Week 6 Legislative Update

Today marks the first funnel deadline, the date by which the majority of policy bills must pass a committee in their chamber of origin in order to remain eligible for consideration this session. With this deadline, many proposals of both interest and concern to the medical community have now died as standalone bills. Check the bill chart for updates on where things stand for some of the top issues we are tracking. The flurry of subcommittee and committee meetings this week saw movement on the following issues:

Certificate of Need

For almost twenty years, the Iowa Medical Society has had policy in support of repealing Iowa’s current Certificate of Need (CON) statute. In the face of a changing healthcare environment, in 2012 the IMS Board of Directors appointed a special study committee to examine IMS’s CON policy to determine if the policy still reflected the positions of the membership. That study committee recommended, and the Board adopted, modifications to specify our organization’s support for improvements to the current CON statute, rather than outright repeal. It is in the context of this policy supporting improvement to the law, that the Committee on Legislation recently reviewed HF 2263, which would modify the current CON statute, and recommended that IMS support the bill.

The legislation, which had a spirited subcommittee hearing on Wednesday, would raise the financial thresholds on capital expenditures and medical equipment purchases that trigger the need to obtain a CON from the current $1.5 million to $5 million, and would create a CON exception for Iowa provider groups looking to establish their own ambulatory surgical center in a county with a population over 30,000. These changes, which are being put forward by a group of independent physician groups, are intended to level the playing field for independent physicians looking to expand the services they are able to offer.

 

Opioid Abuse

This week HF 2299, the opioid omnibus legislation we told you about last week, passed out of subcommittee and committee in the House. In doing so, the legislators voted to take steps to marginally reduce the burden of the prescription monitoring program (PMP) prescriber use mandate. They voted to create a PMP use exception when issuing prescriptions to patients in hospice or a long-term care setting. IMS continues to believe that mandating prescriber use of the PMP is not an effective solution to combat opioid abuse. Legislators have signaled a strong interest in moving forward with the mandate despite no evidence that similar mandates in other states have reduced overdose deaths or led to a greater reduction in opioid prescribing rates than is already occurring across the country, and here in Iowa. IMS is working to narrow the breadth of any potential PMP use mandate so as to limit the burden on physician practices.

 

Behavioral Health

This week saw the introduction of the much-anticipated bills to implement the recommendations of the Complex Service Needs Workgroup. SF 2252 and HF 2327 both implement the majority of the core workgroup recommendations, but they do so in slightly different ways.

Senate File 2252

  • Clarifies Licensure for Subacute Care Facilities
  • Modifies Regions’ Reserve Fund Standards to Establish 30% of Annual Expenditure Limitation
  • Regions Shall Ensure the Availability of Core Services, Contingent Upon Federal Funding Availability, No Later Than July 1, 2021
  • Regions May Partner to Make Core Services Available
  • Regions’ Annual Reports Must Outline Plan to Make Core Services Available
  • Regions Must Provide Quarterly Reports on Their Progress Toward Making Core Services Available
  • Medicaid Must Cover Medically Necessary Core Services
  • Core Services Include:
    • 22 Assertive Community Treatment (ACT) Teams
    • 6 Subacute Regional Access Centers
    • Intensive Residential Service Homes (IRSH) for up to 120 Patients Statewide
    • A Single Statewide Crisis Hotline
    • Warmline Regional Services
  • Allows DHS to Implement Changes with Emergency Rules

House File 2327

  • Clarifies Licensure for Subacute Care Facilities
  • Regions Shall Ensure the Availability of Core Services, Contingent Upon Federal Funding Availability, No Later Than October 1, 2018
  • Regions May Partner to Make Core Services Available
  • Medicaid Must Cover Medically Necessary Core Services
  • Core Services Include:
    • 22 Assertive Community Treatment (ACT) Teams
    • 6 Subacute Regional Access Centers (Established by December 31, 2019)
    • Intensive Residential Service Homes (IRSH) for up to 120 Patients Statewide
  • Modify Regions’ Civil Commitment Process:
    • Ensure Civil Commitment Prescreening Within Four Hours of Emergency Detention
    • Ensure the Coordination of Appropriate Levels of Care, Including Securing Inpatient Psychiatric Beds or Community-Based Resources and Services, When Needed
    • Ensure Ongoing Consultation with a Physician or other Mental Health Professional While Patients Remain in the ER
  • Clarifies Disclosure of Mental Health Information to Law Enforcement
  • Expedites Release of Patients in a Mental Health or Substance Abuse Involuntary Commitment if Recommended by the Examining Physician
  • Clarifies Transport Responsibilities for Patients Under a Mental Health Involuntary Commitment
  • DHS & IDPH Must Establish a Statewide Crisis Hotline
  • DHS & IDPH Must Convene Stakeholders to Review the Mental Health and Substance Abuse Involuntary Commitment Process and Make Recommendations for Improvement
  • DHS & IDPH Must Convene Stakeholders to Review the Role of Tertiary Care Psychiatric Hospitals in Delivering Mental Health Services and Issue Recommendations by November 30, 2018

Both bills advanced out of subcommittee and committee in their respective chamber this week. They will soon move to the full chambers for consideration and the process of merging the two proposals into a single set of policy changes.

 

Fetal Heartbeat

The issue of abortion is one that divides the membership of the Iowa Medical Society. IMS does not have a blanket organizational policy on the matter, but instead follows the AMA’s policy which recognizes that support of or opposition to abortion is a matter for individual members to decide, and that the organization will take no action which may be construed as an attempt to alter or influence the personal views of individual physicians. As a result, IMS does not frequently take a position on abortion-related policy proposals. In some instances, however, an abortion-related proposal has such far-reaching implications for Iowa’s medical community, that the IMS must engage. Recently, you may have seen media coverage of one such instance.

SF 2281, which passed out of committee in the Senate this week, would outlaw virtually all abortions in Iowa except in cases of life of the mother. On its face, this bill would appear like any other abortion proposal, however, these standards would render it impossible for the University of Iowa, Carver Collage of Medicine (UICCOM) to maintain our state’s only obstetrics residency program. Under Council for Graduate Medical Education (ACGME) accreditation standards, obstetric residency programs must offer the option of abortion training to all residents, who then have the ability to opt-out of the training for religious or moral reasons. Loss of the UICCOM obstetric program would not only result in fewer OB/GYNs in a state that already ranks 51st in the nation for the number of OB/GYNs per capita, it would also lead to a series of downstream issues for residency training in other specialty areas, university research and quality improvement projects, and increased operating costs for the University of Iowa Hospitals and Clinics.

As you may have seen in some of the many media reports covering this legislation, IMS has come out against this legislation. We continue to respect the diverse individual beliefs of our more than 6,600 physician, resident, and medical student members, and will not be weighing in on the moral or ethical considerations of abortion. IMS will, however, strongly advocate against legislation that threatens the ability of one of our state’s medical schools to maintain national accreditation and continue to train the next generation of physicians in one of Iowa’s highest-need medical specialties. If you have questions or concerns about IMS’s position on this legislation, please contact Dennis Tibben.

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