House Study Bill 569 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED DEPARTMENT OF HUMAN SERVICES BILL) A BILL FOR An Act revising 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 5356XD (10) 83 jp/nh

S.F. _____ H.F. _____ DIVISION I 1 GENERAL AMENDMENTS 2 Section 1. Section 135C.23, subsection 2, paragraph b, Code 3 Supplement 2009, is amended to read as follows: 4 b. This section does not prohibit the admission of a 5 patient with a history of dangerous or disturbing behavior to 6 an intermediate care facility for persons with mental illness, 7 intermediate care facility for persons with mental retardation, 8 nursing facility, or county care facility when the intermediate 9 care facility for persons with mental illness, intermediate 10 care facility for persons with mental retardation, nursing 11 facility, or county care facility has a program which has 12 received prior approval from the department to properly care 13 for and manage the patient. An intermediate care facility for 14 persons with mental illness, intermediate care facility for 15 persons with mental retardation, nursing facility, or county 16 care facility is required to transfer or discharge a resident 17 with dangerous or disturbing behavior when the intermediate 18 care facility for persons with mental illness, intermediate 19 care facility for persons with mental retardation, nursing 20 facility, or county care facility cannot control the resident’s 21 dangerous or disturbing behavior. The department , in 22 coordination with the state mental health, mental retardation, 23 developmental disabilities, and brain injury commission created 24 in section 225C.5 , shall adopt rules pursuant to chapter 17A 25 for programs to be required in intermediate care facilities 26 for persons with mental illness, intermediate care facilities 27 for persons with mental retardation, nursing facilities, and 28 county care facilities that admit patients or have residents 29 with histories of dangerous or disturbing behavior. 30 Sec. 2. Section 229.24, subsection 3, unnumbered paragraph 31 1, Code 2009, is amended to read as follows: 32 If all or part of the costs associated with hospitalization 33 of an individual under this chapter are chargeable to a 34 county of legal settlement, the clerk of the district court 35 -1- LSB 5356XD (10) 83 jp/nh 1/ 25

S.F. _____ H.F. _____ shall provide to the county of legal settlement and to the 1 county in which the hospitalization order is entered , in a 2 form prescribed by the mental health, mental retardation, 3 developmental disabilities, and brain injury commission, the 4 following information pertaining to the individual which would 5 be confidential under subsection 1: 6 Sec. 3. Section 230A.2, Code 2009, is amended to read as 7 follows: 8 230A.2 Services offered. 9 A community mental health center established or operating 10 as authorized by section 230A.1 may offer to residents of the 11 county or counties it serves any or all of the mental health 12 services defined by the mental health, mental retardation, 13 developmental disabilities, and brain injury commission in the 14 comprehensive state mental health and disability services plan 15 under section 225C.6B . 16 Sec. 4. Section 230A.15, Code 2009, is amended to read as 17 follows: 18 230A.15 Comprehensive community mental health program. 19 A community mental health center established or operating 20 as authorized by section 230A.1, or which a county or group 21 of counties has agreed to establish or support pursuant 22 to that section, may with approval of the board or boards 23 of supervisors of the county or counties supporting or 24 establishing the center, undertake to provide a comprehensive 25 community mental health program for the county or counties. 26 A center providing a comprehensive community mental health 27 program shall, at a minimum, make available to residents of the 28 county or counties it serves all of the comprehensive mental 29 health services described in the comprehensive state mental 30 health and disability services plan under section 225C.6B . 31 Sec. 5. Section 331.424A, subsection 1, Code Supplement 32 2009, is amended to read as follows: 33 1. For the purposes of this chapter, unless the context 34 otherwise requires, “services fund” means the county mental 35 -2- LSB 5356XD (10) 83 jp/nh 2/ 25

