House File 650 H-1415 Amend House File 650 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. Section 222.73, subsection 2, paragraph b, Code 4 2017, is amended to read as follows: 5 b. The per diem costs billed to each mental health and 6 disability services region shall not exceed the per diem costs 7 billed to the county region in the fiscal year beginning July 8 1, 1996 2016 . However, the per diem costs billed to a county 9 may be adjusted for a fiscal year to reflect increased costs 10 to the extent of the percentage increase in the statewide per 11 capita expenditure target amount, if any per capita growth 12 amount is authorized by the general assembly for that fiscal 13 year in accordance with section 331.424A . 14 Sec. 2. Section 229.11, Code 2017, is amended by adding the 15 following new subsection: 16 NEW SUBSECTION . 1A. If a respondent is detained pursuant to 17 subsection 1, paragraph “b” or “c” , the sheriff or the sheriff’s 18 deputy that took the respondent into immediate custody may 19 inform the hospital or facility that an arrest warrant has been 20 issued for or charges are pending against the respondent and 21 may request the hospital or facility to notify the sheriff or 22 the sheriff’s deputy about the discharge of the respondent 23 prior to discharge. 24 Sec. 3. Section 230.20, subsection 2, paragraph b, Code 25 2017, is amended to read as follows: 26 b. The per diem costs billed to each mental health and 27 disability services region shall not exceed the per diem costs 28 billed to the county region in the fiscal year beginning July 29 1, 1996 2016 . However, the per diem costs billed to a mental 30 health and disability services region may be adjusted annually 31 to reflect increased costs, to the extent of the percentage 32 increase in the statewide per capita expenditure target amount, 33 if any per capita growth amount is authorized by the general 34 assembly for the fiscal year in accordance with section 426B.3 . 35 -1- HF650.2508 (2) 87 md/rh 1/ 12 #1.

Sec. 4. Section 331.391, subsection 4, Code 2017, is amended 1 by striking the subsection and inserting in lieu thereof the 2 following: 3 4. a. If a region is meeting the financial obligations 4 for implementation of its regional service system management 5 plan for a fiscal year and residual funding is anticipated, 6 the regional administrator shall reserve an adequate amount of 7 unobligated and unencumbered funds for cash flow of expenditure 8 obligations in the next fiscal year. 9 b. For fiscal years beginning July 1, 2017, July 1, 2018, 10 and July 1, 2019, that portion of each region’s cash flow 11 amount either reserved in the combined account or reserved 12 among all separate county accounts under the control of the 13 governing board that exceeds twenty-five percent of the gross 14 expenditures from the combined account or from all separate 15 county accounts under control of the governing board in the 16 fiscal year preceding the fiscal year in progress shall be used 17 in whole or in part to fund the payment of services provided 18 under the regional service system management plan under section 19 331.393. 20 c. Each region shall certify to the department of management 21 on or before December 1, 2020, and each December 1 thereafter, 22 the amount of the region’s cash flow amount in the combined 23 account that is attributable to each county within the region 24 based upon each county’s proportionate amount of funding and 25 contributions to the region or other methodology specified in 26 the regional governance agreement or certify the cash flow 27 amount for each separate county account that is under the 28 control of the governing board at the conclusion of the most 29 recently completed fiscal year. 30 d. (1) For fiscal years beginning on or after July 1, 2021, 31 for each region having a population of one hundred thousand or 32 over, the region’s cash flow amount shall not exceed twenty 33 percent of the gross expenditures from the combined account 34 or from all separate county accounts under control of the 35 -2- HF650.2508 (2) 87 md/rh 2/ 12

