LEGISLATIVE CONNECTION
A communication of the Iowa Nurses Association
A benefit of membership
Volume 5, Number 15, April 25, 2003

Connecting with Nurses on Health Issues

ASSISTED LIVING BILL PASSES

One of INA's priority bills, HF 675 on changes to assisted living passed on a vote of 97-0 on April 23. It was floor managed by INA member, Rep. Linda Upmeyer (R-Garner). It makes clear that policy making is set by the Dept of Elder Affairs, not the Dept of Inspections and Appeals. Federal regulations direct that the policy-making entity cannot be the enforcement entity, so enforcement remains with DIA, but there is a diminished role for DIA in regulation of assisted living facilities. The landlord-tenant concept will be more prevalent than the "unlicensed nursing home" concept of care under the provisions of the bill. It goes to the Senate for consideration.

FUNDING BOARD OF NURSING

HF 667 was considered by the Senate and no amendments that were offered were accepted, so the bill passed the Senate in the same form as passed the House. This means the Iowa Board of Nursing is allowed to keep 90% of any increase in license fees for operations including the addition of two full-time equivalent (FTE) staff for investigation. A motion to reconsider was placed on the bill by the Senate Appropriations chair, Sen. Jeff Lamberti (R-Ankeny), the same as a number of appropriations bills have motions to reconsider.

Planning for the End of the Session
The work on the appropriations bills is moving forward quickly, with most of the budget subcommittee bills having been through both chambers at least once. Both the House and Senate also took action to clear out the bills that they will not work again this year. Most of the bills referred back to a committee, even those back to Ways & Means or Appropriations, will not come up again this year. The "live rounds" are those bills now on the Unfinished Business Calendars. Given that this is the first year of the General Assembly though, it is still possible that a bill could get sent over from one chamber to the other without the expectation of being finished this year.

The session still lacks one key bill, the $138 million "Re-invention" bill. The re-invention plan includes, roughly, a cut of $57 million in aid to local governments, $40 million from state agencies in rents, $20 million in changes to AEAs and $10 million in changes to the child welfare system. Rep. Gipp said that Republicans have built the passage of this bill into their budget this year, so it needs to come down. Other than that, the Governor, the House and the Senate still need to agree on creating an economic development fund, on what source should be used to finance the fund, on whether bonds should be sold for the fund or if it should be a pay-as-you-go fund, and on whether they need an income tax reform bill, a property tax reform bill, a regulatory reform bill, or some combination of these bills, before an economic development fund can even be approved.

Both sides are now predicting the end of the 2003 session in early May, although they hold out the possibility of a special session this year. The House and Senate will spend most of their remaining time debating on the floor, although both still have significant committee work

Veterans Outreach
Governor Vilsack said that additional efforts to enroll veterans into federal benefits programs and increased the total Federal Veterans Affairs benefits for Iowa's military veterans by $168 million in 2002. The Governor said that the Commission of Veterans Affairs Director, Patrick Palmersheim, and the work of County Veterans Affairs directors, commissioners, and county supervisors is responsible for the increase in enrollment of eligible veterans through expanded outreach and identification efforts. In 2001 there were 74,845 Iowa veterans enrolled in the benefits system. In 2002, there were 85,448 veterans enrolled. The $168 million increase includes a $154 million increase in medical care benefits, and a roughly $14 million increase in compensation and pension benefits. The state hopes to be able to save additional Medicaid dollars by continuing to identify veteran's who are eligible for federal funds under various programs.

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 by Senate; motion to reconsider was placed on bill by the Senate Appropriations Chair; 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. (Language that supports a $1 on all tobacco products is the preferred language; prospects for passage at this time are dim; contacts are needed)

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; contacts are needed)

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; may still be in the ongoing negotiations.)

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 675 passed House 97-0; goes to Senate; makes clear no policy making by Dept of Inspections and Appeals)

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 signed by Governor April 14.

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 sent to Governor.

8. Child Abuse Regulation Changes (Clergy inclusion and lowering age): HF 206 goes to Governor.

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 GOVERNOR

SF 3 ABORTION REPORTING -Requires that the use of RU-486 in inducing abortions be reported to the Department of Public Health.

