House File 2184 - Introduced HOUSE FILE 2184 BY HEDDENS and HEATON A BILL FOR An Act amending the duties of the mental health, mental 1 retardation, developmental disabilities, and brain injury 2 commission and related provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5353HH (5) 83 jp/nh

H.F. 2184 DIVISION I 1 GENERAL AMENDMENTS 2 Section 1. Section 229.24, subsection 3, unnumbered 3 paragraph 1, Code 2009, is amended to read as follows: 4 If all or part of the costs associated with hospitalization 5 of an individual under this chapter are chargeable to a 6 county of legal settlement, the clerk of the district court 7 shall provide to the county of legal settlement and to the 8 county in which the hospitalization order is entered , in a 9 form prescribed by the mental health, mental retardation, 10 developmental disabilities, and brain injury commission, the 11 following information pertaining to the individual which would 12 be confidential under subsection 1: 13 Sec. 2. Section 230A.2, Code 2009, is amended to read as 14 follows: 15 230A.2 Services offered. 16 A community mental health center established or operating 17 as authorized by section 230A.1 may offer to residents of the 18 county or counties it serves any or all of the mental health 19 services defined by the mental health, mental retardation, 20 developmental disabilities, and brain injury commission in the 21 comprehensive state mental health and disability services plan 22 under section 225C.6B . 23 Sec. 3. Section 230A.15, Code 2009, is amended to read as 24 follows: 25 230A.15 Comprehensive community mental health program. 26 A community mental health center established or operating 27 as authorized by section 230A.1, or which a county or group 28 of counties has agreed to establish or support pursuant 29 to that section, may with approval of the board or boards 30 of supervisors of the county or counties supporting or 31 establishing the center, undertake to provide a comprehensive 32 community mental health program for the county or counties. 33 A center providing a comprehensive community mental health 34 program shall, at a minimum, make available to residents of the 35 -1- LSB 5353HH (5) 83 jp/nh 1/ 24

H.F. 2184 county or counties it serves all of the comprehensive mental 1 health services described in the comprehensive state mental 2 health and disability services plan under section 225C.6B . 3 Sec. 4. Section 331.424A, subsection 1, Code Supplement 4 2009, is amended to read as follows: 5 1. For the purposes of this chapter, unless the context 6 otherwise requires, “services fund” means the county mental 7 health, mental retardation, and developmental disabilities 8 services fund created in subsection 2. The county finance 9 committee created in section 333A.2 shall consult with 10 the state commission in adopting shall adopt rules and 11 prescribing forms for administering the services fund. The 12 county finance committee created in section 333A.2 shall 13 prescribe forms in accordance with the rules adopted by the 14 state commission. The forms shall allow for reporting of 15 services for persons with brain injury and other optional 16 services funded through a services fund. 17 Sec. 5. Section 331.438, subsection 1, paragraph b, Code 18 2009, is amended to read as follows: 19 b. “Qualified mental health, mental retardation, and 20 developmental disabilities services” means the services 21 specified on forms issued in the rules adopted by the county 22 finance committee following consultation with the state 23 commission for administering the services fund, pursuant to 24 section 331.424A . 25 Sec. 6. Section 331.438, subsection 4, paragraph b, Code 26 2009, is amended to read as follows: 27 b. The state commission shall do all of the following: 28 (1) Identify Receive and review reports from the department 29 of human services identifying characteristics of the 30 service county services system, including amounts expended, 31 equity of funding among counties, funding sources, provider 32 types, service availability, and equity of service availability 33 among counties and among persons served. 34 (2) Assess the accuracy and uniformity of recordkeeping and 35 -2- LSB 5353HH (5) 83 jp/nh 2/ 24

