House File 984 H-1262 Amend House File 984 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < DIVISION I 4 SERVICES AND SUPPORT FOR CHILDREN AND YOUTH 5 Section 1. Section 125.13, subsection 2, Code 2025, is 6 amended by adding the following new paragraph: 7 NEW PARAGRAPH . k. A psychiatric medical institution for 8 children licensed under chapter 135H, unless the psychiatric 9 medical institution for children provides substance use 10 disorder services. 11 Sec. 2. Section 135H.1, Code 2025, is amended to read as 12 follows: 13 135H.1 Definitions. 14 As used in this chapter , unless the context otherwise 15 requires: 16 1. “Approved qualifying organization” means any of the 17 following: 18 a. The joint commission. 19 b. The commission on accreditation of rehabilitation 20 facilities. 21 c. The council on accreditation. 22 d. A nationally recognized accrediting organization with 23 standards comparable to the entities listed in paragraphs “a” 24 through “c” that are acceptable under federal regulations. 25 e. An entity specified by rule adopted by the department in 26 consultation with the department of health and human services. 27 1. 2. “Department” means the department of inspections, 28 appeals, and licensing. 29 2. 3. “Direction” means authoritative policy or procedural 30 guidance for the accomplishment of a function or an activity. 31 3. 4. “Licensee” means the holder of a license issued to 32 operate a psychiatric medical institution for children. 33 4. 5. “Medical care plan” means a plan of care and services 34 designed to eliminate the need for inpatient care by improving 35 -1- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 1/ 33 #1.

the condition of a child youth . Services must be based upon a 1 diagnostic evaluation, which includes an examination a physical 2 assessment and behavioral health evaluation of the medical, 3 psychological, social, behavioral, and developmental aspects 4 of the child’s youth’s situation, reflecting the need for 5 inpatient care. 6 6. “Mental health disorder” means any of the following: 7 a. A mental disorder as defined by the most recent version 8 of the diagnostic and statistical manual of mental disorders 9 published by the American psychiatric association. 10 b. A mental disorder included in the mental, behavioral, or 11 neurodevelopmental disorders chapter in the most recent version 12 of the international classification of diseases published by 13 the world health organization. 14 5. 7. “Mental health professional” means an individual who 15 has all of the following qualifications: 16 a. The individual holds at least a master’s degree in a 17 mental health field, including but not limited to, psychology, 18 counseling and guidance, nursing, and or social work, or the 19 individual is a physician. 20 b. The individual holds a current Iowa license if practicing 21 in a field covered by that requires an Iowa licensure law 22 license . 23 c. The individual has at least two years of post-degree 24 clinical experience, supervised by another mental health 25 professional, in assessing mental health needs and problems and 26 in providing appropriate mental health services. 27 6. 8. “Nursing care” means services which are provided 28 under the direction of a physician or registered nurse. 29 7. 9. “Physician” means a person licensed under chapter 30 148 . 31 10. “Protective locked environment” means a setting that 32 prevents egress from a building or grounds as a protective 33 measure to ensure safety and security. 34 8. 11. “Psychiatric medical institution for children” or 35 -2- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 2/ 33

“psychiatric institution” means an institution providing more 1 than twenty-four hours of continuous care involving long-term 2 psychiatric services to three or more children youth in 3 residence for expected periods of fourteen or more days for an 4 assessment, evaluation, and diagnosis and evaluation or for 5 expected periods of ninety days or more for treatment. 6 9. 12. “Psychiatric services” means services provided under 7 the direction of a physician which address mental, emotional, 8 medical, or behavioral problems. 9 13. “Record check evaluation system” means the same as 10 defined in section 135C.1. 11 10. 14. “Rehabilitative services” means services to 12 encourage and assist restoration of a resident’s optimum mental 13 and physical capabilities. 14 11. 15. “Resident” means a person who is less than 15 twenty-one years of age and youth who has been admitted by a 16 physician to a psychiatric medical institution for children. 17 16. “Serious emotional disturbance” means a diagnosable 18 mental, behavioral, or emotional disorder that meets the 19 diagnostic criteria specified in the most current diagnostic 20 and statistical manual of mental disorders published by 21 the American psychiatric association. “Serious emotional 22 disturbance” does not include a substance use disorder or 23 developmental disorder unless such disorder co-occurs with a 24 diagnosable mental, behavioral, or emotional disorder. 25 17. “Substance use disorder” means the same as defined in 26 section 125.2. 27 12. 18. “Supervision” means direct oversight and inspection 28 of the an act of accomplishing that accomplishes a function or 29 activity. 30 19. “Youth” means a person who is less than twenty-one years 31 of age. 32 Sec. 3. Section 135H.3, Code 2025, is amended to read as 33 follows: 34 135H.3 Nature of care. 35 -3- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 3/ 33

