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 to counties as cost=share for county
4 34 coverage of services to adult persons with the Iowa department
4 35 of public health for the brain injury in 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 commence service 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