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PAG LIN
1 1 HOUSE CONCURRENT RESOLUTION NO. ____
1 2 BY COMMITTEE ON LOCAL GOVERNMENT
1 3 (SUCCESSOR TO HSB 718)
1 4 A House Concurrent Resolution requesting that the
1 5 Legislative Council create a legislative mental
1 6 health and developmental disability services
1 7 restructuring task force.
1 8 WHEREAS, there is strong interest among those
1 9 involved with the mental health and developmental
1 10 disabilities service system in addressing a new phase
1 11 in the reform of the system; and
1 12 WHEREAS, initial study by counties, the Lieutenant
1 13 Governor, department of human services, and many
1 14 advocacy groups suggests that the approaches outlined
1 15 in this resolution are worthy of further study; NOW
1 16 THEREFORE,
1 17 BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES, THE
1 18 SENATE CONCURRING, That the Legislative Council is
1 19 requested to create a legislative mental health and
1 20 developmental disability (MH/DD) services
1 21 restructuring task force and to appoint a study
1 22 committee of legislators to receive and review task
1 23 force reports and to make recommendations for
1 24 legislative action.
1 25 1. The legislative study committee members should
1 26 be authorized to attend meetings of the task force as
1 27 needed.
1 28 2. If created, it is intended that the task force
1 29 will be appointed and commence deliberations as soon
1 30 as is practicable, provide a progress report to the
2 1 governor and general assembly for the 2001 legislative
2 2 session, and a final report for the 2002 legislative
2 3 session. The task force should be authorized to
2 4 create committees to address topics within the task
2 5 force's charge.
2 6 3. Legislative staffing for the task force may be
2 7 augmented with consultant and contract assistance as
2 8 authorized by the legislative council.
2 9 BE IT FURTHER RESOLVED, That the restructuring task
2 10 force should be directed to make recommendations to
2 11 attain the following objectives for the adult MH/DD
2 12 services system:
2 13 1. IMPLEMENT CORE SERVICES. Implement statewide
2 14 standardization of clinical and financial eligibility
2 15 requirements for adult MH/DD services to be included
2 16 in required county plans. The following aspects are
2 17 to be addressed in particular:
2 18 a. Clinical eligibility standards. A task force
2 19 committee consisting of county central point of
2 20 coordination administrators, clinicians, and other
2 21 professionals should review applicable state and
2 22 federal definitions and recommend standards for Iowa,
2 23 including but not limited to general clinical
2 24 eligibility standards, service access criteria, level
2 25 of care requirements, and terminology changes.
2 26 b. Financial eligibility standardization. Aspects
2 27 addressed should include resources, copayments, and
2 28 treatment of income and assets.
2 29 c. Persons served and costs. Determinations
2 30 should include how many counties serve persons with
3 1 developmental disabilities other than mental
3 2 retardation, types of service coverage, and cost for
3 3 all counties to make core services available to
3 4 persons with developmental disabilities.
3 5 2. EMPHASIZE COMMUNITY SERVICES. Modify statutory
3 6 mandates for provision of services to shift the
3 7 emphasis from institutional services to community
3 8 services by providing service consumers a reasonable
3 9 level of choice to meet individual needs; and begin
3 10 requiring inclusion of the core community services in
3 11 county plans applicable to fiscal year 2002-2003. The
3 12 following are to be considered as an initial set of
3 13 core community services:
3 14 a. (1) Mental illness services to include
3 15 outpatient treatment, inpatient psychiatric evaluation
3 16 and treatment at county-designated facilities.
3 17 (2) Court-appointed mental health advocate,
3 18 attorney, other legal assistance, and transportation
3 19 relating to civil commitment to be included in the
3 20 judicial branch budget.
3 21 b. Chronic mental illness services to include
3 22 services under paragraph "a"; service coordination,
3 23 employment, and psychosocial services funded under
3 24 medical assistance; residential services; and other
3 25 community support services.
3 26 c. (1) Mental retardation and other developmental
3 27 disabilities services to include residential services
3 28 and other community support services, employment and
3 29 day rehabilitation and habilitation services, medical
3 30 assistance home and community-based waiver services,
4 1 and service coordination.
4 2 (2) Court-appointed mental health advocate,
4 3 attorney, other legal assistance, and transportation
4 4 relating to civil commitment to be included in the
4 5 judicial branch budget.
4 6 d. Generally available services to include
4 7 outreach, intake, consultation and education, disaster
4 8 planning, and crisis response and hospital diversion
4 9 services.
4 10 3. REPLACE LEGAL SETTLEMENT PROCESS. Provide for
4 11 a transition from the current legal settlement process
4 12 of determining financial liability for service costs
4 13 to a process that provides for equitable service
4 14 access based upon residency. Implementation of this
4 15 approach would be coordinated with provisions for a
4 16 new funding formula. Exceptions shall be allowed for
4 17 individuals whose county of residence is a result of
4 18 service referral approved by another county and for
4 19 temporary residents for educational or other purposes.
4 20 Referrals from other states, transients from other
4 21 states, and illegal aliens shall remain a state
4 22 responsibility.
4 23 4. INCREASE FEDERAL FUNDING FOR SERVICES. Develop
4 24 strategies to significantly increase federal medical
4 25 assistance funding for mental health and developmental
4 26 disabilities services. Consultant assistance should
4 27 be obtained to complete the following tasks:
4 28 a. Determine the best means for implementing the
4 29 rehabilitation option under the medical assistance
4 30 state plan for mental health services outside the
5 1 state's managed care waiver.
5 2 b. Develop a specific means for expanding and
5 3 improving the flexibility of the medical assistance
5 4 home and community-based services waiver for persons
5 5 with mental retardation and for including persons with
5 6 other developmental disabilities.
