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2017 Issue #4

Issue 4, March 07, 2017

Articles in This Issue:


FAST PACED DEADLINE WEEK @ CAPITOL

Four months is not a lot of time.  Legislators must wade through hundreds of bills that deal with everything from declaring a state butterfly (regal fritillary) to cleaning the state's polluted rivers to balancing a budget when there isn't enough money to go around.  There are more ideas than time, so legislators need to prioritize.  They set deadlines; if bills don't make it far enough in the legislative process by each of these deadlines, they are set aside and no longer discussed.  

These deadlines are called "funnels," and the first of the two funnel deadlines hit on Friday, March 3.  Bills that did not make it out of their assigned committee by that date are done for the year.  The first funnel deadline ended debate on hundreds of bills but left plenty of controversy for the remaining seven (or so) weeks of session. 

Among the dead are bills that would have: reduced HCBS waiver waiting lists; addressed various concerns about Medicaid managed care; funded home modification grants; developed a plan to attract more direct care workers; required gas stations have at least one ADA-compliant pump; expanded the use of medical marijuana and allowed for in-state growing and sales; ended licensure of social workers, mental health counselors, and dozens of other professions; raised the state's minimum wage; directed hospitals to do a better job training home caregivers upon release of a loved one to home care; updated the psychiatric bed tracking system daily; studied pain medication abuse; prohibited health care workers from asking about a patient's gun ownership; reinstated the death penalty; defined life as beginning at conception and thereby ended all abortions; legalized the sale of machine guns; and ended the annual ritual of setting our clocks back in the Fall (keeping daylight savings time as the standard).  

But don’t worry, there is still plenty of controversy in the bills that survived, including: a ban on abortions after 20 weeks; a huge rewrite to the state’s gun laws (including stand your ground); voter ID legislation that also ends straight-party voting, ban on sanctuary (immigrant-friendly) cities; reductions in worker’s compensation benefits (ending at age 67, factoring in pre-existing conditions); forced break-up of the Des Moines Water Works; elimination of the state’s nearly 40-year-old can/bottle deposit law; and legalization of fireworks and fantasy sports. 

Legislators are now keeping their eyes on the second deadline (March 31).  This second funnel deadline is even tougher than the first.  In order for a bill to stay alive, it must be voted out of one chamber (House or Senate) and pass out ot of committee in the other chamber.  To get bills ready for the other chamber, legislators will spend most of their time over the next two week debating bills.  
The end of the first funnel also signals a turn of attention to budgets, including the Medicaid managed care system and the regional mental health and disability services (MH/DS) system.  On March 14, legislators will get updated revenue estimates that will determine how much money they will be allowed to spend this year in budgets.So far, revenue estimates are still coming in slower than expected, so March estimates will probably not give legislators much budget wiggle room.  In other words, probably not enough money to restore the mid-year buget cuts that came at the beginning of this session, but maybe enough money to avoid deeper cuts.  
 
Policy bill debates haven’t been much fun this year; don’t expect budget discussions to be any relief.  If you care about funding - now is the time to start talking to your legislators!  Use our Grassroots Action Center to get started!

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MH/DS BILLS AMONG SURVIVORS

Mental health and disability services (MH/DS) regions are facing their biggest challenge yet - steady, long term funding.  Since the system was created back in the mid-1990s, counties have had a tough time getting money to pay for services. Funding was always decided at the last minute, and counties (now regions) had a tough time planning ahead.  

One of the reasons the state created MH/DS regions was to make sure a core set of services was available throughout the state, and once that was done, build on that with cost-saving additional core services like mobile crisis and jail diversion. But the missing link was funding to grow.  

Counties are locked in at their 1995 property taxes, without any additional state dollars.   The Iowa State Association of Counties and a large coalition of advocacy groups led by the AMOS and NAMI Iowa are asking that the state give counties the ability to set their property taxes according to local need.  So some counties want to raise their property taxes so they can pay their fair share to the region, and give other counties' taxpayers in the region a break.  County boards of supervisors, who are elected by and accountable to their county's voters, would make the decision on the tax rates.  The Department of Human Services would still approve regional MH/DS plans to make sure counties are staying within the law.

To make this happen, legislators need to change the law this year.  Whle there is broad support for this, one powerful organization opposes it (Farm Bureau).  So the news after this funnel deadline is mixed.

