DES MOINES — Two health care leaders in the Iowa Senate have introduced legislation to make significant reforms to Iowa’s privatized Medicaid system.
Senate File 156, the Senate Democratic Medicaid Improvement Bill, has been introduced by Senators Amanda Ragan of Mason City and Liz Mathis of Hiawatha. They are, respectively, the ranking members of the Senate Health & Human Services Budget Committee and the Senate Human Resources Committee.
“Governor Reynolds and legislative Republicans are sticking with privatized Medicaid,” Ragan said. “Given that, our focus is making urgently needed improvements. We are proposing large and small improvements to how privatized Medicaid serves Iowa families and healthcare providers.”
“Iowans need privatized Medicaid to do three things and do them well,” Mathis said. “One, make sure Iowans get the healthcare services they need when they need them. Two, make sure Iowa healthcare providers are correctly paid for the work they do and paid on time. Three, key Medicaid decisions should be made by Iowans rather than by employees of out-of-state, for-profit companies.”
News Conference Video:
Senate File 156 Highlights
Senate File 156 would make these changes to Iowa’s privatized Medicaid on behalf of Iowa patients and providers:
Return the Long Term Services and Supports (LTSS) population to publicly managed Medicaid
The MCOs are supposed to make money by helping sick people get better and thereby lowering costs. Many Iowans suffering the most from privatized Medicaid system are Iowans living with severe, complex, permanent disabilities and conditions. Because these Iowans aren’t going to “get better,” denying care and cutting needed services is largely the only way to “save money.” This is unacceptable.
Require independent conflict-free case management and assessments
There is an inherent conflict of interest in privatized managed care. Case management and patient assessments are both performed by employees of the MCO that pays for the care of those patients. Assessments are more accurate when made by an independent entity and coordinated by case managers who put the patient’s best interest first.
End the practice of requiring prior authorization for substance abuse treatment
Every substance abuse counselor knows that an immediate response is essential when someone requests treatment. “Medication assisted treatment” can quickly take away the cravings once it begins. However, waiting for prior authorizations results in missed opportunities or even overdose deaths that could have been prevented.
Require MCOs to develop and implement workforce recruitment, retention and training programs
Iowa has a severe health care workforce shortage. The MCOs now manage the care of some 600,000 Iowans. Every other major health care provider and insurer in the state of Iowa contributes time, talent, and money to efforts to expand and improve Iowa’s health care workforce. This legislation will require the MCOs to join that effort.
Implement an external review process for providers
Today, when the MCOs deny a claim, an Iowa health care provider can only attempt to negotiate with MCO that denied the claim. When commercial health insurers deny claims, providers can appeal to an external reviewer. This legislation establishes a similar appeal system when the MCOs refuse to pay for care.
Make it easier and quicker for members to switch MCOs
If a local doctor decides to switch the MCO he or she contracts with, that doctor’s patients must be able switch COs if they want to continue seeing that doctor. Currently, patients must wait up to 45 days before they can ask DHS to approve a change for good cause. This is an unusually long and burdensome process for Iowans. This legislation would allow patients to request that DHS approve an MCO switch after 10 days.
Move the Managed Care Ombudsman Program to the State Ombudsman’s Office
Independent advocates for Iowans are an absolute necessary if Iowa managed care is going to work. Iowa’s Long Term Care Ombudsman has only one full-time managed care ombudsman. There could be three to four more working for Iowa families and health care providers if we took full advantage of federal matching funds. The MCO ombudsman services should be moved to the State Ombudsman Office.
SSB 1051 – Eligibility and reporting requirements for skilled workforce shortage tuition grant program
SSB 1051 is a technical correction to eliminate the Iowa Workforce Development reference in the Skilled Workforce Shortage Tuition Grant statute that is scheduled for repeal July 1, 2019, and ensures that students enrolled in programs of study aligned with statewide high-demand jobs continue to qualify for funding. In addition, the bill amends the program to include a grandfather clause for students receiving grants who are enrolled in a program of study that is aligned with a high-demand job that is subsequently removed from eligibility.
