House File 2431 - Introduced HOUSE FILE 2431 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HSB 646) A BILL FOR An Act relating to redesign of publicly funded mental 1 health and disability services by requiring certain core 2 services and addressing other services and providing 3 for establishment of regions, making appropriations, and 4 including effective date and applicability provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 6075HV (2) 84 jp/rj
H.F. 2431 DIVISION I 1 CORE SERVICES 2 Section 1. Section 331.439, Code Supplement 2011, is 3 amended by adding the following new subsection: 4 NEW SUBSECTION . 9A. a. Beginning July 1, 2012, the county 5 management plan for mental health services shall provide that 6 an individual’s eligibility for individualized services shall 7 be determined by the level of care utilization system for 8 psychiatric and addiction services, developed by the American 9 association of community psychiatrists, or other standardized 10 functional assessment methodology approved for this purpose by 11 the state commission. 12 b. Beginning July 1, 2012, the county management plan 13 for intellectual disability services shall provide that an 14 individual’s eligibility for individualized services shall 15 be determined by the supports intensity scale, developed by 16 the American association on intellectual and developmental 17 disabilities, or other standardized functional assessment 18 methodology approved for this purpose by the state commission. 19 c. Beginning July 1, 2012, the county management plan 20 for brain injury services shall provide that an individual’s 21 eligibility for individualized services shall be determined 22 in accordance with a standardized functional assessment 23 methodology approved for this purpose by the state commission. 24 Sec. 2. NEW SECTION . 331.439A Regional service system 25 management plan. 26 1. The mental health and disability services provided 27 by counties operating as a region shall be delivered in 28 accordance with a regional service system management plan 29 approved by the region’s governing board and implemented by 30 the regional administrator in accordance with this section. 31 The requirements for a regional service system management plan 32 shall be specified in rule adopted by the state commission. 33 A regional service system management plan is subject to 34 the approval of the regional governing board and the state 35 -1- LSB 6075HV (2) 84 jp/rj 1/ 98
H.F. 2431 commission. 1 2. The provisions of a regional service system management 2 plan shall include but are not limited to all of the following: 3 a. An approved policies and procedures manual for the use of 4 county, state, and other funding administered by the region. A 5 service system management plan for each county in the region 6 shall be defined in the manual. Once the regional manual 7 is approved, an amendment to the manual shall be submitted 8 to the department of human services at least forty-five 9 days prior to the date of implementation of the amendment. 10 Prior to implementation of an amendment to the manual, the 11 amendment must be approved by the director of human services in 12 consultation with the state commission. 13 b. For informational purposes, a regional service system 14 management plan review submitted by the regional administrator 15 to the department of human services by December 1 of each year. 16 The annual review shall incorporate an analysis of the data 17 associated with the regional service systems managed during 18 the preceding fiscal year by the region. The annual review 19 shall also identify measurable outcomes and results showing the 20 region’s progress in fulfilling the purposes listed in section 21 225C.1 and in achieving the disability services outcomes and 22 indicators identified by the state commission pursuant to 23 section 225C.6. 24 c. For informational purposes, a three-year strategic plan 25 submitted every three years by the regional administrator to 26 the department of human services. The strategic plan shall 27 describe how the region will proceed to attain the plan’s 28 goals and objectives, and the measurable outcomes and results 29 necessary for moving the regional services system toward an 30 individualized, community-based focus in accordance with 31 section 225C.1. The initial three-year strategic plan shall be 32 submitted by April 1, 2015, and by April 1 of every third year 33 thereafter. 34 d. The regional administrator’s plans to implement the 35 -2- LSB 6075HV (2) 84 jp/rj 2/ 98
