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LEGISLATIVE CONNECTION

a communication of the Iowa Nurses Association

Volume 4, Number 10
March 16, 2001

TOP STORIES OF THE WEEK

First Funnel Week Finished

Today is the first funnel deadline; the day that policy bills need to be voted out of committee in order to continue to be considered. Appropriations and taxing bills are exempt from this deadline.

Members are encouraged to make contacts on bills of interest. Policy bills (those with no appropriations or taxing) need to be out of the second committee by March 30, otherwise they are "dead" for the session. Legislators seem interested in minimizing the number of bills they handle since they will be taking up redistricting in six weeks.

Redistricting
The Legislative Service Bureau received the numbers for Iowa on Monday and should begin the redistricting process. Redistricting means that an adjustment is made for the new population numbers gathered from the 2000 census within a geographic area. New legislative district lines will be drawn to reflect an equal population represented by each Representative and Senator. Speaker Siegrist said that the Iowa process, where the Legislative Service Bureau draws a map and the Legislature votes on it, eliminates the fighting that occurs in most states. The reapportionment plan will not come to the floor for a vote before late April. Ten years ago, 40 sitting members of the House were mapped into districts against one another. Your legislators may change by the time the 2002 elections are held.

New State Revenue Estimates Are Out
The Revenue Estimating Council issued a new estimate for state revenues in FY 2001 and FY 2002. The REC reduced the estimate for FY 2001, from 3.5% to 0.7%, and reduced the FY 2002 estimate from 4.8% to 4.3%. The lower estimates means that Governor Vilsack will need to submit a new budget for FY 2002 with approximately $330 million in cuts from his previously submitted budget in two weeks. Randy Bauer, the budget director, said that the new budget proposal would almost certainly include shifting $37 million in gambling receipts from RIIF the General Fund. Republicans are unlikely to accept that shift. Cynthia Eisenhauer, one of the three REC members and the Director of the Department of Management, said that she expects the Iowa economy in FY 2002 to bounce back after a slow quarter or two because the Iowa economy is more stable than the national economy.

The Department of Management estimates that the Governor will need to reduce his budget by $285 million. Governor Vilsack said that he would make selected cuts from new initiatives he proposed in his first budget and make the equivalent of a 6% across-the-board cut in the rest of the budget. Vilsack will not propose a 6% cut in every line-item but will require Departments to reduce their overall budgets by 6%. Vilsack is also proposing that the state no longer roll over revenues that go unspent because of the spending limitation but instead put those into a special fund for pre-school and early education programs and to examine all the services and aspects of that state government provides.

Republican leaders said that they will work with the Governor on the new budget. Speaker Siegrist said that this could be a great opportunity for the state to re-examine the activities of government and to get rid of inappropriate or ineffective services. The Republicans have delayed setting their budget targets for FY 2002 because of the expectation that the REC would lower the estimates and reduce the amount available to spend and the possibility that the Governor would need to submit a new budget. Governor Vilsack has said that school aid and additional funds for teacher compensation are of the table when looking for budget cuts.

Governor Vetoed 1% Cut
Governor Vilsack vetoed the 1% across-the-board cut in SF 267 but will approve the other $8.5 million in cuts in the bill. Vilsack said that he item-vetoed the 1% cut because the Legislature failed to carefully determine which programs should be cut.

STATUS OF THE INA AGENDA

1. Health Care Funding: All tobacco settlement money for health care purposes.
The above stories on the state of the state budget give an understanding of the tightness of the budget for program funding. Conversations with legislators indicate efforts continue to "securitize" the tobacco settlement funds as an effort to maintain a long range revenue stream for health care funding in the state.

2. RN and LPN Pronouncement of Death
House File 354 was introduced into the Senate and assigned to Senate Human Resources Committee, which is chaired by Sen. John Redwine, a physician from Sioux City. Other subcommittee members are Sen. Nancy Boettger of Harlan and Sen Pat Harper of Waterloo.

3. No support for Direct-Entry Midwives (non-nurse midwives)
HF 200 has been introduced and assigned to an unfavorable committee, Commerce and Regulation. It is not expected to move.

