• Telehealth payment parity.
• Emergency 30-day prescription refills without prescriber approval.
• Caps on insulin cost sharing ($100/month).
• Efforts by credit unions to incentivize savings (drawings to win matched deposits).
• Physician assistant code updates.
• Changes to who can apply dental sealants.
• Reasonable limits on Medicaid recoupments.
• Access to birth control without a prescription (for up to one year). 
• Public assistance oversight with new asset tests and more frequent eligibility checks.
• Access Center commitments.
• Ending tenure at state universities.
• Penalties for cities and counties that defund the police.
• Stopping employers from requiring COVID-19 vaccinations.
• All other bills weakening Iowa vaccine laws.
• Allowing college athlete to earn money through sponsorships and use of their name.
• Taxpayer-funded scholarships for private schools (aka school vouchers).
• Added protections for mobile home residents.
• Punishing companies like Facebook/Twitter for restricting what people can say online.

• Audio-only telehealth directives to state licensing boards.
• Social worker supervision changes.
• Allowing dentists to give COVID-19 vaccines.
• Expanding access to the DMU Health Professional Recruitment Program.
• Governor’s bills to expand affordable housing and access to broadband.
• Requiring at least 75% of UI dental and medical school students to be Iowans or students who received undergraduate degree from an Iowa college.
• Requiring schools/universities to do first amendment training for students & faculty, while simultaneously stopping public schools from teaching "divisive concepts" such as racism and sexism.
• Reviewing all boards that license professionals (with automatic sunset).
• Keeping communications between a peer counselor and law enforcement confidential.
• Music therapist "title protection" & occupational therapist compact.
• Medical tort reform (caps on non-economic damages).
• Taxation and regulation of glass/metal pipes used for drugs (marketed for tobacco) to fund specialty courts (including mental health, family, drug courts).
• Another round of reviews of the inpatient psychiatric bed tracking system.
• Allowing only county elected officials on regional MH/DS boards to vote on budgets.
• Allowing charter schools (determined by Board of Education, not local school boards).
• Constitutional amendment stating Iowans do not have the right to an abortion.
• Bottle bill changes to allow grocery stores to stop taking cans.
• Reductions in unemployment benefits.
• Allowing cities to use revitalization incentives in historically red-lined areas.
• Half of the Governor's eight child care bills.
• Stating fundamental parental rights (strict scrutiny standard for state infringement).

• Regions would need to put all their money into one bank account ("pool" it).
• Regions would lower levies to $21.15 per person (also called "per capita").
• State would kick in $15.86 per person (for a total of $37 per capita in each region).
• Regions would have to pay back the amount they receive after two quarters if they are over 40% fund balance (returns go into newly created risk pool).
• No other county tax dollars could be used to pay for services or staff.
• State would pay its share in four even amounts (quarterly payments to regions).
• Funds a risk pool for regions that need additional funds ($9,960,590 plus amount returned after first two quarters).
• Risk pool applications due October 31, decision made on December 15, funds to region on January 1.
• Lists out what risk pool funds can be used for (mandated services, "critical services," avoiding cuts to mobile crisis, avoiding elimination of entire groups of people from services, and assistance in to "maintain consumers in a community setting."
• Regions are given authority to redo their levies since they are already in the process of recertifying them.

• County MH/DS property tax levy eliminated.
• State provides regions with $38 per capita ($1 increase from FY2022).
• Funds risk pool with $5,170,340 (decrease of $4.8 million).
• Requires regions to be below 20% fund balance to avoid repaying first two quarter payments to the state (amount repaid/withheld goes into risk pool).

• State provides regions with $40 per capita ($2 increase from FY 2023).
• Risk pool appropriation based on formula: total amount in risk pool X growth factor but is capped at 3.5% (risk pool growth factor is the % increase in income tax from FY21 to FY22 minus 1.5%, up to 3.5%; so if the sales tax increases from FY21 to FY22 by 2%, the growth factor would .5%....that is, .5% x the risk pool balance, which could be quite small).
• Requires regions above 0% fund balance (or they must repay or have last two quarters withheld for amount above - which goes to risk pool).