H.F. 2431 regional service system management plan and other service 1 management functions in a manner that seeks to achieve all of 2 the following purposes identified in section 225C.1 for persons 3 who are covered by the regional plan or are otherwise subject 4 to the regional service system’s management functions. The 5 regional plan shall describe how the regional service system 6 will accomplish all of the following purposes: 7 (1) The regional service system seeks to empower persons 8 to exercise their own choices about the amounts and types of 9 services and other support to receive. 10 (2) The regional service system seeks to empower the persons 11 to accept responsibility, exercise choices, and take risks. 12 (3) The regional service system seeks to provide services 13 and other support that are individualized, provided to produce 14 results, flexible, and cost-effective. 15 (4) The regional service system seeks to provide services 16 and other support in a manner which enhances the ability of the 17 persons to live, learn, work, and recreate in communities of 18 their choice. 19 e. Measures to address the needs of individuals who have two 20 or more co-occurring mental health, intellectual disability, 21 brain injury, or substance-related disorders and individuals 22 with specialized needs. 23 3. The region may either directly implement a system 24 of service management and contract with service providers, 25 or contract with a private entity to manage the regional 26 service system, provided all requirements of this section 27 are met by the private entity. The regional service system 28 shall incorporate service management and clinical assessment 29 processes developed in accordance with applicable requirements. 30 4. The regional service system management plan for a region 31 shall include but is not limited to all of the following 32 elements, which shall be specified in administrative rules 33 adopted by the state commission: 34 a. The enrollment and eligibility process. 35 -3- LSB 6075HV (2) 84 jp/rj 3/ 98
H.F. 2431 b. The scope of services included in addition to the core 1 services required by this part of this chapter. 2 c. The method of plan administration. 3 d. The process for managing utilization and access to 4 services and other assistance. 5 e. The quality management and improvement processes. 6 f. The risk management provisions and fiscal viability of 7 the plan, if the region contracts with a private entity. 8 g. The access points for services. 9 h. The requirements for designation of targeted case 10 management providers which shall be designed to provide 11 consumer choice, prohibit a provider from referring consumers 12 to services administered by the provider, and include other 13 provisions to ensure compliance with federal requirements for 14 conflict-free case management. 15 i. A plan for a systems of care approach in which multiple 16 public and private agencies partner with families and 17 communities to address the multiple needs of the individuals 18 and their families involved with the regional service system. 19 j. A plan to assure effective crisis prevention, response, 20 and resolution. 21 k. A plan for provider network formation and management. 22 l. A plan for provider reimbursement approaches that 23 includes approaches other than fee-for-service and to 24 compensate the providers engaged in a systems of care approach 25 and other nontraditional providers. 26 m. If the region applies any provider licensing, 27 certification, or accreditation requirements in addition to 28 those required by the state, the procedures for implementing 29 the requirements. 30 n. Service provider payment provisions. 31 o. Financial forecasting measures. 32 p. A process for resolving grievances. 33 q. Measures for implementing interagency and multisystem 34 collaboration and care coordination. 35 -4- LSB 6075HV (2) 84 jp/rj 4/ 98
H.F. 2431 5. A region may provide assistance to service populations 1 with disabilities to which the counties comprising the region 2 have historically provided assistance but who are not included 3 in the service management provisions required under subsection 4 2, subject to the availability of funding. 5 6. If a region determines that the region cannot provide 6 services for the fiscal year in accordance with the regional 7 plan and remain in compliance with applicable budgeting 8 requirements, the region may implement a waiting list for 9 the services. The procedures for establishing and applying 10 a waiting list shall be specified in the regional plan. If 11 a region implements a waiting list for services, the region 12 shall notify the department of human services. The department 13 shall maintain on the department’s internet site an up-to-date 14 listing of the regions that have implemented a waiting list and 15 the services affected by each waiting list. 16 7. The director’s approval of a regional plan shall not be 17 construed to constitute certification of the respective county 18 budgets or of the region’s budget. 19 Sec. 3. NEW SECTION . 331.439B Financial eligibility 20 requirements. 