State News

Legislative Update

The Iowa legislative session started this week at 10:00 a.m. on Monday, January 14.  The new Iowa General Assembly includes 31 new lawmakers and has Republican control of the House and Senate.  The session began with the typical fanfare of speeches, goal setting for the year, and calls of working together for the betterment of Iowa. 

The major highlights of the first week include Governor Reynold’s Condition of the State address and the release of the Governor’s budget. The Governor has tremendous power to set the policy direction for her office and party. Often the Governor’s proposals are the key initiatives passed and/or funded in a given year.  

Condition of the State 

Reynold’s Condition of the State covered a host of issues, including mental health care, the creation of a children’s mental health system, an amendment to the Iowa Constitution for restoration of felon voting rights, some criminal justice reform, expansion of broadband internet, among other initiatives. 

Of importance to LAI members is Gov. Reynolds ask of $20 million for her Future Ready Iowa program. The program seeks to tackle the skilled workforce shortage in the state of Iowa, such as manufacturing, health care, and technology jobs. The previous legislature created the program but did not give a large appropriation to the program. The call for $20 million will give the programs significant resources to tackle skilled workforce shortages.  

LAI and others have asked in the past to increase the scope of Future Ready Iowa to include the high needs jobs of Direct Care Workers (DCW), such as CNAs. Nurses are a prime target for the program, but the lower income level of a DCW often excludes them from consideration. The Governor’s office has signaled to several groups they are interested in listening to the DCW issue for Future Ready Iowa. 

To read the full speech of Governor, click here. 

Governor’s Budget 

The Governor’s Budget was released shortly after the Condition of the State address. Overall, the Governor’s budget prioritizes the limited surplus for several of her initiatives and state agencies. For the remainder of FY 2019, the Governor’s revised FY 2019 General Fund budget includes a carry-over fund of FY 2018 of $71.0 million. The Governor is also recommending supplemental appropriations for FY 2019 totaling $144.5 million for five State programs, which includes an MCO contract increase of $141.1 million. The Governor’s revised FY 2019 budget leaves an estimated surplus of $185.5 million.

 FY 2020 budget recommendations includes total General Fund resources of $7.959 billion. The Governor is recommending General Fund appropriations totaling $7.659 billion, which is $222.2 million below the Expenditure Limitation. The Governor’s FY 2020 General Fund appropriations budget represents an increase of $39.2 million (0.5%) compared to the Governor’s revised FY 2019 appropriations recommendations. The Governor’s FY 2020 budget results in an estimated surplus of $305.9 million. 

The Governor’s proposed budget has a welcome addition for LAI members. The Governor’s office recommended $8.5 million for nursing facility rebasing. The Governor does not have the power to appropriate money, but the Governor’s budget is often the blue print for negotiations moving forward. While IME has estimated a need of $55 million for bringing average reimbursements from Medicaid up to the cost of care, $8.5 million is a start and placeholder for further conversations with legislators. LAI has reached out to the Governor’s office thanking them for the inclusion of the $8.5 million in their budget proposal. 

Moving Forward 

Bills from Iowa legislators are just beginning to be released. Next week's legislative update[AH1]  should have a rundown of all the bills introduced thus far impacting LAI members. Additionally, LAI lobbyist, Matt Blake, is working diligently to get LAI’s proposed bill related to temporary staffing agencies introduced. It is still very early, and several legislators have expressed interest in tackling issues surrounding temporary staffing agencies. Further education and some negotiations are needed before a bill can be introduced. Finally, look for legislative action alert beginning next week to help move forward LAI’s advocacy agenda. 


Des Moines Register Does Story on Controversy on Independent Living Community in Marshalltown 

The Des Moines Register recently published an article about the Embers, an independent living center in Marshalltown. The Embers was devastated by the tornado that tore through the town on July 19 requiring evacuation and complete reconstruction. 

The controversy that is covered by the Des Moines Register Watchdog article is based on costs related to clean up and moving of tenants' personal belongings. Embers had the company ServiceMaster come in and completely rebuild the campus. This required rebuilding most rooms and moving tenants' personal belongings to storage. 

For tenants with no renter's insurance, Embers was billing those residents directly for the costs of moving items. It was discovered by Embers that their insurance policy did not cover “moving of personal belongings,” even after being told previously that it was. Embers had no choice but to forward personal costs on to tenants who did not have renter's insurance. The associated bills amount to $5,000 to $10,000. 

Due to the bills, Embers lost several tenants and several more are hiring attorneys to advise them on their rights as tenants. One tenant was so distraught over the additional bill and costs, that he committed suicide in October. 

The estimated cost for reconstruction was over $10 million. 

LAI recommends reading the article and encourages all members to review their emergency plans and insurance policies with these circumstances in mind to ensure you are covered appropriately. 


DHS Updates Annual Submission Requirements Regarding Prevention and Detection of Medicaid Fraud and Abuse 

The DHS update applies to providers, or part of a provider entity, that receives payments of $5,000,000 or more from Iowa Medicaid in any federal fiscal year (October 1 to September 30). 

Section 6032 of the Deficit Reduction Act of 2005 (Pub L. 109-171) mandates that any provider or provider entity that receives payments, in any federal fiscal year, of $5,000,000 or more from any state Medicaid program must have written policies for all employees, including management, and for all employees of any contractor or agent, that provide detailed information about the following: 

  • The Federal False Claims Act established under section 3729 through 3733 of Title 31, United State Code
  • Administrative remedies for false claims and statements established under Chapter 38 of Title 31, United States Code.
  • State laws pertaining to Civil or Criminal penalties for false claims and statements
  • Whistleblower protections under such laws, with respect to the role of such laws in preventing and detecting fraud, waste and abuse in Federal health care programs.  Previously, providers were required to submit copies of these policies annually. 

Effective immediately, providers are not required to send copies of their policies, but must complete and return the Attestation of Compliance with Section 6032 of The Federal Deficit Reduction Act form annually. 

To learn more, click here.


DHS Releases Changes to High Dose Opioids 

Effective March 1, 2019, the morphine milligram equivalents (MME) per day limit will be reduced from 200 MME per day to 150 MME per day.  Prior authorization (PA) will be required for use of high-dose opioids ≥ 150 MME per day.  Patients undergoing active cancer treatment or end-of-life care will not be subject to PA criteria.  The MME edit will continue to be gradually decreased over time to 90 MME per day as noted in Informational Letter 1907. 

To read more about the change, click here.


CMS Approved Changes to Special Nursing Facility Populations

On November 8, 2018, the Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 18-001.  The approval of the SPA is effective July 1, 2018. 

The SPA increased the maximum age for a special population nursing facility from 21 to age 30.  The definition of a special population nursing facility criteria was also expanded to include persons residing in an Intermediate Care Facility for Medical Complexity (ICF/MC).  ICF/MC is defined as an intermediate care facility for persons with an intellectual disability which provides health and rehabilitation services to individuals who require a skilled nursing level of care, have either a multiple organ dysfunction or severe single organ dysfunction, and requires daily use of medical resources or technology. 

If you have questions, please contact Sally Oudekerk, Program Manager, at [email protected].


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