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PAG LIN 1 1 DIVISION I 1 2 MENTAL RETARDATION SERVICE PROVISIONS 1 3 Section 1. Section 222.2, Code 1995, is amended by adding 1 4 the following new subsection: 1 5 NEW SUBSECTION. 3A. "Single entry point process" means 1 6 the same as defined in section 331.440. 1 7 Sec. 2. Section 222.13, subsections 1 through 3, Code 1 8 Supplement 1995, are amended to read as follows: 1 9 1. If an adult person is believed to be a person with 1 10 mental retardation, the adult person or the adult person's 1 11 guardian may request the county board of supervisors or their 1 12 designated agent to apply to the superintendent of any state 1 13 hospital-school for the voluntary admission of the adult 1 14 person either as an inpatient or an outpatient of the 1 15 hospital-school. Submission of an application is subject to a 1 16 recommendation supporting the placement developed through the 1 17 single entry point process. After determining the legal 1 18 settlement of the adult person as provided by this chapter, 1 19 the board of supervisors shall, on forms prescribed by the 1 20 administrator, apply to the superintendent of the hospital- 1 21 school in the district for the admission of the adult person 1 22 to the hospital-school. An application for admission to a 1 23 special unit of any adult person believed to be in need of any 1 24 of the services provided by the special unit under section 1 25 222.88 may be made in the same manner, upon request of the 1 26 adult person or the adult person's guardian. The 1 27 superintendent shall accept the application providing a 1 28 preadmission diagnostic evaluation, performed through the 1 29 single entry point process, confirms or establishes the need 1 30 for admission, except that an application may not be accepted 1 31 if the institution does not have adequate facilities available 1 32 or if the acceptance will result in an overcrowded condition. 1 33 2. If the hospital-school has no appropriate program for 1 34 the treatment of an adult or minor person with mental 1 35 retardation applying under this section or section 222.13A, 2 1 the board of supervisors shall arrange for the placement of 2 2 the person in any public or private facility within or without 2 3 the state, approved by the director of the department of human 2 4 services, which offers appropriate services for the person, as 2 5 determined through the single entry point process. 2 6 3. Upon applying for admission of an adult or minor person 2 7 to a hospital-school, or a special unit, or upon arranging for 2 8 the placement of the person in a public or private facility, 2 9 the board of supervisors shall make a full investigation into 2 10 the financial circumstances of that person and those liable 2 11 for that person's support under section 222.78, to determine 2 12 whether or not any of them are able to pay the expenses 2 13 arising out of the admission of the person to a hospital- 2 14 school,orspecial treatment unit, or public or private 2 15 facility. If the board finds that the person or those legally 2 16 responsible for the person are presently unable to pay the 2 17 expenses,theythe board shall direct that the expenses be 2 18 paid by the county. The board may review its finding at any 2 19 subsequent time while the person remains at the hospital- 2 20 school, or is otherwise receiving care or treatment for which 2 21 this chapter obligates the county to pay. If the board finds 2 22 upon review that the person or those legally responsible for 2 23 the person are presently able to pay the expenses, the finding 2 24 shall apply only to the charges incurred during the period 2 25 beginning on the date of the review and continuing thereafter, 2 26 unless and until the board again changes its finding. If the 2 27 board finds that the person or those legally responsible for 2 28 the person are able to pay the expenses,theythe board shall 2 29 direct that the charges be so paid to the extent required by 2 30 section 222.78, and the county auditor shall be responsible 2 31 for the collection of the charges. 2 32 Sec. 3. Section 222.13A, subsection 2, Code Supplement 2 33 1995, is amended to read as follows: 2 34 2. Upon receipt of an application for voluntary admission 2 35 of a minor, the board of supervisors shall provide for a 3 1 preadmission diagnostic evaluation of the minor to confirm or 3 2 establish the need for the admission. The preadmission 3 3 diagnostic evaluation shall be performed by a person who meets 3 4 the qualifications of a qualified mental retardation 3 5 professional who is designated through the single entry point 3 6 process. 3 7 Sec. 4. Section 222.28, Code 1995, is amended to read as 3 8 follows: 3 9 222.28 COMMISSION TO EXAMINE. 3 10 The court may, at or prior to the final hearing, appoint a 3 11 commission of one qualified physician and one qualified 3 12 psychologist, designated through the single entry point 3 13 process, who shall make a personal examination of the person 3 14 alleged to be mentally retarded for the purpose of determining 3 15 the mental condition of the person. 3 16 Sec. 5. Section 222.59, subsection 1, unnumbered paragraph 3 17 1, Code Supplement 1995, is amended to read as follows: 3 18 Upon receiving a request from an authorized requester, the 3 19 superintendent of a state hospital-school shallassist3 20 coordinate with the single entry point process in assisting 3 21 the requester in identifying available community-based 3 22 services as an alternative to continued placement of a patient 3 23 in the state hospital-school. For the purposes of this 3 24 section, "authorized requester" means the parent, guardian, or 3 25 custodian of a minor patient, the guardian of an adult 3 26 patient, or an adult patient who does not have a guardian. 