Governor Reynolds has signed 56 bills into law, and plans to sign two more early next week. They include:

  • Telehealth (HF 2305): All state-regulated health insurance plans will have to cover telehealth-delivered services if those services are covered if delivered in person. It applies to plans renewed or started after January 1, 2019 (so full implementation does not begin immediately).

  • Concierge Medicine (HF 2305): Health care providers would be able to offer membership-based primary care services beginning July 1, allowing Iowans access to free primary care services and reduced cost lab testing. Similar legislation has been enacted in Nebraska.

  • Expanded Newborn Safe Havens (SF 360): EMS providers, firefighters, and other first responders are added to the state’s Newborn Safe Haven Act, so beginning July 1 they will be able to accept newborns similar to institutional providers like hospitals.

  • Suicide Prevention & Awareness (SF 2113): School employees will be required to receive one hour of suicide prevention and awareness training each year, beginning July 1, 2019. The training is to be evidence-based, include information about the identification of Adverse Childhood Experiences (ACES) and mitigation of toxic stress response. 

  • The Governor announced plans to sign another bill on Monday - SF 2349 (Farm Bureau Non-ACA Complaint Plan). The Iowa Farm Bureau will be allowed to offer its members a non-ACA compliant individual health insurance plans beginning July 1, 2018. The bill basically states that the Wellmark health insurance plans offered to individuals through the Iowa Farm Bureau are not “insurance” and therefore do not have to comply with ACA requirements. Supporters say this approach is similar to what has been approved in Tennessee (opponents say the federal government just rejected a similar plan in Idaho). Now that its signed, I guess we’ll see if it survives a challenge. 

Governor Kim Reynolds also signed  House File 2456  on Thursday, the final step in turning the recommendations of the 23-member  Complex Needs Work Group  into law. Last year, Iowa lawmakers asked a group of Iowans representing providers, families, law enforcement, advocates, county MH/DS regions, and others to develop a set of recommendations to fill the gaps in services for persons with complex mental health and disability services needs. The goal was to get people with mental illness out of jails and emergency rooms, and into the services they need, with an emphasis on providing those services locally, and in smaller community-based settings.

"This legislation was pushed over the finish line by individuals and families who knew firsthand the importance of having a robust mental health system and the pain caused when services they or a loved one needed weren’t there,” Gov. Reynolds said. “I know we can do better, and with this legislation, we will do better!”

The 18-page report outlined six basic recommendations, and nearly all of them were included in the legislation. The bill requires the following services be made available throughout the state:

  • Access Centers to provide short-term care for those in crisis, and provide resources needed to get Iowans back home to their families. The bill calls for at least six of these to be located around the state.

  • Assertive community treatment (ACT) teams to provide individualized treatment and support to individuals with mental illness in their homes, 365 days a year. The bill calls for at least 22 ACT teams to be established.

  • Intensive residential service homes will provide individuals with severe and persistent mental illness with the chance to live in smaller community-based settings close to home, while receiving the 24-hour intensive services needed to address their individual needs. The legislation calls for a total of 120 beds to be available statewide (to be scattered, with facilities preferably serving no more than four individuals at each site, with a maximum of 16 allowed).

  • A single statewide 24-hour crisis hotline will replace the ones managed by each individual MH/DS region, but it will continue to connect people to the local resources they need.

  • All of the existing crisis services provided by MH/DS regions are moved to the list of "core services" - so mobile response, 23-hour crisis observation and holding, crisis residential services, subacute and crisis stabilization community-based services are no longer considered "extra services." They are now required core services to be available throughout the state. The existing subacute bed cap is removed, so regions are free to develop these beds based on the needs of their community.

House File 2456  also makes changes to free up hospital beds quicker and allows hospitalization hearings to be held via video conference, and improves communications between mental health professionals and law enforcement (consistent with ethics, and still permissive not mandatory). 

While this is an impressive list of recommendations, all present at the bill signing acknowledged there is more work to be done. "Creating a mental health system that we envision is complex and it can’t happen overnight. I look forward to building on the momentum that we have here today,” Reynolds emphasized. “There is more to come.”

