House Amendment to Senate File 2315 S-5234 Amend Senate File 2315, as amended, passed, and 1 reprinted by the Senate, as follows: 2 1. Page 1, by striking line 21 and inserting 3 < consult with take into account any related planning 4 activities implemented by the Iowa department of public 5 health, the state > 6 2. Page 1, line 29, by striking < incorporate > and 7 inserting < incorporate > 8 3. Page 1, line 30, after < services > by inserting 9 < take into account > 10 4. Page 2, line 7, by striking < Coordinate of > and 11 inserting < of Coordinate > 12 5. Page 2, line 10, by striking < to > and inserting 13 < to in connection with > 14 6. Page 3, line 7, by striking < 331.440B. > and 15 inserting < 331.438C. A performance-based contract 16 shall require a regional administrator to fulfill the 17 statutory and regulatory requirements of the regional 18 service system under this chapter and chapter 331. A 19 failure to fulfill the requirements may be addressed 20 by remedies specified in the contract, including but 21 not limited to suspension of contract payments or 22 cancellation of the contract. The contract provisions 23 may include but are not limited to requirements for 24 the regional service system to attain outcomes within 25 a specified range of acceptable performance in any of 26 the following categories: 27 (1) Access standards for the required core 28 services. 29 (2) Penetration rates for serving the number of 30 persons expected to be served. 31 (3) Utilization rates for inpatient and residential 32 treatment. 33 (4) Readmission rates for inpatient and residential 34 treatment. 35 (5) Employment of the persons receiving services. 36 (6) Administrative costs. 37 (7) Data reporting. 38 (8) Timely and accurate claims processing. > 39 7. Page 3, line 7, by striking < pursuant to > and 40 inserting < as described in > 41 8. Page 3, line 28, after < 225C.6A, > by inserting 42 < unnumbered paragraph 1, > 43 9. Page 3, by striking line 30. 44 10. Page 3, line 31, before < The > by inserting < 1. > 45 11. Page 3, after line 33 by inserting: 46 < Sec. ___. Section 225C.6A, subsections 1 through 47 3, Code 2011, are amended to read as follows: > 48 12. Page 4, line 6, by striking < a. 1. > and 49 inserting < a. > 50 -1- SF2315.6030.H (2) 84 md 1/ 28 #1. #2. #3. #4. #5. #6. #7. #8. #9. #10. #11.

13. Page 4, line 15, by striking < b. 2. > and 1 inserting < b. > 2 14. Page 4, line 25, by striking < 3. > and inserting 3 < 2. > 4 15. By striking page 4, line 32, through page 5, 5 line 8. 6 16. Page 5, after line 8 by inserting: 7 < Sec. ___. Section 225C.6B, Code 2011, is amended 8 by adding the following new subsection: 9 NEW SUBSECTION . 3. State and regional disability 10 service systems. The publicly financed disability 11 services for persons with mental illness, intellectual 12 disability or other developmental disability, or 13 brain injury in this state shall be provided by 14 the department and the counties operating together 15 as regions. The financial and administrative 16 responsibility for such services is as follows: 17 a. Disability services for children and adults 18 that are covered under the medical assistance program 19 pursuant to chapter 249A are the responsibility of the 20 state. 21 b. Adult mental health and intellectual disability 22 services that are not covered under the medical 23 assistance program are the responsibility of the 24 county-based regional service system. > 25 17. Page 5, line 16, by striking < department > and 26 inserting < director of human services, in consultation 27 with the commission, > 28 18. Page 5, line 18, by striking < allowed growth > 29 and inserting < the increase in the costs of providing 30 services > 31 19. Page 5, line 20, by striking < allocate > and 32 inserting < distribute > 33 20. By striking page 5, line 27, through page 6, 34 line 1. 35 21. Page 6, line 7, by striking < 3, paragraph “c” > 36 and inserting < 3, paragraph “c” 2 > 37 22. Page 7, line 10, by striking < 1. a. > and 38 inserting < 1. > 39 23. By striking page 7, line 17, through page 8, 40 line 5, and inserting < state commission pursuant to 41 a recommendation made by the department. A regional 42 management plan shall include an annual service and 43 budget plan, a policies and procedures manual, and an 44 annual report. Each region’s initial plan shall be 45 submitted to the department by April 1, 2014. 46 2. Each region shall submit to the department an 47 annual service and budget plan approved by the region’s 48 governing board and subject to approval by the director 49 of human services. Provisions for the director of 50 -2- SF2315.6030.H (2) 84 md 2/ 28 #13. #14. #15. #16. #17. #18. #19. #20. #21. #22.

