House File 2325 - Introduced
HOUSE FILE
BY CARROLL and KURTENBACH
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act creating a county=based brain injury services program and
2 providing for allocation of a previously enacted
3 appropriation.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
5 TLSB 6045YH 81
6 jp/cf/24
PAG LIN
1 1 Section 1. NEW SECTION. 135.22B COUNTY=BASED BRAIN
1 2 INJURY SERVICES PROGRAM.
1 3 1. DEFINITIONS. For the purposes of this section:
1 4 a. "Brain injury services waiver" means the state's
1 5 medical assistance home and community=based services waiver
1 6 for persons with brain injury implemented under chapter 249A.
1 7 b. "CPC administrator" means the administrator of a
1 8 county's central point of coordination process under section
1 9 331.440.
1 10 2. PROGRAM CREATED.
1 11 a. A county=based brain injury services program is created
1 12 and shall be administered by a division of the Iowa department
1 13 of public health in cooperation with counties and the
1 14 department of human services.
1 15 b. The division of the department assigned to administer
1 16 the advisory council on brain injuries under section 135.22A
1 17 shall be the program administrator. The division duties shall
1 18 include but are not limited to serving as the fiscal agent and
1 19 contract administrator for the program and providing program
1 20 oversight.
1 21 c. The division shall consult with the advisory council on
1 22 brain injuries, established pursuant to section 135.22A,
1 23 regarding the program and shall report to the council
1 24 concerning the program at least quarterly. The council shall
1 25 make recommendations to the department concerning the
1 26 program's operation.
1 27 3. PURPOSE. The purpose of the program is to provide
1 28 services to persons with a brain injury who are either on the
1 29 waiting list for the brain injury services waiver or have been
1 30 determined to be ineligible for the brain injury services
1 31 waiver.
1 32 4. GENERAL REQUIREMENTS. The general requirements for the
1 33 program shall include but are not limited to all of the
1 34 following:
1 35 a. Services offered are consistent with the services
2 1 offered through the brain injury services waiver.
2 2 b. Each service consumer has a service plan developed
2 3 prior to service implementation and the service plan is
2 4 reviewed and updated at least quarterly.
2 5 c. All other funding sources for which the service
2 6 consumer is eligible are utilized to the greatest extent
2 7 possible. The funding sources potentially available include
2 8 but are not limited to community resources and public and
2 9 private benefit programs.
2 10 d. The maximum monthly cost of the services provided shall
2 11 be based on the maximum monthly amount authorized for the
2 12 brain injury services waiver.
2 13 e. Assistance under the program shall be made available to
2 14 a designated number of service consumers who are eligible, as
2 15 determined from the funding available for the program, on a
2 16 first=come, first=served basis.
2 17 f. Nothing in this section shall be construed or is
2 18 intended as, or shall imply, a grant of entitlement to
2 19 services to persons who are eligible for participation in the
2 20 program based upon the eligibility provisions adopted
2 21 consistent with the requirements of this section. Any state
2 22 or county obligation to provide services pursuant to this
2 23 section is limited to the extent of the funds appropriated or
2 24 provided for the program.
2 25 5. ELIGIBILITY. An individual must meet all of the
2 26 following requirements to be eligible for the program:
2 27 a. The individual is age one month through sixty=four
2 28 years.
2 29 b. The individual has a diagnosed brain injury as defined
2 30 in section 135.22.
2 31 c. The individual is a resident of this state and either a
2 32 United States citizen or a qualified alien as defined in 8
2 33 U.S.C. } 1641.
2 34 d. The program's financial eligibility requirements shall
2 35 be based on the requirements used for the hawk=i program under
3 1 chapter 514I. The individual must meet the program's
3 2 financial eligibility requirements and be willing to pay a
3 3 cost=share for the program.
3 4 e. The individual does not receive services or funding
3 5 under any type of medical assistance home and community=based
3 6 services waiver.
3 7 f. A county has agreed to pay a cost=share for the
3 8 individual under the program.
3 9 6. COST=SHARE.
3 10 a. An individual's cost=share responsibility for services
3 11 under the program shall be determined on a sliding scale based
3 12 upon the individual's family income. An individual's cost=
3 13 share shall be assessed as a copayment, which shall not exceed
3 14 thirty percent of the cost payable for the service.
3 15 b. The service provider shall bill the individual's county
3 16 for the portion of the cost payable for the service that is
3 17 not covered by the individual's copayment responsibility.
3 18 c. The county shall bill the department for fifty percent
3 19 of the cost payable for the service that is not covered by the
3 20 individual's copayment responsibility.
3 21 d. The county's cost=share responsibility shall be the
3 22 remainder of the cost payable after counting the individual's
3 23 copayment and the amount billed to the department.
3 24 7. APPLICATION PROCESS.
3 25 a. The application form for services under the program
3 26 shall be designed so that it may be used for both the county=
3 27 based brain injury services program and the brain injury
3 28 services waiver.
