Iowa Legislature Approaches Second Funnel Week
The upcoming twelfth week of the Iowa General Assembly (legislature) – March 29 through April 2 – serves as the second of two “funnel weeks” at the Iowa Capitol. A “funnel” is a self-imposed deadline by the General Assembly in order to keep the legislative session moving forward. For the second funnel, bills must be passed out of one chamber (Iowa House or Senate) and a full committee in the other chamber by April 2 in order to remain “alive” or eligible for the rest of the legislative session. If a bill fails to advance through this process, it is considered “dead” for the session and is tabled; however, there are some exceptions to the funnel rule, including appropriations (budget), ways and means and government oversight bills, among others.
American Rescue Plan (ARP) – Iowa Allocation
Iowa will receive about $4.451 billion from the federal American Rescue Plan (APR) Act, with individuals receiving another $3.77 billion in direct stimulus payments. The state is expected to receive $1.379 billion from the State Fiscal Recovery Fund and local governments are expected to receive about $1.162 billion ($612 million to counties, $335 million to metropolitan areas and $216 to other local governments). The state will receive another $152 million for capital projects. The remainder of the aid will go to state agencies for assistance in various areas, including about $774.5 million for K-12 schools, $365.5 million for colleges, about $385 million for programs for childcare, pre-school and toddlers and about $55 million in the Low Income Home Energy Assistance Program (LIHEAP) funds. State and local governments have broad authority to spend the funds as needed, but cannot use the money to reduce taxes, either directly or indirectly, or to make pension payments. Iowa State Senate Majority Leader, Senator Jack Whitver (R-Ankeny), is optimistic the U.S. Treasury will provide significant flexibility in their guidance as to how the State of Iowa will be able to utilize these funds.
Iowa Revenue Forecast
The state’s Revenue Estimating Committee (REC) met on Friday, March 19 to make its March revenue estimate. At its December 2020 meeting, the REC estimated revenues for Fiscal Year (FY) 2021 at almost $7.97 billion and an increase in revenues in FY 2022 to $8.27 billion. The December estimate is used to set the spending level for the Legislature.
At the March meeting, the REC increased the revenue estimate for FY 2021 to $8.079 billion and increased the FY 2022 to $8.385 billion, or an increase of 3.8% over FY 2021. The REC estimated the revenue for FY 2023 at $8.763 billion, a growth rate of 4.5%. The Iowa Legislature may spend 99% of ongoing revenue; however, due to economic uncertainty and conservative budgeting practices, it is unlikely that the state’s Republican majority will appropriate the entirety of this funding.
2021 Budget (including mental health)
Over the next several weeks, the Iowa House and Senate will create their own budget targets and work to find common ground between each chamber. Many of the existing state and local programs will receive a status quo appropriation; however, Iowa Governor Kim Reynolds will work with the Legislature to ensure her priorities are funded, which include but are not limited to:
- a robust statewide broadband expansion,
- housing incentives to address workforce shortages, and
- the adult and children’s mental health systems.
In the Governor’s proposed budget, a dedicated funding stream of an additional $15 million per year the next two FYs for mental health services, plus the $11 million for mental health from the federal ARP Act. The Senate recently released a proposal that would eliminate the county mental health levy and use an existing $152 million city backfill program used to replace “lost revenue” to fund the system. The House has yet to weigh in on this proposal.
Key Bills of Note to UnityPoint Health
Emergency Medical Services (EMS)
As shared in last month’s Iowa Update, HF 562 passed the House with unanimous support four weeks ago. The bill streamlines the local decision-making process that would allow cities and counties to implement an additional levy to fund critical, lifesaving EMS services. The bill requires the levy be approved at an election and requires EMS to be declared an essential county service. The bill is now in the Senate State Government committee and is eligible for consideration. UnityPoint Health supports passage of this legislation and is advocating for advancement of the bill through the Senate.
Telehealth
HF 294 passed the House unanimously earlier this month. This bill requires a “health carrier” (insurer/payor) to reimburse a health care professional or a facility for health care services for a mental health condition, illness, injury, or disease provided to a covered person through telehealth on the same basis and at the same rate as in person care.
HF 784 is on the House calendar eligible for debate. This bill requires a health carrier to reimburse a health care professional or facility for health care services provided to a covered person by telehealth on the same basis and at the same rate as the carrier would apply to the same services provided to the covered person by the professional or facility in person. As a condition of reimbursement, the carrier is prohibited from requiring that an additional professional be located in the same room as the covered person while services for a mental health condition, illness, injury, or disease are delivered via telehealth by another professional to the covered person.
HF 431 has passed the full House chamber and the authorizing committee in the Senate. This bill provides that, notwithstanding any provision of law to the contrary, a health-related professional licensing board that authorizes the use of telehealth or telemedicine by health-related professionals shall amend or adopt administrative rules to allow a health-related professional under the purview of the appropriate licensing board to utilize telehealth or telemedicine to deliver health care services through the use of interactive audio-only communication. The rules amended or adopted by the appropriate licensure board shall ensure that the provision of health care services through the use of interactive audio-only communication is clinically appropriate and that the patient has been provided the opportunity to receive such health care services via in-person or real-time interactive video, unless such opportunity is not reasonably available.
UnityPoint Health continues to work with the Iowa Senate to garner support for passage of telehealth payment parity legislation.
UnityPoint Health supports legislation that provides Iowans with additional tools to access high-quality care and is monitoring potential amendments or changes to the legislation, including ensuring audio-only services are used between providers and patients or clients with existing care relationships.
Medical Liability Reform
SF 557/HF 592 places a $1 million cap on noneconomic damages able to be paid out in a medical malpractice lawsuit. This cap will drive down insurance premiums and set up more favorable recruitment for our physicians in rural Iowa. The Senate File has passed out of the Senate Judiciary committee and the House File has passed out of House Human Resources, and both are eligible for debate. Recognizing the importance of attracting and retaining a robust health care workforce, 34 states have enacted medical liability reforms that promote fairness in the civil justice system and support increased access to high-quality care and services. UnityPoint Health supports passage of this common-sense legislation.
For more information on State of Iowa advocacy, legislative, policy and regulatory issues of impact to UnityPoint Health, please contact Ashley Thompson, director of government & external affairs for UnityPoint Health.