S.F. _____ H.F. _____ DIVISION I 1 COMMUNITY MENTAL HEALTH CENTERS —— CATCHMENT AREAS 2 Section 1. NEW SECTION . 230A.101 Services system roles. 3 1. The role of the department of human services, through 4 the division of the department designated as the state 5 mental health authority with responsibility for state policy 6 concerning mental health and disability services, is to develop 7 and maintain policies for the mental health and disability 8 services system. The policies shall address the service needs 9 of individuals of all ages with disabilities in this state, 10 regardless of the individuals’ places of residence or economic 11 circumstances, and shall be consistent with the requirements of 12 chapter 225C and other applicable law. 13 2. The role of community mental health centers in the 14 mental health and disability services system is to provide 15 an organized set of services in order to adequately meet the 16 mental health needs of this state’s citizens based on organized 17 catchment areas. 18 Sec. 2. NEW SECTION . 230A.102 Definitions. 19 As used in this chapter, unless the context otherwise 20 requires: 21 1. “Administrator” , “commission” , “department” , “disability 22 services” , and “division” mean the same as defined in section 23 225C.2. 24 2. “Catchment area” means a community mental health center 25 catchment area identified in accordance with this chapter. 26 3. “Community mental health center” or “center” means a 27 community mental health center designated in accordance with 28 this chapter. 29 Sec. 3. NEW SECTION . 230A.103 Designation of community 30 mental health centers. 31 1. The division, in collaboration with a county or counties 32 within a catchment area, by action of the respective board or 33 boards of supervisors, shall designate at least one community 34 mental health center under this chapter to serve the mental 35 -1- LSB 5349XD (5) 83 jp/nh 1/ 16

S.F. _____ H.F. _____ health needs of the county or counties comprising the catchment 1 area. 2 2. The division shall utilize objective criteria for 3 designating a community mental health center to serve a 4 catchment area and for withdrawing such designation. The 5 commission shall adopt rules outlining the criteria. The 6 criteria shall include but are not limited to provisions for 7 meeting all of the following requirements: 8 a. An appropriate means shall be used for determining which 9 prospective designee is best able to serve all ages of the 10 targeted population within the catchment area with minimal or 11 no service denials. 12 b. An effective means shall be used for determining the 13 relative ability of a prospective designee to appropriately 14 provide mental health services and other support to consumers 15 residing within a catchment area as well as consumers residing 16 outside the catchment area. The criteria shall address the 17 duty for a prospective designee to arrange placements outside 18 the catchment area when such placements best meet consumer 19 needs and to provide services within the catchment area to 20 consumers who reside outside the catchment area when the 21 services are necessary and appropriate. 22 3. The board of directors for a designated community mental 23 center shall enter into an agreement with the division and 24 the counties affiliated with the catchment area served by 25 the center, as applicable. The terms of the agreement shall 26 include but are not limited to all of the following: 27 a. The period of time the agreement will be in force. 28 b. The services and other support the center will offer or 29 provide for the residents of the catchment area. 30 c. The standards to be followed by the center in determining 31 whether and to what extent the persons seeking services from 32 the center shall be considered to be able to pay the costs of 33 the services. 34 d. The policies regarding availability of the services 35 -2- LSB 5349XD (5) 83 jp/nh 2/ 16

S.F. _____ H.F. _____ offered by the center to the residents of the catchment area as 1 well as consumers residing outside the catchment area. 2 e. The requirements for preparation and submission to the 3 division of an annual budget, and audits, cost reports, program 4 reports, performance measures, and other financial and service 5 accountability information. 6 4. This section does not limit the authority of the board 7 or boards of supervisors of any county or group of counties to 8 continue to expend money to support operation of a center. 9 Sec. 4. NEW SECTION . 230A.104 Catchment areas. 10 1. The division shall collaborate with affected counties in 11 identifying community mental health center catchment areas in 12 accordance with the requirements of this section. 13 2. The division shall implement objective criteria for 14 identifying or revising catchment areas which shall be 15 identified in rule adopted by the commission. The criteria 16 shall include but are not limited to provisions for meeting all 17 of the following requirements: 18 a. Unless the division has determined that exceptional 19 circumstances exist, a catchment area shall be served by one 20 community mental health center. The purpose of this general 21 limitation is to clearly designate the center responsible and 22 accountable for providing core mental health services to the 23 target population in the catchment area and to protect the 24 financial viability of the centers comprising the mental health 25 services system in the state. 26 b. A formal review process shall be used in determining 27 whether exceptional circumstances exist that justify 28 designating more than one center to serve a catchment area. 29 The criteria for the review process shall include but are not 30 limited to a means of determining whether the catchment area 31 can support more than one center. 32 c. Criteria shall be provided that would allow the 33 designation of more than one center for all or a portion of a 34 catchment area if designation or approval for more than one 35 -3- LSB 5349XD (5) 83 jp/nh 3/ 16

