2015 INFONET #5

Issue 5, 3/27/2015

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April 1 will be day 80 of the 110-day legislative session. Normally that means legislators become very serious about getting things done, so they can finish up session in time to plant crops, attend graduations and weddings, and go on family vacations.  Unfortunately, this year legislators will have to cancel their May (and maybe June) plans, because an on-time (May 1) end is not likely.

The biggest reason legislators will have a tough time finishing up before May 1 is the budget. On March 19, the Revenue Estimating Conference (REC) met and gave their best guesses (estimates) as to how much money the state will have to spend for the next two fiscal years.  This is the first step in state budgeting, since Iowa's lawmakers are bound by law to spend only 99% of this estimate. That law makes sure our state never spends more than it has in the bank. 

As expected, the state's economy is growing at a pretty good pace, so revenues (mostly from taxes) are up by about 6%.  That's the good news.  The bad news is the Legislature has already spent it.  The state has about $408 million in new revenues to spend in the next budget year (called "fiscal year 2016" which begins July 1, 2015 and ends June 30, 2016).  However, the Legislature made some big promises when it reformed the education system and cut business property taxes last year. To pay for these past promises, the state needs the following amounts in fiscal year 2016:

  • $162 million is needed to pay for commercial/industrial property taxes
  • $50 million for other business tax replacements
  • $52 million for continued education reform
  • $200 million shortfall for fiscal year 2016 (this is after $50 million in "managed care" savings)

Now pick which funding level you want to fund schools at (the decision on this has not yet been made):

  • $50 million to increase K-12 school funding by 1.25% (as the Governor and House Republicans have proposed), or
  • $162 million to increade K-12 school funding by 4% (as the Senate Democrats have proposed).

Add these all up and you quickly get the picture.  These built-in increases don't include increased costs from a new two-year state employee contract agreement signed last week by Governor Branstad, which will cost the state $51 million next year, and another $53 million the following year.  If you add all that up for the next fiscal year, that's at least $565 million in built-in expenses, without a single new initiative being added to the mix (more if education funding is higher than 1.25%). These expenses do not include funding for the regional mental health and disability services system, that by law should have received $31 million next year.

The budget will shape the rest of the session. It appears that many tough decisions will need to be made in order to fit legislative priorities into the available revenue. The state either has to raise taxes (which legislators will not do) or make some very difficult choices.  You can view the REC's summary here (warning: you may only want to read this if you like math).

In the coming weeks, the majority party in each chamber will release "budget targets," the amount of money they are allowing each of the seven appropriations subcommittees to spend in their budget bills.  From there, the appropriations subcommittees will begin to put together their appropriations bills that collectively will set the fiscal year 2016 budget (as well as the framework for fiscal year 2017).  We hope to have budget targets to report in our next issue of infoNET (April 13).

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To keep things moving along at a good pace, the Iowa Legislature has rules that require bills make progress by certain dates, or they are finished for the session.  Slow and steady may win the race, but if you are too slow you won't make the cut.  The second "funnel" deadline is Friday, April 3.  By that date, all policy bills will need to have been passed by one chamber, and out of committee in the other chamber. 

That means all Senate Files must be voted out of House committees (and all House Files out of Senate committees) by April 3rd. Tax and spending bills (those in Appropriations and Ways & Means committees) are exempt from the funnel, so budget work can begin after this second deadlinel.  Legislators will try to wrap up their work quickly this week, so they can head home for Good Friday/Easter celebrations with their families. So look for most of the activity to be early in the week, with final committee work on Thursday.  After this week, the only committees that will continue to meet are Appropriations, Ways and Means, Government Oversight, and the seven budget subcommittees.  All other committees will be done with their work for the year.

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The Department of Human Services has finished its public hearings on managed care. These six hearings have been packed, with lots of questions asked. Since our last report, much has happened.

