2017 Issue #5

The Legislature has officially been in session for two months, and there is just one month left to go. Legislators will begin their 11th week of work on Monday (March 20); they want to wrap things up by the end of the 15th week (on or around April 18). With only four weeks left to go, legislators will turn their attention to budgets and the second “funnel” deadline on Friday, March 31. That is the date when all bills need to be voted out of one chamber, and out of committee in the other chamber. That means Senate bills need to be voted out of House committees, and House bills need to be voted out of Senate committees. Anything left in committee after March 31 is dead. Deadlines do not apply to anything dealing with a tax (Ways & Means), spending (Appropriations), or government efficiency (Government Oversight). So the regional MH/DS funding fix could still be done in the final weeks (or days) of session since it involves both taxes and spending!

Looking ahead, legislators will turn from long days of floor debate to long hours of subcommittee and committee work. You can listen or watch floor debate live - or archives of each day’s debate - from the main page of the legislative website (www.legis.iowa.gov). If you want to watch debate on a specific bill:

• Put your bill number into the bill search at www.legis.iowa.gov - or click on the bill number in our Bill Tracker.
• On the left, there will be links to “Senate Video Archive” or “House Video Archive.” 
• Click on that, and watch the debate (if its not there, the bill hasn't been debated).

And remember - Advocating for Change Day 2017 is coming up on Wednesday, April 5, 2017. Join hundreds of other advocates at the Capitol to make your voice heard on the issues that are important to you. There’s no shortage of them this year - voter ID, autism insurance coverage, regional mental health and disability services funding, Medicaid, medical marijuana, CMV awareness, and more. If you haven’t signed up to attend, you can do it here.

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Iowa legislators are required by law to balance the state's budget each year, and only spend 99% of the state’s money.  The remaining 1% goes into an “economic emergency fund” to help the state get through tough years.  This year, we need the economic emergency fund! 

The most recent budget estimates came out this week, and they show the state needs to cut another $105.9 million from current year budget - that is, from April-May-June spending.  This is on top of the $88.2 million that was already cut in the Deappropriation Bill (SF 130) passed earlier in session.  That bill also held back $25.2 million in tax credits that would have gone to businesses; if that had not been done, the cuts needed to balance this year’s budget would be $131 million (instead of $105 million).

Legislators have decided that there is no way to cut further in the final months of the budget year, so they will dip into the economic emergency fund and borrow $105.9 million to cover the shortfall.  The key word is “borrow;” legislators say they want to pay the emergency fund back with next year’s budget money.  Here’s a quick rundown of what the budget looks like for next year (the budget year that runs from July 1, 2017 to June 30, 2018):

• $258.5 million total new money to spend.
• $105.9 million will pay back to the Economic Emergency Fund.
• $40 million already spent on 1.1% school funding increase.
• $42 million is needed to fund Medicaid.
• That leaves $70.6 million left for the rest of the budget (including salary increases, increased costs of operations).

These numbers come from the non-partisan Legislative Services Bureau - you can see their review here.  Legislators may use a different set of numbers, as some will want to be more conservative in budgeting so they don't have to come back in an election year (2018) and do another round of cuts.  Whatever numbers are used, there is simply no money for any new programs.   We expect budget decisions to move quite quickly now, as legislators rush toward the second funnel deadline on March 31 and their final session day on (or around) April 19.

So the bottom line - no money to spend on new programs or priorities, more cuts are likely, no state money to pay for regional MH/DS services, and Medicaid may get short-changed.  Decisions will be made very soon.  So if you have priorities in this budget, better let your legislators know now!

• Click here to email your legislators.
• Call your State Senator at (515) 281-3371.
• Call your State Representative at (515) 281-3221.

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There are a lot of challenges to funding this year. This doesn’t have to be one of them. The state’s mental health and disability services (MH/DS) regions have a plan to pay for these locally-managed, county-funded, regionally-delivered services to Iowans who are not eligible for Medicaid or need services not covered by Medicaid. These services help Iowans with disabilities live and work in their community of choice. While the regional system has been called a huge success by state lawmakers, state agency leaders, the Governor, advocates, and others, the system has one serious flaw. There is not enough money to continue to pay for these services.

