H-8102

   Amend House File 2456 as follows:
   1.  Page 1, line 33, by striking <shall> and inserting <may>
   2.  Page 2, after line 18 by inserting: 
   <Sec. ___.  Section 229.1, subsection 20, Code 2018, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  d.  Has a history of lack of compliance with treatment and any of the following apply:
   (1)  Lack of compliance has been a significant factor in the need for emergency hospitalization.
   (2)  Lack of compliance has resulted in one or more acts of serious physical injury to the person’s self or others or an attempt to physically injure the person’s self or others.>
   3.  Page 3, after line 13 by inserting: 
   <Sec. ___.  Section 229.13, subsection 7, paragraph a, subparagraphs (2) and (3), Code 2018, are amended to read as follows:
   (2)  Once in protective custody, the respondent shall be given the choice of being treated by the appropriate medication which may include the use of oral medicine or injectable antipsychotic medicine by a mental health professional acting within the scope of the mental health professional’s practice at an outpatient psychiatric clinic, hospital, or other suitable facility or being placed for treatment under the care of a hospital or other suitable facility for inpatient treatment.
   (3)  If the respondent chooses to be treated by the appropriate medication which may include the use of oral medicine or injectable antipsychotic medicine but the mental health professional acting within the scope of the mental health professional’s practice at the outpatient psychiatric clinic, hospital, or other suitable facility determines that the respondent’s behavior continues to be likely to result in physical injury to the respondent’s self or others if allowed to continue, the mental health professional acting within the scope of the mental health professional’s practice shall comply with the provisions of subparagraph (1) and, following notice and hearing held in accordance with the procedures in section 229.12, the court may order the respondent treated on an inpatient basis requiring full-time custody, care, and treatment in a hospital until such time as the chief medical officer reports that the respondent does not require further treatment for serious mental impairment or has indicated the respondent is willing to submit to treatment on another basis as ordered by the court.>
   4.  Page 6, by striking lines 20 and 21 and inserting: 
   <b.  The rules relating to the availability of intensive mental health services specified in subsection 5 shall specify that the minimum amount of services provided statewide shall be as follows:> 
   5.  Page 6, line 25, by striking <statewide>
   6.  Page 7, line 28, by striking <To the extent> and inserting <Provided that>
   7.  By striking page 11, line 14, through page 16, line 34, and inserting: 
   <Sec. ___.  PROGRAM IMPLEMENTATION —— ADOPTION OF ADMINISTRATIVE RULES.
   1.  The department of human services shall submit a notice of intended action to the administrative rules coordinator and the Iowa administrative code editor pursuant to section 17A.4, subsection 1, paragraph “a”, not later than August 15, 2018, for the adoption of rules to implement the standards of core services specified in this Act.
   2.  The provisions of this Act and rules adopted in accordance with this Act shall minimize any delay or disruption of services or plans for the implementation of such services in effect on July 1, 2018.
   3.  The rules adopted by the department relating to access centers shall provide for all of the following:
   a.  The access centers shall meet all of the following criteria:
   (1)  An access center shall serve individuals with a serious mental health or substance use disorder need who are otherwise medically stable, who are not in need of an inpatient psychiatric level of care, and who do not have alternative, safe, effective services immediately available.
   (2)  Access center services shall be provided on a no reject, no eject basis.
   (3)  An access center shall accept and serve individuals who are court-ordered to participate in mental health or substance use disorder treatment.
   (4)  Access center providers shall be accredited under 441 IAC 24 to provide crisis stabilization residential services and shall be licensed to provide subacute mental health services as defined in section 135G.1.
   (5)  An access center shall be licensed as a substance abuse treatment program pursuant to chapter 125 or have a cooperative agreement with and immediate access to licensed substance abuse treatment services or medical care that incorporates withdrawal management.
   (6)  An access center shall provide or arrange for the provision of necessary physical health services.
