2018 Issue #4

Issue 4, 3/5/2018

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While kids around the state are in countdown mode to next week's spring break, legislators are gearing up for next week's second funnel deadline.  Instead of winding down, legislators are winding up for their final big deadline before the end of session approaches.  In other words, it's crunch time.

Here are a few things you need to know about this time of year at the Capitol:

  • Legislators are focusing on policy bills right now.  In order to survive the March 16 "Second Funnel" deadline, all Senate bills need to be voted out of House committees, and all House bills out of Senate committees.  This is probably the toughest deadline; one chamber (House or Senate) must pass the bill and the other chamber must assign it to a committee, then assign it to a subcommittee, vote it out of subcommittee, and then vote it out of committee to make the cut on March 16.  Check out the next article to learn more about some of the policies being debated now.
  • Legislators have put the brakes on the current year "deappropriation" bill.  As you might recall, legislators were on the fast track to cut between $20-40 million out of the current budget year.  The Governor proposed immediate cuts that included $10 million to the Medicaid system; the Senate and House decided to protect Medicaid and instead cut tax credits to businesses (but the Senate wanted to cut $12 million more than the House).  These cuts would have to be made to state-funded programs and services between now and the end of the fiscal year on June 30, 2018.  That gets hard the longer legislators wait.  The House Appropriations Committee did pass and amend the bill (SF 2117), but no further action has been taken.  Many think legislators are waiting for the Revenue Estimating Conference (REC) meeting next week.
  • Legislators will be watching the Revenue Estimating Conference (REC), which meets on Monday, March 9 to see how Iowa's economy is doing. If the economy is doing well and state revenues are growing (and they look like they are due to federal tax cuts), legislators may decide they have aleady cut enough out of the budget.  That could mean no deappropriation bill - or a much smaller one.  That might also signal a "status quo" budget, one that holds the line on spending but doesn't cut any deeper.  Regardless, with estimates in hand, legislators will get to work quickly on budgets as soon as the March 16 funnel deadline passes.
  • Revenues play a part in deciding budgets, but they also are factoring into decisions about tax reform.  With all that swirling around, the Governor and Legislature are also beginning to move forward now on tax reform legislation.  The Senate proposed a $1 billion tax cut (SF 2383), and passed it within days.  The Governor proposed her $1.7 billion tax cut plan (SSB3195/ HSB671), which a House subcommittee has advanced.  There clearly is an appetite at the Capitol for tax cuts, but they will will need to be done with an eye on budgets.  Iowa's current year budget is $7.2 billion, so this could have a significant impact on the state's ability to pay for services and supports to Iowans with disabilities.  You can read more about the Governor's tax plan here. You can read more about the Senate tax plan here.
  • Legislators will also be watching their backs; the deadline for candidates to announce they are running for statewide office or Legislature is Friday, March 16.  So the week ending March 16 will be an interesting one; we will know which bills survived the last deadline and legislators will know if anyone is running against them.  Read more about this in our Election 2018 Watch article.

Monday, March 5th marks Session Day 57 for a session originally, and technically still, scheduled for 100 days.  The deappropriations bill cut session to 85 days, but with that bill in limbo, so is the expected length of session.  Reducing the number of days only reduces the number of days legislators get paid; they will still have to come to work until they are done.  But since it's an Election year, legislators will be ready to head home sooner than later.  For your planners:

  • Day 85 is April 2
  • Day 90 is April 7
  • Day 100 is April 17 

Now is the time to advocate for the things you care about - however you count it, we're a little over a month away from the end of session and the beginning of campaign season.  Remember you can easily email your elected officials here.

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As you can see, legislators have a lot on their minds.  The funnel deadline, debating policy bills, candidate filing deadline, $1 billion tax cut plans, and potential budget cuts. This is the time of year when bills can get lost in the shuffle.  

Legislators may lose sight of bills that are not in their committees.  Now is the time to ask your legislators for help in getting those bills across the finish line.  Here's a quick update on some bills that need action before March 16:

  • House File 2295 makes it a crime to lie about being a service animal's owner or trainer.  This bill passed unanimously out of committee but has not yet been brought up for a vote in the House.  Rep. Andy McKean of Anamosa is the floor manager.
  • Senate File 2365, which is ready for debate in the Senate, also addresses assistance animals.  This bill requires landlords to waive lease restrictions for assistance animals, assistive animals, and service dogs, but also makes the owner liable for damage done to property by that animal.  People who misrepresent themselves as needing a service animal, or misrepresent their pet as a service dog or assistance animal, may be fined $100.

