2016 ISSUE #5

Issue 5, 3/17/2016

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The last legislative deadline (called a "funnel") hit on Friday, March 11.  Bills that didn't make it through one chamber and out of committee in the other chamber by that time will see no further action.  Some of the bills that didn't make the cut include:

  • Expansion of medical marijuana (cannabis) laws.
  • Autism insurance mandates (coverage for Applied Behavior Analysis).
  • Medicaid managed care organization requirements to cover speech therapy for kids (as hawk-i program does now).
  • Ending Medicaid managed care contracts.
  • Medicaid managed care program integrity and oversight.
  • Efforts to address concussions and brain injuries at high school sporting events.

There were several other bills that did make the deadline, and can now be discussed anytime between now and the end of session (scheduled for April 19).  These include:

  • Strategies to address mental health worker shortage by allowing appropriately trained psychologists to prescribe.
  • Stopping disability parking abuses by replacing non-expiring placards with renwable (every 5 years) placards.
  • Patient safety legislation to allow exchange of mental health information for care coordination.
  • Supported employment provider rate increases.
  • Regulations that could drive Uber (and other social network transportation companies) out of Iowa.

The Cedar Rapids Gazette has a great list of the bills that survived the funnel, and those that did not. Click here for that list.  You can look at bills we flagged for our readers in the INFONET Bill Tracker.

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There is really only one thing legislators must do before they adjourn for the year - pass a state budget for the fiscal year that begins on July 1.  Legislators are required by law to pass a budget that spends only 99% of what the state gets from taxes.  That is where our state's "revenue estimating conference" (or REC for short) comes in - this group of three economists estimates how much the state will have to spend each year. 

The REC met on Wednesday, March 16 and found the state is taking in more money than expected.  That's good news for legislators, who were worried they would have to start making big cuts if the REC predictions were off by too much.  Sen. Bob Dvorsky of Coralville, who chairs the Senate Appropriations Committee, said the new revenue estimates are a "green light to move forward" and start putting together the budget.  Leaders in both House and Senate seemed optimistic that they would come to agreement on final budget numbers soon.

The Governor introduced his budget for Health and Human Services this week - Senate Study Bill 3175.  There are a lot of significant changes in this bill, particularly around Medicaid to allow for managed care, and most provider rates are no longer guaranteed in the bill. The bill contains no plan for oversight of the managed care system, and makes some significant changes that appear to pass on costs previously paid for by the state to MH/DS regions (without funding).  We will provide more information on this as we get details, so stay tuned.

While the Governor always introduces his budget in the form of a bill, legislators almost always start their budgets from scratch.  So while SSB 3175 is the Governor's budget, it probably won't see any debate this  year.  In addition, the House starts the Health and Human Services Budget this year, so they will put together their own bill very soon, and it could (and probably will) include some of what the Governor is recommending.

All this means if you are concerned about funding - for Medicaid, MH/DS regions, child care, education, water quality - now is the time to start making some noise and getting your legislators' attention!  Call, write, email, or attend a local forum - all are effective ways to advocate.  The most important tip we can give you is- to steal from Nike, "Just do it."

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The Iowa Senate passed a bill two weeks ago that would set up a structure to make sure Medicaid managed care organizations (MCOs) are held accountable for the delivery of health care services and long-term services and supports to the 560,000 low-income Iowans, older Iowans, and Iowans with disabilities.  Nearly two-thirds of Iowa's 50 Senators voted to develop a system of oversight to make sure MCOs were doing what was expected, and that care to vulnerable Iowans was monitored and problems were addressed. 

However, bipartisan support in the Senate for Senate File 2213 did not translate to support in the House, and the bill failed to make it out of committee before the March 11th funnel deadline.   But we have always said, in the Legislature nothing is ever really dead, and where there is a will, there is a way. As you might recall, bills coming out of the Government Oversight Committee are not subject to deadlines, so they can be debated at any time.

Sen. Rob Hogg of Cedar Rapids, who chairs the Government Oversight Committee, decided the issue was too important to let it die for the year, so he redrafted the bill and voted it out of committee on March 17.  Sen. Hogg told the committee the  bill (Senate File 2305) gives House members "one more shot" at addressing the oversight of managed care.  Senators Hogg, Schoenjahn, and Kinney voted for the bill; Senators Garrett and Whitver voted against it.

