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[Dome]Interim Calendar and Briefing

November 20, 1996

Contents:
Calendar of Scheduled Meetings
Agenda Information Regarding Scheduled Meetings
BRIEFINGS - Information Regarding Recent Meetings

Calendar of Scheduled Meetings

Friday, November 22, 1996
IOWA ADMINISTRATIVE PROCEDURES STUDY COMMITTEE
10:00 a.m., Room 22
Monday, November 25, 1996
DHS RESTRUCTURING TASK FORCE
10:00 a.m., Hoover Bldg. Conference Room, B-Level
Monday, November 26, 1996
LOCAL INFRASTRUCTURE NEEDS STUDY COMMITTEE
RESCHEDULED FROM NOVEMBER 20
10:00 a.m., Room 22
Wednesday, November 27, 1996
LAW ENFORCEMENT TRAINING STUDY COMMITTEE - (TENTATIVE)
10:00 a.m., Room 1
Monday, December 2, 1996
INTERPRETIVE SERVICES STUDY COMMITTEE
10:00 a.m., Room 116
Wednesday, December 4, 1996
FISCAL COMMITTEE OF THE LEGISLATIVE COUNCIL - (TENTATIVE)
Time and Location to be Announced
Wednesday, December 11, 1996
ADMINISTRATIVE RULES REVIEW COMMITTEE
10:00 a.m., Room 22
Wednesday, December 12, 1996
ADMINISTRATIVE RULES REVIEW COMMITTEE
9:00 a.m., Room 22
Friday, December 13, 1996
Compensation of Justices, Judges, & Magistrates Study Committee - (TENTATIVE)
10:00 a.m., Room 22
Wednesday, December 18, 1996
LOCAL INFRASTRUCTURE NEEDS STUDY COMMITTEE - (TENTATIVE)
Time to be Announced, Room 22

Agenda Information Regarding Scheduled Meetings

Iowa Administrative Procedures Study Committee

Temporary Co-chairperson: Senator Tom Vilsack
Temporary Co-chairperson: Representative Janet Metcalf

DHS Restructuring Task Force

Co-chairperson: Senator Johnie Hammond
Co-chairperson: Representative Hubert Houser

Local Infrastructure Needs Study Committee

Temporary Co-chairperson: Senator Larry Murphy
Temporary Co-chairperson: Representative Barry Brauns

Law Enforcement Training Study Committee (Tentative)

Temporary Co-chairperson: Senator Randal Giannetto
Temporary Co-chairperson: Representative Teresa Garman

Interpretive Services Study Committee

Temporary Co-chairperson: Senator Elaine Szymoniak
Temporary Co-chairperson: Representative Joseph Kremer

Fiscal Committee of the Legislative Council - TENTATIVE

Co-chairperson: Senator Larry Murphy
Co-chairperson: Representative David Millage

Administrative Rules Review Committee

Co-chairperson: Senator Berl E. Priebe
Co-chairperson: Representative Janet Metcalf

Compensation of Justices, Judges, and Magistrates Study Committee - TENTATIVE

Temporary Co-chairperson: Senator Eugene Fraise
Temporary Co-chairperson: Representative Jeff Lamberti

Local Infrastructure Needs Study Committee - TENTATIVE

Temporary Co-chairperson: Senator Larry Murphy
Temporary Co-chairperson: Representative Barry Brauns