human services’ approval of the annual service and 1 budget plan, and any amendments to the plan, and other 2 requirements shall be specified in rule adopted by the 3 state commission. The provisions addressed in the 4 annual plan shall include but are not limited to all 5 of the following: 6 a. The region’s budget and financing provisions for 7 the next fiscal year. The provisions shall address how 8 county, regional, state, and other funding sources will 9 be used to meet the service needs within the region. 10 b. The scope of services included in addition to 11 the required core services. Each service included 12 shall be described and projection of need and the 13 funding necessary to meet the need shall be included. 14 c. The location of the local access points for 15 services. 16 d. The plan for assuring effective crisis 17 prevention, response, and resolution. 18 e. The provider reimbursement provisions. A 19 region’s use of provider reimbursement approaches in 20 addition to fee-for-service reimbursement and for 21 compensating the providers engaged in a systems of care 22 approach and other nontraditional providers shall be 23 encouraged. A region also shall be encouraged to use 24 and the department shall approve funding approaches 25 that identify and incorporate all services and 26 sources of funding used by persons receiving services, 27 including medical assistance program funding. 28 f. Financial forecasting measures. 29 g. The targeted case managers designated for the 30 region. 31 3. Each region shall submit an annual report to the 32 department on or before December 1. The annual report 33 shall provide information on the actual numbers of 34 persons served, moneys expended, and outcomes achieved. 35 4. The region shall have in effect a policies and 36 procedures manual for the regional service system. The 37 manual shall be approved by the region’s governing 38 board and is subject to approval by the director of 39 human services. An approved manual shall remain in 40 effect subject to amendment. An amendment to the 41 manual shall be submitted to the department at least 42 forty-five days prior to the date of implementation of 43 the amendment. Prior to implementation of an amendment 44 to the manual, the amendment must be approved by the 45 director of human services in consultation with the 46 state commission. The manual shall include but is not 47 limited to all of the following: 48 a. A description of the region’s policies and 49 procedures for financing and delivering the services 50 -3- SF2315.6030.H (2) 84 md 3/ 28

included in the annual service and budget plan. 1 b. The enrollment and eligibility process. 2 c. The method of annual service and budget plan 3 administration. 4 d. The process for managing utilization and access 5 to services and other assistance. The process shall 6 also describe how coordination between the services 7 included in the annual service and budget plan and 8 the disability services administered by the state and 9 others will be managed. 10 e. The quality management and improvement 11 processes. 12 f. The risk management provisions and fiscal 13 viability of the annual service and budget plan, if the 14 region contracts with a private entity. 15 g. The requirements for designation of targeted 16 case management providers and for implementation 17 of evidence-based models of case management. The 18 requirements shall be designed to provide the person 19 receiving the case management with a choice of 20 providers, allow a service provider to be the case 21 manager but prohibit the provider from referring a 22 person receiving the case management only to services 23 administered by the provider, and include other 24 provisions to ensure compliance with but not exceed 25 federal requirements for conflict-free case management. 26 The qualifications of targeted case managers and other 27 persons providing service coordination under the 28 management plan shall be specified in the rules. The 29 rules shall also include but are not limited to all of 30 the following relating to targeted case management and 31 service coordination services: 32 (1) Performance and outcome measures relating to 33 the health, safety, work performance, and community 34 residency of the persons receiving the services. 35 (2) Standards for delivery of the services, 36 including but not limited to social history, 37 assessment, service planning, incident reporting, 38 crisis planning, coordination, and monitoring for 39 persons receiving the services. 40 (3) Methodologies for complying with the 41 requirements of this paragraph “g” which may include 42 the use of electronic recordkeeping and remote or 43 internet-based training. 44 h. A plan for a systems of care approach in which 45 multiple public and private agencies partner with 46 families and communities to address the multiple needs 47 of the persons and their families involved with the 48 regional service system. 49 i. Measures to provide services in a decentralized 50 -4- SF2315.6030.H (2) 84 md 4/ 28

