2021 EMS Essential Service
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
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
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
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.
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
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
- 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
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
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
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.
IEMSA 2020 LEGISLATIVE UPDATE
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
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
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.
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
HSB 631 Essential Service/Tax
(IEMSA Position "For")
County EMS -
Optional Taxes for EMS
SSB 3139 Authorized Training Programs
Opens up to Services
HSF 2361 Statewide Mutual Aid
Persons authorized to request - elected CEO or designee
HF 2210 Donation Liability
(IEMSA Position "For")
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
Peace Officer, Public Safety, and EMS Bill of Rights
(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")
Revenue to EMS Fund
HF 2036 Tactical EMS Carry
Allows Tactical EMS Personnel to apply for Prof. License
Lobbyist: Eric Goranson (email@example.com)
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
- 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
- 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
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
- 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
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
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
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
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