Iowa-2021-SF161-Introduced

S.F. 161 Section 1. LEGISLATIVE FINDINGS. 1 1. The COVID-19 pandemic has demonstrated, in Iowa and on 2 a global scale, the need for a comprehensive and professional 3 medical response for those suffering from its related symptoms, 4 including death. 5 2. Although amplified by the COVID-19 pandemic, the need for 6 an organized and coordinated health and long-term services and 7 supports workforce system will continue as Iowa faces growing 8 demand for this essential workforce relative to medical events, 9 regardless of scale. 10 3. Individuals with disabilities and older Iowans, 11 particularly, need assistance from a variety of members of 12 the health and long-term services and supports workforce in 13 order to remain living in their own homes and active in their 14 communities. 15 4. Health and long-term services and supports employers 16 across all settings experience challenges in recruiting and 17 retaining members of the health and long-term services and 18 supports workforce. 19 5. Iowa has an exceptionally qualified and dedicated health 20 and long-term services and supports workforce, the members of 21 which unselfishly serve in the face of personal harm. 22 6. The recognition, coordination, development, 23 compensation, and support of all levels of the health and 24 long-term services and supports workforce are in the best 25 interest of Iowa, its citizens, and economy. 26 7. Direct care workers who are members of the health and 27 long-term services and supports workforce are burdened by 28 the lack of consistency and portability of their training 29 and credentials and currently have no continuing education 30 standards that are linked to the retention of their 31 credentials. 32 8. A comprehensive state-based centralized direct care 33 workforce database system is part of the critical foundational 34 infrastructure needed to build a strong, diverse, and 35 -1- LSB 1902XS (4) 89 pf/rh 1/ 9

S.F. 161 professional direct care workforce to meet the growing demand 1 and to better respond in times of crises such as the COVID-19 2 pandemic. 3 Sec. 2. ESTABLISHMENT OF A CENTRALIZED DIRECT CARE 4 WORKFORCE DATABASE SYSTEM —— EXPANSION OF NURSE AIDE REGISTRY. 5 1. The department of inspections and appeals shall 6 establish a robust and comprehensive centralized direct care 7 workforce database system by expanding the existing registry 8 of nurse aides established pursuant to 42 C.F.R. §483.156 9 located within the department. To the maximum extent possible, 10 the database shall be incorporated into ongoing technological 11 upgrades and shall align with other data collection management 12 and analysis efforts. 13 2. The purposes of the database include all of the 14 following: 15 a. To provide statistical data for the state and employers 16 for the purposes of determining the total number of direct 17 care workers currently employed or eligible for employment; 18 predicting future shortages of direct care workers in all care 19 and support environments; serving as a tool to provide ongoing 20 training and to anticipate changes in the training needs of 21 direct care workers dictated by new technologies and procedures 22 and the diversity of the workforce and populations served; 23 providing employers with easy access to an up-to-date pool of 24 skilled direct care workers to address staffing shortages and 25 to meet specific needs; and enhancing the capacity of the state 26 and employers to respond to emergencies and quickly changing 27 workforce needs such as those recently encountered in the 28 COVID-19 pandemic. 29 b. To provide permanent portable records of trainings, 30 certifications, credentials, continuing education, and 31 experience of direct care workers, regardless of the setting or 32 population served, to maintain such records in a central and 33 secure location, and to assess the number of those involved in 34 providing direct care who transition to other health and social 35 -2- LSB 1902XS (4) 89 pf/rh 2/ 9

S.F. 161 service professions such as nursing, social work, or mental 1 health. 2 c. To reduce the cost, time, and burden on direct care 3 workers and employers associated with repetitive training due 4 to the lack of training portability. 5 d. To increase public protection by streamlining the 6 process to enable completion of required background checks in 7 a timely and efficient manner. 8 3. a. The department of inspections and appeals shall 9 create an advisory council of stakeholders to provide input to 10 the department in determining the essential components for the 11 centralized direct care workforce database system. Members 12 of the advisory council shall include one representative 13 each from the department of public health; the department of 14 human services; the department of education; the department 15 on aging; the department of public safety, division of 16 criminal investigation; Iowa workforce development; the Iowa 17 caregivers; a rural community college and an urban community 18 college; the university of Iowa college of public health 19 midwestern public health training center; the university of 20 Iowa college of nursing certification center; AARP Iowa; the 21 Iowa center for nursing workforce; area agencies on aging; 22 everystep care and support services; the brain injury alliance 23 of Iowa; the national alliance on mental illness-Iowa; the 24 Iowa developmental disabilities council; the older Iowans 25 legislature; the Iowa rural health association; leadingage 26 Iowa; the Iowa association of community providers; united 27 way of central Iowa; the Iowa health care association; the 28 Alzheimer’s association; one rural and one urban public health 29 entity; and the Iowa hospital association. Additionally, the 30 advisory council shall include two direct care workers who have 31 graduated from the Iowa caregivers toughest job you’ll ever 32 love leadership program, a citizen advocate, and two consumers. 33 b. The advisory council shall do all of the following: 34 (1) Review any pertinent historical reports of efforts and 35 -3- LSB 1902XS (4) 89 pf/rh 3/ 9

