House File 2561 - Introduced HOUSE FILE BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HF 2325) Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act creating a brain injury services program and providing for 2 allocation of a previously enacted appropriation. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 6045HV 81 5 jp/cf/24 PAG LIN 1 1 Section 1. NEW SECTION. 135.22B BRAIN INJURY SERVICES 1 2 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. "Program administrator" means the division of the 1 8 department designated to administer the brain injury services 1 9 program in accordance with subsection 2. 1 10 2. PROGRAM CREATED. 1 11 a. A brain injury services program is created and shall be 1 12 administered by a division of the Iowa department of public 1 13 health in cooperation with counties and the department of 1 14 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 2 22 obligation to provide services pursuant to this section is 2 23 limited to the extent of the funds appropriated or provided 2 24 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 6. COST=SHARE. 3 8 a. An individual's cost=share responsibility for services 3 9 under the program shall be determined on a sliding scale based 3 10 upon the individual's family income. An individual's cost= 3 11 share shall be assessed as a copayment, which shall not exceed 3 12 thirty percent of the cost payable for the service. 3 13 b. The service provider shall bill the department for the 3 14 portion of the cost payable for the service that is not 3 15 covered by the individual's copayment responsibility. 3 16 7. APPLICATION PROCESS. 3 17 a. The application form for services under the program 3 18 shall be designed so that it may be used for both the brain 3 19 injury services program and the brain injury services waiver. 3 20 b. An individual must submit an application for the 3 21 program through the program administrator. 3 22 c. An assessment of the individual's needs shall be 3 23 performed. 3 24 d. The program administrator shall file copies of the 3 25 individual's application and needs assessment with the medical 3 26 assistance program and the program resource facilitator 3 27 assigned to the individual's geographic area. 3 28 e. The department's program administrator shall make a 3 29 final determination as to whether program funding will be 3 30 authorized. 3 31 8. SERVICE PROVIDERS AND REIMBURSEMENT. All of the 3 32 following requirements apply to service providers and 3 33 reimbursement rates payable for services under the program: 3 34 a. A service provider must either be certified to provide 3 35 services under the brain injury services waiver or have a 4 1 contract with a county to provide services and will become 4 2 certified to provide services under such waiver within a 4 3 reasonable period of time specified in rule. 4 4 b. The reimbursement rate payable for the cost of a 4 5 service provided under the program is the rate payable under 4 6 the medical assistance program. However, if the service 4 7 provided does not have a medical assistance program 4 8 reimbursement rate, the rate shall be the amount payable under 4 9 the county contract. 4 10 9. RESOURCE FACILITATION. The program shall utilize 4 11 resource facilitators to facilitate program services. The 4 12 resource facilitator shall be available to provide ongoing 4 13 support for individuals with brain injury in coping with the 4 14 issues of living with a brain injury and in assisting such 4 15 individuals in transitioning back to employment and living in 4 16 the community. The resource facilitator is intended to 4 17 provide a linkage to existing services and increase the 4 18 capacity of the state's providers of services to persons with 4 19 brain injury by doing all of the following: 4 20 a. Providing brain injury=specific information, support, 4 21 and resources. 4 22 b. Enhancing the usage of support commonly available to an 4 23 individual with brain injury from the community, family, and 4 24 personal contacts and linking such individuals to appropriate 4 25 services and community resources. 4 26 c. Training service providers to provide appropriate brain 4 27 injury services. 4 28 d. Accessing, securing, and maximizing the private and 4 29 public funding available to support an individual with a brain 4 30 injury. 4 31 Sec. 2. 2005 Iowa Acts, chapter 179, section 1, subsection 4 32 2, paragraph d, is amended to read as follows: 4 33 d. For distribution tocounties as cost=share for county 4 34 coverage of services to adult persons withthe Iowa department 4 35 of public health for the brain injuryin accordance with the 5 1 law enacted as a result of the provisions of 2005 Iowa Acts, 5 2 House File 876, or other law providing for such coverage to 5 3 commenceservice program in the fiscal year beginning July 1, 5 4 2006, as provided in accordance with section 135.22B, if 5 5 enacted by the Eighty=first General Assembly, 2006 Session: 5 6 .................................................. $ 2,426,893 5 7 The amount allocated in this paragraph "d" shall be 5 8 allocated by the Iowa department of public health as follows: 5 9 (1) For state cost=share of services provided under 5 10 section 135.22B: 5 11 .................................................. $ 2,092,665 5 12 (2) For contract resource facilitator services: 5 13 .................................................. $ 173,125 5 14 (3) For a sole source contract with a statewide 5 15 association representing community providers of mental health, 5 16 mental retardation, and brain injury services to provide, in 5 17 collaboration with a statewide organization representing 5 18 individuals with a brain injury