governing board for the fiscal year preceding the fiscal year 1 in progress. 2 (2) For fiscal years beginning on or after July 1, 2021, 3 for each region having a population of less than one hundred 4 thousand, the region’s cash flow amount shall not exceed 5 twenty-five percent of the gross expenditures from the combined 6 account or from all separate county accounts under control of 7 the governing board for the fiscal year preceding the fiscal 8 year in progress. 9 Sec. 5. Section 331.424A, subsection 1, Code 2017, is 10 amended by striking the subsection and inserting in lieu 11 thereof the following: 12 1. For the purposes of part 6 of division III of this 13 chapter, this section, and chapter 426B, unless the context 14 otherwise requires: 15 a. “Base expenditure amount” is an amount determined for 16 each county that is the lesser of the following amounts: 17 (1) The county’s base year expenditures for mental health 18 and disabilities services, as defined in section 331.424A, 19 subsection 1, paragraph “a” , Code 2017. 20 (2) The product of the statewide per capita expenditure 21 target amount multiplied by the county’s population for the 22 fiscal year beginning July 1, 2017. 23 b. “Cash flow reduction amount” means the amount calculated 24 under subsection 4 and used to reduce a county budgeted amount 25 under subsection 9 for fiscal years beginning on or after July 26 1, 2021. 27 c. “County budgeted amount” means the amount calculated 28 under subsection 9 and certified for levy under subsection 6. 29 d. “County services fund” means a county mental health and 30 disabilities services fund created pursuant to this section. 31 e. “Population” means the population shown by the latest 32 preceding certified federal census or the latest applicable 33 population estimate issued by the federal government, whichever 34 is most recent and available as of July 1 of the fiscal year 35 -3- HF650.2508 (2) 87 md/rh 3/ 12

preceding the fiscal year to which the funding calculations 1 apply. 2 f. “Region” means a mental health and disability services 3 region formed in accordance with section 331.389. 4 g. “Regional per capita expenditure target amount” means the 5 amount determined in subsection 8 for each region. 6 h. “Statewide per capita expenditure target amount” means 7 forty-seven dollars and twenty-eight cents. 8 Sec. 6. Section 331.424A, subsection 4, Code 2017, is 9 amended by striking the subsection and inserting in lieu 10 thereof the following: 11 4. a. An amount of unobligated and unencumbered funds, 12 as specified in the regional governance agreement entered 13 into by the county under section 331.392, shall be reserved 14 in the county services fund to address cash flow obligations 15 in the next fiscal year, subject to the limitations of this 16 subsection. 17 b. For fiscal years beginning July 1, 2017, July 1, 2018, 18 and July 1, 2019, that portion of each county’s cash flow 19 amount reserved in the county services fund that exceeds an 20 amount equal to twenty-five percent of the gross expenditures 21 from the county services fund in the fiscal year preceding 22 the fiscal year in progress shall be used in whole or in part 23 to fund the county’s financial obligations for the payment of 24 services provided under the regional service system management 25 plan under section 331.393. 26 c. Each county shall, as part of the financial report 27 required under section 331.403, certify the county’s cash flow 28 amount in the county services fund at the conclusion of the 29 most recently completed fiscal year. 30 d. For each fiscal year beginning on or after July 1, 31 2021, of a county’s cash flow amount maintained in the county 32 services fund or of the region’s cash flow amount attributable 33 to the county under section 331.391, subsection 4, paragraph 34 “c” , an amount equal to the county’s cash flow reduction amount 35 -4- HF650.2508 (2) 87 md/rh 4/ 12

shall be used to fund the county’s financial obligations for 1 the payment of services provided under the regional service 2 system management plan under section 331.393. 3 e. For each fiscal year beginning on or after July 1, 2021, 4 each county’s cash flow reduction amount shall be determined as 5 follows and shall result in a reduction of the county budgeted 6 amount determined pursuant to subsection 9: 7 (1) For each county located in a region having a population 8 of one hundred thousand or over, the county’s cash flow 9 reduction amount equals the sum of the county’s cash flow 10 amount in the county services fund plus the most recent amount 11 certified by the region for the county under section 331.391, 12 subsection 4, paragraph “c” , minus twenty percent of the gross 13 expenditures from the county services fund in the fiscal year 14 preceding the fiscal year in progress. However, the cash flow 15 reduction amount shall not be less than zero and shall not 16 exceed the county budgeted amount determined under subsection 9 17 prior to any reduction resulting from the cash flow reduction 18 amount. 19 (2) For each county located in a region having a population 20 of less than one hundred thousand, the county’s cash flow 21 reduction amount equals the sum of the county’s cash flow 22 amount in the county services fund plus the most recent amount 23 certified by the region for the county under section 331.391, 24 subsection 4, paragraph “c” , minus twenty-five percent of the 25 gross expenditures budgeted from the county services fund for 26 the fiscal year in progress. However, the cash flow reduction 27 amount shall not be less than zero and shall not exceed the 28 county budgeted amount determined under subsection 9 prior to 29 any reduction resulting from the cash flow reduction amount. 30 Sec. 7. Section 331.424A, subsections 6 and 7, Code 2017, 31 are amended to read as follows: 32 6. For each fiscal year, the county shall certify a levy 33 for payment of services. For each fiscal year, county revenues 34 from taxes imposed by the county credited to the county 35 -5- HF650.2508 (2) 87 md/rh 5/ 12

