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PAG LIN 1 1 Section 1. Section 225C.5, subsection 1, Code 2001, is 1 2 amended to read as follows: 1 3 1. A mental health and developmental disabilities 1 4 commission is created as the state policy-making body for the 1 5 provision of services to persons with mental illness, mental 1 6 retardation or other developmental disabilities, or brain 1 7 injury. The commission shall consist of fifteen voting 1 8 members appointed to three-year staggered terms by the 1 9 governor and subject to confirmation by the senate. 1 10 Commission members shall be appointed on the basis of interest 1 11 and experience in the fields of mental health, mental 1 12 retardation or other developmental disabilities, and brain 1 13 injury, in a mannerso that, if possible, the composition of1 14the commission will comply with the requirements of the1 15Community Mental Health Centers Amendments of 1975, 42 U.S.C.1 16} 2689t(a) (1976) relative to a state mental health advisory1 17council, andso as to ensure adequate representation from 1 18 persons with disabilities and individuals knowledgeable 1 19 concerning disability services. The department shall provide 1 20 staff support to the commission, and the commission may 1 21 utilize staff support and other assistance provided to the 1 22 commission by other persons. Members of the commission shall 1 23 include the following persons who, at the time of appointment 1 24 to the commission, are active members of the indicated groups: 1 25 a. Four members shall be members of a county board of 1 26 supervisors selected from nominees submitted by the county 1 27 supervisor affiliate of the Iowa state association of 1 28 counties. 1 29 b. Two members shall be members of a mental health and 1 30 developmental disabilities regional planning council. 1 31 c. One member shall beeitheran active board member of a 1 32 community mental health center or of a statewide association 1 33 of persons with mental illness or of family members of persons 1 34 with mental illness. 1 35 d. One member shall be either an active board member of an 2 1 agency serving persons with mental retardation or of a 2 2 statewide association for persons with mental retardation. 2 3 e. One member shall be an active member of a statewide 2 4 organization for persons with developmental disabilities other 2 5 than mental retardation. 2 6 f. One member shall be an active member of a statewide 2 7 organization for persons with brain injury. 2 8 g. Two members shall be administrators of the single entry 2 9 point process established in accordance with section 331.440 2 10 selected from nominees submitted by the community services 2 11 affiliate of the Iowa state association of counties. 2 12 h. One member shall be selected from nominees submitted by 2 13 the state's council of the association of federal, state, 2 14 county, and municipal employees. 2 15 i. One member shall be a service consumer. 2 16 j. One member shall be selected from nominees submitted by 2 17 service advocates. 2 18 k. In addition to the voting members, the membership shall 2 19 include four members of the general assembly with one member 2 20 designated by each of the following: the majority leader of 2 21 the senate, the minority leader of the senate, the speaker of 2 22 the house of representatives, and the minority leader of the 2 23 house of representatives. A legislative member serves in an 2 24 ex officio, nonvoting capacity and is eligible for per diem 2 25 and expenses as provided in section 2.10. 2 26 Sec. 2. Section 229.24, subsection 3, unnumbered paragraph 2 27 1, Code 2001, is amended to read as follows: 2 28 If all or part of the costs associated with hospitalization 2 29 of an individual under this chapter are chargeable to a county 2 30 of legal settlement, the clerk of the district court shall 2 31 provide to the county of legal settlement and to the county in 2 32 which the hospitalization order is entered, in a form 2 33 prescribed by thecouncil on human services pursuant to a2 34recommendation of the state-county management committee2 35established in section 331.438mental health and developmental 3 1 disabilities commission, the following information pertaining 3 2 to the individual which would be confidential under subsection 3 3 1: 3 4 Sec. 3. Section 249A.12, subsection 5, paragraph a, 3 5 unnumbered paragraph 1, Code Supplement 2001, is amended to 3 6 read as follows: 3 7 Thestate-county management committeemental health and 3 8 developmental disabilities commission shall recommend to the 3 9 department the actions necessary to assist in the transition 3 10 of individuals being served in an intermediate care facility 3 11 for persons with mental retardation, who are appropriate for 3 12 the transition, to services funded under a medical assistance 3 13 waiver for home and community-based services for persons with 3 14 mental retardation in a manner which maximizes the use of 3 15 existing public and private facilities. The actions may 3 16 include but are not limited to submitting any of the following 3 17 or a combination of any of the following as a request for a 3 18 revision of the medical assistance waiver for home and 3 19 community-based services