manner that utilize the strengths and assets of 1 the administrators and service providers within and 2 available to the region. 3 j. A plan for provider network formation and 4 management. 5 k. Service provider payment provisions. 6 l. A process for resolving grievances. 7 m. Measures for implementing interagency and 8 multisystem collaboration and care coordination. 9 5. The provisions of a regional service system 10 management plan shall include measures to address the 11 needs of persons who have two > 12 24. Page 8, line 9, by striking < individuals > and 13 inserting < persons > 14 25. Page 8, after line 16 by inserting: 15 < ___. If a county has been exempted pursuant to 16 section 331.438B from the requirement to enter into a 17 regional service system, the county and the county’s 18 board of supervisors shall fulfill all requirements 19 under this chapter for a regional service system, 20 regional service system management plan, regional 21 governing board, and regional administrator, and any 22 other provisions applicable to a region of counties 23 providing local mental health and disability services. > 24 26. By striking page 8, line 24, through page 10, 25 line 13. 26 27. Page 10, by striking lines 17 and 18 and 27 inserting < in the core services required under section 28 331.439D, subject to the availability of funding. > 29 28. Page 11, line 7, by striking < disability 30 services > and inserting < regional service system > 31 29. Page 11, by striking lines 10 through 12 and 32 inserting < hundred percent of the federal poverty 33 level. > 34 30. Page 11, line 25, by striking < is fully able to 35 absorb the cost > and inserting < is not reimbursed for 36 the cost with public funds > 37 31. Page 11, line 34, after < commission > by 38 inserting < pursuant to a recommendation made by the 39 department > 40 32. Page 12, line 23, by striking < diagnosable > 41 33. Page 12, line 24, after < disorder > by inserting 42 < or, in the opinion of a mental health professional, 43 may now have such a diagnosable disorder > 44 34. Page 13, lines 4 and 5, by striking < or other 45 developmental disability > 46 35. Page 14, by striking lines 8 through 18 and 47 inserting < otherwise requires, “domain” means a set of 48 similar services that > 49 36. Page 14, line 19, by striking < an individual’s > 50 -5- SF2315.6030.H (2) 84 md 5/ 28 #24. #25. #26. #27. #28. #29. #30. #31. #32. #33. #34. #35.

and inserting < a person’s > 1 37. Page 14, by striking line 23 and inserting: 2 < (2) The director of > 3 38. Page 14, line 28, by striking < individuals > and 4 inserting < persons > 5 39. Page 14, line 30, by striking < individual > and 6 inserting < person > 7 40. Page 14, line 32, by striking < individual > and 8 inserting < person > 9 41. Page 14, line 34, by striking < (3) > and 10 inserting < b. > 11 42. Page 15, line 3, by striking < an individual > 12 and inserting < an individual person > 13 43. Page 15, line 6, by striking < individual > and 14 inserting < individual person > 15 44. Page 15, line 9, by striking < b. > and inserting 16 < c. > 17 45. Page 15, line 20, after < program. > by inserting 18 < The rules relating to the credentialing of a person 19 directly providing services shall require all of the 20 following: 21 a. The person shall provide services and represent 22 the person as competent only within the boundaries 23 of the person’s education, training, license, 24 certification, consultation received, supervised 25 experience, or other relevant professional experience. 26 b. The person shall provide services in substantive 27 areas or use intervention techniques or approaches 28 that are new only after engaging in appropriate 29 study, training, consultation, and supervision from a 30 person who is competent in those areas, techniques, or 31 approaches. 32 c. If generally recognized standards do not 33 exist with respect to an emerging area of practice, 34 the person shall exercise careful judgment and take 35 responsible steps, including obtaining appropriate 36 education, research, training, consultation, and 37 supervision, in order to ensure competence and to 38 protect from harm the persons receiving the services in 39 the emerging area of practice. > 40 46. Page 16, line 32, by striking < crisis > and 41 inserting < facility and community-based crisis > 42 47. Page 17, by striking line 15 and inserting: 43 < (3) Peer self-help drop-in centers. > 44 48. Page 17, line 34, by striking < a. > 45 49. Page 18, by striking lines 9 through 25. 46 50. Page 19, line 5, by striking < 331.439E > and 47 inserting < 331.439D > 48 51. Page 19, line 26, after < department > by 49 inserting < of human services > 50 -6- SF2315.6030.H (2) 84 md 6/ 28 #37. #38. #39. #40. #41. #42. #43. #44. #45. #46. #47. #48. #49. #50.

