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State Capitol Report

March 13, 2023


This Week's Highlights


  • Senate may take up psychologist prescribing bill this week (HF 183).
  • The House directs Medicaid to set substance use disorder rates (HF 621).
  • The Senate passed the reorganization bill without significant changes.
  • No movement on mental health non-competes or loan repayment changes.
  • House passes bill to keep people stable on medications (HF 626).
  • MH/DS Region bill one Senate vote from going to Governor (HF 471).
  • Ban on gender-affirming medication and surgeries sent to Governor (SF 538).
  • House pulls "bathroom bill" from debate calendar, but may come up this week.
  • House introduces 12-month postpartum Medicaid expansion bill (HSB 226).


Post-Funnel Updates


Spring break is here!  Unless of course you are an Iowa legislator, lobbyist, or staff.  For those involved with the Legislature, this is simply the start of Week 10, and the 2023 session has now passed the halfway point. 


The last two Fridays were key in the Iowa legislative process.  Friday, March 6 was the first legislative deadline, called a “funnel.” While nearly 1,700 bills have been introduced during the 2023 legislative session, more than half are now dead, having failed to make it out of their originating committees before this first deadline.  


  • Click here for IPA-tracked bills still alive.. The list includes IPA's psychologist prescribing clean-up, ban on mental health non-competes, two approaches to the mental health loan repayment program, certificate of need changes that eliminate CMHCs from requirement, HHS board/commission changes, rural emergency hospital designation, public assistance eligibility hurdles, and a whole host of anti-LGBTQ+ bills.


Friday, March 10 was also a significant session date, the quarterly meeting of the Revenue Estimating Conference (REC). Iowa law permits the Legislature to expend 99% of state revenues collected. That's where the REC comes in; they estimate revenues four times a year to make sure the state doesn't overspend when budgeting.  Iowa law also requires legislators to base their budgets on the lesser of two estimates – December and March.  


The REC increased their March revenue projections for both the current fiscal year (FY2023 – up $135 million) and the upcoming fiscal year (FY2024 – up $25 million). Since the Legislature is required to build their budget using the lower of the December and March projections, legislative leadership will start setting their FY2024 budget targets based on the REC’s December numbers.  Few things to note:


  • Leaders have roughly $9.625 billion to work with as they set their overall budget target.  They’ll eventually divide that overall number up by the ten budgets (Administration/Regulation; Agriculture/Natural Resources; Economic Growth; Education; Health/Human Services; Infrastructure; Judiciary; Justice Systems; Standings; and Transportation).


  • While this overall spending cap is about $100 million less than was available last year, legislators have been underspending for the past several budget cycles to make room for tax cuts adopted over the past two legislative sessions.  So the reduction was anticipated.  


  • The Governor’s budget came in at $8.487 billion.  That’s almost $2 billion below the budget limit. On top of that, the state will have an $854 million surplus at the end of the current fiscal year.  You can look at the Governor’s individual budget requests here.


  • Legislators are waiting to begin detailed budget discussions until the reorganization bills pass.  They are planning to rework the budgets to match the newly redesigned government structure.


With the first legislative deadline in the rear-view mirror, legislators turned their attention to floor debate.  The House and Senate passed 46 bills this week, including several that were protested by groups that support the rights of LGBTQ+ Iowans. Legislators sent a bill to the Governor that bans any gender-affirming medication or surgeries for minors, even if parents approve of it. 


The Senate took the first step in reorganizing government by voting its bill out (SF 514) on a party line vote (34 Republicans voting for, 15 Democrats voting against).  Legislators removed the section that would have changed the number of votes needed to confirm Governor’s appointments to boards and commissions from 34 to 30.  However, all other amendments failed, including:


  • Sen. Wahls' amendment to add back the Board of Health.
  • Sen. Bisignano's amendment to leave the Commission for the Blind in charge of hiring the department director (not the Governor). This actually got two Republican votes (Sen. Zaun and Sen. Shipley).
  • Sen. Bennett's attempt to keep the Consumer Advocate independent.
  • Sen. Boulton's amendment to stop the Attorney General from overriding county attorney decisions.


Other notes from the past two weeks:


  • The Senate may bring up HF 183 this week, which cleans up the prescribing psychologist law to allow licensure of people who completed their training more than five years ago, allow them to be supervised by any physician (no longer board certified), and allow them to serve individuals whose primary care providers are ARNPs or PAs. If the Senate votes on the bill this week, it will be sent to the Governor for a signature.


