Senate File 479 S-3161 Amend Senate File 479 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. Section 225C.2, Code 2019, is amended by adding 4 the following new subsections: 5 NEW SUBSECTION . 1A. “Child” or “children” means a person or 6 persons under eighteen years of age. 7 NEW SUBSECTION . 1B. “Children’s behavioral health 8 services” means services for children with a serious emotional 9 disturbance. 10 NEW SUBSECTION . 1C. “Children’s behavioral health system” or 11 “children’s system” means the behavioral health service system 12 for children implemented pursuant to this subchapter. 13 NEW SUBSECTION . 11. “Serious emotional disturbance” means 14 a diagnosable mental, behavioral, or emotional disorder of 15 sufficient duration to meet diagnostic criteria specified 16 within the most current diagnostic and statistical manual 17 of mental disorders published by the American psychiatric 18 association that results in a functional impairment. “Serious 19 emotional disturbance” does not include substance use and 20 developmental disorders unless such disorders co-occur with 21 such a diagnosable mental, behavioral, or emotional disorder. 22 NEW SUBSECTION . 12. “State board” means the children’s 23 behavioral health system state board created in section 24 225C.51. 25 Sec. 2. Section 225C.2, subsection 9, Code 2019, is amended 26 by striking the subsection. 27 Sec. 3. Section 225C.4, subsection 1, Code 2019, is amended 28 by adding the following new paragraph: 29 NEW PARAGRAPH . 0c. Assist the state board in planning for 30 community-based children’s behavioral health services. 31 Sec. 4. Section 225C.4, subsection 1, paragraphs d and j, 32 Code 2019, are amended to read as follows: 33 d. Encourage and facilitate coordination of mental health 34 and disability services with the objective of developing and 35 -1- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 1/ 13 #1.

maintaining in the state a mental health and disability service 1 delivery system to provide disability services to all persons 2 in this state who need the services, regardless of the place 3 of residence or economic circumstances of those persons. The 4 administrator shall work with the commission and other state 5 agencies, including but not limited to the departments of 6 corrections, education, and public health and the state board 7 of regents, to develop and implement a strategic plan to expand 8 access to qualified mental health workers across the state. 9 j. Establish and maintain a data collection and management 10 information system oriented to the needs of patients, 11 providers, the department, and other programs or facilities in 12 accordance with section 225C.6A . The system shall be used to 13 identify, collect, and analyze service outcome and performance 14 measures data in order to assess the effects of the services on 15 the persons utilizing the services. The administrator shall 16 annually submit to the commission information collected by the 17 department indicating the changes and trends in the mental 18 health and disability services system. The administrator shall 19 make the outcome data available to the public. 20 Sec. 5. Section 225C.4, subsection 1, Code 2019, is amended 21 by adding the following new paragraphs: 22 NEW PARAGRAPH . 0k. Encourage and facilitate coordination 23 of children’s behavioral health services with the objective of 24 developing and maintaining in the state a children’s behavioral 25 health system to provide behavioral health services to all 26 children in this state who need the services, regardless of the 27 place of residence or economic circumstances of those children. 28 The administrator shall work with the state board and other 29 state agencies including but not limited to the department of 30 education and the department of public health to develop and 31 implement a strategic plan to expand access to qualified mental 32 health workers across the state. 33 NEW PARAGRAPH . 00k. Establish and maintain a data 34 collection and management information system oriented to the 35 -2- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 2/ 13

