Senate File 474 - Enrolled Senate File 474 AN ACT RELATING TO SERVICES AND SUPPORT FOR YOUTH, INCLUDING TREATMENT, PHYSICAL ASSESSMENTS, AND BEHAVIORAL HEALTH EVALUATIONS FOR YOUTH INVOLVED IN JUVENILE DELINQUENCY AND CHILD IN NEED OF ASSISTANCE PROCEEDINGS; THE LICENSING AND CERTIFICATION OF CERTAIN RESIDENTIAL FACILITIES; THE PROVISION OF HOME AND COMMUNITY-BASED SERVICES AND HABILITATION SERVICES TO CERTAIN YOUTH BY RESIDENTIAL PROGRAMS; ADMINISTRATION AND SUPERVISION OF JUVENILE COURT SERVICES; AND THE SUSPENSION OF HAWKI ELIGIBILITY FOR INMATES OF PUBLIC INSTITUTIONS. BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: DIVISION I SERVICES AND SUPPORT FOR CHILDREN AND YOUTH Section 1. Section 125.13, subsection 2, Code 2025, is amended by adding the following new paragraph: NEW PARAGRAPH . k. A psychiatric medical institution for children licensed under chapter 135H, unless the psychiatric medical institution for children provides substance use disorder services. Sec. 2. Section 135H.1, Code 2025, is amended to read as follows: 135H.1 Definitions. As used in this chapter , unless the context otherwise requires:

Senate File 474, p. 2 1. “Approved qualifying organization” means any of the following: a. The joint commission. b. The commission on accreditation of rehabilitation facilities. c. The council on accreditation. d. A nationally recognized accrediting organization with standards comparable to the entities listed in paragraphs “a” through “c” that are acceptable under federal regulations. e. An entity specified by rule adopted by the department in consultation with the department of health and human services. 1. 2. “Department” means the department of inspections, appeals, and licensing. 2. 3. “Direction” means authoritative policy or procedural guidance for the accomplishment of a function or an activity. 3. 4. “Licensee” means the holder of a license issued to operate a psychiatric medical institution for children. 4. 5. “Medical care plan” means a plan of care and services designed to eliminate the need for inpatient care by improving the condition of a child youth . Services must be based upon a diagnostic evaluation, which includes an examination a physical assessment and behavioral health evaluation of the medical, psychological, social, behavioral, and developmental aspects of the child’s youth’s situation, reflecting the need for inpatient care. 6. “Mental health disorder” means a mental disorder as defined by the most recent version of the diagnostic and statistical manual of mental disorders published by the American psychiatric association. 5. 7. “Mental health professional” means an individual who has all of the following qualifications: a. The individual holds at least a master’s degree in a mental health field, including but not limited to, psychology, counseling and guidance, nursing, and or social work, or the individual is a physician. b. The individual holds a current Iowa license if practicing in a field covered by that requires an Iowa licensure law license . c. The individual has at least two years of post-degree

Senate File 474, p. 3 clinical experience, supervised by another mental health professional, in assessing mental health needs and problems and in providing appropriate mental health services. 6. 8. “Nursing care” means services which are provided under the direction of a physician or registered nurse. 7. 9. “Physician” means a person licensed under chapter 148 . 10. “Protective locked environment” means a setting that prevents egress from a building or grounds as a protective measure to ensure safety and security. 8. 11. “Psychiatric medical institution for children” or “psychiatric institution” means an institution providing more than twenty-four hours of continuous care involving long-term psychiatric services to three or more children youth in residence for expected periods of fourteen or more days for an assessment, evaluation, and diagnosis and evaluation or for expected periods of ninety days or more for treatment. 9. 12. “Psychiatric services” means services provided under the direction of a physician which address mental, emotional, medical, or behavioral problems. 13. “Record check evaluation system” means the same as defined in section 135C.1. 10. 14. “Rehabilitative services” means services to encourage and assist restoration of a resident’s optimum mental and physical capabilities. 11. 15. “Resident” means a person who is less than twenty-one years of age and youth who has been admitted by a physician to a psychiatric medical institution for children. 16. “Serious emotional disturbance” means a diagnosable mental, behavioral, or emotional disorder that meets the diagnostic criteria specified in the most current diagnostic and statistical manual of mental disorders published by the American psychiatric association. “Serious emotional disturbance” does not include a substance use disorder or developmental disorder unless such disorder co-occurs with a diagnosable mental, behavioral, or emotional disorder. 17. “Substance use disorder” means the same as defined in section 125.2. 12. 18. “Supervision” means direct oversight and inspection