S.F. _____ H.F. _____ health, mental retardation, and developmental disabilities 1 services fund created in subsection 2. The county finance 2 committee created in section 333A.2 shall consult with 3 the state commission in adopting shall adopt rules and 4 prescribing forms for administering the services fund. The 5 county finance committee created in section 333A.2 shall 6 prescribe forms in accordance with the rules adopted by the 7 state commission. The forms shall allow for reporting of 8 services for persons with brain injury and other optional 9 services funded through a services fund. 10 Sec. 6. Section 331.438, subsection 1, paragraph b, Code 11 2009, is amended to read as follows: 12 b. “Qualified mental health, mental retardation, and 13 developmental disabilities services” means the services 14 specified on forms issued in the rules adopted by the county 15 finance committee following consultation with the state 16 commission for administering the services fund, pursuant to 17 section 331.424A . 18 Sec. 7. Section 331.438, subsection 4, paragraph b, Code 19 2009, is amended to read as follows: 20 b. The state commission shall do all of the following: 21 (1) Identify Receive and review reports from the department 22 of human services identifying characteristics of the 23 service county services system, including amounts expended, 24 equity of funding among counties, funding sources, provider 25 types, service availability, and equity of service availability 26 among counties and among persons served. 27 (2) Assess the accuracy and uniformity of recordkeeping and 28 reporting in the service system. 29 (3) Identify for each county the factors associated with 30 inflationary growth of the service system. 31 (4) Identify opportunities for containing service system 32 growth. 33 (5) (2) Consider proposals for revising service county 34 services system administrative rules. 35 -3- LSB 5356XD (10) 83 jp/nh 3/ 25

S.F. _____ H.F. _____ (6) Consider provisions and adopt rules for counties to 1 implement a central point of coordination to plan, budget, 2 and monitor county expenditures for the service system. The 3 provisions shall provide options for counties to implement 4 the central point of coordination in collaboration with other 5 counties. 6 (7) Develop criteria for annual county mental health, 7 mental retardation, and developmental disabilities plans. 8 (8) (3) Adopt administrative rules identifying qualified 9 mental health, mental retardation, and developmental 10 disabilities service expenditures for purposes of state payment 11 pursuant to subsection 1 relating to county management plans . 12 (9) Adopt rules for the county central point of coordination 13 and clinical assessment processes required under section 14 331.440 and other rules necessary for the implementation of 15 county management plans and expenditure reports required for 16 state payment pursuant to section 331.439 . 17 (10) Consider recommendations to improve the programs and 18 cost-effectiveness of state and county contracting processes 19 and procedures, including strategies for negotiations relating 20 to managed care. The recommendations implemented by the 21 commission for the state and county regarding managed care 22 shall include but are not limited to standards for limiting 23 excess costs and profits, and for restricting cost shifting 24 under a managed care system. 25 (11) (4) Provide input, when appropriate, to the director 26 of human services in any decision involving administrative 27 rules which were adopted by the department of human services 28 pertaining to the mental illness, mental retardation, and 29 developmental disabilities services system administered by 30 counties. 31 (12) Identify the fiscal impact of existing or proposed 32 legislation and administrative rules on state and county 33 expenditures. 34 (13) Adopt administrative rules providing statewide 35 -4- LSB 5356XD (10) 83 jp/nh 4/ 25

S.F. _____ H.F. _____ standards and a monitoring methodology to determine whether 1 cost-effective individualized services are available as 2 required pursuant to section 331.439, subsection 1 , paragraph 3 “b” . 4 (14) (5) Consider recommendations for and adopt 5 administrative rules establishing statewide minimum standards 6 for services and other support required to be available to 7 persons covered by a county management plan under section 8 331.439. 9 (15) (6) Consider recommendations for measuring and 10 improving the quality of state and county mental health, mental 11 retardation, and developmental disabilities services and other 12 support. 13 (16) Develop a procedure for each county to disclose to 14 the department of human services information approved by the 15 commission concerning the mental health, mental retardation, 16 developmental disabilities, and brain injury services provided 17 to the individuals served through the county central point 18 of coordination process. The procedure shall incorporate 19 protections to ensure that if individually identified 20 information is disclosed, it is disclosed and maintained in 21 compliance with applicable Iowa and federal confidentiality 22 laws, including but not limited to federal Health Insurance 23 Portability and Accountability Act, Pub. L. No. 104-191, 24 requirements. 25 Sec. 8. Section 331.439, subsection 1, unnumbered paragraph 26 1, Code 2009, is amended to read as follows: 27 The state payment to eligible counties under this section 28 shall be made as provided in sections 331.438 and 426B.2. A 29 county is eligible for the state payment, as defined in section 30 331.438, for a fiscal year if the director of human services , 31 in consultation with the state commission, determines for a 32 specific fiscal year that all of the following conditions are 33 met: 34 Sec. 9. Section 331.439, subsection 1, paragraph a, Code 1 -5- LSB 5356XD (10) 83 jp/nh 5/ 25

