H.F. 2421 Section 1. Section 80B.11, subsection 1, paragraph c, Code 1 2011, is amended by adding the following new subparagraph: 2 NEW SUBPARAGRAPH . (3) In-service training under this 3 paragraph “c” shall include the requirement that all law 4 enforcement officers complete a course on mental health at 5 least once every four years. In developing the requirements 6 for this training, the director shall seek input from mental 7 health care providers and mental health care consumers. 8 Sec. 2. Section 125.91, subsection 1, Code Supplement 2011, 9 is amended to read as follows: 10 1. The procedure prescribed by this section shall only be 11 used for an intoxicated person who has threatened, attempted, 12 or inflicted physical self-harm or harm on another, and is 13 likely to inflict physical self-harm or harm on another unless 14 immediately detained, or who is incapacitated by a chemical 15 substance, if that person cannot be taken into immediate 16 custody under sections 125.75 and 125.81 because immediate 17 access to the court is not possible an application has not been 18 filed naming the person as the respondent pursuant to section 19 125.75 and the person cannot be ordered into immediate custody 20 and detained pursuant to section 125.81 . 21 Sec. 3. Section 135C.4, Code 2011, is amended to read as 22 follows: 23 135C.4 Residential care facilities. 24 1. Each facility licensed as a residential care facility 25 shall provide an organized continuous twenty-four-hour program 26 of care commensurate with the needs of the residents of the 27 home and under the immediate direction of a person approved 28 and certified by the department whose combined training 29 and supervised experience is such as to ensure adequate and 30 competent care. 31 2. All admissions to residential care facilities shall be 32 based on an order written by a physician certifying that the 33 individual being admitted does not require nursing services or 34 that the individual’s need for nursing services can be avoided 35 -1- LSB 5422HV (3) 84 rh/rj 1/ 11

H.F. 2421 if home and community-based services, other than nursing care, 1 as defined by this chapter and departmental rule, are provided. 2 3. For the purposes of this section , the home and 3 community-based services to be provided shall be limited to the 4 type included under the medical assistance program provided 5 pursuant to chapter 249A , shall be subject to cost limitations 6 established by the department of human services under the 7 medical assistance program, and except as otherwise provided by 8 the department of inspections and appeals with the concurrence 9 of the department of human services, shall be limited in 10 capacity to the number of licensed residential care facilities 11 and the number of licensed residential care facility beds in 12 the state as of December 1, 2003. 13 4. A residential care facility is not required to admit 14 an individual through court order, referral, or other means 15 without the express prior approval of the administrator of the 16 residential care facility. 17 Sec. 4. Section 228.1, subsection 6, Code 2011, is amended 18 by striking the subsection and inserting in lieu thereof the 19 following: 20 6. “Mental health professional” means an individual who has 21 either of the following qualifications: 22 a. The individual meets all of the following requirements: 23 (1) The individual holds at least a master’s degree in a 24 mental health field, including but not limited to psychology, 25 counseling and guidance, nursing, and social work, or is an 26 advanced registered nurse practitioner, a physician assistant, 27 or a physician and surgeon or an osteopathic physician and 28 surgeon. 29 (2) The individual holds a current Iowa license if 30 practicing in a field covered by an Iowa licensure law. 31 (3) The individual has at least two years of post-degree 32 clinical experience, supervised by another mental health 33 professional, in assessing mental health needs and problems and 34 in providing appropriate mental health services. 35 -2- LSB 5422HV (3) 84 rh/rj 2/ 11

H.F. 2421 b. The individual holds a current Iowa license if 1 practicing in a field covered by an Iowa licensure law and is 2 a psychiatrist, an advanced registered nurse practitioner who 3 holds a national certification in psychiatric mental health 4 care registered by the board of nursing, a physician assistant 5 practicing under the supervision of a psychiatrist, or an 6 individual who holds a doctorate degree in psychology and is 7 licensed by the board of psychology. 8 Sec. 5. Section 229.1, Code Supplement 2011, is amended by 9 adding the following new subsection: 10 NEW SUBSECTION . 8A. “Mental health professional” means the 11 same as defined in section 228.1. 12 Sec. 6. Section 229.1, subsection 14, Code Supplement 2011, 13 is amended by striking the subsection. 14 Sec. 7. Section 229.1, subsection 16, Code Supplement 2011, 15 is amended to read as follows: 16 16. “Serious emotional injury” is an injury which does not 17 necessarily exhibit any physical characteristics, but which can 18 be recognized and diagnosed by a licensed physician or other 19 qualified mental health professional and which can be causally 20 connected with the act or omission of a person who is, or is 21 alleged to be, mentally ill. 22 Sec. 8. NEW SECTION . 229.5A Preapplication screening 23 assessment —— program. 24 Prior to filing an application for involuntary 25 hospitalization pursuant to section 229.6, the clerk of 26 the district court or the clerk’s designee shall inform 27 the interested person referred to in section 229.6, 28 subsection 1, about the option of requesting a preapplication 29 screening assessment through a preapplication screening 30 assessment program. The state court administrator shall 31 prescribe practices and procedures for implementation of the 32 preapplication screening assessment program. 33 Sec. 9. Section 229.6, Code 2011, is amended to read as 34 follows: 35 -3- LSB 5422HV (3) 84 rh/rj 3/ 11