52. Page 19, after line 34 by inserting: 1 < 3. a. The department of human services shall 2 create a transition committee of appropriate 3 stakeholders with whom to consult on the transition 4 from the current mental health and disability services 5 system to the regional service system as provided 6 in this Act. The transition committee shall make 7 recommendations to the governor and general assembly 8 concerning the efficacy of the property tax levy and 9 other funding provisions for the regional service 10 system, including measures for equalization payments, 11 growth, and addressing the effects of population 12 shifts among the counties. In addition, the transition 13 committee shall consider the data collected for the 14 current system and for the new regional system and 15 whether improvements are warranted. 16 b. In designating the committee members, the 17 director of human services shall consult with the 18 chairpersons and ranking members of the committees 19 on human resources of the senate and house of 20 representatives and other members of the general 21 assembly identified by the majority or minority leader 22 of the senate or the speaker or minority leader of the 23 house of representatives. In addition, the membership 24 shall include four members of the general assembly, 25 with one each appointed by the majority and minority 26 leader of the senate and the speaker and minority 27 leader of the house of representatives. > 28 53. Page 19, after line 34 by inserting: 29 < Sec. ___. MENTAL HEALTH AND DISABILITY SERVICES 30 REDESIGN TRANSITION FUND. 31 1. A mental health and disability services redesign 32 transition fund is created under the authority of 33 the department of human services for the fiscal year 34 beginning July 1, 2012, and ending June 30, 2013. 35 Moneys credited to the fund shall be used as provided 36 in appropriations made from the fund, to be enacted by 37 the general assembly, for allocation by the department 38 to counties for one-time assistance for continuation 39 of current core county mental health and disability 40 services to targeted populations that are not funded by 41 the Medicaid program. 42 2. The eligibility provisions for a county to 43 receive moneys from the fund shall include but are not 44 limited to all of the following: 45 a. The application and application materials 46 submitted are approved by the county board of 47 supervisors. 48 b. The county levy certified for the county’s 49 services fund under section 331.424A for the fiscal 50 -7- SF2315.6030.H (2) 84 md 7/ 28 #52. #53.

