• Scope Issues: Last year the occupational therapists tried to explain why they should be considered mental health professionals, and music and art therapists tried to get licensure. While those bills are still around, there does not appear to be much interest in moving any forward or even reopening them for discussion (knock on some wood). HF2008 allows any licensed mental health professional to supervise a licensed master's level social worker (LMSW) in order to receive payment for the services provided. Right now, LMSWs must be supervised by a licensed independent social worker (LISW) for services to be reimbursed. This way, psychologists, licensed mental health counselors, and licensed marriage and family therapists would be able to provide that supervision, as well as LISW. The supervision however will not count toward an LMSW's practicum to become an LISW (that still needs LISW supervision).

• PsyPACT HF2094: IPA's state state advocacy team (Dr. Paul Ascheman & Dr. Matt Cooper) are on top of the and have spoken to the members of the subcommittee, and have asked many of you to make contact with them as well. Rep. Mike Bergan (R-Winneshiek), Rep. Lindsay James (D-Dubuque), and Rep. Rob Bacon (R-Story) had set a subcommittee but had to cancel twice because of conflicts; we expect another subcommittee to be scheduled soon. Please continue to read & respond to the advocacy alerts sent out on this - there is a lot of pressure to do something on reciprocity and overall licensure reform this year.

• Professional Licensing: During her condition. of the state message, Governor Reynolds cited statistics that showed Iowa has having more licensing and regulatory rules than other states, and supporters of professional licensing reform call regulation of professions "job killers." While last year the bills died a fairly painless death, this year they are back with a vengeance, and it is clear that legislators are pretty serious about passing something. Here are a few points on each of the bills:

• Senate File 2114 will be up for discussion this week in subcommittee. It states that any state-administered professional license will be issued to a person moving to Iowa or stationed in Iowa for the military to receive a state license to practice without additional examination as long as the person: 1) is licensed in good standing in another state and has had that license for at least one year; 2) the licensing state imposed minimum educational requirements and minimum clinical/supervision requirements if appropriate; 3) the person previously passed an exam required by another state; 4) the person's license has not been revoked or voluntarily surrendered; 5) the person has not been disciplined by another state's board; and 6) the person does not have any pending complaints or allegations against them. Subcommittee members on this bill are Sen. Waylon Brown (R-Mitchell), Sen. Dennis Guth (R-Hancock), and Nate Boulton (D-Polk). We have many of the same concerns that we have with Psypact; this bill legislates safety to the lowest common denominator.

• Senate File 2163 ends every state professional licensing or regulatory board over a five year period, with a new batch each year reviewed by a legislative "Occupational Licensing Advisory Committee" that would forward decision packages to legislators - 1) an unamendable bill that would extend the sunset to by 5-10 years; 2) an unamendable bill that would modify the conditions of licensure and oversight of the profession; or 3) submit a report explaining why the licensing body and its professional regulation should be allowed to expire. Review schedule - 2022 (includes boards of medicine, physician assistants); 2023 (includes boards of dentistry, massage therapy, athletic trainers, physical/occupational therapy); 2024 (including boards of nursing, nursing home administrators, speech pathologists/audiologists, hearing aid specialists, sign language interpreters, respiratory care/polysomnography); 2025 (pharmacy, chiropractic, optometry, podiatry, psychology); and 2026 (veterinary medicine, fire protection system installers). There are other boards reviewed each year, we just pulled out some to give you an idea. As if this isn't enough, the bill also requires every agency and board review their rules to make sure they only require the minimum restrictions to ensure safety and accomplish goals of the regulatory entity (they call this part the "Right to Earn a Living Act"). A subcommittees has not yet been assigned, but it is in the Senate State Government Committee.

• Senate Study Bill 3111 eliminates the hospital licensing board; it has a subcommittee on 2/12; subcommittee members are Sen. Roby Smith (R-Scott), Sen. Ken Rozenboom (R-Mahaska), and Sen. Tony Bisignano (D-Polk). There are also bills to get rid of the Boards of Sign Language Interpreters, Hearing Aid Dealers, and Polysomnography. They are even picking on libraries by getting rid of the Commission on Libraries.

