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2716
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HOUSE
FILE
2716
BY
COMMITTEE
ON
HEALTH
AND
HUMAN
SERVICES
(SUCCESSOR
TO
HSB
696)
(As
Amended
and
Passed
by
the
House
March
10,
2026
)
A
BILL
FOR
An
Act
relating
to
the
supplemental
nutrition
assistance
1
program;
the
medical
assistance
program;
the
special
2
supplemental
nutrition
program
for
women,
infants,
and
3
children;
and
other
public
assistance
programs
under
the
4
purview
of
the
department
of
health
and
human
services.
5
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
6
HF
2716
(9)
91
ak/ko/md
H.F.
2716
DIVISION
I
1
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
2
Section
1.
NEW
SECTION
.
135.16E
Supplemental
nutrition
3
assistance
program
error
rate
——
report.
4
Beginning
with
the
fiscal
quarter
that
starts
on
October
5
1,
2026,
and
every
fiscal
quarter
thereafter,
within
thirty
6
calendar
days
of
transmission
of
data
to
the
food
and
nutrition
7
services
of
the
United
States
department
of
agriculture,
the
8
department
shall
submit
a
report
to
the
general
assembly
9
detailing
payment
error
rates
associated
with
the
supplemental
10
nutrition
assistance
program
for
the
immediately
preceding
11
fiscal
quarter.
For
the
purposes
of
this
section,
“supplemental
12
nutrition
assistance
program”
has
the
same
meaning
as
defined
13
in
section
239.1.
14
Sec.
2.
FEDERAL
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
15
——
WAIVER
OF
EARNED
INCOME
RULES.
16
1.
The
department
of
health
and
human
services
shall
17
request
a
waiver
from
the
food
and
nutrition
services
of
the
18
United
States
department
of
agriculture
to
provide
that,
for
19
purposes
of
state
administration
of
the
supplemental
nutrition
20
assistance
program,
the
earned
income
under
21
7
C.F.R.
§273.9(c)(7)
of
household
members
that
meet
all
of
the
22
following
criteria
shall
be
excluded
from
household
income:
23
a.
Less
than
twenty-two
years
of
age.
24
b.
Enrolled
in
an
elementary
or
secondary
school.
25
c.
Resides
with
a
natural
parent,
adoptive
parent,
26
stepparent,
or
other
household
member
who
exercises
parental
27
control
over
the
household
member
described
in
paragraphs
“a”
28
and
“b”.
29
2.
The
department
of
health
and
human
services
shall
30
implement
the
waiver
upon
receipt
of
approval
of
the
waiver
31
from
the
United
States
department
of
agriculture.
32
Sec.
3.
FEDERAL
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
33
——
WAIVER
OF
ELIGIBILITY
VERIFICATION
RULES.
34
1.
The
department
of
health
and
human
services
shall
35
-1-
HF
2716
(9)
91
ak/ko/md
1/
13
H.F.
2716
request
a
waiver
from
the
food
and
nutrition
services
of
the
1
United
States
department
of
agriculture
to
provide
that,
for
2
purposes
of
state
administration
of
the
supplemental
nutrition
3
assistance
program,
information
from
the
following
automated
4
sources
be
considered
verified
upon
receipt
for
purposes
5
of
7
C.F.R.
§272.12(c):
6
a.
The
national
directory
of
new
hires
maintained
by
the
7
office
of
child
support
services
of
the
United
States
office
8
for
the
administration
of
children
and
families.
9
b.
The
unemployment
insurance
benefits
data
released
by
the
10
Iowa
department
of
workforce
development.
11
c.
The
United
States
social
security
administration
12
benefits,
death,
social
security
number,
and
citizenship
13
records.
14
d.
The
residency
and
identity
data
released
by
the
United
15
States
department
of
transportation.
16
e.
The
state
incarceration
data
released
by
the
Iowa
17
department
of
corrections.
18
f.
The
automated
employment
verification
service
known
as
19
work
number,
or
equivalent
third-party
income
verification
20
platforms.
21
2.
The
department
of
health
and
human
services
shall
22
implement
the
waiver
upon
receipt
of
approval
of
the
waiver
23
from
the
United
States
department
of
agriculture.
24
Sec.
4.
FEDERAL
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
25
——
WAIVER
OF
EXPUNGEMENT
RULES.
26
1.
