2015 INFONET #8

Issue 8, 6/5/2015

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The 2015 Iowa Legislative Session finally ended just before 4:00 p.m. on Friday, June 5, 2015.. The end of session was delayed by more than a month when House Republicans and Senate Democrats could not find a middle ground on things like education spending, government budgets, and dozens of policy bills.

It was a difficult session.  Budgets were tight and demands high.  Some legislators were fearful of what the bird flu outbreak will do to our state's economy.  After passing a gas tax increase early in session, many legislators were unhappy and not willing to compromise on other issues.  Add to that tensions over Medicaid managed care, mental health institute closures, school funding, fireworks, bullying prevention, medical marijuana expansion, school start dates, and you soon start to see how the gridlock started.  But it ended on Friday, June 5, with decisions to fund education at 1.25%.  After that, the budgets started falling into place.  But that doesn't mean everyone was happy with the final fall of the gavel, what legislators call "sine die."

Governor Terry Branstad now has 30 days to sign bills into law, or veto things he does not like. In Iowa, our Governor also has the ability to line item veto things in budget bills.  That means the Governor can select which parts of a budget bill he wants to sign, and which parts he wants to veto.  The Governor can only do this in budget bills, in other bills its all or nothing.

So take some time to review the bills that passed this year, either at the list at the end of this issue, or in our online Bill Tracker at www.infonetiowa.org/news/bill-tracker/.  If you see something you like (or don’t like), take action!

  • Send your State Senator and State Representative a note (email or mail) and thank them for their work this session.  Your elected officials worked long and hard this session, and they rarely hear the words “thank you.”  If you see something you liked in the bills that passed, thank them for that too!
  • Tell Governor Branstad what you think about the bills passed this year.  You have 30 days to convince your Governor why something should be signed or vetoed. 

Just a few tips to remember when taking action:

  • Be positive in your message.
  • Tell them which bill you are talking about (use the bill number).
  • Tell them why its important, and how it impacts you.
  • Sign your name, address, email/phone number if you have one.
  • Mailing addresses can be found in your 2015-16 Legislative Guide: http://bit.ly/1BQ87Qw.
  • Use our Grassroots Advocacy Center to email legislators and the Governor:  www.infonetiowa.org/action/actioncenter/.

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Earlier in the year, two Senate committees unanimously passed the Iowa ABLE (Achieving a Better Life Experience) Savings Plan Trust Act. Unfortunately, time ran out but interest in the bill did not.  With support from Senate President Pam Jochum and Senator Joe Bolkcom, the bill was added to the Senate Health/Human Services Budget (SF 505) and is now on its way to the Governor.

Congress passed the ABLE Act in December 2014 to allow individuals with disabilities to establish tax-free savings trusts into which money can be deposited to pay for future disability-related expenses that help maintain health, independence, and quality of life. Expenses could include home modifications, specialized health and dental care services, assistive technology, education, and transportation. Eligible Iowans may save up to $100,000 in an account without losing eligibility for other services, including Social Security benefits and Medicaid.  

The federal government has yet to set their rules for the program, but we know that each state must create its own program for its residents to be able to establish such savings accounts.  Our legislators did that in Senate File 505.  Under current federal gift tax limitations, as much as $14,000 can be deposited annually, with individual donor deduction caps of approximately $3,100 each. Donors will be able to deduct deposits from income taxes, and any gains are not taxed.  To be eligible, the disabling condition must have occurred prior to the age of 26.  Iowa’s program will be modeled after the College Savings Iowa 529 program administered by the State Treasurer, who received a total of $300,000 to administer the program and purchase necessary software.

We know that many of our readers were very, very excited about the ABLE Act.  Unfortunately, our state will not be able to set up its program until federal guidelines come out telling them what is and is not allowed.  Those rules are not expected until late summer or early fall, so be patient. In the meantime, our State Treasurer will be doing all he can to get ready if this legislation is signed into law.

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Eleven companies have submitted proposals to manage Iowa's Medicaid program; the state plans to select up to four companies. The state is now looking through the thousands of pages of proposals, and will make a decision by the end of August.  In the meantime, the state will be doing more meetings to get input on the plans that will be submitted to the federal government asking for permission to privatize Medicaid.  Those meetings have not yet been announced.