1. a. A psychiatric medical institution for children 1 shall provide shelter, food, supervision, care, assessment, 2 evaluation, diagnosis, treatment, counseling, rehabilitative 3 services, and related professional-directed services to 4 youth who have a serious emotional disturbance, a substance 5 use disorder, or both, with the intention of reducing or 6 ameliorating the disorder, the symptoms of the disorder, or the 7 effects of the disorder. 8 b. A psychiatric medical institution for children shall 9 utilize a team of professionals to direct an organized program 10 of diagnostic services, psychiatric services, nursing care, 11 and rehabilitative services to meet the needs of residents 12 in accordance with a medical care plan developed for each 13 resident. The membership of the team of professionals 14 may include but is not limited to an advanced registered 15 nurse practitioner or a physician assistant. Social and 16 rehabilitative services shall be provided under the direction 17 of a qualified mental health professional. 18 2. If a child youth is diagnosed with a biologically 19 based mental illness as defined in section 514C.22 and meets 20 the medical assistance program criteria for admission to a 21 psychiatric medical institution for children, the child youth 22 shall be deemed to meet the acuity criteria for medically 23 necessary inpatient benefits under a group policy, contract, or 24 plan providing for third-party payment or prepayment of health, 25 medical, and surgical coverage benefits issued by a carrier, as 26 defined in section 513B.2 , that is subject to section 514C.22 . 27 Such medically necessary benefits shall not be excluded or 28 denied as care that is substantially custodial in nature under 29 section 514C.22, subsection 8 , paragraph “b” . 30 Sec. 4. Section 135H.4, Code 2025, is amended to read as 31 follows: 32 135H.4 Licensure. 33 1. A person shall not establish, operate, or maintain a 34 psychiatric medical institution for children unless the person 35 -4- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 4/ 33

obtains a license for the institution under this chapter and 1 either holds a license under section 237.3, subsection 2 , 2 paragraph “a” , as a comprehensive residential facility for 3 children or holds a license under section 125.13 , if the 4 facility provides substance use disorder treatment under 5 chapter 237, and holds a license under this chapter . 6 2. In addition to the requirements under subsection 1, a 7 person shall not provide substance use disorder services at a 8 psychiatric medical institution for children unless the person 9 holds a license under section 125.13. The department of health 10 and human services shall adopt rules pursuant to chapter 17A 11 to create an expedited process for a person to simultaneously 12 obtain a license under section 125.13 and a license as a 13 comprehensive residential facility for children under chapter 14 237. 15 Sec. 5. Section 135H.5, Code 2025, is amended to read as 16 follows: 17 135H.5 Application for license —— initial application and 18 annual fees . 19 1. An application for a license under this chapter shall 20 be submitted on a form requesting information required by 21 the department , which . The application may include require 22 affirmative evidence of the applicant’s ability to comply with 23 the rules for standards adopted pursuant to this chapter . The 24 application shall require the applicant to specify whether the 25 applicant intends to provide services for serious emotional 26 disturbances, substance use disorders, or both. 27 2. An application for a license shall be accompanied by the 28 required license fee which shall be credited to the general 29 fund of the state. The initial application fee and the annual 30 license fee is twenty-five dollars. 31 Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, 32 are amended to read as follows: 33 1. The department shall issue a license to an applicant 34 under this chapter if all the following conditions exist: 35 -5- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 5/ 33

