Senate File 2202 S-5061 Amend Senate File 2202 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. Section 135G.1, Code 2026, is amended by adding 4 the following new subsection: 5 NEW SUBSECTION . 3A. “Health carrier” means the same as 6 defined in section 514J.102. 7 Sec. 2. Section 135G.1, subsection 12, paragraph c, Code 8 2026, is amended by striking the paragraph. 9 Sec. 3. Section 135G.3, Code 2026, is amended to read as 10 follows: 11 135G.3 Nature of care —— seclusion room —— admissions —— 12 discharge . 13 1. a. A subacute care facility shall utilize a team of 14 professionals to direct an organized program of diagnostic 15 services, subacute mental health services, social services, 16 and rehabilitative services to meet the needs of residents 17 in accordance with a treatment care plan developed for each 18 resident under the supervision of a mental health professional. 19 b. The goal of a treatment care plan is to transition 20 residents to a less restrictive environment, including a 21 home-based community setting. Social and rehabilitative 22 services shall also be provided under the direction of a mental 23 health professional. 24 c. Within twenty-four hours of a resident’s admission to 25 a subacute care facility, the subacute care facility shall 26 develop a written treatment care plan with the resident. 27 2. a. Prior authorization shall not be required for an 28 individual’s admission to a subacute care facility or for 29 the first fifteen consecutive calendar days of a resident’s 30 treatment. 31 b. Starting from a resident’s first day of treatment, on or 32 after a resident’s forty-fifth consecutive day of treatment, 33 a managed care organization may review the medical necessity 34 of the resident’s treatment. After the initial review of a 35 -1- SF 2202.3182 (1) 91 (amending this SF 2202 to CONFORM to HF 2543) dg/ko 1/ 4 #1.

resident’s treatment, a managed care organization may only 1 review the medical necessity of the resident’s treatment a 2 maximum of one time within any consecutive thirty-calendar-day 3 period. 4 2. 3. The mental health professional providing supervision 5 of the subacute care facility’s treatment care plans shall 6 evaluate the condition of each resident as medically necessary , 7 and shall be available to residents of the facility on an 8 on-call basis at all other times. Additional evaluation and 9 treatment may be provided by a mental health professional. The 10 subacute care facility may employ a seclusion room meeting the 11 conditions described in 42 C.F.R. §483.364(b) with approval 12 of a licensed psychiatrist , or by order of the resident’s 13 physician, a physician assistant, or an advanced registered 14 nurse practitioner. 15 4. A managed care organization shall not require a resident 16 to be discharged from a subacute care facility until the mental 17 health professional providing supervision of the resident’s 18 treatment care plan has determined that there are proper 19 supports in place prior to the resident’s discharge to mitigate 20 the risk of self-harm by the resident, or harm to another 21 individual by the resident. 22 5. Pursuant to section 505.36, a health carrier shall 23 provide coverage for subacute mental health services provided 24 by a subacute care facility. 25 Sec. 4. NEW SECTION . 135H.9A Bed tracking system. 26 The department of health and human services shall establish 27 an electronic system to track the availability of beds at each 28 psychiatric medical institution for children. 29 Sec. 5. NEW SECTION . 505.36 Health carriers —— subacute 30 mental health care services. 31 1. For purposes of this section: 32 a. “Health carrier” means the same as defined in section 33 514J.102. 34 b. “Subacute care facility” means the same as defined in 35 -2- SF 2202.3182 (1) 91 (amending this SF 2202 to CONFORM to HF 2543) dg/ko 2/ 4

section 135G.1. 1 c. “Subacute mental health services” means the same as 2 defined in section 135G.1. 3 2. A health carrier shall provide coverage for subacute 4 mental health services provided by a subacute care facility. A 5 health carrier that violates this section shall be subject to 6 penalties pursuant to section 505.7A. 7 Sec. 6. DEPARTMENTS OF HEALTH AND HUMAN SERVICES AND 8 INSPECTIONS, APPEALS, AND LICENSING —— ADMINISTRATIVE RULE 9 REVIEW. The department of health and human services and 10 the department of inspections, appeals, and licensing shall 11 collaborate to review each department’s administrative rules 12 adopted pursuant to section 135G.10 and eliminate any rule 13 the departments determine impedes any of the following goals 14 without providing an equal or greater benefit: 15 1. Establishment of new subacute mental health care 16 facilities and services. 17 2. Expansion of existing subacute mental health care 18 facilities and services. 19 3. Ease of access to subacute mental health care facilities 20 and services. 21 Sec. 7. DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING 22 —— SUBACUTE MENTAL HEALTH CARE FACILITIES —— BED CAPACITY 23 —— FACILITY AND EMPLOYEE REQUIREMENTS. The department of 24 inspections, appeals, and licensing shall adopt rules pursuant 25 to chapter 17A to do the following: 26 1. Increase the maximum number of beds a subacute care 27 facility may have without the subacute care facility being 28 defined as a state mental health institute. 29 2. Provide that requirements applicable to a subacute 30 mental health care facility, and subacute mental health 31 care facility employees, are less stringent than comparable 32 requirements that apply to a state mental health institute or a 33 state mental health institute’s employees. 34 Sec. 8. EMERGENCY RULES. The department of health and 35 -3- SF 2202.3182 (1) 91 (amending this SF 2202 to CONFORM to HF 2543) dg/ko 3/ 4

human services and the department of inspections, appeals, 1 and licensing may adopt emergency rules under section 17A.4, 2 subsection 3, and section 17A.5, subsection 2, paragraph “b”, 3 to implement the provisions of this Act and shall submit 4 such rules to the administrative rules coordinator and 5 the administrative code editor pursuant to section 17A.5, 6 subsection 1, within the same period. The rules shall be 7 effective immediately upon filing unless a later date is 8 specified in the rules. Any rules adopted in accordance with 9 this section shall also be published as a notice of intended 10 action as provided in section 17A.4. 11 Sec. 9. EFFECTIVE DATE. This Act, being deemed of immediate 12 importance, takes effect upon enactment. > 13 2. Title page, by striking lines 1 and 2 and inserting < An 14 Act relating to mental health care, including subacute mental 15 health care facility requirements; admission to and discharge 16 from a subacute mental health care facility; employment 17 requirements at a subacute mental health care facility; 18 insurance coverage for subacute mental health care; and the 19 establishment of a psychiatric medical institution for children 20 bed tracking system, and providing penalties and including 21 effective date provisions. > 22 ______________________________ KARA WARME -4- SF 2202.3182 (1) 91 (amending this SF 2202 to CONFORM to HF 2543) dg/ko 4/ 4 #2.