News

  • Friday, August 27, 2021 7:30 AM | Sydney Maras (Administrator)


    This week’s full FDA approval of the Pfizer-BioNTech COVID-19 vaccine marks another milestone in the fight to end the pandemic, but nearly half of all Iowans remain unvaccinated and many remain deeply skeptical of the vaccines. In the face of this persistent vaccine hesitancy and confusion over the evolving public health guidance regarding COVID-19, more and more patients are looking for a trusted, local authority for information. Iowa physicians are well-versed in breaking down complex medical conditions and helping their patients make the best care decisions for their individual circumstances, but how do we reach those who are deeply skeptical of the safety, efficacy, or even the need for a COVID-19 vaccine? How do you explain the relatively new Emergency Use Authorization (EUA) process or know which authoritative source to seek out when there is often conflicting guidance from state, federal, and international sources? IMS is here to help.

    IMS has launched a new vaccine confidence initiative aimed at better equipping Iowa physicians to be the trusted local messengers to help their communities navigate the questions and skepticism around the COVID-19 vaccines. This new project is being built in conjunction with state and federal public health experts to ensure that every Iowa physician has the tools necessary to best advise their patients on COVID-19 vaccinations. These resources will include:

    ·         Provider Toolkits, Guidance, and FAQ Documents
    ·         New, Easy-to-Understand Patient Education Materials
    ·         Live & On-Demand Educational Webinars
    ·         Individual Clinical Training and Technical Assistance
    ·         Direct Access to Physician Champions and Subject Matter Experts

    In addition to these more traditional resources, IMS will be standing up one of the country’s first Vaccine ECHO Projects – a hub and spoke model of virtual grand rounds that will regularly connect physicians from across the state to share best practices and what’s working in their local communities. First established nearly twenty years ago by the University of New Mexico School of Medicine, Project ECHO utilizes technology to connect providers with subject matter experts and each other in a virtual “community of practice” to learn from each other and foster greater professional collaboration. Based upon New Mexico’s success in the treatment of hepatitis C, the ECHO model has been expanded and replicated for the treatment and management of a host of medical conditions. Now, IMS is leading the way in utilizing this innovative model to better equip Iowa physicians to build confidence in the COVID-19 vaccine.

    IMS has hired a dedicated project manager with a background in public health and clinical care delivery to help lead this work. In the coming weeks and months, we will begin rolling out additional patient and provider resources, including live and on-demand trainings on skills such as motivational interviewing. The first of these resources – a quick guide on talking with patients about COVID-19, as well as a patient guide to understanding the COVID-19 vaccines and the EUA process – have been posted to the IMS Patient Resource Page. For more information on this project, please contact Kady Reese with IMS.

  • Thursday, August 19, 2021 9:30 AM | Sydney Maras (Administrator)

    Back to School Face Mask Usage

    August 19, 2021

    As the COVID-19 pandemic continues to impact our communities, the impending start of the 2021-2022 school year necessitates continued COVID-conscious planning by parents and students.

    Over the summer, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) issued updated guidance on face mask usage, including the recommendation for universal indoor masking by all students (age 2 and older), staff, teachers, and visitors to K-12 schools, regardless of vaccination status.

    This guidance for universal indoor masking regardless of vaccination status was made in response to evolving understanding of the COVID-19 Delta variant. The Delta variant is significantly more infectious than previous strains of the virus, as contagious as the chicken pox. Delta may also carry with it greater risk for serious illness and potential hospitalization. The increased risk of infection, coupled with the current absence of an authorized COVID-19 vaccine for children under 12 years of age, warrants a return to more stringent COVID precautions.

    As we await authorization for vaccination for individuals under age 12, masking by all individuals in all public indoor spaces, including school-based settings, is our best defense to protect our children against COVID-19 and emerging variants.

    Vaccinated Individuals, Adults and Students Age 12+

    While currently available COVID-19 vaccines have demonstrated strong effectiveness in preventing severe illness and hospitalization, we are learning more about the strength of defense against mild and non-symptomatic infection and transmission. Based on the information available and to best protect those who are currently unable to receive vaccination, vaccinated individuals should resume masking in all indoor public spaces, including school and child care settings.

