Week 11 Legislative Update

This week saw extensive floor debate as more bills, including several of interest to the medical community, are now on their way to the governor’s desk. Leadership in the two chambers are also working behind closed doors to establish budget targets, which will allow budget chairs to begin crafting their sections of the FY19 state budget. Those targets are expected in the near future as we close in on the April 17 target adjournment date. Among the issues of interest to IMS that saw discussion this week are the following:

Behavioral Health

On Wednesday, the Senate debated HF 2456, the Complex Service Needs Workgroup recommendations to strengthen Iowa’s behavioral health system. It was a lively debate with members of both parties rising to voice support for the legislation, while cautioning the need for sufficient funding to ensure successful implementation of the systemic reforms called for in the bill. One Senator voiced support for an idea put forward by the counties, which would raise the state sales tax by a penny and devote 3/8 of those funds toward mental health. While this idea is unlikely to gain sufficient traction for passage this year, it illustrates the creative ways in which stakeholders are approaching the need to sufficiently fund the behavioral health system.

While HF 2456 does not appropriate new funds to implement its reforms, the bill does include the authority for the mental health regions to spend down their reserve funds to cover start up costs, it mandates Medicaid coverage for new service delivery models, and creates blending streams to utilize county and regional funds, Medicaid, and commercial insurance to fund initial services. Senators expressed an interest in devoting additional funds toward this system as part of the budget process, should resources be available. The bill unanimously passed the Senate and is now on its way to the governor’s desk for signature.

 

Telehealth Parity

Also this week, the Senate debated HF 2305, which establishes commercial insurance telehealth parity. In another spirited debate on Tuesday, legislators expressed an interest in expanding this legislation, which only applies to commercial insurance and only established coverage parity. Efforts to amend the bill to expand it, were unsuccessful and the measure passed unanimously. It now goes to the governor for signature. Building upon the IMS-championed 2015 measure, which established Medicaid telehealth payment parity, enactment of this latest legislation will further expand the statewide policy support for telehealth utilization across our state.

 

Opioid Abuse

Work continues behind the scenes to secure final passage of HF 2377, the opioid omnibus legislation that includes a number of provisions supported by the medical community including increased functionality for the Prescription Monitoring Program (PMP) and expanded Good Samaritan protections for overdose situations. The bill also contains mandates, which IMS has worked to scale back including the delayed mandate that all controlled substances must be electronic prescribed by 2020 and the PMP use mandate that now only applies when prescribing opioids. As we reported a few weeks ago, IMS is currently working to scale back the prescriber continuing education mandate, which currently applies to all licensed health professionals and requires that they receive training in the CDC opioid prescribing guidelines.

This amendment, as well as a push to expand the list of controlled substances that a pharmacist must report into the PMP to also include Schedule V, appear to be the two final sticking points for Senate passage of the bill. On Thursday, IMS led a meeting with Senate leadership that included representatives of Team Doctor, as well as the ARNP associations, to push for resolution of the continuing education issue. The message was well received. It is hoped that the opioid bill will soon be returned to the House with the IMS amendment that also repeals the current Board of Medicine chronic pain management continuing education requirement, which would be redundant with the establishment of the new CDC prescribing guidelines requirement. House leadership have expressed support for the amendment.

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