2020 Legislative Review
| June 18, 2020
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Legislative leaders had hoped for a quick, apolitical end to the legislative session when they reconvened on after a 78-day pause in the middle of the 100-day legislative session (March 17-June 2). It was messy, politically charged, and full of emotional outbursts that had the presiding officer in the Senate call for a "time out." One legislator kicked his chair across the room; numerous legislators from all angles of the political spectrum were called to "the well" (the desks where the presiding officers and staff sit), where leaders mediate floor debates that get too personal or break rules of decorum. The number of last-minute things pushed through and surprise language in budgets left no chance for a non-partisan end to the session.
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However, end it did on Sunday afternoon, June 14, after an all-night marathon debate. Legislators spent June 3-5 in a mini-funnel week, pushing priority bills out of committee. The committee process was awkward; they met in the full House and Senate chambers, and the public had to speak from microphones in the third floor galleries (your lobbyist Craig seized the opportunity because "I've been waiting 20 years to be able to tell legislators what I think from the galleries.") The final week was spent passing bills and negotiating budgets. The biggest challenge was navigating the politics of masks; lobbyists wanted to maintain their neutrality but it was clear that if you are a Republican, you don't wear a mask, and if you are a Democrat, you wear one. While a few Republican legislators did wear masks, it really did appear to be a partisan decision. While we wanted to maintain our neutrality (and Craig his Republican street cred), we both sore them.
The Governor now has 30 days to take action on the bills sent to her In the final days of the session, but we expect her to speed that process up and have most (if not all) bills signed before the fiscal year ends on June 30. The review that follows runs down some of the top issues we were following this year. In all, it was a disappointing session. Speaking of disappointment, this will be our last legislative update of the session. We will continue to update your bill tracker as the Governor signs legislation, and will send out a quick email after the Governor completes her work.
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2020 Policy Highlights
The session started out with such hope, with the Governor's plans to give people second chances by restoring voting rights for those with felony convictions, improving funding and access to mental health services, and fully funding water quality and outdoor recreational opportunities Iowans voted on in 2010. That all changed when the state took its two month COVID break, and decisions had to be rushed through with very little public input and comment.
Professional Licensing: The reform of Iowa's "onerous" (per Governor) professional licensing system was a top priority for the party in control of all three parts of the law-making process in Iowa, urged forward by groups like Americans for Prosperity. Dr. Paul Ascheman, IPA's state advocacy chair and attendee at last summer's PsyPact conference, successfully convinced legislators during subcommittee meeting and on follow-up calls to stop legislation adding Iowa to PsyPact (
House File 2094), the psychologist compact that is still in development and threatened the integrity of Iowa's licensure.
Similarly, Dr. Ascheman and Dr. Matt Cooper, IPA's Training Director, came to the Capitol to meet with occupational therapists to help them understand why it is problematic to add them to the definition of "mental health professional" in the Iowa Code, in a section that references those individuals able to sign off on commitment orders and diagnose conditions. That bill (
Senate File 2303) made it through the second funnel, but as not taken up after the long pause. The same with "title protection" legislation (
House File 419) for music therapists, art therapist licensure (
Senate File 2021), and several other professional licensure bills. We felt pretty good that we had successfully killed these bills, but that victory was short lived when the biggest licensure bill of them all suddenly came back to life on the final day of the legislative session.
Considered a "must do" by the Governor, the
Rep. Shannon Lundgren (R-Dubuque) spent countless hours meeting with lobbyists representing various trade organizations to find a solution (including us). Her Senate counterpart refused our attempts to sit down with him, along with other mental health professional groups, to discuss concerns. Unfortunately, our issue of program accreditation was not something that was an issue with any other board, and ultimately was difficult to fix in the resulting compromise. There will be tweaks needed to this legislation since it was done quickly, so we can work over the interim to address those collaboratively with the Board of Psychology. The final bill (
House File 2627):
- Creates universal licensure recognition for all professional licensing and certification in the state, including psychologists. A professional moving to Iowa either permanently or as a military spouse of someone stationed here who has been licensed and practicing in a profession for at least one year in another state without incident or complaint will be eligible for automatic licensure in Iowa.