S.F. _____ H.F. _____ center was provided by both the division and the affected 1 counties as of July 1, 2009. The criteria shall require a 2 determination that all such centers would be financially viable 3 if designation is provided for all. 4 d. All counties in the state shall be part of a catchment 5 area. The identification criteria shall provide a means of 6 determining that each catchment area can financially support at 7 least one center. 8 Sec. 5. NEW SECTION . 230A.105 Target population —— 9 eligibility. 10 1. The target population residing in a catchment area to be 11 served by a community mental health center shall include but is 12 not limited to all of the following: 13 a. Individuals of any age who are experiencing a mental 14 health crisis. 15 b. Individuals of any age who have a mental health disorder. 16 c. Adults who have a serious mental illness or chronic 17 mental illness. 18 d. Children and youth who are experiencing a serious 19 emotional disturbance. 20 e. Individuals described in paragraph “a” , “b” , “c” , 21 or “d” who have a co-occurring disorder, including but not 22 limited to substance abuse, mental retardation, a developmental 23 disability, brain injury, autism spectrum disorder, or another 24 disability or special health care need. 25 2. Specific eligibility criteria for members of the target 26 population shall be identified in administrative rules adopted 27 by the commission. The eligibility criteria shall address both 28 clinical and financial eligibility. 29 Sec. 6. NEW SECTION . 230A.106 Services offered. 30 1. A community mental health center designated in 31 accordance with this chapter shall offer core services and 32 support addressing the basic mental health and safety needs of 33 the target population and other residents of the catchment area 34 served by the center and may offer other services and support. 35 -4- LSB 5349XD (5) 83 jp/nh 4/ 16

S.F. _____ H.F. _____ The core services shall be identified in administrative rules 1 adopted by the commission for this purpose. 2 2. A community mental health center may offer the required 3 core services by one or more of the following means: 4 a. Direct provision of services. 5 b. Coordinating the provision of services through another 6 provider agency. 7 c. Contracting or affiliating with another provider for a 8 particular service. 9 3. A community mental health center shall be responsible 10 for coordinating with associated services provided by other 11 unaffiliated agencies to members of the target population in 12 the catchment area and to integrate services in the community 13 with services provided to the target population in residential 14 or inpatient settings. 15 Sec. 7. NEW SECTION . 230A.107 Forms of organization. 16 Each community mental health center designated in accordance 17 with this chapter shall be organized and administered as one of 18 the following alternative forms: 19 1. A nonprofit corporation. 20 2. A for-profit corporation. The designation criteria for 21 such corporations shall include but are not limited to all of 22 the following: 23 a. The corporation’s allowable administrative costs and 24 profit margins shall be subject to reasonable limitations. 25 b. A percentage of the corporation’s operating budget shall 26 be designated for provision of care to the target population 27 without charge. 28 c. The corporation shall be in substantial compliance with 29 the standards applicable to a nonprofit corporation designee. 30 d. The corporation shall be subject to the same open record 31 and sharing of financial information and reporting requirements 32 as a nonprofit corporation designee. 33 Sec. 8. NEW SECTION . 230A.108 Administrative, diagnostic, 34 and demographic information. 35 -5- LSB 5349XD (5) 83 jp/nh 5/ 16

