Legislative Agenda & Updates 

LAI is the leader in advocating for non-profit aging service providers in Iowa. We strive to be the champion for advancement and innovation in aging services. LAI is a presence in public policy at the Iowa Capitol. Though member driven policy proposals, LAI works tirelessly to advocate for the biggest issues facing aging service provider today. Through direct lobbying at the Iowa Capitol, one-on-one meetings, phone calls, action alerts, and more, LAI is force for non-profit aging services providers in Iowa.

 

Legislative Agenda

2019 Legislative Review 

The 2019 legislative session ended at 2:20 p.m. on Saturday, April 27. Known as Sine Die, the session closed a week before the scheduled date of May 3. After several sleepless nights, legislators powered through to get the final priority bills done to end the 2019 session. The following will outline the key bills that passed, what their impact will be on our members, and other important information you need to know from the 2019 Iowa Legislative Session. 

2019 Session for Aging Services 

Overall, the session is a big win for aging service providers. Nursing facility rebase and tiered rates saw increases of funding, several bills aimed at improving the lives of older Iowans passed, and there were no bills that passed that would have a major negative impact on the industry. The Iowa Legislators were responsive to the needs of our members and were willing to listen about issues related to funding. 

The one set-back LAI had this year was the defeat of our bill, House File 298. The bill would have placed regulatory oversight on the temporary staffing agencies for the first time and given staff working at those agencies the freedom to work for providers without the restrictions of contract buy-outs. The bill was introduced and passed out of subcommittee in the Iowa House but was blocked from debate by the chair of the Human Resources Committee, Rep. Shannon Lundgren.  LAI will continue to work to try and find common ground with Rep. Lundgren.  

Thank you to all of our members for helping voice support for the various initiatives over the course of the legislative session. LAI members sent hundreds of emails and messages to their legislators regarding funding for aging services and different bills. It is the grassroots advocacy from members like you that helped many of our initiatives that passed this year. The wins of the session are shared victories!  

Nursing Facility Rebase 

The largest win for LAI members this year was the nursing facility rebase funding of $23,401,942. That number breaks down to roughly $15 million in new state dollars and $8.4 from QAAF rate increases. While the final number does not meet the requested $54.9 million needed, it is a significant win for nursing facilities across the state. No other provider type received such a substantial appropriation for increasing their rates.  (The next highest appropriation for enhanced rates was $1.5 million) The combined total of $23.4 million is the largest single infusion of funding for the nursing facility rebase ever. 

It took significant amounts of advocacy from LAI and its members to have legislators understand the overall impact underfunding was having on older Iowans and aging services. The legislators heard LAI members issues, but there were differences between the two legislative chambers on how to fund nursing facilities. The Iowa House appropriated $19 million in new money. The Iowa Senate did not meet that goal and initially proposed only $12 million. After negotiating back and forth, the final number landed on $15 million in new funding. 

New rates for the nursing facility rebase will be effective July 1. Rebase funding rate changes will require CMS approval before implementation and will retro back to July 1. QAAF rate increases are approved by CMS and those changes should be reflected in the July 1 rate changes. 

Health and Human Services Budget 

The Health and Human Services Budget Bill, House File 766, was signed into law only a week after the end of session with no vetoes. It was one of the fastest signing in recent memory for the appropriation bill, as it typically takes nearly a month for the Governor to review the extensive piece of legislation.

Besides the nursing facility rebase, there were several other portions of the HHS bill that impacts LAI members, as noted below: 

  • Tiered Rate and HCBS Funding – $1,000,000 was appropriated for the purpose of increasing tiered rates for HCBS providers. Several LAI members have populations that are in the tiered rate payment system. Those rates will be effective July 1.  It was reported in a previous update that the elderly waiver assisted living rates had money for an increase. Unfortunately, that appropriation was struck from the final bill. Therefore, assisted living did not receive any increase. 

  • New IGT Language – Last minute language was included into the HHS bill related to the creation of a Quality of Care Rate Add-On Program for nursing facilities. LAI recommends reviewing the larger article in this communique regarding the new IGT program for more information.  The language is a re-write of the section related to a proposed intergovernmental transfer (IGT) program from previous years which CMS did not approve. The complex IGT system seeks to draw down additional federal dollars for nursing facilities and county hospitals. This is made possible through an agreement between the county hospital and the nursing facility whereas the hospital becomes the license-holder of the beds, and the nursing facility contracts with the hospital as the operator. LAI has supported IGT language in the past, but federal regulators rejected Iowa’s IGT proposal as CMS is seeking to close these funding programs. The new proposal would still require CMS approval, which has been a significant barrier.  