Senate File 474, p. 4 of the an act of accomplishing that accomplishes a function or activity. 19. “Youth” means a person who is less than twenty-one years of age. Sec. 3. Section 135H.3, Code 2025, is amended to read as follows: 135H.3 Nature of care. 1. a. A psychiatric medical institution for children shall provide shelter, food, supervision, care, assessment, evaluation, diagnosis, treatment, counseling, rehabilitative services, and related professional-directed services to youth who have a serious emotional disturbance, a substance use disorder, or both, with the intention of reducing or ameliorating the disorder, the symptoms of the disorder, or the effects of the disorder. b. A psychiatric medical institution for children shall utilize a team of professionals to direct an organized program of diagnostic services, psychiatric services, nursing care, and rehabilitative services to meet the needs of residents in accordance with a medical care plan developed for each resident. The membership of the team of professionals may include but is not limited to an advanced registered nurse practitioner or a physician assistant. Social and rehabilitative services shall be provided under the direction of a qualified mental health professional. 2. If a child youth is diagnosed with a biologically based mental illness as defined in section 514C.22 and meets the medical assistance program criteria for admission to a psychiatric medical institution for children, the child youth shall be deemed to meet the acuity criteria for medically necessary inpatient benefits under a group policy, contract, or plan providing for third-party payment or prepayment of health, medical, and surgical coverage benefits issued by a carrier, as defined in section 513B.2 , that is subject to section 514C.22 . Such medically necessary benefits shall not be excluded or denied as care that is substantially custodial in nature under section 514C.22, subsection 8 , paragraph “b” . Sec. 4. Section 135H.4, Code 2025, is amended to read as follows:

Senate File 474, p. 5 135H.4 Licensure. 1. A person shall not establish, operate, or maintain a psychiatric medical institution for children unless the person obtains a license for the institution under this chapter and either holds a license under section 237.3, subsection 2 , paragraph “a” , as a comprehensive residential facility for children or holds a license under section 125.13 , if the facility provides substance use disorder treatment under chapter 237, and holds a license under this chapter . 2. In addition to the requirements under subsection 1, a person shall not provide substance use disorder services at a psychiatric medical institution for children unless the person holds a license under section 125.13. The department of health and human services shall adopt rules pursuant to chapter 17A to create an expedited process for a person to simultaneously obtain a license under section 125.13 and a license as a comprehensive residential facility for children under chapter 237. Sec. 5. Section 135H.5, Code 2025, is amended to read as follows: 135H.5 Application for license —— initial application and annual fees . 1. An application for a license under this chapter shall be submitted on a form requesting information required by the department , which . The application may include require affirmative evidence of the applicant’s ability to comply with the rules for standards adopted pursuant to this chapter . The application shall require the applicant to specify whether the applicant intends to provide services for serious emotional disturbances, substance use disorders, or both. 2. An application for a license shall be accompanied by the required license fee which shall be credited to the general fund of the state. The initial application fee and the annual license fee is twenty-five dollars. Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, are amended to read as follows: 1. The department shall issue a license to an applicant under this chapter if all the following conditions exist: a. The department has ascertained that the applicant’s

Senate File 474, p. 6 medical facilities and staff are adequate to provide the care and services required of a psychiatric medical institution for children . b. The proposed psychiatric institution is accredited by the joint commission on the accreditation of health care organizations, the commission on accreditation of rehabilitation facilities, the council on accreditation of services for families and children, or by any other recognized accrediting organization with comparable standards acceptable under federal regulation an approved qualifying organization . c. The applicant complies with applicable state rules and standards for a psychiatric institution adopted by the department in accordance with federal requirements under 42 C.F.R. §441.150 – 441.156. d. The department of health and human services has submitted written approval of the application based on the department of health and human services’ determination of need. The department of health and human services shall identify the location and number of children youth in the state who require the services of a psychiatric medical institution for children. Approval of an application shall be based upon the location of the proposed psychiatric institution relative to the need for services identified by the department of health and human services and an analysis of the applicant’s ability to provide services and support consistent with requirements under chapter 232 , particularly regarding specifically community-based treatment. If the proposed psychiatric institution is not freestanding from a facility licensed under chapter 135B or 135C , approval under this paragraph shall not be given unless the department of health and human services certifies that the proposed psychiatric institution is capable of providing a resident with a living environment similar to the living environment provided by a licensee which is freestanding from a facility licensed under chapter 135B or 135C . e. The proposed psychiatric institution is under the direction of an agency which has operated a facility licensed under section 237.3, subsection 2 , paragraph “a” , as a comprehensive residential facility for children for three years or of an agency which has operated a facility for three years

