Iowa Psychological Association
2019 Legislative Update | February 24, 2019
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As the Legislature ends its sixth week out of the roughly sixteen-week session, we have watched your legislators power through a lot of crazy weather while still introducing a staggering 1,305 bills. With the first legislative deadline fast approaching on March 8th, the pace will continue to speed up. This “first funnel” deadline stops discussion of any bill that has not yet made it out of committee, so the next two weeks will be filled with subcommittee and committee meetings.
There have been several highly divisive issues tackled by committees during the first third of session, including a restart of the process to amend expansive gun rights into the state constitution, include language restricting abortions to the constitution, allowing business owners to refuse service to customers if their religious beliefs do not align (Religious Freedom Restoration Act), and much more.
Not controversial is the effort to expand access to CBD oil to treat additional conditions (any form of MS, any condition doctors think would benefit, and any condition with chronic or severe pain). While that part of the bill doesn't have much opposition, expanding the list of health practitioners that can prescribe to PAs and ARNPs is opposed by the medical community.
Expansion of gambling is controversial, but state legislators feel like they have no choice but to allow and regulate sports betting and fantasy sports. A Supreme Court decision paved the way, and lawmakers want to make sure Iowans have a safe, fair and regulated forum for those choosing to gamble, so they don't turn to the growing black market. While there isn't expected to be a huge windfall associated with this, lawmakers are contemplating using some of the additional revenues to help fund community quality of life initiatives and expanded addiction treatment and education. Both chambers have moved forward with bills, which have casinos managing the gaming (horse/dog tracks, Iowa Lottery, and sports organizations all vied for this and lost). Still at issue is the tax rates, use of revenue, and extent of online/mobile gaming (Senate version requires gamblers to first visit a casino to place bets; House version allows 100% online betting).
Finally, the
Iowa House District 55
race in the Decorah area set off a controversy at the State Capitol this year. Rep. Mike Bergan won his race by just seven votes, but there were 29 mail-in ballots that could not be counted because they were not post-marked. A bar code on the envelopes showed the ballots arrived before the election deadline, but they did not bear a postmark or the “intelligent bar code” Iowa law requires. Lawmakers decided a few weeks ago that the type of bar code on these 29 ballots did not meet the type of barcode addressed in Iowa law (it was a subscription service that some, but not all, counties use and the county in question was not a subscriber). Legislators are trying to figure out what to do about this situation, so Iowans can be sure their mail-in ballots are counted. They are looking at two options to determine when a ballot is received by the post office:
- Requiring all ballots be delivered to the Auditor's office by Election Day (no postmarks, no bar codes, must be in hand to be counted on Election Day).
- Changing Iowa law to recognize any USPS or county auditor bar code tracking systems (so any existing or new technology could be used to determine when the ballot was mailed).
The Iowa Secretary of State's office has reported that 1,045 ballots were not counted in November 2018 statewide. The reasons include they either didn't have a postmark or barcode or the ballots arrived to late.
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Ground Hog Day & Early Budgets
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The groundhog didn’t see his shadow this year and predicted an early spring. He may not have been right in his weather predictions, but he certainly could have predicted an early end to the state’s legislative session. The pace has been fast ince the beginning of session, but the real sign of an early end to session is the February announcement of budget targets (the overall amount of money each individual subcommittee has to spend).
House leaders announced their budget targets this week, but they have not been agreed to by the Senate. We expect joint targets at some point, but it's likely there will be some back and forth negotiating before that happens. Typically the real budget work begins once the Revenue Estimating Conference meets on March 15 to review how the state’s finances look. If everything looks good, legislators will move forward with budget development. If things are looking bad, they may look for cuts to make sure they don’t overspend.
The proposed House Republican budget spends $7.668 billion in fiscal year 2020, which is about 97.5% of the amount they are allowed to spend. Iowa law allows lawmakers to spend 99% of the estimated revenues for the year, so the House budget leaves about $80 million on the table that could legally be spent. Those funds will go into the state’s savings account instead. If the House sticks to this budget, they'll put nearly $300 million in the state's reserves.
Below is a chart that shows how the House budget targets compare with the Governor’s proposed budget, and the current year (FY19) budget.
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The House targets are $193 million over the current year’s budget, and about $10 million over the Governor’s recommended budget. The targets for FY19 include about $141 million in supplemental appropriations, most of which goes to fund the Medicaid MCO contract increases.
Budget subcommittee chairs have already started working on their individual budgets, and some of the things we will be looking at include funding for MH/DS regions (including funding for last year's complex needs service expansion), Medicaid, IPA's internship program (we're asking for $100,000 increase and flexibility to serve additional underserved populations, including Medicaid members, regardless of where the psychologist is located), children’s mental health system development, and substance use reimbursement changes.
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School aid has been signed by the Governor; schools will get about $144 per student increase next school year (total $90 million, or 2.06% increase). Schools will now receive $6,880 per student from the state. While school funding is settled, Senators would like to see a review of the state's special education system.
