Text: HSB00225 Text: HSB00227 Text: HSB00200 - HSB00299 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 331.440A ADULT MENTAL HEALTH,
1 2 MENTAL RETARDATION, AND DEVELOPMENTAL DISABILITIES SERVICES
1 3 FUNDING DECATEGORIZATION PILOT PROJECT.
1 4 1. DEFINITIONS. For the purposes of this section, unless
1 5 the context requires otherwise:
1 6 a. "Department" means the department of human services.
1 7 b. "Pilot project areas" means the pilot project created
1 8 under this section involving the three-county or multicounty
1 9 single entry point process administrative areas designated in
1 10 accordance with this section.
1 11 c. "Target population" means any person who is a legal
1 12 resident of a pilot project county and meets all of the
1 13 following conditions:
1 14 (1) The person is between eighteen and sixty-four years of
1 15 age or is more than sixty-four years of age and has a
1 16 diagnosis of having an affective disorder, schizophrenia, or a
1 17 personality disorder. However, a person who is more than
1 18 sixty-four years of age who requires full-time nursing
1 19 facility care shall not be included in the target population.
1 20 (2) The person meets the state definitions and the
1 21 requirements under the pilot project county management plan
1 22 approved under section 331.439 as having mental illness,
1 23 chronic mental illness, or mental retardation or other
1 24 developmental disability.
1 25 (3) The person is eligible for assistance under the
1 26 federal supplemental security income program, the federal
1 27 supplemental security income program for persons with a
1 28 disability, or the pilot project county management plan
1 29 approved under section 331.439.
1 30 Any person who meets the conditions under subparagraphs
1 31 (1), (2), and (3), and is eligible for medical assistance
1 32 under chapter 249A, federal supplemental security income, or
1 33 the federal Medicare program, and any such person with
1 34 multiple disabilities or service needs, including substance
1 35 abuse treatment needs, shall be included in the target
2 1 population.
2 2 For purposes of determining the financial responsibility of
2 3 a pilot project county, a legal resident includes anyone
2 4 living in the county at the time services or other support are
2 5 provided who meets the other requirements of this paragraph
2 6 "c". A legal resident includes but is not limited to a person
2 7 who is homeless or living in a homeless shelter. However, if
2 8 an individual resides in a pilot project county as a result of
2 9 placement or referral for services or other support by another
2 10 county or the state, financial responsibility remains with the
2 11 other county or the state.
2 12 2. PROJECT ESTABLISHED. The department of human services
2 13 shall establish a pilot project for decategorizing the public
2 14 funding for adult mental health, mental retardation, and
2 15 developmental disabilities services in accordance with this
2 16 section. The pilot project shall include the three-county
2 17 single entry point process administrative areas designated for
2 18 decategorization planning under 1997 Iowa Acts, chapter 169,
2 19 section 13. Under the pilot project, each of the three
2 20 administrative areas shall receive an annual payment or
2 21 payments from the state consisting of the funding designated
2 22 in this section. The funding amounts and other requirements
2 23 under the pilot project shall be delineated in contracts
2 24 between the department and the counties involved in the pilot
2 25 project. The purpose of the pilot project is to facilitate
2 26 the utilization by the areas of the overall annual payment
2 27 amount together with other available funding, and thereby to
2 28 creatively meet the divergent needs of the target population
2 29 by providing services in the community.
2 30 3. COUNTY RESPONSIBILITIES.
2 31 a. A county participating in the pilot project is
2 32 responsible to provide or pay for services and other support
2 33 to appropriately address the needs of the target population
2 34 attributable to that county. This responsibility includes
2 35 clinical, administrative, and fiscal functions.
3 1 b. A pilot project area may choose among alternative
3 2 approaches in administering services under the pilot project.
3 3 The alternative approaches are any of the following:
3 4 (1) A case rate approach to purchase of services.
3 5 (2) A fee-for-service purchasing approach with an emphasis
3 6 on flexible, creative services.
3 7 (3) A mixed model involving both case rate and fee-for-
3 8 service approaches.
3 9 c. A pilot project area shall provide data and other
3 10 reports as provided in the contract with the department.
3 11 d. Moneys received by a county under the pilot project
3 12 shall be deposited in the county's services fund. Moneys
3 13 received that remain unencumbered or unobligated at the close
3 14 of the fiscal year shall remain available to be used to
3 15 benefit the county's target population in the succeeding
3 16 fiscal year.
