Legislative Update – WEEK 11

UPDATE to telehealth information written on 3/26/2021 from a meeting with Welmark on 3/25/2021

Status of Telehealth Reimbursement Parity

Background: Under the governor’s proclamation, all telehealth services are to be reimbursed at 100%, equivalent to reimbursement for in-person visits. This requirement will continue until Governor Reynold’s removes the emergency health declaration. In the meantime, IPS and other healthcare providers have worked diligently to pass legislation that requires telehealth parity, especially for behavioral health services, for all insurance companies that are regulated by the state of Iowa. Medicare and Medicaid provide 100% reimbursement, although at lower rates than private insurers.

Status: HF 294 passed the House 95-1. This bill would require that insurers regulated by the state reimburse for behavioral health services at the same level, whether delivered in person or via telehealth. The Senate leadership does not intend to allow this bill to move.

The lobbyists working to advance this legislation share your frustration. However, this is not a situation where more emails, phone calls and contacts with Senate Republicans will change the eventual outcome. Senate leadership’s position should not be construed to oppose telehealth or to assume that they don’t believe it should be reimbursed at the same rate. Bottom line – Senate leadership is opposed to mandates in general, and specifically on insurers.

What’s Next: Current Wellmark telehealth rates are 75% (temporarily increased to 100% under the governor’s proclamation). Their new proposal would guarantee base rates of 85% with the option of earning up to 95% of in-person rates in the short term (transition period from current 100% reimbursement). Once operational efficiencies are achieved (timeframe uncertain), providers can receive 90% reimbursement for telehealth services if they complete the activities outlined in the various phases of this plan.

Baseline Requirements: Standards that ensure baseline safety & consumer experience guardrails to ensure secure, convenient virtual health experiences for members/patients

Providers meeting these requirements would receive 95% reimbursement. In order to receive any reimbursement for telehealth services, providers must meet the baseline criteria at all times.
The baseline requirements allowing for 95% reimburesment would last for three years.

Intermediate Requirements: Introduction of additional customer experience standards & appropriateness metrics to ensure that providers are delivering seamless member experiences, but are also using virtual health appropriately.

Floor is 70% with an opportunity for a 25% earn up for meeting intermediate criteria.

Advanced Requirements: Heightened and expanded standards that focus on performance and clinical efficacy, driving high quality, seamless, effective clinical care that drives improvement to health outcomes

Floor is 70%. Providers meeting the intermediate requirements can earn up to 82.5%. Providers meeting both intermediate and advance requirements can earn up to 95% reimbursement.

Step Down Period: Extended Payment will eventually be reduced in recognition of the operational efficiencies captured by providers via scaled virtual health hybrid operating models.

Floor is 70%. Providers meeting the intermediate requirements can earn up to 80%. Providers meeting both intermediate and advance requirements can earn up to 90% reimbursement.

Conclusion: In the absence of legislation that requires full reimbursement parity, the Wellmark plan appears workable. Some timeframes are still not known AND other insurers do not be engaged in the same manner as Wellmark. Again, your frustration about the Senate is shared by many but unfortunately, we are not going to break that logjam.

MARCH 25, 2021 – Legislative Update – Week 11

1. Bills that have passed this week

HF 485 – Supervision for LMHCs, LMFTs, and social workers

Allows online supervision.
Allows supervision by each license for each license.
Instructs the three groups to work together on joint rules.

SF 52 – Emergency Detention bill – now crisis services with funding

A bill relating to emergency detention of a person experiencing a mental health or substance use crisis and access centers.
Bill is now amended and titled “An Act relating to mobile crisis response serves provided in mental health and disability services regions and making an appropriation.”
The bill adds $2.1 Million in funding for crisis services.

2. New bill to Watch

SSB 1253 – MH tax funding bill

MHDS Levy. The Bill eliminates the MHDS property tax levy over a two-year period, with all county levies reduced to no more than $21.14 per capita for FY 2022 and reduced to $0 beginning in FY 2023.
Per Capita State Appropriations. The Bill provides for the following per capita General Fund appropriations:
$15.86 for FY 2022.
$38.00 for FY 2023.
$40.00 for FY 2024.
$42.00 for FY 2025.
Beginning in FY 2026 and beyond, the previous year’s appropriation is multiplied by a growth factor indexed to sales tax growth for the preceding fiscal year, not to exceed 1.5%.

Fund Balances. The Bill amends provisions related to county fund balances by requiring all county fund balances to be pooled by the region. Regional fund balances are limited to 40.0% of the proposed gross expenditures for the fiscal year beginning in FY 2022. In FY 2023, fund balances are limited to 20.0% and in FY 2024 and beyond, fund balances are limited to zero.

Beginning in FY 2022, State per capita appropriations to a MHDS region are reduced if the MHDS region has a fund balance in excess of the fund balance cap specified above. The reduction doesn’t begin until the second half of the year once fund balances are certified on December 1. The MHDS Regions are also required to pay back any funds received in the first two quarters of the fiscal year if fund balances exceeded the cap. Any funds that are paid back or withheld are appropriated to MHDS the risk pool.

