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PAG LIN
1 1 HOUSE CONCURRENT RESOLUTION NO. ____
1 2 BY (PROPOSED COMMITTEE ON LOCAL GOVERNMENT
1 3 RESOLUTION BY CHAIRPERSON HOUSER)
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 involved with
1 9 the mental health and developmental disabilities service
1 10 system in addressing a new phase in the reform of the system;
1 11 and
1 12 WHEREAS, initial study by counties, the Lieutenant
1 13 Governor, department of human services, and many advocacy
1 14 groups suggests that the approaches outlined in this
1 15 resolution are worthy of further study; NOW THEREFORE,
1 16 BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES, THE SENATE
1 17 CONCURRING, That the Legislative Council is requested to
1 18 create a legislative mental health and developmental
1 19 disability (MH/DD) services restructuring task force and to
1 20 appoint a study committee of legislators be appointed to
1 21 receive and review task force reports and to make
1 22 recommendations for legislative action.
1 23 1. The legislative study committee members should be
1 24 authorized to attend meetings of the task force as needed.
1 25 2. If created, it is intended that the task force will be
1 26 appointed and commence deliberations as soon as is
1 27 practicable, provide a progress report to the governor and
1 28 general assembly for the 2001 legislative session, and a final
1 29 report for the 2002 legislative session. The task force
1 30 should be authorized to create committees to address topics
1 31 within the task force's charge.
1 32 3. Legislative staffing for the task force may be
1 33 augmented with consultant and contract assistance as
1 34 authorized by the legislative council.
1 35 BE IT FURTHER RESOLVED, That the restructuring task force
2 1 should be directed to make recommendations to attain the
2 2 following objectives for the adult MH/DD services system:
2 3 1. IMPLEMENT CORE SERVICES. Implement statewide
2 4 standardization of clinical and financial eligibility
2 5 requirements for adult MH/DD services to be included in
2 6 required county plans. The following aspects are to be
2 7 addressed in particular:
2 8 a. Clinical eligibility standards. A task force committee
2 9 consisting of county central point of coordination
2 10 administrators, clinicians, and other professionals should
2 11 review applicable state and federal definitions and recommend
2 12 standards for Iowa, including but not limited to general
2 13 clinical eligibility standards, service access criteria, level
2 14 of care requirements, and terminology changes.
2 15 b. Financial eligibility standardization. Aspects
2 16 addressed should include resources, copayments, and treatment
2 17 of income and assets.
2 18 c. Persons served and costs. Determinations should
2 19 include how many counties serve persons with developmental
2 20 disabilities other than mental retardation, types of service
2 21 coverage, and cost for all counties to make core services
2 22 available to persons with developmental disabilities.
2 23 2. EMPHASIZE COMMUNITY SERVICES. Modify statutory
2 24 mandates for provision of services to shift the emphasis from
2 25 institutional services to community services by providing
2 26 service consumers a reasonable level of choice to meet
2 27 individual needs; and begin requiring inclusion of the core
2 28 community services in county plans applicable to fiscal year
2 29 2002-2003. The following are to be considered as an initial
2 30 set of core community services:
2 31 a. (1) Mental illness services to include outpatient
2 32 treatment, inpatient psychiatric evaluation and treatment at
2 33 county-designated facilities.
2 34 (2) Court-appointed mental health advocate, attorney,
2 35 other legal assistance, and transportation relating to civil
3 1 commitment to be included in the judicial branch budget.
3 2 b. Chronic mental illness services to include services
3 3 under paragraph "a"; service coordination, employment, and
3 4 psychosocial services funded under medical assistance;
3 5 residential services; and other community support services.
3 6 c. (1) Mental retardation and other developmental
3 7 disabilities services to include residential services and
3 8 other community support services, employment and day
3 9 rehabilitation and habilitation services, medical assistance
3 10 home and community-based waiver services, and service
3 11 coordination.
3 12 (2) Court-appointed mental health advocate, attorney,
3 13 other legal assistance, and transportation relating to civil
3 14 commitment to be included in the judicial branch budget.
3 15 d. Generally available services to include outreach,
3 16 intake, consultation and education, disaster planning, and
3 17 crisis response and hospital diversion services.
3 18 3. REPLACE LEGAL SETTLEMENT PROCESS. Provide for a
3 19 transition from the current legal settlement process of
3 20 determining financial liability for service costs to a process
3 21 that provides for equitable service access based upon
3 22 residency. Implementation of this approach would be
3 23 coordinated with provisions for a new funding formula.
3 24 Exceptions shall be allowed for individuals whose county of
3 25 residence is a result of service referral approved by another
3 26 county and for temporary residents for educational or other
3 27 purposes. Referrals from other states, transients from other
3 28 states, and illegal aliens shall remain a state
3 29 responsibility.
3 30 4. INCREASE FEDERAL FUNDING FOR SERVICES. Develop
3 31 strategies to significantly increase federal medical
3 32 assistance funding for mental health and developmental
3 33 disabilities services. Consultant assistance should be
3 34 obtained to complete the following tasks:
3 35 a. Determine the best means for implementing the
4 1 rehabilitation option under the medical assistance state plan
4 2 for mental health services outside the state's managed care
4 3 waiver.
4 4 b. Develop a specific means for expanding and improving
4 5 the flexibility of the medical assistance home and community-
4 6 based services waiver for persons with mental retardation and
4 7 for including persons with other developmental disabilities.
