Alerts
Iowa Medicaid to Manage AmeriHealth Members
11.27.17
Iowa Medicaid announced today that it will manage the care of 10,000 Iowans who had chosen Amerigroup as their managed care organization (MCO) before... Read More...
SENATE SPECIAL ELECTION SET: December 12
11.06.17
Last month, Senator Bill Anderson (R-Sioux City) announced he would be leaving the Senate.  Voters in Plymouth and parts of Woodbury County will go to... Read More...
ABLE CONTRIBUTIONS INCREASED
11.02.17
November 2, 2017.  The total annual contribution limit to an ABLE account will be increased from $14,000 per tax year to $15,000 per tax year... Read More...
AMERIHEALTH OUT OF MEDICAID MANAGED CARE
10.31.17
Nothing could be more scary on Halloween than more changes to Iowa's Medicaid managed care system.  Today is Halloween and two bits of bad news hit... Read More...
IOWA PULLS ITS STOP GAP PLAN
10.24.17
October 23, 2017.  As you may have heard by now, the Iowa Insurance Division has decided to pull the Stop Gap Plan proposal to help stabilize the... Read More...


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2016 ISSUE #1

Issue 1, January 22, 2016

Articles in This Issue:


SESSION BEGINS

The legislative session officially kicked off on Monday, January 11, 2016.  The session is scheduled to last 100 days; after that legislators stop being reimbursed for their living expenses (called per diems).  As we know from the past few years, the 100th day (April 19) is only a goal.  Legislators want to get done by that day, because they no longer get money to help offset the cost of staying in Des Moines (hotel, mileage, food).  After April 19, they are paying for their stay in Des Moines from their own pockets.  Good incentive to try to wrap things up and get back home.

Here’s a brief timeline of the 2016 session.  You can see the full session timetable here.

January 11, 2016 - First Day of Session

January 22, 2016
- Last day for legislators to ask staff to write bills.

February 19, 2016 - First "funnel" deadline, when all House bills need to be voted out of House committees, and Senate bills to be voted out of Senate committees; bills that don't are dead.

March 11, 2016 - Second "funnel" deadline, when all House bills need to be voted out of Senate committee, and all Senate bills out of House committee; any bills left in committee are dead.

April 19, 2016 - Last day of session (day when legislative expenses run out, they can go longer)

*Note that these "funnel" deadlines do not apply to bills that involve taxes (Ways & Means Committee), spending (Appropriations Committee), and government oversight (Government Oversight Committee).

From the start, the 2016 session is already historic.  Last fall, Rep. Kraig Paulsen announced he would step down from his leadership position (Speaker of the House) and would not seek re-election in November 2016.  That led the House Republicans to elect House Majority Leader Linda Upmeyer of Clear Lake to the position of Speaker of the Iowa House.  When Upmeyer took her position on January 11th, she became the first female Speaker of the Iowa House of Representatives.  Upmeyer and her father also became the first father-daughter in the United States to serve as Speakers of the House (her father Del Stromer served in this position in the 1980s). 

While there are states that have women in leadership in both House and Senate, Iowa appears to be the only one that has women at the top posts in both the House and Senate.  Sen. Pam Jochum of Dubuque is the President of the Senate and Rep. Linda Upmeyer is Speaker of the House.  (Source: NCSL Women in Leadership 2015)  To make 2016 even more historic, Governor Terry Branstad became the longest serving governor in US history just a month before session began. 

Unfortunately, that may be it for the record books.  The budget presented this year by the Governor doesn't do much more than provide additional state funding for education (2.45% increase, or $143 million), patch Medicaid funding holes ($23.4 million), and keep county governments whole by fully funding the business property tax credit as promised ($25 million).  Here are a few highlights to note:

  • No funding for MH/DS regions and no proposal to fix the funding system for these non-Medicaid services.  It is estimated the regional needs for the upcoming fiscal year are at least $7 million, and that figure grows larger with each passing year as regions spend down their ending fund balances.  We'll talk more about this in our next issue.

  • Underfunding of Medicaid. The Governor's budget doesn't fully fund the expected shorftall for the current fiscal year - they are about $4.5 million short, and that is if managed care starts on March 1.  Delays in the start of managed care will increase the money needed for this year.  The Governor's budget expects $110 million in savings from managed care for next year.  Underfunding can cause increases in waiting lists, or in time spent on a waiting list for home and community based (HCBS) waiver services.

