2018 Issue #6

Issue 6, 3/30/2018

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After months of intense meetings, the vision of the Complex Needs Work Group is coming together.  Governor Kim Reynolds signed House File 2456 on Thursday, March 29, the final step in turning the recommendations of this 23-member work group into law.  

Last year, Iowa lawmakers asked a group of Iowans representing providers, families, law enforcement, advocates, county MH/DS regions, and others to develop a set of recommendations to fill the gaps in services for persons with complex mental health and disability services needs.   The goal was to get people with mental illness out of jails and emergency rooms, and into the services they need, with an emphasis on providing those services locally, and in smaller community-based settings.

"This legislation was pushed over the finish line by individuals and families who knew firsthand the importance of having a robust mental health system and the pain caused when services they or a loved one needed weren’t there,” Gov. Reynolds said. “I know we can do better, and with this legislation, we will do better!”

The 18-page report outlined six basic recommendations, and nearly all of them were included in the legislation.  The bill requires the following services be made available throughout the state:

  • Access Centers to provide short-term care for those in crisis, and provide resources needed to get Iowans back home to their families.  The bill calls for at least six of these to be located around the state.
  • Assertive community treatment (ACT) teams to provide individualized treatment and support to individuals with mental illness in their homes, 365 days a year.   The bill calls for at least 22 ACT teams to be established.
  • Intensive residential service homes will provide individuals with severe and persistent mental illness with the chance to live in smaller community-based settings close to home, while receiving the 24-hour intensive services needed to address their individual needs.  The legislation calls for a total of 120 beds to be available statewide (to be scattered, with facilities preferably serving no more than four individuals at each site, with a maximum of 16 allowed).
  • A single statewide 24-hour crisis hotline will replace the ones managed by each individual MH/DS region, but it will continue to connect people to the local resources they need.
  • All of the existing crisis services provided by MH/DS regions are moved to the list of "core services" - so mobile response, 23-hour crisis observation and holding, crisis residential services, subacute and crisis stabilization community-based services are no longer considered "extra services."  They are now required core services to be available throughout the state.  The existing subacute bed cap is removed, so regions are free to develop these beds based on the needs of their community.

House File 2456 also makes changes to free up hospital beds quicker and allows hospitalization hearings to be held via video conference, and improves communications between mental health professionals and law enforcement.  

While this is an impressive list of recommendations, all present at the bill signing acknowledged there is more work to be done.  "Creating a mental health system that we envision is complex and it can’t happen overnight. I look forward to building on the momentum that we have here today,” Reynolds emphasized. “There is more to come.”

Mary Neubauer, whose son took his own life last year, used her skills as a lobbyist and former journalist to tell her story and ask lawmakers for action.  She was at the bill signing.

“Today is a significant day. This is an acknowledgment of the difficulties that have existed here in Iowa, of the people who haven’t gotten the help that they’ve needed,” said Neubauer.  “This puts in place a framework for the real work to begin to develop the programs and to put in place the capacity and the help that is needed...The follow through is absolutely critical. This is an important starting point that, frankly, we have never reached before in Iowa, but truly now the real work begins.”

So what are those next steps?

  • Make sure funding is available for these services.  MH/DS regions and Medicaid MCOs are required to pay for these services, yet funding for both is strapped.  While many regions have some funds available now, they will run out of their "reserves" eventually and will need a stable source of funding.  At least two regions (Polk County & Eastern Iowa) have capacity to do these services, but do not have the resources to pay for them now.  Because these services will be available only as funding allows, fixing the funding is an important next step.  House File 2456 calls for an interim committee this summer to review funding for these and other services delivered through the MH/DS regions, and determine funding needed to make sure they are available statewide.  Action will be needed on this when the Legislature returns in 2019.