Legislators also felt it was important for them to have a say in the system, and make sure their constituents were protected.  So legislators included the following protections in Senate File 505. These can be vetoed by the Governor, so if they are important to you, make sure you let him know.

  • Directs DHS to partner with stakeholders to convene monthly statewide public meetings (beginning March 2016) to get input on the managed care system. These meetings are to be held throughout the state, and would most likely be co-hosted by interested groups.  The Executive Committee of the Medical Assistance Advisory Council will make recommendations, and compile information received from the public.

  • Establishes a Legislative Health Policy Oversight Committee (appointed by the Legislative Council) to receive updates on managed care, review data, listen to public concerns and recommendations, and make recommendations for improving the system.  Recommendations would be referred to the Legislature, although changes could be addressed without legislation.

  • Adds $220,000 to hire two new Long Term Care Ombudsmen in the Office of the Long Term Care Ombudsman, and directs DHS to request Medicaid administrative match for the work thses people will do to address concerns of people receiving Medicaid long term care services and supports. 

  • Directs the Office of the Long Term Care Ombudsman, Department of Public Health, Department of Human Services, Department of Inspections and Appeals, Disability Rights Iowa, Civil Rights Commission, Senior Health Insurance Information Program, Iowa Insurance Advocate, Iowa Legal Aid, and other consumer advocates and assstance programs to develop a proposal for the establishment of a Health Consumer Ombudsman Alliance to provide a permanent, coordinated health plan system navigation and complaint resolution system.

  • If Medicaid managed care is approved and implemented, requires provider rates to be no lower than current rates.

  • Requires DHS is to conduct initial functional assessments of new Medicaid enrollees (required to be done in conflict-free manner).

  • Prohibits DHS from reducing Medicaid HCBS waiver slots below what is in place January 1, 2015.
  • Directs DHS to contract with a private vendor to conduct electronic asset verification as required by the Affordable Care Act.

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After three years of discussion, the Senate passed Senate File 509 on June 2, the "refueling assistance bill" that makes sure drivers with disabilities are able to refuel their vehicles.  The bill requires gas stations comply with the Americans with Disabilities Act.  Any newly constructed gas station, new or replaced pumps would need to be equipped with refueling assistance devices for people with disabilities.These devices must allow a person to contact service station employees with a closed fist, and must be accessible from the driver's side of the car. 

While this does not apply to older service stations unless they renovate or replace pumps, it would apply to all new construction done after the effective date of the bill.  The bill included a $500 tax credit for small businesses that make these accommodations (so not the Hy-Vees and Casey's - its for the smaller mom & pop stores).  The tax credit would be available beginning tax year 2016.

The bill passed the Senate 30-20.  The bill was sent to the House Ways & Means Committee, which did not take the bill up before the session ended. While it did not make the cut this year, it is eligible for debate again when the Legislature reconvenes January 2016 (and it doesn't have to start over in the process).   

  • You can see how your Senator voted here. Make sure to thank them if they voted the way you wanted. If they didn't, talk to them and let them know why you thnk its important.
  • If this is a bill you want to see become law next year, contact your legislators and the legislators on the House Ways & Means Committee. Remember you can use our Grassroots Action Center to contact your legislators here.
  • Sen. Rita Hart (Clinton) has been a long-time supporter of this legislation, and was the bill's original sponsor.  You can read more about the bil in a guest column she wrote for infoNET here.

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The Legislature finished up their work after passing a $7.168 billion budget that keeps the Mt. Pleasant Mental Health Instiute open, allows a private geropsychiatic unit at Clarinda Mental Health Institute, adds $2 million for MH/DS regions, increases provider rates for HCBS providers and home health providers ($2 million), jumpstarts the ABLE Act, and provides a framework for the oversight of Medicaid managed care. 

Senate File 505 also sets requirements on managed care contractors - requiring provider rates be no lower than they are now and prohibiting DHS from closing down HCBS waiver slots.  Legislators also included language directing the Governor not implement controversial Medicaid cost containment measures that would have capped mileage reimbursement for HCBS transportation services and moved up the transition timeline for Consumer Directed Attendant Care services (moving to agency or Consumer Choices Option) by one year to July 1, 2015.

 Here is a very quick review of some other highlights:

  • Directs the Aging and Disability Resource Centers and the Mental Health and Disability Services Commission to submit a proposal to the Legislature to create a home modification grant and tax credit program Iowans with disabilities meeting the federal definition of “disability” and earning no more than 250% of the federal poverty level.

