Lobbying Updates

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April 27, 2012

Budget Deal is Elusive
 The final budget deal which is necessary to conclude the 2012 legislative session remains out of reach. This leaves the various budget conference committees in limbo as they await the final allocations. In addition, the major policy issues – mental health, education and property taxes – remain unresolved. While the overall spending number has apparently been agreed to, the two sides cannot come to agreement on how to allocate that number across the various state programs or how to spend one-time money. The House sent members home after debate on Wednesday and indicated that the earliest they would return to work is Tuesday. The Senate continued to move forward some bills but is also running out of legislation to debate. This may seem like déjà vu as a similar impasse occurred last year with the Legislature finally adjourning on the last day of the state’s fiscal year. Insiders predict that if significant progress toward a final deal is not made in the next week or so, the Legislature will take time off for primary elections and return in mid-June.

House Passes Mental Health Reform
 The House adopted SF 2315, the bill which redesigns the state’s mental health delivery system. The bill was amended on the House floor and returns to the Senate for further consideration. The bill, as amended, does not create scope of practice issues and resolved many concerns raised by IMHCA. The financing issue is still problematic and the question of how much funding to provide continues to be debated. The Senate has not yet taken action on the House amendment. IMHCA is monitoring the bill.

HHS Conference Committee Meets
 The conference committee on SF 2336, the FY 2013 health and human services budget, met briefly in an organizational meeting. No action was taken other than to adopt the two chairs of the conference committee. The committee did not meet again and is not expected to meet until the final budget allocations are determined.

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April 19, 2012

100th Day Passes with No Adjournment

April 17 was the final day of the legislative session, yet the session did not conclude. Legislators no longer receive per diem payments and many of the support functions for the Legislature are no longer funded. Progress appears to be slowly moving forward. It appears that the overall budget number for the 2013 fiscal year has been agreed upon by both chambers and the governor’s office and work now begins to divide that larger number up amongst the various budget bills. The last remaining appropriations bill, the health and human services bill, is headed to conference committee.

The week concluded with a long, slow day of little action as both chambers caucused and waited for amendments to be drafted. Debate was attempted later in the day but a complete shutdown of the Capitol’s computer system coupled with a fire alarm superseded any attempt at substantive floor action. Legislators will return to the Capitol next week and hopefully conclude the final days of the legislative session.

The House has yet to take floor action on the Senate-passed version of mental health redesign. The House intends to adopt several amendments and the bill is likely headed to a conference committee. The health and human services appropriations bill is also headed to conference committee but the Senate was stymied in their efforts to take that formal step because of the computer problems at the Capitol on Thursday.

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April 13, 2012

Legislative D-Day Approaches

In five short days, the 2012 legislative session is scheduled to end. Legislators’ per diem pay ends on that date, as well as funding for some of the support services at the Legislature. It is unlikely that the Legislature can finalize a budget, deal with education, mental health and property tax reform and still adjourn by that date. Most budget bills are poised to go to conference committee. The health and human services bill is the only bill that hadn’t seen floor action until today. The Senate passed its version of the HHS bill. The House has been unable to bring its bill to the floor for a vote because it lacks the votes to pass it.

All other budget bills were sent to conference committee this week but no substantive action took place to resolve significant policy and funding differences. The major reform bills of this legislative session – education, mental health and property tax – are also still unresolved. Each of these proposals also has budgetary implications. Resolving the policy differences will be important to resolving the final budget. SF 2315, the mental health redesign bill, has yet to be debated on the House floor. As reported last week, the basic policy language has been worked out between the two chambers but the House continues to struggle with the financing mechanism.

Senate Passes HHS Budget

The House was the chamber charged with starting the budget process for health and human services but after weeks of delays, the Senate took matters into their own hands and passed SF 2336 to fund those programs for the upcoming fiscal year. The House bill, HF 2345, has been stalled for weeks as Republican leaders search for the votes to pass the bill on the floor.

Some of the programs of interest in the Senate passed bill include:

SF 2312 Signed into Law

The Governor signed into law the bill that makes changes to the 229 commitment process. SF 2312 also creates a unified, common definition of a mental health professional. The bill does not eliminate the physician’s role in making a commitment recommendation or overseeing the evaluation of that patient. However, a physician may consult with any mental health professional as defined in 228.1 for the evaluation and treatment of that patient. IMHCA is registered in support of the bill.

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March 30, 2012

Week Twelve Recap

Back in January, both chambers were optimistic that they could end the session a week to ten days early. That would mean that next week is the last week of the legislative session. That goal would seem to be elusive. While all the majority of the budget bills are headed to conference committee, the health and human services budget bill has yet to see floor action. Only one budget bill, the transportation budget, has been sent to the governor for his signature. And, the three major reform efforts – property taxes, mental health and education – have yet to be resolved. All three have budget implications.

