2014 INFONET #8

Issue 8, 5/1/2014

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Session Ends on May Day

Some years, the Iowa legislative session is like a sprint, and other years it's more like a marathon.  This year, legislators promised it would be a mad dash to the finishing line.  In the end, it was like sprinting in a marathon.  Legislators worked hard and fast all session long to solve problems and work out differences.  They had hoped to end session sometime before the 100-day deadline, some even hoping for the end of March. 

As the 100-day deadline approached, it became clear to legislative leaders that there were still too many issues dividing the Republican-controlled House, Democratic-controlled Senate, and the Governor.  By the end of April, nearly all budget bills were still being negotiated, priority policy bills were still unfinished, and the final "one-time spending bill" had not yet seen the light of day.  The Legislature finally wrapped up work on the 110th day of session, ten days after legislators stopped being paid for their work.

The 2014 Iowa Legislative Session unofficially ended when the House of Representatives adjourned sine die (without date) at 5:54 AM on Thursday, May 1.  Unofficially, because the Senate followed suit 27 hours later, adjourning at 8:50 AM on Friday morning.  The Senate added a day in order to pass a resolution that gives the Government Oversight Committee the ability to subpoena witnesses in the ongoing investigation of the Department of Administrative Services' negotiations of confidential personnel settlements, and the Department of Workforce Development's influence over Administrative Law Judges to compel them to rule in favor of businesses in unemployment compensation cases.  The Government Oversight Committee is one of the few legislative committees that has the ability to meet throughout the year.

To end session, both chambers had to push their work through the night, requiring the House to take action just before midnight to waive a rule that forbids voting after midnight.  This rule was put in place by House leaders years ago because they thought mistakes were made during late night debate.  And to prove that point, one legislator accidentally ran an amendment to a bill in the early morning hours, and before he realized his mistake, the bill had been messaged to the Senate.  No chance for a do-over, so the bill had to be sent to conference committee, which was really more like a middle-of-the-rotunda huddle at 3:30 AM.  The bill was fixed, but it slowed the process down.

The very last bills to make it to the finish line included the Standing Appropriations bill, a spending bill that contains debt reduction and one-time funding, a bill decriminalizing use of cannabidiol for a small group of epileptic sufferers, a bill modernizing HIV laws, a bill establishing a new motorsports recreational vehicle classification, and three other budget bills that were caught up in the final trade-offs.

The Governor now has 30 days to take action on all legislation passed by the Legislature in the final days of the session.  His choices are to sign a bill into law or to veto a bill.  However, in the case of spending bills, the Governor can veto parts of a bill (called a line-item veto).  The Governor cannot change a dollar amount for a program or selectively veto words.

This year's later-than-anticipated finish leaves legislators facing primary elections just a month to knock on doors and talk to voters before the June 3, 2014 primary.  After those primaries, the run-up to the November election promises to be exciting.  The 2014 November election will feature an open U.S. Senate race and two open U.S. House races, something that hasn't happened in Iowa in over a generation.  Excitement generated from those races as well as the contested Governor's race could have a dramatic effect on the legislative races down the ballot.  This year's 26-24 Democratic Senate and 53-47 Republican House could very well change hands, depending on who turns out on Election Day. 

Remember to vote in your primary election on June 3, 2014!  Click here for more information.

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Legislators Compromise on MH/DS Funding

Iowa's mental health and disability services (MH/DS) system has been a work in progress for nearly two decades.  Over the last two years, the Iowa Legislature made some very important changes to the way non-Medicaid services are delivered.   Those changes move Iowa toward a more uniform regional system that will be fully operational on July 1, 2014. Regions will all be required to have a set of basic "core services" that are available to Iowans with intellectual disabilities and mental illness.  Regions will also be encouraged to begin developing "core plus" services like jail diversion and crisis stabilization, as funds are available.

While previous redesign legislation made a lot of changes, they were not all permanent changes.  State funding for the system was only in place until June 30, 2015.  Local funding (property taxes) was only allowed through June 30, 2016.  Regions are expected to meet (and pay for) new core service requirements when they begin operating on July 1, 2014 - yet they are expected to return some of their state dollars just a few months into the year if they saved money because of people enrolling in the Iowa Health and Wellness Plan. 

So legislators knew that the MH/DS redesign was incomplete when they started the legislative session. The biggest challenge was figuring out how to calculate the "savings" counties might see from people signing up for health insurance through the Iowa Health and Wellness Plan, which was developed after Congress passed and the President signed the Affordable Care Act.  Legislators didn't say how to calculate this savings, which has been called both the "Medicaid offset" and the "clawback." The Department of Human Services and counties could not come to an agreement on that calculation either. 

Counties wanted to get rid of the offset entirely, saying it was too early to know how much money they needed to operate their new regional systems and offer the full array of core services.  DHS wanted to calculate the "savings" by looking at the costs picked up by Medicaid for any person that would have been eligible for regional services, whether or not they were reveiving services previously paid for by the county or providers included in the county's network.  This was the dilemma legislators faced this year. 

