Monthly Archives: March 2017

Senate Passes Legislation Impacting Autism and Congenital Cytomegalovirus

During the week of March 20-23, the Iowa Senate acted on bills impacting autism and congenital cytomegalovirus (CMV). The autism legislation now goes to the Governor for his signature, and the CMV bill moves onto the Iowa House for its consideration. Here’s a summary of the two bills.

 

Insurance coverage for applied behavior analysis. The Senate unanimously approved House legislation, HF 215, that expands insurance coverage for applied behavior analysis to treat autism spectrum disorder. The bill requires that certain individual and group health insurance policies for public employees who are not state employees cover this treatment for children under 19 years old. The treatment must be provided by a board-certified behavior analyst or by a licensed physician or psychologist. The bill allows insurers to set annual maximum benefits that are not less than $30,000 for a child through age 6, $25,000 for a child 7 through 13, and $12,500 for a youth 14 through 18. Insurers may also impose deductibles and coinsurance charges. The bill becomes effective on January 1, 2018.

 

Cytomegalovirus education and testing.  The Senate unanimously approved legislation (SF 51) to expand education about and testing for congenital CMV, which is a virus infecting individuals of all ages. While infected adults usually have no signs or symptoms, the virus can have profound and long-term effects on newborns born with the virus, acquired by transmission from their mothers. The CDC estimates that one in 150 newborns are born with congenital CMV.  Most showing no signs or effects, but some do and suffer any of several health effects, including vision and hearing loss, intellectual disability, muscle weakness, small head size, seizures, and death.

 

Determining the existence of congenital CMV presents challenges. Testing for congenital CMV must occur with the newborn’s first three weeks and can be done from the newborn’s saliva or urine. In the absence of a clear indicator of the disease,  SF 51 requires testing if a hospital’s initial newborn hearing screening indicates the newborn a hearing loss – which is a potential, but not certain, indicator of congenital CMV.

 

The Iowa-AAP registered undecided on SF 51 and, after consultation with state and national experts, issued a statement expressing support for and concern over provisions in the legislation. In the absence of statewide standardized testing, the Iowa-AAP statement recommends offering, but not mandating, congenital CMV testing to parents of infants who fail the newborn hearing screen, with the medical provider determining the test based on available resources. Iowa-AAP also recommends that, “Targeted testing should be done in such a manner that the medical community can gather safety, incidence, efficacy and cost effectiveness data to improve diagnosis and treatment.”

 

The bill has an education component, which Iowa-AAP supports. The bill requires the Iowa Department of Public Health to collaborate with health organizations to approve and publish information on congenital CMV, to be distributed to pregnant women, attending health care providers, and child care organizations. SF 51 also provides that health professionals who conduct the mandated test provide information to a newborn’s parents regarding congenital CMV, early intervention, and treatment resources and service.

 

The House has referred the legislation to its Commerce Committee.

 

Update: The Governor signed the autism bill on March 30. House approved the CMV bill on April 6, and the Governor signed it into law on April 20. 

Iowa House Advances Child Safety and Health Legislation

On March 14 and 15, the Iowa House unanimously passed three bills to improve child safety and provide access to health care. The bills, all of which Iowa-AAP supports, will proceed to the Iowa Senate. Here are brief summaries of the legislation:

 

Children exposed to dangerous drugs. HF 543 provides that a parent, guardian, custodian, or other household member who unlawfully uses, possesses, manufactures, cultivates, or distributes a dangerous drug in the presence of a child can be subject to a Child in Need of Assistance proceeding and/or a founded child abuse report. The bill defines “dangerous drug” to include amphetamine, methamphetamine, cocaine, heroin, and opium or opiates. “In the presence of a child” means in the child’s “physical presence” or “occurring under other circumstances in which a reasonably prudent person would know that the use, possession, manufacture, cultivation, or distribution may be seen, smelled, ingested, or heard by a child.”

 

The bill also requires a health practitioner involved in the delivery or care of a newborn or infant to report to the Iowa Department of Human Services if he or she discovers “physical or behavioral symptoms that are consistent with the effects of prenatal drug exposure or a fetal alcohol spectrum disorder.”