3 17 4. FUNDING – PHASES. The department shall negotiate with
3 18 the pilot project areas to identify the annual funding amount
3 19 to be provided to the areas. The annual funding amount shall
3 20 be determined in accordance with a pilot project area's
3 21 relative share of the statewide expenditures for services and
3 22 other support paid by the funding sources included in the
3 23 pilot project plus the related administrative expenses. The
3 24 pilot project shall be implemented in two phases with the
3 25 first phase to commence July 1, 2000, and the second phase to
3 26 commence July 1, 2001. Both phases of the pilot project shall
3 27 end December 31, 2003. The phases of the pilot project shall
3 28 be implemented as follows:
3 29 a. In the first phase, the department and the pilot
3 30 project areas shall negotiate the specific annual funding
3 31 amounts to be provided to the areas. The department and the
3 32 pilot project areas shall provide any data or other
3 33 information necessary to accurately develop the amounts. The
3 34 funding amount for the first phase shall be determined by
3 35 December 30, 1999.
4 1 b. In the first phase, the mental health services funding
4 2 sources for the pilot project areas shall include but are not
4 3 limited to all of the following:
4 4 (1) The state share of the costs of care in the state
4 5 mental health institutes.
4 6 (2) The mental health portion of any federal grant funding
4 7 administered through the United States department of health
4 8 and human services.
4 9 (3) Federal social services block grant funding.
4 10 (4) State case funding.
4 11 (5) State funding for the purchase of local services for
4 12 persons with mental illness where the client has no
4 13 established county of legal settlement.
4 14 (6) State supplementary assistance funding.
4 15 c. In the first phase, the mental retardation and other
4 16 developmental disabilities services funding sources for the
4 17 pilot project areas shall include but are not limited to all
4 18 of the following:
4 19 (1) State and federal medical assistance funding for home
4 20 and community-based waiver services to persons with mental
4 21 retardation.
4 22 (2) The state share of the costs of care in the state
4 23 hospital-schools.
4 24 (3) State and federal medical assistance payments for
4 25 intermediate care facilities for persons with mental
4 26 retardation services.
4 27 (4) Federal social services block grant funding.
4 28 (5) State funding for the purchase of local services for
4 29 persons with mental retardation and other developmental
4 30 disabilities where the client has no established county of
4 31 legal settlement.
4 32 (6) State supplementary assistance funding.
4 33 d. In the second phase, all other medical assistance
4 34 funding for mental health services for the pilot project areas
4 35 shall be incorporated into the lump sum payment.
5 1 5. RISK POOL – OVERSIGHT COMMITTEE.
5 2 a. The pilot project areas and department shall create and
5 3 commit funding to a central risk pool. The central risk pool
5 4 shall be used to cover unexpected costs resulting from an
5 5 unanticipated event such as a legal settlement requirement or
5 6 an exceptionally costly set of services or other support.
5 7 Access to this risk pool funding shall be subject to
5 8 authorization by the oversight committee.
5 9 b. An oversight committee shall be established to provide
5 10 general oversight of the pilot project and the risk pool. The
5 11 oversight committee shall consist of at least one service
5 12 consumer or advocate from each of the three-county or
5 13 multicounty areas participating in the pilot project, an
5 14 individual designated by the legislative council, and an
5 15 individual designated by the governor or the governor's
5 16 designee. If the individual designated by the legislative
5 17 council is a member of the general assembly, that member shall
5 18 be a nonvoting member.
5 19 6. OUTCOMES AND EVALUATION.
5 20 a. The pilot project participants and the department shall
5 21 agree on a set of outcomes and indicators to measure the
5 22 effect of the pilot project upon the system of care in those
5 23 counties. The pilot project areas shall annually report on
5 24 the implementation status of the outcomes and the performance
5 25 on the indicators. The report shall include any findings
5 26 identified by the oversight committee.
5 27 b. The department shall provide funding for the pilot
5 28 project areas to arrange for an independent evaluation of the
5 29 pilot project. The evaluation shall determine whether the
5 30 pilot project has improved services to the target population
5 31 in a cost-effective manner. The evaluation shall include a
5 32 focus on special populations such as persons who are homeless
5 33 or who have multiple disabilities or service needs.
5 34 c. A final report concerning the pilot project shall be
5 35 submitted to the governor and general assembly on or before
6 1 February 15, 2003. It is the intent of the general assembly
6 2 to use that report to determine whether to continue the pilot
6 3 project, terminate it, or implement the pilot project
6 4 provisions or a similar approach statewide.
6 5 7. LAW – RULES – IMPLEMENTATION.
6 6 a. If a provision of state law or administrative rule is
6 7 in conflict with a provision of this section, the provision of
6 8 this section shall prevail. State law and administrative
6 9 rules governing the funding sources specified in this section
6 10 are not applicable to use of the funding by the pilot project
6 11 counties.