Other Bills on Issues on Watch:
Mental Health & Substance Abuse Parity: House File 107/Senate File 137 covers neurobiological conditions and calls for a substance abuse study. In these bills the conditions listed are diagnostic categories and driven more by clinical insight and are clinically consistent with proven efficacy and effectiveness of treatment. The bills were not recommended for passage primarily due to the large premium increase many Iowa employers received. The business community actively worked against them citing large premium increases and their desire for no mandated coverage.

Verbal Orders: SF 242 would extend the length of time for a prescribing practitioner to sign a verbal order from 72 hours to 30 days after discharge. This bill is currently on the Senate calendar awaiting debate.

MAKING CONTACT

Attend local town hall meetings evenings or on Saturdays as locally scheduled.

Phone Numbers for leaving a message:
Governor's Office 515/281-5211
Iowa House of Representatives at 515/281-3221
Iowa Senate at 515/281-3371

Website Contacts for sending emails or regular letters: www.state.ia.us/governor/ On the "Office of Governor" page, go to "Desk Tops" on left side and hit "Comments", this brings up the "Comments Desk" and #3 is the email hot button.
www.legis.state.ia.us On the "Welcome to the Iowa General Assembly" page, go to "Members", then "Find Your Legislator" and you can type in your street address, city and zip code to get to your Congressional and state senator and representative names, phone numbers and email addresses.

Deanna McCallum and Linda Goeldner are the INA registered lobbyists. To learn more about the nursing agenda or nursing issues, call the INA office at 515/225-0495 or email either at DmcCall34@aol.com or Lkgoeld@aol.com.

BILLS PASSED OF INTEREST TO NURSING

Bills Signed by the Governor
HF 192 DIA APPLICANTS BACKGROUND CHECKS - Authorizes the Department of Inspections and Appeals to conduct criminal and child abuse background checks of applicants for employment by the Department.

House Debate
HF 341 INFORMED CONSENT - Creates new code section known as the "Woman's Right to Know Act. Requires informed consent from women including information a doctor is required to provide prior to the medical termination of a pregnancy. Makes a medical emergency exception. Makes it a simple misdemeanor for a doctor to violate informed consent provisions. Effective October 1, 2001.
Numerous amendments to the bill were debated. The House PASSED the Bill, as amended, 66-31; it now goes to the Senate.

BILLS IN COMMITTEE OF INTEREST TO NURSING
Use the website address above to find 1) the bill language and 2) the email address for the legislators listed below. Legislators serving on the following subcommittees are the individuals to whom comments should be initially made. Legislators give first priority to those living in their House or Senate District. Make sure the legislator knows you are a registered nurse.

House Education Committee - Voted out:
HSB 218 AEA REORGANIZATION OR DISSOLUTION - Allows for two or more Area Education Agencies to voluntarily reorganize, an AEA to begin dissolution. Requires an AEA to begin dissolution if petitioned by 20% of school district board members served by the AEA. Establishes dissolution procedures and procedures for a newly formed AEA. Floor Manager: Tymeson

House Human Resources: Voted Out:
HF 45 MEDICAID ELIGIBILITY - Makes all individuals with disabilities who earn less than 250% of the federal poverty line income eligible for discretionary Medicaid. Floor Manager: Grundberg

HF 331 AIDS TESTING - Allows for AIDS testing of individuals receiving assistance from care givers or from persons giving emergency first aid on a voluntary basis and without compensation. Floor Manager: Carroll

HF 344 CHILD PROTECTION CENTER - Creates within the DPH the Child Protection Center Grant Program with grants awarded by the state Board of Health. Allows grants in the five DHS regions served by a Child Protection Center. PASSED, 21-0; Floor Manager: Hoversten

HF 406 SAFE HAVENS - Allows a parent to voluntarily surrender the custody of a child who is four days old or younger at a hospital or other health care facility. Gives the parent immunity from prosecution if the infant is not harmed. Requires the county attorney to proceed with efforts to terminate parental rights as soon as practical. Grants immunity to the individual who receives the child and allows that individual to receive the notice of any hearings. Effective upon enactment. Floor Manager: Barry

HF 510 PEER REVIEW - Defines "Peer Review Activity" related the non-liability of persons serving on a Peer Review Committee. Adds to the definition of "Peer Review Committee" members of nursing facilities. Adds nursing facility administrators to the list of persons that may be sued for personal injuries. PASSED, 20-1; Floor Manager: Roberts