3 29 b. An individual must submit an application for the
3 30 program through the CPC administrator for the individual's
3 31 county of residence.
3 32 c. An assessment of the individual's needs shall be
3 33 performed. The CPC administrator shall file copies of the
3 34 individual's application and needs assessment with the medical
3 35 assistance program, the department, and the program resource
4 1 facilitator assigned for that county.
4 2 d. The CPC administrator shall include with the
4 3 application materials a determination as to whether a county
4 4 cost=share will be authorized.
4 5 e. The department's program administrator shall make a
4 6 final determination as to whether program funding will be
4 7 authorized.
4 8 8. SERVICE PROVIDERS AND REIMBURSEMENT. All of the
4 9 following requirements apply to service providers and
4 10 reimbursement rates payable for services under the program:
4 11 a. A service provider must either be certified to provide
4 12 services under the brain injury services waiver or have a
4 13 contract with the county to provide services and will become
4 14 certified to provide services under such waiver within a
4 15 reasonable period of time specified in rule.
4 16 b. The reimbursement rate payable for the cost of a
4 17 service provided under the program is the rate payable under
4 18 the medical assistance program. However, if the service
4 19 provided does not have a medical assistance program
4 20 reimbursement rate, the rate shall be the amount payable under
4 21 the county contract.
4 22 9. RESOURCE FACILITATION. The program shall utilize
4 23 resource facilitators to facilitate program services. The
4 24 resource facilitator shall be available to provide ongoing
4 25 support for individuals with brain injury in coping with the
4 26 issues of living with a brain injury and in assisting such
4 27 individuals in transitioning back to employment and living in
4 28 the community. The resource facilitator is intended to
4 29 provide a linkage to existing services and increase the
4 30 capacity of the state's providers of services to persons with
4 31 brain injury by doing all of the following:
4 32 a. Providing brain injury=specific information, support,
4 33 and resources.
4 34 b. Enhancing the usage of support commonly available to an
4 35 individual with brain injury from the community, family, and
5 1 personal contacts and linking such individuals to appropriate
5 2 services and community resources.
5 3 c. Training service providers to provide appropriate brain
5 4 injury services.
5 5 d. Accessing, securing, and maximizing the private and
5 6 public funding available to support an individual with a brain
5 7 injury.
5 8 Sec. 2. Section 331.424A, Code Supplement 2005, is amended
5 9 by adding the following new subsection:
5 10 NEW SUBSECTION. 6. Beginning July 1, 2006, a county may
5 11 pay from the services fund the county cost=share for services
5 12 provided under the county=based brain injury services program
5 13 created in section 135.22B.
5 14 Sec. 3. Section 331.439, Code Supplement 2005, is amended
5 15 by adding the following new subsection:
5 16 NEW SUBSECTION. 10. If the county participates in
5 17 providing a cost=share for the county=based brain injury
5 18 services program created in section 135.22B, the participation
5 19 shall be documented in the county's management plan
5 20 implemented pursuant to this section.
5 21 Sec. 4. 2005 Iowa Acts, chapter 179, section 1, subsection
5 22 2, paragraph d, is amended to read as follows:
5 23 d. For distribution to counties as cost=share for county
5 24 coverage of services to adult persons with the Iowa department
5 25 of public health for the county=based brain injury in
5 26 accordance with the law enacted as a result of the provisions
5 27 of 2005 Iowa Acts, House File 876, or other law providing for
5 28 such coverage to commence service program in the fiscal year
5 29 beginning July 1, 2006, as provided in accordance with section
5 30 135.22B, if enacted by the Eighty=first General Assembly, 2006
5 31 Session:
5 32 .................................................. $ 2,426,893
5 33 The amount allocated in this paragraph "d" shall be
5 34 allocated by the Iowa department of public health as follows:
5 35 (1) For state cost=share of services provided under
6 1 section 135.22B:
6 2 .................................................. $ 2,092,665
6 3 (2) For contract resource facilitator services:
6 4 .................................................. $ 173,125
6 5 (3) For a sole source contract with a statewide
6 6 association representing community providers of mental health,
6 7 mental retardation, and brain injury services to provide, in
6 8 collaboration with a statewide organization representing
6 9 individuals with a brain injury and their families, brain
6 10 injury training services and recruiting of service providers
6 11 to increase the capacity within this state to address the
6 12 needs of individuals with brain injuries and such individuals'
6 13 families:
6 14 .................................................. $ 40,000
6 15 (4) For reimbursement for needs assessments performed
6 16 under section 135.22B:
6 17 .................................................. $ 26,750
6 18 (5) For match of federal funding, administrative and
6 19 personnel costs including salaries, support, maintenance, and
6 20 miscellaneous purposes:
6 21 .................................................. $ 94,353
6 22 Notwithstanding section 8.33, the appropriated moneys
6 23 allocated in this paragraph "d" that remain unencumbered or
6 24 unobligated at the close of the fiscal year shall not revert
6 25 but shall remain available for expenditure for the purposes
6 26 designated until the close of the succeeding fiscal year.
