Text: H01291 Text: H01293 Text: H01200 - H01299 Text: H Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 664 as follows:
1 2 #1. By striking everything after the enacting
1 3 clause and inserting the following:
1 4 "Section 1. NEW SECTION. 331.440A ADULT MENTAL
1 5 HEALTH, MENTAL RETARDATION, AND DEVELOPMENTAL
1 6 DISABILITIES SERVICES FUNDING DECATEGORIZATION PILOT
1 7 PROJECT.
1 8 1. DEFINITIONS. For the purposes of this section,
1 9 unless the context requires otherwise:
1 10 a. "Department" means the department of human
1 11 services.
1 12 b. "Pilot project areas" means the pilot project
1 13 created under this section involving the three-county
1 14 or multicounty single entry point process
1 15 administrative areas designated in accordance with
1 16 this section.
1 17 c. "Target population" means any person who is a
1 18 legal resident of a pilot project county and meets
1 19 both of the following conditions:
1 20 (1) The person is eighteen years of age or older.
1 21 However, a person who is more than sixty-four years of
1 22 age who requires full-time nursing facility care shall
1 23 not be included in the target population.
1 24 (2) The person is eligible for assistance under
1 25 the pilot project county management plan approved
1 26 under section 331.439.
1 27 2. PURPOSE. The purpose of the pilot project is
1 28 to improve outcomes for service consumers by allowing
1 29 pilot project counties to administer overall projected
1 30 funding from state and federal sources together with
1 31 other available funding, and by reducing or
1 32 eliminating unnecessary barriers associated with
1 33 funding sources, and thereby to creatively meet the
1 34 divergent, individual needs of service consumers in
1 35 the community.
1 36 3. PROJECT ESTABLISHED. The department of human
1 37 services shall establish a pilot project for
1 38 decategorizing the public funding for adult mental
1 39 health, mental retardation, and developmental
1 40 disabilities services in accordance with this section.
1 41 The pilot project shall include the three-county
1 42 single entry point process administrative areas
1 43 designated for decategorization planning under 1997
1 44 Iowa Acts, chapter 169, section 13. Under the pilot
1 45 project, a projected funding amount for a fiscal year
1 46 shall be developed for each of the three
1 47 administrative areas, from the funding sources
1 48 designated in this section. The projected funding
1 49 amount for a fiscal year, manner of payment, and other
1 50 provisions of the pilot project shall be delineated in
2 1 contracts between the department and the counties
2 2 involved in the pilot project.
2 3 4. COUNTY MANAGEMENT PLAN. The counties
2 4 participating in the pilot project shall amend their
2 5 county management plans approved under section 331.439
2 6 to be applicable to the period of the pilot project.
2 7 Unless a change in federal or state funding provisions
2 8 reduces the availability of funding, a pilot project
2 9 county's management plan eligibility provisions shall
2 10 not be more restrictive than the provisions in effect
2 11 as of June 30, 1999. The amended county management
2 12 plans shall address the service needs of the
2 13 populations served under the funding sources included
2 14 in the pilot project beginning with the applicable
2 15 phase.
2 16 For purposes of determining the financial
2 17 responsibility of a pilot project county, a legal
2 18 resident includes anyone living in the county at the
2 19 time services or other support are provided who is a
2 20 member of the target population. A legal resident
2 21 includes but is not limited to a person who is
2 22 homeless or living in a homeless shelter. However, if
2 23 an individual resides in a pilot project county as a
2 24 result of placement or referral for services or other
2 25 support by another county or another state, financial
2 26 responsibility remains with the other county or other
2 27 state.
2 28 5. COUNTY RESPONSIBILITIES.
2 29 a. A county participating in the pilot project is
2 30 responsible to provide or pay for services and other
2 31 support to appropriately address the needs of the
2 32 target population attributable to that county. This
2 33 responsibility includes accountability for clinical,
2 34 administrative, and fiscal functions.
2 35 b. A pilot project area may choose among
2 36 alternative approaches in administering services under
2 37 the pilot project. The alternative approaches include
2 38 but are not limited to any of the following:
2 39 (1) A case rate approach to purchase of services.
2 40 (2) A fee-for-service purchasing approach with an
2 41 emphasis on flexible, creative services.
2 42 (3) A mixed model involving both case rate and
2 43 fee-for-service approaches.
2 44 c. A pilot project area shall provide data and
2 45 other reports as provided in the contract with the
2 46 department.
2 47 d. Moneys received by a county under the pilot
2 48 project shall be deposited in the county's services
2 49 fund. Moneys received that remain unencumbered or
2 50 unobligated at the close of the fiscal year shall
3 1 remain available to be used to benefit the county's
3 2 target population in the succeeding fiscal year.
