IPA Legislative News

July 5, 2022

2022 Legislative News

2022 Iowa Legislative Session Review

Iowa's legislative session finally ended just after midnight on Wednesday, May 25. The Iowa House and the Iowa Senate fought for a month before "agreeing to disagree" on using taxpayer funds to pay for private school scholarships. Once leaders decided to save the education debate for another day, the end of session happened fast. The Governor then had until the end of June to sign or veto bills.

The Governor signed all but one of the 156 bills sent to her, vetoing a bill dealing with substitute teacher requirements and line-item vetoing a section of the Judicial Branch budget that made changes to the process for nominating district judges. Most of the 155 bills that were signed became law on July 1, 2022. In case you were interested:

1,370 bills were introduced this year (not counting resolutions).
155 were signed into law.
11% of the bills filed this year will become law.

These odds have been pretty consistent from year to year; any given year you have about 1:10 chance that your bill will become law. Fortunately, the odds were in IPA's favor this year and its top priority (provisional licensure for predoctoral interns, HF 2246) is now law. The odds worked in IPA's favor as well when a bill filed by defense attorneys failed early in session; HF 2386 would have given attorneys in a civil case full access to all psychological testing materials and data. While it died in 2022, this could make a comeback in 2023 (although the legislator behind this lost his primary - Rep. Dustin Hite).

IPA also won fights against a myriad of professional licensing "reforms" and scope incursions (speech/audiologists, occupational therapists, music therapists, art therapists), including adding Iowa to PsyPact (SF 78). Unfortunately, IPA's bill (HF 2197) to allow neuropsychologists with concussion training to make school sports concussion determinations.

IPA's calls for other fixes to psychologist recruitment and retention were heard. HF 2549 created and HF 2575 funded a new loan repayment program for non-prescribing mental health professionals, including social workers, mental health counselors, psychologists, and marriage and family therapists. The $520,000 appropriated this year will help an estimated 13 professionals practicing in rural/underserved areas pay off student loans. Only eight counties in Iowa would be ineligible practice areas - Polk/Dallas/Warren, Pottawattamie/Mills, Linn/Johnson, and Scott. The program is going to allow part-time practice in these areas to qualify for loan repayment, but they are currently working on the rules related to this and the use of telehealth.

Despite another round of attacks on public health and vaccines, no significant changes were made. Legislators did try to crack down on health care temp agencies but stopped short of price setting and instead opted for registration and regulation by DIA. House File 2521 also bans these employment agencies from requiring health care professionals to sign non-compete clauses.

While "workforce" is such an all-encompassing, broad issue, it's likely to continue to be on everyone's list of top three issues. This year legislators did make some advances in addressing other health care and mental health workforce shortages:

The Health Care Professional Recruitment Program, which currently is limited to physician assistants, physical therapists, occupational therapists, podiatrists, athletic trainers, and physicians, was expanded to include nurses and ARNPs and allows loan repayment to community colleges (SF 2383). The program continues to be level funded at $500,973 (HF 2575).

The primary loan repayment program for nurses and ARNPs was renamed the “Health Care Award Program,” converting it from a loan repayment program to a direct financial award that is available to nurses, ARNPs, nurse-educators, and physician assistants (SF 2383). The bill also allows part-time nurse educators to receive an award if they are also practicing as a nurse or ARNP. In addition, the program was doubled from $250,000 to $500,000 (HF 2575).

Added two new rural psychiatric residencies ($200,000) and twelve psychiatric residencies in state-owned institutions ($1.2 million) (HF 2578).

Required the development of psychiatric tiered rates, increasing reimbursement for more complex conditions (HF 2546, HF 2578).

Required insurance companies to add any out-of-state telehealth companies to their networks if they provide behavioral health services to Iowans with Iowa-licensed providers (HF 2578). The language was amended so that insurers do not have to pay these out-of-state providers equal to what they would pay someone who practices physically in Iowa.

All efforts to put more barriers up to accessing Medicaid and other forms of public assistance died, as did more attacks on absentee/mail-in voting, teacher-blaming and book-banning. Unfortunately, one anti-LGBTQ+ bill did pass, the much-reported trans athlete ban (HF 2416).

Other bills of interest that passed this year and are now law:

Changed the definition of autism to align with diagnostic manuals (considering it a mental disorder), thereby making mental health parity law applicable (HF 2167). They also updated the definition of " updates the definition of intellectual disability in Iowa Code and amended requirements for admission or transfer to a state MHI of a person with an intellectual disability (only the DHS director or the MHI can determine if the person is eligible and if they have the capacity to serve the person appropriately (HF 2578).