H.F. 2184 reporting in the service system. 1 (3) Identify for each county the factors associated with 2 inflationary growth of the service system. 3 (4) Identify opportunities for containing service system 4 growth. 5 (5) (2) Consider proposals for revising service county 6 services system administrative rules. 7 (6) Consider provisions and adopt rules for counties to 8 implement a central point of coordination to plan, budget, 9 and monitor county expenditures for the service system. The 10 provisions shall provide options for counties to implement 11 the central point of coordination in collaboration with other 12 counties. 13 (7) Develop criteria for annual county mental health, 14 mental retardation, and developmental disabilities plans. 15 (8) (3) Adopt administrative rules identifying qualified 16 mental health, mental retardation, and developmental 17 disabilities service expenditures for purposes of state payment 18 pursuant to subsection 1 relating to county management plans . 19 (9) Adopt rules for the county central point of coordination 20 and clinical assessment processes required under section 21 331.440 and other rules necessary for the implementation of 22 county management plans and expenditure reports required for 23 state payment pursuant to section 331.439 . 24 (10) Consider recommendations to improve the programs and 25 cost-effectiveness of state and county contracting processes 26 and procedures, including strategies for negotiations relating 27 to managed care. The recommendations implemented by the 28 commission for the state and county regarding managed care 29 shall include but are not limited to standards for limiting 30 excess costs and profits, and for restricting cost shifting 31 under a managed care system. 32 (11) (4) Provide input, when appropriate, to the director 33 of human services in any decision involving administrative 34 rules which were adopted by the department of human services 35 -3- LSB 5353HH (5) 83 jp/nh 3/ 24

H.F. 2184 pertaining to the mental illness, mental retardation, and 1 developmental disabilities services system administered by 2 counties. 3 (12) Identify the fiscal impact of existing or proposed 4 legislation and administrative rules on state and county 5 expenditures. 6 (13) Adopt administrative rules providing statewide 7 standards and a monitoring methodology to determine whether 8 cost-effective individualized services are available as 9 required pursuant to section 331.439, subsection 1 , paragraph 10 “b” . 11 (14) (5) Consider recommendations for and adopt 12 administrative rules establishing statewide minimum standards 13 for services and other support required to be available to 14 persons covered by a county management plan under section 15 331.439. 16 (15) (6) Consider recommendations for measuring and 17 improving the quality of state and county mental health, mental 18 retardation, and developmental disabilities services and other 19 support. 20 (16) Develop a procedure for each county to disclose to 21 the department of human services information approved by the 22 commission concerning the mental health, mental retardation, 23 developmental disabilities, and brain injury services provided 24 to the individuals served through the county central point 25 of coordination process. The procedure shall incorporate 26 protections to ensure that if individually identified 27 information is disclosed, it is disclosed and maintained in 28 compliance with applicable Iowa and federal confidentiality 29 laws, including but not limited to federal Health Insurance 30 Portability and Accountability Act, Pub. L. No. 104-191, 31 requirements. 32 Sec. 7. Section 331.439, subsection 1, unnumbered paragraph 33 1, Code 2009, is amended to read as follows: 34 The state payment to eligible counties under this section 35 -4- LSB 5353HH (5) 83 jp/nh 4/ 24

H.F. 2184 shall be made as provided in sections 331.438 and 426B.2. A 1 county is eligible for the state payment, as defined in section 2 331.438, for a fiscal year if the director of human services , 3 in consultation with the state commission, determines for a 4 specific fiscal year that all of the following conditions are 5 met: 6 Sec. 8. Section 331.439, subsection 1, paragraph a, Code 7 2009, is amended to read as follows: 8 a. The county accurately reported by December 1 the 9 county’s expenditures for mental health, mental retardation, 10 and developmental disabilities services and the information 11 required under section 225C.6A, subsection 2 3 , paragraph 12 “c” , for the previous fiscal year on forms prescribed by in 13 accordance with rules adopted by the state commission. If 14 the department determines good cause exists, the department 15 may extend a deadline otherwise imposed under this chapter, 16 chapter 225C, or chapter 426B for a county’s reporting 17 concerning mental health, mental retardation, or developmental 18 disabilities services or related revenues and expenditures. 19 Sec. 9. Section 331.439, subsection 1, paragraph b, 20 unnumbered paragraph 1, Code 2009, is amended to read as 21 follows: 22 The county developed and implemented a county management 23 plan for the county’s mental health, mental retardation, and 24 developmental disabilities services system in accordance with 25 the provisions of this paragraph “b ”. The plan shall comply 26 with the administrative rules adopted for this purpose by the 27 state commission and is subject to the approval of the director 28 of human services in consultation with the state commission. 29 The plan shall include a description of the county’s service 30 management provision for mental health, mental retardation, and 31 developmental disabilities services. For mental retardation 32 and developmental disabilities service management, the plan 33 shall describe the county’s development and implementation of a 34 managed system of cost-effective individualized services and 35 -5- LSB 5353HH (5) 83 jp/nh 5/ 24