3 27 The assistance shall identify alternatives to continued 3 28 placement which are appropriate to the patient's needs and 3 29 shall include but are not limited to any of the following: 3 30 Sec. 6. Section 222.73, subsection 2, Code Supplement 3 31 1995, is amended by adding the following new paragraph: 3 32 NEW PARAGRAPH. f. A county shall not be billed for the 3 33 cost of a patient unless the patient's admission is authorized 3 34 through the applicable single entry point process. The state 3 35 hospital-school and the county shall work together to locate 4 1 appropriate alternative placements and services, and to 4 2 educate patients and the family members of patients regarding 4 3 such alternatives. 4 4 Sec. 7. Section 222.73, subsection 2, unnumbered paragraph 4 5 2, Code Supplement 1995, is amended to read as follows: 4 6 The per diem costs billed to each county shall not exceed 4 7 the per diem costsin effect on July 1, 1988billed to the 4 8 county in the fiscal year beginning July 1, 1996. However, 4 9 the per diem costs billed to a county may be adjustedannually4 10 in a fiscal year to reflect increased costs to the extent of 4 11 theadjustment in the consumer price index published annually4 12in the federal register by the federal department of labor,4 13bureau of labor statisticspercentage increase in the total of 4 14 county fixed budgets pursuant to the allowed growth factor 4 15 adjustment authorized by the general assembly for that fiscal 4 16 year in accordance with section 331.439. 4 17 Sec. 8. EFFECTIVE DATE. Section 222.73, subsection 2, 4 18 unnumbered paragraph 2, Code Supplement 1995, as amended by 4 19 this division of this Act, takes effect July 1, 1997. 4 20 DIVISION II 4 21 MENTAL HEALTH SERVICE PROVISIONS 4 22 Sec. 9. Section 225.11, Code 1995, is amended to read as 4 23 follows: 4 24 225.11 INITIATING COMMITMENT PROCEDURES. 4 25 When a court finds upon completion of a hearing held 4 26 pursuant to section 229.12 that the contention that a 4 27 respondent is seriously mentally impaired has been sustained 4 28 by clear and convincing evidence, and the application filed 4 29 under section 229.6 also contends or the court otherwise 4 30 concludes that it would be appropriate to refer the respondent 4 31 to the state psychiatric hospital for a complete psychiatric 4 32 evaluation and appropriate treatment pursuant to section 4 33 229.13, the judge may order that a financial investigation be 4 34 made in the manner prescribed by section 225.13. If the costs 4 35 of a respondent's evaluation or treatment are payable in whole 5 1 or in part by a county, an order under this section shall be 5 2 for referral of the respondent through the single entry point 5 3 process for an evaluation and referral of the respondent to an 5 4 appropriate placement or service, which may include the state 5 5 psychiatric hospital for additional evaluation or treatment. 5 6 For purposes of this chapter, "single entry point process" 5 7 means the same as defined in section 331.440. 5 8 Sec. 10. Section 225.15, Code 1995, is amended to read as 5 9 follows: 5 10 225.15 EXAMINATION AND TREATMENT. 5 11 Whenthea respondent arrives at the state psychiatric 5 12 hospital,it shall be the duty ofthe admitting physicianto5 13 shall examine the respondent and determine whether or not, in 5 14 the physician's judgment, thepatientrespondent is a fit 5 15 subject forsuchobservation, treatment, and hospital care. 5 16 If, upon examination, the physician decides thatsuch patient5 17 the respondent should be admitted to the hospital, thepatient5 18 respondent shall be provided a proper bed in the hospital; and 5 19 the physician whoshall havehas charge of thepatient5 20 respondent shall proceed withsuchobservation, medical 5 21 treatment, and hospital care as in the physician's judgment 5 22 are proper and necessary, in compliance with sections 229.13 5 23 to 229.16. 5 24 A proper and competent nurse shall also be assigned to look 5 25 after and care forsuch patientthe respondent duringsuch5 26 observation, treatment, and careas aforesaid. Observation, 5 27 treatment, and hospital care under this section which are 5 28 payable in whole or in part by a county shall only be provided 5 29 as determined through the single entry point process. 5 30 Sec. 11. Section 225.17, Code 1995, is amended to read as 5 31 follows: 5 32 225.17 COMMITTED PRIVATE PATIENT – TREATMENT. 5 33 If the judge of the district court, finds upon the review 5 34 and determination made under the provisions of section 225.14 5 35 that the respondent is an appropriate subject for placement at 6 1 the state psychiatric hospital, and that the respondent, or 6 2 those legally responsible for the respondent, are able to pay 6 3 the expensesthereofassociated with the placement, the judge 6 4 shall enter an order directing that the respondent shall be 6 5 sent to the state psychiatric hospital at the state University 6 6 of Iowa for observation, treatment, and hospital care as a 6 7 committed private patient. 6 8 When the respondent arrives at thesaidhospital, the 6 9 respondent shall receive the same treatment as is provided for 6 10 committed public patients in section 225.15, in compliance 6 11 with sections 229.13 to 229.16. However, observation, 6 12 treatment, and hospital care under this section of a 6 13 respondent whose expenses are payable in whole or in part by a 6 14 county shall only be provided as determined through the single 6 15 entry point process. 6 16 Sec. 12. Section 225C.2, Code 1995, is amended by adding 6 17 the following new subsection: 6 18 NEW SUBSECTION. 