House File 529
HOUSE FILE
BY COMMITTEE ON HUMAN RESOURCES
(SUCCESSOR TO HF 221)
(COMPANION TO LSB 2107SS
BY HOUSER)
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act directing the mental health and developmental disabilities
2 commission to make recommendations for redesigning the mental
3 health and developmental disabilities services system for
4 adults and providing an effective date.
5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
6 HF 529
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PAG LIN
1 1 Section 1. MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
1 2 SERVICES SYSTEM REDESIGN.
1 3 In fulfilling the mental health and developmental
1 4 disabilities commission's duty under section 225C.6,
1 5 subsection 1, paragraph "q", the commission shall submit a
1 6 report containing recommendations in accordance with this
1 7 section to the governor and general assembly on or before
1 8 December 31, 2003, for redesign of the state's mental health
1 9 and developmental disabilities services system for adults.
1 10 The commission shall address all of the following system
1 11 components in the report and recommendations:
1 12 1. STANDARD CLINICAL AND FINANCIAL ELIGIBILITY.
1 13 The commission shall do all of the following:
1 14 a. Propose a standard set of clinical and diagnostic
1 15 eligibility requirements for use in determining which
1 16 individuals will be covered for defined core services,
1 17 including but not limited to, general clinical eligibility
1 18 standards, service access criteria, level of care
1 19 requirements, and terminology changes.
1 20 b. Propose financial eligibility criteria for qualifying
1 21 covered individuals, including guidelines for resources,
1 22 copayments, income, and assets.
1 23 c. Identify the total projected cost for all counties to
1 24 adopt the standardized clinical and financial eligibility
1 25 requirements and criteria proposed by the commission.
1 26 2. MINIMUM SET OF CORE SERVICES.
1 27 The commission shall do all of the following:
1 28 a. Identify a minimum set of core services to be provided
1 29 by each county. This core set of services shall be available
1 30 statewide. An individual's eligibility for core services
1 31 shall be based on consistent clinical criteria and service
1 32 necessity.
1 33 b. Identify the total projected cost for all counties to
1 34 make the core services available.
1 35 c. Design the core set of services as a replacement for
2 1 the current statutory mandates for services. The purpose of
2 2 replacing the current statutory mandates with the core set of
2 3 services is to shift the emphasis to community=based services
2 4 by providing covered individuals a reasonable level of choice
2 5 to meet their individual needs within available funding. The
2 6 initial set of core services considered by the commission
2 7 shall include all of the following community=based services:
2 8 (1) Mental health outpatient treatment.
2 9 (2) Inpatient psychiatric evaluation and treatment at
2 10 county=designated facilities.
2 11 (3) Service coordination and case management.
2 12 (4) Vocational services.
2 13 (5) Residential services.
2 14 3. FUNDING FOLLOWS THE COVERED INDIVIDUAL.
2 15 The commission shall include a process by which funding
2 16 follows the covered individual among the options considered,
2 17 including but not limited to the following:
2 18 a. Develop a new formula that allows public funding to
2 19 follow the covered individual regardless of categorical
2 20 funding. Distribution of state funds shall be based on a
2 21 matrix of disability=related reimbursement rate cells. Each
2 22 cell shall specify a reimbursement rate based on disability
2 23 group and level of functioning. The funding formula shall
2 24 take into account the number of covered individuals enrolled
2 25 in each county and the average cost of services provided to
2 26 covered individuals in each cell. The formula shall
2 27 incorporate all of the following principles:
2 28 (1) Each county will receive a quarterly allotment equal
2 29 to the product of the average costs per cell times the number
2 30 of individuals enrolled in each cell during the previous
2 31 quarter. To accommodate cash flow needs of counties and
2 32 reduce the level of fund balances counties need to maintain,
2 33 the state would make payments at the beginning of each quarter
2 34 based on the anticipated number of covered individuals, with a
2 35 reconciliation in the next quarter to the actual number of
3 1 covered individuals.
3 2 (2) Increasing overall state funding levels in proportion
3 3 to county funding levels.
3 4 (3) Allocating any increased state funding to achieve
3 5 statewide equity in service access.
3 6 (4) Allocating the state funding for state institutions
3 7 through counties rather than directly to the institutions so
3 8 that these services operate on an equal basis with other
3 9 services.
3 10 (5) Allocating state funding and administrative costs for
3 11 state cases to the covered individual's county of residence.
3 12 (6) Allocating the risk for service cost increases to the
3 13 counties and allocating the cost for increases in the number
3 14 of covered individuals to the state. Risk allocation
3 15 provisions shall address methods for managing the risk.
3 16 (7) Providing for risk management and flexibility
3 17 provisions such as cell rate adjustments, allowing waiting
3 18 lists to be used for an unanticipated increase in the number
3 19 of covered individuals, distributing quarterly allocations to
3 20 counties based upon the previous quarter's number of covered
3 21 individuals, removing categorical funding restrictions,
3 22 applying standards to ensure county cash flow capacity, and
3 23 allowing inflation adjustments.
3 24 (8) Expanding the state risk pool provisions under section
3 25 426B.5 to allow access to risk pool funding for specific
3 26 purposes and to allow counties to maintain a certain level of
3 27 fund balances in order to address certain cost factors.
3 28 b. All of the following factors shall be considered in
3 29 developing formula provisions for calculating the distribution
3 30 of funds:
3 31 (1) A county's ability to levy based on available taxable
3 32 valuation and average per capita income.
3 33 (2) A requirement for each county to have a fund balance
3 34 sufficient to cover all of the following:
3 35 (a) Cash flow for current services.
4 1 (b) Building maintenance and repair costs.
4 2 (c) Investments in new programs.
4 3 (d) A local risk pool that will cover extraordinary
4 4 expenses while a county is preparing an application to the
4 5 statewide risk pool.
4 6 (3) County costs for administration and infrastructure.
4 7 (4) Funds for counties to pay the costs of crisis
4 8 response, hospital diversion, prevention, consultation,
4 9 education, and outreach services that are provided outside the
4 10 rate cell methodology or fee payment policy.
4 11 (5) Incentives to counties for coordination,
4 12 collaboration, and infrastructure development.
4 13 c. Identify state and county costs to implement the
4 14 proposed funding formula for the individuals and services
4 15 identified under subsections 1 and 2.
4 16 4. ADDRESS THE LEGAL SETTLEMENT PROCESS.
4 17 The commission shall consider options for addressing the
4 18 deficiencies in the legal settlement process currently used
4 19 for determining governmental financial liability for service
4 20 costs. The options considered may include but are not limited
4 21 to providing for a transition to a system that provides for
4 22 service access based upon an individual's residency.
4 23 5. COORDINATION OF FUNDING STREAMS.
4 24 The commission shall do all of the following:
4 25 a. Develop a specific approach for counties and the state
4 26 to access additional federal housing funds.
4 27 b. In consultation with counties, support new efforts to
4 28 maximize federal funding for defined core services, including
4 29 accessing federal funds to support or match county
4 30 expenditures to standardize inpatient and outpatient treatment
4 31 and hospital diversion costs for Medicaid program recipients.
4 32 c. Develop recommendations identifying the manner in which
4 33 services will be funded by the federal government, the state,
4 34 and the counties.
4 35 Sec. 2. EFFECTIVE DATE. This Act, being deemed of
5 1 immediate importance, takes effect upon enactment.
5 2 HF 529
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