S.F. _____ H.F. _____ 2009, is amended to read as follows: 2 a. The county accurately reported by December 1 the 3 county’s expenditures for mental health, mental retardation, 4 and developmental disabilities services and the information 5 required under section 225C.6A, subsection 2 3 , paragraph 6 “c” , for the previous fiscal year on forms prescribed by in 7 accordance with rules adopted by the state commission. If 8 the department determines good cause exists, the department 9 may extend a deadline otherwise imposed under this chapter, 10 chapter 225C, or chapter 426B for a county’s reporting 11 concerning mental health, mental retardation, or developmental 12 disabilities services or related revenues and expenditures. 13 Sec. 10. Section 331.439, subsection 1, paragraph b, 14 unnumbered paragraph 1, Code 2009, is amended to read as 15 follows: 16 The county developed and implemented a county management 17 plan for the county’s mental health, mental retardation, and 18 developmental disabilities services system in accordance with 19 the provisions of this paragraph “b ”. The plan shall comply 20 with the administrative rules adopted for this purpose by the 21 state commission and is subject to the approval of the director 22 of human services in consultation with the state commission. 23 The plan shall include a description of the county’s service 24 management provision for mental health, mental retardation, and 25 developmental disabilities services. For mental retardation 26 and developmental disabilities service management, the plan 27 shall describe the county’s development and implementation of a 28 managed system of cost-effective individualized services and 29 shall comply with the provisions of paragraph “f” . The goal 30 of this part of the plan shall be to assist the individuals 31 served to be as independent, productive, and integrated into 32 the community as possible. The service management provisions 33 for mental health shall comply with the provisions of paragraph 34 “e” . A county is subject to all of the following provisions 35 in regard to the county’s services system management plan and 1 -6- LSB 5356XD (10) 83 jp/nh 6/ 25

S.F. _____ H.F. _____ planning process: 2 Sec. 11. Section 331.439, subsection 1, paragraph b, 3 subparagraphs (2) and (3), Code 2009, are amended to read as 4 follows: 5 (2) For informational purposes, the county shall submit a 6 management plan review to the department of human services by 7 December 1 of each year. The annual review shall incorporate 8 an analysis of the data associated with the services 9 system managed during the preceding fiscal year by the county 10 or by a managed care private entity on behalf of the county. 11 The annual review shall also identify measurable outcomes 12 and results showing the county’s progress in fulfilling 13 the purposes listed in paragraph “c” , and in achieving the 14 disability services outcomes and indicators identified by the 15 commission pursuant to section 225C.6. 16 (3) For informational purposes, every three years the 17 county shall submit to the department of human services a 18 three-year strategic plan. The strategic plan shall describe 19 how the county will proceed to attain the plan’s goals and 20 objectives, and the measurable outcomes and results necessary 21 for moving the county’s service services system toward an 22 individualized, community-based focus in accordance with 23 paragraph “c” . The three-year strategic plan shall be 24 submitted by April 1, 2000, and by April 1 of every third year 25 thereafter. 26 Sec. 12. Section 331.439, subsection 1, paragraphs c, e, and 27 f, Code 2009, are amended to read as follows: 28 c. The county implements its county management plan under 29 paragraph “b” and other service management functions in a 30 manner that seeks to achieve all of the following purposes 31 identified in section 225C.1 for persons who are covered by the 32 plan or are otherwise subject to the county’s service services 33 system management functions: 34 (1) The service services system seeks to empower persons 35 to exercise their own choices about the amounts and types of 1 -7- LSB 5356XD (10) 83 jp/nh 7/ 25