Prohibited Medicaid (or MCOs) from recouping payment or offsetting an "overpayment" to a provider if the person is later deemed ineligible for Medicaid if the provider got all required prior authorizations and they were told the person was eligible at the time of services. Rules will be coming out soon on this, as there will be a process that a provider will need to take in order to clear the "overpayment." (HF 736)

Prohibited insurance companies from retroactively reversing prior authorizations after a service has been provided. (HF 2399)

Made law enforcement crisis response reports on a person experiencing a mental health, substance use, or housing crisis confidential (SF 513).

Criminalized elder abuse, including financial exploitation, and allowed DHS to share information about starting a dependent adult abuse investigation with banks and other financial institutions if the person's finances are at risk (SF 522, HF 2252). You can read a complete summarrey of the elder abuse bill here.

Made the Legislature responsible for appropriating funds from the state's share of the opioid settlement, instead of the Attorney General. Any funds that were directed to first responders and specific entities do not require legislative action. (HF 2573). That means next session legislators will be making decisions on how to spend the discretionary funds (an estimated $174 million over 18 years is expected to come into Iowa from these settlements).

Legislators also opted for a massive tax cut this year that when fully implemented in FY 2028 will reduce state revenues by $1.9 billion, instead of spending the entire $9 billion available for appropriations(HF 2317) An end of session second tax bill (SF 2367) exempted feminine hygiene products and diapers (for all ages) from state tax.

Once the Senate lost its private school scholarship battle, the House had little to negotiate with and had to give up much of their budget priorities. Here's a rundown of what the House had in their budget and where we ended up at the close of session:

$14.6 million increase HCBS provider rates for raises for direct support staff, which will equate to a 4.25% increase.The final budget did not include general fund dollars for this; instead DHS got approval from the federal government to use $14.6 million in ARPA funds to increase the wages of those providing direct support services to those receiving services under any of the HCBS waivers, including habilitation, consumer directed attendant care (CDAC) and consumer choice option (CCO). This is not just for those with a title "direct support professional" and can be used for supervisors who are filling shifts because of workforce shortages.

$1.8 million increase to expand rural access to home health care. The funds are to be used to help offset the increased cost in gas as well as find other innovative options such as remote monitoring to help address workforce shortages. The House had included $4 million.

No change in funding for IPA's postdoctoral psychological internship program ($48,000). The House had originally eliminated all earmarks from the Department of Public Health budget, including the line item for this program. While the money was still there, it was left entirely up to the discretion of the department to fund it. Fortunately, the Senate added the direct line item back in.

Used one-time ARPA funds to fund the addition of multi-systemic, functional family therapy as a Medicaid-covered service ($200,000). These funds were originally in the House budget but the Senate opted to fund it with one-time funds, knowing that they will have to replace these funds with general fund dollars in a couple years when ARPA funds are exhausted. These ARPA funds are able to draw down federal match, like a state appropriation would.

The announcement of the Glenwood State Resource Center, and the Department of Justice report that preceded it, shaped most of the HHS budget priorities. There was an additional $1.3 million increase in ICF/ID provider rates as well as using $7.4 million in additional ARPA funds to remove up to 200 people with intellectual disabilities from the ID waiver waiting list. It's likely that this is just a downpayment in advance of the corrective action plan that will be coming out sometime later this summer.

The timing of the use of ARPA funds for these significant, ongoing programs will make the estimated Medicaid hole caused by the future end to the enhanced FMAP even bigger, so demand for state resources here is going to increase at a time when the tax cuts really start to kick in. This could make future asks for resources even more difficult.

Finally, DHS got approval to begin the process of merging the Departments of Public Health and Human Services in the HHS Budget, although they are now operating as a combined Department of Health and Human Services. While not overt, aging services continue to be bookmarked in every discussion of this merger.

Final Appropriation Bill Reviews by non-partisan Legislative Services Agency:

Administration & Regulation (SF 2385)
Agriculture and Natural Resources (HF 2560)
Economic Development (HF 2564)
Education (HF 2575)
Health and Human Services (HF 2578)
Judicial Branch (HF 2558)
Justice Systems (HF 2559)
Infrastructure (HF 2579)
Transportation (HF 2557)
Standings (HF 2589)

The IPA Bill Tracker includes complete descriptions of each bill tracked. You can see the bills that are now law here. If you want to see the bills that didn't pass, just change the status box to "Inactive."