HF 531 ADULT DAY SERVICES OVERSIGHT - Direct the Department of Elder Affairs to develop an adult day services oversight system in cooperation with the DIA, DHS, DPH, area agencies on aging, industry representatives, and consumers to study adult day services issues. PASSED, 21-0; Floor Manager Brunkhorst

HSB 166 CENTRALIZED CHILD ABUSE REPORTING - Requires the DHS to create a statewide central intake unit for child abuse reporting. Requires the use of a toll-free number and staff trained to take child abuse reports. AMENDED & PASSED, 21-0; Floor Manager: Hoversten

HSB 180 DEPT PUBLIC HEALTH TECHNICAL BILL- Allows the DPH to grant per diem expenses to ad hoc committees. Makes corrective changes in Nurse Practice Act to assure no unlicensed individual can use title and initials of RN or LPN and other technical amendments AMENDED: Corrective Changes; PASSED

HF 47 DRUG TEST ORDERS - Allows a juvenile court to issue an ex parte order that a child who has been exposed to illegal drugs be tested to determine if illegal drugs are in the child's system. PASSED, 21-0; Floor Manager: Boddicker

HF 444 CHILD ABUSE ASSESSMENT REPORTS - Directs that after a Child Protection Worker determines a child abuse report was spurious or that no protective concerns are present, that the Assessments Report need not include identification of strengths and needs of the child or the services available to address the strengths and needs. PASSED, 15-6; Floor Manager: Kreiman

HSB 73 ABUSE REPORTER TRAINING - Requires training for mandatory reporters of child and dependent adult abuse. Requires licensing boards to training procedures for mandatory reporters. AMENDED & PASSED, 21-0; Floor Manager: Hoversten

HSB 203 PHYSICIAN ASSISTANT LICENSING - Requires physician assistants be licenses, not just registered. Makes the Physician Assistants Board the governing body of the profession. Eliminates the physician assistants rules review group and appeal rights of physician assistants to the Medical Board. AMENDED & PASSED, 21-0; Floor Manager:Tymeson

House Local Government Committee - Voted out: HF 411 HOSPITAL BOARD TRUSTEES - Allows persons with medical staff privileges or receives compensation greater than $1,500 to serve on county public hospital boards. AMENDED & PASSED, 20-0; Floor Manager: Sievers

HSB 207 COMMUNITY EMPOWERMENT BOARDS - Lets an AEA be the fiscal agent for a community empowerment board. Makes the empowerment board administrator for funds from DHS child abuse prevention grants and pregnancy prevention grants. AMENDED & PASSED, 21-0; Floor Manager: Johnson

House Commerce Committee: Assigned to Subcommittee:
HF 531 ADULT DAY SERVICES OVERSIGHT - Brunkhorst (C), Reynolds, Tymeson
HF 149 UNAUTHORIZED PATIENT DISCHARGE - Hansen(C), Shey, Schrader
HF 153 NEUROBIOLOGICAL COVERAGE - Hansen(C), Osterhaus, Johnson
HF 198 HEALTH CARE FINANCIAL INCENTIVES - Hansen(C), Bradley, Chiodo
HF 285 CONSUMER PRIVACY - Raecker(C), Johnson, Quick
HF 319 HAWK-I ELIGIBILITY - Hansen(C), Osterhaus, Shey
HF 487 HEATH INSURANCE INCREASE NOTICE - Hoffman(C), Peterson Bradley
HF 488 MAMMOGRAPHY COVERAGE - Hansen (C), Hoffman, Petersen
HF 489 MANAGED HEALTH PLANS INDEMNIFICATION - Hoffman(C), Hansen, Osterhaus
HF 491 MENTAL ILLNESS COVERAGE - Hansen(C), Schrader, Shey
HF 528 DOMESTIC ABUSE INSURANCE DISCRIMINATION - Hansen (C), Chiodo, Hoffman
HF 558 HIV TESTING - Carroll (C), Hoversten, Murphy

House Judiciary: Voted Out:
HF 563 MENTAL HEALTH COURT STUDY - Directs the Judicial Branch to study creating a Mental Health Court and report back to the General Assembly by October 1, 2002. Floor Manager: Grundberg

Senate Commerce: Voted Out:
SF 232 PRESCRIPTION DRUG CARDS - Requires the use of a uniform prescription card by providers of third-party payment or by prepayment of prescription drug expenses. PASSED, 14-0; Floor Manager: Redwine

