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SENATE
FILE
2464
BY
COMMITTEE
ON
APPROPRIATIONS
(SUCCESSOR
TO
SSB
3182)
A
BILL
FOR
An
Act
relating
to
state
finances
by
modifying
the
taxes
1
imposed
on
health
maintenance
organizations,
making
2
transfers
from
the
taxpayer
relief
fund,
making
and
3
supplementing
appropriations
to
the
department
of
health
and
4
human
services,
and
including
effective
date,
contingent
5
effective
date,
and
retroactive
applicability
provisions.
6
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
7
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DIVISION
I
1
HEALTH
MAINTENANCE
ORGANIZATION
TAXATION
2
Section
1.
Section
249A.13,
subsection
1,
Code
2026,
is
3
amended
to
read
as
follows:
4
1.
A
Medicaid
managed
care
organization
premiums
health
5
care
tax
fund
is
created
in
the
state
treasury
under
the
6
authority
of
the
department
of
health
and
human
services.
7
Moneys
collected
by
the
director
of
the
department
of
revenue
8
as
taxes
on
premiums
pursuant
to
section
432.1B
432B.2
shall
be
9
deposited
in
the
fund.
10
Sec.
2.
Section
432.1,
unnumbered
paragraph
1,
Code
2026,
11
is
amended
to
read
as
follows:
12
Every
insurance
company
or
association
of
whatever
kind
or
13
character,
not
including
fraternal
beneficiary
associations,
14
health
maintenance
organizations,
and
nonprofit
hospital
and
15
medical
service
corporations,
shall,
as
required
by
law,
pay
to
16
the
director
of
the
department
of
revenue,
or
to
a
depository
17
designated
by
the
director,
as
taxes,
an
amount
equal
to
the
18
following,
except
that
the
premium
tax
applicable
to
county
19
mutual
insurance
associations
shall
be
governed
by
section
20
518.18
:
21
Sec.
3.
Section
432.1,
subsection
2,
unnumbered
paragraph
22
1,
Code
2026,
is
amended
to
read
as
follows:
23
The
“applicable
percent”
for
purposes
of
subsection
1
of
this
24
section
,
section
432.1B
,
and
section
432.2
is
the
following:
25
Sec.
4.
NEW
SECTION
.
432B.1
Definitions.
26
As
used
in
this
chapter:
27
1.
“Commissioner”
means
the
commissioner
of
insurance.
28
2.
“Health
maintenance
organization”
means
the
same
as
29
defined
in
section
514B.1.
“Health
maintenance
organization”
30
includes
a
health
maintenance
organization
contracting
with
31
the
department
of
health
and
human
services
to
administer
the
32
medical
assistance
program
under
chapter
249A.
33
3.
a.
“Taxable
funds”
means
all
of
the
following:
34
(1)
Payments
received
by
the
health
maintenance
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organization
for
health
care
services,
insurance,
indemnity,
1
or
other
benefits
to
which
an
enrollee
is
entitled
through
a
2
health
maintenance
organization.
3
(2)
Payments
made
by
the
health
maintenance
organization
4
to
providers
for
health
care
services,
to
insurers,
or
to
5
corporations
authorized
under
chapter
514
for
insurance,
6
indemnity,
or
other
authorized
service
benefits,
except
7
a
payment
made
by
a
health
maintenance
organization
that
8
qualifies
both
as
a
payment
received
under
subparagraph
(1)
and
9
a
payment
made
under
this
subparagraph,
shall
be
considered
10
taxable
funds
under
subparagraph
(1).
11
b.
“Taxable
funds”
does
not
include
payments
made
to
a
12
health
maintenance
organization
by
the
United
States
secretary
13
of
health
and
human
services
under
a
contract
issued
under
14
section
1833
or
1876
of
the
federal
Social
Security
Act,
or
15
under
section
4015
of
the
federal
Omnibus
Budget
Reconciliation
16
Act
of
1987.
17
Sec.
5.
NEW
SECTION
.
432B.2
Imposition
of
health
18
care-related
tax.
19
1.
Each
health
maintenance
organization
transacting
20
business
in
the
state
shall
be
subject
to
a
health
care-related
21
tax
payable
to
the
director
of
revenue
in
an
amount
equal
to
22
the
following
applicable
percentage
of
taxable
funds:
23
a.