H.F. 2184 shall comply with the provisions of paragraph “f” . The goal 1 of this part of the plan shall be to assist the individuals 2 served to be as independent, productive, and integrated into 3 the community as possible. The service management provisions 4 for mental health shall comply with the provisions of paragraph 5 “e” . A county is subject to all of the following provisions 6 in regard to the county’s services system management plan and 7 planning process: 8 Sec. 10. Section 331.439, subsection 1, paragraph b, 9 subparagraphs (2) and (3), Code 2009, are amended to read as 10 follows: 11 (2) For informational purposes, the county shall submit a 12 management plan review to the department of human services by 13 December 1 of each year. The annual review shall incorporate 14 an analysis of the data associated with the services 15 system managed during the preceding fiscal year by the county 16 or by a managed care private entity on behalf of the county. 17 The annual review shall also identify measurable outcomes 18 and results showing the county’s progress in fulfilling 19 the purposes listed in paragraph “c” , and in achieving the 20 disability services outcomes and indicators identified by the 21 commission pursuant to section 225C.6. 22 (3) For informational purposes, every three years the 23 county shall submit to the department of human services a 24 three-year strategic plan. The strategic plan shall describe 25 how the county will proceed to attain the plan’s goals and 26 objectives, and the measurable outcomes and results necessary 27 for moving the county’s service services system toward an 28 individualized, community-based focus in accordance with 29 paragraph “c” . The three-year strategic plan shall be 30 submitted by April 1, 2000, and by April 1 of every third year 31 thereafter. 32 Sec. 11. Section 331.439, subsection 1, paragraphs c, e, and 33 f, Code 2009, are amended to read as follows: 34 c. The county implements its county management plan under 35 -6- LSB 5353HH (5) 83 jp/nh 6/ 24

H.F. 2184 paragraph “b” and other service management functions in a 1 manner that seeks to achieve all of the following purposes 2 identified in section 225C.1 for persons who are covered by the 3 plan or are otherwise subject to the county’s service services 4 system management functions: 5 (1) The service services system seeks to empower persons 6 to exercise their own choices about the amounts and types of 7 services and other support received. 8 (2) The service services system seeks to empower the persons 9 to accept responsibility, exercise choices, and take risks. 10 (3) The service services system seeks to provide services 11 and other support that are individualized, provided to produce 12 results, flexible, and cost-effective. 13 (4) The service services system seeks to provide services 14 and other supports support in a manner which supports the 15 ability of the persons to live, learn, work, and recreate in 16 communities of their choice. 17 e. (1) For mental health service management, the county 18 may either directly implement a system of service management 19 and contract with service providers, or contract with a 20 private entity to manage the county services system, provided 21 all requirements of this lettered paragraph are met by the 22 private entity. The mental health service management services 23 system shall incorporate a central point of coordination and 24 clinical assessment process developed in accordance with the 25 provisions of section 331.440. 26 (2) A managed care The county services system for mental 27 health proposed by a county shall include but is not limited 28 to all of the following elements which shall be specified in 29 administrative rules adopted by the state commission: 30 (a) The enrollment and eligibility process. 31 (b) The scope of services included. 32 (c) The method of plan administration. 33 (d) The process for managing utilization and access to 34 services and other assistance. 35 -7- LSB 5353HH (5) 83 jp/nh 7/ 24

