SSB 3129 (LSB 5349XD (5) 83)

SENATE/HOUSE FILE _____

BY  (PROPOSED DEPARTMENT OF HUMAN SERVICES BILL)

A BILL FOR

An Act relating to community mental health centers.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
COMMUNITY MENTAL HEALTH CENTERS —— CATCHMENT AREAS
    Section 1.  NEW SECTION.  230A.101  Services system roles.
   1.  The role of the department of human services, through the division of the department designated as the state mental health authority with responsibility for state policy concerning mental health and disability services, is to develop and maintain policies for the mental health and disability services system. The policies shall address the service needs of individuals of all ages with disabilities in this state, regardless of the individuals’ places of residence or economic circumstances, and shall be consistent with the requirements of chapter 225C and other applicable law.
   2.  The role of community mental health centers in the mental health and disability services system is to provide an organized set of services in order to adequately meet the mental health needs of this state’s citizens based on organized catchment areas.
    Sec. 2.  NEW SECTION.  230A.102  Definitions.
   As used in this chapter, unless the context otherwise requires:

   1.  “Administrator”, “commission”, “department”, “disability services”, and “division” mean the same as defined in section 225C.2.
   2.  “Catchment area” means a community mental health center catchment area identified in accordance with this chapter.
   3.  “Community mental health center” or “center” means a community mental health center designated in accordance with this chapter.
    Sec. 3.  NEW SECTION.  230A.103  Designation of community mental health centers.
   1.  The division, in collaboration with a county or counties within a catchment area, by action of the respective board or boards of supervisors, shall designate at least one community mental health center under this chapter to serve the mental health needs of the county or counties comprising the catchment area.
   2.  The division shall utilize objective criteria for designating a community mental health center to serve a catchment area and for withdrawing such designation. The commission shall adopt rules outlining the criteria. The criteria shall include but are not limited to provisions for meeting all of the following requirements:
   a.  An appropriate means shall be used for determining which prospective designee is best able to serve all ages of the targeted population within the catchment area with minimal or no service denials.
   b.  An effective means shall be used for determining the relative ability of a prospective designee to appropriately provide mental health services and other support to consumers residing within a catchment area as well as consumers residing outside the catchment area. The criteria shall address the duty for a prospective designee to arrange placements outside the catchment area when such placements best meet consumer needs and to provide services within the catchment area to consumers who reside outside the catchment area when the services are necessary and appropriate.
   3.  The board of directors for a designated community mental center shall enter into an agreement with the division and the counties affiliated with the catchment area served by the center, as applicable. The terms of the agreement shall include but are not limited to all of the following:
   a.  The period of time the agreement will be in force.
   b.  The services and other support the center will offer or provide for the residents of the catchment area.
   c.  The standards to be followed by the center in determining whether and to what extent the persons seeking services from the center shall be considered to be able to pay the costs of the services.
   d.  The policies regarding availability of the services offered by the center to the residents of the catchment area as well as consumers residing outside the catchment area.
   e.  The requirements for preparation and submission to the division of an annual budget, and audits, cost reports, program reports, performance measures, and other financial and service accountability information.
   4.  This section does not limit the authority of the board or boards of supervisors of any county or group of counties to continue to expend money to support operation of a center.
    Sec. 4.  NEW SECTION.  230A.104  Catchment areas.
   1.  The division shall collaborate with affected counties in identifying community mental health center catchment areas in accordance with the requirements of this section.
   2.  The division shall implement objective criteria for identifying or revising catchment areas which shall be identified in rule adopted by the commission. The criteria shall include but are not limited to provisions for meeting all of the following requirements:
   a.  Unless the division has determined that exceptional circumstances exist, a catchment area shall be served by one community mental health center. The purpose of this general limitation is to clearly designate the center responsible and accountable for providing core mental health services to the target population in the catchment area and to protect the financial viability of the centers comprising the mental health services system in the state.
   b.  A formal review process shall be used in determining whether exceptional circumstances exist that justify designating more than one center to serve a catchment area. The criteria for the review process shall include but are not limited to a means of determining whether the catchment area can support more than one center.
   c.  Criteria shall be provided that would allow the designation of more than one center for all or a portion of a catchment area if designation or approval for more than one center was provided by both the division and the affected counties as of July 1, 2009. The criteria shall require a determination that all such centers would be financially viable if designation is provided for all.
   d.  All counties in the state shall be part of a catchment area. The identification criteria shall provide a means of determining that each catchment area can financially support at least one center.
