Senate Study Bill 3185
SENATE/HOUSE FILE
BY (PROPOSED DEPARTMENT OF
HUMAN SERVICES BILL)
Passed Senate, Date Passed House, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act providing for establishment of a mental health services
2 system for children and youth.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 5355DP 82
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PAG LIN
1 1 Section 1. NEW SECTION. 225C.51 DEFINITIONS.
1 2 For the purposes of this division:
1 3 1. "Child" or "children" means a person or persons under
1 4 eighteen years of age.
1 5 2. "Children's system" or "mental health services system
1 6 for children and youth" means the mental health services
1 7 system for children and youth implemented pursuant to this
1 8 division.
1 9 3. "Functional impairment" means difficulties that
1 10 substantially interfere with or limit a person from achieving
1 11 or maintaining one or more developmentally appropriate social,
1 12 behavioral, cognitive, communicative, or adaptive skills and
1 13 that substantially interfere with or limit the person's role
1 14 or functioning in family, school, or community activities.
1 15 "Functional impairment" includes difficulties of episodic,
1 16 recurrent, and continuous duration. "Functional impairment"
1 17 does not include difficulties resulting from temporary and
1 18 expected responses to stressful events in a person's
1 19 environment.
1 20 4. "Other qualifying mental health disorder" means a
1 21 mental health crisis or any diagnosable mental health disorder
1 22 that is likely to lead to mental health crisis unless there is
1 23 an intervention.
1 24 5. "Serious emotional disturbance" means a diagnosable
1 25 mental, behavioral, or emotional disorder of sufficient
1 26 duration to meet diagnostic criteria specified within the most
1 27 current diagnostic and statistical manual of mental disorders
1 28 published by the American psychiatric association that results
1 29 in a functional impairment. "Serious emotional disturbance"
1 30 does not include substance use and developmental disorders
1 31 unless such disorders co=occur with such a diagnosable mental,
1 32 behavioral, or emotional disorder.
1 33 6. "Youth" means a person eighteen years of age or older
1 34 but under twenty=two years of age who met the criteria for
1 35 having a serious emotional disturbance prior to the age of
2 1 eighteen.
2 2 Sec. 2. NEW SECTION. 225C.52 MENTAL HEALTH SERVICES
2 3 SYSTEM FOR CHILDREN AND YOUTH == PURPOSE.
2 4 1. Establishing a comprehensive community=based mental
2 5 health services system for children and youth is part of
2 6 fulfilling the requirements of the division and the commission
2 7 to facilitate a comprehensive, continuous, and integrated
2 8 state mental health services plan in accordance with sections
2 9 225C.4, 225C.6, and 225C.6A, and other provisions of this
2 10 chapter. The purpose of establishing the children's system is
2 11 to improve access for children and youth with serious
2 12 emotional disturbances and youth with other qualifying mental
2 13 health disorders to mental health treatment, services, and
2 14 other support in the least restrictive setting possible so the
2 15 children and youth can live with their families and remain in
2 16 their communities. The children's system is also intended to
2 17 meet the needs of children and youth who have mental health
2 18 disorders that co=occur with substance abuse, mental
2 19 retardation, developmental disabilities, or other
2 20 disabilities. The children's system shall emphasize
2 21 community=level collaborative efforts between children and
2 22 youth and the families and the state's systems of education,
2 23 child welfare, juvenile justice, health care, substance abuse,
2 24 and mental health.
2 25 2. The goals and outcomes desired for the children's
2 26 system shall include but are not limited to all of the
2 27 following:
2 28 a. Identifying the mental health needs of children and
2 29 youth.
2 30 b. Performing comprehensive assessments of children and
2 31 youth that are designed to identify functional skills,
2 32 strengths, and services needed.
2 33 c. Providing timely access to available treatment,
2 34 services, and other support.
2 35 d. Offering information and referral services to families
3 1 to address service needs other than mental health.
3 2 e. Improving access to needed mental health services by
3 3 allowing children and youth to be served with their families
3 4 in the community.
