House File 690 H-1041 Amend House File 690 as follows: 1 1. Page 1, before line 1 by inserting: 2 < DIVISION I 3 CHILDREN’S MENTAL HEALTH SYSTEM > 4 2. Page 1, line 5, by striking < behavioral > and inserting 5 < mental > 6 3. Page 1, line 7, after < disturbance > by inserting < , 7 substance use disorder, or neurobiological condition > 8 4. Page 1, line 8, by striking < behavioral > and inserting 9 < mental > 10 5. Page 1, line 9, by striking < behavioral > and inserting 11 < mental > 12 6. Page 1, after line 10 by inserting: 13 < NEW SUBSECTION . 8A. “Neurobiological condition” means an 14 illness of the nervous system caused by genetic, metabolic, or 15 other biological factors. > 16 7. Page 1, line 21, by striking < behavioral > and inserting 17 < mental > 18 8. Page 1, line 28, by striking < behavioral > and inserting 19 < mental > 20 9. Page 2, line 21, by striking < behavioral > and inserting 21 < mental > 22 10. Page 2, line 22, by striking < behavioral > and inserting 23 < mental > 24 11. Page 2, line 23, by striking < behavioral > and inserting 25 < mental > 26 12. Page 2, line 33, by striking < behavioral > and inserting 27 < mental > 28 13. Page 3, line 6, by striking < behavioral > and inserting 29 < mental > 30 14. Page 3, line 14, by striking < behavioral > and inserting 31 < mental > 32 15. Page 3, line 18, by striking < behavioral > and inserting 33 < mental > 34 16. Page 3, line 20, by striking < behavioral > and inserting 35 -1- HF690.951 (2) 88 hb/rh 1/ 11 #1. #2. #3. #4. #5. #6. #7. #8. #9. #10. #11. #12. #13. #14. #15.

< mental > 1 17. Page 3, line 22, by striking < behavioral > and inserting 2 < mental > 3 18. Page 3, line 24, after < disturbance > by inserting < , 4 substance use disorder, or neurobiological condition > 5 19. Page 3, line 30, by striking < behavioral > and inserting 6 < mental > 7 20. Page 3, line 33, by striking < behavioral > and inserting 8 < mental > 9 21. Page 4, line 32, by striking < behavioral > and inserting 10 < mental > 11 22. Page 5, after line 4 by inserting: 12 < r. One member shall be a children’s psychiatrist. 13 s. One member shall be a children’s psychologist. 14 t. One member shall be an early childhood educator. > 15 23. Page 5, line 5, by striking < r. > and inserting < u. > 16 24. Page 5, line 24, by striking < behavioral > and inserting 17 < mental > 18 25. Page 5, line 29, by striking < behavioral > and inserting 19 < mental > 20 26. Page 5, line 32, by striking < behavioral > and inserting 21 < mental > 22 27. Page 5, line 33, by striking < behavioral > and inserting 23 < mental > 24 28. Page 5, line 34, after < disturbance > by inserting < , 25 substance use disorder, or neurobiological condition > 26 29. Page 6, after line 1 by inserting: 27 < d. Collect data information related to children’s mental 28 health outcomes and indicators utilizing a system that 29 connects county mental health community services to determine 30 eligibility, current services, and prior services. > 31 30. Page 6, line 2, by striking < d. > and inserting < e. > 32 31. Page 6, line 6, by striking < behavioral > and inserting 33 < mental > 34 32. Page 6, line 7, by striking < behavioral > and inserting 35 -2- HF690.951 (2) 88 hb/rh 2/ 11 #17. #18. #19. #20. #21. #22. #23. #24. #25. #26. #27. #28. #29. #30. #31.