    Sec. 5.  NEW SECTION.  230A.105  Target population —— eligibility.
   1.  The target population residing in a catchment area to be served by a community mental health center shall include but is not limited to all of the following:
   a.  Individuals of any age who are experiencing a mental health crisis.
   b.  Individuals of any age who have a mental health disorder.
   c.  Adults who have a serious mental illness or chronic mental illness.
   d.  Children and youth who are experiencing a serious emotional disturbance.
   e.  Individuals described in paragraph “a”, “b”, “c”, or “d” who have a co-occurring disorder, including but not limited to substance abuse, mental retardation, a developmental disability, brain injury, autism spectrum disorder, or another disability or special health care need.
   2.  Specific eligibility criteria for members of the target population shall be identified in administrative rules adopted by the commission. The eligibility criteria shall address both clinical and financial eligibility.
    Sec. 6.  NEW SECTION.  230A.106  Services offered.
   1.  A community mental health center designated in accordance with this chapter shall offer core services and support addressing the basic mental health and safety needs of the target population and other residents of the catchment area served by the center and may offer other services and support. The core services shall be identified in administrative rules adopted by the commission for this purpose.
   2.  A community mental health center may offer the required core services by one or more of the following means:
   a.  Direct provision of services.
   b.  Coordinating the provision of services through another provider agency.
   c.  Contracting or affiliating with another provider for a particular service.
   3.  A community mental health center shall be responsible for coordinating with associated services provided by other unaffiliated agencies to members of the target population in the catchment area and to integrate services in the community with services provided to the target population in residential or inpatient settings.
    Sec. 7.  NEW SECTION.  230A.107  Forms of organization.
   Each community mental health center designated in accordance with this chapter shall be organized and administered as one of the following alternative forms:

   1.  A nonprofit corporation.
   2.  A for-profit corporation. The designation criteria for such corporations shall include but are not limited to all of the following:
   a.  The corporation’s allowable administrative costs and profit margins shall be subject to reasonable limitations.
   b.  A percentage of the corporation’s operating budget shall be designated for provision of care to the target population without charge.
   c.  The corporation shall be in substantial compliance with the standards applicable to a nonprofit corporation designee.
   d.  The corporation shall be subject to the same open record and sharing of financial information and reporting requirements as a nonprofit corporation designee.
    Sec. 8.  NEW SECTION.  230A.108  Administrative, diagnostic, and demographic information.
   Release of administrative and diagnostic information, as defined in section 228.1, and demographic information necessary for aggregated reporting to meet the data requirements established by the division, relating to an individual who receives services from a community mental health center through the applicable central point of coordination process, may be made a condition of support of that center by any county in the center’s catchment area.
    Sec. 9.  NEW SECTION.  230A.109  Funding —— legislative intent.
   1.  It is the intent of the general assembly that public funding for community mental health centers designated in accordance with this chapter shall continue to be provided as a combination of federal, state, and county funding. The funding sources may include but are not limited to federal supplemental security income, block grants and other grants, and medical assistance program funding, state allowed growth and property tax relief funding, and county property tax funding.
   2.  It is the intent of the general assembly that the shared state and county funding provided to centers be a sufficient amount for the core services and support addressing the basic mental health and safety needs of the residents of the catchment area served by each center to be provided regardless of individual ability to pay for the services and support.
    Sec. 10.  NEW SECTION.  230A.110  Standards.
   1.  The division shall recommend and the commission shall adopt standards for designated community mental health centers and comprehensive community mental health programs, with the overall objective of ensuring that each center and each affiliate providing services under contract with a center furnishes high-quality mental health services within a framework of accountability to the community it serves. The standards adopted shall be in substantial conformity with the applicable behavioral health standards adopted by the joint commission, formerly known as the joint commission on accreditation of health care organizations, and other recognized national standards for evaluation of psychiatric facilities unless in the judgment of the division, with approval of the commission, there are sound reasons for departing from the standards.