Now for the good news!  Legislators were able to find common ground in the final weeks of session.  A small group of legislators worked out the details of a compromise that will provide regions with greater financial stability for the next two years.  This will give regions time to determine how much money is needed to provide core services, core plus services, and services to other populations (i.e. people with brain injuries and people with developmental disabilities other than intellectual disabilties), and it will give legislators time to decide if the current way of funding the system is the best way.  Here are the details:

  • Increases funding for regional mental health and disability services by $735,435.  This maintains the $47.28 per person spending level (called "per capita equalization"). This increase was needed because Iowa's population increased, and more money was needed to keep equalization at that level. Regions will receive a total of  $30,555,823 for services delivered July 1, 2014 to June 30, 2015.
  • Extends the "Equalization Formula" and county property tax levies for another year (through June 30, 2016).  These laws were to expire after next year, but regions wanted stability while they evaluate the impacts of redesign, health care reform, and the new payment system.  No one wanted to come back next year and have to readjust redesign again - this way regions have at least one year of operations before the Legislature considers any other changes.
  • Continues the Medicaid Offset, but outlines a process for calculating actual savings.  The Medicaid offset reduces funding to MH/DS regions who "save" money because of the Iowa Health and Wellness Plan.  The formula passed by the Legislature this year will look at actual county expenses.  Under legislation passed, by June 30, 2014, counties and DHS will agree to the categories of services (CPT codes) and types of diagnoses (ICD9 codes) to be included in the savings calculated. These codes will be things that were previously paid for by the county, but are paid for now by the Iowa Health and Wellness Plan.  DHS would look at actual county expenses for those codes in the first six months of the year (July-December 2013) and the second six months (January-June 2014); the difference is the "savings."   Counties would repay 80% of that savings to the Property Tax Relief Fund (which by law is to be reinvested by the Legislature in "mental health and disability services delivered by the regions").  For the second year, counties would take their costs for those codes in 2013 and compare them to the amount paid in 2014; again that would be their savings and they would be required to repay 80% of that amount.  The only difference is that in year two, counties that do not receive state equalization funds would have to reduce their levies in the amount of their savings.  That is a controversial issue that will likely be an issue for next legislative session.

    • Medicaid Offset Example:  A county pays $2 million for services in those select "savings" codes during the first six months of the fiscal year (July-December 2013).  That county then pays $1 million for those services in the second half of the fiscal year (January-June 2014).  That county's savings would be $1 million, so they would be allowed to keep $200,000 of that amount (20%) and have to pay $800,000 back to the state (80%).  That money goes into the Property Tax Relief Fund; that money is to be reinvested by the Legislature to improve the regional services system.
  • Allows counties to maintain a 25% ending fund balance.  This was a recommendation of the MH/DS Redesign Interim Committee, which felt it important for counties to have enough money in the bank to get through the first three months of the fiscal year, before property taxes are collected and state funding is available. The legislation passed this year allows counties to have up to 25% of their annual budgets in the bank at the end of the year; any extra money is to be spent on expanding core services and developing core plus services.
  • Other changes to the MH/DS Regional Services System:
    • Mahaska and Marion Counties will be allowed to operate as a two-county region for a year (this temporary permission can be extended by an additional year by DHS, and can be made permanent if they meet the requirements of a region within that time period). 

    • People currently served in the regional system with resources in excess of the limits adopted last year by rule may continue to receive regional services; any new people would need to get an exception to policy, or spend down their resources.  Redesign legislation directed the Department of Human Services to adopt resource limits for the regional services system. They did that, but set the limits very low (same as SSI limits).  Before redesign, these resource limits were the floor (counties could go above but not below in requirements).  After redesign, they became the ceiling (that is, counties could not go above in setting resource limits).  This change will allow those currently being served to be grandfathered in (allowing them to continue to be served without spending down), and will still allow new people to access services through the exception to policy process.

    • Adds funding ($250,000) to establish a mental health advocate division in the Department of Inspections and Appeals but this is repealed in another bill (HF2473). The bill originally had language making the advocates state employees overseen by DIA, but the language was taken out in the final compromise. The money was also supposed to be taken out, but it was not.

Coming to this agreement on redesign was not an easy task, and it took legislators all session to make it happen.  A small group of legislators has invested a tremendous amount of time and energy into finding a way to fund a system that improves the lives of the people it serves.  These dedicated legislators include: Senators Amanda Ragan, Joe Bolkcom, and Jack Hatch; and Representatives Linda Miller, Dave Heaton, Joel Fry, and Lisa Heddens.



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Legislature Passes Balanced Budget

By law, Iowa legislators can spend 99% of the money it collects in taxes for the year. But this year a group of legislators agreed not to spend more than $7 billion, even though that meant spending less than allowed.  In order to pass a budget, legislators agreed to spend only 91% of the money available ($6.97 billion).   While the state will have nearly $2 billion in its savings account by the end of next year, some legislators (and the Govenror) did not want to spend that money and say those funds are needed to pay for the property tax and educational reforms passed last year.

