With just two weeks remaining until targeted adjournment on April 30, legislators continue to move steadily through the remaining policy measures for consideration and to advance initial budget bills, positioning them to move quickly once a budget deal is reached. This week saw continued discussions on several issues of interest to medicine, including the following:
We continue to work closely with leadership and our legislative champion to build support for HF 592 and SF 557 – the companion bills to enact a $1 million hard cap on noneconomic damages. The coalition of provider, payer, and business groups that IMS is leading on this issue has continued targeted in-building and in-district outreach to the handful of holdout votes we need to move in order to secure final passage of the legislation.
With the targeted end of session now just a few weeks away, this week IMS launched a new Action Alert to remind the full chambers that this issue must be resolved before they adjourn for the year. This fresh round of local grassroots contacts has reminded many rank and file members that passage of a hard cap remains a priority for their local physicians and has helped to spur new internal conversations in both chambers about what more can be done to move this issue forward.
Thank you all who took new action to contact their local legislators this week. If you have not reached out to your legislators in recent days, please do so immediately.
Last week, we told you about the House Education Budget bill, which includes $300,000 in new funding for the Rural Physician Loan Repayment Program – the program that offers up to $200,000 in loan repayment in exchange for a physician agreeing to practice in a qualifying community. On Wednesday, the Senate Appropriations Committee approved SSB 1263 – their version of the FY 22 Education Budget. The Senate bill also proposes to increase funding for the loan repayment program, however, they seek to do so at a more modest $100,000 increase over the current fiscal year. The Senate also proposed a $100,000 increase in funding for the companion rural loan repayment program open to ARNPs, PAs, and RNs. This funding increase was not included in the House Education budget proposal.
With budget bills now out of committee in both chambers, the legislative vehicles are positioned to move quickly once the two chambers reach consensus on final spending levels. As we noted last week, Iowa College Student Aid Commission, which administers the Rural Physician Loan Repayment Program has indicated that it must allocate the full $200,000 for a medical student’s loan repayment in the year the student is enrolled in the program. As such, any funding increase less than this amount will not result in an increase in program slots this coming year. IMS will continue to work with the members of Team Doctor to push for a minimum funding increase of $200,000 to ensure an additional medical student is able to enroll in the program in FY 2022.
On Tuesday, the House debated HF 852, a bill we told you about last week that creates a new grant program to help community-based residency programs afford the soaring costs of medical liability insurance. The bill expands the existing medical residency grant program through the Iowa Department of Public Health to allow community-based residency programs may apply to the state for a dollar-for-dollar match to cover a portion of the costs for medical liability coverage for their program.
We’ve now entered the final phase of legislative session, with legislators focused on completing work on the policy bills that cleared the second funnel and developing the budget for the coming fiscal year. Shells for nearly all budget bills have now been introduced, however, negotiations toward the final budget deal are still in their early stages. This week saw a modest bit of good budget news for the medical community and further action on multiple issues of interest.
On Thursday, the joint Education Appropriations Subcommittee met to discuss the initial draft of the FY22 Education Budget that includes funding for the Rural Physician Loan Repayment Program. The initial education budget, which has not yet been assigned a bill number, includes $300,000 in additional funding for the program. This raises the total state funding for the joint public-private trust fund to $1.7 million in the coming year. Education leaders in both chambers have expressed support for increasing funding to this popular program, however, the final funding increase may change once the two chambers agree upon final budget targets.
The Rural Physician Loan Repayment Program provides up to $200,000 in loan repayment in exchange for a qualifying physician agreeing to practice in an eligible community for a period of five years. Earlier this session, IMS and the Iowa Psychiatric Physician Society successfully pushed for expansion of the program to include eligibility for OB/GYNs and for part-time physicians who agree to a longer service commitment. Iowa College Student Aid Commission, which administers the program, has indicated that the $300,000 funding increase currently under consideration would allow for one additional medical student to qualify for the program this year as they must allocate the full $200,000 in the year the student enters into the program. The additional dollars would rollover to next year, allowing for two additional students to participate next if the $300,000 increase is sustained.
