The Iowa Legislature adjourned shortly before midnight on Wednesday, May 19, a full 19 days beyond the scheduled 110-day session. The 2021 Iowa legislative session went into overtime as lawmakers worked to come to agreements on the state budget, tax reform, mental health funding, and other key pieces of legislation. Throughout the 18-week session, the UnityPoint Health Government & External Affairs team, health system and regional leaders, team members and patients advocated to advance the priorities of the 2021 UnityPoint Health State Legislative Agenda and Children’s Legislative Agenda, as well as additional issues of importance to patients and communities. A number of key bills were passed by both chambers – the Iowa House of Representatives and the Iowa Senate – and are awaiting the decision of the governor or have already been signed into law.
Key Policies and Legislation
Emergency Medical Services (EMS)
Image: Pocahontas Community Hospital (an affiliate of UnityPoint Health) Emergency Medical Services Department, Pocahontas, Iowa.
Standings Appropriations – Iowa Senate File 615
Status (as of May 26): Passed the Iowa House and Senate; Sent to the Governor.
Emergency Medical Services (EMS) is a system that provides lifesaving, urgent medical care to individuals with illnesses and injuries. EMS is most easily recognized when ambulances, helicopters or other emergency vehicles are seen responding to emergency incidents.
In Iowa, unlike fire and police protection, EMS does not receive the same recognition and financial support as an “essential service”. Because of this, many EMS services – particularly in Iowa’s rural communities – continue to face significant financial challenges and rely on volunteers to offer ambulance services, as well as donations and fundraisers.
Following a multi-year effort in the Iowa Legislature, language was included in this year’s Standings Appropriations bill to support EMS efforts at the county level. The bill creates a better-defined process for counties and its residents to plan for and implement long-term sustainable support for lifesaving EMS in its local communities, such as:
- Allows the establishment of a local advisory council to help review and guide EMS service operations.
- Allows counties or EMS districts to declare EMS an essential service through a vote of its residents.
- Allows counties or EMS districts provide funding of these services through a drawdown of tax levies through property tax or local income surtax if approved by the vote residents.
- Sets a sunset of the declaration of EMS services at 15 years for those counties that are not the 11 most-populous counties and 10 years for the most-populous counties.
Why this legislation matters: “[This bill] is truly a generational change. To be able to give our counties the ability to finally…raise funds to fully fund our ambulance services,” said Iowa Representative Bobby Kaufmann (R-Wilton) during the 2021 Iowa legislative session.
“As a city-owned hospital that is the main provider of EMS services for our county, this legislation will enable us to move forward with discussions on how we can move forward with the formation of a countywide system that will make sure all residents of Pocahontas County have access to the emergency services they deserve,” said James Roetman, chief executive officer of Pocahontas Community Hospital, a Critical Access Hospital affiliate of UnityPoint Health. “The legislation will give counties a much easier way to make EMS a priority for its residents and those who travel through our communities and may need emergency care.”
Health Care Workforce
In partnership with the Iowa Legislature, UnityPoint Health and other health care providers across Iowa continue to support and expand programs that support recruitment and retention of a health care workforce in the state. During the 2021 session, two key statewide health care professional recruitment programs targeting Iowa’s rural communities were expanded to enable greater offerings and participation.
Rural Iowa Primary Care Loan Repayment Program – Senate File 129
Status: Passed the Iowa House and Senate; Signed into law by the Governor.
Senate File 129 makes changes to the Rural Iowa Primary Care Loan Repayment Program, a statewide initiative that was established by the Iowa Legislature in 2012 to help address physician shortages in the state’s rural communities.
The bill adds obstetrics and gynecology to the types of specialty providers allowed to participate, allows for part-time physicians to participate (70% of a 40-hour week), and broadens current definitions of eligible areas of practice in the state to allow for more psychiatrists to participate in the program.
Additionally, as part of the Education Appropriations bill (Senate File 868) an increase of $300,000 was allocated to fund additional awards under the program.
Iowa Health Care Professional Recruitment Program – House File 196
Status: Passed the Iowa House and Senate; Signed into law by the Governor.
House File 196 expands the Iowa Health Care Professional Recruitment Program to include health care professionals who graduate from and are recruited by “eligible institutions” to practice in an eligible rural community in this state that matches state funds for educational loan repayment for the health care professional. Prior to this legislation, only health care professionals who graduated from Des Moines University were eligible for the program; the bill expands the types of institutions to include a regents university or accredited private institutions.
The bill also expands eligibility to occupational therapists and athletic trainers. Prior to this legislation, only physicians, physician assistants, podiatrists and physical therapists are eligible for the program.
