Text: HSB00733 Text: HSB00735 Text: HSB00700 - HSB00799 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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. 2A. "Management plan" means a county's 1 6 plan for management of mental health, mental retardation, and 1 7 developmental disabilities services implemented and approved 1 8 in accordance with section 331.439. 1 9 Sec. 2. Section 222.13, subsections 1 through 3, Code 1 10 Supplement 1995, are amended to read as follows: 1 11 1. If an adult person is believed to be a person with 1 12 mental retardation, the adult person or the adult person's 1 13 guardian may request the county board of supervisors or their 1 14 designated agent to apply to the superintendent of any state 1 15 hospital-school for the voluntary admission of the adult 1 16 person either as an inpatient or an outpatient of the 1 17 hospital-school. Submission of an application is subject to 1 18 the provisions of the management plan of the person's county 1 19 of legal settlement. After determining the legal settlement 1 20 of the adult person as provided by this chapter, the board of 1 21 supervisors shall, on forms prescribed by the administrator, 1 22 apply to the superintendent of the hospital-school in the 1 23 district for the admission of the adult person to the 1 24 hospital-school. An application for admission to a special 1 25 unit of any adult person believed to be in need of any of the 1 26 services provided by the special unit under section 222.88 may 1 27 be made in the same manner, upon request of the adult person 1 28 or the adult person's guardian. The superintendent shall 1 29 accept the application providing a preadmission diagnostic 1 30 evaluation confirms or establishes the need for admission, 1 31 except that an application may not be accepted if the 1 32 institution does not have adequate facilities available or if 1 33 the acceptance will result in an overcrowded condition. 1 34 2. If the hospital-school has no appropriate program for 1 35 the treatment of an adult or minor person with mental 2 1 retardation applying under this section or section 222.13A, 2 2 the board of supervisors shall arrange for the placement of 2 3 the person in any public or private facility within or without 2 4 the state, approved by the director of the department of human 2 5 services, which offers appropriate services for the person, 2 6 subject to the county's management plan. 2 7 3. Upon applying for admission of an adult or minor person 2 8 to a hospital-school, or a special unit, or upon arranging for 2 9 the placement of the person in a public or private facility, 2 10 the board of supervisors shall make a full investigation into 2 11 the financial circumstances of that person and those liable 2 12 for that person's support under section 222.78, to determine 2 13 whether or not any of them are able to pay the expenses 2 14 arising out of the admission of the person to a hospital- 2 15 school,orspecial treatment unit, or public or private 2 16 facility. If the board finds that the person or those legally 2 17 responsible for the person are presently unable to pay the 2 18 expenses,theythe board shall direct that the expenses be 2 19 paid by the county. The board may review its finding at any 2 20 subsequent time while the person remains at the hospital- 2 21 school, or is otherwise receiving care or treatment for which 2 22 this chapter obligates the county to pay. If the board finds 2 23 upon review that the person or those legally responsible for 2 24 the person are presently able to pay the expenses, the finding 2 25 shall apply only to the charges incurred during the period 2 26 beginning on the date of the review and continuing thereafter, 2 27 unless and until the board again changes its finding. If the 2 28 board finds that the person or those legally responsible for 2 29 the person are able to pay the expenses,theythe board shall 2 30 direct that the charges be so paid to the extent required by 2 31 section 222.78, and the county auditor shall be responsible 2 32 for the collection of the charges. 2 33 Sec. 3. Section 222.13A, subsections 2 and 3, Code 2 34 Supplement 1995, are amended to read as follows: 2 35 2. Upon receipt of an application for voluntary admission 3 1 of a minor, the board of supervisors shallprovideact in 3 2 accordance with the county's management plan in arranging for 3 3 a preadmission diagnostic evaluation of the minor to confirm 3 4 or establish the need for the admission. The preadmission 3 5 diagnostic evaluation shall be performed by a person who meets 3 6 the qualifications of a qualified mental retardation 3 7 professional. 3 8 3. During the preadmission diagnostic evaluation, the 3 9 minor shall be informed both orally and in writing that the 3 10 minor has the right to object to the voluntary admission. If 3 11 the preadmission diagnostic evaluation determines that the 3 12 voluntary admission is appropriate in accordance with the 3 13 county's management plan but the minor objects to the 3 14 admission, the minor shall not be admitted to the state 3 15 hospital-school unless the court approves of the admission. A 3 16 petition for approval of the minor's admission may be 3 17 submitted to the juvenile court by the minor's parent, 3 18 guardian, or custodian. 3 19 Sec. 4. Section 222.31, subsection 2, unnumbered paragraph 3 20 1, Code 1995, is amended to read as follows: 3 21 Commit the person to the state hospital-school designated 3 22 by the administrator to serve the county in which the hearing 3 23 is being held, or to a special unit. The court shall prior to 3 24 issuing an order of commitment request that a diagnostic 3 25 evaluation of the person be made by the superintendent of the 3 26 hospital-school,orthe special unit, or the superintendent's 3 27 qualified designee. The evaluation shall be conducted at a 3 28 place as the superintendent may direct. The cost of the 3 29 evaluation shall bedefrayedpaid by the county of legal 3 30 settlement unless otherwise ordered by the court. The cost 3 31 may be equal to but shall not exceed the actual cost of the 3 32 evaluation. Persons referred by a court to a hospital-school 3 33 or the special unit for diagnostic evaluation shall be 3 34 considered as outpatients of the institution.NoAn order of 3 35 commitment shall not be issued unless the superintendent of 4 1 the institution recommends that the order be issued, and 4 2 advises the court that adequate facilities for the care of the 4 3 person are available. In addition, an order of commitment to 4 4 a state hospital-school, special unit, or the superintendent's 4 5 qualified designee shall not be issued unless the placement is 4 6 in accordance with the management plan of the person's county 4 7 of legal settlement. 