2019 ISSUE #5

Issue 5, 4/8/2019

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United Health Care (UHC) will become the second Medicaid managed care organization to leave Iowa.  UHC currently gets $2 billion in combined state and federal dollars to manage the health and long-term care service needs of 425,000 Iowans.  The March 29 announcement has many Iowans wondering what's next in the ongoing Medicaid managed care discussion.

It is important to also note that the state is working with what was to be a third MCO (Iowa Total Care) to prepare for a startup on July 1, 2019.  Letters have already gone out reassigning people to ensure a balance of numbers in each MCO, so those letters will need to be resent. In the days since UHC’s announcement, several concerned state legislators have drafted amendments that would take Iowans with long term service and support (LTSS) out of managed care and return them to the old fee for service model. Legislators added these amendments to several bills that were debated in the House this week but all failed to advance.

If you share the concerns of these legislators, now is the time to talk with your legislators about what can be done in the remaining days of the session.  You can use our Grassroots Action Center to contact them, or you can call them Monday-Thursday at 515.281.3221 (Representatives) and 515.281.3371 (Senators).


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Friday marked the final legislative deadline for the 2019 session. To stay alive, all policy bills had to have passed committees in both the House and Senate before the end of last week (April 5).  As a result, a lot of bills died this week.  However, be on the lookout for some of them to come back to life. As the legislative session starts to wind down; legislators sometimes find ways to amend these dead issues into other bills.

With the second funnel passed, the policy committees have completed their work for 2019. In fact, the State Government Committee continued a long-standing Capitol tradition and served lobbyist Lana Schope's world famous pies at their final meeting, with eight choices ranging from apple praline to luscious lemon to some Templeton Rye concoction. Needless to say, lots of lobbyists who never before set foot in a House State Government Committee were in the audience.

Bills in three other committees – Government Oversight, Appropriations, and Ways & Means – are exempt from deadlines. Usually their bills do not get much attention until the deadlines pass, but all three met last week to pass bills, including several budgets. A few budget bills even saw floor debate, very unusual for a deadline week and a definite sign that the House and Senate want to wrap up work earlier than the May 3 session deadline (the "110th day" through which legislators are paid a per diem for their work).  

Right now legislators have just 14 working days until their daily expenses end (since they work half day Mondays and do not work Fridays).  That is not much time for all the work still ahead, but it's clear they are getting ready.

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The second deadline (which legislators call a "funnel") killed a lot of policy bills, which may still find ways to be resurrected in other bills before the clock runs out. 

Bills that survived the funnel include things like legalized sports betting, property tax reform, extension of the one cent sales tax for schools, only allowing hands free phone use while driving, animal cruelty legislation, fees for new homeowners generating energy from solar panels, constitutional amendments for gun rights and governor line of succession, limits on unemployment benefits, the Governor's plan to expand access to contraceptives, and more.

Bills that survived and may become law this year include:

  • Governor's proposal to build a comprehensive children's mental heath system (HF 690). You can read more about what's in this bill in our March 10 Issue #3.

  •  Allows mental health and disability services (MH/DS) regions to keep more money in their reserve accounts to help pay for new complex needs services or the build-out of children's mental health services. HF 691 allows regions to retain up to 40% in reserve until 2023; current law would have required them to spend that down to 20-25% this year. This does not help the regions with a permanent funding fix, and no bills have been introduced to do that.
  • Addressing absentee ballot tracking issues that came up last election cycle (HF 692), more about this below.
  • Increasing access to medical cannabidiol (HF 732) that allows physician assistants and nurse practitioners to authorize use, changes the definition of pain to align with medical terms, and streamlines processes so you don't have to go to the DOT to get a CBD card.  The House-passed version removes the 3% limit on the psychoactive component THC and replaces it with a 25 gram limit over 90 days.  The Senate removed that change, adding back the 3% THC limit per dose, but allowing up to 25 grams of THC in 90 days.  So less THC in each dose, but more dosages authorized.
  • Removes an extra step people with brain injuries have had to go through in order to access services from the brain injury HCBS waiver (HF 570)
  • Adds personal degradation as a form of dependent adult abuse by a caretaker (HF 569).