   (7)  An access center shall provide navigation and warm handoffs to the next service provider as well as linkages to needed services including housing, employment, and shelter services.
   b.  The rules shall include access center designation criteria and standards that allow and encourage multiple mental health and disability services regions to strategically locate and share access center services including bill-back provisions to provide for reimbursement of a region when the resident of another region utilizes an access center or other non-Medicaid covered services located in that region.
   4.  The department shall establish uniform, statewide standards for assertive community treatment based on national accreditation standards, including allowances for nationally recognized small team standards. The statewide standards shall require that assertive teams meet fidelity to nationally recognized practice standards as determined by an independent review of each team that includes peer review. The department shall ensure that Medicaid managed care organization utilization management requirements do not exceed the standards developed by the department.
   5.  The rules relating to intensive residential service homes shall provide for all of the following:
   a.  That an intensive residential service home be enrolled with the Iowa Medicaid enterprise as a section 1915(i) home and community-based services habilitation waiver or intellectual disability waiver-supported community living provider.
   b.  That an intensive residential service home have adequate staffing that includes appropriate specialty training including applied behavior analysis as appropriate.
   c.  Coordination with the individual’s clinical mental health and physical health treatment.
   d.  Be licensed as a substance abuse treatment program pursuant to chapter 125 or have a cooperative agreement with and timely access to licensed substance abuse treatment services for those with a demonstrated need.
   e.  Accept court-ordered commitments.
   f.  Have a no reject, no eject policy for an individual referred to the home based on the severity of the individual’s mental health or co-occurring needs.
   g.  Be smaller in size, preferably providing services to four or fewer individuals and no more than sixteen individuals, and be located in a neighborhood setting to maximize community integration and natural supports.
   h.  The department of human services shall provide guidance for objective utilization review criteria.
   6.  The department of human services and the department of public health shall provide a single statewide twenty-four-hour crisis hotline that incorporates warmline services which may be provided through expansion of the YourLifeIowa platform.>
   8.  Page 17, by striking lines 1 through 4 and inserting <human services, in cooperation with the department of public health, representative members of the judicial branch, the Iowa hospital association, the Iowa medical society, the national alliance on mental illness, the Iowa state sheriffs’ and deputies’ association,>
   9.  Page 17, by striking line 13 and inserting <departments of human services and inspections and appeals, representative members of the Iowa hospital association, managed care organizations, the national alliance on mental illness, the mental health institutes, and other>
   10.  Page 17, after line 23 by inserting: 
   <Sec. ___.  MENTAL HEALTH AND DISABILITY SERVICES FUNDING —— FISCAL VIABILITY REVIEW DURING 2018 LEGISLATIVE INTERIM.  The legislative council is requested to authorize a study committee to analyze the viability of the mental health and disability services funding including the methodology used to calculate and determine the base expenditure amount, the county budgeted amount, the regional per capita expenditure amount, the statewide per capita expenditure target amount, and the cash flow reduction amount. The study committee shall consist of five members of the senate, three of whom shall be appointed by the majority leader of the senate and two of whom shall be appointed by the minority leader of the senate, and five members of the house of representatives, three of whom shall be appointed by the speaker of the house of representatives and two of whom shall be appointed by the minority leader of the house of representatives. The study committee shall meet during the 2018 legislative interim to make appropriate recommendations for consideration during the 2019 legislative session in a report submitted to the general assembly by January 15, 2019.
   Sec. ___.  DIRECTIVE TO DEPARTMENT OF HUMAN SERVICES —— PSYCHIATRIC BED TRACKING SYSTEM.  The department of human services shall amend its administrative rules pursuant to chapter 17A to require subacute mental health care facilities to participate in the psychiatric bed tracking system and to report the number of beds available for children and adults with a co-occurring mental illness and substance abuse disorder.
   Sec. ___.  ASSERTIVE COMMUNITY TREATMENT —— REIMBURSEMENT RATES.  The department of human services shall review the reimbursement rates for assertive community treatment and shall report recommendations for reimbursement rates to the governor and the general assembly by December 15, 2018. The recommendations shall address any potential sustainable funding.>
   11.  By renumbering as necessary.

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LUNDGREN of Dubuque