H.F. _____ Section 1. 2009 Iowa Acts, chapter 179, section 1, is 1 amended by adding the following new subsection: 2 NEW SUBSECTION . 3. a. For the purposes of this subsection, 3 “services fund” means the county mental health, mental 4 retardation, and developmental disabilities services fund 5 created in section 331.424A. 6 b. The department of human services may implement one or 7 more pilot projects consisting of county groupings for mental 8 health, mental retardation, and developmental disabilities 9 services paid from the participating services funds. The 10 initial term of a pilot project implemented under this 11 subsection is limited to the three-year period beginning July 12 1, 2010, and ending June 30, 2013. 13 c. Under a pilot project, the department may enter into an 14 agreement with the counties participating in the pilot project 15 delineating how the service needs of the consumer populations 16 receiving mental health, mental retardation, and developmental 17 disabilities services paid from the services funds of the 18 participating counties will be addressed. A pilot project area 19 shall be comprised of at least five counties with a general 20 population of at least 75,000 and not more than 250,000, based 21 on the latest applicable population estimate issued by the 22 federal government. The pilot project provisions may include 23 but are not limited to all of the following: 24 (1) Pooling of all or a portion of the state funding 25 provided for use by the pilot project counties’ services funds. 26 (2) Pooling of medical assistance program home and 27 community-based services waiver slots for the participating 28 counties, to the extent current waiver provisions allow slots 29 to be designated for counties. 30 (3) To the extent allowed under federal requirements, 31 decategorizing the funding streams for mental health, mental 32 retardation, and developmental disabilities services available 33 to the counties participating in the pilot project. 34 (4) If the department implements a new program, initiative, 35 -1- LSB 5242YC (1) 83 jp/nh 1/ 4

H.F. _____ or service addressing the needs of the populations receiving 1 services paid for by a county services fund, adapting any 2 associated requirements to optimize implementation within the 3 pilot project counties. 4 (5) Establishing a standard practice in which the pilot 5 project counties may utilize assessment tools such as the 6 level of care and utilization system (LOCUS) or the supports 7 intensity scale (SIS) to determine the functional needs of a 8 consumer. The functional assessment would be used to develop 9 an individual budget allocation for each consumer that the 10 consumer can direct toward the service needs of the consumer. 11 (6) State funding distributed to the pilot project 12 counties may be reallocated among the pilot project counties 13 as determined by those counties based upon individual budget 14 allocations and county administrative costs and historical 15 needs. 16 (7) County property taxes credited to the respective county 17 services funds shall continue to be used for the services costs 18 of the respective counties. 19 (8) As determined and approved by the respective county 20 board of supervisors for the second and third years of the 21 pilot project, in lieu of the limitation otherwise applicable 22 under section 331.424A, subsection 4, county revenues from 23 taxes imposed by a pilot project county that are credited to 24 the county’s services fund shall be subject to a levy rate 25 limitation. The levy rate for a pilot project county shall not 26 exceed the actual levy rate of the county’s services fund for 27 the fiscal year beginning July 1, 1997. 28 d. For purposes of qualifying for the allowed growth and 29 MH/DD community services fund moneys distributed under this 30 section, the minimum levy and services fund ending balances of 31 the counties participating in the pilot project may be combined 32 and an average utilized to qualify for the moneys. 33 e. For the allowed growth and MH/DD community services fund 34 moneys distributed for the fiscal years of the pilot project, 35 -2- LSB 5242YC (1) 83 jp/nh 2/ 4

H.F. _____ provided the counties participating in the pilot project do 1 not reduce levies below the required percentages, the combined 2 percentage of those moneys of such counties shall not be less 3 than the combined percentage of such moneys in the preceding 4 fiscal year. 5 f. A county’s participation in the pilot project and the 6 provisions of the pilot project must be agreed upon by the 7 department and the board of supervisors of each of the counties 8 participating in the pilot project. 9 g. The pilot project counties shall provide periodic 10 performance and evaluation information to the department, 11 governor, and general assembly, and shall share nonidentifying 12 functional assessment and individual budget allocation data 13 with the department and interested counties. 14 h. The outcomes addressed by the pilot project may include 15 but are not limited to any of the following: 16 (1) Validating the use of functional assessment tools. 17 (2) Validating the use of individual budget allocations. 18 (3) Determining the statewide viability of implementing the 19 alternative funding approaches utilized in the pilot project. 20 (4) Evaluating whether the funding approaches used in 21 the pilot project can be applied statewide as a means of 22 instituting a residency-based approach for funding in place of 23 legal settlement. 24 (5) Determining whether the approaches utilized in the 25 pilot project have enhanced consumer choice, empowerment, 26 community involvement with consumers, and community capacity to 27 support consumers in achieving improved outcomes. 28 EXPLANATION 29 This bill authorizes the department of human services 30 to implement county mental health, mental retardation, and 31 developmental disabilities (MH/MR/DD) services pilot projects. 32 The bill amends the authorization into 2009 Iowa Acts, 33 chapter 179, section 1, which appropriates funding for 34 distribution to counties of the county MH/MR/DD allowed growth 35 -3- LSB 5242YC (1) 83 jp/nh 3/ 4

H.F. _____ factor adjustment for fiscal year 2010-2011. 1 A pilot project area must be comprised of at least five 2 counties with a general population of at least 75,000 and not 3 more than 250,000. The initial pilot project period is limited 4 to the three fiscal years beginning July 1, 2010, and ending 5 June 30, 2013. 6 The pilot project provisions are required to be outlined 7 in an agreement between the department and pilot project 8 counties and may include any of the following: pooling of 9 state funding, pooling of medical assistance program home 10 and community-based services waiver slots, decategorizing of 11 funding streams, adapting any new program requirements to 12 optimize implementation within the pilot project counties, 13 establishing as a standard practice the use of functional 14 assessment tools to determine the functional needs of a 15 consumer and develop an individual budget allocation for each 16 consumer, reallocation of the state funding distributed to the 17 pilot project counties based upon individual budget allocations 18 and county administrative costs and historical needs, and use 19 of a levy rate limit for MH/MR/DD services fund property taxes 20 in lieu of a dollar amount levy limit. 21 The pilot project counties are required to provide 22 evaluation and outcome information. A list of possible 23 outcomes which may be realized by the pilot projects is 24 provided. 25 -4- LSB 5242YC (1) 83 jp/nh 4/ 4