a. The department has ascertained that the applicant’s 1 medical facilities and staff are adequate to provide the care 2 and services required of a psychiatric medical institution for 3 children . 4 b. The proposed psychiatric institution is accredited 5 by the joint commission on the accreditation of health 6 care organizations, the commission on accreditation of 7 rehabilitation facilities, the council on accreditation of 8 services for families and children, or by any other recognized 9 accrediting organization with comparable standards acceptable 10 under federal regulation an approved qualifying organization . 11 c. The applicant complies with applicable state rules 12 and standards for a psychiatric institution adopted by the 13 department in accordance with federal requirements under 42 14 C.F.R. §441.150 – 441.156. 15 d. The department of health and human services has submitted 16 written approval of the application based on the department 17 of health and human services’ determination of need. The 18 department of health and human services shall identify the 19 location and number of children youth in the state who require 20 the services of a psychiatric medical institution for children. 21 Approval of an application shall be based upon the location 22 of the proposed psychiatric institution relative to the need 23 for services identified by the department of health and human 24 services and an analysis of the applicant’s ability to provide 25 services and support consistent with requirements under chapter 26 232 , particularly regarding specifically community-based 27 treatment. If the proposed psychiatric institution is not 28 freestanding from a facility licensed under chapter 135B or 29 135C , approval under this paragraph shall not be given unless 30 the department of health and human services certifies that 31 the proposed psychiatric institution is capable of providing 32 a resident with a living environment similar to the living 33 environment provided by a licensee which is freestanding from a 34 facility licensed under chapter 135B or 135C . 35 -6- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 6/ 33

e. The proposed psychiatric institution is under the 1 direction of an agency which has operated a facility licensed 2 under section 237.3, subsection 2 , paragraph “a” , as a 3 comprehensive residential facility for children for three years 4 or of an agency which has operated a facility for three years 5 providing psychiatric services exclusively to children or 6 adolescents and the facility meets or exceeds requirements for 7 licensure under section 237.3, subsection 2 , paragraph “a” , as a 8 comprehensive residential facility for children. 9 f. e. If a child youth has an a serious emotional , 10 behavioral, or mental health disorder disturbance , the 11 psychiatric institution does not require court any of the 12 following as a condition for the youth to obtain treatment: 13 (1) Court proceedings to be initiated or that a child’s . 14 (2) For the youth’s parent, guardian, or custodian must 15 to terminate parental rights over , or transfer legal custody 16 of , the child for the purposes of obtaining treatment from the 17 psychiatric institution for the child youth . 18 (3) Relinquishment of a child’s the youth’s custody shall 19 not be a condition of the child receiving services . 20 4. The department of health and human services may give 21 approval to approve a conversion of beds approved under 22 subsection 2 , to if the beds which are specialized to provide 23 substance use disorder treatment. However, the total number of 24 beds approved under subsection 2 and this subsection shall not 25 exceed four hundred thirty , unless approved for good cause by 26 the director pursuant to subsection 2 . Beds The limitations 27 on the number of beds under this section shall not apply to 28 beds for children youth who do not reside in this state and 29 whose service costs are not paid by public funds in this state 30 are not subject to the limitations on the number of beds 31 requirements otherwise applicable under this section . 32 5. A psychiatric institution licensed prior to July 1, 1999, 33 may exceed the number of beds authorized under subsection 2 34 if the excess beds are used to provide services funded from 35 -7- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 7/ 33