8. "Single entry point process" means the 6 19 same as defined in section 331.440. 6 20 Sec. 13. Section 225C.12, Code 1995, is amended to read as 6 21 follows: 6 22 225C.12 PARTIAL REIMBURSEMENT TO COUNTIES FOR LOCAL 6 23 INPATIENT MENTAL HEALTH CARE AND TREATMENT. 6 24 1. A county which pays, from county funds budgeted under 6 25 section331.424, subsection 1, paragraphs "d" and "g"6 26 331.424A, the cost of care and treatment of amentally ill6 27 person with mental illness who is admitted pursuant to a 6 28 preliminary diagnostic evaluation under sections 225C.14 to 6 29 225C.17 for treatment as an inpatient of a hospital facility, 6 30 other than a state mental health institute, which has a 6 31 designated mental health program and is a hospital accredited 6 32 by the accreditation program for hospital facilities of the 6 33 joint commission on accreditation ofhospitalshealth 6 34 organizations, is entitled to reimbursement from the state for 6 35 a portion of the daily cost so incurred by the county. 7 1 However, a county is not entitled to reimbursement for a cost 7 2 incurred in connection with the hospitalization of a person 7 3 who is eligible for medical assistance under chapter 249A, or 7 4 who is entitled to have care or treatment paid for by any 7 5 other third party payor, or who is admitted for preliminary 7 6 diagnostic evaluation under sections 225C.14 to 225C.17. The 7 7 amount of reimbursement for the cost of treatment of a local 7 8 inpatient to which a county is entitled, on a per-patient-per- 7 9 day basis, is an amount equal to twenty percent of the average 7 10 of the state mental health institutes' individual average 7 11 daily patient costs in the most recent calendar quarter for 7 12 the program in which the local inpatient would have been 7 13 served if the patient had been admitted to a state mental 7 14 health institute. 7 15 2. A county may claim reimbursement by filing with the 7 16 administrator a claim in a form prescribed by the 7 17 administrator by rule. Claims may be filed on a quarterly 7 18 basis, and when received shall be verified as soon as 7 19 reasonably possible by the administrator. The administrator 7 20 shall certify to the director of revenue and finance the 7 21 amount to which each county claiming reimbursement is 7 22 entitled, and the director of revenue and finance shall issue 7 23 warrants to the respective counties drawn upon funds 7 24 appropriated by the general assembly for the purpose of this 7 25 section. A county shall place funds received under this 7 26 section in the county mental healthand institutions, mental 7 27 retardation, and developmental disabilities services fund 7 28 created under section 331.424A. If the appropriation for a 7 29 fiscal year is insufficient to pay all claims arising under 7 30 this section, the director of revenue and finance shall 7 31 prorate the funds appropriated for that year among the 7 32 claimant counties so that an equal proportion of each county's 7 33 claim is paid in each quarter for which proration is 7 34 necessary. 7 35 Sec. 14. Section 225C.14, subsection 1, Code 1995, is 8 1 amended to read as follows: 8 2 1. Except in cases of medical emergency, a person shall be 8 3 admitted to a state mental health institute as an inpatient 8 4 only after a preliminary diagnostic evaluationby a community8 5mental health center or by an alternative diagnostic facility8 6 performed through the single entry point process has confirmed 8 7 that the admission is appropriate to the person's mental 8 8 health needs, and that no suitable alternative method of 8 9 providing the needed services in a less restrictive setting or 8 10 in or nearer to the person's home community is currently 8 11 available. If provided for through the single entry point 8 12 process, the evaluation may be performed by a community mental 8 13 health center or by an alternative diagnostic facility. The 8 14 policy established by this section shall be implemented in the 8 15 manner and to the extent prescribed by sections 225C.15, 8 16 225C.16 and 225C.17. 8 17 Sec. 15. Section 225C.15, Code 1995, is amended to read as 8 18 follows: 8 19 225C.15 COUNTY IMPLEMENTATION OF EVALUATIONS. 8 20 The board of supervisors of a county shall, no later than 8 21 July 1, 1982, require that the policy stated in section 8 22 225C.14 be followed with respect to admission of persons from 8 23 that county to a state mental health institute. A community 8 24 mental health center which is supported, directly or in 8 25 affiliation with other counties, by that countyshallmay 8 26 perform the preliminary diagnostic evaluations for that 8 27 county, unless the performance of the evaluations is not 8 28 covered by the agreement entered into by the county and the 8 29 center under section 230A.12, and the center's director 8 30 certifies to the board of supervisors that the center does not 8 31 have the capacity to perform the evaluations, in which case 8 32 the board of supervisors shall proceed under section 225C.17. 8 33 Sec. 16. Section 225C.16, Code 1995, is amended to read as 8 34 follows: 8 35 225C.16 REFERRALS FOR EVALUATION. 9 1 1. The chief medical officer of a state mental health 9 2 institute, or that officer's physician designee, shall advise 9 3 a person residing in that county who applies for voluntary 9 4 admission, or a person applying for the voluntary admission of 9 5 another person who resides in that county, in accordance with 9 6 section 229.41, that the board of supervisors has implemented 9 7 the policy stated in section 225C.14, and shall advise that a 9 8 preliminary diagnostic evaluation of the prospective patient 9 9 be soughtfrom the appropriate community mental health center9 10or alternative diagnostic facility, if that has not already 9 11 been done. This subsection does not apply when voluntary 9 12 admission is sought in accordance with section 229.41 under 9 13 circumstances which, in the opinion of the chief medical 9 14 officer or that officer's physician designee, constitute a 9 15 medical emergency. 