For
the
period
in
calendar
year
2026
beginning
January
24
1,
2026,
and
ending
September
30,
2026,
three
and
one-half
25
percent.
For
the
period
in
calendar
year
2026
beginning
26
on
or
after
October
1,
2026,
and
ending
December
31,
2026,
27
ninety-five
hundredths
of
one
percent.
28
b.
For
the
2027
calendar
year
and
subsequent
calendar
years,
29
ninety-five
hundredths
of
one
percent.
30
2.
The
amounts
received
by
the
director
of
revenue
from
the
31
imposition
of
the
tax
shall
be
deposited
in
the
health
care
tax
32
fund
created
in
section
249A.13.
33
Sec.
6.
NEW
SECTION
.
432B.3
Date
tax
due
——
method
of
34
payment
——
statute
of
limitations.
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1.
Except
as
provided
in
subsection
2,
the
tax
imposed
1
under
this
chapter
shall
be
paid
on
or
before
March
1
of
the
2
year
following
the
calendar
year
for
which
the
tax
is
due.
The
3
commissioner
may
suspend
or
revoke
the
license
of
a
health
4
maintenance
organization
subject
to
the
health
care-related
tax
5
in
this
chapter
that
fails
to
pay
the
health
care-related
tax
6
on
or
before
the
due
date.
7
2.
a.
Each
health
maintenance
organization
transacting
8
business
in
this
state
that
is
subject
to
the
tax
in
section
9
432B.2
shall
remit
on
or
before
June
1,
on
a
prepayment
basis,
10
an
amount
equal
to
one-half
of
the
product
of
the
current
rate
11
in
effect
in
section
432B.2
and
the
taxable
funds
in
the
prior
12
calendar
year.
13
b.
In
addition
to
the
prepayment
amount
in
paragraph
“a”
,
14
each
health
maintenance
organization
subject
to
the
tax
in
this
15
chapter
shall
remit
on
or
before
August
15,
on
a
prepayment
16
basis,
an
additional
amount
equal
to
one-half
of
the
product
of
17
the
current
rate
in
effect
in
section
432B.2
and
the
taxable
18
funds
in
the
prior
calendar
year.
19
c.
(1)
The
sums
prepaid
by
a
health
maintenance
20
organization
under
paragraphs
“a”
and
“b”
shall
be
allowed
21
as
credits
against
the
health
maintenance
organization’s
22
health
care-related
tax
liability
for
the
calendar
year
during
23
which
the
payments
are
made.
If
a
prepayment
made
under
this
24
subsection
exceeds
the
health
maintenance
organization’s
annual
25
health
care-related
tax
liability,
the
excess
shall
be
allowed
26
as
a
credit
against
the
health
maintenance
organization’s
27
subsequent
prepayment
or
tax
liabilities
under
this
chapter.
28
The
commissioner
shall
authorize
the
department
of
revenue
29
to
make
a
cash
refund
to
a
health
maintenance
organization,
30
in
lieu
of
a
credit
against
subsequent
prepayment
or
tax
31
liabilities
under
this
section,
if
the
health
maintenance
32
organization
demonstrates
the
inability
to
recoup
the
funds
33
paid
via
a
credit.
34
(2)
The
commissioner
shall
adopt
rules
establishing
a
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health
maintenance
organization’s
eligibility
for
a
cash
1
refund,
and
the
process
for
the
department
of
revenue
to
make
a
2
cash
refund
to
an
eligible
health
maintenance
organization
from
3
the
Medicaid
managed
care
organization
health
care
tax
fund
4
created
in
section
249A.13.
The
commissioner
may
suspend
or
5
revoke
the
license
of
a
health
maintenance
organization
that
6
fails
to
make
a
prepayment
on
or
before
the
due
date
under
this
7
subsection.
8
3.
The
commissioner
shall
determine
whether
or
not
the
tax
9
remitted
is
correct.
If
the
tax
remitted
is
not
sufficient,
10
the
commissioner
shall
notify
the
delinquent
company
of
the
11
amount
of
such
delinquency
and
certify
the
amount
to
the
12
department
of
revenue
which
shall
proceed
to
collect
the
13
delinquency.