4 8 Sec. 5. Section 222.59, subsection 1, unnumbered paragraph 4 9 1, Code Supplement 1995, is amended to read as follows: 4 10 Upon receiving a request from an authorized requester, the 4 11 superintendent of a state hospital-school shallassist4 12 coordinate with the county of legal settlement in assisting 4 13 the requester in identifying available community-based 4 14 services, which are authorized in accordance with the county's 4 15 management plan, as an alternative to continued placement of a 4 16 patient in the state hospital-school. For the purposes of 4 17 this section, "authorized requester" means the parent, 4 18 guardian, or custodian of a minor patient, the guardian of an 4 19 adult patient, or an adult patient who does not have a 4 20 guardian. The assistance shall identify alternatives to 4 21 continued placement which are appropriate to the patient's 4 22 needs and shall include but are not limited to any of the 4 23 following: 4 24 Sec. 6. Section 222.73, subsection 2, Code Supplement 4 25 1995, is amended by adding the following new paragraph: 4 26 NEW PARAGRAPH. f. A county shall not be billed for the 4 27 cost of any patient whose admission or continued stay was not 4 28 authorized in accordance with the county's management plan. 4 29 Sec. 7. Section 222.73, subsection 2, unnumbered paragraph 4 30 2, Code Supplement 1995, is amended to read as follows: 4 31 The per diem costs billed to each county shall not exceed 4 32 the per diem costsin effect on July 1, 1988billed to the 4 33 county in the fiscal year for which the county's base year 4 34 expenditures were established for purposes of the definition 4 35 of base year expenditures in section 331.438.However, the5 1per diem costs may be adjusted annually to the extent of the5 2adjustment in the consumer price index published annually in5 3the federal register by the federal department of labor,5 4bureau of labor statistics.5 5 DIVISION II 5 6 MENTAL HEALTH SERVICE PROVISIONS 5 7 Sec. 8. Section 225.11, Code 1995, is amended to read as 5 8 follows: 5 9 225.11 INITIATING COMMITMENT PROCEDURES. 5 10 When a court finds upon completion of a hearing held 5 11 pursuant to section 229.12 that the contention that a 5 12 respondent is seriously mentally impaired has been sustained 5 13 by clear and convincing evidence, and the application filed 5 14 under section 229.6 also contends or the court otherwise 5 15 concludes that it would be appropriate to refer the respondent 5 16 to the state psychiatric hospital for a complete psychiatric 5 17 evaluation and appropriate treatment pursuant to section 5 18 229.13, the judge may order that a financial investigation be 5 19 made in the manner prescribed by section 225.13. Evaluation 5 20 or treatment shall not be ordered under this section unless in 5 21 accordance with the provisions of the management plan, as 5 22 defined in section 229.1, of the respondent's county of legal 5 23 settlement. 5 24 Sec. 9. Section 225.15, Code 1995, is amended to read as 5 25 follows: 5 26 225.15 EXAMINATION AND TREATMENT. 5 27 Whenthea respondent arrives at the state psychiatric 5 28 hospital,it shall be the duty ofthe admitting physicianto5 29 shall examine the respondent and determine whether or not, in 5 30 the physician's judgment, the patient is a fit subject for 5 31suchobservation, treatment, and hospital care. If, upon 5 32 examination, the physician decides thatsuch patientthe 5 33 respondent should be admitted to the hospital, thepatient5 34 respondent shall be provided a proper bed in the hospital; and 5 35 the physician whoshall havehas charge of thepatient6 1 respondent shall proceed withsuchobservation, medical 6 2 treatment, and hospital care as in the physician's judgment 6 3 are proper and necessary, in compliance with sections 229.13 6 4 to 229.16. 6 5 A proper and competent nurse shall also be assigned to look 6 6 after and care forsuch patientthe respondent duringsuch6 7 observation, treatment, and careas aforesaid. Observation, 6 8 treatment, and hospital care under this section shall only be 6 9 provided in accordance with the provisions of the management 6 10 plan, as defined in section 229.1, of the respondent's county 6 11 of legal settlement. 6 12 Sec. 10. Section 225.17, Code 1995, is amended to read as 6 13 follows: 6 14 225.17 COMMITTED PRIVATE PATIENT – TREATMENT. 6 15 If the judge of the district court, finds upon the review 6 16 and determination made under the provisions of section 225.14 6 17 that the respondent is an appropriate subject for placement at 6 18 the state psychiatric hospital, and that the respondent, or 6 19 those legally responsible for the respondent, are able to pay 6 20 the expensesthereofassociated with the placement, the judge 6 21 shall enter an order directing that the respondent shall be 6 22 sent to the state psychiatric hospital at the state University 6 23 of Iowa for observation, treatment, and hospital care as a 6 24 committed private patient. 6 25 When the respondent arrives at thesaidhospital, the 6 26 respondent shall receive the same treatment as is provided for 6 27 committed public patients in section 225.15, in compliance 6 28 with sections 229.13 to 229.16. However, observation, 6 29 treatment, and hospital care under this section of a 6 30 respondent whose expenses are payable in whole or in part by a 6 31 county shall only be provided in accordance with the 6 32 provisions of the management plan, as defined in section 6 33 229.1, of the respondent's county of legal settlement. 6 34 Sec. 11. Section 225C.2, Code 1995, is amended by adding 6 35 the following new subsection: 7 1 NEW SUBSECTION. 6A. "Management plan" means a county's 7 2 plan for management of mental health, mental retardation, and 7 3 developmental disabilities services implemented and approved 7 4 in accordance with section 331.439. 7 5 Sec. 12. Section 225C.12, Code 1995, is amended to read as 7 6 follows: 7 7 225C.12 PARTIAL REIMBURSEMENT TO COUNTIES FOR LOCAL 7 8 INPATIENT MENTAL HEALTH CARE AND TREATMENT. 7 9 1. A county which pays, from county funds budgeted under 7 10 section331.424, subsection 1, paragraphs "d" and "g"7 11 331.424A, the cost of care and treatment of amentally ill7 12 person with mental illness who is admitted pursuant to a 7 13 preliminary diagnostic evaluation under sections 225C.14 to 7 14 225C.17 for treatment as an inpatient of a hospital facility, 7 15 other than a state mental health institute, which has a 7 16 designated mental health program and is a hospital accredited 7 17 by the accreditation program for hospital facilities of the 7 18 joint commission on accreditation ofhospitalshealth 7 19 organizations, is entitled to reimbursement from the state for 7 20 a portion of the daily cost so incurred by the county. 