Health and Human Services Budget

HF 2435, the FY 2013 budget bill for DHS, is stalled in the House. The bill has been pulled from the debate calendar as House leaders struggle to find the votes to pass this bill. At issue is an amendment on abortion. IMHCA is registered opposed to this bill for two reasons. First, it imposes further cuts to provider reimbursement. Second, the bill gives board authority and emergency rulemaking power to the department to implement further cost containment measures for Medicaid. Emergency rulemaking authority limits the ability of provider groups to influence the process. In addition, the resolution that would overturn the emergency rule adopted by the department in August imposing further reductions on certain procedures provided in a facility setting has been pulled from the House debate calendar.

Mental Health Reform

The two chambers are working behind the scenes to finalize a deal on mental health reform. SF 2315 is on the House debate calendar but no floor action has taken place. Legislators are working to resolve both the policy and the funding issues. IMHCA is working with House leaders to address concerns with language establishing a new sub-acute care system. The bill creates a sub-acute system that would provide an alternative to commitment for those individuals diagnosed with a mental health condition who need more than out-patient care. Under the proposal, a licensed mental health provider as defined in 228.1 could recommend a patient for treatment at one of the approved facilities. A physician would be required at a facility but treatment could be provided by any licensed mental health provider within that provider’s scope of practice. As originally drafted, the language would have excluded the ability of LMHCs to provide services to patients in a subacute care facility. I am working to resolve that issue and we are close on the final language.

Most of the policy changes that are being negotiated deal with the establishment and management of the regional delivery system. One issue that IMHCA raised as a concern will be deleted from the bill. Language in the Senate-passed version of SF 2135 allowed the newly established region to adopt additional licensing or credentialing requirements on providers. Our concern was this creates a potential patchwork of licensing requirements for providers and is inconsistent with the goal of establishing a common definition of a mental health professional. In addition, we expressed concern that this could be used to discriminate against certain providers and further limit access to care. The appropriate place for provider licensure and credentialing decisions is at the state level.

I anticipate that we could see action on the House floor next week on the redesign of the mental health delivery system. If that occurs and the House passes the bill, it will return to the Senate for further consideration. Logistically, the House is trying to work out the final deal with the Senate so that this bill does not have to go to conference committee. Insiders in both chambers have suggested that a deal is very close. IMHCA is registered undecided on the bill.

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March 26, 2012

March to the End Begins

The week was primarily spent doing work on the floor. Under legislative rules, the Senate could only consider House bills and the House could only consider Senate bills. They also began the process of passing more budget bills, setting the stage for negotiations on the final budget numbers. The House has set their spending targets very low and the Senate is much higher. The governor’s targets are in the middle. The HHS bill has not passed yet as House leaders struggle to find support for a bill that does not include abortion restriction language. The three big issues remain on their plate (property tax relief, education reform and mental health reform) and both chambers have taken decidedly different approaches. This could stall the end game that allows for adjournment. Both chambers have passed rules that would end the legislative session ten days early – on April 7. While legislators still say this is the date, it is becoming less clear if they will be able to resolve all the budget and policy issues in the next two weeks.

Mental Health Redesign/Reform

The House Appropriations Committee approved SF 2315 with changes the funding mechanism. Senator Jack Hatch has stated that these changes are unacceptable to the Senate. Policy issues related to the bill including the development and oversight of the new regions were discussed but amendments were not provided at this time. IMHCA has raised a number of issues with the Senate version of the bill which we are working to have addressed on the House floor. The bill passed the committee on a party line vote and will likely be debated on the House floor this week. IMHCA is registered as undecided on the bill.

Bills on the Move

SF 2312: This bill incorporates the recommendations of the DHS/Courts workgroup on commitment proceedings. The bill passed the House 96-1 and now goes to the governor for his signature. IMHCA is registered in support of the bill.

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March 16, 2012

Second Funnel Narrows Legislative Issues

The second funnel deadline cleared the calendar of many legislative bills that do not have sufficient support in both chambers. Both chambers referred some priorities to either their respective appropriations or ways and means committees to keep the issue alive for further debate.Next week, the House may consider only Senate files on the floor while the Senate is restricted to considering only House files. The exception is for budget bills. The Senate intends to bring those budget bills it is responsible for starting to the floor for debate. Word on the street is that both chambers have agreed to pass their initial version of the budget bills and then work things out rather than bouncing the bills back and forth. Both sides remain far apart on how to fund the various functions of state government in the upcoming fiscal year. The HHS budget bill has not been debated by the House. The bill is being held up by Republicans who want to see language further restricting abortions on the bill. Enough Republicans have said they will not vote for the bill without such language so the bill was pulled from the debate calendar until this stalemate can be worked out.In addition, no agreement has been reached on property tax reform, education reform or the redesign of the mental health delivery system. These are three top priorities of each chamber. While there are similarities in their proposals, the differences are large enough to make these tough issues to resolve. Legislators are still hopeful that the 2012 session will adjourn a week early.