14
4.
Within
five
years
after
the
tax
return
is
filed
or
within
15
five
years
after
the
tax
return
became
due,
whichever
is
later,
16
the
commissioner
shall
examine
the
return
and
determine
the
17
tax.
An
assessment
or
a
claim
for
credit
must
be
made
within
18
five
calendar
years
after
the
annual
tax
filing
is
made.
For
19
a
five-year
period
preceding
the
current
calendar
year,
a
20
company
may
apply
for
a
credit,
or
the
commissioner
may
make
21
an
assessment,
as
appropriate.
The
period
of
examination
and
22
determination
of
the
correct
amount
of
tax
is
unlimited
in
the
23
case
of
a
false
or
fraudulent
return
made
with
the
intent
to
24
evade
tax
or
in
the
case
of
a
failure
to
file
a
return.
25
Sec.
7.
Section
508C.19,
Code
2026,
is
amended
to
read
as
26
follows:
27
508C.19
Credits
for
assessments
paid.
28
1.
An
insurer
may
offset
an
assessment
made
pursuant
to
29
section
508C.9
against
its
premium
tax
liability
pursuant
to
30
chapter
432
or
health
care-related
tax
liability
pursuant
to
31
chapter
432B
to
the
extent
of
twenty
percent
of
the
amount
of
32
the
assessment
for
each
of
the
five
calendar
years
following
33
the
year
in
which
the
assessment
was
paid.
If
an
insurer
34
ceases
doing
business,
all
uncredited
assessments
may
be
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credited
against
its
premium
or
health
care-related
tax
1
liability
for
the
year
it
ceases
doing
business.
2
2.
Sums
acquired
by
refund
from
the
association
which
have
3
been
written
off
by
contributing
insurers
and
offset
against
4
premium
taxes
or
health
care-related
taxes
as
provided
in
5
subsection
1
and
are
not
then
needed
for
purposes
of
this
6
chapter
shall
be
paid
by
the
association
to
the
commissioner.
7
The
commissioner
shall
remit
the
moneys
to
the
treasurer
of
8
state
to
deposit
in
the
state
general
fund.
9
Sec.
8.
Section
514B.31,
Code
2026,
is
amended
by
striking
10
the
section
and
inserting
in
lieu
thereof
the
following:
11
514B.31
Health
maintenance
organization
health
care-related
12
taxation.
13
Every
health
maintenance
organization
and
including
health
14
maintenance
organizations
contracting
with
the
department
of
15
health
and
human
services
to
administer
the
medical
assistance
16
program
under
chapter
249A
shall
be
subject
to
taxation
under
17
chapter
432B.
18
Sec.
9.
Section
514E.1,
subsection
3,
Code
2026,
is
amended
19
to
read
as
follows:
20
3.
“Carrier”
means
an
insurer
providing
accident
and
21
sickness
insurance
under
chapter
509
,
514
,
514A
and
includes
a
22
health
maintenance
organization
established
under
chapter
514B
23
if
payments
received
by
the
health
maintenance
organization
24
are
considered
premiums
pursuant
to
section
514B.31
and
are
25
taxed
under
chapter
432
subject
to
the
health
care-related
26
tax
under
chapter
432B
.
“Carrier”
also
includes
a
corporation
27
which
becomes
a
mutual
insurer
pursuant
to
section
514.23
and
28
any
other
person
as
defined
in
section
4.1,
subsection
20
,
who
29
is
or
may
become
liable
for
the
tax
imposed
by
chapter
432
or
30
432B
.
31
Sec.
10.
Section
514E.2,
subsection
13,
Code
2026,
is
32
amended
to
read
as
follows:
33
13.
An
insurer
may
offset
an
assessment
made
pursuant
to
34
this
chapter
against
its
premium
tax
liability
pursuant
to
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chapter
432
or
against
its
health
care-related
tax
liability
1
pursuant
to
chapter
432B,
as
applicable,
to
the
extent
of
2
twenty
percent
of
the
amount
of
the
assessment
for
each
3
of
the
five
calendar
years
following
the
year
in
which
the
4
assessment
was
paid.
If
an
insurer
ceases
doing
business,
all
5
uncredited
assessments
may
be
credited
against
its
premium
or
6
health
care-related
tax
liability
for
the
year
it
ceases
doing
7
business.