Senate File 316
, which passed out of committee last week, would set up an interim committee to look at ways to improve outcomes for students that have individualized education programs (IEPs) and would seek input from school administrators, teachers, parents, and mental health professionals with a focus in this area.
Mental health providers and other health care professionals would also be at the center of the debate over assistance and service animals, as landlords have expressed concern about people passing off "comfort animals" as the more highly trained service animals.
Senate File 341
also passed out of committee last week, and would require any renter with a service or assistance animal provide documentation from a health professional (including psychologists) that they have a condition that qualifies them for a reasonable accommodation under federal civil rights laws.
Subcommittees in both the House and Senate last week rejected
twin bills
that would have legitimized "alternative or companion medicine," making the practitioners free of any potential lawsuits for the practice of medicine without a license. The bills were universally opposed by licensed professionals, including IPA. Unfortunately, a bill IPA also finds concerning, also passed out of committee in the House. That bill,
HF 332
, recognizes the practice of music therapy, which is defined as
"clinical and evidence-based use of musical interventions to to accomplish individualized goals for people of all ages or ability levels within a therapeutic relationship by a music therapist."
Mental health professionals, including psychologists, would be eligible for a health care loan repayment program if
SF 167
becomes law. The bill has escaped the first funnel and is on the Senate Calendar; it would open up a primary care repayment program to mental health professionals, but the program is underfunded and right now can only fund 3-4 people each year.There is discussion about increasing funding, but that is currently not in the bill.
Expanding on last year's efforts to expand teacher preparation for suicide awareness and prevention, a Senate committee this week also advanced a bill (
SF270
) that would expand health education for high school students to include mental health awareness, coping skills, and suicide awareness. Lobbyist Mary Neubauer, who lost her son to suicide two years ago, said the legislation is very much in line with the "
Make it Okay
" campaign that the Des Moines Science Center is promoting with its
Mind Matters
exhibit launched earlier this month, and suggested that the subcommittee look for ways to integrate this in middle school health classes as well. The Subcommittee did agree to continue to look for ways to integrate it at earlier levels as well, but an amendment has not yet been filed.
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Medicaid MCO Changes Not Likely in 2019
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Senators Liz Mathis (D-Cedar Rapids) and Amanda Ragan (D-Mason City) have introduced a bill to address ongoing problems that constituents say they are still having with the state’s now three-year-old Medicaid managed care system.
Senator Mathis emphasized, “Iowans need privatized Medicaid to do three things and do them well. One, make sure Iowans get the healthcare services they need when they need them. Two, make sure Iowa healthcare providers are correctly paid for the work they do and paid on time. Three, key Medicaid decisions should be made by Iowans rather than by employees of out-of-state, for-profit companies.”
Senate File 156
ends managed care for those receiving long-term services and supports (LTSS) and goes back to the fee-for-service system. The bill also prohibits the use of prior authorization for medication assisted treatment used for those with substance use disorders; requires independent conflict-free case management and assessments to avoid the conflict of interest; directs MCOs to partners with providers to improve efforts to keep workers; implements an independent, external review system that allows providers to go through a neutral party to assess denied claims, just like they have with claims denied by other health insurers; allows patients to switch MCOs in 10 days, rather than 45 days; and moves the Managed Care Ombudsman Program to the State Ombudsman’s Office in order to get federal matching funds that will allow the hiring of additional ombudsman. Rep. Lisa Heddens is expected to introduce a similar bill in the House, which would also charge MCOs an interest rate for payment errors (with those penalties going back to the provider) as a way to create a financial disincentive for not fixing claims system errors.
There are quite a few MCO-related bills, but all are filed by minority members and are unlikely to pick up much steam this year. It appears majority party members are hoping the addition of Iowa Total Care to the managed care scene will create more stability.
However, addressing public assistance fraud is something legislators may take up this year. State Senators decided to set aside a bill that would have required people receiving services through the Iowa Health and Wellness Plan to work, volunteer, or go to school for at least 20 hours a week.
Senate Study Bill 1134
would have only applied to the “expansion population” and not to those on traditional Medicaid or to children. It also would not have applied to anyone who was physically or mentally unable to work, was pregnant or caring for a child under the age of one, or was the parent of a dependent child with a disability.
Sen. Jason Schultz (R-Schleswig) tabled the bill after hearing that early estimates showed 8 out of every 10 Medicaid members already worked. Iowa Medicaid was unable to provide updated estimates. However, Sen. Schultz did advance a broader public assistance bill earlier in the week. That bill,
Senate File 334
, would require DHS or a contractor they hire to electronically verify the eligibility of everyone receiving Medicaid (
all
Medicaid), food assistance (SNAP), and the Family Investment Program (FIP). This verification would be done
quarterly
, and a person would have 30 business days to respond to notifications that they are ineligible. To test eligibility, DHS is to look at death records, lottery winnings, earned and unearned income, employment status or changes to employment, immigration and residency status, enrollment in other public assistance programs, incarceration, enrollment in out-of-state programs (i.e. no double dipping), and records of fraud or identity theft.