  • The Bad News: Two bills that would give counties local control over their MH/DS levy rates did not survive the funnel (House File 342 and House File 343.  But since this deals with a tax, the issue can be brought up in the House Ways & Means Committee at any time, or dealt with in a budget.
  • The Good News: Senate File 365 survived the funnel, because it was sent to the Senate Ways & Means Committee (deadlines don't apply to this committee). It is sponsored by Sen. David Johnson of Ocheyden and is assigned to a subcommittee of Sen. Randy Feenstra of Hull, Sen. Waylon Brown of St. Ansgar, and Sen. Pam Jochum of Dubuque.

Another bill drafted by the Department of Human Services survived the funnel as well. This bill (House Study Bill 156) originally moved additional core services into core services, scooped any excess county tax funds from regions and put them into a state property tax relief fund, required hospitals and mental health institutes (MHIs) to use the psychiatric bed tracking system, and continued the work of a state work group that is developing regional strategies to address the needs of Iowans with complex mental health, disability, and substance use disorders.  

That bill passed of of committee, but all that is left is the psychiatric bed tracking system and the state work group.  In addition, legislators added regional work groups that pull in providers and law enforcement locally to develop plans to address this population's complex needs.  Those regional reports would be due in October, and the state work group would review them and respond with a state plan that would be due by December 2017.  Just in time to ask for action in the 2018 legislative session.  This scaled back version will be given a new bill number soon, so watch the Bill Tracker for updates.

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PUBLIC HEARING HELD ON VOTER ID BILLS

Hundreds of Iowans turned out for a public hearing on Monday night (March 6) to comment on the bill that would require all voters to show an ID card in order to vote.  Voter ID laws are very controversial. Supporters say they secure our voting systems.  Opponents say they create barriers to voting, especially people with disabilities, the elderly, minorities, and the poor who may not own a car (or have a license).  

House File 516 and Senate Study Bill 1163 both survived the funnel deadline.  The bills would:

  • Require voters show a valid ID in order to vote (Iowa driver license, Iowa non-operator ID, military or veteran ID, US passport, or a free non-photo voter registration card issued by the Secretary of State's office to all current and new registered voters who do not have other forms of ID).
     
  • Anyone without an ID would be allowed to vote a provisional ballot, but would likely need to produce proof of identity sometime in the next three days, perhaps requiring a trip to the county courthouse.
     
  • Poll workers and election officials would be allowed to question a person's identity based on information on the ID, including a voter's signature. In fact, the bills require a poll worker to give a voter a provisional ballot if they don't think the person looks like their ID, or the signature doesn't match.
     
  • Post-election audits are required every two years to ensure accuracy of voting results and expanded (and eventually statewide) use of electronic pollbooks are encouraged to increase voting site efficiency.

Over 100 people signed up to speak during the 90-minute public hearing, but it appears everyone that wanted to speak got to do so.  Opponents heavily outnumbered supporters. Their main arguments were based on:

  • Cost ("This is an unnecesary, poor use of taxpayer money.")
  • Need ("The Washington Post reported the results of a comprehensive investigation that found 31 possible counts of fraud among 1 billion votes cast since the year 2000.")
  • Intent ("It's pretty obvious the bill is about voter suppression, not election integrity.")
You can read all the comments submitted here.  Unfortunately, we did hear there were many that did not speak at the heaing because it was held at the same time as the off-year Demcoratic Party caucuses.  No disability advocate groups spoke at the hearing, but the Iowa Developmental Disabilities Council submitted the following statement.

The DD Council is a federally funded state agency charged with effecting systems change that creates opportunities for Iowans with disabilities to live, learn and work in the communities of their choice. Meaningful and enduring change occurs only when Iowans with disabilities and their families are represented in the decision-making processes that drive opportunities for their greater independence.

The right to vote is an important part of that representation and the Council resists any attempts to erode the access to the electoral process that Iowans with disabilities currently enjoy. Most concerning is the identification requirement that has the potential to disproportionately limit the voting rights of Iowans with disabilities. One of the most common forms of identification, the driver’s license, is out of reach for many Iowans with disabilities simply because they are less likely to drive. And while many Iowans with disabilities can and do have passports and other forms of identification, they are often unaffordable or inaccessible to the one in three people with disabilities who live in poverty. According to the Brennan Center for Justice at the New York University School of Law about 11 percent of Americans do not have a government issued photo identification card, and the 2012 edition of the Pew Charitable Foundation’s Election Performance Index, found that 7.2 percent of registered voters with disabilities had no photo identification, compared with 4.5percent of those without disabilities. HF 516 does provide for the issuance of a free photo ID card to voters but even this may not be accessible to many Iowans with disabilities who experience housing shortages or other conditions that result in frequent moves.