Risk Pool. The Bill creates a MHDS Risk Pool in the Property Tax Relief Fund to provide additional funding to the MHDS regions. The Bill establishes the composition of the Risk Pool Board and the criteria for the Board to distribute funding. The Bill also makes a General Fund appropriation of $10.0 million to the MHDS Risk Pool for FY 2022 and $5.2 million for FY 2023. Beginning in FY 2026, any funds in the risk pool will be multiplied by a risk pool growth factor which is equal to the sales tax growth rate for the preceding fiscal year, minus 1.5%.

Bills & Rules Watch
Note	Name	Title
mental health telehealth parity – support* In Senate	HF 294	A bill for an act relating to reimbursement rates for health care services for mental health conditions, illnesses, injuries, or diseases provided to covered persons by telehealth, and including effective date and retroactive applicability provisions.(Formerly HF 89.)
Audio only telehealth-support* In senate passed committee	HF 431	A bill for an act relating to the provision of audio-only telehealth or telemedicine by health care professionals.(Formerly HF 88.)
Supervision Requirements-support* passed senate committee	HF 485	A bill for an act relating to supervision requirements for licensed marital and family therapists, mental health counselors, and social workers, and including effective date provisions.(Formerly HF 107.)
Outside Health Carriers-undecided* In house	HF 731	A bill for an act prohibiting certain health carriers from excluding certain out-of-state health care professionals from participating as providers, via telehealth, under the carriers’ policies, plans, and contracts, and including effective date and applicability provisions.(Formerly HF 269.)
Limitations of Medicaid-support* Fiscal Note: https://www.legis.iowa.gov/docs/publications/FN/1216499.pdf amended to not include medicaid past claims with cost settlement – in senate	HF 736	A bill for an act relating to limitations on activities related to paid claims under the Medicaid program, and including effective date provisions. (Formerly HSB 225.)
IMD Waiver-undecided* In Senate recommends indefinite postponment	HF 773	A bill for an act relating to a determination of the availability of mental health services in the state including the value of pursuing a Medicaid institutions for mental diseases waiver, and including effective date provisions.(Formerly HF 479.)
Reimbursement $ Parity-support* in house	HF 784	A bill for an act relating to reimbursement rates for health care services provided to covered persons by telehealth, and including applicability provisions.(Formerly HF 706.)
Voting Rights – passed house and in Senate	HF 818	A bill for an act relating to the restoration of voting rights to certain convicted persons and including effective date provisions.(Formerly HSB 231.)
Amendment to the Constitution of the State of Iowa – support* Fiscal Note: https://www.legis.iowa.gov/docs/publications/FN/1215310.pdf in Senate	HJR 11	A joint resolution proposing an amendment to the Constitution of the State of Iowa relating to the qualifications of electors.(Formerly HSB 143.)
Continuing Education Requirements -support*- in house judiciary	SF 354	A bill for an act relating to continuing education requirements for persons holding certain professional and occupational licenses. (Formerly SF 163.)
Public Assistance Program Oversight – oppose* In the House	SF 389	A bill for an act relating to public assistance program oversight.(Formerly SSB 1125.)
Voting Members of Governing Board-undecided* In the House – passed sub	SF 461	A bill for an act relating to the voting members of a governing board of a mental health and disability services region.(Formerly SSB 1158.)
Operation of State Government-undecided*- in the house	SF 487	A bill for an act relating to the operation of state government, including the review of state boards and the regulation of professions and occupations, and including effective date and applicability provisions. (Formerly SSB 1046.)
Psychiatric Bed Tracking – support* In the House passed subcommittee	SF 524	A bill for an act establishing an inpatient psychiatric bed tracking system study committee.(Formerly SSB 1227.)
Emergency Detention – undecided* In the Senate fiscal note https://www.legis.iowa.gov/docs/publications/FN/1216183.pdf – amended to be approps for more crisis services https://www.legis.iowa.gov/legislation/BillBook?ga=89&ba=SF%20526	SF 526	A bill for an act relating to the emergency detention of a person experiencing a mental health or substance use crisis and access centers.(Formerly SSB 1234.)
Mental Illness Reports – support* In the Senate – committee approved	SF 528	A bill for an act relating to reports prepared by a chief medical officer, licensed physician, or a mental health professional concerning the hospitalization of a person with a mental illness.(Formerly SSB 1229.)
Undecided. Senate committee passed	SSB 1253	A bill for an act relating to state and local government financing, programs, and operations, by modifying provisions relating to mental health and disability services funding, school district funding, commercial and industrial property tax replacement payments, and other specified tax provisions, making appropriations, providing penalties, and including effective date, applicability, and retroactive applicability provisions.(See SF 587.)