The bill is safe from the funnel, but there is not a companion bill yet in the House. You can see how organizations are registered on this bill
here.
As always, you can see real-time status of the bills were tracking for IPA
here
.
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Just five weeks into the state legislative session, a State Senator has resigned from office, effective
immediately
. Cedar Falls Democratic Senator Jeff Danielson announced he would resign from the Iowa Legislature last week. Danielson quit his job at the Cedar Falls Fire Department and will be starting a new job leading policy efforts in the Midwest for the American Wind Energy Association. Danielson and ten other firefighters have quit their jobs in recent months after the city announced they would begin having police officers filling in as firefighters.
Senate District 30
covers all of Cedar Falls, Hudson, and parts of Waterloo and southwest Black Hawk County. It is considered a toss-up seat, with 13,333 registered Democrats, 12,488 registered Republicans, and 15,986 voters with no party affiliation. Several of Danielson’s earlier races have been very close – he won by just 22 votes in 2008.
The Special Election will be on Tuesday, March 19.
This date may be difficult for some voters, as it is Spring Break week for both public schools and UNI, and students and teachers may not be around. There are three people running:
- Eric Giddens (Democrat): Giddens lives in Cedar Falls and is a program manager for the Center for Energy and Environmental Education at UNI. He is also a member of the Cedar Falls School Board, is involved in the Aldo Leopold Distinguished Lecture Series, Dry Run Creek Advisory Board, Cedar Falls Food Coop Investment Campaign Committee, Community Foundation of Northeast Iowa’s Scholarship Selection Committee, and Cedar Valley Activate. His wife Kendra is a teacher and their son is in 8thGrade at Peet Junior High.
- Fred Perryman (Libertarian): Perryman also lives in Cedar Falls and is a sales manager. He ran unsuccessfully for State Auditor in 2018.
- Walt Rogers (Republican): Former State Representative Walt Rogers lost his re-election in 2018 to Dave Williams after serving eight years in the Iowa House of Representatives. Governor Reynolds appointed him recently to the Iowa Public Employee Relations Board, but he resigned from that position in order to run. Rogers is a former youth pastor and has served on several community boards, including Leader in Me, One City United, Guiding Star Cedar Valley, Safe and Drug-Free Committee, Alternatives Pregnancy Center, My Waterloo Days, and Love Cedar Valley. He and his wife Jenny have three adult children. Rogers ran against Danielson in 2008 and lost by 22 votes.
There could be more candidates announcing Independent runs; they have until March 5 to file paperwork. SD 30 residents are also likely to see many national candidates get involved in the race given Iowa’s upcoming “first in the nation” Presidential Caucuses.
Right now, Senate Democrats have only 17 members in the Iowa Senate. Sen. Danielson’s resignation meant Senate Minority Leaders had to reassign members to cover his committees until the special election determines the makeup of the Iowa Senate. Will it go back to 32-18, or swing more Republican with a 33-17 margin. Until then, Senate Democrats have temporarily been assigned to the following committees:
- Transportation Committee: Sen. Todd Taylor (D-Cedar Rapids) moves up to Ranking Member, and Sen. Pam Jochum joins the committee.
- Senate Education Committee: Sen. Amanda Ragan (D-Mason City)
- Senate State Government Committee: Sen. Jim Lykam (D-Davenport)
- Senate Veteran Affairs Committee: Sen. Kevin Kinney (D-Oxford)
- Senate Ways & Means Committee: Sen. Jackie Smith (D-Sioux City)
Sen. Danielson isn’t the only one that’s missing these days at the Capitol. Rep. Megan Jones (R-Sioux Rapids) gave birth to her third child two weeks ago. Baby boy Archie joins Megan and her husband Will and their other two kids, Alma and Anchor. But don’t plan on her being gone long; Rep. Jones made national news when she returned to the Capitol just weeks after giving birth last year with baby daughter in a front-pack. For now, her committees will be covered by:
- House Judiciary Committee: Rep. Matt Windschitl (R-Missouri Valley)
- House Local Government Committee: Rep. Dan Huseman (R-Aurelia)
- House Ways & Means Committee: Rep. Brian Lohse (R-Bounderant)
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IPA Legislative Breakfast
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Thanks to all the IPA members that braved the icy weather and blowing snow to make it to the Capitol for our annual Legislative Breakfast.
Legislators are of course stranded, so they are always around. So even though we had a small crew, they were able to make contact with many key legislators and about a third of all lawmakers (we stopped counting after a while).
Dr. Brenda Payne and Dr. Bethe Lonning talk to first-year Senator Chris Cournoyer (R-Clinton).
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Your Bill Tracker
Click above to see status of important bills, or create your own report with our custom download.
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Town Halls & Public Forums
Find a local event with your state or federal elected officials here. Three weeks are shown at a time on this website.
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Your Legislative Team:
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