for persons with mental retardation 3 20 in effect as of June 30, 1996: 3 21 Sec. 4. Section 249A.12, subsection 5, paragraph b, 3 22 unnumbered paragraph 1, Code Supplement 2001, is amended to 3 23 read as follows: 3 24 In implementing the provisions of this subsection, the 3 25state-county management committeemental health and 3 26 developmental disabilities commission shall consult with other 3 27 states. The waiver revision request or other action necessary 3 28 to assist in the transition of service provision from 3 29 intermediate care facilities for persons with mental 3 30 retardation to alternative programs shall be implemented by 3 31 the department in a manner that can appropriately meet the 3 32 needs of individuals at an overall lower cost to counties, the 3 33 federal government, and the state. In addition, the 3 34 department shall take into consideration significant federal 3 35 changes to the medical assistance program in formulating the 4 1 department's actions under this subsection. Thedepartment4 2shall consult with the state-county management committee in4 3adopting rulesmental health and developmental disabilities 4 4 commission shall adopt rules for oversight of facilities 4 5 converted pursuant to this subsection. A transition approach 4 6 described in paragraph "a" may be modified as necessary to 4 7 obtain federal waiver approval.The department shall report4 8on or before January 2, 1997, to the general assembly4 9regarding its actions under this subsection and any federal4 10response, and shall submit an update upon receiving a federal4 11response to the waiver request or other action taken which4 12requires a federal response. If implementation of any of the4 13provisions of this subsection does not require a federal4 14waiver, the department shall implement the provisions in the4 15fiscal year beginning July 1, 1996.4 16 Sec. 5. Section 331.424A, subsection 1, Code Supplement 4 17 2001, is amended to read as follows: 4 18 1. For the purposes of this chapter, unless the context 4 19 otherwise requires, "services fund" means the county mental 4 20 health, mental retardation, and developmental disabilities 4 21 services fund created in subsection 2. The county finance 4 22 committee created in section 333A.2 shall consult with the 4 23state-county management committeemental health and 4 24 developmental disabilities commission in adopting rules and 4 25 prescribing forms for administering the services fund. 4 26 Sec. 6. Section 331.438, subsection 1, paragraph c, Code 4 27 Supplement 2001, is amended to read as follows: 4 28 c. "Qualified mental health, mental retardation, and 4 29 developmental disabilities services" means the services 4 30 specified on forms issued by the county finance committee 4 31 following consultation with thestate-county management4 32committeemental health and developmental disabilities 4 33 commission. 4 34 Sec. 7. Section 331.438, subsection 4, paragraph a, Code 4 35 Supplement 2001, is amended to read as follows: 5 1 a.AThe mental health and developmental disabilities 5 2 commission shallstate-county management committee is created5 3in the department of human services tomake recommendations 5 4 and take actions for joint state and county planning, 5 5 implementing, and funding of mental health, mental 5 6 retardation, and developmental disabilities services, 5 7 including but not limited to developing and implementing 5 8 fiscal and accountability controls, establishing management 5 9 plans, and ensuring that eligible persons have access to 5 10 appropriate and cost-effective services. 5 11 Sec. 8. Section 331.438, subsection 4, paragraph b, Code 5 12 Supplement 2001, is amended by striking the paragraph. 5 13 Sec. 9. Section 331.438, subsection 4, paragraph c, Code 5 14 Supplement 2001, is amended to read as follows: 5 15 c. Themanagement committeemental health and 5 16 developmental disabilities commission shall do all of the 5 17 following: 5 18 (1) Identify characteristics of the service system, 5 19 including amounts expended, equity of funding among counties, 5 20 funding sources, provider types, service availability, and 5 21 equity of service availability among counties and among 5 22 persons served. 5 23 (2) Assess the accuracy and uniformity of recordkeeping 5 24 and reporting in the service system. 5 25 (3) Identify for each county the factors associated with 5 26 inflationary growth of the service system. 5 27 (4) Identify opportunities for containing service system 5 28 growth. 5 29 (5)Make recommendationsConsider proposals for revising 5 30 service system administrative rules. 5 31 (6) Consider provisions and adopt rules for counties to 5 32 implement a single point of accountability to plan, budget, 5 33 and monitor county expenditures for the service system. The 5 34 provisions shall provide options for counties to implement the 5 35 single point in collaboration with other counties. 6 1 (7) Develop criteria for annual county mental health, 6 2 mental retardation, and developmental disabilities plans. 6 3 (8)Make recommendations to the council on human services6 4forAdopt administrative rules identifying qualified mental 6 5 health, mental retardation, and developmental disabilities 6 6 service expenditures for purposes of state payment pursuant to 6 7 subsection 1. 