needs of children utilizing the children’s behavioral health 1 system, providers, the department, and other programs or 2 facilities in accordance with section 225C.6A. The system 3 shall be used to identify, collect, and analyze service 4 outcome and performance measures data in order to assess the 5 effects of the services on the children utilizing the services. 6 The administrator shall annually submit to the state board 7 information collected by the department indicating the changes 8 and trends in the children’s behavioral health system. The 9 administrator shall make the outcome data available to the 10 public. 11 Sec. 6. Section 225C.4, subsection 1, paragraph u, Code 12 2019, is amended by adding the following new subparagraph: 13 NEW SUBPARAGRAPH . (9) School attendance. 14 Sec. 7. Section 225C.6B, subsection 3, Code 2019, is amended 15 by adding the following new paragraph: 16 NEW PARAGRAPH . c. Children’s behavioral health services 17 provided to eligible children that are not covered under the 18 medical assistance program or other third-party payor are the 19 responsibility of the county-based regional service system. 20 Sec. 8. NEW SECTION . 225C.51 Children’s behavioral health 21 system state board. 22 1. A children’s behavioral health system state board 23 is created as the state body to provide guidance on the 24 implementation and management of a children’s behavioral health 25 system for the provision of services to children with a serious 26 emotional disturbance. The state board’s public voting members 27 shall be appointed to four-year staggered terms by the governor 28 and are subject to confirmation by the senate. All other 29 state board voting members shall be appointed to four-year 30 staggered terms and are not subject to confirmation by the 31 senate. State board members shall be appointed on the basis of 32 interest and experience in the fields of children’s behavioral 33 health to ensure adequate representation from persons with life 34 experiences and from persons knowledgeable about children’s 35 -3- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 3/ 13

behavioral health services. The department shall provide 1 support to the state board, and the board may utilize staff 2 support and other assistance provided to the state board by 3 other persons. The state board shall meet at least four times 4 per year. The membership of the state board shall consist of 5 the following persons who, at the time of appointment to the 6 state board, are active members of the indicated groups: 7 a. The director of the department or the director’s 8 designee. 9 b. The director of the department of education or the 10 director’s designee. 11 c. The director of the department of public health or the 12 director’s designee. 13 d. The director of workforce development or the director’s 14 designee. 15 e. One member shall be selected from nominees submitted by 16 the state court administrator. 17 f. One member shall be selected from nominees submitted 18 by the early childhood Iowa office in the department of 19 management. 20 g. One member shall be a member of the mental health and 21 disability services commission. 22 h. One member shall be a board member or an employee of a 23 provider of mental health services to children. 24 i. One member shall be a board member or an employee of a 25 provider of child welfare services. 26 j. One member shall be an administrator of an area education 27 agency. 28 k. One member shall be an educator, counselor, or 29 administrator of a school district. 30 l. One member shall be a representative of an established 31 advocacy organization whose mission or purpose it is, in part, 32 to further goals related to children’s mental health. 33 m. One member shall be a parent or guardian of a child 34 currently utilizing or who has utilized behavioral health 35 -4- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 4/ 13

services. 1 n. One member shall be a sheriff. 2 o. One member shall be a pediatrician. 3 p. One member shall be a representative from a health care 4 system. 5 q. One member shall be a chief executive officer of a mental 6 health and disability services region. 7 r. In addition to the voting members, the membership shall 8 include four members of the general assembly with one member 9 designated by each of the following: the majority leader of 10 the senate, the minority leader of the senate, the speaker of 11 the house of representatives, and the minority leader of the 12 house of representatives. A legislative member serves for a 13 term as provided in section 69.16B in a nonvoting, ex officio 14 capacity and is not eligible for per diem and expenses as 15 provided in section 2.10. 16 2. The four-year terms shall begin and end as provided in 17 section 69.19. Vacancies on the state board shall be filled as 18 provided in section 2.32. A member shall not be appointed for 19 more than two consecutive four-year terms. 20 3. The director and the director of the department of 21 education, or their designees, shall serve as co-chairpersons 22 of the state board. Board members shall not be entitled to a 23 per diem as specified in section 7E.6 and shall not be entitled 24 to actual and necessary expenses incurred while engaged in 25 their official duties. 26 Sec. 9. NEW SECTION . 225C.52 Children’s behavioral health 27 system state board —— duties. 28 To the extent funding is available, the state board shall 29 perform the following duties: 30 1. Advise the administrator on the administration of the 31 children’s behavioral health system. 32 2. Provide consultation services to agencies regarding 33 the development of administrative rules for the children’s 34 behavioral health system. 35 -5- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 5/ 13