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 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. Puts a representative of AEAs on the school health insurance reform team.
H-1325 by Commerce - Requires the health insurance study to look at the health coverage available to private attorneys in the area. ADOPTED
The House PASSED the bill, as amended, 96-0; it now returns to the Senate

HF 565 HAWKI & MEDICAID CHANGES - Cost Sharing: Strikes the requirement for cost sharing based on a sliding fee scale and allows the HAWK-I board to set cost share amounts. Allows for cost sharing for families whose income exceeds the 150% level of federal poverty standards. Makes changes regarding the HAWK-I board's power to determine eligibility under certain conditions. Reports: Requires the DHS, rather than the HAWK-I board, to perform annual, random reviews of applications to ensure compliance and requires quality assurance reports be made to the HAWK-I board and to the DHS. Requires the board, in consultation with the clinical advisory committee, to assess the initial health status of participants to develop baselines and measures to assess the subsequent health of children in the program, and the strikes the requirement for the use of nationally recognized assessment for the health of children in the program. Requires the clinical advisory committee to make annual recommendations. Other: Strikes the requirement for a comprehensive statewide media campaign. Eliminates certain other requirements regarding marketing and identification of potential participants.
S-3194 by Human Resources - Requires that the cost share amounts be at least $10 per person and $20 per family. Strikes provisions which allow denial of coverage if a child had health insurance within the previous six months, but requires a report on any increased program cost due to this.
ADOPTED
The House CONCURRED & PASSED the bill 95-0; it now goes to the Governor

HF 675 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 and passed 97-0; now it goes to the Senate.

Senate Floor Action

SF 416 DEPENDENT ELDER ABUSE
S-3223 by the House - 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. The Senate CONCURRED & PASSED the bill, as amended, 50-0; it goes to the Governor

HF 560 MEDICAL ASSISTANCE WAIVERS - Lets a provider of services under a Medicaid 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.. Requires the county of legal settlement to pay the nonfederal share of the waiver, or the state if the person does not have a county of legal settlement.
S-3228 by Tinsman - Requires that the home and community based services waiver include adult day care, prevocational services and transportation services, and for DHS to seek approval to add day habilitation services. Requires the DHS review the reimbursement methodology, and establish in consultation with the Iowa Association of Counties and the Iowa Association of Community providers, payment limitations. ADOPTED The Senate PASSED the bill, 49-0; it now returns to the House.

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. Includes as members representatives of schools of different sizes, a representative from school unions, a representative from AEAs, representatives from a health insurance carrier and a health insurance provider, or any others whom the Insurance Commissioner believes can assist the process.
S-3250 by House - Requires the health insurance study to look at the health coverage available to private employees in the area. concurred. The Senate CONCURRED & PASSED the bill, 46-0; it now goes to the Governor

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.
H-3255 by Hatch - Strikes the provisions requiring mandatory reporters who are not caretakers of a child to report suspected abuse for children under the age of 16 instead of 12. FAILED, 15-32
H-3256 by Hatch - Includes the employees and volunteers of organizations who do pregnancy counseling as mandatory reporters of child abuse. FAILED, 18-28
S-3262 by Kreiman - Rewrites the provisions which make the clergy mandatory reporters except for any confidential communication properly entrusted to the person in the person's professional capacity, and necessary and proper to enable the person to discharge the functions of the person's office according to the usual course of practice or discipline. FAILED, 19-27
S-3260A & B - WITHDRAWN or RULED NOT GERMANE
The Senate PASSED the bill, 33-12; it now goes to the Governor
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 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. Effective January 1, 2004.
S-3125 by Boettger - A Strike & Replace: Requires newborn babies to be screened for hearing loss as of January 1, 2004 according to certain methods. Requires birthing facilities to perform the tests or to refer the parents to a testing facility. Requires pediatric care specialists who treat babies born outside of regular birthing facilities to ensure that the babies are screened for hearing loss and to report the test results to the parents and to the DPH. Requires the DPH to adopt rules.
The Senate PASSED the bill, as amended, 46-0; it now returns to the House
SF 407 INFANT HEARING TESTS - WITHDRAWN
HF 457 CHILD TO ADULT TRANSITION - Requires DHS to establish Local Transition Committees to address the transition to adulthood needs of children 16 or older and are receiving child welfare services. Contains other related provisions.
S-3253 by Hatch - Lets the written services plan be developed with any person who may be a service provider for the child when they become an adult.
S-3254 by Hatch & Kreiman - Lets a guardian ad litem continue a relationship with and advise a child after their eighteenth birthday if authorized by the court.
The Senate PASSED the bill, as amended, 46-0; it now returns to the House
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.
The Senate PASSED the bill, 49-0; it now goes to the Governor

