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 tocounties as cost=share for county 5 24 coverage of services to adult persons withthe Iowa department 5 25 of public health for the county=based brain injuryin 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 commenceservice 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