S.F. _____ H.F. _____ services and other support received. 2 (2) The service services system seeks to empower the persons 3 to accept responsibility, exercise choices, and take risks. 4 (3) The service services system seeks to provide services 5 and other support that are individualized, provided to produce 6 results, flexible, and cost-effective. 7 (4) The service services system seeks to provide services 8 and other supports support in a manner which supports the 9 ability of the persons to live, learn, work, and recreate in 10 communities of their choice. 11 e. (1) For mental health service management, the county 12 may either directly implement a system of service management 13 and contract with service providers, or contract with a 14 private entity to manage the county services system, provided 15 all requirements of this lettered paragraph are met by the 16 private entity. The mental health service management services 17 system shall incorporate a central point of coordination and 18 clinical assessment process developed in accordance with the 19 provisions of section 331.440. 20 (2) A managed care The county services system for mental 21 health proposed by a county shall include but is not limited 22 to all of the following elements which shall be specified in 23 administrative rules adopted by the state commission: 24 (a) The enrollment and eligibility process. 25 (b) The scope of services included. 26 (c) The method of plan administration. 27 (d) The process for managing utilization and access to 28 services and other assistance. 29 (e) The quality assurance process. 30 (f) The risk management provisions and fiscal viability of 31 the provisions, if the county contracts with a private managed 32 care entity. 33 f. For mental retardation and developmental disabilities 34 services management, the county must either develop and 35 implement a managed system of care which addresses a full 1 -8- LSB 5356XD (10) 83 jp/nh 8/ 25

S.F. _____ H.F. _____ array of appropriate services and cost-effective delivery of 2 services by contracting directly with service providers or 3 contract by contracting with a state-approved managed care 4 contractor or contractors private entity to manage the county 5 services system . Any system or contract implemented under 6 this paragraph The county services system shall incorporate a 7 central point of coordination and clinical assessment process 8 developed in accordance with the provisions of section 331.440. 9 The elements of the county managed system of care a county 10 services system shall be specified in rules developed by the 11 department of human services in consultation with and adopted 12 by the state commission. 13 Sec. 13. Section 331.439, subsection 3, paragraph b, Code 14 2009, is amended to read as follows: 15 b. Based upon information contained in county management 16 plans and budgets and proposals made by representatives of 17 counties, the state commission shall recommend an allowed 18 growth factor adjustment to the governor by November 15 19 for the fiscal year which commences two years from the 20 beginning date of the fiscal year in progress at the time the 21 recommendation is made. The allowed growth factor adjustment 22 shall may address various costs including but not limited to 23 the costs associated with new consumers of service, service 24 cost inflation, and investments for economy and efficiency. In 25 developing the service cost inflation recommendation, the state 26 commission shall consider the cost trends indicated by the 27 gross expenditure amount reported in the expenditure reports 28 submitted by counties pursuant to subsection 1, paragraph 29 “a” . The governor shall consider the state commission’s 30 recommendation in developing the governor’s recommendation for 31 an allowed growth factor adjustment for such fiscal year. The 32 governor’s recommendation shall be submitted at the time the 33 governor’s proposed budget for the succeeding fiscal year is 34 submitted in accordance with chapter 8. 35 Sec. 14. Section 331.439, subsection 7, Code 2009, is 1 -9- LSB 5356XD (10) 83 jp/nh 9/ 25

