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It was a successful year for nursing issues in the 2005 Iowa General Assembly. Thanks needs to be given to INA member and House Human Resources Committee Chair, Rep. Linda Upmeyer (R-Garner) for her hard work on nursing issues and understanding the consequences of some of the bills that are introduced. We have better health care legislation because of her knowledge of nursing issues. Safe Patient Care was the theme of the 2005 Legislative and Public Policy Agenda for the Iowa Nurses Association. The membership ranked the issues under the headings listed further below. For adequate funding of Medicaid and HAWK-I, concern is being expressed that while many providers of Medicaid and human services received increases, the Medicaid program is $38 million under funded according DHS Director Kevin Concannon. The cigarette tax was not passed that could have filled this shortfall. Still state spending was increased by 7 ½% over last fiscal year. Many question the sustainability of that kind of an increase in the state budget. Iowa legislators passed a bill to create the Iowacare Act to keep Medicaid solvent and to experiment with individuals age 19-64 who do not currently qualify for Medicaid to receive limited health care at very limited sites (Broadlawns in Des Moines; University of Iowa Hospitals and Clinics in Iowa City and the four Mental Health Institutes in Independence, Mt Pleasant, Clarinda and Cherokee. It would also be an experiment in providing preventive health measures to the new eligibles. Initial review is that nursing care services will be much more utilized than in the past, especially for advanced practice nurse services. Mental Health Parity passed in a very modest form. Legislators who voted for it are receiving negative comments for doing so. It is important that you thank your legislators that did vote for it. Iowa no longer will be one of three states that have no mandate for any coverage of mental health services. Work on including coverage for substance abuse services will continue to take more advocacy efforts in the future although there was some state funding for some substance abuse services allocated and reshaping of the Substance Abuse Commission into a Board. In the last hours of legislative debate up to $50,000 was appropriated for nursing faculty loan forgiveness from the Iowa General Fund in a bill that had many “miscellaneous” appropriations and deappropriations. This money will go to the College Aid Commission, a state agency. Administrative rules will need to be written and adopted to implement this program. Legislative intent is that it is for residents of Iowa who are registered nurses and are seeking to become qualified as nursing faculty in Iowa and teach in Iowa. They would have to enroll in a not-for-profit accredited school of nursing in Iowa. It is hoped that at least ten individuals would each receive $5,000 for this program. In 2004 private funds had been identified by Iowa Student Loan, the private sector, non-profit secondary market for student loans in Iowa that generates resources for programs by issuing lower cost tax-exempt bonds and the receipt of government subsidies on its student loans. With additional resources identified in 2005, the Iowa Student Loan program effort will bring a total of 800 Iowa nurses financial assistance for working in nursing education, long term care facilities and rural county facilities. Staffing and patient ratios was an issue raised in several proposed bills introduced by Service Employees International Union (SEIU) and no action was taken. Discussion continues as to the legislative and regulatory actions that should be taken in Iowa that can be agreed to between staff nurses and management nurses. Bills on Dependent Adult Abuse and criminalization of nurses for their actions were considered in committee and not moved forward. INA members and staff spoke to legislators about the impact such legislation would have on discouraging care of the elderly. It still may remain an issue in the Iowa Legislature in the future. Safety in pharmaceutical use was a major focus this legislative session. The biggest issue for nursing was the self-administration of prescriptions of residents of assisted living facilities, elder group homes and clients of adult day care. The legislation clarified that a nurse could cue, prompt and remind an individual to take their prescription without the nurse taking total control of medication administration and thereby adding to the individual’s cost of health care services. Some nurses were being cited by the Department of Inspections and Appeals for cueing, prompting and reminding. Iowa legislators passed the strictest meth precursor bill in the nation making ephedrine and phenylpropanolamine