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2021 EMS Essential Service Legislation
SF 615 Bill Passed on May 20, 2021, and on June 9, 2021 Monticello Ambulance Service set the stage beautifully for Gov. Reynolds to sign this important Iowa EMS legislation. A historic first step for Iowa EMS that took many years to take! With IEMSA Board Members and Iowa EMS Providers, Iowa Senators and House of Representatives present.

SF615: An Iowa EMS Essential Service Summary
In the last budget bill to get passed on the final night of debate, this year’s legislature passed our EMS Essential Service language with unanimous support for the provisions related to EMS.

A HUGE debt of gratitude for the legislators and staffers in both chambers for their hard work to bridge gaps between the House and Senate on details of the bill and to our coalition partners including Mercy One, Unity Point, the Iowa Hospital Association, and the Association of Counties and Supervisors.

Representative Bobby Kaufmann championed the bill in the House and we appreciate his tireless efforts on this issue as well as great support from Representatives Hein, Thompson, and Neilsen along with a number of other legislators and House staffers who worked to ensure there was a unanimous vote. Also, a gigantic thank-you to Senator Klimesh for his support and hard work to get a deal done in the Senate along with Senators Kraayenbrink, Driscoll, Dawson, Whitver, and others who spoke up for EMS this year and were part of the last-minute negotiations.

The “Standings Bill” is the last budget bill passed most years and has a number of standing appropriations and is the vehicle for last-minute budget and some policy issues that are negotiated to get the session wrapped up each year. This year’s standings bill was much smaller than usual and the issue that took up the most space in this year’s “skinny” standings bill was EMS. Our essential services bill was altered slightly to put some language in that the Senate required to secure the time on the floor to get the vote and also some language to help create some uniformity between Iowa Code chapters 357F, 357G, and 422D. Here are the highlights:

Starting on page 17 through the end of the bill, you can read the full text of the EMS portion of the bill. Keep in mind that underlined words are added, words that are stricken are in current Code and being removed, and pay special attention to the words “amended” and “striking.” Unlike its stand-alone bill, this one doesn’t have an explanation to summarize what the bill does.

In short, this bill allows Supervisors and EMS districts to initiate a plan, stretches out the sunset to a less prohibitive amount of time, and adds options for funding that didn’t previously exist - all while creating the most transparent system of levying we’ve seen in Iowa Code.

The EMS verbiage in SF 615 does the following (with links to relevant sections of current Iowa Code):

Iowa Code 357F is the Emergency Medical Services Districts portion of the Code.

  • Clarifies a sixty percent vote of the people is required to pass the levy.
  • After passing the initial levy of up to $1 per thousand, the district requires additional resources, a “second effort” (what we are calling it) can be made to provide more funds. This is a new option for funding.
  • Creates a district advisory council to research and assess need, annually review progress and solicit public input on the report, as well as guide implementation.
  • A reverse referendum option is created if citizens want to discontinue the levy.

Iowa Code 357G is the City EMS Districts portion of the Code.

  • Makes vote threshold the same as other sections of code (60%) and largely mirrors 357F.

Iowa Code 422D is the portion of Code that allows for optional taxes for EMS at the County level:

  • Requires County Supervisors to declare EMS an essential service. This resolution is necessarily void if the plan does not pass the ballot initiative.
  • Limits tax to .75 per thousand
  • Requires plan to be voted on at two meetings prior to going to the ballot
  • Local EMS must be involved in creating the plan and be on the advisory council
  • Changes vote requirements to match 357F and G.
  • Sunset was removed in our version introduced in the House. Final version stretches sunset from five years to fifteen for rural counties and ten years for the 11 most populous counties. Most populous counties also have a smaller threshold for signatures to get a reverse referendum initiated which we supported. We may have an opportunity next year to re-address the sunsets but we are pleased they were stretched out to make the initial planning an attractive option.

The bill also allows for service programs to apply for authorization as a training program to the Department of Public Health. IEMSA has supported this bill the last two sessions and we supported its inclusion in this legislation as it could make training programs more accessible to a broader demographic without lowering the standards of training.

Finally, the bill adds local option sales tax as a method of supplementing EMS services along with district and county-wide property and income surcharge taxes. This process is intended to work in tandem with 422D and 357F/G and will be governed by the local option sales tax procedures in Code. We are thrilled to see multiple avenues of funding provided to locals to design a system that utilizes any or all of the three methods to create a plan that works within the local realities.