  • House File 2345 deals with that age old question - what to do with aging sex offenders? Legislators are again trying to find a way to keep sex offenders out of facilities where older Iowans and Iowans with disabilities live by having DHS and the Department of Corrections work with providers to develop an alternative.  The bill also got the full support of a House committee, but has not been debated by the full House.  The floor manager is Rep. Gary Worthan of Storm Lake.

  • House File 2377 is a little further along, having been passed out of the House unanimously and now in the Senate Human Resources Committee.  This bill came out of an interim on the state's opioid addiction epidemic, and requires health care providers and phamacists to update the Prescription Monitoring Program whenever they prescribe or fill a controlled substance (like an opioid).  Providers would get notification if a patient might be developing an addiction.  The bill also requires all phamacists to send prescriptons to pharmacies electronically begining January 1, 2020.  Sen. Tom Greene of Burlington (a pharmacist) will take the lead on this bill.
  • House File 2428 requires the Department of Human Services to apply for a Medicaid waiver to require Iowa's Medicaid expansion population (those in the Iowa Health & Wellness Plan) to work.  Over 80% of Iowa's Medicaid members are currently employed or in a household where at least one adult is employed.  Advocates say that doesn't matter; when more paperwork is required, there are more chances for people tobe inadvertently dropped from coverage.   These "work requirement" bills are popping up all over the country, after President Trump suggested he would let states move forward with such requirements.  Iowans with disabilities know how hard it can be to find a job, particularly in rural areas, find employers willing to make accommodations, and find reliable transportation to and from work.  It's also tough to break through others' stereotypes, something legislation can't fix.  The bill passed out of the House Human Resources COmmittee and is ready for debate by the full House.  Rep. Steven Holt of Denison is this bill's floor manager.
  • The Senate has its own version of the work requirement bill (Senate File 2370), but it goes much further by requiring reporting of immigration status, public assistance recieved in another state, and drug testing of all adults receiving public assistance.  The background checks and information required to be enrolled in public assistance programs could cause delays, and people are only given 10 days to fix any issues that arise.  The bill requires people to prove they have lived in Iowa for at least one year before receiving public assistance, and requests that DHS ask the federal government for a waiver that will allow them to exclude "low nutrition foods" from food assistance programs. Iowans would be required to work or volunteer a total of at least 20 hours a week, unless they are under age 19, over age 64, pregnant or caring for an infant or child with a disability or serious medical condition, or (and this is a direct quote from the bill) "medically-certified as physically or mentally unfit for employment."  Sen. Jason Schultz of Schleswig is in charge of this bill, which has passed a Senate committee but not the full Senate.
  • If House File 2453 passes, insurance companies would not be able to switch a person's medication if a person's doctor wants them on it, and the person is medically stable.  This "No Switching" bill also passed out of a House committee, but has not yet moved over to the Senate.  Rep. Tom Moore of Griswold is managing this bill.
  • Filling gaps in services around the state for individuals with complex mental health and disability services needs is the focus of House File 2456.  A large work group met over the last year to develop recommendations, and this bill includes almost all of them. This bill is very close to surviving the funnel, it's passed the House unanimously and a Senate subcommittee will meet on it this week.  Read more about this bill in the next article.
  • Senate File 2284 was drafted to fix the late-2017 miscommunications about Integrated Health Homes (IHHs).  Several provider have ended their IHH services or are in the process of making that decision after United MCO announced they would be ending those contracts and doing the work themselves.  DHS, the MCOs, and providers are meeting to address the situation, but Senators wanted to take a stand with this bill that would not allow MCOs to perform the work of IHHs themselves, and would require existing IHH contracts to continue.  That bill got a lot of support in the Senate Human Resources Committee, but it has not yet moved out of the Senate. Sen. Mark Chelgren of Ottumwa is in charge of the bill in the Senate. 
  • Last year's medical cannabidiol law was passed in the very last hour of the legislative session, and one of the biggest hold-ups was the THC limit for cannabidiol (currenlty law says no more than 3%).  THC is the active ingrediant in cannabis that makes a person feel "high."   Senate File 2313 allows the Medical Cannabidiol Board to allow the use of medical cannabidiol that is over 3% THC, and the Department of Public Health to do this by rule.  Currently, only the Legislature can increase the THC levels allowed.  Sen. Rich Taylor of Mt. Pleasant is the lead on this bill.|
  • Senate File 2340 is the only other bill regulating MCOs left alive, and if it doesn't move soon, there will be none.  MCOs would be required to give at least 60 days written (or electronic) notice of changes, require MCOs pay 18% interest on claims that are held up, and require internal reviews of claims be completed within 90 days.  Sen. Mark Chelgren of Ottumwa is in charge of htis bill too.  
There are many other bills you might find of interest, from creating a Dyslexia Task Force to preventing brain injuries with better coach training to addressing suicide in schools with teacher training.  You can find these and more in our bill tracker - and track the status of your priorities as we approach the March 16 deadline - www.infonetiowa.org/news/bill-tracker/.