HF 667 HEALTH AND HUMAN SERVICES APPROPRIATION
Appropriates to health and human services agencies: Total (from the GF): $772.7 million; Appropriations: DEPT. OF ELDER AFFAIRS $3.0 million; DEPT. OF PUBLIC HEALTH Total: $24.1 million; Other Funds ELDER AFFAIRS: $7.2 million PUBLIC HEALTH Total $3.7 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; Supplementary Assistance: $19.2 million. CHILD & FAMILY SERVICES: ($131.1 million Total); MM/MR/DD/BI: ($100 million Total) Institutions: Cherokee: $12.4 million; Clarinda: $7.1 million; Independence: $16.9 million; Mt. Pleasant: $5.8 million; Glenwood: $4.4 million; Woodward: $2.7 million; DHS ADMINISTRATION: Field Operations: $50.7 million; General Administration: $10.8 million. Other Funds TANF: Total: $146.6 million; Pregnancy Prevention: $2.5 million; $85,000 for the Iowa Marriage Initiative and adds requirements that DHS establish a fatherhood initiative grant program. Other: $1.5 million. Medicaid Supplemental: 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) Other Provisions: Lets the nursing board raise fees and keep 90% of the increase. Adds language regarding Medicaid/Medicare cross-over claims to protect hospitals. Directs the DHS to develop a consumer child care provider information program. Gives HAWK-I board the authority to work with several dental insurers. Changes the fee for dispensing prescription drugs to $4.26.

S-3266 by Shull - Strikes the Scope of Practice Review Commission- WITHDRAWN
S-3272 by Tinsman - Gives DHS the fatherhood initiative responsibility. FAILED,
S-3276 by Putney - Requires services by practitioners other than physicians to be reimbursed at the same rate as physicians by third party payors. WITHDRAWN
S-3273 by Tinsman - Phases out the 7 cent transaction fee paid to retailers who do not use the state's EDT machine over two years. FAILED, 5-44
S-3274 by Tinsman - Prohibits lay-offs in the child protection staff. Authorizes up to $400,000, if available in TANF funds, for case management positions in each judicial district for methamphetamine abuse. Authorizes the Commission on Veteran's Affairs, with the Veterans Home, the DIA and the DHS to determine the eligibility of veterans who are in nursing homes for veteran's benefits. FAILED, 22-25
S-3279A - WITHDRAWN
S-3278B by Hatch, et al - Increases the appropriation for the DEA by $550,000, for infectious disease by $100,000, to the DPH by $200,000, for substance abuse treatment by $1.8 million and strikes caps on group foster care. FAILED,
S-3282 by Holveck, et al - Requires the any excess monies received this year from Medicaid be used to repay the Senior Living Trust Fund. FAILED, 22-28
S-3284 by Holveck, et al - Appropriates $10,000 for up to three counseling visits for family members of persons called to active duty. WITHDRAWN
The Senate PASSED the bill, 28-22; MTR filed by Lamberti

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

HF 685 TOBACCO TRUST APPROPRIATIONS (Appropriations; Successor to LSB 3481HC) Appropriates from the Tobacco Trust to DEPT. HUMAN SERVICES Medical Assistance ($34.9 million total) $8.1 million -Reimbursements; $3.8 million - Dental; $3 million - Hospitals $2.1 - Home Health Care; $250,000 - critical access hospitals $2 million - special needs children; $1.1 million - Respite Care; $250,00 Breast & Cervical Cancer $14.3 - non- specified Medical Assistance supplemental. Child & Family Services $3.2 million - Rehabilitative Treatment; Other DHS $1.2 million. DEPT. PUBLIC HEALTH Smoking Prevention: $5 million Substance Abuse Treatment $10 million; Healthy Iowans $2 million ($187,00 - Trauma & EMS) ($437,00 - Poison Control Center) ($141,000 - Environmental Epidemiology) ($76,000 Child Lead Poisoning Prevention) DEPT. CORRECTIONS: $860,000; Special Needs Unit: $1.1 million. PROPERTY TAX RELIEF FUND $146,000. IOWA EMPOWERMENT FUND $2.1 million FM: Heaton

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