Image: Iowa State Capitol, April 20, 2022. (Image Source: Ashley Thompson)
102nd Iowa General Assembly
2022 Iowa Legislative Session in Overtime
The second year of the 102nd Iowa General Assembly officially moved into overtime after failing to adjourn sine die on April 19, the 100th calendar day of the legislative session. This date also marks the end of the per diem period for legislators and an increasing, palpable energy from members of both parties to reach agreements on key budget and policy bills so that attention can be shifted toward campaigning, or the annual planting season – an ongoing topic of conversation for the 1 in 5 Iowa lawmakers who are farmers.
The House and Senate remain $72 million apart on the state’s $8.2 billion budget and have yet to reach an agreement on a number of key legislative priorities, including private school scholarships, school transparency provision, the bottle bill, unemployment benefits, and Pharmacy Benefit Managers (PBM).
As of April 26, Iowa Governor Kim Reynolds has signed 35 bills into law and 65 are pending enrollment – that is, bills and resolutions that have passed both chambers and are awaiting a decision by the Governor.
This week, the Iowa Senate amended and passed the Governor’s biofuels bill. The House passed the amended version on Tuesday afternoon, sending it down to the Governor for her signature. This legislation is one of Governor Reynolds’ 2022 legislative priorities and has been a major sticking point in the stalemate between the chambers. Another bill that is heading down to the Governor is Senate File (SF) 2383: Workforce Omnibus, sweeping legislation that includes changes to city and county inspections, regulations affecting veterans and military spouses, and most notably to health care, changes to health care workforce recruitment programs. SF 2383 is detailed in a section below.
Health and Human Services (HHS) Budget Update
The House voted their budget proposal, House File (HF) 2578: Health and Human Services (HHS) Appropriations, out of the chamber on April 5, with a vote of 60-35. As of April 27, the Senate has not released their HHS budget proposal. The House bill addresses community-based services for those with intellectual disabilities by providing a $14.6 million increase for providers (dedicated for wage & benefit costs) and an increase in the number of Home and Community-Based Services (HCBS) waiver slots available throughout the state. The budget clearly supports areas that will increase community-based settings rather than institutional settings. This has been a key topic this session due to the U.S. Department of Justice investigation the state has been working through involving Iowa’s two State Resource Centers. The HHS budget also addresses the need for additional mental health beds, by funding a plan to create a new psychiatric level of care within the Medicaid program while also addressing children’s providers. Substance use disorder treatment facilities and rural home health providers would also see an increase in funding if adopted in the final proposal. The Notes on Bills and Amendments (NOBA) document, can be read here.
Other Bills of Note
MENTAL HEALTH WORKFORCE
This week, HF 2549: Mental Health Provider Loan Forgiveness, passed unanimously out of the Senate with an amendment by Senator Chris Cournoyer (R-LeClaire). Originally passed by the House in March, the bill must now be sent back to the House for another vote since it has been amended by the Senate.
The legislation seeks to establish a new statewide Mental Health Practitioner Loan Repayment Program Trust Fund under the Iowa College Student Aid Commission for the purpose of providing loan repayments for specific types of mental health professionals who agree to practice in “high-need areas” for at least five years under certain requirements. The bill includes a proposed $1.5 million annual appropriation that would be used to fund the loan repayments.
The House version expanded previous forms of the bill (see the UnityPoint Health Government & External Affairs’ February 2022 Iowa Update for more details) to include psychiatrists and psychologists; however, when considered in the Senate, Sen. Cournoyer said that the state already had other loan repayment programs that could assist those professionals, and amended the bill to pare it back down to prior versions.
UnityPoint Health supports the health care workforce priorities of the Governor and Iowa General Assembly as strategies to aid in recruitment, training and retention efforts for physicians, providers and clinicians to serve the health care needs of Iowans.
Also, this week, a House Appropriations subcommittee met to discuss SF 2381 (formerly SF 2354), a bill addressing maternal health options for Iowans. This legislation passed through the Senate on April 5, with a vote of 32-16. This bill would extend postpartum coverage for 12 months and creates a statewide More Options for Maternal Support (MOMS) program to be administered by DHS. Division II of the bill proposes expanded postpartum care Medicaid coverage and has been adopted in 32 states. Opponents of the bill spoke to Division I of the bill and the concerns around data privacy for women utilizing the MOMS program at certain private facilities.
UnityPoint Health supports the expansion of postpartum Medicaid coverage to 12 months and represents one of its key identified legislative priorities.
