Legislation Now: Featuring updates on state legislation
Bills that moved
Feb. 26, 2021
- Emergency medical services (EMS): House File 562 (formerly House Study Bill 186) passed unanimously through the House Tuesday. This bill would update the process for EMS to be deemed an essential service. This new process would have three distinct differences from what the process currently involves:
- The ability for county or city EMS districts to levy additional tax funds in a future election if the funds levied in the first vote are insufficient.
- The petition to begin the process for entire counties would be eliminated.
- The five-year sunset on the tax levy would be eliminated.
IHA thanks members of the House for approving this legislation and encourages members to reach out to their representative to thank them as well. IHA now will work with the Senate to keep the bill moving forward.
- Tort reform: Senate Study Bill 1125 was introduced this week by Sen. Brad Zaun. This bill increases the cap for noneconomic damages against a health provider to $1 million. A similar bill, House File 517, passed out of the full committee last week and is now eligible for debate in the House.
- Telehealth: House File 612 was introduced this week by House Democrats. This bill provides telehealth payment parity for mental health and physical health visits. This bill is similar to the bill put forward last year and is a step further than the bill already passed in the House that only covers telehealth reimbursement for mental health.
- Medicaid/Days awaiting placement: The Legislature has been considering policy to address Medicaid managed care in Iowa. Three bills have been introduced and were considered this week, although only one has advanced through committee:
- Senate File 462: This bill would require DHS to conduct a study to determine the feasibility of providing Medicaid reimbursement for hospitalized patients who no longer meet medical necessity criteria but an alternative level of care for placement cannot be identified. This bill has advanced through committee and is now eligible for floor debate. Although this bill is advancing in study form, IHA continues to work to identify a reimbursement rate that can be used in lieu of a study process. IHA wants to thank Sen. Jeff Edler for bringing this bill forward and Sens. Liz Mathis and Mark Costello for their continued dedication to resolving this issue.
- Senate Study Bill 1164: This bill has two divisions that would create more rigorous requirements for managed care companies. The first division concerns claims. It would establish more-stringent timelines to pay or deny claims and a better system for tracking. The second division would require DHS to issue a request for proposal for a single-credentialing verification organization. This bill passed subcommittee but has yet to pass full committee. The bill must pass through committee next week to survive first funnel. A companion bill has been introduced in the House and has not advanced.
- House Study Bill 225: This bill would prohibit managed care companies from seeking repayment of overpayments incurred after 12 months. This bill had broad support from providers but did not pass subcommittee and will not advance.
Feb. 19, 2021
- Medicaid oversight: A Senate subcommittee reviewed a bill that would impose stricter Medicaid requirements on the state's managed care organizations. Senate Study Bill 1164 would create more stringent timeframes for them to pay or deny claims and require them to develop a system to better track claims, claim disputes, claim reconsiderations and appeals. The legislation also would require the Department of Human Services to use a request-for-proposal process for services of a single-credentialing verification organization to be use in credentialing and re-credentialing providers for both Medicaid managed care and fee for service. Further, the managed care organizations would be contractually required to accept verified information from the single-credentialing organization and approve any provider approved and enrolled by the Department of Human Services as an Iowa Medicaid provider. SSB 1164 now will be reviewed by a full committee.
- Emergency medical services: House Study Bill 186, legislation updating the process for emergency medical services to be deemed an essential service, passed out of the House Ways and Means Committee this week. This new process would have three distinct differences from what the process currently involves:
- The ability for county or city emergency medical services districts to request to levy additional funds in a future election if the funds originally levied are insufficient.
- The petition to begin the process for entire counties would be eliminated.
- The five-year sunset on the tax levy would be eliminated.
Because it was approved by a committee, HSB 186 was given a new bill number, House File 562, and is eligible for floor debate in the House. The Iowa Hospital Association thanks the members of the House Ways and Means Committee and especially appreciates the work by Reps. Bobby Kaufmann (R-Wilton) and Lee Hein (R-Monticello) on this issue.
