LEGISLATIVE CONNECTION
A communication of the Iowa Nurses Association
A benefit of membership
Volume 5, Number 11, March 28, 2003

Connecting with Nurses on Health Issues

BOARD OF NURSING PROPOSED TO GET FUNDING INCREASE

Joint House and Senate Appropriations Subcommittee on Health and Human Services met Wednesday evening to discuss the budget numbers for appropriations. The budget numbers show no increases over last year's budget. However, in discussion, the co-chairs, Sen. Maggie Tinsman (R-Davenport) and Rep. David Heaton (R-Mt. Pleasant) announced that the bill would reflect some adjustments for the Board of Nursing. Committee chairs would allow that the Board of Nursing could raise the RN and LPN license fees by $5/year; i.e. $15 in a 3 year license. Based upon one-third of the licensees paying the increase, approximately $200,000 would be raised and could be retained by the Board for hiring two investigators. 90% of the new funds raised would go to the Board of Nursing while 10% of the new funds would go to the General Fund. INA staff wants to thank the graduate students at Drake students for their second visit to the Capitol after Nurse Lobby Day to encourage such language. Your emails, letters, phone calls and personal contacts do make a difference! The actual bill has not been introduced as of March 28.

VOTE COUNT ON ARNPS BILL
The vote on HF 479 was 88-9 in the House on March 20. The following individuals voted against the bill (not supportive to the nurses' position): Ford, Hansen, Jacobs, Kramer, Lykam, Miller, Olson, D., Raecker and Roberts. Absent: Mertz, Taylor, D. and Taylor, T. Please thank your Representative for their favorable vote. They need recognition for supporting nurses. While the Senate took up SF 410 from the Senate calendar and substituted HF 479, there was a challenge to debating the bill on Wednesday since the Senate rules state that no House File can be debated during the 11th week. Your contacts to Senators are needed to ensure passage of HF 479. If you have not yet made contact, please do it as soon as possible. The physicians are calling and attending local legislative forums to oppose passage.

COLLEGE/COMMUNITY TUITION
Democrats said that the funding levels in the HF 632 EDUCATION APPROPRIATIONS bill will lead to "double-digit tuition increases" at the three state universities. They said that the HF 632 will cut funding to the universities by $25 million when salary increases are factored in. Rep. Myers said that tuition has increased by 39% over the last two years, and that the Legislature needs to work towards helping more students attend college. Senator Gronstal said that Iowa community colleges have the highest tuition rates in the country and they need more help from the state in order to be a source for of skilled workers for the Iowa economy. Both Democrats said that the Legislature should restore money to tuition grants for Iowa colleges and appropriate $2.8 million for college work-study programs. Myers said that the state could look at using the $47 million that will go into the reserve funds this year to fund the programs; Gronstal said that the Legislature could approve combined corporate reporting and the internet sales tax provisions to bring in $50 million. Rep Gipp said that HF 632 does not cut the appropriation for higher education and that the salary bill levels have not been set, so the $25 million figure is speculative. Gipp said that the underlying cause of education budget problems is the recent contract with state employees which costs too much. He said that the universities raised tuition more than needed last year, and do not have to raise tuition as much as the Democrats have predicted in order to balance their budgets.

NATIONAL MEDICAID REFORM TASKFORCE
Governor Vilsack has been appointed a member of the Governors' Association Medicaid Reform Task Force. The task force will work with the Bush Administration and Congress to strengthen and modernize the current state-federal health care programs for low-income and disabled individuals. individuals.

The task force will be co-chaired by Kentucky Governor Paul Patton and Idaho Governor Dirk Kempthorne. Other members besides Vilsack include Florida Governor Jeb Bush; Indiana Governor Frank O'Bannon; Connecticut Governor John Rowland; MarylandGovernor Robert Ehrlich; Missouri Governor Bob Holden; North Dakota Governor John Hoeven; and New Mexico Governor Bill Richardson.