• State provides regions with $42 per capita ($2 increase from FY 2024).
• Risk pool appropriation based on formula from above but the sales tax collection years based on % increase in sales tax between FY 2022 and FY 2023. 
• Requires regions above 0% fund balance (amount over that refunded/withheld and put in risk pool).

• State funding is the prior year's per capita amount X regional growth factor (uses same calculation as risk pool growth factor, but caps annual increases at 1.5%).
• For FY 2026 that means $42 X growth factor up to 1.5% (% increase in sales taxes from FY23 to FY24, minus 1.5%). 
• Risk pool appropriation based on formula from above but the sales tax collection years change to FY23-FY24 increase, with dates updated each year after. 
• Requires regions above 0% fund balance (withhold/repayment goes to risk pool).

• Where is the DS?  When legislators talk about the regional system, they continue to refer to it as "mental health regions." Legislators are starting to forget the DISABILITY SERVICES side of MH/DS regions and the importance of those non-Medicaid services to those with intellectual and developmental disabilities. Some advocates fear that any limitation in funding would not only pit the adult and children's mental health system against each other, but also the disability side against the mental health side. This is not specific to this bill; it's been happening under the current system as well, but the question remains if a state-funded system will help or further fracture.

• Ramps up funding over time and includes a growth factor.  However, the growth factor is connected to sales tax growth, so if the economy goes down, the state's funding for mental health does as well (even though demand for mental health services goes up during times of economic uncertainty). In addition, the growth factor is based on two-year old data to improve predictability (but that's a big lag for a service system).

• Allows for funds to be allocated where they are needed, not where the property tax dollars can be generated.  One of the problems with the old freeze on property taxes is that it froze the amount a county could collect, so counties are allowed to collect the same amount from property taxes this year (Fiscal Year 2021) as they did when the state started partnering with counties in FY 1998. Since that time there have been two censuses and population has shifted. Iowa's urban counties have grown significantly since that time: Story County added 25,000 residents, Linn County and Johnson County combined serve 100,000 additional residents, and Polk County increased its population by 140,000. Some regions have more than enough money from property taxes, and could even tax more, but the state cannot take those funds and give them to other areas of the state in need. With an entirely state-funded system, the state could do this. Unfortunately, the way its structured there will continue to be a few regions that will be risk pool dependent each year to fund their service array (so it doesn't fully fix the problem).

• There are several operational issues with the structure of the new system.  First, no region can operate on zero fund balance. Regions need some money in the bank to pay providers, or provider payments will be delayed or service authorizations slowed. Second, most (if not all) regional staff are county employees or the county pays their salaries. Without a levy and with the prohibition on any other funds being used to pay for those salaries, this would cut into service dollars. Third, a non-elected person is the new administrator of the funds (no longer county auditor, now regional administrator). Other issues include uncertainty in risk pool dependent areas, lack of definition in the risk pool criteria, absence of a children's provider representative on the risk pool board, fast implementation date (starts less than two months if bill passes and is signed), and prohibits some sharing of other county resources to accomplish regional goals.

• The state has not been a reliable partner.  This is not an opinion; it's fact. The state has rarely lived up to its promises in funding their part of the MH/DS regional system and regions have relied on local property tax dollars to fill in those gaps. Local funding means local input into the process, and a degree of responsiveness that you do not see in other state funded systems. That of course has not always been the case, as some regions have had administrators who are not as collaborative as others. Without some reliable locally-controlled funding source, regions are entirely dependent on the Governor, DHS and the 150 state legislators to fund the system. Instead of going to your local county supervisors for help, you will need to go to your two legislators and DHS to make your case. That all said, the Senators writing this bill fully intend to retain local control, but that may or may not be possible without local dollars in the system and the way the bill is currently structured.