House File 2456 H-8102 Amend House File 2456 as follows: 1 1. Page 1, line 33, by striking < shall > and inserting < may > 2 2. Page 2, after line 18 by inserting: 3 < Sec. ___. Section 229.1, subsection 20, Code 2018, is 4 amended by adding the following new paragraph: 5 NEW PARAGRAPH . d. Has a history of lack of compliance with 6 treatment and any of the following apply: 7 (1) Lack of compliance has been a significant factor in the 8 need for emergency hospitalization. 9 (2) Lack of compliance has resulted in one or more acts of 10 serious physical injury to the person’s self or others or an 11 attempt to physically injure the person’s self or others. > 12 3. Page 3, after line 13 by inserting: 13 < Sec. ___. Section 229.13, subsection 7, paragraph a, 14 subparagraphs (2) and (3), Code 2018, are amended to read as 15 follows: 16 (2) Once in protective custody, the respondent shall be 17 given the choice of being treated by the appropriate medication 18 which may include the use of oral medicine or injectable 19 antipsychotic medicine by a mental health professional acting 20 within the scope of the mental health professional’s practice 21 at an outpatient psychiatric clinic, hospital, or other 22 suitable facility or being placed for treatment under the 23 care of a hospital or other suitable facility for inpatient 24 treatment. 25 (3) If the respondent chooses to be treated by the 26 appropriate medication which may include the use of oral 27 medicine or injectable antipsychotic medicine but the mental 28 health professional acting within the scope of the mental 29 health professional’s practice at the outpatient psychiatric 30 clinic, hospital, or other suitable facility determines that 31 the respondent’s behavior continues to be likely to result in 32 physical injury to the respondent’s self or others if allowed 33 to continue, the mental health professional acting within 34 the scope of the mental health professional’s practice shall 35 -1- HF2456.3690 (2) 87 hb/rh 1/ 6 #1. #2. #3.

comply with the provisions of subparagraph (1) and, following 1 notice and hearing held in accordance with the procedures in 2 section 229.12 , the court may order the respondent treated 3 on an inpatient basis requiring full-time custody, care, and 4 treatment in a hospital until such time as the chief medical 5 officer reports that the respondent does not require further 6 treatment for serious mental impairment or has indicated the 7 respondent is willing to submit to treatment on another basis 8 as ordered by the court. > 9 4. Page 6, by striking lines 20 and 21 and inserting: 10 < b. The rules relating to the availability of intensive 11 mental health services specified in subsection 5 shall specify 12 that the minimum amount of services provided statewide shall 13 be as follows: > 14 5. Page 6, line 25, by striking < statewide > 15 6. Page 7, line 28, by striking < To the extent > and 16 inserting < Provided that > 17 7. By striking page 11, line 14, through page 16, line 34, 18 and inserting: 19 < Sec. ___. PROGRAM IMPLEMENTATION —— ADOPTION OF 20 ADMINISTRATIVE RULES. 21 1. The department of human services shall submit a notice 22 of intended action to the administrative rules coordinator and 23 the Iowa administrative code editor pursuant to section 17A.4, 24 subsection 1, paragraph “a”, not later than August 15, 2018, 25 for the adoption of rules to implement the standards of core 26 services specified in this Act. 27 2. The provisions of this Act and rules adopted in 28 accordance with this Act shall minimize any delay or disruption 29 of services or plans for the implementation of such services in 30 effect on July 1, 2018. 31 3. The rules adopted by the department relating to access 32 centers shall provide for all of the following: 33 a. The access centers shall meet all of the following 34 criteria: 35 -2- HF2456.3690 (2) 87 hb/rh 2/ 6 #4. #5. #6. #7.

(1) An access center shall serve individuals with a 1 serious mental health or substance use disorder need who are 2 otherwise medically stable, who are not in need of an inpatient 3 psychiatric level of care, and who do not have alternative, 4 safe, effective services immediately available. 5 (2) Access center services shall be provided on a no reject, 6 no eject basis. 7 (3) An access center shall accept and serve individuals who 8 are court-ordered to participate in mental health or substance 9 use disorder treatment. 10 (4) Access center providers shall be accredited under 441 11 IAC 24 to provide crisis stabilization residential services and 12 shall be licensed to provide subacute mental health services 13 as defined in section 135G.1. 14 (5) An access center shall be licensed as a substance abuse 15 treatment program pursuant to chapter 125 or have a cooperative 16 agreement with and immediate access to licensed substance abuse 17 treatment services or medical care that incorporates withdrawal 18 management. 19 (6) An access center shall provide or arrange for the 20 provision of necessary physical health services. 21 (7) An access center shall provide navigation and warm 22 handoffs to the next service provider as well as linkages to 23 needed services including housing, employment, and shelter 24 services. 25 b. The rules shall include access center designation 26 criteria and standards that allow and encourage multiple mental 27 health and disability services regions to strategically locate 28 and share access center services including bill-back provisions 29 to provide for reimbursement of a region when the resident of 30 another region utilizes an access center or other non-Medicaid 31 covered services located in that region. 32 4. The department shall establish uniform, statewide 33 standards for assertive community treatment based on national 34 accreditation standards, including allowances for nationally 35 -3- HF2456.3690 (2) 87 hb/rh 3/ 6