8
Sec.
11.
REPEAL.
Section
432.1B,
Code
2026,
is
repealed.
9
Sec.
12.
PREMIUM
TAX
——
HEALTH
MAINTENANCE
10
ORGANIZATION.
For
purposes
of
imposing
the
premium
tax
11
under
section
432.1,
beginning
with
calendar
2026,
and
12
subsequent
calendar
years,
a
health
maintenance
organization
13
is
not
subject
to
the
premium
tax
under
section
432.1,
if
the
14
health
maintenance
organization
is
subject
to
the
imposition
15
of
the
health
care-related
tax
under
chapter
432B,
if
enacted
16
by
this
division
of
this
Act.
17
Sec.
13.
PREPAYMENT
OF
TAXES
FOR
CALENDAR
YEAR
18
2026.
Notwithstanding
section
432B.3,
subsection
2,
paragraphs
19
“a”
and
“b”,
if
enacted
by
this
division
of
this
Act,
the
first
20
prepayment
date
shall
be
sixty
days
and
the
second
prepayment
21
date
shall
be
one
hundred
thirty-five
days
after
the
effective
22
date
of
this
division
of
this
Act.
23
Sec.
14.
CONTINGENT
EFFECTIVE
DATE.
This
division
of
24
this
Act
takes
effect
upon
the
date
the
department
of
health
25
and
human
services
notifies
the
general
assembly
and
the
Code
26
editor
of
the
approval
by
the
federal
centers
for
Medicare
and
27
Medicaid
services
of
the
United
States
department
of
health
28
and
human
services
of
the
method
of
taxation
upon
a
health
29
maintenance
organization
imposed
pursuant
to
this
division
of
30
the
Act.
31
Sec.
15.
RETROACTIVE
APPLICABILITY.
This
division
of
this
32
Act
applies
retroactively
to
January
1,
2026,
for
tax
years
33
beginning
on
or
after
that
date.
34
DIVISION
II
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TAXPAYER
RELIEF
FUND
TRANSFERS
——
SUPPLEMENTAL
APPROPRIATIONS
1
Sec.
16.
Section
8.57E,
subsection
2,
paragraph
b,
2
subparagraph
(1),
Code
2026,
is
amended
to
read
as
follows:
3
(1)
(a)
For
the
fiscal
year
beginning
July
1,
2024,
and
for
4
each
fiscal
year
thereafter,
if
the
actual
net
revenue
for
the
5
general
fund
of
the
state
for
the
fiscal
year
is
less
than
the
6
net
general
fund
appropriation
for
the
fiscal
year,
there
is
7
transferred
from
the
taxpayer
relief
fund
to
the
general
fund
8
of
the
state
an
amount
equal
to
fifty
percent
of
the
difference
9
or
the
remaining
balance
of
the
taxpayer
relief
fund,
whichever
10
is
lower.
11
(b)
For
the
fiscal
year
beginning
July
1,
2025,
if
the
12
actual
net
revenue
for
the
general
fund
of
the
state
for
the
13
fiscal
year
is
less
than
the
net
general
fund
appropriation
for
14
the
fiscal
year,
there
is
transferred
from
the
taxpayer
relief
15
fund
to
the
general
fund
of
the
state
an
amount
equal
to
one
16
hundred
percent
of
the
difference
or
the
remaining
balance
of
17
the
taxpayer
relief
fund,
whichever
is
lower.
18
(c)
For
the
fiscal
year
beginning
July
1,
2026,
if
the
19
actual
net
revenue
for
the
general
fund
of
the
state
for
the
20
fiscal
year
is
less
than
the
net
general
fund
appropriation
21
for
the
fiscal
year,
there
is
transferred
from
the
taxpayer
22
relief
fund
to
the
general
fund
of
the
state
an
amount
equal
to
23
seventy-five
percent
of
the
difference
or
the
remaining
balance
24
of
the
taxpayer
relief
fund,
whichever
is
lower.
