Image (left to right): UnityPoint Health chief operating officer John Sheehan; director of government & external affairs Ashley Thompson; chief compliance officer Andrea Eklund; and chief information officer Laura Smith. Iowa Governor Kim Reynolds 2022 Condition of the State address, Iowa State Capitol, January 11, 2022. (Image Source: Ashley Thompson)
February 18 marked the end of the sixth week of the 2022 session and the first “funnel” at the Iowa Capitol, where bills are in general required to be passed by a full committee of the state legislature to remain alive for consideration. A number of priorities for UnityPoint Health have successfully advanced through the legislature’s self-imposed funnel and are highlighted below.
Iowa Governor Kim Reynolds Delivers Condition of the State
Following the start of the 2022 Iowa legislative session on January 10, Iowa Governor Kim Reynolds delivered her annual Condition of the State address and released her proposed state budget for Fiscal Year (2023). The Governor’s annual address and budget provides clear guidance to the Iowa General Assembly as to appropriations, legislative and policy priorities of importance and previews much of what is expected to be the focus of the legislature for the 2022 session.
UnityPoint Health leaders were in attendance for the Governor’s address and were pleased to learn several the health system’s key priorities were included in her budget and policy proposal, such as:
- Expansion of the Iowa Health Care Loan Repayment Program, Health Professional Recruitment Program, and the Rural Iowa Primary Care Loan Repayment Program;
- Expansion of the state’s Rural Psychiatry Residency Program;
- Establishment of a formal Iowa Health Careers Registered Apprenticeship Grant program to offer Iowa secondary students with hands-on experience and training opportunities for careers in health care;
- Expansion of work-based learning, financial support and other educational programs for youth and adults to more easily move into health care careers and support Iowa’s health care workforce;
- Medical liability reform; and
- Increased funding to Iowa’s Child Advocacy/Protection Centers (CAC/CPC) and the Iowa Poison Control Center.
102nd General Assembly Key Legislative Issues
Health Care Workforce
A continued legislative priority for UnityPoint Health to expand the health care workforce in Iowa. As part of the Governor’s address in January, a recommended strategy for drawing more physicians, providers and clinicians to the state is to expand state loan repayment programs and establish new opportunities to recruit, train and retain a workforce. Additionally, the Governor called for the legislature to pass cross-industry tort reform, with specific emphasis on hard caps on noneconomic damages for medical and trucking industries.
The Governor’s workforce priorities advanced through the funnel, with committees passing companion legislation in the House and Senate, Iowa House Study Bill 682 and Iowa Senate File 2361. Among other provisions, a Division of the bills include enhancements to, and expansion of, eligibility for participation in the state’s established Rural Iowa Primary Care Loan Repayment Program and the newly named Health Care Awards Program (currently known as the Health Care Loan Repayment Program).
Specific to mental health care workforce legislation, Iowa House File 2137 creates such a loan repayment program for mental health prescribing professions and Iowa Senate File 2195 proposes the establishment of a program for mid-level non-prescribing professions. While it has not occurred yet, it is believed both bills with be amended during floor debate to cover both prescribing and non-prescribing mental health professionals under the loan repayment program. Additionally, Iowa House File 2157 proposes the creation of new psychiatry residency positions at the University of Iowa Hospitals and Clinics (UIHC) in cooperation with the state’s two Mental Health Institutes (MHI) and the Iowa Medical and Classification Center (IMCC).
Finally, the House and Senate have advanced companion bills, Iowa House File 2279 and Iowa Senate File 2275, that would place a $1 million hard cap on noneconomic damages in medical liability cases. David Stark, president and chief executive officer of UnityPoint Health – Des Moines, and Ashley Thompson both spoke in favor of medical liability reform legislation during various hearings at the Capitol.
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. Additionally, UnityPoint Health supports establishment of new and expansion of existing programs, services and appropriations that support Iowa’s health care workforce, and modification of the state’s medical malpractice liability statue to include a reasonable cap on noneconomic damages.
Maternal Health and Medicaid
The Iowa Senate released its “More Options for Maternal Health (MOMS)” bill, Iowa Senate File 2354, which included two divisions focused on maternal health services and supports. The first division replicates a program from Texas aimed at improving pregnancy outcomes and reducing abortions by creating a statewide program administered through nonprofit organizations that provide pregnancy support services. The bill appropriates $2 million for creation of the program. Division II of the bill requires the Iowa Department of Human Services (DHS) to submit a state plan amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) to extend postpartum Medicaid coverage from 60 days to 12 months. The bill appropriates $5.5 million to expand Medicaid coverage in FY 2023 and $8.8 million in FY 2024. Chaney Yeast, director of family services & government relations for Blank Children’s Hospital, and Ashley Thompson, director of government & external affairs for UnityPoint Health, both spoke in favor of the proposed extension of postpartum Medicaid coverage during the subcommittee of the year, with comments indicating that over half of states and U.S. territories are currently or in the process of extending coverage under their respective Medicaid programs and data supporting extension of coverage leads to better physical and mental health outcomes.
UnityPoint Health supports the expansion of postpartum Medicaid coverage to 12 months and is one of its identified legislative priorities this session.
Mental Health and Medicaid
There are several other mental health related bills which survived first funnel including:
- Iowa House File 2245, telehealth reimbursements for out-of-state providers;
- Iowa Senate File 2216, increasing intensive psychiatric care beds for adults and adolescents at the state’s two Mental Health Institutes (MHI); and
- Iowa House File 2310, mandating Medicaid coverage for Functional Family Therapy and Multi-Systemic Therapy for youth and families.
The legislature has also advanced a longstanding discussion among policymakers, state agencies and health care providers specific to tiered psychiatric inpatient care reimbursement. Companion bills Iowa House File 2125 and Iowa Senate File 2331 move to establish this type of reimbursement system. House and Senate leadership asked for UnityPoint Health to provide input on recommendations; Aaron McHone, behavioral health service line operations director for UnityPoint Health, and Ashley Thompson are actively working with bill sponsors and legislative leadership on this important legislation.
UnityPoint Health supports thoughtful approaches and strategies to increase infrastructure and reimbursement for Iowa’s mental health system.
Vaccinations
Several anti-vaccination bills have been introduced this session. These bills are not limited to vaccinations for COVID-19, but also include legislation which potentially negatively impact Iowa’s high rate of childhood immunizations, or directly conflicts with federal laws and regulations. While many did not survive the first funnel, a few bills of note remain alive, including but not limited to:
- Iowa Senate File 2335 which would require documented consent by parent or legal guardian for a minor to receive a vaccine. This amended bill codifies the current standard of care for childhood immunizations. The initial version of the bill mandated written parental consent. Documented consent allows for verbal consent allowed under Iowa law.
- Iowa House File 2298 prohibits licensed childcare centers, elementary and secondary schools, and post-secondary schools in Iowa from requiring immunization against COVID-19 prior to July 1, 2029. This would include the prohibition of such a mandate even if the COVID-19 vaccination is added to the recommended Childhood Immunization Schedule at a future date before 2029.
- Iowa Senate File 2269 requires vaccine information statements to be provided, recorded and reported by health care providers relative to certain vaccinations and vaccination injuries to the Vaccine Adverse Event Reporting System (VAERS). The bill also provides for disciplinary action and fines by the respective health profession board for non-compliance.
UnityPoint Health takes seriously its responsibility to protect the health and wellbeing of the people and families we serve. While we recognize there are strong opinions regarding immunization, we trust the medical evidence that shows the benefits of vaccination far outweigh the associated risks, and we strongly encourage vaccination and childhood immunizations for our patients and anyone eligible.
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.