7 21 However, a county is not entitled to reimbursement for a cost 7 22 incurred in connection with the hospitalization of a person 7 23 who is eligible for medical assistance under chapter 249A, or 7 24 who is entitled to have care or treatment paid for by any 7 25 other third party payor, or who is admitted for preliminary 7 26 diagnostic evaluation under sections 225C.14 to 225C.17. The 7 27 amount of reimbursement for the cost of treatment of a local 7 28 inpatient to which a county is entitled, on a per-patient-per- 7 29 day basis, is an amount equal to twenty percent of the average 7 30 of the state mental health institutes' individual average 7 31 daily patient costs in the most recent calendar quarter for 7 32 the program in which the local inpatient would have been 7 33 served if the patient had been admitted to a state mental 7 34 health institute. 7 35 2. A county may claim reimbursement by filing with the 8 1 administrator a claim in a form prescribed by the 8 2 administrator by rule. Claims may be filed on a quarterly 8 3 basis, and when received shall be verified as soon as 8 4 reasonably possible by the administrator. The administrator 8 5 shall certify to the director of revenue and finance the 8 6 amount to which each county claiming reimbursement is 8 7 entitled, and the director of revenue and finance shall issue 8 8 warrants to the respective counties drawn upon funds 8 9 appropriated by the general assembly for the purpose of this 8 10 section. A county shall place funds received under this 8 11 section in the county mental healthand institutions, mental 8 12 retardation, and developmental disabilities services fund 8 13 created under section 331.424A. If the appropriation for a 8 14 fiscal year is insufficient to pay all claims arising under 8 15 this section, the director of revenue and finance shall 8 16 prorate the funds appropriated for that year among the 8 17 claimant counties so that an equal proportion of each county's 8 18 claim is paid in each quarter for which proration is 8 19 necessary. 8 20 Sec. 13. Section 225C.14, subsection 1, Code 1995, is 8 21 amended to read as follows: 8 22 1. Except in cases of medical emergency, a person shall be 8 23 admitted to a state mental health institute as an inpatient 8 24 only after a preliminary diagnostic evaluationby a community8 25mental health center or by an alternative diagnostic facility8 26 performed in accordance with the management plan of the 8 27 person's county of legal settlement has confirmed that the 8 28 admission is appropriate to the person's mental health needs, 8 29 and that no suitable alternative method of providing the 8 30 needed services in a less restrictive setting or in or nearer 8 31 to the person's home community is currently available. If 8 32 provided for under the management plan of the person's county 8 33 of legal settlement, the evaluation may be performed by a 8 34 community mental health center or by an alternative diagnostic 8 35 facility. The policy established by this section shall be 9 1 implemented in the manner and to the extent prescribed by 9 2 sections 225C.15, 225C.16 and 225C.17. 9 3 Sec. 14. Section 225C.15, Code 1995, is amended to read as 9 4 follows: 9 5 225C.15 COUNTY IMPLEMENTATION OF EVALUATIONS. 9 6 The board of supervisors of a county shall, no later than 9 7 July 1, 1982, require that the policy stated in section 9 8 225C.14 be followed with respect to admission of persons from 9 9 that county to a state mental health institute. A community 9 10 mental health center which is supported, directly or in 9 11 affiliation with other counties, by that countyshallmay 9 12 perform the preliminary diagnostic evaluations for that 9 13 county, unless the performance of the evaluations is not 9 14 covered by the agreement entered into by the county and the 9 15 center under section 230A.12, and the center's director 9 16 certifies to the board of supervisors that the center does not 9 17 have the capacity to perform the evaluations, in which case 9 18 the board of supervisors shall proceed under section 225C.17. 9 19 Sec. 15. Section 225C.16, Code 1995, is amended to read as 9 20 follows: 9 21 225C.16 REFERRALS FOR EVALUATION. 9 22 1. The chief medical officer of a state mental health 9 23 institute, or that officer's physician designee, shall advise 9 24 a person residing in that county who applies for voluntary 9 25 admission, or a person applying for the voluntary admission of 9 26 another person who resides in that county, in accordance with 9 27 section 229.41, that the board of supervisors has implemented 9 28 the policy stated in section 225C.14, and shall advise that a 9 29 preliminary diagnostic evaluation of the prospective patient 9 30 be soughtfrom the appropriate community mental health center9 31or alternative diagnostic facility, if that has not already 9 32 been done. This subsection does not apply when voluntary 9 33 admission is sought in accordance with section 229.41 under 9 34 circumstances which, in the opinion of the chief medical 9 35 officer or that officer's physician designee, constitute a 10 1 medical emergency. 10 2 2. The clerk of the district court in that county shall 10 3 refer a person applying for authorization for voluntary 10 4 admission, or for authorization for voluntary admission of 10 5 another person, in accordance with section 229.42, to the 10 6 appropriatecommunity mental health center or alternative10 7diagnostic facilityentity designated by the person's county 10 8 of legal settlement under section 225C.14 for the preliminary 10 9 diagnostic evaluation unless the applicant furnishes a written 10 10 statement fromthat center or facilitythe appropriate entity 10 11 which indicates that the evaluation has been performed and 10 12 that the person's admission to a state mental health institute 10 13 is appropriate. This subsection does not apply when 10 14 authorization for voluntary admission is sought under 10 15 circumstances which, in the opinion of the chief medical 10 16 officer or that officer's physician designee, constitute a 10 17 medical emergency. 10 18 3. Judges of the district court in that county or the 10 19 judicial hospitalization referee appointed for that county 10 20 shall so far as possible arrange fora physician on the staff10 21of or designated by the appropriate community mental health10 22center or alternative diagnostic facilitythe entity 10 23 designated by the county of legal settlement under section 10 24 225C.14 to perform a prehearing examination of a respondent 10 25 required under section 229.8, subsection 3, paragraph "b". 