Senate File 474, p. 7 providing psychiatric services exclusively to children or adolescents and the facility meets or exceeds requirements for licensure under section 237.3, subsection 2 , paragraph “a” , as a comprehensive residential facility for children. f. e. If a child youth has an a serious emotional , behavioral, or mental health disorder disturbance , the psychiatric institution does not require court any of the following as a condition for the youth to obtain treatment: (1) Court proceedings to be initiated or that a child’s . (2) For the youth’s parent, guardian, or custodian must to terminate parental rights over , or transfer legal custody of , the child for the purposes of obtaining treatment from the psychiatric institution for the child youth . (3) Relinquishment of a child’s the youth’s custody shall not be a condition of the child receiving services . 4. The department of health and human services may give approval to approve a conversion of beds approved under subsection 2 , to if the beds which are specialized to provide substance use disorder treatment. However, the total number of beds approved under subsection 2 and this subsection shall not exceed four hundred thirty , unless approved for good cause by the director pursuant to subsection 2 . Beds The limitations on the number of beds under this section shall not apply to beds for children youth who do not reside in this state and whose service costs are not paid by public funds in this state are not subject to the limitations on the number of beds requirements otherwise applicable under this section . 5. A psychiatric institution licensed prior to July 1, 1999, may exceed the number of beds authorized under subsection 2 if the excess beds are used to provide services funded from a source other than the medical assistance program under chapter 249A . Notwithstanding subsection 1 , paragraph “d” , and subsection 2 , the provision of services using those excess beds does not require a review by the department of health and human services. Sec. 7. Section 135H.7, subsection 2, paragraph a, Code 2025, is amended to read as follows: a. If a person who has been convicted of a crime or has a record of founded child abuse is being considered for licensure

Senate File 474, p. 8 under this chapter , or for employment with a psychiatric institution involving direct responsibility for a child youth or with access to a child youth when the child youth is alone, by a licensed psychiatric institution, or if a person will reside residence in a facility utilized by a licensee, and if the person has been convicted of a crime or has a record of founded child abuse, the record check evaluation system and the licensee for an employee of the licensee considering the person for employment shall perform an evaluation to determine whether the crime or founded child abuse warrants prohibition of licensure, employment, or residence in the facility utilized by a licensee . The record check evaluation system of the department of health and human services shall conduct criminal and child abuse record checks in this state and may conduct these checks in other states. The record check evaluation shall be performed in accordance with procedures adopted for this purpose by the department of health and human services. Sec. 8. NEW SECTION . 135H.7A Protective locked environment —— rules. The department, in cooperation with the department of health and human services, shall adopt rules pursuant to chapter 17A relating to the application of a protective locked environment in a psychiatric medical institution for children. Sec. 9. Section 135H.10, subsection 2, Code 2025, is amended to read as follows: 2. This chapter shall not be construed as prohibiting the use of to prohibit funds appropriated for foster care to from being used to provide payment to a psychiatric medical institution for children for the financial participation required of a child youth whose foster care placement is in a psychiatric medical institution for children. In accordance with established policies and procedures for foster care, the department of health and human services shall act to recover any such payment for financial participation, apply to be named payee for the child’s youth’s unearned income, and recommend parental liability for the costs of a court-ordered foster care placement in a psychiatric medical institution. Sec. 10. Section 135H.13, subsection 1, Code 2025, is amended to read as follows:

Senate File 474, p. 9 1. The department’s final findings and the survey findings of the joint commission on the accreditation of health care organizations an approved qualifying organization regarding licensure or program accreditation shall be made available to the public in a readily available form and place. Other information relating to the psychiatric institution is confidential and shall not be made available to the public except in proceedings a proceeding involving licensure, a civil suit involving a resident, or an administrative action involving a resident. Sec. 11. Section 229.13, subsection 1, paragraph c, Code 2025, is amended to read as follows: c. (1) If the court orders evaluation and treatment of the respondent on an inpatient basis under this section , the court may order the respondent placed under the care of an appropriate subacute care facility licensed under chapter 135G . (2) If the court orders evaluation and treatment of a minor respondent on an inpatient basis under this section, the court may order the minor respondent placed under the care of an appropriate public hospital. Sec. 12. Section 229.13, subsection 5, Code 2025, is amended to read as follows: 5. a. (1) The chief medical officer of the hospital or facility at which the respondent is placed shall report to the court and make a recommendation for disposition of the matter no more than fifteen days after the date the respondent is placed , making a recommendation for disposition of the matter at the hospital or facility . An (2) If the respondent is a minor and is placed under the care of a public hospital pursuant to subsection 1, paragraph “c” , subparagraph (2), the chief medical officer of the public hospital shall report to the court and make a recommendation for disposition no later than thirty calendar days after the date the minor respondent is placed under the care of the public hospital. b. A copy of the chief medical officer’s report shall be sent to the respondent’s attorney. c. (1) Upon request, the court may grant the chief medical officer an extension of time may be granted , not to exceed

Senate File 474, p. 10 seven days , upon a showing of cause. A copy of the report shall be sent to the The respondent’s attorney , who may contest the need for an extension of time if one is requested . An (2) The court shall grant an extension of time shall be granted upon request unless the request is contested, in which case the court shall make such inquiry as it deems appropriate and may either order the respondent’s release from the hospital or facility , or grant an extension of time for psychiatric evaluation. d. If the chief medical officer fails to report to the court within fifteen days after the individual is placed under the care of the hospital or facility the time specified in paragraph “a” , and an extension of time has not been requested granted , the chief medical officer is guilty of contempt and shall be punished under chapter 665. The court shall order a rehearing on the application to determine whether the respondent should continue to be detained at or placed under the care of the hospital or facility. Sec. 13. Section 229.14, subsection 2, paragraph e, Code 2025, is amended to read as follows: e. (1) If the court orders placement and treatment of the a respondent on an inpatient basis under this section , the court may order the respondent placed under the care of an appropriate subacute care facility licensed under chapter 135G . (2) If the court orders placement and treatment of a minor respondent on an inpatient basis under this section, the court may order the minor respondent placed under the care of an appropriate public hospital. Sec. 14. Section 232.2, Code 2025, is amended by adding the following new subsections: NEW SUBSECTION . 3A. “Behavioral health condition” means a serious emotional disturbance, a mental health disorder, a substance abuse disorder, life stressors and crises, and stress-related physical symptoms. NEW SUBSECTION . 3B. “Behavioral health evaluation” means a process used to assess an individual’s behavioral health status and functioning for purposes including but not limited to the diagnosis of a behavioral health condition or to determine the need for treatment or intervention.

Senate File 474, p. 11 NEW SUBSECTION . 38A. “Mental health disorder” means the same as defined in section 135H.1. NEW SUBSECTION . 48A. “Physical assessment” means direct physical touching, viewing, and medically necessary manipulation of any area of a child’s body by a physician licensed under chapter 148. NEW SUBSECTION . 58A. “Serious emotional disturbance” means the same as defined in section 135H.1. NEW SUBSECTION . 64A. “Substance use disorder” means the same as defined in section 125.2. Sec. 15. Section 232.2, subsection 34, Code 2025, is amended to read as follows: 34. “Juvenile court social records” or “social records” means all records , other than official records, made with respect to a child in connection with proceedings over which the court has jurisdiction under this chapter other than official records and includes but is not limited to the records made and compiled by intake officers, predisposition reports, and reports of physical assessments and mental examinations behavioral health evaluations . Sec. 16. Section 232.8, subsection 4, Code 2025, is amended to read as follows: 4. In a proceeding concerning a child who is alleged to have committed a second delinquent act or a second violation excluded from the jurisdiction of the juvenile court, the court or the juvenile court shall determine whether there is reason to believe that the child regularly abuses alcohol or other controlled substance has a behavioral health condition and may be in need of treatment. If the court so determines, the court shall advise appropriate juvenile authorities and refer such offenders to the juvenile court for disposition pursuant to section 232.52A . Sec. 17. Section 232.49, Code 2025, is amended to read as follows: 232.49 Physical assessments and mental examinations behavioral health evaluations —— juvenile delinquency . 1. a. Following Any time after the entry of an order of adjudication under section 232.47 , the court may, after a hearing which may be simultaneous with the adjudicatory