9 16 2. The clerk of the district court in that county shall 9 17 refer a person applying for authorization for voluntary 9 18 admission, or for authorization for voluntary admission of 9 19 another person, in accordance with section 229.42, to the 9 20 appropriatecommunity mental health center or alternative9 21diagnostic facilityentity designated through the single entry 9 22 point process under section 225C.14 for the preliminary 9 23 diagnostic evaluation unless the applicant furnishes a written 9 24 statement fromthat center or facilitythe appropriate entity 9 25 which indicates that the evaluation has been performed and 9 26 that the person's admission to a state mental health institute 9 27 is appropriate. This subsection does not apply when 9 28 authorization for voluntary admission is sought under 9 29 circumstances which, in the opinion of the chief medical 9 30 officer or that officer's physician designee, constitute a 9 31 medical emergency. 9 32 3. Judges of the district court in that county or the 9 33 judicial hospitalization referee appointed for that county 9 34 shall so far as possible arrange fora physician on the staff9 35of or designated by the appropriate community mental health10 1center or alternative diagnostic facilitythe entity 10 2 designated through the single entry point process under 10 3 section 225C.14 to perform a prehearing examination of a 10 4 respondent required under section 229.8, subsection 3, 10 5 paragraph "b". 10 6 4. The chief medical officer of a state mental health 10 7 institute shall promptly submit to the appropriatecommunity10 8mental health center or alternative diagnostic facilityentity 10 9 designated through the single entry point process under 10 10 section 225C.14 a report of the voluntary admission of a 10 11 patient under the medical emergency clauses of subsections 1 10 12 and 2. The report shall explain the nature of the emergency 10 13 which necessitated the admission of the patient without a 10 14 preliminary diagnostic evaluation by thecenter or alternative10 15facilitydesignated entity. 10 16 Sec. 17. Section 227.10, Code 1995, is amended to read as 10 17 follows: 10 18 227.10 TRANSFERS FROM COUNTY OR PRIVATE INSTITUTIONS. 10 19 Patients who have been admitted at public expense to any 10 20 institution to which this chapter is applicable may be 10 21 involuntarily transferred to the proper state hospital for the 10 22 mentally ill in the manner prescribed by sections 229.6 to 10 23 229.13. The application required by section 229.6 may be 10 24 filed by the administrator of the division or the 10 25 administrator's designee, or by the administrator of the 10 26 institution where the patient is then being maintained or 10 27 treated. If the patient was admitted to that institution 10 28 involuntarily, the administrator of the division may arrange 10 29 and complete the transfer, and shall report it as required of 10 30 a chief medical officer under section 229.15, subsection 4. 10 31 The transfer shall be made at county expense, and the expense 10 32 recovered, as provided in section 227.7. However, transfer 10 33 under this section of a patient whose expenses are payable in 10 34 whole or in part by a county is subject to an authorization 10 35 for the transfer through the single entry point process. 11 1 Sec. 18. Section 229.1, Code Supplement 1995, is amended 11 2 by adding the following new subsection: 11 3 NEW SUBSECTION. 15. "Single entry point process" means 11 4 the same as defined in section 331.440. 11 5 Sec. 19. NEW SECTION. 229.1B SINGLE ENTRY POINT PROCESS. 11 6 Notwithstanding any provision of this chapter to the 11 7 contrary, any person whose hospitalization expenses are 11 8 payable in whole or in part by a county shall be subject to 11 9 all requirements of the single entry point process. 11 10 Sec. 20. Section 229.11, unnumbered paragraph 1, Code 11 11 1995, is amended to read as follows: 11 12 If the applicant requests that the respondent be taken into 11 13 immediate custody and the judge, upon reviewing the 11 14 application and accompanying documentation, finds probable 11 15 cause to believe that the respondentis seriously mentally11 16impairedhas a serious mental impairment and is likely to 11 17 injure the respondent or other persons if allowed to remain at 11 18 liberty, the judge may enter a written order directing that 11 19 the respondent be taken into immediate custody by the sheriff 11 20 or the sheriff's deputy and be detained until the 11 21 hospitalization hearing, which. The hospitalization hearing 11 22 shall be held no more than five days after the date of the 11 23 order, except that if the fifth day after the date of the 11 24 order is a Saturday, Sunday, or a holiday, the hearing may be 11 25 held on the next succeeding business day. If the expenses of 11 26 a respondent are payable in whole or in part by a county, for 11 27 a placement in accordance with subsection 1, the judge shall 11 28 give notice of the placement to the single entry point process 11 29 and for a placement in accordance with subsection 2 or 3, the 11 30 judge shall order the placement in a hospital or facility 11 31 designated through the single entry point process. The judge 11 32 may order the respondent detained for the period of time until 11 33 the hearing is held, and no longer, in accordance with 11 34 subsection 1 if