BRIEFINGS - Information Regarding Recent Meetings

ADMINISTRATIVE RULES REVIEW COMMITTEE

November 12-13, 1996

DEPARTMENT OF ECONOMIC DEVELOPMENT
Industrial new jobs training: average regional wage, 261 IAC subrule 5.13(2).
Overview. The committee reviewed an adopted subrule relating to the average regional wage for the Industrial New Jobs Training Program. The rule states, "This average will be the sum of the county averages divided by the number of counties in the region." When first reviewed in August as a notice of intended action, members noted this would lower the average regional wage because it does not take into account the relative population base of the counties. In response, department representatives reviewed this issue, but concluded that in the initial legislation the department provided fiscal information based on this type of calculation. For this reason the department felt that legislative intent of S.F. 2351 requires the use of the per county average and that to do otherwise would yield a result that would differ from the information originally sent to the Legislature.
Action. Committee members accepted this explanation, but did act to refer this subrule to the General Assembly, to further consider the calculation of regional averages.
INSPECTIONS AND APPEALS
Medicare certification for in-home health care, selective review.
Overview. In response to a public complaint, the committee reviewed the Medicare certification procedures for home health care providers; these procedures are established by the federal Health Care Financing Administration (HCFA), but the certification process itself is administered by Iowa's Department of Inspections and Appeals.
At issue was an oral change in policy that occurred late in August 1996, but was not reduced to writing until October. That change in essence requires an applicant to provide 10 client records for review before an on-site survey is performed and certification granted. The prior policy required only one record. That change was made effective immediately, with no prior notice to persons currently in the process of qualifying. Following discussions with representatives of Iowa's Citizens' Aide/Ombudsman, the Kansas City HCFA office did "grandparent" in those persons who were in the midst of preparations for review and survey. For the following reasons committee members felt that the policy change is both arbitrary and unfair.
  1. The difficulty in obtaining 10 home health care clients. Especially in rural Iowa, where populations are low, finding 10 clients in close proximity will be difficult. The committee members were concerned the 10 client requirement will reduce the number of providers in rural Iowa and for that reason believe the number should be reduced.
  2. The fact that there are very few private pay clients-virtually all clients are Medicare-based. While a few clients have insurance, companies often demand certification as a condition of their own reimbursement. This means that new applicants must provide services without charge or at drastically reduced levels, simply to obtain the needed contacts.
  3. The change itself was instituted without notice or an opportunity for public participation. Iowa government agencies are required to go through a rigorous process of public notice and opportunity for public comment. Committee members questioned whether Iowa government agencies should be enforcing a policy, to the detriment of Iowa citizens, which was implemented with no public process.
  4. The policy change was implemented without publication. In Iowa, a fundamental part of due process involves the publication and distribution of policy-making sure that citizens are aware of the law, policy, and procedures they must follow. In this case the policy change was implemented by telephone and was never formally communicated to those persons who were attempting to obtain certification.
Action. Committee members acknowledged the fact this policy is federal, and thus beyond its' jurisdiction. The committee did vote to send a letter of protest to Iowa's congressional delegation, requesting a reduction in the number of required contacts.
DEPARTMENT OF HUMAN SERVICES
Boot camps, 441 IAC paragraph 202.17(1)"a", selective review.
Overview. Initially reviewed in October, some question remained whether this adopted rule commits the department to fund 50 boot camp beds. Senate File 2442, section 10, specifically provides, "not more than $1,077,995," to fund 50 beds. The departments rule language states, "Not more than $1,077,995 of the appropriation can be allocated as state matching funding for 50 highly structured juvenile program beds." This language continued to raise questions whether the department would, in fact, fund 50 beds. Department representatives restated their intentions to fund a total of 50 boot camp beds.
Action. Committee members were satisfied with this commitment and took no further action.
MEDICAL EXAMINERS BOARD
Physician assistants, 653 IAC Chapter 21.
Overview. In response to an earlier committee action, the board has dropped provisions relating to the ineligibility of a physician to supervise a physicians assistant and has re-adopted the provisions that were in place prior to the rulemaking; this re-filing was done using the "emergency" rulemaking process. This action in effect restores the status quo. The current language is itself controversial, but it does provide a temporary standard.
Action. The committee has requested that the two boards meet and attempt to develop standards for determining ineligibility that are acceptable to both groups. The committee will again review this issue in January; if no compromises have been reached, the members may refer the issue to the General Assembly for further review.
DEPARTMENT OF PUBLIC HEALTH
Parental notification concerning an abortion. 641 IAC Chapter 89.
Overview. The department has proposed a notice of intended action relating to the requirements of parental notification before a minor may obtain an abortion. The enabling legislation, Senate File 13, requires the Department of Public Health to adopt rules to implement the notification procedures relating to abortion; this requirement includes rules regarding the documents necessary for notification of a parent, grandparent, or aunt or uncle of a pregnant minor who is designated to receive notification under this chapter. The rules first establish the decision-making assistance program, where the department creates a video and other decision-making materials concerning the options available to the pregnant minor. Under the Act, these materials will be made available through both the Departments of Public Health and Human Services, the courts, and doctors' offices. The proposed rules fairly implement the statutory provisions and were not an issue to the committee.
Discussion. Members did express concern that neither the statutory nor the proposed rules contain any confidentiality provision to ensure that an official or individual notified under the Act has an obligation to keep that information confidential. Current laws provide confidentiality protection between a physician or other medical practitioner and the patient, but disclosures to family members or other officials have less certain protection.
Action. The members felt that the procedure should be reviewed to determine whether adequate confidentiality provisions currently exist or whether a specially drafted provision should be added to the parental notification law. For that reason the committee voted to refer this proposal to the General Assembly for additional study.

