IMS Legislative Summary
April 27, 2009
The Iowa General Assembly adjourned at 5:55 a.m. on April 26 after a marathon week punctuated by lots of heated negotiations and many starts and stops in the process. Many major pieces of legislation were passed in the waning days of the session including appropriations bills, health care reform, bonding proposals, and major modifications of the sex offender law. Mental health parity legislation was not as fortunate but expect it to resurface again next year. The governor has 30 calendar days to act on bills passed during the final three calendar days of session.
The FY 2010 Health and Human Services Appropriations bill, HF 811, passed the House and the Senate without much contention and is on its way to the governor. The Medicaid program funding for reimbursements to physicians and hospitals was kept at level funding with no increase. A late amendment to the bill avoiding a cut to the prospective payment system (PPS) hospitals, was approved late on Friday restoring money to the base reimbursement for those PPS hospitals. Federal stimulus money in the form of increase federal participation is included in the Department of Human Services budget to avoid any cuts. Also included is language directing the Executive Committee of the Electronic Health Information Advisory Council to review the electronic exchange of patient information by health care providers. The intent is to recommend ways to increase the electronic sharing of treatment-related information among providers.
The annual health care reform package, SF 389, underwent numerous changes over the course of the session after introduction in the Senate and after major modification in the House. In the end, many of the provisions that were of concern to IMS were removed from the bill. The following is a short summary:
Division I: Legislative Health Care Coverage Commission
A legislative health care coverage commission is created under the authority of the Legislative Council. The commission members include a representative of large employers, Iowa insurers, health underwriters, a health care provider, labor, pre-Medicare population, middle-income adults and families and low-income adults and families, small business, non-profit entities, and independent insurance agents. The Insurance Commissioner, directors of the Departments of Human Services and Public Health and four members of the General Assembly as ex-officio, non-voting members.
The commission is required to develop an Iowa health care reform strategic plan which includes, but is not limited to review, analysis, and recommendations for the following:
- Options and recommendations for the coordination of a children's health care network.
- Options and recommendations for children, adults, and families to transition among public and private health care coverage options.
- Options and recommendations for subsidized and unsubsidized health care coverage programs with the goal that the contribution be no more than 6.5% of family income.
- Options and recommendations to offer a program to provide coverage under a state health or medical group insurance plan to non-state public employees.
- The consequences of requiring each employer in Iowa with more than 10 employees to adopt and maintain a Section 125 cafeteria plan.
- Options and recommendations for development of a long-term strategy to provide access to affordable health care coverage to the uninsured in Iowa.
The commission must collaborate with health insurance experts in developing the plan. Progress reports are required to be submitted to the Legislature every quarter. The first progress report is due by January 1, 2010, which in addition to the activities of the commission, should include recommendations for subsidized and unsubsidized health care coverage programs that could be available for purchase by the public by July 1, 2010. The second report is due by January 1, 2011. Lastly, the commission must conclude its deliberations by July 1, 2011, and submit a final report to the Legislature by October 1, 2011.
Division II: Adult Children Health Care Coverage
Exempts from state income tax the health benefits coverage of a non-qualified tax dependent. The amendment would be retroactive to January 1, 2009. Allows adult children not currently on their parent's coverage who are under age 25 to re-enroll if otherwise eligible. Also strikes the current requirement that an adult child must be continuously covered in order to be eligible under a parent's insurance plan.
Division III: Children's Health Care
- Requires the Department of Human Services to provide medical assistance or hawk-i coverage, as appropriate, to individuals under 19 years of age who meet income eligibility requirements under the respective program and if federal funding is available.
- Amends the income tax provision for reporting of a dependent child's health care coverage status to require, beginning with returns for tax year 2009, that the filer must indicate whether each dependent child has health care coverage. If the dependent child does not have health care coverage and the income of the taxpayer's tax return does not exceed the highest level of income eligibility standard for Medicaid or hawk-i, the Department of Revenue is required to send a notice to the taxpayer that the child may be eligible for these programs and provide information on how to enroll. The taxpayer is then required to submit an application for the appropriate program within 90 days.
- Allow the legislative council to employ or contract with a person or persons to assist the commission in carrying out its duties and to gather information from and coordinate the activities related to the various health care reform advisory bodies.
- Requires the Department of Revenue, in cooperation with DHS, to submit annual reports to the governor and the Legislature regarding the number of dependent children without health care coverage.
- Improves access and retention in Medicaid and hawk-i by directing DHS to implement provisions included in the federal Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) for hawk-i and Medicaid including implementing premium assistance options and presumptive eligibility starting January 1, 2010.
- Authorizes DHS to cover legal immigrant children who have been in the United States less than 5 years with a federal match requirement, allow for the use of one pay stub as verification of income for Medicaid and hawk-i and makes other changes to Medicaid.
- Allows DHS, with the approval of the hawk-i board to contract with participating insurers to provide supplemental dental-only coverage to eligible children who are currently covered by hawk-i.
- DHS, in cooperation with IDPH and other appropriate agencies, are required to apply for grants available under CHIPRA to promote outreach and quality child health outcomes under the Medicaid and hawk-i programs. The section takes effect July 1, 2010.
Division IV: Expansion of the Volunteer Health Care Provider Program
Expands the volunteer health care provider program to include specialty health care provider offices. A specialty health care provider office providing free care under this program is considered a state agency and would receive immunity protections under this program. Employees working in offices that are registered with the program would also receive immunity protections since they would be considered an employee of the state for the purposes of this chapter.
Division V: Health Care Workforce Support Initiatives and Fund
Establishes a health care workforce support initiative, including a health care workforce shortage fund. This includes establishment of Medical Residency Training Grants administered by IDPH; Health Care Incentive Payment Program administered by the College Student Aid Commission with assistance of Des Moines University Osteopathic Medical Center; a Nurse Educator Incentive Payment Program, a Nursing Faculty Fellowship Program, and a Registered Nurse and Nurse Educator Loan Forgiveness Program administered by the Student College Aid Commission with consultation with IDPH; and a Safety Net Provider Recruitment and Retention Initiative administered by IDPH in cooperation with a newly established governing group of the Iowa Collaborative Safety Net Provider Network.
The division also establishes within IDPH a physician assistant mental health fellowship program. The purpose of the program is to determine the effect of specialized training and support for physician assistants in providing mental health services to address the mental health professional shortage in Iowa.
All these workforce programs are to be implemented to the extent that funding is available. And all the programs, except for the nurse and nurse educator loan forgiveness program are repealed June 30, 2014.
Division VI: Gifts and Reporting of Sanctions
The division requires all health licensing boards to report to the Legislature by January 15, 2010, any public information regarding sanctions levied against a health care professional for receipt of gifts that are not in compliance with any such requirements or limitations established by the board.
Division VII: Health Care Transparency
Codifies that IDPH shall enter into a memorandum of understanding with the Iowa Hospital Association to collect, maintain, and disseminate hospital inpatient, outpatient, and ambulatory information.
The list of things of interest to IMS that DID NOT get acted on this legislative session are as follows:
WORKERS' CHOICE OF DOCTOR: Iowans injured on the job could choose their own doctors in workers' compensation cases. IMS closely monitored this measure.
MENTAL HEALTH INSURANCE: Smaller businesses that provide health insurance for their workers would have to provide coverage for almost all mental health conditions. IMS was very supportive of the mental health and substance abuse parity legislation and we will continue to support this measure next year.
DEATH CLAIMS: Iowans who file a wrongful-death claim could be awarded damages for their deceased loved one's loss of enjoyment of life. IMS opposed this measure.