Mary Neubauer, whose son took his own life last year, used her skills as a lobbyist (for the Iowa Lottery) and former journalist (for AP) to tell her story and ask lawmakers for action. She was at the bill signing. “Today is a significant day. This is an acknowledgment of the difficulties that have existed here in Iowa, of the people who haven’t gotten the help that they’ve needed,” said Neubauer. “This puts in place a framework for the real work to begin to develop the programs and to put in place the capacity and the help that is needed...The follow through is absolutely critical. This is an important starting point that, frankly, we have never reached before in Iowa, but truly now the real work begins.”

So what are those next steps?

  • Make sure funding is available for these services. MH/DS regions and Medicaid MCOs are required to pay for these services, yet funding for both is strapped. While many regions have some funds available now, they will run out of their "reserves" eventually and will need a stable source of funding. At least two regions (Polk County & Eastern Iowa) have capacity to do these services, but do not have the resources to pay for them now. Because these services will be available only as funding allows, fixing the funding is an important next step. House File 2456 calls for an interim committee this summer to review funding for these and other services delivered through the MH/DS regions, and determine funding needed to make sure they are available statewide. Action will be needed on this when the Legislature returns in 2019.

  • Begin work to fill gaps in the children's mental health system. House File 2456 focuses entirely on the adult system, but the work group acknowledged work needed to be done to implement the recommendations of the Children's Mental Health and Well-Being Work Group. In response to this, the Governor announced that she will be signing an Executive Order to begin this process, and start to implement the recommendations made by this group, in preparation for more action in 2019. We will send out more information on this when the Executive Order is available.

  • Address the role of tertiary care hospitals in the system.  House File 2456 directs DHS to pull together stakeholders to review the role of tertiary care psychiatric hospitals in the array of mental health services and make further recommendations if necessary. The workgroup will include the Department of Inspections and Appeals, representative members of the Iowa Hospital Association, managed care organizations, the National Alliance on Mental Illness, the mental health institutes, and other interested stakeholders. A report is to be completed by November 30, 2018 (so expect work to begin soon).

  • Further streamline commitment processes.  House File 2456 also directed DHS to bring stakeholders together to review the mental health and substance use disorder commitment processes and make recommendations for improvements in the process. The workgroup will include the Department of Public Health, representative members of the judicial branch, the Iowa Hospital Association, the Iowa Medical Society, the National Alliance on Mental Illness, the Iowa State Sheriffs’ and Deputies’ Association, Iowa Behavioral Health Association, and other interested stakeholders. This report is due on December 31, 2018 (so work here will also begin soon).

  • Last (but definitely not least) - rules! Legislators pass bills. Bills are signed into law by the Governor. But state agencies need to figure out how to implement those laws, and they do that by writing rules. Administrative rules are important here, because they will more fully define these services, set service provider standards, establish reimbursement rates (always key to making services available), access standards, implementation dates, and possibly even location of the services. While DHS has been asked to get rules in place quickly, it will still need to go through the normal rules process that includes many opportunities for input, including public hearings, public comment period, required responses to comments, and a review by a legislative panel (called the Administrative Rules Review Committee). As the saying goes, the Devil is in the details (and this is where the details are outlined).

Finally, the House unanimously passed the  Medicaid MCO Directives Bill  ( HF 2462 ), which directs MCOs to follow certain industry best practices, including requirements that MCOs pay timely claims, denied claims include reasons for denial, the development of standardized provider enrollment forms and credentialing processes, extension of services for members who win appeals, requirement that court-ordered substance use or mental health treatment be authorized for at least five days, required DHS review of any level of care reassessments that decrease services, mandate that MCOs continue services at existing levels for those whose level of care determinations find no change, and an independent audit of all small claims for long-term care supports and services. 

In addition, the bill establishes a health home work group (with representation of health home providers and MCOs) to review the health home program. Another work group (with MCOs and Medicaid providers) will determine the effectiveness of prior authorizations used by MCO and develop a threshold when they are no longer needed. 

The bill is now in the Senate Appropriations Committee, assigned to Sen. Mark Costello (R-Imogene). During a committee meeting several weeks ago, Sen. Costello said this bill will not move, but that MCO-related changes would be done in the Health/Human Services Budget (which he co-chairs and starts in the Senate this year). So while this bill might not move, the issue itself is still very much alive.

Check out the status of the bill tracked for IPA here .
The default page shows you only the bills still alive.
To see bills that didn’t make the funnel, switch the list to “inactive."
You can export either list to an excel sheet for your own use/tracking.