6 8 (9)Make recommendations to the council on human services6 9for administrativeAdopt rules for the county single entry 6 10 point and clinical assessment processes required under section 6 11 331.440 and other rules necessary for the implementation of 6 12 county management plans and expenditure reports required for 6 13 state payment pursuant to section 331.439. 6 14 (10)MakeConsider recommendations to improve the programs 6 15 and cost effectiveness of state and county contracting 6 16 processes and procedures, including strategies for 6 17 negotiations relating to managed care. The recommendations 6 18developedimplemented by the commission for the state and 6 19 county regarding managed care shall include but are not 6 20 limited to standards for limiting excess costs and profits, 6 21 and for restricting cost shifting under a managed care system. 6 22 (11) Provide input, when appropriate, to the director of 6 23 human services in any decision involving administrative rules 6 24 which wereinitially recommendedadopted by themanagement6 25committeedepartment of human services pertaining to the 6 26 mental illness, mental retardation, and developmental 6 27 disabilities services administered by counties. 6 28 (12) Identify the fiscal impact of existing or proposed 6 29 legislation and administrative rules on state and county 6 30 expenditures. 6 31(13) No later than January 1, annually, submit a report to6 32the governor, the general assembly, and the department of6 33human services concerning the management committee's6 34activities and findings.6 35(14) On or before December 1, 1994, submit to the governor7 1and general assembly a methodology for the state and counties7 2to move toward the goal of an equal partnership in the funding7 3of mental health, mental retardation, and developmental7 4disabilities services. The committee consideration of7 5methodology options shall include an expenditure per consumer7 6basis.7 7(15) Make recommendations to the mental health and7 8developmental disabilities commission for7 9 (13) Adopt administrative rules providing statewide 7 10 standards and a monitoring methodology to determine whether 7 11 cost-effective individualized services are available as 7 12 required pursuant to section 331.439, subsection 1, paragraph 7 13 "b". 7 14(16)(14)MakeConsider recommendationsto the mental7 15health and developmental disabilities commissionfor and adopt 7 16 administrative rules establishing statewide minimum standards 7 17 for services and other support required to be available to 7 18 persons covered by a county management plan under section 7 19 331.439. 7 20(17)(15)MakeConsider recommendationsto the mental7 21health and developmental disabilities commission and counties7 22 for measuring and improving the quality of state and county 7 23 mental health, mental retardation, and developmental 7 24 disabilities services and other support. 7 25 Sec. 10. Section 331.439, subsection 1, unnumbered 7 26 paragraph 1, Code 2001, is amended to read as follows: 7 27 The state payment to eligible counties under this section 7 28 shall be made as provided in sections 331.438 and 426B.2. A 7 29 county is eligible for the state payment, as defined in 7 30 section 331.438, for the fiscal year beginning July 1, 1996, 7 31 and for subsequent fiscal years if the director of human 7 32 services, in consultation with thestate-county management7 33committeemental health and developmental disabilities 7 34 commission, determines for a specific fiscal year that all of 7 35 the following conditions are met: 8 1 Sec. 11. Section 331.439, subsection 1, paragraph b, 8 2 unnumbered paragraph 1, Code 2001, is amended to read as 8 3 follows: 8 4 The county developed and implemented a county management 8 5 plan for the county's mental health, mental retardation, and 8 6 developmental disabilities services in accordance with the 8 7 provisions of this paragraph "b". The plan shall comply with 8 8 the administrative rules adopted for this purpose by the 8 9council on human servicesmental health and developmental 8 10 disabilities commission and is subject to the approval of the 8 11 director of human services in consultation with thestate-8 12county management committee created in section 331.4388 13 commission. The plan shall include a description of the 8 14 county's service management provision for mental health, 8 15 mental retardation, and developmental disabilities services. 8 16 For mental retardation and developmental disabilities service 8 17 management, the plan shall describe the county's development 8 18 and implementation of a managed system of cost-effective 8 19 individualized services and shall comply with the provisions 8 20 of paragraph "d". The goal of this part of the plan shall be 8 21 to assist the individuals served to be as independent, 8 22 productive, and integrated into the community as possible. 