year is the maximum amount authorized by law. 1 c. The county financial information provided 2 with the application is independently verified. The 3 financial information to be provided shall be specified 4 by the department and may include actual and projected 5 cash and accrued fund balances, detailed accounts 6 receivable and payable information, budgeted revenues 7 and expenditures, identification of the need for the 8 amount requested, and costs for the county’s services 9 administration. 10 d. The required county service information is 11 provided with the application. The county service 12 information to be provided shall be specified by the 13 department and may include the following: 14 (1) The type, amount, and scope of services 15 provided by the county as compared with other counties. 16 (2) The extent to which the county subsidizes the 17 services directly provided or authorized by the county. 18 (3) The extent to which the services funded by the 19 county are included in the county’s management plan 20 approved under section 331.439. 21 (4) The extent to which services are provided 22 to persons other than adults with an intellectual 23 disability or mental illness with income that is at or 24 below 150 percent of the federal poverty level. 25 e. The application contains a sustainability plan 26 in accordance with the requirements specified by the 27 department. The requirements shall include but are not 28 limited to explanation as to how the moneys requested 29 will be used during this transition year to provide 30 services in a manner that will allow the county to 31 remain within the funding available to the county under 32 per capita funding provisions, applicable to the county 33 as enacted by this Act, commencing with the fiscal year 34 beginning July 1, 2013. 35 f. The application is submitted on or before the 36 specified application date. The initial application 37 date specified shall be on or after October 15, 2012. 38 g. Other items specified by rule. The department 39 shall consult with the transition committee created by 40 this division of this Act in recommending the adoption 41 of rules by the mental health and disability services 42 commission delineating the requirements for funding 43 under this section. 44 3. The department may provide for distribution 45 provisions in which the amount awarded is distributed 46 in more than one payment based upon actual expenditures 47 and submission of required information. 48 4. The mental health and disability services 49 commission may adopt administrative rules under section 50 -8- SF2315.6030.H (2) 84 md 8/ 28

17A.4, subsection 3, and section 17A.5, subsection 1 2, paragraph “b”, to implement the provisions of 2 this section, and the rules shall become effective 3 immediately upon filing or on a later effective date 4 specified in the rules, unless the effective date is 5 delayed by the administrative rules review committee. 6 Any rules adopted in accordance with this subsection 7 shall not take effect before the rules are reviewed 8 by the administrative rules review committee. The 9 delay authority provided to the administrative rules 10 review committee under section 17A.4, subsection 7, and 11 section 17A.8, subsection 9, shall be applicable to a 12 delay imposed under this subsection, notwithstanding a 13 provision in those sections making them inapplicable 14 to section 17A.5, subsection 2, paragraph “b”. Any 15 rules adopted in accordance with the provisions of 16 this subsection shall also be published as notice of 17 intended action as provided in section 17A.4. > 18 54. Page 20, line 2, by striking < department of 19 human services > and inserting < department of public 20 health > 21 55. Page 20, line 9, by striking < director of human 22 services > and inserting < director of public health > 23 56. Page 20, line 12, after < representatives > by 24 inserting < and other members of the general assembly 25 identified by the majority or minority leader of the 26 senate or the speaker or minority leader of the house 27 of representatives > 28 57. Page 21, line 4, after < representatives > by 29 inserting < and other members of the general assembly 30 identified by the majority or minority leader of the 31 senate or the speaker or minority leader of the house 32 of representatives > 33 58. Page 21, after line 27 by inserting: 34 < Sec. ___. CHILDREN’S DISABILITY SERVICES 35 WORKGROUP. The December 2012 report of the workgroup 36 created by the department of human services pursuant 37 to 2011 Iowa Acts, chapter 121, section 1, to develop 38 a proposal for publicly funded children’s disability 39 services shall include an analysis of service and 40 cost effects of transitioning the behavioral health 41 intervention services formerly known as remedial 42 services and the psychiatric medical institution 43 for children services to the Iowa plan. The report 44 shall also provide a specific proposal for developing 45 services in this state to meet the needs of children 46 who are placed out-of-state due to the lack of 47 treatment services in this state. The workgroup 48 membership shall be expanded to include up to four 49 legislators, with one each appointed by the majority 50 -9- SF2315.6030.H (2) 84 md 9/ 28 #54. #55. #56. #57. #58.

