2016 Session Adjourns – Legislative Scorecard

Date of Publication (May 4, 2016)

The second session of Iowa’s 86th General Assembly adjourned sine die shortly after 6 p.m. last Friday, April 29. Extending only ten days past the day legislators’ per diem compensation ran out, this session will likely be remembered as much for the major policy initiatives that remain unfinished as it will for those that were sent to the governor’s desk. The medical community experienced both wins and losses this year, with progress made on nearly every one of IMS’s 2016 legislative priorities.

Many health policy issues external of our proactive agenda also saw significant discussion. Below are some of the major issues that IMS worked on this session:

Prescription Drug Abuse (IMS Legislative Agenda Item) – IMS Win

The legislature passed and the governor signed SF 2218, expanding access to the opioid antagonist naloxone, in response to calls from IMS and other stakeholder organizations to address the state’s growing opioid overdose epidemic. The bill allows for prescriptions of naloxone to be issued to emergency service programs, fire departments, law enforcement agencies, and the friends and families of individuals at risk for opioid abuse. Corrections to the measure’s language included in the final Health and Human Services budget bill also provide for pharmacists to dispense naloxone through a standing order or collaborative practice agreement with a physician. Full details of this new life-saving legislation are available in this IMS One-Pager.

Medicaid Oversight (IMS Legislative Agenda Item) – IMS Win

The final Health and Human Services (HHS) budget bill includes many of the oversight protections IMS has demanded throughout the transition to the IA Health Link managed care program. These measures, detailed in this week’s Health and Human Services Budget Breakdown, offer both patients and providers needed mechanisms to ensure providers are paid fairly, patients have access to receive the care they need, and the public has adequate avenues to address any programmatic issues. While IMS will continue to advocate for additional program improvements, including the ongoing need to align and centralize as many administrative processes within the program as possible, the oversight measures established so far constitute a much-needed step forward.

Medicaid Rate Increase (IMS Legislative Agenda Item) – Progress Made

The legislature once again failed to establish Medicaid payment rates that cover the actual costs of providing care to Medicaid beneficiaries. However, IMS was successful in fending off attempts to cut physicians’ Medicaid payment rates by up to $13 million. These include a proposal by the governor that would eliminate the enhanced primary care payment rates that IMS successfully secured state funds to extend after temporary federal enhancements expired in 2014. IMS also successfully pushed for language in the final HHS budget bill codifying the IA Health Link program’s fee-for-service payment rate floor.

Banning Managed Care All Products Clauses (IMS Legislative Agenda Item) – IMS Loss

Efforts to prohibit insurers from using “all products” clauses in provider contracts as a way of coercing physicians into participating in their Medicaid managed care networks failed this year, thanks in large part to opposition from the insurance industry. SSB 3093 failed to clear the first funnel deadline due to arguments that two of the three Medicaid managed care companies are not yet participating in the commercial market. IMS will continue to push for enactment of this preventative legislation to protect Iowa physicians from insurance abuses.

Modernizing Iowa’s Tobacco Control Approach (IMS Legislative Agenda Item) – Progress Made

IMS was joined by the American Academy of Pediatrics, Iowa Chapter, and several public health organizations in supporting SF 2016, which would have raised the legal age for smoking and using electronic cigarettes in Iowa to 21. This 2016 IMS Legislative Priority was the result of PRS 15-3-04 and would have brought Iowa in line with over 115 local municipalities in nine states, as well as the state of Hawaii. As expected, SF 2016 saw strong opposition from the tobacco and vaping industries, as well as retailers who fear lost revenue from limiting youth access to tobacco and vaping products. The bill’s subcommittee was split in its assessment of the need to raise the legal minimum smoking age, and declined to advance the legislation. It is not uncommon for new policy proposals to take several years of education and advocacy before legislators are comfortable enacting legislation. This year’s efforts served as an opportunity to formally start this conversation. In coming years IMS will continue to work with our public health allies in pursuit of this legislation.

Optometrist Injections – Win

The Optometrists sought to remove some of the current statutory restrictions on the injections that may be performed by an optometrist and significantly expand the scope of delicate procedures these non-physicians could legally administer. IMS worked closely with the Iowa Ophthalmologist Association outlining the dangers of this measures and keeping it from moving forward.

