The pace at the capitol has slowed considerably as the legislature now moves into overtime. There was limited floor debate this week while budget chairs and leadership worked to find consensus on the remaining policy priorities and the state budget for the upcoming fiscal year.
Last week, we told you about the fast-tracked effort to enact a ban on COVID-19 passports in the state of Iowa. HF 889 would prevent any governmental entity from issuing an ID denoting whether or not an individual has received the COVID-19 vaccine and would prevent any business or government entity from requiring proof of COVID-19 vaccination as a condition for entry. The bill does include an exemption for healthcare facilities, which has been a point of much contention for the anti-vaccine community.
On Wednesday, the Senate took up the matter following a lengthy closed-door caucus discussion. Anti-vaccine advocates have dramatically increased their pressure to not enact the bill at all if it means healthcare facilities are exempt from the ban. At one point, they stated publicly that their intention was to utilize the new law to sue healthcare facilities for inquiring about COVID-19 vaccination status if the emption were to be removed. HF 889 ultimately passed the Senate on a near party-line vote, with the healthcare exemption intact and virtually no floor debate.
The legislation now goes to the governor for signature. Anti-vaccine advocates have shifted their focus downstairs and are increasing their calls for her to veto the measure and instead issue an executive order that includes healthcare facilities in the ban.
FY 22 Budget
Annual budget negotiations between the two chambers typically take several weeks with leadership needing to first agree on general budget parameters before budget chairs can reach agreements on their individual budget units. The state budget is comprised of ten individual budget units including the Health and Human Services (HHS) budget, which is the largest unit and funds a host of programs through IDPH and DHS. Thus far this year, the two chambers have reached agreement and passed two of the smaller budget units, but have not made further progress on consensus over the remaining eight budget units.
Recently, we told you about the elements of the two competing HHS budget proposals. IMS has compiled a cross compassion summaryof the elements of the two HHS proposals. Budget leads in the two chambers are now working behind closed doors to find common ground on these proposals and identify any additional elements that need to be included in the final HHS budget deal. This week, IMS had conversations with leads in both chambers about adding an additional element to the final budget bill – a minor technical change to the Iowa Physician Orders for Scope of Treatment (IPOST) Code section to allow Iowa to transition from its current state-specific IPOST form to the new uniform national POLST form.
Current Iowa law, written in 2012 prior to development of national POLST standards or a uniform POLST form, is more prescriptive that the new national form, which was developed and released for the first time in 2019. Throughout the course of the pandemic, IPOST utilization has increased dramatically and barriers have been identified, especially for patients in border communities whose IPOST wishes are not transferable across state lines like they will be with the new national form. With the removal of a single statutory criteria, the IPOST advisory group will be able to recommend that IDPH move forward with adoption of the new form. The Budget chairs have responded favorably to this request and indicated this change will likely be included in the final budget deal.
Telehealth Payment Parity
With end-of-session budget and policy negotiations at a virtual stand-still, this week the House unveiled a new omnibus proposal intended to help break the logjam and move several top priorities forward. The governor announced her own efforts to bundle a series of priorities for the two chambers, with both chambers able to claim some clear wins while also accepting some clear losses – SSB 1276. Of note to the healthcare community, both the new House bill – HSB 278 – and SSB 1276 include another push for telehealth commercial payment parity for telehealth services.
This proposal, which has previously passed the House as a standalone bill and is now included in the House version of the HHS budget bill, has consistently faced fierce opposition from the Senate where several key members are philosophically opposed to insurance mandates. Neither SSB 1276 nor HSB 278 has been agreed upon by leadership of both chambers, but the public release of these proposals is a promising sign that this critical telehealth guardrail is on the shortlist for end-of-session negotiations and still has a chance of passing this session. Closed door negotiations are ongoing.