S.F. _____ H.F. _____ amended to read as follows: 2 7. A county shall annually report data concerning the 3 county’s services system managed by in accordance with the 4 county management plan . At a minimum, the data reported shall 5 indicate the number of different individuals who utilized 6 services in a fiscal year and the various types of services. 7 Data reported under this subsection shall be submitted with 8 the county’s expenditure report required under subsection 1, 9 paragraph “a” . 10 DIVISION II 11 CODE CHAPTER 225C AMENDMENTS 12 Sec. 15. Section 225C.4, subsection 1, paragraph a, Code 13 2009, is amended to read as follows: 14 a. Prepare and administer the comprehensive mental health 15 and disability services plan as provided in section 225C.6B, 16 including state mental health and mental retardation plans 17 for the provision of disability services within the state and 18 prepare and administer the state developmental disabilities 19 plan. The administrator shall consult with the Iowa department 20 of public health, the state board of regents or a body 21 designated by the board for that purpose, the department 22 of management or a body designated by the director of the 23 department for that purpose, the department of education, the 24 department of workforce development and any other appropriate 25 governmental body, in order to facilitate coordination of 26 disability services provided in this state. The state mental 27 health and mental retardation plans shall be consistent with 28 the state health plan, and shall incorporate county disability 29 services plans. 30 Sec. 16. Section 225C.6, subsections 1 and 3, Code 2009, are 31 amended to read as follows: 32 1. To the extent funding is available, the commission shall 33 perform the following duties: 34 a. Advise the administrator on the administration of the 35 overall state disability services system. 1 -10- LSB 5356XD (10) 83 jp/nh 10/ 25

S.F. _____ H.F. _____ b. Adopt necessary rules pursuant to chapter 17A which 2 relate to disability programs and services, including but not 3 limited to definitions of each disability included within the 4 term “disability services” as necessary for purposes of state, 5 county, and regional planning, programs, and services. 6 c. Adopt standards for community mental health centers, 7 services, and programs as recommended under section 230A.16. 8 The commission administrator shall determine whether to grant, 9 deny, or revoke the accreditation of the centers, services, and 10 programs. 11 d. Adopt standards for the care of and services to persons 12 with mental illness and mental retardation residing in county 13 care facilities recommended under section 227.4 the provision 14 under medical assistance of individual case management 15 services . 16 e. Unless another governmental body sets standards for a 17 service available to persons with disabilities, adopt state 18 standards for that service. The commission shall provide that 19 a service provider’s compliance with standards for a service 20 set by a nationally recognized body shall be deemed to be in 21 compliance with the state standards adopted by the commission 22 for that service. The commission shall adopt state standards 23 for those residential and community-based providers of services 24 to persons with mental illness or developmental disabilities 25 that are not otherwise subject to licensure by the department 26 of human services or department of inspections and appeals, 27 including but not limited to remedial services payable under 28 the medical assistance program and other services payable from 29 funds credited to a county mental health, mental retardation, 30 and developmental disabilities services fund created in section 31 331.424A . In addition, the The commission shall review the 32 licensing standards used by the department of human services 33 or department of inspections and appeals for those facilities 34 providing disability services to persons with mental illness 35 or developmental disabilities . 1 -11- LSB 5356XD (10) 83 jp/nh 11/ 25

S.F. _____ H.F. _____ f. Assure that proper reconsideration and appeal procedures 2 are available to persons aggrieved by decisions, actions, or 3 circumstances relating to accreditation. 4 g. Adopt necessary rules for awarding grants from the state 5 and federal government as well as other moneys that become 6 available to the division for grant purposes. 7 h. Annually submit to the governor and the general assembly: 8 (1) A report concerning the activities of the commission. 9 (2) Recommendations formulated by the commission for 10 changes in law. 11 i. By January 1 of each odd-numbered year, submit to the 12 governor and the general assembly an evaluation of: 13 (1) The extent to which services to persons with 14 disabilities are actually available to persons in each county 15 in the state and the quality of those services. 16 (2) The effectiveness of the services being provided by 17 disability service providers in this state and by each of the 18 state mental health institutes established under chapter 226 19 and by each of the state resource centers established under 20 chapter 222. 21 j. Advise the administrator, the council on human services, 22 the governor, and the general assembly on budgets and 23 appropriations concerning disability services. 24 k. Coordinate activities with the governor’s developmental 25 disabilities council and the mental health planning council, 26 created pursuant to federal law . Work with other state 27 agencies on coordinating, collaborating, and communicating 28 concerning activities involving persons with disabilities. 29 l. Establish standards for the provision under medical 30 assistance of individual case management services. The 31 commission shall determine whether to grant, deny, or revoke 32 the accreditation of the services. 33 m. l. Identify basic financial eligibility standards for 34 disability services. The standards shall include but are not 35 limited to the following: 1 -12- LSB 5356XD (10) 83 jp/nh 12/ 25

