a communication of the Iowa Nurses Association

Interstate Compact is voted out of Committee

After two years of educating legislators on the issue of the mutual recognition of the nursing license, the legislative proposal was unanimously recommended for passage by the House State Government Committee on Tuesday, January 25. Rep. Clyde Bradley (R-Camanche) handled the bill in the committee chaired by Rep. Mona Martin (R-Davenport). Our thanks to the members employed at Genesis Medical Center in Davenport for their numerous letters and contacts with these legislators!

Rep. Bradley commented on the uniqueness of the bill and noted how e-commerce was moving forward. He said what makes the bill possible was standardized education and licensure testing. He stated the bill discusses how a compact between states would work. He explained that the first reason for the bill is to protect the public, to provide a process for mutual recognition of the nursing license across state lines and a mechanism to store the data collected.

He gave an opportunity to the Iowa Association of Nurse Practitioners’ president, Wanda Marshall, to explain their group’s opposition to the bill. They indicated that they were concerned that advanced practice nurses would be next to go into a compact and diminish the liberal advanced practice in the state. She stated the Attorney General’s proposed amendments would help address the association’s need. Pediatric nurse practitioners with the Iowa Health System and Allen College in Waterloo were in attendance to provide support for passage.

Lorinda Inman, Executive Director of the Iowa Board of Nursing answered a few technical questions asked by the committee about advanced practice nurses and the kinds and types and their education.

In closing remarks, Rep. Bradley advised the committee that there was no real good reason for not moving the bill forward. It is anticipated that the bill will be taken up shortly after receiving a new bill number as a House File. Contact your representative soon to urge a yes vote on the bill.

State Representative/Senator

State Capitol Building

Des Moines, IA 50319

House Switchboard: (515) 281-3221

Senate Switchboard (515) 281-3371

Or e-mail your legislators using the first letter of the first name and the first six letters of the last name, for example: for Speaker of the House Brent Siegrist, bsiegri@legis.state.ia.us.

On Wednesday, January 26, 2000, the Mental Health Advocacy Coalition held an educational forum for legislators on the need to pass mental health parity. Linda Goeldner, INA Executive Director, is the current Coalition chair and made introductions of the consumers who spoke at the forum. Fifty legislators attended part or all of the forum. Two consumers spoke, Carol Porch of Iowa City, past president of NAMI Johnson County and chairperson of Iowa Protection and Advocacy, and Mark Riley, a Principal Life Insurance Company registered representative in Des Moines. Legislators asked questions of them and there was good dialogue.

It was reported that House File 2080 was introduced in the House of Representatives with 23 cosponsors which calls for limited mental health parity under the terms and conditions of the Iowa Life and Health Insurance Association. The bill’s lead sponsor is Rep. Betty Grundberg (R-Des Moines). Also announced was that the Governor’s proposal was almost finished being drafted but would include additional areas of mental health coverage and coverage for substance abuse. It appears that House Majority Leader Christopher Rants (R-Sioux City) plans to bring a bill to floor debate. It is not as clear that Senate Majority Leader Stu Iverson (R-Dows) is as interested in bringing a bill for floor debate.

Keep those calls and letters coming in.

1. Support adoption of an Interstate Compact to facilitate a system of licensure in which a single license allows a nurse to practice in multiple states with a "multistate licensure privilege." Recommended for passage by committee.
2. Appropriate the tobacco settlement dollars for health care purposes with attention to: 1) school programs to reduce tobacco use and improve health, 2) assuring health services provided by school nurses are included in state school accreditation standards, and 3) programs to reduce school violence. Much discussion, no bill.
3. Support parity in health insurance policies for mental health and substance abuse coverage and appropriate housing. House File 2080 introduced, Governor’s bill expected soon.
4. Assure nursing supervision of emergency medical services personnel when they work in the non-emergency, non-lifesaving acute care settings. Nursing recommended amendment was filed. House File 392 with amendment H-8005 can be viewed on the legislative website: www.legis.state.ia.us
5. Increase funding for public health nursing/core public health functions. Director of Public Health and Governor recommend $1.5 million in additional funding.
6. No support for legal recognition of direct-entry midwives. Scope of Practice Review Committee recommends legal recognition by registration.

There is expected to be large political debates on the tobacco settlement and mental health and substance abuse parity this session.