Commercial Sale of Fireworks – Win

IMS again worked in collaboration with public health advocates, insurers, and public safety organizations to oppose efforts to repeal Iowa’s long-standing ban on the commercial sale of fireworks. Proponents of the legislation pushed until the final hours of session to find an avenue for final passage of the measure, but were unsuccessful.

Virtual Credit Cards (IMS Legislative Agenda Item) – IMS Loss

IMS initiated conversations with lawmakers this year on a measure regarding provider payment options that will require additional education before legislative action is to be successful. In recent years, Iowa practices have alerted IMS to a troubling practice, wherein health insurers fail to disclose the expensive fees associated with receiving electronic provider payments via virtual credit cards. SSB 3098 would have required health insurers to inform practices of all payment options available to them and to disclose the fees associated with each option. As expected, the measure drew significant opposition from the banking and insurance industries. The bill failed to advance. IMS will continue to work with legislators on avenues to address this situation.

Trauma System Funding (IMS Legislative Agenda Item) – Progress Made

IMS advocacy this year included a push for dedicated state funding of Iowa’s Trauma System. The system, which matches injured patients with the facilities best suited to meet their emergent needs, currently relies almost exclusively on federal block grants that can be unpredictable and are contingent upon Congressional action. This year, IMS’s advocacy efforts, including a highly productive Physician Day on the Hill in March, initiated conversations with legislators about securing this needed state funding. While the final HHS budget did not include state funding for Iowa’s Trauma System, legislative leadership is now aware of this critical gap in our state’s public safety system and has committed to working with IMS to address the issue moving forward.

Rural Physician Loan Repayment (IMS Legislative Agenda Item) – IMS Win

For the fourth year in a row, IMS again successfully partnered with the Iowa Academy of Family Physicians (IAFP) to secure state matching funds for the Rural Physician Loan Repayment Program. As in years past, IMS and IAFP collaborated to secure $1.7 million for the joint public-private trust fund, which will ensure the continuation of this crucial measure to address the critical shortage of physicians in Iowa’s rural communities.

Underage Indoor Tanning Ban (IMS Legislative Agenda Item) – Progress Made

The medical community’s continued efforts to restrict the unsafe practice of indoor tanning by minors made significant progress this year, though the measure again failed to see final passage. IMS has worked closely with the Iowa Dermatological Society and the American Cancer Society to prohibit underage tanning for the past four years. The legislation has drawn opposition from parental consent advocates, who have pushed for an exception to allow parents to give permission for their children to tan. The ban reached its furthest progress to date this year when legislators struck a compromise with those advocates, amending the bill from a clean under 18 ban to a clean under 17 ban. While the bill again failed to see final passage, that deal now paves the way for renewed efforts at passing this important legislation next year.

Medical Marijuana – IMS Win

Proponents sought this session to significantly expand Iowa’s Medical Cannabidiol Act to allow patients with some cancers, MC, epilepsy, HIV/AIDS, Crohn’s disease, ALS, and terminal illnesses to obtain and utilize Cannabidiol. In addition, the proposed legislation would have allowed for in-state production and distribution of this unregulated substance. IMS continues to support reclassification of marijuana to a schedule II controlled substance to allow for further research into its potential medical efficacy and oppose these efforts to circumvent the federal review and regulatory efforts. Proponents of expanding Iowa’s medical marijuana statute were unsuccessful in enacting reforms to the current law.

CPR for School Coaches (IMS Legislative Agenda Item) – Progress Made

IMS was unable to secure final passage of legislation requiring CPR training as a condition of certification for school coaches, however, significant progress was made, with the bill passing the full House and a committee in the Senate. Ultimately, the politics around an unrelated issue – the presence of athletic trainers at sporting events prone to student athlete concussions – proved to be the impediment to final passage. In an effort to keep the athletic training measure alive after its standalone bill failed to advance, the two policy proposals were merged. The addition of the athletic trainer legislation resulted in sufficient opposition to ultimately halt the bill. Department of Education officials have indicated a willingness to pursue administrative rules to enact the CPR training requirements absent further legislative action. IMS will work with the department over the interim to pursue enactment of this public safety measure.

Statute of Repose – IMS Win

IMS was the lone organization to speak up when the trial attorneys brought legislation in that could effectively repeal the statute of repose, allowing plaintiffs to bring suit against a physician at any time, no matter how long it has been since the incident in question. Doing so would eliminate one of the few clear limitations in statute on a physician’s liability exposure and cause serious legal and administrative repercussions for Iowa practices. IMS successfully halted this legislation early in session.

 

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