2012 Election Update

The Iowa caucuses are long over and attention now turns to the upcoming legislative elections. Redistricting has changed the face of many legislative districts and continues the shift toward more urban-based and suburban districts. March 16 was the filing deadline for candidates. The battle for control of the State House will be intense with Republicans hoping to change the numbers in the Senate and Democrats hoping to make some inroads into increasing their margin in the House.

Iowa Senate

Republicans have fielded candidates for all twenty-six of the Senate seats up for election this year. This includes nine incumbent senators who are running for re-election and one primary challenge. Incumbent senators Shawn Hamerlinck and Jim Hahn were thrown together into the same district and will face each other in a primary. Democrats have nine incumbent senators running for re-election and have candidates in twenty-two of twenty-six seats. No Democrat incumbents face a primary race. Two incumbent senators will face off in the general election.

Senators Merlin Bartz (R) and Mary Jo Wilhem (D) were tossed into the same district due to redistricting. Wilhelm is currently chairwoman of the Senate Local Government Committee and Bartz is the committee’s top Republican member. Two former Republican senators -- Larry McKibben and Jim Black – are making an attempt at returning to the chamber. Senator Bacon decided to run for the House after redistricting put him together with fellow Republican Bill Dix.

Senators Not Running:

Jack Kibbie (D)
Paul McKinley (R)
Steve Kettering (R)
Jim Seymour (R)
Rob Bacon (R) – running for the House

Iowa House

Republicans hold a 60-40 majority in the Iowa House and Democrats hope to erode that margin in the 2012 election. Fourteen House Republicans are retiring while three House Democrats are retiring and two are running for the Iowa Senate. Republicans have fielded candidates in 85 of the seats up for election. Two Republican incumbents – Pat Grassley and Annette Sweeney – will face each other in a primary election. Redistricting put their homes in the same district and neither was willing to move to avoid a primary race.Democrats have candidates in 82 of the races this cycle. Five former members of the Iowa House are seeking to return including two which are rematches from the 2010 election. Donovan Olson will challenge Rep. Chip Baltimore and Tom Schueller will challenge Rep. Brian Moore. One race will put two incumbents against each other. Sioux City representatives Jeremy Taylor (R) and Chris Hall (D) were put into the same district and will fight it out in the general election.

House Members Not Running

Rich Anderson (R)
Rich Arnold (R)
Royd Chambers (R)
Betty DeBoeuf (R)
Mary Gaskill (D)
Lance Horbach (R)
Jeff Kaufmann (R)
Stew Iverson (R)
Glen Massie (R)
Kim Pearson (R)
Janet Peterson (D) –running for the Senate
Scott Raecker (R)
Dan Rasmussen (R)
Dave Tjepkes (R)
Jim Van Englenhoven (R)
Andrew Wenthe (D)
Nate Willems (D) – running for the Senate

Bills of Interest

SF 2128: The Senate passed a bill that would require state-regulated insurance plans to include coverage for treating autism spectrum disorders including applied behavioral analysis. The bill was amended on the House floor to restrict the practitioners who could diagnose or prescribe treatment to licensed physicians or licensed psychologists. This language mirrors the current law that requires coverage for those on the state employee health insurance plans. In addition, the bill was amended to restrict those who could deliver ABA treatment to only those certified by the national board. Language adopted by the Senate would have ensured that any mental health professional as defined in 228.1 would have been covered for treating autism spectrum disorders. IMHCA worked closely with the autism interest groups and Senator Beall to tighten the definitions in the bill. The bill was approved by the Senate on a 43-7 vote but failed to receive any consideration by the House Commerce committee. It is dead for this session. IMHCA was registered in support of this bill.

SF 2243: The bill to create a social worker loan program was not considered by the House Human Resources Committee and failed to survive the second funnel deadline. IMHCA was registered undecided on the bill which had earlier passed the Senate.

SF 2312/HF 2421: These bills would implement the recommendations of the DHS-courts workgroup on 229 commitment procedures. Both bills are on the House debate calendar. To escape the funnel deadline, the House put HF 2421 on the unfinished business calendar and SF 2312 was passed on file which is a procedural move that also keeps the bill alive. IMHCA is registered in support of both bills.