On Thursday, the House debated SF 296 to expand the pharmacist statewide protocol statute.
In response to concerns raised by IMS and others in the medical community, the House Human Resources Committee scaled back the original proposal when it passed out of committee a few weeks ago. On Thursday, the House amended SF 296 to align with the more restrictive House version of the bill. The measure now returns to the Senate for consideration of the House amendment.
As Passed By House
Recently, we told you about a new effort to offset the soaring costs of medical liability coverage for community-based residency programs in the state. This week we saw continued work on this stop-gap measure. After multiple attempts to identify a workable option for offsetting these costs, Representative Ann Meyer filed a strike-after amendment to HF 852 this week to roll this effort into the existing medical residency matching grant program through the Iowa Department of Public Health. Under the new model, community-based residency programs may apply to the state for a dollar-for-dollar match to cover a portion of the costs for medical liability coverage for their program.
Yesterday marked the second funnel deadline – the date by which the majority of policy bills must have passed a full chamber and a committee in the opposite chamber in order to remain viable for consideration this session. This week saw a flurry of activity on several issues of interest to the medical community, as advocates pushed to advance policy measures ahead of this crucial deadline.
Of the more than twenty anti-vaccine measures introduced this session, three advanced out of committee to survive the first funnel deadline:
Over the past few weeks, Informed Choice Iowa (ICI) – the anti-vaccine advocacy group – has been aggressively advocating for further action on the bills, focusing primarily on the two Senate bills as ICI opposes the IRIS use mandate in HF 769. IMS has been working closely with a coalition of patient and provider groups to oppose the measures. This week, we saw a last-minute push to advance SF 555, first as a stand-alone bill and then as an amendment on another bill coming out of committee, in an effort to keep the measure alive. IMS worked closely with our partners in the business community who strongly oppose the legislation, to halt these efforts. All three bills died in this week’s funnel, however, we expect to see SF 555 reappear in some form later in the session.
On Tuesday, a Senate subcommittee met to consider HF 468, which would mandate that at least 75% of all students admitted to the University of Iowa medical and dental school either be an Iowa resident or have received their undergraduate degree from an institution in Iowa. Officials from the University of Iowa report that currently approximately 70% of admissions would meet these criteria so the impact of this bill would be negligible. It would, however, still result in a reduction in tuition paid by out-of-state residents of approximately $1 million.
At Tuesday’s subcommittee meeting, the Senate floor manager for the bill announced that the Education Committee was considering amending HF 468 to also incorporate the elements of HF 487. This more controversial bill would require select residency programs at the University of Iowa to offer an interview to any applicant who is an Iowa resident or who completed their undergraduate degree in Iowa. Impacted residencies would include OB/GYN, Psychiatry, General Surgery, Emergency Medicine, Cardiology, Neurology, and Primary Care. In addition, all University of Iowa residency programs would be required to offer an audition rotation to any Des Moines University medical student who applied for their program.
During the subcommittee meeting, the senators expressed concerns with the logistical implications of HF 487 and questioned the need for HF 468 when the University of Iowa is already nearly achieving this threshold without a mandate. The subcommittee opted to still move the bill forward and on Thursday the Senate Education Committee voted to move HF 468 with the amendment language to integrate the components of HF 487, to the full Senate for consideration.
This session has seen extensive discussion of telehealth commercial payment parity as legislators recognize the crucial role this technology has played throughout the pandemic. Discussions have been slowed considerably by the Wellmark proposal to increase telehealth payment 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 would then qualify for a further increase in payment rates, initially up to 95% of in-person rates and eventually 90% of in-person rates.