- People getting automatic licensure must still pay the licensure fee, but they will be deemed eligible for licensure as long as they had a similar scope in the other state and they passed the exams required by that state. The biggest difference for psychology is APA accreditation, which his not required in all states. One of the biggest changes from earlier versions is that they MUST be residents of the state to do this, a nod to concerns about doctor shops outside our borders providing telehealth services.
- In addition, this version made it clear that professionals had to learn and abide by Iowa's practice laws, and boards can require an exam to demonstrate competency and understanding of Iowa's laws (like mandatory reporting). If a board were to add an exam, it could be required for only those that are seeking licensure under these new "universal" licensure requirements. Earlier versions did not make this clear.
- Professionals applying for the first time for licensure will have their fees waived if they are below 200% of the federal poverty level, but this applies to only the initial license.
- While some of the more drastic changes regarding a person's criminal convictions applied only to plumbers and electricians (including disregarding any misdemeanor convictions), there were changes that apply to all health boards. Under the bill, all health boards (including psychology) are no longer required to revoke/deny/suspend licenses (but still may) because of a criminal conviction. Currently a board can revoke a license because of conviction of a felony related to the occupation; this is changed to state that a felony conviction can be grounds for licensure sanctions if it is directly related to the duties and responsibilities of the profession and poses an unreasonable threat to public safety. In addition, it states that if a person is convicted of a crime in another state that would be a felony here, the boards are to consider it a felony conviction.
- Licensing boards can reinstate a person's license that was removed because of a criminal conviction after waiting five years from the date a person was released from incarceration; but that does not apply to crimes involving dependent adult abuse, sexual abuse, sexually violent offenses, a forcible felony, or domestic abuse.
- As a nod to some challenges with COVID, language was added to require all professional licensing boards to extend expiring licenses through the end of FY 2021 (June 30, 2021). Anyone whose license expires before that date will have until the end of the fiscal year to renew. All boards are also required to allow CEUs to be done electronically (and that change is permanent).
- Finally, the bill gets rid of the hospital licensing board, which was apparently not controversial at all.
Obviously there are a lot of things professional licensing boards will need to do in their rules to implement this. Does this mean a return to a jurisprudence exam for out-of-state licensees pursing a state license under this new provision? These things will need to be worked out in the coming months. You can see a full fiscal analysis of the bill
here.
Telehealth: Despite the focus COVID has placed on the need for telehealth services and the gaps in broadband access that exist around the state, legislators could not come to agreement on a permanent reimbursement fix.
House File 2192, which was strongly supported by the House and its sponsor
Rep. Joel Fry (a Osceola social worker), would have guaranteed 100% payment parity for telehealth services. IPA and other health professional organizations asked that the Legislature also amend the bill to allow for continued audio-only reimbursement when video alternatives are not available or affordable and allow reimbursement regardless of the location of the Iowa-based provider or the Iowan being served. The Senate countered, amending the bill to allow a "floor rate" of 95% for mental health services provided by telehealth and 65% for other health services (their original offer was 85% & 60%).
Sen. Jeff Edler insisted that the data shows telehealth costs less to deliver (he didn't say that the savings has been shown to be at the insurer level - not the provider level where it is not less costly to deliver).
Rep. Joel Fry was able to add language to an early version of the professional licensing amendment to extend all telehealth waivers currently in place from the Governor's orders through February 2021. Instead, the Governor and insurance industry agreed to voluntarily continue 100% reimbursement for video and audio-only, regardless of location of provider and patient, through February 2021. That most likely will come out as an extension of the Governor's emergency proclamations. This will be something all health profession groups will need to work on over the summer/fall, as a permanent solution will be needed in the 2021 session.
Finally, a school-based mental health telehealth bill
did pass (
Senate File 2261); it requires 100% payment parity for services delivered in person or via telehealth at a school and designates a school or AEA as a site of service for both private insurance and Medicaid. No medications can be changed or prescribed in these sessions, parental consent is required (and parents may participate if appropriate), maintains confidentiality (school not involved in records retention, etc), and sets a few requirements that require an patient-provider relationship be established prior to providing services via telehealth (which may include an in person visit first).
