2018 Issue #11

Issue 11, 11/19/2018

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ELECTION NIGHT RECAP: Change in DC, Stability in Iowa

Iowans broke records on Election Night, with 6 out of every 10 voters getting to the polls.   That's 1.3 million votes.  That's good news for our democracy!  Your vote is your voice - so we hope that you got a chance to use it!

Here’s a few quick notes about the election.  At the federal level, Iowa went from being represented by three Republicans and one Democrat, to being represented by three Democrats and one Republican.  Iowa elected its first women to Congress - Cindy Axne defeated David Young, and Abby Finkenauer defeated Rob Blum.  Finkenauer would have been the youngest woman ever elected to Congress, but she was beat out by New Yorker Alexandria Ocasio-Cortez, who was also elected to Congress on Tuesday, November 6.  Both are 29 years old (only 10 months apart).

At the state level, Republicans will continue to control of all three decision-making bodies, winning the Governorship, gaining seats in the Iowa Senate, and holding the Iowa House (although with a smaller majority).

Iowa Governor Kim Reynolds became the first female Governor elected in Iowa, by beating Fred Hubbell, 50-47%. In other statewide races, Democrat Rob Sand defeated Republican Mary Mosiman in the State Auditor’s race, 51-47%.  All other statewide incumbents won, including Republican Secretary of State Paul Pate, Democrat Attorney General Tom Miller, Democrat State Treasurer Mike Fitzgerald, and Republican Secretary of Agriculture Mike Naig.  Of note, one of Rob Sand's biggest issues on the campaign trail was Medicaid managed care.  He promised to begin a process to audit the MCOs to make sure Iowa taxpayers are getting what they are paying for. 

In the Iowa Senate, Republicans gained three seats overall and will enter January with a 32-18 majority.  They did it by losing one seat (Rick Bertrand’s Sioux City seat to Jackie Smith), but gaining four seats (David Johnson’s independent seat in NW Iowa to Zach Whiting, Chaz Allen’s seat in East Polk and Jasper counties to Zach Nunn, Tod Bowman’s seat in NE Iowa to Carrie Koelker and Rita Hart’s seat in East Iowa to Chris Cournoyer).   There are many other new faces on the list, but none of them resulted in a new party in control of the seat.   

In the Iowa House, Republicans lost five seats overall and will enter January with a 54-46 majority.  They did it by gaining two seats (Helen Miller’s Fort Dodge seat to Ann Meyer and Phil Miller’s Fairfield seat to Jeff Shipley), and by losing seven (Kevin Koester’s Ankeny seat to Heather Matson, Jake Highfill’s Johnston/Grimes seat to Karin Derry, Peter Cownie’s West Des Moines seat to Kristin Sunde, Chris Hagenow’s former seat to Jennifer Konfrst,  Rob Taylor’s West Des Moines/Waukee seat to Kenan Judge, Walt Rogers’ Cedar Falls seat to Dave Williams, and Ken Rizer’s Cedar Rapids seat to Molly Donahue).  As with the Senate, there are many other new faces on the list, but none of them resulted in a new party in control of the seat.  

Some more fun facts:

  • Women made gains, but they still are under-represented in the Legislature.  Only 1/3 of the Iowa House seats are held by women, and only 1/5 of Iowa Senators are women.  Of note, more than half of the 46 Democratic seats in the Iowa House are women!
  • 1 in 5 legislators is new this year.  There are 22 new Representatives and 9 new Senators (although two are not really new - Todd Taylor and Zach Nunn are moving from House to Senate).
  • In 2018, there were no Senators named Zach.  In 2019, there will be three Senators named Zach (Zach Whiting, Zach Wahls, and Zach Nunn).  Zach is now tied as the most popular name in the Iowa Senate (with Mark - Mark Costello, Mark Segebart, Mark Lofgren).  Not that this has any importance, but there are also two Tims (Kapucian, Kraayenbrink), two Jims (Lykam, Carlin), and two Toms (Greene, Shipley).

You can see election results on the Secretary of State's website here.  

In the coming weeks, committee assignments will be announced.  We will get that information out as it is available, and are updating our Guide to the Iowa Legislature so it is available soon after session beings on January 14, 2019.  In the meantime, reach out to your newly elected legislators, and congratulate them on their win!  Ask them to put you on their email or newsletter lists!  

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The Senate Republicans and Democrats, and House Republicans and Democrats held their initial post-election caucuses and elected their leadership teams.  The only big change was Rep. Mark Smith's decision to step down as House Minority Leader. The list is still incomplete; the House Republicans were missing ten of their members due to weather, so they postponed the election of assistant majority leaders until their policy caucus next month. 