S.F. _____ H.F. _____ Release of administrative and diagnostic information, as 1 defined in section 228.1, and demographic information necessary 2 for aggregated reporting to meet the data requirements 3 established by the division, relating to an individual who 4 receives services from a community mental health center through 5 the applicable central point of coordination process, may be 6 made a condition of support of that center by any county in the 7 center’s catchment area. 8 Sec. 9. NEW SECTION . 230A.109 Funding —— legislative 9 intent. 10 1. It is the intent of the general assembly that public 11 funding for community mental health centers designated in 12 accordance with this chapter shall continue to be provided as a 13 combination of federal, state, and county funding. The funding 14 sources may include but are not limited to federal supplemental 15 security income, block grants and other grants, and medical 16 assistance program funding, state allowed growth and property 17 tax relief funding, and county property tax funding. 18 2. It is the intent of the general assembly that the shared 19 state and county funding provided to centers be a sufficient 20 amount for the core services and support addressing the 21 basic mental health and safety needs of the residents of the 22 catchment area served by each center to be provided regardless 23 of individual ability to pay for the services and support. 24 Sec. 10. NEW SECTION . 230A.110 Standards. 25 1. The division shall recommend and the commission shall 26 adopt standards for designated community mental health centers 27 and comprehensive community mental health programs, with 28 the overall objective of ensuring that each center and each 29 affiliate providing services under contract with a center 30 furnishes high-quality mental health services within a 31 framework of accountability to the community it serves. The 32 standards adopted shall be in substantial conformity with 33 the applicable behavioral health standards adopted by the 34 joint commission, formerly known as the joint commission 35 -6- LSB 5349XD (5) 83 jp/nh 6/ 16

S.F. _____ H.F. _____ on accreditation of health care organizations, and other 1 recognized national standards for evaluation of psychiatric 2 facilities unless in the judgment of the division, with 3 approval of the commission, there are sound reasons for 4 departing from the standards. 5 2. When recommending standards under this section, the 6 division shall designate an advisory committee representing 7 boards of directors and professional staff of designated 8 community mental health centers to assist in the formulation 9 or revision of standards. The membership of the advisory 10 committee shall include representatives of professional and 11 nonprofessional staff, at least one representative of county 12 boards of supervisors and central point of coordination 13 administrators, and other appropriate individuals. 14 3. The standards recommended under this section shall 15 include requirements that each community mental health center 16 designated under this chapter do all of the following: 17 a. Maintain and make available to the public a written 18 statement of the services the center offers to residents of 19 the catchment area being served. The center shall employ or 20 contract for services with affiliates to employ staff who are 21 appropriately credentialed or meet other qualifications in 22 order to provide services. 23 b. If organized as a nonprofit corporation, be governed by 24 a board of directors which adequately represents interested 25 professions, consumers of the center’s services, socioeconomic, 26 cultural, and age groups, and various geographical areas in 27 the catchment area served by the center. If organized as a 28 for-profit corporation, the corporation’s policy structure 29 shall incorporate such representation. 30 c. Arrange for the financial condition and transactions of 31 the community mental health center to be audited once each year 32 by the auditor of state. However, in lieu of an audit by state 33 accountants, the local governing body of a community mental 34 health center organized under this chapter may contract with 35 -7- LSB 5349XD (5) 83 jp/nh 7/ 16

S.F. _____ H.F. _____ or employ certified public accountants to conduct the audit, 1 pursuant to the applicable terms and conditions prescribed by 2 sections 11.6 and 11.19 and audit format prescribed by the 3 auditor of state. Copies of each audit shall be furnished by 4 the accountant to the administrator of the division of mental 5 health and disability services and the board or boards of 6 supervisors supporting the audited community mental health 7 center. 8 d. Comply with the accreditation standards applicable to the 9 center. 10 Sec. 11. NEW SECTION . 230A.111 Review and evaluation. 11 1. The review and evaluation of designated centers shall 12 be performed through a formal accreditation review process as 13 recommended by the division and approved by the commission. 14 The accreditation process shall include all of the following: 15 a. Specific time intervals for full accreditation reviews 16 based upon levels of accreditation. 17 b. Use of random or complaint-specific, on-site limited 18 accreditation reviews in the interim between full accreditation 19 reviews, as a quality review approach. The results of such 20 reviews shall be presented to the commission. 21 c. Use of center accreditation self-assessment tools to 22 gather data regarding quality of care and outcomes, whether 23 used during full or limited reviews or at other times. 24 2. The accreditation process shall include but is not 25 limited to addressing all of the following: 26 a. Measures to address centers that do not meet standards, 27 including authority to revoke accreditation. 28 b. Measures to address noncompliant centers that do not 29 develop a corrective action plan or fail to implement steps 30 included in a corrective action plan accepted by the division. 31 c. Measures to appropriately recognize centers that 32 successfully complete a corrective action plan. 33 d. Criteria to determine when a center’s accreditation 34 should be denied, revoked, suspended, or made provisional. 35 -8- LSB 5349XD (5) 83 jp/nh 8/ 16