The committee members did agree that the practice of direct entry midwifery should be legalized. Further, the committee recommended that persons holding either the Certified Professional Midwife (CPM) or Certified Midwife (CM) credential should be eligible to apply to the Iowa Department of Public Health as CPMs or CMs. Certified Midwives (CMs) would be required to complete a minimum supervised out-of-hospital birth experience as outlined by the North American Registry of Midwives (NARM). CPMs would be allowed to practice under a set of protocols that limit their scope of practice. Such practice would exclude the authority to prescribe drugs and to order diagnostic testing.

The committee recommended that the director of the Department of Public Health establish a Midwifery Advisory Council composed of professionals currently in clinical practice, including two board certified physicians (one whom should be a Board Certified Obstetrician, with the other to be determined by the Director-either Board Certified Pediatrician or Board Certified Family Practice physician); one licensed Certified Nurse Midwife; two Certified Professional Midwives; and two public members.

The committee recommended that the Iowa Department of Public Health direct the Midwifery Advisory Council to formulate regulations for the practice of direct entry midwifery to include, but not be limited to:

• Certification by North American Registry of Midwives (CPMs) and/or the American College of Nurse Midwives (CMs with stipulated home birth experiences as outlines by NARM);
• Current neonatal resuscitation program certification;
• Protocol for review of clinical practice;
• Protocol for disciplinary action;
• Procedures for data collection and submission that include risk assessment and outcome data related to both mother and child.

The advisory council would also function to formulate clinical practice protocols to include, but not be limited to:

• Mandatory consultation with a licensed provider of obstetric services or certified nurse midwifery for risk assessment a least two times during the pregnancy;
• Mandatory statement by the midwife that the client is strongly encouraged to seek consultation with a licensed provider of child health services for the infant within a week of the birth;
• Rigorous and ongoing risk assessment with mandatory consultation and/or referral to either a licensed provider of obstetric services, certified nurse midwife, or licensed provider of child health services as appropriate; and
• Written informed consent that includes a written, emergency backup plan.

This recommendation goes to the legislature. A determination will be made about drafting legislation to implement the recommendation.

For those of you who somehow missed the Iowa Caucus results . . .

Senator Hatch dropped out of the race today.

• Including the right to sue insurors or HMOs in the Patients Bill of Rights (See SF 276 PATIENT PROTECTION passed last session).
• Prohibiting the use of genetic testing to limit or reject health insurance coverage
• Expanding coverage for children and the disabled by requiring insurers to offer coverage for anesthesia and other hospital charges related to dental care. (See SF 2034)

Senator Gronstal said that the right-to-sue provisions are similar to those signed into law in Texas by Governor George Bush. He said that those provisions have lead to only six lawsuits in three years and that he expects support from the Republicans for those provisions.

HSB 545 CAMPAIGN LAW UPDATES (State Government) Changes language to meet with current constitutional requirements. Prohibits making knowing false statements on campaign reports. Prohibits any person from using public resources in a campaign. Signs: Conforms the sign law with constitutional requirements. Allows signs to be placed on rented corporate property. Makes removing signs without permission a violation of campaign laws. Other: Contains other provisions. (Ethics and Campaign Disclosure Board)
Gipp (C), Arnold, Chiodo, Jager, Jochum, O’Brien, Van Engelenhoven

HSB 546 MEDICAID PAYMENTS TO DOCTORS (Human Resources) Requires that the DHS adopt rules to entitle doctors to receive payments for services for Medicaid recipients, subject to federal law and funds available in the Medicaid program.

Boddicker (C), Lord, Foege

SF 2046 MINIMUM WAGE RAISE (Bolkcom, et al) Raises the minimum wage to $6.15 on January 1, 2001 and $7.15 on January 1, 2002. Makes the minimum training wage $5.15 1/1/20001 and $6.15 on 1/1/2002.

HF 2062 GUARDIAN MEDICAL POWERS (Hahn; Companion to SF 2007) Allows a guardian to authorize the use of anesthesia for a ward for professional care, if necessitated by the disability of the ward. Exempts such professional care from the definition of major elective surgery or non-emergency medical procedures. (Judiciary)

SF 2034 COVERAGE OF DENTAL CARE (McCoy, et al) Requires that health benefit coverage include coverage for anesthesia and other hospital charges related to dental care for children, the disabled or a person with a condition which requires hospitalization and treatment.

HSB 538 INSPECTION & APPEALS DUTIES (State Government) Health Facilities Division: Codifies the responsibilities of the Health Facilities Division within Department of Inspections and Appeals. Inspections Divisions: Removes obsolete duties of Audits, Inspections, & Investigation Division. Codifies inspections of hospitals, other types of health care centers, and child foster care facilities. Adds inspections and licensing of social and charitable gambling. (DIA)
Van Engelenhoven (C), Houser, O’Brien