services fund shall not exceed an amount equal to the county 1 budgeted amount of base year expenditures for mental health 2 and disability services for the fiscal year . A levy certified 3 under this section is not subject to the appeal provisions of 4 section 331.426 or to any other provision in law authorizing 5 a county to exceed, increase, or appeal a property tax levy 6 limit. 7 7. Appropriations specifically authorized to be made from 8 the mental health and disabilities county services fund shall 9 not be made from any other fund of the county. 10 Sec. 8. Section 331.424A, subsection 8, Code 2017, is 11 amended by striking the subsection and inserting in lieu 12 thereof the following: 13 8. For the fiscal year beginning July 1, 2017, the regional 14 per capita expenditure target amount is the sum of the base 15 expenditure amount for all counties in the region divided by 16 the population of the region. However, a regional per capita 17 expenditure target amount shall not exceed the statewide 18 per capita expenditure target amount. For the fiscal year 19 beginning July 1, 2018, and each subsequent fiscal year, the 20 regional per capita expenditure target amount for each region 21 is equal to the regional per capita expenditure target amount 22 for the fiscal year beginning July 1, 2017. 23 Sec. 9. Section 331.424A, Code 2017, is amended by adding 24 the following new subsection: 25 NEW SUBSECTION . 9. For the fiscal year beginning July 1, 26 2017, and each subsequent fiscal year, the county budgeted 27 amount determined for each county shall be the amount necessary 28 to meet the county’s financial obligations for the payment 29 of services provided under the regional service system 30 management plan approved pursuant to section 331.393, not to 31 exceed an amount equal to the product of the regional per 32 capita expenditure target amount multiplied by the county’s 33 population, and, for fiscal years beginning on or after July 1, 34 2021, reduced by the amount of the county’s cash flow reduction 35 -6- HF650.2508 (2) 87 md/rh 6/ 12

amount for the fiscal year calculated under subsection 4, if 1 applicable. 2 Sec. 10. Section 331.432, subsection 3, Code 2017, is 3 amended to read as follows: 4 3. Except as authorized in section 331.477 , transfers 5 of moneys between the county mental health and disabilities 6 services fund created pursuant to section 331.424A and any 7 other fund are prohibited. This subsection does not apply to 8 appropriations made or the value of in-kind care and treatment 9 provided pursuant to section 347.7, subsection 1, paragraph 10 “c” . 11 Sec. 11. Section 347.7, subsection 1, Code 2017, is amended 12 by adding the following new paragraph: 13 NEW PARAGRAPH . c. For the fiscal years beginning July 14 1, 2017, July 1, 2018, and July 1, 2019, if a county public 15 hospital is located in a county having a population of two 16 hundred twenty-five thousand or over and having a county 17 budgeted amount for the fiscal year under section 331.424A, 18 subsection 9, equal to the product of the regional per 19 capita expenditure target amount multiplied by the county’s 20 population, as those terms are defined in section 331.424A, the 21 board of trustees shall appropriate for payment on July 1 of 22 each such fiscal year from the county public hospital fund to 23 the board of supervisors for deposit in the county services 24 fund created pursuant to section 331.424A, two million eight 25 hundred thousand dollars, and the county public hospital shall, 26 in each such fiscal year, contract with the county in which the 27 county public hospital is located to provide care and treatment 28 to patients who are residents of the county and whose costs for 29 such care and treatment would otherwise qualify for payment 30 from the county services fund under section 331.424A, in an 31 amount equal to three million five hundred thousand dollars. 32 Sec. 12. Section 426B.1, subsection 2, Code 2017, is amended 33 to read as follows: 34 2. Moneys shall be distributed from the property tax 35 -7- HF650.2508 (2) 87 md/rh 7/ 12