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Crowd at a Mental Health Rally last week.Hundreds of interested Iowans participated in discussions about the lack of services available around the state for Iowans with complex mental health and disability service needs.  This "Complex Needs" work group met throughout the summer and developed a set of recommendations to help fill those gaps. House File 2456 is the product of that work, and it is well-positiioned to survive the second funnel, having passed the House unanimously and planned to come out of a Senate committee later this week.

The bill moves most of the crisis services that are currently optional for regions, and requires they now be a part of the regional set of core services.  These are things like mobile crisis, crisis residential services, and crisis stabilization.  In addition, the bill adds several new core intense mental health services:

  • At least six "acess centers" to provide short term services to Iowans who do not need inpatient hospital care, but do not have the resources to remain stable in a home environment.  The set of services outlined in these centers can either be offered at a single site, or be a virtual access center, with the service array available at various locations. These centers would be dually licensed for subacute and crisis residential, but each site would only be allowed a total of 16 beds.
  • At least 22 Assertive Community Treatment (ACT) teams around the state. This is a treatment model that provides multidisciplinary, flexible treatment and support to people with mental illness 24/7. It is based on the idea that people receive better care when their mental health care providers work together.
  • Up to 120 beds in "Intensive Residential Service Homes (IRiSH) that would be licensed as HCBS/ID or habilitation waiver providers that have adequate staffing to take on individuals with the most serious needs in a small neighborhood setting (each facility would ideally have four beds, but could have up to sixteen).  

The bill also gets rid of the subacute bed cap, makes changes that allow psychiatric hospital beds to open up quicker, allows mental health and substance use disorder hospitalization hearings to be held via videoconference, and allows information about a person's mental health to be disclosed to law enforcement if s/he may cause harm to self or others.

The bill directs DHS to require MCOs pay for these core services for Medicaid members, and requires MHDS regions to pick up the cost for those that are not eligible for Medicaid.  There is no requirement that private insurance pay, and only requires payment from Medicaid and regions "subject to available funding."

The Legislative Fiscal Bureau reports that there is over $100 million in MH/DS region reserves, but those reserves are not spread throughout the state.  Some areas will have extra money to roll-out of these new services; others will not.   Polk County is in trouble this year, with less than a 1% fund balance available at the end of the next fiscal year.  Eastern Iowa Region is spending their ending fund balance in FY19, so they are on track for trouble too.   

Legislators acknowledge that this bill does not include "sustainable funding" for the system; instead they have included a Fiscal Viability Study to look at regional funding needs over this summer (with action to be taken on it in the 2019 legislative session).

A Senate companion (Senate File 2351) was sent to the Senate Ways and Means Committee, making it exempt from funnel deadlines.  It's there as a protective measure, in case the House bill gets in trouble.  It is not the same as the House version, but is close.  You can see a complete section-by-section analysis of both bills here.

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Children's mental health services have been set aside (again) as legislators try to figure out how to patch the holes in the adult mental health and disability services.  Several members of the Children's Mental Health & Well Being Task Force presented to a joint budget committee on the need to get started on a comprehensive approach to children's mental health.  