The Governors' Association has made Medicaid reform its highest priority because of the high costs of the program as currently structured. The association members believe that restructuring Medicaid is one of the most effective actions that can be taken to bring control state budgets expenses. The task force will work to fashion an agreement that is based on NGA's Medicaid reform principles. Those are:

• The Medicare and Medicaid programs are interrelated and any change made to Medicare should be considered in conjunction with reforms to Medicaid.
• The federal government should assume full responsibility for the acute, primary, long-term, and pharmaceutical care of the dual-eligible individuals
• It is also unacceptable for Medicaid to be the only long-term care program in this country. Other sources of coverage whether public or private must be developed.
• States must have greater ability to manage the Medicaid program with respect to eligibility, benefits, cost-sharing, and coordination with private sector insurance.
• Medicaid reform proposals that provide states broader Medicaid program authority should weigh fiscal and health policy implications of the current financing structure, or an alternative approach.
• Efforts to reduce fraud and abuse are essential to safeguarding limited health care resources, but any effort to develop error rates to measure state performance should be strongly opposed.
• To the extent possible, all current waivers should be replaced with clear statutory authority.
• The federal government should pay 100 percent of the cost of any new federal Medicaid mandate.
• The federal cap on the commonwealths and territories should be removed and a federal contribution for commonwealths and territories should be implemented that is comparable to that of the states.

HAVA Bill
The House approved HF 614 which contains the statutory provisions for the Help America Vote Act, as well as a number of other provisions regarding absentee ballots and the transfer of election duties to the Campaign and Ethics Board. The Legislature will need to appropriate $1.2 million this year and $300,000 next year in order to receive the $35 million the federal government is offering to help implement the federal requirements of HAVA.

Democrats have objected to many of the provisions which go beyond the HAVA requirements, but their amendment to strip out those provisions failed.

Rep Jacobs said that the additional provisions are not prohibited by HAVA and she said that will help insure the integrity of voting in Iowa. Jacobs said that the restrictions on absentee ballots are not designed to reduce the number of absentee ballots cast. Jacobs also said that the move to a no-partisan board will allow the Secretary of State to be a "one-stop shop" on business matters, and the Campaign board to be a "one-stop shop" on election matters.

Senator Zieman, who will manage the Senate version (SF 370) said that changes in the bills will increase efficiency by eliminating duplicative absentee ballot requests and by shortening up the times that the ballots can be requested. Zieman said that the earlier poll closing time (8 PM instead of 9 PM) will also save counties money.

Governor Vilsack has said that he has problems with some parts of the bills. Other Democrats are predicting that the bill in its current form will be vetoed.

STATUS OF 2003 LEGISLATIVE AGENDA

1. FUNDING THE BOARD OF NURSING: Appropriate funds to reflect funding of the Board of Nursing with 100% of license and renewal fees collected. (Appropriations history released; Issue Review released; HF 377 failed in the funnel; meeting with committee chair about a 90%/10% sharing plan.)

2. TOBACCO REDUCTION INITIATIVE: Pass an increase of the cigarette excise tax by $1.00 per package to reduce tobacco use by Iowa's youth and strengthen the state tobacco use prevention and control program. (HF 284; SF 144 only taxes cigarettes; HSB 284; exempt from funnel; increasing discussion by legislators to raise the "user fee".)

3. FUNDING OF NURSE RETENTION AND RECRUITMENT PROGRAM: Appropriate funding for the College Aid Commission to support registered nurses increasing their education to become nursing faculty and to support recruitment. (HF 436 introduced; exempt from funnel which recommends $500,000 from Senior Living Trust Fund)

4. MANDATORY OVERTIME: Pass legislation similar to that passed in Maine, Maryland, Minnesota, New Jersey, Oregon, Texas and Washington State which bans or severely limits the use of mandatory overtime as a staffing measure and which is defined as being compelled or forced to work hours beyond agreed upon assignments by threat of discrimination, dismissal, licensure discipline and/or other sanctions. (SF 174 died in funnel )

5. MENTAL HEALTH PARITY: Pass legislation providing for parity in health insurance for mental health to be no different than physical health coverage, with recognition for children and adolescents including services for chemically dependent and appropriate housing for individuals with persistent mental illness. (HF 627)