The House has advanced multiple payment parity bills this year, including HF 294 to enact 100% commercial payment parity for behavioral health services. The Senate has consistently declined to take these measures up and the standalone bills died in yesterday’s second funnel. On Thursday morning, the House Human Resources Committee took steps to keep the issue alive, opting to amend the contents of HF 294 on to SF 524 – legislation the full Senate has previously passed to establish a psychiatric bed tracking study committee. SF 524, which unanimously passed out of House Human Resources Committee, is now funnel-proof and viable for consideration through the end of the session. It is expected the full House will pass the amended SF 524 back to the Senate where it is unlikely to advance so long as the telehealth parity language is included.
Iowa practices have reported receiving a check that appears to be an insurance payment from TRPN DirectPay. The check, typically for $15 or $20, includes a restricted endorsement. This means that cashing or depositing the check automatically enrolls the clinic in TRPN’s network. Being enrolled in the network subjects the clinics to TRPN’s terms and conditions, which can be highly restrictive and unfavorable to clinics. For example, once enrolled, a clinic has agreed to:
Once enrolled, the clinic is bound to the terms for three years and the agreement auto-renews. If you or your clinic receive a check from TRPN DirectPay, review the enclosed terms and conditions carefully. You should be aware that merely depositing the check subjects your organization to these terms. IMS has notified the Iowa Attorney General’s Office of the issue.
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.
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.
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.
Both chambers spent considerable time in floor debate this week as they work to move policy bills through the legislative process. On Friday, the state’s Revenue Estimating Conference (REC) met to revise their estimates of the state’s tax receipts for the coming year. Legislators are required to follow the lower of the December or March REC estimates in the formation of the state budget each year. With this week’s revised estimates, budget discussions are expected to begin gaining steam in the next few weeks.
Discussions continue on our top legislative priority this session – a hard cap on noneconomic damages. On Monday, the House placed HF 592, the bill to enact a $1 million hard cap on noneconomic damages, on its debate calendar. Under House rules, leadership is required to publish its debate calendar at least 24 hours in advance to give legislators notice of the bills coming up for consideration and time to hold closed-door party caucus meetings to prepare for debate. On Monday afternoon, House Republicans began their caucus on HF 592. Ahead of this meeting and throughout the discussion, IMS helped prepare our legislative champions and the bill’s floor manager to make the case for this reform and respond to opposition being raised by the handful of House Republicans who oppose the measure.
HF 592 remains eligible for consideration at any time, as long as it remains on the debate calendar. Leadership typically will not call a bill up for consideration until they have confirmed they have at least 51 members of their caucus in support of the measure. We continue to be a handful of votes short of this threshold. This week, IMS arranged for medical students and residents to travel to the capitol to have targeted discussions with our final holdout votes about how Iowa’s unfavorable liability climate is impacting our state’s ability to recruit and retain the next generation of physicians. It continues to be vitally important for House Republicans to hear from local physicians about the need for this reform. If you haven’t spoken to your House members lately on this issue, please contact them again directly or via the IMS Action Center.
On Tuesday, the Senate State Government took up consideration of HF 528, a bill to allow dentists to administer the flu and COVID-19 vaccines. The committee opted to not advance the amendment we told you about last week, which would prohibit dental administration of the COVID-19 vaccine, as well as limit administration of the flu vaccine to only adult patients who have an established relationship with that dentist.
Instead, the committee adopted a lesser amendment, which would prohibit the administration of either vaccine to patients under the age of 18, unless administered by a dentist as part of a state or county public health-organized vaccination clinic in accordance with CDC recommendations. The bill now moves to the full Senate where it is expected to pass. Upon passage, the bill must return to the House for consideration of the pediatric restriction amendment.
On Wednesday, the Senate took up and unanimously passed SF 296, which would expand the pharmacist statewide protocol statute to allow for administration of pediatric immunizations to patients over the age of three; allow for point-of-care testing and treatment for flu, strep, and COVID-19 to patients of any age; and allow for pharmacists to enter into a collaborative practice agreement with any authorized prescriber.