S.F. _____ H.F. _____ (1) A financial eligibility standard providing that a 2 person with an income equal to or less than one hundred fifty 3 percent of the federal poverty level, as defined by the most 4 recently revised poverty income guidelines published by the 5 United States department of health and human services, is 6 eligible for disability services paid with public funding. 7 However, a county may apply a copayment requirement for a 8 particular disability service to a person with an income 9 equal to or less than one hundred fifty percent of the 10 federal poverty level, provided the disability service and 11 the copayment amount both comply with rules adopted by the 12 commission applying uniform standards with respect to copayment 13 requirements. A person with an income above one hundred fifty 14 percent of the federal poverty level may be eligible subject 15 to a copayment or other cost-sharing arrangement subject to 16 limitations adopted in rule by the commission. 17 (2) A requirement that a person who is eligible for 18 federally funded services and other support must apply for the 19 services and support. 20 (3) Resource limitations that are derived from the federal 21 supplemental security income program limitations. A person 22 with resources above the federal supplemental security income 23 program limitations may be eligible subject to limitations 24 adopted in rule by the commission. If a person does not 25 qualify for federally funded services and other support 26 but meets income, resource, and functional eligibility 27 requirements, the following types of resources shall be 28 disregarded: 29 (a) A retirement account that is in the accumulation stage. 30 (b) A burial, medical savings, or assistive technology 31 account. 32 n. m. Identify disability services outcomes and indicators 33 to support the ability of eligible persons with a disability to 34 live, learn, work, and recreate in communities of the persons’ 35 choice. The identification duty includes but is not limited to 1 -13- LSB 5356XD (10) 83 jp/nh 13/ 25

S.F. _____ H.F. _____ responsibility for identifying, collecting, and analyzing data 2 as necessary to issue reports on outcomes and indicators at the 3 county and state levels. 4 o. Prepare five-year plans based upon the county management 5 plans developed pursuant to section 331.439 . 6 p. Work with other state agencies on coordinating, 7 collaborating, and communicating concerning activities 8 involving persons with disabilities. 9 q. Perform analyses and other functions associated with 10 a redesign of the mental health and developmental disability 11 services systems for adults and for children. 12 3. If the executive branch creates a committee, task force, 13 council, or other advisory body to consider mental health 14 and developmental disabilities disability services policy , 15 services, or program options involving children or adult 16 consumers, the commission is designated to receive and consider 17 any report, findings, recommendations, or other work product 18 issued by such body. The commission may address the report, 19 findings, recommendations, or other work product in fulfilling 20 the commission’s functions and to advise the department, 21 council on human services, governor, and general assembly 22 concerning disability services. 23 Sec. 17. Section 225C.6A, Code 2009, is amended to read as 24 follows: 25 225C.6A Mental health, developmental disability, and brain 26 injury service system redesign implementation . 27 1. Purpose. It is the intent of the general assembly 28 to implement a redesign of the mental health, developmental 29 disability, and brain injury service system over a period of 30 years in order to transition to a coordinated system for Iowans 31 with mental illness, mental retardation or other developmental 32 disabilities, or brain injury. Because of the significance of 33 the redesign to the persons who may be affected by it and the 34 degree of uncertainty regarding the extent of funding changes 35 necessary for implementation, the department and the commission 1 -14- LSB 5356XD (10) 83 jp/nh 14/ 25

