LEGISLATIVE CONNECTION
A communication of the Iowa Nurses Association
A benefit of membership
Volume 5, Number 14, April 18, 2003

Connecting with Nurses on Health Issues

NURSE CONFIRMED AS HEALTH HEAD

On April 12, INA member Mary Mincer Hansen was confirmed by the Senate as Director of Public Health on a vote of 49-0. Our congratulations to Mary on being the first nurse appointed to head this state agency!!!!

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 (dead)

5. Elimination of CON for Birth Centers: Amendment filed and withdrawn.

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 Senate; to Governor.

8. Child Abuse Regulation Changes (Clergy inclusion and lowering age): HF 206 on Senate calendar.

9. Elder Abuse Regulation Changes: SF 132 Died

10. IPERS Changes: HF 398 Died

11. Public Employee Collective Bargaining: SF 313 House calendar

12. External Review Coverage Decisions: HF 543 Senate calendar.

Bills Signed by 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

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.

HF 472 FEDERAL BLOCK GRANTS - Appropriates federal block grants beginning October 1, 2003.

HF 636 LEGISLATIVE CONSOLIDATION - Creates a single Legislative Services Agency from the Legislative Service Bureau, the Legislative Fiscal Bureau, and the Computer Support Bureau. 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. Effective upon enactment.

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 3 ABORTION REPORTING -Requires that the use of RU-486 in inducing abortions be reported to the Department of Public Health.
The House PASSED the bill, 93-5; it now goes to the Governor

SF 416 DEPENDENT ELDER ABUSE
H-1300 by Human Resources - A Strike & Replace: Requires the DEA to identify the area agencies on aging which have demonstrated their ability to be collaborative. Allows the emergency shelter and support services projects to be set up in counties with multi-disciplinary teams from these agencies. Abuse: Allows sealed dependent elder abuse records to be re-opened in the case of another founded report of elder abuse. Requires the records in cases of alleged abuse that is not proven by a preponderance of the evidence to be kept for one year. ADOPTED
The House PASSED the bill, as amended, 97-0; it now returns to the Senate

SF 361 INCAPACITATION EXAMINATIONS - Authorized the examining physician, rather than the chief medical officer, to make treatment recommendations for persons who been detained due to incapacitation caused by substance abuse or mental health problems. Eliminates the requirement that a judge travel to where the person is being held but requires the judge to file an order with the Clerk of Courts regarding detention the next day.
The House PASSED the bill, 98-2; it now goes to the Governor

Senate Floor Action

Appointments
The Senate CONFIRMED the en Bloc Calendar, 48-0
Individual Confirmation Calendar
Mary Mincer Hansen, Director of Public Health, CONFIRMED, 49-0
Kevin Concannon, Director of the Department of Human Services, CONFIRMED, 50-0
John Cacciatore, Director of the Office for State-Federal Relations, CONFIRMED, 43-6

HF 619 MEDICAID REFORMS
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 in savings and reducing the multiplier used to determine the payment for generic drugs (SMAC program) from 2.1 to 1.4. $1.9 million 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 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 for the Medicaid program. $13.5 million in savings
• Implementing an ICF/MR provider participation fee to draw down additional federal Medicaid funding (cost neutral to the facility) $6.1 million in savings
• Letting the e nursing home "hold harmless" provisions expire. $5.1 million in savings.
• Reducing the inflation adjustment for nursing homes. $3.045 million in savings
• Examining high-expense cases and expanded fraud investigations. $2.0 million in savings
• Requiring nursing homes to bill to Medicare instead of Medicaid when possible($1.056 million in savings) and 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. $600,000 in savings.

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.
• 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 affecting nursing homes.