  • Allows a person who is deaf or hard of hearing to request a symbol to be placed on their driver's licenses to reflect their status, which will also be viewable to a law enforcement officer during traffic stops (HF 643).
  • Requires landlords to waive lease restrictions for people with disabilites who have service animals, and makes lying about the need to have a service animal or about the service animal's training a crime (SF 341).
  • Establishes an interim committee to study special education program requirements and outcomes for students with individualized education plans (SF 316)
  • Makes home improvement fraud a felony, including improvements intended increase accessibility of the home (SF 461).
  • Eliminates state income tax on all income earned by a person providing services to individuals with physical or intellectual disabilities through a non-profit organization (SSB 1185).

High profile issues that didn't make the cut this year include legalization of needle exchange programs, traffic camera bans, eliminating a requirement that schools collect student health screening information, mandates that employers participate in the federal E-Verify system, end to criminal statute of limitations for child sex abuse, abortion constitutional amendment, death penalty, bills allowing Iowans to have guns at work/courthouses/school parking lots, decriminalization of small amounts of marijuana, and legislation to allow public money to be used for school choice. 

Some things you can wipe off your list for the year include:

  • Constitutional amendment to restore voting rights to individuals convicted of felonies when they are done with their sentence, including parole and probation (HJR 14).  The bill passed the House 95-2 and has broad support, but the Senate Judiciary Committee refused to pass it out. Senators want some guarantees that restitution to victims is paid before voting rights are restored.  The Senate has until the end of next session to pass this language to keep this on track to go to voters in 2022.

  • Adding mental health awareness and suicide prevention into high school health classes (SF 376).
  • Massive rewrite of state election laws (SF 575 is dead, but issue is not).
  • All things Medicaid managed care.
  • Medicaid work requirements (i.e. community engagement) and real-time eligibility public assistance verification, along with all similar bills that impacted access to food assistance (SNAP). 

Speaking of real-time: You can see near real-time status of the issues we're tracking for you in your Bill Tracker. We update that with changes in status and bill descriptions as they are amended and passed by the Legislature. So bookmark it and check whenever you wonder how things are going (or not going!).

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The one thing legislators must do each year is pass a budget.  Ten of the eleven budget bills that need to pass before the end of the session are now on paper in one of the chambers. That doesn’t mean the two chambers agree yet on the exact language or how money is spent in those ten bills. However, having all but one of them out for discussion before the end of the first week of April is definitely a signal that Legislature could adjourn early. That's important because bills get thrown aside quickly when a budget agreement is reached, so fast action is needed on any policy bills still out there. The longer they linger on the debate calendar, the tougher it is for final action.

 The House and Senate are each scheduled to debate budget bills early this next week, and it is not impossible to think that each of those first ten budget bills could have been approved by one chamber by the end of the week. Rep. Joel Fry is currently working on an amendment to the Health and Human Services Budget (now HF 766), but it is not an "agreed to" budget yet and we're sure the Senate will want to put its own twist on this budget that funds child welfare, aging, public health, veteran's programs, and Medicaid. We have heard debate on this budget could be as soon as Wednesday or Thursday (April 10-11).  Here's a quick review of what's in each budget, but you can find legislative staff reviews (called NOBAs, or Notes on Bills and Amendments) here.

Health/Human Services Budget (HF 766)

  • Spends total of $1.94 billion, which is $30.2 million less than the current year.
  • Includes $150.3 million in supplemental spending for the current year (mostly Medicaid).
  • Adds $1.2 million to eliminate the children's mental health waiver waiting list.
  • Increase of $306,000 to IDPH to expand YourLifeIowa to add 24x7 children's MH hotline/info.
  • Adds $1.1 million to increase rates for Assertive Community Treatment (ACT) teams (a complex needs service).
  • Allows the Polk County MH/DS region to use other funds to cover shortfalls in those services.
  • Eliminates sole source contracts for projects administered by the Iowa Psychological Association, Delta Dental, SafeNetRx, Free Clinics of Iowa, Iowa Caregivers Association, Brain Injury Alliance of Iowa, Iowa Epilepsy Foundation, Iowa Association of Rural Health Clinics, and more. It's important to note that the funding is still appropriated, but the Legislature wants the Department of Public Health to open up bids for them instead of automatically giving them to the organizations named.
  • All IDPH (and some DHS) line items were rounded down, so funding was cut between $69 and $993.Changes the $191,000 that was designated to the Iowa Caregivers Association to funding for "health care and public health workforce initiatives."
  • Requires DHS to notify the HHS Budget sub and staff within 30 days of an MCO contract change.
  • $400,000 for four new rural psychiatric residencies and $150,000 for psychiatric training for PAs and ARNPs
  • Require a plan to move the Iowa Department of Public Health's Substance Abuse Bureau to DHS' MH/DS Division.
  • Increases funding for nursing home rates ($27.5 million) and critical access hospitals ($1.5 million), but no other provider rate increases are made. No additional funds were added to address Tiered Rate changes made to community-based providers.