3. Identify behavioral health outcomes and indicators for 1 eligible children with a serious emotional disturbance to 2 promote children living with their own families and in the 3 community. 4 4. Submit a written report on or before December 1 of each 5 year to the governor and the general assembly. At a minimum, 6 the report shall include a summary of all activities undertaken 7 by the state board, a summary of state board activities, 8 and results from identified behavioral health outcomes and 9 indicators for the children’s behavioral health system. 10 Sec. 10. Section 331.388, Code 2019, is amended by adding 11 the following new subsections: 12 NEW SUBSECTION . 01. “Children’s behavioral health services” 13 means the same as defined in section 225C.2. 14 NEW SUBSECTION . 4A. “Serious emotional disturbance” means 15 the same as defined in section 225C.2. 16 NEW SUBSECTION . 4B. “State board” means the children’s 17 system state board created in section 225C.51. 18 Sec. 11. Section 331.390, subsection 2, Code 2019, is 19 amended by striking the subsection and inserting in lieu 20 thereof the following: 21 2. The governing board shall comply with all of the 22 following requirements: 23 a. The voting membership of the governing board shall 24 consist of at least one board of supervisors member from each 25 county comprising the region or their designees. 26 b. The membership of the governing board shall also include 27 one adult person who utilizes mental health and disability 28 services or is an actively involved relative of such an adult 29 person. This member shall be designated by the regional 30 advisory committee formed by the governing board pursuant to 31 paragraph “h” . 32 c. The membership of the governing board shall not include 33 employees of the department of human services or an unelected 34 employee of a county. 35 -6- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 6/ 13

d. The membership of the governing board shall also consist 1 of one member representing adult service providers in the 2 region. This member shall be designated by the regional 3 advisory committee formed by the governing board pursuant to 4 paragraph “h” . The member designated in accordance with this 5 paragraph shall serve in a nonvoting, ex officio capacity. 6 e. The membership of the governing board shall also 7 consist of one member representing children’s behavioral 8 health services providers in the region. This member shall be 9 designated by the regional children’s advisory committee formed 10 by the governing board pursuant to paragraph “i” . The member 11 designated in accordance with this paragraph shall serve in a 12 nonvoting, ex officio capacity. 13 f. The membership of the governing board shall also consist 14 of one member representing the education system in the region. 15 This member shall be designated by the regional children’s 16 advisory committee formed by the governing board pursuant to 17 paragraph “i” . 18 g. The membership of the governing board shall also 19 consist of one member who is a parent of a child who utilizes 20 children’s behavioral health services or actively involved 21 relatives of such children. This member shall be designated 22 by the regional children’s advisory committee formed by the 23 governing board pursuant to paragraph “i” . 24 h. The governing board shall have a regional advisory 25 committee consisting of adults who utilize services or actively 26 involved relatives of such adults, service providers, and 27 regional governing board members. 28 i. The governing board shall have a regional children’s 29 advisory committee consisting of parents of children who 30 utilize services or actively involved relatives of such 31 children, a member of the education system, an early childhood 32 advocate, a child welfare advocate, a children’s behavioral 33 health service provider, a member of the juvenile court, a 34 pediatrician, a child care provider, a local law enforcement 35 -7- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 7/ 13

