There is not a lot of change from last week. Many of our bills have been moved to the “unfinished business calendar” which means it is alive until sine die (adjournment). So telehealth, audio only and several others are still kicking.
The Governor’s HHS bill came out. This is not the HHS bill that will be the final version. The Senate is expected to drop the final HHS budget bill any day. The house will amend it (and likely spend more) then it will go back to the Senate to finish out (or move into conference which I will explain later as it all plays out.)
The session is scheduled to end April 30. They won’t get per diem pay past that 110th day. That does not mean they will actually be finished. It depends on if the two chambers agree on budget numbers.
SSB 1266– Governor’s HHS Bill
|Bills & Rules Watch|
|Audio only telehealth-support* – unfinished business calendar||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 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.)
|Amendment to the Constitution of the State of Iowa – support* Fiscal Note: https://www.legis.iowa.gov/docs/publications/FN/1215310.pdf||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* – unfinished business calendar||SF 354||
A bill for an act relating to continuing education requirements for persons holding certain professional and occupational licenses. (Formerly SF 163.)
|Governing Board-undecided* – unfinished business calendar||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* – unfinished business calendar||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.)
|New BH Telehealth and Psychiatric Bed Tracking – support* – unfinished business calendar||SF 524||
A bill for an act establishing an inpatient psychiatric bed tracking system study committee.(Formerly SSB 1227.)
|Applied Behavioral Analysis-undecided* Amended and sent back to Senate||SF 532||
A bill for an act providing for statements of professional recognition for licensed behavior analysts and mental health counselors by the board of educational examiners and including effective date provisions. (Formerly SSB 1231.)
|Mental Health Financing-undecided* In house ways and means. Fiscal note https://www.legis.iowa.gov/docs/publications/FN/1218726.pdf||SF 587||
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 and applicability provisions. (Formerly SSB 1253.)
|Block Grants-undecided*||SSB 1257||
A bill for an act appropriating federal moneys made available from federal block grants and other nonstate sources, allocating portions of federal block grants, and providing procedures if federal moneys or federal block grants are more or less than anticipated, and including effective date and retroactive applicability provisions.
|Governor’s HHS Bill-undecided*||SSB 1266||
A bill for an act relating to appropriations for health and human services and veterans and including other related provisions and appropriations, providing penalties, and including effective date provisions.
IMHCA Member, Amanda Olson, has had multiple opportunities to be interviewed for radio shows and was able to attend a town hall with her legislators. I just wanted to highlight her impeccable work and ability to articulate the issues. Amanda owns her own growing company – Champion State Of Mind – and has allowed us to share her feedback to her senator. The following is an excerpt from her email communication:
It seems there are two main arguments for not passing Telehealth Parity, and I would like to offer my professional opinion on why these are invalid.
1) A “free market” solution is the superior response to Telehealth Parity. —- Incorrect
In most cases, yes, I would agree that a free market solution is preferable. In this case, however, it is not feasible. A “free market” solution implies there is a “free market” to begin with. Insurance companies currently hold a monopoly on reimbursement systems. A free-market solution also implies that there would be reasonable, business sustaining options for Iowa medical businesses, which would include small Iowa companies (like myself). When insurance companies hold the power to fully dictate reimbursement rates and the set requirements to receive such rates, it can quickly cause revenue decline, job loss or even closures among Iowa businesses.
2) Wellmark will reimburse Telehealth at 95% so Telehealth Parity should not be an issue for the state —- Incorrect
Based on the most recent release information, yes, Wellmark is claiming that they would still agree to an reimbursement of telehealth services up to 95%. [Source: https://imhca.net/wp-content/uploads/2021/04/Virtual-Health-Strategy-Provider-1-21-FINAL.pdf ] However, the promise of a 95% reimbursement rate is based on a three-year value-based payment (VBP) model which is to be applied to ALL telehealth services, not just Behavioral Health.
To put it bluntly, VBP models CANNOT be applied to Behavioral Health Services. While such models are heavily reliant on point data, many behavioral health providers do not use a universal, standardized system of data measurement to evaluate client outcomes. Additionally, each client’s treatment plan and goals are subjective by design; each highly individualized to meet the client’s needs. A person’s mental health is always adapting, fluid in its own right. To try to apply hard data points to such fluidity will result in overly complex results. If such reimbursement rate requirements are rigidly set by insurance companies, behavioral health agencies will quickly and consistently fall short of such strict data-based requirements. This will result in profit loss, job loss and less access to mental health services to Iowans. Trying to force Behavioral Health companies to follow such telehealth models proposed by Wellmark could be compared to trying to get a large square into a small round peg. – It doesn’t work. –
Furthermore, the 3-year progression platform proposed by Wellmark is riddled with holes and is structured to cater to their internal pocket-lining structure. If behavioral health agencies were forced into such a platform, many businesses would struggle to stay at the 95% reimbursement rate level after year one. Businesses would likely have to purchase high priced tracking software and/or try to revamp their entire business model to, once again, fit into a model that is not designed for the behavioral health field in the first place. This would force many companies, like myself, to make difficult decisions on taking a lower reimbursement rate for the same service as in-person or not offering the service at all, which continues to further limit mental health services within our already-strained state.
Senator, by not passing Telehealth Parity it will create a Lose-Lose situation for both behavioral health providers and Iowa behavioral health companies.
As a business owner, a mental health provider and a lifetime Iowan, I cannot stress enough the importance of needing your support right now for Telehealth Parity. Without it, we risk large amounts of money being lost to out-of-state businesses, the closing of behavioral health facilities due to profit loss, losing more mental health providers and specialists due to a poor competitive workforce, and a limitation to mental health services across the State of Iowa. Telehealth services are not meant to replace in-person sessions, Senator, but serve to offer an additional choice in one’s options when accessing such services.
I do hope and pray that I and MANY Iowans can count on your support to bring SF 524 to vote on the Senate Floor.
Please feel free to contact me directly with any comments or questions that you may have regarding my comments or Mental Health in general.