2022 Iowa Legislative Session Review

There will be a lot of new faces in the 2023 Iowa Legislature. One out of every three legislators will not return to work at the Capitol in 2023. Some are retiring while others are running for a different office, and a six were tossed into the same districts (so three definitely are not coming back). Here is a quick rundown:

Sen. Craig Williams (R) - retiring
Sen. Roby Smith (R) - running for State Treasurer
Sen. Amanda Ragan (D) - retiring
Sen. Zach Nunn (R) - running for Congress (against US Rep. Cindy Axne)
Sen. Liz Mathis (D) - running for Congress (against US Rep. Ashley Hinson)
Sen. Jim Lykam (D) - retiring
Sen. Craig Johnson (R) - running for State Senate
Sen. Rob Hogg (D) - retiring
Sen. Tim Goodwin (R) - retiring
Sen. Jim Carlin (R) - ran for US Senate (lost in primary to US Sen. Chuck Grassley)
Sen. Joe Bolkcom (D) - retiring
Rep. Marti Anderson (D) - retiring
Rep. Rob Bacon (R) - retiring
Rep. Terry Baxter (R) - retiring
Rep. Liz Bennett (D) - running for State Senate
Rep. Christina Bohannan (D) - running for Congress (against US Rep. Mariannette Miller-Meeks)
Rep. Mike Bousselot (R) - running for State Senate
Rep. Holly Brink (R) - retiring
Rep. Dennis Bush (R) - lost in primary election
Rep. Cecil Dolecheck (R) - retiring
Rep. Molly Donahue (D) - running for State Senate
Rep. Chris Hall (D) - retiring
Rep. Lee Hein (R) - lost in primary election
Rep. Dustin Hite (R) - lost in primary election
Rep. Bruce Hunter (D) - retiring
Rep. Jon Jaccobsen (R) - retiring
Rep. David Kerr (R)- retiring
Rep. Jarad Klein (R) - retiring
Rep. Mary Mascher (D) - retiring
Rep. Dave Maxwell (R) - lost in primary election
Rep. Charlie McClintock (R) - running for State Senate
Rep. Charlie McConkey (D) - retiring
Rep. Jeff Mitchell (R) - lost in primary election
Rep. Jo Oldson (D)- retiring
Rep. Ross Paustian (R)- retiring
Rep. Todd Prichard (D)- retiring
Rep. Kirsten Running-Marquardt (D)- running for Linn County Supervisor
Rep. Sandy Salmon (R)- running for State Senate
Rep. Ras Smith (D)- retiring
Rep. Kristin Sunde (D)- retiring
Rep. Jon Thorup (R) - lost in primary election
Rep. Cherielynn Westrich (R)- running for State Senate
Rep. Dave Williams (D)- retiring
Rep. Cindy Winckler (D)- running for State Senate
Rep. Mary Wolfe (D)- retiring
Rep. Gary Worthan (R)- retiring

Senators are elected for four-year terms, so Senators in even numbered districts are not up for election this year. The following legislators are not up for re-election this year:

Sen. Nate Boulton (D)
Sen. Mark Costello (R)
Sen. Dan Dawson (R)
Sen. Jeff Edler (R)
Sen. Eric Giddens (D)
Sen. Jessse Greene (R)
Sen. Dennis Guth (R)
Sen. Pam Jochum (D)
Sen. Mike Klimesh (R)
Sen. Mark Lofgren (R)
Sen. Janet Petersen (D)
Sen. Jeff Reichman (R)
Sen. Amy Sinclair (R)
Sen. Jeff Taylor (R)
Sen. Brad Zaun (R)

Iowa voters went to the polls on Tuesday, June 7 to select their party's candidates for the November 8 General Election. The primary election was also the first time voters are selecting someone to run in new districts, and voters turned out in near record numbers (it was the second highest turnout in a primary election since 1994). Almost 40% of the registered voters in both parties turned out to vote in the primary (195,355 Republicans; 156,589 Democrats). Here's a quick recap on the legislative races:

State Senate:

All current State Senators will move on to the General Election (most didn't have an opponent, but those who did won). Likewise, all current State Representatives who are running for State Senate won their races (Rep. Liz Bennett, Rep. Mike Bousselot, Rep. Molly Donanue, Rep. Charlie McClintock, Rep. Sandy Salmon, Rep. Cherielynn Westrich, Rep. Cindy Winckler).

No surprises on the Democratic side. There was a bit more drama on the Republican side. Rep. Charlie McClintock decided to run for State Senate this year, and faced a primary opponent. He lost by two votes on election night but a hand recount a week later changed the election results (he won by two votes).