Legislators agreed to spend another $139.8 million to pay off some of the state's debt ($60 million) and fund one-time projects that include building renovations at state universities and electronic medical records for substance use treatment providers and community mental health centers. The biggest challenge to the state's Health and Human Services Budget this year was a change in the federal match rate for Medicaid, something the state cannot control.  Because Iowa's economy has been better than other states, the Medicaid match rate went down, so Iowa must come up with more money to pay for Medicaid services.  This year, that meant an addiional $35 million was needed just to provide the same level of service.

While legislators were able to find $6 million to provide services to people on the HCBS waiver waiting lists, Iowa's Medicaid program did not get the $30 million it needs to make it through the final two months of this fiscal year (May and June 2014). Here is more detail about the budget passed:

For People with Disabilities & Family Members

  • Fully funded Medicaid for next year ($1.3 billion) but did not add the $30 million needed to get through the current year (May & June 2014).  Mediciad is short about $30 million this year, and does not have enough money to pay for services for the next two months. We do not know what Medicaid plans to do; that will be a decision made by the Governor and DHS but could include temporary provider cuts, waiting lists, and delays in starting new programs. The Governor can also shift money around if there are other programs that will not spend all of their money. We will post more information on this as it becomes available.
  • Added $6 million to take people off HCBS Waiver waiting lists. There are currently more than 7,000 individuals with disabilities waiting for Medicaid waiver services (Health and Disability Waiver; Brain Injury Waiver; Physical Disability Waiver; Children's Mental Health Waiver).  The Governor vetoed similar appropriations last year - so if this is important to you, make sure you let the Governor know!  
  • Increases funding for Regional Mental Health/Disability Services (MH/DS) by $735,435 to maintain the $47.28 per person spending level (per capita equalization) - the total funding for regions is now $30,555,823.        

  • Adds new funding ($250,000) for a mental health advocate division in the Department of Inspections and Appeals. This was part of the recommendation of the MHDS Redesign Study Committtee, but it does not do anything to create a common job description or make sure the people serving in this position meet a minimum set of qualifications.  Last year the Governor vetoed this appropriation.

  • Maintains funding for the state's brain injury services program ($891,644) and the $95,000 earmark for the brain injury program service manager. 

  • Adds $50,000 to the program that provides education, client-centered programs, and client and family support for people living with epilepsy and their families (total $149,823).   The additional funds must be matched dollar for dollar with private funds.

  • Adds $1 million to the state's Autism Support Program ($3 million total), which was created last year to provide Applied Behavioral Analysis and other treatment for children that do not qualify for Medicaid and whose private insurance does not provide autism coveraage.

  • No change in funding for other autism programs funded by the state - including the University of Iowa's Regional Autism Services Program (RASP) provided through the network of child health specialty clinics ($400,000), Four Oaks autism services ($25,000), Dubuque hospital-based autism support ($25,000),

  • Adds $775,000 for additional client services provided by the Division of Vocational Rehabilitation in the Department of Education - this was needed to draw down additional federal dollars.  Iowa was not fully matching federal dollars, so the state was continuing to miss out on federal funding for these services.  The Legislature also increased funding for independent living services at Vocational Rehabilitation by $50,000, and the Centers for Independent Living by $50,000.  Also increases funding for independent living programs in the Department for the Blind by $250,000. 
  • No change in funding for the Entrepreneurs with Disabilities Program ($145,535) and increased funding by 4% to the Iowa School for the Deaf ($361,000) and Iowa Braille & Sight Saving School ($151,000).
  • Appropriates $5 million over two years to Broadlawns Hospital for a new inpatient psychiatric hospital wing and outpatient clinic ($2 million in FY15 and $3 million in FY16).  This Polk County hospital made the case that it is now serving as the psychiatric hospital for a big part of the state, as other hospitals have closed their psychiatric programs.  This new $20 million facility will add 12 psychiatric beds to its existing 30 (which are full 100% of the time) and feature a new outpatient clinic.  The bill also gives new psychiatric medical residencies preference in getting some of the $2 million available to train new doctors, which should help Broadlawns create a new psychiatric medical residency program (right now, the University of Iowa has the only one in the state).
  • Adds $200,000 to build a new inpatient psychiatric bed tracking system.  This was another recommendation of the MH/DS Redesign Study Committee.  It is difficult for hospitals, medical providers, law enforcement, and family members to find available psychiatric beds, and there are stories of people travelling across the state, only to find the bed taken.  This would create a real-time tracking system - so beds are located quickly, and people are stabilized faster.  The Department of Human Services is to work with MHDS regional administrators and provider groups to get this in place.

  • Adds $107,608 for a discharge specialist to assist residents and tenants with voluntary and involuntary discharges and evictions from health care facilities.  This was a recommendation made by the Governor, and a high priority for the Office of Long-Term Care Ombudsman.  This position helps people transition out of nursing home levels of care, and find other community placements..    