3 5 f. Preventing or reducing utilization of more costly,
3 6 restrictive care by reducing the unnecessary involvement of
3 7 children and youth who have mental health needs and their
3 8 families with law enforcement, the corrections system, and
3 9 detention, juvenile justice, and other legal proceedings;
3 10 reducing the involvement of children and youth with child
3 11 welfare services or state custody; and reducing the placement
3 12 of children and youth in out=of=state residential treatment
3 13 facilities or in group foster care settings.
3 14 g. Increasing the number of children and youth assessed
3 15 for functional skill levels.
3 16 h. Increasing the capacity to develop individualized,
3 17 strengths=based, and integrated treatment plans for children,
3 18 youth, and families.
3 19 i. Promoting communications with caregivers and others
3 20 about the needs of children, youth, and families engaged in
3 21 the children's system.
3 22 j. Developing the ability to aggregate data and
3 23 information, and to evaluate program, service, and system
3 24 efficacy for children, youth, and families being served on a
3 25 local and statewide basis.
3 26 k. Implementing and utilizing outcome measures that are
3 27 consistent with but not limited to the national outcomes
3 28 measures identified by the substance abuse and mental health
3 29 services administration of the United States department of
3 30 health and human services.
3 31 Sec. 3. NEW SECTION. 225C.53 ROLE OF DEPARTMENT AND
3 32 DIVISION == TRANSITION TO ADULT SYSTEM.
3 33 1. The department is the lead agency responsible for the
3 34 development, implementation, oversight, and management of the
3 35 mental health services system for children and youth in
4 1 accordance with this chapter. The department's
4 2 responsibilities shall be fulfilled by the division.
4 3 2. The division's responsibilities relating to the
4 4 children's system include but are not limited to all of the
4 5 following:
4 6 a. Ensuring that the rules adopted for the children's
4 7 system provide that, within the limits of appropriations for
4 8 the children's system, children and youth shall not be
4 9 inappropriately denied necessary mental health services.
4 10 b. Establishing standards for the provision of home and
4 11 community=based mental health treatment, services, and other
4 12 support under the children's system.
4 13 c. Identifying and implementing eligibility criteria for
4 14 the treatment, services, and other support available under the
4 15 children's system.
4 16 d. Ongoing implementation of recommendations identified
4 17 through children's system improvement efforts.
4 18 3. An adult person who met the criteria for having a
4 19 serious emotional disturbance prior to the age of eighteen may
4 20 qualify to continue services through the adult mental health
4 21 system.
4 22 Sec. 4. NEW SECTION. 225C.54 MENTAL HEALTH SERVICES
4 23 SYSTEM FOR CHILDREN AND YOUTH == INITIAL IMPLEMENTATION.
4 24 1. The mental health services system for children and
4 25 youth shall be initially implemented by the division
4 26 commencing with the fiscal year beginning July 1, 2008. The
4 27 division shall begin implementation by utilizing a competitive
4 28 bidding process to allocate state block grants to develop
4 29 services through existing community mental health centers and
4 30 other local service partners. The implementation shall be
4 31 limited to the extent of the appropriations provided for the
4 32 children's system.
4 33 2. In order to maximize federal financial participation in
4 34 the children's system, the division and the department's
4 35 Medicaid program staff shall analyze the feasibility of
5 1 leveraging existing Medicaid options, such as expanding the
5 2 home and community=based services waiver for children's mental
5 3 health services, reviewing the feasibility of implementing
5 4 other Medicaid options such as the federal Tax Equity and
5 5 Financial Responsibility Act of 1982 (TEFRA) option for
5 6 children with severe mental illness or emotional disturbance
5 7 and Medicaid administrative funding, and determining the need
5 8 for service enhancements through revisions to the Medicaid
5 9 state plan and the federal state children's health insurance
5 10 program and the healthy and well kids in Iowa program.
5 11 3. Initial block grants shall support a wide range of
5 12 children, youth, and family services and initiatives including
5 13 but not limited to school=based mental health projects, system
5 14 reviews providing service gap analysis, status studies of the
5 15 mental health needs of children and youth in representative
5 16 areas of the state, and mental health assessment capacity
5 17 development based in public schools and clinical settings
5 18 using standard functional assessment tools. The purpose of
5 19 developing the assessment capacity is to determine childrens'
5 20 and youths' degree of impairment in daily functioning due to
5 21 emotional, behavioral, psychological, psychiatric, or
5 22 substance use problems.