Other Bills of Interest
We supported HF 761 creating a local fire protection and emergency medical providers grant program to provide fireworks safety education programs and/or equipment related to the sale of fireworks in Iowa. IEMSA President Mark Sachen attended the bill signing earlier this week.

We supported HF 708 which created a public safety equipment fund for the Iowa DPS. It is awaiting the Governor's signature.

We supported a few bills that would increase the volunteer fire and EMS personal tax credit and we are pleased SF 619 included an increase from $100 to $250 and is awaiting the Governor’s signature.

NOTE: Above Photo Credit to Legislators on the floor when the SF 615 Bill passed and Board Members present at the signing.

The Legislative session convened January 13, 2020 as one of 21 Republican state government trifectas. Invest in Iowa, criminal justice reform, occupational licensing reforms, and increased spending on education were all major points of the Governor’s Condition of the State Address in January.

At the end of the session, the legislature’s FY 21 Budget spends $7.7785 billion. This is largely a status quo budget with a 2.3% increase in public K-12 funding (almost $100 million) and rainy day funds still full. The regents and a few other items in the budget were cut and ending balances were used to backfill RIIF due to a lack of the usual gaming revenues that fund it.

There were many controversial bills taken up during this two-week end-of-session period that we all were told would include few policy bills that weren’t agreed to already. Controversial bills passed at the 11th hour include occupational licensing reform, a 24 Hour waiting period for abortions, firearms caliber “clarifications” related to hunting, and “election integrity” legislation.

Also passed during the final two weeks of the legislative session, was a law that conforms Iowa law to Federal law increasing the age from 18 to 21 for tobacco and vaping purchases, online learning legislation (not altogether noncontroversial), classroom behavior management legislation, a dyslexia bill aimed at serving dyslexic students better in Iowa’s public schools, and changes to the Future Ready Iowa education program.

The State Housing Trust Fund (SHTF) and REAP programs were funded at status quo levels due to the backfilling of RIIF with ending balance funds and REAP was extended for 2 years, giving the next General Assembly the ability to address the Governor’s Invest in Iowa Act or move in a different direction.

One of the most substantive bills to pass during the June wrap-up session was the COVID Liability Protections Bill. This bill includes broad language protecting Iowa businesses and organizations from frivolous lawsuits if they make good faith efforts to follow guidelines to mitigate COVID infections. The bill does not protect businesses or organizations that act with malice or that ignore guidelines, putting the public at unnecessary risk of infection.

Our biggest area of focus this year was on empowering counties and the cities and townships within their borders to declare EMS an essential service, create a plan with public input, and levy only for the amount needed to fund that plan. The final version of the bill had additional language that would have required a vote of the people on the plan and implementation at the next regularly scheduled countywide election. We supported that version of the bill and it passed the Iowa House with only one dissenting vote (a retiring member who told us before the session started he’d never vote for it) but was not afforded a vote in the Iowa Senate. We now have good working language, have smoked out some concerns, know who is working behind the scenes for an against the bill, and have a great roadmap ahead of us to work from. A special thank-you to the Iowa Hospital Association, MercyOne, and the Counties and Supervisors associations for their support of the bill and their tireless work alongside us this year. Although IEMSA is seen as the voice of the EMS profession as a whole at the Capitol, we can’t get something this transformational done without great support and energy from all interested stakeholders and we appreciate their help. The Iowa Hospital Association and MercyOne lobbyists, in particular, went above and beyond the call of duty to advocate for the bill this year and we hope to be able to work with them again next session.

HF 2528 - Persons authorized to request assistance pursuant to the statewide mutual aid compact. We were registered undecided on the Senate version of the bill. Passed unanimously on June 13.

SF 2373 - This bill modifies provisions related to telecommunicators by designating them “first responders.” IEMSA declared in favor of this bill and spoke in favor of it in subcommittees. It passed unanimously in both chambers.


Bill Watch List
Attention Iowa EMS Providers and Organizations:

We are through funnel week. Below is a list of bills that made it through funnel week for consideration during the 2020 General Session.

NOTE: This legislation will change and move too quickly to be able to give an accurate bill status, but we are providing links to all these bills for our members to follow them online.

Standby to call your legislators when we make a push we'll notify you.