SF 2315/HF 2431: The Senate passed its version of mental health reform with some amendments but did not address the concerns raised by IMHCA. The House bill does not include an expansion of the definition of psychiatric services and is preferable to the Senate bill. The House has referred its version, HF 2431, to the House Appropriations Committee. It also referred the Senate bill, SF 2315, to the House Appropriations Committee to avoid this week’s funnel deadline. IMHCA is registered as undecided on both bills.

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March, 1, 2012

Post Funnel Week Update

After the first funnel, both chambers spent the majority of their time either in caucus or on floor debate. The respite from a constant stream of subcommittees and committee meetings was welcome to lobbyists and legislators alike. Now the attention has turned to making sure priorities survive the second funnel deadline. That deadline is March 16 by which time a bill must have passed one chamber and a committee in the other chamber to remain alive for consideration. As with the first funnel, this deadline does not apply to Appropriations, Ways and Means or leadership bills.

The House also began the FY 2013 budget process by passing several budget bills this week. These bills passed on party-line votes and, if adopted into law, would impose fairly severe budget reductions on almost every program and state agency. The DHS budget, HSB 661, was on the debate calendar but was not brought up for consideration. The Senate has not yet passed budget bills but has begun the process of consideration through the Appropriations Committee. Their proposals are not as draconian as those presented by the House. Governor Branstad’s budget proposal falls in the middle, setting the stage for some contentious negotiations to finalize the FY 2013 budget.

Mental Health Update

The two larger bills that redesign the mental health delivery system have been approved by their respective committees with major amendment. The new versions of the bills were introduced late today (SF 2315 and HF 2431). We have been assured that these are not final versions and we will have continued opportunity to make changes. Once a complete review of the bills is completed, I will provide you with my analysis. The bills that would make revisions to Chapter 229 commitments have been introduced (SF 2312 and HF 2421). Both bills are similar and were amended in their respective committees to ensure that physicians may collaborate or consult with other mental health professionals when doing evaluations and assessments on individuals presented for Chapter 229 commitments. IMHCA is registered undecided on these proposals.

SF 2243 – Social Worker Loan Repayment Program

The Senate passed SF 2243 on a party-line vote. Republicans voted against the proposal because of the potential cost exposure to the state general fund. The bill was not amended and as currently written, applies only to social workers. The issue of workforce development is under consideration in the larger mental health reform bills. IMHCA is registered undecided on this bill and will continue to work with legislators to ensure that all mental health professions, not just social workers, are given the appropriate incentives to enter into practice. The bill faces an uncertain future in the House.

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February 10, 2012

Week Five and the Countdown to the First Funnel

The Legislature has now completed five weeks of the 2012 session. The pace of work continues to be relatively slow compared with past years. Things will pick up next week as we are two weeks from the first funnel deadline. This deadline means that a bill must have passed a committee in one chamber to remain alive. This does not include appropriations or tax bills and nothing is ever really dead until the conclusion of the legislative session but the funnel deadline does clear things out a bit and allow for clearer focus on the “must do” issues. The FY 2013 budget promises to be a controversial issue with legislators. The chart below explains the problem. The House and Senate are nearly $300 million apart in how much should be spent in the upcoming fiscal year. Despite the fact that last year’s Legislature budgeted for 50 percent of the FY 2013 budget year (which starts July 1), the core philosophical differences in how much should be spent and how healthy Iowa’s economy remain.

A Big Thank You

Thanks to all of you who took time from your schedule to visit the Capitol this week. I hope that you found the time spent worthwhile. I know that it can be frustrating to try to track down legislators and often have to remind myself that patience is a virtue! I have heard from several legislators who followed up with me after you raised questions and concerns about some of the proposals contained in the various mental health bills. If you have anything to specifically report, I would appreciate your feedback both on what you heard from legislators and what could be done to make your time at the Capitol more effective.

Mental Health Bills on the Move

The first two bills have been introduced as study bills and subcommittee work will begin next week. The one of interest to IMHCA members is HSB 623/SSB 3137. These bills incorporate the changes proposed to Chapter 229 (civil commitments) and Chapter 228 (definition of a qualified mental health provider). As noted last week, the legislation eliminates the definition of qualified mental health provider in Chapter 229 and uses the definition in Chapter 228 to increase consistency and cover all who fit that definition. However, the legislation also eliminates the ability of a psychiatric physician to consult with or utilize the services of a non-physician qualified mental health provider in evaluating those under a 229 commitment order. Rep. Renee Schulte has assured me that this was not their intent and that the bills will be amended to restore that ability.

