LEGISLATIVE CONNECTION
A communication of the Iowa Nurses Association
A benefit of membership
Volume 5, Number 12, April 4, 2003

Connecting with Nurses on Health Issues

BOARD OF NURSING PROPOSED TO GET FUNDING INCREASE

The House Appropriations Committee took up HSB 309 on Thursday, which appropriates money to the Departments of Health, Elder Affairs and Human Services. In the bill there is a provision that allows the Board of Nursing to increase nursing license fees by $15 ($5/year) to $96 for a three-year license.

The Board of Nursing renews an estimated 12,384 licenses each year. The additional revenue generated will be $185,769. Of this amount the Board will retain $167,192 (90%) and $18,576 (10%) will be deposited into the General Fund. The bill was passed out of committee with no debate on this issue. It moves to the floor of the House for consideration.

ARNP BILL TO THE GOVERNOR!!!
The final vote on HF 479 by the Senate on April 2 was 38-12. Three amendments were offered. The first amendment would have required a written collaborative agreement with a primary care physician. Voting for the amendment 14-36 (against nursing) were: Black, Brunkhorst, Dearden, Gronstal, Hatch, Holveck, Johnson, Kettering, Kramer, Lamberti, Larson, Quirmbach, Rehberg and Seng. The second amendment was withdrawn. The third amendment would have required carrying liability insurance. It lost on a voice vote.

On the final vote, those voting against nursing were: Brunkhorst, Gronstal, Holveck, Iverson, Johnson, Kettering, Kramer, Lamberti, Larson, McKibben, Rehberg and Seng. Contact your Senator and thank him/her or express your disappointment in their vote. Try to learn from them why they voted against the bill and discuss nursing issues with them. Continued education of your elected officials is important to good policy making for nursing. A bill signing ceremony has been requested of the Governor. Please send the Governor an email, letter or phone call, if you have not already done so, requesting signature of the bill. It is the nursing profession's contribution to saving Medicaid funds for the state.

MEDICAID
The Republicans released their plan for dealing with the problems in Medicaid funding for next year. They said that the plan is not intended to be a long-term solution, but will help keep rising Medicaid costs from using all of the estimated revenue growth in the FY 2004 budget. The estimated cost of Medicaid in FY 2004 is $595 million; the cost savings in HF 619, as amended, is about $44.8 million.

The House ultimately passed the bill, after a detour through the Ways & Means Committee, on largely party lines. Rep. Carroll said that the Legislature still needs to pass a supplemental bill for this year. Estimated savings in the bill include:

Drugs & Pharmacists

• Using a preferred drug list, such as Michigan's, to approve drugs and get discounts. Allowing other manufacturers to place their drugs on the list if they agree to subsidize the cost, and encouraging the DHS to work with other states on a purchasing pool. $7 million in savings
• Reducing the prescription fill fee paid to pharmacists from $5.17 to $4.26. $622,222 in savings
• Increasing the discount on the average wholesale price (AWP) paid to pharmacists from the AWP minus 10% to AWP minus 12%. $2,040,000 in savings
• Reducing the multiplier used to determine the payment for generic drugs from 2.1 to 1.4. $1,900,000 in savings
• Increasing co-payments required of Medicaid participants to the maximum allowed under federal law. $1 per generic prescription; $.50 per brand-name prescription under $10; $1 per brand name prescription between $10 and $25; $2 per brand name prescription between $25 and $50; $3 per brand name prescription that costs more than $50; $3 per physician office visit $854,000 in savings

Nursing Homes, Providers & Others

• Revising University of Iowa Hospitals and Clinics physician reimbursement to draw down increased federal funds to the state, which will be used for the Medicaid program $13,500,000 in savings
• Implementing an ICF/MR provider participation fee to draw down additional federal Medicaid funding (cost neutral to the facility) $6,100,000 in savings
• Letting the e nursing home "hold harmless" provisions expire. $5,100,000 in savings.
• Reducing the inflation adjustment for nursing homes. $3,045,490 in savings
• Examining high-expense cases and expanded fraud investigations. $2,000,000 in savings
• Requiring nursing homes to bill to Medicare instead of Medicaid whenever possible. $1,056,000 in savings.
• Requiring all nursing homes to be certified by both the Medicaid and Medicare program. $994,000 in savings
• Adjusting the nursing home bed hold policy by reducing reimbursements from 75% to 42% when the Medicaid recipient is not in the facility. Results in a savings of $600,000

