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State Capitol Report

February 13, 2023


This Week's Highlights


  • House passed prescribing psychologist updates 95-0; ready for Senate debate.
  • Senate officially tables OTs as mental health professionals bill.
  • House kills PSYPACT while Senate introduces a companion.
  • Tort Reform has passed; the Governor will sign it on Thursday in Fort Dodge.
  • Mental health provider loan repayment changes out in both House & Senate.
  • House committee adds two psychiatric fellowships to residency programs.
  • Senate begins hearings on Governor's 1,500+ reorganization bill.
  • DHHS presents their initial findings on MH/DS regions and Medicaid rates.


Legislative leaders are keeping up the pace of session by checking things off their session "to do" lists, marking off the Governor's priority bills one by one.


School choice and school funding bills are now signed into law.  This week legislators finally ended a decades-long effort to limit jury awards in medical malpractice suits. The final Tort Reform package caps non-economic damages at $2 million for hospitals and $1 million for clinics, and establishes a task force to look at medical errors and options to prevent.


The bill passed the House 54-46 with 11 Republicans (Andrews, Cisneros, Dieken, Gerhold, Hayes, Jones, Lohse, Osmundson, Sherman, Shipley, Stoltenberg) voting with Democrats against the bill. Representative Croken voted with Republicans for the bill. The Senate approved the bill on a 29-20 vote, with Senators Alons, Lofgren, Salmon, Jeff Taylor and Westrich voting with Democrats against the bill. 


With work done on that, legislators will turn to the next item on their list, reorganizing state government. Senators have already held one meeting and held its second meeting today at 11 a.m. The final section of the bill (dealing with the HHS sections) will be discussed in a future meting. The Governor is rumored to have asked legislators for no amendments, but there are several areas stirring up controversy (state takeover of community based corrections, allowing attorney general to trump any county attorney decision, eliminating independence of state fire marshal, plus changes that eliminate the child advocacy board and make the Department for the Blind less autonomous).



The House unanimously passed updates to the prescribing psychologist law adopted in 2014, a top IPA priority in 2023. House File 183 and its companion Senate File 133 are now on the Senate calendar, ready for final debate. It is also safe from all deadlines, and is one vote away from being sent to the Governor. The bills address three barriers to the training of prescribing psychologists: 1) no longer requires a person to have graduated their program within five years of licensure; 2) no longer requires supervised practicum to be under a board-certified physician (just must be an Iowa-licensed physician); and 3) recognizes a person's primary care provider may be a PA or ARNP (prescribing psychologists are directed to coordinate care with a person's primary care provider whether they are a physician, PA or ARNP).


A Senate subcommittee announced this week it would officially table the bill that identifies occupational therapists as "mental health professionals" and the House has tabled the PSYPACT bill (but the Senate has introduced another one, Senate File 244).


Other news of interest this week:


  • The House has unanimously passed a bill (House File 93) to prohibit the use of non-compete contracts for mental health professionals (including psychologists). The bill is now in the Senate HHS Committee assigned to a subcommittee of Sen. Julian Garrett, Sen. Dave Rowley, and Sen. Sarah Trone Garriott. The Senate's bill addressing this issue (Senate Study Bill 1106) will not move; the House version will be the main vehicle for this discussion. The House bill does not allow any contracts that limit where a mental health professional can practice (location), or impose a time period, or limit ability to contact patients.


  • Mental health provider loan repayment changes out in both House & Senate. House File 244 and Senate File 253 are both out on their respective chamber calendars, ready for debate. They allow annual payments to be made at the end of the service year, thus avoiding having to recoup funds already paid for a partial year of service. Since they are both out of committee on each side, they are actually now funnel-proof and safe from both March 3 and final March 31 deadlines.


  • Continuing on the theme to expand access to services, the House HHS Committee approved House File 274 to expand the University of Iowa's psychiatric residency program to add two new fellowships. The Senate version of the bill (Senate Study Bill 1104) has been voted out of subcommittee, but has not yet been brought up for a full committee vote.