    Unvaccinated Individuals, Adults and Students under Age 12

    Currently, there are no COVID-19 vaccines approved to protect children under the age of 12. While many infections among children may have been asymptomatic or have resulted in less severe illness with previous COVID variants, the Delta variant may potentially carry a higher risk of symptomatic infection and potential severe illness.

    Until there is a vaccine available for all age groups, continued masking is critical to protect children under age 12 and vulnerable individuals who are otherwise unable to receive vaccination. Any unvaccinated person over the age of 2 should wear a mask in all indoor settings outside of your own home, including school and child care settings.

    Persons with Previous COVID Infection

    While prior COVID-19 infection does provide a level of natural immunity against COVID, current studies indicate this immunity is shorter-lived than immunity from vaccination.  Vaccination among those who have also previously had COVID-19 strengthens and prolongs any existing immunity. Vaccination is appropriate and encouraged for persons who have had COVID-19.  As with vaccinated individuals, wearing of face masks is the best practice to both protect yourself and those around you.

    As we continue to navigate this pandemic and prepare for approval of COVID-19 vaccinations for children under the age of 12, it is understandable that parents and families have questions. Iowa’s physician community stands ready to help you make sense of it all. If you or a family member have not yet received your vaccination, speak with your family’s care provider about your individual health circumstances, the COVID-19 vaccines, and how best to keep your family safe.

  • Wednesday, July 14, 2021 1:38 PM | Sydney Maras (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) has published the proposed rule for the 2022 Medicare Physician Fee Schedule (PFS). The proposed rule seeks to implement or receive public input on a number of payment and policy changes of interest including:

    • A 3.89% Reduction in the Medicare PFS conversion factor to comply with budget neutrality restrictions (Note: Congressional action averted budget neutrality cuts in the 2021 Medicare PFS)
    • Additional E/M updates to conform with the AMA CPT Codebook that took effect January 1, 2021
    • Further extension of temporary telehealth coverage initiated under the COVID-19 Public Health Emergency (PHE)
    • New regulations for expanded coverage of mental health services provided via telehealth and of audio-only telehealth
    • Direct billing authority for Physician Assistants as mandated by Congress
    • Provider input on vaccine administration practices and expenses
    • Continued authorization to provide Opioid Treatment Program (OTP) counseling and services via audio-only telehealth after the expiration of the PHE
    • Additional exceptions to and delayed enforcement of the electronic prescribing mandate for controlled substances prescribed to Medicare beneficiaries
    • Extension of the transition period for ACOs reporting electronic clinical quality measure/Merit-based Incentive Payment System clinical quality measures (eCQM/MIPS CQM)
    • Streamlining of the Shared Savings Program application process

    More information on these and additional policy and payment changes under consideration is available on the CMS website. IMS staff are in the process of completing a comprehensive review of the 1,700-page rule. In consultation with the AMA and other stakeholders, we will be preparing written comments ahead of the September 13, 2021, submission deadline. Watch future IMS publications for additional information. Please contact Dennis Tibben in the IMS Center for Physician Advocacy if you have questions or would like to provide input on this proposed rule.

  • Monday, May 24, 2021 3:00 PM | Sydney Maras (Administrator)

    In recent weeks, the Centers for Disease Control and Prevention (CDC) and the Iowa Department of Public Health (IDPH) have issued updated guidance on face mask usage. In recent days, the Iowa Legislature has enacted a new statutory ban on local municipalities and school districts enacting their own mask usage mandates.

    These rapidly changing guidelines, coupled with the fatigue of a global pandemic now entering its fifteenth month, have left many Iowans understandably confused and frustrated about how best to protect themselves and their families from COVID-19. Iowa’s physician community understands your confusion and frustration, and stands ready to help you make sense of it all.

    It is important to remember that while the local mandates are no longer in place, this new law does not prohibit individual mask use and still allows for private businesses to make their own decisions. If you are not yet fully vaccinated, masking in public settings, including schools, is one of the most effective ways to protect yourself and your family until the majority of Iowans are vaccinated.