a source other than the medical assistance program under 1 chapter 249A . Notwithstanding subsection 1 , paragraph “d” , and 2 subsection 2 , the provision of services using those excess beds 3 does not require a review by the department of health and human 4 services. 5 Sec. 7. Section 135H.7, subsection 2, paragraph a, Code 6 2025, is amended to read as follows: 7 a. If a person who has been convicted of a crime or has a 8 record of founded child abuse is being considered for licensure 9 under this chapter , or for employment with a psychiatric 10 institution involving direct responsibility for a child youth 11 or with access to a child youth when the child youth is alone, 12 by a licensed psychiatric institution, or if a person will 13 reside residence in a facility utilized by a licensee, and if 14 the person has been convicted of a crime or has a record of 15 founded child abuse, the record check evaluation system and 16 the licensee for an employee of the licensee considering the 17 person for employment shall perform an evaluation to determine 18 whether the crime or founded child abuse warrants prohibition 19 of licensure, employment, or residence in the facility utilized 20 by a licensee . The record check evaluation system of the 21 department of health and human services shall conduct criminal 22 and child abuse record checks in this state and may conduct 23 these checks in other states. The record check evaluation 24 shall be performed in accordance with procedures adopted for 25 this purpose by the department of health and human services. 26 Sec. 8. NEW SECTION . 135H.7A Protective locked environment 27 —— rules. 28 The department, in cooperation with the department of health 29 and human services, shall adopt rules pursuant to chapter 17A 30 relating to the application of a protective locked environment 31 in a psychiatric medical institution for children. 32 Sec. 9. Section 135H.10, subsection 2, Code 2025, is amended 33 to read as follows: 34 2. This chapter shall not be construed as prohibiting 35 -8- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 8/ 33

the use of to prohibit funds appropriated for foster care to 1 from being used to provide payment to a psychiatric medical 2 institution for children for the financial participation 3 required of a child youth whose foster care placement is in a 4 psychiatric medical institution for children. In accordance 5 with established policies and procedures for foster care, the 6 department of health and human services shall act to recover 7 any such payment for financial participation, apply to be named 8 payee for the child’s youth’s unearned income, and recommend 9 parental liability for the costs of a court-ordered foster care 10 placement in a psychiatric medical institution. 11 Sec. 10. Section 135H.13, subsection 1, Code 2025, is 12 amended to read as follows: 13 1. The department’s final findings and the survey findings 14 of the joint commission on the accreditation of health care 15 organizations an approved qualifying organization regarding 16 licensure or program accreditation shall be made available 17 to the public in a readily available form and place. Other 18 information relating to the psychiatric institution is 19 confidential and shall not be made available to the public 20 except in proceedings a proceeding involving licensure, a 21 civil suit involving a resident, or an administrative action 22 involving a resident. 23 Sec. 11. Section 229.13, subsection 1, paragraph c, Code 24 2025, is amended to read as follows: 25 c. (1) If the court orders evaluation and treatment of 26 the respondent on an inpatient basis under this section , the 27 court may order the respondent placed under the care of an 28 appropriate subacute care facility licensed under chapter 135G . 29 (2) If the court orders evaluation and treatment of a minor 30 respondent on an inpatient basis under this section, the court 31 may order the minor respondent placed under the care of an 32 appropriate public hospital. 33 Sec. 12. Section 229.13, subsection 5, Code 2025, is amended 34 to read as follows: 35 -9- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 9/ 33

5. a. (1) The chief medical officer of the hospital or 1 facility at which the respondent is placed shall report to the 2 court and make a recommendation for disposition of the matter 3 no more than fifteen days after the date the respondent is 4 placed , making a recommendation for disposition of the matter 5 at the hospital or facility . An 6 (2) If the respondent is a minor and is placed under the 7 care of a public hospital pursuant to subsection 1, paragraph 8 “c” , subparagraph (2), the chief medical officer of the public 9 hospital shall report to the court and make a recommendation 10 for disposition no later than thirty calendar days after the 11 date the minor respondent is placed under the care of the 12 public hospital. 13 b. A copy of the chief medical officer’s report shall be 14 sent to the respondent’s attorney. 15 c. (1) Upon request, the court may grant the chief medical 16 officer an extension of time may be granted , not to exceed 17 seven days , upon a showing of cause. A copy of the report shall 18 be sent to the The respondent’s attorney , who may contest the 19 need for an extension of time if one is requested . An 20 (2) The court shall grant an extension of time shall be 21 granted upon request unless the request is contested, in which 22 case the court shall make such inquiry as it deems appropriate 23 and may either order the respondent’s release from the hospital 24 or facility , or grant an extension of time for psychiatric 25 evaluation. 26 d. If the chief medical officer fails to report to the 27 court within fifteen days after the individual is placed under 28 the care of the hospital or facility the time specified in 29 paragraph “a” , and an extension of time has not been requested 30 granted , the chief medical officer is guilty of contempt 31 and shall be punished under chapter 665. The court shall 32 order a rehearing on the application to determine whether the 33 respondent should continue to be detained at or placed under 34 the care of the hospital or facility. 35 -10- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 10/ 33