S.F. _____ H.F. _____ Sec. 12. IMPLEMENTATION. 1 1. Community mental health centers operating under 2 the provisions of chapter 230A, Code 2009, and associated 3 standards, rules, and other requirements as of June 30, 2010, 4 may continue to operate under such requirements until the 5 department of human services, division of mental health and 6 disability services, and the mental health, mental retardation, 7 developmental disabilities, and brain injury commission 8 have completed the rules adoption process to implement the 9 amendments to chapter 230A enacted by this Act, identified 10 catchment areas, and completed designations of centers. 11 2. The division and the commission shall complete the rules 12 adoption process and other requirements addressed in subsection 13 1 on or before June 30, 2011. 14 Sec. 13. IMPLEMENTATION OF ACT. Section 25B.2, subsection 15 3, shall not apply to this Act. 16 Sec. 14. REPEAL. Sections 230A.1, 230A.2, 230A.3, 230A.4, 17 230A.5, 230A.6, 230A.7, 230A.8, 230A.9, 230A.10, 230A.11, 18 230A.12, 230A.13, 230A.14, 230A.15, 230A.16, 230A.17, and 19 230A.18, Code 2009, are repealed. 20 DIVISION II 21 CONFORMING AMENDMENTS 22 Sec. 15. Section 225C.4, subsection 1, paragraph o, Code 23 2009, is amended to read as follows: 24 o. Recommend to the commission minimum accreditation 25 standards for the maintenance and operation of community 26 mental health centers, services, and programs designated under 27 section 230A.16 chapter 230A . The administrator’s review 28 and evaluation of the centers, services, and programs for 29 compliance with the adopted standards shall be as provided in 30 section 230A.17 chapter 230A . 31 Sec. 16. Section 225C.6, subsection 1, paragraph c, Code 32 2009, is amended to read as follows: 33 c. Adopt standards for community mental health centers, 34 services, and programs as recommended under section 230A.16 by 35 -9- LSB 5349XD (5) 83 jp/nh 9/ 16

S.F. _____ H.F. _____ the administrator . The commission shall determine whether 1 to grant, deny, or revoke the accreditation of the centers, 2 services, and programs. 3 Sec. 17. Section 225C.7, subsection 3, Code 2009, is amended 4 to read as follows: 5 3. If a county has not established or is not affiliated 6 with a community mental health center under chapter 230A , 7 the county shall expend a portion of the money received 8 under this appropriation to contract with a community mental 9 health center to provide mental health services to the 10 county’s residents. If such a contractual relationship 11 is unworkable or undesirable, the commission may waive the 12 expenditure requirement. However, if the commission waives the 13 requirement, the commission shall address the specific concerns 14 of the county and shall attempt to facilitate the provision 15 of mental health services to the county’s residents through 16 an affiliation agreement or other means. A county must be 17 affiliated with the community mental health center designated 18 in accordance with chapter 230A in order to receive moneys from 19 the fund. 20 Sec. 18. Section 225C.15, Code 2009, is amended to read as 21 follows: 22 225C.15 County implementation of evaluations. 23 The board of supervisors of a county shall , no later 24 than July 1, 1982, require that the preadmission diagnostic 25 evaluation policy stated in section 225C.14 be followed with 26 respect to admission of persons from that county to a state 27 mental health institute. A community mental health center 28 which is supported, directly or in affiliation with other 29 counties, by that county designated for the county’s catchment 30 area may perform the preliminary diagnostic evaluations for 31 that county, unless the performance of the evaluations is 32 not covered by the agreement entered into by the county and 33 the center under section 230A.12 , and the center’s director 34 certifies to the board of supervisors that the center does not 35 -10- LSB 5349XD (5) 83 jp/nh 10/ 16