possible, and if not then in accordance with 11 35 subsection 2 or, only if neither of these alternatives are 12 1 available, in accordance with subsection 3. Detention may be: 12 2 Sec. 21. Section 229.13, unnumbered paragraph 1, Code 12 3 1995, is amended to read as follows: 12 4 If upon completion of the hearing the court finds that the 12 5 contention that the respondentis seriously mentally impaired12 6has beenhas a serious mental impairment is sustained by clear 12 7 and convincing evidence,itthe court shall orderthea 12 8 respondentplaced inwhose expenses are payable in whole or in 12 9 part by a county committed to the care of a hospital or 12 10 facility designated through the single entry point process, 12 11 and shall order any other respondent committed to the care of 12 12 a hospital or a facility licensed to care for persons with 12 13 mental illness or substance abuse or under the care of a 12 14 facility that is licensed to care for persons with mental 12 15 illness or substance abuse on an outpatient basis as 12 16 expeditiously as possible for a complete psychiatric 12 17 evaluation and appropriate treatment. If the respondent is 12 18 ordered at the hearing to undergo outpatient treatment, the 12 19 outpatient treatment provider must be notified and agree to 12 20 provide the treatment prior to placement of the respondent 12 21 under the treatment provider's care. The court shall furnish 12 22 to the chief medical officer of the hospital or facility at 12 23 the time the respondent arrives at the hospital or facility a 12 24 written finding of fact setting forth the evidence on which 12 25 the finding is based. If the respondent is ordered to undergo 12 26 outpatient treatment, the order shall also require the 12 27 respondent to cooperate with the treatment provider and comply 12 28 with the course of treatment. 12 29 PARAGRAPH DIVIDED. The chief medical officer of the 12 30 hospital or facility shall report to the court no more than 12 31 fifteen days after the individual is admitted to or placed 12 32 under the care of the hospital or facility, making a 12 33 recommendation for disposition of the matter. An extension of 12 34 time may be granted for not to exceed seven days upon a 12 35 showing of cause. A copy of the report shall be sent to the 13 1 respondent's attorney, who may contest the need for an 13 2 extension of time if one is requested. Extension of time 13 3 shall be granted upon request unless the request is contested, 13 4 in which case the court shall make such inquiry as it deems 13 5 appropriate and may either order the respondent's release from 13 6 the hospital or facility or grant extension of time for 13 7 psychiatric evaluation. If the chief medical officer fails to 13 8 report to the court within fifteen days after the individual 13 9 is admitted to or placed under the care of the hospital or 13 10 facility, and no extension of time has been requested, the 13 11 chief medical officer is guilty of contempt and shall be 13 12 punished under chapter 665. The court shall order a rehearing 13 13 on the application to determine whether the respondent should 13 14 continue to be held at or placed under the care of the 13 15 facility. 13 16 Sec. 22. Section 229.24, subsection 3, unnumbered 13 17 paragraph 1, Code Supplement 1995, is amended to read as 13 18 follows: 13 19 If all or part of the costs associated with hospitalization 13 20 of an individual under this chapter are chargeable to a county 13 21 of legal settlement, the clerk of the district court shall 13 22 provide to the county of legal settlement and to the county in 13 23 which the hospitalization order is enteredshall have access13 24to, in a form prescribed by the council on human services 13 25 pursuant to a recommendation of the state-county management 13 26 committee established in section 331.438, the following 13 27 information pertaining to the individual which would be 13 28 confidential under subsection 1: 13 29 Sec. 23. Section 229.42, unnumbered paragraph 1, Code 13 30 1995, is amended to read as follows: 13 31 If a person wishing to make application for voluntary 13 32 admission to a mental hospital established by chapter 226 is 13 33 unable to pay the costs of hospitalization or those 13 34 responsible forsuchthe person are unable to paysuchthe 13 35 costs, application for authorization of voluntary admission 14 1 must be made to any clerk of the district court before 14 2 application for admission is made to the hospital.After14 3determiningThe clerk shall determine the person's county of 14 4 legal settlement and if the admission is approved through the 14 5 single entry point process, thesaidclerk shall, on forms14 6provided by the administrator of the division,authorizesuch14 7 the person's admission to a mental health hospital as a 14 8 voluntary case. The authorization shall be issued on forms 14 9 provided by the administrator. The clerk shall at once 14 10 provide a duplicate copy of the form to thecounty board of14 11supervisorssingle entry point process. The costs of the 14 12 hospitalization shall be paid by the county of legal 14 13 settlement to the director of revenue and finance and credited 14 14 to the general fund of the state, providing the mental health 14 15 hospital rendering the services has certified to the county 14 16 auditor of theresponsiblecounty of legal settlement the 14 17 amount chargeabletheretoto the county and has sent a 14 18 duplicate statement ofsuchthe charges to the director of 14 19 revenue and finance. A county shall not be billed for the 14 20 cost of a patient unless the patient's admission is authorized 14 21 through the single entry point process. The mental health 14 22 institute and the county shall work together to locate 14 23 appropriate alternative placements and services, and to 14 24 educate patients and family members of patients regarding such 14 25 alternatives. 