H.F. 2421 229.6 Application for order of involuntary hospitalization. 1 1. Proceedings for the involuntary hospitalization of an 2 individual may be commenced by any interested person by filing 3 a verified application with the clerk of the district court of 4 the county where the respondent is presently located, or which 5 is the respondent’s place of residence. The clerk, or the 6 clerk’s designee, shall assist the applicant in completing the 7 application. The application shall: 8 1. a. State the applicant’s belief that the respondent is 9 seriously mentally impaired. 10 2. b. State any other pertinent facts. 11 3. c. Be accompanied by any of the following : 12 a. (1) A written statement of a licensed physician in 13 support of the application ; or . 14 b. (2) One or more supporting affidavits otherwise 15 corroborating the application ; or . 16 c. (3) Corroborative information obtained and reduced to 17 writing by the clerk or the clerk’s designee, but only when 18 circumstances make it infeasible to comply with, or when the 19 clerk considers it appropriate to supplement the information 20 supplied pursuant to, either paragraph “a” or paragraph “b” of 21 this subsection subparagraph (1) or (2) . 22 2. Prior to the filing of an application pursuant to this 23 section, the clerk or the clerk’s designee shall inform the 24 interested person referred to in subsection 1 about the option 25 of requesting a preapplication screening assessment pursuant 26 to section 229.5A. 27 Sec. 10. Section 229.10, subsection 1, paragraph b, Code 28 2011, is amended to read as follows: 29 b. Any licensed physician conducting an examination pursuant 30 to this section may consult with or request the participation 31 in the examination of any qualified mental health professional, 32 and may include with or attach to the written report of the 33 examination any findings or observations by any qualified 34 mental health professional who has been so consulted or has so 35 -4- LSB 5422HV (3) 84 rh/rj 4/ 11

H.F. 2421 participated in the examination. 1 Sec. 11. Section 229.12, subsection 3, paragraph b, Code 2 2011, is amended to read as follows: 3 b. The licensed physician or qualified mental health 4 professional who examined the respondent shall be present at 5 the hearing unless the court for good cause finds that the 6 licensed physician’s or qualified mental health professional’s 7 presence or testimony is not necessary. The applicant, 8 respondent, and the respondent’s attorney may waive the 9 presence or the telephonic appearance of the licensed physician 10 or qualified mental health professional who examined the 11 respondent and agree to submit as evidence the written 12 report of the licensed physician or qualified mental health 13 professional. The respondent’s attorney shall inform the 14 court if the respondent’s attorney reasonably believes that 15 the respondent, due to diminished capacity, cannot make an 16 adequately considered waiver decision. “Good cause” for finding 17 that the testimony of the licensed physician or qualified 18 mental health professional who examined the respondent is not 19 necessary may include but is not limited to such a waiver. 20 If the court determines that the testimony of the licensed 21 physician or qualified mental health professional is necessary, 22 the court may allow the licensed physician or the qualified 23 mental health professional to testify by telephone. 24 Sec. 12. Section 229.19, subsection 1, paragraph d, Code 25 2011, is amended by adding the following new subparagraph: 26 NEW SUBPARAGRAPH . (7) To utilize the related best practices 27 for the duties identified in this paragraph “d” developed and 28 promulgated by the judicial council. 29 Sec. 13. Section 229.19, subsection 1, Code 2011, is amended 30 by adding the following new paragraph: 31 NEW PARAGRAPH . e. An advocate may also be appointed 32 pursuant to this section for an individual who has 33 been diagnosed with a co-occurring mental illness and 34 substance-related disorder. 35 -5- LSB 5422HV (3) 84 rh/rj 5/ 11