The
department
of
health
and
human
services
shall
27
request
a
waiver
from
the
food
and
nutrition
services
of
the
28
United
States
department
of
agriculture
to
provide
that,
for
29
purposes
of
state
administration
of
the
supplemental
nutrition
30
assistance
program,
expungement
of
benefits
on
a
household’s
31
electronic
benefit
account
under
7
C.F.R.
§274.2(i)
be
32
permitted
after
three
months
or
ninety-one
days
of
inactivity,
33
or
of
benefits
remaining,
on
the
electronic
benefit
account.
34
2.
The
department
of
health
and
human
services
shall
35
-2-
HF
2716
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91
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2/
13
H.F.
2716
implement
the
waiver
upon
receipt
of
approval
of
the
waiver
1
from
the
United
States
department
of
agriculture.
2
Sec.
5.
FEDERAL
SUPPLEMENTAL
NUTRITION
ASSISTANCE
PROGRAM
3
——
WAIVER
OF
PAYMENT
QUALITY
CONTROL
SAMPLING
PROCEDURES.
4
1.
The
department
of
health
and
human
services
shall
5
request
a
waiver
from
the
food
and
nutrition
services
of
the
6
United
States
department
of
agriculture
to
provide
that,
for
7
purposes
of
state
administration
of
the
supplemental
nutrition
8
assistance
program,
when
reporting
the
state’s
payment
error
9
rate
as
outlined
by
7
C.F.R.
§275.14,
and
food
and
nutrition
10
services
handbooks
310
and
311,
the
department
of
health
and
11
human
services
be
permitted
to
report
the
payment
error
rate
12
based
only
on
errors
directly
attributable
to
the
department.
13
2.
The
department
of
health
and
human
services
shall
14
implement
the
waiver
upon
receipt
of
approval
of
the
waiver
15
from
the
United
States
department
of
agriculture.
16
DIVISION
II
17
MEDICAL
ASSISTANCE
PROGRAM
18
Sec.
6.
Section
249A.3,
subsection
2,
paragraph
a,
19
subparagraph
(1),
Code
2026,
is
amended
to
read
as
follows:
20
(1)
(a)
As
allowed
under
42
U.S.C.
21
§1396a(a)(10)(A)(ii)(XIII),
individuals
with
disabilities,
22
who
are
less
than
sixty-five
years
of
age,
who
are
members
of
23
families
whose
income
is
less
than
two
hundred
fifty
three
24
hundred
percent
of
the
most
recently
revised
official
poverty
25
guidelines
published
by
the
United
States
department
of
health
26
and
human
services
for
the
family,
who
have
earned
income
27
and
who
are
eligible
for
mandatory
medical
assistance
or
28
optional
medical
assistance
under
this
section
if
earnings
are
29
disregarded.
30
(b)
As
allowed
by
42
U.S.C.
§1396a(r)(2),
unearned
income
31
shall
also
be
disregarded
in
determining
whether
an
individual
32
is
eligible
for
assistance
under
this
subparagraph.
33
(c)
For
the
purposes
of
determining
the
amount
of
an
34
individual’s
resources
under
this
subparagraph
and
as
allowed
35
-3-
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3/
13
H.F.
2716
by
42
U.S.C.
§1396a(r)(2),
a
maximum
of
ten
thousand
dollars
of
1
available
resources
for
an
individual
,
and
twenty-one
thousand
2
dollars
of
available
resources
for
a
couple
as
defined
in
20
3
C.F.R.
§416.1101,
shall
be
disregarded
.
The
earned
income
of
4
an
individual’s
spouse
as
defined
in
20
C.F.R.
§416.1101,
one
5
motor
vehicle
per
household,
and
any
additional
resources
held
6
in
a
retirement
account,
in
a
pension
account,
in
a
medical
7
savings
account,
or
in
any
other
account
approved
under
rules
8
adopted
by
the
department
shall
also
be
disregarded.
9
(b)
(d)
Individuals
eligible
for
assistance
under
this
10
subparagraph,
whose
individual
income
exceeds
one
hundred
11
fifty
percent
of
the
official
poverty
guidelines
published
12
by
the
United
States
department
of
health
and
human
services
13
for
an
individual,
shall
pay
a
premium.
The
amount
of
the
14
premium
shall
be
based
on
a
sliding
fee
schedule
adopted
by
15
rule
of
the
department
and
shall
be
based
on
a
percentage
of
16
the
individual’s
income.