representative, and regional governing board members. 1 Sec. 12. Section 331.390, subsection 3, paragraph b, Code 2 2019, is amended to read as follows: 3 b. The regional administrator staff shall include one or 4 more coordinators of mental health and disability services 5 and one or more coordinators of children’s behavioral 6 health services . A coordinator shall possess a bachelor’s 7 or higher level degree in a human services-related or 8 administration-related field, including but not limited 9 to social work, psychology, nursing, or public or business 10 administration, from an accredited college or university. 11 However, in lieu of a degree in public or business 12 administration, a coordinator may provide documentation of 13 relevant management experience. An action of a coordinator 14 involving a clinical decision shall be made in conjunction with 15 a professional who is trained in the delivery of the mental 16 health or disability service or children’s behavioral health 17 service addressed by the clinical decision. The regional 18 administrator shall determine whether referral to a coordinator 19 of mental health and disability services or children’s 20 behavioral health services is required for a person or child 21 seeking to access a service through a local access point of the 22 regional service system or the children’s behavioral health 23 system . 24 Sec. 13. Section 331.393, subsection 2, Code 2019, is 25 amended by adding the following new paragraphs: 26 NEW PARAGRAPH . i. The scope of children’s behavioral health 27 core services. Each service included shall be described and a 28 projection of need shall be included. 29 NEW PARAGRAPH . j. The eligibility requirements for 30 children’s behavioral health core services under the children’s 31 behavioral health system. 32 Sec. 14. Section 331.393, subsection 4, paragraph g, 33 subparagraph (1), Code 2019, is amended to read as follows: 34 (1) Performance and outcome measures relating to the 35 -8- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 8/ 13

health, safety, education, work performance, and community 1 residency of the persons receiving the services. 2 Sec. 15. Section 331.396, subsection 1, paragraph b, Code 3 2019, is amended to read as follows: 4 b. The person is at least eighteen years of age and is a 5 resident of this state. However, a person who is seventeen 6 years of age, is a resident of this state, and is receiving 7 publicly funded children’s services may be considered eligible 8 for services through the regional service system during the 9 three-month period preceding the person’s eighteenth birthday 10 in order to provide a smooth transition from children’s to 11 adult services. 12 Sec. 16. Section 331.396, subsection 1, paragraph d, Code 13 2019, is amended by striking the paragraph. 14 Sec. 17. NEW SECTION . 331.396A Eligibility requirements —— 15 children’s behavioral health services. 16 A child shall be eligible for behavioral health services 17 under the regional service system if all of the following 18 conditions are met: 19 1. The child is under eighteen years of age and is a 20 resident of this state. 21 2. The child has been diagnosed with a serious emotional 22 disturbance. 23 3. a. The child’s family has a family income equal to or 24 less than five hundred percent of the federal poverty level as 25 defined by the most recently revised poverty income guidelines 26 published by the United States department of health and human 27 services. 28 b. Notwithstanding paragraph “a” , a child’s family whose 29 household income is between one hundred fifty percent but not 30 more than five hundred percent of the federal poverty level 31 shall be eligible for behavioral health services subject to 32 a copayment, a single statewide sliding fee scale, or other 33 cost-sharing requirements approved by the department. 34 Sec. 18. NEW SECTION . 331.397A Children’s behavioral health 35 -9- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 9/ 13

core services. 1 1. For the purposes of this section, unless the context 2 otherwise requires, “domain” means a set of similar behavioral 3 health services that can be provided depending on a child’s 4 service needs. 5 2. a. (1) A region shall work with children’s behavioral 6 health service providers to ensure that services in the 7 required behavioral health core service domains in subsection 8 4 are available to children who are residents of the region, 9 regardless of any potential payment source for the services. 10 (2) Subject to the available appropriations, the director 11 of human services shall ensure the behavioral health core 12 service domains listed in subsection 4 are covered services 13 for the medical assistance program under chapter 249A to the 14 greatest extent allowable under federal regulations. The 15 medical assistance program shall reimburse Medicaid enrolled 16 providers for Medicaid covered services under subsection 4 when 17 the services are medically necessary, the Medicaid enrolled 18 provider submits an appropriate claim for such services, and 19 no other third-party payor is responsible for reimbursement 20 of such services. Within the funds available, the region 21 shall pay for such services for eligible children when payment 22 through the medical assistance program or another third-party 23 payment is not available, unless the child is on a waiting list 24 for such payment or it has been determined that the child does 25 not meet the eligibility criteria for any such service. 26 b. Until funding is designed for other service populations, 27 eligibility for the service domains listed in this section 28 shall be limited to such children who are in need of behavioral 29 health services. 30 3. Pursuant to recommendations made by the state board, the 31 department of human services shall adopt rules to define the 32 services included in the core domains listed in this section. 33 The rules shall provide service definitions, service provider 34 standards, service access standards, and service implementation 35 -10- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 10/ 13