Other Policy Changes

• Creating an interagency pharmaceutical bulk purchasing council to allow state agencies that purchase prescription drugs to work together in order to obtain better prices on pharmaceuticals.
• Restricting the gifts that pharmaceutical marketers can give to medical professionals to food or other gifts valued up to $25, excluding the samples currently given to doctors for distribution to patients.
• Placing controls on who may authorize eligibility for Home and Community-Based Services (HCBS) by banning the use of subcontractors to perform eligibility determinations for the Frail and Elderly waiver, which allows seniors to receive care in their home instead of in a nursing home. (The practice violates federal law, and could cost federal funding.)
• Implementing a disease management project to help Medicaid recipients manage their chronic conditions and s a pilot project between DHS and a chronic care management resources group to work with Medicaid recipients with diabetes, congestive heart failure, or asthma.
• Implementing "Operation Awareness" for Veterans by requiring that nursing homes assist the Iowa Commission on Veterans Affairs to determine who in their facilities are eligible for benefits from the Department on Veterans Affairs. For individuals, or spouses of dependents who are eligible for federal veteran's benefits, then Medicaid is the payer of last resort.
• Implementing a quality assurance fee for nursing homes, similar to the ICF/MR provider participation fee, that allows the state to receive additional federal Medicaid funding without adversely impacting nursing homes. The bill has various effective dates for different provisions.

Mental Health Parity
Lt. Governor Pederson said that the Legislature should pass the mental health insurance coverage in HF 627. She said that such insurance "will improve outcomes for people with mental illness, boost workforce productivity, and reduce costs to employers and the state that are currently caused by untreated mental illness."

Pederson said that the experience of other states is that passing HF 627 will save the state money while improving health insurance coverage for people with mental illnesses. INA was invited to participate in the press conference.

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 Bill HSB 309 was recommended for passage by House Appropriations; bill includes an increase in funding and 2 FTEs for the Board of Nursing based on a license fee increase.)

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; no recent action)

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 on House Calendar)

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 in House Appropriations)

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 to Governor)

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 in House committee.

5. Elimination of CON for Birth Centers: Seeking to amend SF 415 to add.

6. Disaster Preparedness: HF 396 recommended by 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 passed House.

8. Child Abuse Regulation Changes: HF 206, HF 320

9. Elder Abuse Regulation Changes: SF 132

10. IPERS Changes: HF 398

11. Public Employee Collective Bargaining: SF 313 debated by Senate and amended.

Bills Signed by the Governor

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.

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.

Bills to the Senate:

HF 641 DPH CHANGES - Requires the chickenpox vaccination for children. Adds physician assistants and advanced registered nurse practitioners to the list of who can sign an immunization medical waivers. Directs that no exemption exists for nursing students performing nursing activities under circumstances. Creates licensee review committees for self-reporting licensees suffering from alcohol or drug abuse impairment.

The House PASSED the Bill, as amended, 93-4; it now goes to the Senate

HF 381 ORGAN DONOR INCENTIVES - Establishes a bone marrow and vascular organ donation incentive program for state employees. Grants leaves to employees who serve as bone marrow donors or as vascular organ donors. Establishes documentation requirements and other requirements for the program.
H-1032 by Watts - ADOPTED
The House PASSED the Bill, as amended, 98 -0; it now goes to the Senate HF 147 ORGAN DONOR INCENTIVES - WITHDRAWN

HF 454 UNIVERSAL INFANT HEARING TEST - Requires birthing hospitals to test newborns for hearing loss using either ABR or OAE methods or other method approved by the DPH and report the results to the parents and to DPH. Requires testing within 3 months if the birth takes place other than a birthing center. Allows for exemption on religious grounds. Effective January 1, 2004.
H-1043 by Boddicker - - WITHDRAWN

H-1111 by Upmeyer - Allows a parent to exempt a child from the testing procedure through a written objection. Requires the health professional to report the refusal to the DPH. ADOPTED
The House PASSED the Bill, as amended, 98-1; it now goes to the Senate
HF 190 UNIVERSAL INFANT HEARING TEST - WITHDRAWN

HF 586 HEALTH INSURANCE INCREASE NOTICE - Requires group health insurance a 45-day notice of premium rate increases and permit the policyholder to renew coverage in one-moth increments.
The House PASSED the Bill, 96-0; it now goes to the Senate
HF 444 HEALTH INSURANCE INCREASE NOTICE - WITHDRAWN
Senate Floor Action