H.F. 2184 (e) The quality assurance process. 1 (f) The risk management provisions and fiscal viability of 2 the provisions, if the county contracts with a private managed 3 care entity. 4 f. For mental retardation and developmental disabilities 5 services management, the county must either develop and 6 implement a managed system of care which addresses a full 7 array of appropriate services and cost-effective delivery of 8 services by contracting directly with service providers or 9 contract by contracting with a state-approved managed care 10 contractor or contractors private entity to manage the county 11 services system . Any system or contract implemented under 12 this paragraph The county services system shall incorporate a 13 central point of coordination and clinical assessment process 14 developed in accordance with the provisions of section 331.440. 15 The elements of the county managed system of care a county 16 services system shall be specified in rules developed by the 17 department of human services in consultation with and adopted 18 by the state commission. 19 Sec. 12. Section 331.439, subsection 3, paragraph b, Code 20 2009, is amended to read as follows: 21 b. Based upon information contained in county management 22 plans and budgets and proposals made by representatives of 23 counties, the state commission shall recommend an allowed 24 growth factor adjustment to the governor by November 15 25 for the fiscal year which commences two years from the 26 beginning date of the fiscal year in progress at the time the 27 recommendation is made. The allowed growth factor adjustment 28 shall may address various costs including but not limited to 29 the costs associated with new consumers of service, service 30 cost inflation, and investments for economy and efficiency. In 31 developing the service cost inflation recommendation, the state 32 commission shall consider the cost trends indicated by the 33 gross expenditure amount reported in the expenditure reports 34 submitted by counties pursuant to subsection 1, paragraph 35 -8- LSB 5353HH (5) 83 jp/nh 8/ 24

H.F. 2184 “a” . The governor shall consider the state commission’s 1 recommendation in developing the governor’s recommendation for 2 an allowed growth factor adjustment for such fiscal year. The 3 governor’s recommendation shall be submitted at the time the 4 governor’s proposed budget for the succeeding fiscal year is 5 submitted in accordance with chapter 8. 6 Sec. 13. Section 331.439, subsection 7, Code 2009, is 7 amended to read as follows: 8 7. A county shall annually report data concerning the 9 county’s services system managed by in accordance with the 10 county management plan . At a minimum, the data reported shall 11 indicate the number of different individuals who utilized 12 services in a fiscal year and the various types of services. 13 Data reported under this subsection shall be submitted with 14 the county’s expenditure report required under subsection 1, 15 paragraph “a” . 16 DIVISION II 17 CODE CHAPTER 225C AMENDMENTS 18 Sec. 14. Section 225C.4, subsection 1, paragraph a, Code 19 2009, is amended to read as follows: 20 a. Prepare and administer the comprehensive mental health 21 and disability services plan as provided in section 225C.6B, 22 including state mental health and mental retardation plans 23 for the provision of disability services within the state and 24 prepare and administer the state developmental disabilities 25 plan. The administrator shall consult with the Iowa department 26 of public health, the state board of regents or a body 27 designated by the board for that purpose, the department 28 of management or a body designated by the director of the 29 department for that purpose, the department of education, the 30 department of workforce development and any other appropriate 31 governmental body, in order to facilitate coordination of 32 disability services provided in this state. The state mental 33 health and mental retardation plans shall be consistent with 34 the state health plan, and shall incorporate county disability 35 -9- LSB 5353HH (5) 83 jp/nh 9/ 24

