SF 2252 (LSB 5837XS (8) 87)

SENATE FILE 2252

BY  EDLER

A BILL FOR

An Act relating to mental health and disability services and funding.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 135G.6, Code 2018, is amended by striking the section and inserting in lieu thereof the following:
   135G.6  Inspection —— conditions for issuance.
   The department shall issue a license to an applicant under this chapter if the department has ascertained that the applicant’s facilities and staff are adequate to provide the care and services required of a subacute care facility.
    Sec. 2.  Section 331.391, subsection 4, Code 2018, is amended by striking the subsection and inserting in lieu thereof the following:
   4.  For the fiscal years beginning on or after July 1, 2018, if a region is meeting the financial obligations for implementation of its regional service system management plan for a fiscal year and residual funding is anticipated, the regional administrator shall reserve an adequate amount for cash flow of expenditure obligations in the next fiscal year. The cash flow amount shall not exceed thirty percent of the gross expenditures budgeted for the combined account or for all regional accounts for the fiscal year in progress. Residual funding remaining after the cash flow amount is reserved shall be used to expand the region’s core services under section 331.397, subsections 4 and 5, and then to make additional core service domains available in the region as enumerated in section 331.397, subsection 7.
    Sec. 3.  Section 331.393, subsection 3, Code 2018, is amended to read as follows:
   3.  a.  Each region shall submit an annual report to the department on or before December 1. The annual report shall provide information on the actual numbers of persons served, moneys expended, and outcomes achieved.
   b.  Each region shall submit a quarterly report to the department. Each quarterly report shall provide information on the accessibility of intensive mental health services described in section 331.397, subsection 5, and the progress the region has made in meeting the region’s milestones for compliance with such service requirements, using forms and procedures established by the department. If a region fails to meet the milestones in the region’s plan for compliance with access requirements for intensive mental health services described in section 331.397, subsection 5, the department shall require the region to submit a plan of correction to the department to address deficiencies in the region’s plan. The department shall ensure the region’s plan of correction addresses deficiencies in the region’s plan. The department shall combine and analyze the quarterly reports and make the results of the reports public within thirty days of receipt of all reports on a quarterly basis.
    Sec. 4.  Section 331.397, Code 2018, is amended to read as follows:
   331.397  Regional core services.
   1.  For the purposes of this section, unless the context otherwise requires, “domain” means a set of similar services that can be provided depending upon a person’s service needs.
   2.  a.  (1)  A region shall work with service providers to ensure that services in the required core service domains in subsections 4 and 5 are available to residents of the region, regardless of potential payment source for the services.
   (2)  Subject to the available appropriations, the director of human services shall ensure the initial core service domains listed in subsection subsections 4 and 5 are covered services for the medical assistance program under chapter 249A to the greatest extent allowable under federal regulations.  The medical assistance program shall reimburse Medicaid enrolled providers for Medicaid covered services under subsections 4 and 5 when the services are medically necessary, no other third-party payer is responsible for reimbursement of such services, and the Medicaid enrolled provider submits an appropriate claim for such services. Within funds available, the region shall pay for such services for eligible persons when payment through the medical assistance program or another third-party payment is not available, unless the person is on a waiting list for such payment or it has been determined that the person does not meet the eligibility criteria for any such service.
   b.  Until funding is designated for other service populations, eligibility for the service domains listed in this section shall be limited to such persons who are in need of mental health or intellectual disability services. However, if a county in a region was providing services to an eligibility class of persons with a developmental disability other than intellectual disability or a brain injury prior to formation of the region, the class of persons shall remain eligible for the services provided when the region is was formed, provided that funds are available to continue such services without limiting or reducing core services.
   c.  It is the intent of the general assembly to address the need for funding so that the availability of the service domains listed in this section may be expanded to include such persons who are in need of developmental disability or brain injury services.
   3.  Pursuant to recommendations made by the director of human services, the state commission shall adopt rules as required by section 225C.6 to define the services included in the initial and additional core service domains listed in this section. The rules shall provide service definitions, service provider standards, service access standards, and service implementation dates, and shall provide consistency, to the extent possible, with similar service definitions under the medical assistance program.
   a.  The rules relating to the credentialing of a person directly providing services shall require all of the following:
   a.  (1)  The person shall provide services and represent the person as competent only within the boundaries of the person’s education, training, license, certification, consultation received, supervised experience, or other relevant professional experience.
   b.  (2)  The person shall provide services in substantive areas or use intervention techniques or approaches that are new only after engaging in appropriate study, training, consultation, and supervision from a person who is competent in those areas, techniques, or approaches.
   c.  (3)  If generally recognized standards do not exist with respect to an emerging area of practice, the person shall exercise careful judgment and take responsible steps, including obtaining appropriate education, research, training, consultation, and supervision, in order to ensure competence and to protect from harm the persons receiving the services in the emerging area of practice.
   b.  The rules relating to the availability of services shall provide for all of the following:
   (1)  Twenty-two assertive community treatment teams.