  • Makes $100,000 available to study placement options for hard-to-place persons or sex offenders needing long-term care services.  There have been several high-profile cases of sexual assaults in care facilities after sex offenders have been placed there by court orders.  Residents of care facilities have been concerned about their safety, but lawmakers have not been able to find alternative placement options for sex offenders that need that level of care.  Legislators have in the past looked at funding a speicialized facility or dedicating space in one of the state's institutions, but no action has been taken.  The Department of Human Services is directed to select a private group to perform this study and make recommendations to the Legislature.   
  • Directs DHS to work with other state agencies, regional MH/DS system, providers, and other stakeholders to study community-based placement options for persons with serious mental illness. The goal is to find ways to divert people with serious mental illness from or end their need for institutional placement.  The group is to review of services currently available, services that should be developed, regulatory and liability issues involved, funding needed and availble, and other barriers to maintaining current community-based options and developing new options.  The group will report back to the Legislature by December 15, 2014 with recommendations.
  • Requires the State Patrol and Department of Public Safety to implement the Endangered Persons Alert System, which issues alerts when a person with a cognitive disorder goes missing.  Similar to an "Amber Alert" when children are abducted, this will help notify the public when a person with an intellectual disability or older person with dementia goes missing.

  • Requires the Department of Education to submit a written report to the Legislature (by 1/15/15) detailing the department's anti-bullying programming and current and projected expenditures for such programming for the fiscal year.  No other bullying prevention legislation passed this year, despite much discussion and work on it.

For Providers & Caregivers

  • Very few provider increases this year.  EMS providers will get a 10% increase.  Community mental health centers will be able to choose between cost-based reimbursement and an alternative reimbursement methodology developed by Magellan (retroactive to July 1, 2013).  Several CMHCs say Medicaid is three years behind on reimbursements, threatening the financial stability of some centers.  No increase for hospitals this fiscal year, but nursing homes got a partial supplemental rebase.  Hospital rebasing would have cost $6 million.  Language in the budget delays the rebase until October 1, 2015, but that is outside this fiscal year.  Nursing homes received a supplemental rebase of $1.25 million.  Last year, their rebase was short by $4 million, so this appropriation only partially addresses that shortfall. 
  • Directs the Department of Public Health to work with stakeholders to review reimbursement to substance-related disorder providers, including adequacy of reimbursement, whether it is appropriate to rebase reimbursement, reimbursement equity compared to other behavioral health service providers, and the effect of health coverage expansion through IHWP), with recommendations due 12/15/14.
  • Appropriates $3.6 million to help community mental health centers and substance abuse providers pay for electronic health records - $800,000 goes to DHS for up to $100,000 grants to community mental health centers, and $2.8 million to substance abuse providers in one-time funds for the purchase of electronic health records and data warehouse technology.  Both grants require systems to be operational by July 1, 2018, and consistent with federal requirements.
  • Extends presumptive eligibility to federally qualified health centers and others upon request for the Iowa Health And Wellness Plan population (subject to federal approval).  Presumptive eligibility allows the provider to provide immediate Iowa Health and Wellness Plan covered services to a person that qualifies for that coverage. The person is assumed to be eligible if they meet the qualifications on paper, but the provider will not have to wait for enrollment to be finalized in order to be paid for the services.

  • Requires the Iowa Medicaid Enterprise (IME) notify legislators when a state plan amendment or Medicaid waiver is submitted.  Lawmakes were upset that more information was not given to them throughout the process of submitting the Iowa Health and Wellness Plan; this language was prompted by that frustration.

  • Requires IME to release an RFP for a contract with a private vendor to establish an electronic asset, income, and identity eligibility verification system for determining and redetermining Medicaid eligibility (effective upon enactment). IME is required by federal law to do this service, but they have another year before the federal requirement begins.  While this tells IME to release the RFP, it does not say it must award it. 

  • Directs the Departments of Human Services, Public Health, Aging, Workforce Development, and Corrections to implement an interagency collaborative effort to provide an integrated approach to address the medical and psychosocial needs of individuals upon release from a correctional facility, including communications with community-based providers (report 12/15/14 to address approach developed, barriers to implementation, and recommended changes to laws/rules).  
  • Eliminates $37,500 for development of uniform cost report, but requires to DHS report on implementation of the uniform cost report by 12/15/14. 

  • Appropriates $825,000 for the Homestead Autism Project to expand Altoona clinic and to a new site yet to be selected.  Other providers recieved funds as well for building and renovaations - $250,000 for the New Hope Center in Carroll and $250,000 for Camp Sunnyside Adult Day Program in Des Moines. 

  • Maintains funding for a contract with the Iowa Caregivers Association for education, outreach, recruitment and retention ($178,875) and caregiver conference and training scholarships ($75,000) – and increases funding for the Direct Careworker Advisory Council by $75,000 to make up for lost grant dollars ($213,400).


The Governor has until June 2 to take action on the budget bills that fund these programs.  The Governor is allowed to selectively veto parts of budget bills; this is called a "line item veto."  He cannot veto a word or a sentence, but can veto entire appropriations and paragraphs.  If you see something you want to make sure gets signed into law, contact the Governor!