  • Staffing Increases for State Departments – Several funding increases for agencies impacting aging services allowed for additional Full Time Employees (FTE). Here are agency increases compared to estimated FY 2019:
    • Department on Aging: Net budget increase of $149,000 and 9.0 FTE positions.
    • Office of the LTC Ombudsman: No budget increase of funding and increase of 5.0 FTE positions.
    • Department of Human Services: Net budget decrease of $35.7 million and an increase of 237.9 FTE position.
    • Department of Inspection and Appeals Health Facilities Division: Current level of funding with an increase of 3.0 FTE positions. 

  • Pre-Medicaid Pilot Project – There was an allocation of $250,000 for the continuation and expansion of the Pre-Medicaid Pilot Project managed by the Iowa Department on Aging. The project seeks to keep individuals in the community and out of a long-term care facility following a nursing facility stay. 

  • Changes to the MAAC – The bill reformed the Medical Assistance Advisory Council (MAAC) by eliminating the Executive Committee and limits the voting membership of the Council to ten members, down from over 40. LAI sits on the MAAC and will be impacted on whether LAI will stay as a voting member within the ten. LAI or other associations will be voted on by the membership of the MAAC. 

Analysis of Bills Passed in 2019 

The following are bills passed out of both chambers of the Iowa Legislature. Some have been signed by the Governor, others await her signature. All the bills listed below are expected to be signed by the Governor. 

House File 323 - Removes requirement of personal profit for caretaker financial exploitation – The law ends the requirement of a caretaker of a dependent adult needing to receive some sort of personal or pecuniary profit for financial exploitation. Now the act of financial exploitation is enough to be a punishable offense.  LAI position: Monitor - Status: Passed Senate, Passed House, Signed by the Governor   
  
 House File 328– Changes the definition of a “vulnerable elder” – Removes age as factor for being a vulnerable elder and changes it to mental or physical condition or because of a personal circumstance which results in an increased risk of harm to the person. LAI position: Monitor - Status: Passed Senate, Passed House, Awaiting Governor’s Signature     

House File 304 - Technical fix to personal degradation law allowing for a variance in penalties – The law allows for individuals who commit the act of personal degradation in an institution that is unlikely to reoccur, is minor, or isolated to not be included on the founded dependent adult abuse registry.  LAI position: Monitor - Status: Passed Senate, Passed House, Sighed by Governor.   

House File 291 – Increases the community spouse allowance for the Medicaid spend-down to align with federal law – LAI position: Monitor - Status: Passed Senate, Passed House, Awaiting Governor’s Signature      

House File 518 - Removes the Hospice room and board pass through and allows the MCOs to pay nursing facilities directly – This law directs the Department of Human Services to submit a state plan amendment to CMS allowing MCOs to pay nursing facilities directly at 95 percent of the base rate for dually eligible Medicare and Medicaid members and Medicaid-only members receiving the hospice benefit. LAI position: For - Status: Passed Senate, Passed House, Signed by the Governor     

House File 681– Allows qualified entities to request national criminal history checks of certain covered individuals – On a voluntary basis, individuals would be able to submit applicants to the Iowa Department of Public Safety to obtain a national background check through the FBI fingerprint database. Further work will need to be done with DHS to finalize the program. LAI Position: Monitor - Status: Passed Senate, Passed House, Awaiting Governor’s Signature  

House File 610 - The bill updates Iowa’s guardianship code sections – The bill covers guardianship and conservatorship issues. The bill includes references to Iowa Physician Orders for Scope of Treatment (IPOST) portion of the Iowa Code, chapter 144D and includes responsibilities of guardian portion of the Iowa code, chapter 633.635. This would align the IPOST with living wills and ease burdens on families during sometimes difficult times. LAI Position: Monitor - Status: Passed Iowa Senate, Passed Iowa House, Awaiting Governor’s Signature  

House File 731 - Changes Iowa’s mandatory reporter training guidelines. - The bill separates child abuse and dependent adult abuse training and requires two hours of training for each, every three years, which is reduced from the five years previously. Mandatory reporters will be in compliance for an additional three years if they complete at least one hour of training prior to the original three-year expiration period. DHS is required to create the training and the training will be free to all persons.   LAI Position: Monitor - Status: Passed Iowa Senate, Passed Iowa House, Awaiting Governor’s Signature.