    Fully Vaccinated Individuals

    Protecting you and your family starts with getting vaccinated as soon as possible, if you are eligible and able. Vaccine supply is now plentiful, widely available across the state, and approved down to age 12. Once you are fully vaccinated, the CDC and IDPH advise that a mask is no longer necessary in most settings to help protect you from COVID-19.  Of note, in healthcare settings, masks are still recommended.

    Partially-Vaccinated Individuals

    Full protection from COVID-19 occurs approximately two weeks following the completion of your vaccination series. If you have received the Pfizer/BioNTech or Moderna vaccines, this means a two-dose series. Between these two doses, you are not yet fully protected. You should continue to wear a mask in public settings. Similarly for the two weeks after receiving these or the single-dose Johnson & Johnson/Janssen vaccine, you should continue to wear a mask in public settings.

    Children

    On May 10th, the Pfizer vaccine was approved for use in 12-15 year-olds. Currently, there are no COVID-19 vaccines approved to protect children under the age of 12. While infections among most children are less severe, some have seen severe complications. Children with even a mild infection are still able to transmit the disease to more vulnerable populations. We are also still learning about the long-term side effects of even mild infection. Until vaccines are approved for them, children ages 2-11 should wear a mask in public indoor spaces to protect themselves and those around them. The CDC continues to recommend children wear masks in school unless fully protected by vaccination- two weeks after their second dose is received.

    A return to a more normal daily routine is on the horizon. For many of us who are now fully vaccinated, this return has already begun to occur. Adapting to the final phases of the COVID-19 pandemic can be stressful and confusing. As we move together toward a more normal tomorrow, we must exercise grace and understanding for the individual, small business, or family who is navigating mask usage in the manner that makes sense for their unique circumstances. Continue to look to your local physician as a trusted source to help make sense of evolving public health guidance, and encourage your friends and neighbors to join you in becoming vaccinated.

    Together, we will emerge stronger from this pandemic.

  • Thursday, May 20, 2021 12:00 PM | Sydney Maras (Administrator)

    After running nearly three weeks beyond the targeted date for adjournment, the Iowa General Assembly adjourned sine die on Wednesday, May 19. These additional weeks of session proved critical in allowing the two chambers to negotiate a substantial tax reform package that includes multiple provisions impacting healthcare in Iowa, as well as a final deal on the FY 22 state budget.

    Mental Health Delivery & Funding

    This week, the House agreed to support SF 619 – the end-of-session omnibus bill put forward jointly by the Senate and the Governor’s Office to enact a host of tax and policy reforms, including sweeping changes to the way that mental health services are funded and delivered in the state of Iowa. As we told you last week, this legislation requires 100% commercial payment parity for behavioral health services delivered via telehealth. The bill also eliminates the current property tax funding mechanism that provides approximately $100 million in funding annually to the mental health regions. In its place, the bill would establish a new regional services fund with state General Fund dollars, which the Department of Human Services will distribute on a per capita basis to the regions. This phased transition will occur over the next two years.

    HHS Budget

    On Monday, the two chambers agreed to a final deal on the FY22 Health and Human Services (HHS) budget bill – HF 891. The final funding agreement largely mirrored the initial House spending proposal of $2.05 billion in total General Fund spending. IMS has updated its HHS Budget Matrix to compare the provisions of the final budget deal with those of the two initially-proposed budgets. In addition to numerous key funding provisions, this legislation includes several policy measures of interest to the medical community. These include expansion of the state medical residency grant program to allow community-based residency programs to apply for financial assistance to help offset a portion of the skyrocketing costs of their medical liability insurance coverage. The bill also includes the language we told you about a few weeks ago, which will allow Iowa to transition its approved IPOST form to the new uniform national POLST form as recommended by the IDPH advisory committee. A more in-depth summary of the final budget deal is available here.

    Tort Reform

    Up until the final hours of session, IMS continued to work with our coalition partners and legislative leadership to try to identify a path to final passage of our hard cap on noneconomic damages. Unfortunately, despite record grassroots engagement and our most expansive lobbying campaign to date, we were unable to secure the final votes necessary to move this legislation through the Iowa House. Over the coming weeks, IMS will spend time assessing our efforts this session and determining what additional steps we might take to best position ourselves to continue this fight moving forward.  

