441—25.91 (331) Exemption from joining into mental health and disability services region.
	 25.91(1) Definitions.
“Applicant” means a single county or two counties that submit an application for an exemption from the requirement to join a region of three or more contiguous counties.
“Clear lines of accountability” means the governing board’s organizational structure makes it evident that the ultimate responsibility for the administration of non-Medicaid-funded mental health and disability services lies with the governing board and that the governing board directly and solely supervises the organization’s chief executive officer.
“Coordinator of disability services” means a person who meets the qualifications of a coordinator of disability services as defined in Iowa Code section 331.390(3)“b” and is responsible for ensuring that individuals receive effective service coordination consistent with the county’s or counties’ management plan.
“Core services” means core services mandated to be provided by the regional service system as defined in Iowa Code section 331.397.
“Department” means the Iowa department of human services.
“Director” means the director of the department.
“Evidence-based practice” means interventions that have been rigorously tested, have yielded consistent, replicable results, and have proven safe, beneficial, and effective.
“Penetration rate,” for the purposes of this rule, means the per capita number of adults in the adult population of a county who are receiving mental health and disability services.
“Reasonably close proximity” means a distance of 100 miles or less or a driving distance of two hours or less from the county seat or county seats of the applicant.
“Trauma-informed care” means services that are based on an understanding of the vulnerabilities or triggers of individuals who have experienced trauma, recognize the role trauma has played in the lives of those individuals, are supportive of trauma recovery, and avoid retraumatization.
	 25.91(2) Application for exemption from the requirement to form a region of three or more contiguous counties. The following requirements apply to an application for exemption from the requirement to form a region of three or more contiguous counties:
	  a.   	 The applicant shall submit a written statement that the applicant intends to apply for an exemption from the requirement to form a region of three or more contiguous counties. The statement must be signed by the chairperson of the county board of supervisors of the applicant’s county. The signed written statement of intent must be received by the department on or before May 1, 2013, at 4:30 p.m.
	  b.   	 The applicant shall submit a written application on forms specified by the department with required supporting documentation. The department shall only accept applications that are complete, signed by the applicant’s chairperson of the county board of supervisors, dated, and received by the department on or before June 30, 2013, at 4:30 p.m.
	  c.   	 The director of the department shall issue a decision on the application within 45 days of receiving the application. The director shall deny an application if the application does not meet the criteria described in Iowa Code or rule.
	 25.91(3) Applicant criteria. The application shall include written documentation and evidence that the applicant has:
	  a.   	 The capacity to provide required core services and perform required functions described in Iowa Code section 331.397.
	  b.   	 A contract with a community mental health center or a federally qualified health center that provides psychiatric and outpatient mental health services in the applicant’s county or counties or written intent from the community mental health center or federally qualified health center to enter into such a contract.
	  c.   	 A contract with a hospital with an inpatient psychiatric unit or a state mental health institute located in or within reasonably close proximity that has the capacity to provide inpatient services to the applicant or written intent from the state mental health institute or inpatient psychiatric unit to enter into such a contract.
	  d.   	 An administrative structure with clear lines of accountability. A description of the applicant’s administrative functions shall be included with the application.
	  e.   	 Taken steps to determine and demonstrate that forming a region of three or more contiguous counties is not workable.
	 25.91(4) Core services and required functions standards. The department shall review the application to determine if the applicant has provided written documentation and evidence for the availability of:
	  a.   	 A 24-hour, 7-day-a-week, 365-days-per-year telephone response system for mental health and disability-related emergencies in the applicant’s county or counties.
	  b.   	 Service providers in the applicant’s county or counties that demonstrate the capability of providing evidence-based practices that the applicant has independently verified meet established fidelity to evidence-based service models including, but not limited to:
	 (1) 	 Assertive community treatment or strengths-based case management.
	 (2) 	 Integrated treatment of co-occurring substance abuse and mental health disorders.
	 (3) 	 Supported employment.
	 (4) 	 Family psychoeducation.
	 (5) 	 Illness management and recovery.