  • Increases funding for Medicaid by $52.5 million ($1.3 billion total). This is about $40.6 million short of estimates (so likely Medicaid will have a shortfall that lawmakers will need to address when they return in 2016).

  • Increases provider rates for nursing homes  ($17 million), home health providers ($1 million), HCBS providers by .5% ($1 million), supported employment providers by 10% ($750,000), and substance-related treatment providers by 3% (no fiscal impact).

  • Includes $66.5 million in Medicaid cuts for "cost containment" (including the $50 million the Governor plans to save in the transition to managed care). Also included in this is implementation of a complex pharmaceutical oversight program, change drug reimbursement methodology to the national average drug acquisition cost, and use of new functional assessments for certain Medicaid waiver services.
  • Prohibits the Governor from implementing cost containment strategies that cap HCBS waiver reimbursement for transportation, or speed up the transition from Consumer Directed Attendant Care to agency or Consumer Choices Option (this transition will be complete on June 30, 2016).

  • Requires DHS to submit an application to CMS/SAMHSA to participate in a two-year pilot project for certified community behavioral health clinics (but no additional money provided to do this).

  • Cuts the Medicaid Health Home Contract by $3 million (because it will become part of managed care), but continues level funding ($900,000) for the children's mental health home initiative.
  • Keeps the Mt. Pleasant Mental Health Institute (MHI) open, but reduces spending by $746,000.  Both the acute adult psychiatric services and inpatient dual diagnosis program remain open, with total funding of $6.4 million. 
  • Closes the Clarinda MHI psychiatric unit on December 16, 2015 ($1.8 million appropriation to keep it open for this six-month period). Directs DHS to issue an RFP to contract (beginning December 16, 2015) with a private nursing facility to manage a 15-bed geropsychiatric unit at Clarinda for hard to place persons who are sexually aggressive or combative due to mental illness or who have unmet geropsychiatric needs. 
  • Eliminates $30.6 million mental health and disability services equalization payments to regions because all but two regions have large ending fund balances.  Replaces this with $2 million appropriation directed to those regions who will not be able to maintain a 25% ending fund balance at the end of the next fiscal year (Polk County). DHS is directed to work with the Southern Hills region to look at options for merging into another region to address funding problems.
  • Extends the MH/DS Equalization Payment Formula for an additional year (until June 30, 2017) to give the Legislature time to develop a new structure (no funding appropriated).  Freezes the MH/DS per capita levy rates at FY15 levels and eliminates the Medicaid offset that required regions to pay back savings from the Iowa Health and Wellness Plan. So no state money for regions this year beyond their local property taxes and the $2 million for the Polk County Region.
  • Cuts the Autism Treatment Program by $1 million ($2 million remaining) but allows a family to submit a health benefits summary showing that no autism services are covered in lieu of a formal denial of payment from the insurance company in order to be eligible for reimbursement from the program.   The program is also modified to allow reimbursement for services provided by a Board Certified Assistant Behavior Analyst who is supervised by a Board Certified Behavior Analyst (and adds licensed psychologists and psychiatrists to the list of qualified providers),.  Finally, the Legislature appropriated $250,000 to establish a grant program to support educational expenses of persons pursing board certification as a behavior analyst or assistant behavior analyst.

  • Reduces the Family Support Subsidy by $107,807 due to children aging out, but shifts $102,000 of that to the Children at Home Program to add three new providers.

  • Extends the repeal of the Prevention of Disabilities Council for another year (June 30, 2016), and requires the MH/DS Commission and Iowa DD Council to work with the Prevention Council, the Department of Human Services, and the Department of Public Health to provide for a transfer of duties prior to dissolution.

  • Eliminates the restrictions on how funds can be disbursed from Medicaid Special Needs Trusts and sets new standards that are no more restrictive than federal law and enhances reporting requirements.
  • Directs DHS to establish (in cooperation with the Departments of Education and Public Health) a Children’s Mental Health and Well-Being Work Group made up of stakeholders to study and make recommendations on children’s mental health and well-being (including crisis response). A report is due December 15, 2015.

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The infoNET Bill Tracker is updated with all action as of the close of the legislative session.  As the Governor signs and vetoes bills, we will make those changes quickly, so check back frequently.  The Governor has until July 5 to make his decisions. 

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