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State Capitol Report

May 12, 2023

Session Ends on May 4th

The Iowa Legislature adjourned for the year just after Noon on May 4th after passing a budget that spends only 89% of the state's estimated revenues, leaving more than $1 billion on the table (ostensibly for future tax cuts).


It wouldn't be a legislative session without some form of a tax cut on the table, and this year the target was property taxes. In the final days of session, lawmakers came to an agreement on what Senators are calling "Phase 1" of an effort to make property taxes more predictable and transparent. The final deal limits growth in taxable value to 2-3% each year, consolidates city levies, changes bond thresholds and dates, and requires more information be provided to property taxpayers. You can read a two-page summary of HF 718 here.


The budget for fiscal year 2024 reflects a small (3%) growth in state spending, but the infrastructure budget faced serious shortfalls for the first time in years as the gambling taxes that feeds it began to feel the effects of new border state gambling. Legislators warned those reliant upon this funding source (mostly Regents institutions) that next year will be much worse. Last year $300 million was budgeted for infrastructure project, and this budget only appropriates $180 million. In 2024, budget subcommittee chairs warn they expect only $120 million available.


There were no changes in funding for the psychological internship program and the mental health loan repayment program. Below are some budget highlights:


  • Increases Medicaid by a total of $33.5 million, which includes increases for mental health treatment rates ($10 million) and increase substance use disorder residential treatment rates ($3 million). It appears $7 million of the mental health increase will be earmarked for therapy and counseling provider types or codes, but the remaining $3 million has not yet been determined. (SF 561)


  • Increases funding for state's two remaining mental health institutes to have speciality programs (sex offenders at Cherokee, children at Independence) by $500,000, and adds $1 million for the Civil Commitment Unit for Sex Offenders to expand capacity. (SF 561)


  • HHS field staff and foster care social workers will see a bump in their salaries with a new $1.37 million appropriation. (SF 561)


  • Added $500,000 to the Office of Public Guardian to help clear backlogs. (SF 561)


  • $500,000 increase for the More Opportunities for Maternal Support (MOMS) program, but did not add a fatherhood component as recommended by the Governor. (SF 561)


  • Funds MH/DS regions as planned, with per capita rate moving to $40 (an increase $6,489,138, for total of $121,723,160). (SF 561)


  • A new $200,000 appropriation for the 2022-passed Language Equity and Acquisition for Deaf Kids (LEAD-K) initiative to make sure students who are deaf or hard of hearing enter Kindergarten with age-appropriate language skills (HF 161).


  • Slashes 1/3 of the funding for public transit infrastructure projects ($500,000 cut), which is the only state funds going to public transit. (SF 577)



You can read through the budget bills in the Bill Tracker, or see the nonpartisan legislative service staff reviews here. (Tip: use the most recent analysis until the one marked "final" is posted)

Non-Competes, Prescribing Psychologists, and More...

Legislators passed 64 bills in the final week of session, finally breaking the end-of-session policy gridlock that had formed. Here is a quick rundown of the good, the promising, and the disappointing (and sometimes downright ugly), but you can see the full list of what happened and didn't happen in the Bill Tracker.


THE GOOD


  • Non-compete clauses in mental health professional contracts are no longer legal or enforceable in Iowa, effective July 1. (HF 93)


  • Three barriers were removed to create a smoother path to practicing as a prescribing psychologist - supervision no longer must be with a physician that is board-certified, patients may have a non-physician primary care provider, and the requirement that a prescribing psychologist become licensed in Iowa within five years of graduating their program was removed (HF 183).


  • Other health professionals also saw changes in their licensing and scopes of practice this year: physical therapists can refer patients for diagnostic imaging (HF 174),non-nurse certified professional midwives will now be licensed (HF 265), the UI psychiatric residency program was expanded to include fellowships (HF 274), physician assistants no longer must be supervised by a physician (HF 424), and Iowa joined two licensing compacts - the Professional Counselors Licensure Compact for LMHCs and LMFTs (HF 671) and the dentist and dental hygienist compact (HF 656).


  • Middle & high school ID cards will include the suicide/crisis hotline and Your Life Iowa website on them (HF 602).


  • Health professionals (including psychologists) would be able to provide televised testimony at an involuntary commitment hearing for substance-related disorders or mental illness (HF 466).


  • Created "Rural Emergency Hospital" designation to preserve urgent care access in rural areas (SF 75).


  • Enacted tort reform for health care claims to cap non-economic "pain and suffering" damage awards (HF 161).


  • Authorized a new insurance premium tax on Medicaid MCOs to be used to match federal Medicaid funds before the base amount is returned to the MCOs (HF 685). The state would keep the expected $100-120 million in drawdown for Medicaid, which also happens to be about the same amount Medicaid expects they will have to invest annually into disability home and community based systems when the second US Department of Justice consent decree is released (per the Glenwood closure).