Senate File 474, p. 12 hearing , order a physical assessment or mental examination behavioral health evaluation of a child if it the court finds that an examination a physical assessment or a behavioral health evaluation is necessary to determine the child’s physical condition or mental to determine if the child has a behavioral health condition. b. The court may consider chemical dependency as either a physical condition or mental behavioral health condition and may consider a chemical dependency evaluation as either a physical assessment or mental examination behavioral health evaluation . If the examination c. A hearing to order a physical assessment or behavioral health evaluation may be held at the same time as the adjudicatory hearing. 2. Unless otherwise ordered by the court, if a physical assessment or behavioral health evaluation indicates the child has behaved in a manner that threatened the safety of another person, has committed a violent act causing bodily injury to another person, or has been a victim or perpetrator of sexual abuse, unless otherwise ordered by the court, the child’s parent, guardian, or foster parent , or other person with custody of the child shall be provided with that information. 2. 3. a. When possible an examination , a physical assessment or behavioral health evaluation shall be conducted on an outpatient basis , but . However, if deemed necessary by the court, the court may , if it deems necessary commit order the child to a suitable hospital, facility , or institution for the purpose of examination an inpatient physical assessment or an inpatient behavioral health evaluation . b. Commitment for examination An inpatient physical assessment or an inpatient behavioral health evaluation shall not exceed thirty days and the civil commitment provisions of chapter 229 shall not apply . 3. 4. a. At any Any time after the filing of a delinquency petition , the court may order a physical assessment or mental examination behavioral health evaluation of the child if all of the following circumstances apply: (1) The court finds such examination a physical assessment or a behavioral health evaluation to be in the best interest

Senate File 474, p. 13 of the child ; and . (2) The parent, guardian, or custodian and the child’s counsel agree to the physical assessment or behavioral health evaluation . b. (1) An examination A physical assessment or behavioral health evaluation shall be conducted on an outpatient basis unless the court, the child’s counsel, and the child’s parent, guardian, or custodian agree that it is necessary the child should be committed ordered to a suitable hospital, facility, or institution for the purpose of examination an inpatient physical assessment or an inpatient behavioral health evaluation . Commitment for examination (2) An inpatient physical assessment or inpatient behavioral health evaluation shall not exceed thirty days and the civil commitment provisions of chapter 229 shall not apply . Sec. 18. Section 232.52A, subsection 1, Code 2025, is amended to read as follows: 1. In addition to any other order of the juvenile court, a person under age eighteen, child who may be in need of treatment , as determined under section 232.8 , may be ordered to participate in an alcohol or controlled substance education or a physical assessment or behavioral health evaluation program approved by the juvenile court. If recommended after evaluation, the The court may also order the person child to participate in a treatment program approved by the court if the treatment program is recommended after the child’s physical assessment or behavioral health evaluation . The juvenile court may also require the custodial parent or parents , or other legal guardian , to participate in an educational program with the person under age eighteen child if the court determines that such participation is in the best interests of the person under age eighteen child . Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 1, Code 2025, is amended to read as follows: “Confidential access to a child” means access to a child, during an assessment of an alleged act of child abuse, who is alleged to be the victim of the child abuse , during a child abuse assessment . The access may be accomplished by interview, observation, or examination physical assessment of the child.