   2.  When recommending standards under this section, the division shall designate an advisory committee representing boards of directors and professional staff of designated community mental health centers to assist in the formulation or revision of standards. The membership of the advisory committee shall include representatives of professional and nonprofessional staff, at least one representative of county boards of supervisors and central point of coordination administrators, and other appropriate individuals.
   3.  The standards recommended under this section shall include requirements that each community mental health center designated under this chapter do all of the following:
   a.  Maintain and make available to the public a written statement of the services the center offers to residents of the catchment area being served. The center shall employ or contract for services with affiliates to employ staff who are appropriately credentialed or meet other qualifications in order to provide services.
   b.  If organized as a nonprofit corporation, be governed by a board of directors which adequately represents interested professions, consumers of the center’s services, socioeconomic, cultural, and age groups, and various geographical areas in the catchment area served by the center. If organized as a for-profit corporation, the corporation’s policy structure shall incorporate such representation.
   c.  Arrange for the financial condition and transactions of the community mental health center to be audited once each year by the auditor of state. However, in lieu of an audit by state accountants, the local governing body of a community mental health center organized under this chapter may contract with or employ certified public accountants to conduct the audit, pursuant to the applicable terms and conditions prescribed by sections 11.6 and 11.19 and audit format prescribed by the auditor of state. Copies of each audit shall be furnished by the accountant to the administrator of the division of mental health and disability services and the board or boards of supervisors supporting the audited community mental health center.
   d.  Comply with the accreditation standards applicable to the center.
    Sec. 11.  NEW SECTION.  230A.111  Review and evaluation.
   1.  The review and evaluation of designated centers shall be performed through a formal accreditation review process as recommended by the division and approved by the commission. The accreditation process shall include all of the following:
   a.  Specific time intervals for full accreditation reviews based upon levels of accreditation.
   b.  Use of random or complaint-specific, on-site limited accreditation reviews in the interim between full accreditation reviews, as a quality review approach. The results of such reviews shall be presented to the commission.
   c.  Use of center accreditation self-assessment tools to gather data regarding quality of care and outcomes, whether used during full or limited reviews or at other times.
   2.  The accreditation process shall include but is not limited to addressing all of the following:
   a.  Measures to address centers that do not meet standards, including authority to revoke accreditation.
   b.  Measures to address noncompliant centers that do not develop a corrective action plan or fail to implement steps included in a corrective action plan accepted by the division.
   c.  Measures to appropriately recognize centers that successfully complete a corrective action plan.
   d.  Criteria to determine when a center’s accreditation should be denied, revoked, suspended, or made provisional.
    Sec. 12.  IMPLEMENTATION.
   1.  Community mental health centers operating under the provisions of chapter 230A, Code 2009, and associated standards, rules, and other requirements as of June 30, 2010, may continue to operate under such requirements until the department of human services, division of mental health and disability services, and the mental health, mental retardation, developmental disabilities, and brain injury commission have completed the rules adoption process to implement the amendments to chapter 230A enacted by this Act, identified catchment areas, and completed designations of centers.
   2.  The division and the commission shall complete the rules adoption process and other requirements addressed in subsection 1 on or before June 30, 2011.
    Sec. 13.  IMPLEMENTATION OF ACT.  Section 25B.2, subsection 3, shall not apply to this Act.
    Sec. 14.  REPEAL.  Sections 230A.1, 230A.2, 230A.3, 230A.4, 230A.5, 230A.6, 230A.7, 230A.8, 230A.9, 230A.10, 230A.11, 230A.12, 230A.13, 230A.14, 230A.15, 230A.16, 230A.17, and 230A.18, Code 2009, are repealed.

DIVISION II
CONFORMING AMENDMENTS
    Sec. 15.  Section 225C.4, subsection 1, paragraph o, Code 2009, is amended to read as follows:
   o.  Recommend to the commission minimum accreditation standards for the maintenance and operation of community mental health centers, services, and programs designated under section 230A.16 chapter 230A. The administrator’s review and evaluation of the centers, services, and programs for compliance with the adopted standards shall be as provided in section 230A.17 chapter 230A.
    Sec. 16.  Section 225C.6, subsection 1, paragraph c, Code 2009, is amended to read as follows:
   c.  Adopt standards for community mental health centers, services, and programs as recommended under section 230A.16 by the administrator. The commission shall determine whether to grant, deny, or revoke the accreditation of the centers, services, and programs.