   (2)  Six access centers.
   (3)  Intensive residential service homes that provide services to up to one hundred twenty persons statewide.
   4.  The initial core service domains shall include the following:
   a.  Treatment designed to ameliorate a person’s condition, including but not limited to all of the following: 
   (1)  Assessment and evaluation.
   (2)  Mental health outpatient therapy.
   (3)  Medication prescribing and management.
   (4)  Mental health inpatient treatment.
   b.  Basic crisis response provisions, including but not limited to all of the following:
   (1)  Twenty-four-hour access to crisis response.
   (2)  Evaluation.
   (3)  Personal emergency response system.
   c.  Support for community living, including but not limited to all of the following:
   (1)  Home health aide.
   (2)  Home and vehicle modifications.
   (3)  Respite.
   (4)  Supportive community living.
   d.  Support for employment or for activities leading to employment providing an appropriate match with an individual’s abilities based upon informed, person-centered choices made from an array of options, including but not limited to all of the following:
   (1)  Day habilitation.
   (2)  Job development.
   (3)  Supported employment.
   (4)  Prevocational services.
   e.  Recovery services, including but not limited to all of the following:
   (1)  Family support.
   (2)  Peer support. 
   f.  Service coordination including coordinating physical health and primary care, including but not limited to all of the following:
   (1)  Case management.
   (2)  Health homes.
   5.  a.  To the extent federal matching funds are available under the Iowa health and wellness plan pursuant to chapter 249N, the following intensive mental health core services shall be provided in strategic locations throughout the state no later than July 1, 2021, within the following core service domains:
   (1)  Access centers that are located in crisis residential and subacute residential settings with sixteen beds or fewer that provide immediate, short-term assessments for persons with serious mental illness or substance use disorders who do not need inpatient psychiatric hospital treatment, but who do need significant amounts of supports and services not available in the persons’ homes or communities.
   (2)  Assertive community treatment services.
   (3)  Comprehensive facility and community-based crisis services, including all of the following:
   (a)  A single statewide twenty-four-hour crisis hotline.
   (b)  A mobile response.
   (c)  Twenty-three-hour crisis observation and holding.
   (d)  Crisis stabilization community-based services.
   (e)  Crisis stabilization residential services.
   (f)  Warmline services.
   (4)  Subacute services provided in facility and community-based settings.
   (5)  Intensive residential service homes for persons with severe and persistent mental illness in scattered site community-based residential settings.
   b.  The department shall accept arrangements between multiple regions sharing intensive mental health services under this subsection when determining compliance to access standards for such services.
   5.  6.  A region shall ensure that access is available to providers of core services that demonstrate competencies necessary for all of the following:
   a.  Serving persons with co-occurring conditions. 
   b.  Providing evidence-based services. 
   c.  Providing trauma-informed care that recognizes the presence of trauma symptoms in persons receiving services. 
   6.  7.  A region shall ensure that services within the following additional core service domains are available to persons not eligible for the medical assistance program under chapter 249A or receiving other third-party payment for the services, when public funds are made available for such services:
   a.  Comprehensive facility and community-based crisis services, including but not limited to all of the following:
   (1)  Twenty-four-hour crisis hotline.
   (2)  Mobile response.
   (3)  Twenty-three-hour crisis observation and holding, and crisis stabilization facility and community-based services.
   (4)  Crisis residential services.
   b.  Subacute services provided in facility and community-based settings.
   c.  a.  Justice system-involved services, including but not limited to all of the following:
   (1)  Jail diversion.
   (2)  Crisis intervention training.
   (3)  Civil commitment prescreening.
   d.  b.  Advances in the use of evidence-based treatment, including but not limited to all of the following:
   (1)  Positive behavior support. 
   (2)  Assertive community treatment.
   (3)  (2)  Peer self-help drop-in centers.