10 26 4. The chief medical officer of a state mental health 10 27 institute shall promptly submit to the appropriatecommunity10 28mental health center or alternative diagnostic facilityentity 10 29 designated by the patient's county of legal settlement under 10 30 section 225C.14 a report of the voluntary admission of a 10 31 patient under the medical emergency clauses of subsections 1 10 32 and 2. The report shall explain the nature of the emergency 10 33 which necessitated the admission of the patient without a 10 34 preliminary diagnostic evaluation by thecenter or alternative10 35facilitydesignated entity. 11 1 Sec. 16. Section 225C.17, Code 1995, is amended to read as 11 2 follows: 11 3 225C.17 ALTERNATIVE DIAGNOSTIC FACILITY. 11 4 If the entity designated by a county to perform preliminary 11 5 diagnostic evaluations is notserved bya community mental 11 6 health center having the capacity to perform the required 11 7 preliminary diagnostic evaluations, the board of supervisors 11 8shallmay arrange for the evaluations to be performed by an 11 9 alternative diagnostic facility for the period until the 11 10 county is served by a community mental health center with the 11 11 capacity to provide that service. An alternative diagnostic 11 12 facility may be the outpatient service of a state mental 11 13 health institute or any other mental health facility or 11 14 service able to furnish the requisite professional skills to 11 15 properly perform a preliminary diagnostic evaluation of a 11 16 person whose admission to a state mental health institute is 11 17 being sought or considered on either a voluntary or an 11 18 involuntary basis. 11 19 Sec. 17. Section 227.10, Code 1995, is amended to read as 11 20 follows: 11 21 227.10 TRANSFERS FROM COUNTY OR PRIVATE INSTITUTIONS. 11 22 Patients who have been admitted at public expense to any 11 23 institution to which this chapter is applicable may be 11 24 involuntarily transferred to the proper state hospital for the 11 25 mentally ill in the manner prescribed by sections 229.6 to 11 26 229.13. The application required by section 229.6 may be 11 27 filed by the administrator of the division or the 11 28 administrator's designee, or by the administrator of the 11 29 institution where the patient is then being maintained or 11 30 treated. If the patient was admitted to that institution 11 31 involuntarily, the administrator of the division may arrange 11 32 and complete the transfer, and shall report it as required of 11 33 a chief medical officer under section 229.15, subsection 4. 11 34 The transfer shall be made at county expense, and the expense 11 35 recovered, as provided in section 227.7. However, transfer 12 1 under this section of a patient whose expenses are payable in 12 2 whole or in part by a county shall only be authorized in 12 3 accordance with the provisions of the management plan, as 12 4 defined in section 229.1, of the patient's county of legal 12 5 settlement. 12 6 Sec. 18. Section 229.1, Code Supplement 1995, is amended 12 7 by adding the following new subsection: 12 8 NEW SUBSECTION. 6A. "Management plan" means a county plan 12 9 for management of mental health, mental retardation, and 12 10 developmental disabilities services implemented and approved 12 11 in accordance with section 331.439. 12 12 Sec. 19. Section 229.13, unnumbered paragraph 1, Code 12 13 1995, is amended to read as follows: 12 14 If upon completion of the hearing the court finds that the 12 15 contention that the respondentis seriously mentally impaired12 16has beenhas a serious mental impairment is sustained by clear 12 17 and convincing evidence,itthe court shall order the 12 18 respondent placed in a hospital or a facility licensed to care 12 19 for persons with mental illness or substance abuse or under 12 20 the care of a facility that is licensed to care for persons 12 21 with mental illness or substance abuse on an outpatient basis 12 22 as expeditiously as possible for a complete psychiatric 12 23 evaluation and appropriate treatment. If the respondent is 12 24 ordered at the hearing to undergo outpatient treatment, the 12 25 outpatient treatment provider must be notified and agree to 12 26 provide the treatment prior to placement of the respondent 12 27 under the treatment provider's care. The court shall furnish 12 28 to the hospital or facility at the time the respondent arrives 12 29 at the hospital or facility a written finding of fact setting 12 30 forth the evidence on which the finding is based. If the 12 31 respondent is ordered to undergo outpatient treatment, the 12 32 order shall also require the respondent to cooperate with the 12 33 treatment provider and comply with the course of treatment. 12 34 The chief medical officer of the hospital or facility shall 12 35 report to the court no more than fifteen days after the 13 1 individual is admitted to or placed under the care of the 13 2 hospital or facility, making a recommendation for disposition 13 3 of the matter. An extension of time may be granted for not to 13 4 exceed seven days upon a showing of cause. A copy of the 13 5 report shall be sent to the respondent's attorney, who may 13 6 contest the need for an extension of time if one is requested. 13 7 Extension of time shall be granted upon request unless the 13 8 request is contested, in which case the court shall make such 13 9 inquiry as it deems appropriate and may either order the 13 10 respondent's release from the hospital or facility or grant 13 11 extension of time for psychiatric evaluation. If the chief 13 12 medical officer fails to report to the court within fifteen 13 13 days after the individual is admitted to or placed under the 13 14 care of the hospital or facility, and no extension of time has 13 15 been requested, the chief medical officer is guilty of 13 16 contempt and shall be punished under chapter 665. The court 13 17 shall order a rehearing on the application to determine 13 18 whether the respondent should continue to be held at or placed 13 19 under the care of the facility. However, an order under this 13 20 section for a respondent whose expenses are payable in whole 13 21 or in part by a county shall conform with the provisions of 13 22 the management plan of the respondent's county of legal 13 23 settlement. 