IPA Legislative News

January 23, 2021

2021 Legislative News

Legislators are back at it in Des Moines, starting their 110-day legislative session on January 11. As a reminder, Republicans control the Iowa House with 59 seats (Democrats have 41) and the Iowa Senate with 31 seats (Democrats have 18). If you are looking at the Senate math, we are indeed down one member. Voters in now Congressperson Mariannette Miller-Meeks' former Senate District will go to the polls on Tuesday (January 26) to select their new state senator. Republican candidate Adrian Dickey is President of his family's trucking company (Dickey Transport) and is from Packwood. Democrat Mary Stewart is the retired Dean of Academic Services at Indian Hills Community College and lives in Ottumwa. We expect some committee shuffling next week after the winner of this race is seated. In the meantime you can check out who serves on the committees here.

As we wrap up week two at the Iowa Legislature, lawmakers are settling into their "new normal," a hybrid of in-person and virtual subcommittee meetings scheduled meticulously in 15-minute increments. This newly regimented schedule allows committees to meet throughout the Capitol in larger rooms to accommodate social distancing. Senate committees meet in the large Senate chamber; Senate subcommittees are 100% virtual via Zoom (no in-person option). House committees meet throughout the Capitol in larger rooms with chairs arranged for social distancing; their subcommittees are held in-person with an option for lobbyists and the public to watch online via WebEx. People wanting to comment during a House subcommittee must either appear in person, use the "chat" function, or submit comments through a portal that is available online.

Some legislators have chosen to join subcommittees and committees virtually, others are working out of a nearby state office building, and the rest have spread out around the Capitol. Legislator’s clerks are working from home or from seats in the galleries, and the rotunda-busting Capitol days have all been cancelled or converted to a virtual function. While the Capitol is open to members of the public, few are risking icy roads and COVID-19 exposure with a visit. National threats of violence around the Biden Inauguration did not transpire; our Capitol was quiet and almost serene.

COVID-19 has driven the need for the Legislature to issue special protocols for being in the building this year. Those protocols are available here. In order to keep the flow of session moving, legislators have adopted new rules that allow bills to be assigned to subcommittee before a formal committee meeting is held, and bills can be released before being officially read into the record. Everything is online and public as soon as the assignments and introductions are made, so these formal processes are not as important as they were in the days before the Internet.

The Legislature is trying to keep its agenda as light as possible for 2021 with an eye toward more heavy lifting in 2022. The hope is that doing so will limit the general public’s exposure to COVID-19. There are plenty of controversial majority-party priorities that will see debate time, but as a general rule, the more controversial or complicated the bill, the less likely it will be taken up this year. Aside from the top leadership priorities, the second tier of bills to be considered are those that were well on the path to passage when COVID-19 shut down the 2020 session. These bills (like telehealth) have or are in the process of being redrafted for consideration this year.

IPA Priorities: This year is shaping up to be a defensive year, with another slew of licensure bills taking up time, including a title protection bill for music therapists (SF 9/HSB 61), another round of PsyPact psychologist compact legislation (SF 78), and a forthcoming bill that defines OT/PT as a mental health provider. Your advocacy team has been making calls to the Psychology Interjurisdictional Compact subcommittee this weekend and plan to attend the meeting on Monday at 2:00 p.m. (zoom link here; submit written publicly viewable comment here). Contact Dr. Paul Ascheman for more details if you want to participate or take action. IPA killed this bill last year because of serious concerns about patient safety, contradictory components to the existing compact, and failure to require APA accreditation.

IPA's proactive agenda this year includes expansion of the IPA internship program (expanding sites, funding) and allowing reimbursement for supervised pre-doctoral interns. Chief among the list of priorities is full payment parity for services delivered with telehealth, without opening the doors of competition to out-of-state provider banks that will never see a patient in person. Last week, Rep. Joel Fry, a social worker from Osceola, got his bill (HF 89) out of subcommittee and we expect it to be ready for debate in committee sometime in the next two weeks. It requires equal payment for in-person and virtual (telehealth) services and removes all site of service restrictions (location of patient or provider, requirement for a provider to be present with patient), effective back to 1/1/2021. It does not address audio-only reimbursement, but HF 88, also sponsored by Rep. Fry, requires each professional board to permit services to be delivered via telehealth and establish standards of practice. That subcommittee meets 1/26 @ 4:30 p.m. (Webex link here; by phone at (408) 418-9388 (access code 146 256 1239); submit publicly viewable comment here).

Bill Tracker: The IPA Bill Tracker is updated daily with changes of status. You can see them at: www.ialobby.com/billtracker/ipa/. Legislators introduced a whopping 634 bills in the first two weeks of the session, so you might want to bookmark the bill tracker so you can find what you need, as you need it. Here are some we wanted to highlight:

HF 54: Requires a hospital to update the psychiatric bed tracking system within 24 hours of when a bed becomes available. Requires mental health institutes and hospitals to allow authorized system users to reserve an open bed.

