Legislative News March 2012

Legislative news – 03/09/2012

The Legislature continues its slow march to an early adjournment but veteran watchers of the process wonder if that will actually happen. The House and Senate both began work on budget bills but are significantly far apart on what should be spent in the upcoming fiscal year. Legislators seem committed to adjourning a week early but that will be a challenge given the strong budget differences. Legislators’ goal is to avoid the back and forth of budget bills that occurred last year and try to work things out behind the scenes. Friday, March 16 is the next funnel deadline. All bills must have passed one chamber and a committee in another chamber with the exception of appropriations, ways and means and budget bills. Both chambers have had lengthy debate calendars as they try to move their priorities forward to the other chamber.

Social Worker Loan Program

SF 2243 would create the infrastructure for a social worker loan repayment program. The bill is designed to provide additional incentives for students to enter the field of social work. Last week, I met with Kelly Soyer and Lyle Krewsen with Iowa Chapter of the National Association of Social Workers. They asked for our help in pushing this bill forward including the inclusion of marriage and family therapy and mental health counselors in the loan repayment program. The bill was assigned to subcommittee and will meet early next week at which point, these changes will be proposed. Despite the fact that this merely creates the framework for an incentive for students in those programs, it faces an uphill battle in the House. IMHCA is registered undecided on the bill which is in the House Human Resources Committee. Once amended to include marriage and family therapy, IMHCA will register in support of the bill.

Mental Health Reform

The House and Senate both passed the first of three mental health reform bills this week. The Senate also passed SF 2312 which makes incorporates the recommendations of the DHS-Courts workgroup. The House companion, HF 2421, is on the calendar. These bills are funnel proof. The major changes of interest to IMHCA members include:

  1. Refining the definition of a mental health professional in 228.1 but maintaining scope of practice, education and licensure requirements for all current mental health professionals.
  2. Expanding the 24-hour hold option for persons presented for a 229 commitment. This option had previously only been allowed if the courts were closed.
  3. Allowing physicians to collaborate with any mental health professional as defined in 228.1 when doing an evaluation or ongoing treatment for those presented or committed under 229.
  4. Continuation of the DHS-Courts workgroup with a specific focus on the expansion and reimbursement of the advocates program.

IMHCA is registered in support of both bills.

The major redesign bills, SF 2315 and HF 2431 have yet to be debated. The Senate version is on the Senate debate calendar while the House version was referred to the Appropriations Committee to keep it alive through the next funnel deadline. Both bills are similar but major differences exist, particularly as it relates to the formation of regions. IMHCA is registered as undecided on both bills. Both bills create a new subacute care system, develop a new system based on regions (although how they are governed and formed is different) and include a task force to study workforce development issues.

I have identified some areas of concern and am working with legislators to address those questions or concerns. Any member who has specific issues that are not included should contact me directly with their suggestions or concerns. Any feedback on the issues below is welcome as well.

HF 2431

Division I — Core Services

  • Provide more direction to the establishment of the provider network to ensure equal distribution and access to providers
  • Concern with a provision that allows regions to establish additional licensure, certification or accreditation requirements for providers. This is the role of the state and could lead to a patchwork of regulations.
  • Clarify that a provider will be reimbursed for an assessment of an individual who is subsequently determined to not have a mental illness. Under the current code language, a person’s eligibility is based on having a diagnosis of a mental illness but it is unclear if the system will reimburse a provider for all assessments or just those that make a diagnosis

Division II — Workforce Development & Regulation

  • Provide better direction and representation for all mental health professionals on this task force. Current bill language allows for at least three. Each mental health profession has unique needs with respect to workforce development
  • Question what patients or families of patients will bring to this task force. Current bill language provides them representation on the task force.
  • Improve the charge to the task force to include an identification of impediments to practicing in rural areas and possible solutions and the use of technology to enhance mental health services in underserved areas
  • Include a charge that would ask the task force to study the issues surrounding the shortage of mental health professionals in the state and make recommendations for addressing the issues

SF 2315

Division I –- Core Services

  • Provide more direction to the establishment of the provider network to ensure equal distribution and access to providers
  • Concern with a provision that allows regions to establish additional licensure, certification or accreditation requirements for providers. This is the role of the state and could lead to a patchwork of regulations.
  • Clarify that a provider will be reimbursed for an assessment of an individual who is subsequently determined to not have a mental illness. Under the current code language, a person’s eligibility is based on having a diagnosis of a mental illness but it is unclear if the system will reimburse a provider for all assessments or just those that make a diagnosis

Division II — Workforce Development and Regulation

  • Provide better direction and representation for all mental health professionals on this task force. Current bill language allows for at least three. Each mental health profession has unique needs with respect to workforce development
  • Question what patients or families of patients will bring to this task force. Current bill language provides them representation on the task force.

Division IV — Regional Service System

  • Clarify what is meant by the term “psychiatric consultant”. Current bill language requires the presence of either a CMHC or a FQHC with a psychiatric consultant when establishing a region.

Division V — Subacute Care Facilities

  • Maintains physician oversight of evaluation and treatment for those admitted to a subacute facility but allows delegation of that authority to either ARNPs or PAs. Question why this would be restricted to only those professions and not include others considered mental health professionals under 228.1
  • Maintains physician oversight of evaluation and treatment for those admitted to a state psychiatric hospital but allows the physician to delegate treatment and care upon admission to either an ARNP or a PA. Question why this would be restricted to only those professions and not include others considered mental health professionals under 228.1

Submitted by: 

Emily Piper | [email protected]

Piper Consulting Services

P.O. Box 12011 | Des Moines, Iowa 50312-2011

Phone: 515-202-7772 | Fax: 866-869-2842