Text: HF00528 Text: HF00530 Text: HF00500 - HF00599 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 HOUSE FILE 529
1 2
1 3 AN ACT
1 4 DIRECTING THE MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
1 5 COMMISSION TO MAKE RECOMMENDATIONS FOR REDESIGNING THE MENTAL
1 6 HEALTH AND DEVELOPMENTAL DISABILITIES SERVICES SYSTEM FOR
1 7 ADULTS AND PROVIDING AN EFFECTIVE DATE.
1 8
1 9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 10
1 11 Section 1. MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
1 12 SERVICES SYSTEM REDESIGN.
1 13 In fulfilling the mental health and developmental
1 14 disabilities commission's duty under section 225C.6,
1 15 subsection 1, paragraph "q", the commission shall submit a
1 16 report containing recommendations in accordance with this
1 17 section to the governor and general assembly on or before
1 18 December 31, 2003, for redesign of the state's mental health
1 19 and developmental disabilities services system for adults.
1 20 The commission shall address all of the following system
1 21 components in the report and recommendations:
1 22 1. STANDARD CLINICAL AND FINANCIAL ELIGIBILITY.
1 23 The commission shall do all of the following:
1 24 a. Propose a standard set of clinical and diagnostic
1 25 eligibility requirements for use in determining which
1 26 individuals will be covered for defined core services,
1 27 including but not limited to, general clinical eligibility
1 28 standards, service access criteria, level of care
1 29 requirements, and terminology changes.
1 30 b. Propose financial eligibility criteria for qualifying
1 31 covered individuals, including guidelines for resources,
1 32 copayments, income, and assets.
1 33 c. Identify the total projected cost for all counties to
1 34 adopt the standardized clinical and financial eligibility
1 35 requirements and criteria proposed by the commission.
2 1 2. MINIMUM SET OF CORE SERVICES.
2 2 The commission shall do all of the following:
2 3 a. Identify a minimum set of core services to be provided
2 4 by each county. This core set of services shall be available
2 5 statewide. An individual's eligibility for core services
2 6 shall be based on consistent clinical criteria and service
2 7 necessity.
2 8 b. Identify the total projected cost for all counties to
2 9 make the core services available.
2 10 c. Design the core set of services as a replacement for
2 11 the current statutory mandates for services. The purpose of
2 12 replacing the current statutory mandates with the core set of
2 13 services is to shift the emphasis to community-based services
2 14 by providing covered individuals a reasonable level of choice
2 15 to meet their individual needs within available funding. The
2 16 initial set of core services considered by the commission
2 17 shall include all of the following community-based services:
2 18 (1) Mental health outpatient treatment.
2 19 (2) Inpatient psychiatric evaluation and treatment at
2 20 county-designated facilities.
2 21 (3) Service coordination and case management.
2 22 (4) Vocational services.
2 23 (5) Residential services.
2 24 3. FUNDING FOLLOWS THE COVERED INDIVIDUAL.
2 25 The commission shall include a process by which funding
2 26 follows the covered individual among the options considered,
2 27 including but not limited to the following:
2 28 a. Develop a new formula that allows public funding to
2 29 follow the covered individual regardless of categorical
2 30 funding. Distribution of state funds shall be based on a
2 31 matrix of disability-related reimbursement rate cells. Each
2 32 cell shall specify a reimbursement rate based on disability
2 33 group and level of functioning. The funding formula shall
2 34 take into account the number of covered individuals enrolled
2 35 in each county and the average cost of services provided to
3 1 covered individuals in each cell. The formula shall
3 2 incorporate all of the following principles:
3 3 (1) Each county will receive a quarterly allotment equal
3 4 to the product of the average costs per cell times the number
3 5 of individuals enrolled in each cell during the previous
3 6 quarter. To accommodate cash flow needs of counties and
3 7 reduce the level of fund balances counties need to maintain,
3 8 the state would make payments at the beginning of each quarter
3 9 based on the anticipated number of covered individuals, with a
3 10 reconciliation in the next quarter to the actual number of
3 11 covered individuals.
3 12 (2) Increasing overall state funding levels in proportion
3 13 to county funding levels.