Senate File 474, p. 14 As used in this subsection and this part: Sec. 20. Section 232.68, subsection 3, paragraph c, Code 2025, is amended by striking the paragraph. Sec. 21. Section 232.69, subsection 3, paragraph b, Code 2025, is amended to read as follows: b. A person required to make a report under subsection 1, other than a physician whose professional practice does not regularly involve providing primary health care to children, shall complete the core training curriculum relating to the identification and reporting of child abuse within six months of initial employment or self-employment involving the examination physical assessments or behavioral health evaluations , or attending, counseling, or treatment of treating children on a regular basis. Within one month of initial employment or self-employment, the person shall obtain a statement of the abuse reporting requirements from the person’s employer or, if self-employed, from the department. The person shall complete the core training curriculum relating to the identification and reporting of child abuse every three years. Sec. 22. Section 232.71B, subsection 10, Code 2025, is amended to read as follows: 10. Physical examination assessment . If the department refers a child to a physician or physician assistant for a physical examination assessment , the department shall contact the physician or physician assistant regarding the examination physical assessment within twenty-four hours of making the referral. If the physician or physician assistant who performs the examination upon referral by the department physical assessment reasonably believes the child has been abused, the physician or physician assistant shall report to the department within twenty-four hours of performing the examination physical assessment . Sec. 23. Section 232.77, subsection 1, Code 2025, is amended to read as follows: 1. a. A person who is required to report suspected child abuse may take or perform, or may cause to be taken or performed , at public expense, photographs, X rays, or other physical examinations assessments, or other tests of a child which would provide medical indication of allegations arising

Senate File 474, p. 15 from an assessment. b. A health practitioner may, if medically indicated, cause to be performed a radiological examination, physical examination assessment , or other medical tests test of the child. c. A person who takes any photographs or X rays or performs any physical examinations assessments or other tests pursuant to this section shall notify the department that the photographs or X rays have been taken or the examinations physical assessments or other tests have been performed . The person who made notification , and shall retain the photographs , or X rays , or examination physical assessment or other test findings for a reasonable time following the notification. d. Whenever the person is required to report under section 232.69 , in that person’s capacity as a member of the staff of a medical or other private or public institution, agency or facility, that person shall immediately notify the person in charge of the institution, agency, or facility or that person’s designated delegate of the need for photographs , or X rays or examinations , physical assessments, or other tests. Sec. 24. Section 232.78, subsection 1, paragraph a, Code 2025, is amended to read as follows: a. Any of the following circumstances exist: (1) The person responsible for the care of the child consents to the removal. (2) The person responsible for the care of the child is absent , or . (3) The person responsible for the care of the child, though present, was asked and refused to consent to the removal of the child and was informed of an intent to apply for an order under this section , or there . (4) There is reasonable cause to believe that a request for consent would further endanger the child , or there . (5) There is reasonable cause to believe that a request for consent will cause the parent, guardian, or legal custodian person responsible for the care of the child to take flight with the child. Sec. 25. Section 232.78, subsection 1, paragraph c, subparagraph (1), Code 2025, is amended to read as follows:

Senate File 474, p. 16 (1) The refusal or failure of the person responsible for the care of the child to comply with the request of a peace officer, juvenile court officer, or child protection worker for such the person to obtain and provide to the requester the results of a physical assessment or mental examination behavioral health evaluation of the child. The request for a physical examination assessment of the child may specify the performance of a medically relevant test. Sec. 26. Section 232.78, subsection 5, Code 2025, is amended to read as follows: 5. The juvenile court, before or after the filing of a petition under this chapter , may enter an ex parte order authorizing a physician or physician assistant or hospital to conduct an inpatient or outpatient physical examination or authorizing a physician or physician assistant, a psychologist certified under section 154B.7 , or a community mental health center accredited pursuant to chapter 230A to conduct an outpatient mental examination assessment or an inpatient or outpatient behavioral health evaluation of a child if necessary to identify the nature, extent, and cause of injuries to the child as required by section 232.71B , provided all of the following apply: a. Any of the following circumstances exist: (1) The child’s parent, guardian, or custodian consents to the physical assessment or the behavioral health evaluation. (2) The child’s parent, guardian, or legal custodian is absent , or . (3) The child’s parent, guardian, or custodian, though present, was asked and refused to provide written consent to the examination physical assessment or the behavioral health evaluation . b. The juvenile court has entered an ex parte order directing the removal of the child from the child’s home or a child care facility under this section. c. There is not enough time to file a petition and to hold a hearing as provided in section 232.98. Sec. 27. Section 232.79, subsection 5, Code 2025, is amended to read as follows: 5. When there has been an emergency removal or keeping of a