It was another busy week at the capitol. Subcommittees and committees are working at a more rapid pace than this point in session most years, which also means the first substantive debate by the full chambers also occurred this week. Several issues of interest to the medical committee saw movement:
Our top legislative priority has seen a lot of activity during the first few weeks of session. Again this year, IMS has assembled a large coalition of provider, facility, insurer, and business groups working collectively in support of a hard cap on noneconomic damages. IMS has been meeting with legislative leadership and key members to discuss strategy, and has been coordinating coalition contacts with key undecided House members who will determine whether legislation like the bill that passed the Senate will ultimately see final passage this session. These efforts have been aided by numerous local meetings between target legislators and physicians in their area. These on-the-ground perspectives have been invaluable in helping to inform legislators about the extent of this problem and the local support for action to fix it. If you are interested in becoming move involved in the tort reform fight, please contact Andy Conlin, IMS Grassroots Coordinator, to learn how you can help.
Scope of Practice
This week saw action on several scope of practice proposals, with various provider groups pointing to the ongoing COVID-19 pandemic as the impetus for allowing their profession to provide more medical services.
Pharmacists (HSB 73; HSB 91; HSB 121)
In a trio of subcommittee hearings this week, legislators considered legislation that would impact pharmacist scope of practice. On Tuesday, a subcommittee considered HSB 91, which would amend the statewide protocols statute to allow pharmacists to administer point-of-care testing and treatment for influenza, strep, and COVID-19; administer pediatric immunizations; and enter into collaborative practice agreements with any prescribing profession. Despite objections from the medical community, the bill unanimously passed out of subcommittee and now moves to the House Human Resources Committee for consideration.
Wednesday saw subcommittee action on HSB 121, which allows pharmacists to dispense hormonal birth control pursuant to a statewide standing order under the oversight of the state Medical Director within the Department of Public Health. This proposal, which is being put forward by the governor, limited dispensing to patients over age 18, limits dispensing to no more than a one-year supply, and requires pharmacists to provide patients with information about the importance of receiving an annual exam from a medical provider. The bill unanimously passed out of subcommittee and now moves to the House Human Resources Committee for consideration.
On Thursday, a House subcommittee considered HSB 73, which makes numerous technical changes to pharmacist practices. Of concern to the medical community, the legislation would allow pharmacists to delegate services and medications ordered or administered via the statewide protocols to pharmacy support staff. The bill passed out of subcommittee and now moves to the House Human Resources Committee for consideration.
Dentists (HSB 71)
Also on Tuesday, a House subcommittee took up consideration of HSB 71, allowing dentists to administer the influenza and COVID-19 vaccines to patients of any age. Discussion of the bill largely centered on the COVID-19 vaccine sections, with proponents arguing more providers are necessary to speed vaccine administration across our state. IMS spoke in opposition to the legislation, noting that more than 2,400 provider entities representing thousands of individual providers have already been approved to administer the COVID-19 vaccine. The vast majority of these entities are not yet administering the vaccine due in large part to the limited doses available to the state.
Legislators expressed some reservations about the proposal, but did move the bill out of subcommittee and to the full House Human Resources Committee for consideration. IMS is continuing conversations with the full committee and members of the Senate to work to halt the legislation in its current form.
IMS was approached this week by representatives of the Iowa Podiatric Medical Society (IPMS) to discuss their pending proposal to allow podiatrists to administer all CDC recommended immunizations. IPMS has asked legislators in both chambers to introduce legislation to grant this authority. We have not yet seen the legislative language, but the IPMS representative indicated they had not included any limitations on administration to pediatric, elderly, or high-risk populations. Conversations continue on this newest proposed scope expansion.
Telehealth Coverage & Parity
Two of the telehealth bills we told you about last week saw movement at the capitol this week. HF 89, which would require commercial insurers to reimburse for behavioral health services at 100% on in-person rates, passed its subcommittee last week and on Tuesday passed the House Human Resources Committee. The bill now moves to the full chamber for consideration.
On Tuesday, a House subcommittee met to consider HF 88, which would permanently recognize audio-only as a permissible form of telehealth in the state of Iowa. The original bill included a requirement that providers of audio-only telehealth services must meet all in-person standards of care. IMS worked with the subcommittee and stakeholders to craft amendment language to replace this requirement with a directive that the individual licensing boards adopt rules to guide licensees in determining clinically appropriate services to provide via audio-only telehealth. The legislation with amendment passed the subcommittee and now moves to the House Human Resources Committee for consideration.
Also last week, we told you that Wellmark has developed a new proposal for a long-term telehealth payment model, which is under consideration by the Committee on Legislation. As those deliberations continue, we want to hear the broader membership’s thoughts on the proposal. Wellmark has shared a summary document with IMS and other stakeholders outlining the framework for this new model, which would begin after the pandemic ends. Under the structure proposed by Wellmark, they would raise their base telehealth payment rates from 50% of in-person rates for physical health services and 75% of in-person rates for behavioral health services, to 70% of in-person care for physical health and 85% of in-person rates for behavioral health services. Providers who meet certain service criteria outlined in the overview document would then qualify for a further increase in payment rates, up to 95% of in-person rates.
As the model advances through the baseline and intermediary phases to the advanced criteria, baseline rates would remain the same but maximum payment rates would drop to 90% of in-person rates and stay at these levels long-term. Among the criteria for the advanced phase of the model is that providers be enrolled in a risk-sharing agreement such as an ACO model with Wellmark. In conversations with Wellmark this week, IMS noted that under this risk-sharing arrangement, providers would already be accepting a reduced global payment as they seek to more comprehensively manage patient utilization. We suggested modifying the maximum payment rate under the final long-term phase to 100% of in-person rates for those practices in a risk-sharing agreement, recognizing that Wellmark’s global spending to these providers is already expected to be reduced as part of that agreement. The Wellmark representatives expressed an openness to discussing this change further with stakeholders.IMS wants to hear from you. After you’ve had an opportunity to review the Wellmark proposal, please contact us to share your thoughts, questions, and concerns. This input will help to inform the Committee on Legislation’s deliberations and IMS discussions with Wellmark moving forward.