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Medical Marijuana Passes; Bullying Prevention Fails

Lawmakers have spent a lot of time over the last two years trying to find ways to prevent bullying in schools, and by students using social media.  The Govenror has sponsored two conferences on the topic and proposed major legisltation that would require schools to take action whether or not the bullying happens on school grounds and during the school day.  Despite all the talk, the Legislature left town without addressing this issue.  No legislation was passed, and advocates say the problem is not going to go away (and ignoring it may make it worse).

The Governor also asked the Legislature to look for ways to encourage companies to provide broadband (high-speed) Internet to rural areas of the state.  It was another issue with lots of talk, but no action in the end.  In a surprising twist, early in the morning on the final day of session, Iowa lawmakers passed a bill that decriminializes the use of Cannabidiol (oil derived from marijuana/cannabis) for patients who have seizure disorders that are not well-controlled by other medications.  To be immune from criminal penalties for possession, the person must be diagnosed with intractable epilepsy by an Iowa-licensed neurologist, obtain a card from the Department of Public Health, and keep only 32 ounces of the product on hand.  Iowans are not able to sell this product, so people will have to travel to one of the 20 states that have legalized it, and transport it back (a federal crime).  Cannabidiol is different from the marijuana people smoke - it has low THC (less than 3%) and therefore won't make the person high when used.  While cannabidiol is inhaled, it is not smoked. People use a vaporizer to inhale it.  The Governor said earlier in the year he would consider signing the bill, but has recently said he's not sure.

Below is a list of bills that passed the Legislature this year - and their current status.  Remember to let the Governor know if you want these bills signed (or vetoed).  You can see a full list of related bills in our Bill Tracker.  You can also see all bills passed by the Legislature here.


 HF 2159 - Miller Trusts - Miller Trusts are income sheltering agreements that allow otherwise income-ineligible Medicaid applicants to qualify for Medicaid.  This raises income thresholds from 100% to 125% (allowing people to have more income and still qualify for Medicaid covered services).   Effective 7/1/2014 and applicable to trusts in existence on or after that date. Signed

HF 2379 - Crisis Stabilization Regulation - Direct DHS to write rules for crisis stabilization programs, and exempts these programs from regulation by the Department of Inspections and Appeals (DIA).  This ensures the programs are not required to be licensed as hospitals, health care facilities, sub acute mental health care facilities or assisted living programs. Clarifies that the MH/DS Commission will approve the rules, and gives programs that have national accreditation to have deemed status (so they do not have to meet the additional criteria set out by the state).  Effective 7/1/2014. ­Signed.

HF 2450 - Justice Systems Budget - Appropriates $556.9 million to the Attorney General's Office, Department of Public Safety, Department of Corrections, and other justice-related programs.  This is $6.9 million above the Governor's level, and $9.1 million above current spending. Most of this increase is directed at funding more state troopers and state trooper salaries that were not funded last year ($5 million) and Community-Based Corrections ($4 million). Requires the State Patrol and Department of Public Safety to implement the Endangered Persons Alert System, which issues alerts when a person with a cognitive disorder goes missing. Cuts the Civil Rights Commission by $130,000.  Sent to Governor.

HF 2463 - Health/Human Services Budget - Appropriates $1.9 billion for public health, Medicaid, child welfare, and other human services programs and services. This is an increase of $107.4 million over current funding levels but $950,000 less than the Governor's recommendation. Adds $6 million to take people off HCBS waiver waiting lists, increases regional MH/DS funding to $30.1 million, and adds $250,000 for a mental health advocate division  See specifics above, or go to the Bill Tracker for more detail. Sent to Governor.

HF 2468 - Adoption Tax Credit - Allows individuals/families who adopt a child to get a $2,500 state tax credit to offset actual expenses related to the adoption. Doubles that credit ($5,000) for individuals/families who adopt a child with special needs.  Applies retroactively to January 1, 2014.  Sent to Governor.

HF 2473 - Standings Budget - Spends $18.3 million less than the current year on various appropriations that are required by state law.  This is a "catch all" bill that ends up being a vehicle for a variety of appropriations and policy changes that were left out of other bills.  Adds $250,000 for awards to each Area Agencies on Aging for congregate meals and home-delivered meals to address food insecurity among older Iowans. Reduces AEA funding by $15 million. Sent to Governor.

SF 366 - Radon Testing/Schools - Requires the Department of Education to notify each school district and accredited nonpublic school about the risks associated with radon at attendance centers. Such notification shall include information on radon testing and mitigation, including relevant statistical data and information on sources of funding available for radon testing and mitigation, and shall encourage school districts and accredited nonpublic schools to implement a radon testing and mitigation plan. By December 1, 2014, each school district and accredited nonpublic school must tell the Department if they have a radon testing and mitigation plan and whether any testing/mitigation has taken place.  School districts or accredited nonpublic school that do not have a radon testing and mitigation plan in place as of December 1, 2014, shall also notify the Department of any plans the district or school has to implement a radon testing and mitigation plan in the future. The Department is to report back on this information to the Legislature by January 1, 2015. Effective 7/1/2014. Signed.