6. ASSISTED LIVING. Pass legislation that assures that registered nurses are available and utilized to provide services at their level of education to assess and evaluate residents and participate in policy-making discussion about the tenant's choice to stay in assisted living as long as they meet the criteria for the level of care; not forcing tenants to a higher level of care by unduly restrictive state regulations. (HF 582)

Public Policy Priorities

1. Support adequate funding of Medicaid and Hawk-I program. Appropriate sufficient resources for programs that provide services to the poor. (HF 49 now HF 565, SJR 4 proposes a redesign)

2. Recognize ARNPs as Medicaid Primary Care Providers. Pass legislation that recognizes advanced registered nurse practitioners (ARNPs) as primary care providers under the Medicaid Managed Care Program which covers 85% of the Medicaid enrollees. (HF 479 on Senate Calender)

3. Medical Privacy: Pass legislation that modifies Iowa Code Section 622.10 to prohibit the release of medical records as "evidence". (HSB 207 by Attorney General's Office failed in funnel)

Other Bills Tracked Still Alive

4. Criminal History Checks Prior to Licensure. SF 235 5. Elimination of CON for Birth Centers: Seeking to amend SF 415 to add. 6. Disaster Preparedness: HF 396 passed House 95-0 on March 18; in Senate Human Resources 7. Dept of Public Health Omnibus Bill (allows ARNP to sign immunization waivers and no exemption for licensure for student nurses performing nursing activities): HF 641. 8. Child Abuse Regulation Changes: HF 206, HF 320 survived 9. Elder Abuse Regulation Changes: SF 132 survived 10. IPERS Changes: HF 398 survived. 11. Public Employee Collective Bargaining: SF 313 debated by Senate and amended.

Bills to the Governor
HF 503 ANESTHESIA BY PODIATRISTS - Authorizes a podiatric physician to give local anesthesia and allows a podiatric physician to administer conscious sedation in a hospital or surgical center.

The Senate PASSED the bill, 47-0; it now goes to the Governor SF 355 ANESTHESIA BY PODIATRISTS - WITHDRAWN

FLOOR ACTION

House Floor Action
The text of the Bills and amendments can be found by going to www.legis.state.ia.us "Tracking Legislation". Contact your legislator by going to "Find Your Legislator" on the Homepage.

SF 357 HOSPITAL TRUSTEES - Requires candidates for hospital trustee be residents of the area served by the hospital. Allows hospital trustee boards to fill vacancies until the next election. Requires a special election if a petition is filed within fourteen days of the appointment. The House PASSED the bill 94-0; it now goes to the Governor HF 528 HOSPITAL TRUSTEES - WITHDRAWN

HF 614 VOTING CHANGES - Makes changes necessary under the federal Help America Vote Act (HAVA) of 2002. The House PASSED, as amended, 53-44; it now goes to the Senate

HF 567 ENVIRONMENTAL HEALTH SPECIALIST - Allows the county Board of Supervisors to appoint an environmental health specialist to enforce laws related to solid waste and littering. related issues. Allows the specialist to enter all public lands in the county, except within cities. Makes interference with the specialist a simple misdemeanor.

The House PASSED the bill, 87-3; it now goes to the Senate HF 251 - WITHDRAWN

HF 655 ADMINISTRATION & REGULATION
Appropriates from the General Fund for the offices of the Governor and Lt. Governor, the Dept. of General Services, Dept. of Appeals & Inspections, Dept. of Management, Dept. of Personnel and other regulatory and administrative agencies. Total: $86.6 million; Operations: $86.58 million, Standings: $28,166. Dept. of Inspections & Appeals: Total $7.3 million, Administration $712,000; Hearings $496,000 ; Investigations $1.4 million; Health Facilities $2.2 million; Inspections $749,000; Employment Appeals Board $33,000; Child Advocacy $1.7 million, plus Racing & Gaming $3.8 million; H-1138 by Lykam - Increases funding to the Governor's recommendations. FAILED
H-1139 by Murphy - Decreases the appropriation to the Auditor by $105,000 and appropriates the money to the Department of Management for REC reporting. FAILED 45-51
H-1142 by D. Olson - WITHDRAWN
The House PASSED the bill, 55-43; it now goes to the Senate