  • Shifts money for Mental Health Workforce Shortages. The Department of Public Health has seen very low demand in its Mental Health Professional Workforce Shortage Area Program that provides $105,448 for stipends to support psychiatrist positions with an emphasis on securing and retaining medical directors at community mental health centers and hospital psychiatric units that are located in mental health professional shortage areas. These funds have never been fully used, so the Governor is recommending this program end.  Instead of funding that program, he is shifting some of those funds to the PRIMECARE health care workforce recruitment and retention program, which is in high demand.  The additional funding ($74,059) will be dedicated to recruiting mental health professionals for high-need areas.   Unfortunately, that cuts the resources available to tackle mental health workforce shortages by $31,389 (since the Govenror does not recommend shifting the entire amount over to PRIMECARE).

  • Adds funding to the Office of Substitute Decision Maker in the Department on Aging to fully fund existing staffing levels.This increase of $36,334 recommended by the Governor brings the total budget for this office up to $375,000.  The Office of Substitute Decision Maker was established to enhance the quality of life for Iowans who are not capable of making their own decisions about legal, financial or health care matters. Depending on the situation, the office may act as an individual's guardian; conservator; attorney-­in-fact under a health care power of attorney document; agent under a financial power of attorney document; personal representative; or representative payee. The mission of the Office of Substitute Decision Maker is to preserve individual independence through a person-centered process by providing education; providing assistance to public and private substitute decision makers; assisting in substitute decision-making proceedings; and providing substitute decision-making services in the least restrictive manner.

In Iowa, our budget is divided into pieces by subject area.  Budget subcommittees are assigned to these areas and make recommendations to the Appropriations Committee on budget related matters.  These budget subcommittees meet jointly (that is, House and Senate members meet together).  Below are links to each budget subcommittee, where you can find schedules, committee documents, and photos/contact info of the committee members.

You can also find the Governor's complete budget recommendations, and his annual Condition of the State speech here

It is your right and responsibility to let your legislators know about the issues you care about.  But remember that you can also contact the members of the budget subcommittees that directly work on your funding issues.  If you want to do that, always copy your legislators on those emails or letters. That helps your legislator stay informed, and help you get results.

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MEDICAID MODERNIZATION: An Update on the Health Consumer Ombudsman Alliance Report

By Deanna Clingan-Fischer, State Long-Term Care Ombudman

As your State Long-Term Care Ombudsman, I always appreciate the opportunity to share more about my office and recent legislative changes that will help us assist you with your health care needs.

The mission of the Office of the State Long-Term Care Ombudsman is to serve as an advocate for residents of nursing and residential care facilities, as well as for tenants of assisted living programs and elder group homes.  My team works to protect the health, safety, welfare and rights of individuals residing in long-term care by investigating complaints, seeking resolutions to problems and providing advocacy to enhance the quality of life and care.

We have eight Local Long-Term Care Ombudsmen to serve residents and tenants in specific areas of the state.  Our office  also has a Discharge Specialist to advocate on behalf of residents who receive a notice of involuntary discharge or facility closure and two Volunteer Coordinators dedicated to implementing a certified volunteer program to recruit, train, and monitor certified volunteer long-term care ombudsmen.

Managed Care Ombudsman Program (MCOP)

After the 2015 legislative session, we were directed to take on two new responsibilities. The first was to hire a new team member to serve as the Managed Care Ombudsman for the approximately 57,000 Iowans who are covered under the seven Medicaid Home and Community Based Services (HCBS) waivers and institutional care. Our new Managed Care Ombudsman is already working with Iowans in transition, providing unbiased assistance with coverage questions and issue resolution. When the state fully transitions on March 1, the Managed Care Ombudsman will also connect members to our legal resource network to assist with new legal rights to grievances, appeals, and fair hearings. 

The second task was to lead a group of agencies and consumer organizations to develop a proposal for a Health Consumer Ombudsman Alliance, a statewide consumer assistance program for health care needs. You can see a complete listing of Alliance workgroup members in our final report. The proposed Alliance would help provide unbiased information and assistance to those attempting to navigate the complex Medicaid system, obtain and understand coverage, access health services and resolve problems. The group’s report was sent to lawmakers and the Governor in December and detailed five recommendations:

  1. Establish a Health Consumer Ombudsman Alliance.
    The purpose of the Alliance would be to identify gaps and discuss the overall health care needs of Iowans, make recommendations to address issues encountered and make appropriate consumer referrals. The Alliance would start with Medicaid managed care members and expand to help other groups of Iowans in the future.

  2. Develop a Medicaid Managed Care Information Program.
    The group recommended establishing a program to assist Medicaid members in obtaining objective and unbiased information, counseling and options for enrollment beyond what they are able to receive independently. The program, based upon the current Senior Health Insurance Information Program (SHIIP) model, will provide free, in-depth, one-on-one counseling and assistance to Medicaid members and their families and caregivers.