8 23 The service management provisions for mental health shall 8 24 comply with the provisions of paragraph "c". A county is 8 25 subject to all of the following provisions in regard to the 8 26 county's management plan and planning process: 8 27 Sec. 12. Section 331.439, subsection 1, paragraph b, 8 28 subparagraph (1), Code 2001, is amended to read as follows: 8 29 (1) The county shall have in effect an approved policies 8 30 and procedures manual for the county's services fund. The 8 31 county management plan shall be defined in the manual. The 8 32 manual submitted by the county as part of the county's 8 33 management plan for the fiscal year beginning July 1, 2000, as 8 34 approved by the director of human services, shall remain in 8 35 effect, subject to amendment. An amendment to the manual 9 1 shall be submitted to the department of human services at 9 2 least forty-five days prior to the date of implementation. 9 3 Prior to implementation of any amendment to the manual, the 9 4 amendment must be approved by the director of human services 9 5 in consultation with thestate-county management committee9 6 mental health and developmental disabilities commission. 9 7 Sec. 13. Section 331.439, subsection 1, paragraph c, 9 8 subparagraph (2), unnumbered paragraph 1, Code 2001, is 9 9 amended to read as follows: 9 10 The basis for determining whether a managed care system for 9 11 mental health proposed by a county is comparable to a mental 9 12 health managed care contractor approved by the department of 9 13 human services shall include but is not limited to all of the 9 14 following elements which shall be specified in administrative 9 15 rules adopted by thecouncil on human services in consultation9 16with the state-county management committeemental health and 9 17 developmental disabilities commission: 9 18 Sec. 14. Section 331.439, subsection 1, paragraph d, Code 9 19 2001, is amended to read as follows: 9 20 d. For mental retardation and developmental disabilities 9 21 services management, the county must either develop and 9 22 implement a managed system of care which addresses a full 9 23 array of appropriate services and cost-effective delivery of 9 24 services or contract with a state-approved managed care 9 25 contractor or contractors. Any system or contract implemented 9 26 under this paragraph shall incorporate a single entry point 9 27 and clinical assessment process developed in accordance with 9 28 the provisions of section 331.440. The elements of the 9 29 managed system of care and the state-approved managed care 9 30 contract or contracts shall be specified in rules developed by 9 31 the department of human services in consultation withthe9 32state-county management committeeand adopted by thecouncil9 33on human servicesmental health and developmental disabilities 9 34 commission. 9 35 Sec. 15. Section 331.439, subsection 3, paragraph b, Code 10 1 2001, is amended to read as follows: 10 2 b. Based upon information contained in county management 10 3 plans and budgets and proposals made by representatives of 10 4 counties, thestate-county management committeemental health 10 5 and developmental disabilities commission shall recommend an 10 6 allowed growth factor adjustment to the governor by November 10 7 15 for the fiscal year which commences two years from the 10 8 beginning date of the fiscal year in progress at the time the 10 9 recommendation is made. The allowed growth factor adjustment 10 10 shall address costs associated with new consumers of service, 10 11 service cost inflation, and investments for economy and 10 12 efficiency. In developing the service cost inflation 10 13 recommendation, thecommitteecommission shall consider the 10 14 cost trends indicated by the gross expenditure amount reported 10 15 in the expenditure reports submitted by counties pursuant to 10 16 subsection 1, paragraph "a". The governor shall consider the 10 17committee'scommission's recommendation in developing the 10 18 governor's recommendation for an allowed growth factor 10 19 adjustment for such fiscal year. The governor's 10 20 recommendation shall be submitted at the time the governor's 10 21 proposed budget for the succeeding fiscal year is submitted in 10 22 accordance with chapter 8. 10 23 Sec. 16. Section 331.440, subsection 4, Code 2001, is 10 24 amended to read as follows: 10 25 4. Thecouncil on human servicesmental health and 10 26 developmental disabilities commission shall consider the 10 27 recommendations ofthe state-county management committee10 28established in section 331.438county representatives in 10 29 adopting rules outlining standards and requirements for 10 30 implementation of the single entry point and clinical 10 31 assessment processes on the date required by subsection 2. 10 32 The rules shall permit counties options in implementing the 10 33 process based upon a county's consumer population and 10 34 available service delivery system. 10 35 Sec. 17. Section 426B.4, Code 2001, is amended to read as 11 1 follows: 11 2 426B.4 RULES. 11 3 Thecouncil on human servicesmental health and 11 4 developmental disabilities commission shall consult withthe11 5state-county management committee created in section 331.43811 6 county representatives and the director of human services in 11 7 prescribing forms and adopting rules pursuant to chapter 17A 11 8 to administer this chapter. 