The larger reform bill establishes the regional delivery system and has yet to be formally introduced. The fate of this bill is less certain as the counties are opposing it in its current form. I have been assured that, whatever the final outcome, changes will be made to address our concerns with respect to representation on the workforce development task force. The issue of provider representation on the regional governance boards is less certain. Some provider groups have indicated that they do not believe that it is appropriate for providers to serve in this capacity.

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IMHCA/IAMFT Day on the Hill – Monday, February 6

Please join other mental health counselors at the Iowa State Capitol today, Monday, February 6, 2012 as part of our annual lobby day. IMHCA will partner with IAMFT to talk with legislators about issues important to our professions, most notably the effort to redesign the mental health delivery system. We will begin with a quick briefing and lobbying tutorial at the Lucas Building Cafeteria (6th Floor) at 3:00 p.m. As a group, we will walk through the tunnel to the Capitol to meet with legislators. Our lobbyist, Emily Piper, will provide you with a list of targeted legislators in the House and Senate and be available to help you answer any questions.

This is your opportunity to talk about the role that you play in providing mental health services in Iowa, the types of cases that you see and the demand for your services. No one can speak better for your profession than you and we hope you will make time out of your busy schedule to join us. This is our opportunity to have direct input into the mental health redesign and to offer our thoughts on how to best accomplish that goal. There is no cost to attend. We look forward to seeing you at the Iowa State Capitol!

Mental Health Reform Update

The interim committee on mental health reform met Thursday and voted to formally dissolve and send two of the three bill drafts to the House and Senate Human Resources Committee for further consideration. The larger draft is considered more controversial as it establishes the new regional delivery system and the financing mechanisms. The two drafts which will be introduced as study bills include (1) a bill incorporating the recommendations of the DHS-Judicial Workgroup and (2) a bill that incorporates terminology changes for mental retardation and adult day care.

Draft #1 (regional delivery system): This bill draft addresses the overall regional delivery system. Specific concerns that have been identified at this point include the following:

  1. A person must be diagnosed with a mental health, behavioral or emotional disorder to be eligible for treatment under this system. The diagnosis is tied to the reimbursement to the provider. It would appear that if a provider in this regional system sees a patient who is not subsequently diagnosed, there is no reimbursement mechanism.
  2. Any provider of services who participates in this delivery system must be capable of working with individuals who have co-occurring disabilities or specialized needs. It is unclear if this means a provider must be able to diagnose and treat any intellectual disability, mental health condition or substance abuse problem.
  3. The bill establishes a workforce development workgroup to formulate recommendations on workforce development issues. This workgroup is heavily weighted against providers and those institutions that provide education and training to mental health providers.
  4. The Regional Service System Outcomes and Performance Measures committee is a required component but like the workgroup above, is heavily weighted against providers. This committee is responsible for developing and monitoring outcomes and performance measures for service delivery.
  5. The regional governance structure is a required component and does not include any providers. This governance structure is responsible for determining budgets, qualified providers, services etc.
  6. The dispute resolution mechanism available to providers is too long. This bill draft sets that process at a minimum of 120 days.

Draft #2 (Judicial work group): This bill addresses the committal process and basically encompasses six major changes:

  1. Creates a 12-hour training requirement for law enforcement officers to be taken every three years
  2. Allows for involuntary commitment without filing with court if access to the court to file is not possible at the time
  3. Resident care facilities don’t have to admit a person who has a court referral unless the care facility director gives prior approval – new level of approval
  4. Strikes the definition of qualified mental health professional in 229.1, subsection 14 and instead refers back to the definition of a qualified mental health professional contained in 228.1, subsection 6. This does not expand the list who professions considered to qualified mental health providers.
  5. Deletes all duties and rights of qualified mental health professionals who are not physicians from 229, placing sole reliance on physicians for hospitalization. This includes removing language the specifically authorizes a physician to consult with or utilize the services of a qualified mental health professional as defined in 228.1, subsection 6. Author’s note: I’m not sure the intent was to do this and will likely be addressed as the bill moves through the process.
  6. Establishes a pre-application screening process for involuntary hospitalization in 229.6 to prevent people being hospitalized and going through the court process if they are not really in need of the hospitalization. The state court administrator is given the power to develop the pre-application screening program.


The Iowa Mental Health Counselors Association is a chapter of the American Mental Health Counselors Association. IMHCA is the only organization dedicated exclusively to meeting the professional needs of mental health counselors in Iowa. Its sole purpose is to promote the profession of mental health counseling and the needs of our clients.