• Governor’s Invest in Iowa plan is out (SSB 3116 & HSB 657).  The Governor will be holding a press conference on Wednesday at 10 a.m. to formally launch her plan. The bills cut income taxes immediately in 2021 and again in 2023 (going from nine tax brackets to four), expanding access to the childcare tax credits (changing eligibility from $45,000 annually to $90,000 annually), and increasing the sales tax by one cent to pay for water quality initiatives (the bill also changes the formula by reducing money going to trails and outdoor recreation and increasing the share going to farmers and the nutrient reduction strategy) and to add more state dollars to the regional MH/DS system. The bill eliminates sales taxes on feminine hygiene products and diapers (both adult and child). To pay for MH/DS services, it shifts costs from property taxes to the state. Counties would now levy $12.50 per capita for MH/DS services (currently they are between $25 and $47.28), which cuts property taxes by $77 million. The state would kick in $80 million (distributed per capita) for fiscal year 2021, $90 million for fiscal year 2022, and$95 million in fiscal year 2023. While the fund that will distribute these state dollars is separate from the general fund (so somewhat protected from raiding), no funds are appropriated in this bill (they will be in the budget...which has people worried that the cut will happen but the budget won't). A section by section analysis of the MH/DS portion of the bill is included here, and a full review of the bill is here.

• Children’s Mental Health Bills are also rolling out. There are a number of bills addressing access to services for kids in schools, including printing Your Life Iowa suicide hotline on school ID cards (SF 2081, which passed out of committee) and allowing students to have three (or more) excused absences due to mental illness (SF 2067). Another bill (SF 2100) passed out of an Education subcommittee last week; it allows schools to use telehealth to provide behavioral health screenings and services to kids in school. It is being amended to require insurers designate schools as a “site of service” so they can get reimbursed for the services, and Medicaid is required to cover. Schools and AEA would require existing patient-provider relationships before using telehealth with a student. Parental consent is required, and families could be included in the sessions if appropriate. Oddly, this seems to be in conflict with SF 2153, which passed out of committee and prohibits school districts from performing health screenings (including identifying kids in schools that may be at risk of a behavioral health issue) without written parental consent, unless the situation is emergent. Another set of bills (SF 2190, HSB 598) creates grants to AEAs for “therapeutic classrooms” to address the needs of students with serious behavior issues (by reinstating the $15 million reduction in AEA aid). These bills are quite controversial, as they also allow teachers and school personnel to “lay hands on” a child who is being disruptive, including kids that are passive-resistant (without liability and free from disciplinary procedures). The only criteria for the use of physical contact is that the child is "disrupting the learning of other students." Advocates for marginalized communities fear that this will be racialized and used disproportionately with minority and immigrant communities, and with kids who have a history of trauma or have disabilities (whether identified, diagnosed, or not).  The Senate has already voted their bill out of committee; the House has had one public hearing on the bill and will have another subcommittee next week. The House subcommittee includes Rep. Cecil Dolecheck (R-Ringgold), Rep. Joel Fry (R-Clarke), Rep. Tom Moore (R-Cass), Rep. Ras Smith (D-Black Hawk), and Rep. Molly Donahue (D-Linn). Sen. Amy Sinclair (R-Wayne) is the lead in the Senate.

• Speaking of Telehealth: The House Human Resources unanimously advanced HF 2192 earlier last week; it requires insurance companies to pay for services delivered via telehealth at the same level they reimburse if delivered in person (“payment parity”). Insurers don’t like it, but this is a Governor’s priority to address access barriers, particularly in rural Iowa. Legislators also believe this can bolster rural and critical access hospitals that are struggling. Broadband bills were also introduced and subcommittees have been set for next week (SSB 3112, HSB 638); these bills are receiving more attention this year from health groups who see broadband as essential to providing quality telehealth services in all areas of the state.

• Medicaid Managed Care: Don’t get your hopes up for major changes to managed care, but Sen. Dan Dawson (R-Pottawattamie) has a bill (SSB 3094) that would streamline prior authorization processes for both fee for service (FFS) and managed care (MCOs), require 24x7x365 resources availability for prior authorization requests, required use of single credentialing agency and uniform credentialing criteria for both FFS and MCOs. As the new chair of the Senate Commerce Committee, Sen. Dawson wants to address some of the biggest issues that have caused problems for his local providers. DHS and MCOs don’t like this, so it probably won’t make it out of the House, but may pass the Senate.

• Public Assistance Income Verification: Last year efforts to "catch" people misusing or fraudulently obtaining public assistance programs failed, but they are back at it this year despite reports of Iowa's very low rates of fraud and the high expense of the programs that would be designed to catch the few bad actors out there. The House Human Resources Committee killed its version of public assistance income verification (HSB 627, which impacts food assistance/SNAP, FIP, and Medicaid), but a Senate subcommittee approved and amended its more controversial version (SSB 3068). 

• Vaping Bills are out of committee. Subcommittees in both the House and Senate have approved bills that would move Iowa law into compliance with the newly signed federal legislation to increase the age for smoking and vaping from 18 to 21 (HSB 557, SSB 3016). A Senate subcommittee has approved another bill (SSB 3052) to add vaping to the smoke-free air act (the House has a subcommittee on Monday to discuss companion HSB 627). The bill to eliminate the casino exemption (HF 2143) isn’t going to move.