The bill now goes to the House where the Human Resources Committee has previously passed companion bill HF 794. In doing so, the committee amended that bill to remove the expanded pediatric immunization authority and prohibit treatment resulting from point-of-care testing for patients under the age of six. The House must now determine how to reconcile the two forms of the bill before sending the bill in some form back to the Senate for final passage.
Progress continues on one of our priority telehealth bills – HF 431, which would update statutory and administrative references to recognize audio-only telehealth as a permissible form of telehealth following the end of the public health emergency. This bill has previously passed the House unanimously. On Wednesday, a Senate subcommittee met to discuss the bill and unanimously passed the measure to the full Senate Human Resources Committee for consideration. While the telehealth payment parity bills have encountered significant pushback from the insurance industry and some members of the Senate, this coverage expansion enjoys wide support.
With the first funnel deadline now passed, the legislature spent significant time this week on floor debate as the work to move bills to the opposing chamber so they can begin to move through the process once more. We have just three weeks until the second funnel deadline on Friday, April 2 – the deadline for the majority of policy bills to clear a full chamber and a committee in the opposing chamber to remain eligible for consideration. These funnel deadlines help to shorten the list of policy measures under consideration, allowing the legislature to turn its attention to development of the annual budget and any tax policy, which will impact state revenues.
With last week’s Senate Judiciary Committee passage of SF 557, our tort reform efforts are now funnel-proof through the end of the legislative session given that the House companion bill HF 592 has previously cleared a committee in that chamber as well. This critical designation gives us additional time to work with leadership and our champions in the two chambers to educate and push our remaining holdout votes on the need for a hard cap on noneconomic damages.
IMS continues to coordinate with our coalition of provider, business, and insurance organizations to strategically approach each of the individual holdouts in a manner that seems most likely to be impactful based upon our extensive group conversations with each this session. At the same time, grassroots efforts continue outside the building. To date, Iowa physicians, residents, and medical students have sent more than 800 emails to their individual legislators via the Iowa Action Alert system. Andy Conlin, our Grassroots Coordinator, is directly reaching out physicians in targeted House districts to make sure local physicians are connecting with legislators at the moment our lobbying team identifies someone in need of additional local reinforcement of the need for this critical reform. This week, IMS President Brian Privett, MD, also personally called several of our most persistent undecided votes to have a more in-depth discussion about the implications of the current liability climate in Iowa.
No more than ever, it is critical that legislators – especially House Republicans – hear from their local physicians on the need for a hard cap on noneconomic damages. If you haven’t reached out yet, please take a minute to send a note via the IMS Action Center. If you’ve already reached out, please follow up with your legislators to ask about the progress of this issue. These sustained conversations throughout the next few weeks will be an important reminder to legislators that this issue matters to their local physicians and that their constituents are continue to track the progress of these efforts.
On Wednesday, a Senate subcommittee took up consideration of HF 528, a bill to allow dentists to administer the flu and COVID-19 vaccines. As we have reported previously, IMS has had numerous conversations over the summer and fall on this issue. Following the guidance of the Committee on Legislation, we have told the dental community that IMS would not object to authorizing dentists to administer the flu vaccine to adult patients so long as these vaccinations were reported into IRIS. We would, however, oppose efforts to authorize dental administration of the COVID-19 vaccine at a time when doses remain scare and Iowa has a sufficient number of authorized administrators, or to administer either vaccine to pediatric patients or seniors.
This week, IMS and the Iowa Dental Association agreed upon amendment language to narrow HF 528 to authorize only the administration of the flu vaccine to established patients over the age of 18. The Iowa Dental Board and representatives of the Dental Services Organizations objected to the compromise language, arguing that administration of the COVID-19 vaccine was their primary motivation for pursuing the legislation in the first place. The subcommittee opted to move the bill to the full State Government Committee without amendment, asking the interested parties to work to work toward agreement on amendment language.