H.F. 2184 services plans. 1 Sec. 15. Section 225C.6, subsections 1 and 3, Code 2009, are 2 amended to read as follows: 3 1. To the extent funding is available, the commission shall 4 perform the following duties: 5 a. Advise the administrator on the administration of the 6 overall state disability services system. 7 b. Adopt necessary rules pursuant to chapter 17A which 8 relate to disability programs and services, including but not 9 limited to definitions of each disability included within the 10 term “disability services” as necessary for purposes of state, 11 county, and regional planning, programs, and services. 12 c. Adopt standards for community mental health centers, 13 services, and programs as recommended under section 230A.16. 14 The commission administrator shall determine whether to grant, 15 deny, or revoke the accreditation of the centers, services, and 16 programs. 17 d. Adopt standards for the care of and services to persons 18 with mental illness and mental retardation residing in county 19 care facilities recommended under section 227.4 the provision 20 under medical assistance of individual case management 21 services . 22 e. Unless another governmental body sets standards for a 23 service available to persons with disabilities, adopt state 24 standards for that service. The commission shall provide that 25 a service provider’s compliance with standards for a service 26 set by a nationally recognized body shall be deemed to be in 27 compliance with the state standards adopted by the commission 28 for that service. The commission shall adopt state standards 29 for those residential and community-based providers of services 30 to persons with mental illness or developmental disabilities 31 that are not otherwise subject to licensure by the department 32 of human services or department of inspections and appeals, 33 including but not limited to remedial services payable under 34 the medical assistance program and other services payable from 35 -10- LSB 5353HH (5) 83 jp/nh 10/ 24

H.F. 2184 funds credited to a county mental health, mental retardation, 1 and developmental disabilities services fund created in section 2 331.424A . In addition, the The commission shall review the 3 licensing standards used by the department of human services 4 or department of inspections and appeals for those facilities 5 providing disability services to persons with mental illness 6 or developmental disabilities . 7 f. Assure that proper reconsideration and appeal procedures 8 are available to persons aggrieved by decisions, actions, or 9 circumstances relating to accreditation. 10 g. Adopt necessary rules for awarding grants from the state 11 and federal government as well as other moneys that become 12 available to the division for grant purposes. 13 h. Annually submit to the governor and the general assembly: 14 (1) A report concerning the activities of the commission. 15 (2) Recommendations formulated by the commission for 16 changes in law. 17 i. By January 1 of each odd-numbered year, submit to the 18 governor and the general assembly an evaluation of: 19 (1) The extent to which services to persons with 20 disabilities are actually available to persons in each county 21 in the state and the quality of those services. 22 (2) The effectiveness of the services being provided by 23 disability service providers in this state and by each of the 24 state mental health institutes established under chapter 226 25 and by each of the state resource centers established under 26 chapter 222. 27 j. Advise the administrator, the council on human services, 28 the governor, and the general assembly on budgets and 29 appropriations concerning disability services. 30 k. Coordinate activities with the governor’s developmental 31 disabilities council and the mental health planning council, 32 created pursuant to federal law . Work with other state 33 agencies on coordinating, collaborating, and communicating 34 concerning activities involving persons with disabilities. 35 -11- LSB 5353HH (5) 83 jp/nh 11/ 24

H.F. 2184 l. Establish standards for the provision under medical 1 assistance of individual case management services. The 2 commission shall determine whether to grant, deny, or revoke 3 the accreditation of the services. 4 m. l. Identify basic financial eligibility standards for 5 disability services. The standards shall include but are not 6 limited to the following: 7 (1) A financial eligibility standard providing that a 8 person with an income equal to or less than one hundred fifty 9 percent of the federal poverty level, as defined by the most 10 recently revised poverty income guidelines published by the 11 United States department of health and human services, is 12 eligible for disability services paid with public funding. 13 However, a county may apply a copayment requirement for a 14 particular disability service to a person with an income 15 equal to or less than one hundred fifty percent of the 16 federal poverty level, provided the disability service and 17 the copayment amount both comply with rules adopted by the 18 commission applying uniform standards with respect to copayment 19 requirements. A person with an income above one hundred fifty 20 percent of the federal poverty level may be eligible subject 21 to a copayment or other cost-sharing arrangement subject to 22 limitations adopted in rule by the commission. 23 (2) A requirement that a person who is eligible for 24 federally funded services and other support must apply for the 25 services and support. 26 (3) Resource limitations that are derived from the federal 27 supplemental security income program limitations. A person 28 with resources above the federal supplemental security income 29 program limitations may be eligible subject to limitations 30 adopted in rule by the commission. If a person does not 31 qualify for federally funded services and other support 32 but meets income, resource, and functional eligibility 33 requirements, the following types of resources shall be 34 disregarded: 35 -12- LSB 5353HH (5) 83 jp/nh 12/ 24