HF 88: Requires health professional licensing boards to amend or adopt rules to allow use of audio-only telehealth or telemedicine, as long as it upholds expected standards of care. Subcommittee scheduled 1/26 @ 4:30 pm.

HF 89: Requires health insurers to pay the same for mental health services, whether provided in person or virtually (telehealth). Prohibits requiring a health professional be in the room with the patient in order to receive reimbursement, and requires reimbursement regardless of where the patient or provider are located. Does not require reimbursement for audio-only services. Passed out of subcommittee; Human Resources Committee will discuss next week.

HF 98: Taxes alternative nicotine and vapor products in the same manner as cigarettes and other tobacco products. In changing definitions of nicotine products, it appears this bill will also add these products to the state's Smokefree Air Act.

HF 107: Prohibits licensing boards from requiring in-person supervision for LMFTs, LMHCs, and LISWs and clinical hours in excess of the board of social work requirements. This is a permanent change - not tied to the public health emergency.

HF 108: Requires Medicaid submit a waiver to allow coverage for a comprehensive range of evidence-based substance use disorder treatment services.

HF 132: Prohibits some licensing boards (mostly trades) from requiring in-person CEUs during a national public health emergency, including the boards of behavioral analysts, teachers/educators, gambling treatment programs, lead inspectors, controlled substances licensees, occupational safety and health inspectors.

HF 133: Extends the time period for all state professions regulated through he state by law or rule to get waived CEUs until six months after the end of the national or state disaster proclamation.

HF 196: Expands the DMU health professional recruitment program to include professionals trained at other universities, but does not expand the types of professionals eligible for the program.

HSB 22 & SSB 1047: Criminalizes defrauding a drug or alcohol test (simple misdemeanor for first time; serious misdemeanor after). The House subcommittee passed the bill; it is expected to come out of committee next week. The Senate subcommittee meets 1/26 at 8:30 a.m.

HSB 51: Allows a pharmacist to refill a prescription without prescriber authorization in emergency situations (but limits an emergency refill to once per year).

SF 4 : Eliminates the certificate of need process entirely, including for psychiatric facilities.

SF 81: Requires DHS to develop and oversee a direct primary care agreement pilot to allow Medicaid members who are childless adults or pregnant women to receive primary care through a direct arrangement, with Medicaid payment coming from state-only funds.

SF 92: Requires total telehealth payment parity (mental health, physical health, dental), including audio-only modalities (but not including site of service waivers).

SF 118: Allows physicians to deduct the value of donated medical care to recipients of Medicaid or hawk-I from state income taxes. If this moves, we'll make sure to make a case to add psychologists.

SF 129: Adds OB/GYNs to the list of physician specialists in the primary care loan repayment program, and allows "less than full-time employment" (70% of 40-hour work week) to qualify and changes areas of practice to include any mental health shortage area if the person is a psychiatrist (but keeps the current requirement that the person be located in a county with a population of less than 26,000 and at least twenty miles from a city with population more than 50,000). This bill is out of committee - already safe from first funnel.

SSB 1046: Requires legislators review any legislation proposing changes to regulated health professional licensing or required education/continuing education, they take steps to ensure the changes are the least restrictive needed to protect the public, and sets up a process to review and sunset all boards.

Rep. Sandy Salmon (R-Waverly) introduced a whole slew of anti-LGBTQ+ bills, including some that limit access to mental health services. These bills are dangerous, but we have heard the lead bill (HF 193) will not emerge from the House Human Resources Committee. The bill is filled with "findings statements" that are inaccurate and not scientifically founded. Other bill are in another committee and could make it out, including a "bathroom bill" (HF 187), biological sex restrictions in athletics (HF 184), limits on what minors can access in public and school libraries (HF 185), enactment of a Freedom of Conscience from Government Act (HF 170), and more. IPA has opposed legislation in the past that marginalizes the LGBTQ+ community and restricts health and mental health options available to them.

Legislative Leader Priorities: Speaking of leadership priorities, during opening day speeches revealed leadership priorities. The Senate's majority party leaders stuck to themes of "limited government and individual liberty," talking about the need to make Iowa's tax climate more competitive and to keep on the path of fiscal restraint in budgeting, Republican House leaders had similar messages, but chose instead to focus on the need to make childcare more available and affordable to working parents and inshrining gun rights in Iowa's constitution. Senate Democrats focused on the need for investments in public health and help for working Iowans hit hardest by the pandemic by addressing wages, food insecurity, and assistance for struggling small businesses. Similarly, House Democrats talked about recovery with a focus on schools and getting the pandemic under control.