recognized small team standards. The statewide standards 1 shall require that assertive teams meet fidelity to nationally 2 recognized practice standards as determined by an independent 3 review of each team that includes peer review. The department 4 shall ensure that Medicaid managed care organization 5 utilization management requirements do not exceed the standards 6 developed by the department. 7 5. The rules relating to intensive residential service 8 homes shall provide for all of the following: 9 a. That an intensive residential service home be enrolled 10 with the Iowa Medicaid enterprise as a section 1915(i) home and 11 community-based services habilitation waiver or intellectual 12 disability waiver-supported community living provider. 13 b. That an intensive residential service home have adequate 14 staffing that includes appropriate specialty training including 15 applied behavior analysis as appropriate. 16 c. Coordination with the individual’s clinical mental 17 health and physical health treatment. 18 d. Be licensed as a substance abuse treatment program 19 pursuant to chapter 125 or have a cooperative agreement 20 with and timely access to licensed substance abuse treatment 21 services for those with a demonstrated need. 22 e. Accept court-ordered commitments. 23 f. Have a no reject, no eject policy for an individual 24 referred to the home based on the severity of the individual’s 25 mental health or co-occurring needs. 26 g. Be smaller in size, preferably providing services to 27 four or fewer individuals and no more than sixteen individuals, 28 and be located in a neighborhood setting to maximize community 29 integration and natural supports. 30 h. The department of human services shall provide guidance 31 for objective utilization review criteria. 32 6. The department of human services and the department of 33 public health shall provide a single statewide twenty-four-hour 34 crisis hotline that incorporates warmline services which may be 35 -4- HF2456.3690 (2) 87 hb/rh 4/ 6

provided through expansion of the YourLifeIowa platform. > 1 8. Page 17, by striking lines 1 through 4 and inserting 2 < human services, in cooperation with the department of public 3 health, representative members of the judicial branch, the Iowa 4 hospital association, the Iowa medical society, the national 5 alliance on mental illness, the Iowa state sheriffs’ and 6 deputies’ association, > 7 9. Page 17, by striking line 13 and inserting < departments 8 of human services and inspections and appeals, representative 9 members of the Iowa hospital association, managed care 10 organizations, the national alliance on mental illness, the 11 mental health institutes, and other > 12 10. Page 17, after line 23 by inserting: 13 < Sec. ___. MENTAL HEALTH AND DISABILITY SERVICES FUNDING —— 14 FISCAL VIABILITY REVIEW DURING 2018 LEGISLATIVE INTERIM. The 15 legislative council is requested to authorize a study committee 16 to analyze the viability of the mental health and disability 17 services funding including the methodology used to calculate 18 and determine the base expenditure amount, the county budgeted 19 amount, the regional per capita expenditure amount, the 20 statewide per capita expenditure target amount, and the cash 21 flow reduction amount. The study committee shall consist of 22 five members of the senate, three of whom shall be appointed 23 by the majority leader of the senate and two of whom shall 24 be appointed by the minority leader of the senate, and five 25 members of the house of representatives, three of whom shall 26 be appointed by the speaker of the house of representatives 27 and two of whom shall be appointed by the minority leader 28 of the house of representatives. The study committee shall 29 meet during the 2018 legislative interim to make appropriate 30 recommendations for consideration during the 2019 legislative 31 session in a report submitted to the general assembly by 32 January 15, 2019. 33 Sec. ___. DIRECTIVE TO DEPARTMENT OF HUMAN SERVICES —— 34 PSYCHIATRIC BED TRACKING SYSTEM. The department of human 35 -5- HF2456.3690 (2) 87 hb/rh 5/ 6 #8. #9. #10.

services shall amend its administrative rules pursuant to 1 chapter 17A to require subacute mental health care facilities 2 to participate in the psychiatric bed tracking system and 3 to report the number of beds available for children and 4 adults with a co-occurring mental illness and substance abuse 5 disorder. 6 Sec. ___. ASSERTIVE COMMUNITY TREATMENT —— REIMBURSEMENT 7 RATES. The department of human services shall review the 8 reimbursement rates for assertive community treatment and 9 shall report recommendations for reimbursement rates to the 10 governor and the general assembly by December 15, 2018. The 11 recommendations shall address any potential sustainable 12 funding. > 13 11. By renumbering as necessary. 14 ______________________________ LUNDGREN of Dubuque -6- HF2456.3690 (2) 87 hb/rh 6/ 6 #11.