    Given that 2021 was the first year of the two-year 89th General Assembly, our companion bills HF 592 and SF 557 will remain eligible for consideration when the legislature reconvenes in January of 2022. If you have questions or feedback on our tort reform efforts, please contact us. IMS shares your disappointment that we were unable to secure this critical reform and remains committed to addressing Iowa’s worsening medical liability climate.

  • Saturday, May 15, 2021 7:30 AM | Sydney Maras (Administrator)

    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.

    Telehealth Payment Parity

    This week, the Senate took action to advance their end-of-session omnibus bill – SF 619. This legislation, which represents agreed upon measures between the Senate and the Governor’s Office includes a host of tax reform provisions, as well as a key priority of both the governor and the House – commercial telehealth payment parity for behavioral health services. This section, which would require state-regulated health insurance plans to reimburse for behavioral health services via telehealth at 100% parity with in-person services, has been opposed by several key members of the Senate. Inclusion in SF 619 represents a key concession from the Senate as they seek to secure support from the House and the governor on other Senate priorities included in the bill.

    A Senate subcommittee moved SF 619 forward on Monday and on Tuesday the bill passed out of both the Appropriations and the Ways and Means Committees on a party-line vote. The House end-of-session omnibus bill – HF 893 – contains the same telehealth parity language as the Senate bill, as does the House’s version of the HHS budget bill. While there is still a chance the insurance industry, which is strongly opposed to this measure, is successful in getting this parity language stripped from the final deal between the two chambers and the Governor’s Office, this looks unlikely. The House and Senate continue to differ on a handful of other provisions that are included in SF 619 but not HF 893.

    Mental Health Funding

    Among the largest differences between the Senate and Governor’s end-of-session omnibus proposal – SF 619 – and the House’s end-of-session omnibus proposal – HF 893 – are the provisions of the Senate bill that change the manner in which mental health services in the state of Iowa are funded. SF 619 would eliminate the current property tax funding mechanism that provides approximately $100 million in funding annually to the mental health regions. In its place, the bill would establish a new regional services fund with with state General Fund dollars, which the Department of Human Services would distribute on a per capita basis to the regions. The bill provides for annual increases in this funding stream until FY2025 when a regional growth factor would begin to be utilized in determining the per capita rates paid to the regions.

    Proponents of the change have noted that Iowa is the only state in the nation that utilizes property taxes to fund its mental health system, and the General Fund and reserve funds are currently well-positioned to support this change in funding streams. During the subcommittee meeting on Monday and committee discussion of the proposal on Tuesday, opponents cautioned that this change would leave funding for mental health services entirely subject to the whims of the legislature. They noted that SF 619 would also eliminate the property tax backfill – a mechanism established in 2013 to utilize General Fund dollars to offset the reductions in tax revenue for local municipalities as a result of property tax cuts passed by the legislature that year. Opponents argue that the legislature committed to continuing this General Fund support to keep local municipalities whole and just eight years later are not walking away from that commitment, which they believe is likely to occur with mental health funding as well.

    House leadership has signaled their reservations to the proposed funding change, which is now part of the larger end-of-session budgeting and policy negotiations.

    Tort Reform

    IMS continues to have discussions with legislators about the importance of passing a hard cap on noneconomic damages before adjourning this session. Our companion bills HF 592 and SF 557 to enact a $1 million cap remain eligible for consideration at any time and the legislative language could be included as an amendment to another bill if we are successful in securing the final votes needed to pass the bill through the House. With likely adjournment rapidly approaching, the window of time for action on this critical reform is beginning to close. Your sustained legislative outreach throughout session has helped to keep this issue front and center with lawmakers.

    If you haven’t contacted your legislators on this issue recently, please touch base with them again to ask for an update on where things stand with tort reform and remind them how important it is to their local physicians that this reform get passed this session. The IMS Action Alert on this issue remain active and can quickly connect you with your legislators if you have not yet taken action and do not know who are your local legislators.

  • Saturday, May 08, 2021 7:30 AM | Sydney Maras (Administrator)

    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.

    Vaccine Passports

    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.

  • Thursday, April 29, 2021 7:30 AM | Sydney Maras (Administrator)

    Friday marked the 110th day of legislative session – the end of legislative per diem and the targeted date for adjournment. With the budget and several policy priorities still unresolved, the legislature now heads into overtime.

