IPA Legislative News

January 17, 2021

2022 Legislative News

The Iowa legislative session is underway with its first official week of business behind us, it's now down to serious business. The ceremonial work of the first week is done - leadership, Governor, Supreme Court, National Guard speeches gave shape to what we will see ahead this session. It was clear that some common issues are rising to the top for the year - workforce, tax cuts, trusting Iowans to make good choices.

There is both good, and of course not-so-good, news to report this first week.

Predoctoral Internships: Believe it or not, Iowa has only two locations for predoctoral internships right now, and both are in Iowa City! That prompted Rep. Ann Meyer (Chair of the House Human Resources Committee) and Rep. Joel Fry (Chair of the House Health/Human Services Budget Subcommittee) to sponsor House File 2017. They are both also on the subcommittee for this bill, a really good sign they plan to do it. The bill allows predoctoral interns to get a provisional license and therefore be able to bill for services provided. This is one of IPA's top priorities for the year.

Mental Health Professional Loan Forgiveness: Two bills have been filed to create two separate loan forgiveness programs for mental health professionals. Senate Study Bill 3003 creates a non-prescribing mental health professional loan forgiveness program for psychologists, social workers, mental health counselors, and marriage and family therapists who agree to work full time in a mental health shortage area for five years (seven years for part-time). Full time is considered 70% of a 40-hour work week, and forgiveness is $8,000/year for up to $40,000 total. House Study Bill 537 creates a similar program for prescribing mental health professionals, including prescribing psychologists ($8,000/year for up to $40,000 total), psych ARNPs ($10,000/year for up to $50,000), and psychiatrists ($40,000/year up to $200,000 total). It is slightly different, in addition to a community being a shortage area, it must also contribute $20,000 to the program in order to participate. IPA is registered in support of both.

Neuropsychologists/Concussion Screening: Last year, a bill was adopted to add occupational therapists as professionals that can assess concussions for school sport events and do return-to-play assessments. While we tried to get psychologists added to that, it got politically complicated. Rep. Ann Meyer remembered - and has filed a House Study Bill 517 to add "a person who holds a doctorate in psychology with specialty training in neuropsychology or concussion management" to the list. IPA supports....and the subcommittee is Tuesday at 12:30 p.m.

Autism Definition: Autism Speaks has a bill (House Study Bill 512) that updates references to autism disorders and changes the definition in insurance code to define it as a mental health condition (defining by referencing DSM). This is being done so that denials by insurance can be challenged under mental health parity law (and telehealth payment parity would also apply). IPA supports, but you can be sure insurers will oppose.

Autism Definition: Autism Speaks has a bill (House Study Bill 512) that updates references to autism disorders and changes the definition in insurance code to define it as a mental health condition (defining by referencing DSM). This is being done so that denials by insurance can be challenged under mental health parity law (and telehealth payment parity would also apply). IPA supports, but you can be sure insurers will oppose.

Cognitive Screenings: IPA is going to register undecided on Senate File 2015 until we can get more information and see if we can amend it to address concerns. The bill allows speech therapists and audiologists to perform cognitive screenings, but it is overly broad as written and definitely a scope expansion. This is a concerning bill - so the registration is only temporary while we await a meeting with the speech pathologists.

Public Assistance Oversight Bills: The House stopped the Senate's efforts to put barriers in place to Iowans receiving public assistance - extra paperwork and more opportunities for them to be unfairly dropped from Medicaid, SNAP, FIP, and hawk-I. The House introduced a bunch of bills - throwing out all ideas that groups supporting these types of bills want - but we are not sure which ones will become the lead bills, so for the time being IPA is registered undecided like all other health professions (but this may change as we see bills start to move). Subcommittees were held already on one of these bills, and others are planned for next week. Check them out in our bill tracker.

IPA will continue to support and work on bills that are still alive from last year - capping recoupment for Medicaid overpayments to two years (HF 736) and audio-only telehealth payment parity (HF 431), and oppose licensure changes that threaten the integrity of the state's licensure laws or infringe on psychologist scope of practice.

It's a good time to note that IPA's Bill Tracker got a new look, and it's automatically updated every morning and evening so you can be sure you have the most current status. You can also sort by IPA's position or by subject. Check it out!