25
(d)
For
the
fiscal
year
beginning
July
1,
2027,
and
for
26
each
fiscal
year
thereafter,
if
the
actual
net
revenue
for
the
27
general
fund
of
the
state
for
the
fiscal
year
is
less
than
the
28
net
general
fund
appropriation
for
the
fiscal
year,
there
is
29
transferred
from
the
taxpayer
relief
fund
to
the
general
fund
30
of
the
state
an
amount
equal
to
fifty
percent
of
the
difference
31
or
the
remaining
balance
of
the
taxpayer
relief
fund,
whichever
32
is
lower.
33
Sec.
17.
TRANSFER
INCREASES
FOR
TAXPAYER
RELIEF.
The
34
increases
in
transfer
percentage
amounts
from
the
taxpayer
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relief
fund
set
forth
in
the
section
of
this
division
of
this
1
Act
amending
section
8.57E
are
made
in
accordance
with
section
2
8.57E,
subsection
2,
paragraph
“a”,
for
state
tax
relief
based
3
on
the
reduction
in
state
revenue
associated
with
federal
tax
4
law
changes
pursuant
to
section
422.3,
subsection
5,
paragraph
5
“b”,
including
but
not
limited
to
the
allowance
of
income
tax
6
deductions
for
qualified
tips,
overtime
compensation,
and
7
qualified
passenger
vehicle
loan
interest
under
the
federal
8
Internal
Revenue
Code,
as
amended
by
Pub.
L.
No.
119-21,
9
commonly
referred
to
as
the
One
Big
Beautiful
Bill
Act.
10
Sec.
18.
DEPARTMENT
OF
HEALTH
AND
HUMAN
SERVICES
——
11
SUPPLEMENTAL
APPROPRIATION.
There
is
appropriated
from
the
12
general
fund
of
the
state
to
the
department
of
health
and
human
13
services
for
the
fiscal
year
beginning
July
1,
2025,
and
ending
14
June
30,
2026,
the
following
amount,
or
so
much
thereof
as
is
15
necessary,
to
be
used
for
the
purposes
designated:
16
To
supplement
the
appropriation
made
for
medical
assistance
17
program
reimbursement
and
associated
costs
in
2025
Iowa
Acts,
18
chapter
169,
section
9,
unnumbered
paragraph
2:
19
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
70,300,000
20
Notwithstanding
section
8.33,
moneys
appropriated
in
this
21
section
that
remain
unencumbered
or
unobligated
at
the
close
of
22
the
fiscal
year
shall
not
revert
but
shall
remain
available
for
23
expenditure
for
the
purposes
designated
until
the
close
of
the
24
succeeding
fiscal
year.
25
Sec.
19.
EFFECTIVE
DATE.
This
division
of
this
Act,
being
26
deemed
of
immediate
importance,
takes
effect
upon
enactment.
27
EXPLANATION
28
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
29
the
explanation’s
substance
by
the
members
of
the
general
assembly.
30
This
bill
modifies
the
taxes
imposed
on
health
maintenance
31
organizations,
makes
transfers
from
the
taxpayer
relief
fund,
32
and
makes
supplemental
appropriations.
33
DIVISION
I
——
HEALTH
MAINTENANCE
ORGANIZATION
TAXATION.
34
Currently,
health
maintenance
organizations
premiums
(HMO)
are
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subject
to
taxation
under
Code
chapter
432
(insurance
companies
1
tax).
2
The
bill
defines
“HMO”
to
mean
the
same
as
defined
in
Code
3
section
514B.1,
and
includes
an
HMO
contracting
with
the
4
department
of
health
and
human
services
to
administer
the
5
medical
assistance
program
under
Code
chapter
249A.
6
The
bill
strikes
the
tax
on
HMO
premiums
and
creates
a
health
7
care-related
tax
on
the
taxable
funds
of
an
HMO
in
new
Code
8
chapter
432B.
By
striking
the
taxation
of
HMO
premiums
in
Code
9
chapter
432
and
creating
the
new
health
care-related
tax
in
10
Code
chapter
432B,
the
tax
credits
available
to
an
HMO
in
Code
11
chapter
432
are
not
available
to
an
HMO
in
new
Code
chapter
12
432B.
13
The
bill
applies
the
health
care-related
tax
on
the
14
taxable
funds
of
an
HMO.