Governor's Priorities: Governor Kim Reynolds delivered her annual "Condition of the State" speech in a prime time appearance, a departure from the normal 10 a.m. time slot. The Governor's top priorities for 2022 are clearly shaped by the COVID-19 experience. They include:

High Speed Internet: Iowa is not only low in the list of states in access to broadband Internet, it is the second lowest in speed. The Governor recommended a $450 million investment over three years ($150 million per year) to expand and address access and speed.

Childcare: Working families need childcare, and this was an issue on the Governor's list before the pandemic hit. The Governor recommended expanding the number of families qualifying for the child/dependent tax credit to families earning up to $90,000/year (up from $45,000/year), giving businesses incentives to create onsite daycare or provide childcare benefits to their employees, and addressing the childcare cliff by allowing working parents to gradually phase out their assistance as their earnings increase.

Economic Recovery: While the top two issues are definitely a part of that economic recovery, the Governor recommends immediately enacting the tax reforms passed in 2018 by removing the “revenue triggers.” The reforms were only to go into effect if the state’s revenues increased by more than 4% in two consecutive years; Iowa was on track to do that before COVID struck, and revenue estimators think the economy will get back on track once the pandemic is under control. The state will lose about $157 million in revenues when all the cuts take effect.

Medicaid Providers: Medicaid providers that provide services to individuals in residential settings will see a bump in their reimbursement rates after COVID-19 has put already short-staffed agencies on a critical path. Psychiatric Medical Institutions for Children (PMICs) will get a $3.9 million bump in reimbursements, Home and Community Based Services (HCBS) waiver providers will see $8 million to increase in rates, and nursing homes and skilled nursing facilities will see a $10 million added to their rebasing. Unfortunately our SUD rates were not included in this budget, but we continue to try to tie other sources of funds to our request (see agenda & talking points link at end of report).

Education: Governor Reynolds added $20 million to the current year to help schools that opted to have a !00% in-person option available to kids, and then added 2.5% “allowed growth” to schools for each of the next two years (about $20 million each year). She also urged the Legislature to pass a law that requires all schools provide 100% in person option and end 100% online-only instruction.

Mental Health: The strain on Iowans’ mental health during the pandemic and its resulting quarantines has taken a toll on more families’ mental wellness. The Governor recommended adding $15 million each year for two years to help fill in gaps in the state’s Mental Health and Disability Services (MH/DS) regional system. It should be noted that this does not “fully fund” the system as the Governor said in her speech, as one region alone has a $15 million gap. The Governor did not recommend how to distribute those dollars.

Housing: The Governor is recommending a full court press to address housing gaps, including removing the cap on funds going to local housing trust funds ($4.7 million addition will bring total for affordable housing and homeless programs to $7.7 million). The Governor also recommended creating an affordable housing tax credit for developers ($4.4 million impact) and doubling the existing workforce housing tax incentive program (to $50 million).

Governor's Budget: The rest of the budget is largely status quo. Medicaid will have a healthy balance at the end of this year and carried forward funds from the last fiscal year, thanks to continued enhanced federal match. Some highlights to note:

The Governor’s budget for FY22 spends $253.2 million less than the 99% expenditure limit allows, leaving a cushion should things change midyear.

At the end of FY22, the Governor’s budget leaves a $340.9 million surplus.

The FY22 budget is a 3.7% increase over the current fiscal year - $289.5 million over the adjusted final budget for FY21.

The state’s cash reserves (“rainy day funds”) will be well-stocked at the end of the Governor’s budget years – with $825 million in the bank at the end of FY22 and $841.2 million upon conclusion of FY23.

Funding for two items in the state budget – K12 School Per-Pupil Funding and Medicaid – make up 60.2% of the Governor’s FY22 budget, and 62% of her FY23 recommendations.

Legislative leaders cautioned everyone to slow down in their run for the money; the extra federal money is not permanent. The Governor's budget showed similar restraint. Rep. Joel Fry (Chair of the Health/Human Services Budget) told lobbyists observing the first meeting of the group that the extra money in the Medicaid system is short-lived and the state's normal collections will return, so big requests will need to be backed with identifiable, sustainable funding sources. You can read the non-partisan fiscal staff review of the budget here.

Advocacy: While they might be trying to limit everyone’s exposure to COVID-19, the Legislature has taken a number of steps to expand access for constituents, lobbyists and members of the press. Committees and subcommittees are now available online and feedback can be provided to bills through electronic means. The only hang up is the chambers are using different systems – Zoom for the Senate and Webex for the House – but the transparency is at an all time high. That means it’s easier to connect via phone, email and text with legislators than it has ever been, but it’s harder than ever before to connect with them face-to-face, even if you’re in the Capitol building at the same time as them. You can best help our efforts on the ground by being actively engaged on your issues and then keeping us up-to-speed if you have feedback to share.