    Tort Reform

    With the legislature now officially past its targeted adjournment date, the window of time to take action on HF 592 and SF 557 – the companion bills to enact a $1 million hard cap on noneconomic damages – is rapidly closing. As we’ve reported previously, the problem remains a handful of holdout votes in the House. Throughout session, IMS has coordinated with our coalition partners to strategically dial up grassroots and lobbying pressure at critical junctures and dial it back as swing votes show signs of issue fatigue that threatens to cause them to shutdown on further consideration of supporting a hard cap. Over the past few weeks, we have maintained a steady stream of internal and external contacts to keep the issue in front of these holdout House members, while working behind the scenes on a series of political strategies to get the bill through that chamber.

    This period of session is traditionally when closed-door deals are made between the two chambers, with the Governor’s Office, and amongst members of the same chamber. We saw these dynamics on display this week with the impassioned and messy House consideration and passage of the vaccine passport bill. House passage of this controversial bill over the strident objections of a handful of House Republicans demonstrates that there is still a will in that chamber to move bills like our hard cap legislation, where there are strongly-held beliefs both in support and opposition within the majority caucus. IMS continues to explore ever possible angle to engineer a similar deal to pass HF 592.

    Vaccine Passports

    This week saw the introduction of a rare pair of companion leadership bills intended to prevent vaccine passports in the state of Iowa. HF 889 and SF 610 would prevent any governmental entity from issuing an ID denoting whether or not an individual has received the COVID-19 vaccine and it would prevent any business or government entity from requiring proof of COVID-19 vaccination as a condition for entry. Of note to the healthcare community, the bill includes an exemption IMS pushed for in previous iterations of this ban to exempt healthcare facilities from this ban. Under the exemption, healthcare providers can still require patients, visitors, and staff to provide proof of vaccination status and impose limitations or additional infection control protocols to limit the spread of COVID-19.

    Inclusion of the medical exemption in these bills proved to be a flashpoint for the antivaccine community who turned up in force to speak in-person at the House subcommittee hearing for HF 889 on Monday. Throughout the week, these advocates and their champions in the House pushed to strip the medical exemption from the bill. Barring removal of this exemption, the advocates argued that the bill should be scrapped entirely or stripped back to solely the first division banning state issuance of a vaccine passport. After a lengthy, heated House Republican caucus on Wednesday, the House took up HF 889 on Wednesday evening. In a rare public display of caucus division, the majority party successfully opposed attempts by fellow House Republicans to strip the medical exemption, to strip the entirety of the second division banning non-healthcare entities from requiring proof of vaccination, and to resurrect another antivaccine measure to limit employer’s ability to require that employees receive the COVID-19 vaccine.

    HF 889 ultimately passed the House in its original form with a handful of House Republicans voting against the measure and a handful of House Democrats breaking with their own caucus to vote in support of the bill. The bill now moves to the Senate where SF 610 passed out of committee on Tuesday and is now awaiting floor debate. It is expected that this fast-tracked leadership bill will soon be on its way to the Governor’s desk with the medical exemption intact.

    Pharmacist Statewide Protocols

    On Wednesday, the Senate completed action on SF 296 the bill to expand pharmacist statewide protocols. You may recall earlier this session, we reported that the House had amended the original proposal to strip authority for pharmacists to administer pediatric immunizations to patients over the age of three. On Wednesday, the Senate voted to accept this House change and send SF 296 to the governor for signature. Under the final bill, pharmacists gain the authority to administer point-of-care testing and treatment for flu, strep, and COVID-19. They also gain the authority to enter into a collaborative practice agreement with any authorized prescriber. Previously this authority was limited to only pharmacist-physician agreements.

    Under the federal Public Health Emergency (PHE) declaration pharmacists retain the ability to administer pediatric immunizations for the duration of the pandemic, at which time the authority will revert to existing Iowa law. Another piece of legislation currently awaiting the governor’s signature legislation – HF 514 – would codify the authority for pharmacists to delegate vaccine administration to pharmacy support staff. This authority has also been temporarily implemented as part of the federal PHE declaration.