4 8 5. INCREASE FEDERAL FUNDING FOR HOUSING. With consultant
4 9 assistance, develop a specific approach for counties and the
4 10 state to access federal housing funding so that there is a
4 11 statewide increase of seven hundred fifty consumers in new
4 12 subsidized housing within three years of implementing the
4 13 approach. The following steps should be completed:
4 14 a. Develop a comprehensive state plan for housing of
4 15 persons with disabilities.
4 16 b. Develop technical assistance at the state level to
4 17 assist local communities in securing federal housing funding
4 18 that can be accessed without detailed planning requirements
4 19 and complex financing structures.
4 20 6. DEVELOP FORMULA IN WHICH FUNDING FOLLOWS CONSUMERS.
4 21 Develop a new funding formula that links state and federal
4 22 funding to individual consumers based upon a consumer's
4 23 disability. The formula should incorporate the following
4 24 principles:
4 25 a. Allocating formula funding on a quarterly basis while
4 26 defining allowable elements for use of a county fund balance
4 27 and limiting those elements to a specified percentage of the
4 28 fund balance. If an element exceeds the specified percentage
4 29 in a quarter, the next quarterly allocation would be reduced
4 30 in an amount equal to the excess.
4 31 b. Increased state funding levels in proportion to county
4 32 funding.
4 33 c. Initially maintaining maximum county levies for adult
4 34 MH/DD services at the amounts existing in fiscal year 1999-
4 35 2000.
5 1 d. Allocating any increased state funding to achieve
5 2 equity in service access.
5 3 e. Eventually allocating the state funding for state
5 4 institutions through counties so that these services operate
5 5 equally with other services.
5 6 f. Allotting state funding and administrative costs for
5 7 state cases to the individual service consumer's county of
5 8 residence.
5 9 g. Allocating state funding by use of a case rate approach
5 10 based upon a consumer's particular disability grouping (mental
5 11 illness, chronic mental illness, mental retardation, or
5 12 another developmental disability other than mental
5 13 retardation).
5 14 h. Allocating the risk for service cost increases to
5 15 counties and for eligible consumer increases to the state.
5 16 i. Providing for risk management and flexibility
5 17 provisions such as case rate adjustments, allowing waiting
5 18 lists to be used for unanticipated new eligible consumers,
5 19 distributing quarterly allotments to counties based upon the
5 20 previous quarter's enrollment, removing categorical funding
5 21 restrictions, applying standards to ensure county cash flow
5 22 capacity, and allowing inflation adjustments.
5 23 7. ADDRESS FINANCIAL RISK. In addition to other
5 24 provisions for dealing with financial risk for unanticipated
5 25 costs, provide for expanding the state risk pool, for allowing
5 26 access to risk pool funding for specific purposes, and for
5 27 allowing counties to maintain fund balances for certain cost
5 28 factors.
5 29 8. REDEFINE STATE AND COUNTY ROLES – ENHANCE CONSUMER
5 30 CHOICE. Develop an implementation plan for redefining state
5 31 and county roles and enhancing consumer input into the service
5 32 system. The plan should include provision for the following
5 33 elements:
5 34 a. Review the roles of the state-county management
5 35 committee and the mental health and developmental disabilities
6 1 commission.
6 2 b. Using technical assistance to develop statewide
6 3 contracting, rate setting, and quality assurance processes for
6 4 the state, counties, and providers.
6 5 c. Clarifying department of human services'
6 6 responsibilities for implementing policy, standards, and
6 7 system evaluation.
6 8 d. Redefining the county role and responsibility for local
6 9 system planning, development, operations, performance, and
6 10 quality management.
6 11 e. Expanding the "net budgeting" approach for state
6 12 institutions to increase the institutions equity with
6 13 community service providers.
6 14 f. Improving collaboration between service purchasers and
6 15 groups composed of consumers, families of consumers, and
6 16 advocacy organizations such as the Governor's Planning Council
6 17 for Persons With Developmental Disabilities by forming a
6 18 representative stakeholder advisory committee to respond to
6 19 task force recommendations; and
6 20 BE IT FURTHER RESOLVED, That the Legislative Council is
6 21 requested to limit task force membership to not more than
6 22 nineteen persons and to appoint the task force to include all
6 23 of the following:
6 24 1. One member representing the State-County Management
6 25 Committee.
6 26 2. One member representing the Mental Health and
6 27 Developmental Disabilities Commission.
6 28 3. Two members representing the Iowa Association of
6 29 Community Providers.
6 30 4. Two members representing consumers of mental health and
6 31 developmental disability services.
6 32 5. One member representing families of service consumers.
6 33 6. One member representing consumer advocates.
6 34 7. One member representing the Iowa Governor's Planning
6 35 Council for Developmental Disabilities.
7 1 8. Four members representing counties with three
7 2 representing county central point of coordination
7 3 administrators and one representing county supervisors.
7 4 9. Four members representing the Department of Human
7 5 Services.
7 6 10. One member representing the Iowa Farm Bureau
7 7 Federation.
7 8 11. One member representing participants at the lieutenant
7 9 Governor's Mental Health and Developmental Disabilities
7 10 Service System Summit held in December 1999; and
7 11 BE IT FURTHER RESOLVED, That the Legislative Council is
7 12 requested to create the task force as expeditiously as
7 13 possible upon passage of this resolution.
7 14 LSB 6266YC 78
7 15 jp/cls/14.1
Text: HSB00717 Text: HSB00719 Text: HSB00700 - HSB00799 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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