The Iowa State Association of Counties knew state legislators would not be willing to spend the $30 million promised for the system when it was redesigned in 2012. So they developed a plan of their own - elected county supervisors would set their own property tax rates to pay for these services (up to the current $47.28 per person limit). Counties in a region would work together to figure out a fair way to fund their system. Budgets and plans would continue to be approved by the Department of Human Services, who would make sure that the services provided are appropriate and meet state guidelines.

Only one of the three funding bills introduced this session is still alive (SF 365 by Sen. David Johnson). Legislators have not yet held a single subcommittee, committee, or hearing on the bills that were introduced. They have not publicly discussed what they will do, despite a growing list of supporters for the county plan. In a year of public protests and public hearings, not one discussion has been held on this very important issue. If this is important to you:

• Come to Advocating for Change Day on April 6 (click here to register).
• Email your legislators here.
• Call your State Senator (515-281-3371) and State Representative (515-281-3221).

Tips on Your Message:

• introduce yourself, and let them know where you live (city).
• Tell them what types of services you get that are funded by your MH/DS region.
• Tell them what those services mean to you, and what would happen if funding was not available.
• Urge them to support the county plan for funding regional MH/DS services.

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Iowa became the 19th state to enact autism insurance reform in 2010, but the legislation only applied to state employee health insurance plans. Since 2010, state employee insurance plans covered “applied behavior analysis," a service that is proven to benefit children with autism. According to the Department of Human Services, about 3,000 Iowans receive autism services through the state health insurance plan. Experts say applied behavior analysis (ABA) can help children diagnosed with autism modify their behavior and improve their communication skills.

This week, the Iowa House expanded this access beyond state employees by unanimously passing House File 215, which extends ABA coverage to all health insurance plans offered by companies that have 50 or more employees. “This bill is a long-time coming, “ said Rep. Chris Hall of Sioux City. “It’s difficult for the public often to understand that public policy can be a very incremental process. It takes conversation. It takes people from opposing views actually coming to the table and sitting down together and trying to find that common ground.” Advocates for this legislation have been working on this for nearly a decade, and their chief advocate in the House was emotional in his thanks to those working on the bill. “I just wanted to rise and say what a wonderful day this is,” said Rep. Dave Heaton of Mt. Pleasant. "It’s been a long haul…and today we’re going to bring it home and make it all possible."

For others, the passage of this legislation was very personal. “Our oldest daughter is autistic,” said Rep. Andy McKean of Anamosa. "I can simply say that my wife and I would have very much wished that this legislation was in effect back so many years ago.” While the bill passed 96-0, it was not without its controversy. Iowa’s insurance industry and business organizations opposed it. A representative from the Iowa Association of Business and Industry said the legislation would require coverage for a small number of people but would be paid for by all employees. The Iowa Federation of Insurers said they were opposed to the bill because ABA is “not a proven therapy.”

The bill’s floor manager, Rep. Brian Best of Carroll, said that the cost to add this to insurance is the amount of one postage stamp per year, and cited studies that have shown that 87% of children receiving applied behavior analysis see improvement (and 40% see “significant improvement”). The bill now moves to the Senate, where it does not need to go through the committee process because it has a companion bill (Senate File 400) already on the Senate Calendar. That means it has passed the second funnel hurdle, and is ready for Senate debate.

If this bill is important to you:

• Thank your State Representative for passing House File 215, and encourage your State Senator to vote for it. You can email them here.
• You can watch the House debate on the bill here.
• You can see the list of Representatives voting for the bill here.

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Iowa’s limited medical cannabis laws are about to expire. On July 1, Iowans with severe epilepsy will no longer be protected from law enforcement for possessing and using cannabidiol, the oil that comes from the cannabis (marijuana) plant and has shown to be effective in preventing or reducing seizures. Iowans who are allowed to use this oil cannot purchase it in Iowa, so they must break other state and federal laws to bring it into the state. Many go to Colorado to get it.

Advocates for the use of medical cannabis want a fix now - ASAP - before the law expires. But legislators are not on the same page about what to do. Some want the legislation expanded to include other “debilitating conditions” and want it to be grown and available for purchase in the state. Others want to simply extend the current program. Others would prefer the current program expire, and all forms of cannabis remain illegal, even for medical treatment. That is why most of the bills this year died. Only House File 520 and its companion Senate File 470 survive. They would allow the Iowa Pharmacy Board to allow the prescribing of medical cannabidiol immediately after FDA approval. The federal Food & Drug Authority (FDA) is likely to approve use of the oil for epilepsy soon, which means doctors could prescribe it and pharmacies could fill the prescription. If this legislation doesn’t pass, the Pharmacy Board would have to wait for legislative action in 2018. These bills allow the Board to move forward without delay. In addition, the bill extends the current law indefinitely (that is, it removes the expiration date on the current state law).