 Equally troubling is that even Iowans with the necessary identification may have their eligibility to vote challenged on the basis of their signature. If the poll worker feels that the voter’s signature is not a match with their identification card, the voter will be required to cast a provisional ballot and furnish additional proof of their identity to have their vote counted. A voter’s signature may change over time and this is particularly problematic for individuals who are aging and/or who experience limiting physical disabilities.

Finally, these and other provisions of HF 516 that limit Iowan’s access to elections seem unnecessary in a system that Secretary of State Paul Pate just last year held up as “one of the cleanest, best election systems in the country”. The DD Council urges the Iowa Legislature to oppose this bill.

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Your legislators want to hear from you too.  Do you think voters should be required to show IDs to vote? Do you think this will cause problems for you?  What would make the bill better?  Email your legislators now!  Cick here to get started!

 

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END OF THE ROAD FOR HUNDREDS OF BILLS

Committees worked hard over the last two weeks to make sure their priorities made it through the first legislative funnel deadline.  For hundreds of bills, there was no light at the end of the funnel. Below is a list of the surviving bills - and a list of bills that didn't make the cut.  As always, you can find the most current status of these bills in our Bill Tracker: www.infonetiowa.org/news/bill-tracker/.

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SURVIVIORS:

  • Requires insurance plans base step therapy protocols for prescription medications (requirements that a person fail first on cheaper drugs) on clinical guidelines, make the appeals process clear and easy to find, and allow a physician to override insurance decisions.  (HF233 & SF436)
     
  • Allows a mental health advocate to file reports as needed or required by judge, instead of quarterly. (HF234)

  • Gives a tax cut to people who donate to an Iowa-based regenerative medicine research facility. (HF240 & SF269)

  • Exempts school-based preschool programs that provide special education to three year olds from state child care licensing requirements. (HF277)

  • Allows pharmacists to substitute an interchangeable biological product for what is prescribed. (HF305)

  • Allows certified nurse aide (CNA) training and continuing education to be done online. (HF306)
     
  • Allows non-physician mental health professionals perform examinations, provide treatment, and submit necessary reports for voluntary and involuntary hospitalizations. (HF319)
     
  • Limits driving time required for students driving a car modified with special adaptive equipment. (HF325)
     
  • Limits "pain and suffering" awards for medical errors (HF487)
  • Licenses genetic counselors. (HF444)
     
  • Requires voters show ID (HF516 & SSB1163) and allows a county auditor to combine precincts. (HF471).
     
  • Fast-tracks the prescribing of medical cannabidiol once approved by FDA, and continues the state's current medical cannabidiol program indefinitely (it was set to expire on June 30). (HF520 & SF282)
     
  • Authorizes regional and state work groups to develop plan to address needs of Iowans with complex MH/DS/SA needs, and requires hospitals and MHIs use the psychiatric bed tracking system. (HSB156)
     
  • Requires a progress report on efforts to establish an electronic asset and identify verification system for Medicaid recipients, and requires a review of data sharing efforts among states to address program integrity for public assistance programs. (HSB172)
     
  • Allows dependents to continue to be covered by their parent's health insurance until they turn 26. (SF130)
     
  • Exempts all wages earned by a person working for a non-profit disability services provider from state income taxes (SF191)
     
  • Creates a psychiatric practitioner loan repayment program in areas not considered a health worker shortage areas. (SF285)
     
  • Allows Medicaid HCBS reimbursement for supported community living services provided in the home of a family member. (SF316)
     
  • Allows each county board of supervisors to set the levy rate for regionally delivered mental health and disability services (MH/DS), up to $47.28 per capita. (SF365)
     
  • Requires health insurance plans cover applied behavior analysis for the treatment of autism spectrum disorder (SF400 & HF215). 
     
  • Includes personal degradation (willful acts or statements intended to shame, degrade, or humiliate) as a form of dependent adult abuse (SF420 & HSB146)
     
  • Requires state and local agencies to work together to educate and raise awareness of congenital cytomegalovirus, and requires testing of newborns with hearing loss. (SF436)
     
  • Excludes social security benefits from state taxes. (SF58)
     
  • Allows a mental health professional to disclose mental health information to a law enforcement officer, parole/probation officer, or a jailor if it will protect the client or others from harm. (SF75)
     
  • Eliminates income tax on amount of a student loan debt that is released (cancelled) because the student/borrower died or has a permanent disability (SSB1142). 

