There are just two more weeks left until the Iowa Legislature is scheduled to finish its work. April 30 is the 110th day of the 2021 session and the last day legislators get their expense checks. If they plan to work longer, they'll do so without being paid and without extra staff to help answer emails and coordinate schedules.
You would never know the end is near if you visited the State Capitol this week. Legislators spent long days in caucus before doing a handful of bills; the Senate did only 12 bills this week (all on Tuesday). The House did 22 bills over three days, yet still has 57 bills that are or could be debated. The Senate has almost double that - 97 bills that are ready for debate. Some of the bills on the calendars include:
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Reviewing the psychiatric bed tracking system, which was amended in committee (H-1334) to require insurers to pay equally for services provided to a person with a mental health condition, whether delivered in person or virtually via telehealth. (SF 524)
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Directing all health professional licensing boards to recognize telehealth as an appropriate way to deliver services. (HF 431)
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Ongoing five-year revolving review of all state professional licensing boards; the House takes out Senate automatic sunset of boards and extra hoops for licensing health care professions. (SF 487)
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Allowing licensing boards to waive CEU requirements for up to 90 days for hardship (SF 354).
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Allowing occupational therapists licensed in Iowa to practice in other compact states without an extra license (SF 463). This is an example of how a compact should work...vs. PsyPact for psychologists.
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Allowing only therapists certified in music therapy to use the title "music therapist" in Iowa (title protection) (HF 285).
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Protecting conversations between a law enforcement officer and a peer support group counselor (HF 303).
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Allowing only county supervisors to vote on budgets in mental health and disability services regions. (SF 461)
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Stopping schools from talking about racism/sexism in ways that are "divisive." (HF 802)
Oddly, another bill (HF 485) was not moved to the Senate Unfinished Business Calendar two weeks ago, and procedural move that keeps the bill alive in the final month of session. Unless that is done, the bill (which allows for cross supervision of LMHCs, LMFTs, LISWs and prohibits boards from requiring supervision to be in person) is not eligible for debate. There has been some discussion about allowing psychologists to supervise these individuals as well, so if it does not pass it may be something for IPA to consider next year.
Another bill IPA was watching has been sent to the Governor - allowing OTs to be included in the list of professionals who can assess concussions for school sports (SF 466). We had asked that neuropsychologists be added to the list, but there was a huge kerfuffle over it that could not be easily cleared up, so Rep. Mary Mascher (D-Iowa City) removed her amendment while vowing to push for this next year.
SO....When Will It End?
Predicting the final day of session is always difficult, but this year may be harder than most. The chambers are not in agreeing on much at this point. Most of the eleven budget bills have been introduced by both chambers, but there are some glaring differences in funding. There is also not yet agreement between the chambers on the overall budget numbers, which makes it impossible to start debating the individual budget bill and leaves previously passed tax bills (like SF 576 and SF 587) in limbo. More on these tax bills below.
Budget Update
Out of the eleven budget bills that need to pass this year, eight of them now have a version in each chamber (and on their respective calendars). Two of them have a version in only one chamber - the Health & Human Services Budget and the Federal Block Grant Bill. The one remaining appropriations bill no yet introduced (and likely won't see it until the final days of session) is the Standings Budget bill, which typically becomes a catch-all bill for last minute policy and spending provisions.
Bill numbers change as the legislation moves forward, but here are the current budget bill numbers as of Friday, April 16:
· Federal Block Grants – SSB 1257 (Governor’s version)
· Rebuild Iowa’s Infrastructure Fund (RIIF) – HF 862 & SF 600
· Standings – Waiting
· Transportation (the only set of budget bills that are the same!) – HF 863 & SF 592
Some highlights of note in the budget bills so far:
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Only Medicaid provider reimbursements increases are for HCBS waiver and habilitation provider rates ($8 million) and hospitals (rebase for both mental health and other hospitalization rates). Nursing home rebasing is delayed for two years (until FY 2023) but $8 million is appropriated to adjust rates for inflation (rebasing would have cost $35 million). DHS is directed to convene a work group of stakeholders to review the rebasing process, consider quarterly rebasing, find efficiencies and reduce duplication, and come up with a recommendation by 12/1/2021. (Senate HHS Budget)
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Retains the $48,000 psychologist internship program, but mangled the language we had requested to allow more flexibility in service provision. We'll need to work on this or return to existing language. No changes were made to allow for provisional licensure of pre-doctoral interns (expanding options for reimbursement). (Senate HHS Budget)
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Requires all court-ordered substance use and mental health services to be authorized and reimbursed for three days before MCO criteria can be applied. Currently only those ordered under commitment sections (chapters 125 & 229) are subject to this, and only for “treatment” not all services. (Senate HHS Budget)
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Two new rural psychiatric residencies are added to the program started last year (adding $200,000; total $600,000 will support six residents).