The Skilled Workforce Shortage Tuition Grant statute references a section of the Iowa Code requiring a report to be produced quarterly. This Code section was rescinded during the 2018 legislative session. Because the College Student Aid Commission references an Iowa Workforce Development Code section that will be repealed, a technical correction must be made. In addition, the Skilled Workforce Shortage Tuition Grant does not provide a grandfather clause for students who are enrolled in a program of study that is subsequently removed from the list of high-demand jobs.
[2/11: Short Form]
SSB 1052 – Requirements for eligibility under the all Iowa opportunity scholarship program
SSB 1052 strikes the age provisions for two populations to ensure all applicants are held to the same eligibility criteria under the All Iowa Opportunity Scholarship.
Over the course of the past two years, two new student populations have been granted access to the All Iowa Opportunity Scholarship. House File 642 granted eligible foster care students first priority for funding; and House File 2502 granted students whose parent was a public safety worker killed in the line of duty second priority for funding. The defining language for each of these student populations contains an age threshold that would allow them to lose eligibility prior to receiving the maximum benefit under the program. There is no such age threshold for the general student population.
[2/11: Short Form]
SSB 1099 – Public forums, speech at universities and community colleges
SSB 1099 governs public forums, freedom of expression and freedom of association at community colleges and state universities. It requires Regent universities and community colleges to adopt statements protecting speech; the freedom to discuss, assemble and engage in spontaneous expressive activities subject to reasonable time, place and manner restrictions; and public areas of campuses as traditional public forums. Protected activities include all forms of peaceful assembly, protests, speeches (including by invited speakers), distribution of literature and circulating petitions. The bill requires that the outdoor areas of campuses be deemed traditional public forums. Specific areas cannot be deemed free speech zones, and policies cannot otherwise restrict expressive activities to a particular outdoor area of campus.
The bill also prohibits institutions from denying a student organization any benefit or privilege available to any other student organization. An aggrieved member of the campus community may bring an action against an institution responsible for a violation of this law and may assert such violation as a defense or counterclaim.
A committee amendment was offered that made some technical changes but did not address concerns regarding the continued protection of certain protected classes under Iowa’s Civil Rights Act.
[2/13: 11-4, party-line (Yes: Quirmbach voting “yes” with Republicans)]
HF 306 – FY20 state supplemental aid at 2.06 percent
HF 306 is the FY20 state supplemental aid or basic school funding for the school year starting in July 2019. HF 306 provides for a 2.06 percent increase in basic school funding, which Republicans have said they will fund at $78.6 million. This funding level includes a $22.5 million cut to the Area Education Agencies. If there was no additional cut to AEAs; SF 172’s 2.06 percent will cost $93.6 million. Governor Reynolds proposed 2.3 percent increase in state funding for schools.
General State Aid: HF 306 establishes a total cost per pupil of $6,875; an increase of $139 per pupil over last year. The 2.06 percent increase will cost the state $78.6 million more than last year. This assumes that the Legislature continues the $22.5 million AEA reduction in this year’s Standings Bill.
Categorical State Aid: The FY20 allowable growth rate for each of the State Categorical Supplements (Teacher Leadership and Compensation; Teacher Salary Supplement; and Professional Development and Early Intervention) totals $537.9 million, an increase of $10.7 million.
- Teacher Salary Supplement: $304.9 million (increase of $6 million)
- Professional Development Supplement: $34.6 million (increase of $680,000)
- Early Intervention (general purpose allowed): $35.6 million (increase of $700,000)
- Teacher Leadership Supplement: $162.7 million (increase of $3.3 million)
Budget Guarantee: This is the amount made up entirely of local property taxes to guarantee a school district receives 101 percent of the previous year’s funding level. It only occurs when a district’s enrollment decline is greater than the basic state funding percentage increase. It’s estimated that 117 districts will be on budget guarantee under 2.06 percent.
Property Taxes: Since 2013, the Legislature makes a determination on whether it will pay for the increment increase in property taxes associated with an increase in the percentage growth for schools. The total funding for this effort is now $62.1 million, an increase of $10 million over last year. This is not new money for schools, just shifting dollars from local property taxes to state funding.
A Democratic amendment to increase the state funding for schools by 3 percent, a $43 million increase over HF 306 levels, failed on a party-line vote.