The
maximum
premium
payable
by
an
17
individual
whose
income
exceeds
one
hundred
fifty
percent
of
18
the
official
poverty
guidelines
shall
be
commensurate
with
19
the
cost
of
state
employees’
group
health
insurance
in
this
20
state.
The
payment
to
and
acceptance
by
an
automated
case
21
management
system
or
the
department
of
the
premium
required
22
under
this
subparagraph
shall
not
automatically
confer
initial
23
or
continuing
program
eligibility
on
an
individual.
The
24
department
shall
maintain
a
page
on
the
department’s
internet
25
site
where
individuals
can
electronically
pay
any
premium
owed
26
by
an
individual
to
the
department.
A
premium
paid
to
and
27
accepted
by
the
department’s
premium
payment
process
that
is
28
subsequently
determined
to
be
untimely
or
to
have
been
paid
on
29
behalf
of
an
individual
ineligible
for
the
program
shall
be
30
refunded
to
the
remitter
in
accordance
with
rules
adopted
by
31
the
department.
Any
unpaid
premium
shall
be
a
debt
owed
to
the
32
department.
33
Sec.
7.
Section
249A.4,
Code
2026,
is
amended
by
adding
the
34
following
new
subsections:
35
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NEW
SUBSECTION
.
15.
Submit
a
report
to
the
general
1
assembly,
including
the
official
payment
error
rate
and
2
a
summary
of
the
data
submitted
in
the
payment
error
rate
3
measurement
report,
within
thirty
calendar
days
of
receipt
by
4
the
department
of
the
annual
official
payment
error
rate
from
5
the
centers
for
Medicare
and
Medicaid
services
of
the
United
6
States
department
of
health
and
human
services.
7
NEW
SUBSECTION
.
16.
Submit
an
annual
report
to
the
general
8
assembly
on
or
before
October
1
on
petitions
for
a
waiver,
also
9
referred
to
by
the
department
as
exceptions
to
policy,
of
rules
10
governing
the
Medicaid
program
filed
pursuant
to
the
rules
of
11
the
department.
The
report
must
include
all
the
following
for
12
the
immediately
preceding
fiscal
year:
13
a.
The
total
number
of
exceptions
to
policy
granted.
14
b.
The
cumulative
cost
of
the
exceptions
to
policy
that
were
15
granted.
16
c.
The
types
of
exceptions
to
policy
that
were
granted.
17
d.
Identifiable
trends
noted
by
the
department
including
any
18
of
the
following:
19
(1)
The
number
of
exceptions
to
policy
granted
in
a
20
particular
geographic
location.
21
(2)
The
types
of
Medicaid
services
that
were
the
basis
for
22
exceptions
to
policy.
23
(3)
The
Medicaid
program
eligibility
classification
of
24
individuals
granted
Medicaid
program
exceptions
to
policy.
25
Sec.
8.
NEW
SECTION
.
249A.32C
Home
and
community-based
26
service
waivers
——
rural
provider
rate
increase.
27
1.
For
the
purposes
of
this
section,
unless
context
28
otherwise
requires:
29
a.
“Consumer”
means
the
same
as
defined
in
section
249A.29.
30
b.
“Rural
area”
means
a
geographical
area
that
is
not
part
31
of
a
metropolitan
statistical
area
as
designated
by
the
United
32
States
office
of
management
and
budget.
33
c.
“Waiver”
means
the
same
as
defined
in
section
249A.29.
34
2.
The
base
reimbursement
rate
for
a
provider
of
services
35
-5-
HF
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ak/ko/md
5/
13
H.F.
2716
under
a
medical
assistance
program
home
and
community-based
1
services
waiver
shall
be
increased
to
cover
the
travel
time
2
and
expenses
incurred
by
the
provider
to
provide
services
to
a
3
consumer
who
resides
in
a
rural
area.
4
Sec.
9.
NEW
SECTION
.
249A.32D
Waivers
——
cost
neutrality.
5
1.
As
used
in
this
section,
“cost
neutral”
means
federal
6
approval
of
a
waiver
related
to
the
medical
assistance
program
7
submitted
by
the
department
to
the
federal
government
will
not
8
result
in
a
net
increase
in
spending
for
state
administration
9
of
the
medical
assistance
program.
10
2.
Prior
to
submitting
a
request
for
a
waiver
to
the
United
11
States
department
of
health
and
human
services
related
to
12
the
medical
assistance
program,
the
department
shall
conduct
13
an
analysis
to
determine
if
the
waiver
is
cost
neutral.