13 24 Sec. 20. Section 229.14, Code 1995, is amended by adding 13 25 the following new unnumbered paragraph: 13 26 NEW UNNUMBERED PARAGRAPH. If a respondent's expenses are 13 27 payable in whole or in part by a county, an order under this 13 28 section shall be limited to those placements which are in 13 29 accordance with the provisions of the management plan of the 13 30 respondent's county of legal settlement. 13 31 Sec. 21. Section 229.24, subsection 3, unnumbered 13 32 paragraph 1, Code Supplement 1995, is amended to read as 13 33 follows: 13 34 If all or part of the costs associated with hospitalization 13 35 of an individual under this chapter are chargeable to a county 14 1 of legal settlement, the clerk of the district court shall 14 2 provide to the county of legal settlement and to the county in 14 3 which the hospitalization order is enteredshall have access14 4to, in a form prescribed by the council on human services 14 5 pursuant to a recommendation of the state-county management 14 6 committee established in section 331.438, the following 14 7 information pertaining to the individual which would be 14 8 confidential under subsection 1: 14 9 Sec. 22. Section 229.42, unnumbered paragraph 1, Code 14 10 1995, is amended to read as follows: 14 11 If a person wishing to make application for voluntary 14 12 admission to a mental hospital established by chapter 226 is 14 13 unable to pay the costs of hospitalization or those 14 14 responsible forsuchthe person are unable to paysuchthe 14 15 costs, application for authorization of voluntary admission 14 16 must be made to any clerk of the district court before 14 17 application for admission is made to the hospital.After14 18determiningThe clerk shall determine the person's county of 14 19 legal settlement and if the admission is approved in 14 20 accordance with the county's management plan, thesaidclerk 14 21 shall, on forms provided by the administrator of the division,14 22 authorizesuchthe person's admission to a mental health 14 23 hospital as a voluntary case. The authorization shall be 14 24 issued on forms provided by the administrator. The clerk 14 25 shall at once provide a duplicate copy of the form to the 14 26 county board of supervisors. The costs of the hospitalization 14 27 shall be paid by the county of legal settlement to the 14 28 director of revenue and finance and credited to the general 14 29 fund of the state, providing the mental health hospital 14 30 rendering the services has certified to the county auditor of 14 31 theresponsiblecounty of legal settlement the amount 14 32 chargeabletheretoto the county and has sent a duplicate 14 33 statement ofsuchthe charges to the director of revenue and 14 34 finance. A county shall not be billed for the cost of a 14 35 patient whose admission or continued stay was not approved in 15 1 accordance with the provisions of the management plan of the 15 2 patient's county of legal settlement. 15 3 Sec. 23. Section 230.1, Code 1995, is amended by adding 15 4 the following new unnumbered paragraph: 15 5 NEW UNNUMBERED PARAGRAPH. A county of legal settlement is 15 6 not liable for costs and expenses associated with a person 15 7 with mental illness unless the costs and expenses are for 15 8 services and other support authorized for the person in 15 9 accordance with the county's management plan. For the purpose 15 10 of this chapter, "management plan" means a county plan for 15 11 management of mental health, mental retardation, and 15 12 developmental disabilities services implemented and approved 15 13 in accordance with section 331.439. 15 14 Sec. 24. Section 230.20, subsection 2, Code Supplement 15 15 1995, is amended to read as follows: 15 16 2. a. The superintendent shall certify to the director of 15 17 revenue and finance the billings to each county for services 15 18 provided to patients chargeable to the county during the 15 19 preceding calendar quarter. The county billings shall be 15 20 based on the average daily patient charge and other service 15 21 charges computed pursuant to subsection 1, and the number of 15 22 inpatient days and other service units chargeable to the 15 23 county. However, a county billing shall be decreased by an 15 24 amount equal to reimbursement by a third party payor or 15 25 estimation of such reimbursement from a claim submitted by the 15 26 superintendent to the third party payor for the preceding 15 27 calendar quarter. When the actual third party payor 15 28 reimbursement is greater or less than estimated, the 15 29 difference shall be reflected in the county billing in the 15 30 calendar quarter the actual third party payor reimbursement is 15 31 determined. 15 32 b. The per diem costs billed to each county shall not 15 33 exceed the per diem costsin effect on July 1, 1988billed to 15 34 the county in the fiscal year for which the county's base year 15 35 expenditures were established for purposes of the definition 16 1 of base year expenditures in section 331.438.However, the16 2per diem costs may be adjusted annually to the extent of the16 3adjustment in the consumer price index published annually in16 4the federal register by the federal department of labor,16 5bureau of labor statistics.16 6 DIVISION III 16 7 SERVICE REGULATION, INFORMATION, PLANNING, AND PAYMENT 16 8 PROVISIONS 16 9 Sec. 25. Section 230A.13, unnumbered paragraph 2, Code 16 10 1995, is amended to read as follows: 16 11 Release of administrative information, as defined in 16 12 section 228.1, which would identify an individual who is 16 13 receiving or has received treatment at a community mental 16 14 health centershall notmay be made a condition of support of 16 15 that center by any county under this section.Section16 16331.504, subsection 8 notwithstanding, a community mental16 17health center shall not be required to file a claim which16 18would in any manner identify such an individual, if the16 19center's budget has been approved by the county board under16 20this section and the center is in compliance with section16 21230A.16, subsection 3.16 22 Sec. 26. Section 235A.15, subsection 2, paragraph c, Code 16 23 Supplement 1995, is amended by adding the following new 16 24 subparagraph: 16 25 NEW SUBPARAGRAPH. (13) To the administrator of an agency 16 26 providing mental health, mental retardation, or developmental 16 27 disability services under a county management plan developed 16 28 pursuant to section 331.439, if the information concerns a 16 29 person employed by or being considered by the agency for 16 30 employment. 