LEGISLATIVE CONNECTION
A communication of the Iowa Nurses Association
A benefit of membership
Volume 5, Number 13, April 11, 2003

Connecting with Nurses on Health Issues

GOVERNOR SIGNS ARNP AS MEDICAID PRIMARY CARE PROVIDER BILL

A bill signing ceremony was held Wednesday, April 9. It allows ARNPs to be considered primary care providers under Medicaid managed care programs. It is the nursing profession's contribution to saving Medicaid funds for the state.

MENTAL HEALTH PARITY
Prospects for passage of HF 627 look grim this session. Speaker of the House Christopher Rants (R-Sioux City) supports amending the language to SF 344 Regulatory Reform in order to force the Governor to sign a bill with regulatory reform matters sought by the Republicans and avoid the predicted veto by the Governor of that bill. However, the House Republicans are now not considering improving the list of diagnoses covered. The improvement of HF 627 over the status quo is the parity in coinsurance and deductible amounts.

CIGARETTE USER FEE TO FUND ECONOMIC DEVELOPMENT?
Increasing the cigarette tax and making the fund for economic development into a pay-as-you-go fund is one proposal to fund Iowa economic development, but Speaker Rants said that he opposes raising the cigarette tax. Plans for an economic development fund moved a little farther this week, but there is still no agreement between the parties or between the chambers. Speaker Rants said that in some areas, such as where the fund should be spent, the Legislature is closer to an agreement than in how to finance the fund. Governor Vilsack has said that he will work with the Legislature on cigarette user fees, if they decide to go that way.

HOUSE PROPERTY TAX PROPOSAL
The House Republicans released their proposals for overhauling the property tax system in Iowa. The members of the team working on the ideas included Rep. Jamie Van Fossen, Rep. Paulsen, Rep. Kramer, Rep. Kurtenbach, and Rep. Sands. Rep. Rants said that this proposal "will modernize and simplify the property tax code, making it transparent and easy to understand. In addition, it will eliminate the automatic tax increases that have plagued the system for years." Republicans said that their plan was due to the challenge from the Governor to completely revamp the property tax system. In addition to changing how land is valued, the proposal ends the rollback which decreases the taxable value of residential and farm property. Property tax credits, at least initially, are unchanged, and the current proposal does not include any language designed to limit the rates that can be charged. Rep. Kramer said that he wants the system to allow voters to hold elected officials responsible for rate increases, rather than have the Legislature control the process.

APPLICATIONS FOR ANA-PAC BOARD
Applications for election to the ANA-PAC Board of Trustees are due to the Iowa Nurses Association office on Friday, April 18, 2003. Applications for the PAC Board were sent to the state nurses association offices. ANA-PAC Board applications and job descriptions can also be requested by contacting ANA-PAC Administrator Shari Dexter at 202-651-7096 or sdexter@ana.org.

Candidates for the ANA-PAC Board election must be approved by the state (Iowa) nurses association and will be elected before the House of Delegates meeting June 2003. According to the ANA-PAC bylaws, the term of office for a member of the ANA-PAC Board of Trustees begins at the end of the House of Delegates in June 2003 and runs until the end of the House of Delegates 2005. There are five seats on the ANA-PAC Board of Trustees that are open for election in 2003.

If you have any questions, please feel free to call Shari Dexter at the ANA Office at 202-651-7096.

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 HF 667 was debated and passed; 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. (Numerous bills introduced, none likely to be the final vehicle to increase 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 could be amended to a bill SF 344 that the Governor may veto.)

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 passed by Appropriations; reintroduced as a committee bill HF 675; awaits House debate)

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 565 modifies HAWK-I recommended for passage, HF 667 passed by House appropriates to Medicaid from General Fund, Senior Living Trust and Hospital Trust Fund; Senate adopted SJR 4 which 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 signed by Governor April 9)

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 (likely dead)

5. Elimination of CON for Birth Centers: Seeking to amend a bill to add.

6. Disaster Preparedness: HF 396 passed Senate; to Governor

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; recommended by Senate committee.

8. Child Abuse Regulation Changes (Clergy inclusion and lowering age): HF 206 Senate Human Resources recommended passage

9. Elder Abuse Regulation Changes: SF 132 Died

10. IPERS Changes: HF 398 Died

11. Public Employee Collective Bargaining: SF 313 House Commerce recommended.

12. External Review Coverage Decisions: HF 543 Senate Commerce recommended.

Bills Signed by the Governor

HF 479 ADVANCED REGISTERED 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.

