House File 2402 S-5172 Amend House File 2402, as amended, passed, and reprinted by 1 the House, as follows: 2 1. By striking everything after the enacting clause and 3 inserting: 4 < Section 1. Section 135H.6, subsection 1, paragraph d, Code 5 2024, is amended by striking the paragraph. 6 Sec. 2. Section 135H.6, subsections 2, 3, 4, and 5, Code 7 2024, are amended to read as follows: 8 2. The department of health and human services shall 9 not give approval to an application which would cause the 10 total number of beds licensed under this chapter for services 11 reimbursed by the medical assistance program under chapter 12 249A to exceed four hundred thirty beds , unless the director 13 of health and human services determines approval of such 14 an application is necessary for good cause. Good cause 15 is established if the health and safety of Iowans would be 16 adversely impacted if the application for additional beds is 17 not approved . 18 3. In addition to the beds authorized under subsection 19 2 , the department of health and human services may establish 20 not more than thirty beds licensed under this chapter at the 21 state mental health institute at Independence. The beds shall 22 be exempt from the certificate of need requirement under 23 subsection 1 , paragraph “d” . 24 4. The department of health and human services may give 25 approval to conversion of beds approved under subsection 2 , to 26 beds which are specialized to provide substance use disorder 27 treatment. However, the total number of beds approved under 28 subsection 2 and this subsection shall not exceed four hundred 29 thirty , unless approved for good cause by the director pursuant 30 to subsection 2 . Conversion of beds under this subsection 31 shall not require a revision of the certificate of need 32 issued for the psychiatric institution making the conversion. 33 Beds for children who do not reside in this state and whose 34 service costs are not paid by public funds in this state are 35 -1- HF 2402.4303 (2) 90 pf/ko 1/ 5 #1.

not subject to the limitations on the number of beds and 1 certificate of need requirements otherwise applicable under 2 this section . 3 5. A psychiatric institution licensed prior to July 1, 1999, 4 may exceed the number of beds authorized under subsection 2 5 if the excess beds are used to provide services funded from 6 a source other than the medical assistance program under 7 chapter 249A . Notwithstanding subsection 1 , paragraphs “d” and 8 paragraph “e” , and subsection 2 , the provision of services using 9 those excess beds does not require a certificate of need or a 10 review by the department of health and human services. 11 Sec. 3. PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN —— 12 ENHANCED MEDICAID REIMBURSEMENT. No later than January 1, 13 2025, the department of health and human services shall select 14 one or more psychiatric medical institutions for children 15 (PMICs) to provide access to PMIC services for children with 16 specialized needs including problematic sexualized behaviors, 17 a history of aggression, or a diagnosis of intellectual or 18 developmental disability. Prior to rendering services, a 19 selected PMIC shall be licensed pursuant to section 135H.4 and 20 offer a payment structure that provides enhanced reimbursement, 21 which may be used to provide increased staffing ratios, 22 ongoing training of staff in specialized programs that 23 provide evidence-based treatment, and appropriate services and 24 modalities, including but not limited to telemedicine, for 25 children and their families. 26 Sec. 4. REDUCTION OF REGULATORY BARRIERS AND RESTRICTIONS 27 —— PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN. The 28 department of health and human services shall review the 29 department’s administrative rules regarding psychiatric medical 30 institutions for children (PMICs) and shall update the rules, 31 informed by the findings of the association of children’s 32 residential centers’ most recent nationwide survey and scan 33 of psychiatric residential treatment facilities, and the 34 recommendations of the coalition for family and children’s 35 -2- HF 2402.4303 (2) 90 pf/ko 2/ 5

services in Iowa, to do all of the following: 1 1. Allow a physician assistant or advanced registered nurse 2 practitioner to serve as a member of the plan of care team 3 as a member who is experienced in child psychiatry or child 4 psychology pursuant to 481 IAC 41.13(2). 5 2. Allow a physician assistant or advanced registered 6 nurse practitioner to be a member of the team to complete 7 the certification of need for services for a PMIC placement 8 pursuant to 481 IAC 41.9. 9 3. Allow licensed professionals, based on competencies 10 rather than license type, to order the use of restraints 11 or seclusions and to conduct post-restraint or seclusion 12 assessments, including via telehealth, to increase response 13 times and expand access to care. 14 4. a. Allow family therapy and family behavioral health 15 intervention services to be included in billable services 16 during the placement of a child in a PMIC without requiring 17 the child’s presence for the family to work on targeted skills 18 essential for the child’s success and to prepare the family for 19 the child’s return home. 20 b. Provide reimbursement codes to cover services beyond 21 those provided outside the PMIC care team as necessary to 22 adequately treat substance use disorder, sexualized behaviors, 23 autism, and other services needed to support the child. 24 5. Standardize all of the following across all managed care 25 organizations as follows: 26 a. Require that authorization for a PMIC placement shall 27 be retroactive to the date the request for authorization is 28 submitted to the managed care organization not the date the 29 managed care organization responds; or require a managed care 30 organization to respond within five business days from receipt 31 of a request for authorization for a PMIC placement, if the 32 certification of need and independent assessment have been 33 received in a timely manner. 34 b. Prohibit a managed care organization from denying 35 -3- HF 2402.4303 (2) 90 pf/ko 3/ 5

authorization for a PMIC placement based on lack of parental 1 involvement, lack of participation in behavioral health 2 intervention services on an outpatient basis, or based on other 3 perceived behavioral issues. 4 c. Allow a managed care organization to authorize an initial 5 PMIC placement of sixty days upon admission with concurrent 6 stay reviews every thirty days thereafter. A PMIC shall submit 7 a care plan to the managed care organization within thirty days 8 of the admission. 9 d. Require concurrent stay reviews to be standardized 10 and limited to a brief description of progress, or lack of 11 progress, toward the child’s goals and objectives. 12 e. Require a managed care organization to offer support to 13 families, including assistance with transportation to and from 14 a PMIC to visit a child. 15 6. Notwithstanding any provision of law to the contrary, 16 including certificate of need requirements, allow a previously 17 licensed PMIC that has the capacity to provide up to an 18 additional four intermediate care facility for persons with an 19 intellectual disability beds, and which additional beds meet 20 all other licensing and state fire marshal requirements, to 21 increase their licensed capacity to include the additional 22 beds without further review including by the health facilities 23 council. 24 7. Allow for step-down PMIC placements or supervised 25 apartment living for a child to utilize programming provided 26 in a PMIC while living independently in a smaller residential 27 setting without twenty-four-hour supervision. 28 Sec. 5. HAWKI PROGRAM —— BENEFITS INCLUDED IN QUALIFIED 29 CHILD HEALTH PLAN —— REVIEW. The department of health 30 and human services shall review the benefits included in a 31 qualified child health plan under the Hawki program and shall 32 specifically address the inclusion of applied behavior analysis 33 services as a covered benefit. The department shall report the 34 findings of the review to the general assembly by December 1, 35 -4- HF 2402.4303 (2) 90 pf/ko 4/ 5