On Monday evening, the House took up and overwhelmingly passed HF 686, which would allow podiatrists to order and administer and CDC-recommended vaccines, as well as epinephrine. Unlike the current pharmacist immunization statute and the proposal for dental immunizations, the bill does not impose any limitations on podiatric immunization of pediatric or high-risk populations, require additional vaccine-specific education prior to offering this service, and require reporting of podiatric-administered immunizations into the IRIS system. The bill now moves to the Senate where it’s future remains uncertain.
As we have previously reported, there are a record number of anti-vaccine bills moving through the legislature this session. Last week’s first legislative funnel eliminated many of these proposals, whoever, three anti-vaccine bills were able to clear committee and remain eligible for consideration yet this session:
Infant Medical Examiner Forms
SF 125 would require the listing of children’s vaccination history on the medical examiner’s form for any death under the age of three. The bill ignores the fact that the Child Death Review Team through the Iowa Department of Public Health already completes a more comprehensive review of all pediatric deaths and would create a pathway for anti-vaccine advocates to more easily identify grieving families so they can share misinformation about the widely-discredited purported link between vaccines and SIDS.
Restricting Vaccine Mandates
SF 555 originally started as an omnibus bill that included a number anti-vaccine, however, it was amended as it passed committee last week to only retain the section, which prohibits employers from mandating that employees the COVID-19 vaccine and the section, which prohibits the linking of vaccination status and any state-issued ID. While this dramatic scaling back of the bill represents a significant improvement to the original bill, it still poses a number of problems for healthcare facilities who may want to put in place limitations such as ensuring that unvaccinated staff are not in patient-facing roles.
IRIS & VAERS Reporting
HF 769 requires vaccine providers to report into VAERS any adverse events a patient experiences within eight weeks of receiving a vaccine and requires all vaccine administrators to report into IRIS. As written, the bill would significantly penalize providers who fail to report an adverse event, even if it were something like a broken arm that is clearly unrelated to the patient’s vaccinations or if it were a minor event that does not meet the federal reporting criteria. Earlier this session, a standalone bill mandating IRIS use was derailed when a group of anti-vaccine legislators tried to add an amendment requiring explicit informed consent for reporting a patient’s vaccinations into IRIS and the option to opt-out of having records included in the system. It is unclear if a similar amendment will be proposed to this bill now that is it eligible for consideration by the full House.
Friday marked the first legislative funnel deadline – the date by which the majority of policy bills must have passed out of a committee in their chamber of origin to remain eligible for consideration this session. We saw action this week on a number of priority areas including:
Our tort reform efforts cleared another procedural hurdle this week as SSB 1225, the Senate bill to impose a $1 million hard cap on noneconomic damages, passed out of subcommittee on Monday and committee on Wednesday, both on a party-line vote. SSB 1225 and House companion bill HF 592 are now both funnel-proof and will remain eligible for consideration through the end of session. We continue to engaged with rank-and-file members of both chambers, along with leadership, to push for the votes necessary to move this reform through the full chambers. We remain at a critical tipping point in the fight for a hard cap. If you haven’t already, please reach out to your local legislators to make your voice heard in this fight.
This week saw movement on a new telehealth payment parity bill in the House. HF 706, which passed subcommittee on Tuesday and committee on Wednesday, would enact 100% commercial payment parity for both physical and behavioral health services. This is now the third telehealth bill to move in the House. HF 431, which would permanently recognize audio-only telehealth, has passed the full House and HF 294, which would enact 100% commercial payment parity for behavioral health services, has previously passed out of committee and is now eligible for consideration by the full House.
During this week’s discussion of HF 706, Representative Joel Fry – the sponsor of all three bills – acknowledged that there are discrepancies between facility restrictions and audio-only telehealth regulations in the various bills. He indicated that they would work to reconcile these differences before bringing another bill up in the full House consideration. There continues to be a number of concerns about the telehealth measures in the Senate where the future of these efforts remains unknown.
