Legislative news – 06/04/2013
Legislative Session Ends Twenty Days Late
In a split decision, the 2013 legislative decision ended officially on May 23. The Senate adjourned sine die late on May 22 and the House followed suit on May 23. The delay was due to a House rule that prohibits voting after midnight. House Democrats spent a significant amount of time in caucus on the evening of May 22, pushing the House to come back on Thursday morning to finish its work. Both sides claim victory in this legislative session and point out that significant legislation was passed benefitting Iowans including education reform, commercial property tax relief and Medicaid expansion. And, the legislature was able to complete a budget for health and human services, something that eluded them in 2012. This legislative session is counted as one of the most successful in recent years as the Legislature reached agreement on Medicaid expansion, education reform and property tax reform.
Below is a summary of key issues in which IAMFT was involved on behalf of its members. Keep in mind that the majority of these bills have yet to be signed by Governor Branstad. IAMFT will update you as action takes place. In addition, bills that include an appropriation are subject to a line item veto.
SF 203 – DHS Technical Correction Bill
This legislation made changes to language approved last year regarding oversight of the newly authorized sub-acute care system for mental health. Groups representing physician assistants and nurse practitioners made an effort to include their professions in those with authority to run those facilities. The final product allows a non-physician to run a facility but maintains the role of physicians and other mental health professionals in providing treatment within their scope of practice. This bill was signed into law by the Governor. IMHCA was registered as undecided on the legislation.
SF 337 – School Suicide Training
This legislation requires teachers to undergo training in the identification of the signs of suicide in teenagers and the appropriate steps to take to help that child receive assistance. The training requirement would be completed as part of their five-year license renewal. The bill made it clear that teachers would not assume the role of mental health professionals. The bill passed the Senate but failed to be considered in the House due to two concerns. First, House Education Committee chairman Ron Jorgensen (R-Sioux City) was concerned that this training requirement did not apply to all school personnel. Second, House Republican leaders expressed concern about the potential costs of this legislation to either districts or the individuals required to undergo the training. Representative Ron Jorgensen agreed to revisit this legislation next year but has asked the Department of Education and the Department of Public Health to work cooperatively to identify appropriate training materials and to make those available to school districts. This plan was codified in SF 446, the health and human services budget bill/Medicaid expansion. This bill failed to advance to final passage. IMHCA was registered in support of the bill.
SF 330 – Licensed Social Worker Loan Repayment Program
This legislation created a program in the College Student Aid Commission to award grants to licensed social workers who agree to practice in mental health shortage areas. The grants are designed to reduce student loan obligations. The bill failed to advance although the Senate did attempt to include this provision in the education appropriations bill (HF 604). Ultimately that language was deleted from HF 604. This bill failed to advance. IMHCA was registered as undecided on the legislation.
SF 373/HF 418 – Licensure Identification
This legislation imposes additional requirements on licensed health care professionals by requiring that their license was clearly displayed. In addition, while in a clinical setting, physicians and other health care providers are required to wear a badge that clearly identifies their licensure and name. The legislation was modeled after national AMA legislation and is designed to provide a clearer protection of the various levels of licensure. Both bills were approved by their respective chambers Human Resources Committee but failed to be considered on the Senate or House floor. This bill failed to advance to final passage. IMHCA was registered in support of the bill.
SF 406 – Involuntary Commitments
This legislation implements the recommendations of the judicial branch – DHS task force. It relates primarily to moving the mental health advocates from the jurisdiction (and cost) of the counties and placing these positions in the Department of Inspections and Appeals. The legislation passed in the last weeks of the legislative session after being bogged down with disputes over the appropriate agency to house the advocates and the cost to state government. This bill passed both chambers and is on the Governor’s desk for his signature. IMHCA was registered as undecided on the bill.
SF 446 – Medicaid Expansion/Health and Human Services Budget Bill
This legislation represents a combination of the budget for health and human services programs, the state’s approach to Medicaid expansion and a potpourri of other policy issues that were discussed but failed to advance as stand-alone bills.
o Increase of 1% for outpatient hospital services
o Increase to the equivalent of the federal Medicare reimbursement rate or the costs supported by Medicare-audited costs for rural clinics and acute mental hospitals
o PMICS will receive 100% of allowable costs
o Increase of 1% for all non-institutional medical provider rates
o Increase of 1% for inpatient mental health services
o 100% of reasonable costs for community mental health centers and those providing services to county residents
o Psychiatric services at the medical assistance program fee-for-service rate
Creation of an Autism Support Program to provide reimbursement for applied behavioral analysis
o Maximum reimbursement is $36,000 per year
o Maximum time for reimbursement of ABA treatment is 24 months
o Reimbursement for children up to age 9
o Graduated cost-sharing for those families at or above 200% of the federal poverty level
o Limited only to those children not eligible under medical assistance or private insurance for ABA coverage if household income does not exceed 400% of federal poverty level
o Appropriates $2 million for FY 14; becomes a standing appropriation going forward
Iowa Health and Wellness Plan (Medicaid expansion)
Ultimately, legislators and the Governor agreed to meld characteristics of proposals by Governor Branstad and Senate Democrats to create Iowa’s version of Medicaid expansion. The plan includes incentives to lead healthier lifestyles and to reduce emergency room care. It includes two tiers of coverage targeted to low income Iowans based on their percent of household income as compared to the federal poverty level. Under the plan, those individuals at or below 100% of the federal poverty level will be enrolled in the same manner as traditional Medicaid coverage. For those with household incomes within 101% – 138% of the federal poverty level, individuals will receive a subsidy to purchase coverage through the Health Insurance Marketplace. The proposal will cover an estimated 150,000 Iowans. The plan, which must be approved by the federal Department of Health and Human Services, also includes a mechanism to address Republicans’ concerns about the stability of federal funding. Under the proposal, if federal funding falls below 90%, DHS has the authority to reduce reimbursement rates for inpatient and outpatient hospital services. Unlike the original proposal by Governor Branstad, the Iowa Health and Wellness Plan covers mental health services. The legislation requires an annual report of the mental health services provided under the plan. In addition, counties must repay the state 80% of the yearly projected savings in non-Medicaid mental health spending for individuals now covered under the state plan. The reimbursement begins July 1, 2014.
HF 569 – Licensure of Addiction Counselors
This legislation creates a licensure program for addiction counselors modeled after the licensure program for social workers. It creates several levels of licensure based on the amount of education and training. The licensure program would be incorporated into the Board of Behavioral Science which currently oversees marriage and family therapists and mental health counselors. Concerns with some of the language that blurred the lines between additional counseling and mental health providers was addressed during floor consideration of the bill in the House. The bill passed both chambers but was vetoed by the Governor. His veto message expressed concern with the expansion of the size of government and the potential cost to applicants and state government. This bill was vetoed. IMHCA was registered as undecided on the bill.
Emily Piper | firstname.lastname@example.org Piper Consulting Services P.O. Box 12011 | Des Moines, Iowa 50312-2011 Phone: 515-202-7772 | Fax: 866-869-2842