and most pseudoephedrine products a Schedule V controlled substance. Over-the-counter sales are allowed if the package contains under 360 milligrams and is in liquid or gel-cap form. A prescription drug donation and redispensing program was established to authorize charitable clinic pharmacies to redispense prescription drugs that would otherwise be destroyed. Participation is voluntary. An exemption from professional disciplinary action, civil liability or criminal prosecution is provided if the person acts in conformity with any applicable professional standards and requirements. An electronic drug database system to track overuse and abuse of prescription drugs went through the legislative process and opponents killed passage. However, it is understood the Governor will proceed through Executive Order to implement the electronic drug database as another tool in the fight against meth in Iowa. Despite numerous contacts with legislators to assure safe patient care by assuring investigation and discipline of nurses, the Iowa General Assembly did not appropriate additional funds to the Iowa Board of Nursing. In fiscal year 2004 24% of fees and revenues collected by the Board of Nursing went to the General Fund instead of to the work of the Board of Nursing. Lack of additional appropriations has led to the Board of Nursing filing administrative rules to increase the three-year license fee from $99 to $120 effective August 2005. The ARNP compact was passed making Iowa a second state to pass such compact language. A three-year sunset was put on the bill. Much work will have to be done among the states that do not recognize all four categories of advanced practice nurses: nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists. The Drug Enforcement Agency (DEA) number for prescribing across state lines will be a major focus of national discussions before such a compact comes into existence. Due to a judge throwing out samples drawn by an ARNP in an Iowa county, legislation was adopted to assure that ARNPs and physician assistants could draw samples from individuals without their consent in cases of operating a motor vehicle while under the influence. The Department of Public Health will conduct a study on direct care workers educational preparation and other issues with a report to be submitted in 2006. Legislators set a policy to make the criteria for admission to long term care facilities higher to reduce the number of individuals in long term care facilities. Legislators also made it easier for long term care facilities to operate other businesses, such as a day care center, in conjunction with the long term care services. There was discussion about the universal assessment for individuals going into the facilities with more discussion directed to be conducted. The Medical Assistance Advisory Council to the Medicaid program had its membership expanded to include more advocacy groups involved in aging and elderly care issues. It was then doubled in size to include a voice for consumers of Medicaid services and will be an 80 member Council now. INA Legislative Agenda and Bills of Interest to Nursing in 2005 To get the final version of a bill that was passed and signed/vetoed by the Governor, go to www.legis.state.ia.us Under “Popular Links”, click on “2005 Enrolled Bills”. Use the list below to identify the bill number since the bills are listed numerically by bill number. Click on the bill number to get the final version. Bills that have “…to Governor” were sent in the closing days of the session. The Governor has 30 days to make a decision as to what he will sign or veto during that time. He can “Item Veto” appropriations bills. SAFE PATIENT CARE 1. Adequately Fund Medicaid –HF 825 to Governor and HAWK-I/Fund with tobacco tax: HF 237, HF 502, SF 130, SF 162, SSB 1314 (cig& prop tax) 2. Support passage of Mental Health and Substance Abuse Parity with coverage for children and adolescents HF 420 Governor signed May 2, 2005 without substance abuse or coverage for children and adolescents 3. Fund state scholarships for nurses with special attention to nursing faculty. HF 882 Announcement of additional funds to Iowa Student Loan for Loan Forgiveness for 75 more nurses. Amendment to HF 882 for $50,000 for RN Recruitment Program for nursing faculty loan forgiveness. 4. Support limiting the use of mandatory overtime as a routine staffing tool. Discussion with Iowa Organization of Nurse Leaders
DEPENDENT ADULT ABUSE
SUPPORT PATIENT SAFETY IN PHARMACEUTICAL ISSUES
SUPPORT THE BOARD OF NURSING OTHER ISSUES
1. CLIENT ADVOCACY
2. NURSING PRACTICE
3. WORKPLACE ISSUES
4. SYSTEM DESIGN AND ORGANIZATION
Linda Goeldner, CHE, CAE © 2008 The American Nurses Association, Inc. All Rights Reserved
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