2022 Legislative Summary

The long legislative session came to a close on Wednesday, May 25. The session went weeks over the traditional end of session due to internal debates in Republican leadership on whether to pass a school voucher bill. In the end, the policy did not move forward, and this helped to finalize the budget.

For LAI members, the legislative session had far more wins than losses. The 2022 session saw the passage of bills through LAI advocacy dealing with temporary staffing, NF rebase procedure changes, HCBS funding increases, health care workforce initiatives, NF construction funding and eligibility changes, and several others. Additionally, early in the session, LAI helped to defeat a bill related to monitoring devices in private rooms in nursing facilities.

The only real set back was no increase in funding for nursing facility rates. Iowa legislators made it very clear early in session that any increases to funding were going to be geared towards helping HCBS providers, in particular the ID and BH waivers. Aging services was not a priority this year, as the legislature was reacting to the DOJ report released late last year that stated that Iowa institutionalized to many individuals who had intellectual or development disabilities. The DOJ warned Iowa to expand their HCBS services or face a potential lawsuit. The DOJ report set the tone for the session and could have lasting repercussions on the HHS budget for the next several sessions.

Temporary Staffing Bill

One of LAI’s top priorities passed this year, HF 2521, which created new regulations and restrictions on temporary staffing agencies in Iowa. An in-depth look of the law can be found here. The law regulates the temporary staffing industry for the first time, makes agencies responsible for training and maintaining records of agency staff, requires agencies to have general liability insurance to cover certain acts of their agency staff, makes non-compete clauses and contract buy-outs in contracts between agencies and providers unenforceable, mandates quarterly reports to DIA from agencies on how much agencies charge providers and how much agencies pay agency workers, and create penalties for noncompliance.

The bill received unanimous support from both the Iowa Senate and Iowa House.

NF Rebase Procedure Changes

HF 2171 is a law that would release rebased nursing facility reimbursement rates to providers prior to receiving CMS approval. The law seeks to limit retroactive payments from the MCOs/IME to nursing facilities due to the delay in approval by CMS of new reimbursement rates under the State Plan Amendment (SPA).

This law change is one component of the proposed changes to the Case Mix Index (CMI) in Iowa that will go into effect July 1, 2023. 

The bill received unanimous support from both the Iowa Senate and Iowa House. 

Elder Abuse Bill

SF 522, the elder abuse bills, passed thorough the Iowa House after passing the Iowa Senate last year. The new law seeks to put new criminal penalties and procedures in place to protect vulnerable older adults. The target of this legislation is caretakers and community-based violations, not aging services facility and program based caretakers. Specifically, it creates new or enhanced criminal penalties for assault towards an individual over 60, establishing a crime of theft, changes civil penalty for consumer fraud against older individuals, creates penalties for elder abuse, establishing the crime of financial exploitation of older individuals, among other changes.

LAI was supportive of this bill and helped voice support that secured passage in legislature.

HCBS Funding

The HHS budget bill contained rate increases of $14.6 million for the HCBS waivers. The entire rate increase must be used for wages and associated costs specific to wages and benefits to direct support professionals and frontline management. LAI was very supportive of increases to rates to HCBS waivers that supports the aging services continuum.

However, the $14.6 million in funding was one-time funding through federal ARPA dollars. ARPA funding is federal money appropriated to states through COVID relief bills that could be used to fill gaps in state budgets or provide relief to residents. ARPA funds in the HHS budget will be used to prop up increases in the Iowa budget through 2024.

LAI is worried about the use of one-time funding in the HHS budget. If the legislature desires to make those rate increases permanent, ongoing general funds will need to be appropriated. LAI fears that the one-time funding coupled with the tax cuts from earlier this year could make it more difficult for aging services to receive rate increases in the future and make these rate increase permanent.

Health Care Workforce and Unemployment

A top priority for LAI members was workforce. Members are struggling to recruit and retain staff in Iowa. The Governor, taking recommendations from a health care workforce taskforce that met through the summer, put forward a variety of health care worker recommendations that were included in an omnibus workforce bill.

The sections related to LAI include a work-based learning program in high schools for certifications, expands the scope of the health care loan repayment program which could impact RNs, and allow spouses of active-duty personnel to have expediated certification process. These initiatives are targeted at trying to get more individuals into the health care workforce, specifically, nursing. The other initiatives of the bill related to health care workforce focused on medical doctors and mental health specialties.

Additionally, during the 2022 Condition of the State Address, Gov. Reynolds announced the new Iowa Health Careers Registered Apprenticeship Program aimed providing high school students with the opportunity to explore health care careers. The grant recipients will establish a new, or expand an existing, high school-based Registered Apprenticeship program modeled on the Patient Care Registered Apprenticeship Program launched last year which takes advantage of virtual reality training and real-world work experience with a local nursing facility and hospital. Before they leave high school, students can become a CNA and be qualified for employment in a variety of health care careers.

LAI was supportive of the initiatives but would advocate in future workforce plans an emphasis on the aging services workforce sector and direct care workers. While LAI is supportive of finding ways to get more individuals into the health care pipeline, the aging services workforce has been one of the hardest hit in the state of Iowa and is lagging behind hospitals and clinical settings in recruiting and retaining staff.

NF Construction Funding and Changes

In the HHS budget bill, the legislature allocated $800,000 in funding for the nursing facility construction fund. Formerly known as RIIF construction funding, this is the money that nursing facilities can apply for to help reimburse for specific construction costs. This is state based money only and does include federal matching funds.

Additionally, the HHS budget bill also included changes to the construction laws to expand the scope of eligible projects. Specifically, the bill lowered the threshold to apply for major renovation value threshold from $1.5 million to $750,000 and it would allow for HVAC systems to be an allowable expense, in addition to expanding or adding HCBS or correcting Life Safety Code issues. Finally, the new law would change the calculation related to the minimum 40 percent threshold of Medicaid utilization in order to apply for construction funds from the number of Medicaid days versus total beds to Medicaid days versus in-house patient days.