LEGISLATIVE CONNECTION

The Interstate Compact bill is scheduled for consideration in the Iowa House of Representatives on Monday, February 7. Rep. Clyde Bradley (R-Camanche) is handling the bill.

Please continue to make contacts with your legislators with a phone call, letter or email.

Mental Health Parity Bill Moving

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). A subcommittee composed of Rep. Brad Hansen (R-Council Bluffs), Clarence Hoffman (R-Charter Oak) and Bob Osterhaus (D-Maquoketa) considered the bill on Tuesday afternoon and indicated that House Commerce committee would take the bill up on Thursday afternoon, February 3.

The bill includes coverage for biologically based mental illnesses including: schizophrenia, bipolar disorders, major depressive disorders, schizo-affective disorders, obsessive-compulsive disorders, pervasive developmental disorders and autistic disorder.

There is no listing of providers or treatment settings. Managed care principles can be utilized. Co-insurance and deductibles are applicable if utilized at the same level in the medical/surgical benefit package. It mandates coverage on large group. Does not mandate coverage on small group, but if mental health benefits are included, they must be at the large group employers' mandate level.

The yearly benefit limitations are 30 days inpatient and 52 outpatient visits. Substance abuse is not covered and the bill is effective January 1, 2001.

The Iowa Life and Health Insurance Association drafted the bill at the request of the Speaker of the House and as an association they are neutral on the bill. John Deere Health Insurance is registered in support of the proposal. The Association of Business and Industry and the small employers association, the National Federation of Independent Businesses are actively opposing.

The Mental Health Advocacy Coalition is a coalition of health providers. Along with the Iowa Nurses Association, the group includes psychiatrists, psychologists, social workers, Alliance for the Mentally Ill, the Coalition (consumers), mental health counselors, substance abuse counselors, and marriage and family therapists. The coalition has stated their members could support the bill, House File 2080. The coalition is in the process of expressing concern that the proposal did not include substance abuse. The coalition also agreed that coverage for anorexia, bulimia, anxiety disorders and early childhood psychoses and other disorders diagnosed in childhood should be included. The coalition also would support substitution of partial hospitalization for some inpatient days.

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 is not available yet in bill form.

Proponents of House File 2080 say that a very fragile compromise has been made for the bill. The Speaker of the House and the House Majority Leader have made a commitment to bring the bill as presently drafted to the floor for debate. Contacts with legislators are needed.

EMS Association Seeks Code Changes

In 1999, the EMS Association had House File 392 introduced. The intent was 1) to establish a mechanism for disciplinary action for EMS personnel as individuals; 2) to have the individual recognized for their title an EMS person in the hospital setting whether or not employed as a member of an authorized ambulance service, rescue or first responder service; and 3) to have the legal authority to be available for standby in settings such as standby at football games.

INA representatives sought language to clarify the role of the registered nurse in supervision of the EMS personnel in the hospital setting when the registered nurse is not acting in the capacity of "physician designee" and nursing duties are being delegated to the EMS personnel. The Board of Nursing holds that the registered nurse cannot delegate to the EMS personnel any activity beyond that which is delegated to the licensed practical nurse, otherwise the registered nurse is vulnerable to discipline by the Iowa Board of Nursing for improper delegation.

STATUS OF INA AGENDA

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." Awaiting House debate.
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. No bill, lots of discussion. INA participation in Iowans United for a Healthy Future (IUHF) activities, including meetings with legislative leadership to ask that all funds go to health care purposes.
3. Support parity in health insurance policies for mental health and substance abuse coverage and appropriate housing. House File 2080 introduced; subcommittee will present to House Commerce committee and recommend passage.
4. Assure nursing supervision of emergency medical services personnel when they work in the non-emergency, non-lifesaving acute care settings. INA desired language was agreed to by legislators, EMS Association and the Medical Society.
5. Increase funding for public health nursing/core public health functions. Director of Public Health and Governor recommended $1.5 million, recommendations to Health and Human Rights Appropriations Subcommittee. No appropriations bill yet.
6. No support for legal recognition of direct-entry midwives. Scope of Practice Review Commission recommends legal recognition by registration. Recommendation to the Legislature. Bill would have to be drafted.

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

BILL SUMMARY

HF 2093 CIVIL COMMITMENT PROCEDURES (Kreiman) Requires applicants for substance abuse commitments certify that there is no other pending commitment proceedings. Requires medical evaluation reports be electronically sent to the parties involved before filing a written report in court. Requires hearing held for involuntary commitments be held within five business days from. (Judiciary)

HF 2080 COVERAGE FOR MENTAL ILLNESS (Grundberg, et al) Requires that group health benefit policies include payment for biologically-based mental illness for employers with more than fifty employees, or who meet the guidelines for small employers or for certain public employees. Definitions: Adopts a definition of biologically-based illness which includes schizophrenia, depression, autism, developmental disorders and other illnesses. (Commerce)

SF 2048 HOSPITAL BOARDS (State Government; Successor to SSB 3004) Regulates the terms of new members of a public hospital board when the board expands its membership. Allows boards to establish five-member or seven-member boards and establishes a schedule for staggering the terms of new members.

HSB 580 HMO REGULATION (Commerce) Establishes capitalization requirements and reporting requirements for HMO's (Dept. Commerce - Ins Div.)
Hoffman (C), Shey, Chiodo

SSB 3027 and HSB 580 INSURANCE PAYMENTS (Commerce) Requires HMOs and group insurance policies to pay for services by optometrists, chiropractor, nursing, podiatric physicians at the same level that doctors are paid for such services and to pay for the services of podiatric physicians, including the prescription of drugs, that are within the scope of practice for podiatry, if the policy pays for the services, including the prescription of drugs of doctors. Hansen (C), Lundby, Jensen

HF 2105 NURSING LICENSING COMPACT (Successor to HSB 143) (State Government) Adopts the nurse licensure compact to allow the mutual recognition of nursing licenses by states.

HSB 557 OUTPATIENT MENTAL HEALTH TREATMENT (Judiciary) Establishes procedure and criteria for court ordered outpatient mental health treatment akin to involuntary hospitalizations. Allows for pre-hearing examination by a doctor. Requires Department of Human Services to develop summary of procedures for applicants and respondents. Provides for payment of costs for applications filed without probable cause or good faith belief.
Kreiman (C) Raecker, Kettering

SF 2069 SPECIALIST COVERAGE (Hammond) Prohibits a third-party payor from denying coverage for medical specialists if the patient has a standing referral from a regular physician

1999-2000 Bill List By Subject

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