Legislators say the intent of the bill is the same   - Medicaid managed care should be implemented and administered in a manner that safeguards the interests of Medicaid members, encourages the participation of Medicaid providers and protects the interests of Iowa taxpayers.  The new bill (Senate File 2305) has not changed much and includes:

  • Vigorous government oversight of the privatized Medicaid system
  • Significant stakeholder involvement
  • Investments in system improvements and not just private company profits
  • Requirements that DHS and the managed care companies comply with provisions to protect consumers, preserve provider networks, address the unique needs of children and assure accountability.
  • Requirements that the Legislative Health Policy Oversight Committee created as part of the Legislature last session to meet at least quarterly to provide continuing oversight for the publicly funded hawk-i and Medicaid programs to:
    • Ensure effective and efficient administration of hawk-i and Medicaid
    • Address stakeholder concerns
    • Monitor program costs and expenditures
    • Ensure the needs of eligible members are being met and health outcomes are improving
  • Comprehensive review of program integrity activities
  • Creation of a Medicaid Reinvestment Fund
  • Strengthening of Duties and Authority of the Managed Care Ombudsman Program
  • Expansion and Enhancement of the Medical Assistance Advisory Council
  • Direction to the Patient-Centered Health Advisory Council to recommend appropriate alignment with holistic, population-health based approaches
  • Direction to DHS to undertake specific tasks to improve policies in the areas of: consumer protections, children, provider participation enhancement, rates and payments, data collection, and evaluation and oversight.

Click here for a full review of the bill. 

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When the Senate Government Oversight Committee convened on March 17 to discuss the new Medicaid Managed Care Program Integrity & Oversight Bill (Senate File 2305), they invited two providers (hospital and rural health clinic) and two advocates to speak about the need for oversight.

Many of you know Bill Stumpf from Dubuque (and if you don't know him, you may know his son Kyle).  Bill and Kyle have been active advocates with ID Action, and Bill has served on the Iowa DD Council and the Iowa Patient-Centered Health Home Advisory Council.  Bill made the trip from Dubuque to share his thoughts with the committee, and his message was simple.  His son has been successful, despite early in life health conditions, and he wants to make sure those advances are not lost as the state moves its system into managed care.  "Kyle is an integral part of the community," said Stumpf.  "He pays taxes, votes, and enjoys participating in community activities like everyone does...I am concerned about Kyle being able to continue to receive the services at the same level he has for the past 24 years...there is no doubt in my mind that without these services he would not be employed in the community and would not be paying into the system he benefits from. Especially job supports." 

Bill told the committee that "effective oversight is imperative to assure Iowans on Medicaid continue to receive the services they need to be full participants in their communities."  He added that "lastly, and most importantly, there must be stakeholder input."  You can watch Bill's testimony here, and you can read it here

Rhonda Shouse of Marion also testified before the committee.  For her, it comes down to a lack of trust.  "Ultimately oversight needs to be implemented because of a lack of trust and accountability that has been well-earned over the last year," said Shouse. She said oversight is critical to "protect Iowa's financial interest and the health of over half a million Iowans."  She reiterated Bill's push for stakeholder involvement, "we have beneficiaries and family members who have more working knowledge on this issue than many of the state legislators voting on it."  You can watch Rhonda's testimony here, and you can read it here.

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In order to park in an accessible parking spot, you must have a permit.  You can get that permit with a doctor's note, and it can be either permanent (non-expiring) or temporary.  These accessible parking placards are hung from a car's review mirror. A placard is only to be used by the person that was issued it. 

Legislators have heard stories about family members who will use the placards even if they do not have a disability, or of others that keep them after the person issued the permit has died.  The Iowa Department of Transportation has no way of tracking this misuse, or getting the placards back.