    Sec. 17.  Section 225C.7, subsection 3, Code 2009, is amended to read as follows:
   3.  If a county has not established or is not affiliated with a community mental health center under chapter 230A, the county shall expend a portion of the money received under this appropriation to contract with a community mental health center to provide mental health services to the county’s residents. If such a contractual relationship is unworkable or undesirable, the commission may waive the expenditure requirement. However, if the commission waives the requirement, the commission shall address the specific concerns of the county and shall attempt to facilitate the provision of mental health services to the county’s residents through an affiliation agreement or other means.  A county must be affiliated with the community mental health center designated in accordance with chapter 230A in order to receive moneys from the fund.
    Sec. 18.  Section 225C.15, Code 2009, is amended to read as follows:
   225C.15  County implementation of evaluations.

   The board of supervisors of a county shall, no later than July 1, 1982, require that the preadmission diagnostic evaluation policy stated in section 225C.14 be followed with respect to admission of persons from that county to a state mental health institute. A community mental health center which is supported, directly or in affiliation with other counties, by that county designated for the county’s catchment area may perform the preliminary diagnostic evaluations for that county, unless the performance of the evaluations is not covered by the agreement entered into by the county and the center under section 230A.12, and the center’s director certifies to the board of supervisors that the center does not have the capacity to perform the evaluations, in which case the board of supervisors shall proceed with an alternative diagnostic facility as provided under section 225C.17.
    Sec. 19.  Section 225C.54, subsection 1, Code Supplement 2009, is amended to read as follows:
   1.  The mental health services system for children and youth shall be initially implemented by the division commencing with the fiscal year beginning July 1, 2008. The division shall begin implementation by utilizing a competitive bidding process to allocate state block grants to develop services through existing community mental health centers, providers approved in a waiver adopted by the commission to provide services to a county in lieu of a community mental health center, designated in accordance with chapter 230A and other local service partners. The implementation shall be limited to the extent of the appropriations provided for the children’s system.
    Sec. 20.  Section 228.6, subsection 1, Code 2009, is amended to read as follows:
   1.  A mental health professional or an employee of or agent for a mental health facility may disclose mental health information if and to the extent necessary, to meet the requirements of section 229.24, 229.25, 230.20, 230.21, 230.25, 230.26, 230A.13 230A.108, 232.74, or 232.147, or to meet the compulsory reporting or disclosure requirements of other state or federal law relating to the protection of human health and safety.
    Sec. 21.  Section 235A.15, subsection 2, paragraph c, subparagraph (6), Code Supplement 2009, is amended to read as follows:
   (6)  To an administrator of a community mental health center accredited under designated in accordance with chapter 230A if the data concerns a person employed or being considered for employment by the center.
    Sec. 22.  Section 331.321, subsection 1, paragraph e, Code Supplement 2009, is amended by striking the paragraph.
    Sec. 23.  Section 331.382, subsection 1, paragraph f, Code Supplement 2009, is amended by striking the paragraph.
EXPLANATION
   This bill relates to the requirements of community mental health centers under Code chapter 230A. The bill is organized into divisions.
   CODE CHAPTER 230A AMENDMENTS. This division repeals and replaces Code chapter 230A which was originally enacted by 1974 Iowa Acts, chapter 1160.
   The bill maintains the requirements under current law for accreditation of community mental health centers to be performed by the department of human services (DHS), division of mental health and disability services, in accordance with standards adopted by the mental health, mental retardation, developmental disabilities, and brain injury (MH/MR/DD/BI) commission. 2008 Iowa Acts, chapter 1187, required the division to utilize an advisory group to develop a proposal for revising Code chapter 230A and for revising the accreditation process for centers. Until the proposal has been considered and acted upon by the general assembly, the division administrator is authorized to defer consideration of requests for accreditation of a new community mental health center or for approval of a provider to fill the role of a center. The proposal was submitted to the governor and general assembly April 17, 2009. The bill provides for implementation of the proposal.
   The current Code chapter provides for community mental health centers to either be directly established by a county or counties and administered by a board of trustees or by establishment of a nonprofit corporation operating on the basis of an agreement with a county or counties. Code section 225C.7 allows the department of human services to authorize the center services to be provided by an alternative provider.