dates, and shall provide consistency, to the extent possible, 1 with similar service definitions under the medical assistance 2 program. 3 4. The children’s behavioral health core service domains 4 shall include all of the following: 5 a. Treatment designed to ameliorate a child’s serious 6 emotional disturbance, including but not limited to all of the 7 following: 8 (1) Prevention, early identification, early intervention, 9 and education. 10 (2) Assessment and evaluation relating to eligibility for 11 services. 12 (3) Medication prescribing and management. 13 (4) Behavioral health outpatient therapy. 14 b. Comprehensive facility and community-based crisis 15 services regardless of a diagnosis of a serious emotional 16 disturbance, including all of the following: 17 (1) Mobile response. 18 (2) Crisis stabilization community-based services. 19 (3) Crisis stabilization residential services. 20 (4) Behavioral health inpatient treatment. 21 5. A region shall ensure that services within the following 22 additional core service domains are available to children not 23 eligible for the medical assistance program under chapter 249A 24 or receiving other third-party payment for the services, when 25 public funds are made available for such services: 26 a. Treatment designed to ameliorate a child’s serious 27 emotional disturbance including but not limited to behavioral 28 health school-based therapy. 29 b. Support for community living including but not limited 30 to all of the following: 31 (1) Family support. 32 (2) Peer support. 33 (3) Therapeutic foster care. 34 (4) Respite care. 35 -11- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 11/ 13

c. Transition services for children to the adult mental 1 health system providing an appropriate match with a child’s 2 abilities based upon informed, person-centered choices made 3 from an array of options including but not limited to all of 4 the following: 5 (1) Day habilitation. 6 (2) Job development. 7 (3) Supported employment. 8 (4) Prevocational services. 9 (5) Educational services. 10 d. Service coordination including physical health and 11 primary care that follow the principles of the system of care 12 including but not limited to all of the following: 13 (1) Care coordination. 14 (2) Health homes. 15 Sec. 19. DEPARTMENT OF HUMAN SERVICES AND DEPARTMENT OF 16 PUBLIC HEALTH —— CRISIS HOTLINE. The department of human 17 services and the department of public health shall provide 18 a single, statewide twenty-four-hour crisis hotline that 19 incorporates information for families of children with a 20 serious emotional disturbance which may be provided through 21 expansion of the YourLifeIowa platform. 22 Sec. 20. MENTAL HEALTH AND DISABILITY SERVICES REGION 23 —— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION 24 PLAN. Each mental health and disability services region shall 25 submit to the department of human services an implementation 26 plan to implement children’s behavioral health services 27 described under section 331.397A, as enacted in this Act, no 28 later than April 1, 2020. 29 Sec. 21. DEPARTMENT OF HUMAN SERVICES —— RULES. The 30 department of human services shall submit a notice of intended 31 action to the administrative rules coordinator and the 32 Iowa administrative code editor pursuant to section 17A.4, 33 subsection 1, paragraph “a”, not later than January 1, 2020, 34 for the adoption of rules to implement this Act. 35 -12- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 12/ 13

Sec. 22. REPEAL. Sections 225C.51, 225C.52, 225C.53, and 1 225C.54, Code 2019, are repealed. 2 Sec. 23. CODE EDITOR’S DIRECTIVES. The Code editor may 3 change the current subchapter title of chapter 225C, subchapter 4 VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”. 5 The Code editor may change the current subchapter title of 6 chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES 7 —— REGIONAL SERVICE SYSTEM —— CHILDREN’S BEHAVIORAL HEALTH 8 SYSTEM”. > 9 ______________________________ JEFF EDLER -13- SF479.1132 (3) 88 (amending this SF 479 to CONFORM to HF 690) hb/rh 13/ 13