2019 Legislative Update | Issue #5 | April 7, 2019
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Friday marked the final legislative deadline for the 2019 session. By the end of the week, all policy bills had to have been passed by committee in both the House and Senate in order to stay alive. As a result, a lot of bills died this week, however parts of them could be resurrected by being tucked into other bills in the weeks ahead. The process requires advocates to be vigilant uil the very end of the session. With the second funnel passed, the policy committees have essentially completed their work for 2019.
Bills under the jurisdiction of three committees – Government Oversight, Appropriations, and Ways & Means – are exempt from the funnel deadlines. Usually their bills do not usually get much attention until the funnel deadlines pass, since those committees typically pause their activity for the funnels. This year, not so! All three met this week to pass bills, including multiple appropriations bill being voted out of committee in both chambers. Several budget bills even saw floor debate, very unusual for deadline week and likely an indication that the House and Senate want to wrap up work earlier than the May 3 session deadline (the "110th day" that legislators are paid a per diem for their work).
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Funnel Survivors
The second funnel killed a lot of policy bills, which may find ways to be resurrected in other bills before the clock runs out. Bills that survived the funnel include things like sports betting, fantasy sport legalization, medical cannabidiol expansion, property tax reform, judicial nominating reform, addressing absentee ballot tracking to avoid future situations like the ballots not counted in a close NE Iowa election, fees on new solar power, property tax reforms, penny extension for schools, hand free driving only, gun rights constitutional amendment, and more.
High profile issues that didn't make the cut this year, and were casualties of the second funnel include allowing employees to have guns at work/courthouses/school parking lots, giving legal protected residents Medicaid coverage while they are pregnant, needle exchange legalization, death penalty, the constitutional amendment stating Iowans do not have the right to an abortion, Medicaid work requirements, traffic camera bans, felon voting rights restoration, eliminating a requirement that schools collect student health screening information, r
eligious freedom legislation, mandates that employers participate in the federal E-Verify system, end to criminal statute of limitations for child sex abuse, and legislation to allow p
ublic money to be used for school choice.
Here are some of the bills we're tracking for IPA that survived:
- HF423 - Suspends Medicaid for anyone incarcerated, so it can be immediately reinstated.
- HF 642 - Allows release confidential info to a multidisciplinary team in human trafficking cases.
- HF 690 - Governor's children's mental health bill
- HF 691 - Allows MH/DS region counties to keep an ending fund balance up to 40% until 2023.
- HF 731 - Creates uniformity in child and dependent adult mandatory reporter training.
- HF 732 - Expands uses of medical CBD oil, and allows PAs and ARNPs to authorize use.
- SF 304 - Prohibits suspending/revoking professional licensure for non-payment of student loans.
- SF 329 - Fixes bad case law that has been disallowing expert testimony in child abuse cases.
- SSB 1185 - Makes income earned caring for those with disabilities state tax free.
Some things you can wipe off the list (are ineligible for debate for the rest of this year) include:
- All things Medicaid managed care.
- Music therapist recognition & professional standards
- Elimination of IDPH and DHS "unnecessary" boards (including Patient Centered Health Care).
- Legalization of needle exchange programs ("harm reduction").
- Prohibitions against requiring a person to switch to a health plan that doesn't cover their Rx/Tx.
- Use of hyperbaric oxygen to treat veteran PTSD.
- Review of all state boards and commissions, and automatic sunset of those deemed unnecessary.
- Medicaid work requirements, community engagement mandates, or real-time verification.
Speaking of real-time: You can see near real-time status of the issues we're tracking for you in your
Bill Tracker. We update that with changes in status and bill descriptions as they are amended and passed by the Legislature. So bookmark it and check whenever you wonder how things are going (or not going!).
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Budget Update
Ten of the eleven appropriation bills that need to pass before the end of the session are now on paper in one of the chambers. That doesn’t mean the two chambers agree yet on the exact language in those ten bills. However, having all but one of them out for discussion before the end of the first week of April is definitely a signal that Legislature could adjourn early. That's important because bills get thrown aside quickly when a budget agreement is reached, so fast action is needed on any policy bills still out there. The longer they linger on the debate calendar, the tougher it is for final action.
The House and Senate are each scheduled to debate budget bills early this next week, and it is not impossible to think that each of those first ten budget bills could have been approved by one chamber by the end of the week. Rep. Joel Fry is currently working on an amendment to the Health and Human Services Budget (now
HF 766), but it is not an "agreed to" budget yet and we anticipate the Senate will put its own twist on the largest of the ten budget bills. We have heard debate on this budget, which includes funding for aging programs and Medicaid, will be on Wednesday or Thursday.
It is important to note that HF 766 ends all sole-source contracts that were included in previous appropriations to the Iowa Department of Public Health, including IPA's psychological internship program. In previous years, our $48,000 appropriation was allocated directly to IPA. There were at least 12 of these types of direct-source contracts; the House HHS Budget instructs the state to RFP these funds out. Practically, IDPH would not be able to do that, so I expect language to be changed.
Please know that we have met with the appropriations leaders and requested a change in the language to both return to a sole-source contract with IDPH (although that may not be possible as they want the policy to affect all, but may phase in the awards), or at least respect the timeline for internships when considering timing for an RFP. We also asked for language to be more flexible to allow interns serving underserved populations as well as counties designated as underserved areas. This is the language we supplied = please encourage your legislators to support this change:
- Amend HF 766, page 9, line 35 through page 10, line 9, as follows: b. Of the funds appropriated in this subsection, $48,000 shall be used
for to continue a program to rotate intern psychologists in placements in urban and rural mental health professional shortage areas, or in placements that serve underserved populations, including but not limited to individuals receiving Medicaid or Medicare services, children, adolescents, or geriatric populations. For the purposes of this paragraph “b,”“mental health professional shortage areas” means geographic areas in this state that have been designated by the United States department of health and human services, health resources and services administration, bureau of health professionals, as having a shortage of mental health professionals.