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THE DEAD:

For hundreds of bills, there is no light at the end of the funnel.  The following bills didn't make the funnel, so will no longer be discussed this year:

  • Increasing the size of the Commission for the Blind by two members (National Federation of the Blind in Iowa & Iowa Council of the United Blind). (HF149)
     
  • Expands the definition of child in need of assistance for mental health treatment to include a child whose parent, guardian or custodian is unwilling to provide such treatment. (HF11)
     
  • Allows a county or MH/DS region to issue an RFP and contract with private companies to provide transportation for individuals needing hospitalization for substance-related disorders or mental illnesses. (HF125)
     
  • Eliminates same-day voter registration (HF150) and requires photo ID to vote. (SF47)
     
  • Appropriates $7.1 million to reduce Medicaid HCBS waiver waiting lists (HF172) and requires HCBS waivers to pay for home delivered meals. (SF169)

  • Expands the current state medical marijuana law to cover more debilitating conditions, and allow in-state production, distribution, and sales. (HF199HSB132SF205)
     
  • Requires motorcycle/scooter riders to wear helmets on highways (HF286) and requires individuals under 18 years old to wear helmets while riding motorcycles, motorized bicycles, and all-terrain vehicles (SF96).
     
  • Allows counties to set their MH/DS property tax levies. (HF343 & HF 342)
     
  • Directs DHS to appoint a committee to address the long-term care needs of elderly persons who are sexually aggressive. (HF345)
     
  • Requires health insurance policies pay for services delivered via telehealth. (HF348SSB1160SSB1168)
     
  • Requires school districts to provide suicide prevention training for school employees. (HF352)
     
  • Requires state agencies that regulate a profession to provide a waiver process for people with a criminal record who would be otherwise barred from that profession. (HF364)
     
  • Allows a licensed psychologist to bill for the services provided by a pre-doctoral psychological intern or post-doctoral psychological resident. (HF423)
     
  • Allows car owners to order special registration plates with a hearing impaired emblem bearing the international symbol of access for hearing loss. (HF431)
     
  • Allows any interested individual to file an involuntary commitment application for a person with an intellectual disability who presents a danger to self or others. (HF448)
     
  • Requires hospitals to provide transitional care for up to 24 hours for veterans who may be at risk of causing harm to themselves or others. (HF482)
     
  • Allows registered voters to request absentee ballots through email or the county election commissioner's website (HF55) and make those absentee ballot requests permanent (so they don't have to ask for them for each election) (HF78).
     
  • Restores the voting rights of felons once they have completed their sentence, unless the felony was for election misconduct or was a forcible felony. (HF79)
     
  • Eliminates licensure for mental health counselors, social workers, massage therapists, and other professions (HSB138), creates new licensure for applied behavior analysts and assistant applied behavior analysts (SF192), and establishes new licensure for clinical art therapists (SF85). 

  •  Requires DHS to transition Medicaid recipients who lose coverage through the health insurance premium payment program to Medicaid fee-for-service and not Medicaid managed care. (SF140)
     
  • Requires a school district to pay for the educational costs of a child who lives in the district, but is receiving medical treatment outside the district. (SF181 & HF354)
     
  • Establishes guidelines for the use physical restraints and seclusion for disruptive students (SF204) and allows disruptive children to be removed from the classroom (SF323).
     
  • Directs IDPH to lead a coordinated effort to address recruitment and retention of direct care workers (SF214HF275SSB1071) and directs the Governor's Future Ready Iowa Alliance to make recommendations on addressing the state’s health care workforce shortages (SSB1167).
     
  • Funds home modification grants. (SF223 & HF318)
     
  • Requires the development of a new cost-reporting methodology for HCBS providers. (SF286)
     
  • Eliminates the Department of Education and transfers all its duties to the appropriate Area Education Agency (SF29) and requires school districts to assist in completing Medicaid reimbursement forms for special education services that it provides to a child who requires special education and is participating in open enrollment. (SF330)
     
  • Requires Medicaid MCOs pay 1.5% interest to providers for claims not paid within 60 days (SF342) and allows Medicaid providers to submit claims to MCOs within 365 days of the service date (SF343).
     
  • Requires gas stations to comply with the Americans with Disabilities Act. (SF353 & HF417)
     
  • Makes the following improvements to the Medicaid managed care system (SF368)
    • Adds Integrated Health Home (IHH) services, residential substance abuse treatment, assertive community treatment, nonemergency medical transportation, and peer support to the Iowa Health & Wellness Plan. 
    • Requires MCOs to allow a non-participating case manager to enter into a single case agreement. 
    • Requires MCOs give providers at least 14-day notice of member benefit changes and 30-day notice for transfers between MCOs (and requires payment for services during that time). 
    • Requires MCO reimbursement to a provider for services provided while awaiting authoriation.
    • Requires establishment of uniform MCO processes and procedures for claims filing, denials, IHH criteria, and appeals/grievances. 
    • Defines "medically necessary services" and requires MCOs to use this definition. 
    • Moves up the required initial External Quality Review of Medicaid Managed Care by one year (to 1/1/2018).  
    • Expands on the required MCO reporting of clean claims.
    • Resets the floor reimbursement rates to those in place 4/1/2016 (and no lower).
    • Requires prior authorizations be approved within the same time periods in law for private health plans. 
    • Requires pharmacy prior authorizations be in effect for 12 months. 
    • Requires MCOs all use the same prior authorization process and forms.
       