[2/13: 35-13, party-line (Bisignano, Danielson, Kinney, Mathis voting “yes” with Republicans; Excused: Jochum, Nunn)]
SF 237 – Judicial Nominating Commissions
SF 237 is a Republican proposal that makes drastic changes to the way judges in Iowa will be chosen, primarily through changes to the judicial nominating commissions. Currently, judicial nominating commissions recommend nominees whose names are sent to the Governor to fill judge vacancies on the Iowa Supreme Court, the Iowa Court of Appeals and district courts. Currently, the Governor appoints half the members of the commissions and Iowa attorneys elect half the members. This bill does away with the election of members to the judicial nominating commissions by resident attorneys. Instead, the House and Senate majority and minority leaders, will appoint members to the commissions. There is one State Judicial Nominating Commission and 14 District Judicial Nominating Commissions. This bill politicizes Iowa courts and is a power grab by Republicans who want control of the Judicial Branch. This process could result in extremist individuals being appointed as judges.
[2/11: 9-4, party line (Absent: Nunn)]
SSB 1009 – Threat of a targeted attack and cyberharassment
SSB 1009 establishes the criminal offense of assault by threat of a targeted attack. It will be a “D” felony when a person threatens to cause serious injury or death to people assembled in a public place, a school building or any occupied structure other than a single-family residence when the people threatened reasonably believe there is a possibility of death or serious injury, or have a reasonable expectation that the threat will be carried out. A “D” felony is punishable by up to five years in prison and a fine of at least $750 up to $7,500. “Public place” is defined as an indoor area, privately or publicly owned, where the public has access by right or by invitation, express or implied, regardless of whether or not payment is required.
The Committee adopted an amendment creating the crime of cyberharassment, which is when a person makes an electronic communication with the intent to threaten, intimidate or alarm another person; knowingly sends or posts comments, requests, suggestions or threats of physical harm to or about another or the other person’s property without legitimate purpose and in a manner that a reasonable person under the same circumstances would interpret to cause fear of physical or emotional harm. Cyberharassment will be second degree harassment, a serious misdemeanor, punishable by up to one year in jail and a fine of at least $315 but not to more than $1,875.
[2/13: short form (No: Hogg, Taylor; Absent: Petersen)]
SSB 1037 – Illegal practice of massage therapy
SSB 1037 imposes a criminal penalty for unlicensed people who practice massage therapy or hold themselves out as a massage therapist. Current law requires massage therapists in Iowa to be licensed. Unlicensed people are prohibited from engaging in massage therapy or holding themselves out in any way as a massage therapist or masseuse, or using any other word or title that implies the person is a massage therapist.
This bill makes it a serious misdemeanor for an unlicensed person to engage in or hold themselves out as a massage therapist. Currently, under Chapter 152C relating to the regulation of massage therapists, unlicensed people are only subject to a civil penalty. A serious misdemeanor is punishable by up to two years in prison and a fine.
[2/13: short form (Absent: Petersen)]
SSB 1057 – Sexual misconduct with offenders
SSB 1057 is a Department of Corrections bill that would make it a “D” felony, rather than the current aggravated misdemeanor, for any peace officer or Department of Corrections employee, contractor, vendor, volunteer or any agent of the Department to engage in a sex act with an offender if the peace officer or employee has knowledge that the person is committed to the Department’s custody. The bill also applies to officers, employees or agents of a judicial district department of correctional services (community based corrections). A “D” felony is punishable by up to five years in prison and a fine of at least $750 but not more than $7,500. An aggravated misdemeanor is punishable by up to two years in prison and a fine.
The committee adopted an amendment to the bill, which increases the penalty for officers, employees, agents, etc., who engage in sexual misconduct with juvenile offenders who are placed in a juvenile detention facility and persons committed to a county jail. The amendment increases the penalty under these circumstances to a “D” felony as well.
[2/13: short form (Absent: Petersen)]
SSB 1066 – Educational Debt Management Services
SSB 1066 is an Attorney General proposal that that relates to debt management services in connection with educational loans. The Attorney General worked with the Division of Banking to craft this legislation.