HF 479 ADVANCED NURSE PRACTITIONERS Makes advanced registered nurse practitioners approved health care providers for the purposes of managed care or pre-paid service contracts under Medicaid. States that the bill does not expand the scope of practice for advanced nurse practitioners.
S-3128 by Brunkhorst, et al - Requires the advanced nurse practitioner to have a written collaborative agreement with a doctor if the practitioner engages in primary care services. FAILED, 14-36
S-3112 by Holveck, et al - Requires the advanced nurse practitioners to carry $1 million in liability coverage per incident and $3 million in aggregate liability coverage. FAILED S-3111 - WITHDRAWN
The Senate PASSED the bill, 38-12; it now goes to the Governor (SF 410 - WITHDRAWN)
SF 412 ELDER GROUP HOMES - Strikes the requirement that an elder group home be owner-occupied and requires the home to be staffed at all hours.
The Senate PASSED the bill, 50-0; it now goes to the House
SF 344 REGULATORY REFORMS - Makes changes to Torts & Legal Proceedings . Limits non-economic damages to $250,000, or no more than the economic damages. . Unemployment, Worker's Comp, OSHA, Environmental, Public Works, and Financial areas of the Code.: Strikes the requirement in certain consumer credit transaction that a payment be applied to the current amount due, to avoid additional late charges, rather than the delinquent amount. Allows loan fee charges to include all charges unless expressly prohibited by law. Strikes the Rule against Perpetuities in certain areas. Amendments were adopted.
The Senate PASSED the bill, as amended, 26-24; it now goes to the House

COMMITTEE ACTION
House Committee Action

House Appropriations: Voted Out:
HSB 309 HEALTH AND HUMAN SERVICES APPROPRIATION FM: Heaton
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: Assigned to Subcommittee:
SF 235 CRIMINAL HISTORY CHECKS - Greiner (C), Jones, Petersen

Senate Committee Action

Senate Appropriations Committee: Voted Out:
HF 472 FEDERAL BLOCK GRANTS - Appropriates federal block grants beginning October 1, 2003 (federal fiscal year). PASSED, 24-0; FM: Seymour
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 PASSED, 15-9; FM: Zieman
Senate Commerce: Assigned to Subcommittee:
HF 586 HEALTH INS INCREASE NOTICE Bolkcom (C), Kettering, Redfern

Senate Judiciary Committee: Voted Out:
HF 65 BAC 08 - Reduces the BAC level to 0.08 for OWI purposes. Removes the 30 day hard suspension for first offense if BAC below .15 and no personal injury or property damage. Requires these offenders to have interlock devices installed. PASSED, 14-0; FM: Redfern

Senate Human Resources: Voted Out:
HF 396 EPIDEMIOLOGY AND DISASTER DIVISION - Creates the Division of Epidemiology, Emergency Medical Services, and Disaster Operations in the DPH. Authorizes the DPH to create disaster medical assistance teams during times of disaster, and to carry out additional duties during a public health disaster. Authorizes the DPH to investigate diseases that may be a potential cause of a public health disaster. Effective upon enactment.

Bills Introduced of Interest to Nurses
Find the bills at http://www.legis.state.ia.us "Track Legislation"

Resolutions

SR 30 NURSING HOME ADMINISTRATORS (Iverson) Urges the State Board of Examiners for Nursing Home Administrators make recommendations for dealing with the loss of such administrators.

House Study Bills

HSB 307 TOBACCO APPROPRIATIONS (Appropriations) Healthy Iowans Tobacco Trust: DHS $16.5 million Medicaid supplemental; Other: ($8.1 million to maintain the reimbursement rate for most non-institutional Medicaid; $3.8 million specifically for dental services under Medicaid, $3.0 million to maintain the hospital reimbursement rate; $2.1 million to maintain the health care facility reimbursement rate; $250,000 for critical access hospitals under Medicaid, $1.98 million for home health care services for children under Medicaid; $1.14 million for respite care under Medicaid; $3.4 million for colas for rehab services under child and family services, $469,000 for colas for adoption, shelter care and independent living services; $200,000 supplemental for children's health insurance; $250,000 for breast cancer treatment under Medicaid;) Tobacco: $5 million for tobacco use control. Substance Abuse: $11.8 million for substance abuse treatment. DPH: $2.4 million (includes the poison control center, epidemiology work, free health clinics and core public health functions. Appropriates additional money for counties with limited MH/MR/DD service fund balances, school ready children grants, and special needs at the DOC. Heaton (C), Chambers, Smith

HSB 309 HEALTH AND HUMAN SERVICES APPROPRIATION
Appropriates to health and human services agencies: Total (from the GF): $772.4 million; Appropriations: DEPT. OF ELDER AFFAIRS $2.7 million; DEPT. OF PUBLIC HEALTH Total - $24.1 million; Other Funds ELDER AFFAIRS: $7.2 million PUBLIC HEALTH Total $3.7 million; Gambling Treatment Fund $2 million; Addictive Disorders $1.7 million. Total from the General Fund: $772.4 million. ECONOMIC ASSISTANCE: ($41.7 million Total) FIP: $36.2 million; Child Support Recovery: $5.5 million. MEDICAL SERVICES: ($397.4 million Total) Medical Assistance: $357.5 million; Health Insurance: $574,000; Child Health Insurance: $11.1 million; Medical Contracts: $9 million; Other Provisions: Lets the nursing board raise fees and keep 90% of the increase. FM: Heaton

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