- Tort reform: House File 517 provides a $1 million cap on noneconomic damages for personal injury against a health care provider for injury or death in a civil action. The bill was reviewed by a House subcommittee and advanced out of the House Human Resources Committee this week. HF 517 is now eligible for floor debate. A bill allowing residents of medical programs statewide to be covered by the Iowa Tort Claims Act, House File 436, was approved by a House subcommittee. HF 436 will now be reviewed by a full House committee.
- Days awaiting placement: Senate Study Bill 1193 was introduced early this week and has already passed through a Senate subcommittee. This bill would require a study by the Department of Human Services to determine the feasibility of providing Medicaid reimbursement to hospitals for administrative days. Administrative days under the bill means an inpatient stay during which a Medicaid eligible patient no longer meets medical necessity criteria for acute hospital care and is awaiting placement in a nursing facility or other subacute or post-acute care facility.
- Workforce: House File 289, a bill expanding those who qualify to have direct care agreements with patients beyond primary care health professionals, was approved by a House subcommittee and passed by the House Human Resources Committee this week. This legislation is now eligible for debate on the House floor.
- Public improvement contracts: Monday, Feb. 15, legislators in the Senate continued a subcommittee on public improvement contracts that started the week before. Senate File 183 is a construction-manager-at-risk bill that provides for alternative bidding methods and prohibits design build projects. The subcommittee approved the bill, and now a full committee will review the bill.
- Other bills:
- House File 372 – Nonmedical switching (HF 372) prohibits insurance companies from switching patients to other drugs without their consent. This bill passed out of subcommittee and full committee unanimously. The full House now will review the legislation. A similar bill, Senate File 178, was set for subcommittee and postponed in the Senate.
- Senate File 193 – Employee vaccinations (SF 193) provides that a hospital cannot discriminate against an employee or health care provider for their refusal to be vaccinated. It also prevents a hospital from requiring an employee get vaccinated as a condition of employment. A Senate subcommittee reviewed and approved the bill this week. SF 193 will now be reviewed by a full committee.
Feb. 12, 2021
- Emergency medical services: On Monday, legislators on the House Ways and Means Committee introduced legislation updating the process for emergency medical services to be deemed an essential service, which would also allow the services to draw down tax funds to support the service. House Study Bill 186 has been moving quickly, having passed through a subcommittee Wednesday morning and scheduled for review by the full Ways and Means Committee Monday afternoon. HSB 186 is divided into two parts with the first pertaining to county or city districts declaring EMS an essential service and the second pertaining to the entire county declaring EMS an essential service. Further, the bill directs that after city or county EMS district trustees or county boards of supervisors adopt a resolution declaring EMS an essential service, the issue would go up for a vote of the people. If approved, the district or county would coordinate with local EMS agencies to develop an EMS system advisory council responsible for making recommendations about needed funding and submitting an annual report. Tax funds would continue to be used to support EMS until an effort to discontinue the practice is approved through another vote of the people. This new process would have three distinct differences from what the process currently involves:
- The ability for county or city EMS districts to levy additional tax funds in a future election if the funds levied in the initial vote are insufficient.
- The petition process to begin the process for entire counties would be eliminated.
- The five-year sunset on the tax levy would be eliminated.
- Workforce: Several workforce bills passed through the subcommittee and committee process:
- Senate File 129 is legislation providing new specialty areas including OB/GYN services, enlarged service commitment area distance requirements and other practice-related requirements under the Rural Iowa Primary Care Loan Repayment Program. This bill passed unanimously out of the full committee.
- House File 196 is legislation expanding the professional recruitment program to students who graduate from an academic program at an eligible institution that leads to licensure in a health care profession. This bill passed out of subcommittee.
- House Study Bill 168 is legislation that establishes requirements for the University of Iowa Colleges of Medicine and Dentistry to accept 75% of Iowa students for those programs, rather than about 70%. This passed out of subcommittee and the full committee, and it was renumbered House File 468.