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.

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 667 HEALTH AND HUMAN SERVICES APPROPRIATION Total (from the GF): $772.4 million; Appropriations: DEPT. OF ELDER AFFAIRS $2.7 million; DEPT. OF PUBLIC HEALTH Total - $24.1 million; Other Provisions: Lets the nursing board raise fees and keep 90% of the increase. Requires a single superintendent for Toledo and Eldora
H-1308 by Heaton - Increases the FTE's for the DPH. Changes the fee for dispensing prescription drugs to $426 Increases the appropriation for the DEA by $300,000 and adds intent language that the money should be used to maximize federal funds under the Older Americans Act ADOPTED
H-1306 by Osterhaus - Appropriates $100,000 to the DPH for communications funding. FAILED
H-1313 by Kurtenbach - Allocates $85,000 on TANF money for the Iowa Marriage Initiative Adds requirements that DHS establish a fatherhood initiative grant program.
H-1316 to H-1313 by Carroll - Numbering correction. ADOPTED
H-1317 to H-1313 by Jochum - Strikes the fatherhood initiative FAILED
H-1313 as amended - ADOPTED
H-1302 by Heaton - Increases the appropriation to Eldora by $12 million, to Toledo by $410,000, and to Independence by $544,000 and decreases the appropriation to Child and Family Services by the same amount. Decreases the statewide expenditure target for group foster care to $1.9 million. Reduces school based supervision by $220,000. Allows some institutions to purchase used cars for their fleet. Adds other intent language.
H-1314 to H-1302 by Heaton - Correction. ADOPTED
H-1302 as amended - ADOPTED
H-1307 by Osterhaus - Appropriates $430,000 for Child Support Recovery. FAILED
H-1305 by Heaton - Adds language regarding Medicaid/Medicare cross-over claims to protect hospitals. ADOPTED
H-1309 by Petersen, et al - Directs the DHS to develop a consumer child care provider information program.
H-1315 to H-1309 by Petersen - Corrective. ADOPTED
H-1319 to H-1309 by Petersen - Corrective ADOPTED
H-1309 as amended - ADOPTED
H-1310 by Heddens - Increases the funding in the DHS to the Governor's level. FAILED
H-1312 by Hansen - Gives HAWK-I board the authority to work with several dental insurors. ADOPTED
H-1311 by Dix - Appropriates $57 million in FY 2003 as a supplemental to Medicaid ($41.4 million from the GF, $9.5 million from the Senior Living Trust Fund, $7 million from the Hospital Trust Fund) ADOPTED
H-1301, H-1318 - WITHDRAWN
The House Passed the bill, as amended, 67-30; it now goes to the Senate HF 636 LEGISLATIVE CONSOLIDATION - Creates a single Legislative Services Agency from the Legislative Service Bureau, the Legislative Fiscal Bureau, and the Computer Support Bureau. Effective upon enactment.
H-1213 by the Senate - Gives the new LSA the responsibility for the Official Register (the Redbook), currently published by the Secretary of State. Allows the LSA to decide whether to distribute the publication for free or for a charge. CONCURRED The House PASSED the bill, as amended, 96-0; it now goes to the Governor

HF 541 BIRTH CERTIFICATE FEES - Increases the fee for birth certificates to $15 for FY 2004 and to $20 thereafter to fund a birth defects institute central registry. Authorizes the continued use of $10 from the registration fee to fund primary and secondary child abuse prevention programs.
H-1110, H-1297 - WITHDRAWN
The House Passed the bill, as amended, 78-20; it now goes to the Senate

HF 662 EDUCATION APPROPRIATION (Appropriations; Successor to HSB 299) 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) The House PASSED the bill, as amended, 99-0; it now goes to the Senate

HF 628 LICENSING PHYSICIAN ASSISTANTS - Requires an education course for physician assistants be approved by the AMA Committee on Allied Health Education and Accreditation. Allows physician assistants to render care in emergencies or disaster without the supervision of a physician and gives limited criminal and civil immunity. Exempts physician assistants working under federal jurisdiction from licensing requirements. Strikes provisions requiring the Board of Medical Examiners to consult with the Board of Physician Assistants regarding the ineligibility of a doctor to serve as a supervising physician. Effective upon enactment.
H-1274 by Boddicker - Strikes the changes in the provisions regarding the Medical Examiners and P.A. examiners and allows a physician to serve as a supervising physician until such time as the Board decides that the physician is ineligible to serve.
H-1288 to H-1274 by Boddicker - Limits a doctor to supervising two P.As at one time. ADOPTED H-1274 as amended, ADOPTED The House PASSED the bill, as amended, 99-0; it now goes to the Senate

