IPA Capitol Report

State Capitol Report

February 20, 2024

Today marks Session Day 44, almost halfway to the end of the 100-day scheduled session. Friday was a a major turning point in the session, when the first legislative funnel deadline hit. The funnels are procedural mechanisms employed by the Iowa Legislature to winnow away policy bills that are not showing forward progress. Policy bills that were not passed by their originating committee by the end of Friday were marked ineligible for further debate. In other words, they are dead. The next major hurdle comes on March 15, when policy bills will need to be voted out of a committee in the opposite chamber in order to survive. Bills dealing with taxes and spending are exempt from these deadlines.

Now that you know the technical explanation of the funnel week, here’s the practical explanation: about a week and half of pure insanity. To reach the funnel, legislators hold hundreds of subcommittees on bills, sometimes over a dozen at any given moment, scattered in every last corner of the Capitol building. As subcommittees pass bills, they go onto full committee meeting agendas that often exceeded 20 bills. This made for some long and contentious committee meetings as legislators tried to close out the week.

Second Funnel Preparation

The second funnel will arrive in four weeks (March 15), but it is typically less chaotic with fewer bills in play. By the second funnel deadline, policy bills will need to have been passed by committee in both chambers. In order to prepare for that, the House and Senate will spend the next two weeks debating bills in order to give the second chamber time to advance them through the subcommittee and committee process. Heavy debate days means your legislators will be at their desks a lot, so it's a great time to call or email them about bills that may be important to you.

Budget and Appropriations Work Starts

The end of the first funnel flurry of activity also signals the soft start of the tax and budget discussions between the chambers. We will soon see an early-March meeting notice for the Revenue Estimating Conference (REC), where the 3-person panel will update their December predictions about State revenues and expenditures. Between the December and March estimates, the Legislature will use the lower of the two estimates.

While the Legislature cannot officially begin assembling appropriations bills until after that REC meeting, behind-the-scenes discussions will begin immediately between the Governor and House and Senate leaders. Any tax bill or spending initiative will alter the overall budget picture, so they need to agree to some basic principles before they can start to move forward, even if it’s just to nail down an overall number for acceptable tax reductions or an overall spending target. Despite all three decision-making bodies being currently controlled by the same political party, there are always a fair amount of disagreements that need to be worked through. This is the same every year, no matter who is in charge.

Candidate Deadline Coming

The second funnel's arrival on March 15th will also mark an important political deadline – the final date for legislators to file their campaign paperwork for the upcoming elections. On this day, we’ll become aware of a number of legislative retirements as well as determining which candidates will have primary and/or general election opponents.

Funnel Survivors

HF 626 is the “non-medical switching” bill that bars insurance companies from switching a person to a lower cost drug if the person is stable and their health care professional wants to keep them on it.

HF 2112 requires HHS to verify public assistance eligibility for all self-identified non-citizens applying for public assistance and creates a crime of "smuggling" people.

HF 2210 prohibits hospitals from asking an applicant for clinical privileges about their mental health and substance use disorder history.

HF 2236 requires HHS to apply for a Medicaid waiver to cover individuals in jail or prison during the 90 days leading up to their release.

HF 2268 limits Medicaid retrospective claims reviews to 24 months (so recoupments would never go back further than that). This does not affect the current policy of ending recoupments if a provider received prior authorization or checked eligibility at the time of service. It only shortens the time period that they can review.

HF 2375 & HF 2512 are (respectively) the dietician and social worker licensure compacts.

HF 2389 has been dubbed the "Transgender Erasure Act," as it defines man and woman, female and male, in binary-only terms. The Governor sponsored this bill, which states that "separate accommodations are not inherently unequal" (someone needs to read Brown vs. Board of Education). The reproductive system you are born with will determine your gender, which is to be used for all government documents.

HF 2396 prohibits schools from disciplining employees, contractors, and other students for using a student's legal name or failing to use a preferred pronoun. The names and pronouns are already approved by a student's parents but this would stop the disciplining of anyone that did not comply with a parent's explicit instructions for their child.

HF 2427 is a bipartisan approach to spending opioid settlement funds. It creates an opioid epidemic response advisory council and allocates funding for the Attorney General's opioid addiction prevention surgery support program ($6.8 million), public safety survivor benefits ($150,000), YSS Ember youth substance use disorder treatment campus in Cambridge ($3 million).

HF 2486 requires health care licensing boards to allow a licensee to carry over up to 10 CEUs each year.

HF 2509 & SF 2354 are the Governor's bills to restructure the state’s regional behavioral health system and move regional disability services into the Aging and Disability Resource Center (ADRC) system. Instead of 13 mental health and disability services regions, the state will have seven behavioral health districts that manage funding for mental health, substance use, addiction, and tobacco prevention and treatment. The state would also expand the ADRC network to manage aging and disability services.