16 31 Sec. 27. Section 235B.6, subsection 2, paragraph c, Code 16 32 Supplement 1995, is amended by adding the following new 16 33 subparagraph: 16 34 NEW SUBPARAGRAPH. (6) To the administrator of an agency 16 35 providing mental health, mental retardation, or developmental 17 1 disability services under a county management plan developed 17 2 pursuant to section 331.439, if the information concerns a 17 3 person employed by or being considered by the agency for 17 4 employment. 17 5 Sec. 28. Section 249A.12, subsection 2, Code Supplement 17 6 1995, is amended to read as follows: 17 7 2. A county shall reimburse the department on a monthly 17 8 basis for that portion of the cost of assistance provided 17 9 under this section to a recipient with legal settlement in the 17 10 county, which is not paid from federal funds, if the 17 11 recipient's placement has been approved by the appropriate 17 12 review organization as medically necessary and appropriate and 17 13 the placement is authorized in accordance with the county's 17 14 management plan developed and approved in accordance with 17 15 section 331.439. A county shall not be required to reimburse 17 16 the department for a service provided more than one hundred 17 17 eighty days prior to the date of the claim submitted to the 17 18 county. If the department does not complete and credit a 17 19 county with cost settlement for the actual costs of a medical 17 20 assistance home and community-based waiver service within two 17 21 hundred seventy days of the end of a fiscal year for which 17 22 cost reports are due from providers, the county shall not be 17 23 required to reimburse the state for costs under this section 17 24 until the cost settlement is completed. The department shall 17 25 place all reimbursements from counties in the appropriation 17 26 for medical assistance, and may use the reimbursed funds in 17 27 the same manner and for any purpose for which the 17 28 appropriation for medical assistance may be used. 17 29 Sec. 29. Section 249A.12, Code Supplement 1995, is amended 17 30 by adding the following new subsection: 17 31 NEW SUBSECTION. 5. The department shall take the actions 17 32 necessary to revise the medical assistance home and community- 17 33 based waiver for adults with mental retardation requirements 17 34 to provide for reimbursement under the waiver for services 17 35 provided in residential and intermediate care facilities for 18 1 the mentally retarded licensed under chapter 135C and for day 18 2 program costs, including but not limited to activity, work 18 3 activity, and supported employment. The actions shall include 18 4 but are not limited to requesting that the federal government 18 5 revise an approved waiver, requesting an amendment to state 18 6 law, revising rules, or other action necessary to comply with 18 7 this subsection. The department shall consult with providers 18 8 of residential and intermediate care facility for the mentally 18 9 retarded services, service consumers, and other knowledgeable 18 10 persons in developing the waiver revision request or other 18 11 action. A waiver revision request and the other actions 18 12 developed pursuant to this subsection shall be completed on or 18 13 before September 16, 1996. The department shall report on 18 14 September 16, 1996, to the general assembly regarding its 18 15 actions under this subsection and any federal response, and 18 16 shall submit an update upon receiving a federal response to 18 17 the waiver request or other action taken which requires a 18 18 federal response. If implementation of the requirements of 18 19 this subsection does not require a federal waiver, the 18 20 department shall implement the requirements on July 1, 1996. 18 21 Sec. 30. Section 249A.26, Code 1995, is amended to read as 18 22 follows: 18 23 249A.26 COUNTY PARTICIPATION IN FUNDING FOR SERVICES TO 18 24 PERSONS WITH DISABILITIES. 18 25 The state shall pay for one hundred percent of the 18 26 nonfederal share of the cost of services provided under any 18 27 prepaid mental health services plan for medical assistance 18 28 implemented by the department as authorized by law. The 18 29 county of legal settlement shall pay for fifty percent of the 18 30 nonfederal share of the cost of case management provided to 18 31 adults, day treatment, and partial hospitalization provided 18 32 under the medical assistance program for persons with mental 18 33 retardation, a developmental disability, or chronic mental 18 34 illness. For purposes of this section, persons with mental 18 35 disorders resulting from Alzheimer's disease or substance 19 1 abuse shall not be considered chronically mentally ill. A 19 2 county's responsibility to pay for costs under this section is 19 3 limited to services and other support authorized in accordance 19 4 with the management plan developed and approved in accordance 19 5 with section 331.439 of the person's county of legal 19 6 settlement. 19 7 Sec. 31. Section 331.424A, subsection 2, Code Supplement 19 8 1995, is amended to read as follows: 19 9 2. For the fiscal year beginning July 1, 1996, and 19 10 succeeding fiscal years, county revenues from taxes and other 19 11 sources designated for mental health, mental retardation, and 19 12 developmental disabilities services shall be credited to the 19 13 mental health, mental retardation, and developmental 19 14 disabilities services fund of the county. The board shall 19 15 make appropriations from the fund for payment of services 19 16 provided under the county management plan approved pursuant to 19 17 section 331.439. The county may pay for the services in 19 18 cooperation with other counties by pooling appropriations from 19 19 the fund with other counties or through county regional 19 20 entities including but not limited to the county's mental 19 21 health and developmental disabilities regional planning 19 22 council created pursuant to section 225C.18. 19 23 Sec. 32. Section 331.438, subsection 4, paragraph b, 19 24 unnumbered paragraph 1, Code Supplement 1995, is amended to 19 25 read as follows: 19 26 The management committee shall consist of not more than 19 27eleventwelve voting membersrepresenting the state and19 28countiesas follows: 19 29 Sec. 33. Section 331.438, subsection 4, paragraph b, 19 30 subparagraph (2), Code Supplement 1995, is amended to read as 19 31 follows: 19 32 (2) The committee shall include one member nominated by 19 33 service providers,andone member nominated by service 19 34 advocates and consumers, and one member nominated by the 19 35 state's council of the association of federal, state, county, 20 1 and municipal employees, withboththese members appointed by 20 2 the governor. 