Two additional scope measures passed out of committee this week to survive the first legislative funnel – a measure to expand the pharmacist stateside protocols and a new measure to update physician assistant practice regulations.
On Thursday, the House Human Resources Committee considered for the third time HSB 91, which would allow pharmacists to administer all pediatric immunizations to patients over the age of three; allow point-of-care testing and treatment for flue, strep, and COVID-19; and allow pharmacists to enter into collaborative practice agreements with any currently authorized prescriber. On two previous occasions, the committee was scheduled to take up this measure, but deferred after objections were raised by members in their closed-door caucus meetings on the bill.
On Thursday, the committee amended HSB 91 to remove the changes to pediatric immunizations, keeping in place the current limitations that prohibit pharmacist immunization aside from the flu vaccine to patients over the age of six months and dose completion on the HPV vaccine series. SF 296, the Senate companion bill, has previously passed out of committee in that chamber. The two bills are now eligible for consideration by their respective chambers.
On Tuesday, a House subcommittee took up HSB 255 – an expansive updating of Code sections to address physician assistant practice. Many of these Code sections have not been updated for decades and in some instances pre-date the state’s recognition of physician assistants entirely. The IMS Committee on Legislation, along with the Iowa Psychiatric Society (IPS), jointly negotiated the contents of HSB 255 with the Iowa Physician Assistants Society over the past several months. The bill represents a series of practice updates IMS and IPS believe are safe and appropriate for physician assistants to perform under appropriate physician supervision. A summary of many of these updates is available here.
With just one week to go until the March 5 first legislative funnel deadline – the date by which the majority of policy bills must have passed out of a committee in their chamber of origin to remain eligible for consideration this session – it’s been another busy week for subcommittee and committee work. Equally important, efforts to halt dangerous legislation continue as opponents work to keep bills from clearing this first procedural hurdle.
We saw continued movement this week on our top legislative priority – a hard cap on noneconomic damages. On Wednesday, the Senate introduced its companion bill to the House hard cap legislation, which was introduced last week. SSB 1225 has been assigned to a subcommittee, with subcommittee and committee discussion expected next week.
Last week, IMS issued an Action Alert to help drive a record number of pro-tort reform messages into the Iowa House. On Wednesday, we issued a second Action Alert to ensure the same is true for the Iowa Senate. While the Senate has a strong record on the issue – having previously passed hard cap legislation in 2017 and 2019 – there are several new members this year and the trial attorneys have been contacting legislators in force to oppose this needed reform.
It is vital that legislators in both chambers hear from Iowa physicians, residents, and medical students about the need for tort reform. If you haven’t already, please take a moment to contact your State Senator and your State Representative in support of HF 592 and SSB 1225.
On Tuesday, a House subcommittee took up HSB 225, which would enact a twelve-month limitation on recoupment of Medicaid overpayments. The bill was brought forward by the Iowa Behavioral Health Association following multiple instances where member facilities recently received substantial recoupment requests from the MCOS, in some cases stretching back the maximum five years allowed by the MCOs’ contracts with the state. In Tuesday’s subcommittee, DHS blamed this spike in recoupment requests on recently-obtained Department of Corrections (DOC) data showing individuals who became incarcerated and as a resulted ceased being eligible for Medicaid benefits.
In 2018, the legislature enacted legislation to suspend, rather than terminate, Medicaid eligibility for individuals who enter the correctional system. This recent transfer of DOC records is part of the attempt to better align departmental records to implement this statutory change. DHS is now receiving monthly DOC reports to allow for more real-time reconciliation, however, that fails to address the potential for other lengthy retroactive recoupments.
The bill failed to advance out of subcommittee on Tuesday over concerns that it was more narrowly written than federal recoupment regulations and did not allow sufficient time for the MCOs to meet the federal requirements to ensure Medicaid benefits are not provided to ineligible individuals. Proponents of the bill are working with DHS and the MCOs on a potential amendment to shorten the current five year look-back period to a period longer than the twelve months currently in the bill.