SF 2080 - Iowa Information Program for Drug Prescribing and Dispensing - Allows information in the Iowa Prescription Monitoring Program to be exchanged with border state systems or the Kansas system. Effective 7/1/2014. Signed.

SF 2130 - Transportation Budget - Appropriates funds from the Road Use Tax Fund ($358.2 million) to fund transportation programs, services, maintenance and construction.  Sent to Governor.

 SF 2168 - Uniform Power of Attorney - Creates the Iowa Uniform Power of Attorney Act to outline the powers of a person designated to manage another’s personal property. Includes penalties for abuse of this power and applies to all powers of attorney other than a durable power of attorney for health care, a voting proxy, a power created on a governmental form for a governmental purpose, and a power coupled with an interest of the agent such as a creditor’s right to protect title in pledged collateral.  The bill specifies details on durability, execution, validity, meaning and effect, termination, liability, and reimbursement and compensation.  The bill allows for appointments of conservators and guardians to have power of attorney. Effective 7/1/2014, applicable to powers of attorney created before, on, or after that date.  Applies to judicial proceedings on or after the effective date. Signed.

SF 2193 - Adult Day Service Programs - Allows adult day service programs to serve clients that are more difficult and currently prohibited from being served by adult day services providers.  The program may not knowingly admit or retain persons who are under the age of 18, require three-person assistance, or pose a danger to that participant, other participants or the staff. No additional regulatory oversight is added.  Effective 7/1/2014.  Signed.

SF 2296 - MH Treatment Costs/Chapter 812 Commitments - Clarifies that the state is responsible for paying the costs of commitments under Chapter 812 (not competent to stand trial).  The bill makes the Department of Human Services responsible for the costs associated with commitments to state Mental Health Institutes, and makes the Department of Corrections responsible for the costs associated with commitments to Oakdale Medical Classification Center or other appropriate facility.    Currently the law does not state who is responsible for this payment, but counties have been disputing these bills (and winning). Effective 7/1/2014.  Signed.

SF 2319 - Dyslexia Definition/Literacy Skills - Requires the Iowa Reading Resource Center to collaborate and coordinate with AEAs to develop and offer school districts professional development opportunities to enhance the skills of elementary teachers in use of evidence-based strategies to improve all students' literacy skills.  Assistance is to include strategies to formally address dyslexia, and defines "dyslexia" as "a specific and significant impairment in the development of reading, including but not limited to phonemic awareness, phonics, fluency, vocabulary, and comprehension, that is not solely accounted for by intellectual disability, sensory disability or impairment, or lack of appropriate instruction." Effective 7/1/14.  Signed.

SF 2320 - Consumer-Directed Attendant Care - Allows two different types of self-directed care - Consumer Choices Option (CCO) and Consumer Directed Attendant Care (CDAC).  Beginning July 1, 2016 DHS may require CDAC providers to be affiliated with an agency, but allows individual CDAC providers to continue if under contract before July 1, 2016.  After that date, people with disabilities would have the choice of an agency-based CDAC provider or a CCO provider. CCO allows people to self-direct care from individual (non-agency affiliated) providers.  Permits a guardian to also act as CDAC or CCO provider, but adds safeguards for CDAC providers that beginning July 1, 2016 are acting as both provider and legal guardian (payment rate is fair and reasonable for skill level, which cannot exceed statewide median level unless DHS approves; limits payment to 40 hours per week; agreement includes contingency plan for service provision in the event of provider illness or injury).  Directs DHS to amend HCBS waivers to replace agency-provided consumer-directed attendant care services with personal care services. Effective 4/3/14 and retroactive to 12/1/13. Signed.

SF 2342 - Administration/Regulation Budget - Appropriates $51.8 million for various state government operations, which is the same as current budget levels but is $164,000 under the Governor's recommendations. Maintains level funding for the Secretary of State ($2.9 million) and the Department of Human Rights' Community Advocacy and Services Division ($1,028,077) which includes the Commissions on the Status of African Americans. Status of Asians and Pacific Islanders, Status of Women, Status of Native Americans, Latino Affairs, Persons with Disabilities, and Deaf Services.  Sent to Governor.

SF 2347 - Education Budget - Appropriates $986.1 million for the Department of the Blind, Department of Education, College Student Aid Commission, and the Board of Regents (an increase of $87.2 million over current year and an increase of $34.1 million over the Governor's recommended level).  Adds $50,000 for state funding to public libraries ($2,574,228). Increases funding for independent living programs in the Department for the Blind by $250,000. Adds $775,000 for additional client services in Vocational Rehabilitation, $50,000 for independent living services at Vocational Rehabilitation, and $50,000 for Centers for Independent Living.  No change in funding for the Entrepreneurs with Disabilities Program ($145,535), Increases funding by 4% to the Iowa School for the Deaf ($361,000) and Iowa Braille & Sight Saving School ($151,000). Requires the Department of Education to submit a written report to the Legislature (by 1/15/15) detailing the department's anti-bullying programming and current and projected expenditures for such programming for the fiscal year. Adds new language that requires Area Education Agency (AEA) boards and all employees providing services to a school to have background investigations prior to employment (to include Iowa Court Information System, the Sex Offender Registry, Child Abuse Registry, and Dependent Adult Registry). Sent to Governor.