For
14
any
waiver
that
is
determined
to
be
not
cost
neutral,
the
15
department
shall
not
submit
the
request
for
a
waiver
unless
the
16
waiver
has
been
presented
to
the
general
assembly
and
approved
17
by
a
majority
vote
of
both
houses
of
the
general
assembly.
18
Sec.
10.
MEDICAID
EXCEPTIONS
TO
POLICY
REVIEW
——
REPORT
19
TO
GENERAL
ASSEMBLY.
The
department
of
health
and
human
20
services
shall
conduct
a
review
of
petitions
for
a
waiver,
21
also
referred
to
by
the
department
as
exceptions
to
policy,
of
22
rules
governing
the
Medicaid
program
granted
by
the
department
23
between
January
1,
2020,
and
January
1,
2026,
and
shall
submit
24
a
report
on
or
before
December
15,
2026,
of
the
findings
of
the
25
review.
The
report
shall
include
all
of
the
following:
26
1.
The
total
number
of
exceptions
to
policy
granted.
27
2.
The
cumulative
cost
of
the
exceptions
to
policy
that
were
28
granted.
29
3.
The
types
of
exceptions
to
policy
that
were
granted.
30
4.
Identifiable
trends
noted
by
the
department
including
31
any
of
the
following:
32
a.
The
number
of
exceptions
to
policy
granted
in
a
33
particular
geographic
location.
34
b.
The
types
of
Medicaid
services
that
were
the
basis
for
35
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HF
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ak/ko/md
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2716
the
waiver.
1
c.
The
Medicaid
program
classification
of
individuals
2
granted
exception
to
policy.
3
Sec.
11.
CONTINGENT
EFFECTIVE
DATE.
The
following
takes
4
effect
contingent
upon
receipt
of
federal
approval
by
the
5
department
of
health
and
human
services
from
the
centers
for
6
Medicare
and
Medicaid
services
of
the
United
States
department
7
of
health
and
human
services:
8
The
section
of
this
division
of
this
Act
amending
section
9
249A.3,
subsection
2,
paragraph
“a”,
subparagraph
(1),
Code
10
2026,
relating
to
Medicaid
eligibility
for
employed
individuals
11
with
disabilities.
12
DIVISION
III
13
ELIGIBILITY
FOR
CERTAIN
PROGRAMS
14
Sec.
12.
NEW
SECTION
.
234.6A
Program
eligibility
——
15
residency.
16
1.
As
used
in
this
section,
“public
assistance
program”
17
means
any
of
the
following:
18
a.
The
state
child
care
assistance
program
under
section
19
237A.13.
20
b.
The
family
investment
program
under
chapter
239B.
21
c.
The
medical
assistance
program
under
chapter
249A.
22
d.
The
supplemental
nutrition
assistance
program
23
administered
by
the
state
pursuant
to
7
C.F.R.
pts.
270
–
283,
24
as
amended.
25
e.
The
special
supplemental
nutrition
program
for
women,
26
infants,
and
children
as
provided
in
42
U.S.C.
§1786
et
seq.
27
2.
a.
Unless
prohibited
under
federal
law,
the
department
28
may
require
from
an
applicant
to
a
public
assistance
program
29
proof
of
at
least
twelve
months
of
continuous
residency
within
30
the
state
including
any
of
the
following:
31
(1)
A
statement
from
the
applicant
attesting
to
the
32
applicant’s
reasons
for
being
in
the
state
and
length
of
33
residency
within
the
state.
34
(2)
A
statement
from
the
applicant’s
employer
confirming
35
-7-
HF
2716
(9)
91
ak/ko/md
7/
13
H.F.
2716
the
applicant’s
employment
in
the
state.
1
(3)
Any
other
statement
from
other
persons
with
knowledge
2
who
can
attest
to
the
applicant’s
reasons
for
being
in
the
3
state
and
length
of
residency
within
the
state.
4
(4)
A
copy
of
the
applicant’s
most
recently
filed
Iowa
state
5
income
tax
return.
6
b.
Paragraph
“a”
shall
not
apply
to
applicants
who
receive
7
benefits
under
the
federal
Social
Security
Act,
42
U.S.C.
§423
8
et
seq.
9
Sec.
13.
Section
239.6,
subsection
1,
paragraph
a,
10
subparagraph
(4),
Code
2026,
is
amended
to
read
as
follows:
11
(4)
Information
maintained
by
the
United
States
citizenship
12
and
immigration
services
of
the
United
States
department
of
13
homeland
security
,
including
but
not
limited
to
information
14
accessible
through
the
systematic
alien
verification
for
15
entitlements
online
service
.