  • A House subcommittee gave its initial (and unanimous) approval to allowing more independence for physicians assistants this week. House Study Bill 115 allows a PA to practice without supervision, as long as they have a collaborative practice agreement in place with a physician. The Senate State Government has a bill (Senate Study Bill 1142) that simply eliminates supervision, and allows PAs to practice independently. The bill has not yet been scheduled for a subcommittee. One of these bills will need to make it out of committee in the next three weeks to continue to be considered.


  • No movement on the bill that would require insurance coverage for eating disorders, but there is still time. The Bill (House File 50) was sponsored by a majority party member (Rep. Megan Jones) and was assigned to House Commerce Committee, but it has not yet been assigned a three-person subcommittee (not a good sign).


  • The Senate Education Committee has advanced a bill (Senate File 248) that creates a task force to study the impact of the use of technology in schools on children's cognitive functioning. Legislators sent a clear message during hearings that psychologists need to be on this task force, not just educators.


  • There is no shortage of bad anti-LGBTQ+ bills, particularly related to gender identity and parental rights, under the guise of "transparency." IPA is closely monitoring these and encourages members to get involved in these bills. You can find them in the Bill Tracker, which will list who is on the subcommittees and the committees where they are assigned.


You can find updates to these bills and other bills introduced daily in the 

IPA Bill Tracker.

MH/DS Regions, Medicaid Rates Discussed

The Iowa Department of Health and Human Services (HHS) reviewed a report on the state’s regional mental health and disability services (MH/DS) system during a House Health and Human Services Committee meeting last week. Marissa Eyanson, Behavioral Health Division Director, said the report found the regional system “lacks consistency everywhere we turn.”   The report found that:


  • Core services are not available in every region.  According to Marissa Eyanson, workforce challenges and COVID does not fully explain this gap.


  • Not all regions cover justice-involved services, and there is no consistent model and measuring success is not uniform. Justice involved services target people who may encounter police, jail, or court system.


  • Community-based competency restoration is not clearly a responsibility of the regions. If regions were required to pay for this justice-involved service, it would help with the backlog of people waiting for a spot at one of the state’s mental health institutions or individuals who are stuck in a hospital.


  • There no common understanding of crisis services, the way regions do crisis services is different, and there is a need for more regional investment in these services.  Eyanson noted that these services are eligible for an enhanced Medicaid match, so HHS expected them to be more widely available.


Eyanson added that the report highlights some opportunities to address these issues:


  • Better define services.
  • Focus on statewide goals, while delegating to the regions.
  • Make eligibility criteria statewide (not region to region).
  • Make regional administration more consistent.
  • Look for ways to integrate regional (county) and state data.
  • Move regions under HHS (in law they are still under counties).
  • Allow regions to maintain 10% fund balance (now only 5%).
  • Add community competency restoration to the list of mandated regional services.
  • Update regional governing board membership, so there are more stakeholders (report recommends no more than 49% of the board being elected officials).


Liz Matney, Medicaid Division Director, gave committee members an update on the department's progress in reviewing Medicaid provider rates. Mental health and substance use disorder providers are the farthest behind other states, and have not received rate increases for many years. Other things she noted:


  • Nursing homes have received the most increases.
  • HCBS providers got less than half of nursing home increases. 
  • Home health has had regular rate adjustments.
  • Over the last eleven years, increases totalled:
  • $74.9 million for nursing homes
  • $29.5 million for HCBS providers
  • $10.3 million for home health
  • $4.5 million for all Medicaid providers
  • $3 million for hospitals
  • $2 million in other miscellaneous increases


The rate review report will be available sometime in mid-February. Matney said she hopes to provide recommendations to legislators on investments in provider rates, and try to find a way to bring rates more in line with neighboring states. Matney said they would like to be in a position to present a new rate package each year, based in data collected by this and future studies.

MH/DS Regions Report
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