6 27 Sec. 5. EMERGENCY RULES. The Iowa department of public
6 28 health may adopt administrative rules under section 17A.4,
6 29 subsection 2, and section 17A.5, subsection 2, paragraph "b",
6 30 to implement the provisions of this Act, and the rules shall
6 31 become effective immediately upon filing or on a later
6 32 effective date specified in the rules, unless the effective
6 33 date is delayed by the administrative rules review committee.
6 34 Any rules adopted in accordance with this section shall not
6 35 take effect before the rules are reviewed by the
7 1 administrative rules review committee. The delay authority
7 2 provided to the administrative rules review committee under
7 3 section 17A.4, subsection 5, and section 17A.8, subsection 9,
7 4 shall be applicable to a delay imposed under this section,
7 5 notwithstanding a provision in those sections making them
7 6 inapplicable to section 17A.5, subsection 2, paragraph "b".
7 7 Any rules adopted in accordance with the provisions of this
7 8 section shall also be published as notice of intended action
7 9 as provided in section 17A.4.
7 10 EXPLANATION
7 11 This bill creates a new county=based brain injury services
7 12 program and provides for funding of the program through
7 13 allocation of a previously enacted appropriation.
7 14 The new program is created in new Code section 135.22B to
7 15 be administered by the division of the Iowa department of
7 16 public health assigned to administer the advisory council on
7 17 brain injuries.
7 18 The bill provides definitions and states the program's
7 19 purpose. The bill addresses general requirements, including a
7 20 provision that the program is not an entitlement but is
7 21 limited to the extent of the funding provided. Program
7 22 eligibility is limited to individuals with a diagnosed brain
7 23 injury who are willing to pay cost=share under the program,
7 24 are not receiving services under a medical assistance
7 25 (Medicaid) home and community=based services waiver, and have
7 26 a county that agrees to provide a cost=share under the
7 27 program. The program's financial eligibility requirements are
7 28 required to be based on those applicable under the hawk=i
7 29 program for providing health coverage for low=income children.
7 30 Various cost=share requirements are applicable, including a
7 31 sliding scale for individual cost=share, state cost=share for
7 32 50 percent of the portion not covered by the individual cost=
7 33 share, and county cost=share for the remainder.
7 34 The program's application provisions include a requirement
7 35 for an application that can be used both by this program and
8 1 the Medicaid program's home and community=based brain injury
8 2 services waiver. The application is required to be submitted
8 3 through the administrator of the county central point of
8 4 coordination (CPC) process for mental health, mental
8 5 retardation, and developmental disabilities (MH/MR/DD)
8 6 services of the individual's county of residence. The CPC
8 7 administrator is required to file copies of the needs
8 8 assessment and application materials and include a
8 9 determination as to whether the county will authorize a cost=
8 10 share. The department administrator has final authority in
8 11 determining whether program funding will be authorized.
8 12 Service provider and reimbursement provisions include
8 13 requirements that service providers must be certified to
8 14 provide services under the brain injury services waiver or
8 15 have a county contract to provide services and become
8 16 certified to provide services under the waiver. Reimbursement
8 17 rates payable under the program are the same as the Medicaid
8 18 rates. If there is not a Medicaid rate, the county contract
8 19 rate applies.
8 20 The program includes a resource facilitator component to
8 21 assist individuals with the program and to enhance the service
8 22 system available to individuals in the state with brain
8 23 injury. The bill addresses the duties of resource
8 24 facilitators.
8 25 Code section 331.424A, relating to the county MH/MR/DD
8 26 services fund, is amended to authorize counties to pay the
8 27 brain injury program cost=share from that fund.
8 28 Code section 331.439, relating to county management plans
8 29 for MH/MR/DD services, is amended to require a county that
8 30 participates in the brain injury program to document the
8 31 participation in the management plan.
8 32 The provisions of an appropriation made for MH/MR/DD
8 33 allowed growth for fiscal year 2006=2007 in a contingent
8 34 allocation made for brain injury services are amended. The
8 35 language is revised to refer to the program created in the
9 1 bill and to allocate the appropriation to the Iowa department
9 2 of public health for various purposes associated with the
9 3 brain injury services program created in the bill. Moneys in
9 4 the allocation that remain unencumbered or unobligated at the
9 5 close of the fiscal year do not revert but remain available
9 6 for expenditure for the brain injury program in the succeeding
9 7 fiscal year.
9 8 The Iowa department of public health is authorized to adopt
9 9 rules to implement the county=based brain injury services
9 10 program utilizing emergency procedures that forego various
9 11 public comment periods, but the rules remain subject to review
9 12 by the administrative rules review committee before being
9 13 adopted.
9 14 LSB 6045YH 81
9 15 jp:rj/cf/24