Education Budget (HF 758)

  • New $3 million appropriation for school-based children's mental health training and support, of which $1.4 million is for AEAs to develop "range of approaches to best meet the MH needs of students and strengthen community supports" and $200,000 for AEA clearinghouse of MH resources for schools and community providers.
  • No change in Health Care Provider Loan Program (SF 167 expands the program to include MH professionals).
  • No change in funding for vocational rehabilitation, independent living programs, Centers for Independent Living, and the Entrepreneurs with Disabilities program.

Other Budgets:

  • No change in funding for the Office of Persons with Disabilities and Office of Deaf Services in the Department of Human Rights (HF 759).
  • No change in $500,000 funding for nursing home infrastructure improvements (HF 765)
  • No change in $1.5 million funding for public transit (HF 765)
  • $2.1 million to upgrade the Secretary of State's voter registration system, an increase of $1.05 million (HF 765)

The eleventh and final appropriations bill, the Standing Appropriations bill, is traditionally one of the final bills of session and often carries with it a number of policy provisions that were unable to find approval during the legislative session. We do not expect to see Standings for a couple more weeks. Lobbyists call it "the last train out of the station."

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A bipartisan group of Representatives worked with county officials, voting rights advocates, and organizations representing older voters and voters with disabilities to narrowly craft a bill (HF 692) to ensure that all counties are uniformly counting and tracking mail-in ballots. The bill would require all counties to use the US Postal Service's bar code system, and would allow the counting of any ballot that is verified as having been mailed on time using a postmark or bar code tracking system, and would continue to count those received by the office by the end of Election Day. That bill passed the House unanimously, and was sent to the Senate, where the Senate State Government Committee amended it to add their highly controversial election law rewrite (SF 575).

This is exactly what we mean about dead bills coming back to life as amendments. HF 692 is on the Senate calendar ready for debate, having cleared the funnel. But there is a committee amendment (S-3119) that does things like allow the counting of only those mail-in ballots that make it to the election office by the end of Election Day (regardless of mailing date), requiring students who want to vote to sign affidavits that they'll stay in the state after graduation, allow for signature verification of absentee balloting, close polls an hour earlier (8 pm), removing county auditors' names from ballots, changing process for constitutional amendment (including eliminating the ability of any Iowa citizen to challenge a constitutional amendment) and much, much more. The one thing they did take out was the prohibition against satellite early voting in state owned buildings.  They also corrected a mistake that accidentally said that a signature stamp or voter allowing another person to sign for them would not be allowed.  It was changed and both continue to be recognized, although could be challenged and force a voter with a disability to make extra trips to the auditor's office to show proof of identity.

Early on, the House said they were not interested in making this political and doing more than just fixing the problem. There are some non-controversial fixes in the Senate amendment, but whether that weighs the entire issue down or not is left to be seen. So the amendment could end up killing the bil, or some elements of the amendment could end up in the bill.  

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With the end of session very near, it is appropriate for us to note that this publication, which typically comes out every two weeks during session, will not be published in two weeks if it looks like the Legislature could adjourn in the near future. If that is the case, we will instead wait and publish after they adjourn for the year (or we'll send out an abbreviated or email-only report). In the meantime, keep an eye out for timely alerts requesting you to take action, and watch our Facebook page and Breaking News at www.infonetiowa.org.

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You can see real-time status of bills of interest to Iowans with disabilities in our Bill Tracker here. You can see the list of bills that survived the deadline under the “active” list, and the list that didn’t make the cut under the “inactive list.”  

Remember we update these daily, so you can watch progress from your computers and smart phones!

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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 tradition of visiting all of Iowa's 99 counties each year.

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