3 3 e. Receipt and expenditures of moneys under the
3 4 pilot project shall be subject to examination during
3 5 the regular audit of the pilot project area counties
3 6 performed in accordance with chapter 11.
3 7 6. FUNDING – PHASES. The department shall
3 8 negotiate with the pilot project areas to identify the
3 9 projected funding amount to be provided to the areas
3 10 for a fiscal year. The projected funding amount shall
3 11 be determined in accordance with a pilot project
3 12 area's relative share of the statewide expenditures
3 13 for services and other support paid by the funding
3 14 sources included in the pilot project plus the related
3 15 administrative expenses. Unless the commencement
3 16 dates are delayed due to a determination by the
3 17 oversight committee, the pilot project funding shall
3 18 be implemented in two phases with the first phase to
3 19 commence July 1, 2000, and the second phase to
3 20 commence July 1, 2001, as provided in paragraph "d".
3 21 Both phases of the pilot project shall end December
3 22 31, 2003. The phases of the pilot project shall be
3 23 implemented as follows:
3 24 a. In the first phase, the department and the
3 25 pilot project areas shall negotiate the specific
3 26 projected funding amounts to be provided to each area.
3 27 The department and the pilot project areas shall
3 28 provide any data or other information necessary to
3 29 accurately develop the projected amounts. The funding
3 30 amount for the first phase shall be determined by
3 31 December 30, 1999.
3 32 b. In the first phase, the mental health services
3 33 funding sources for the pilot project areas shall
3 34 include but are not limited to all of the following:
3 35 (1) The state share of the costs of care in the
3 36 state mental health institutes.
3 37 (2) The mental health portion of any federal grant
3 38 funding administered through the United States
3 39 department of health and human services.
3 40 (3) Federal social services block grant funding.
3 41 (4) State case funding.
3 42 (5) State funding for the purchase of local
3 43 services for persons with mental illness where the
3 44 client has no established county of legal settlement.
3 45 (6) State supplementary assistance funding.
3 46 (7) To the extent allowed by the federal
3 47 government, the mental health portion of federal
3 48 funding provided for vocational rehabilitation of
3 49 individuals with disabilities.
3 50 c. In the first phase, the mental retardation and
4 1 other developmental disabilities services funding
4 2 sources for the pilot project areas shall include but
4 3 are not limited to all of the following:
4 4 (1) State and federal medical assistance funding
4 5 for home and community-based waiver services to
4 6 persons with mental retardation.
4 7 (2) The state share of the costs of care in the
4 8 state hospital-schools.
4 9 (3) State and federal medical assistance payments
4 10 for intermediate care facilities for persons with
4 11 mental retardation services.
4 12 (4) Federal social services block grant funding.
4 13 (5) State funding for the purchase of local
4 14 services for persons with mental retardation and other
4 15 developmental disabilities where the client has no
4 16 established county of legal settlement.
4 17 (6) State supplementary assistance funding.
4 18 (7) To the extent allowed by the federal
4 19 government, the mental retardation and other
4 20 developmental disabilities portion of federal funding
4 21 provided for vocational rehabilitation of persons with
4 22 disabilities.
4 23 d. In the second phase, all other medical
4 24 assistance funding for mental health services for the
4 25 pilot project areas shall be incorporated into the
4 26 annual projected funding amount. Implementation of
4 27 the second phase shall be subject to enactment by the
4 28 general assembly of an implementation authorization.
4 29 7. OVERSIGHT COMMITTEE.
4 30 a. An oversight committee shall be established to
4 31 provide general oversight of the pilot project and the
4 32 risk pool and to perform the duties outlined in this
4 33 subsection. The oversight committee shall consist of
4 34 the following members:
4 35 (1) At least one service consumer, one service
4 36 provider, and one county supervisor from each of the
4 37 three pilot project areas, designated by the county
4 38 board of supervisors.
4 39 (2) An individual designated by the governor.
4 40 (3) One individual designated by the division of
4 41 medical services of the department of human services
4 42 and one individual designated by the division of
4 43 mental health and developmental disabilities of the
4 44 department of human services.
4 45 (4) An individual designated by the legislative
4 46 council. If the individual designated by the
4 47 legislative council is a member of the general
4 48 assembly, that member shall be a nonvoting member.
4 49 b. The oversight committee shall have the
4 50 following duties and responsibilities:
5 1 (1) The oversight committee may make a
5 2 determination that implementation by the department of
5 3 human services of a significant funding provision such
5 4 as the rehabilitation option for persons with chronic
5 5 mental illness or a waiver under the medical
5 6 assistance program or another good cause reason
5 7 justifies delay of the implementation of the pilot
5 8 project phases as provided in subsection 6. If such a
5 9 determination is made, the department of human
5 10 services and pilot project counties shall delay
5 11 implementation of the pilot project phases until a
5 12 date identified by the oversight committee.