Senate Republican (Majority) Leadership Team:
Senator Jack Whitver (Ankeny) - Senate Majority Leader
Senator Charles Schneider (West Des Moines) - President of the Senate
Senator Jerry Behn (Boone) - President Pro Tempore of the Senate
Senator Amy Sinclair (Allerton) - Senate Majority Whip
  • Senator Waylon Brown (St. Ansgar) - Asst. Majority Leader
  • Senator Jake Chapman (Adel) - Asst. Majority Leader
  • Senator Randy Feenstra (Hull) - Asst. Majority Leader
  • Senator Dan Zumbach  (Ryan) - Asst. Majority Leader
Senate Democrat (Minority) Leadership Team:
Senator Janet Petersen (Des Moines) - Senate Minority Leader
Senator Amanda Ragan (Mason City) - Senate Minority Whip
  • Senator Joe Bolkcom (Iowa City) - Asst. Minority Leader
  • Senator Bill Dotzler (Waterloo) - Asst. Minority Leader
  • Senator Pam Jochum (Dubuque) - Asst. Minority Leader
  • Senator Liz Mathis (Hiawatha) - Asst. Minority Leader
  • Senator Herman Quirmbach (Ames) - Asst. Minority Leader
  • Senator Rich Taylor (Mount Pleasant) - Asst. Minority Leader
House Republican (Majority) Leadership Team:
Representative Linda Upmeyer (Clear Lake) - Speaker of the House
Representative Chris Hagenow (Urbandale) - House Majority Leader
Representative Matt Windschitl (Missouri Valley) - Speaker Pro Tempore 
Representative John Wills (Spirit Lake) - House Majority Whip
  • Asst. Majority Leaders to be elected in December.
House Democrat (Minority) Leadership Team:
Representative Todd Prichard (Charles City) - House Minority Leader
Representative Jo Oldson (Des Moines) - House Minority Whip
  • Representative Wes Breckenridge (Newton) - Asst. Minority Leader
  • Representative John Forbes (Urbandale) - Asst. Minority Leader
  • Representative Brian Meyer (Des Moines) - Asst. Minority Leader
  • Representative Sharon Steckman (Mason City) - Asst. Minority Leader

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The Ways and Means Committee is one of the most powerful in the Legislature.  It is the committee that addresses all tax issues, which means it is the committee that will need to take the lead to fix the funding of the regional Mental Health and Disability Services system.  As you may know, adult MH/DS services for those not eligible for Medicaid or needing services that Medicaid does not cover are funded through local property taxes.  These property taxes were frozen in the mid-1990s and have not been allowed to grow to cover increased costs, new services, and accellerating demand for the services.  Since property taxes are involved, the Ways & Means Committee will be front and center on this issue.

For several years, Rep. Guy Vander Linden (R-Oskaloosa) was the chair of the House Ways & Means Committee.  He retired this year, but Rep. Peter Cownie (R-West Des Moines) was tapped to take over that position.  However, Rep. Cownie lost his election, so the House Ways & Means Committee Chair position was up for grabs again.

While House leaders have not yet announced their committee chairs or the members of various committees, they did announce that Rep. Lee Hein (R-Monticello) will be the new House Ways & Means Committee Chair.  Rep. Hein is a farmer and has been chair of the Agriculture Committee, where he's worked very closely with the Iowa Farm Bureau, one of the biggest opponents of a property tax funded mental health and disability services system.

 “It is an honor to be chosen by Speaker Upmeyer to lead the Ways and Means Committee,” said Rep. Hein.  “As a lifelong farmer, I understand the importance of certainty and simplification of the tax code.  I will continue to protect hard-working taxpayers while leaving more money in the pockets of Iowa families and small business owners.  I am excited for the opportunity to lead this important committee.”

Committee chairs will be announced in the coming weeks, with full committee lists available sometime around the beginning of the year.  Stay tuned to our social media & breaking news section of www.infonetiowa.org for updates.

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All summer long, dozens of work groups have been tackling tough issues that our legislative leaders felt were too difficult to resolve in the chaotic months of session.  Since the legislative session ended in May, hundreds of Iowans from all walks of life have volunteered their time to research, discuss, and find solutions.  Here's a quick recap:

  • Mental Health & Disability Services Funding Study Committee:  Legislators assigned to this committee met once to get a review of the history of the regional services system and tour some of the new crisis services rolling out in Polk County.  They also discussed the use of telehealth to deliver specialized services that may not be available locally.  This group will meet at least one more time, but the date has not yet been announced.  It's charge is to find a permanent, sustainable, and sufficient funding stream for adult MH/DS services delivered through the regional system.  You can find more information and all committee handouts (including the historical review of the system and property taxes currently being levied for the services) hereThis will be a big issue at the Capitol in 2019.
  •  Health Home Stakeholders Work Group: Prior to managed care, there were three types of health homes that coordinated the care of individuals at a local (provider) level.  Integrated Health Homes and Pediatric Integrated Health Homes for adults and children with serious behavioral health conditions, and Chronic Condition Health Homes for those with serious physical health conditions.  Without notice, one MCO (United) suspended most of its health home programs, and MCO staff assumed the role of care coordination for many Medicaid members.  Lawmakers asked for health home changes to be delayed (although some changes were not reversable), and asked the Medicaid Director to bring stakeholders together to talk about health homes, discuss why changes were or should be made, and identify a plan moving forward, including communication expectations and development of a consistent model with clear outcomes and data reporting expectations.  The group met twice, but did not discuss a plan moving forward or outline a clear and consistent model. There are 21,722 members enrolled in a health home as of September 2018.  Of those, 12,068 adults and 7,601 children are in integrated health homes and 2,053 members are in chronic condition health homes. It's report is due December 15, so it is unclear if the group will have time to meet again.  You can find information (and the report once posted) here.  This will continue to be an issue at the Capitol in 2019.
  • Children's System State Board: Gov. Kim Reynolds signed an executive order earlier this year creating this board, which is responsible for the development and implementation of a children's behavioral health system that is committed to improving children’s well-being, building healthy and resilient children, providing for educational growth, and coordinating medical and mental health care for those in need. These 18 members have met as a whole and in work groups to develop an initial set of recommendations for legislative reivew.  The report was due on November 15, and can be found here.  You can see all of the work group's meeting materials here.  This will be a big issue in 2019, and will likely (in whole or in part) be among the Governor's priorities.
  • Medicaid Process Improvement Work Group: This group advises the Medicaid Director on current Medicaid processes and systemic issues, so he can work with Medicaid staff, the Managed Care Organizations and providers to help improve the processes. While this group includes providers of all types (who have broken into several smaller subgroups), it is not an open public meeting.  The intent is to fix common problems with Medicaid processes - it's the mechanical nuts and bolts issues that are addressed here.  You can see its work to date here.   While Medicaid/MCO process issues are likely still to be issues, the future of this work group is up in the air.
  • Substance Use Disorder Provider Reimbursement Work Group: Rate inequity between substance use disorder providers and mental health providers is signficant, and is impacting the viability of substance use providers around the state.  This group is to look at reimbursement for these services, where there are gaps, and develop strategies to improve reimbursement.  This group has met twice and is looking at a program developed in Virginia through a Medicaid demonstration waiver. They will meet on November 29 to develop their final recommendations, which are due December 15.  You can see their work to date here.  Given the attention the opioid crisis has been given in the media, this will probably be an issue in 2019. 
  • Commitment Process Review Work Group: This group is continuing to look for ways to simplify and address gaps in Iowa's involuntary commitment laws.  Iowa currently has two laws on the books for commitments - one for substance use and one for mental health.  There was a lot of discussion about merging the two commitment laws and there was discussion about eliminating commitment laws altogeher (after all, we don't commit someone for failing to comply with their cancer treatment).  Ultimately, the work group came up with several recommendations to improve the commitment process, including longer temporary holds (from 48 hours to 72 hours), requiring the courts to process commitments 24x7, funding for education on involuntary commitments, continued review of the possibility of merging substance use and mental health commitments into a single law,  available screening at any point in the commitment process, and further review of the possibility of an outpatient treatment commitment law.  You can reveiw the draft report (due on December 31, 2019) and all work group materials here.
  • Tertiary Care Psychiatric Hospitals Work Group:   This group is looking at the role of psychiatric hospitals (now being referred to as Psychiatric Intensive Care hospital units or PIC hospital units) in the array of mental health services.  There were several recommendations related to these hospitals in the complex needs report, but they were not acted upon last year.  This group is continuing that work, with a report due November 30, 2019.  You can review this work group's information here
There are other reviews going on that have not yet published their reports, including:
  • Review of specialty courts, including mental health, family, and drug court.
  • Safe long-term care options for sex offenders or persons who exhibit sexually agressive behaviors.
  • Contrast of Medicaid vs. Medicare services and rates, and potential recommendations to align.
  • Review of mandatory reporter training curriculum (for both dependent adult abuse and child abuse).
  • Ongoing discussion of tiered rates for community based providers.
  • Prior authorization review by Medicaid, with goal to eliminate some prior authorization requirements.
  • Review of ACT (Assertive Community Treatment) Team reimbursement rates.

We will summarize the report recommendations in our December "2019 Session Issues Review" issue that will come out just before the end of the year.  In the meantime, check out what's online now, and think about how those recommendations may help you, and what may be missing.  Your legislators will be interested in your thoughts!

Special thanks to NAMI Greater Des Moines and the Iowa Behavioral Health Association for some of the information included in this report.  While I didn't copy it - I certainly sourced pieces of this from their excellent membership reports!

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January 3:         US Congress Begins Session in Washington D.C.
January 14:       Iowa Legislative Session Begins in Des Moines, Iowa
January 15:       Iowa Governor Presents Budget & Priorities
January 16:       President "State of the Union" with Budget & Priorities (tentative date)
February 15:     Deadline for Iowa legislators to request bills
March 5:           First "Funnel" Deadline (bills have to be out of their originating committees)
April 8:              Second "Funnel" Deadline (bills must be voted out of one chamber, then out of other chamber's committee)
April 10:            Advocating Change Day 2019
May 3:               Last Day of Iowa Legislative Session (last day legislators are paid - it can go longer, or shorter)

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