The
bill
defines
“taxable
funds”
to
15
mean
payments
received
by
an
HMO
for
health
care
services,
16
insurance,
indemnity,
or
other
benefits
to
which
an
enrollee
17
is
entitled
through
an
HMO;
and
payments
made
by
the
HMO
18
to
providers
for
health
care
services,
to
insurers,
or
to
19
corporations
authorized
under
Code
chapter
514
for
insurance,
20
indemnity,
or
other
authorized
service
benefits.
The
bill
21
excludes
from
the
definition
of
taxable
funds
the
payments
made
22
to
an
HMO
by
the
United
States
secretary
of
health
and
human
23
services
under
a
contract
and
pursuant
to
federal
authority.
24
If
a
payment
qualifies
as
both
a
payment
received
by
an
HMO
for
25
services
provided
and
a
payment
made
by
the
HMO
to
providers,
26
the
bill
requires
the
HMO
to
classify
the
payment
as
a
payment
27
received
by
the
HMO.
28
Currently,
the
tax
rate
on
premiums
in
Code
section
432.1(2)
29
is
gradually
being
reduced
and
the
current
rate
for
calendar
30
year
2026
is
.925
percent
of
premiums.
The
new
tax
rates
on
31
the
taxable
funds
of
an
HMO
in
the
bill
are
as
follows:
for
32
the
period
in
calendar
year
2026
beginning
January
1,
2026,
33
and
ending
September
30,
2026,
3.5
percent;
for
the
period
34
in
calendar
year
2026
beginning
on
or
after
October
1,
2026,
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and
ending
December
31,
2026,
.95
percent;
and
for
the
2027
1
calendar
year
and
subsequent
calendar
years,
the
rate
remains
2
at
.95
percent.
3
Currently,
the
premium
tax
is
due
March
1
of
the
year
4
following
the
calendar
year
for
which
the
tax
is
due;
however,
5
one-half
of
the
premium
taxes
are
required
to
be
prepaid
on
6
June
1
and
one-half
on
August
15.
The
health
care-related
tax
7
is
also
due
on
March
1
of
the
year
following
the
calendar
year
8
for
which
the
tax
is
due,
and
the
bill
establishes
the
same
9
prepayment
framework.
The
HMO
is
required
to
prepay
one-half
10
of
the
health
care-related
tax
on
June
1
and
one-half
on
August
11
15.
Due
to
the
effective
date
of
the
division
being
dependent
12
upon
notification
of
federal
approval,
for
calendar
year
2026
13
the
first
prepayment
date
shall
be
60
days
and
the
second
14
prepayment
date
shall
be
135
days
after
the
effective
date
of
15
the
division.
16
The
division
takes
effect
upon
the
date
the
department
of
17
health
and
human
services
notifies
the
general
assembly
and
the
18
Code
editor
of
the
approval
by
the
federal
centers
for
Medicare
19
and
Medicaid
services
of
the
United
States
department
of
health
20
and
human
services
of
the
method
of
taxation
imposed
pursuant
21
to
the
division.
The
division
applies
retroactively
to
tax
22
years
beginning
on
or
after
January
1,
2026.
23
DIVISION
II
——
TAXPAYER
RELIEF
FUND
TRANSFERS
——
24
SUPPLEMENTAL
APPROPRIATIONS.
Under
current
law,
for
FY
25
2024-2025
through
FY
2028-2029,
if
the
actual
net
revenue
for
26
the
general
fund
of
the
state
(GF)
for
the
fiscal
year
is
less
27
than
the
net
GF
appropriation
for
the
fiscal
year,
there
is
28
transferred
from
the
taxpayer
relief
fund
to
the
GF
an
amount
29
equal
to
50
percent
of
the
difference.
The
bill
provides
that
30
the
transfer
is
100
percent
of
the
difference
for
FY
2025-2026
31
and
75
percent
of
the
difference
for
FY
2026-2027.
Under
32
current
law
and
the
bill,
the
transfer
does
not
readjust
the
33
GF
expenditure
limitation
for
the
associated
fiscal
year
(Code
34
section
8.54(5)(b)).
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The
bill
makes
a
supplemental
appropriation
to
the
1
department
of
health
and
human
services
from
the
GF
for
FY
2
2025-2026
for
the
medical
assistance
program.
3
This
division
of
the
bill
takes
effect
upon
enactment.
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