Therapeutic Classrooms: One of the most hotly debated issues this year was the effort to encourage schools to develop therapeutic classrooms for children who have disruptive behaviors in the classroom. Defining "disruptive" and making sure this didn't end up putting minorities and those with disabilities in separate classrooms kept this issue from getting resolved early in session. Many teachers came to the ten or so subcommittee meetings held on the bill (
Senate File 2360) to talk of injuries and PTSD from violent children, and others talked about the need to use force to remove kids when they are threatening the safety of other children (which they can legally but school administrators fail to back up their staff).The bill originally had a lot of corporal punishment and liability exemptions in the bill, but that was changed to a grant program to encourage the creation of these classrooms (which can be done jointly with local providers) and a directive to the Board of Education to develop clear guidelines and best practices in dealing with disruptive kids.
COVID Liability: One of the biggest priorities for the Legislature during the return was to pass legislation (
Senate File 2338) that would provide liability protections from potential COVID-19 lawsuits for a broad range of businesses including all health care providers and long-term care residential facilities, provided they followed public health guidances. They named it the “COVID-19 Response and Back-to-Business Limited Liability Act" and it was signed into law today.
Second Chances & Police Reform: The Senate refused to pass one of the Governor's top priorities, ending Iowa's status as the only state to permanently deny voting rights to those with felony convictions by amending the Iowa constitution (
House Joint Resolution 14). The Senate had said they would pass it if the Governor signed a "conditions bill" (
Senate File 2348) that requires all victim restitution be paid prior to getting voting rights restored (which she did). The Governor recently announced she would fix this through Executive Order, since the constitutional amendment process is now set back two years. Likewise, a long-dead bill that restructure criminal penalties and eliminated add-on civil penalties that added costs that disproportionately impacted minorities and the poor (
Senate File 457).
Legislators did come together after days of Black Lives Matter peaceful protests at the Capitol, and passed
House File 2647. This is the first bill in anyone's memory to be introduced by bipartisan leadership in each chamber, voted out of committee in each chamber, and pass each chamber in a single day. The bill bans the use of chokeholds except in extreme conditions, prohibits the rehiring or hiring of police officers who have been fired or voluntary resigned for police misconduct (including if they leave in the middle of an investigation), allows the Attorney General to investigate and prosecute incidences of police misconduct, and requires all officers to undergo annual de-escalation and racial profiling training. The Governor signed this bill into law the day after it was introduced, and it became effective upon enactment.
Other Stuff: Efforts to resurrect the Religious Freedom Restoration Act, require work/volunteerism as a condition of receiving public assistance, and allowed landlords to discriminate against people who use Section 8 housing vouchers all died. Unfortunately, so did legislation to ban conversion therapy and add vaping to Iowa's smoke free air act (they did increase the age to 21 as required by the feds). Legislators did find time to squeak in another bill targeting abortion (changing the 72 hour waiting period that the courts struck down to 24 hours) and a bill to limit the ability of county auditors to use their voter databases to correct missing information on an absentee ballot request, or correct the simplest of errors (like transposing numbers or using social security number instead of voter verification number). Instead an auditor will have to email or call the voter, and if they do not reach them in 24 hours, send them a letter telling them they need to correct the missing information or they will not get their ballot.
It would not be a legislative session without gun legislation.
House File 2502 severely limits the ability of cities to regulate guns and zone firing ranges (yes, it may be impossible for them to enforce zoning around a school or day care even). The bill would also prevent a local governments from banning guns on government-owned property unless they provide screening and security at entrances. The Iowa League of Cities and several organizations voiced concerns about this legislation, given the cost of hiring security for all city buildings (which could include libraries, park structures).
On the workforce side, the Legislature continued to support the Governor's Future Ready Iowa initiative with a bill (
House File 2629
) that builds upon past legislation to help meet the goal for 70% of Iowa’s workforce having education or training beyond high school by the year 2025. According to the Governor’s Office, currently 60.2% of our workforce ages 25 to 64 qualify. The bill is very focused on trades and expands the Apprenticeship Opportunities Program, creates the Iowa Child Care Challenge Fund to encourage businesses and others to improve childcare availability, and establishes requirements for K-12 computer science education. IPA and others continue to reinforce the need to include Iowa's health care workforce shortages in these strategies.