   The bill replaces this approach by requiring the division and commission to consult with affected counties in identifying catchment areas of counties to be served by a center. The general requirement is for one center to be designated to serve a catchment area but more than one can be designated if exceptional circumstances outlined in the bill are determined to exist.
   New Code section 230A.101 describes the regulatory and policy role to be filled by the department and the service provider role of the community mental health centers.
   New Code section 230A.102 provides definitions. These terms, defined in Code chapter 225C, are adopted by reference: “administrator” (administrator of MH and disability services division), “commission” ((MH/MR/DD/BI) commission), “department” (DHS), “disability services” (services and other support available to a person with mental illness, MR or other DD, or BI), and “division” (MH and disability services division). In addition, the terms “community mental health center” and “catchment area” are defined to reflect the contents of the bill.
   New Code section 230A.103 provides criteria to be implemented by the division for designation of at least one community mental health center to serve a catchment area consisting of a county or counties. Various operating and services requirements are to be addressed in the terms of an agreement between the designated center, the division, and the counties comprising the catchment area.
   New Code section 230A.104 provides for the division to implement objective criteria for identifying catchment areas for centers. A general limitation of one center per catchment area is stated, however, the criteria are to include a formal review process for use in determining whether exceptional circumstances exist for designating more than one center for a catchment area. The other stated criteria involve determinations of financial viability for a center to operate.
   New Code section 230A.105 lists the attributes of the target population required to be served by a center. The list includes individuals of any age experiencing a mental health crisis or disorder, adults who have a serious or chronic mental illness, children and youth experiencing a serious emotional disturbance, and listed individuals who also have a co-occurring disorder. The specific clinical and financial eligibility criteria are required to be identified in rules adopted by the commission.
   New Code section 230A.106 requires each designated center to offer core services and support addressing the basic mental health and safety needs of the target population and other residents of the catchment area. The core services are to be identified in rules adopted by the commission. The core services may be offered by the center directly, by coordination through another provider agency, or by contracting or affiliating with another provider. In addition, a center is responsible for coordinating associated services provided by other unaffiliated agencies to members of the target population and for integrating services provided to the target population in residential or inpatient settings.
   New Code section 230A.107 authorizes a designated center to be organized as either a nonprofit or for-profit corporation and includes specific criteria applicable to for-profit corporations.
   New Code section 230A.108 requires release of administrative, diagnostic, and demographic information as a condition of support by any of the counties in the catchment area served by a center. Language with a similar requirement is part of current law in Code section 230A.13, relating to annual budgets of centers.
   New Code section 230A.109 states legislative intent regarding continuation of the current combination of federal, state, and county funding supporting centers and for the amount of funding to be sufficient for core services to be provided regardless of an individual’s ability to pay for the services.
   New Code section 230A.110 provides for accreditation standards for centers to be recommended by the division and adopted by the commission. The standards are to be in substantial conformity with certain national standards. The division is directed to use an advisory committee to assist in standards development. In addition, the standards recommended are required to include various organizational requirements.
   New Code section 230A.111 addresses how the review and evaluation components of the accreditation process are to be performed.
   An implementation section authorizes centers operating under current law as of June 30, 2009, to continue operating until the rules are adopted, catchment areas are identified, and centers are designated, as required by the bill. The division and commission are required to complete those requirements on or before June 30, 2011.
   The bill may include a state mandate as defined in Code section 25B.3. The bill makes inapplicable Code section 25B.2, subsection 3, which would relieve a political subdivision from complying with a state mandate if funding for the cost of the state mandate is not provided or specified. Therefore, political subdivisions are required to comply with any state mandate included in the bill.
   CONFORMING AMENDMENTS. This division amends internal references and provides other conforming amendments in the following Code provisions: Code section 225C.4, relating to the duties of the MH and disability services administrator; Code section 225C.6, relating to the duties of the commission, Code section 225C.7, relating to the requirements for the MH/DD community services fund; Code section 225C.15, relating to county implementation of evaluations relating to admissions of persons from the counties to a state mental health institute; Code section 225C.54, relating to implementation of a mental health services system for children and youth; Code section 228.6, relating to disclosure of confidential mental health information; Code section 331.321, by striking the requirement for county appointments to an initial community mental health center board of trustees; and Code section 331.382, by striking the authority of a county board of supervisors to establish a community mental health center.