S.F. _____ H.F. _____ shall not implement a redesign provision through rulemaking or 2 other means unless specific statutory authority provides for 3 the provision’s implementation. 4 2. Initial activities. For the fiscal years beginning 5 July 1, 2004, and July 1, 2005, the The commission shall do 6 the following relating to redesign of the disability services 7 system in the state : 8 a. 1. Identify sources of revenue to support statewide 9 delivery of core disability services to eligible disability 10 populations. 11 b. Further develop adult disability services system redesign 12 proposals and propose a redesign of the children’s disability 13 service system. The redesign of the children’s system shall 14 address issues associated with an individual’s transition 15 between the two systems. 16 2. Ensure there is a continuous improvement process for 17 development and maintenance of the disability services system 18 for adults and children. The process shall include but is not 19 limited to data collection and reporting provisions. 20 c. (1) 3. a. Plan, collect, and analyze data as necessary 21 to issue cost estimates for serving additional populations and 22 providing core disability services statewide. The department 23 shall maintain compliance with applicable federal and state 24 privacy laws to ensure the confidentiality and integrity of 25 individually identifiable disability services data. The 26 department shall regularly assess the status of the compliance 27 in order to assure that data security is protected. 28 (2) b. In implementing a system under this paragraph 29 “c” subsection for collecting and analyzing state, county, 30 and private contractor data, the department shall establish a 31 client identifier for the individuals receiving services. The 32 client identifier shall be used in lieu of the individual’s 33 name or social security number. The client identifier shall 34 consist of the last four digits of an individual’s social 35 security number, the first three letters of the individual’s 1 -15- LSB 5356XD (10) 83 jp/nh 15/ 25

S.F. _____ H.F. _____ last name, the individual’s date of birth, and the individual’s 2 gender in an order determined by the department. 3 (3) c. Each county shall report to the department annually 4 on or before December 1, for the preceding fiscal year the 5 following information for each individual served: demographic 6 information, expenditure data, and data concerning the services 7 and other support provided to each individual, as specified in 8 administrative rule adopted by the commission. 9 d. With consumer input, identify and propose standardized 10 functional assessment tools and processes for use in the 11 eligibility determination process when eligibility for a 12 particular disability population group is implemented. The 13 tools and processes shall be integrated with those utilized 14 for the medical assistance program under chapter 249A . For 15 the initial diagnostic criteria, the commission shall consider 16 identifying a qualifying functional assessment score and any 17 of the following diagnoses: mental illness, chronic mental 18 illness, mental retardation, developmental disability, or brain 19 injury. 20 e. The commission shall adopt a multiyear plan for 21 developing and providing the data, cost projections, revenue 22 requirements, and other information needed to support decision 23 making concerning redesign provisions. The information shall 24 be provided as part of the commission’s regular reports to the 25 governor and general assembly or more often as determined to be 26 appropriate by the commission. 27 f. Propose case rates for disability services. 28 g. 4. Work with county representatives and other qualified 29 persons to develop an implementation plan for replacing the 30 county of legal settlement approach to determining service 31 system funding responsibilities with an approach based upon 32 residency. The plan shall address a statewide standard for 33 proof of residency, outline a plan for establishing a data 34 system for identifying residency of eligible individuals, 35 address residency issues for individuals who began residing in 1 -16- LSB 5356XD (10) 83 jp/nh 16/ 25

S.F. _____ H.F. _____ a county due to a court order or criminal sentence or to obtain 2 services in that county, recommend an approach for contesting 3 a residency determination, and address other implementation 4 issues. 5 Sec. 18. Section 225C.6B, subsection 1, Code 2009, is 6 amended to read as follows: 7 1. Intent. 8 a. The general assembly intends for the state to implement 9 a comprehensive, continuous, and integrated state mental 10 health and disability services plan in accordance with 11 the requirements of sections 225C.4 and 225C.6 and other 12 provisions of this chapter, by increasing the department’s 13 responsibilities in the development, funding, oversight, and 14 ongoing leadership of mental health and disability services in 15 this state. 16 b. In order to further the purposes listed in 17 sections section 225C.1 and 225C.27 and in other provisions 18 of this chapter, the general assembly intends that efforts 19 focus on the goal of making available a comprehensive array 20 of high-quality, evidence-based consumer and family-centered 21 mental health and disability services and other support in the 22 least restrictive, community-based setting appropriate for a 23 consumer. 24 c. In addition, it is the intent of the general assembly 25 to promote policies and practices that achieve for consumers 26 the earliest possible detection of mental health problems and 27 the need for disability services and for early intervention; 28 to stress that all health care programs address mental 29 health disorders with the same urgency as physical health 30 disorders; to promote the policies of all public programs 31 that serve adults and children with mental disorders or with 32 a need for disability services , including but not limited to 33 child welfare, Medicaid, education, housing, criminal and 34 juvenile justice, substance abuse treatment, and employment 35 services; to consider the special mental health and disability 1 -17- LSB 5356XD (10) 83 jp/nh 17/ 25