HSB 631 Essential Service/Tax
(IEMSA Position "For") County EMS - Optional Taxes for EMS

SSB 3139 Authorized Training Programs (IEMSA Position "Undecided") Opens up to Services

HSF 2361 Statewide Mutual Aid (IEMSA Position "Undecided") Persons authorized to request - elected CEO or designee

HF 2210 Donation Liability (IEMSA Position "For") Liability arising from donation of equipment to municipality

HSB 584 Length of Service Award (IEMSA Position "For") Authorizing Length of service award program for volunteers

SF 2293 First Responder Bill of Rights (IEMSA Position "Undecided") Peace Officer, Public Safety, and EMS Bill of Rights

HF2395 Telecommunicators (IEMSA Position "For") Telecommunicators are First Responders

HF 2396 Deaf and Hard of Hearing (IEMSA Position "For") Terminology Changes - Technical

HF 2005 Invidiual Tax Credits (IEMSA Position "For") Increases Individual tax credit from $100 to $200-Volunteer

HSB 508 Sports Wagering to EMS (IEMSA Position "For")
Puts Fantasy/Sports Betting Profits in EMS Fund

HSB191 Speeding Tickets - EMS (IEMSA Position "For") Speeding Ticket Revenue to EMS Fund

HF 2036 Tactical EMS Carry (IEMSA Position "Undecided") Allows Tactical EMS Personnel to apply for Prof. License

IEMSA's Lobbyist: Eric Goranson (eric@goranson-consulting.com)

Legislative Accomplishments

IEMSA had a solid and active 2018 legislative session, with key victories and continued support voiced from our friends in Capitol.

  • GEMT - IEMSA led a coalition of groups that worked extensively on ground emergency medical transport (GEMT) funding. HF 2285 requires the Iowa Department of Human Services to submit a state plan amendment to the federal Centers for Medicare and Medicaid Services to allow for qualified EMS programs to access GEMT funding. Our language was drafted to allow for both public and private EMS programs to be eligible, subject to CMS approval. Gov. Reynolds signed the bill on March 29, with immediate effect. IEMSA is also leading the way on helping DHS draft its state plan amendment. We will continue to update you on its progress through this state and federal bureaucratic maze.
  • EMS as an Essential Service - IEMSA also made significant progress in its push to create a dedicated funding stream for rural EMS. HF 2479 passed the House 96-0, but stalled in the Senate Ways and Means committee after rural firefighters raised questions about how this would impact townships that are already at their maximum property tax levy. IEMSA had offered an amendment to address this perceived problem, but the shot clock ran out and the Legislature adjourned before they could bring it up. All throughout this process, legislators acknowledged the needs of rural EMS in Iowa, and lauded IEMSA for coming to them with new ideas to study. IEMSA will continue its push for permanent and sustainable funding for all levels of EMS in Iowa.
  • Concussion Protocols - The Legislature took another crack at addressing the concussion problem in high school sports with the passage of HF 2442. Many rural legislators voiced concerns that some sports contests would have to be cancelled if specific types of medical providers were not available, so they narrowly allowed circumstances in which EMRs, EMTs, AEMTs and paramedics could remove a player from competition if they observe “signs, symptoms, or behaviors consistent with a concussion or brain injury”. However, these same emergency medical care providers are NOT allowed to clear the student to return to practice or play. IEMSA was glad to work with legislators to address their concerns within the context of our training, insurance and certifications.
  • Narcan ... again - IEMSA also worked with legislators late in the session on the vexing issue of who can administer narcan and by which method. As you know, our scope of practice is narrow and does not allow several levels of emergency care providers to inject medicines; however, several legislators were hearing from some of their constituents (some of whom are paramedics) that they should expand our scope of practice to allow for injectable delivery of opioid antagonists. IEMSA opposes this, and spent a significant bulk of one afternoon explaining to lawmakers why they should leave our scope as is. In the end, IEMSA’s views prevailed and our scope of practice remained intact.
  • This will be my last article as Legislative Counsel for IEMSA. Due to another client’s merger with a large, national health insurer, there is a distinct possibility that I would be in conflict on an insurance issue if I were to work with both groups. As a result, I feel it is only fair to all for me to choose now rather than in the middle of the 2019 session. This will also give you time to prepare your new lobbyists to help you strategize and advocate for your issues.
  • IEMSA has accomplished so much in the past few years, and I am glad to have been a part of your successes. The GEMT bill is a perfect example of this. It passed and was signed before the end of March, when some people thought it would be a 2 or 3 year process to get it signed. The language that ended up passing existed in FIVE different bills in various forms, which shows that
    a) lawmakers were hearing our concerns and wanted to help and; b) we knew how to work the process to position ourselves for success. Kudos to all of us for such great work!
  • I must say that I was proud to represent you every day I walked into the Capitol. You are strong and passionate advocates and sacrifice so much to make your communities safer. Legislators are hearing your voice, and I would urge you to continue your push for permanent and sustainable funding for all levels of EMS.

