Week 13 Legislative Update
The pace at the capitol has slowed considerably as negotiations between the two chambers over tax reform and joint budget targets have stalled. The list of issues of interest to the medical community that are still moving has dwindled, but work remains on significant priorities like combating opioid abuse. This week included work on these issues:
Student Athlete Concussions
Over the past three years, IMS has been involved in discussions around evaluating student athletes suspected of having sustained a concussion. Legislation has been introduced each year that would establish various criteria and procedures for high schools across the state to meet with respect to evaluating a student suspected of having a concussion, as well as protocols for when a student can return to play and return to learn in the classroom. These multi-faceted bills have each year encountered resistance from a host of entities that have concerns around liability, funding limitation to implementation, and ensuring the individuals evaluating students are appropriately trained to do so. This year has seen a renewed push to enact legislation.
On Wednesday, the Senate took up HF 2422 – this year’s legislative vehicle for these policy reforms. In debating the measure, which previously passed the House, the Senate adopted an extensive amendment that sought to address several of the concerns that have stalled previous iterations of the bill. Under the amendment, the Iowa Department of Public Health, in conjunction with the Iowa High School Athletic Association and the Iowa Girls High School Athletic Union, would develop a return-to-play protocol that is consistent with CDC guidelines. Individual school districts would be responsible for adopting this protocol by July 1, 2019. These school districts would also be required to develop individual return-to-learn plans for students diagnosed with a concussion or brain injury, based upon the Brain Injury Association of America’s protocol, in collaboration with the student, the student’s parents, and the student’s health care provider. Beginning July 1, all students who play collision sports would be required to receive information on concussions, and the student and the student’s parent would be required to a form acknowledging receipt of this information prior to the student beginning to play the sport. HF 2422 with this amendment passed the Senate unanimously. It now returns to the House where it’s future is uncertain.
Legislators continue to look for consensus on legislation enacting greater oversight of the Medicaid managed care system. This week, the House Appropriations took up and passed HSB 680, which impacts many of the functions of the Department of Human Services (DHS) including the Medicaid program. This bill, the latest in a string of oversight measures to be introduced this session, includes a number of oversight provisions that have been previously proposed. These include timely payment of clean claims, expedited resolution of systemic MCO claims issues, extending service authorizations if a Medicaid member successfully appeals an adverse determination for a period of time equivalent to the appeal, DHS convening a workgroup to review the health homes program, reviewing the effectiveness of the MCOs’ prior authorization procedures, and contracting for an independent audit of small dollar claims. Earlier this session, the House passed a similar package of reforms when it voted to pass HF 2462. As with that legislation, this week’s efforts are strongly opposed by the MCOs. So far this session, their efforts to halt such oversight measures have been successful. It appears unlikely that HSB 680 will be enacted. It remains to be seen if any Medicaid oversight legislation will be enacted this session.
Reporting Spontaneous Terminations of Pregnancy
Recently, IMS reported on a reminder notice the Iowa Department of Public Health (IDPH) has issued about reporting requirements around induced and spontaneous terminations of pregnancy. As we reported, this notice and the policy changes that spurred it were a result of enactment last session of the 20 week abortion statute that is currently under review by the Iowa Supreme Court. When IDPH widely published a notice on these policy changes and reminding physicians of their reporting requirements under Iowa law in early February, this caused significant concern among many in the physician community. It revealed a communications failure tracing back to the original termination reporting statute that was enacted in 1997 that has resulted in a significant under-reporting of spontaneous terminations for the past 21 years.
Working with IDPH, IMS has determined that this data is not utilized in any way other than to compile an annual report as required by the 1997 statute and IDPH staff have confirmed that there is no public health benefit to tracking this information. Coupled with the significant difficulty of accurately reporting spontaneous pregnancy terminations and the additional administrative burden of doing so, many have called upon IMS to advocate for repeal of this reporting requirement. This has included PRS 18-1-06, which is currently under consideration in the Testimony Forum and will be considered by the IMS Policy Forum when it meets on April 27. That PRS seeks to establish formal IMS policy specific to this issue and secure a legislative directive to work on repeal of he reporting requirement. In recent weeks, IMS has had conversations with key legislators in both chambers to make them aware of this issue and to explore their interest in addressing this unnecessary burden. Members in both chambers have expressed an openness to addressing this issue yet this session as part of the budget process.