3 14 (3) Allocating any increased state funding to achieve
3 15 statewide equity in service access.
3 16 (4) Allocating the state funding for state institutions
3 17 through counties rather than directly to the institutions so
3 18 that these services operate on an equal basis with other
3 19 services.
3 20 (5) Allocating state funding and administrative costs for
3 21 state cases to the covered individual's county of residence.
3 22 (6) Allocating the risk for service cost increases to the
3 23 counties and allocating the cost for increases in the number
3 24 of covered individuals to the state. Risk allocation
3 25 provisions shall address methods for managing the risk.
3 26 (7) Providing for risk management and flexibility
3 27 provisions such as cell rate adjustments, allowing waiting
3 28 lists to be used for an unanticipated increase in the number
3 29 of covered individuals, distributing quarterly allocations to
3 30 counties based upon the previous quarter's number of covered
3 31 individuals, removing categorical funding restrictions,
3 32 applying standards to ensure county cash flow capacity, and
3 33 allowing inflation adjustments.
3 34 (8) Expanding the state risk pool provisions under section
3 35 426B.5 to allow access to risk pool funding for specific
4 1 purposes and to allow counties to maintain a certain level of
4 2 fund balances in order to address certain cost factors.
4 3 b. All of the following factors shall be considered in
4 4 developing formula provisions for calculating the distribution
4 5 of funds:
4 6 (1) A county's ability to levy based on available taxable
4 7 valuation and average per capita income.
4 8 (2) A requirement for each county to have a fund balance
4 9 sufficient to cover all of the following:
4 10 (a) Cash flow for current services.
4 11 (b) Building maintenance and repair costs.
4 12 (c) Investments in new programs.
4 13 (d) A local risk pool that will cover extraordinary
4 14 expenses while a county is preparing an application to the
4 15 statewide risk pool.
4 16 (3) County costs for administration and infrastructure.
4 17 (4) Funds for counties to pay the costs of crisis
4 18 response, hospital diversion, prevention, consultation,
4 19 education, and outreach services that are provided outside the
4 20 rate cell methodology or fee payment policy.
4 21 (5) Incentives to counties for coordination,
4 22 collaboration, and infrastructure development.
4 23 c. Identify state and county costs to implement the
4 24 proposed funding formula for the individuals and services
4 25 identified under subsections 1 and 2.
4 26 4. ADDRESS THE LEGAL SETTLEMENT PROCESS.
4 27 The commission shall consider options for addressing the
4 28 deficiencies in the legal settlement process currently used
4 29 for determining governmental financial liability for service
4 30 costs. The options considered may include but are not limited
4 31 to providing for a transition to a system that provides for
4 32 service access based upon an individual's residency.
4 33 5. COORDINATION OF FUNDING STREAMS.
4 34 The commission shall do all of the following:
4 35 a. Develop a specific approach for counties and the state
5 1 to access additional federal housing funds.
5 2 b. In consultation with counties, support new efforts to
5 3 maximize federal funding for defined core services, including
5 4 accessing federal funds to support or match county
5 5 expenditures to standardize inpatient and outpatient treatment
5 6 and hospital diversion costs for Medicaid program recipients.
5 7 c. Develop recommendations identifying the manner in which
5 8 services will be funded by the federal government, the state,
5 9 and the counties.
5 10 Sec. 2. EFFECTIVE DATE. This Act, being deemed of
5 11 immediate importance, takes effect upon enactment.
5 12
5 13
5 14
5 15 CHRISTOPHER C. RANTS
5 16 Speaker of the House
5 17
5 18
5 19
5 20 MARY E. KRAMER
5 21 President of the Senate
5 22
5 23 I hereby certify that this bill originated in the House and
5 24 is known as House File 529, Eightieth General Assembly.
5 25
5 26
5 27
5 28 MARGARET THOMSON
5 29 Chief Clerk of the House
5 30 Approved , 2003
5 31
5 32
5 33
5 34 THOMAS J. VILSACK
5 35 Governor
Text: HF00528 Text: HF00530 Text: HF00500 - HF00599 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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