If this is important to you, let your legislators know! Attend a local forum, or come to Advocating for Change Day. Write a letter to the editor, or email or call your legislator. It’s a very controversial issue, so legislators need to hear what you think. Remember that you can email your legislators here, and you can find a list of public forums held around the state here.

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Bills making big changes to Iowa’s workers’ compensation system are moving quickly through the Legislature.  Workers’ compensation programs give people who are hurt on the job, payment for lost wages, medical treatment, and rehabilitation.  Some of these injuries result in a permanent disability, so benefits currently cover that worker for life.  This year, the Iowa Legislature is considering two bills (House File 518 and Senate File 435) that would make four basic changes to Iowa’s century-old workers’ compensation law:

1. Ends most benefits at age 67.
2. Decreases benefits for injuries related to a pre-existing condition.
3. Reduces penalties employers get for paying benefits late.
4. Limits attorney fees.

In addition, the bills raise the burden of proof, making it harder for an injured worker with a pre-existing condition to prove the work injury is the cause of a disability.  Right now, Iowa’s law clearly states that if a person has a pre-existing condition that was aggravated, accelerated, or worsened by the injury, s/he would be covered under workers' compensation. Cutting benefits short for injured Iowans that may be unable to return to work might put more pressure on our already over-burdened Medicaid system.

As more Iowans with disabilities find jobs and are integrated into the workplace, this change may have a broader impact.  Take this scenario:

• An Iowan with a disability works for a company and falls, resulting in a spinal cord injury.  Should that person receive less compensation because they had a pre-existing condition that may or may not have contributed to the fall?  Should they have to make a stronger case for that compensation just because they already have a disability?  Should the state's Medicaid system pick up their cost of care, instead of the workers' compensation system? 

• An Iowan with a disability who is 66 years old is injured on the job.  Should her compensation end at age 67? Should she be treated differently than someone who is 40 and injured?   

While the House fixed the 67-year-old age limitation, the Senate bill still limits benefits for older workers. In addition, the House bill also establishes a new vocational rehabilitation program for persons with shoulder injuries to give them appropriate training at the closest community college, if employee will not be able to return to work. The House passed its bill 55-38 on a largely party-line vote (Rep. Rob Taylor, a Republican, joined Democrats in voting against the bill).

The bills are supported by business groups, who say their premiums for workers compensation insurance are increasing dramatically.  However, records from the National Council on Compensation Insurance, which sets workers' compensation insurance premiums for Iowa and other states, show no large increases in premium costs, claims or medical costs associated with workplace injuries. In fact, Iowa employers saw their workers' compensation premiums decrease 4.7% last year.  State figures also show that the number of Iowans injured on the job and the number of those cases sent to courts has not increased in recent years.  

Employers point to a different study (the the Oregon Department of Consumer and Business Services) that showed Iowa’s workers compensation insurance premiums were ranked 45th lowest in the country in 2006. By 2016, Iowa had risen to 24th.  They say that study shows that employer costs are rising at an uncontrollable rate.

If this issue is important to you, contact your State Senator and State Representative. 

• Click here to email your legislators.
• You can call your State Senator during the week at (515) 281-3371.   
• You can call your State Representatives during the week at (515) 281-3221.

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Congress is on a fast track to repeal major portions of the Affordable Care Act (ACA) and to make drastic cuts to state Medicaid programs. These cuts will affect services, maybe even services you receive. Your federal lawmakers want to get this done by mid-April, right about the time the Iowa Legislature adjourns for the year. Advocates need to explain why the Affordable Care Act (aka “Obamacare”) and Medicaid are essential to people with disabilities and their families. 

_____________________ WHAT YOU CAN DO: Share Your Story! ____________________

For many adults with developmental disabilities, Iowa’s Medicaid program is their health insurance. It pays for care from doctors, specialists, and hospitals, as well as prescriptions. Iowa, like all states, receives Medicaid funding to help pay for the cost of long-term supports that people with disabilities receive. Still more receive services through our state’s expansion program, the Iowa Health & Wellness Plan.