and their families, brain 5 19 injury training services and recruiting of service providers 5 20 to increase the capacity within this state to address the 5 21 needs of individuals with brain injuries and such individuals' 5 22 families: 5 23 .................................................. $ 40,000 5 24 (4) For reimbursement for needs assessments performed 5 25 under section 135.22B: 5 26 .................................................. $ 26,750 5 27 (5) For match of federal funding, administrative and 5 28 personnel costs including salaries, support, maintenance, and 5 29 miscellaneous purposes: 5 30 .................................................. $ 94,353 5 31 Notwithstanding section 8.33, the appropriated moneys 5 32 allocated in this paragraph "d" that remain unencumbered or 5 33 unobligated at the close of the fiscal year shall not revert 5 34 but shall remain available for expenditure for the purposes 5 35 designated until the close of the succeeding fiscal year. 6 1 Sec. 3. EMERGENCY RULES. The Iowa department of public 6 2 health may adopt administrative rules under section 17A.4, 6 3 subsection 2, and section 17A.5, subsection 2, paragraph "b", 6 4 to implement the provisions of this Act, and the rules shall 6 5 become effective immediately upon filing or on a later 6 6 effective date specified in the rules, unless the effective 6 7 date is delayed by the administrative rules review committee. 6 8 Any rules adopted in accordance with this section shall not 6 9 take effect before the rules are reviewed by the 6 10 administrative rules review committee. The delay authority 6 11 provided to the administrative rules review committee under 6 12 section 17A.4, subsection 5, and section 17A.8, subsection 9, 6 13 shall be applicable to a delay imposed under this section, 6 14 notwithstanding a provision in those sections making them 6 15 inapplicable to section 17A.5, subsection 2, paragraph "b". 6 16 Any rules adopted in accordance with the provisions of this 6 17 section shall also be published as notice of intended action 6 18 as provided in section 17A.4. 6 19 EXPLANATION 6 20 This bill creates a new brain injury services program and 6 21 provides for funding of the program through allocation of a 6 22 previously enacted appropriation. 6 23 The new program is created in new Code section 135.22B to 6 24 be administered by the division of the Iowa department of 6 25 public health assigned to administer the advisory council on 6 26 brain injuries. 6 27 The bill provides definitions and states the program's 6 28 purpose. The bill addresses general requirements, including a 6 29 provision that the program is not an entitlement but is 6 30 limited to the extent of the funding provided. Program 6 31 eligibility is limited to individuals with a diagnosed brain 6 32 injury who are willing to pay cost=share under the program, 6 33 and are not receiving services under a medical assistance 6 34 (Medicaid) home and community=based services waiver. The 6 35 program's financial eligibility requirements are required to 7 1 be based on those applicable under the hawk=i program for 7 2 providing health coverage for low=income children. 7 3 Various cost=share requirements are applicable, including a 7 4 sliding scale for individual cost=share and state cost=share 7 5 for the portion not covered by the individual cost=share. 7 6 The program's application provisions include a requirement 7 7 for an application that can be used both by this program and 7 8 the Medicaid program's home and community=based brain injury 7 9 services waiver. The application is required to be submitted 7 10 through the program administrator. The program administrator 7 11 is required to file copies of the needs assessment and 7 12 application materials with the medical assistance (Medicaid) 7 13 program and the area resource facilitator. The program 7 14 administrator has final authority in determining whether 7 15 program funding will be authorized. 7 16 Service provider and reimbursement provisions include 7 17 requirements that service providers must be certified to 7 18 provide services under the brain injury services waiver or 7 19 have a county contract to provide services and become 7 20 certified to provide services under the waiver. Reimbursement 7 21 rates payable under the program are the same as the Medicaid 7 22 rates. If there is not a Medicaid rate, the county contract 7 23 rate applies. 7 24 The program includes a resource facilitator component to 7 25 assist individuals with the program and to enhance the service 7 26 system available to individuals in the state with brain 7 27 injury. The bill addresses the duties of resource 7 28 facilitators. 7 29 The provisions of an appropriation made for MH/MR/DD 7 30 allowed growth for fiscal year 2006=2007 in a contingent 7 31 allocation made for brain injury services are amended. The 7 32 language is revised to refer to the program created in the 7 33 bill and to allocate the appropriation to the Iowa department 7 34 of public health for various purposes associated with the 7 35 brain injury services program created in the bill. Moneys in 8 1 the allocation that remain unencumbered or unobligated at the 8 2 close of the fiscal year do not revert but remain available 8 3 for expenditure for the brain injury program in the succeeding 8 4 fiscal year. 8 5 The Iowa department of public health is authorized to adopt 8 6 rules to implement the brain injury services program utilizing 8 7 emergency procedures that forego various public comment 8 8 periods, but the rules remain subject to review by the 8 9 administrative rules review committee before being adopted. 8 10 LSB 6045HV 81 8 11 jp:rj/cf/24