  • The House passed Rep. Lohse's bill (HF 621) that requires Medicaid to set rates for intensive outpatient and residential substance use disorder (B3) services. The bill passed 96-0 and has not yet been assigned a Senate subcommittee.


  • No movement on Mental Health Non-Competes (HF 93). Sen. Julian Garrett, Sen. Sarah Trone Garriott, and Sen. Dave Rowley have been assigned to it and have said they will hold a subcommittee sometime in the next two weeks. The Senate does have a different view on how this should be constructed, so they may amend it to provide more detail about communications to address potential "poaching."


  • The House and Senate are still at a standstill with their opposing approaches to the mental health professional loan repayment program. The House bill (HF 151) has not moved since February 8, when it was voted out of a House Appropriations subcommittee. It changes the entire program, requiring a local match, opening it up to any Iowa community, giving preference to providers with at least 25% Medicaid payor mix, adding prescribing mental health professionals, and appropriating $1.5 million for the program. The Senate bill (SF 253) only makes changes requested by Iowa College Student Aid to allow payment at the end of the service year to avoid recoupment of funds if they fail to be eligible mid-year. That bill is on the Senate calendar, where it has been since early February.


  • The House unanimously passed the non-medical switching bill (HF 626), which bars insurers from discontinuing coverage or switching a person to a cheaper medication if they are stable on their current medication and their primary care provider opposes the change. The Senate Commerce Committee did not advance their bill, so the House bill will need to go through subcommittee and committee in the Senate by March 31.


  • The House also unanimously passed its MH/DS Region bill (HF 471), which gives providers a vote on regional governing boards and limits county supervisor participation to 49% of the board makeup. The bill requires a new regional core service (community-based competency restoration) but keeps the 5% fund balance requirement (since fund balances are currently sitting at $63 million).


  • The House Appropriations Committee introduced a bill to expand postpartum Medicaid coverage for 12 months (HSB 226). The bill appropriates $5.6 million next year, and $8.9 million the following year. Rep. Shannon Lundgren, Rep. Brent Siegrist, and Rep. Amy Nielsen are on the subcommittee. Because this bill is in Appropriations, it is not subject to funnel deadlines.


  • Legislators sent the ban on gender-affirming medication and surgeries for minors (SF 538) to the Governor last week, and it's clear she will sign the bill into law. It goes into effect upon enactment, but those currently receiving treatment have 180 days before their physician must end care. The bill also makes it illegal for a health care professional to "knowingly aid or abet" these services, which makes a provider liable if they refer a patient to another state. There were five Republicans who voted against the bill: Rep. Rep. Mike Bergan, Rep. Chad Ingels, Rep. Megan Jones, Rep. Brian Lohse, and Rep. Hans Wilz.


  • The House pulled the "school bathroom bill" (SF 482) from debate calendar last week after the Senate passed it on a party line vote. The House may vote on it this week. There are still several anti-LGBTQ+ bills still alive, including a requirement that teachers "out" kids who confide in them (HF 180), elimination of gender identity and sexual orientation in K-6 human growth and development curriculum (HF 348, SF 496), a new "age appropriate" definition for school library content that may not only eliminate sex education materials but also some of the classics (HF 597), protecting schools from lawsuits for refusing to use a student's preferred pronoun (HF 610), and eliminating required education on HIV, HPV, and availability of HPV vaccine (SF 496).


  • So far no action on the anti-DEI bill (HF 616). It would prohibit state universities from hiring diversity, equity, and inclusion staff or having any kind of DEI infrastructure, no matter how it is funded. The bill does not impact curricula. Another bill (HF 182) requires universities to report on an extensive list of terms used in coursework and course titles that gets to the same issue.


There were very few new bills introduced this week, and most were just renumbering bills that were voted out of committee.  The Bill Tracker is updated with these new numbers.  

Second Funnel Coming...


We are two weeks away from the second funnel week, which occurs in legislative week 12 (March 27-31).  By the end of that week, any policy bill will need to have been passed out of committee in the second chamber in order to stay alive for the year.  So House bills have to be voted out of Senate committees, and Senate bills out of House committees to stay alive. Exceptions from the funnel deadlines exist for bills from three committees:  Appropriations, Ways & Means, and Government Oversight.  

 

Look for more floor debate this week as the chambers try to move their priority bills across the rotunda to the other side.  Next week the focus will begin to shift away from floor debate and back to subcommittee and committee meetings as legislators try to move bills out of committee prior to the funnel deadline. 


Remember to join us at the Capitol for

IPA's Legislative Breakfast on Tuesday, March 21 (7:30-9:00 a.m.)

in the Legislative Dining Room (G15) at the State Capitol.


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