20 3 Sec. 34. Section 331.438, subsection 4, paragraph c, 20 4 subparagraph (10), Code Supplement 1995, is amended to read as 20 5 follows: 20 6 (10) Make recommendations to improve the programs and cost 20 7 effectiveness of state and county contracting processes and 20 8 procedures, including strategies for negotiations relating to 20 9 managed care. The recommendations developed regarding managed 20 10 care shall include but are not limited to standards for 20 11 limiting excess costs and profits, and for restricting cost 20 12 shifting under a managed care system. 20 13 Sec. 35. Section 331.438, subsection 4, paragraph c, Code 20 14 Supplement 1995, is amended by adding the following new 20 15 subparagraphs: 20 16 NEW SUBPARAGRAPH. (15) Make recommendations to the 20 17 council on human services for administrative rules providing 20 18 statewide standards and a monitoring methodology to determine 20 19 whether cost-effective individualized services are available 20 20 as required pursuant to section 331.439, subsection 1, 20 21 paragraph "b". 20 22 NEW SUBPARAGRAPH. (16) Make recommendations to the 20 23 council on human services for administrative rules 20 24 establishing statewide minimum standards for services and 20 25 other support required to be available to persons covered by a 20 26 county management plan under section 331.439. 20 27 NEW SUBPARAGRAPH. (17) Make recommendations to the 20 28 council on human services for administrative rules allowing 20 29 counties, within parameters of acceptable managed care 20 30 guidelines, to manage voluntary and involuntary referrals to 20 31 the state hospital-schools, state mental health institutes, 20 32 intermediate care facilities for the mentally retarded, 20 33 services provided under a medical assistance home and 20 34 community-based waiver, medical assistance case management 20 35 services, and county service management. 21 1 NEW SUBPARAGRAPH. (18) Make recommendations for measuring 21 2 and improving the quality of state and county mental health, 21 3 mental retardation, and developmental disabilities services 21 4 and other support. 21 5 Sec. 36. EFFECTIVE DATE. Section 29 of this division of 21 6 this Act, being deemed of immediate importance, takes effect 21 7 upon enactment. 21 8 DIVISION IV 21 9 APPLICABILITY 21 10 Sec. 37. APPLICABILITY. Prior to January 1, 1997, the 21 11 applicability of the amendments in this Act to the following 21 12 sections which relate to a county management plan is limited 21 13 to those counties with a county management plan for mental 21 14 retardation and developmental disabilities services approved 21 15 in accordance with section 331.439: sections 222.12, 222.13A, 21 16 222.31, 222.59, 222.73, subsection 2, new paragraph "f", and 21 17 249A.12. 21 18 EXPLANATION 21 19 This bill relates to mental health, mental retardation, and 21 20 developmental disabilities (MH/MR/DD) services paid for in 21 21 whole or in part by counties. 21 22 Various sections of the Code of Iowa providing for county 21 23 payment or county requirements for mental retardation and 21 24 mental health services are amended to provide that the 21 25 payments or requirements are subject to the provisions of the 21 26 county's management plan for mental health, mental 21 27 retardation, and developmental disabilities services. The 21 28 management plan is required under section 331.439 to be 21 29 implemented as a condition of county eligibility for state 21 30 property tax relief fund moneys. According to section 21 31 331.439, the management plan provisions for mental health must 21 32 be implemented by July 1, 1996, and the management plan 21 33 provisions for mental retardation and developmental 21 34 disabilities must be implemented by January 1, 1997. The bill 21 35 includes an applicability provision which excludes the 22 1 applicability of the bill's provisions to those counties which 22 2 have not implemented a management plan. 22 3 Division I relates to mental retardation service 22 4 provisions. 22 5 Section 222.2 is amended to provide a definition of a 22 6 county management plan applicable to chapter 222, relating to 22 7 persons with mental retardation. 22 8 Section 222.13, relating to procedures for voluntary 22 9 commitment of person with mental retardation, is amended to 22 10 apply the management plan requirement to applications and 22 11 facility selections. 22 12 Section 222.13A, relating to voluntary admission to a state 22 13 hospital-school of a minor with mental retardation, is amended 22 14 to apply the management plan requirement. 22 15 Section 222.31, relating to commitment and liability of a 22 16 person with mental retardation, is amended to prohibit 22 17 placement of a person unless the placement is in accordance 22 18 with the management plan of the person's county of legal 22 19 settlement. 22 20 Section 222.59, relating to requests for alternatives to an 22 21 individual's state hospital-school placement, is amended to 22 22 require the state hospital-school to coordinate with the 22 23 individual's county of legal settlement in locating 22 24 alternative services approved in accordance with the 22 25 management plan. 22 26 Section 222.73, relating to billing of patient charges at 22 27 the state hospital-schools, is amended to prohibit billing a 22 28 county for a patient's admission or continued stay which was 22 29 not authorized in accordance with the county's management 22 30 plan. In addition, the section is amended to revise the cap 22 31 on the per diem costs billed to counties for services at a 22 32 state hospital-school. The current law sets the cap at the 22 33 per diem costs in effect on July 1, 1988, as adjusted for 22 34 inflation. The revised cap would be the amount the county 22 35 paid in the base year used to establish the county's levy 23 1 limit for MH/MR/DD services. 23 2 Division II relates to mental health service provisions. 23 3 Sections 225.11, 225.15, and 225.17 relate to commitments 23 4 and placements at the state psychiatric hospital affiliated 23 5 with the university of Iowa hospitals and clinics. The 23 6 commitments and placements are made subject to the county 23 7 management plan provisions. 23 8 Section 225C.12, relating to partial state reimbursement of 23 9 counties for local inpatient mental health care and treatment, 23 10 is amended to revise references from the county supplemental 23 11 levy to the county MH/MR/DD services fund levy. 23 12 Sections 225C.14, 225C.15, 225C.16, and 225C.17, relating 23 13 to preadmission diagnostic evaluations for admission to a 23 14 state mental health institute, are amended to provide that the 23 15 evaluation is designated under the county's management plan. 23 16 Under current law the evaluation must be performed by the 23 17 community mental health center affiliated with the county or 23 18 an alternative facility if the center cannot perform the 23 19 evaluation. 