Here are a few other highlights from the House version of the HHS Budget:
- Spends total of $1.94 billion, which is $30.2 million less than the current year.
- Includes $150.3 million in supplemental spending for the current year (mostly Medicaid).
- Annualizes all but $56 million of the mid-year increase to Medicaid.
- Adds $1.2 million to eliminate the children's mental health waiver waiting list.
- Adds $1.1 million to increase rates to Assertive Community Treatment (ACT) teams.
- Adds $1.5 million to return Critical Access Hospitals to cost based reimbursement.
- Increase $306,000 to IDPH to expand YourLifeIowa to add 24x7 children's MH hotline/info.
- Eliminates funding ($225k) for IDPH patient-centered health advisory council.
- Changes the $191,000 that was designated to the Iowa Caregivers Association to funding for "health care and public health workforce initiatives."
- Requires DHS to notify the HHS Budget sub and staff within 30 days of an MCO contract change.
- $400,000 for four new rural psychiatric residencies.
- $150,000 for psychiatric training for PAs and ARNPs.
- Requires IDPH and DHS to develop a plan to transfer the IDPH substance abuse bureau to DHS.
- Requires IDPH Director to appoint the executive directors of the Boards of Nursing, Medicine, Dentistry, and Pharmacy (instead of their own boards).
In addition, the Education budget (
HF 758), which has already passed the Iowa House, includes:
- New $3 million appropriation for school-based children's mental health training and support, of which $1.4 million is for AEAs to develop "range of approaches to best meet the MH needs of students and strengthen community supports" and $200,000 for AEA clearinghouse of MH resources for schools and community providers.
- $300,000 increase for the Rural Primary Care Loan Repayment Program.
- No change in Health Care Provider Loan Program (SF 167 expands to cover MH professionals).
The eleventh and final appropriations bill, the Standing Appropriations bill, is traditionally one of the final bills of session and often carries with it a number of policy provisions that were unable to find approval during the legislative session. We do not expect to see Standings for a couple more weeks. Lobbyists call it "the last train out of the station."
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Property Tax Reform
Legislative leaders in both chambers claim to be committed to finding some common ground on property tax reform yet this session. The outcry of Iowans receiving letters from their county assessors over the last week has definitely solidified that position. Many Iowans from all corners of that State are complaining to legislators about their property taxes going up, in some cases 10-15%, while their local government did nothing to raise or lower their tax levy.
The key factor for legislators on whether they can address this issue yet this year will be time. From the progress made on appropriations, it is clear that a number of legislators are serious about completing their work soon for the year. Property tax will take some time - to discuss, to analyze, to negotiate within the caucuses in order to secure the votes. None of that process can start without a bill.
Currently, the only property tax reform bill officially out for discussion is
HSB 165, a highly controversial bill that caps all growth of levies at 2% (but would allow a reverse referendum if exceeded), and it limits unassigned ending fund balances at 25%, which could hurt local governments’ credit ratings and ability to respond to disasters. It's currently in the House Ways & Means Committee, and has been the subject of several subcommittee meetings.
We know the Senate is also working on a property tax bill, one which we have heard would focus largely on transparency and ensuring that taxpayers had more information about
why their tax bills are rising. The Senate may opt, however, to simply continue working with the House behind the scenes in order to perfect HSB 165 into a bill that can gain the support of both chambers and the Governor. Or they may decide to work over the summer when they have more time (and fewer lobbyists bothering them on a daily basis). They then could come back with a bi-chamber proposal to pass in an election year.
At this point, it is worth noting to keep an eye out in this discussion for efforts to eliminate the property tax backfill. We know that a number of legislators have been eyeing it, either to pay for mental health reform or to offset part of the property tax reform bill. The backfill is about $150 million in total, and would create enough revenue to help in either of those causes. We are watching this closely.
The best thing advocates that depend on any level of city or county services can do right now is to just be vocal with your legislators about city and county government and the services you (or the people. you serve) rely on locally.
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Final Notes
Never forget that there are variables in the process that can stir up legislators on an issue. A recent example: While the Legislature did not advance a number of bills relating to Medicaid, a recent announcement that the State is ending their relationship with one of the Managed Care Organization companies (United Health Care) could re-ignite that discussion. Iowa Total Care is about to enter the managed care system, but it's been rumored to be behind in its network adequacy. With the departure of UHC, the uncertainty about the readiness of ITC, and the unknown about AmeriGroup's willingness to absorb large groups of new members, there could be legislation to slow down the transition, pull out the LTSS population, or deem all providers a member of MCO networks until there is more time for contract negotiations. Right now - legislators are very, very quiet about this (almost too quiet). Don't be surprised if something pops up in these final weeks.
Publication Note - And speaking of "these final weeks," it is appropriate for us to note that this publication, which typically comes out every two weeks during session, will
not be published two weeks
if it looks like the Legislature could adjourn in the near future. If that is the case, we will instead wait and publish
after they adjourn for the year (or we'll send out an abbreviated report). In the meantime, keep an eye out for timely alerts requesting you to take action.
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Pioneer Lawmaker Ceremony In The House Chamber on March 27, 2019
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