leader and the minority leader of the senate and 1 the speaker and the minority leader of the house of 2 representatives. > 3 59. Page 21, after line 27 by inserting: 4 < Sec. ___. DISPUTED BILLINGS. 5 1. To the extent allowable under federal law or 6 regulation, if the costs of a service are payable in 7 whole or in part by a county in accordance with a 8 chapter of the Code listed in this section, the service 9 was rendered prior to July 1, 2011, and the county that 10 would be obligated to pay for the costs of the service 11 has not been billed for the service or has disputed the 12 billing prior to the effective date of this section, or 13 the state has fully charged off the cost of the service 14 or has not provided information to appropriately 15 document the basis for the billing, the county shall 16 have no obligation to pay for the service. 17 2. This section is applicable to service costs that 18 are a county obligation for services provided under any 19 of the following chapters of the Code: 20 a. Chapter 221. 21 b. Chapter 222. 22 c. Chapter 230. 23 d. Chapter 233B. 24 e. Chapter 249A. 25 f. Chapter 812. > 26 60. Page 24, by striking lines 12 through 15 and 27 inserting: 28 < 1. a. Local access to mental health and 29 disability services for adults shall be provided either 30 by counties organized into a regional service system or 31 by individual counties that are exempted as provided 32 by this subsection. The department of human services 33 shall encourage counties to enter into a regional 34 system when the regional approach is likely to increase 35 the availability of services to residents of the state 36 who need the services. It is the intent of the general 37 assembly that the adult residents of this state should 38 have access to needed mental health and disability 39 services regardless of the location of their residence. 40 b. (1) The director of human services shall exempt 41 a county from being required to enter into a regional 42 service system if the county furnishes evidence 43 that the county complies with the requirements in 44 subsection 3, paragraphs “d” , “e” , “f” , and “g” , and 45 is able to provide the core services required by law 46 to the county’s residents in a manner that is as cost 47 effective and with outcomes that are at least equal to 48 what could be provided to the residents if the county 49 would provide the services through a regional service 50 -10- SF2315.6030.H (2) 84 md 10/ 28 #59. #60.

system. The director shall identify criteria for 1 evaluating the evidence provided by counties applying 2 for the exemption. The criteria identified shall be 3 specified in rule adopted by the state commission. 4 (2) To be considered for an exemption under 5 subparagraph (1), a county must file a written 6 statement of intent to apply for an exemption with the 7 department on or before May 1, 2013, and the county’s 8 exemption application must be filed with the department 9 on or before June 30, 2013. The director of human 10 services shall issue a decision on the application 11 within forty-five days of receiving the application. 12 This subparagraph is repealed July 1, 2013. 13 c. If a county has been exempted pursuant to 14 this subsection from the requirement to enter into a 15 regional service system, the county and the county’s 16 board of supervisors shall fulfill all requirements 17 under this chapter and chapter 225C for a regional 18 service system, regional service system management 19 plan, regional governing board, and regional 20 administrator, and any other provisions applicable to 21 a region of counties providing local mental health and 22 disability services. > 23 61. Page 24, by striking lines 20 and 21 and 24 inserting < to the minimum number of counties if there 25 is convincing evidence that > 26 62. Page 24, line 24, by striking < region > and 27 inserting < region, unless exempted pursuant to 28 subsection 1 > 29 63. Page 24, by striking lines 29 through 31. 30 64. Page 25, lines 1 and 2, by striking < with 31 assistance from psychiatric consultants > and inserting 32 < through contractual arrangements with mental health 33 professionals qualified to provide psychiatric 34 services > 35 65. Page 26, line 7, by striking < region > and 36 inserting < region, unless exempted pursuant to 37 subsection 1 > 38 66. Page 26, line 10, by striking < November 1, 39 2012 > and inserting < April 1, 2013 > 40 67. Page 26, line 11, by striking < June 30, 2015, > 41 and inserting < June 30, 2014, unless exempted pursuant 42 to subsection 1, > 43 68. Page 26, line 27, by striking < access > and 44 inserting < local access > 45 69. Page 27, line 8, by striking < with the 46 concurrence of > and inserting < in consultation with > 47 70. Page 27, after line 13 by inserting: 48 < ___. If the department determines that a region 49 or an exempted county is not adequately fulfilling the 50 -11- SF2315.6030.H (2) 84 md 11/ 28 #61. #62. #63. #64. #65. #66. #67. #68. #69. #70.