5 23 4. The initial block grants may also support an array of
5 24 programs and services including not limited to mobile crisis
5 25 intervention services, or other support intended to prevent
5 26 more intensive or in=patient interventions, skills training,
5 27 intensive care coordination, and cognitive=behavioral and
5 28 multisystemic family therapy. In addition, support may be
5 29 provided for prevention=oriented services including mental
5 30 health consultations regarding home visits, child welfare,
5 31 juvenile justice, and maternal and child health services, and
5 32 consultation for preschool programs.
5 33 5. The division shall report regularly to the commission,
5 34 general assembly, and governor concerning the implementation
5 35 status of the children's system, including but not limited to
6 1 an annual report submitted each January. The report may
6 2 address funding requirements and statutory amendments
6 3 necessary to further develop the children's system.
6 4 Sec. 5. EMERGENCY RULES. The mental health, mental
6 5 retardation, developmental disabilities, and brain injury
6 6 commission may adopt administrative rules under section 17A.4,
6 7 subsection 2, and section 17A.5, subsection 2, paragraph "b",
6 8 to implement the provisions of this Act and the rules shall
6 9 become effective immediately upon filing or on a later
6 10 effective date specified in the rules, unless the effective
6 11 date is delayed by the administrative rules review committee.
6 12 Any rules adopted in accordance with this section shall not
6 13 take effect before the rules are reviewed by the
6 14 administrative rules review committee. The delay authority
6 15 provided to the administrative rules review committee under
6 16 section 17A.4, subsection 6, and section 17A.8, subsection 9,
6 17 shall be applicable to a delay imposed under this section,
6 18 notwithstanding a provision in those sections making them
6 19 inapplicable to section 17A.5, subsection 2, paragraph "b".
6 20 Any rules adopted in accordance with the provisions of this
6 21 section shall also be published as a notice of intended action
6 22 as provided in section 17A.4.
6 23 EXPLANATION
6 24 This bill provides for creation of a mental health services
6 25 system for children and youth by the division of mental health
6 26 and disability services of the department of human services.
6 27 New Code section 225C.51 provides definitions of the terms
6 28 "child" or "children", "children's system" or "mental health
6 29 services system for children and youth", "functional
6 30 impairment", "other qualifying mental health disorder",
6 31 "serious emotional disturbance", and "youth". "Youth" is
6 32 defined to mean a person age 18 or older but less than age 22
6 33 who met the criteria for having a serious emotional
6 34 disturbance prior to age 18.
6 35 New Code section 225C.52 states the purpose and the goals
7 1 and outcomes desired for the children's system. The purpose
7 2 is to improve access for children and youth with serious
7 3 emotional disturbances and youth with other qualifying mental
7 4 health disorders to mental health treatment, services, and
7 5 other support in the least restrictive setting possible so the
7 6 children and youth can live with their families and remain in
7 7 their communities.
7 8 New Code section 225C.53 outlines the role of the
7 9 department of human services as the lead agency for the
7 10 children's system and designates the division of mental health
7 11 and disability services to fulfill various responsibilities
7 12 relating to the system.
7 13 New Code section 252C.54 outlines requirements for the
7 14 initial implementation of the system in FY 2008=2009 using
7 15 competitive block grants through existing community mental
7 16 health centers and other local service providers, requiring
7 17 the department to analyze options for leveraging additional
7 18 Medicaid options, and engaging local school, child welfare,
7 19 juvenile justice, mental health, and health care
7 20 professionals. Certain services, such as school=based mental
7 21 health services and the development of mental health
7 22 assessment capacity based in public schools and clinical
7 23 settings, are required to be supported through the block
7 24 grants. The services supported may also include other
7 25 services such as mobile crisis intervention services and
7 26 prevention=oriented services.
7 27 The division is required to regularly report on the status
7 28 of the implementation to the mental health, mental
7 29 retardation, developmental disabilities, and brain injury
7 30 commission, governor, and general assembly, including an
7 31 annual report each January.
7 32 The bill includes authority for the commission to adopt
7 33 administrative rules to implement the bill using emergency
7 34 provisions that forgo public comment periods but maintain a
7 35 final review by the administrative rules review committee
8 1 prior to adoption of the rules.
8 2 LSB 5355DP 82
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