H.F. 2184 (a) A retirement account that is in the accumulation stage. 1 (b) A burial, medical savings, or assistive technology 2 account. 3 n. m. Identify disability services outcomes and indicators 4 to support the ability of eligible persons with a disability to 5 live, learn, work, and recreate in communities of the persons’ 6 choice. The identification duty includes but is not limited to 7 responsibility for identifying, collecting, and analyzing data 8 as necessary to issue reports on outcomes and indicators at the 9 county and state levels. 10 o. Prepare five-year plans based upon the county management 11 plans developed pursuant to section 331.439 . 12 p. Work with other state agencies on coordinating, 13 collaborating, and communicating concerning activities 14 involving persons with disabilities. 15 q. Perform analyses and other functions associated with 16 a redesign of the mental health and developmental disability 17 services systems for adults and for children. 18 3. If the executive branch creates a committee, task force, 19 council, or other advisory body to consider mental health 20 and developmental disabilities disability services policy , 21 services, or program options involving children or adult 22 consumers, the commission is designated to receive and consider 23 any report, findings, recommendations, or other work product 24 issued by such body. The commission may address the report, 25 findings, recommendations, or other work product in fulfilling 26 the commission’s functions and to advise the department, 27 council on human services, governor, and general assembly 28 concerning disability services. 29 Sec. 16. Section 225C.6A, Code 2009, is amended to read as 30 follows: 31 225C.6A Mental health, developmental disability, and brain 32 injury service system redesign implementation . 33 1. Purpose. It is the intent of the general assembly 34 to implement a redesign of the mental health, developmental 35 -13- LSB 5353HH (5) 83 jp/nh 13/ 24

H.F. 2184 disability, and brain injury service system over a period of 1 years in order to transition to a coordinated system for Iowans 2 with mental illness, mental retardation or other developmental 3 disabilities, or brain injury. Because of the significance of 4 the redesign to the persons who may be affected by it and the 5 degree of uncertainty regarding the extent of funding changes 6 necessary for implementation, the department and the commission 7 shall not implement a redesign provision through rulemaking or 8 other means unless specific statutory authority provides for 9 the provision’s implementation. 10 2. Initial activities. For the fiscal years beginning 11 July 1, 2004, and July 1, 2005, the The commission shall do 12 the following relating to redesign of the disability services 13 system in the state : 14 a. 1. Identify sources of revenue to support statewide 15 delivery of core disability services to eligible disability 16 populations. 17 b. Further develop adult disability services system redesign 18 proposals and propose a redesign of the children’s disability 19 service system. The redesign of the children’s system shall 20 address issues associated with an individual’s transition 21 between the two systems. 22 2. Ensure there is a continuous improvement process for 23 development and maintenance of the disability services system 24 for adults and children. The process shall include but is not 25 limited to data collection and reporting provisions. 26 c. (1) 3. a. Plan, collect, and analyze data as necessary 27 to issue cost estimates for serving additional populations and 28 providing core disability services statewide. The department 29 shall maintain compliance with applicable federal and state 30 privacy laws to ensure the confidentiality and integrity of 31 individually identifiable disability services data. The 32 department shall regularly assess the status of the compliance 33 in order to assure that data security is protected. 34 (2) b. In implementing a system under this paragraph 35 -14- LSB 5353HH (5) 83 jp/nh 14/ 24