S.F. _____ H.F. _____ services needs of adults and children; and to promote recovery 2 and resiliency as expected outcomes for all consumers. 3 Sec. 19. Section 225C.6B, subsection 2, Code 2009, is 4 amended by striking the subsection and inserting in lieu 5 thereof the following: 6 2. Comprehensive plan. The division shall develop a 7 comprehensive written five-year state mental health and 8 disability services plan with annual updates and readopt 9 the plan every five years. The plan shall describe the key 10 components of the state’s mental health and disability services 11 system, including the services that are community-based, state 12 institution-based, or regional or state-based. The five-year 13 plan and each update shall be submitted annually to the 14 commission on or before October 30 for review and approval. 15 Sec. 20. Section 225C.21, subsection 2, Code 2009, is 16 amended to read as follows: 17 2. The commission shall adopt rules pursuant to chapter 17A 18 establishing minimum standards for supported community living 19 services. The commission administrator shall determine whether 20 to grant, deny, or revoke approval for any supported community 21 living service. 22 Sec. 21. Section 225C.52, subsection 1, Code 2009, is 23 amended to read as follows: 24 1. Establishing a comprehensive community-based mental 25 health services system for children and youth is part of 26 fulfilling the requirements of the division and the commission 27 to facilitate a comprehensive, continuous, and integrated state 28 mental health and disability services plan in accordance with 29 sections 225C.4, 225C.6, and 225C.6A, and other provisions 30 of this chapter. The purpose of establishing the children’s 31 system is to improve access for children and youth with 32 serious emotional disturbances and youth with other qualifying 33 mental health disorders to mental health treatment, services, 34 and other support in the least restrictive setting possible 35 so the children and youth can live with their families 1 -18- LSB 5356XD (10) 83 jp/nh 18/ 25

S.F. _____ H.F. _____ and remain in their communities. The children’s system is 2 also intended to meet the needs of children and youth who 3 have mental health disorders that co-occur with substance 4 abuse, mental retardation, developmental disabilities, or 5 other disabilities. The children’s system shall emphasize 6 community-level collaborative efforts between children and 7 youth and the families and the state’s systems of education, 8 child welfare, juvenile justice, health care, substance abuse, 9 and mental health. 10 Sec. 22. REPEAL. Section 225C.27, Code 2009, is repealed. 11 DIVISION III 12 COMMISSION AND WAIVER NAME CHANGE 13 Sec. 23. Section 225C.2, subsection 3, Code 2009, is amended 14 to read as follows: 15 3. “Commission” means the mental health , mental retardation, 16 developmental disabilities, and brain injury and disability 17 services commission. 18 Sec. 24. Section 225C.5, subsection 1, unnumbered paragraph 19 1, Code Supplement 2009, is amended to read as follows: 20 A mental health , mental retardation, developmental 21 disabilities, and brain injury and disability 22 services commission is created as the state policy-making body 23 for the provision of services to persons with mental illness, 24 mental retardation or other developmental disabilities, 25 or brain injury. The commission’s voting members shall 26 be appointed to three-year staggered terms by the governor 27 and are subject to confirmation by the senate. Commission 28 members shall be appointed on the basis of interest and 29 experience in the fields of mental health, mental retardation 30 or other developmental disabilities, and brain injury, in a 31 manner so as to ensure adequate representation from persons 32 with disabilities and individuals knowledgeable concerning 33 disability services. The department shall provide staff 34 support to the commission, and the commission may utilize staff 35 support and other assistance provided to the commission by 1 -19- LSB 5356XD (10) 83 jp/nh 19/ 25