HF 560 MEDICAL ASSISTANCE WAIVERS - Lets a provider of services under a Medical Assistance Home and Community-Based Services waiver end the contract of a person providing care if the provider finds the contractor hasn't provided the services.
H-1125 by Heaton - Requires the county of legal settlement, or the state in other cases, to pay the non-federal costs for certain transportation costs under a waiver. ADOPTED
The House PASSED the bill, as amended, 96-0; it now goes to the Senate HF 383 MEDICAL ASSISTANCE WAIVERS - WITHDRAWN

Senate Floor Action
Deferred On:

HF 479 ADVANCED NURSE PRACTITIONERS - Lets advanced nurse practitioners be providers of health care services including primary care for medical assistance managed care or prepaid service contracts. States that the bill does not expand the scope of practice for advanced nurse practitioners.
The Senate deferred on the bill after substituting it for SF 410.

SF 386 SCHOOL INSURANCE - Requires the Insurance Division to review health insurance coverage for school districts, including availability, ratings practices, continuity of coverage, and other matters.. Requires a review of alter natives by a school health insurance reform team, selected by the Insurance Commissioner, which include the a number of specified representatives.
S-3088 by Kreiman & Boettger - Puts a representative of AEAs on the school health insurance reform team. ADOPTED
The Senate PASSED the bill, 49-0; it now goes to the House

SF 416 DEPENDENT ELDER ABUSE - Establishes an emergency shelter and support services demonstration project for dependent adults at risk of abuse to be run by an area agency on aging that is affiliated with a community college and serves 60,000 elders. Makes changes to changes in definitions related to elder abuse, and in reports and other related matters.
S-3076 by Tinsman - Language correction. ADOPTED
The Senate PASSED the bill, 48-0; it now goes to the House

HJR 3 MENTALLY UNFIT VOTERS - Proposes an amendment to the Iowa Constitution striking the voting disqualification for a person who is an idiot or insane and adding language to disqualify someone who is adjudged mentally incompetent from voting. PASSED, 13-0; FM: Courtney
The Senate ADOPTED the Resolution

SF 313 PUBLIC EMPLOYEE COLLECTIVE BARGAINING - Limits scope of collective bargaining with public employees to those items specifically mentioned in code. Requires arbitrators to be Iowa residents and have private sector employment experience. Requires consideration of total compensation including benefits. Requires comparison with private sector as well as public sector employees. Eliminates the public employer's ability to tax as a consideration.

S-3085 by Schuerer -A Strike & Replace: Requires a study for the total compensation for state employees. Includes, as bargaining factors, looking at past collective bargaining agreements, comparisons of total compensation with private sector employees or other public employees doing comparable work, consideration of the economic cost of each item in the proposed agreement, the interests and the welfare of the public, the ability of the employer to finance adjustments without allowing the arbitrator to consider the employer's ability to tax and the general condition of the economy and the employer. Requires that these enumerated bargaining factors be considered for a collective bargaining agreement or arbitrator's decision to be valid.

AMENDMENTS to S-3085
S-3093 by Schuerer - Strikes the consideration of the economy of a whole. ADOPTED
S-3094 by Schuerer - Requires the consideration of private sector employees based on federal labor statistics. ADOPTED
S-3095 by Schuerer & Dotzler - Makes technical changes for the Public Employees Relation Board. ADOPTED
S-3098 by Connolly - Strikes comparisons with the private sector and other public employees. Allows the arbitrator to consider the government's ability to raise taxes, and strikes some of the other economic considerations. FAILED, 22-26
S-3085, as amended, ADOPTED

