2015 ISSUE #9

Issue 9, 7/8/2015

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On July 2, the 2015 legislative session officially came to an end when Governor Terry Branstad took action on several bills.  The 2015 Legislative Session will be remembered as a difficult one, with disagreement about how much to increase education spending driving session into overtime.  Ultimately schools went home with an increase of 1.25%.  Gas taxes were increased to pay for road maintenance and construction.  Iowa's limited medical marijuana laws were not expanded, fireworks were not legalized, and fantasy sports betting remains illegal. Kids under 14 are not allowed to use handguns after an NRA-backed bill failed to get support in the Senate. 

The biggest news this session came from two actions taken by the Governor early in session, both of which did not require legislative approval but certainly got legislative attention.  When the Governor presented his budget during the first week of session, he rolled out a plan to close two of the state's four Mental Health Institutes (Mt. Pleasant and Clarinda).  Legislative attempts to keep the facilities open failed, and both are in the process of being shut down and patients are currently being transferred.

The second action to send shock waves through the Legislature was the Governor's move to turn over the state's Medicaid system to private managed care companies.  The Department of Human Services issued an RFP during session, hoping to award a contract to 2-4 managed care organizations (MCOs).  Eleven companies submitted proposals, and DHS hopes to have an announcement sometime late summer.  Some legislators were upset that they were not consulted, and that the timeline is too fast (managed care companies will need to be up and running by January 1, 2016). As a representative from one managed care company said, "Yes it can be done this quickly, but it can be done better with more time."

With all the issues that legislators were faced with this year, what may be the most remarkable is that they were able to find a middle ground at all.  Legislators will be battle-worn after this session, so now would be a great time to remind them how much you appreciate the work they do.

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At the start of session, your lawmakers were faced with an $80 million shortfall in Medicaid for the current year and a $200 million increase needed for the next year.  This caused some legislators to refer to the Medicaid budget as the "Pac Man" of the state budget, gobbling up all available funds just to keep services at current levels.  Ultimately, the Governor signed the following into law last week:

  • Includes funding for the State Treasurer to implement the ABLE Act and purchase needed software.
  • Funds Medicaid at $40 million below the mid-point estimate (so more money will probably be needed next session).
  • Pays for the Medicaid 2014-2015 shortfall by using unspent funds, shifting money around in DHS, and using $43 million appropriated in the one-time funding bill.
  • Increases reimbursements for supported employment providers by 10%, HCBS waiver providers by .5%, and home health services by $1 million.  The Governor vetoed a 3% increase for substance abuse providers.
  • Modernizes the mental health advocate system to create efficiencies needed after legal settlement was ended - per the recommendations of the MH/DS Redesign.  Mental health advocates are appointed to represent the best interests of a person who is being committed for mental health treatment.
  • Creates a Legislative Health Care Policy Oversight Committee to watch over the transition to managed care and make recommendations for legislative changes.  Only legislators will serve on this committee, but each meeting will reserve time for public comment.
  • Directs DHS to hold monthly public meetings around the state (beginning March 2016) to get input from stakeholders and the public on the transition to managed care.  The Executive Committee of the Medical Assistance Advisory Council is directed to take all of the input received and turn it into recommendations for legislative or administrative action.  Nearly all (if not ALL) Medicaid providers are represented on the Medical Assistance Advisory Council.

  • Requires the development of a plan to create a “Health Care Ombudsman Alliance" to provide a permanent, coordinated system to help people navigate managed care plans and resolve complaints. Those to be involved in the development of this plan include: Long Term Care Ombudsman; Departments of Human Services, Public Health, and 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 assistance programs.
  • Adds funding to hire two more Long Term Care Ombudsman staff and allows the Office of Long Term Care Ombudsmen to provide assistance and advocacy services to recipients of Medicaid long-term services and supports (and directs them to draw down federal Medicaid match to do this).  
  • Fails to appropriate $32 million in "MH/DS Equalization" funding for MH/DS regions. Only two regions will be affected by this - Polk and Southern Hills (because other regions have enough money to get through the year without state funds).  The four-county Southern Hills Region is to look at merging with another region; the $2 million appropriated to help the Polk County Region is not expected to be enough to avoid service impacts (their need was $4 million), but we do not yet know the extent of that impact.