5 13 (2) The oversight committee shall arrange for an
5 14 independent evaluation of the pilot project in
5 15 accordance with subsection 9.
5 16 (3) The oversight committee shall provide
5 17 assistance to the pilot project counties, the
5 18 department of human services, and other interested
5 19 persons concerning implementation of the pilot
5 20 project.
5 21 (4) The oversight committee shall perform
5 22 functions for the risk pool in accordance with
5 23 subsection 8.
5 24 8. RISK POOL. In order to augment assistance from
5 25 the risk pool of the property tax relief fund for
5 26 which the pilot project counties may be eligible under
5 27 section 426B.5, the pilot project administrative areas
5 28 shall create and commit funding to a pilot project
5 29 risk pool. The pilot project risk pool shall be used
5 30 to cover unexpected costs resulting from an
5 31 unanticipated event such as a legal settlement
5 32 requirement or need for an exceptionally costly set of
5 33 services or other support. Funding shall be committed
5 34 on the basis of a percentage of the pilot project
5 35 counties overall budget for services under the
5 36 counties' management plan with an annual maximum
5 37 percentage for each area and an overall combined
5 38 percentage maximum, as determined by the pilot project
5 39 counties in consultation with the oversight committee.
5 40 Expenditure of this risk pool funding shall be subject
5 41 to authorization by the oversight committee.
5 42 9. OUTCOMES AND EVALUATION.
5 43 a. In consultation with the oversight committee,
5 44 the pilot project participants and the department
5 45 shall agree on a set of outcomes and indicators to
5 46 measure the effect of the pilot project upon the
5 47 system of care in those counties. The department and
5 48 pilot project areas shall annually report to the
5 49 governor and general assembly by December 15 on the
5 50 implementation status of the pilot project and the
6 1 performance on the indicators. The report shall
6 2 include any findings identified by the oversight
6 3 committee.
6 4 b. The oversight committee shall arrange for an
6 5 independent evaluation of the pilot project. The
6 6 evaluation shall assess the quality of services as
6 7 well as the cost-effectiveness of the pilot project.
6 8 The evaluation shall include a focus on special
6 9 populations such as persons who are homeless or who
6 10 have multiple disabilities or service needs.
6 11 c. A final report concerning the pilot project
6 12 shall be submitted by the department and the pilot
6 13 project areas to the governor and general assembly.
6 14 It is the intent of the general assembly to use that
6 15 report to determine whether to continue the pilot
6 16 project, revise it, terminate it, or implement the
6 17 pilot project provisions or a similar approach
6 18 statewide.
6 19 10. LAW – RULES – IMPLEMENTATION.
6 20 a. If a provision of state law or administrative
6 21 rule is in conflict with a provision of this section,
6 22 the provision of this section shall prevail. State
6 23 law and administrative rules governing the funding
6 24 sources specified in this section are not applicable
6 25 to use of the funding by the pilot project counties.
6 26 b. The department shall amend the medical
6 27 assistance state plan and apply for federal waivers as
6 28 necessary to implement the provisions of this section.
6 29 c. The department shall amend its contract for
6 30 managed behavioral health care under medical
6 31 assistance as necessary to implement the second phase
6 32 of the pilot project and for the medical assistance-
6 33 eligible persons covered under that contract to
6 34 instead be covered by the pilot project counties.
6 35 d. The pooling of funding sources and the
6 36 provision of services under this pilot project and
6 37 implementation of a risk pool as authorized in this
6 38 section is not insurance and is not subject to
6 39 regulation under chapters 505 through 523C.
6 40 e. The department of human services shall amend
6 41 the state medical assistance plan, implement federal
6 42 waivers, or take other actions as necessary for the
6 43 pilot project areas to be able to draw federal funding
6 44 for the start-up and other costs to implement the
6 45 pilot project.
6 46 f. The department shall give consideration to
6 47 implementing a rehabilitation option under the medical
6 48 assistance program for persons with chronic mental
6 49 illness.
6 50 g. The requirements of this section may be adapted
7 1 as necessary to comply with federal law, regulation,
7 2 or other requirements in order to assure federal
7 3 financial participation in the pilot project."
7 4 #2. By renumbering as necessary.
7 5
7 6
7 7
7 8 HOUSER of Pottawattamie
7 9
7 10
7 11
7 12 MYERS of Johnson
7 13 HF 664.301 78
7 14 jp/cf
Text: H01291 Text: H01293 Text: H01200 - H01299 Text: H Index Bills and Amendments: General Index Bill History: General Index
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