H.F. 2184 “c” subsection for collecting and analyzing state, county, 1 and private contractor data, the department shall establish a 2 client identifier for the individuals receiving services. The 3 client identifier shall be used in lieu of the individual’s 4 name or social security number. The client identifier shall 5 consist of the last four digits of an individual’s social 6 security number, the first three letters of the individual’s 7 last name, the individual’s date of birth, and the individual’s 8 gender in an order determined by the department. 9 (3) c. Each county shall report to the department annually 10 on or before December 1, for the preceding fiscal year the 11 following information for each individual served: demographic 12 information, expenditure data, and data concerning the services 13 and other support provided to each individual, as specified in 14 administrative rule adopted by the commission. 15 d. With consumer input, identify and propose standardized 16 functional assessment tools and processes for use in the 17 eligibility determination process when eligibility for a 18 particular disability population group is implemented. The 19 tools and processes shall be integrated with those utilized 20 for the medical assistance program under chapter 249A . For 21 the initial diagnostic criteria, the commission shall consider 22 identifying a qualifying functional assessment score and any 23 of the following diagnoses: mental illness, chronic mental 24 illness, mental retardation, developmental disability, or brain 25 injury. 26 e. The commission shall adopt a multiyear plan for 27 developing and providing the data, cost projections, revenue 28 requirements, and other information needed to support decision 29 making concerning redesign provisions. The information shall 30 be provided as part of the commission’s regular reports to the 31 governor and general assembly or more often as determined to be 32 appropriate by the commission. 33 f. Propose case rates for disability services. 34 g. 4. Work with county representatives and other qualified 35 -15- LSB 5353HH (5) 83 jp/nh 15/ 24

H.F. 2184 persons to develop an implementation plan for replacing the 1 county of legal settlement approach to determining service 2 system funding responsibilities with an approach based upon 3 residency. The plan shall address a statewide standard for 4 proof of residency, outline a plan for establishing a data 5 system for identifying residency of eligible individuals, 6 address residency issues for individuals who began residing in 7 a county due to a court order or criminal sentence or to obtain 8 services in that county, recommend an approach for contesting 9 a residency determination, and address other implementation 10 issues. 11 Sec. 17. Section 225C.6B, subsection 1, Code 2009, is 12 amended to read as follows: 13 1. Intent. 14 a. The general assembly intends for the state to implement 15 a comprehensive, continuous, and integrated state mental 16 health and disability services plan in accordance with 17 the requirements of sections 225C.4 and 225C.6 and other 18 provisions of this chapter, by increasing the department’s 19 responsibilities in the development, funding, oversight, and 20 ongoing leadership of mental health and disability services in 21 this state. 22 b. In order to further the purposes listed in 23 sections section 225C.1 and 225C.27 and in other provisions 24 of this chapter, the general assembly intends that efforts 25 focus on the goal of making available a comprehensive array 26 of high-quality, evidence-based consumer and family-centered 27 mental health and disability services and other support in the 28 least restrictive, community-based setting appropriate for a 29 consumer. 30 c. In addition, it is the intent of the general assembly 31 to promote policies and practices that achieve for consumers 32 the earliest possible detection of mental health problems and 33 the need for disability services and for early intervention; 34 to stress that all health care programs address mental 35 -16- LSB 5353HH (5) 83 jp/nh 16/ 24

H.F. 2184 health disorders with the same urgency as physical health 1 disorders; to promote the policies of all public programs 2 that serve adults and children with mental disorders or with 3 a need for disability services , including but not limited to 4 child welfare, Medicaid, education, housing, criminal and 5 juvenile justice, substance abuse treatment, and employment 6 services; to consider the special mental health and disability 7 services needs of adults and children; and to promote recovery 8 and resiliency as expected outcomes for all consumers. 9 Sec. 18. Section 225C.6B, subsection 2, Code 2009, is 10 amended by striking the subsection and inserting in lieu 11 thereof the following: 12 2. Comprehensive plan. The division shall develop a 13 comprehensive written five-year state mental health and 14 disability services plan with annual updates and readopt 15 the plan every five years. The plan shall describe the key 16 components of the state’s mental health and disability services 17 system, including the services that are community-based, state 18 institution-based, or regional or state-based. The five-year 19 plan and each update shall be submitted annually to the 20 commission on or before October 30 for review and approval. 21 Sec. 19. Section 225C.21, subsection 2, Code 2009, is 22 amended to read as follows: 23 2. The commission shall adopt rules pursuant to chapter 17A 24 establishing minimum standards for supported community living 25 services. The commission administrator shall determine whether 26 to grant, deny, or revoke approval for any supported community 27 living service. 28 Sec. 20. Section 225C.52, subsection 1, Code 2009, is 29 amended to read as follows: 30 1. Establishing a comprehensive community-based mental 31 health services system for children and youth is part of 32 fulfilling the requirements of the division and the commission 33 to facilitate a comprehensive, continuous, and integrated state 34 mental health and disability services plan in accordance with 35 -17- LSB 5353HH (5) 83 jp/nh 17/ 24