	 (6) 	 Permanent supportive housing.
	  c.   	 Service providers in the applicant’s county or counties that are trained to provide effective services to persons with two or more of the following co-occurring conditions: mental illness, intellectual disability, developmental disability, brain injury, or substance use disorder. Training for serving persons with co-occurring conditions shall be training identified by the Substance Abuse and Mental Health Services Administration, the Dartmouth Psychiatric Research Center or other generally recognized professional organization specified in the application.
	  d.   	 Service providers in the applicant’s county or counties that are trained to provide effective trauma-informed care. Trauma-informed care training shall be training identified by the National Center for Trauma-Informed Care or other generally recognized professional organization specified in the application.
	 25.91(5) Service capacity. The department shall review the material provided in the application and by the applicant and other counties in their required county reports to determine if the applicant demonstrates that it has:
	  a.   	 Sufficient financial resources to fund required core services.
	  b.   	 A penetration rate that is at least equal to or exceeds the statewide per capita average for individuals with a mental illness or individuals with an intellectual disability.
	  c.   	 A per capita use of inpatient psychiatric hospital services that is less than or equal to the statewide per capita average.
	  d.   	 A per capita use of intermediate care facilities for individuals with intellectual disabilities that is less than or equal to the statewide per capita average.
	  e.   	 A per capita use of outpatient mental health services that is greater than or equal to the statewide per capita average.
	  f.   	 A per capita use of supported community living services that is greater than or equal to the statewide per capita average.
	  g.   	 An average cost of service per individual served that is equal to or less than the statewide average.
	  h.   	 Administrative costs, as a percentage of non-Medicaid service expenditures, that are less than or equal to the statewide average.
	 25.91(6) Provider network sufficiency. The department shall review the application to determine if the applicant provided written documentation and evidence of:
	  a.   	 A contract with a community mental health center that provides services in the applicant’s county or counties or a federally qualified health center that provides psychiatric and outpatient mental health services in the applicant’s county or counties or written intent by a community mental health center or federally qualified health center to enter into such a contract.
	  b.   	 Contracts with licensed and accredited providers to provide each service in the required core service domains or written intent by providers to enter into such contracts.
	  c.   	 Adequate numbers of licensed and accredited providers to ensure availability of core services so that there is no waiting list for services due to lack of available providers.
	  d.   	 A contract with an inpatient psychiatric hospital unit or state mental health institute within reasonably close proximity or written intent by an inpatient psychiatric hospital unit or state mental health institute to enter into such a contract.
	 25.91(7) to 25.91(9) Reserved.
	 25.91(10) Staffing. The department shall review the application to determine if the applicant provided written documentation and evidence of:
	  a.   	 Clear lines of accountability.
	  b.   	 The inclusion of one or more coordinators of disability services on the county administrator staff.
	 25.91(11) Reserved.
	 25.91(12) Determination that formation of a region is unworkable. The department shall review the application to determine if the applicant has provided documentation and convincing evidence that the applicant has evaluated the feasibility of forming into a region of three or more contiguous counties and that forming into such a region is unworkable.
	 25.91(13) Compliance with requirements of a mental health and disability services region. The applicant shall continuously fulfill all of the requirements of a region under Iowa Code chapters 331 and 225C for a regional service system, regional service system management plan, regional governing board, and regional administrator and any other requirements applicable to a region of counties providing local mental health and disability services. If the applicant does not fulfill these requirements, the department may address the deficiencies in the following order:
	  a.   	 Require compliance with a corrective action plan that may include, but is not limited to, participation in technical assistance provided or arranged by the department, revision of the regional management plan, or other corrective actions required by the department.
	  b.   	 Reduce the amount of the annual state funding provided through the mental health and disabilities regional services fund for the regional service system, not to exceed 15 percent of the amount of the annual state funding.
	  c.   	 Withdraw approval for the county exemption.
This rule is intended to implement Iowa Code section 331.389.
[ARC 0576C, IAB 2/6/13, effective 1/8/13]