State Capitol Report

May 14, 2024

Legislators wrapped up their work for the year in the early morning hours of Saturday, April 20. It took them just 104 days to introduce 1,617 new bills and pass an $8.9 billion budget for the upcoming year (a 4% increase over the current year’s budget).

One out of every ten bills introduced this year made it through the entire legislative process, which is a pretty consistent percentage over the last 30 years. Legislators sent 169 bills to the Governor and she has signed all but 23 of those bills. Governor Reynolds has until May 20 to sign or veto bills. She has one other option for budget bills, called a "line item veto." This allows the Governor to strike language or line-item appropriations from a budget bill while still signing the rest of it into law. Of the bills still left to be signed:

• HF 2605 Hemp Regulation: closes loopholes that allow high-THC consumable hemp (think "Flying Kites" soda) but inadvertently also made it illegal for children to use non-intoxicating CBD products from hemp. Mandatory reporters would be required to report parents using such products with children, beginning July 1, 2025.

• HF 2652 School Security: allows school professional development funds to be used to pay for training that is required to allow school employees to carry weapons in schools, as allowed under already signed HF 2586. This second bill allows schools to purchase mobile panic systems, requires all future schools be built in accordance with specific safety measures, and requires security software be single-sourced. There are also grants (with no funding) set up to help pay for arming school employees and a School Infrastructure Task Force to set specific requirements for schools….all of which is effective the minute the Governor signs this bill. IPA opposes these bills.

• HF 2673 Behavioral Health Realignment: splits MH/DS regions into six new BH districts managed by a non-profit or government agency Administrative Services Organization. The bill will be signed on Wednesday (May 15) at Foundation 2 in Cedar Rapids.

• HF 2677: Vapor Product Registry: requires all vapor products to be registered with the state in order to sell in Iowa (an effort to weed out counterfeit Chinese products from being sold in Iowa).

• HF 2686: Reorganization 2.0: second round of Code cleanup from last year's massive reorganization of state government agencies. Nothing crazy here, but does update salary ranges for state directors and others.

• SF 345: Smoking Device Tax: taxes the sale of glass or metal devices used to smoke hemp, tobacco, or controlled substances, with proceeds going to specialty courts (including drug courts and mental health courts). The tax is 40% - and is expected to generate $1.9 million in FY 2025 and increasing gradually to $3.1 million in FY 2029. There is also an annual permit fee that will be retained by local governments, generating about $50,000/year. This is the first state funding source for specialty courts.

• SF 2385: Boards & Commissions: enacts the compromise on eliminating boards & commissions and streamlining operations by creating more uniformity in licensing board policies. This is where the Boards of Social Work, Behavioral Health and Psychology are combined (with advisory committees for each previous board's regulated professions), effective 7/1/2024. When it became clear that this was the only issue dividing the House with the Senate and Governor, we knew that there was little chance to stop it. In the end, the House insisted that each of the former boards retain an advisory committee under the newly combined Behavioral Health Professional Board. Psychologists have two members on the combined board. IPA opposes this bill because of the board merger.

IPA’s Bill Tracker is updated as soon as the Governor takes action on bills. Check it to see which bills made it through the session, which bills did not make it, and which bills are signed into law. 

You can also see the full list of bills passed by the Legislature this year here. It includes the date signed by the Governor and the enactment date. While most bills become law officially on July 1, some are effective immediately, are backdated (retroactive to a date), or have a later effective date.

Policy & Budget Highlights

In the final days of session, legislators agreed to increase spending on state programs and services by 4%, just shy of an overall $9 billion budget. It was mixed news for psychologists.

• $2.1 million to increase behavioral health rates (HHS decides how to do this).
• $1.7 million to take another 70 people off the Medicaid ID waiver waiting list.
• $369,000 to increase psychiatric medical institutions for children (PMIC) rates.
• $276,947 to increase community mental health center (CMHC) rates.
• $120,007 for vocational rehabilitation.
• $14.5 million to increase home and community based service (HCBS) providers.
• $16.5 million to backfill HCBS provider increases made in 2022 with federal dollars.
• $1.4 million to more than double residential based supported community living (this is intended to help bring children placed out of state back to Iowa).
• $1.3 million to make state parks and recreational areas more accessible to older Iowans and people with disabilities.
• $22 million cut in AEA funding, with $12.2 shifted to the Department of Education.
• $14 million increase to improve paraeducator salaries.
• 5% increase for adoption and foster care subsidies.
• $3 million to help a Florida-based PMIC to purchase a facility to specialize in services to youth with difficult, violent, or sexualized behaviors.
• $725,000 to allow ChildServe to expand access to ABA services.
• $5 million increase for enhanced Medicaid case management.