Sec. 13. Section 229.14, subsection 2, paragraph e, Code 1 2025, is amended to read as follows: 2 e. (1) If the court orders placement and treatment of the 3 a respondent on an inpatient basis under this section , the 4 court may order the respondent placed under the care of an 5 appropriate subacute care facility licensed under chapter 135G . 6 (2) If the court orders placement and treatment of a minor 7 respondent on an inpatient basis under this section, the court 8 may order the minor respondent placed under the care of an 9 appropriate public hospital. 10 Sec. 14. Section 232.2, Code 2025, is amended by adding the 11 following new subsections: 12 NEW SUBSECTION . 3A. “Behavioral health condition” means 13 a serious emotional disturbance, a mental health disorder, 14 a substance abuse disorder, life stressors and crises, and 15 stress-related physical symptoms. 16 NEW SUBSECTION . 3B. “Behavioral health evaluation” means a 17 process used to assess an individual’s behavioral health status 18 and functioning for purposes including but not limited to the 19 diagnosis of a behavioral health condition or to determine the 20 need for treatment or intervention. 21 NEW SUBSECTION . 38A. “Mental health disorder” means the 22 same as defined in section 135H.1. 23 NEW SUBSECTION . 48A. “Physical assessment” means 24 direct physical touching, viewing, and medically necessary 25 manipulation of any area of a child’s body by a physician 26 licensed under chapter 148. 27 NEW SUBSECTION . 58A. “Serious emotional disturbance” means 28 the same as defined in section 135H.1. 29 NEW SUBSECTION . 64A. “Substance use disorder” means the 30 same as defined in section 125.2. 31 Sec. 15. Section 232.2, subsection 34, Code 2025, is amended 32 to read as follows: 33 34. “Juvenile court social records” or “social records” means 34 all records , other than official records, made with respect to 35 -11- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 11/ 33

a child in connection with proceedings over which the court has 1 jurisdiction under this chapter other than official records and 2 includes but is not limited to the records made and compiled 3 by intake officers, predisposition reports, and reports of 4 physical assessments and mental examinations behavioral health 5 evaluations . 6 Sec. 16. Section 232.8, subsection 4, Code 2025, is amended 7 to read as follows: 8 4. In a proceeding concerning a child who is alleged to 9 have committed a second delinquent act or a second violation 10 excluded from the jurisdiction of the juvenile court, the court 11 or the juvenile court shall determine whether there is reason 12 to believe that the child regularly abuses alcohol or other 13 controlled substance has a behavioral health condition and may 14 be in need of treatment. If the court so determines, the court 15 shall advise appropriate juvenile authorities and refer such 16 offenders to the juvenile court for disposition pursuant to 17 section 232.52A . 18 Sec. 17. Section 232.49, Code 2025, is amended to read as 19 follows: 20 232.49 Physical assessments and mental examinations 21 behavioral health evaluations —— juvenile delinquency . 22 1. a. Following Any time after the entry of an order 23 of adjudication under section 232.47 , the court may, after 24 a hearing which may be simultaneous with the adjudicatory 25 hearing , order a physical assessment or mental examination 26 behavioral health evaluation of a child if it the court finds 27 that an examination a physical assessment or a behavioral 28 health evaluation is necessary to determine the child’s 29 physical condition or mental to determine if the child has a 30 behavioral health condition. 31 b. The court may consider chemical dependency as either 32 a physical condition or mental behavioral health condition 33 and may consider a chemical dependency evaluation as either a 34 physical assessment or mental examination behavioral health 35 -12- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 12/ 33