  • Extends the $47.28 equalization formula until 6/30/17, giving legislators an additional year to consider other funding options (including one proposed by regions that allows them to self-fund with property taxes). No funding was appropriated for this extension - that will need to be done next year.  Nearly all regions are expected to need some state dollars when the Legislature comes back next year,  the although we do not yet know if the full $32 million will be needed.
  • Eliminates the Medicaid offset (repayment of savings due to Medicaid expansion) for MH/DS regions.  DHS will continue to calculate savings regions experience because of the implementation of the Iowa Health and Wellness Plan, but regions will no longer be required to repay 80% of those savings.
  • Ends the Prevention of Disabilities Council after this year, and directs several groups (including the Iowa Developmental DIsabilities Council) to work on a plan to transition the duties of the Council to other existing councils and agencies. 

The Governor did not approve (he vetoed) the following that prohibited DHS from:

  • Setting a uniform mileage rate ($.575/mile) for HCBS waivers and capping the total allowed at $9.29/one way. 
  • Reducing HCBS waiver slots (levels to stay at or over what was available on 1/1/15).
  • Fast tracking the CDAC transition to agency-based or Consumer Choices Option (will begin 7/1/15 instead of 7/1/16).

These vetoes mean the Governor can move up the transition from Consumer Directed Attendant Care (CDAC) a year early, starting July 1, 2015.  It also means that DHS can implement "cost containment" strategies to limit how much can be spent on HCBS waiver funded transportation.  The vetoes mean DHS can also reduce the number of HCBS waiver slots they have in anticipation of managed care, which could have the affect of increasing waiting lists. 

You can read the Governor's veto message for the Health/Human Services Budget here. You can read all of the Governor's veto messages here.

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Six months after a federal law paved the way for tax-free savings accounts for people with disabilities, the IRS is providing details on how they expect the new program to operate. These guidelines are expected to help states create their ABLE (Achieving a Better Life Experience) accounts.

Each state must take action to create these accounts (if they want them to be available to their citizens).  The Iowa Legislature did that in Senate File 505.  The Governor signed the bill into law, so these federal fules give Iowa the green light to start creating its program..  You can read more about the IRS rules here.  You can read more about the ABLE Act here.  Follow us on social media and at www.infonetiowa.org to watch for updates on the ABLE Act implementation. 

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The following update comes from the Department of Human Serviices. The Iowa Department of Human Services (DHS) is working very closely with its federal partners at the Centers for Medicare & Medicaid Services (CMS) on the best route for Iowa as it modernizes its Medicaid program. This collaboration makes DHS confident that CMS will approve Iowa’s upcoming waiver applications.

Iowa plans to move forward with concurrent 1915(b) and 1915(c) waiver authority. This means a new 1915(b) waiver application will be submitted to include physical health, behavioral health and long-term care services in the Medicaid managed care program. In addition, existing Section 1115 Demonstration waivers (Iowa Wellness Plan and Family Planning) will be amended to transition service delivery to managed care organizations. The seven 1915(c) home and community based services waivers will also be amended to transition service delivery to managed care organizations.

There will be a formal public notice and comment period before submitting the documents to CMS. The waiver application and waiver amendments will be posted on the website and stakeholders will be encouraged to review the documents and offer comments. At this time, DHS anticipates posting the application and amendments for public comment in July 2015. After reviewing the public's input, DHS anticipates formally submitting the waivers at the end of summer. Watch the Medicaid Modernization web page for more information in the coming months about the federal approval process.

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You can read more about the bills that passed the Legislature in the infoNET Bill Tracker here.  The bill tracker lists all bills that were signed or vetoed in the "Active" list, and all the bills that didn't make the cut this year in the "Inactive" list.  Those bills that didn't make it this year become alive again when the 2016 Legislative Session begins on January 11, 2016.  So if you see a bill in that "Inactive List" that you want to become law - let your legislators know! Now is the best time to get started on your advocacy - when legislators are back home with more time to consider the issues their constituents bring to them.

You can also see a complete list of bills signed into law this year here.

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