Thousands of Iowans with disabilities depend on Medicaid - or will need it in the future - to remain healthy, live in the community, and stay out of costly institutions. Many other groups of people will also be affected. While the discussion of the Congressional plan is ongoing and there may be changes, it is clear that Medicaid at the state level will be impacted. It is important to share your story of Why Medicaid Matters to You.

Our Congressional Representatives and Senators need to know the impact Medicaid has on people's lives - and they need to know now. If you or someone you know relies on Medicaid-paid services -- or will in the future -- take these easy steps:

• Think about "Why Medicaid Matters to Me.” How do these services help you? What would you do without them?
   
• Email Senator Charles Grassley, Senator Joni Ernst, and your US Representative. Briefly tell them the positive impact Medicaid-funded services and community supports have had on your life or the life of someone you care about. Ask them to reject the plan moving through Congress now, and reconsider the impact it will have on Iowans with disabilities. Use some of the information from the messages below to help you. You can email all three of your federal elected officials here.
   
• Email President Trump. Let him know the positive impact Medicaid-funded services and community supports have had on your life or the life of someone you care about. Ask him to revise his plan to cut these services.  You can email him here.

Here are a few messages that you might consider using if this change affects you:

• Do not cut and cap Medicaid! Medicaid is funded with state and federal funds. Under a Medicaid cap, the federal government would limit its share. The intent of this cap is to save federal government money, which means cuts to states. That could mean losing home and community-based services and supports, increasing HCBS waiver waiting lists, losing optional services that help people live successfully in the community, more unnecessary institutionalization, and shifting costs to individuals or family members to make up for the federal cuts. The costs of providing health care and long term services and supports will not go away, but will be shifted to individuals, parents, states, and providers. For additional information, see the Consortium of Citizens with Disabilities’ fact sheet about Medicaid.
   
• Do not repeal the Affordable Care Act’s protections for people with disabilities! The ACA is the most significant law for people with disabilities since the Americans with Disabilities Act. Because of the ACA: 1) health insurers can't deny health insurance or charge higher premiums if you have a disability or chronic condition; 2) there aren't arbitrary financial limits to how much health care you can get in a year or in your lifetime; and 3) more people with disabilities and chronic health conditions are able to access health care due to the Medicaid expansion. For additional information, see Consortium of Citizens with Disabilties' fact sheet about the ACA.

There are several resources that can help you in sending your messages.

• Check out the alert from the Consortium for Citizens with Disabilities.
• Be sure to read the Autistic Self Advocacy Network's toolkit that explains how to be an advocate.
• Read how cuts to Medicaid will harm Iowans here.

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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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You can see the most current status of bills we are tracking in our infoNET Bill Tracker.  Updates are made daily.  Right now, here is a list of bills that are safe from the March 31 deadline - and those that need to make more progress to remain alive.

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The following bills have been signed into law:

HF305 - Biological Products - Allows pharmacists to substitute an interchangeable biological product, rather than the product named in the prescription.

SF130 – Deappropriation Bill - Cuts appropriations for the current fiscal year (FY2017) by $88 million and increases revenues by capping business tax credits (saving $25 million).

The following bills have made enough progress that they are safe from the March 31 funnel deadline, or they are in a committee that is exempt from the deadline.  They are all eligible for debate until session ends.

HF215- Autism Treatment Coverage (Senate Floor with Companion SF400) Requires health insurance plans cover applied behavior analysis for autism treatment.

HF240 - Regenerative Medicine Research Tax Credit (House Ways & Means Committee) Gives a tax credit for contributions to an Iowa regenerative medicine research institution.

HF444 - Genetic Counselor Licensing (House Ways & Means Committee) Requires licensure for genetic counselors.

HF487 & SF465 - Medical Malpractice (Senate & House Floors) Caps non-economic (pain & suffering) damage awards, limits legal fees, makes changes to expert witnesses, and requires evidence-based medical practice guidelines in medical malpractice claims.

HF516 - Voter ID (Senate Floor with companion SF 474) Requires Iowans to show ID to vote, makes changes to voter registration and absentee voting law, creates a loan program to help counties pay for conversion to electronic poll books, requires post-election audits, and eliminates straight-party voting.