Additionally, as part of the Education Appropriations bill (Senate File 868) an increase of $100,000 was allocated to fund additional awards under the program.
Why this legislation matters: Recent data shows that the demand for health care services in Iowa is expected to increase, with nearly a 10% increase in primary care providers needed to meet this demand.
“These two programs are invaluable to the health care organizations in our state,” said Rachel Hardin, director of physician services for UnityPoint Health. “As we recruit health care providers, we consistently hear about the significant educational debt burden so many candidates face. Expanding the scope of who can benefit from these programs demonstrates Iowa’s commitment to building a strong health care provider workforce, particularly in our rural communities.”
“We are thrilled to see these changes that will expand our ability to attract qualified candidates to our rural markets,” said Jessica Meisner, vice president of human resources and education for UnityPoint Clinic and UnityPoint at Home. “Oftentimes it is challenging to recruit physicians and providers to rural parts of the state, and these changes will allow us to broaden our reach when discussing loan repayment options.”
Health and Human Services (HHS) Appropriations
Image: Ashlea Lem, a nurse practitioner for UnityPoint at Home, provides care to a patient in the home setting.
Health and Human Services Appropriations – Iowa House File 891
Status (as of May 26): Passed the Iowa House and Senate; Sent to the Governor.
Each year, the Iowa Legislature must pass several budget bills that fund the operations of the state. One of these bills, known as the Health and Human Services (HHS) Appropriations, funds many health care and other related programs and services for Iowans. Some of the key health care programs and services funded under the bill are highlighted below:
- Creates a new Center of Excellence program, a grant program that will fund collaborations between rural hospitals, health systems and other health care providers to develop a model for delivering high-need services like maternity or cancer care, among others.
- Increases funding for the Rural Psychiatry Residency Program and the Medical Residency State Matching Grant Program, two programs created to increase the number of practicing psychiatrists and physicians in Iowa, respectively.
- Increases funding for certain programs and services offered under the state’s Medicaid program, such as home health care, home- and community-based services, nursing facilities, and Psychiatric Medical Institutions (PMIC) for children
- Maintains stable funding for the Iowa Poison Control Center, a free 24-hour poison information and treatment advise center for all Iowans that is housed under the umbrella of UnityPoint Health – Sioux City. During the last fiscal year, the Center served over 24,000 individual cases and saved the Iowa Medicaid program $6.4 million in avoided medical costs.
- Maintains stable funding for Iowa’s six accredited Child Advocacy/Protection Centers, of which UnityPoint Health proudly offers in Cedar Rapids/Eastern Iowa, Des Moines/Central Iowa, and Waterloo/Northeast Iowa.
- Maintains the Cost Adjustment Factor for Critical Access Hospitals, a state- and federally-funded program to help maintain health care services in rural communities.
- Extends the Hospital Health Care Access Assessment, a state and federal match program that supports health care services for Medicaid patients.
Why this legislation matters: Each year, the HHS Appropriations bill represents significant funding allocations that impact the health care services UnityPoint Health and other health care providers across Iowa provide to Iowans of all ages.
On the Medicaid health home program: “Funding of Medicaid home health services is important to the well-being and quality of life for vulnerable Iowans,” said Jenn Ofelt, chief operating officer for UnityPoint at Home. “In many cases, Medicaid home health services are what allow older adults to stay independently at home versus moving to an institutional setting, as well as supporting the unique health care needs high-risk children and their families by allowing parents to work and these children to go to school with their peers.”
On the Child Protection/Advocacy Centers: “Often we see children come into our center who have had neglect, physical injury, child sexual abuse…but what we see they carry with them is the emotional component. That is often times what gives them their struggles and what they need the most help with,” said Dr. Ken McCann, medical director for the UnityPoint Health – Blank Children’s Hospital STAR Center (one of the state’s six Child Advocacy/Protection Centers).
Mental Health Funding
Tax Omnibus – Iowa Senate File 619
Status (as of May 26): Passed the Iowa House and Senate; Sent to the Governor.
A significant outcome of the 2021 Iowa legislative session is a shift in how mental health services will be funded in the state. As part of the tax omnibus bill, funding for adult and children’s mental health services that are administered by the state’s 14 Mental Health and Disability Services (MHDS) regions will move from county property taxes to the state’s general fund. Currently, Iowa is the only state in the country to fund its mental health system through property taxes.
The shift in funding will occur over the next two years, while also enacting rules, requirements and a process for performance-contracts between the state and each of the MHDS regions. Reviewed each year, these contracts will include each region’s plan for how mental health services will be developed and implemented in their designated areas of the state. For those MHDS regions who meet the goals and outcomes of their contracts with the state, additional funds will be set aside to act as an “incentive” to support local efforts.