requirements under this chapter for a regional service 1 system, the department shall address the region or 2 county in the following order: 3 a. Require compliance with a corrective action 4 plan. 5 b. Reduce the amount of the annual state funding 6 provided for the regional service system, not to exceed 7 fifteen percent of the amount. 8 c. Withdraw approval for the region or for the 9 county exemption, as applicable. > 10 71. Page 27, by striking lines 25 through 34 and 11 inserting: 12 < b. The membership of the governing board shall 13 also include one individual who utilizes mental health 14 and disability services or is an actively involved 15 relative of such an individual. This member shall 16 be designated by the advisory committee or committees 17 formed by the governing board purusant to this section. 18 The member designated in accordance with this paragraph 19 shall serve in a nonvoting, ex officio capacity. > 20 72. Page 28, by striking lines 2 through 9 and 21 inserting: 22 < d. The membership of the governing board shall 23 also consist of one member representing service 24 providers in the region. This member shall be 25 designated by the advisory committee or committees 26 formed by the governing board pursuant to this section. 27 The member designated in accordance with this paragraph 28 shall serve in a nonvoting, ex officio capacity. > 29 73. Page 28, line 14, after < 3. > by inserting < a. > 30 74. Page 28, line 16, after < department > by 31 inserting < in accordance with section 225C.4, 32 subsection 1, paragraph “u” > 33 75. Page 28, after line 22 by inserting: 34 < b. The regional administrator staff shall 35 include one or more coordinators of disability 36 services. A coordinator shall possess a bachelor’s 37 or higher level degree in a human services-related 38 or administrative-related field, including but not 39 limited to social work, psychology, nursing, or public 40 or business administration, from an accredited college 41 or university. However, in lieu of a degree in public 42 or business administration, a coordinator may provide 43 documentation of relevant management experience. An 44 action of a coordinator involving a clinical decision 45 shall be made in conjunction with a professional who 46 is trained in the delivery of the mental health or 47 disability service addressed by the clinical decision. 48 The regional administrator shall determine whether 49 referral to a coordinator of disability services is 50 -12- SF2315.6030.H (2) 84 md 12/ 28 #71. #72. #73. #74. #75.

required for a person seeking to access a service 1 through a local access point of the regional service 2 system. > 3 76. Page 31, line 29, by striking < in the county > 4 77. Page 31, line 35, by striking < a > and inserting 5 < the > 6 78. Page 32, after line 8 by inserting: 7 < ___. “Mental health professional” means the same as 8 defined in section 228.1. > 9 79. Page 32, lines 11 and 12, by striking < service 10 authorization or other services-related determination > 11 and inserting < a decision regarding a service 12 authorization or other services-related decision > 13 80. Page 32, after line 16 by inserting: 14 < 3. If a service authorization or other 15 services-related decision made by a regional 16 administrator concerning a person varies from the type 17 and amount of service identified to be necessary for 18 the person in a clinical determination made by a mental 19 health professional and the mental health professional 20 believes that failure to provide the type and amount of 21 service identified could cause an immediate danger to 22 the person’s health or safety, the person may request 23 an expedited review of the regional administrator’s 24 decision to be made by the department of human 25 services. An expedited review held in accordance with 26 this subsection is subject to the following procedures: 27 a. The request for the expedited review shall 28 be filed within five business days of receiving the 29 notice of decision by the regional administrator. The 30 request must be in writing, plainly state the request 31 for an expedited review in the caption and body of the 32 request, and be supported by written documentation from 33 the mental health professional who made the clinical 34 determination stating how the notice of decision 35 on services could cause an immediate danger to the 36 person’s health or safety. 37 b. The expedited review shall be performed by 38 a mental health professional, who is either the 39 administrator of the division of mental health 40 and disability services of the department of human 41 services or the administrator’s designee. If the 42 administrator is not a mental health professional, the 43 expedited review shall be performed by a designee of 44 the administrator who is a mental health professional 45 and is free of any conflict of interest to perform 46 the expedited review. The expedited review shall be 47 performed within two business days of the time the 48 request is filed. If the reviewer determines the 49 information submitted in connection with the request is 50 -13- SF2315.6030.H (2) 84 md 13/ 28 #76. #77. #78. #79. #80.

