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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