S.F. _____ H.F. _____ have the capacity to perform the evaluations, in which case 1 the board of supervisors shall proceed with an alternative 2 diagnostic facility as provided under section 225C.17. 3 Sec. 19. Section 225C.54, subsection 1, Code Supplement 4 2009, is amended to read as follows: 5 1. The mental health services system for children and youth 6 shall be initially implemented by the division commencing with 7 the fiscal year beginning July 1, 2008. The division shall 8 begin implementation by utilizing a competitive bidding process 9 to allocate state block grants to develop services through 10 existing community mental health centers , providers approved 11 in a waiver adopted by the commission to provide services to a 12 county in lieu of a community mental health center, designated 13 in accordance with chapter 230A and other local service 14 partners. The implementation shall be limited to the extent of 15 the appropriations provided for the children’s system. 16 Sec. 20. Section 228.6, subsection 1, Code 2009, is amended 17 to read as follows: 18 1. A mental health professional or an employee of or 19 agent for a mental health facility may disclose mental health 20 information if and to the extent necessary, to meet the 21 requirements of section 229.24, 229.25, 230.20, 230.21, 230.25, 22 230.26, 230A.13 230A.108 , 232.74, or 232.147, or to meet the 23 compulsory reporting or disclosure requirements of other state 24 or federal law relating to the protection of human health and 25 safety. 26 Sec. 21. Section 235A.15, subsection 2, paragraph c, 27 subparagraph (6), Code Supplement 2009, is amended to read as 28 follows: 29 (6) To an administrator of a community mental health center 30 accredited under designated in accordance with chapter 230A if 31 the data concerns a person employed or being considered for 32 employment by the center. 33 Sec. 22. Section 331.321, subsection 1, paragraph e, Code 34 Supplement 2009, is amended by striking the paragraph. 35 -11- LSB 5349XD (5) 83 jp/nh 11/ 16

S.F. _____ H.F. _____ Sec. 23. Section 331.382, subsection 1, paragraph f, Code 1 Supplement 2009, is amended by striking the paragraph. 2 EXPLANATION 3 This bill relates to the requirements of community mental 4 health centers under Code chapter 230A. The bill is organized 5 into divisions. 6 CODE CHAPTER 230A AMENDMENTS. This division repeals and 7 replaces Code chapter 230A which was originally enacted by 1974 8 Iowa Acts, chapter 1160. 9 The bill maintains the requirements under current law 10 for accreditation of community mental health centers to be 11 performed by the department of human services (DHS), division 12 of mental health and disability services, in accordance with 13 standards adopted by the mental health, mental retardation, 14 developmental disabilities, and brain injury (MH/MR/DD/BI) 15 commission. 2008 Iowa Acts, chapter 1187, required the 16 division to utilize an advisory group to develop a proposal for 17 revising Code chapter 230A and for revising the accreditation 18 process for centers. Until the proposal has been considered 19 and acted upon by the general assembly, the division 20 administrator is authorized to defer consideration of requests 21 for accreditation of a new community mental health center or 22 for approval of a provider to fill the role of a center. The 23 proposal was submitted to the governor and general assembly 24 April 17, 2009. The bill provides for implementation of the 25 proposal. 26 The current Code chapter provides for community mental 27 health centers to either be directly established by a county 28 or counties and administered by a board of trustees or by 29 establishment of a nonprofit corporation operating on the basis 30 of an agreement with a county or counties. Code section 225C.7 31 allows the department of human services to authorize the center 32 services to be provided by an alternative provider. 33 The bill replaces this approach by requiring the division 34 and commission to consult with affected counties in identifying 35 -12- LSB 5349XD (5) 83 jp/nh 12/ 16

S.F. _____ H.F. _____ catchment areas of counties to be served by a center. The 1 general requirement is for one center to be designated to 2 serve a catchment area but more than one can be designated if 3 exceptional circumstances outlined in the bill are determined 4 to exist. 5 New Code section 230A.101 describes the regulatory and 6 policy role to be filled by the department and the service 7 provider role of the community mental health centers. 8 New Code section 230A.102 provides definitions. These 9 terms, defined in Code chapter 225C, are adopted by reference: 10 “administrator” (administrator of MH and disability 11 services division), “commission” ((MH/MR/DD/BI) commission), 12 “department” (DHS), “disability services” (services and other 13 support available to a person with mental illness, MR or 14 other DD, or BI), and “division” (MH and disability services 15 division). In addition, the terms “community mental health 16 center” and “catchment area” are defined to reflect the 17 contents of the bill. 18 New Code section 230A.103 provides criteria to be 19 implemented by the division for designation of at least one 20 community mental health center to serve a catchment area 21 consisting of a county or counties. Various operating and 22 services requirements are to be addressed in the terms of an 23 agreement between the designated center, the division, and the 24 counties comprising the catchment area. 25 New Code section 230A.104 provides for the division to 26 implement objective criteria for identifying catchment areas 27 for centers. A general limitation of one center per catchment 28 area is stated, however, the criteria are to include a formal 29 review process for use in determining whether exceptional 30 circumstances exist for designating more than one center 31 for a catchment area. The other stated criteria involve 32 determinations of financial viability for a center to operate. 33 New Code section 230A.105 lists the attributes of the 34 target population required to be served by a center. The 35 -13- LSB 5349XD (5) 83 jp/nh 13/ 16