During the 2015 86th Iowa General Assembly, IEMSA was able accomplish and make progress on a NUMBER OF IMPORTANT items on our legislative agenda.

  • We were able to hold off the fireworks legislation. By working with a coalition of healthcare and public safety entities, along with our members engaging their legislators on this important item, we kept this piece of legislation from becoming law. The end of the session only means the start of our work for the 2016 87th Iowa General Assembly. The hurdles this bill passed this session, assures that it WILL be introduced next year. Our lobbyist, Lynzey Kenworthy, has already met with the coalition to strategize on how to best prevent this from becoming law next session. It will be imperative we remain engaged in the fight to keep Iowans safe from dangerous fireworks.
  • We secured a seat on the Statewide Interoperable Communications System Board. Now, Iowa’s EMS providers will have a voice and representation in communications issues going forward.
  • Work continues on drafting a Comprehensive EMS Reform Bill. IEMSA is continuing to solicit concerns through our membership surveys to identify issues that need to be addressed in Iowa. Rather than rush through legislation that would need reworking later, drafting a well thought out piece of legislation that addresses these issues is our goal. Findings from the National Highway Traffic Safety Administration EMS Assessment will be critical in making a strong case for change.
  • Building a strong foundation for Mobile Integrated Healthcare and Community Paramedicine in Iowa continues to be a priority for IEMSA. This is a great opportunity to move EMS forward and provide the best and most appropriate care for our patients.
  • Medicaid reimbursement is still a challenge. With two years of 10% increases in the Iowa Medicaid reimbursement rate, Iowa still ranks the lowest in the Midwest. With anticipated changes, IEMSA will continue to pursue to bring Iowa’s Medicaid reimbursement in line with other states and ultimately, at a parity with Medicare reimbursement rates.

HF 2459 increased the individual state income tax credit for qualifying volunteer firefighters and emergency medical services personnel from the existing maximum of $50 to $100, with changes retroactive to tax year 2014. The bill also created a tax credit for reserve peace officers equal to $100, first eligible for tax year 2014. This is a great achievement for volunteer and reserve public safety personnel in the state of Iowa!

More than 100 public safety professionals attended the bill signing ceremony in West Des Moines, during which Governor Branstad paid tribute to First Responders, saying, “I personally have benefitted from those services as I know literally hundreds of thousands of other Iowans have,” recalling the care he received from Lake Mills Emergency Medical Services 34 years ago after being involved in a motor vehicle crash. Governor Branstad also signed a proclamation declaring the week of May 18, 2014 as Emergency Medical Services Week in Iowa.

Positive news regarding other IEMSA supported initiatives included:

  • HF 2463 - HHS Appropriations Bill.
    Contains language that increases the Medicaid reimbursement for ambulance service another 10 percent, signed by Governor Branstad.
  • SF 2349 - Infrastructure Funding.
    Contains language that appropriates $150,000 to the Bureau of EMS for software development and data tracking, signed by Governor Branstad.

Thanks to the hard work of our IEMSA Lobbyists, Mike Triplett and Lynzey Kenworthy, as well as our President, Jerry Ewers, the Board of Directors, and our Office Manager, Lisa Arndt for their hard work and persistence, which contributed to the legislative success achieved this year.

IEMSA will continue to work to make Emergency Medical Services an essential service in the state of Iowa, and to accomplish this, we need your help! Please take a moment to take our survey which will assist in determining our legislative priorities for the upcoming session. If you aren’t a member of IEMSA, please consider joining to help the greatest EMS Association in our county make a difference for our patients, communities, and our people; it’s time to make a difference!

THANK you for your dedication to the improvement of emergency medical services in the state of Iowa!