  3. Implement a Statewide Single Point of Entry.
    A single point of entry, or “no wrong door” approach, will make it easier to connect Iowans to experts who provide unbiased information and support in a specified area of need. The group proposed the expansion of the established LifeLong Links™ to serve as the statewide single point of entry for health care consumer information.

  4. Expand the Managed Care Ombudsman Program.
    The group also recommended expanding the Managed Care Ombudsman Program we just established, so we can serve all 57,000 Medicaid managed care members covered under the seven waivers or in institutional care.

  5. Expand the Current Legal Assistance Network.
    The group also believes Iowa's Medicaid members who will be served by managed care organizations may need legal assistance due to new rights. The Report recommends expanding the current legal assistance network to assist with appeals, grievances and state fair hearings.

The legislature has already begun work on the recommendations in the Report. Over the next few months, watch this newsletter or our website for more information. If you would like to learn more about the Office of the State Long-Term Care Ombudsman, our new Managed Care Ombudsman Program, or read the full report from the Health Consumer Ombudsman Alliance, please visit the links below.

___________________________________________________________________________________________________

You can contact the Office of Long-Term Care Ombudsman at: 510 E 12th St., Ste. 2, Des Moines, IA 50319-9025 | (515) 725-3333 or (866) 236-1430 | Click here to find a local ombudsman near you.

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BATTLE OVER THE BUDGET

You knew this session was going to be tough.  Early reports showed the state is not collecting as much in taxes as it had expected.  The state is still bringing in more money, but just not as much as it hoped.  Much of that has to do with the state's farm economy.  Prices are down, and the bird flu made matters worse.  So we knew there would be a battle over how much to spend.  But now we are faced with a new battle - a battle over how much money we have to spend.

Iowa can only spend 99% of what it takes in every year.  That's how we save for a rainy day (think natural disasters or economic recession).  A group of economists (called the Revenue Estimating Conference) meet four times a year to tell our state leaders what they think we'll have to spend.  By law, we have to base our state budget on those estimates.

The Governor has proposed spending $7.4 billion next year.  The problem is, the Revenue Estimating Conference says we only have $7.3 million available.  The Governor balances his budget by shifting money around, and using $143 million in ending fund balances.  That is, money left over at the end of this current fiscal year (which ends June 30, 2016).  Senate Democrats will say that this is a result of underfunding programs and not fully spending the 99% allowed, causing shortfalls in priority programs. House Republicans will say it is irresponsible to spend "one time funds" for ongoing services, and say that any money left over at the end of the year should be returned to taxpayers.

We wanted you to know that, depending on who you are talking to, you might hear different numbers when talking budgets.  One person may say the state has $280 million more to spend, while another says they have only $150 million.  We want you to know why that is happening - and give our promise that the numbers we use will come from the non-partisan Legislative Services Agency.  This agency works for both parties and both chambers, is held to a high standard and works hard to stay on that middle path.   So you can feel confident that the numbers we use represent the facts, not affected by partisan politics.  We'll let you draw your own conclusions as to whether what is proposed is good, bad, or simply inconsequential.

You can see all of the Legislative Services Agency budget documents here.

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RULES SITE LAUNCHED

If you think lawmaking in the legislature is complicated, just wait until you get into the rulemaking process!  Not many  people know that once a bill is passed, the agency in charge must write rules that explain how they are going to do it.  Agencies are not supposed to do anything beyond what is in the law, but sometimes rules go too far and include requirements that were not included in the original legislation.  That's why all rules must go through the Administrative Rules Review process.

  • The public must first be notified of the rules, and have an opportunity to submit comments about them.
  • The agency then can fix them, or move forward without changes.
  • Rules are reviewed by a legislative committee, called the Administrative Rules Review Committee.
  • This committee can stop or delay a rule, but you need the majority of legislators to do that.

Because rules are so important, the Governor has announced a new user-friendly website to highlight rules being considered, including those out for public comment.  It's kind of a one-stop-shop for administrative rules.  Just go to: https://rules.iowa.gov/. You can search by agency or by topic.  

You might consider bookmarking this page (https://rules.iowa.gov/) and checking back often to see if there are changes in rules that may affect you.  You will find information on how to submit comments on rules, and more information on the rule-making process at this site as well.