S.F. 161 recommendations generated by previous state-led and federally 1 funded initiatives for consideration in informing the work of 2 the advisory council. 3 (2) Investigate initiatives by the centers for Medicare and 4 Medicaid services of the United States department of health and 5 human services relating to nurse aide registries or consumer 6 public portals. 7 (3) Review, and utilize lessons learned from, the 8 development and implementation of other state database systems 9 utilized for similar occupations or professions. 10 (4) Evaluate the features of the database system that would 11 be most beneficial to respective stakeholders including the 12 types of data to be collected and the types of analyses to be 13 performed. 14 (5) Identify critical database system content and 15 functionality including but not limited to all of the 16 following: 17 (a) Verification of direct care workers’ education and 18 training records, credentials, certifications, and experience. 19 (b) A means to include in the new database existing 20 qualified direct care workers not currently included on the 21 nurse aide registry through a phased-in grandfathering process. 22 (c) An option to provide access to the database by employers 23 and consumers to obtain contact information of qualified direct 24 care workers who choose to be accessible to the public via a 25 public portal. 26 (d) Demographic and other information to assist in 27 workforce data collection and analysis. 28 (e) Accurate supply and demand projections regarding the 29 entirety of the direct care workforce. 30 (6) Recommend strategies to provide state-recognized, 31 competency-based, comprehensive, cross-setting, portable 32 training approaches, including the prepare to care curriculum 33 and the mental health first aid curriculum, apprenticeships, 34 and other existing and new opportunities in order to provide a 35 -4- LSB 1902XS (4) 89 pf/rh 4/ 9

S.F. 161 recognized career path for, increase professionalism in, and 1 improve retention by employers of, the direct care workforce. 2 (7) Explore state, federal, and other public and private 3 sources of funding to support ongoing expansion and maintenance 4 of the database system. 5 c. In support of the work of the advisory council, the 6 following entities shall do all of the following: 7 (1) Iowa workforce development shall do all of the 8 following: 9 (a) Conduct a workforce projection analysis that identifies 10 the top five demand occupations by legislative district 11 of those earning fifteen dollars an hour or less similar 12 to previous analyses that identified the highest-demand 13 occupations by legislative district for those earning fifteen 14 dollars an hour or more. 15 (b) Adapt workforce projections taking into consideration 16 the impact of the COVID-19 pandemic and, in particular, the 17 health and long-term services and supports workforce. 18 (c) Report the findings of the workforce projection 19 analyses described in subparagraph divisions (a) and (b) to the 20 advisory council for review by April 1, 2022. 21 (2) The department of education and the department of public 22 health shall do all of the following: 23 (a) Lead an effort to streamline and integrate existing 24 workforce database systems including various licensing or 25 certification boards with the direct care workforce database 26 system in order to do all of the following: 27 (i) Build upon and enhance existing efforts by the 28 departments’ health and long-term services and supports 29 workforce dashboard data. 30 (ii) Utilize information to inform the state’s strategies 31 to build a strong health and long-term services and supports 32 workforce. 33 (b) The department of education and the department of 34 public health shall submit results of the effort described in 35 -5- LSB 1902XS (4) 89 pf/rh 5/ 9