14 26 Sec. 24. Section 230.1, Code 1995, is amended by adding 14 27 the following new unnumbered paragraph: 14 28 NEW UNNUMBERED PARAGRAPH. A county of legal settlement is 14 29 not liable for costs and expenses associated with a person 14 30 with mental illness unless the costs and expenses are for 14 31 services and other support authorized for the person through 14 32 the single entry point process. For the purposes of this 14 33 chapter, "single entry point process" means the same as 14 34 defined in section 331.440. 14 35 Sec. 25. Section 230.20, subsection 2, Code Supplement 15 1 1995, is amended to read as follows: 15 2 2. a. The superintendent shall certify to the director of 15 3 revenue and finance the billings to each county for services 15 4 provided to patients chargeable to the county during the 15 5 preceding calendar quarter. The county billings shall be 15 6 based on the average daily patient charge and other service 15 7 charges computed pursuant to subsection 1, and the number of 15 8 inpatient days and other service units chargeable to the 15 9 county. However, a county billing shall be decreased by an 15 10 amount equal to reimbursement by a third party payor or 15 11 estimation of such reimbursement from a claim submitted by the 15 12 superintendent to the third party payor for the preceding 15 13 calendar quarter. When the actual third party payor 15 14 reimbursement is greater or less than estimated, the 15 15 difference shall be reflected in the county billing in the 15 16 calendar quarter the actual third party payor reimbursement is 15 17 determined. 15 18 b. The per diem costs billed to each county shall not 15 19 exceed the per diem costsin effect on July 1, 1988billed to 15 20 the county in the fiscal year beginning July 1, 1996. 15 21 However, the per diem costs billed to a county may be adjusted 15 22 annually to reflect increased costs to the extent of the 15 23adjustment in the consumer price index published annually in15 24the federal register by the federal department of labor,15 25bureau of labor statisticspercentage increase in the total of 15 26 county fixed budgets pursuant to the allowed growth factor 15 27 adjustment authorized by the general assembly for the fiscal 15 28 year in accordance with section 331.439. 15 29 Sec. 26. EFFECTIVE DATE. Section 230.20, subsection 2, 15 30 paragraph "b", Code Supplement 1995, as amended by this 15 31 division of this Act, takes effect July 1, 1997. 15 32 DIVISION III 15 33 SERVICE REGULATION, INFORMATION, PLANNING, AND PAYMENT 15 34 PROVISIONS 15 35 Sec. 27. Section 230A.13, unnumbered paragraph 2, Code 16 1 1995, is amended to read as follows: 16 2 Release of administrative and diagnostic informationwhich16 3would identify, as defined in section 228.1, subsections 1 and 16 4 3, and demographic information necessary for aggregated 16 5 reporting to meet the data requirements established by the 16 6 department of human services, division of mental health and 16 7 developmental disabilities, relating to an individual whois16 8receiving or has received treatment atreceives services from 16 9 a community mental health centershall notthrough the 16 10 applicable single entry point process, may be made a condition 16 11 of support of that center by any county under this section. 16 12Section 331.504, subsection 8 notwithstanding, a community16 13mental health center shall not be required to file a claim16 14which would in any manner identify such an individual, if the16 15center's budget has been approved by the county board under16 16this section and the center is in compliance with section16 17230A.16, subsection 3.16 18 Sec. 28. Section 235A.15, subsection 2, paragraph c, Code 16 19 Supplement 1995, is amended by adding the following new 16 20 subparagraph: 16 21 NEW SUBPARAGRAPH. (13) To the administrator of an agency 16 22 providing mental health, mental retardation, or developmental 16 23 disability services under a county management plan developed 16 24 pursuant to section 331.439, if the information concerns a 16 25 person employed by or being considered by the agency for 16 26 employment. 16 27 Sec. 29. Section 235B.6, subsection 2, paragraph c, Code 16 28 Supplement 1995, is amended by adding the following new 16 29 subparagraph: 16 30 NEW SUBPARAGRAPH. (6) To the administrator of an agency 16 31 providing mental health, mental retardation, or developmental 16 32 disability services under a county management plan developed 16 33 pursuant to section 331.439, if the information concerns a 16 34 person employed by or being considered by the agency for 16 35 employment. 17 1 Sec. 30. Section 249A.12, subsection 2, Code Supplement 17 2 1995, is amended to read as follows: 17 3 2. A county shall reimburse the department on a monthly 17 4 basis for that portion of the cost of assistance provided 17 5 under this section to a recipient with legal settlement in the 17 6 county, which is not paid from federal funds, if the 17 7 recipient's placement has been approved by the appropriate 17 8 review organization as medically necessary and appropriate. 