  • The State has said it will pick up to four managed care organizations. Seventeen (17) managed care organizations have submitted a letter saying the plan to submit a proposal to managed the state's Medicaid system.  They are:
    • Aetna Better Health of Iowa Inc.
    • Amerigroup Corporation
    • AmeriHealth Caritas Iowa
    • CHA HMO, Inc.
    • Cigna HealthSpring
    • Gateway Health Plan, LP on behalf of its managed care affiliates
    • Goold Health Systems, an Emdeon company
    • Health Information Designs
    • Iowa Total Care, Inc. (Centene)
    • Magellan Complete Care of Iowa, Inc
    • Medica Health Plans
    • Meridian Health Plan
    • Molina Healthcare, Inc
    • MultiPlan Shared Health
    • UnitedHealthcare Plan of the River Valley, Inc.
    • UnityPoint Health
    • WellCare Health Plans, Inc.
    • You can read the questions (with answers) asked by these managed care organizations here.

  • The state has issued amendments to the Request for Propsals (RFP) based on the questions from the companies.  Here are the updated documents:
  • The first round of questions/answers has passed, but those with questions about the plan to move Iowa's Medicaid program to managed care have until Thursday, April 2 to ask questions.  These questions are answered in "Frequently Asked Questions" document, which is now being updated weekly to address questions from stakeholders and the general public.

The Department will do another round of public meetings when it puts together its waiver, which will show the Federal government how we plan to roll out managed care.  Those meetings will likely be in June.  Managed care organizations will submit their proposals on May 8, but DHS has until July 31 to make its decision. Here are a few other resources you may find helpful:

Finally, the Iowa Senate has a bill that would create strong legislative oversight of the Medicaid managed care contracts. That bill is Senate File 452, and it was passed unanimously (50-0) by the Iowa Senate two weeks ago.  The bill does two things:

  • Creates a Legislative Medicaid Transformation and Oversight Commission that will monitor the transition to managed care and make recommendations for improvement. The focus of the Commission's work will be defining and monitoring outcomes, reviewing DHS' contract oversight, and ensuring that members are able to access appropriate, high quality healthcare services.

  • Outlines conditions that must be included in any managed care contracts. These conditions focus on consumer protections that ensure access to high quality care that emphasizes consumer choice, self-direction, person- and family-centered care, access to care in close proximity, and necessary appeal processes; transition provisions that ensure people do not "fall through the cracks" as the system changes; healthcare provider protections that ensure adequate reimbursement while promoting care coordination and improved health outcomes; healthcare provider financial incentives that align with outcome metrics and care integration; common metrics and evaluation methodologies across managed care organizations based on socioeconomic determinants of health and improvement in population health outcomes; and appropriate planning, contract monitoring and enhanced legislative oversight.

Obviously the second bullet is causing some heartburn with legislators in the House, who do not want to disrupt the already tight managed care timeline. Some of the things in this bill would require an amendment to the RFP, which would delay the timelines. A subcommittee of the House Human Resources Committee met last week to hear from lobbyists on the bill, most of whom supported the bill (the rest were just "monitoring" it).  Rep. Linda Miller, who chaired the subcommittee, said she needs to think about the bill before deciding to move it forward.  She indicated parts of the bill that woud affect the RFP would need to be amended out.  The subcommittee, which also included Rep. Brian Best and Rep. Ruth Ann Gaines, will discuss the bill's future early in the week.  At this point it appears that the bill will either be heavily amended before passing out of committee, or it will die in the funnel and legislators will work on something smaller to put in a budget bill (where the Governor can veto parts he doesn't like).


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ADVOCATING FOR CHANGE DAY 2015 Reminder that registrations are due on April 6 for Advocating for Change Day (April 22, 2015).  Click here to get registered before the deadline; contact ID Action if you have any questions at contactus@idaction.org or 866-432-2846.

The infoNET Grassroots Action Center is easy to use - it really does take just minutes to email your legislators.  We have a new video featuring Rik Shannon, the Iowa Developmental Disabilities Council public policy manager.  He's a familiar face to many of you, and he'll show you just how easy it is to email your legislations in less than three minutes! 

ATTEND A LOCAL LEGISLATIVE FORUM: Most legislators hold public forums and town hall meetings when they are back in their districts on Fridays and Saturdays. These are excellent opportunities for you to meet your legislators, learn from them, and educate them on your priorities. Click here to find a forum near you.

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Keep track of bills that may impact the lives of individuals with disabilities in our Bill Tracker.  Status is updated daily, so you can always find out where your priority bills are at in the process. 

Below is a list of those bills still alive, some of which need to make progress before Friday (April 3) to stay alive. Safe indicates bills that are safe from the April 3rd deadline.



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