• Takes the first steps in creating a children’s behavioral health system that parallels the adult system managed by regions (HSB 206 & SF 479), and allowing regions to keep a bit more money in reserve while they build out both the adult complex needs service system and the children’s behavioral health system (HF548). More on this follows.

• Requires anyone calling themselves "music therapists" to hold a board-certified credentials or be on the national registry, but does not create state licensure or require third-party payor reimbursement (HF 419).

• Convenes another work group to address the ongoing challenges of the psychiatric patient placement clearinghouse and inpatient psychiatric bed tracking system, this time including a review of tele-psychiatry services (HF 624).

• Allows DHS to release confidential information to a multidisciplinary team if the team’s sole focus is identifying services for children who are victims of, and children at risk of becoming victims of, human trafficking (HF 642).

• Fixes recent bad case law in appellate courts by stating that expert testimony in child abuse, child sexual abuse, and child endangerment cases is permitted (SF 329, HSB 19)

• Requires Medication Assisted Treatment (MAT) be available without prior authorization in both the Medicaid managed care and fee-for-service systems. At least one prior authorization free option must be made available for methadone, buprenorphine, naloxone, buprenorphine and naloxone combination (Suboxone), and naltrexone (HF 623 & SSB 1231).

• Requires Medicaid coverage for tobacco cessation without prior authorization for members that reach out to an MCO tobacco cessation program or through Quitline Iowa - but they can require prior authorization for minors and those that have twice-failed in a consecutive 18-month period (SF 490).

• Expands use of cannabidiol (CBD oil) for additional conditions (including PTSD), allows ARNPs and PAs to authorize use, increases THC levels dispensed over a six-month period, and authorizes home delivery in some instances (SF 501, HSB 244).

• Authorizes the IDPH to set up syringe exchange pilot programs in five jurisdictions around the state, and legalizes possession and distribution of syringes for participants in the pilot programs (SF 500).

• Prohibits a state licensing board from suspending or revoking a practitioner's license solely because they defaulted or are delinquent on student loans (HF 660).

• Opens up the Health Care Loan Repayment Program to mental health professionals, but does not add additional funding to build out the program (SF 167).

• Directs an interim committee to review the income cliff effect in public assistance programs and examine ways to phase out programs to encourage career advancement (HF 597).

• Requires quarterly real-time monitoring and quarterly eligibility verification for public assistance programs (FIP, Medicaid, SNAP), with individuals found ineligible given only 30 days to provide proof of continued eligibility. Fortunately, the fiscal note on this estimates the state share of the cost to be $15.9 million in FY20 and $24.4 million in FY21, making passage highly unlikely (SF 334).

• Requires the Medicaid expansion population (Iowa Health & Wellness Plan members) to participate in community engagement activities (work, volunteer) to remain eligible; more on this later (SF 538).

• Takes the schools out of the equation for school-based health screening, instead making the parent and provider responsible for submitting necessary vision, dental, and blood lead test screenings to the Iowa Department of Public Health. Interestingly, part of the Governor's children's mental health initiative includes school-based mental health screenings for students; seems this bill goes in the opposite direction (SF 438).

• Each MH/DS region is required to plan for and ensure access to core children’s behavioral health services within their area.  Each region must designate at least one children’s behavioral health coordinator. They would continue to have at least one staff person designated as an adult mental health and disability services coordinator.  The region must have their initial plan for services completed by April 1, 2020.

• Children living in families with incomes up to 500% of the federal poverty level would be eligible for these regional services, and the region will use a sliding fee scale for children in families between 150-500% of the federal poverty level.

• Regions are to make sure the following comprehensive facility and community-based crisis services are available to any eligible child, regardless of diagnosis:
• Mobile response
• Crisis stabilization community-based services
• Crisis stabilization residential services
• Behavioral health inpatient treatment

• Regions are to make sure the following core services are available to eligible children with a diagnosed serious emotional disturbance:
• Prevention, early identification, early intervention, education
• Assessment and evaluation to determine eligibility for services
• Medication prescribing and management
• Behavioral health outpatient therapy

• If additional resources are identified, regions are to make sure the following additional core services are available to eligible children with a diagnosed serious emotional disturbance: 
• Behavioral health school-based therapy
• Support for community living (family & peer support, therapeutic foster care, respite care)
• Transition services to bridge to adult system (day habilitation, job development, supported employment prevocational service, educational services, care coordination, health homes)

• Regions are required to pay for core services to children with diagnosed serious emotional disorders who are not eligible for Medicaid and do not have other insurance coverage, but only if funding is available.  No additional funding sources have been identified, and funding for services is not addressed in this bill (or any other bill filed to date).

• Medicaid (and managed care organizations) would be required to pay for the services that are provided to their members, “to the extent funding is available.”  If these are to be funded, the Health and Human Services Budget would need to include additional funding for the Medicaid share of these services.

• The Children’s Behavioral Health System Board is also formalized in these bills. The Board will continue to provide guidance and support the ongoing development of the system, and representatives from state agencies, courts, MH/DS Commission, Early Childhood Iowa, providers, schools and AEA, parents, advocates, regional MH/DS administrators, sheriffs, pediatricians, and hospitals.

• Regional MH/DS governing boards are also reconfigured.  Currently only elected officials are allowed to vote on these boards.  The changes would add a parent, AEA, and children’s service provider to the board, and allow the AEA, parent, and the existing adult consumer member to vote.  The bill splits the current advisory committee into an adult services advisory committee, and a children’s service advisory committee.

• End managed care for everyone or only persons receiving long term supports and services, returning to fee-for-service system.

• End managed care for everyone and move to an administrative services contract (this managed care hybrid is similar to what the state had with Magellan prior to managed care and was proposed by the Iowa Hospital Association as their “better way” – basically the state hires a single company to administer the fee-for-service system).

• Require an independent external review process for appealing decisions on claims and services.

• Demand true conflict-free case management, separate from the MCO.

• Ban MCOs from asking for payment back or denying payment for services that were provided according to a service plan or contract.

• Make MCOs pay a provider 12% interest on claims that were not paid on time, inaccurately denied, not paid according to the contract, or not settled in a timely manner. MCOs would pay a provider 20% interest if they deny coverage and it is overturned on an appeal.

• Require independent, conflict-free administration of the uniform Supports Intensity Scale (SIS) assessment given to individuals who have an intellectual disability or developmental disability.

• Report on long term supports and services provided to individuals with disabilities to make sure people are receiving necessary services and supports.

• Develop a single, uniform credentialing process for Medicaid providers, using the same criteria for both fee-for-service and managed care.

• Eliminate prior authorization for some services or require a uniform prior authorization process for both fee-for-service and managed care.

• Streamline all administrative processes and procedures, so they are the same for all managed care organizations and the state’s fee-for-service system.

• Direct MCOs to work with state agencies and provider groups to help recruit, retain, and train the direct care and health care workforce.

• Require MCOs honor requests to switch MCOs for good cause within 10 days (currently it may take up to 45 days for this to be done).

• Add staff to the Ombudsman Office to investigate complaints made by any Medicaid member, whether receiving long term supports and services, whether in managed care or fee-for-service.