relief fund to counties for the mental health and disability 1 regional service system for providing county base property tax 2 equivalent equalization payments and the per capita growth 3 amount established pursuant to section 426B.3 mental health and 4 disabilities services , in accordance with the appropriations 5 made to the fund and other statutory requirements. 6 Sec. 13. Section 426B.2, Code 2017, is amended to read as 7 follows: 8 426B.2 Property tax relief fund payments. 9 1. The director of human services shall draw warrants on the 10 property tax relief fund, payable to the county treasurer in 11 the amount due to a county in accordance with section 426B.3 12 statutory requirements , and mail the warrants to the county 13 auditors in July and January of each year. 14 2. As used in this chapter and in section 331.424A , for 15 purposes of population-based funding calculations, “population” 16 means the population shown by the latest preceding certified 17 federal census or the latest applicable population estimate 18 issued by the federal government, whichever is most recent and 19 available as of July 1 of the fiscal year preceding the fiscal 20 year to which the funding calculations apply. 21 Sec. 14. REPEAL. Section 426B.3, Code 2017, is repealed. 22 Sec. 15. COUNTY BUDGET RECERTIFICATION. If this Act takes 23 effect on or after March 15, 2017, notwithstanding section 24 24.17, for the fiscal year beginning July 1, 2017, a county may 25 recertify the county’s budget as necessary to implement the 26 provisions of this Act. A budget recertified pursuant to this 27 section must be recertified in duplicate to the county auditor 28 not later than thirty days after the effective date of this 29 Act, and protests to the budget shall be filed not later than 30 ten days after the county’s budget is recertified. 31 Sec. 16. MENTAL HEALTH AND DISABILITY SERVICES FUNDING —— 32 FISCAL VIABILITY REVIEW DURING 2018 LEGISLATIVE INTERIM. The 33 legislative council is requested to authorize a study 34 committee to analyze the viability of the mental health and 35 -8- HF650.2508 (2) 87 md/rh 8/ 12

disability services funding provisions in this Act, including 1 the methodology used to calculate and determine the base 2 expenditure amount, the county budgeted amount, the regional 3 per capita expenditure target amount, the statewide per 4 capita expenditure target amount, and the cash flow reduction 5 amount. The study committee shall consist of five members of 6 the senate, three of whom shall be appointed by the majority 7 leader of the senate and two of whom shall be appointed by 8 the minority leader of the senate, and five members of the 9 house of representatives, three of whom shall be appointed by 10 the speaker of the house of representatives and two of whom 11 shall be appointed by the minority leader of the house of 12 representatives. The study committee shall meet during the 13 2018 legislative interim to make appropriate recommendations 14 for consideration during the 2019 legislative session in a 15 report submitted to the general assembly by January 15, 2019. 16 Sec. 17. WORKGROUP —— MENTAL HEALTH, DISABILITY, AND 17 SUBSTANCE USE DISORDER SERVICES. The department of human 18 services shall convene a stakeholder workgroup to make 19 recommendations relating to the delivery of, access to, and 20 coordination and continuity of mental health, disability, and 21 substance use disorder services and supports for individuals 22 with mental health, disability, and substance use disorder 23 needs, particularly for individuals with complex mental 24 health, disability, and substance use disorder needs. The 25 workgroup shall be comprised of representatives from community 26 mental health centers, law enforcement agencies, the national 27 alliance on mental illness, the Iowa hospital association, 28 the judicial system, mental health and disability services 29 regions, substance abuse treatment providers, the department 30 of public health, and other entities as appropriate. The 31 report shall incorporate selected strategies from community 32 service plans submitted by the mental health and disability 33 services regions to the department of human services pursuant 34 to this Act to address services and supports for individuals 35 -9- HF650.2508 (2) 87 md/rh 9/ 12