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New funding ($1 million) for two Centers of Excellence to encourage innovation and collaboration among regional health providers to transform health care delivery. This was a strategy developed by the Governor and DHS to address hospital closures around the state.
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Includes $100 million downpayment to build out broadband Internet access across the state. Senate budgets do not include this; they expect the Governor to use federal ARPA dollars to fund this. (House Administration/Regulation Budget)
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No language changes in distribution of SUD Block Grant or CMHC Block Grant, although amounts are updated to reflect expected federal funding availability (SUD down $1,303; CMHC up $263,773). (Federal Block Grant Budget)
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The public assistance oversight bill (SF 389) was dropped into the Senate HHS Budget; IPA opposed this as it is expected to save almost $48 million total when fully implemented in FY 2023 (that's $48 million in food assistance, family support, and Medicaid denied).
All of these bills with an HF or SF number are on their chamber’s calendar and can be debated at any time once a deal is in place. If they stick to the deal made early in session, the Senate will vote first on their version of Admin/Reg, Economic Development, Health/Human Services, Transportation, and Standings. The other six bills will start in the House.
The Closedown Deal
If the House and Senate can lock in deals soon on all the outstanding policy bills and budget bills, and start churning through the pile of legislation, they have a chance at adjourning for the year (“sine die”) on or just before the Friday, April 30th. However, that is a very big if at this point. Every step of the way will require caucus meetings so each party in each chamber can walk through the bills and understand the line items and amendments. That process takes some time. People outside the building, when logging on to the Legislature’s website from home, will see a lot of blank screens that say “At Ease for Caucus” over the next few weeks.
Sand in the Gears
What can delay a closedown deal? A whole host of issues, existing and yet to be discovered. First there is the budget and the differences that need to be ironed out there. Next, we know the Senate and the Governor are insistent on passing legislation to repeal the “tax triggers,” allowing the 2018 income tax cuts to take effect regardless of the State meeting revenue requirements. The House is reluctant to repeal the triggers due to the uncertainty about State revenues, despite the Revenue Estimating Conference's prediction the State will hit that 4% revenue increase threshold in FY 2022 or FY 2023.
The Senate has also passed a repeal of the estate tax (SF 576), and a second tax bill (SF 587) that includes funding regional mental health services with 100% state funding (no more property taxes), a repeal of the backfill to cities and counties, and a repeal of the charitable conservation tax credit. The House has expressed reluctance to act on either bill, and particularly the larger bill with the mental health buy-out.
The House and Senate also have a number of smaller wedge issues, including the telehealth legislation that the House repeatedly passes (and the Senate repeatedly ignores). Not to be outdone, the Senate added the "public assistance oversight bill" (SF 389) to its Health and Human Services Budget Bill; the Senate has repeatedly passed this over to the House and the House has repeatedly ignored it. Another example, eleven House Republicans signed on to an amendment to the Justice Budget that would enact the so-called “Religious Freedom Restoration Act,” a bill that died in the first funnel and whose passage has caused some states to lose NCAA tournaments and other large national conferences and events.
Navigating through issues like these typically add time to the session as legislative leaders try to get their members all on the same page. Expect more similar surprises in the next few weeks.
Redistricting Update
The Iowa Supreme Court issued a statement on redistricting this week implying they will “cause the state to be apportioned into senatorial and representative districts” by asking the Legislature to follow the process in Iowa law and have new district maps by the end of the calendar year. As you’ll recall, this was prompted by the US Census Bureau announcement earlier this year that they would not be able to get states their raw census data until the end of September. Iowa’s Constitution requires the Legislature to redraw the state’s legislative districts by September 1, with enactment by September 15 (or the Supreme Court is charged with that role).
By stating that they will kick the job back to the Legislature if the data comes in too late, the Supreme Court is keeping with Iowa’s model redistricting law that has a non-partisan staff draw the lines without regard to politics and existing incumbents. Prepare yourself for an October special legislative session!
Publication Note
This will probably be the last issue of our lobbyist report until before the end of session. Meanwhile, keep an eye out for timely alerts and requests for action. The next issue will be our regular post-session review - done a few days after the adjournment dust settles.