,002,912 (Governor had $ 10 million)
• $ 8 million in price increases for home and community-based service providers. This corresponds to an increase of approx. 3.5%. (Like governor)
• $ 3.9 million for the Children’s Psychiatric Medical Institute (PMIC) increase its provider rate, an increase of over 27%. (Like governor)
• $ 100,000 to increase the air ambulance. Medicaid rates are much lower than Medicare and Commercial.
• The MCO capitalization rates are earmarked for $ 14.5 million. This is the six month increase they have seen over the past year on an annual basis. So it’s just an estimate.

New policy included in Budget Bill

• Department VII, restoration of the care facility: Due to the pandemic and the low occupancy, etc. there will be no typical start-up for FY 22 / FY 23. FY22 will only represent an inflationary increase based on FY20. The start-up for Fiscal Year 24-25 will use 70% utilization instead of 85%, and then normal re-base will be performed again.
• Division VIII instructs DHS to convene a working group to investigate the methodology and process of reimbursement of mixed cases for care facilities and to make recommendations.
• Division IX directs DHS to review and report on laws and regulations related to the provision of telemedicine for PT, OT, SpT, ABA, and other services to Medicaid children to determine the necessary changes to maintain consistency with Early and Regular Screening, Diagnosis and Treatment (EPSDT). Program. Report due October 1, 2021.
• Division XIII is the Senate-passed law to oversee the Public Aid Program (SF 389), with the exception of CSRU collaboration.
• Division XIII creates additional oversight and restrictions, including eligibility determination and redefinition, identity authentication, and asset identification for all public utility programs. The definition of public support includes children’s health insurance programs, Medicaid, SNAP, and the Family Investment Program (FIP). The DHS can enter into contracts with third-party providers within the meaning of the Federal Act on Fair Credit Reporting in order to carry out multiple data matches for all applicants. The bill lists many sources of possible data matches and databases to be verified from federal, state, and other public sources. A contract for the services must save more money than the contract cost. The invoice requires real-time verification and establishes a process by which recipients can contest a discrepancy or change in circumstances.
  [4/20: 12-7, party line (No: Democrats; Excused: Lofgren, Mathis)]

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