Senate Floor Action
SJR 4 MEDICAID REDESIGN - Proposes a redesign of the Medicaid system The Senate ADOPTED the Resolution, 50-0

CONFIRMATIONS
Mark Haverland, Director of the Department of Elder Affairs, CONFIRMED, 47-1 Ruth Mosher, Council on Human Services, CONFIRMED, 48-0

HF 472 FEDERAL BLOCK GRANTS - Appropriates federal block grants beginning October 1, 2003 (federal fiscal year). The Senate PASSED the bill, 49-0; it now goes to the Governor

HF 381 ORGAN DONOR INCENTIVES - Establishes a bone marrow and vascular organ donation incentive program for state employees. Grants 5-day paid leaves to employees who serve as bone marrow donors or 30-day paid leaves to vascular organ donors, which are not subject to other rules concerning time off under the collective bargaining agreement. Establishes documentation requirements and other requirements for the program. Grants: Changes the transplant grant language to reserve up to 50% of the grants for recepients rather than the hospitals which perform the grants The Senate PASSED the bill, 49-0; it now goes to the Governor
SF 222 ORGAN DONOR INCENTIVES - WITHDRAWN

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.
The Senate PASSED the bill, 50-0; it now goes to the Governor

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.
S-3168 by Wieck - Increase the range of fines for littering to $500 to $1,000. ADOPTED
S-3181 by Black - Gives the power to appoint the environmental health specialist to the county and city boards of health. ADOPTED
The Senate PASSED the bill, as amended, 48-0; it now returns to the House

Held on a Motion to Reconsider:
HF 662 EDUCATION APPROPRIATION - 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); $663.3 million (Operations); $206.8 million (Grants & Aid); $49.3 million (Standings The Senate PASSED the bill, 29-19; MTR - Lamberti

COMMITTEE ACTION
House Committee Action
House Appropriations: Voted Out: HF 582 ELDER FAMILY HOMES - Directs the Department of Elder Affairs regulate elder family homes and assisted living programs with the DIA. AMENDED & PASSED, 23-0; FM: Upmeyer HF 596 ASSISTED LIVING AND ADULT DAY CARE - Authorizes the Department of Elder Affairs, with the cooperation of the Department of Inspections and Appeals, to regulate assisted living and adult care. Requires the DEA to establish a certification and monitoring program. Requires consultation with the DIA and industry groups. Establishes application and fee requirements; procedures for denial, suspension, or revocation of certification; including a complaint process. Contains other related provisions. AMENDED & PASSED, 23-0; FM: Upmeyer

House Commerce & Labor: Voted Out: (2)
SF 344 REGULATORY REFORMS - PASSED; 13-8; FM: Horbach

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. AMENDED & PASSED 12-10; FM: Watts

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 alternatives by a school health insurance reform team, selected by the Insurance Commissioner, which include the a number of specified representatives, including a representative of AEAs. AMENDED & PASSED 23-0; FM: Hoffman

House Human Resources: Voted Out:
SF 3 ABORTION REPORTING -Requires that the use of RU-486 in inducing abortions be reported to the Department of Public Health. PASSED 21-0; FM: Carroll

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. AMENDED & PASSED 21-0; FM: Upmeyer

Senate Committee Action

Senate Commerce Committee: Voted Out:
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. PASSED, 11-0; FM: Bolkcom
HF 543 INSURANCE COVERAGE - Requires health insurance plans and HMOs to print on insurance cards a phone number for the insured to call for more information on the external review process and to post such information in a prominent place in health care facilities. PASSED, FM: Angelo

HF 647 INSURANCE DIVISION OMNIBUS - Makes numerous changes to the Insurance Code regarding filing requirements and deadlines, the reporting of information, fees for MEWAS, registered agents, the commissioner's ability to void contracts or annuities and other matters. Allows students who are called up by the National Guard or reserves to keep their insurance coverage. PASSED, FM: Wieck