< mental > 1 33. Page 6, line 10, by striking < behavioral > and inserting 2 < mental > 3 34. Page 7, line 5, by striking < behavioral > and inserting 4 < mental > 5 35. Page 7, line 18, by striking < behavioral > and inserting 6 < mental > 7 36. Page 7, line 31, by striking < behavioral > and inserting 8 < mental > 9 37. Page 8, line 4, by striking < behavioral > and inserting 10 < mental > 11 38. Page 8, line 15, by striking < behavioral > and inserting 12 < mental > 13 39. Page 8, line 19, by striking < behavioral > and inserting 14 < mental > 15 40. Page 8, line 21, by striking < behavioral > and inserting 16 < mental > 17 41. Page 8, line 25, by striking < behavioral > and inserting 18 < mental > 19 42. Page 8, line 29, by striking < behavioral > and inserting 20 < mental > 21 43. Page 8, line 30, by striking < behavioral > and inserting 22 < mental > 23 44. Page 9, line 14, by striking < behavioral > and inserting 24 < mental > 25 45. Page 9, line 15, by striking < behavioral > and inserting 26 < mental > 27 46. Page 9, line 16, by striking < behavioral > and inserting 28 < mental > 29 47. Page 9, line 20, by striking < been diagnosed > and 30 inserting < displayed symptoms consistent > 31 48. Page 9, line 21, after < disturbance > by inserting < , 32 substance use disorder, or neurobiological condition > 33 49. Page 9, line 30, by striking < behavioral > and inserting 34 < children’s mental > 35 -3- HF690.951 (2) 88 hb/rh 3/ 11 #33. #34. #35. #36. #37. #38. #39. #40. #41. #42. #43. #44. #45. #46. #47. #48.

50. Page 9, line 33, by striking < behavioral > and inserting 1 < mental > 2 51. Page 10, line 1, by striking < behavioral > and inserting 3 < mental > 4 52. Page 10, line 4, by striking < behavioral > and inserting 5 < mental > 6 53. Page 10, line 6, by striking < behavioral > and inserting 7 < children’s mental > 8 54. Page 10, line 9, by striking < Subject to the available 9 appropriations, the > and inserting < The > 10 55. Page 10, line 10, by striking < behavioral > and inserting 11 < children’s mental > 12 56. Page 10, line 27, by striking < behavioral > and inserting 13 < mental > 14 57. Page 11, line 2, by striking < behavioral > and inserting 15 < mental > 16 58. Page 11, line 5, after < disturbance, > by inserting 17 < substance use disorder, or neurobiological condition, > 18 59. Page 11, line 12, by striking < Behavioral > and inserting 19 < Mental > 20 60. Page 11, after line 12 by inserting: 21 < (5) Home visitation services. 22 (6) Transportation services. > 23 61. Page 11, line 15, after < disturbance, > by inserting 24 < substance use disorder, or neurobiological condition, > 25 62. Page 11, line 19, by striking < Behavioral > and inserting 26 < Mental > 27 63. Page 11, by striking line 27 and inserting < emotional 28 disturbance, substance use disorder, or neurobiological 29 condition including but not limited to mental > 30 64. Page 12, after line 14 by inserting: 31 < Sec. ___. MENTAL HEALTH AND DISABILITY SERVICES REGIONS —— 32 CHILDREN’S COMPLEX NEEDS IMPLEMENTATION. Each mental health 33 and disability services region shall submit to the department 34 of human services an implementation plan to implement and fund 35 -4- HF690.951 (2) 88 hb/rh 4/ 11 #50. #51. #52. #53. #54. #55. #56. #57. #58. #59. #60. #61. #62. #63. #64.

complex mental health services for children including all of 1 the following: 2 1. Subacute care. 3 2. Intensive outpatient services. 4 3. Day treatment. 5 4. Juvenile justice screening and diversion. 6 The implementation plan shall be submitted no later than 7 January 1, 2020. > 8 65. Page 12, line 16, by striking < BEHAVIORAL > and inserting 9 < MENTAL > 10 66. Page 12, line 19, by striking < behavioral > and inserting 11 < mental > 12 67. Page 12, line 32, by striking < BEHAVIORAL > and inserting 13 < MENTAL > 14 68. Page 12, line 35, by striking < BEHAVIORAL > and inserting 15 < MENTAL > 16 69. Page 13, after line 1 by inserting: 17 < DIVISION ___ 18 MENTAL HEALTH SUPPORTS AND SERVICES FOR CHILDREN AND ADULTS 19 Sec. ___. Section 135.175, subsection 1, paragraph a, Code 20 2019, is amended to read as follows: 21 a. A health care workforce support initiative is established 22 to provide for the coordination and support of various efforts 23 to address the health care workforce shortage in this state. 24 This initiative shall include the medical residency training 25 state matching grants program created in section 135.176 , 26 the mental health professional fellowship program created in 27 section 135.177, the nurse residency state matching grants 28 program created in section 135.178 , and the fulfilling Iowa’s 29 need for dentists matching grant program created in section 30 135.179 . 31 Sec. ___. Section 135.175, subsection 5, Code 2019, is 32 amended by adding the following new paragraph: 33 NEW PARAGRAPH . e. The mental health professional fellowship 34 program account. The mental health professional fellowship 35 -5- HF690.951 (2) 88 hb/rh 5/ 11 #65. #66. #67. #68. #69.