THE PROMISING


  • Expanded childcare assistance eligibility to 160% of the federal poverty level, but also increase the work requirement by four hours/week (to 32 hours). (HF 707)


  • Required HHS to work with the Iowa Health Information Network (IHIN) board to develop plans for program enhancements that will empower Iowans to access and direct their health information using the network, protect data privacy, facilitate data exchange to improve health outcomes, and increase provider participation. (SF 561)


  • Updated the newborn custody release procedures under Iowa's Safe Haven Act to allow release to a fire station through a "baby box" or at an adoption agency, increasing the number of locations a parent can surrender a newborn without risk of arrest. (SF 561)


  • Created a new Public Assistance Modernization Fund using $8 million from the Centene/Iowa Total Care settlement to help build a single-entry portal to help Iowans easily determine benefits for which they qualify and apply for them. Unfortunately it is also the portal that will be used to verify identity, run database checks, and enact the new household asset tests that were required in another bill that is listed more appropriately in the "disappointing" category. (SF 561)


  • Created a new Licensing & Regulation Fund for all professional licensing fees, including health professional licensing fees, and requires all boards to share staff (but retains the executive officers of the Boards of Nursing, Pharmacy, and Medicine). Legislators hope this helps make staffing across boards more uniform and keep costs for licensing down (SF 557).


  • Required school districts to adopt a policy on the removal of students that threaten or commit an act of violence, including an escalating set of disciplinary measures that start with mandated counseling and parental meetings and end with potential expulsion or removal to an alternative classroom (HF 604). This is hopeful because it started out with a three-strikes = expulsion approach, with no exemptions for kids with an IEP or 504 plan.


  • Required the judicial branch to adopt rules that prohibit a defendant from being physically present when a child is deposed, but there are some other things in the bill that are concerning to the Innocence Project (HF 644).


THE DISAPPOINTING


  • Shifted state tax dollars from public schools to private schools (HF 68); made the current list of topics to be covered by school health education courses optional and added CPR but took out references to AIDS, HPV, and the HPV vaccine (SF 391,SF 496); required students to use school bathrooms aligned with biological sex at birth (SF 482); bans all human growth and development curricula from mentioning gender identity and sexual orientation in elementary schools (SF 496); requires high school students to pass a high-stakes civics test and score higher than required to become a citizen (SF 496); requires schools to remove any book with a description of a sex act from a school library or classroom materials (SF 496); and restricted the ability of schools to survey students about conditions of learning without parental notification, which may impact the state's ability to do public health surveillance and learn more about the challenges students are facing outside the classroom, including substance use (SF 496).


  • Enacted new income verification processes on all public benefit programs (including Medicaid), and new household asset tests on food assistance (SNAP). An estimated 8,000 Iowans will lose Medicaid, 2,800 will lose SNAP, 600 children will lose insurance under the children's health insurance program, and 100 will lose Family Investment Program (FIP) benefits (SF 496).


  • Barred any health professional from providing gender-affirming care or transition procedures on minors, including helping those minors to find such care (SF 538).  Other bills that allowed health professionals to refuse care to someone based on their moral or religious beliefs failed to pass.


  • Weakened Iowa's child labor law, but moderated the bill before passing so only applied to 15-16 year olds (SF 542).


  • After fast-tracking a bill that one Senator called the first step toward allowing Iowans to carry guns anywhere without restriction, legislators killed a bill that would have allowed guns in cars on K-12 school and state university property, public parking lots, casinos, on snowmobiles, and more.  It would also have allowed people driving kids to school events to carry guns with the permission of the school. The bill died, but it will likely be resurrected in the 2024 session. The biggest cause of its 2023 demise: school insurance rates would skyrocket (if they could get insurance at all).


  • Failed to pass a bill banning universities from spending any funds (regardless of source) on diversity, equity, and inclusion (DEI) initiatives, but they did require the Regents universities to report back on all DEI activity and put a hiring freeze on any new DEI staff or contracts (SF 560).



  • Struck the meeting requirements for the Health Policy Oversight Committee, which is currently required to meet twice each year (SF 561).   


  • Required in-person attendance at the Iowa caucuses when Presidential preference is counted, but allows the political parties to set other rules (Republicans want to limit participation to those registered with the party 70 days prior to the caucus). (HF 716)


Despite a lot of discussion, legislators ultimately kicked the can down the road on certificate of need reforms, the carbon capture pipeline, Medicaid 12-month postpartum coverage, over-the-counter contraceptives, spending of the opioid settlement (waiting for AG to develop comprehensive plan for consideration in 2024), guardianship law updates, and the elimination and combining of several HHS boards and commissions.


IPA engaged in many other issues this year - including a study on the impact of student technology use on cognitive development (HF 248), PSYPACT (HF 24), eating disorder coverage (HF 50), occupational therapists being designated mental health professionals (SSB 1045), and all of the anti-LGBTQ+ and anti-diversity bills introduced this year.

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Click above to see status of important bills, or create your own report with our custom download.

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Your Legislative Team:

Amy Campbell | amy@ialobby.com | 515.554.5838

Craig Patterson | craig@ialobby.com | 515.554.7920

The Advocacy Cooperative | www.ialobby.com

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