Week 12 Legislative Update
It was an exciting week at the capitol as IMS saw two legislative priorities become law and work continued behind the scenes on additional priorities, including the opioid abuse legislation, which is expected to be taken up by the full Senate soon. Much work is occurring in closed door meetings between leadership of the two chambers as they work to reach agreement on spending and policy priorities that must be resolved before the end of session. Issue of interest to the medical community that saw movement this week were the following:
During a large public ceremony in the capitol rotunda on Thursday, Governor Reynolds signed
HF 2456, the Complex Service Needs Workgroup recommendations. On hand to witness the bill signing, and to thank the governor and legislators who championed this issue, were IMS President Joyce Vista-Wayne, MD, and IMPAC Chair Ken Wayne, MD. HF 2456, which will take effect July 1, directs Iowa’s 14 mental health regions to ensure the availability of a series of core services no later than October 1, 2018. These core services include the establishment of 22 Assertive Community Treatment (ACT) teams and Intensive Residential Service Homes (IRSH) for up to 120 patients across the state. By December 31, 2019, these core services must also include at least six subacute regional access center to divert patients that would otherwise seek care from an Emergency Room or a higher level care provider.
The legislation clarifies providers’ responsibilities for disclosing mental health information to law enforcement, and it expedites the process by which physicians can discharge patients held under an involuntary commitment. The Department of Human Services (DHS) and the Iowa Department of Public Health (IDPH) are directed to establish a single statewide crisis hotline. DHS and IDPH are also directed to convene stakeholders to review the mental health and substance abuse involuntary commitment statutes with the intention of further streamlining this process, and to review the role of tertiary care psychiatric hospitals in delivering services to the most high-need patients.
HF 2456 represents some of the most sweeping reforms ever enacted for Iowa’s behavioral health system. It establishes a long-term pathway for additional reforms, with the goal of ensuring that every Iowa patient is able to access the appropriate level of behavioral health care, in as local of a setting as possible.
In a second signing ceremony on Thursday, Governor Reynolds also signed IMS-priority legislation HF 2305, which establishes commercial insurance telehealth parity. This bill is a direct result of PRS 17-2-04, which established IMS policy in support of Medicare, Medicaid, and commercial telehealth parity, and called upon IMS to pursue commercial telehealth parity legislation. Enactment of this legislation marks successful completion of the Policy Forum process that included input from numerous IMS members as part of the Testimony Forum. Policy Forum 17-2 voted unanimously to adopt the Policy Request Statement and refocus IMS advocacy efforts that began with the successful implementation of Medicaid payment parity in 2015, but which had stalled out after repeated attempts at commercial parity fell short. This renewed focus led IMS to approach the commercial parity issue in a new way that ultimately proved successful.
On hand Thursday to thank the governor and legislators for their work on this issue was one of the original authors of PRS 17-2-04, IMS member Andrea Greiner, MD, as well as Pamela Villacorta, Director of the University of Iowa Signal Center for Health Innovation.
Leadership in the two chambers continue to hold marathon closed door meetings as they work to finalize joint budget targets for the upcoming 2019 Fiscal Year. Due to its significant budgetary impact, these joint budget targets must be worked on in tandem with efforts to reach agreement on reforming Iowa’s tax code. Earlier this session, the Senate passed legislation to enact far-reaching tax reform that would reduce state tax revenue by nearly $1.2 billion annually. In her January budget recommendations, Governor Reynolds called for a more conservative tax reform package that would reduce state revenue by $1.7 billion over the next six years. House leadership initially indicated their intent to work from the governor’s less expansive reform package.
This week, leaders in both chambers indicated that they are close to a deal on both issues and expect to release joint targets soon. Once these targets are released, budget chairs can begin the process of building their sections of the FY19 state budget – the final piece they must complete before the General Assembly can adjourn for the year.