Next Friday marks the second funnel deadline – the date by which the majority of policy measures must have passed a full chamber and a committee in the opposite chamber in order to remain viable for consideration this session. With policy measures continuing to move through the process, the Revenue Estimating Conference (REC) delivered positive news at their meeting last Friday – a slight increase in projected state tax receipts for the coming fiscal year. Senate leadership released their budget targets this week and House leadership indicated their targets will be out soon.
On Monday, IMS efforts to expand state-based physician workforce initiatives took another step forward when the governor signed SF 129 into law. This legislation, jointly crafted by IMS and the Iowa Psychiatric Society (IPS), expands the Rural Physician Loan Repayment Program to allow more physicians to take advantage of the program’s $200,000 in loan repayments in exchange practicing in a high-need area.
Under the legislation, OB/GYNs will now be eligible for the program, as well be part-time physicians who agree to a longer service commitment than the five years required for full-time practice physicians. The legislation clarifies the criteria for qualifying rural communities and adds federally-designated mental health shortage areas as a qualifying service area for psychiatrists participating in the program.
This legislation represents half of our 2021 physician workforce legislative priority. In addition to expanding eligibility, IMS is working with IPS and other stakeholders to push for increased funding for this program. Currently funded at $1.4 million annually, this joint public-private trust fund only has enough funds to enroll 11 physicians-in-training each year. The College Student Aid Commission, which administers the program, estimates the state would need to appropriate $4 million to fund annual enrollment of the maximum 20 students allowable under the program – 10 each from Des Moines University and the University of Iowa. The positive REC revenue estimates help as we make the case for increasing funding for this popular program.
Mental Health & SUD Services
On Wednesday, a Senate subcommittee met to consider HF 773 – a bill that would lay the groundwork for Medicaid service expansions through the use of one or more federal 1115 innovation waivers. Over the past few years, the state has discussed utilization of these waivers as a means of expanding Medicaid coverage for substance use disorder (SUD) services or services for adults with a serious mental illness (SMI) or for children with a serious emotional disturbance (SED). Several states have implemented such waivers as part of their Medicaid programs and seen dramatic results including expanded service coverage, provider rate increases, improved patient outcomes, and reduced in program expenses.
Under federal law, states must first complete a comprehensive review of the current services available under their mental health system prior to submitting for an 1115 waiver. Legislation similar to HF 773 was moving through the legislature last year, but was sidetracked by the COVID-19 shutdown. This year’s bill requires a report to the General Assembly by February of 2022 to allow time for legislation to pursue the 1115 waivers next year. The bill unanimously passed the House and on Wednesday unanimously passed the Senate subcommittee. It now moves to the full Human Resources Committee for consideration.
Residency Liability Coverage
On Wednesday, the House Appropriations Committee took up and passed HF 763, which would create a new grant program through the Iowa Department of Public Health to help offset the soaring costs of medical liability insurance for community-based residency programs in the state. The bill is a result of concerns that arose when four community-based programs recently were dropped by their long-term liability carrier and subsequently faced immense difficulty in locating a carrier willing to quote them for new coverage. One program came within days of closing last December before IMS was able to successfully intervene and secure new coverage, albeit at a substantial cost increase.
The Department of Public Health conservatively estimates that the program would cost the state at least $2.5 million annually, with the potential for significantly higher costs if more programs experience coverage issues as the state’s liability climate worsens. Throughout the process of advancing this bill first through the House Human Resources Committee and now through the Appropriations Committee, the bill’s floor manager and cosponsor Rep. Ann Meyer shared her frustrations that this short-term solution has become necessary as the underlying issue of our state’s worsening liability climate remains unresolved. Rep. Meyer is also the floor manager for HF 592
– the bill to enact a $1 million hard cap on noneconomic damages. She continues to lead the fight on both short and long-term measures to address our state’s medical liability crisis.