Legislative Summary

The Iowa General Assembly adjourned on Thursday, April 29, the 109^th day of Session.

Status of 1999 INA Legislative Agenda

Increase funding for core public health functions (HF 737): Additional new funding for core public health functions of $250,000 was appropriated in this legislative session, raising the funds to $350,000 for local boards of health to ensure that core public health functions are maintained and to support essential services in communities. This year funding in the Department of Public Health reflects the funding priorities of: adult wellness, child and adolescent wellness, chronic conditions, elderly wellness and community capacity rather than identified as being directed toward public health nursing and home care aide funding.

Amend the composition of the Board of Nursing to add an additional practicing registered nurse (SF 99): This bill passed and is being implemented.

Increase Medicaid funding/expand HAWK-I and reimburse gerontological ARNPs (HF 760): The bill increases the general fund appropriation by $29.9 million for medical assistance which includes a 2% increase for provider assistance. The HAWK-I program was increased by $3.3 million. No action was taken to appropriate funds for direct reimbursement of gerontological ARNPs.

Evaluate and respond to EMS Code Changes: House File 392 was introduced by the Emergency Medical Services Association and did not move out of committee. INA was working with the EMS Association during the legislative interim.

Support adoption of Interstate Compact for Nurses: House Study Bill 143 and Senate Study Bill 1145 were introduced by the Iowa Board of Nursing with INA support. The bills did not move out of committee due to physician community opposition. INA and the IBON were working with Rep. Clyde Bradley of Camanche and other interested parties during the legislative interim to resolve questions raised by several organizations.

Support parity in health insurance for mental health coverage: Senate File 83 and House File 241/401 were both on the respective debate calendars of each chamber, but no agreement was achieved. Governor Vilsack stated his intent to bring together the business community and the insurance industry to see if providing parity in mental health insurance could be achieved.

Additional Bills of Interest to Nursing Signed by the Governor

Senate Files

SF 8 Diabetes Mandated Coverage

Requires third party health insurance plans to cover costs of treatment, equipment, supplies and self-management education

SF 115 Drug Testing Clean Up Bill

Provides a technical correction to drug testing bill for testing in private sector.

SF 194 PMIC Accreditation

Authorizes a variety of accrediting entities meeting federal standards to accredit.

SF 248 HIV Code Chapter Rewrite

Replaces the existing statute previously in subchapters into a single Code chapter.

Removes the requirement for pre-AIDS test counseling

SF 276 Managed Care-Patient’s Bill of Rights

Provides protections for patients when managed care claims are in dispute.

SF 277 ARNP Clinical Privileges in the hospital

Mandates that hospitals cannot deny "clinical" privileges on basis of licensure

SF 361 Meth Prevention and Enforcement

Appropriates $3.3 million including $1.5 million to Department of Public Health

SF 439 Empowerment Act

Provides for funding to communities so that children are at school ready to learn

SF 460 Appropriations-Administration & Regulation

Includes $100,000 for more frequent inspections of non-JCAHO hospitals

SF 464 Appropriations-Education

$1.1 million to establish a School of Public Health at the University of Iowa

Funds for Indigent Patient Care Program and Child Health Services

SF 470 Campaign Contributions

Makes changes in the laws of campaign finance disclosure.

SF 482 Tobacco Settlement

Creates a master agreement for Iowa’s share of the national tobacco settlement.

House Files

HF 308 Department of Inspections & Appeals- Investigative Powers

Gives peace officer status to investigators while performing their job.

HF 402 Midwifery-Scope of Practice Review

Establishes a review committee to advise on licensure for direct entry midwives.

HF 489 Infectious Waste Program

Eliminates requirement to institute an infectious waste program in Health Dept.

HF 497 Public Health Programs

Amends language for emergency care providers and definition of spinal injuries

HF 624 Electronic Commerce

Defines and gives legal recognition to electronic records, signatures, etc.

HF 661 Offense of Sexual Abuse and Definitions

Relates to offense when occurs on mentally or physically incapacitated persons

HF 664 Adult Decategorization Projects

Provides for improving outcomes for MH/MR/DD by pooling all funds.