program account shall be under the control of the department 1 and the moneys in the account shall be used for the purposes of 2 the mental health professional fellowship program as specified 3 in section 135.177. Moneys in the account shall consist of 4 moneys appropriated or allocated for deposit in or received 5 by the fund or the account and specifically dedicated to the 6 mental health professional fellowship program or the account 7 for the purposes of the account. 8 Sec. ___. NEW SECTION . 135.177 Mental health professional 9 fellowship program. 10 1. For the purposes of this section, “mental health 11 professional shortage area” means a geographic area in this 12 state that has been designated by the United States department 13 of health and human services, health resources and services 14 administration, bureau of health professionals, as having a 15 shortage of mental health professionals. 16 2. The department, in cooperation with the college 17 student aid commission, shall establish a mental health 18 professional fellowship program in accordance with this 19 section. Funding for the program may be provided through 20 the health care workforce shortage fund or the mental health 21 professional fellowship program account created in section 22 135.175. The purpose of the program is to determine the 23 effect of specialized training and support for mental health 24 professionals in providing mental health services to address 25 Iowa’s shortage of mental health professionals. 26 3. The program shall provide for all of the following: 27 a. Collaboration between Iowa institutions of higher 28 education and mental health professional programs to educate 29 mental health professionals. 30 b. Elderly, youth, and general population clinical 31 experiences, with a primary emphasis on youth clinical 32 experiences and a secondary emphasis on elderly and general 33 population clinical experiences. 34 c. Supervision of students participating in the program 35 -6- HF690.951 (2) 88 hb/rh 6/ 11

provided by Iowa institutions of higher education and other 1 clinical partners participating in the program. 2 4. A contract for the program shall stipulate the time 3 period the mental health professional shall practice in 4 a mental health professional shortage area in this state. 5 In addition, the contract shall stipulate that the mental 6 health professional repay any funds paid on the mental health 7 professional’s behalf by the program if the mental health 8 professional is unable to fulfill the time period in the 9 contract. 10 5. State and private entity clinical partners shall 11 regularly evaluate and document their experiences with the 12 approaches utilized and outcomes achieved by the program 13 to identify an optimal model for operating the program. 14 The evaluation process shall include but is not limited to 15 identifying ways the program’s clinical and training components 16 could be modified to facilitate other students and practicing 17 mental health professionals specializing as mental health 18 professionals. 19 Sec. ___. Section 135H.3, subsection 1, Code 2019, is 20 amended to read as follows: 21 1. A psychiatric medical institution for children shall 22 utilize a team of professionals to direct an organized program 23 of diagnostic services, psychiatric services, nursing care, 24 and rehabilitative services to meet the needs of residents 25 in accordance with a medical care plan developed for each 26 resident. The membership of the team of professionals may 27 shall include but is not limited to an advanced registered 28 nurse practitioner or a physician assistant mental health 29 professionals . Social Psychiatric, social, and rehabilitative 30 services shall be provided under the direction of by a 31 qualified mental health professional. 32 Sec. ___. Section 225C.52, subsection 1, Code 2019, is 33 amended to read as follows: 34 1. Establishing a comprehensive community-based mental 35 -7- HF690.951 (2) 88 hb/rh 7/ 11

health services system for children and youth is part of 1 fulfilling the requirements of the division and the commission 2 to facilitate a comprehensive, continuous, and integrated state 3 mental health and disability services plan in accordance with 4 sections 225C.4 , 225C.6 , and 225C.6A , and other provisions 5 of this chapter . The purpose of establishing the children’s 6 system is to improve access for children and youth with 7 serious emotional disturbances and youth with other qualifying 8 mental health disorders to mental health treatment, services, 9 and other support in the least restrictive setting possible 10 so the children and youth can live with their families and 11 remain in their communities. The children’s system is also 12 intended to meet the needs of children and youth who have 13 mental health disorders that co-occur with substance abuse, 14 intellectual disability, developmental disabilities, or 15 other disabilities. The children’s system shall emphasize 16 community-level collaborative efforts between children and 17 youth and the families and the state’s systems of education, 18 child welfare, juvenile justice, health care, substance abuse, 19 and mental health. The children’s system shall ensure the 20 children and youth served are provided treatment by a mental 21 health professional as defined in section 228.1 or a person who 22 has obtained an advanced degree that will qualify the person as 23 a mental health professional following a period of professional 24 supervision. 25 Sec. ___. NEW SECTION . 279.70A Suicide prevention 26 committee. 27 The board of directors of a school district shall require all 28 schools in the school district to develop suicide prevention 29 committees to develop professional development strategies and 30 materials for teachers of students in kindergarten through 31 grade twelve to support teacher effectiveness in the use 32 of evidence-based teaching strategies for students with a 33 serious emotional disturbance, substance use disorder, or 34 neurobiological condition. 35 -8- HF690.951 (2) 88 hb/rh 8/ 11