The budget eliminated the line-item for many legacy public health programs, including the $48,000 appropriation for the Psychology Internship Program. Fortunately the money remains and the amount is below the level that forces a competitive application. Eliminating line items does open the door for HHS to put MORE money into a program it feels is working well, so there is an opportunity to make the case for additional dollars.

There were no changes to the Mental Health Professional Loan Repayment Program despite demand exceeding the funds currently available. On a positive side, legislation to expand eligibility of this program to include prescribers (ARNPs, PAs, psychiatrists) failed.

Other policies that were adopted (in addition to those noted in opening article):

• Extended postpartum Medicaid coverage from 60 days to one year. Eligibility was reduced from 375% FPL to 215% FPL. IPA supports this bill but lobbied against the eligibility change (something to work on bringing back up in coming years). (Signed, effective 1/1/25, SF 2251)

• Adopted the social worker compact, which has now been passed by 14 states, including Kansas, Nebraska, South Dakota, and Missouri. (Signed, effective 7/1/24, HF 2512)

• Prohibited the Boards of Social Work and Behavioral Health from requiring live or recorded direct client observation for supervised clinical experience )in addition to the current ban on required in-person supervision) and streamlines licensure of LMHCs and LMFPs previously licensed in another state. (Signed, effective 4/19/24, HF 2515)

• Prohibited an insurer from switching a person's medication if they are stable on it and the person's health care provider wants them to stay on it. (Signed, effective 1/1/25, HF 626)

• Allowed ambulances to be reimbursed by Medicaid for a trip to an access center (for persons experiencing mental health crisis). (Signed, effective 7/1/24, HF 2397)

• Cleaned up various parts of HHS code including changing the required "two hour" mandatory reporter training to a "core training." (Signed, effective 7/1/24, HF 2404)

• No longer requires state and local boards and commissions to be gender balanced. (Signed, effective 7/1/24, SF 2096)

• Banned state universities from having Diversity, Equity, and Inclusion (DEI) offices and staff, and prohibits any spending (including non-state funds) on these activities. (Signed, effective 7/1/24, SF 2435)

• Required schools to set up new escalating penalties for chronic truants (missing >10% of school days) but exempts children with IEPs and 504 plans. (Signed, effective 7/1/24, SF 2435)

• Extended the sunset of the Iowa Dyslexia Board for an additional two years (until July 1, 2027). (Signed, effective 7/1/24, SF 2435)

Despite a last minute amendment by the House, the opioid settlement spending bill (SF 2395) failed to pass, leaving approximately $30 million in funds sitting unspent for another year. The House and Senate could not agree on the use of a stakeholder advisory council to distribute funds. The House wanted this stakeholder council, the Senate and Governor opposed and preferred to leave it to state agencies to determine best use of funds. The House's final amendment would have kept the Council and added a few earmarks ($3 million for a YSS (Youth Shelter Services) youth treatment facility in Cambridge, $8 million for a CFR (Community & Family Resources) comprehensive youth and adult residential/outpatient/MAT clinic/detox campus in East Des Moines, and $1.5 million for anti-opioid post-surgery kits). The Senate rejected that amendment, instead keeping the earmarks but eliminating the council.

Also caught up in the end-of-session drama was a bill (SF 2431) to create a narrow window waiving the state's civil statute of limitations for childhood sexual assault to allow victims to receive compensation under a master settlement with the Boy Scouts of America. Oddly, the House resisted passage of the bill until the deadline for joining the settlement. They feared this would set a precedence that would put pressure on the Legislature to eliminate the civil statute of limitations, as they have already done with the criminal statute of limitations. Fortunately for the 300+ Iowans who qualify for this, the Governor signed it immediately. Had Iowa not passed this, survivors would have only been eligible for 30% of the settlement funds owed to them.