  • Saturday, April 24, 2021 7:30 AM | Sydney Maras (Administrator)

    The pace at the capitol slowed considerably this week as legislators shift to closed-door negotiations on the budget and end-of-session policy deals. The two chambers still have a substantial budget divide to close and several notable issues left unresolved before they can adjourn for the year.

    Tort Reform

    Just one week remains until the scheduled adjournment of the legislative session on Friday, April 30. This deadline obviously has important ramifications for our ongoing push for a hard cap on noneconomic damages, however, it is important to note that this is not a hard and fast deadline. April 30 simply marks the last day legislators receive their daily per diem for their annual work in Des Moines. The legislature frequent works past this deadline and is expected to do so again this session.

    HF 592 and SF 557 – the companion bills to enact a $1 million hard cap on noneconomic damages – remain eligible for consideration through the end of session. IMS continues to work closely with legislative leadership and our legislative champions to push our final holdout votes to a position of support on this critical reform. You have an important role to play in the final days of session. Continued contact with your local legislators is crucial to ensure they know the importance of tort reform to their local physician community and are prioritizing this bill as one of the end-of-session deals. If you haven’t already, please contact your legislators immediately. If you haven’t contacted them within the past few days, please follow up to ask them for an update on the effort. These contacts matter. Please use your voice. 

    HHS Budget

    We got our first look at the Health and Human Services (HHS) budget this week with the Senate introducing SSB 1297, its initial budget proposal and the House introducing its initial budget proposal as an unnumbered bill draft. This budget, which funds the Department of Public Health, the Department of Human Services, and the myriad of health-related programs they administer, is the largest section of the state’s annual budget. The Senate is proposing a $2.03 billion HHS budget for FY22 and the House is proposing a larger $2.05 billion FY22 budget. Of note, SSB 1297 does not include additional funding for the state’s mental health system, which is instead included as a $68 million appropriation in SF 587 – the bill to restructure mental health funding by shifting funding from county property taxes to state General Fund appropriations. The House HHS budget contains approximately $36 million in new mental health funding across a host of programs.

    Both proposals include several notable new funding proposals, including funding for three additional staff members to help ease the backlog of autopsies at the State Medical Examiner’s Office; additional funding to continue state grant funding for four rural psychiatric residency slots; funding to establish at least one regional center of excellence as proposed by the governor in her Condition of the State Address; funding from the sports waging tax receipts to fund additional gambling addiction and SUD treatment; and funding to increase PMIC reimbursement rates – a proposal the IMS Policy Forum endorsed in adopting PRS 19-2-05. The Senate also seeks to resurrect a controversial DHS eligibility verification proposal that died earlier this year and the House seeks to again push for telehealth behavioral health commercial payment parity. IMS has prepared a summary comparing the notable provisions of the two HHS budget proposal.

    Telehealth Payment Parity

    On Tuesday, the House debated SF 524 – a bill we told you about a few weeks ago, which create a new workgroup to study improvements to the inpatient psychiatric bed tracking system. As we noted at the time, the House Human Resources Committee passed the bill with an amendment to resurrect the telehealth behavioral health commercial payment parity proposal that had previously overwhelmingly passed the House as a standalone measure, but stalled in the Senate. On Tuesday, the House again overwhelmingly supported the telehealth parity measure, passing both it and the bed tracking workgroup as a now-bundled SF 524 back to the Senate for consideration. The Senate has indicated that it will not support advancing the telehealth insurance mandate, which is now also included in the House’s proposed HHS budget bill.

  • Saturday, April 17, 2021 7:30 AM | Sydney Maras (Administrator)

    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:

    Tort Reform

    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.

    Physician Workforce

    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.

    Residency Liability Protections

    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.

    In recent years, a handful of programs have seen dramatic increases in their liability coverage costs, with some being dropped by their long-time carriers and facing extreme difficulties in finding a carrier willing to even issue a quote for coverage. This has resulted in dramatic cost increases and restructuring of multiple community-based programs. HF 852, which overwhelmingly passed the House and now moves to the Senate for consideration, is a short-term solution to the problem as we work to address the underlying problem of Iowa’s worsening medical liability climate. IMS continued discussion this week with legislators about the need for including sufficient funding for this new grant program as part of the forthcoming Health and Human Services Budget.


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