17 9 The department's goal for the maximum time period for 17 10 submission of a claim to a county is not more than sixty days 17 11 following the submission of the claim by the provider of the 17 12 service to the department. The department's goal for 17 13 completion and crediting of a county for cost settlement for 17 14 the actual costs of a home and community-based waiver service 17 15 is within two hundred seventy days of the close of a fiscal 17 16 year for which cost reports are due from providers. The 17 17 department shall place all reimbursements from counties in the 17 18 appropriation for medical assistance, and may use the 17 19 reimbursed funds in the same manner and for any purpose for 17 20 which the appropriation for medical assistance may be used. 17 21 Sec. 31. Section 249A.12, Code Supplement 1995, is amended 17 22 by adding the following new subsection: 17 23 NEW SUBSECTION. 5. a. The state-county management 17 24 committee shall recommend to the department the actions 17 25 necessary to assist in the transition of individuals being 17 26 served in an intermediate care facility for the mentally 17 27 retarded, who are appropriate for the transition, to services 17 28 funded under a medical assistance waiver for home and 17 29 community-based services for persons with mental retardation 17 30 in a manner which maximizes the use of existing public and 17 31 private facilities. The actions may include but are not 17 32 limited to submitting any of the following or a combination of 17 33 any of the following as a request for a revision of the 17 34 medical assistance waiver for home and community-based 17 35 services for persons with mental retardation in effect as of 18 1 June 30, 1996: 18 2 (1) Allow for the transition of intermediate care 18 3 facilities for the mentally retarded licensed under chapter 18 4 135C as of June 30, 1996, to services funded under the medical 18 5 assistance waiver for home and community-based services for 18 6 persons with mental retardation. The request shall be for 18 7 inclusion of additional persons under the waiver associated 18 8 with the transition. 18 9 (2) Allow for reimbursement under the waiver for day 18 10 program or other service costs. 18 11 (3) Allow for exception provisions in which an 18 12 intermediate care facility for the mentally retarded which 18 13 does not meet size and other facility-related requirements 18 14 under the waiver in effect on June 30, 1996, may convert to a 18 15 waiver service for a set period of time such as five years. 18 16 Following the set period of time, the facility would be 18 17 subject to the waiver requirements applicable to services 18 18 which were not operating under the exception provisions. 18 19 b. In implementing the provisions of this subsection, the 18 20 state-county management committee shall consult with other 18 21 states. The waiver revision request or other action necessary 18 22 to assist in the transition of service provision from 18 23 intermediate care facilities for the mentally retarded to 18 24 alternative programs shall be implemented by the department in 18 25 a manner that can appropriately meet the needs of individuals 18 26 at an overall lower cost to counties, the federal government, 18 27 and the state. In addition, the department shall take into 18 28 consideration significant federal changes to the medical 18 29 assistance program in formulating the department's actions 18 30 under this subsection. The department shall consult with the 18 31 state-county management committee in adopting rules for 18 32 oversight of facilities converted pursuant to this subsection. 18 33 A transition approach described in paragraph "a" may be 18 34 modified as necessary to obtain federal waiver approval. The 18 35 department shall report on or before January 2, 1997, to the 19 1 general assembly regarding its actions under this subsection 19 2 and any federal response, and shall submit an update upon 19 3 receiving a federal response to the waiver request or other 19 4 action taken which requires a federal response. If 19 5 implementation of any of the provisions of this subsection 19 6 does not require a federal waiver, the department shall 19 7 implement the provisions in the fiscal year beginning July 1, 19 8 1996. 19 9 Sec. 32. Section 249A.26, Code 1995, is amended to read as 19 10 follows: 19 11 249A.26 COUNTY PARTICIPATION IN FUNDING FOR SERVICES TO 19 12 PERSONS WITH DISABILITIES. 19 13 1. The state shall pay for one hundred percent of the 19 14 nonfederal share of the services paid for under any prepaid 19 15 mental health services plan for medical assistance implemented 19 16 by the department as authorized by law. 19 17 2. The county of legal settlement shall pay for fifty 19 18 percent of the nonfederal share of the cost of case management 19 19 provided to adults, day treatment, and partial hospitalization 19 20 provided under the medical assistance program for persons with 19 21 mental retardation, a developmental disability, or chronic 19 22 mental illness. For purposes of this section, persons with 19 23 mental disorders resulting from Alzheimer's disease or 19 24 substance abuse shall not be considered chronically mentally 19 25 ill. To the maximum extent allowed under federal law and 19 26 regulations, the department shall consult with and inform a 19 27 county of legal settlement's single entry point process, as 19 28 defined in section 331.440, regarding the necessity for and 19 29 the provision of any service for which the county is required 19 30 to provide reimbursement under this subsection. 19 31 3. To the maximum extent allowed under federal law and 19 32 regulations, a person with mental illness or mental 19 33 retardation shall not be eligible for any service which is 19 34 funded in whole or in part by a county share of the nonfederal 19 35 portion of medical assistance funds unless the person is 20 1 referred through the single entry point process, as defined in 20 2 section 331.440. However, to the extent federal law allows 20 3 referral of a medical assistance recipient to a service 20 4 without approval of the single entry point process, the county 20 5 of legal settlement shall be billed for the nonfederal share 20 6 of costs for any adult person for whom the county would 20 7 otherwise be responsible. 