Sec. ___. NEW SECTION . 279.70B Children’s mental health 1 services. 2 The board of directors of a school district may develop and 3 implement mental health services at each attendance center in 4 the district. The school district may coordinate with mental 5 health professionals within the school district to provide 6 services at the attendance center for students who are in need 7 of mental health services. 8 Sec. ___. ADVERSE CHILDHOOD EXPERIENCES. The departments 9 of human services and public health shall develop information 10 related to the identification of adverse childhood experiences. 11 The information shall be distributed to the board of directors 12 of a school district for distribution during required training 13 pursuant to section 279.70. The departments shall provide 14 support services to a school district following media reports 15 relating to adverse childhood experiences impacting ten or more 16 children within the school district or a report of a suicide of 17 a child from the school district. 18 Sec. ___. CHILDREN’S MENTAL HEALTH INFORMATION —— 19 DISTRIBUTION. The department of public health shall develop 20 information relating to the identification of the early signs 21 and symptoms of mental health concerns in children and shall 22 coordinate with existing statewide mental health hotlines to 23 distribute the information to members of the public utilizing 24 telephone and text messaging systems. 25 DIVISION ___ 26 THIRD-PARTY PAYMENT OF COVERAGE BENEFITS FOR CHILDREN’S MENTAL 27 HEALTH SERVICES PROVIDED AT A SCHOOL 28 Sec. ___. NEW SECTION . 514C.35 Mental health services 29 provided at a school —— coverage. 30 1. As used in this section, unless the context otherwise 31 requires: 32 a. “Facility” , “health care professional” , and “health care 33 services” mean the same as defined in section 514J.102. 34 b. “Mental health services” means services provided by a 35 -9- HF690.951 (2) 88 hb/rh 9/ 11

health care professional operating within the scope of the 1 health care professional’s practice which address mental, 2 emotional, medical, or behavioral conditions, illnesses, 3 diseases, or problems. 4 c. “School” means a public or private school that provides 5 premises for teaching any grade from kindergarten through grade 6 twelve. 7 2. Notwithstanding the uniformity of treatment requirements 8 of section 514C.6, a policy, contract, or plan providing for 9 third-party payment or prepayment of health or medical expenses 10 shall not discriminate between coverage benefits for mental 11 health services that are provided in a facility and the same or 12 similar mental health services that are provided at a school. 13 3. This section applies to the following classes of 14 third-party payment provider policies, contracts, or plans 15 delivered, issued for delivery, continued, or renewed in this 16 state on or after January 1, 2020: 17 a. Individual or group accident and sickness insurance 18 providing coverage on an expense-incurred basis. 19 b. An individual or group hospital or medical service 20 contract issued pursuant to chapter 509, 514, or 514A. 21 c. An individual or group health maintenance organization 22 contract regulated under chapter 514B. 23 d. A plan established pursuant to chapter 509A for public 24 employees. 25 4. This section shall not apply to accident-only, 26 specified disease, short-term hospital or medical, hospital 27 confinement indemnity, credit, dental, vision, Medicare 28 supplement, long-term care, basic hospital and medical-surgical 29 expense coverage as defined by the commissioner, disability 30 income insurance coverage, coverage issued as a supplement 31 to liability insurance, workers’ compensation or similar 32 insurance, or automobile medical payment insurance. 33 5. The commissioner of insurance, in collaboration with the 34 state board of education, may adopt rules pursuant to chapter 35 -10- HF690.951 (2) 88 hb/rh 10/ 11

17A as necessary to administer this section. > 1 70. Title page, by striking lines 1 through 5 and inserting 2 < An Act relating to mental health and disability services for 3 children and adults, by establishing a children’s mental health 4 system and a children’s mental health system state board, 5 requiring certain children’s mental health core services, 6 requiring third-party payment of coverage benefits for mental 7 health services delivered at a school, and establishing a 8 mental health professional fellowship program. > 9 71. By renumbering, redesignating, and correcting internal 10 references as necessary. 11 ______________________________ MASCHER of Johnson -11- HF690.951 (2) 88 hb/rh 11/ 11 #70. #71.