COMMITTEE ACTION
House Committee Action

House Appropriations: Voted Out:
HF 662 EDUCATION APPROPRIATION (Appropriations) Appropriates funds to the Dept. of Education, the College Student Aid Commission, the Dept. of Cultural Affairs, the Board of Regents and Regent's schools. GF: $914.4 million (Total); $718.0 million (Operations); $147.7 million (Grants & Aid); $48.7 million (Standings); COLLEGE STUDENT AID COMMISSION: $1.175 million (National Guard tuition); $1 million (Student Aid) $472,000 (Teacher forgivable loans); $355,000 (Des Moines University); $289,000 (administration); $225,000 (ACE grants). DEPT. OF EDUCATION: $6.3 million (Public Broadcasting); $5.0 million (administration); $4.2 million (Vocational Rehabilitation Services Division); $2.6 million (school food service); $1.2 million (State Library); $577,000 (vocational education); $197,000 (School to Work); $ 62,000 (Independent living); $43,000 (Educational Examiners); Grants & State Aid: $22.5 million (Total); $14.7 million (Empowerment Fund), $3.3 million (vocational education); $1.9 million (Enrich Iowa Libraries); $1.6 million (regional library); $611,000 (nonpublic school textbooks); $579,000 (National Certification Stipends & Beginning teacher/mentor). $44.3 million (Student Achievement & Teacher Quality) Community Colleges: $140.4 million; including Merged Area I ($6.7 million); Merged Area II ($8.3 million); Merged Area III ($7.4 million); Merged Area IV ($3.6 million); Merged Area V ($7.5 million); Merged Area VI ($7.0 million); Merged Area VII ($10.1 million); Merged Area IX ($12.4 million); Merged Area X ($19.4 million); Merged Area XI ($20.5 million); Merged Area XII ($8.1 million); Merged Area XIII ($8.4 million); Merged Area XIV ($3.6 million); Merged Area XV ($11.4 million); Merged Area XV ($6.4 million). REGENTS: $13.3 million (tuition replacement); $106,000 (Southwest Iowa Graduate Center); $78,000 (Tri-State Graduate Center); $158,000 (Quad-Cities Graduate Center); Institutions: UI: $250.5 million (Total); $222.2 million (salaries & support); $28.1 million (indigent medical services); $7.2 million (psychiatric hospital); $7.0 million (hospital school); $2.7 million (Oakdale); $3.8 million (State hygienic lab); $2.1 million (Family Practice); $918,000 (Biocatalysis); $783,000 (Primary Health Care); $648,000 (Hemophilia & Cancer schools); $185,000 (Cancer Registry); $66,000 (Substance Abuse); (Public Health Initiative) $0 (Agricultural Health & Safety); AMENDED & PASSED, 13-11; FM: Dolecheck

House Human Resources: Assigned to Subcommittee:
SF 416 DEPENDENT ELDER ABUSE - Upmeyer (C), Berry, Boddicker

House Human Resources: Voted Out: SF 303 ABUSE WORKERS - Allows a child abuse worker to not make certain determinations for the need for services or other areas if the worker determines the report was spurious or if there are no protective concerns. PASSED 16 - 0; Floor Manager: Boddicker

House State Government: Voted Out: HF 211 PROGRAM ELIMINATIONS - Implements recommendations from the Program Elimination Commission. PASSED 16 - 5; Floor Manager: Raecker

House State Government: Assigned to Subcommittee: SF 235 CRIMINAL HISTORY CHECKS - Greiner (C), Jones, Petersen

Senate Committee Action

Senate Human Resources: Assigned to Subcommittee:
HF 489 DHS CHANGES - McKinley (C), Ragan, Tinsman HF 457 CHILD TO ADULT TRANSITION - Hatch (C), McKinley, Veenstra HF 557 VOL HEALTH CARE PROTECTIONS - Tinsman (C), Boettger, Horn HF 558 SEX OFFENDERS - Kreiman (C), Hosch, Veenstra HF 565 HAWKI & MEDICAID CHANGES - Tinsman (C), Kreiman, Veenstra HF 575 COUNTY MH REPAYMENT - Schuerer (C), Hatch, Seymour HF 560 MEDICAL ASSISTANCE WAIVERS - Tinsman (C), Ragan, Veenstra

Bills Introduced of Interest to Nurses

Find the bills at http://www.legis.state.ia.us "Track Legislation"

HF 662 EDUCATION APPROPRIATION (Appropriations) Appropriates funds to the Dept. of Education, the College Student Aid Commission, the Dept. of Cultural Affairs, the Board of Regents and Regent's schools. GF: $914.4 million (Total)

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