H.F. 2421 Sec. 14. Section 229.22, subsection 1, Code Supplement 1 2011, is amended to read as follows: 2 1. The procedure prescribed by this section shall not be 3 used unless when it appears that a person should be immediately 4 detained due to serious mental impairment, but that person 5 cannot be immediately detained by the procedure prescribed 6 in sections 229.6 and 229.11 because there is no means of 7 immediate access to the district court an application has not 8 been filed naming the person as the respondent pursuant to 9 section 229.6, and the person cannot be ordered into immediate 10 custody and detained pursuant to section 229.11 . 11 Sec. 15. Section 602.1209, Code 2011, is amended by adding 12 the following new subsection: 13 NEW SUBSECTION . 15A. Prescribe practices and procedures 14 for the implementation of the preapplication screening 15 assessment program referred to in section 229.5A. 16 Sec. 16. CONTINUATION OF WORKGROUP BY JUDICIAL BRANCH AND 17 DEPARTMENT OF HUMAN SERVICES —— CONSOLIDATION OF SERVICES —— 18 PATIENT ADVOCATE. The judicial branch and department of human 19 services shall continue the workgroup implemented pursuant to 20 2010 Iowa Acts, chapter 1192, section 24, subsection 2, and 21 extended pursuant to 2011 Iowa Acts, chapter 121, section 2, to 22 study and make recommendations relating to the consolidation 23 of the processes for involuntary commitment for persons with 24 substance-related disorders under chapter 125, for intellectual 25 disability under chapter 222, and for serious mental 26 illness under chapter 229. The workgroup shall also include 27 representatives from the department of public health. The 28 workgroup shall also study and make recommendations concerning 29 the feasibility of establishing an independent statewide 30 patient advocate program for qualified persons representing 31 the interests of patients suffering from mental illness, 32 intellectual disability, or a substance-related disorder and 33 involuntarily committed by the court, in any matter relating 34 to the patients’ hospitalization or treatment under chapters 35 -6- LSB 5422HV (3) 84 rh/rj 6/ 11

H.F. 2421 125, 222, and 229. The workgroup shall also consider the 1 implementation of consistent reimbursement standards for 2 patient advocates supported by a state-funded system and 3 shall also consider the role of the advocate for a person 4 who has been diagnosed with a co-occurring mental illness 5 and substance-related disorder. The workgroup shall solicit 6 input from current mental health advocates and mental health 7 and substance-related disorder care providers and individuals 8 receiving services whose interests would be represented by 9 an independent statewide advocate program and shall submit a 10 report on the study and make recommendations to the governor 11 and the general assembly by December 1, 2012. 12 Sec. 17. COMPREHENSIVE JAIL DIVERSION PROGRAM —— MENTAL 13 HEALTH COURTS —— STUDY. The division of criminal and juvenile 14 justice planning of the department of human rights shall 15 conduct a study regarding the possible establishment of a 16 comprehensive statewide jail diversion program, including the 17 establishment of mental health courts, for nonviolent criminal 18 offenders who suffer from mental illness. The division 19 shall solicit input from the department of human services, 20 the department of corrections, and other members of the 21 criminal justice system including but not limited to judges, 22 prosecutors, and defense counsel, and mental health treatment 23 providers and consumers. The division shall establish the 24 duties, scope, and membership of the study commission and shall 25 also consider the feasibility of establishing a demonstration 26 mental health court. The division shall submit a report on the 27 study and make recommendations to the governor and the general 28 assembly by December 1, 2012. 29 Sec. 18. PRIOR LAW ENFORCEMENT MENTAL HEALTH TRAINING. A 30 law enforcement officer who has completed academy-approved 31 mental health training within the twelve-month period prior to 32 the effective date of this Act, either through in-service or 33 academy-approved basic training, shall be considered to have 34 met the first four-year mental health training requirement of 35 -7- LSB 5422HV (3) 84 rh/rj 7/ 11

H.F. 2421 section 80B.11, subsection 1, paragraph “c”, subparagraph (3), 1 as enacted in this Act. 2 EXPLANATION 3 This bill relates to persons with mental health illnesses 4 and substance-related disorders. 5 MENTAL HEALTH TRAINING —— LAW ENFORCEMENT. The bill 6 requires all law enforcement officers to complete a course 7 on mental health at least once every four years and requires 8 the director of the law enforcement academy, subject to 9 the approval of the Iowa law enforcement council, to adopt 10 rules relating to mental health training for law enforcement 11 officers, with input from mental health care providers and 12 mental health care consumers. A law enforcement officer who 13 has completed academy-approved mental health training within 14 the 12-month period prior to the effective date of the bill 15 will be considered to have met the first four-year mental 16 health training requirement prescribed in the bill. 17 RESIDENTIAL CARE FACILITIES —— ADMITTANCE. The bill 18 provides that a residential care facility is not required to 19 admit an individual through court order, referral, or other 20 means without the express prior approval of the administrator 21 director of the residential care facility. 22 EMERGENCY DETENTION AND HOSPITALIZATION —— PERSONS WITH 23 SUBSTANCE-RELATED DISORDERS AND MENTAL HEALTH ILLNESSES. 24 The bill amends Code sections 125.91 and 229.22 relating to 25 after-hours access to emergency detention and hospitalization 26 procedures for an intoxicated person who has threatened, 27 attempted, or inflicted physical self-harm or harm on another, 28 and is likely to inflict physical self-harm or harm on another 29 unless immediately detained, or who is incapacitated by a 30 chemical substance, or for a seriously mentally impaired 31 person. Current law provides for the immediate custody of such 32 persons in an emergency situation only after an application 33 for involuntary commitment or hospitalization has been filed, 34 which is an option only during regular court hours. The bill 35 -8- LSB 5422HV (3) 84 rh/rj 8/ 11

