Week 4 Legislative Update

With just two weeks remaining until the February 16 first funnel deadline, work at the capitol this week continued at a rapid pace. Legislators devoted their time to numerous subcommittee meetings and private meetings to finalize details on a series of measures of interest to the medical community these included the following:


Behavioral Health

Work continues behind the scenes to put the final touches on legislation to implement the recommendations of the Complex Service Needs Workgroup, as well as the changes IMS crafted to streamline Iowa’s temporary involuntary commitment process. This week, the IMS-IHA led coalition met with healthcare leaders in the House and Senate, as well as staff from the Governor’s Office to discuss specifics of the legislation.


The Senate has nearly completed drafting on three pieces of legislation to enact these policy measures – a bill containing nearly all of the Complex Service Needs Workgroup recommendations, a bill to develop a bed tracking system and reimbursement mechanism to workgroup’s recommendations around tertiary care psychiatric hospitals, and a bill to implement the involuntary commitment streamlining changes crafted by IMS.


The House is working to craft a single bill to address these issues, but has indicated that they are not as far along in the drafting process and have not settled on a final policy strategy. The first of these bills are expected to drop early next week and will move quickly through the subcommittee and committee process to ensure they survive the first funnel deadline in two weeks.


Pediatric Obesity


Governor Reynolds, in her FY19 budget recommendations, included approximately $450,000 in additional funding to the Iowa Department of Public Health (IDPH) for expanding the department’s childhood obesity prevention programming. This week, IDPH released additional information outlining how the governor proposed to utilize these new funds. The plan includes an additional FTE at the department to coordinate community-level efforts and best practices, and to coordinate ongoing efforts among a host of state agencies looking to address pediatric obesity. These efforts include expanded utilization of the 5-2-1-0 resources. Increased access to pediatric obesity resources is an IMS 2018 Legislative Priority.


Opioid Abuse


This week saw continued discussion on policy measures intended to help address opioid abuse in the state of Iowa. On Tuesday, a Senate subcommittee reviewed five pieces of legislation put forward by the Board of Pharmacy and the Office of Drug Control Policy on this issue. These included expanded PMP reporting and functionality, confidential annual reports to providers on their controlled substance prescribing rates, and a proposal to mandate that all prescriptions for controlled substances be issued electronically by July 1, 2019. Physicians from around the state have raised concerns with IMS that this timeline may be too aggressive. Several noted that this may not allow sufficient time for their practice be able to test and fully implement the double-verification upgrades that are required by federal regulation to electronically prescribing Schedule II controlled substances.


IMS raised these concerns in Tuesday’s subcommittee hearing and pushed legislators to delay implementation until July 1, 2020. This proposal spurred significant discussion, as did a proposal from Walgreens to remove the responsibility for a pharmacist to verify that any paper prescriptions issued after the implementation date are written in compliance with one of the bill’s permissible exceptions. The subcommittee opted to delay moving the bill forward to allow for additional discussion and review of the implications of the Walgreens proposal.


Also this week, IMS members Chris Buresh, MD, and Sarah Ziegenhorn, M4, from the University of Iowa visited the capitol to further educate legislators about the need to legalize syringe exchange programs in the state. Ms. Ziegenhorn serves as Executive Director and Dr. Buresh as Medical Director for the Iowa Harm Reduction Coalition, a group dedicated to reducing the harms associated with drug use and promoting health equity. Their outreach and advocacy efforts over the past few years has helped expand utilization of the opioid antagonist naloxone and increase awareness about the associated health effects of injection drug use. This week’s educational session was intended to educate about how Iowa’s growing HIV and hepatitis infection rates are linked to the growth in injection opioid use in our state.

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