with mental health, disability, and substance use disorder 1 needs, particularly for individuals with complex mental health, 2 disability, and substance use disorder needs. The workgroup 3 shall submit a report with recommendations to the governor and 4 general assembly by December 15, 2017. 5 Sec. 18. REGIONAL WORKGROUP —— MENTAL HEALTH AND DISABILITY 6 REGIONAL SERVICES. 7 1. The regional administrator of each mental health 8 and disability services region shall convene a stakeholder 9 workgroup to meet on a regular basis, beginning July 1, 2017, 10 to create collaborative policies and processes relating to 11 the delivery of, access to, and continuity of services and 12 supports for individuals with mental health, disability, and 13 substance use disorder needs, particularly for individuals with 14 complex mental health, disability, and substance use disorder 15 needs. Each region shall review resources currently available 16 including the reduction of mental health and disability 17 services fund balances and options for combining funding from 18 different sources, particularly funding available pursuant 19 to Tit. XIX of the federal Social Security Act, and shall 20 consider providing additional services and supports in their 21 own region or partnering with one or more regions to provide 22 additional services and supports to serve such individuals. 23 The workgroup shall be comprised of representatives from 24 hospitals, the judicial system, law enforcement agencies, 25 managed care organizations, mental health providers, crisis 26 service providers, substance abuse providers, the national 27 alliance on mental illness, and other entities as appropriate. 28 2. Each mental health and disability services region 29 shall submit a community service plan to the department of 30 human services by October 16, 2017. The plan shall include 31 planning and implementation time frames and assessment tools 32 for determining the effectiveness of the plan in achieving the 33 department’s identified outcomes for success in the delivery 34 of, access to, and coordination and continuity of services and 35 -10- HF650.2508 (2) 87 md/rh 10/ 12

supports for individuals with mental health, disability, and 1 substance use disorder needs, particularly for individuals with 2 complex mental health, disability, and substance use disorder 3 needs, and financial strategies to support the plan including 4 combined funding from different sources, particularly funding 5 available pursuant to Tit. XIX of the federal Social Security 6 Act. The plan shall address how mental health and disability 7 services regions will spend down mental health and disabilities 8 services fund balances remaining from the fiscal year ending 9 June 30, 2016. 10 3. The regional administrator of each mental health and 11 disability services region shall enter into a memorandum of 12 understanding with each of Iowa’s managed care organizations 13 that delineates the roles and responsibilities of the region 14 and the managed care organizations in relation to the plan 15 developed by the region to address the services and supports 16 necessary to meet the needs of individuals with mental health, 17 disability, and substance use disorder needs, particularly 18 individuals with complex mental health, disability, and 19 substance use disorder needs. 20 4. In addition to the requirements specified in subsections 21 2 and 3, the eastern Iowa mental health and disability 22 services region shall consult with the department to complete 23 an analysis of the region’s mental health, disability, and 24 substance use disorder service and support concerns and 25 identify funding opportunities to address such areas of concern 26 in the region, and shall include information in the region’s 27 plan that includes the concerns, strategies to address the 28 concerns, and the budget. 29 5. The department shall submit a report to the governor 30 and general assembly by December 3, 2018, providing a summary 31 of services implemented by each mental health and disability 32 services region and an assessment of each region in achieving 33 the department’s identified outcomes for success. 34 Sec. 19. SAVINGS PROVISION. This Act, pursuant to section 35 -11- HF650.2508 (2) 87 md/rh 11/ 12

4.13, does not affect the operation of, or prohibit the 1 application of, prior provisions of law amended or repealed 2 by this Act, or rules adopted under chapter 17A to administer 3 prior provisions of law amended or repealed by this Act, for 4 fiscal years beginning before July 1, 2017. 5 Sec. 20. EFFECTIVE UPON ENACTMENT. This Act, being deemed 6 of immediate importance, takes effect upon enactment. 7 Sec. 21. APPLICABILITY. This Act applies to fiscal years 8 beginning on or after July 1, 2017. > 9 2. Title page, by striking lines 1 through 7 and inserting 10 < An Act relating to mental health and disabilities, including 11 the funding of mental health and disability services by 12 modifying the mental health and disability services property 13 tax levy, providing for the expenditure and deposit of certain 14 county hospital property tax revenues, requiring the use 15 of specified excess cash flow funds, including certain law 16 enforcement notification provisions, and including effective 17 date and applicability provisions. > 18 ______________________________ RIZER of Linn -12- HF650.2508 (2) 87 md/rh 12/ 12 #2.