SF 2349 - Infrastructure Budget - Appropriates nearly $100 million in gambling funds for various infrastructure and technology projects in the fiscal year that begins July 1, 2014 (FY15) and additional funds for the fiscal year that begins July 1, 2015 (FY16). Adds new appropriations for rural YMCA infrastructure ($500,000), Iowa Homeless Youth Shelter infrastructure ($250,000), inpatient/outpatient building at Broadlawns Hospital in Polk County ($2 million in FY15 and $3 million in FY16), nursing home facility renovations ($500,000 - last year Governor vetoed $250,000 appropriation), Homestead Autism Project to expand Altoona clinic and to a new site yet to be selected ($825,000), renovations to the New Hope Center in Carroll County ($250,000), Good Earth State Park at Blood Run ($2 million), and Iowa Park Foundation to promote parks in Iowa ($2 million).  Doubles funding for recreational trails ($6 million).  Maintains current funding for Camp Sunnyside Adult Day Program Building Renovations ($250,000) and Public Transit Grants ($1.5 million). Directs the Department of Transportation to study administrative needs, projected demand, necessary capital and operating costs, and public transit service structures including park-and-ride lots, employer or public van pool programs, and traditional fixed-route transit (report due 12/15/14. Sent to Governor.

SF 2352 - Disabled Veteran Property Tax Credit - Currently, veterans that have service-related disabilities can receive a property tax credit equal to the entire amount of the tax levied on the home (if it was purchased through special veterans assistance programs).  This bill expands this to include veterans that served in the National Guard of any state who otherwise meets the service requirements for Iowa National Guard members with a service-connected disability rating of 100%. Strikes the maximum income limitation qualifications for the credit. Effective upon enactment.. Sent to Governor.

SF 2360 - Medical Cannabidiol Act - Allows a person to knowingly or intentionally recommend, possess, use, dispense, deliver, transport, or administer cannabidiol if it contains no more than 3% THC and the person has been diagnosed with a form of epilepsy that is not controlled through traditional medications. Requires an Iowa-licensed neurologist to recommend the prescription. Directs the Department of Public Health to develop rules on this and issue cards that show the person meets the requirements of this ac; only recognizes Iowa medical cannabidioil cards. Limits the amount of cannabidiol oil that can be possessed to 32 ounces. Requires the University of Iowa College of Medicine to submit a report detailing the scientific literature, studies, and clinical trials regarding the use of cannabidiol on patients diagnosed with intractable epilepsy annually beginning July 1, 2015.  Effective upon enactment, and repeals on July 1, 2017. Sent to Governor.

SF 2363 - Debt Reduction Act/One-Time Funding Bill - Spends $60.5 million to pay off state debt (effective upon enactment).  Spends another $79.8 million on various one-time projects:  $1.24 million agricultural drainage well water quality assistance; $3.5 million for water quality initiative special projects; $1.5 million watershed improvement fund; $5 million soil and water conservation district commissioners; $2 million Low Income Home Energy Assistance Program (LIHEAP); $1.22 million for special education costs for juveniles transferred from Iowa Juvenile Home in Toledo; $100,000 to study placement options for hard-to-place persons or sex offenders needing long-term care services (RFP required to select private entity able to perform study and make recommendations); $1 million to school districts for radon testing; $800,000 for Community Mental Health Center funding for electronic health records (to DHS for up to $100,000 grants; $400,000 for a third-party entity for asset verification; $200,000 for development and initial implementation of a inpatient psychiatric bed tracking system (and working with MHDS regional administrators, Iowa Behavioral Health Association, Iowa Association of Community Providers, MHIs); and $2.8 million for Iowa Behavioral Health Association for bulk purchase of electronic health records.  Sent to Governor.

SR 121 - Government Oversight/Continued Investigations - Gives the Government Oversight Committee the power to continue investigations on the handling of confidential personnel agreements by the Department of Administrative Services and the intervention of Department of Workforce Development staff in the decision-making of Administrative Law Judges (pressuring them to side with businesses in unemployment compensation hearings).  The Government Oversight Committee is given the authority to subpoena witnesses, and cite them for contempt for failure to appear.  Adopted.


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Make Sure to Say THANKS!

Legislators are public servants - they serve the public for very little pay, and are away from their families for months while working at the Capitol.  They work hard to get re-elected to a job that can be both incredibly frustrating and very rewarding.  They get many complaints and requests, but often never hear the words "thank you."  Please take time to write a note to your State Senator and State Representative.  Handwritten notes are the best, but e-mails and typewritten letters are okay too (especially if your handwriting is like mine!). 

You can thank them for passing something you liked during this session or something you read about in the newspaper.  Or you can just simply thank them for their service to the state and to you as their contsitutent.  Let them know the issues you care about, and ask them to keep you updated ths summer and let you know when they are having events in the area. 