- House File 270 is legislation requiring interviews be offered to medical residency applicants from Iowa or graduates from an Iowa program. This piece of legislation passed out of the full committee.
- Surgical smoke: Last week, HSB 59 was introduced in the House and was reviewed by a subcommittee this week. The bill was brought forward by the Association of Perioperative Nurses and introduced by Rep. Bobby Kaufmann (R-Wilton). The purpose of the bill is to eliminate surgical smoke in operating rooms. The bill requires the Iowa Department of Inspections and Appeals to promulgate rules for hospitals and ambulatory surgical centers no later than July 1, 2023, and for critical access hospitals no later than July 23, 2025. IHA is registered undecided on the bill. At the subcommittee, IHA advised that most, if not all, hospitals have systems for elimination of surgical smoke. The bill passed out of subcommittee and will now move on to the full committee.
- Public improvement contracts: A House subcommittee was held this week and will continue next week after committee members heard from people on both sides of Senate File 183. This bill was brought forth by Master Builders of Iowa with the support of other associations. Design builders and the Board of Regents are registered against the bill because it bans design build projects. IHA will continue to provide updates on this as they develop.
Feb. 5, 2021
- Medicaid oversight: Two bills were introduced this week that would impose stricter Medicaid requirements on Iowa's managed care organizations (MCOs). House Study Bill 169 and Senate Study Bill 1164 would:
- Put stricter timeframes in place for the MCOs to pay or deny clean claims.
- Put on a stricter timeline on when the MCOs need to have updated payment rates uploaded to their systems.
- Require the MCOs to develop a tool allowing providers to track claims, claim disputes, claim reconsiderations and appeals on the MCO’s website.
- Require uniform authorization criteria and single credentialing verification.
The bill in the House has been assigned to a subcommittee, but a meeting has not been scheduled yet. The Senate bill, having been introduced Thursday, Feb. 4, has not been assigned yet to a subcommittee, but that is expected to occur early next week. IHA is registered in support of these bills and will continue to provide updates as they progress.
- Telehealth: Conversations about telehealth services continued at the Capitol this week, resulting in legislation advancing. IHA anticipates that telehealth will remain a significant topic in the coming weeks and will provide updates as they develop.
- House File 294 (formerly House File 89) – A bill that would require mental health services provided through telehealth be reimbursed in the same way and at the same rate as if the service was provided in person advanced through a full committee last week. This bill is now eligible for floor debate in the House.
- House File 269 – This is legislation prohibiting health carriers from excluding out-of-state health care professionals from providing telehealth services in Iowa. This bill advanced through a subcommittee this week and will now be reviewed in a full committee.
- House File 88 – This legislation would allow providers to provide telehealth services through audio-only means. During its review in a subcommittee, IHA and the Iowa Medical Society offered an amendment that would require appropriate licensure boards to develop rules to ensure services provided through audio-only communication are clinically appropriate. Concerns also arose during the subcommittee that audio-only services could be overused and IHA again worked with the society on an amendment highlighting the importance of face-to-face interactions when possible. Both amendments were approved, and the bill advanced through a full committee. This legislation is now eligible for floor debate in the House.
- Senate Study Bill 1089 – This legislation pertains to the expansion of broadband service and includes updated requirements for the Empower Rural Iowa Broadband Grant Fund. This bill was reviewed in a subcommittee this week, and the committee decided to meet again for further discussion on the bill. IHA will continue to monitor this legislation.
- Days awaiting placement: Last week, a bill for payment for days awaiting placement was introduced. Senate File 154 requires that, under private insurance, Medicaid fee-for-service and Medicaid managed care hospitals cannot be denied reimbursement for the continuation of higher-level services, including inpatient care, provided while the patient is waiting to be moved to a lower-level facility. This bill has been assigned to a subcommittee but a meeting has not been set yet. IHA is registered in support of this legislation and will continue to provide updates.