20 8 Sec. 33. Section 331.424A, subsection 2, Code Supplement 20 9 1995, is amended to read as follows: 20 10 2. For the fiscal year beginning July 1, 1996, and 20 11 succeeding fiscal years, county revenues from taxes and other 20 12 sources designated for mental health, mental retardation, and 20 13 developmental disabilities services shall be credited to the 20 14 mental health, mental retardation, and developmental 20 15 disabilities services fund of the county. The board shall 20 16 make appropriations from the fund for payment of services 20 17 provided under the county management plan approved pursuant to 20 18 section 331.439. The county may pay for the services in 20 19 cooperation with other counties by pooling appropriations from 20 20 the fund with other counties or through county regional 20 21 entities including but not limited to the county's mental 20 22 health and developmental disabilities regional planning 20 23 council created pursuant to section 225C.18. 20 24 Sec. 34. Section 331.438, subsection 4, paragraph b, 20 25 unnumbered paragraph 1, Code Supplement 1995, is amended to 20 26 read as follows: 20 27 The management committee shall consist of not more than 20 28eleventwelve voting membersrepresenting the state and20 29countiesas follows: 20 30 Sec. 35. Section 331.438, subsection 4, paragraph b, 20 31 subparagraph (2), Code Supplement 1995, is amended to read as 20 32 follows: 20 33 (2) The committee shall include one member nominated by 20 34 service providers,andone member nominated by service 20 35 advocates and consumers, and one member nominated by the 21 1 state's council of the association of federal, state, county, 21 2 and municipal employees, withboththese members appointed by 21 3 the governor. 21 4 Sec. 36. Section 331.438, subsection 4, paragraph c, 21 5 subparagraph (10), Code Supplement 1995, is amended to read as 21 6 follows: 21 7 (10) Make recommendations to improve the programs and cost 21 8 effectiveness of state and county contracting processes and 21 9 procedures, including strategies for negotiations relating to 21 10 managed care. The recommendations developed for the state and 21 11 county regarding managed care shall include but are not 21 12 limited to standards for limiting excess costs and profits, 21 13 and for restricting cost shifting under a managed care system. 21 14 Sec. 37. Section 331.438, subsection 4, paragraph c, Code 21 15 Supplement 1995, is amended by adding the following new 21 16 subparagraphs: 21 17 NEW SUBPARAGRAPH. (15) Make recommendations to the mental 21 18 health and developmental disabilities commission for 21 19 administrative rules providing statewide standards and a 21 20 monitoring methodology to determine whether cost-effective 21 21 individualized services are available as required pursuant to 21 22 section 331.439, subsection 1, paragraph "b". 21 23 NEW SUBPARAGRAPH. (16) Make recommendations to the mental 21 24 health and developmental disabilities commission for 21 25 administrative rules establishing statewide minimum standards 21 26 for services and other support required to be available to 21 27 persons covered by a county management plan under section 21 28 331.439. 21 29 NEW SUBPARAGRAPH. (17) Make recommendations to the mental 21 30 health and developmental disabilities commission and counties 21 31 for measuring and improving the quality of state and county 21 32 mental health, mental retardation, and developmental 21 33 disabilities services and other support. 21 34 Sec. 38. Section 331.440, Code Supplement 1995, is amended 21 35 by adding the following new subsection: 22 1 NEW SUBSECTION. 2A. An application for services may be 22 2 made through the single entry point process of a person's 22 3 county of residence. However, if a person who is subject to a 22 4 single entry point process has legal settlement in another 22 5 county or the costs of services or other support provided to 22 6 the person are the financial responsibility of the state, an 22 7 authorization through the single entry point process shall be 22 8 coordinated with the person's county of legal settlement or 22 9 with the state, as applicable. The county of residence and 22 10 county of legal settlement of a person subject to a single 22 11 entry point process may mutually agree that the single entry 22 12 point process functions shall be performed by the single entry 22 13 point process of the person's county of legal settlement. 22 14 Sec. 39. MEDICAL ASSISTANCE CLAIMS AND COST SETTLEMENT. 22 15 The department of human services shall formulate a work group 22 16 which includes representatives of counties designated by the 22 17 Iowa state association of counties in developing a course of 22 18 action to meet the goals for submission of claims and 22 19 completion of cost settlement under section 249A.12, 22 20 subsection 2, as amended by this Act. A report which includes 22 21 data describing the conditions which cause the goal time 22 22 frames to be exceeded, other conditions associated with 22 23 billings and payments, and options to address the problems 22 24 identified shall be submitted to the governor and general 22 25 assembly on or before December 16, 1996. The options may 22 26 include possible sanctions for failure to meet the time 22 27 frames. 22 28 Sec. 40. EFFECTIVE DATE. Section 31 of this division of 22 29 this Act, being deemed of immediate importance, takes effect 22 30 upon enactment. 22 31 HF 2427 22 32 jp/pk/25
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