5 7 5. INCREASE FEDERAL FUNDING FOR HOUSING. With
5 8 consultant assistance, develop a specific approach for
5 9 counties and the state to access federal housing
5 10 funding so that there is a statewide increase of seven
5 11 hundred fifty consumers in new subsidized housing
5 12 within three years of implementing the approach. The
5 13 following steps should be completed:
5 14 a. Develop a comprehensive state plan for housing
5 15 of persons with disabilities.
5 16 b. Develop technical assistance at the state level
5 17 to assist local communities in securing federal
5 18 housing funding that can be accessed without detailed
5 19 planning requirements and complex financing
5 20 structures.
5 21 6. DEVELOP FORMULA IN WHICH FUNDING FOLLOWS
5 22 CONSUMERS. Develop a new funding formula that links
5 23 state and federal funding to individual consumers
5 24 based upon a consumer's disability. The formula
5 25 should incorporate the following principles:
5 26 a. Allocating formula funding on a quarterly basis
5 27 while defining allowable elements for use of a county
5 28 fund balance and limiting those elements to a
5 29 specified percentage of the fund balance. If an
5 30 element exceeds the specified percentage in a quarter,
6 1 the next quarterly allocation would be reduced in an
6 2 amount equal to the excess.
6 3 b. Increased state funding levels in proportion to
6 4 county funding.
6 5 c. Initially maintaining maximum county levies for
6 6 adult MH/DD services at the amounts existing in fiscal
6 7 year 1999-2000.
6 8 d. Allocating any increased state funding to
6 9 achieve equity in service access.
6 10 e. Eventually allocating the state funding for
6 11 state institutions through counties so that these
6 12 services operate equally with other services.
6 13 f. Allotting state funding and administrative
6 14 costs for state cases to the individual service
6 15 consumer's county of residence.
6 16 g. Allocating state funding by use of a case rate
6 17 approach based upon a consumer's particular disability
6 18 grouping (mental illness, chronic mental illness,
6 19 mental retardation, or another developmental
6 20 disability other than mental retardation).
6 21 h. Allocating the risk for service cost increases
6 22 to counties and for eligible consumer increases to the
6 23 state.
6 24 i. Providing for risk management and flexibility
6 25 provisions such as case rate adjustments, allowing
6 26 waiting lists to be used for unanticipated new
6 27 eligible consumers, distributing quarterly allotments
6 28 to counties based upon the previous quarter's
6 29 enrollment, removing categorical funding restrictions,
6 30 applying standards to ensure county cash flow
7 1 capacity, and allowing inflation adjustments.
7 2 7. ADDRESS FINANCIAL RISK. In addition to other
7 3 provisions for dealing with financial risk for
7 4 unanticipated costs, provide for expanding the state
7 5 risk pool, for allowing access to risk pool funding
7 6 for specific purposes, and for allowing counties to
7 7 maintain fund balances for certain cost factors.
7 8 8. REDEFINE STATE AND COUNTY ROLES – ENHANCE
7 9 CONSUMER CHOICE. Develop an implementation plan for
7 10 redefining state and county roles and enhancing
7 11 consumer input into the service system. The plan
7 12 should include provision for the following elements:
7 13 a. Review the roles of the state-county management
7 14 committee and the mental health and developmental
7 15 disabilities commission.
7 16 b. Using technical assistance to develop statewide
7 17 contracting, rate setting, and quality assurance
7 18 processes for the state, counties, and providers.
7 19 c. Clarifying department of human services'
7 20 responsibilities for implementing policy, standards,
7 21 and system evaluation.
7 22 d. Redefining the county role and responsibility
7 23 for local system planning, development, operations,
7 24 performance, and quality management.
7 25 e. Expanding the "net budgeting" approach for
7 26 state institutions to increase the institutions equity
7 27 with community service providers.
7 28 f. Improving collaboration between service
7 29 purchasers and groups composed of consumers, families
7 30 of consumers, and advocacy organizations such as the
8 1 Governor's Planning Council for Persons With
8 2 Developmental Disabilities by forming a representative
8 3 stakeholder advisory committee to respond to task
8 4 force recommendations; and
8 5 BE IT FURTHER RESOLVED, That the Legislative
8 6 Council is requested to limit task force membership to
8 7 not more than nineteen persons and to appoint the task
8 8 force to include all of the following:
8 9 1. One member representing the State-County
8 10 Management Committee.
8 11 2. One member representing the Mental Health and
8 12 Developmental Disabilities Commission.
8 13 3. Two members representing the Iowa Association
8 14 of Community Providers.
8 15 4. Two members representing consumers of mental
8 16 health and developmental disability services.
8 17 5. One member representing families of service
8 18 consumers.
8 19 6. One member representing consumer advocates.
8 20 7. One member representing the Iowa Governor's
8 21 Planning Council for Developmental Disabilities.
8 22 8. Four members representing counties with three
8 23 representing county central point of coordination
8 24 administrators and one representing county
8 25 supervisors.
8 26 9. Four members representing the Department of
8 27 Human Services.
8 28 10. One member representing the Iowa Farm Bureau
8 29 Federation.
8 30 11. One member representing participants at the
9 1 lieutenant Governor's Mental Health and Developmental
9 2 Disabilities Service System Summit held in December
9 3 1999; and
9 4 BE IT FURTHER RESOLVED, That the Legislative
9 5 Council is requested to create the task force as
9 6 expeditiously as possible upon passage of this
9 7 resolution.
9 8 LSB 6266HV 78
9 9 jp/cls/14.1
Text: HCR00112 Text: HCR00114 Text: HCR00100 - HCR00199 Text: HCR Index Bills and Amendments: General Index Bill History: General Index
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