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HOST YOUR OWN CAPITOL DAY: Apply for an ID Action Capitol Day Grant

During the 2016 legislative session, ID Action will provide eight (8) Capitol Day grants up to $500 each for advocacy training and support to local advocacy groups who are interested in meeting with their legislators at the Iowa State Capitol and advocating on behalf of disability related issues.  As an ID Action Capitol Day grant recipient, your group must:

  • Schedule a Capitol Day on either Tuesday or Wednesday in the months of January through April
  • Participate in an advocacy training at the beginning of the Capitol Day  
  • Set appointments with your legislators (ID Action can assist)  
  • Provide a written recap of your Capitol Day within two weeks of your visit.

While at the Capitol you may also want to watch a floor debate, attend a committee meeting, meet with other state agencies, or meet with ID Action or Iowa Developmental Disabilities Council staff.  To participate you must have at least 10 individuals committed to attend (but no more than 20), and you must be advocating on a disability related issue.  While we can help you with your message, we will not tell you what to say.

To apply for an ID Action Capitol Day grant, please fill out the grant application.  Call 866-432-2846 or email us at contactus@idaction.org with any questions. Grants are available on a first come, first served basis for eligible groups. Grants cannot be used to attend other organization's lobby days.

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2016 BILLS INTRODUCED

A complete list of the bills introduced to date, with status updated daily, can be found on the infoNET Bill Tracker

2015 Bills.  Bills that didn't pass last year are alive again this year.  Some of interest include:

  • HF 510 MH/SA Transportation Contracts:  Allows a county or mental health/disability services (MH/DS) region to contract with a private company to transport people with substance use disorders or mental illness to a hospital or facility (where they have been involuntarily or voluntarily committed).   The private company is required to make arrangements for transfer to a different facility if the facility or hospital determines better treatment would be given at another location.  The bill provides details for the contracts, and requirements for security and safety.  Requiers the Department of Public Health and Department of Human Services work with stakeholders (counties, law enforcement, sheriffs, regions) to develop rules. Status: Senate Human Resources Committee
  • HF 588 - Removable Disability Parking Placards: Current law allows individuals with disabilities to get a removable windshield parking placard that does not expire.  Unfortunately, there has been reported misuse of these placards, as they are not always returned upon the person's death.  To address this, legislators proposed this bill that will eliminate these non-expiring placards, and replace them with a placard that expires every five years.  The placard can be renewed as many times as needed.  The bill also requires the  removable windshield placard be displayed in a manner that allows the entire placard to be visible through the vehicle’s windshield. Applies to new placards issued after January 1, 2016.  Status: Senate Transportation Committee
  • SF 509 ADA Compliance/Gas Stations: Requires gas stations to comply with the federal Americans with Disabilities Act. Requires any new or renovated fuel pumps constructed after this bill becomes law offer refueling assistance for Iowans with disabilities, including the posting of signs and the use of a refueling assistance device that allows a driver with a disability to notify employees that they need assistance (device must be able to be operated by the individual’s closed fist or other method that does not require manual operation). Gives a $500 income tax credit to small businesses to help pay for the cost of making these changes. The tax credit is not refundable but may be used over several tax years.  Changes must be made by January 1, 2016; tax credit effective January 1, 2016; the rest of the bill is effective upon enactment. Status: House Ways & Means Committee 

2016 Bills.  The following bills of interest have been introduced during the first two weeks of sesson:

  • HF 2039 - Disclosure of Mental Health Information: Requires a health care provider who is caring for or treating an adult to tell that person’s immediate family member about the involuntary civil commitment process, if that person is likely to seriously physically injure his/herself or attempt suicide, and only if asked to do so by the immediate family member.  Health care providers who disclose this information cannot face civil or criminal actions for that disclosure. Status: House Human Resources Committee
  • HF 2040 - Mental Health Advocate Duties: States that a mental health advocate shall have exclusive control over the performance of the advocate’s duties. Guidelines and best practices for the performance of the advocate’s duties are to be developed by the Judicial Council, and adopted by the state Mental Health and Disability Services Commission. Status: House Human Resources Committee
  • HSB 533 - Supported Employment Reimbursement Rates: Increases reimbursement rates for Medicaid supported employement providers by 20% over the rates in effect on June 30, 2015. The Governor signed a 20% increase into law last year, the funds were appropriated ($750,000) but the Department of Human Services has failed to implement the increase.  This bill again directs that increase, and makes it effective back to the start of the fiscal year (July 1, 2015). 
  • SSB 3044 - Athletic Trainers at High School Sporting Events: Requires the home team at certain high school sporting events (football, soccer, wrestling, hockey, or lacrosse) to have a licensed athletic trainer present and available to assess athletic injuries. Requires an athletic trainer to notify the visiting team’s athletic director within 48 hours after the contest occurs if a visiting team's athlete shows signs, symptoms, or behaviors consistent with a concussion or brain injury. Status: Senate Education Committee

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