Last year, the Iowa House unanimously passed a bill (House File 588) that would no longer allow these non-expiring permits.  Instead, individuals will be issued a placard good for five years.  The placard could be renewed every five years with a note from their doctor, physician assistant, nurse practitioner or chiropractor.  On Wednesday (March 16) the Iowa Senate passed the bill 47-2 (Sen. Rich Taylor & Sen. Steve Sodders voting "no"). 

Normally the bill would head straignt to the Govenror's desk for a signature, but the Senate made a small amendment to change the dates in the bill since its passage was delayed by a year.  The bill will only affect placards authorized after January 1, 2017 (the bill had said January 1, 2016).  Expect the House to take it up quickly when they return next week.

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Iowa's privacy laws on the exchange of mental health records are among the most strict in the country.  With new federal laws in place, most states have moved to align their state laws with federal law (HIPAA, which stands for the Health Insurance Portability & Accountability Act).   Our neighbors Wisconsin and Ilinois were among the most recent to make the change.  

Before session, health providers and mental health advocates got together to work on a bill that would revise Iowa's mental health information privacy laws to make sure a person's health care providers could exchange mental health information between each other in order to coordinate care.  So things like what medications a person is on, or their treatment plan and diagnosis.  By federal law, the provider is only allowed to disclose the "minimum necessary amount needed" for patient care coordination.  So things in a patient's psychotherapy notes would never be exchanged unless the patient okays it in writing.

At an early meeting, mental health advocates said this was important for patient safety, so a provider knows all the medications a person is taking so they can avoid potentially dangerous interactions.  Earlier this year, the Senate passed Senate File 2144 with only one legislator voting no (Sen. Jake Chapman of Adel).  This week, the House passed the bill unaimously (96-0).  The bill is now on its way to the Governor's office.

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By State Representative Lisa Heddens of Ames

Ames is among cities, with population of at least 25,000 or more, with the lowest jobless rate of 2.7% according to the Bureau of Labor Statistics.  How sweet the sound unless you are a person with a disability and have a dream of working, paying taxes and contributing to the community.  If there ever was a time to take a serious look at the largest unemployment group in the nation it is now.

People with disabilities have an unemployment rate of nearly 13%.  This means that they have actively sought employment and are available for work, but they don’t have a job.  This doesn’t include the huge number of folks who have just given up the dream of working. 

Ames is considered “a vibrant, youthful community where people are engaged in meaningful employment opportunities.” according to Dan Culhane, president and CEO of the Ames Chamber.  I know this to be true except for many students and residents of Ames who happen to have a disability. 

Walgreens executives have taken a national lead in actively recruiting people with disabilities to work in their distribution centers across the US, as one example of corporate success.  This recruitment of workers has increased the productivity of the Walgreens operations.  Walgreens executives contribute this increase to less absenteeism and better outcomes with little accommodation from the employer.  Additionally, Walgreens has made a promise (quota) to hire a larger percent of people with disabilities in their national distribution centers.

ISU recently entered into an agreement to pilot an internship program called Project Search.  The Arc of Story County, Project SEARCH and ISU are investing in students who want an “on the job training” experience so they can then transfers those skills to a fulltime career with benefits.  Recently Cedar Rapids St. Luke’s Hospital graduated 11 Project Search students with 10 of them having already secured jobs.  Easter Seals, is in their third year collaborating with DMACC and Project SEARCH. Their program has graduated 18 Project Search students with 16 of them having secured jobs.  My hope is ISU will grow their program and other entities in Ames will participate as well.

Ames corporations also have an opportunity to partner with Progress Industries who promotes employment for those who are desperately seeking a chance.  People with disabilities don’t want a hand out and are offended by the notion.  But a hand up to the hardest working people you will ever meet would be an opportunity for Ames and all of Iowa.


This article was published in Rep. Heddens' weekly newsletter.  Most legislators send out newsletters during the legislative session to let their constiuents know what they are doing when they are at the Capitol.  You can sign up for your legislators' newsletters by going to www.legis.iowa.gov/legislators/find.  You will need to put in your address; then just click on the name of your legislator and click on the link to "sign up for newsletter."  That's all there is to it.  Or you can call your legislators direclty and ask to be put on the list (Senate 515.281.3371; House 515.281.3221)

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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. 

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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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