IPA's ongoing efforts to address Medicaid recoupments continued with a positive reception in the House. Reps. Joel Fry, Ann Meyer, Barb Kniff McCulla, John Forbes and Brian Best were forceful in their push to pass HF 2268 end all post payment claims reviews after one year. It passed the House HHS Committee but did not make it through the second funnel. While this did not apply to private insurance, it was a step in the right direction.

Likewise, the House also passed a bill out of committee to set stronger timeframes around prior authorizations (HF 2488). Unlike the recoupment bill, this legislation DID apply to private insurance as well as MedicaidThis bill actually passed the House unanimously, but was tabled after the Senate sent it back with an amendment including a poison pill, the "right to save" language it had wanted but the House had rejected. The Senate amendment included an interesting provision making "improper denial of claims" an unfair competition practice which could trigger Insurance Commissioner action. Ultimately, the bill died when House and Senate refused to compromise.

Despite getting very close to a compromise, the bill to moderate the state's certificate of need (CON) process (SF 506) did not pass. It would have exempted CMHCs and birthing centers from the CON process and increased thresholds for spending that trigger CON. Instead, HHS is directed to review the CON process over the summer (SF 2385).

Finally, IPA exerted a lot of energy and effort in making sure bad bills did not pass into law this year. These include:

• Allowing schools to hire chaplains who would be exempt from mandatory reporting and other school employee requirements, without a requirement for equal opportunity for all religions. IPA opposed. (HF 2073)

• Removing gender identity protections under Iowa Civil Rights Act, which IPA also opposed. (HF 2072)

• Allowing social workers, mental health counselors, marriage and family therapists, physicians, nurse practitioners and physician assistants ("and any other advance practice profession") to diagnose "intellectual disability" for Iowa Medicaid and other programs. IPA opposed. (HF 2200)

• Enacting the Governor's extreme "gender" definition bill that defines "male" and "female" as the internal reproductive system at birth. IPA opposed. (HF 2389)

• Prohibiting schools from disciplining employees, teachers, and other students who refuse to use another person's approved and preferred pronouns (a pro bullying bill). IPA opposed. (HF 2396)

• Adding psychiatrists, psychiatric ARNPs, and psychiatric PAs to those eligible for the mental health professional loan repayment program without any additional funding. IPA opposed as those professions have other, better funded loan repayment programs. (HSB 690)

• Prohibiting local governments from using ordinances or zoning to keep out conversion therapy and allows non-regulated therapists to operate outside of licensing laws. This super confusing bill looked like one thing but opened a giant gaping hole to allow anyone to hang a shingle to do therapy. IPA opposed. (SF 2037)

• Requiring psychologists, social workers, and other behavioral health professionals to have at least three credit hours of graduate coursework in domestic violence and at least two hours of continuing education on it every license cycle (in addition to other CEU requirements). IPA opposed the mandate, but not the intentions behind it. IPA and other professionals submitted coursework already required, but legislators did say they hope professional groups will offer more opportunities to learn about this subject. (SF 2107)

• Allowing health care professionals to deny care that they object to morally or ethically or on religious grounds. There was no guidelines, guardrails or restrictions on this blanket protection. IPA opposed this (SF 2286), as well as the Religious Freedom Protection Act (RFRA) that did pass and was signed into law and became effective in early April (SF 2095)

• Giving defense attorneys access to psychological testing materials and raw data, which IPA opposed for the third year in a row. (SSB 3011 & HSB 511)

Other bills IPA supportedthat didn't make it through this year include:

• Adopting the dietician compact (those working with individuals with eating disorders suggested this would be a good thing for IPA to support). IPA supported. (HF 2375)

• Allowing licensed professionals (including psychologists) to apply up to 10 extra continuing education credits to the next rental cycle. This bill, which IPA supported, passed the House (91-1) but stalled in the Senate State Government Committee. (HF 2486)

• Increasing penalties and including spitting for assaults on health care workers (including mental health professionals). (HF 2321)

A final note of thanks to our amazing intern Chloe Gayer, who is finishing up her junior year at Drake University. We were so fortunate to have her this year and do not know how we'd have made it through this crazy fast session without her! Finger crossed, she'll be back with us next session.

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