H.F. 2421 amends the current emergency detention and hospitalization 1 procedures available for such persons to apply only when there 2 is no immediate access to the district court to allow access to 3 emergency detention and treatment services, at all times, even 4 if an application for involuntary commitment or hospitalization 5 has not been filed. 6 QUALIFIED MENTAL HEALTH PROFESSIONAL. The bill amends 7 the definition of “mental health professional” in Code 8 chapter 228 (relating to the disclosure of mental health and 9 psychological information). The bill eliminates the definition 10 of “qualified mental health professional” in Code chapter 229 11 (hospitalization of persons with mental illness) and adopts the 12 new definition of “mental health professional” in the bill for 13 purposes of Code chapter 229. 14 PREAPPLICATION SCREENING ASSESSMENT. The bill provides that 15 prior to filing an application for involuntary hospitalization 16 pursuant to Code section 229.6, the clerk of the district court 17 or the clerk’s designee is required to inform the interested 18 person referred to in Code section 229.6, subsection 1, 19 about the option of requesting a preapplication screening 20 assessment through a preapplication screening assessment 21 program. The bill requires the state court administrator to 22 prescribe practices and procedures for implementation of the 23 preapplication screening assessment program. 24 A conforming change is made to Code section 229.6 requiring 25 the district court clerk or the clerk’s designee to inform 26 the interested person about the option of requesting a 27 preapplication screening assessment of the proposed respondent 28 prior to the filing of an application for involuntary 29 commitment. A conforming change is also made to Code 30 section 602.1209 relating to the duties of the state court 31 administrator. 32 MENTAL HEALTH ADVOCATE. The bill provides that a mental 33 health advocate shall utilize the related best practices for 34 the mental health advocate’s duties identified in Code section 35 -9- LSB 5422HV (3) 84 rh/rj 9/ 11

H.F. 2421 229.19 developed and promulgated by the judicial council. 1 The bill allows a mental health advocate to be appointed by 2 the appropriate appointing authority for an individual who 3 has been diagnosed with a co-occurring mental illness and 4 substance-related disorder. 5 CONTINUATION OF WORKGROUP BY JUDICIAL BRANCH AND 6 DEPARTMENT OF HUMAN SERVICES —— CONSOLIDATION OF SERVICES 7 —— PATIENT ADVOCATE. The bill requires the judicial branch 8 and department of human services to continue the workgroup 9 implemented pursuant to 2010 Iowa Acts, chapter 1192, section 10 24, subsection 2, and extended pursuant to 2011 Iowa Acts, 11 chapter 121, section 2, to study and make recommendations 12 relating to the consolidation of the processes for involuntary 13 commitment for persons with substance-related disorders under 14 Code chapter 125, for intellectual disability under Code 15 chapter 222, and for serious mental illness under Code chapter 16 229. The workgroup shall also include representatives from 17 the department of public health. The workgroup shall also 18 study and make recommendations concerning the feasibility of 19 establishing an independent statewide patient advocate program 20 for qualified persons representing the interests of patients 21 suffering from mental illness, intellectual disability, or a 22 substance-related disorder and involuntarily committed by the 23 court. The workgroup shall also consider the implementation of 24 consistent reimbursement standards for patient advocates and 25 the role of the advocate for a person who has been diagnosed 26 with a co-occurring mental illness and substance-related 27 disorder. The workgroup shall submit a report on the study and 28 make recommendations to the governor and the general assembly 29 by December 1, 2012. 30 COMPREHENSIVE JAIL DIVERSION PROGRAM —— MENTAL HEALTH 31 COURTS —— STUDY. The bill directs the division of criminal and 32 juvenile justice planning of the department of human rights 33 to conduct a study regarding the possible establishment of a 34 comprehensive statewide jail diversion program, including the 35 -10- LSB 5422HV (3) 84 rh/rj 10/ 11

H.F. 2421 establishment of mental health courts, for nonviolent criminal 1 offenders who suffer from mental illness. The division 2 shall solicit input from the department of human services, 3 the department of corrections, and other members of the 4 criminal justice system including but not limited to judges, 5 prosecutors, and defense counsel, and mental health treatment 6 providers and consumers. The division shall establish the 7 duties, scope, and membership of the study commission and shall 8 also consider the feasibility of establishing a demonstration 9 mental health court. The division shall submit a report on the 10 study and make recommendations to the governor and the general 11 assembly by December 1, 2012. 12 -11- LSB 5422HV (3) 84 rh/rj 11/ 11