16
Sec.
14.
Section
239.6,
subsection
2,
Code
2026,
is
amended
17
by
adding
the
following
new
paragraph:
18
NEW
PARAGRAPH
.
g.
The
systematic
alien
verification
for
19
entitlements
online
service
maintained
by
the
United
States
20
citizenship
and
immigration
services
of
the
United
States
21
department
of
homeland
security
or
other
accessible
sources
to
22
verify
immigration
and
United
States
citizenship
information.
23
DIVISION
IV
24
MISCELLANEOUS
PUBLIC
ASSISTANCE
PROGRAMS
25
Sec.
15.
NEW
SECTION
.
135.16E
Special
supplemental
26
nutrition
program
for
women,
infants,
and
children
——
citizens
27
and
qualified
aliens.
28
1.
The
department
shall
restrict
participation
in
the
29
special
supplemental
nutrition
program
for
women,
infants,
and
30
children
to
citizens
and
qualified
aliens
pursuant
to
section
31
742
of
the
federal
Personal
Responsibility
and
Work
Opportunity
32
Reconciliation
Act
of
1996,
Pub.
L.
No.
104-193.
33
2.
An
infant
or
child
who
is
a
citizen
or
qualified
alien
34
and
who
is
otherwise
eligible
for
the
special
supplemental
35
-8-
HF
2716
(9)
91
ak/ko/md
8/
13
H.F.
2716
nutrition
program
for
women,
infants,
and
children
shall
be
1
eligible
regardless
of
whether
the
infant’s
or
child’s
parent
2
is
a
citizen
or
qualified
alien.
3
Sec.
16.
Section
249N.6,
subsection
5,
Code
2026,
is
amended
4
by
adding
the
following
new
paragraph:
5
NEW
PARAGRAPH
.
c.
Notwithstanding
any
other
provision
of
6
law
to
the
contrary,
an
Iowa
health
and
wellness
plan
provider
7
may
impose
a
fee
of
no
more
than
five
dollars
on
a
member
based
8
on
the
member’s
failure
to
attend
a
scheduled
appointment
with
9
the
provider.
10
Sec.
17.
Section
249N.7,
subsection
1,
Code
2026,
is
amended
11
to
read
as
follows:
12
1.
Membership
in
the
Iowa
health
and
wellness
plan
shall
13
require
payment
of
monthly
contributions
for
members
whose
14
household
income
is
at
or
above
fifty
one
hundred
percent
15
of
the
federal
poverty
level.
Members
shall
be
subject
16
to
an
eight
dollar
copayment
amounts
applicable
only
to
17
for
nonemergency
use
of
a
hospital
emergency
department.
18
Total
member
cost-sharing,
annually,
shall
align
with
the
19
cost-sharing
limitations
requirements
for
the
American
health
20
benefits
exchanges
under
the
Affordable
Care
Act
,
as
amended
21
by
Pub.
L.
No.
119-21,
commonly
referred
to
as
the
One
Big
22
Beautiful
Bill
Act
.
Contributions
Monthly
contributions
and
23
copayment
amounts
for
members
shall
be
established
by
rule
of
24
the
department.
25
Sec.
18.
Section
249N.7,
Code
2026,
is
amended
by
adding
the
26
following
new
subsections:
27
NEW
SUBSECTION
.
3.
Notwithstanding
subsection
1,
a
member
28
who
fails
to
complete
all
required
preventative
care
services
29
and
wellness
activities
specified
during
the
prior
annual
30
membership
period
shall
be
subject
to
a
monthly
five
dollar
fee
31
during
the
subsequent
year
of
membership.
32
NEW
SUBSECTION
.
4.
Notwithstanding
subsection
1,
a
member
33
whose
household
income
is
at
or
above
one
hundred
percent
of
34
the
federal
poverty
level
shall
be
subject
to
the
following
35
-9-
HF
2716
(9)
91
ak/ko/md
9/
13
H.F.
2716
copay
amounts:
1
a.
A
five
dollar
copay
for
a
diagnostic
dental
procedure.
2
As
used
in
this
paragraph,
“diagnostic
dental
procedure”
means
3
a
dental
procedure
that
is
not
performed
for
preventative
4
purposes.
5
b.