Representatives of the work group said they need local leadership and statewide standards.  "If we don’t have that, we’ll have the same scattered system that we have now," said one member, who asked for at least $700,000 to start to build out the system.  

Currently one in five Iowa children have a mental illness, and over 80% of adult mental illnesses develop first during childhood.  That statistic caught Rep. John Forbes' attention immediately.  "It seems to me we're missing the boat here," said Forbes. "We need to really invest our dollars in these early childhood years to mitigate the problems when we get to adulthood.  We’ll save millions, if not billions, of dollars."  Rep. Forbes went on to say he hoped the Health and Human Services Budget Subcommittee could look for ways to make sure we can treat children earlier, rather than waiting for them to become adults and costing the health care system much more.
Rep. Lisa Heddens added that there are only 31 children’s psychiatrists statewide, causing access issues as well.  Sen. Joe Bolkcom asked if the MH/DS regions should be required to coordinate children's mental health services.  The answer - it's better than nothing, but that's not the vision of the work group.  The work group vision was built around systems of care that pull in everyone that has a part in a child's life, not just address mental health issues separately.   

NAMI Greater Des Moines spokesperson Teresa Bomhoff, who serves as chair of the state's Mental Health Planning Council, didn't mince her words when she presented the Council's plans to address children's mental health needs.

Bomhoff acknowledged much has been done to develop a statewide MH/DS system, "but it still seems like we're nibbling around the edges."  She cited several disturbing statistics:

  • Girls have reached all time high in suicide rates, doubling between 2007 and 2015.
  • Suicide rates among teen boys and young men rose 30% .
  • Suicide is now the second leading cause of death among teens in Iowa.

“This year, right now, in this legislative session, you could do four things to make a statewide mental health system for children," urged Bomhoff.  She outlined five steps that need to be taken:

  • Step 1 - Update the Iowa law by requiring mental health services be available to Iowa children.  As activist Tammy Nyden says, “when kids are not written in, you are writing kids off.”
  • Step 2:  Include the children's mental health core services recommended by the work group in that update of the law.
  • Step 3: Move the MH/DS division from DHS to the Iowa Department of Public Health, so the focus is on prevention and early intervention.  “DHS is a mega agency, with mega dollars, that is struggling to get things done,” said Bomhoff.
  • Step 4: Identify new funding streams to pay for this.  She suggested increasing Iowa's sales tax and devoting 5/8 of a penny to adult and children's mental health services.  She said estimates that would bring in about $280 million, enough to pay for children and take adult services off the backs of property taxpayers.  "You might just make Farm Bureau happy," said Bomhoff referring to the farming group's opposition to having mental health and disability services funded by local property taxes.

Bomhoff then went down the reasons she's heard to not find a permanent funding source for these services, and not move forward in developing a children's mental health system.  To each she said, "I call BS."  No words minced. At all.  

You can see the detailed work group recommendations here. You can see Teresa's handouts here.


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Legislators will find out if they have anyone running against them on March 16, the last day for candidates for statewide and legislative office to announce their candidacy (and file the appropriate paperwork).  This year there are a lot of retirements, but there are always a few surprises after the deadline passes.  Here is what we know so far:

  • So far, eight Republicans and four Democrats have announced they are leaving the Iowa House of Representatives:
    • Clel Baudler (R-Greenfield)
    • Abby Finkenauer (D-Dubuque) - she is running instead for US Congress (Rod Blum's seat)
    • Dave Heaton (R-Mt. Pleasant)
    • Chuck Holz (R-Le Mars)
    • Jerry Kearns (D-Keokuk)
    • Helen Miller (D-Fort Dodge)
    • Dawn Pettengill (R-Mt. Auburn)
    • Ken Rizer (R-Marion)
    • Todd Taylor (D-Cedar Rapids) - he is running instead for State Senate (Wally Horn's seat)
    • Rob Taylor (R-Waukee)
    • Guy Vander Linden (R-Oskaloosa)
    • Ralph Watts (R-Adel)
  • Iowa House Majority Leader Chris Hagenow (R-Windsor Heights) made the news last week when he announced he was going to leave his Windsor Heights district, and run in the open seat that Rep. Ralph Watts is vacating.  So you can't really call it a retirement, but he will have to run in a new district (albeit a district that is much safer for a Republican).  
  • The three longest-serving Democratic Senators are retiring this year - together they have served in the Iowa Legislature for more than 100 years!
    • Bob Dvorsky (D-Coralville)
    • Wally Horn (D-Cedar Rapids)
    • Matt McCoy (D-Des Moines) - he is running instead for Polk County Supervisor
  • Sen. Nate Boulton is running for Governor, but he is in the middle of a four-year term and only would give up his seat if he wins the election.
All of Iowa's statewide elected officials are up for election this year - Governor/Lt. Governor, Attorney General, Secretary of Agriculture, Secretary of State, State Auditor, and State Treasurer.  We'll report more on these in the coming week, but there was a big announcement this week.
The US Senate finally took action and confirmed Iowa's Secretary of Agriculture Bill Northey as a new undersecretary for the US Department of Agriculture, overseeing the Farm Services Agency and Natural Resources Conservation Service.  Governor Kim Reynolds quickly named Mike Naig, the Deputy Director of the Iowa Department of Agriculture and Land Stewardship, as the state's new Secretary of Agriculture.  
Because the Secretary of Agriculture is an elected position in Iowa, and all statewide offices are up for election this year, Naig will only hold the title for 10 months (unless he decides to put his name on the ballot, which we've heard he is seriously considering).  But it could be a crowded field.  We have heard several people are interested in the job, including Iowa Farm Bureau President Craig Lang, Soybean Association Chair Ray Gaesser, and former USDA official Tim Gannon. Rep. Pat Grassley (R-New Hartford) had been rumored to be interested, but he will seek re-election to his seat instead.
Stay tuned - there are sure to be more surprises in the coming weeks.

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With Mike Naig becoming Iowa's new Secretary of Agriculture, we have updated our online 2018 Guide to the Iowa Legislature.  We won't be reprinting them, but you can always find the updated versions on the website here.

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Check out the full list of disability-related bills in our online Bill Tracker here.  Status is updated daily, so check it out whenever you want to know where your priorities stand.

  • Bills that are still eligible for debate will show automatically ("Active" list).
  • To see bills that failed to make the first funnel, just switch to the "Inactive" list.
  • Remember that you can download a spreadsheet of the bills by clicking "Export."

 The surviving bills now have until March 16 (next week) to make it through committee in the other chamber. So if you see something you want to pass, let your legislators know using our Advocacy Center.

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Do not miss out on the best way to advocate - in person, in your own area.  Iowa's elected officials are really good about getting back to their districts and talking to the people they represent.  That goes for our members of Congress as well as your state legislators, and Governor Kim Reynolds, who is continuing the Branstad tradition of getting to all of Iowa's 99 counties each year.

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Advocacy alone is rewarding - but we thought we'd add an extra incentive this year to tell your story.  Remember, you can alwasy get tips on telling your story here.  Here's what to do:

  1. When you go to the Capitol, take a picture with your legislators or their staff.  Email it to us at: infonetiowa@gmail.com with your name.  We will put it in infoNET or on social media, and enter your name in our drawing.
  2. When you go to a local legislative forum, take a selfie with your elected official.  Email it to us at: infonetiowa@gmail.com with your name.  We will put it in infoNET or on social media, and enter your name in our drawing.
  3. Participate in the #IamMedicaidIowa movement by tagging #IDAction or @idaction when you post to Facebook or tweet.  
  4. Send your legislator a video advocacy message.  Use your phone or other mobile device to video your advocacy message to your legislator.  Talk about the issue you care about, how it impacts your life, and what you want them to do.  Send it to your legislator or email it to us and we'll post it on our YouTube channel.  Again, send us your name and we'll enter you into our drawing!
  5. When you use our Action Center, make sure when asked that you save your name in the system, and we'll be notified that you took action.  We'll enter your name into our drawing! 

If you do all of these things, you'll get multiple entries.  We'll draw for prizes at the end of the legislative session, and then have another challenge issued for the months leading up to the fall elections.  So what are you waiting for? Get started!

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