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All summer long, dozens of work groups have been tackling tough issues that our legislative leaders felt were too difficult to resolve in the chaotic months of session.  Since the legislative session ended in May, hundreds of Iowans from all walks of life have volunteered their time to research, discuss, and find solutions.  Here's a quick recap:

  • Mental Health & Disability Services Funding Study Committee:  Legislators assigned to this committee met once to get a review of the history of the regional services system and tour some of the new crisis services rolling out in Polk County.  They also discussed the use of telehealth to deliver specialized services that may not be available locally.  This group will meet at least one more time, but the date has not yet been announced.  It's charge is to find a permanent, sustainable, and sufficient funding stream for adult MH/DS services delivered through the regional system.  You can find more information and all committee handouts (including the historical review of the system and property taxes currently being levied for the services) hereThis will be a big issue at the Capitol in 2019.
  •  Health Home Stakeholders Work Group: Prior to managed care, there were three types of health homes that coordinated the care of individuals at a local (provider) level.  Integrated Health Homes and Pediatric Integrated Health Homes for adults and children with serious behavioral health conditions, and Chronic Condition Health Homes for those with serious physical health conditions.  Without notice, one MCO (United) suspended most of its health home programs, and MCO staff assumed the role of care coordination for many Medicaid members.  Lawmakers asked for health home changes to be delayed (although some changes were not reversable), and asked the Medicaid Director to bring stakeholders together to talk about health homes, discuss why changes were or should be made, and identify a plan moving forward, including communication expectations and development of a consistent model with clear outcomes and data reporting expectations.  The group met twice, but did not discuss a plan moving forward or outline a clear and consistent model. There are 21,722 members enrolled in a health home as of September 2018.  Of those, 12,068 adults and 7,601 children are in integrated health homes and 2,053 members are in chronic condition health homes. It's report is due December 15, so it is unclear if the group will have time to meet again.  You can find information (and the report once posted) here.  This will continue to be an issue at the Capitol in 2019.
  • Children's System State Board: Gov. Kim Reynolds signed an executive order earlier this year creating this board, which is responsible for the development and implementation of a children's behavioral health system that is committed to improving children’s well-being, building healthy and resilient children, providing for educational growth, and coordinating medical and mental health care for those in need. These 18 members have met as a whole and in work groups to develop an initial set of recommendations for legislative reivew.  The report was due on November 15, and can be found here.  You can see all of the work group's meeting materials here.  This will be a big issue in 2019, and will likely (in whole or in part) be among the Governor's priorities.
  • Medicaid Process Improvement Work Group: This group advises the Medicaid Director on current Medicaid processes and systemic issues, so he can work with Medicaid staff, the Managed Care Organizations and providers to help improve the processes. While this group includes providers of all types (who have broken into several smaller subgroups), it is not an open public meeting.  The intent is to fix common problems with Medicaid processes - it's the mechanical nuts and bolts issues that are addressed here.  You can see its work to date here.   While Medicaid/MCO process issues are likely still to be issues, the future of this work group is up in the air.
  • Substance Use Disorder Provider Reimbursement Work Group: Rate inequity between substance use disorder providers and mental health providers is signficant, and is impacting the viability of substance use providers around the state.  This group is to look at reimbursement for these services, where there are gaps, and develop strategies to improve reimbursement.  This group has met twice and is looking at a program developed in Virginia through a Medicaid demonstration waiver. They will meet on November 29 to develop their final recommendations, which are due December 15.  You can see their work to date here.  Given the attention the opioid crisis has been given in the media, this will probably be an issue in 2019. 
  • Commitment Process Review Work Group: This group is continuing to look for ways to simplify and address gaps in Iowa's involuntary commitment laws.  Iowa currently has two laws on the books for commitments - one for substance use and one for mental health.  There was a lot of discussion about merging the two commitment laws and there was discussion about eliminating commitment laws altogeher (after all, we don't commit someone for failing to comply with their cancer treatment).  Ultimately, the work group came up with several recommendations to improve the commitment process, including longer temporary holds (from 48 hours to 72 hours), requiring the courts to process commitments 24x7, funding for education on involuntary commitments, continued review of the possibility of merging substance use and mental health commitments into a single law,  available screening at any point in the commitment process, and further review of the possibility of an outpatient treatment commitment law.  You can reveiw the draft report (due on December 31, 2019) and all work group materials here.
  • Tertiary Care Psychiatric Hospitals Work Group:   This group is looking at the role of psychiatric hospitals (now being referred to as Psychiatric Intensive Care hospital units or PIC hospital units) in the array of mental health services.  There were several recommendations related to these hospitals in the complex needs report, but they were not acted upon last year.  This group is continuing that work, with a report due November 30, 2019.  You can review this work group's information here
There are other reviews going on that have not yet published their reports, including:
  • Review of specialty courts, including mental health, family, and drug court.
  • Safe long-term care options for sex offenders or persons who exhibit sexually agressive behaviors.
  • Contrast of Medicaid vs. Medicare services and rates, and potential recommendations to align.
  • Review of mandatory reporter training curriculum (for both dependent adult abuse and child abuse).
  • Ongoing discussion of tiered rates for community based providers.
  • Prior authorization review by Medicaid, with goal to eliminate some prior authorization requirements.
  • Review of ACT (Assertive Community Treatment) Team reimbursement rates.

We will summarize the report recommendations in our December "2019 Session Issues Review" issue that will come out just before the end of the year.  In the meantime, check out what's online now, and think about how those recommendations may help you, and what may be missing.  Your legislators will be interested in your thoughts!

Special thanks to NAMI Greater Des Moines and the Iowa Behavioral Health Association for some of the information included in this report.  While I didn't copy it - I certainly sourced pieces of this from their excellent membership reports!