AMENDMENTS
S-3207 by Ragan - States the purposes of the case management for frail elderly program, including that DEA, DHS and other interested parties should collaborate on a redesign of the program. FAILED
S-3209 by Ragan, et al - Raises the fill fee for pharmacists to $4.35. Strikes the information reporting by pharmacists in the regarding drug prices, increases the cost multiplier to 1.8, and makes the state payment for drugs 11% instead of 12% of the average wholesale price. FAILED
S-3212 by Holveck - Restricts the gifts that pharmaceutical marketers can give to medical professionals to food or other gifts valued up to $25. Exclude samples or compensation for participating in a legitimate clinical trial. FAILED
The Senate PASSED the bill, 49-0; it now goes to the Governor

HF 65 BAC 08 - Reduces the BAC level to 0.08 for OWI purposes. Suspensions: Removes the 30 day suspension of a license, without the possibility of a work permit, for a first offense if the BAC is below 0.15 and no personal injury or property damage. Requires these offenders to have interlock devices installed. Does not require an interlock device if the BAC is between 0.08 and 0.10, and no injury or property damage occurred.

S-3074 by Miller - Authorizes courts to order community service in lieu of prison time for a 1st OWI offense. Reduces the mandatory prison time for a 2nd offense to 5 days and for a third offense to 10 days and allows a court to order 30 days or 60 days of community service. FAILED, 22-28

S-3028 by McCoy - Allows a court to order a deferred judgment for a first OWI offense even if the BAC is over 0.15. FAILED, 4-46

S-3204 by Brunkhorst, et al - Requires the DOT to destroy records relating to an OWI arrest and to restore a person's driving privileges if the arrest does not result in a conviction. RULED NOT GERMANE

S-3177 - Requires bars to have a breath testing machine for patrons. Prohibits using the results in civil or criminal cases. RULED NOT GERMANE

S-3036, S-3037, S-3215, S-3216, S-3218 - WITHDRAWN
The Senate PASSED the bill, 49-0; it now goes to the Governor

HF 392 ECONOMIC GOALS - Requires all state agencies, rather than just those involved in economic development, to include economic growth in their mission statements. Requires the Economic Development Board to include performance measures and benchmarks in its three-year comprehensive strategic plan and in its evaluation of the attainment of goals.

S-3214 by Kreiman - Strikes the changes in the mission statements of state agencies. FAILED
The Senate PASSED the bill, 43-7; it now goes to the Governor

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.

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

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. Supervising Physicians: Allows a physician to serve as a supervising physician until such time as the Board decides that the physician is ineligible to serve. Limits a doctor to supervising two P.As at one time. The Senate PASSED the bill, 50-0; it now returns to the Governor

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. S-3230 - WITHDRAWN The Senate PASSED the bill, 50-0; it now returns to the Governor

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 Guard to keep their insurance coverage.
The Senate PASSED the bill, 50-0; it now returns to the Governor

HF 565 HAWKI & MEDICAID CHANGES- Provides for changes in the HAWK-I program. Amended by Tinsman. The Senate PASSED the bill 50-0; it returns to the House.

COMMITTEE ACTION
Senate Committee Action

Senate Appropriations: Voted Out:
HF 667 HEALTH & HUMAN SERVICES APPROPRIATIONS - PASSED, 15-8; FM: Tinsman The committee voted down Senator Tinsman's proposed amendments, but she said that she will offer them again on the floor.

Senate Ways and Means: Voted Out
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. PASSED, 15-0; FM: Connolly

Bills Introduced of Interest to Nurses

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

SF 448 DEPT OF CORRECTIONS CHANGES (Ways & Means; Successor to SF 360) Allows the release of a pre-sentence investigation report to a substance abuse or mental health service provider. Permits the DOC to operate a substance abuse facility. Allows treatment of a mentally ill inmate at any appropriate DOC facility. Makes other changes. FM: Larson

Senate Study Bills

SSB 1201 DPH/DHS CONSOLIDATION STUDY (Government Oversight) Establishes a planning group to study consolidating the DHS ad the DPH. Includes the membership of the planning group, the goals of consolidation and the a target date of 2005.

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