HF 708 Governor’s Award for Quality in Health Care Facilities

Establishes an award for quality in health care facilities

HF 737 Appropriations- Health, Elder Affairs and Human Rights

Appropriates funds for various activities of the state agencies including the Board of Nursing

HF 741 Psychiatric Medical Institutions for Children (PMIC) Bed Flexibility

Allows for flexibility of beds between mental health and substance abuse needs

HF 760 Appropriations-Human Services

Appropriates funds for the medical assistance program (Medicaid)

Includes Rural Health Clinic Reimbursement-Guarantees 100% cost-based reimbursement for rural health clinics and community health centers

HF 762 Appropriations- Oversight and Communications

Funds information technology services to state agencies and funding of a "report card" for state-licensed health care facilities and IowAccess revolving fund.

Resolutions of Interest to Nursing

SCR 11 urges that Congress act to keep the federal government from taking back any of the tobacco settlement money from the states.

HCR 24/SCR 23 encourages Congress to rescind Health Care Financing Administration rules requiring onerous home health agency reporting. Urges Congress to amend the Health Care Financing Administration (HCFA) authority over the OASIS project reporting requirements to only Medicare patients.

SCR 24 requests the Legislative Council to study the long term health care needs of Iowans.

Nursing Issue Resolved without Legislation

While Senate File 314 passed the Senate and moved to the House State Government Committee, in discussions with the Department of Public Health it was determined that advanced registered nurse practitioners (ARNPs) can order X-rays. This was clarified then in administrative rules.

Regulatory Issues of Interest to Nursing

Maintain Control of the Practice

Critical Access hospitals (481-51): These rules add a category of specialty hospital as created by the Balanced Budget Act of 1997. The rules will be in compliance with the state licensure requirement for all general hospitals to have at least one registered nurse on duty at all times.

Foreign-educated nurses (655-3): These rules bring Iowa requirements for foreign-educated nurses into conformity with the new English proficiency requirements of the Commission on Graduates of Foreign Nursing Schools.

Formal advanced practice education (655-2):These rules replace the term "post-basic program" with the term "formal advanced practice education program in nursing" and define master’s degree programs.

Licensure Fee Increases (655-3, 7): These amendments increase licensure fees for registered nurses and licensed practical nurses, place a limit on fees charged for licensure reinstatement and eliminate refunding of overpayment of fees if less than $10. Registration renewal fees for advanced registered nurse practitioners are increased and moved to the same chapter as registered nurses and licensed practical nurses.

Trauma Education and Training (641-137): These rules establish trauma care education and training requirements for advanced registered nurse practitioners, registered nurses, physicians, physician assistants, licensed practical nurses and emergency medical care providers.

Advocate on behalf of the Client

Adolescent Pregnancy Prevention Grants (441-163): These rules revise the categories of grants and make changes in the availability of grants for projects and project evaluation.

Child Abuse Assessment Program (441-175): These amendments implement revisions including deletion of the definition of "harm", notification of county attorneys of all reports of child abuse, establishment of three Citizen Review Panels to identify strengths and weaknesses of the child protective services system as a whole. Membership of each panel shall include professionals practicing in a variety of disciplines including nursing.

Financial Assistance to eligible end-stage renal disease patients (641-111): These rules describe the financial criteria for determination of program eligibility, application procedures, types of financial assistance which may be provided and payment procedures.

HAWK-I program (441-1): This rule sets forth the organization, duties, powers and procedures of the Board. (441-86): These amendments revise policy governing eligibility for the program, i.e. a child must be uninsured to qualify. There is a six-month waiting period if the child was covered by an employer-sponsored health plan, unless dependent coverage was terminated due to an extreme economic hardship on the part of the employee or the employer.

Healthy Families Iowa (HFI) (641-87): These rules establish standards to be used in the provision of services to families and children during the prenatal to preschool years.

Iowa Child Death Review Team (641-90): These rules incorporate 1997 Iowa Code chapter 159 sections pertaining to confidentiality of information used by the child death review team, immunity of members and liability associated with violations of confidentiality.