Why this legislation matters: “I would like to personally thank the Iowa House, Senate, and Governor’s office for coming together to improve access for individuals who face behavioral health challenges,” said Aaron McHone, behavioral health service line operations director for UnityPoint Health. “The legislature passed a compromise bill that will provide a higher level of equity for services by transitioning from a county property tax funded system to one where funds come from the State’s general fund. This bill also allows for payment parity for telehealth services. What this means is that Iowan’s access to behavioral health services will no longer be tied to where the individual lives. All Iowans deserve access to services, regardless of where they live.”
Telehealth Payment Parity for Behavioral Health Services
Tax Omnibus – Iowa Senate File 619
Status (as of May 26): Passed the Iowa House and Senate; Sent to the Governor
Image: Elizabeth (Betty) Brimeyer, a psychiatric nurse practitioner at UnityPoint Clinic Behavioral Health in Dubuque, Iowa, meets with a patient using telehealth technology.
In addition to mental health funding, another key issue that was included in the tax omnibus bill is telehealth payment parity. Building upon legislation that was passed by the Iowa Legislature in 2015 and 2018 that formalized telehealth coverage under the state’s Medicaid program and commercial health insurance plans, this tax bill requires Iowa commercial health insurance plans to reimburse health care professionals and facilities for health care services for mental health conditions provided to a patients by telehealth on the same basis and at the same rate as the same services provided by the health care professional or facility in person.
Why this legislation matters: “Over the course of the last year with COVID, we have all learned the importance of telehealth and its ability to provide health care to Iowans, regardless of where they live in the state,” said Iowa Representative and licensed social worker Joel Fry (R-Osceola) during the 2021 legislative session.
“Telehealth payment parity for behavioral health is important as it allows patients to be seen by a behavioral health care professional more quickly, and will help improve access and coordination,” said Dr. Azeza Uddin, a psychiatrist for UnityPoint Health – Berryhill Center and medical director of the behavioral health service line for UnityPoint Health. “This legislation supports our work to bring care to patients with immediate or longer-term behavioral health needs in a timely fashion, as well as being able to help patients to connect with other points of care they may not already be accessing for not only mental health needs, but their physical health needs.”
“Telehealth technology has allowed health care providers like the Abbe Mental Health Center to connect with patients in new and improved ways,” said Kathy Johnson, a licensed social worker and executive director of the UnityPoint Health – Abbe Mental Health Center. “During the COVID-19 pandemic, many of our patients had heightened symptoms of depression and anxiety and without telehealth services, they would have dropped out or disengaged from needed treatment services. Our patients have found telehealth beneficial, as they are able to receive treatment from the safety and comfort of their home. Sometimes, individuals can be hesitant to come in for treatment when they are feeling at their worst. Telehealth allows us to connect with our patients to keep them engaged in care, as well as for ongoing treatment needs.”
Broadband
As shared in last month’s Iowa Update, On April 28, Governor Reynolds signed Iowa House File 848 into law. Passed unanimously by the Iowa House and Senate, the bill will soon award grants through the Empower Rural Iowa Broadband Grant Program to internet companies and providers that expand broadband in the state. Specific to funding, during the bill signing the governor announced that lawmakers have agreed to provide $100 million for the first year of the program and are reviewing the state’s ability to utilize federal stimulus dollars to provide additional funding. Governor Reynolds proposed an annual investment for $150 million for three years as part of her 2021 State Priorities.
Why this legislation matters: “With broadband, we’re able to use technology like telehealth to bring these much-needed services directly to our patients who need it,” said Laura Smith, senior vice president and chief information officer for UnityPoint Health. “Access to broadband is an important step to achieving health equity and putting all of us, regardless of whether we live in an urban, suburban or rural community, on more equal footing.”
Next Steps
All bills passed by the Legislature must be reviewed by Governor Reynolds. For bills that were sent to the governor during the last three calendar days of session, she has 30 days to review and take action. The governor has the option to sign a bill into law, or to use three types of vetoes: the veto, line-item veto, and pocket veto.
- The veto indicates the governor’s disapproval of an entire bill.
- The line-item veto may be used only for bills that appropriate funds, like the Health and Human Services Appropriations bill. It strikes or removes a specific item of a bill while leaving the remaining parts of the bill in place.
- A pocket veto occurs when the governor does not take action within 30 calendar days on a bill received within the last three calendar days of session. The entire bill fails to become law.
When the governor vetoes or line-item vetoes a bill, the legislature may override the veto if two-thirds of the members of each chamber vote to pass the bill again.
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.