State House:

Three current Republican State Representatives lost their primaries after Governor Kim Reynolds endorsed their opponents (Rep. Dennis Bush, Rep. Dustin Hite, Rep. Jon Thorup). Another three lost because they were thrown into districts with other legislators:

Rep. Dean Fisher (R) beat Rep. Dave Maxwell (R).
Freshman Rep. Steven Bradley (R) beat House Ways & Means Chair Rep. Lee Hein (R).
Rep. Jeff Shipley (R) beat Rep. Joe Mitchell (R). Interestingly, Rep. Shipley will go up against former Republican State Representative Dave Heaton's nephew, who is running as a Democrat.

The Republican primary in one district (new HD 46 - Grimes and Northern Polk County) had to be decided at a June 27 special convention, since none of the five candidates received the required 35% of the vote. Jeremy Freeman, a Grimes business owner who also got the highest number of votes in the primary election, will be the Republican candidate for this House seat. Former Democratic State Representative Dan Kelly was one of those who lost in this primary; he had switched parties and moved from Newton to run in this newly formed district.

Another former legislator (former Republican State Senator Mark Chelgren) lost a primary to Austin Harris, who served in the Trump Administration and was Congresswoman Marianette Miller-Meeks' deputy chief of staff. Former Republican Congresssman David Young and former Democratic Congressional candidate J.D. Shoulton were unopposed in their primaries for State Representative.

All Democratic State Representatives will move on to the General Election. The Democratic races were pretty boring; even the six-way primary in the Des Moines area was decided on election night. UnityPoint doctor Austin Baeth won that race with nearly 50% of the vote. Another Des Moines doctor won her Democratic primary; Dr. Megan Srinivas beat former Democratic Congressional candidate Eddie Mauro.

Three primary races were decided by less than 100 votes! Only 25 votes made the difference in one Senate District (out of 3,132 total votes). As noted above, Rep. Charlie McClintock won his primary for State Senate by only two votes in a recount (out of the 3,736 votes cast). It looks like the November 8 General Election may produce a few nail-biters as well!

You can see final results of the primary on the Secretary of State's website here.
You can see the new Congressional Districts here.
You can find the new State Senate Districts here and State House Districts here.
To find which district you are now in, type in your address here.

HCBS Input Sessions Begin This Month

The Harkin Institute is working with Mathematica and the Iowa Department of Human Services to look at community-based behavioral health, disability, and aging services across Iowa. They hope to learn how people access and use these services, including those paid for by Medicaid. The team will make recommendations after they collect this important information.

The Department of Human Services has set the following guiding principles for this project:

Services should be accessed equitably by all.
High-quality care should meet the needs of people living in the community.
Service delivery should be well-coordinated, without gaps in or duplication of services.
System providers should have clearly defined roles and responsibilities.
The workforce should be well-trained, including paid staff and family members.
Available services should have demonstrated value to improve health & quality of life.

HOW CAN IOWANS GET INVOLVED?

The Harkin-Mathmatica team will be holding listening sessions throughout Iowa over the next five months (July - November 2022), and you can submit your comments online through the end of August. Here are some things you can do:

Go to dhs.iowa.gov/CBSE for updates. You can also subscribe to this page's updates by clicking the link at the bottom of this page.

Consider participating in a listening session. The research team will hear from Iowans across the state in-person and virtually at the following locations and dates: July 7-9: Northeast Iowa (Cedar Rapids, Dubuque, Independence, Mason City, Waterloo); August 4-6: Northwest Iowa (Denison, Estherville, Fort Dodge, Rock Valley, Sioux City, Spencer, Storm Lake); September 15-17: Southeast Iowa (Burlington, Columbus Junction, Davenport, Fort Madison, Iowa City, Muscatine, Ottumwa); October 26-28: Southwest Iowa (Atlantic, Clarinda, Council Bluffs, Creston, Shenandoah); July-November (various dates): Des Moines and virtual options. American Sign Language and Communication Access Realtime Translation (CART) will be provided. Participants will receive a $25 gift card for their time. They can also receive a $10 gift card to help cover travel and child care costs. Session space is limited, so the research team requires registration to attend. Sign up by emailing harkinoutreach@drake.edu or calling (515) 271-3688.

Share your thoughts online. You can share your thoughts—anonymously or not—at www.CommunityServicesIowa.com. This is a great option if the listening sessions in your area are at capacity or not convenient for you to attend. The feedback form will be open from July 5 through August 31.

Express your interest in joining the Advisory Committee by emailing us at iowahcbs@mathematica-mpr.com. Committee members will provide input to the research team to make sure that the assessment reflects the voices of Iowans who use community-based behavioral health, disability and aging services. Although all spots are currently filled, DHS will keep track of people who are interested as opportunities arise in the future.

For any other questions, people can call (515) 271-3688 or email harkinoutreach@drake.edu. Please feel free to share this information by email and social media with people who might want to attend a session!