6 12 b. The department shall amend the medical assistance state
6 13 plan and apply for federal waivers as necessary to implement
6 14 the provisions of this section.
6 15 c. The department shall amend its contract for managed
6 16 behavioral health care under medical assistance as necessary
6 17 to implement the second phase of the pilot project and for the
6 18 medical assistance-eligible persons covered under that
6 19 contract to instead be covered by the pilot project counties.
6 20 d. The pooling of funding sources and the provision of
6 21 services under this pilot project and implementation of a risk
6 22 pool as authorized in this section is not insurance and is not
6 23 subject to regulation under chapters 505 through 523C.
6 24 Sec. 2. PILOT PROJECT IMPLEMENTATION. There is
6 25 appropriated from the general fund of the state to the
6 26 department of human services for the fiscal year beginning
6 27 July 1, 1999, and ending June 30, 2000, the following amount,
6 28 or so much thereof as is necessary, to be used for the
6 29 purposes designated:
6 30 For allocation in equal amounts to the three-county and
6 31 multicounty areas participating in the pilot project created
6 32 in this Act to be used for start-up and other costs to
6 33 implement the pilot project:
6 34 .................................................. $ 600,000
6 35 EXPLANATION
7 1 This bill creates an adult mental health, mental
7 2 retardation, and developmental disabilities services funding
7 3 decategorization pilot project in the department of human
7 4 services to involve three-county and multicounty areas. The
7 5 counties involved were designated under a 1997 law authorizing
7 6 a planning process for the concepts in the bill. The county
7 7 and multicounty areas are Polk, Linn, and Tama/Poweshiek. The
7 8 purpose of the pilot project is to provide state and federal
7 9 funding in a lump sum to the involved counties to meet
7 10 individual needs in the community. The pilot project
7 11 provisions are codified in new Code section 331.440A, which is
7 12 part of the county home rule chapter.
7 13 The bill provides various definitions, including a
7 14 description of the target population to which the project is
7 15 directed. Under the application of this definition, a pilot
7 16 project area must fund or provide necessary services to
7 17 persons who are residents of the area, with certain
7 18 exceptions.
7 19 The department is directed to establish the pilot project
7 20 and the specific provisions are to be spelled out in contracts
7 21 with the participating counties.
7 22 County responsibilities under the pilot project include
7 23 fiscal, clinical, and administrative responsibilities,
7 24 choosing an approach for administering services, provision of
7 25 data, and use of any excess funding for specified purposes.
7 26 The project is to be implemented in two phases during the
7 27 period of July 1, 2000, through December 31, 2003. Various
7 28 funding sources are to be consolidated and distributed in an
7 29 annual payment or payments based upon the pilot project areas'
7 30 proportion of the statewide usage of the funding sources. The
7 31 first phase amounts are to be determined by December 30, 1999.
7 32 The second phase brings in state and federal funding for
7 33 mental health services under medical assistance (Medicaid).
7 34 The department and the participating areas are directed to
7 35 establish a risk pool for unanticipated costs. The risk pool
8 1 is to be administered by an oversight committee that is also
8 2 to provide general oversight of the pilot project. Membership
8 3 of the committee is specified.
8 4 The pilot project areas are to work with the department in
8 5 developing outcomes and performance measures for the project.
8 6 In addition, these areas are to contract for an independent
8 7 evaluation of the project to be funded by the department. A
8 8 final report is to be submitted concerning the pilot project
8 9 by February 15, 2003, and legislative intent is stated to use
8 10 the report to determine whether to terminate or continue the
8 11 project or to expand it statewide.
8 12 The bill provides an exemption from the application of
8 13 state law or administrative rules that are in conflict with or
8 14 apply to the funding sources for the pilot project. The
8 15 department is to amend its state plan for medical assistance
8 16 and to apply for various federal waivers in order to implement
8 17 the pilot project. In addition, the department is to amend
8 18 its contract for managed behavioral health care in order to
8 19 provide the funding for associated medical assistance-eligible
8 20 persons in pilot project areas. The bill provides that
8 21 implementation of the pilot project is not insurance and is
8 22 not subject to regulation by the insurance commissioner.
8 23 A fiscal year 1999-2000 appropriation is provided for
8 24 start-up and other implementation costs in the pilot project
8 25 areas.
8 26 LSB 2017YC 78
8 27 jp/cf/24
Text: HSB00225 Text: HSB00227 Text: HSB00200 - HSB00299 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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