HSB 689 is the Governor's opioid settlement spending plan ($1.55 million for naloxone distribution and prevention/awareness activities, $650,000 for HHS for opioid syndromic surveillance and overdose mapping, $1 million for opioid prescribing prevention, $500,000 for substance use mobile crisis, $1 million for peer support in hospital ERs, $8 million for recovery provider infrastructure grants, $3 million for recovery housing grants, $3 million for YSS Ember youth recovery campus, and $1.5 million for scholarships to individuals in recovery.

HSB 710 & SF 2385 are not the same, but they both deal with the Governor’s recommended changes to boards and commissions. The House version eliminates nearly 50 boards and commissions but has taken out all changes that were controversial and merged professional licensing boards (it retains a separate Board of Psychology). The Senate version is more similar (but not identical) to the Governor's recommendation, and does still merge the Boards of Behavioral Sciences, Social Work, and Psychology into a single Board of Behavioral Health Professionals.

HSB 713 & SF 2386 are the revised versions of the Governor's AEA restructuring, but they are not identical. The Senate's version is much closer to the Governor's original bill, while the House version slows down changes significantly and employs a stakeholder task force to do a deeper dive into the current system.

SF 2096 ends gender balance on state boards and commissions.

SF 2195 requires insurers to pay for biomarker tests, which can help doctors diagnose diseases or conditions without more expensive and invasive procedures (and help get people the right medications).

SF 2251 extends postpartum Medicaid coverage to 12 months (from 60 days). The bill also lowers eligibility to 215% FPL for moms and 300% for infants (from 380%), which is why the Senate vote today was split (34-13). The bill will be attached to its House companion (HF 2583) on the House Calendar, which means it's fast-tracked and no longer subject to funnel deadlines.

SF 2286 is the "health care right of conscience," which allows a health care provider to refuse to provide service to a person if it conflicts with their moral or religious beliefs.

SF 2380 & HSB 697 make another round of election law changes. The bills end the use of early voting drop boxes, require absentee ballots be received by the county auditor by close of business on the day before Election Day (instead of before polls close on Election Day), move to an expensive three-envelope system for voting from home, require voters to put their voter verification number on one of the three envelopes, eliminate the postage paid return envelope, and allow only the voter to return an absentee ballot (current law allows family and household members to return a ballot). The bill also includes a division that lists only a narrow set of criteria for disqualifying someone from the ballot for national office (to avoid the Colorado situation banning former President Trump from the ballot).

SF 2381 is the "Patient's Right to Safe" Act, which requires all health care providers to establish and disclose their discounted cash price that they will accept for service. Health care providers are also to let people know about the cash price option at the time of scheduling. Psychologists would be considered health care providers.

SSB 3178 is the Senate's approach to spending opioid settlement funds. Instead of allocating funds for specific programs and purposes, it gives 75% to HHS and 25% to the Attorney General.

Funnel Week Fails

HF 24 implemented PSYPACT.
HF 50 required insurance coverage of eating disorders.
HF 2063 required mental health professionals in each school.
HF 2073 allowed schools to hire or have volunteer chaplains without restrictions.
HF 2082 removed gender identity as a protected class under Iowa Civil Rights law.
HF 2107 required schools to post mental health resources on their websites.
HF 2108 & HF 2205 would have ended HCBS waiver waiting lists.
HF 2195 would have made all HCBS waiver benefits the same as the ID waiver.
HF 2200 allowed most health care professionals to diagnose ID for Medicaid.
HF 2233 prohibited requiring CEUs for things not directly related to the profession.
HF 2296 allowed harm reduction vending machines.
HF 2342 gave an option to refer students caught vaping or in possession of alcohol or controlled substances to go to a rehabilitation or treatment program.
HSB 511 disclosed psychological testing materials to defense counsel.
HSB 690 added psychiatrists to the MH Professional Loan Repayment Program.
SF 2037 was an oddly written bill intended to sidestep state professional regulation and open up conversion therapy by unlicensed individuals under the guise of prohibiting local governments from regulating mental health professionals beyond traditional zoning.
SF 2055 expanded the school "bathroom bill" to all bathrooms.
SF 2107 required psychologists, social workers, and others to have at least three credit hours of graduate level classes in domestic violence and 2 CEUs every two years in domestic violence.
SF 2122 banned licensing boards from limiting prescribing scope if within a professional's scope of training.
SF 2208 required a physician to review opioid risks before prescribing.
SF 2289 banned conversion therapy.
SSB1045 defined occupational therapists as mental health professionals.