Iowa Plan for Behavioral Health (441-88): This rules implement the "Iowa Plan for Integrated Access", a managed care plan for the delivery of mental health and substance abuse services under the Medicaid program.

Iowa Plan for Behavioral Health (441-153): These rules revise state policy governing the Iowa Plan for services otherwise available from county funds in the areas of: application procedures, eligible services, service provision, eligibility determination, program administration, reduction, denial or termination of benefits and appeals.

Nursing Facility Reimbursement Rate (441-81): This rule changes the basis for the maximum reimbursement rate to $73.21 per day.

Radiation (X-ray orders) (641-41,42,45): These amendments clarify that an advanced registered nurse practitioner (ARNP) may order diagnostic x-rays in the course of patient treatment.

Rehabilitative Treatment and Supportive Services (RTSS) (441-156): These rules revise the authorization process for RTSS and eliminate the Clinical Assessment and Consultation Teams (CACT).

Resident Assessments (441-81): These rules implement revised federal regulations requiring nursing facilities to electronically transmit the information on the resident assessments to the state.

Return of drugs and appliances (657-6): This amendment prohibits the return to the pharmacy of any previously dispensed controlled substances prescription medications, unless dispensed to the same patient, in conformance with such prohibition under federal law.

School health accreditation standards (281-12): These rules revise the accreditation standards for Iowa schools according to the direction provided by the Iowa Code. The assumed standards for school health are removed due to a lack of authority in the Iowa Code to include provision of school health standards in this chapter.

Institute Workplace Reforms

Criminal History Records (661-11): These rules provides access to Iowa and national criminal history records by non-criminal justice agencies involved in the care of children, the elderly, or the disabled.

School to Career Program (261-11): These rules implement a program to provide a workplace context for classroom training at the postsecondary level which is an articulated sequential program of study.

Strategic Workforce Development Fund (877-15): These rules provide direction for regions with funding for the development and maintenance of a workforce sufficient in size and skill to meet occupational demands and for programs like statewide mentoring.

Welfare-to-Work Program (877-14): These rules create a new chapter to provide guidance to county officials, private industry councils, workforce development officials and welfare recipients on the implementation and operation of the federally authorized program.

Impact Health Care Policy

Accident and Health Insurance (191-35,36,40,71,75): These rule changes require health insurance carriers and health maintenance organizations to include in contracts and "evidence of coverage" contracts a disclosure of the existence of any drug formularies and existence of any contractual arrangements which provide rebates or other incentives for drugs or medical devices. The rule is added to all chapters, which govern various types of health benefit plans.

Campaign Disclosure policies (351-4): The rules make it easier for interested and affected parties to be able to find the correct rule revision.

ChildCare Assistance (441-169): These rules define and structure childcare funding for empowerment areas. The rules establish conditions and procedures for disbursements, use and administration of funds.

Home Health Agencies-Surety Bonds (441-77): These rules require home health agencies participating in Medicaid to obtain, maintain, and timely file surety bonds. The compliance date is suspended until the Health Care Financing Administration evaluates the U.S. General Accounting Office report. The published rule absolves participating home health agencies from having to show compliance with the requirements until 60 days after publication of new regulations.

Hospital Records and Reports (481-51): These rules delete obsolete language and update the language to reflect current standards of practice relating to medical and hospital records and radiological and laboratory services in hospitals.

Medicaid Medically Needy Program (441-75): These amendments make revisions including elimination of the medical expense verification form and acupuncture expenses will be allowed to meet spenddown.

Medicare Supplement Insurance Minimum Standards (191-37): Changes by the federal government in the Balanced Budget Act (P.L. 105-33) necessitate Medicare supplement rule changes.

Medically Needy Policy (441-75): This rule amends the Medically Needy policy to allow an adjustment for spendown when an unpaid Medicaid-covered service has been used to meet spenddown and a paid claim is subsequently received.

Medicaid Reimbursement Increases (441-79): These amendments implement reimbursement rates increases of two percent for non-institutional providers and certain other increases for institutional providers.