Finally, bill that waived chauffeur license requirements for farmhands (
House File 2372) was amended in the final days of session to give Iowans diagnosed with autism spectrum disorder to have this diagnosis noted on their Driver's License and in law enforcement databases. Autism advocates said this will help police better understand why a person may not communicate or react in expected ways when encountering a law enforcement.
I'm sure there is a ton more I missed, but you can check them all out in your
Bill Tracker. A final list of bills will be sent out when the Governor finishes her work signing and/or vetoing the 113 bills sent to her this year.
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Continuing Resolution Takes Place of Budget
While they chose to work on a number of policy bills, the only thing the Legislature
had
to do was enact a budget for Fiscal Year 2021 (July 1, 2020 through June 30, 2021). The budget typically requires ten appropriations bills created by seven subcommittees of the House and Senate Appropriations Committee. Those bills are detailed, have tables and explanations of the spending line items, and the public is allowed to speak in the subcommittee meetings.
The COVID-19 pandemic made the normal process impossible this year. The drafting of the different appropriations bills, the subcommittees required, and debates that would be required for each of those bills would have kept the Legislature in session for much, much longer. What the Legislature did during the abbreviated session was to wrap all appropriations into three bills:
- HF 2644 – The Transportation Appropriations Bill - which allocates gas tax revenues for road projects and other DOT expenditures.
- HF 2642 – The Rebuild Iowa’s Infrastructure Fund (RIIF) Bill – allocates revenues derived from gaming receipts (which obviously took a hit when casinos were closed from mid-March until recently).
- HF 2643 – The Omnibus Continuing Resolution Bill – This bill appropriates funds to the vast majority of agencies and programs for the upcoming fiscal year. Borrowing a page from the Federal government, this bill essentially funds everything at the exact same levels as the previous year, with a few exceptions.
The Department of Management and Governor were given broad authority in the Omnibus Budget to spend Federal funds brought into the state, and adjust spending in FY20 as needed to address any shortfalls so the FY20 budget ends balanced.
IPA's internship was level funded ($48,000), but no changes were made in the program language to make it more flexible and allow for the use of telehealth.
We fully believe this change would have been made in a normal budget process, but the use of a continuing resolution made this impossible. Next year ... (something heard a lot at the Capitol in the end).
Changes of note from the status quo budget:
- $5 million for Broadband Grants to improve access around the state.
- Shifts the source of $1.45 million of the Department of Public Health's substance use disorder treatment and prevention funding to revenues from sports betting (the total available is not changed).
- Reduces funds for Medicaid by $56.7 million (total $1.46 billion is within the expected range needed because of FMAP changes) and increases the children's health insurance program (hawk-I) by $16.5 million. The expected $500,000 in unspent decategorization funds (flexible child welfare spending) is appropriated to Medicaid instead of the state's General Fund.
- Does not require IDPH contractors that were subject to an RFP in FY 2020 to go through another round of RFPs (like IPA).
- Makes several changes to MHDS Regions; gives Polk County Region $5 million and allows the county to shift funds from other sources to supplement the MH/DS levy (reporting of those shifts and maximizing Medicaid funding is required); allows DHS to force a region to engage in mediation to resolve a dispute (with costs borne by the county and/or region per governance agreement); gives DHS more access to a region's financials and requires an annual independent audit; and requires DHS to facilitate a discussion about breaking the large County Social Services MH/DS region into two separate regions (new regions to be fully operational by July 1, 2021).
- Nonpartisan fiscal staff review of the budget can be found here (but this is not the final one that will be available; the budget bill is still not enrolled yet). When ready, a final version will be posted here, and marked "FY 2021 Omnibus Appropriations Bill (Final)."
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Iowa's five black legislators (the only minorities out of 150) raise a fist for the passage of police reform legislation, as do members of the Black Lives Matter movement following days of peaceful protests at the Iowa Capitol .
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The House Appropriations Committee meets in the Iowa House Chamber.
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Status is updated as the Governor takes action.
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