2020 Legislative Priorities

We work at the state and federal levels of government on legislative priorities to ensure that public policy decisions improve the lives of Iowans in need of care from nursing facilities, assisted living programs and home health agencies.

Skilled Nursing Facilities
  • Nursing Facility (NF) Reimbursement – The Legislature is tasked with appropriating funding to ensure Medicaid rates are adjusted as costs rise over time. However, in the past the system has not been adequately funded, creating a significant shortfall in the rates NF providers are receiving from Medicaid. In 2019, the Iowa Legislature included $23.4 million in its Health and Human Services (HHS) budget which included approximately $15 million in new appropriations and $8.4 million in Quality Assurance Assessment Fee (QAAF) provider return. Nursing facilities faced a $54.9 million shortfall at the time of the appropriation, leaving $31.5 million remaining to be addressed during the 2020 legislative session. Until NF Medicaid is funded to provide cost coverage, NF providers will continue to face challenges delivering health care to vulnerable Iowans. Position: IHCA is asking the Iowa Legislature to appropriate $31.5 million- the remainder of the state share of the 2019 NF Medicaid funding shortfall.
  • Nursing Home Renovation Funding – The General Assembly has historically appropriated Rebuilding Iowa Infrastructure Fund (RIIF) funding for renovation of older nursing facilities and those caring for high numbers of Iowans on Medicaid. These facilities typically have limited access to capital. Renovation of aging facilities is vital to meeting evolving regulatory and quality improvement requirements. Since its inception, this funding has helped leverage over $100 million in capital investment in many rural and high-Medicaid Iowa nursing homes. Position: In order to help rural and high-Medicaid nursing homes remain compliant with state and federal regulations and continue providing quality care, IHCA requests an $800,000 appropriation from the RIIF fund.
  • Monitor Progress of Removal of the Hospice Room and Board Pass-Through – Last session Governor Reynolds signed House File 518, which directs DHS to take appropriate actions to allow for payment of nursing facility room and board expenses for dual-eligible and Medicaid only recipients who have elected their hospice benefit to be paid directly from managed care organizations and fee for service payors. Eliminating the hospice room and board pass-through reduces administrative burden by removing the middleman and allows providers to view client participation changes for residents on hospice. IHCA continues working with DHS to design and submit these changes in a timely and approvable manner.
  • Certificate of Need (CON) – The Iowa’s Health Facilities Council (HFC), the 5-panel council that votes to approve or deny applications for expansion or new institutional health care facilities, has historically prevented over-construction of expensive health care facilities (hospitals and nursing homes) by applying an objective test to each application it reviews. This has helped keep health care cost increases in check by reducing duplication in services across the state. However, each year the legislature is presented with proposals that would weaken Iowa’s current CON system. Weakening the requirements for a CON, especially the project cost threshold, would allow new classes of providers to “cherry-pick” patients/residents from higher reimbursement categories, and would tilt the playing field against providers required to seek CON approval. Position: IHCA will continue to oppose any legislative measures that would weaken or eliminate the CON process.
Assisted Living Programs
  • Elimination of the Home and Community Based Services (HCBS) Elderly Waiver Rate Cap – Assisted living programs operate under the HCBS Elderly Waiver Cap of approximately $44 per day. ICAL proposes that the Iowa Legislature direct the Department of Human Services to eliminate the monthly budget maximum or cap for individuals eligible for the Medicaid home and community-based services Elderly Waiver.
  • Continued Support of ALP’s Social Model Foundation – ICAL advocates for allowing tenants to make their own choices of how to live and supports any state initiative that carries forward and enhances this practice. As elderly Iowans begin transitioning to home and care models like assisted-living and/or nursing facility care, it is important that their care is provided in settings that prioritize social well-being, quality care and high patient satisfaction.
  • Certificate of Need – ICAL supports continuation of free market opportunities allowing ALP construction unfettered by additional state oversight and opposes the establishment of a certificate of need process for assisted living development.
Home Health Agencies
  • Increase State Funding for Home Health – Home care utilization in Iowa continues to climb. ICHC is requesting a $7.8 million appropriation from the Iowa Legislature to increase the Medicaid funding for low-income elderly and disabled Iowans receiving care in their own home. The appropriation would produce cost coverage for Iowa Home Health Agencies (HHA) providers through the low utilization payment adjustment (LUPA) rate system. HHA providers are currently reimbursed at 85% of the LUPA rate. This funding request is vital to ensuring that home care providers are able to continue to serve Iowa Medicaid patients and ensuring Iowa has a robust health care continuum. Additionally, home health care providers offer the most affordable service in Iowa’s Medicaid care continuum.
All Providers
  • Department of Public Safety Background Checks – Currently long-term care and many other providers are required to utilize the Department of Public Safety’s (DPS) background check system for current and prospective employees. The DPS system only provides a background check for Iowa offenses and is inexpedient—requiring providers to wait to hire prospective new employees. IHCA supports modernizing the system to ensure a more thorough, national background check for every applicant and a real-time system that operates 365 days a year, 7 days a week and 24 hours a day.
  • TORT Reform – In 2017 the Iowa legislature passed SF 465 related to medical malpractice claims. In an effort to contain health care costs, the bill established $250,000 “soft” caps for non-economic damages, while still allowing plaintiffs to recover punitive and economic damages. These caps, however, are subject to exceptions for particular injuries, scheduled increases and inflation adjustments, and therefore claims still often result in exorbitant malpractice judgements against facilities. Such outcomes promote a negative litigious environment and make it difficult for providers to maintain operations. Position: IHCA supports hard caps that are not subject to exceptions and do not adjust over time on non-economic damages in medical malpractice claims.