inadequate to perform the review, the reviewer shall 1 request the submission of additional information and 2 the review shall be performed within two business days 3 of the time that adequate information is submitted. 4 The regional administrator and the person, with the 5 assistance of the mental health professional who made 6 the clinical determination shall each provide a brief 7 statement of facts, conclusions, and reasons for the 8 decision made. Supporting clinical information shall 9 also be attached. All information related to the 10 proceedings and any related filings shall be considered 11 to be mental health information subject to chapter 228. 12 c. The administrator or designee shall issue an 13 order, including a brief statement of findings of fact, 14 conclusions of law, and policy reasons for the order, 15 to justify the decision made concerning the expedited 16 review. If the decision concurs with the contention 17 that there is an immediate danger to the person’s 18 health or safety, the order shall identify the type 19 and amount of service which shall be provided for the 20 person. The administrator or designee shall give such 21 notice as is practicable to persons who are required 22 to comply with the order. The order is effective when 23 issued. 24 d. The decision of the administrator or designee 25 shall be considered a final agency action and is 26 subject to judicial review in accordance with section 27 17A.19. The record for judicial review consists of any 28 documents regarding the matter that were considered 29 or prepared by the administrator or designee. The 30 administrator or designee shall maintain these 31 documents as the official record of the decision. If 32 the matter is appealed to the district court, the 33 record shall be filed as confidential. > 34 81. Page 32, line 16, by striking < a final agency 35 decision > and inserting < final agency action > 36 82. Page 32, line 17, by striking < 3. > and 37 inserting < 4. > 38 83. Page 32, line 29, by striking < 4. > and 39 inserting < 5. > 40 84. Page 33, line 10, by striking < section > and 41 inserting < subsection > 42 85. Page 33, line 30, by striking < is a > and 43 inserting < shall be considered > 44 86. Page 34, line 4, by striking < section > and 45 inserting < subsection > 46 87. Page 34, line 25, by striking < decision > and 47 inserting < determination > 48 88. Page 34, after line 27 by inserting: 49 < 5. a. The dispute resolution process implemented 50 -14- SF2315.6030.H (2) 84 md 14/ 28 #81. #82. #83. #84. #85. #86. #87. #88.

in accordance with this subsection applies to 1 billing disputes between the state and a county 2 or region, other than residency disputes or other 3 dispute processes under this section, involving the 4 responsibility for service costs under any of the 5 following: 6 (1) Chapter 221. 7 (2) Chapter 222. 8 (3) Chapter 230. 9 (4) Chapter 249A. 10 (5) Chapter 812. 11 b. If a county, region, or the department, as 12 applicable, disputes a billing for service costs listed 13 in paragraph “a” , the dispute shall be resolved as 14 provided in this subsection. The county or region 15 shall notify the department of the county’s or region’s 16 assertion within ninety days of receiving the billing. 17 If the department disputes such a billing of a regional 18 administrator, the department shall notify the affected 19 counties or regions of the department’s assertion. 20 c. The department, county, or region that received 21 the notification, as applicable, shall respond to the 22 party that provided the notification within forty-five 23 days of receiving the notification. If the parties 24 cannot agree to a settlement as to the dispute within 25 ninety days of the date of notification, on motion of 26 any of the parties, the matter shall be referred to the 27 department of inspections and appeals for a contested 28 case hearing under chapter 17A before an administrative 29 law judge assigned in accordance with section 10A.801 30 to determine facts and issue a decision to resolve the 31 dispute. 32 d. (1) The administrative law judge’s decision 33 is a final agency action, notwithstanding contrary 34 provisions of section 17A.15. The party that does 35 not prevail in the decision or subsequent judicial 36 review is liable for costs associated with the 37 proceeding, including reimbursement of the department 38 of inspections and appeals’ actual costs associated 39 with the administrative proceeding. Judicial review of 40 the decision may be sought in accordance with section 41 17A.19. 42 (2) If following the decision regarding a dispute 43 in accordance with this subsection, additional 44 evidence becomes available that merits a change in that 45 decision, the parties affected may change the decision 46 by mutual agreement. Otherwise, a party may move that 47 the matter be reconsidered by the department, county, 48 or region, or by the administrative law judge. 49 e. (1) Unless a petition is filed for judicial 50 -15- SF2315.6030.H (2) 84 md 15/ 28