2020 Legislative Update | Issue #1 | January 24, 2020
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Welcome Back to Session
The Iowa Legislature came back into session on January 13 and is off to a fast start. Already days are filled with subcommittee meetings, which probably means leaders will be trying hard to make the most of the 100 days that make up the 2020 legislative session. There are already some significant issues popping up that we need to put on your radar. First thing first; you are all busy so our biweekly reports to you will be much more brief and focused on our top priorities and practice issues, which unfortunately will be big this year.
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Scope & Licensure Issues Emerge
Governor Reynolds told lawmakers in her Condition of the State speech that Iowa’s licensure laws are barriers to attracting a skilled workforce:
"One quarter of Iowa’s workforce requires some kind of professional license. If that sounds like a lot, that’s because it is. It’s the second highest in the nation, which puts our state and its people at a competitive disadvantage. A recent study shows that our licensing system cost Iowa 48,000 jobs and $290 million. Our licensing requirements are also the worst for low-income people, meaning that those who need opportunity the most have the hardest time getting a license.We should never dismiss the importance of protecting the health and safety of the people, but it’s been far too long since we’ve modernized our licensing structure. That’s what I’m asking you to do today.
First, we need to adopt universal licensing recognition. Those who go through a rigorous application process in another state, and meet certain conditions in our state, should be able to have that license recognized here.
Let’s encourage these skilled workers to move to Iowa. Second, we should waive license fees for low-income individuals. That doesn’t mean we lower any standards. It just ensures that we don’t deny someone a professional license simply because of their inability to pay."
Already there are several bills that would infringe on psychologist scope of practice, including the introduction of Psypact legislation two days ago (
House File 2094
).
It is our understanding the bill came from the Council of State Governments, but it already has powerful conservative supporters that have signed on, primarily Americans for Prosperity (Koch Brothers). You Advocacy Chairs are on top of this and communicating with legislators serving on the subcommittee, and your lobbyists will be following up on thise conversations at the Capitol. It is likely that a subcommittee meeting will be called soon, so watch your inboxes for action alerts. For those unfamiliar with Psypact and this legislation, it would allow psychologists licensed in states with looser standards to provide psychology services in Iowa via telehealth. It’s more than an interstate compact providing licensure reciprocity with state that have like-licensure requirements; it allows unqualified (by Iowa standards) providers to deliver services to Iowa patients without Board of Pharmacy regulation. This is very dangerous legislation, and we’ll be acting quickly to kill this bill, but may need everyone’s help to do so.
As if that isn’t enough, there is a pharmacy bill (
HF2094
) that was introduced and
could open the door for pharmacists to manage a patient’s mental health conditions and medications without additional training through expanded collaborative practice arrangements.
While the intent of was to allow ARNPs and other prescribers the opportunity to enter into collaborative practice agreements as physicians are not permitted to do, the way the bill is written opens the door to an expanded scope for pharmacists. The Board of Pharmacy introduced another bill (
House Study Bill 533
) that does a number of things, including allowing these collaborative practice agreements without an expansion of scope.
Music therapists
are want the state to adopt professional standards as a step toward their own licensure (
House File 419
) and
clinical art therapists
would like their own licensure and be added to the list of health professions in order for reimbursement (
Senate File 2021
). Others are facing these scope and practice issues as well.
Licensed Masters Social Workers (LMSW)
are currently supervised by Licensed Independent Social Workers (LISWs);
House File 2008
would allow any mental health professional to supervise them (although that would only be for reimbursement and provision of services, and would not count as supervision in their path to LISW).
Another bill would
prohibit a state agency from putting more restrictions on a health care profession
than is placed on the profession by its own licensure board (
House File 2011
). So under this legislation, Medicaid would not be able to require psychologists have additional certification and licensure to practice and receive funding if the Board of Psychology doesn’t require it for licensure. Obviously, that would not apply to federal requirements, but could help keep other agencies from establishing more restrictive requirements.
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Telehealth Payment Parity Introduced
The Governor expressed strong support for expansion of telehealth services, and put $5 million more into the Medicaid budget to achieve payment parity between in-person and telehealth visits. Hand in hand with this, she continues to support the state’s broadband initiative to make sure all areas of the state have the infrastructure available needed for these services. Rep. Joel Fry (an LISW by trade) has introduced
House File 2001
to require all insurance plans, private and public, to pay equally for telehealth services. It does not mention Iowa licensure, so current board regulations governing licensure would apply.
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Budget Proposal Outlined
Governor Reynold’s recommended raising the state’s sales tax by a penny to pay for water quality and quality of life initiatives, income tax cuts, property tax cuts, and regional mental health and disability services. The Governor would cut MH/DS property taxes by $77 million and replace those funds with $80 million state appropriation. Essentially, county MH/DS levies would be reduced to $12.50 per capita (they are now between $25 and $47.28 per capita). That would generate $40 million, for a total of $120 million to fund the system. Regions are still crunching the numbers but it doesn’t look like that will be enough money to pay for the new complex needs services and children’s mental heath services authorized over the past two years.
As a refresher, the Legislature and Governor added 27 new services to the regional system without any additional dollars. It doesn’t look like $ 3 million in new funds will do the job, even with a planned increase to $90 million in FY22 and $95 million in FY23. More to come on this. The Governor also proposed an additional $900,000 (total $3 million) to train teachers to recognize the signs of mental illness in a child and understand how to properly respond, and added a little over $6 million to Medicaid to improve substance use disorder provider outpatient and residential rates.
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Public Assistance Income Verification Back Again
Legislators have dumped their efforts to adopt work requirements for Medicaid and other public assistance programs, and instead are going to support (and will likely pass) a bill that will require the state to contract with a private company to verify income of all people receiving public assistance.
House File 2030
would check several databases quarterly to ensure people are still eligible for the assistance they receive, and it would apply to SNAP (food assistance), Medicaid, childcare, and Family Investment Program. Those that are flagged would have to send in a bunch of paperwork to prove they are still eligible. Opponents to this last year had good stats that showed most states spent far more to “reduce fraud” than what they saved in kicking people off the assistance.
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Other Bills (and there are a lot)
There are lots of other bills that you might be interested in depending on your area of practice. The IPA Bill Tracker is updated daily with new bills - check back frequently in these early days at
www.ialobby.com/billtracker/ipa/
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Your Bill Tracker
Click above to see status of important bills, or create your own report with our custom download.
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Town Halls & Public Forums
Find a local event with your state or federal elected officials here. Three weeks are shown at a time on this website.
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Your Legislative Team:
Your Advocacy Toolkit:
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