  • Medicaid Managed Care Reform – IHCA supports Prompt Accurate Claim Payment. Adjust requirements to ensure providers are paid accurately and timely by the Managed Care Organizations (MCOs). Any Willing Provider – Ensure that any provider who is an enrolled Iowa Medicaid provider is allowed to be a network provider with all of the MCOs the provider chooses to contract/credential with. No Prior Authorizations for Long-Term Services and Supports (LTSS) – Statutorily prevent the installation of prior authorization requirements for LTSS patients. This would include Nursing Facilities patients and Assisted Living/Home Health patients who are on the elderly waiver.
  • Workforce – IHCA, ICAL and ICHC support public policies and appropriations that support workforce development and retention to Iowa’s health care field. Providers are continually burdened by an inadequate pool of trained health care providers to meet the demands of the patients they serve every day.
  • Medical Cannabis – Throughout the 2019 legislative session IHCA worked to educate legislative and regulatory entities on the impact of the medical cannabidiol program on Iowa’s long-term care providers. The issue is expected to resurface in future legislative sessions. As the medical cannabidiol program evolves, IHCA will continue to work with legislative and regulatory entities to ensure clear, expedient guidance is available to long-term care providers.
Federal Priorities
  • Nursing Facility Relief for Requirements of Participation (RoP) (CMS-3347-P) – In 2019 the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that changes the current RoP and delays implementation of some elements of Phase 3 by a year. The intention of this rule is to ease some of the pressures of the RoP and reduce excessively burdensome and overly prescriptive regulations. IHCA supports the proposed rule, which will bring the regulatory relief needed to allow for more time and greater focus on providing high-quality care to Iowa’s nursing facility residents.
  • Home Health Payment Innovation Act (S. 433 & H.R. 2573) – In 2020 CMS plans to implement a new payment model for home health services: The Patient-Driven Groupings Model (PDGM). In doing so, Medicare will apply “behavioral adjustments” to account for anticipated changes in provider behavior. These adjustments would mean a 6.42% base rate reduction that would start before any actual behavioral changes occur, translating to a $7.8 million reduction in home health payments to Iowa home health providers in 2020 alone. The ICHC strongly supports the Home Health Payment Innovation Act, which would prohibit pre-change rate reductions based on untested assumptions, and require behavioral adjustments based on real, actual changes in provider behavior that reflect provider behavioral changes in response to the new payment model rather than changes in the patient population.
  • Veterans Administration (VA) Managed Care – Optum – ICHC has significant concerns regarding the rollout of the new managed care system for VA home care patients. Several changes have already been imposed, including a contract transition to TriWest, and most recently a switch to new third-party payor, Optum. The rollout to Optum for Iowa VA patients begins October 8, 2019. Providers have received little information to date and lack answers regarding the impact of this change on their contracting and billing. Throughout this transition, ICHC will continue to seek answers from the VA to ensure clear guidance is available to home care patients and providers.
  • Home Health Care Planning Improvement Act (296/H.R. 2150) – Medicare law requires that a physician certify a patient’s eligibility for coverage of home health services. However, much of the primary care provided today comes from highly skilled non-physician practitioners. In order to comply with the current Medicare certification requirements, these professionals are forced to “hand-off” their patients to a physician who has not previously cared for them. ICHC supports the Home Health Care Planning Improvement Act which would allow non-physician providers to certify a patient’s eligibility for the Medical Home Health Benefit.
  • National Practitioner Data Bank (NPDB) (45 CFR § 60.1) – The NPDB is a repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers. It is a workforce tool intended to prevent practitioners from moving between states without disclosure of previous damaging performance. Currently, our providers do not have authorization under federal regulations to access the NPDB. IHCA seeks authorization as an eligible entity to access all reports and queries of the NPDB to assist in promoting quality health care and deterring fraud and abuse within our health care delivery system.
  • JOBS Act of 2019 (S.839) – The JOBS Act proposes making federal financial aid available to individuals seeking skills training (not just those seeking college degrees) by expanding Pell grants for short-term training programs that lead to higher-paying, in-demand jobs. IHCA supports this initiative for extending federal financial aid to short-term education and training high-quality programs.
  • Nursing Home Workforce Quality Act (HR 1265) – IHCA is supportive of this act that would eliminate the mandatory Certified Nurse Assistant (CNA) training lockout for skilled nursing facilities, and instead allow the Secretary of the Department of Health and Human Services to impose a lockout based on a substandard quality of care.
  • Workforce for an Expanding Economy Act (H.R. 1740) – This act provides critical access to new workers and create a commonsense visa system, capped at 85,000 positions annually, that would allow the government to ensure workers and employers are utilizing the system as it was intended. If a U.S. employer is offering a job that American citizens are not available to take, IHCA supports immigration reform that will fill these critical jobs.
  • Dream Act (H.R. 6) -Workforce recruitment and retention are among the most pressing challenges confronting long-term care providers today. IHCA supports the Dream Act which provides permanent legal protections and a path to citizenship for undocumented immigrants brought to the United States as children (“Dreamers”). The legislation offers protection for Temporary Protected Status (TPS) recipients from deportation, as recently TPS was terminated for individuals from several important countries that have typically contributed to the U.S. workforce.

2019 Legislative Session Report