HF520 & SF470 - Medical Use of Cannabidiol (House & Senate Floors) Allows cannabidiol products to be prescribed immediately upon FDA approval, and continues the state’s limited medical cannabidiol program (for persons with severe forms of epilepsy).

HSB188 - Genetic Counselor Licensing (House Government Oversight Committee) Requires licensure for genetic counselors.

SF58 - Social Security Benefits (Senate Ways & Means Committee) Excludes social security benefits from state taxes.

SF191 - Income Tax Exemption (Senate Ways & Means Committee) Exempts all wages earned by a person working for a non-profit, tax-exempt business providing services to individuals with disabilities from state income taxes, effective January 1, 2018.

SF365 - MH/DS Regional Funding (Senate Ways & Means Committee) 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.

SF420 & HF544 - Dependent Adult Abuse/Personal Degradation (Senate & House Floors) Includes personal degradation by caregivers as a form of dependent adult abuse.

SF436 & HF233 - Step Therapy Protocols (Senate & House Floors) Establishes guidelines that must be followed by health insurers that use step therapy protocols for prescription medications (requirements that a person fail first on cheaper drugs).

SSB1142 - Student Loan Debt Cancellation (Senate Ways & Means Committee) – Gives a state income tax exemption for the cancellation of student loan debt due to the death or permanent disability of the student or borrower. 

SSB1181 - Appropriation of Federal Funds (Senate Appropriations Committee) Appropriates federal block grants, including the substance abuse block grant, the community mental health center block grant, and more.

The following bills need to be voted out of committee before the deadline.  If they do not make it out of committee before March 31, they will be dead.

HF234 - Mental Health Advocate Reporting (Senate Human Resources Committee) Allows a county-appointed mental health advocate to file reports as needed or as required by the court (versus quarterly). 

HF306 - Nurse Aid Training and Testing (Senate Human Resources Committee) Allows continuing education and training for certified nurse aides (CNA) to be delivered online.

HF496 - Driver's Education for Students Requiring Adaptive Equipment (Senate Transportation Committee) Limits driving time for students who require a motor vehicle modified with special adaptive equipment.

The following bills need to be voted out of one chamber, and then out of committee in the other chamber before the deadline.  If they do not make it through these two steps before March 31, they will be dead. 

HF466 - Health Coverage for Dependents (House Floor) Allows kids to continue to be covered by their parent's health insurance until they turn 26.

HF531 - Public Assistance Programs Oversight (House Floor) 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.

HF546 - MH/DS/SA Work Groups (House Floor) Directs regions to develop plans to address the needs of individuals with complex mental health, disability, and substance use disorder needs, and directs a statewide stakeholder group to make recommendations based on these plans. Mandates MHI and hospital participation in the psychiatric bed tracking system. 

HF576 - Background Checks/Temps (House Floor) Requires temporary staffing agencies to conduct criminal and child/dependent adult abuse record checks for people working in a nursing home, assisted living facility, or similar provider.

HF586 - Rent Subsidy Program (House Floor) Establishes a rent subsidy program for participants in the Medicaid Home and Community-Based Services waiver and the Money Follows the Person program.

HF593 - Mental Health Professionals/Commitments (House Floor) Allows mental health professionals to perform examinations, provide treatment, and submit necessary reports for voluntary and involuntary hospitalizations (currently only physicians can do this).

SF453 - Mental Health Information Disclosure (Senate Floor) Allows a mental health professional to disclose mental health information to a law enforcement officer, jailer, or county attorney if it will protect the individual or others.

SF458 - Psychiatric Practitioner Loan Repayment Program (House Human Resources Committee) Creates a psychiatric practitioner loan repayment program.

SF477 - Medicaid MCO Interest Penalty (Senate Floor) Requires Medicaid managed care organizations (MCOs) to pay an interest penalty for clean claims not paid within 90 days and requires MCOs to allow providers to submit a claim within 365 days of service. 

SF478 - Supported Community Living Services (Senate Floor) Allows Medicaid HCBS reimbursement for supported community living services provided in the home of a family member.

SF51 - Cytomegalovirus Public Health Initiative (Senate Floor) Requires collaboration among state and local health agencies and others to educate and raise awareness of cytomegalovirus, and requires testing of newborns with hearing loss. 

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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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