SF 2383: Workforce Omnibus relates to various matters under the purview of the State, including city and county zoning, work-based learning, recruitment of health care professionals, regulations affecting veterans and military spouses, insurance producer temporary licenses, and the State building code. The bill passed the House on April 26 sending it down to Governor Reynolds for her signature. Of particular importance to UnityPoint Health and other health care providers in Iowa is Division III of the bill, which focuses on some of the health care loan repayment and recruitment programs in the state.
SF 2383: Division III – Health Care Workforce Recruitment
- Makes changes to Iowa Code section 261.113 regarding the Rural Primary Care Loan Repayment Program.
- The bill eliminates the Iowa-based residency program requirement for applications and adds neurology as an eligible specialty for applicants.
- The bill also adds part-time rural practitioners as eligible applicants for the program.
- Makes changes to Iowa Code section 261.115 regarding the Health Care Professional Recruitment Program.
- The bill allows for advanced registered nurse practitioners (ARNP) and registered nurses to be eligible for the Program.
- The bill also adds Iowa community colleges established under Iowa Code chapter 260C as eligible institutions.
- Makes changes to Iowa Code section 261.116 regarding the Health Care Loan Repayment Program.
- The bill renames the Health Care Loan Repayment Program to the Health Care Award Program.
- Additionally, the bill allows part-time nurse educators to qualify for the program as long as the individual is also practicing as a registered nurse (RN) or ARNP.
- Applicants are eligible for a $12,500 award on an annual basis for up to four consecutive years, totaling $50,000.
UnityPoint Health applauds passage of this important legislation as it supports Iowa’s health care workforce through expanded eligibility and appropriations of some of the state’s loan repayment and recruitment programs.
PHARMACY BENEFIT MANAGERS (PBM)
SF 2231/HF 2384: Pharmacy Benefit Managers (PBM) has been championed by Iowa State Senator and Ways & Means Chair Dan Dawson (R-Council Bluffs) and the Iowa Pharmacy Association (IPA) and is mirrored off legislation that passed in West Virginia. This multi-year effort legislation relates to PBMs, pharmacies and prescription drug benefits and includes term definitions, rulemaking requirements, and changes to PBM reimbursements, among other changes.
PBMs are intermediary firms that manage prescription drug benefits for health insurers, Medicare Part D drug plans and many employers through contracts – including contracts with insurers to process patient claims and contracts with pharmacies to reimburse them for the cost of purchasing drugs and dispensing prescriptions. Additionally, PBMs often solely determine which pharmacies will be included in a prescription drug plan’s network and how much individual pharmacies will be paid for services. According to the IPA, PBM payment reductions have resulted in the closure of over 70 local, community pharmacies in Iowa.
While support exists for PBM reforms in the legislature, details regarding certain provisions of the bill have yet to be agreed to by the House and Senate.
UnityPoint Health supports passage of PBM legislation to ensure access to vital prescription and pharmacy services for Iowans.
Other Agency and Legislative News of Note
Iowa Public Health and Human Services Agencies
The Iowa Department of Human Services (DHS) and the Iowa Department of Public Health (IDPH) on March 24 released the final change package and functional organizational chart of the soon-to-be-formed Iowa Department of Health and Human Services (HHS). The HHS will serve as a single state agency that will align overlaps and streamline the departments, programs, services, and functionality of IDPH and DHS. In a March 24 email to public health and human services partners and stakeholders, Iowa DHS director and IDPH interim director Kelly Garcia stated that the new department “aims to integrate programs, policies, and practices to improve service delivery with a population health approach, and to leverage funding more effectively.” Additionally, Garcia wrote, “one of the major next steps in the alignment process is going from the functional organizational chart to a detailed table of organization. Additionally, we will identify, scope, and plan a sequence of projects to start implementing priority change initiatives in the Final Change Package. This next step will be a collaborative process – feedback from staff, partners, and stakeholders is essential in understanding how new collaboration can be established and where existing program structures should remain intact.”
First announced by the state in 2020, an official Iowa HHS Alignment website was launched in 2021. Full alignment of the two state agencies will continue over the next two years.
HHS Announces Jess Benson as new CFO
The IDPH and DHS announced the appointment of current Iowa Legislative Services Agency (LSA) senior health and human services legislative analyst Jess Benson as the chief financial officer of the soon-to-be-aligned Iowa HHS. Benson has served in his role with the LSA for more than 16 years and is widely recognized by the legislature, state agency leaders and Iowa constituents for his extensive knowledge in public health and human services funding.
For more information about State of Iowa advocacy, legislative, policy and regulatory issues of impact to UnityPoint Health, please contact Ashley Thompson, director of government & external affairs. For State of Iowa children’s issues, please contact Chaney Yeast, director of family services and government relations for Blank Children’s Hospital.