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Public Comment on HCBS Waiver Transition Wanted!

Whenever the state or federal government wants to make big changes to services, they usually ask what the public thinks about those changes before making final decisions.  Right now, Iowans with disabilities, family members, and others have an opportunity to do just that.   The federal Centers for Medicare and Medicaid Services (CMS) has proposed some changes that would redefine where and how Medicaid Home and Community Based Services (HCBS) can be provided.

CMS is now moving away from defining HCBS settings based on where they are and what they look like to defining them by the nature and quality of the experiences of the person receiving services. The final rule was published in January 2014 and became effective March 17, 2014. The purpose of these regulations is to ensure that individuals receive Medicaid HCBS in settings that are a part of, and support full access to the greater community. They will also ensure that members have a choice in where they live and who provides their services.

Iowa Medicaid is required to submit a transition plan to CMS with their first Waiver renewal application, which was done on March 31, 2014 as part of the renewal process for the Intellectual Disability (ID) Waiver.  But before CMS approves the final transition plan, Iowa Medicaid must get public input. 

  • You can read a summary of these changes (and why they were proposed) here.
  • You can read the transition plan here.
  • You can read how various HCBS services fare under the new rules here.
Iowa Medicaid wants to know what you think about the change, and about their proposed transition process. Public comments will be accepted from May 1, 2014, through May 31, 2014.  You can provide comments in writing or by attending a stakeholder forum held at various locations around the state and online by webinar. 

Stakeholder Forums

  • FORT DODGE - Tuesday, May 20 (11:30 am - 1:30 pm) - Fort Dodge Public Library, 424 Central Ave.
  • CORALVILLE/IOWA CITY - Wednesday, May 21 (11:30 am - 1:30 pm) - Coralville Public Library (Room A) 1401 5th St.
  • DAVENPORT - Thursday, May 22 (11:30 am - 1:30 pm) - Davenport Public Library (Film Room), 321 N. Main
  • COUNCIL BLUFFS - Wednesday, May 28 (11:30 am - 1:30 pm) - Council Bluffs Public Library (Room B), 400 Willow Ave.
  • DES MOINES - Thursday, May 29 (9:30 am - 11:30 am) - Urbandale Public Library (Rooms A & B), 3520 86th St.
  • SIOUX CITY- Friday, May 30 (11:30 am - 1:30 pm) - Public Library (Mornigside Branch-Garretson Rm), 4005 Morningside Dr.
  • Click here for public forums flyer. 

Written Comment

  • Comments on the transition plan and settings analysis should be submitted in writing to: HCBSsettings@dhs.state.ia.us.

  • All comments will be reviewed, summarized and responses developed. Appropriate suggestions will be incorporated into the transition plan and responses to public comments will be posted on the IME website (/www.ime.state.ia.us/HCBS/HCBSTraining.html).


  • You will have a chance to ask questions at the public forums and learn more about the changes being proposed.
  • You can also submit any questions to HCBSsettings@dhs.state.ia.us.

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Mark Your Calendars! Self-Advocacy Conference 2014

ID Action is always breaking new ground - this time by sponsoring a 2014 ID Action Self-Advocacy Conference this fall in Coralville. The conference "Make Your Mark!" will be held October 1-3, 2014 at the Coralville Marriott Hotel & Conference Center. 

We have all heard the expression “make your mark,” but what does it really mean?  Ray Kroc made his mark when he opened his first McDonald’s restaurant and changed the way the world eats; the Wright brothers made theirs with the invention of the airplane, which changed travel forever.  Jessica Elg, is making hers in the community of Spencer where she lives, volunteers, and fundraises; and Adam Reynolds is making his as an ex-officio ambassador in Des Moines’ East Village. Whatever mark you make, it means you have had an impact and something is different because you were here. 

ID Action is a non-partisan project that promotes the active civic and political engagement of Iowans with disabilities—people like Adam and Jessica and their 300,000-plus peers.  Our inaugural advocacy conference will provide an opportunity for Iowans with disabilities to learn and grow as advocates and agents for change.

Who Should Attend: Iowans with disabilities that want to make a difference in their community or state!

Registration Information: Registration for the conference will open June 1, 2014. Register on or before Wednesday, September 3, 2014 to receive the early bird discount. Individuals with a disability: $100 (Early Bird: $80); Direct Care Provider/Family member attending with an Individual with a disability: $100 (Early Bird: $80); Professional: $200.00 (Early Bird $175.00); Other - $200.00 (Early Bird $175.00)

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You can check out disability-related bills (including budget bills) that were passed by the Legislature this year in the infoNET Bill Tracker.  All status is updated.  The Governor has until June 2 to sign bills into law, so we will be updating status daily as the Governor takes actions on bills.  Please check back frequently or watch for updates on Facebook (like us here).

Bills that didn't pass the Legislature this year are still listed in the "Inactive" list here. If you see something you wish would have passed this year, let your legislators know and ask them to file a new bill next year for you.

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