2019 E-ISSUE 1

Issue 101, 5/3/2019

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The 2019 legislative session ended at 2:25 pm on Saturday, April 27th. It was a terribly difficult final week as leaders and budget chairs spent countless hours negotiating the final agreement that allowed lawmakers to adjourn the legislative session one week early (on day 104 out of the 110-day session).  

The final week of session was filled with long nights, flurries of activity combined with long, multi-hour waits for action, and some contentious disputes between the two chambers.  The stress was intensified by the sudden decision by long-time (some would say old school) Republican legislator Rep. Andy McKean of Anamosa to switch parties and become a Democrat.  McKean, who is the parent of a child with a disability, is the longest serving Iowa legislator, having served in the iowa House from 1977 to 1993, in the Iowa Senate from 1993-2003, and returning to the Iowa House in 2017 after retiring from his law practice.  

McKean's switch changed the House party split to 53 Republicans and 47 Democrats.  Since 51 votes are needed to pass bills in the Iowa House, Republicans had to work hard to make sure all of their members would vote for priority bills.  For instance, Rep. Megan Jones of Sioux Rapids objected to some of the policy language added to the Health/Human Services Budget bill, so she voted against it.  If two more Republicans had joined her, the bill would not have passed.  So the move by Rep. McKean really did shake things up in those final days.

 Rep. Andy McKean explaining his decision to switch parties and become a Democrat.
You can watch his explanation here (you'll need to scroll ahead to the time stamp 8:30:04).  
The Governor now has 30 days to sign bills (until May 27), and so far she's not wasting any time.  For that reason, we decided to send this end of session update out only via email.  Our final session recap will come out after the Governor finishes signing (or vetoing) legislation.  

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The Governor can either sign or veto the policy bills headed her way. On the eleven budget bills and any other bills that contain spending, she has the added option of using a line item veto to strike sections out of a bill. We will be monitoring the Governor’s actions over the next 30 days and update the Bill Tracker as changes are made.

The Govenror has already signed legislation that will create a children's mental health system, allow mental health and disability services regions to keep more of their funds in reserve to help pay for these new services, require landlords to allow tenets with a documented need to have properly trained service animals, protects dependent adults from abuse by closing loopholes in Iowa's dependent adult abuse laws, and updates Iowa's guardianship laws.  

There are still a lot of bills pending, including the Health and Human Services Budget.  Here's a quick review of the bills on Governor Reynolds' desk:

  • HF570 - Eliminates the need to go through an exception to policy to exceed the brain injury waiver cap (since all exceptions have been granted, this bill just eliminates the cap entirely
  • HF570 - Requires all counties to use the postal service bar code system to track absentee ballots, fixing issues that occurred in one race this year that ended up with 29 absentee ballots going uncounted because they lacked a postmark. If this bill is signed, count auditors could tell if a mailed absentee ballot should be counted by either date received, postmark, or the bar code system that will tell them when the ballot entered the mail system.  There are other election law changes in the bill, but they are corrective or not controversial.

  • HF732 - Expands access to medical cannabidiol and increases the amount of THC that can be in the product.  Physician Assistants and Nurse Practitioners will be able to authorize use, and Iowans with chronic pain or seizure disorders will be able to purchase CBD that includes up to 25 grams of THC over a 90-period.  To put this in perspective, recreational marijuana state Colorado considers a daily dose of THC to be 10-100 milligrams.  This change allows Iowans to get more than double that on a daily basis in Iowa.  Iowa's CBD Board sent a letter to legislators asking this bill to be amended to allow 4.5 grams per 90 days; advocates say that amount is too low as many persons would have to go down in dosage to meet that requirement and say those with chronic pain deserve this less-dangerous relief.  This bill also allows a physician to allow a person to exceed caps if they are terminally ill, and have a life expenctancy of less than a year.
  • HF766 - The 108-page budget that funds Medicaid, oversees the managed care system, and ensures funding for epilepsy programs, brain injury services, and more. Read more about it in the next article.

If you care about one of these issues, you can contact the Governor's office and ask that they sign the bill (if you like it) or veto it (if you do not like it).  You can also ask that the Governor veto parts of the Health & Human Services budget, called a line-item veto.  So if you see something you like, ask for it to be signed. If you see something you disagree with, ask for it to be vetoed or line-item vetoed!  You can send the Governor an email quickly with your thoughts here.

  • Click here for a full list of bills sent to the Governor.
  • Click here for a list of bills that didn't pass this year, but will become alive again when the session begins again in 2020.

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It took two weeks to work out the final agreement, but the Health and Human Services Budget (HF 766) finally passed on the last day of the legislative session.  The way amendments were done in the House and Senate, the minority party was not able to offer amendments (including several that would have addressed Medicaid managed care and provider rates).  

Once the Governor finishes her work, we will hold a final "wrap session" call to give you the opportunity to ask questions about the session, and learn more about what you can do to prepare for next year.  So stay tuned!