Senate Commerce: Assigned to Subcommittee:
SF 421 GENETIC TEST PROHIBITIONS - Redwine (C), Flynn, King

Senate Human Resources: Assigned to Subcommittee:
HF 310 CHILD SUPPORT ENFORCEMENT - Miller (C), Bartz, Holveck
HF 341 INFORM- CONSENT - Redwine (C), Behn, Harper
SF 368 FAMILY CHILD CARE REGISTRATION - Tinsman (C), Bartz, Dvorsky
SF 370 ADULT DAY SERVICES OVERSIGHT - Veenstra (C), Boettger, Shearer
Senate Human Resources Voted Out:
SSB 1017 BIRTHING CENTER FEES - Eliminates hospital and birthing center licensing fees from the Code. Authorizes the Department of Inspections & Appeals to establish a hospital fee schedule and to set birthing center license fees by rule. Establishes the initial license fee for hospitals at $1,000 and for birthing centers at $15. PASSED, 11-0; FM: Miller See SF 393
SSB 1187 BIRTH CENTERS - Repeals the Code provisions regarding birth centers and makes conforming changes. PASSED, 10-1; FM: Schuerer See SF 390
SSB 1213 CHILD ABUSE INTAKE REPORTS - Requires DHS to establish a statewide intake unit for the first reports of child abuse. Requires the intake unit to receive single statewide toll-free phone number. Requires the unit's staff to have special training and to receive calls 24 hours a day, seven days a week. PASSED, 13-0; Floor Manager: Redwine
SSB 1214 DPH CHANGES - Designates GHB (Gamma-hydroxybutyric acid) as a controlled substance. Allows the DPH to grant per diem expenses to ad hoc committees. Makes corrective changes dealing with Licensed Practical Nurses, barber assistants, and continuing education requirements for optometrists. AMENDED & PASSED, 13-0 Changes certain provisions regarding the duties for some employees and requires them to be certified and not just trained. Floor Manager: Tinsman
SCR 12 OBESITY - Requests the Director of Public Health to review the effects of obesity and to report on programs to increase awareness of obesity.

Senate Judiciary: Voted Out:
HF 228 PUBLIC SAFETY - Building Code: Requires governmental subdivisions that accept the applicability of the state building code to file a certified copy of the ordinance with the Commissioner of Public Safety. Background Check: Requires the Department of Human Services to notify the residential care or nursing facility upon finding an employment applicant has a child or dependent adult abuse, or criminal record. Requires nursing homes to do background checks for new hires. PASSED, 14-0; FM: Angelo
SSB 1219 SUBSTANCE ABUSE TREATMENT - Requires the Department of Public Health to establish a substance abuse treatment facility for persons who are on probation. Requires the DPH and the DOC to execute a 28E agreement for structured substance abuse treatment. Allows a judicial district, with the permission of the DPH, to place a person at a substance abuse facility. PASSED, 14-0; Floor Manager: Maddox
SSB 1205 TOBACCO ENFORCEMENT - Transfers the authority for tobacco licensing authority within the Alcoholic Beverages Division. Allows the division to keep 35% of licensing fees for enforcement purposes. Consolidates tobacco enforcement laws into one Code chapter. Requires a minor who is issued a citation for tobacco use to appear before a magistrate. Makes other changes. PASSED, 12-0; FM: McKean

Senate State Government: Voted Out
SSB 1174 PHYSICIAN ASSISTANTS - Provides that a P.A. practices medicine with the supervision of physicians rather than under the supervision of a specific physician. Strikes provisions and rules regarding the P.A. rules review group and regarding the eligibility of a physician to serve as a supervising physician. Makes changes to the certification of P.A.'s Contains related provisions. PASSED, 15-0; FM: Rittmer

SSB 1247 IPERS CHANGES - Creates the IPERS Division within the Department of Personnel with all the powers necessary to manage the Fund. Requires the Division CEO to have pension fund management experience and subject to Senate confirmation. Makes the Investment Board the Trustee of the IPERS Retirement Fund and is allowed to set investment policy to be carried out by the Division. Eliminates the Director of the DOP as a Investment Board members and makes the state Treasurer a voting member of the Board. Makes the legislative members of the Board non-voting members. Changes the qualifications of various board members. Establishes transition Board membership. PASSED, 14-0 ; FM: Drake