11 9 Sec. 18. Section 426B.5, subsection 2, paragraph c, Code 11 10 Supplement 2001, is amended to read as follows: 11 11 c. A risk pool board is created. The board shall consist 11 12 of two county supervisors, two county auditors, a member of 11 13 thestate-county management committee created in section11 14331.438mental health and developmental disabilities 11 15 commission whowas not appointed by the Iowa state association11 16of countiesis not a member of a county board of supervisors 11 17 or employed by a service provider, a member of the county 11 18 finance committee created in chapter 333A who is not an 11 19 elected official, and two single entry point process 11 20 administrators, all appointed by the governor, and one member 11 21 appointed by the director of human services. All members 11 22 appointed by the governor shall be subject to confirmation by 11 23 the senate. Members shall serve for three-year terms. A 11 24 vacancy shall be filled in the same manner as the original 11 25 appointment. Expenses and other costs of the risk pool board 11 26 members representing counties shall be paid by the county of 11 27 origin. Expenses and other costs of risk pool board members 11 28 who do not represent counties shall be paid from a source 11 29 determined by the governor. Staff assistance to the board 11 30 shall be provided by the department of human services and 11 31 counties. Actuarial expenses and other direct administrative 11 32 costs shall be charged to the pool. 11 33 Sec. 19. CODE EDITOR DIRECTIVE. The Code editor shall 11 34 amend the headnote to section 331.438 to remove the reference 11 35 to "management committee" and instead reference the mental 12 1 health and developmental disabilities commission or utilize 12 2 other language as determined to be most appropriate by the 12 3 Code editor. 12 4 Sec. 20. ADOPTED RULES. Notwithstanding the transfer in 12 5 this Act of the authority to adopt rules from the council on 12 6 human services to the mental health and developmental 12 7 disabilities commission, a rule adopted by the council on 12 8 human services prior to July 1, 2002, shall remain in effect 12 9 unless amended or repealed by the commission or pursuant to 12 10 other executive or legislative branch action. 12 11 Sec. 21. COMMISSION MEMBERS. The revision in the 12 12 membership of the mental health and developmental disabilities 12 13 commission in accordance with section 225C.5, as amended by 12 14 this Act, shall be implemented by applying the new membership 12 15 requirements for voting members as membership terms expire and 12 16 other vacancies in membership occur. The revision shall be 12 17 fully complete on or before June 30, 2005. 12 18 EXPLANATION 12 19 This bill provides for the mental health and developmental 12 20 disabilities commission to assume the duties of the state- 12 21 county management committee, incorporates membership positions 12 22 from the committee into the commission, and transfers certain 12 23 rules adoption authority from the council on human services to 12 24 the commission. 12 25 Code section 225C.5, relating to the membership of the 12 26 commission, is amended to make the following revisions in the 12 27 membership appointed by the governor and confirmed by the 12 28 senate: the existing positions for county supervisors must be 12 29 appointed from nominees submitted by the supervisors affiliate 12 30 of the Iowa state association of counties, two positions are 12 31 designated for administrators of the county single entry point 12 32 process for mental health and developmental disabilities 12 33 services, one member is to be nominated by the state council 12 34 for the American association of federal, state, county, and 12 35 municipal employees, one member is to be nominated by service 13 1 consumers, and one member is to be nominated by service 13 2 advocates. In addition, four members of the general assembly 13 3 are to be designated by legislative leaders to serve in an ex 13 4 officio, nonvoting capacity. 13 5 The bill includes conforming changes throughout the Code to 13 6 change references to the state-county management committee to 13 7 the commission and to transfer rules adoption authority for 13 8 various county-administered mental health and developmental 13 9 disabilities services from the council on human services to 13 10 the commission. 13 11 Under current law, the primary responsibilities and 13 12 membership appointment provisions for the state-county 13 13 management committee are in Code section 331.438 as part of 13 14 the county home rule Code chapter. The bill transfers the 13 15 committee's duties to the commission, eliminates references to 13 16 the committee, and repeals the committee's membership 13 17 requirements in Code section 331.438. 13 18 The bill includes a directive to the Code editor to make a 13 19 conforming change to the headnote for Code section 331.438, 13 20 provides that the rules adopted by the council on human 13 21 services prior to the effective date of the Act will remain in 13 22 effect until amended or repealed by the commission or pursuant 13 23 to legislative or executive action, and provides that the 13 24 changes in the membership of the commission are to be 13 25 implemented by June 30, 2005, at the time there is membership 13 26 attrition. 13 27 LSB 6404SS 79 13 28 jp/sh/8
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