Review of HHS Budget

  • Adds $150.3 million to the current year's budget (called a supplemental).  Almost all of this increase goes to the managed care organization (MCO) contracts.  The current budget year ends June 30.
  • Spends $1.937 billion for the next budget year, which begins July 1, 2019.  This is $34.9 million less than the current year (because the Legislature didn't add the $150.3 million supplemental to the base). 
  • Includes new $306,000 appropriation to add a children’s behavioral health component to the YourLifeIowa referral service, hotline, and website.  In addition, $32,000 is transferred from DHS to help offset the costs of this hotline. This makes both adult and children crisis service information available through a single portal.
  • Eliminates $191,000 funding for the Iowa Caregivers Association to address direct care workforce challenges and redirects it for “health care and public health workforce initiatives.”  Several legislators promised advocates these funds would still be used for direct care workforce initiatives, but the language does not require it.
  • Adds $400,000 to create and train four psychiatric residents per year to provide mental health services to underserved areas of the state and adds $150,000 for psychiatric training for physician assistants and nurse practitioners through Des Moines University.  
  • No change in funding for the epilepsy foundation, but includes language that would require the entire amount of the funds be allocated on July 1 (organizations typically get paid quarterly or monthly after filing reports; this would continue to require reporiting but the money would be given to the Foundation upfront).
  • Increases the Children’s Health Insurance Program (hawk-I) by $12.3 million to replace lost federal funds and nursing home reimbursement (called rebasing) by $23.4 million.
  • Adds $1.2 million to eliminate the children’s mental health waiver waiting list, $211,332 for Assertive Community Treatment (ACT) team reimbursement, and $1 million for community living provider tiered rates (distributed equally among all tiers). 
  • No change in funding for Aging & Disability Resource Centers, audiological services and hearing aids to children, youth suicide prevention and a survey of children who experienced adverse childhood experiences (ACEs),  medically necessary foods for those with metabolic conditions, brain injury services and training/recruitment of providers, child health specialty clinics, regional autism assistance program, Prevent Blindness Iowa, Des Moines University training of doctors to identify and treat patients with mental health needs, standardized assessments for persons with MI/ID/DD/BI, Medicaid oversight, Tanager Place support services to children with autism spectrum disorder, State Supplementary Assistance (SSA),  State Resource Centers, technical assistance to HCBS waiver habilitation providers, family support subsidy, and ABLE account support. 
  • Allows the Polk County Mental Health & Disability Services Region to use other county funds to cover shortfalls in its MH/DS budget.  Without this, the region would not have enough money available to sustain core services.
  • Requires the Legislature be notified within 30 days of an MCO contract changes (including withheld incentive payments. Also requires MCOs and DHS develop and use a uniform prior authorization form and process by October 1, 2019. DHS is also to look into the development of a single electronic portal for submitting prior authorizations.  Prior authorization directives are effective upon enactment. 
  •  Requires MCO contracts to be revised to require an assessment of liquidated damages for prior authorization and claims payment system issues that were reported by the MCO as corrected, but reoccurred within 60 days of the reported correction, and an assessment of liquidated damages for failure of an MCO to complete provider credentialing or to accurately load provider rosters as required in the contract.  
  • Directs the Directors of the Departments of Public Health and Human Services to develop recommendations for enhanced delivery of co-occurring (mental health/substance use) conditions services, examine current service delivery system to identify opportunities to reduce administrative burden on departments and providers, evaluate the use of integrated helpline and website for data collection and sharing outcomes, and create a structure for ongoing collaboration (five-year plan and report due 12/15/19).

  • Eliminates boards and commissions that are no longer functioning or been replaced by other groups, including the Children’s Mental Health Waiver Implementation Committee and the MH/DS Property Tax Relief Fund Risk Pool.

  • Eliminates payment of travel expenses for public members on various boards and commissions in the Department of Public Health (and instead requires teleconferencing options to be provided).  

  • Changes the voting members on the 50-plus member Medical Assistance Advisory Council (MAAC). The bill eliminates the elected “Executive Council” and replaces it with 10 voting members (5 professional/business entity representatives elected by the entire membership and all five of the Governor-appointed members).    All current MAAC members will become non-voting members.  Changes the ten Governor-appointed public members to five, of which at least one needs to be receiving Medicaid services.  There are currently no vacancies for public members on this board, but if you are interested in serving on other boards, here is a list of vacancies.

  • Expands Medicaid coverage to pregnant women who have legal protection status (that is, refugees in the five-year window before they can apply for citizenship).  Federal law requires state Medicaid programs to pay for the costs associated with these births, but not prenatal care for the women before birth.  Legislators found that it is cheaper to cover the care of these women while pregnant, so they can have healthy babies - than pay for the costs of one child ending up in the neontal intensive care unit with preventable conditions.

  • Changes Iowa Civil Rights Law to state that it does not provide the right to tax-supported gender reassignment surgery or any other reconstructive surgery for transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder (effective immediately after signed).  This was never discussed as a bill this year, but it was added after the iowa Supreme Court ruled (in early March) Medicaid should cover the costs of such surgery.  You can read that ruling here.  Advocates are likely to appeal this if signed; this language could be line-item vetoed by the Governor.
  • Makes technical changes to the children’s behavioral health system state board (allows the MH/DS Commission representative to be appointed by the Commission, instead of the Governor).  

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Remember you can follow status of bills in our Bill Tracker, or see when your legislators and other elected officials are hosting public meetings in your area:

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