Senate File 138
SENATE FILE
BY HOUSER
(COMPANION TO LSB 2107HH
BY HEATON)
Passed Senate, Date Passed House, 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 children and providing an effective date.
5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
6 TLSB 2107SS 80
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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 and
1 10 children. The commission shall address all of the following
1 11 system 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 do all of the following:
2 16 a. Develop a new formula that allows public funding to
2 17 follow the covered individual regardless of categorical
2 18 funding. Distribution of state funds shall be based on a
2 19 matrix of disability=related reimbursement rate cells. Each
2 20 cell shall specify a reimbursement rate based on disability
2 21 group and level of functioning. The funding formula shall
2 22 take into account the number of covered individuals enrolled
2 23 in each county and the average cost of services provided to
2 24 covered individuals in each cell. The formula shall
2 25 incorporate all of the following principles:
2 26 (1) Each county will receive a quarterly allotment equal
2 27 to the product of the average costs per cell times the number
2 28 of individuals enrolled in each cell during the previous
2 29 quarter. To accommodate cash flow needs of counties and
2 30 reduce the level of fund balances counties need to maintain,
2 31 the state would make payments at the beginning of each quarter
2 32 based on the anticipated number of covered individuals, with a
2 33 reconciliation in the next quarter to the actual number of
2 34 covered individuals.
2 35 (2) Increasing overall state funding levels in proportion
3 1 to county funding levels.
3 2 (3) Allocating any increased state funding to achieve
3 3 statewide equity in service access.
3 4 (4) Allocating the state funding for state institutions
3 5 through counties rather than directly to the institutions so
3 6 that these services operate on an equal basis with other
3 7 services.
3 8 (5) Allocating state funding and administrative costs for
3 9 state cases to the covered individual's county of residence.
3 10 (6) Allocating the risk for service cost increases to the
3 11 counties and allocating the cost for increases in the number
3 12 of covered individuals to the state. Risk allocation
3 13 provisions shall address methods for managing the risk.
3 14 (7) Providing for risk management and flexibility
3 15 provisions such as cell rate adjustments, allowing waiting
3 16 lists to be used for an unanticipated increase in the number
3 17 of covered individuals, distributing quarterly allocations to
3 18 counties based upon the previous quarter's number of covered
3 19 individuals, removing categorical funding restrictions,
3 20 applying standards to ensure county cash flow capacity, and
3 21 allowing inflation adjustments.
3 22 (8) Expanding the state risk pool provisions under section
3 23 426B.5 to allow access to risk pool funding for specific
3 24 purposes and to allow counties to maintain a certain level of
3 25 fund balances in order to address certain cost factors.
3 26 b. All of the following factors shall be considered in
3 27 developing formula provisions for calculating the distribution
3 28 of funds:
3 29 (1) A county's ability to levy based on available taxable
3 30 valuation and average per capita income.
3 31 (2) A requirement for each county to have a fund balance
3 32 sufficient to cover all of the following:
3 33 (a) Cash flow for current services.
3 34 (b) Building maintenance and repair costs.
3 35 (c) Investments in new programs.
4 1 (d) A local risk pool that will cover extraordinary
4 2 expenses while a county is preparing an application to the
4 3 statewide risk pool.
4 4 (3) County costs for administration and infrastructure.
4 5 (4) Funds for counties to pay the costs of crisis
4 6 response, hospital diversion, prevention, consultation,
4 7 education, and outreach services that are provided outside the
4 8 rate cell methodology or fee payment policy.
4 9 (5) Incentives to counties for coordination,
4 10 collaboration, and infrastructure development.
4 11 c. Identify state and county costs to implement the
4 12 proposed funding formula for the individuals and services
4 13 identified under subsections 1 and 2.
4 14 4. REPLACE LEGAL SETTLEMENT PROCESS.
4 15 The commission shall do all of the following:
4 16 a. Develop a plan to provide for a transition from the
4 17 current legal settlement process of determining financial
4 18 liability for service costs to a process that provides for
4 19 equitable service access based upon an individual's residency.
4 20 Implementation of this approach shall be coordinated with the
4 21 provisions for implementing a new funding formula. Exceptions
4 22 shall be allowed for those individuals who establish residence
4 23 in a county due to a service referral approved by another
4 24 county or who establish temporary residence for educational or
4 25 other temporary purposes. Individuals who are residents due
4 26 to referrals from other states or are transients from other
4 27 states shall remain a state responsibility.
4 28 b. Propose a definition for "legal resident". The initial
4 29 meaning of this term is an individual who is legally residing
4 30 within the state, has established a place of residence with an
4 31 address, and intends to remain within the geographic
4 32 boundaries of a particular county. Examples of indicators
4 33 that an individual has become a legal resident of a county may
4 34 include but are not limited to any of the following:
4 35 (1) Having an E911 address.
5 1 (2) Receiving utility bills for that address.
5 2 (3) Being registered to vote at that address.
5 3 A legal resident shall not include an individual who is
5 4 residing in the county as a result of placement or referral
5 5 for services or other support by another county, this state,
5 6 or another state; an individual temporarily living in a county
5 7 for education or training; or an individual who is a transient
5 8 from another state. The commission shall propose a means of
5 9 resolving disputes, such as a mediation committee composed of
5 10 county representatives, to review such disputes, and make a
5 11 determination as to the appropriate county of residence.
5 12 c. Identify the costs for each county to make services
5 13 available on the basis of residency instead of legal
5 14 settlement.
5 15 5. COORDINATION OF FUNDING STREAMS.
5 16 The commission shall do all of the following:
5 17 a. Develop a specific approach for counties and the state
5 18 to access additional federal housing funds.
5 19 b. In consultation with counties, support new efforts to
5 20 maximize federal funding for defined core services, including
5 21 accessing federal funds to support or match county
5 22 expenditures to standardize inpatient and outpatient treatment
5 23 and hospital diversion costs for Medicaid program recipients.
5 24 c. Develop recommendations identifying the manner in which
5 25 services will be funded by the federal government, the state,
5 26 and the counties.
5 27 Sec. 2. EFFECTIVE DATE. This Act, being deemed of
5 28 immediate importance, takes effect upon enactment.
5 29 EXPLANATION
5 30 This bill directs the mental health and developmental
5 31 disabilities commission to make recommendations for
5 32 redesigning the mental health and developmental disabilities
5 33 services system for adults and children.
5 34 One of the commission's duties under current law in Code
5 35 section 225C.6 is to perform "analyses and other functions
6 1 associated with a redesign of the mental health and
6 2 developmental disability services systems for adults and for
6 3 children". The bill requires the commission to address these
6 4 system components with recommendations: standardizing
6 5 clinical and financial eligibility, identifying a minimum set
6 6 of core services to be available in each county statewide,
6 7 developing a funding formula so that funding follows an
6 8 eligible individual, providing a transition from the current
6 9 legal settlement process of determining financial liability
6 10 for service costs to a new system, and developing methods for
6 11 improved coordination of federal, state, and county funding
6 12 streams.
6 13 The commission's report and recommendations are required to
6 14 be submitted to the governor and general assembly on or before
6 15 December 31, 2003.
6 16 The bill takes effect upon enactment.
6 17 LSB 2107SS 80
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