S.F. 161 subparagraph division (a) to the advisory council for review 1 by April 1, 2022. 2 (3) The department of human services shall do all of the 3 following: 4 (a) Work with the disability community, advocates, consumer 5 directed attendant care workers, the departments of public 6 health, inspections and appeals, and education, and the office 7 of the attorney general to create a plan to make the contact 8 information of members of the health and long-term services 9 and supports workforce who so elect accessible to the public 10 through a public portal. The public portal shall be designed 11 to automatically populate with information contained in other 12 health and long-term services and supports workforce databases. 13 (b) Submit the plan for a public portal developed under 14 subparagraph division (a) to the advisory council for review 15 by April 1, 2022. 16 d. The advisory council shall convene no later than 17 September 1, 2021. The department of inspections and appeals 18 shall prepare and submit a progress report, including the Iowa 19 workforce development projections reports, the efforts of 20 the departments of education and public health to streamline 21 workforce data systems, and the plan to establish a public 22 portal, following review by the advisory council, to the 23 governor and the general assembly by June 30, 2022. 24 EXPLANATION 25 The inclusion of this explanation does not constitute agreement with 26 the explanation’s substance by the members of the general assembly. 27 This bill relates to the health and long-term services 28 and supports workforce, including the establishment of a 29 centralized direct care workforce database and a consumer 30 public portal. 31 The bill includes legislative findings relating to the need 32 for an organized and coordinated health and long-term services 33 and supports workforce system to face the growing demand 34 for this essential workforce; to meet the needs of Iowans, 35 -6- LSB 1902XS (4) 89 pf/rh 6/ 9

S.F. 161 particularly individuals with disabilities and older Iowans, 1 who require assistance from this workforce to remain living in 2 their own homes and active in their communities; to meet the 3 needs of employers across all settings experiencing challenges 4 in recruiting and retaining members of the health and long-term 5 services and supports workforce; and to provide a system for 6 permanent, portable records of trainings, certifications, 7 credentials, continuing education, and experience of direct 8 care workers. 9 The bill requires the department of inspections and appeals 10 (DIA) to establish a robust and comprehensive centralized 11 direct care workforce database system by expanding the existing 12 registry of nurse aides located within the department. To the 13 maximum extent possible, the database shall be incorporated 14 into ongoing technological upgrades and shall align with other 15 data collection management and analysis efforts. The bill 16 specifies the purposes of the database. 17 The bill requires DIA to create an advisory council of 18 stakeholders to provide input to the department in determining 19 the essential components for the centralized direct care 20 workforce database system and specifies the membership of the 21 advisory council. The advisory council is required to review 22 pertinent historical reports generated by previous state-led 23 and federally funded initiatives for consideration in informing 24 the work of the advisory council; investigate initiatives by 25 the centers for Medicare and Medicaid services of the United 26 States department of health and human services relating to 27 nurse aide registries or consumer public portals; review, 28 and incorporate lessons learned from, the development and 29 implementation of other state database systems utilized for 30 similar occupations or professions; evaluate the features of 31 the database system that would be most beneficial to respective 32 stakeholders including the types of data to be collected and 33 the types of analyses to be performed; identify critical 34 database system content and functionality; recommend strategies 35 -7- LSB 1902XS (4) 89 pf/rh 7/ 9

S.F. 161 to provide state-recognized, competency-based, comprehensive, 1 cross-setting, portable training approaches, apprenticeships, 2 and other existing and new opportunities in order to provide a 3 recognized career path for, increase professionalism in, and 4 improve retention by employers of, the direct care workforce; 5 and explore state, federal, and other public and private 6 sources of funding to support ongoing expansion and maintenance 7 of the database system. 8 In support of the work of the advisory council, several 9 agencies are tasked with assignments. 10 Iowa workforce development is tasked with conducting a 11 workforce projection analysis that identifies the top five 12 demand occupations by legislative district of those earning 13 $15 an hour or less, adapting the workforce projections taking 14 into consideration the impact of the COVID-19 pandemic, and 15 reporting the findings of the workforce projection analyses to 16 the advisory council for review by April 1, 2022. 17 The department of education and the department of public 18 health are tasked with leading an effort to streamline and 19 integrate existing workforce database systems including 20 various licensing or certification boards with the direct care 21 workforce database system to build upon and enhance existing 22 efforts and to utilize information to inform the state’s 23 strategies to build a strong health and long-term services and 24 supports workforce. These departments are required to submit 25 the results of these efforts to the advisory council for review 26 by April 1, 2022. 27 The department of human services (DHS) is tasked with 28 working with a variety of stakeholders to develop a plan to 29 make the contact information of members of the health and 30 long-term services and supports workforce, who so elect, 31 accessible to the public through a consumer public portal. 32 DHS shall submit the plan for a consumer public portal to the 33 advisory council for review by April 1, 2022. 34 The advisory council shall convene no later than September 35 -8- LSB 1902XS (4) 89 pf/rh 8/ 9