Under current law, the Banking Division at the Iowa Department of Commerce licenses and regulates those engaged in the business of debt management. This bill requires those who serve as intermediaries between debtors and creditors or loan servicers of the debtor for the purposes of modifying an educational loan to be licensed and subject to the requirements of Chapter 533A relating to Debt Management and Regulation by the Division of Banking.
Under the bill:
- A licensee shall not receive any compensation in connection with educational loan debt management services until after the licensee has fully performed all services under the contract.
- Debtors have an unconditional right to cancel a contract prior to midnight of the third business day following the date of the contract, and cancellation will occur when the debtor delivers by any means, a written notice of cancellation to a specified address supplied by the licensee. This includes by mail delivery, e-mail delivery and personal delivery.
- There are requirements for contracts for educational loan debt management services, including the size of the type in the contracts. In addition, any contract must include a disclosure statement regarding the debtor’s rights of cancellation.
- The bill sets out behaviors and prohibitions that licensees may not engage in relating to the educational loans debt management services.
- Violations of provisions of the bill will be a consumer fraud pursuant to Code section 714.16.
The committee adopted an amendment to clarify that this legislation will apply to licensees who engage primarily in the business of educational loan debt management, not any licensee who does a limited amount of educational loan debt management. It is intended to focus on the bad actors who do only or mostly educational loan management.
[2/13: short form (Absent: Petersen)]
SSB 1072 – Surety bonds for travel trailer dealer licenses
SSB 1072 is an Attorney General bill that increases the required amount for a surety bond for a travel trailer dealer’s license from the Iowa Department of Transportation. The bond amount is increased to $75,000 from $25,000. This change will apply to applications for licenses submitted on or after July 1, 2019. The cost of travel trailers has risen significantly. This bill is intended to protect consumers who purchase travel trailers.
[2/13: short form (Absent: Petersen)]
SF 76 expands Iowa Code to prohibit any use of an electronic device when driving, but exempts public safety agencies performing duties, health care professionals in the course of an emergency and anyone reporting an emergency situation. A violation is a moving violation, and the fine is increased from $30 to $100. Current law prohibits the use of a hand-held electronic device to write, send or view messages when driving a motor vehicle (texting and driving).
[2/13: 12-0 (Absent: Zumbach)]
SF 88 allows the Iowa Department of Transportation to issue a $35 blackout special registration plate. The plate’s background must be black and the numbering white. The vehicle owner must not place a frame that blocks plate number, state or county name, or validation/registration sticker. Monies collected by the DOT go to the Statutory Allocation Fund and are returned to each county’s county mental health and disabilities services fund.
Additionally, the bill allows a minimum standard of transparency of 35 percent light transmittance (window tint) and sets a $50 fine for violation of the provision. A driver must lower their side window to the lowest possible position before an officers approaches the vehicle.
[2/13: short form (Absent: Zumbach)]
SSB 1050 eliminates the burden on aircraft owners to keep current paper registration certificates in their aircraft if they have been junked or destroyed by fire or accident, since aircraft registrations are now checked electronically. The bill removes outdated references to paper aircraft certificates and changes references from “returning certificates” to “providing notice” to the DOT.
[2/13: short form (Absent: Zumbach)]
SR 2 is the Code of Ethics governing the conduct of members of the Senate. It updates the reference to the new General Assembly and makes a clarification in three locations to include explicitly the joint rules governing lobbyists as a basis for complaint. The bill clarifies that discrimination, abuse or harassment, as provided and defined in the personnel guidelines of the Iowa Senate, applies to the Senate Code of Ethics. It removes language that a complaint must be filed within three years to be considered timely and also strikes provisions that senators with a conflict of interest can participate in floor debate.
[2/13: voice vote (Absent: Jochum, Nunn)]
SF 171 – School Funding: Transportation and Per Pupil Equity
SF 171 is year two of policy and funding efforts to decrease the transportation and per pupil inequities within Iowa’s school aid formula. First, SF 171 adds an additional $5 per student on top of the state supplemental aid for the upcoming budget year. This equates to an additional $2.3 million for schools. It is estimated that 179 school districts will receive additional funding, 170 of which will see the full $5 per student increase. This is new money for those schools. The rest of the school districts will get a small property tax decrease because $5 of their current district cost per pupil will be paid for by state dollars. These districts won’t see “new” money under this portion of this bill.