 

Insurance coverage for applied behavior analysis. HF 215 requires that certain individual and group health insurance policies for public employees who are not state employees cover applied behavior analysis for the treatment of autism spectrum disorder for children 18 years old or younger. Treatment must be provided by a board-certified behavior analyst or by a licensed physician or psychologist. The bill allows insurers to set annual maximum benefits that are not less than $30,000 for a child through age 6, $25,000 for a child 7 through 13, and $12,500 for a youth 14 through 18. The bill allows a plan to impose deductibles and coinsurance charges. The bill becomes effective on January 1, 2018.

 

Youth athlete concussion. HF 563 requires coaches to have training in CPR and the use of an automated defibrillator by July 2018. The bill states findings on concussions, their frequency in sports and recreational activities, and potential consequences. The bill requires the state’s athletic associations to work together to develop training materials, guidelines, and protocols on concussions and distribute information sheets on concussions to parents and guardians. The bill further mandates removing an athlete from a contest if he or she shows signs, symptoms, or behaviors consistent with a concussion or brain injury.

 

Under legislative rules, the bills must pass out of a Senate Committee by March 31 to remain eligible for final passage. Since a companion bill on autism coverage has already passed a Senate committee, HF 215 is not subject to this deadline.

 

Update: The Iowa Legislature approved the drugs and autism bills, which the Governor has signed.The Senate Human Resources Committee approved the concussion bill, but the full Senate did not vote on it before session’s end.  

Divided Senate Subcommittee Advances Gun Bill

Divided Senate Subcommittee Advances Gun Bill

After an hour of public testimony from supporters and opponents, a subcommittee advanced an omnibus gun bill (HF 517) to the Senate Judiciary Committee by a 2-1 vote. Senators Dan Dawson (R-Council Bluffs) and Brad Zaun (R-Urbandale) supported the bill, which Janet Petersen (D-Des Moines) opposed – while raising multiple questions about its meaning and consequences.

 

The Des Moines Register reported on the competing testimony. Bill proponents Included a father and two young daughters, who have lobbied for removing Iowa’s minimum age of 14 for possessing a pistol or revolver. Others stressed the primacy of the rights to bear arms and to act in self-defense, with one speaker maintaining that “self-defense is the most basic of human rights.”

 

Opponents argued the bill would increase the risk of deaths and injuries because of expanded “stand your ground” rights, more gun carrying in public spaces, and removal of the 14-year-old minimum age limit. Several speakers urged legislators to err on the side of public safety in balancing competing rights.

 

Representing Iowa-AAP, Steve Scott warned in his testimony that removing the 14-year minimum age would lead to more accidental injuries and deaths. He cited an October 2016 study by the Associated Press and USA Today finding at least one child being accidentally killed by a firearm every two days from January 1 to June 30, 2016.

 

While recognizing many parents will provide the hands-on supervision required by HF 517, Scott insisted others will not. He cited the fatal consequences of parental failure to protect children in Iowa Child Death Review Team’s most recent report. The report found dozens of preventable child deaths resulting from unsupervised swimming, unsafe sleep positions, failure to use car seats, absence of smoke alarms, and unsecured firearms. Scott noted that the difficulty for anyone in supervising children handling firearms due to their physical and emotional immaturity, the inherent danger of firearms, and potential harm during only a few distracted seconds.

 

The Senate Judiciary Committee is scheduled to vote on HF 517 on Thursday, March 16 at 11 a.m.

 

Update: Both chambers approved the gun bill, which the Governor signed on April 13. 

Vaccine Exemption Bill Dies in Committee

Vaccine Exemption Bill Dies in Committee

March 2 is the end of the Iowa Legislature’s first “funnel”: the date by which most policy bills must advance through committee in order to receive further consideration. One of the casualties of the funnel deadline is HF 7, which would allow an exemption from compulsory immunization based on someone’s “personal conviction.” (For more information on this legislation, visit here).

 

By a 2-1 vote, a House Human Resources subcommittee approved the legislation after a hearing on January 24. The subcommittee acted despite organizational opposition and statements against it, including testimony by Dr. Nathan Boonstra, a UnityPoint infectious disease expert and an Iowa-AAP board member. Dr. Boonstra warned that adding unvaccinated children to a classroom dramatically increases the risk of disease for others around them who might not be able to be vaccinated — particularly children with special medical needs like congenital heart disease or severe asthma.

 

HF 7 reportedly faced bipartisan opposition from a significant majority of the House Human Resources Committee. As a result, the committee chair, Rep. Joel Fry (pictured), did not bring the bill up for a vote — leading it to its demise at funnel’s end.