   7.  8.  A regional service system may provide funding for other appropriate services or other support and may implement demonstration projects for an initial period of up to three years to model the use of research-based practices. In considering whether to provide such funding, a region may consider the following criteria for research-based practices:
   a.  Applying a person-centered planning process to identify the need for the services or other support.
   b.  The efficacy of the services or other support is recognized as an evidence-based practice, is deemed to be an emerging and promising practice, or providing the services is part of a demonstration and will supply evidence as to the services’ effectiveness.
   c.  A determination that the services or other support provides an effective alternative to existing services that have been shown by the evidence base to be ineffective, to not yield the desired outcome, or to not support the principles outlined in Olmstead v. L.C., 527 U.S. 581 (1999). 
    Sec. 5.  Section 331.424A, subsection 1, paragraph b, Code 2018, is amended by striking the paragraph.
    Sec. 6.  Section 331.424A, subsection 4, Code 2018, is amended by striking the subsection and inserting in lieu thereof the following:
   4.  An amount of unobligated and unencumbered funds, as specified in the regional governance agreement entered into by the county under section 331.392, shall be reserved in the county services fund to address cash flow obligations.
    Sec. 7.  Section 331.424A, subsection 9, Code 2018, is amended to read as follows:
   9.  a.  For the fiscal year beginning July 1, 2017, and each subsequent fiscal year, the county budgeted amount determined for each county shall be the amount necessary to meet the county’s financial obligations for the payment of services provided under the regional service system management plan approved pursuant to section 331.393, not to exceed an amount equal to the product of the regional per capita expenditure target amount multiplied by the county’s population, and, for fiscal years beginning on or after July 1, 2021, reduced by the amount of the county’s cash flow reduction amount for the fiscal year calculated under subsection 4, if applicable.
   b.  If a county officially joins a different region, the county’s budgeted amount shall be the amount necessary to meet the county’s financial obligations for payment of services provided under the new region’s regional service system management plan approved pursuant to section 331.393, not to exceed an amount equal to the product of the new region’s regional per capita expenditure target amount multiplied by the county’s population.
    Sec. 8.  MENTAL HEALTH AND DISABILITY SERVICES REGIONS —— FY 2018 ANNUAL REPORTS.  Each mental health and disability services region’s annual report due to the department of human services on or before December 1, 2018, pursuant to section 331.393, subsection 3, paragraph “a”, shall include a plan that identifies milestones for meeting intensive mental health service requirements described in section 331.397, subsection 5, no later than July 1, 2021. The plan shall, at a minimum, include information relating to processes, implementation time frames, plans for collaboration with other regions and the Medicaid program, and the region’s associated budget plan.
    Sec. 9.  EMERGENCY RULES.  If specifically authorized by a provision of this Act, the department of human services or the mental health and disability services commission may adopt administrative rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement provisions of this Act and the rules shall become effective immediately upon filing or on a later effective date specified in the rules, unless the effective date of the rules is delayed or the applicability of the rules is suspended by the administrative rules review committee. Any rules adopted in accordance with this section shall not take effect before the rules are reviewed by the administrative rules review committee. The delay authority provided to the administrative rules review committee under section 17A.4, subsection 7, and section 17A.8, subsection 9, shall be applicable to a delay imposed under this section, notwithstanding a provision in those sections making them inapplicable to section 17A.5, subsection 2, paragraph “b”. Any rules adopted in accordance with the provisions of this section shall also be published as a notice of intended action as provided in section 17A.4.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to mental health and disability services and funding.
   Under current law, the department of inspections and appeals is required to issue a license to an applicant for a subacute mental health care facility if the department of inspections and appeals has ascertained that the applicant’s facilities and staff are adequate to provide the care and services required of a subacute care facility. The bill strikes additional conditions for licensure requiring the department of human services to submit written approval of the application based upon the process used by the department of human services to identify the best qualified providers, prohibiting the department of human services from approving an application which would cause the number of publicly funded subacute care facility beds to exceed 75 beds, and requiring that the subacute care facility beds identified be new beds located in hospitals and facilities licensed as a subacute care facility under Code chapter 135G.
   Under current law, each mental health and disability services region is required to submit an annual report to the department of human services on or before December 1. The annual report is required to provide information on the actual numbers of persons served, moneys expended, and outcomes achieved. 