Second, this bill addresses the transportation inequity. Schools pay for transportation costs out of their general fund budgets. For larger geographical districts, this results in more money going to transportation costs than other districts. SF 171 provides $7.8 million increase in funding for FY20. This is on top of last year’s $11.2 million appropriation for a total investment of $19 million. Not every school district will receive transportation assistance. If a school district exceeds the statewide adjusted transportation cost per pupil, a portion of $19 million will be distributed to them. Transportation costs are recalculated every year. An estimated 190 districts will receive funding in FY20, which is 57.1 percent of all Iowa school districts.
[2/7: 20-0 (Excused: Lykam)]
HF 307– School Funding: Transportation and Per Pupil Equity
HF 307 is year two of policy and funding efforts to decrease the transportation and per pupil inequities within Iowa’s school aid formula. First, HF 307 adds an additional $5 per student on top of the state supplemental aid for the upcoming budget year. This equates to an additional $2.3 million for schools. It is estimated that 179 school districts will receive additional funding, 170 of which will see the full $5 per student increase. This is new money for those schools. The rest of the school districts will get a small property tax decrease, because $5 of their current district cost per pupil will be paid for by state dollars. These districts won’t see “new” money under this portion of this bill.
Second, this bill addresses the transportation inequity. Schools pay for transportation costs out of their general fund budgets. For larger geographical districts, this results in more money going to transportation costs than other districts. HF 307 provides $7.8 million increase in funding for FY20. This is on top of last year’s $11.2 million appropriation, for a total investment of $19 million. Not every school district will receive transportation assistance. If a school district exceeds the statewide adjusted transportation cost per pupil, a portion of $19 million will be distributed to them. Transportation costs are recalculated every year. An estimated 190 districts will receive funding in FY20, which is 57.1 percent of all Iowa school districts.
The bill requires a report every five years to the Legislature on the effectiveness of the transportation funding and any appropriate recommendations. HF 307 replaces SF 171. The bill will now go to the Governor.
[2/13: 48-0 (Excused: Jochum, Nunn)]
SCR 2 – Mother’s Milk Bank of Iowa
SCR 2 recognizes the Mother’s Milk Bank of Iowa for its critical role in supplying breast milk and its benefits to infants in Iowa and the United States.
[2/13: short form (Excused: Carlin, Edler, Jochum, Johnson)]
SR 3 – Senate Rules
SR 3 is the permanent rules for the Senate in the 88th General Assembly. Prior to passage of these rules, the Senate is operating under temporary rules (those from the 87th General Assembly). In addition to updating the General Assembly number from 87th to 88th, there are non-substantive updates and notable changes, including:
- Changing the affirmative voting word to “yea” (from “aye”) to be consistent with the Iowa Constitution.
- Adding that Senators may introduce school groups, not just the President of the Senate.
- Clarifying that a committee doesn’t have to meet just to announce subcommittee assignments; those will be put in the journal.
- Adding that a committee cannot consider legislation until a public subcommittee is held.
- Clarifying that the Secretary of the Senate is not the supervisor of caucus or leadership staff.
- Extending the time to assign subcommittees for Governor’s appointees to three days (from one).
- Making funnel deadlines earlier in the second year of the General Assembly.
[Committee 2/7: 9-0 (Absent: Feenstra, Jochum); Floor 2/13: vv]
SCR 5 – Joint Rules
SCR 5 is the joint rules for the House and Senate. The sole change is updating the 87th General Assembly to the 88th General Assembly.
[Committee 2/7: 9-0 (Absent: Feenstra, Jochum); Floor 2/13: vv]
SSB 1111 – Wild golden oyster mushroom sales
SSB 1111 allows the sale of wild golden oyster mushrooms at farmers markets under authority of the Iowa Department of Inspections and Appeals.
[2/12: short form]
SF 170 – Agricultural extension council report deadlines & elections
SF 170 moves the deadline for county agricultural extension councils to submit annual financial reports from August 1 to September 1. The bill also changes special elections to fill a vacancy on the county agricultural extension council to the next general election.
[2/12: short form]