STATE-COUNTY MANAGEMENT COMMITTEE

November 14, 1996

Background.
The Committee was created in the 1994 Session in H.F. 2430 to make recommendations for joint state and county planning, implementing, and funding of mental health, mental retardation, and developmental disabilities (MH/MR/DD) services. The Committee includes state, county, and Governor's appointees, as well as legislative members. It is jointly staffed by the Department of Human Services (DHS) and the Iowa State Association of Counties (ISAC).
Allowed Growth Recommendation.
Legislation enacted during the 1996 Legislative Session requires the Committee to make a recommendation to the Governor by November 15 for an MH/DD services growth factor to "address costs associated with new consumers of services, service cost inflation, and investments for economy and efficiency." In considering options, the Committee's work group for this recommendation surveyed counties, reviewed data for growth in number of consumers, and considered various price and inflation indices. The work group presented six options for the full Committee's consideration ranging from a low of 2.5 percent to a high of 10.9 percent.
The Committee adopted by unanimous consent a recommendation of 10.1 percent for fiscal year 1997-1998, which applied to the overall base expenditures of counties ($213,259,880) equals $21,539,348. The recommendation is comprised of the following elements:
Distribution Considerations.
The Committee noted the following considerations and principles associated with allowed growth funding:
Mental Retardation Service Plans.
The Committee is required to make a recommendation to the Director of Human Services regarding approval of county plans for mental health and mental retardation (MH & MR) services. Mental health service plans were considered early in the summer and many counties submitted mental retardation service plans at that time although counties are not required to implement the MR plans until January 1, 1997. Problems were identified with the plan submitted by Decatur county and more information was requested concerning the Cerro Gordo county plan.

IOWA'S INSTITUTE FOR PUBLIC LEADERSHIP

November 14, 1996

Background.
Iowa's Institute for Public Leadership was established with the mission of creating a more efficient and responsive government at all levels by facilitating communication between levels and branches of government and providing leadership training for public officials. The initial Institute was held in the fall of 1995 and included selected executive branch agency personnel, judges and judicial administrators, and recently elected legislators and legislative staff. An advisory board of senior personnel from the three branches and from the three Regents' institutions provides guidance to the Institute with staffing assistance from Iowa State University. Recently, the Institute was recognized for excellence by the National Association of State Personnel Executives.
Alumni Session.
The Institute held an alumni session available to attendees at the initial session. The agenda included meetings of previously created action groups, a review of the futures planning process recently completed by Iowa's judicial branch, a briefing on Iowa's economic outlook, and a briefing on the important issues facing Iowa's three branches of government.
Upcoming Session.
A second full Institute is slated in June 1997 for a new group of upcoming leaders.

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