- Workforce: This week, workforce bills continued to advance in the House and Senate. Legislators looked at creative ways to recruit and retain physicians and other health care workers. These bills include:
- House File 270 – This legislation requires interviews be offered to medical residency applicants from Iowa or graduates from Iowa programs.
- Senate File 129 – This legislation provides new specialty areas, including OB/GYN services, enlarged service-commitment-area distance requirements and other practice-related requirements under the Rural Iowa Primary Care Loan Repayment Program.
- Senate Study Bill 1112 – This legislation concerns disciplinary hearings conducted by professional licensing boards.
These bills have moved out of subcommittee and into full committees. IHA will provide updates as these bills advance.
- Vaccines, immunizations and masks: Several bills were introduced this week about vaccines, immunizations and masks. These bills concern employers, hospitals and other health care facilities, and only one has advanced. These bills include:
- Senate File 125 – Adds immunization information requested on a medical examiner investigation form and has passed out of a full committee. This bill is now eligible for floor debate.
- House File 175 – Allows administering, prescribing or ordering immunizations or vaccines by a licensed podiatric physician while also providing an effective date.
- House File 217 – Allows exemptions from immunizations in schools based on sincerely held beliefs.
- House File 329 – Provides an exemption from immunization based on prerequisite conditions with a vaccine.
- House File 330 – Provides requirements and prohibitions for employers requiring employees to get vaccinated or immunized and discriminating against employees for their decisions concerning vaccines and immunizations and providing civil remedies.
- House File 342 – Provides a civil rights creed to include various sincerely held religious beliefs and sincerely held beliefs about vaccinations and wearing face masks.
- Senate File 193 – Provides requirements and prohibitions about vaccines and immunizations as well as provides civil remedies.
Jan. 29, 2021
- Telehealth: Both telehealth bills in the House advanced this week:
- House File 89, a bill providing for telehealth payment parity for mental health services, passed a full committee vote unanimously and is now eligible to be debated on the House floor.
- Legislators in a subcommittee also advanced a telehealth bill, House File 88, that would allow providers to deliver audio-only telehealth services. The original bill required providers of audio-only telehealth to meet the same standards of care as in-person health care. The Iowa Hospital Association worked with the Iowa Medical Society to instead allow licensing boards to determine the appropriate standards of care for audio-only telehealth. When amended, this bill will be reviewed in the full Human Resources Committee.
- Workforce: Health care workforce issues made their ways through both houses:
- In the House, House File 196, which expands the Healthcare Professional Recruitment Loan Repayment Program beyond those attending Des Moines University to any student who graduates from an academic program leading to health care professional licensure, was debated and passed through the house 99-0. It now will move to the Senate.
- On the Senate side, Senate File 129, which expands specialty areas to include OB-GYN and expands distance and practice-related requirements under the rural Iowa Primary Care Loan Repayment Program, passed out of committee and is on the debate calendar for a floor vote in the Senate.
- Public improvement contracts: This week, the Senate approved Senate File 183, which provides construction-manager-at-risk as an alternative delivery method and prohibits design build. This is a bill brought up by Master Builders of Iowa and passed through the Senate. The bill will now be reviewed in the House
- Other bills:
- Though legislation for emergency medical services (EMS) and public hospital trustee elections has not yet been introduced, the Iowa Hospital Association has been talking to legislators and working to ensure hospital positions are included. The Iowa Hospital Association is advocating for an EMS bill like the House passed last session, which would create a process for county boards of supervisors to declare EMS an essential service allowing for financial support to be provided by the county.
- Another area the Iowa Hospital Association is keeping a close watch on concerns patient visitor issues. There have been concerns raised by legislators in the Senate that hospitals have restricted visitation unnecessarily during the pandemic. So far, legislation has not been introduced.