H.F. 2184 sections 225C.4, 225C.6, and 225C.6A, and other provisions 1 of this chapter. The purpose of establishing the children’s 2 system is to improve access for children and youth with 3 serious emotional disturbances and youth with other qualifying 4 mental health disorders to mental health treatment, services, 5 and other support in the least restrictive setting possible 6 so the children and youth can live with their families 7 and remain in their communities. The children’s system is 8 also intended to meet the needs of children and youth who 9 have mental health disorders that co-occur with substance 10 abuse, mental retardation, developmental disabilities, or 11 other disabilities. The children’s system shall emphasize 12 community-level collaborative efforts between children and 13 youth and the families and the state’s systems of education, 14 child welfare, juvenile justice, health care, substance abuse, 15 and mental health. 16 Sec. 21. REPEAL. Section 225C.27, Code 2009, is repealed. 17 DIVISION III 18 COMMISSION AND WAIVER NAME CHANGE 19 Sec. 22. Section 225C.2, subsection 3, Code 2009, is amended 20 to read as follows: 21 3. “Commission” means the mental health , mental retardation, 22 developmental disabilities, and brain injury and disability 23 services commission. 24 Sec. 23. Section 225C.5, subsection 1, unnumbered paragraph 25 1, Code Supplement 2009, is amended to read as follows: 26 A mental health , mental retardation, developmental 27 disabilities, and brain injury and disability 28 services commission is created as the state policy-making body 29 for the provision of services to persons with mental illness, 30 mental retardation or other developmental disabilities, 31 or brain injury. The commission’s voting members shall 32 be appointed to three-year staggered terms by the governor 33 and are subject to confirmation by the senate. Commission 34 members shall be appointed on the basis of interest and 35 -18- LSB 5353HH (5) 83 jp/nh 18/ 24

H.F. 2184 experience in the fields of mental health, mental retardation 1 or other developmental disabilities, and brain injury, in a 2 manner so as to ensure adequate representation from persons 3 with disabilities and individuals knowledgeable concerning 4 disability services. The department shall provide staff 5 support to the commission, and the commission may utilize staff 6 support and other assistance provided to the commission by 7 other persons. The commission shall meet at least four times 8 per year. The membership of the commission shall consist of 9 the following persons who, at the time of appointment to the 10 commission, are active members of the indicated groups: 11 Sec. 24. Section 249A.12, subsection 4, paragraph b, Code 12 2009, is amended to read as follows: 13 b. Effective July 1, 1995, the The state shall be 14 responsible for all of the nonfederal share of medical 15 assistance home and community-based services waivers 16 for persons with mental retardation intellectual 17 disabilities services provided to minors and a county is not 18 required to reimburse the department and shall not be billed 19 for the nonfederal share of the costs of the services. 20 Sec. 25. Section 249A.12, subsection 5, paragraph a, 21 unnumbered paragraph 1, Code 2009, is amended to read as 22 follows: 23 The mental health , mental retardation, developmental 24 disabilities, and brain injury and disability 25 services commission shall recommend to the department 26 the actions necessary to assist in the transition of 27 individuals being served in an intermediate care facility for 28 persons with mental retardation, who are appropriate for the 29 transition, to services funded under a medical assistance 30 home and community-based services waiver for persons with 31 mental retardation intellectual disabilities in a manner which 32 maximizes the use of existing public and private facilities. 33 The actions may include but are not limited to submitting any 34 of the following or a combination of any of the following 35 -19- LSB 5353HH (5) 83 jp/nh 19/ 24