evaluation . If the examination 1 c. A hearing to order a physical assessment or behavioral 2 health evaluation may be held at the same time as the 3 adjudicatory hearing. 4 2. Unless otherwise ordered by the court, if a physical 5 assessment or behavioral health evaluation indicates the child 6 has behaved in a manner that threatened the safety of another 7 person, has committed a violent act causing bodily injury to 8 another person, or has been a victim or perpetrator of sexual 9 abuse, unless otherwise ordered by the court, the child’s 10 parent, guardian, or foster parent , or other person with 11 custody of the child shall be provided with that information. 12 2. 3. a. When possible an examination , a physical 13 assessment or behavioral health evaluation shall be conducted 14 on an outpatient basis , but . However, if deemed necessary by 15 the court, the court may , if it deems necessary commit order 16 the child to a suitable hospital, facility , or institution for 17 the purpose of examination an inpatient physical assessment or 18 an inpatient behavioral health evaluation . 19 b. Commitment for examination An inpatient physical 20 assessment or an inpatient behavioral health evaluation shall 21 not exceed thirty days and the civil commitment provisions of 22 chapter 229 shall not apply . 23 3. 4. a. At any Any time after the filing of a delinquency 24 petition , the court may order a physical assessment or mental 25 examination behavioral health evaluation of the child if all of 26 the following circumstances apply: 27 (1) The court finds such examination a physical assessment 28 or a behavioral health evaluation to be in the best interest 29 of the child ; and . 30 (2) The parent, guardian, or custodian and the child’s 31 counsel agree to the physical assessment or behavioral health 32 evaluation . 33 b. (1) An examination A physical assessment or behavioral 34 health evaluation shall be conducted on an outpatient basis 35 -13- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 13/ 33

unless the court, the child’s counsel, and the child’s 1 parent, guardian, or custodian agree that it is necessary the 2 child should be committed ordered to a suitable hospital, 3 facility, or institution for the purpose of examination an 4 inpatient physical assessment or an inpatient behavioral health 5 evaluation . Commitment for examination 6 (2) An inpatient physical assessment or inpatient 7 behavioral health evaluation shall not exceed thirty days and 8 the civil commitment provisions of chapter 229 shall not apply . 9 Sec. 18. Section 232.52A, subsection 1, Code 2025, is 10 amended to read as follows: 11 1. In addition to any other order of the juvenile court, 12 a person under age eighteen, child who may be in need of 13 treatment , as determined under section 232.8 , may be ordered 14 to participate in an alcohol or controlled substance education 15 or a physical assessment or behavioral health evaluation 16 program approved by the juvenile court. If recommended after 17 evaluation, the The court may also order the person child to 18 participate in a treatment program approved by the court if the 19 treatment program is recommended after the child’s physical 20 assessment or behavioral health evaluation . The juvenile court 21 may also require the custodial parent or parents , or other 22 legal guardian , to participate in an educational program with 23 the person under age eighteen child if the court determines 24 that such participation is in the best interests of the person 25 under age eighteen child . 26 Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 27 1, Code 2025, is amended to read as follows: 28 “Confidential access to a child” means access to a child, 29 during an assessment of an alleged act of child abuse, who is 30 alleged to be the victim of the child abuse , during a child 31 abuse assessment . The access may be accomplished by interview, 32 observation, or examination physical assessment of the child. 33 As used in this subsection and this part: 34 Sec. 20. Section 232.68, subsection 3, paragraph c, Code 35 -14- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 14/ 33

2025, is amended by striking the paragraph. 1 Sec. 21. Section 232.69, subsection 3, paragraph b, Code 2 2025, is amended to read as follows: 3 b. A person required to make a report under subsection 1, 4 other than a physician whose professional practice does not 5 regularly involve providing primary health care to children, 6 shall complete the core training curriculum relating to 7 the identification and reporting of child abuse within six 8 months of initial employment or self-employment involving 9 the examination physical assessments or behavioral health 10 evaluations , or attending, counseling, or treatment of treating 11 children on a regular basis. Within one month of initial 12 employment or self-employment, the person shall obtain a 13 statement of the abuse reporting requirements from the person’s 14 employer or, if self-employed, from the department. The person 15 shall complete the core training curriculum relating to the 16 identification and reporting of child abuse every three years. 17 Sec. 22. Section 232.71B, subsection 10, Code 2025, is 18 amended to read as follows: 19 10. Physical examination assessment . If the department 20 refers a child to a physician or physician assistant for a 21 physical examination assessment , the department shall contact 22 the physician or physician assistant regarding the examination 23 physical assessment within twenty-four hours of making the 24 referral. If the physician or physician assistant who performs 25 the examination upon referral by the department physical 26 assessment reasonably believes the child has been abused, the 27 physician or physician assistant shall report to the department 28 within twenty-four hours of performing the examination physical 29 assessment . 30 Sec. 23. Section 232.77, subsection 1, Code 2025, is amended 31 to read as follows: 32 1. a. A person who is required to report suspected 33 child abuse may take or perform, or may cause to be taken or 34 performed , at public expense, photographs, X rays, or other 35 -15- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 15/ 33