  • Requires daily updates on the number of available inpatient psychiatric beds. (SF369)
     
  • Removes the statewide subacute bed cap (50 beds). (SF380)
     
  • Creates a lottery game to benefit individuals with Multiple Sclerosis. (SF48)
     
  • Allows 17-year-olds to vote in a primary election if they will be 18 by the time of the general election. (SF61, HF167, HF201)

  • Requires a study to investigate the possibility of establishing a paid Family & Medical Leave Program. (SF63)
     
  • Funds ($100,000) a comprehensive cytomegalovirus public health initiative. (SF68 & HF120)
     
  • Requires hospitals to provide each patient or legal guardian with an opportunity to designate a caregiver to provide after-care assistance to the patient upon discharge from the hospital to the patient's residence, and requires the hospital to provide training on the care needed. (SF90)
     
  • Requests an interim legislative committee to study the creation of a long-term care facility to care for geriatric persons who are registered sex offenders or who are sexually aggressive. (SR4)
     
  • Requires a health insurance utilization review group that requires priority authorization to make its requirements readily accessible on its website (SSB1161) and requires Medicaid MCOs comply with prior authorization requirements already in law for private insurance companies. (SSB1165)
     
  • Requires Medicaid MCOs to recognize licensed physicians, physician assistants, and advanced registered nurse practitioners as primary care providers. (SSB1166)

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ADVOCATE NOW!

Now is the time to let your legislators know about the bills, programs, and services you care about.  Use our Grassroots Advocacy Center to send your legislators emails - it'll look up their addresses for you.  It will even find out who represents you if you do not know the names of your legislators!

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REGISTER NOW FOR #ACD2017

You can be the crowd at the Capitol on Wednesday, April 5, 2017!  Join other self-advocates at the State Capitol for Advocating Change Day 2017.  The Governor and Lt. Governor have been invited to speak - and advocacy and networking opportunities abound.  Register now here

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PUBLIC FORUMS

The State Capitol isn't the only place where crowds are growing.  Legislators are reporting record turnout at their local legislative forums, held on Fridays and Saturdays in their districts.  

Last year we tracked more than 500 of these events in our calendar.  You can see the next three weeks of public forums here.  


Local Forum Tips

  • Get there early. As you may have seen from news stories, legislative forums have been packed. Think about going 15-30 minutes early in order to get a seat.  The other added benefit to going early - you may get a chance to talk with your legislator one-on-one, even if its just to introduce yourself. Bring a business card, or something with your contact information on it.
     
  • Understand and follow the rules. There are a lot of people, and a lot of controversial issues being discussed.  Many forum organizers have decided to issue rules so that things go smoothly and everyone has a chance to ask questions, particularly those from the district.  If you don't know the rules, ask. Some forums want you to submit questions, others just call on you.  Don't be shy - just ask how questions will be handled.

  • Be confident.  Remember that your legislator was elected to serve and take input from constituents.  This is their job - and they can't help you unless you ask!
     
  • Be Iowa nice! If you’re called on, start by thanking your legislator for attending the forum. Introduce yourself, and maybe say how long you’ve lived or worked in the district. Ask them a simple question about an issue you care about.  If you aren't sure what to ask, contact some of the organizations you work with to see if they have examples.  Even if you and your legislator don’t see eye-to-eye on your issue, being polite and respectful will make your legislator much more likely to take you and your issues seriously.
     
  • Make it personal. A good question for a legislator includes facts (if you have them) and personal stories (the most important) to demonstrate how the issue directly affects you and others in the district.
     
  • Follow up. Send a quick email to your legislators after the event, thanking them for their time and for answering your question. If they disagreed with you, a polite email gives you another opportunity to raise the issue with them and provide them with more information.  Ask them to put you on their email newsletter lists.

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BILL TRACKER

Know your stuff!  Use our online Bill Tracker to follow bills introduced this legislative session.   Our bill tracker is updated daily, and keeps tabs on bills of interest to Iowans with disabilities.  Just click here to see bills tracked.

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