S.F. _____ H.F. _____ list includes individuals of any age experiencing a mental 1 health crisis or disorder, adults who have a serious or chronic 2 mental illness, children and youth experiencing a serious 3 emotional disturbance, and listed individuals who also have a 4 co-occurring disorder. The specific clinical and financial 5 eligibility criteria are required to be identified in rules 6 adopted by the commission. 7 New Code section 230A.106 requires each designated center 8 to offer core services and support addressing the basic 9 mental health and safety needs of the target population and 10 other residents of the catchment area. The core services 11 are to be identified in rules adopted by the commission. 12 The core services may be offered by the center directly, by 13 coordination through another provider agency, or by contracting 14 or affiliating with another provider. In addition, a center is 15 responsible for coordinating associated services provided by 16 other unaffiliated agencies to members of the target population 17 and for integrating services provided to the target population 18 in residential or inpatient settings. 19 New Code section 230A.107 authorizes a designated center to 20 be organized as either a nonprofit or for-profit corporation 21 and includes specific criteria applicable to for-profit 22 corporations. 23 New Code section 230A.108 requires release of 24 administrative, diagnostic, and demographic information as a 25 condition of support by any of the counties in the catchment 26 area served by a center. Language with a similar requirement 27 is part of current law in Code section 230A.13, relating to 28 annual budgets of centers. 29 New Code section 230A.109 states legislative intent 30 regarding continuation of the current combination of federal, 31 state, and county funding supporting centers and for the amount 32 of funding to be sufficient for core services to be provided 33 regardless of an individual’s ability to pay for the services. 34 New Code section 230A.110 provides for accreditation 35 -14- LSB 5349XD (5) 83 jp/nh 14/ 16

S.F. _____ H.F. _____ standards for centers to be recommended by the division 1 and adopted by the commission. The standards are to be in 2 substantial conformity with certain national standards. The 3 division is directed to use an advisory committee to assist in 4 standards development. In addition, the standards recommended 5 are required to include various organizational requirements. 6 New Code section 230A.111 addresses how the review and 7 evaluation components of the accreditation process are to be 8 performed. 9 An implementation section authorizes centers operating under 10 current law as of June 30, 2009, to continue operating until 11 the rules are adopted, catchment areas are identified, and 12 centers are designated, as required by the bill. The division 13 and commission are required to complete those requirements on 14 or before June 30, 2011. 15 The bill may include a state mandate as defined in Code 16 section 25B.3. The bill makes inapplicable Code section 25B.2, 17 subsection 3, which would relieve a political subdivision from 18 complying with a state mandate if funding for the cost of 19 the state mandate is not provided or specified. Therefore, 20 political subdivisions are required to comply with any state 21 mandate included in the bill. 22 CONFORMING AMENDMENTS. This division amends internal 23 references and provides other conforming amendments in the 24 following Code provisions: Code section 225C.4, relating to 25 the duties of the MH and disability services administrator; 26 Code section 225C.6, relating to the duties of the commission, 27 Code section 225C.7, relating to the requirements for the MH/DD 28 community services fund; Code section 225C.15, relating to 29 county implementation of evaluations relating to admissions of 30 persons from the counties to a state mental health institute; 31 Code section 225C.54, relating to implementation of a mental 32 health services system for children and youth; Code section 33 228.6, relating to disclosure of confidential mental health 34 information; Code section 331.321, by striking the requirement 35 -15- LSB 5349XD (5) 83 jp/nh 15/ 16