23 20 Section 227.10, relating to transfers of patients placed in 23 21 county or private mental health and mental retardation 23 22 facilities at public expense, is amended to require that the 23 23 transfer is subject to the county management plan provisions. 23 24 Section 229.1 is amended to include a definition of 23 25 management plan in this chapter relating to hospitalization of 23 26 persons with mental illness. 23 27 Section 229.13 relates to court orders for psychiatric 23 28 evaluations of persons found to have a serious mental 23 29 impairment. The section is amended to require that orders 23 30 pertaining to a person whose expenses are paid in whole or in 23 31 part by a county must conform with the management plan of the 23 32 county of legal settlement. 23 33 Section 229.14, relating to the evaluation report to the 23 34 court by the state mental health institute chief medical 23 35 officer and subsequent placement, is amended to require a 24 1 resulting court order be limited to placements in accordance 24 2 with the management plan of the county of legal settlement. 24 3 Section 229.24, relating to confidentiality of involuntary 24 4 hospitalization proceedings, is amended to require the clerk 24 5 of the district court to provide information to the county of 24 6 commitment and county of legal settlement, if the costs are 24 7 chargeable to a county. Current law authorizes access by 24 8 county. 24 9 Section 229.42, relating to county payment of costs of 24 10 persons applying for voluntary commitment to a state mental 24 11 health institute, is amended to make the application process 24 12 subject to the management plan of the county of legal 24 13 settlement. The bill provides a county cannot be billed for 24 14 admission or continued stay of a patient who was not approved 24 15 under the county's management plan. 24 16 Section 230.1, relating to liability of the state and 24 17 counties for the costs associated with a person with mental 24 18 illness, is amended to provide a county is not liable for 24 19 services and other support unless authorized by the county's 24 20 management plan. 24 21 Section 230.20, relating to billing of patient costs at a 24 22 state mental health institute, is amended to prohibit billing 24 23 a county for a patient's admission or continued stay which was 24 24 not authorized in accordance with the county's management 24 25 plan. In addition, the section is amended to revise the cap 24 26 on the per diem costs billed to counties for services at a 24 27 state mental health institute. The current law sets the cap 24 28 at the per diem costs in effect on July 1, 1988, as adjusted 24 29 for inflation. The revised cap would be the amount the county 24 30 paid in the base year used to establish the county's levy 24 31 limit for MH/MR/DD services. 24 32 Division III relates to service regulation, information, 24 33 payment, and planning provisions. 24 34 Section 230A.13, relating to the annual budgets of 24 35 community health centers approved by counties, is amended. 25 1 Under current law, a county is prohibited from requiring a 25 2 center to release information to the county identifying an 25 3 individual being treated. The bill authorizes the county to 25 4 require the release of identifying administrative information, 25 5 as defined in section 228.1. 25 6 Section 235A.15 is amended to provide access to child abuse 25 7 registry information to an agency providing MH/MR/DD services 25 8 under a county management plan if the information concerns a 25 9 person employed by or being considered for employment by the 25 10 agency. Section 235B.6 is amended to provide similar access 25 11 to dependent adult abuse information. 25 12 Section 249A.12 relates to county payment for the 25 13 nonfederal share of an intermediate care facility for the 25 14 mentally retarded and community-based services provided under 25 15 medical assistance. The bill restricts payment to placements 25 16 made in accordance with the county's management plan. In 25 17 addition, the bill prohibits requirements for a county to pay 25 18 claims for services provided more than 180 days prior to the 25 19 claim being submitted. In addition, a county is not required 25 20 to reimburse certain costs until the state completes 25 21 processing of cost settlement credits to counties. 25 22 Section 249A.12 is also amended to require the department 25 23 of human services to revise federal medical assistance waiver 25 24 provisions to provide for waiver payment for services provided 25 25 in a residential or intermediate care facility for the 25 26 mentally retarded and for certain day services. This 25 27 provision takes effect upon enactment. 25 28 Section 249A.26 relates to county payment liability for the 25 29 nonfederal share of services provided to persons with chronic 25 30 mental illness, mental retardation, or developmental 25 31 disabilities. The bill limits county liability to services 25 32 and other support authorized in accordance with the county 25 33 management plan. 25 34 Section 331.424A, relating to the county MH/MR/DD services 25 35 fund, is amended to authorize a county to pay for the services 26 1 in cooperation with other counties by pooling appropriations 26 2 with individual counties or county regional entities. 26 3 Section 331.438 is amended to expand the membership of the 26 4 state-county management by one member nominated by the state's 26 5 council of the association of federal, state, county, and 26 6 municipal employees to be appointed by the governor. 26 7 Section 331.438 is also amended to add various 26 8 recommendation duties to the committee. The recommendations 26 9 include standards for MH/MR/DD managed care, statewide 26 10 standards for individualized MR/DD services, minimum statewide 26 11 standards for MH/MR/DD services, rules for counties to manage 26 12 referrals to state institutions, medical assistance 26 13 facilities, and medical assistance programs, and provisions 26 14 for quality measure and improvement. 26 15 The bill includes an applicability section which until 26 16 January 1, 1997, limits the applicability of the management 26 17 plan provisions in the bill associated with mental retardation 26 18 to those counties which have a management plan for mental 26 19 retardation and developmental disabilities services approved 26 20 by the department of human services under section 331.439. 26 21 LSB 3744HC 76 26 22 jp/cf/24
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