IPA Capitol Report

2019 Legislative Update | Issue #6 | April 18, 2019

Legislators Ready to End Session

While Iowans get a taste of spring fever, legislators are getting shutdown fever. It’s clear they are ready to be done with the session and are starting to throw bills over the side as they lighten their debate calendar loads to make space for the heavier lift budget and tax bills. This is the time of year if a bill gets too tough, too complicated, or takes too much time to educate members, it gets put on the “next year” pile.

It’s also the time of year when you get surprised on a daily basis. When legislators (and lobbyists) get bored, they start thinking of ways to resurrect dead policy issues. It’s a time of high paranoia, where every bill and amendment are heavily scrutinized and even technical corrective changes become larger than life.

Take the “non-con” annual bill that makes adjustments to the controlled substances schedules. But a House amendment to the bill took the “non” out of “non-con,” when it left cough syrup with codeine (one of the most abused substances nationally, according to pharmacist and Representative John Forbes), nerve pain medication like Lyrica, and Epidiolex (CBD oil) off the prescription monitoring program. With the passage of that amendment, Schedule Vs will remain off the PMP.

With the official end of the Iowa legislative session coming up on May 3, it’s clear that leaders are lining things up to end session sometime in the next ten days. Legislative leaders have said privately that they want to end next weekend (April 26-28). However, experience tells us that it takes time for the paper (amendments, bills, fiscal summaries) to catch up. Every amendment and bill goes through an extensive editing process, where bill drafters and proof readers review it to make sure errors do not end up in Iowa lawbooks. Then comes the inevitable caucuses, where party members work out their messaging. That’s why it is more likely sine die (the official term for the end of session, roughly translated as without another day ) will happen closer to April 30-May 1.

Leaders Agree to Spending Plan

There are two signs that the end of session is near:

Legislative leaders agree on a joint spending plan (done - April 18)
The last bill of the year is introduced - the Standings Bill (done – April 18).

While budgets are moving through the process, the House and Senate were operating off different budget targets. Now that legislative leaders have agreed to a joint spending plan, the House and Senate budget subcommittee chairs can begin to negotiate a deal for their area of the budget and reconcile their differences. They started those meetings last night (April 18).

You can see the differences between the current year, the Senate’s plan, the House plan, and the joint target they have been given. You can also get the PDF here .

We don’t know what is in the Senate version of the Health/Human Services budget, but we'll let you know when it comes out. The subcommittee will meet on Monday (April 22) at 10 am to discuss the Senate version, so we’ll report on the differences later that day. We do believe they will try to add in language making pregnant women who have legal protected resident status eligible for Medicaid (which was a priority of Sen. Miller-Meeks).

The Senate spends less than the House and may have different policy language included in the bill. As a reminder, the House-passed budget ( HF 766 ) includes the following:

Extra money for Medicaid this year ($150.3 million) but only carries forward about $94 million of that amount into next year.
Eliminates the children's mental health waiver waiting list ($1.2 million).
Improves Medicaid rates for Assertive Community Treatment (ACT) teams ($1.1 million).
Adds $1.5 million to return Critical Access Hospitals to cost based reimbursement.
No change in psychologist reimbursement.

Requires the Legislature be notified within 30 days of an MCO contract change, and requires an expedited claims and dispute resolution process be implemented for MCOs exiting Iowa.

Requires MCOs and DHS develop and use a uniform prior authorization form and process by October 1, 2019. DHS is also to look into the development of a single electronic portal for submitting prior authorizations.

Begins the process of having all pass-through funds going to organizations via an Iowa Department of Public Health appropriation to compete in an RFP process. Originally the bill had most contracts (including IPA's psychologist internship program) competitively bid. That language was changed back to a direct appropriation for the psychologist internship program ($48,000) but no change in the location where the internships are allowed. We are not hopeful that the Senate will change this to allow IPA to place interns in urban locations that serve underserved populations, like seniors, adolescents, and children. It was a big fight to just get us back to where we were.

Other IDPH changes of note:
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.
Eliminates travel reimbursement for public members serving on public health boards, and requires a teleconference option.
Requires the Departments of Public Health and Human Services to work on a five-year plan to better coordinate and streamline substance use disorder and mental health treatment programs.
Repurposes $191,00 used for direct care workforce initiatives, instead using it for broader "health care and public health workforce initiatives."
Expands access to psychiatric services with four new rural psychiatric residencies ($400,000) and psychiatric training for PAs and ARNPs ($150,000).
Requires IDPH Director to appoint the executive directors of the Boards of Nursing, Medicine, Dentistry, and Pharmacy (instead of their own boards).

Other changes of note:
Allows the Polk County MH/DS region to use other funds to cover shortfalls in those services.
Adds $212,000 for substance use treatment at Eldora Training School.

The House version of the Education Budget includes a 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. It also includes $300,000 increase for the Rural Primary Care Loan Repayment Program and an increase of $50,000 for the Health Care Provider Loan Program. These new line items are not currently included in the Senate version.

You can read updated staff reviews of each budget here . J ust make sure you look at the most recent version for each budget subcommittee (there is usually at least two - one for the House, and one for the Senate, but may be additional ones for each step in the process).

Updates on Other Priorities

The IPA Bill Tracker is updated at least once daily – book mark it to watch how your priorities are progressing. Just a few things to note from the last two weeks.

There are several bills that have been signed or sent to the Governor:

HF 606 - Bans Social Work Board from limiting number of CEUs that can be taken online.
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 623 - Ends prior authorization for medication assisted treatment (MAT) by requiring Medicaid have one PA-free option in five categories.
HF423 - Suspends Medicaid for anyone incarcerated, so it can be immediately reinstated.
SF 304 - Prohibits suspending/revoking professional licensure for student loan default (signed).

There are a few bills that could still make it to the Governor’s desk this year, but are stuck right now:

HF 642- Allows DHS to release confidential information to multidisciplinary teams if the focus is to identify services for children who are victims of, and children at risk of becoming victims of, human trafficking.
HF 732 - Expands uses of medical CBD oil, and allows PAs and ARNPs to authorize use.
SF 167 - Makes mental health professionals eligible for Health Care Loan Repayment Program.

The CBD bill noted above became very controversial after the CBD board sent a note to legislators expressing concern that the bill went far beyond their recommendations, authorizing 20 grams of THC every 90 days (vs. their recommendation of 4.5 grams per 90 day periods with per dose cap of 3% THC still in effect). With that, it's unclear whether the bill will advance this year. Bills that would address youth vaping are unlikely to pass this year, and a massive property tax rewrite is gaining momentum but unlikely to pass both chambers in the final days of session. Stay tuned for updates if something significant comes up in these final days.

Final Notes

This will be our last biweekly report before the end of session. Our next issue will report on what passed, what didn’t, what was funded, and what wasn’t.