   The bill provides each region shall additionally submit a quarterly report to the department. Each quarterly report shall provide information on the accessibility of intensive mental health services and the progress the region has made in meeting the region’s milestones for compliance with such service requirements using forms and procedures established by the department. If a region fails to meet the milestones in the region’s plan for compliance with such access requirements, the department shall require the region to submit a plan of correction to the department to address deficiencies in the region’s plan. The department shall ensure the region’s plan of correction addresses deficiencies in the region’s plan. The department shall combine and analyze the quarterly reports and make the results of the reports public within 30 days of receipt of all reports on a quarterly basis.
   Under current law, subject to available appropriations, the director of human services shall ensure that a mental health and disability services region’s core service domains are covered services for the medical assistance program under Code chapter 249A to the greatest extent allowable under federal regulations. The bill provides the medical assistance program shall reimburse Medicaid enrolled providers for Medicaid covered core services when the services are medically necessary, and the Medicaid enrolled provider submits an appropriate claim for such services. No other third-party payer is responsible for reimbursement of such services.
   The bill provides that the administrative rules of the state mental health and disability services commission relating to the availability of mental health and disability services shall, in addition to other mental health and disability service requirements, provide for 22 assertive community treatment teams, six access centers, and intensive residential service homes that serve up to 120 persons statewide.
   The bill provides that, to the extent matching federal funding is available under the Iowa health and wellness plan, intensive mental health core services shall be provided in strategic locations throughout the state on or before July 1, 2021, within certain core service domains including access centers that are located in crisis residential and subacute residential settings, assertive community treatment services, comprehensive facility and community-based crisis services, subacute services, and intensive residential service homes. The bill provides the department of human services shall accept arrangements between multiple regions sharing intensive mental health services when determining compliance with access standards for such services.
   Current Code section 331.391 establishes requirements related to the permissible amount of cash flow for each mental health and disability services region. For fiscal years beginning July 1, 2017, July 1, 2018, and July 1, 2019, that portion of each region’s cash flow amount that exceeds 25 percent of the gross expenditures from the region’s combined account or from all separate county accounts under the control of the governing board in the fiscal year preceding the fiscal year in progress are required to be used in whole or in part to fund the payment of mental health and disabilities services provided under the regional service system management plan. Current law also imposes similar requirements for the amount of unobligated and unencumbered funds that are reserved in each county’s county services fund to address cash flow obligations in the next fiscal year, imposes annual reporting requirements for region and county cash flow amounts, and imposes, for fiscal years beginning on or after July 1, 2021, either a 20 or 25 percent limitation on each county or region’s cash flow amount based on the region’s population. Current law also requires that for fiscal years beginning on or after July 1, 2021, of a county’s cash flow amount maintained in the county services fund or of the region’s cash flow amount attributable to the county, the county budgeted amount, used to limit the amount of property taxes levied by the county, is reduced by the county’s cash flow reduction amount. The cash flow reduction amount is equal to the amount of the county’s cash flow in excess of the permissible percentage limits based on population of the region.
   The bill strikes the requirement for fiscal years beginning July 1, 2017, July 1, 2018, and July 1, 2019, that the portion of each county’s or region’s cash flow amount that exceeds the 25 percent limitation be used in whole or in part to fund the payment of mental health and disability services provided under a region’s regional service system management plan. The bill also strikes the reporting requirements for counties and regions and eliminates the reduction in a county’s budgeted amount due to the county’s cash flow reduction amount for fiscal years beginning on or after July 1, 2021. The bill establishes a limitation on the cash flow amount of a region equal to 30 percent of the gross expenditures budgeted for the fiscal year in progress for the combined account of the region or for all regional accounts and requires residual funding remaining in excess of such limitation to be used to expand the region’s core services and then make additional core services available. The bill also provides that an amount of unobligated or unencumbered funds, as specified in the regional governance agreement, is required to be reserved in each county’s county services fund to address cash flow obligations.
   Under the bill, if a county officially joins a different mental health and disability services region, that county’s budgeted amount shall be the amount necessary to meet the county’s financial obligations for payment of services provided under the new region’s regional service system management plan, not to exceed an amount equal to the product of the new region’s regional per capita expenditure target amount multiplied by the county’s population.
   The bill provides that each mental health and disability services region, in the region’s annual report due to the department of human services on or before December 1, 2018, shall include a plan that identifies milestones for meeting intensive mental health service requirements described in Code section 331.397(5), no later than July 1, 2021. The plan shall, at a minimum, include information relating to processes, implementation time frames, plans for collaboration with other regions and the Medicaid program, and the region’s associated budget plan.
   The bill provides that the department of human services or the mental health and disability services commission may adopt emergency rules to implement the provisions of the bill.