Multiple scope expansion bills continue to move forward at the capitol. On Tuesday, the House took up and overwhelmingly passed HF 528, which would allow dentists to administer the flu and COVID-19 vaccines to patients of any age. As we have noted in previous weeks, IMS has raised multiple concerns with the proposal and recommended scaling back this authority if the legislation is to become law. The bill now moves to the Senate where there is no companion bill and the proposal’s future remains uncertain.
Also on Tuesday, the House Human Resources Committee took up and passed HF 686, which would allow podiatrists to administer any CDC-recommended immunizations to patients of any age. The bill does not require additional vaccine-specific education as is the case with the other vaccine expansion proposals that have been put forward this year and it does not require that vaccines administered by a podiatrist be reported into IRIS. The bill is now eligible for consideration by the full House. It too does not have a companion bill in the Senate and it’s future in that chamber remains uncertain.
It is absolutely critical that Iowa physicians, residents, medical students, and clinic administrators contact their legislators to urge support for a hard cap on noneconomic damages. If you haven’t already, please take a minute to reach out via the IMS Action Alert System. We have sample messages that you can edit as you see fit, enter your information to be matched to your local legislators, and hit send. It takes two minutes to make your voice heard. Take action today!
Senate Action Alert
House Action Alert
Author: Michael Kitchell, MD - Iowa AMA Delegation Chair, Neurology - McFarland Clinic PC, Ames
This year’s National Advocacy Conference was held virtually, on February 23 and 24th, but it did give more of our AMA delegates and executive committee members a chance to participate compared to last year.
Dr. MaryGrace Elson, Dr. Hillary Johnson, Dr. Mike Kitchell, Dr. Anne Langguth, Dr. Rob Lee, Dr. Doug Martin, Dr. Tiffani Milless, Dr. Doug Peters, Dr. Brian Privett, Dr. Jessica Zuzga-Reed, Dr. Victoria Sharp, Dr. Scott Truhlar, along with Mike Flesher and Dennis Tibben of our IMS staff, all participated in the National Advocacy conference and Zoom meetings.
The AMA had various presentations for a few hours each day, and there were many legislators, AMA staff and officers who spoke about issues and AMA advocacy priorities. The AMA had five major issues:
Though many of the legislators who spoke, especially physicians in Congress, had some interesting comments, one of the highlights of the NAC conference was the historian and author Doris Kearns Goodwin. Goodwin had many interesting historical stories to tell, but one stood out as a precedent to January 6, 2021. That was a description of an assault in the US Senate in 1856, when a pro-slavery advocate broke in and brutally beat a Massachusetts senator with a large cane, leaving the abolitionist senator with major head and spinal injuries that took three years to heal. The assault did result though in triggering action by the US Senate to bring legislation forward to abolish slavery.
Our crew, led by our IMS president Brian Privett, met on Zoom with Senator Joni Ernst, Representative Ashley Hinson, Senator Grassley, Representative Randy Feenstra, and Representative Marianette Miller-Meeks. We were received warmly by all our members of Congress, and we detailed our concerns about the Geographic Practice Cost Indexes that reduce our Medicare reimbursement to among the lowest in the nation. We are still awaiting the General Accounting Office study of the GPCIs, which we hope will finally uncover the inaccurate methodology for determining the GPCI penalties we have endured since 1992.
We also outlined our concerns about the COVID relief packages and vaccine shortages, and our concern about physician shortages that will become even greater as we lose more residency programs for both primary care and specialties.
We described for each of our members of Congress how important telemedicine visits, including audio-only visits, are to our Iowa physicians and patients who also need broadband to connect more reliably. Each member did express support continuing coverage for telehealth after the pandemic.
Our group urged our members of Congress to support the bill by Senator Grassley that authorizes more research on cannabidiol and marijuana. We also urged our members to sign on to a bill, called the MOMMAs act, which would promote better maternal health and equity, reducing the very high US maternal mortality rate.
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