physical examinations assessments, or other tests of a child 1 which would provide medical indication of allegations arising 2 from an assessment. 3 b. A health practitioner may, if medically indicated, 4 cause to be performed a radiological examination, physical 5 examination assessment , or other medical tests test of the 6 child. 7 c. A person who takes any photographs or X rays or 8 performs any physical examinations assessments or other tests 9 pursuant to this section shall notify the department that the 10 photographs or X rays have been taken or the examinations 11 physical assessments or other tests have been performed . The 12 person who made notification , and shall retain the photographs , 13 or X rays , or examination physical assessment or other test 14 findings for a reasonable time following the notification. 15 d. Whenever the person is required to report under section 16 232.69 , in that person’s capacity as a member of the staff of 17 a medical or other private or public institution, agency or 18 facility, that person shall immediately notify the person in 19 charge of the institution, agency, or facility or that person’s 20 designated delegate of the need for photographs , or X rays or 21 examinations , physical assessments, or other tests. 22 Sec. 24. Section 232.78, subsection 1, paragraph a, Code 23 2025, is amended to read as follows: 24 a. Any of the following circumstances exist: 25 (1) The person responsible for the care of the child 26 consents to the removal. 27 (2) The person responsible for the care of the child is 28 absent , or . 29 (3) The person responsible for the care of the child, though 30 present, was asked and refused to consent to the removal of the 31 child and was informed of an intent to apply for an order under 32 this section , or there . 33 (4) There is reasonable cause to believe that a request for 34 consent would further endanger the child , or there . 35 -16- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 16/ 33

(5) There is reasonable cause to believe that a request for 1 consent will cause the parent, guardian, or legal custodian 2 person responsible for the care of the child to take flight 3 with the child. 4 Sec. 25. Section 232.78, subsection 1, paragraph c, 5 subparagraph (1), Code 2025, is amended to read as follows: 6 (1) The refusal or failure of the person responsible for 7 the care of the child to comply with the request of a peace 8 officer, juvenile court officer, or child protection worker 9 for such the person to obtain and provide to the requester 10 the results of a physical assessment or mental examination 11 behavioral health evaluation of the child. The request for a 12 physical examination assessment of the child may specify the 13 performance of a medically relevant test. 14 Sec. 26. Section 232.78, subsection 5, Code 2025, is amended 15 to read as follows: 16 5. The juvenile court, before or after the filing of a 17 petition under this chapter , may enter an ex parte order 18 authorizing a physician or physician assistant or hospital to 19 conduct an inpatient or outpatient physical examination or 20 authorizing a physician or physician assistant, a psychologist 21 certified under section 154B.7 , or a community mental health 22 center accredited pursuant to chapter 230A to conduct an 23 outpatient mental examination assessment or an inpatient or 24 outpatient behavioral health evaluation of a child if necessary 25 to identify the nature, extent, and cause of injuries to the 26 child as required by section 232.71B , provided all of the 27 following apply: 28 a. Any of the following circumstances exist: 29 (1) The child’s parent, guardian, or custodian consents to 30 the physical assessment or the behavioral health evaluation. 31 (2) The child’s parent, guardian, or legal custodian is 32 absent , or . 33 (3) The child’s parent, guardian, or custodian, though 34 present, was asked and refused to provide written consent to 35 -17- HF 984.1668 (2) 91 (amending this HF 984 to CONFORM to SF 474) dg/ko 17/ 33