Governor's Priorities for 2022

The Governor presented her budget and priorities in a primetime address last Tuesday. She had three main themes - cut taxes and allow Iowans to keep more of their hard earned money; get Iowans back to work and find ways to fix Iowa's worker shortage; and trust Iowans to make the right choices, what she called "getting government out of the way."

She asked the Legislature to institute a flat 4% state individual income tax, eliminate taxes on retirement income, allow school choice, change Iowa’s unemployment system, create teacher and health care apprenticeship programs, cap noneconomic damages in health care lawsuits, support ethanol and biodiesel, continue to improve Iowa’s childcare system, and give $1,000 retention bonuses to teachers, childcare workers, prison staff, and police officers.

It's important to note that unemployment changes will shorten benefits by 10 weeks (from 26 weeks down to 16 weeks), delay the start of benefits by a week, and require more job seeking. To make childcare more available, the Governor is allowing higher staffing ratios and letting teens take on some of the work. Her school choice plan will only apply to students with an IEP or who live in families at or below the federal poverty level ($106,000 for a family of four).

Finally, and probably most importantly, the Governor's tax cuts will reduce revenues by $1.5 billion when fully implemented (average family will save $1,300/year in state taxes). Iowa has been spending about $8 billion per year, and the state's $2-billion surplus is largely because of the influx of federal pandemic dollars. With Medicaid, human services, corrections and education taking up almost 90% the state's budget, a tax cut will inevitably impact the sustainability of one or more of those programs.

As is the custom, the Governor released her Fiscal Year (FY) 2023 budget along with her priorities. Her budget serves as the first shot across the bow in the budget process. Legislators will keep her proposal in mind as they wait for the March revenue estimates. You can see the non-partisan fiscal staff review of the budget here.

The Governor’s budget proposes to spend $8.2 billion out of the projected $9.2 billion in revenues, or 89% of incoming revenue. Iowa is allowed to spend up to 99% of available revenues, but she's also making room for tax cuts by keeping spending near status quo levels. The Governor’s overall expenditures would increase by only $83.2 million over FY2022, but the budget does include an increase for K-12 school funding of 2.5% (or $154.1 million). Few more highlights to note:

No funding included to address the US Department of Justice report that found Iowa in violation of the ADA for over-reliance on institutional levels of care, and no significant changes to Medicaid rates or services.

Increase of $72.1 million to finish the state takeover of funding for the regional MH/DS system that started last year. This is the amount needed to eliminate the remaining property taxes in the system (total funding available for regions is $121.2 million).

Funding for some workforce programs: $3 million more for health care worker tuition programs (not the new ones proposed above), $200,000 for two new psychiatric residencies, and a new "Health Careers Registered Apprenticeship Program" that starts kids in high school on a path to a career in healthcare (primarily focused on nursing and lab-techs).

Capitol Protocols & Schedules

Beyond the April 19 (100th day of session), when per diems expire, a couple of other notable dates to keep in mind this year are the first and second funnel deadlines - February 18 and March 18. The funnels are procedural measures the Legislature uses to winnow down the number of active bills by killing for the year legislation that is not showing forward progress. Tax bills and spending bills are exempt from this deadline. So for instance, our predoctoral licensing bill will need to be voted out of House Committee by February 18, and Senate Committee by March 18 to stay alive.

How to tune in

Full House and Senate debate has been available to watch live for a few years now by just following the link to either the House or Senate’s live feed. Last year, due to COVID, committee and subcommittee meetings were brought online too. At the moment, it appears that they will again be carried live online, enabling the general public to tune in and watch from their homes and offices. However, only the Senate is allowing virtual testimony at meetings. While you can watch subcommittees in the House, you must be present at the Capitol to speak (you can submit comments online though).

Generally, the best way to keep up to speed is to check the Senate Meeting Schedule and House Meeting Schedule. There will often be a link next to the committee and subcommittee entries on those lists that will take you to the live feed.

A key indicator that legislators are intent on getting done early is they have set the March meeting of the Revenue Estimating Conference (March 10). This March meeting is critical to the budget process, but the date of the meeting is usually not set until late February. The Legislature is required to use the smaller of the revenue estimates between the December and March meetings in putting together their budget for the next fiscal year. It is our understanding that budget chairs have been told to build their budgets around the December numbers.