Senate Rules: Voted Out:
SCR 15 OBESITY - Requests the Director of Public Health to review the effects of obesity and to report on programs to increase awareness of obesity. PASSED, 7-0

Senate Transportation Voted Out: (1)
SF 291 CHILD SEAT BELTS - Requires that children who are at least 3 and under the age of 7 to be secured by a federally approved child restraint system. Requires children between the ages of 6 and 13 to wear seatbelts regardless of where they are in the vehicle. Makes violations punishable by a $50 fine. AMENDED & PASSED; Reduces the scheduled fine to $25. Makes language changes. Floor Manager: Dvorsky

BILLS INTRODUCED OF INTEREST TO NURSING
Resolutions:
SCR 16 OBESITY (Human Resources; Successor to SCR 12) SCR 12 Requests the Director of Public Health to review the effects of obesity and to report on programs to increase awareness of obesity.
House Files:
HF 563 MENTAL HEALTH COURT STUDY (Grundberg) Directs the Judicial Branch to study creating a Mental Health Court and report back to the General Assembly by October 1, 2002. (Judiciary)

HF 590 AIDS TESTING (Human Resources; Successor to HF 331) Allows for AIDS testing of individuals receiving assistance from care givers or from persons giving emergency first aid on a voluntary basis and without compensation. (Calendar) FM: Carroll
HF 591 MEDICAID ELIGIBILITY (Human Resources; Successor to HF 45) Makes all individuals with disabilities who earn less than 250% of the federal poverty line income eligible for discretionary Medicaid. FM: Grundberg
HF 593 SAFE HAVENS (Human Resources; Successor to HF 406) Allows a parent to voluntarily surrender the custody of a child who is four days old or younger at a hospital or other health care facility. Gives the parent immunity from prosecution if the infant is not harmed. Requires the county attorney to proceed with efforts to terminate parental rights as soon as practical. Grants immunity to the individual who receives the child and allows that individual to receive the notice of any hearings. Effective upon enactment. (Calendar); FM: Barry
HF 596 CHILD WORKERS (Mascher) Makes restrictions on 16 and 17 year old minors working before 7 a.m. and after 9 p.m. during the school year and places limits on the number of hours they may work. Allow the Labor Commissioner to impose civil fines up to $10,000 for violation. (Labor)
HF 598 CHILD PROTECTION CENTER (Human Resources; Successor to HF 344) Creates within the DPH the Child Protection Center Grant Program with grants awarded by the state Board of Health. Allows grants in the five DHS regions served by a Child Protection Center. (Calendar) FM: Hoversten
HF 606 MEDICAL INFORMATION (Dotzler) Makes medical information contained in medical records the property of the patient. Prohibits the release of such information for marketing purposes. (Commerce)
HF 626 HEALTH INSURANCE (Tremmel) Defines several terms related to third-party payor health insurance payments. Establishes duty of care standards for third-party payors and creates defenses. Prohibits third-party payors from denying coverage or renewal of a health care provider for advocating medically necessary service. Prohibits indemnification and hold harmless clauses. (Commerce)

Senate Study Bills:
SSB 1213 CHILD ABUSE INTAKE REPORTS (Human Resources) Requires DHS to establish a statewide intake unit for the first reports of child abuse. Requires the intake unit to receive single statewide toll-free phone number. Requires the unit's staff to have special training and to receive calls 24 hours a day, seven days a week.
Redwine (C), Hammond, Boettger
SSB 1214 DPH CHANGES (Human Resources) Designates GHB (Gamma-hydroxybutyric acid) as a controlled substance. Allows the DPH to grant per diem expenses to ad hoc committees. Makes corrective changes dealing with Licensed Practical Nurses, barber assistants, and continuing educational requirements for Optometry. (DPH) Boddicker (C), Hoversten, Atteberry
SSB 1219 SUBSTANCE ABUSE TREATMENT (Judiciary) Requires the Department of Public Health to establish a substance abuse treatment facility for persons who are on probation. Requires the DPH and the DOC to execute a 28E agreement for structured substance abuse treatment. Allows a judicial district, with the permission of the DPH, to place a person at a substance abuse facility.
Maddox (C), Hammond, McKean
SSB 1247 IPERS CHANGES (State Government) Creates the IPERS Division within the Department of Personnel with all the powers necessary to manage the Fund. Requires the Division CEO to have pension fund management experience and subject to Senate confirmation. Makes the Investment Board the Trustee of the IPERS Retirement Fund and is allowed to set investment policy to be carried out by the Division. Eliminates the Director of the DOP as a Investment Board members and makes the state Treasurer a voting member of the Board. Makes the legislative members of the Board non-voting members. Changes the qualifications of various board members. Establishes transition Board membership. (Governor) Drake (C), Rittmer, Kibbie