A
one
dollar
copay
for
a
prescription
drug
when
a
6
suitable
generic
equivalent
drug
approved
by
the
United
States
7
food
and
drug
administration
is
available
to
the
member.
8
Sec.
19.
2023
Iowa
Acts,
chapter
104,
section
12,
subsection
9
3,
is
amended
to
read
as
follows:
10
3.
Unless
otherwise
provided
in
this
Act,
the
department
11
of
health
and
human
services
shall
implement
the
provisions
of
12
this
Act
in
an
incremental
fashion,
beginning
July
1,
2023,
13
with
a
goal
of
full
implementation
no
later
than
July
1,
2025
14
completed
by
January
1,
2027
,
to
minimize
duplication
of
15
efforts
and
to
maximize
coordination
with
the
implementation
16
time
frames
of
other
departmental
resource
enhancements.
17
Sec.
20.
IOWA
HEALTH
AND
WELLNESS
PLAN
——
MEMBER
18
REENROLLMENT
FOLLOWING
TERMINATION
FOR
NONPAYMENT
OF
MONTHLY
19
CONTRIBUTIONS.
The
department
of
human
services
shall
seek
20
approval
of
an
amendment
to
the
section
1115
demonstration
21
waiver
for
the
Iowa
health
and
wellness
plan
from
the
centers
22
for
Medicare
and
Medicaid
services
of
the
United
States
23
department
of
health
and
human
services
to
provide
the
24
following:
25
1.
An
Iowa
health
and
wellness
plan
member
who
is
subject
26
to
payment
of
a
monthly
contribution
as
the
result
of
failure
27
to
complete
required
preventative
care
services
and
wellness
28
activities,
and
whose
eligibility
for
the
program
is
terminated
29
due
to
nonpayment
of
monthly
contributions,
shall
be
allowed
30
to
subsequently
reenroll
in
the
program
without
first
paying
31
any
outstanding
monthly
contributions,
if
the
member
has
not
32
been
terminated
from
the
program
previously
for
nonpayment
of
33
monthly
contributions.
34
2.
If
an
Iowa
health
and
wellness
plan
member
has
been
35
-10-
HF
2716
(9)
91
ak/ko/md
10/
13
H.F.
2716
terminated
from
the
program
previously
for
nonpayment
of
1
monthly
contributions,
and
is
subsequently
terminated
from
2
the
program
for
nonpayment
of
monthly
contributions
owed
as
3
a
result
of
failure
to
complete
required
preventative
care
4
services
and
wellness
activities,
the
member
shall
be
subject
5
to
payment
of
any
outstanding
monthly
contributions
prior
to
6
reenrollment
in
the
program.
7
DIVISION
V
8
PUBLIC
ASSISTANCE
FRAUD
——
REPORT
9
Sec.
21.
NEW
SECTION
.
10A.404
Fraud
in
public
assistance
10
——
report.
11
On
or
before
October
1,
2026,
and
every
fiscal
year
12
thereafter,
the
department
shall
submit
a
report
to
the
general
13
assembly
concerning
the
department’s
activities
relative
14
to
fraud
in
public
assistance
programs
for
the
immediately
15
preceding
fiscal
year.
The
report
shall
include
but
is
not
16
limited
to
a
summary
of
the
number
of
cases
investigated,
17
case
outcomes,
overpayment
dollars
identified,
amount
of
cost
18
avoidance,
and
actual
dollars
recovered.
19
Sec.
22.
NEW
SECTION
.
10A.404A
Fraud
in
special
20
supplemental
nutrition
program
for
women,
infants,
and
children
21
——
report.
22
On
or
before
November
1,
2026,
and
by
November
1
every
23
fiscal
year
thereafter,
the
department
shall
submit
a
report
24
to
the
general
assembly
concerning
the
department’s
activities
25
relative
to
fraud
in
the
special
supplemental
nutrition
26
program
for
women,
infants,
and
children.
The
report
shall
27
include
but
is
not
limited
to
a
summary
of
the
number
of
cases
28
investigated,
case
outcomes,
violation
points
issued,
and
29
actual
dollars
recovered.
30
DIVISION
VI
31
HIGH-ACUITY
PEDIATRIC
WORK
GROUP
——
REPORT
32
Sec.
23.
HIGH-ACUITY
PEDIATRIC
WORK
GROUP
——
REPORT
TO
33
GENERAL
ASSEMBLY.
34
1.
