Every legislative session has a personality, a personality developed in part by the challenges legislators are asked to address and the opportunities they leverage to move forward with priorities. A session is typically defined by either known challenges that developed over the interim that must be considered by policymakers, or by those that occur during the session that ultimately redirect focus and often redefine the personality of the session. The 2009 session was blessed with both scenarios.
On the first day of the 83rd General Assembly it was clear that rebuilding Iowa would be a top priority for the legislature after natural disasters in 2008 resulted in the designation of 86 counties as federal disaster areas. Not quite as clear, until the meeting of the state’s Revenue Estimating Conference (REC) in March, was the anticipated impact of the national economic downturn on state revenue collections. When the REC came back with a mid-session answer that net General Fund revenues would be $129.7 million less in the current fiscal year and $269.9 million less in FY2010, both the Governor’s and the Legislature’s proposed budgets had to be re-tooled. This already arduous process was complicated by the enactment of the Federal American Recovery and Reinvestment Act of 2009 and the determination of how federal stimulus money received by Iowa should be used.
Despite all of this, the 83rd Iowa General Assembly ended five days earlier than the scheduled adjournment date and, not to be overlooked in the presence of high winds and waters, health care policy continued to be a top-five priority for both the General Assembly and the Governor. A few of the health-care highlights included:
· Health Care Reform: Senator Hatch (D – Des Moines) sponsored the second consecutive year of legislative health care reform efforts. Senate File 389 was signed into law on May 19th and included a number of provisions such as: the creation of the Legislative Health Care Commission charged with developing a health care reform strategic plan, adding registered specialty health care providers and clinics to the voluntary health care services immune from civil liability, establishment of a health care workforce support initiative and shortage fund to help with the coordination and financial support of efforts addressing health care worker shortages in the state including those established by the bill – the medical residency training state matching grant program, the physician assistant mental health fellowship program, the health care professional incentive payment program, and the nursing workforce shortage initiative.
· PMIC Inpatient Benefits: A new paragraph was added to Iowa Code section 135H.3 requiring group insurance to pay for medically necessary inpatient benefits and prohibiting exclusions or denials for those children diagnosed with a biologically based mental illness and meeting medical assistance criteria for admission to a Psychiatric Medical Institution for Children (PMIC). (Senate File 478. See also: Senate File 236 relating to PMIC services and cost-based reimbursement.)
· Mental Health Parity: Despite statewide grassroots efforts, positive polling numbers, and legislative leadership, the mental health and substance abuse parity bills supported and passed by both the House and Senate Human Resources Committees stalled on the debate calendars and were never brought to the floor for debate. Mandated health care coverage for prosthetics (HF311) and oral chemotherapy medications (SF 478), however, were passed by the General Assembly.
· Stipends for Psychiatrists: Receiving a decrease in total funds available, but maintained in the Health & Human Services Appropriations for FY10, were the stipends created in 2007 to help address the mental health professional shortage through financial support to psychiatrists serving as medical directors in community mental health centers. In the upcoming year, four $40,000 stipends will be available (total appropriated $163,6000) whereas in FY09 five stipends were funded. House File 811 has not yet been signed by the Governor who does have line-item veto authority for this and other appropriations bills.
· Federal Dollars: House File 820 allocates to state agencies, programs, and projects federal funds made available to the state through federal grants, block grants, and stimulus dollars. Included in these allocations: $13.4 million in substance abuse prevention and treatment block grants, $3.5m in community mental health services block grants, $1m in preventative health and health services block grants, and additional dollars to the state mental health institutes in Cherokee, Clarinda, Independence, and Mt. Pleasant.
· Veterans Prescription Drug Coverage: Senate File 440 directs state health care facilities and the state Department of Veterans Affairs (VA) to identify residents’ eligibility for benefits through the US Department of Veterans Affairs. Eligible residents must be allowed to access any prescription drug benefit included and the health care facility should assist residents in accessing prescription drugs for which they are qualified. The state Department of Inspection & Appeals, the VA, and the Department of Human Services are directed to identify barriers to residents in accessing these benefits and are required to assist health care facilities in adjusting procedures for medication administration to comply with Iowa Code 135C.31A.