Senate Files:
SF 390 BIRTH CENTERS (Human Resources; Successor to SSB 1187) Repeals the Code provisions regarding birth centers and makes conforming changes. FM: Schuerer
SF 394 BIRTHING CENTER FEES (Human Resources; Successor to SSB 1017)Eliminates hospital and birthing center licensing fees from the Code. Authorizes the Department of Inspections & Appeals to establish a hospital fee schedule and to set birthing center license fees by rule. Establishes the initial license fee for hospitals at $1,000 and for birthing centers at $15. FM: Miller
SF 397 RESUSCITATION ORDERS (Lundby) Creates the Resuscitation Status Orders Act. Defines resuscitation order. Determines who may consent to an order. Allows the DPH to determine the forms for such orders. Specifies the provisions for the revocation of an order. (Human Resources) Schuerer (C), Harper, Miller
SF 410 INDOOR EMISSION SOURCES (Natural Resources; Successor to SSB 1161) Prohibits the Department of Natural Resources from regulating indoor air emission sources. Defines such indoor emission sources. FM: Sexton
SF 428 CHILD ABUSE INTAKE REPORTS (Human Resources; Successor to SSB 1213) Requires DHS to establish a statewide intake unit for the first reports of child abuse. Requires the intake unit to receive single statewide toll-free phone number. Requires the unit's staff to have special training and to receive calls 24 hours a day, seven days a week. FM: Redwine
SF 432 CHILD SEAT BELTS (Transportation; Successor to SF 291) Requires that children who are at least 3 and under the age of 7 to be secured by a federally-approved child restraint system. Requires children between the ages of 6 and 13 to wear seatbelts regardless of where they are in the vehicle. Makes violations punishable by a $25 fine. FM: Dvorsky
SF 433 DPH CHANGES (Human Resources; Successor to SSB 1214 ) Designates GHB (Gamma-hydroxybutyric acid) as a controlled substance. Allows the DPH to grant per diem expenses to ad hoc committees. Adds LPNs and RNs to the list of certain health professionals under the Iowa Code who receive licensing information from the DPH electronically. Makes corrective changes dealing with water purification systems, hearing aid dispensers and barber assistants. FM: Tinsman
SF 442 ASSISTED LIVING PROGRAMS (Tinsman) Creates enforcement provisions for certified and voluntarily accredited assisted living programs. SF 448 SUBSTANCE ABUSE TREATMENT (Judiciary; Successor to SSB 1219) Requires the Department of Public Health to establish a substance abuse treatment facility for persons who are on probation. Requires the DPH and the DOC to execute a 28E agreement for structured substance abuse treatment. Allows a judicial district, with the permission of the DPH, to place a person at a substance abuse facility. FM: Maddox
SF 452 PRESCRIPTION DRUG CARDS (Ways & Means; Successor to SF 232) Requires the use of a uniform prescription card by providers of third-party payment or by prepayment of prescription drug expenses. Requires the Insurance Commissioner to adopt rules (Commerce)
SF 457 TOBACCO ENFORCEMENT (Human Resources; Successor to SSB 1205) Transfers the authority for tobacco licensing authority within the Alcoholic Beverages Division. Allows the division to keep 35% of licensing fees for enforcement purposes. Consolidates tobacco enforcement laws into one Code chapter. Requires a minor who is issued a citation for tobacco use to appear before a magistrate. Makes other changes. FM: McKean
SF 467 PHYSICIAN ASSISTANTS (State Government; Successor to SSB 1174) Provides that a P.A. practices medicine with the supervision of physicians rather than under the supervision of a specific physician. Strikes provisions and rules regarding the P.A. rules review group and regarding the eligibility of a physician to serve as a supervising physician. Makes changes to the certification of P.A.'s Contains related provisions. Rittmer

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