Senate Human Resources: Voted Out:
HF 386 ELDER AFFAIRS ACT - Conforms the Elder Iowans Act with federal legislation by amending definitions. Reduces the number of meeting times for the Commission on Elder Affairs to four. Strikes obsolete or outdated provisions. PASSED, 9-0; FM: Behn

HF 387 MR FACILITIES AND COMMISSION MEMBERS - Waivers: Allows up to 40 residential care facilities licensed to serve up to five people with mental retardation to be converted to residential programs operating under the current HCBS waiver. Makes the converted facilities subject to the same requirements as other such residential programs and keeps the five persons limit. Requires the converted program to have county support and to verify the need for the program. MH/DD commission: Allows membership slots for active board members of a community MH/DD center to be filled by center employees. AMENDED & PASSED, 9-0; FM: Tinsman

HF 389 CONTROLLED & PRECURSOR SUBSTANCES - Makes technical changes to conform the Iowa Code to the federal Uniform Controlled Substances Act and to the precursor chemical federal amendments. Allows the suspension or restriction of the authority of a health care professional to prescribe controlled substances if the professional has been the subject disciplinary action by the appropriate licensing board. PASSED, 8-0; FM: Seymour

HF 489 DHS CHANGES - Adds domestic abuse discipline to the Multidisciplinary Team under the Child Abuse chapter. Changes certain DHS debt collection procedures related from a medical assistance recipient's estate. Updates references regarding persons with disabilities eligible for medical assistance. Makes the state responsible for the nonfederal share of the intermediate care facility for persons with mental retardation Makes other changes. PASSED, 11-0; FM: McKinley

HF 206 CHILD ABUSE REPORTING - Requires mandatory reporters who are not caretakers of a child to report suspected abuse for children under the age of 16 instead of 12. Makes clergy mandatory child abuse reporters. Exempts confidential communications, such as sacramental confessions, from the reporting requirement. PASSED, 11-2; FM: Veenstra Several amendments were withdrawn, and could be taken up on the floor.
HF 457 CHILD TO ADULT TRANSITION - Requires DHS to establish Local Transition Committees to address the transition to adulthood needs of children 16 or old and are receiving child welfare services. Contains other related provisions. PASSED, 13-0; FM: Hatch

HF 529 MH/DD SERVICE REPORT - Directs the MH/DD commission to make recommendations for redesigning the MH/DD services system. Requires recommendations to the Legislature and Governor on standardizing clinical and financial eligibility, identifying a minimum set of core services, developing a funding formula that follows the individual, and on improved coordination of funding by 12/31/03. PASSED, 13-0; FM: Tinsman

HF 557 VOLUNTEER HEALTH CARE PROTECTIONS - Establishes civil liability immunity for hospitals, and other health care facilities, health care referral programs, and charitable organizations that offer free medical, dental, or chiropractic services through the volunteer health care provider program. Includes psychologists, pharmacists and providers licensed by the behavioral examiners under this coverage. Requires that free clinics covered in the bill solely offer free services rather than primarily. PASSED, 13-0; FM: Tinsman

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. PASSED, 13-0; FM: Tinsman

Senate Ways & Means:
Senator McKibben briefly brought up SSB 1192 FLAT TAX II, which will replace the earlier bills (SF 165, SSB 1180, SSB 1189), and will only include flat tax provisions--3.5% rate, elimination of federal deductibility and the alternative minimum tax, and sales tax exemption studies. The committee deferred on the bill.

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

HF 672 ADULT DAY CARE (Appropriations; Successor to HF 596) Authorizes the Department of Elder Affairs, with the cooperation of the Department of Inspections and Appeals, to regulate adult care. Requires the DEA to establish a certification and monitoring program. Requires consultation with the DIA and industry groups. Establishes application and fee requirements; procedures for denial, suspension, or revocation of certification; including a complaint process. Contains other related provisions. FM: Upmeyer

HF 675 ASSISTED LIVING AND ELDER FAMILY HOMES (Appropriations; Successor to HF 582) Directs the Department of Elder Affairs regulate elder family homes and assisted living programs in cooperation with the DIA. Requires the DEA to adopt rules regarding certification of assisted living, in conjunction with industry groups. Contains other related provisions. Contains provisions regarding affordable assisted living programs and complaint procedures. Strikes provisions requiring elder group homes to be owner operated and requires them to be staffed 24 hours a day instead. FM: Upmeyer

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