Here are some highlights from the first week of the 86th General Assembly:
The Governor’s Condition of the State AddressThe Governor gave his Condition of the State Address to the General Assembly on January 13, 2015. The address serves as the platform for the Governor to outline his budgetary goals for the executive branch as well as his policy agenda for the 2015 session. For resources relating to the Governor’s priorities, including a recorded video stream of his speech, please click here.
IDPH Budget Priorities
IDPH ACA Impact Study Summary
IDPH Omnibus Bill and Memo
Local Public Health Flexibility Bill and Memo
IHIN Transition White Paper
IDPH has several budget priorities for the 2015 session:
- General Fund. IDPH is requesting a reallocation of $200,000 of the $500,000 that is received annually from the General Fund for cervical cancer screening to be used in our Bureau of EMS and Trauma Systems. There are a couple of reasons for this.
First, we have had significant reversions since the initial appropriation in FY 2013. The program reverted $306,000 in FY 2013 and $271,000 in FY 2014. In addition to this, over the interim, IDPH subcontracted with an actuary to better understand how the Affordable Care Act may impact some of our programs. The cervical cancer screening program was one of four that were reviewed. The study found that the overall number of Iowans seeking IDPH-funded cervical cancer screening preventative services is projected to decrease as historically eligible women become enrolled in new health plans. For additional information on the study’s findings please see the attachments to this publication.
EMS has been a priority for the department in the last couple of sessions. IDPH staff have been in communication with the Iowa EMS Associationthat indicated that they would like to see more technical expertise at the state level to assist with county-level planning relating to budget and data analysis. IDPH is requesting two additional FTEs for the department for this purpose.
- The Governor also recommended an additional $1.0 million for the IDPH Medical Residency Training Grant Program for a total of $3.0 million for FY 2016 and FY 2017. IDPH will be seeking a substantive change to the program in an effort to attract bidders that would like to start new residency programs. More information is provided below in the discussion of the department’s legislative package. An organization starting a program must bear all start-up costs and do not receive Graduate Medical Education (GME) funding from the federal government until resident physicians are already in place and are functioning. The startup costs for residencies can vary from one to two hundred thousand dollars and higher, depending on the number of residents and the type of residencies, amongst other variables. Additional slots for existing programs are also a targeted goal of the IDPH program and are also expensive to establish.
- Technology Reinvestment Fund. IDPH is also making the following requests from the Technology Reinvestment Fund that is under the purview of the Transportation, Infrastructure, and Capitals Joint Appropriations Subcommittee:
- $500,000 for FY 2016 and FY 2017 (a total of $1.0 million). The project’s goal is to integrate several program data collection systems in our Division of Health Care Promotion and Chronic Disease Prevention to better support our clients and improve the health of families in Iowa. The identified programs operate in all 99 counties in Iowa and serve all children and pregnant women enrolled in Medicaid, as well as those who are low-income and uninsured or underinsured. Currently, five data management systems are operated by the Division’s Bureau of Family Health (BFH) and Bureau of Oral and Health Delivery Systems (OHDS), all of which function independently of each other. Not all are web-based and all lack the ability to easily share data among programs or with the public. These systems are aging and are costly to update and repair. Several have limited time before risks to data security occur. This project will replace the five existing systems with a single web-based, integrated electronic data management system. Features of the new system will include case management, referral management, risk assessment, billing, and client and population-level reporting. The integrated system will support eight programs within the Division. For more information on the initiative please see the attachments to this publication.
- $500,000 in one-time funding in FY 2016 to subcontract the services of a large, national, firm with public health experience and information technology (IT) experience. The subcontractor would study the department’s 98 data software systems to help us with long-term planning goals. IDPH’s Bureau of IT has been working through a process to identify these 98 systems, assess where they are in their lifespan (i.e. Are they in need of immediate replacement?). Red, yellow, and green color coding has been used to clearly identify these stages. Unfortunately, we’re seeing a great deal of systems that are in the red. The department recognizes that it is inefficient and costly to replace each system one at a time and in silos. Instead, we are seeking some outside assistance and expertise to assist with identifying strategies for consolidation of systems, identification of appropriate products to use, and to help us understand how other states are approaching their data collection efforts. This way we can get ahead of the larger problem, understand it fully, and then implement strategies for long and short term planning. IT is expensive and we should be thoughtful and deliberate in our approach moving forward. We know as public health professionals that we need good data to make good policy decisions. This request supports the effort to do so.
IDPH Legislative Package
IDPH has three bills for the 2015 session:
- Omnibus Bill: The IDPH Omnibus bill will consist of two parts. The first is a request made by the Board of Hearing Aid Dispensers to change their professional name to “hearing aid specialists.” The bill makes this technical change where applicable in code. The second part proposes changes to IDPH’s Medical Residency Training Grants program in an effort to make the program more attractive to potential bidders, especially those who may wish to establish new residency programs. As of this writing the bill has not been introduced in either chamber however the final draft has been approved. To view the finalized bill language and summary memo, please see the attachments to this publication.
- Local Public Health Flexibility Bill: This bill will also consist of two parts. The first proposes changes to the process for merging local boards of health into district boards of health. A few years ago, Wayne and Appanoose counties attempted a voluntary merger however there were several reasons that it was not accomplished. A few of the points of impasse were related to inflexible code requirements. The department is proposing to remove some of those requirements. The second part of the bill makes significant changes to the Iowa Public Health Modernization Act that was established in 2009. It strikes language requiring a voluntary accreditation process at the state level, removes references to the Iowa Public Health Standards, and merges the two councils that were established in 2009 under the Act. The newly merged council will assist the department in evaluating the public health system in Iowa as a whole and will make recommendations to the department and the state board of health. To view the finalized bill language and summary memo, please see the attachments to this publication. The bill was introduced as SSB 1039 in the Senate Chamber and was referred to the Human Resources Committee. A subcommittee of Senator Chaz Allen, Mary Jo Wilhelm, and Mark Segebart has been assigned. As of this writing a meeting has not been scheduled.
- Iowa Health Information Network (IHIN) Transition.The third bill in the IDPH legislative package pertains to the IHIN that is administered by the IDPH Office of e-Health. The primary goal of the legislation is for IDPH to receive authorization to conduct a request for proposals (RFP) process to begin to transition the IHIN from a state government-led model of governance to a not-for-profit model of governance. In 2012, the legislature included a directive in Iowa Code Section 135.156F for the department to review various governance options for the IHIN and make recommendations. A not-for-profit model of governance continues the spirit of collaboration for an essential public good amongst the IHIN’s stakeholders while putting it in the position to respond to its customers’ needs with more urgency than what a state government-led model can provide. To read more about the recommendation from IDPH please see the attachments to this publication.
The second goal for the bill is to resurrect the legislation that died last session to expand eligibility for the record locator service (aka query function) that the IHIN provides. The service is used to query participants (any entity that has signed a participation agreement with the Office of e-Health) in the IHIN for a patient’s health information. This service is useful for entities involved in care coordination efforts, especially insurance providers.To understand how a bill moves through the legislative process, click here.
Currently, the legislation is still under construction however, it is close to completion.
Highlights for Next Week:
The Health and Human Services Joint Appropriations Subcommittee has invited IDPH Director Gerd Clabaugh to present on the department’s budget priorities on January 28, at 10:00 in room 116.
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- The Iowa General Assembly website is a great source of legislative information. The address is www.legis.iowa.gov . Take a few minutes to check out the wealth of resources available.