Bill Summary – FastDemocracy

Fiscal Note
                                       Fiscal Services Division
HF 2391 – Health Care Employment Agencies, Nursing Services Charges (LSB5265HV)
Staff Contact: Louie Hoehle (515.281.6561) louie.hoehle@legis.iowa.gov
Fiscal Note Version – New
Description
House File 2391 makes the following changes to health care employment agencies as
described in Iowa Code chapter 135Q:
• Prohibits a health care employment agency from contracting with a health care entity if the
   health care employment agency has not registered with the Department of Inspections,
   Appeals, and Licensing (DIAL).
• Requires the Department of Health and Human Services (HHS) to annually establish and
   publish a maximum allowable charges schedule for nursing services provided by health care
   employment agency workers. The amounts established in the charges schedule must be no
   greater than 150.0% of the statewide average wage paid in the most recently preceding cost
   report year by a specific type of health care entity.
• Modifies the current civil penalty structure and adds new civil penalties for health care
   employment agencies that fail to comply with the Iowa Code.
• Requires the DIAL to submit an annual report to the General Assembly that includes
   information on health care employment agency registrations, registration fees collected,
   violations of Iowa Code chapter 135Q, monetary penalties collected, registration revocations
   and denials, the statewide maximum allowable charges schedule, and recommendations for
   changes to the Iowa Code chapter.
Background
Currently, there is no maximum allowable charges schedule for nursing services provided by
health care employment agency workers.
The DIAL receives quarterly reports from health care employment agencies that include the
average amount charged to the health care entity for each individual agency worker category
and the average amount paid by the agency to workers in each individual agency worker
category. The DIAL is responsible for reviewing agency reports and investigating agencies that
are noncompliant.
Assumptions
• House File 2391 may require an additional Executive Officer, a Management Analyst, and a
   Statistical Research Analyst for a total of 3.0 new full-time equivalent (FTE) positions for the
   HHS.
• According to the Department of Management (DOM), the starting costs for an Executive
   Officer 3 is approximately $98,000, for a Management Analyst 3 is approximately $79,000,
   and for a Statistical Research Analyst 3 is approximately $77,000.
• The HHS anticipates one-time support costs (phone, equipment, etc.) of approximately
   $10,000 in FY 2025 and approximately $3,000 in FY 2026 for the 3.0 FTE positions.
• Federal funds will cover half of the costs for FTEs needed by the HHS, while the State will
   cover the remainder.
• The Bill may require 1.0 new Administrative Assistant FTE position for the DIAL.
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•   According to the DOM, the starting costs for an Administrative Assistant 2 is approximately
    $65,000. The DIAL anticipates one-time support costs of approximately $2,000 for a new
    FTE position in FY 2025.
•   Revenues could potentially increase for the DIAL if a health care employment agency is
    noncompliant, but the amount of the increase cannot be estimated.
Fiscal Impact
House File 2391 is estimated to cost the State $200,000 in FY 2025 and $195,000 in FY 2026
as shown in Figure 1. Federal funds are estimated to cover half of the costs for FTEs needed
by the HHS.
                                Figure 1 — Costs Per Year Under HF 2391
                                                                      FY 2025                 FY 2026
                     Estimated Costs
                                                                Total        State      Total        State
1.0 Administrative Assistant 2 FTE Position for DIAL          $   67,000 $     67,000 $   65,000 $     65,000
1.0 Executive Officer 3 FTE Position for HHS                      98,000       49,000     98,000       49,000
1.0 Management Analyst 3 FTE Position for HHS                     79,000       40,000     79,000       40,000
1.0 Statistical Research Analyst 3 Position for HHS               77,000       39,000     77,000       39,000
Support Costs for HHS FTE Positions                               10,000        5,000      3,000        2,000
Total Costs                                                   $ 331,000 $ 200,000 $ 322,000 $ 195,000
Sources
Department of Health and Human Services
Department of Inspections, Appeals, and Licensing
Department of Management
                                                                               /s/ Jennifer Acton
                                                                               February 27, 2024
Doc ID 1447284
The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in developing this
fiscal note is available from the Fiscal Services Division of the Legislative Services Agency upon request.
                                                 www.legis.iowa.gov
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Statutes affected: 
Introduced: 135Q.1, 231C.2