The
department
of
health
and
human
services
shall
convene
35
-11-
HF
2716
(9)
91
ak/ko/md
11/
13
H.F.
2716
a
work
group
to
examine
the
unique
service
needs
of
high-acuity
1
pediatric
recipients
of
medical
assistance
under
chapter
249A,
2
and
high-acuity
pediatric
members
of
the
healthy
and
well
kids
3
in
Iowa
program
under
chapter
514I.
The
work
group
shall
do
4
all
of
the
following:
5
a.
Identify
the
barriers
that
prevent
the
high-acuity
6
pediatric
recipients
and
members
from
remaining
in
the
least
7
restrictive
environment
possible.
8
b.
Develop
a
proposal
for
a
tiered
reimbursement
9
methodology
to
provide
high-acuity
home
health
services
10
tailored
to
meet
the
allowable
medical
and
nonmedical
support
11
needs
of
high-acuity
pediatric
recipients
and
members.
12
2.
The
work
group
shall
be
comprised
of
at
least
one
13
representative
of
a
provider
of
high-acuity
home
health
14
services,
one
representative
of
the
Iowa
chapter
of
the
15
American
academy
of
pediatrics,
one
representative
of
the
16
Iowa
association
of
community
providers,
one
representative
17
of
the
Iowa
health
care
association,
and
other
individuals
or
18
organizations
deemed
appropriate
by
the
department.
19
3.
On
or
before
December
1,
2026,
the
department
shall
20
submit
a
report
to
the
general
assembly
that
includes
all
of
21
the
following:
22
a.
The
barriers
identified
by
the
work
group
that
prevent
23
high-acuity
pediatric
recipients
and
members
from
remaining
in
24
the
least
restrictive
environment
possible.
25
b.
The
working
group’s
proposed
tiered
reimbursement
26
methodology
and
the
estimated
fiscal
impact
on
affected
27
providers
and
health
care
facilities.
28
4.
The
department
of
health
and
human
services
shall
provide
29
administrative
support,
including
scheduling
meetings
of
the
30
work
group
as
necessary
to
complete
the
work
of
the
work
group.
31
DIVISION
VII
32
MEDICAID
REIMBURSEMENT
RATE
——
SPECIAL
POPULATION
NURSING
33
FACILITIES
34
Sec.
24.
Section
249A.2,
Code
2026,
is
amended
by
adding
the
35
-12-
HF
2716
(9)
91
ak/ko/md
12/
13
H.F.
2716
following
new
subsection:
1
NEW
SUBSECTION
.
15.
“Special
population
nursing
facility”
2
refers
to
a
nursing
facility
that
serves
one
of
the
following
3
populations
and
has
been
designated
as
a
special
population
4
nursing
facility
by
the
department:
5
a.
One
hundred
percent
of
the
residents
served
are
aged
6
thirty
and
under
and
require
a
skilled
level
of
care.
7
b.
Seventy
percent
of
the
residents
served
require
a
skilled
8
level
of
care
for
neurological
disorders.
9
c.
One
hundred
percent
of
the
residents
require
care
from
a
10
facility
licensed
by
the
department
of
inspections,
appeals,
11
and
licensing
as
an
intermediate
care
facility
for
persons
with
12
mental
illness.
13
d.
One
hundred
percent
of
the
residents
require
care
from
a
14
facility
licensed
by
the
department
of
inspections,
appeals,
15
and
licensing
as
an
intermediate
care
facility
for
persons
with
16
medical
complexity.
17
Sec.
25.
NEW
SECTION
.
249A.38C
Medicaid
reimbursement
rate
18
——
special
population
nursing
facilities.
19
The
provider
reimbursement
rate
for
each
special
population
20
nursing
facility
enrolled
in
Medicaid
before
July
1,
2025,
must
21
be
the
special
population
nursing
facility’s
average
allowable
22
per
diem
costs
as
adjusted
for
inflation.
The
inflation
factor
23
is
based
on
the
most
recent
centers
for
Medicare
and
Medicaid
24
services
total
skilled
nursing
facility
market
basket
index.
25
If
a
special
population
nursing
facility
subject
to
this
26
section
increases
the
special
population
nursing
facility’s
27
number
of
beds
or
expands
to
provide
additional
services
on
28
or
after
July
1,
2025,
the
reimbursement
rate
in
this
section
29
shall
apply
to
such
additional
beds
or
services.
30
-13-
HF
2716
(9)
91
ak/ko/md
13/
13