  • Begin work to fill gaps in the children's mental health system.  House File 2456 focuses entirely on the adult system, but the work group acknowledged work needed to be done to implement the recommendations of the Children's Mental Health and Well-Being Work Group.  In response to this, the Governor announced that she will be signing an Executive Order to begin this process, and start to implement the recommendations made by this group, in preparation for more action in 2019.  When this Executive Order is available, we will post it on www.infonetiowa.org. You can also watch for it on the Governor's website here.
  • Address the role of hospitals that provide inpatient psychiatric care.  House File 2456 directs DHS to pull together stakeholders to review the role of tertiary care psychiatric hospitals in the array of mental health services and make further recommendations if necessary. The workgroup will include the Department of Inspections and Appeals, representative members of the Iowa Hospital Association, managed care organizations, the National Alliance on Mental Illness, the mental health institutes, and other interested stakeholders.  A report is to be completed by November 30, 2018 (so expect work to begin soon).
  • Further streamline commitment processes.  House File 2456 also directed DHS to bring stakeholders together to review the mental health and substance use disorder commitment processes and make recommendations for improvements in the process. The workgroup will include the Department of Public Health, representative members of the judicial branch, the Iowa Hospital Association, the Iowa Medical Society, the National Alliance on Mental Illness, the Iowa State Sheriffs’ and Deputies’ Association, Iowa Behavioral Health Association, and other interested stakeholders.  This report is due on December 31, 2018 (so work here will also begin soon).
  • Last (but definitely not least) - rules!  Legislators pass bills.  Bills are signed into law by the Governor.  But state agencies need to figure out how to implement those laws, and they do that by writing rules.  Administrative rules are important here, because they will more fully define these services, set service provider standards, establish reimbursement rates (always key to making services available), access standards, implementation dates, and possibly even location of the services.  While DHS has been asked to get rules in place quickly, it will still need to go through the normal rules process that includes many opportunities for input, including public hearings, public comment period, required responses to comments, and a review by a legislative panel (called the Administrative Rules Review Committee).  During that final legislative review, stakeholders are also able to provide comment, and legislators can stop rules if they feel public comments have not been adequately addressed.  So lots of opportunity for input; we'll make sure you know about these as this gets started!

 We know this is a lot to read in one sitting, but here are a few other resources you might find helpful: 

  • Read the Governor's comments from the bill signing here.
  • Review House File 2456 here.
  • Read more detail on House File 2456 here.
  • Read the Complex Needs Report here.
  • See who was on the Complex Needs Work Group here.
  • Read the recommendations of the Children's Mental Health & Well-Being Work Group here.
  • See who is on the Children's Mental Health & Well-Being Work Group here.

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Iowa legislators are wrapping up their work for the year, but they have not yet taken action on legislation that would give some Iowans with disabilities up to $5,000 to modify their homes to make them more accessible.  Bills that would have created this grant program (Senate File 2070Senate File 223House File 318) died in the first funnel.  

Since this issue is funding-related, supporters are now trying to revive this issue and are asking for lawmakers to add $600,000 to the Rebuild Iowa Infrastructure Fund (RIIF) budget to jump start this program.  Those that would like to see this program funded are being asked to contact their legislators, as well as the decision-makers on the Transportation & Infrastructure Budget Subcommittee:


We have an advocacy campaign ready to go - with the message already written (although you may want to modify it to include your own personal stories).  Just click here to get started (you just need to know your address, and our system will find your legislators for you).

If you want to send an email yourself, or call legislators, here is sample language you can use for your messages (courtesy of the MS Society).  Always personalize it a bit so you tell your own story and why this is important to you.  

Dear Representative ____/Senator ______:

I am writing to ask for your support for funding to create a home modification assistance program for Iowans living with disabilities. Please help us secure a $600,000 appropriation in the Infrastructure budget (RIIF) to create a program to provide grants up to $5,000 to low-income, Iowa homeowners to help offset the costs of modifying a home to increase accessibility and safety, such as exterior ramps, grab bars, railings, or bathroom features.

This appropriation is an investment in improving Iowa's housing infrastructure to ensure that Iowans can stay in their homes and out of long term care. Staying in a safe home is not only important to help maintain independence and safety, but it also avoids the significant cost of long-term care and reduces the slide into Medicaid, ultimately reducing the impact on the state budget.

Please support the home modification program in this year's RIIF budget, and ask your colleagues serving on this budget subcommittee for their help. Thank you so much, and please feel free to contact me at any time!

Want more information?  Click here for a fact sheet on the program (again thanks to MS Society!). 

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Legislators are running out of time.  While they can work as long as they want, they will only receive their expense checks through April 17.  That means lawmakers will return to the Capitol with only a few working days left, and a lot on their plates.  Here is a quick update:

  • Current Year Budget Cut (aka "Deappropriation):  The Legislature passed, and the Governor signed, a bill (Senate File 2117) that cuts $23.3 million in spending from the current state budget, and stops another $20 million from being used for business tax credits. These cuts include $55,000 from vocational rehabilitation, $660,000 from public health programs, and $4.3 million from DHS.  The DHS cuts cannot be made in a way that cuts Medicaid benefits, but may impact Medicaid in other ways. The cuts need to be made in the last three months of this fiscal year (before June 30, 2018).  You can read more about these cuts here.
  • Next Year's Budget & Tax Cuts: People always think that when one party controls the Legislature and the Governor's Office, negotiations are a breeze.  Not so.  Legislative leaders have been working on budgets for next year (fiscal year 2019, which begins July 1).  However, the budget is complicated this year by an effort to cut taxes.  The Iowa Senate wants to cut taxes by $1.7 billion; the Governor recommended $1 billion.  The Senate wants to cut taxes on businesses; the Governor suggested a task force review it before making changes.  Cutting taxes means less money is available for budgets.  So, it is impossible to come up with a budget until there is a decision on taxes.   There is apparently light at the end of the tunnel.  House Speaker Linda Upmeyer and Senate President Charles Schneider agreed that next year’s budget will be more than the $7.25 billion currently being spent (after deappropriations).   “I anticipate it will be a little bit bigger, yes,” Upmeyer told reporters this week. “We will fund the priorities of Iowa. That’s not to say that nobody might move backwards, they may.”  Schneider added, "Our numbers are very close to one another. There’s not a whole lot of daylight between the two of us.” 
  • Budget Targets.  The first step in getting a budget moving is to announce budget targets. Once leaders decide how much money they want to spend next year, they will divide it up between the 10 budget areas (Administration/Regulation, Agriculture/Natural Resources, Economic Development, Education, Health/Human Services, Judicial Branch, Justice Systems, Infrastructure, Standings, and Transportation).  Each of those budget subcommittees will then take that number and decide how much each agency, service, or program will get.  That process does take some time, even if there are joint budget targets.  Without joint budget targets, the House and Senate will come up with their own budget bills, and then have to negotiate.  It just adds to the overall time needed to pass a budget.  
  • Bills Signed Into Law or Sent to Governor. On the same day the Complex Needs Bill was signed into law, the Governor signed another bill to address mental illness in Iowa's teens, and begin to address the increase in suicide rates.   SF 2113 requires teachers to have at least one hour of suicide prevention and awareness training each year, including the identification of Adverse Childhood Experiences (ACES) and ways to address toxic stress response.   SF 192 is on its way to the Governor's desk; it licenses behavior analysts and assistant behavior analysts under the Board of Behavioral Science.  These professionals are experts in applied behavior analysis (ABA), which is an effective therapy that helps people with autism improve specific behaviors (and reduce others).  Another bill is one step away from being sent to the Governor.  The Senate need to take one final vote (which we expect it to do next week) before SF 2360 can be signed. It establishes a Dyslexia Task Force in the Department of Education to make recommendations on screening, interventions, teacher preparation and professional development, classroom accommodations, and assistive technology.  The report is to also include an overview of the symptoms and effects of dyslexia, review of current practices in treating dyslexia and teaching kids with dyslexia, and an analysis of the state's current response.  
  • Bills Still Needing Action.  Time might run out on several bills that passed earlier deadlines, but have not yet been sent to the Governor.  If you care about these bills, now is the time for action:
    • Brain Injury Prevention (HF 2442): This bill requires school sports programs adopt and follow policies intended to identify and treat brain injuries and concussions in student athletes.  Schools would be required to remove kids from games if there is a suspected brain injury, and prohibits return to play until a licensed health care professional gives their okay.  The Advisory Council on Brain Injuries is tasked with making further recommendations on the prevention, identification, and treatment of sports-related brain injuries. The bill passed the House 96-1 - Rep. Tom Moore (R-Griswold) was the only "no" vote.  The Senate has not yet voted on the bill; if they pass it, it will go to the Governor for signature.
    • Medicaid MCO Directives (HF 2462):  The  House unanimously passed this bill, which directs MCOs to follow certain industry best practices, including requirements that MCOs pay timely claims, denied claims include reasons for denial, the development of standardized provider enrollment forms and credentialing processes, extension of services for members who win appeals, requirement that court-ordered substance use or mental health treatment be authorized for at least five days, required DHS review of any level of care reassessments that decrease services, mandate that MCOs continue services at existing levels for those whose level of care determinations find no change, and an independent audit of all small claims for long-term care supports and services.  In addition, the bill establishes a health home work group (with representation of health home providers and MCOs) to review the health home program.  Another work group (with MCOs and Medicaid providers) will determine the effectiveness of prior authorizations used by MCO and develop a threshold when they are no longer needed.  The bill is now in the Senate Appropriations Committee, assigned to Sen. Mark Costello (R-Imogene).  During a committee meeting several weeks ago, Sen. Costello said this bill will probably not move, but that MCO-related changes would be done in the Health/Human Services Budget (which he co-chairs).  So while this bill might not move, the issue itself is still very much alive, so talk to your legislators about changes you would like to see in the MCO world.
Some of our readers were watching the discussion about ending the can and bottle return law, as many organizations collect and return cans and bottles as a way to raise money.   Grocery Stores and Convenience Stores don't want to be in the business of collecting cans and bottles.  Environmental groups want to expand the law to include plastic water and juice bottles. Two subcommittees were held; both the House and Senate said they would not be looking at changes this year to the state's bottle redemption law.  