- The Iowa Hospital Association is working to ensure a provision about public hospital trustees is included in this year’s election bill. Last session, the Iowa Hospital Association secured a temporary fix on the timeline for trustee candidates to submit their paperwork in early fall – as they have historically done – rather than early spring, as outlined in a 2019 elections bill. This year, the Iowa Hospital Association is working to make that timeline fix permanent, allowing trustee candidates to continue to submit their campaign paperwork in early fall.
Jan. 15, 2021
- Certificate of need: The first week of legislative session has seen many bills introduced for consideration. Among those is a bill to eliminate Iowa’s certificate-of-need process. The bill, Senate File 4, was introduced by Sen. Brad Zaun (R-Urbandale). The bill would completely remove the process. The bill has not been set for subcommittee, and IHA will remain vigilant for any movement related to it this session. Please reach out to Kim Murphy at email@example.com with questions or concerns.
- Hospital price transparency: Monday, Jan. 11, legislation in the Senate was introduced that would require hospitals to report prices on services charged before negotiations or discounts. Senate File 5 would require hospitals to post on their websites the prices of the 25 most-common health care services provided by the hospitals as well as the 75 most-common inpatient and 75 most-common outpatient services provided by the hospitals. This bill has been assigned to a subcommittee, but a subcommittee meeting has not been scheduled.
Jan. 22, 2021
- Telehealth payment parity: The Iowa Hospital Association has been advocating for telehealth payment parity for the last two legislative sessions. After a yearlong COVID-19 pandemic highlighting the need for robust telehealth options in Iowa, three separate telehealth bills have been introduced in the legislature. Two bills were presented in the House by Rep. Joel Fry (R, Osceola) and one bill was presented in the Senate by Sen. Brad Zaun (R, Urbandale):
- House File 88 provides audio-only telehealth or telemedicine for health-related professional licensing boards and instructs them to adopt rules to use telehealth. But this bill does not address payment parity.
- House File 89 provides telehealth payment parity for health care services for mental health conditions, illnesses, injuries or diseases to covered patients by telehealth through the use of real-time interactive audio or video. This bill covers only mental health and not physical health, and it was passed through a subcommittee. Rep. Fry reported, during a subcommittee, that he will soon introduce a telehealth bill for physical health services.
- Senate File 92 provides telehealth payment parity for covered patients who receive health care services through interactive audio or video, and it covers mental and physical health.
- Workforce: Senate Study Bill 1042, Rural Primary Care Loan Repayment Program, expands the rural primary care loan repayment program to specialty areas, such as OB-GYN, and expands service-commitment-area distance requirements. The Iowa Hospital Association is registered in favor of this bill, and it passed out of subcommittee. House File 5, Professional Recruitment Program, expands the health care professional recruitment program from Des Moines University to other institutions for other health care professional licensing programs. The Iowa Hospital Association is registered in favor, and it passed out of subcommittee.
- Hospital patient data collection: House File 8 is similar to what The Iowa Hospital Association has seen in the past for hospital patient data collection. This legislation would remove the patients name in the data the Iowa Department of Public Health collects and is proposed to protect patient privacy. The bill was approved by a subcommittee this week and will move to a full committee. The Iowa Hospital Association is registered undecided.
- Public improvement contracts: Senate Study Bill 1018 provides only for construction-manager-at-risk commercial-construction-alternative-delivery method and prohibits other alternative-delivery methods such as design build in the public sector. This is a repeat bill from last year that prohibits design build for the Board of Regents. The Iowa Hospital Association is registered undecided on this bill, and it passed out of subcommittee.
- Primary care pilot projects: Senate File 81 is a pilot program to allow Medicaid members to participate in primary direct care agreements. The Iowa Hospital Association is registered undecided on the bill, and it passed out of subcommittee.
- Insulin prescription costs: House Study Bill 50 is another bill legislators have reviewed in the past. This legislation would limit how much a policy, contract or plan providing for third-party payment or prepayment of medical expenses providing coverage on prescription drugs can charge a covered person on insulin drugs of not more than $100 for a 31-day supply. This bill passed through a subcommittee. The Iowa Hospital Association is registered as undecided on the bill.