House File 648 creates a Public Safety Training Task Force and includes a representative from IEMSA. The bill also appropriates $50,000 to run the task force through its period to make recommendations.

Senate File 446 included language to create an EMS Task Force of 23 members, who are charged with holding six meetings. The Task Force is also required to issue a report that will be due to the Legislature and others by December 2013. The bill also appropriates $28,664 to run this task force.

The House and Senate finally agreed, in Senate File 446, to expand Medicaid for certain populations currently covered by Iowa Care. This means we will be reimbursed at the Medicaid rate for ambulance service for these patients, effective January 1, 2014. Iowa Care will officially go out of existence on December 31, 2013.

SF 446 also includes a 10 percent increase in funding for EMS reimbursement in Medicaid. Effective July 1, 2013.

Governor Branstad has until June 22 to sign both of these bills. Since they are both appropriations bill, he has the constitutional item veto authority to approve bills but disapprove of specific provisions within. IEMSA has written a letter to Governor Branstad, urging him to approve of all four items.

In 2012, IEMSA worked with several other groups to pass the IPOST bill, HF 2165. This bill expanded a pilot project that created a transportable medical order, called a “Physicians Orders for Scope of Treatment”,  for the elderly, the frail and infirm or people with terminal diseases. This document would travel with the patient to all settings and would give health care providers guidance on the patient’s end-of-life wishes in certain circumstances. Under Iowa Code 144D, EMS personnel are given the flexibility to comply with or disregard the directives in a POST form, and will not be subject to criminal, civil or regulatory liability for acting in compliance with or failure to comply with a POST form. The new law was effective July 1, 2012.

Also in 2012, IEMSA and the Iowa Fire Fighters Association worked on a bill that created a $50 income tax credit for volunteer EMS and fire personnel. This has been an IEMSA priority issue for many years, and Governor Branstad signed SF 2322 into law on April 27, 2012, for tax years beginning on or after January 1, 2013. This has been a long-standing priority issue for IEMSA.

Also in 2012, IEMSA supported a bill that changed the E911 system in Iowa. The bill changed the funding allocation for the wireless surcharge, moving more money toward the local PSAPs to help them build their infrastructure. SF 2332 also created a Task Force to review local and state governance issues facing the E911 system. The new law has a variety of effective dates.

In 2011, IEMSA worked with the American Heart Association and the Red Cross to defeat a bill, HF 109, that would have eliminated the requirement that CPR be taught in all Iowa high schools.

In 2010, IEMSA worked with the Iowa Department of Public Health’s EMS Bureau and a group of legislators to make technical changes to the existing statutes governing EMS. These changes were necessary with the advent of the new national scope of practice model. The changes took effect on July 1, 2010. In 2010, IEMSA worked with a coalition of groups on clarifying the obligations of EMS personnel to communicate with law enforcement when treating gunshot wounds, stab wounds or other serious injuries in certain circumstances. The changes are incorporated in Iowa Code 147.111. This law took effect on July 1, 2010.

Also in 2010, IEMSA worked with a coalition of other groups to pass HF 2402. This law establishes a stroke triage system and registry, and was effective July 1, 2010.

In 2009, IEMSA helped pass legislation HF 380, which granted volunteer EMS medical directors immunity from civil liability for acts within the scope of their practice. Now, the definition of an “emergency medical services medical director” under Iowa Code 147A. 1(6) contains language that an EMS medical director “who receives no compensation for the performance of the director’s volunteer duties ….. shall be considered a state volunteer”. Under Iowa Code 669.24, state volunteers are granted limited immunity from liability in certain circumstances. This became effective on July 1, 2009. This was one of IEMSA’s major priority issues for 2009.

Also that year, IEMSA worked to amend and pass legislation (HF 671) that granted volunteer EMS personnel protection from job termination for responding to EMS-related situations. Known as the “Volunteer Emergency Services Providers Job Protection Act, Iowa Code 100B.14 offers limited protection for volunteer EMS personnel against job termination and discrimination in hiring. This law also took effect on July 1, 2009.

In 2008, IEMSA lobbied the Iowa Public Employers Retirement Systems’ Benefits Advisory Committee to get EMS personnel included in its definition of “protection class”. After persuading the Committee to adopt the change, IEMSA followed up with work on
SF 2424 to codify this in Iowa Code 97B.49B. It became effective on July 1, 2008. This was one of IEMSA’s major priority issues for 2008.

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