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We know that we sound like a broken record, reminding our readers of the importance of talking to their elected officials.  But there are many ways to advocate, and volunteering your time to serve on a state board or commission is one of those ways!

The Iowa Developmental Disabilities Council is looking for Iowans with developmental disabilities to step up and help provide leadership in this area.  To apply, you need to be at least 18 years old, have the patience to plan for change that may take time to occur, be able to form opinions about issues and share them with others and use your personal experience(s) as examples to advocate for systems change.

Serving on the Council does take time - but not too much time!  One day every other month for Council meetings (so 6 days a year plus time to read information between meetings). Members who elect to serve on committees may also have occasional conference calls, but all in-person committee meetings are held on the same day as the Council meeting.

DD Council Members are reimbursed for their costs to attend meetings (like mileage, meals, hotel, personal assistance services, drivers, or childcare).  So serving on the Council should not cost you anything more than your time.  Lunch is provided during the meetings.  

Please Note:

  • Appointments are made by the Governor’s Office in June of each year.
  • The number of positions available on the Council may vary from year to year (currently 3 are open, 3 are leaving).
  • Membership is balanced by political affiliation, gender, geography, cultural diversity, and disabilities/family members and required agency representation. 

You may download the membership packet at the links above or request a packet by contacting the DD Council at:

Iowa Developmental Disabilities Council
700 2nd Avenue, Suite 101, Des Moines, IA 50309
Phone: 800.452.1936  or 515.288.0463

For information on all Governor-appointed Boards and Commissions, please visit:  Boards and Commissions

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While it's not the Academy Awards, Iowans will have a chance to attend a free screening of the award-winning documentary Bottom Dollars.

The Iowa Department of Human Rights, Center for Disabilities and Development, and Iowa’s University Center for Excellence on Disabilities, in partnership with the Iowa Developmental Disabilities Council and Disability Rights Iowa, are hosting the screening of Bottom Dollars in eight cities around Iowa. This award winning film calls for the phase out of the sub-minimum wages and sheltered workshops, and offers solutions for fair wages and inclusive employment. The documentary features personal stories and expert interviews with advocates that have been working to improve the employment opportunities for people with disabilities. Bottom Dollars is an original documentary from the disability rights group Rooted in Rights

Following the film, local panelists will share their perspectives related to subminimum wage employment and alternatives to segregated employment in Iowa.

Advocates, families, policy makers, disability service providers, and the general public are encouraged to attend.  This showing is free! To help us plan accordingly RSVPs are strongly encouraged via a short online form.  RSVP Online: https://tinyurl.com/bottomdollars.


April 26 (5-7 pm):  Iowa City
Governor's Ridge (Kirkwood Room), 515 Kirkwood Avenue

May 2 (5-7 pm): Council Bluffs
Council Bluffs Public Library (Meeting Room B), 400 Willow Ave.

May 3 (5-7 pm): Sioux City
Stoney Creek Hotel & Conference Center (Pioneer Room), 300 3rd Street

May 9 (5-7 pm):  Des Moines
State Historical Building (Auditorium), 600 E. Locust

May 10 (5-7 pm):  Creston
SW Iowa Community College (Room 180), 1501 W. Townline St.

May 17 (5-7 pm): Dubuque
Holiday Inn Dubuque (Capital Conference Room), 450 Main St.

May 18 (5-7 pm):  Waterloo
Hawkeye Community College (Tama Hall, Room 102), 1501 East Orange Rd.

May 24 (5-7 pm):  Burlington
Howard Johnson (The Gallery 150 Room), 2759 Mt. Pleasant St.

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

Time's running out for your priorities. Let your legislators know about the issues you care about using our Advocacy Center. Legislators can amend other bills if your issues are not already addressed in legislation - but you need to let them know what you want them to do!

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Get the formatted version of this issue in PDF here.

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