21 A person must comply with all of the following financial 22 eligibility requirements to be eligible for services under the 23 regional service system: 24 1. The person must have an income equal to or less than 25 one hundred fifty percent of the federal poverty level, as 26 defined by the most recently revised poverty income guidelines 27 published by the United States department of health and 28 human services, to be eligible for disability services 29 public funding. It is the intent of the general assembly to 30 consider increasing this income eligibility provision to two 31 hundred percent of the federal poverty level, contingent upon 32 implementation of the federal Patient Protection and Affordable 33 Care Act beginning in January 2014. 34 2. a. A region or a service provider contracting with 35 -5- LSB 6075HV (2) 84 jp/rj 5/ 98
H.F. 2431 the region may apply a copayment requirement for a particular 1 service to a person with an income equal to or less than one 2 hundred fifty percent of the federal poverty level, provided 3 the disability service, uniform copayment standards, and the 4 copayment amounts comply with rules adopted by the state 5 commission. 6 b. A person with an income above one hundred fifty percent 7 of the federal poverty level may be eligible subject to a 8 copayment or other cost-sharing arrangement, in accordance with 9 limitations adopted in rule by the state commission. 10 c. A provider under the regional service system of a service 11 that is not funded by the medical assistance program under 12 chapter 249A may waive the copayment or other cost-sharing 13 arrangement if the provider is fully able to absorb the cost. 14 3. A person who is eligible for federally funded services 15 and other support must apply for such services and support. 16 4. The person is in compliance with resource limitations 17 identified in rule adopted by the state commission. The 18 limitation shall be derived from the federal supplemental 19 security income program resource limitations. A person with 20 resources above the federal supplemental security income 21 program resource limitations may be eligible subject to 22 limitations adopted in rule by the state commission. If a 23 person does not qualify for federally funded services and other 24 support but meets income, resource, and functional eligibility 25 requirements for regional services, the following types of 26 resources shall be disregarded: 27 a. A retirement account that is in the accumulation stage. 28 b. A burial, medical savings, or assistive technology 29 account. 30 Sec. 4. NEW SECTION . 331.439C Diagnosis —— functional 31 assessment. 32 1. A person must comply with all of the following 33 requirements to be eligible for mental health services under 34 the regional service system: 35 -6- LSB 6075HV (2) 84 jp/rj 6/ 98
H.F. 2431 a. The person complies with financial eligibility 1 requirements under section 331.439B. 2 b. The person is at least eighteen years of age and is a 3 resident of this state. 4 c. The person has had at any time during the preceding 5 twelve-month period a diagnosable mental health, behavioral, or 6 emotional disorder. The diagnosis shall be made in accordance 7 with the criteria provided in the diagnostic and statistical 8 manual of mental disorders, fourth edition text revised, 9 published by the American psychiatric association, and shall 10 not include the manual’s “V” codes identifying conditions other 11 than a disease or injury. The diagnosis shall also not include 12 substance-related disorders, dementia, antisocial personality, 13 or developmental disabilities, unless co-occurring with another 14 diagnosable mental illness. 15 d. The person’s eligibility for individualized services 16 shall be determined by the level of care utilization system for 17 psychiatric and addiction services, developed by the American 18 association of community psychiatrists, or other standardized 19 functional assessment methodology approved for this purpose by 20 the state commission. 21 2. A person must comply with all of the following 22 requirements to be eligible for intellectual disability or 23 other developmental disability services under the regional 24 service system: 25 a. The person complies with financial eligibility 26 requirements under section 331.439B. 27 b. The person is at least eighteen years of age and is a 28 resident of this state. 29 c. The person has a diagnosis of intellectual disability or 30 an intelligence quotient of seventy or less or has a diagnosis 31 of developmental disability other than intellectual disability. 32 d. The person’s eligibility for individualized services 33 shall be determined by the supports intensity scale, developed 34 by the American association on intellectual and developmental 35 -7- LSB 6075HV (2) 84 jp/rj 7/ 98
H.F. 2431 disabilities, or other standardized functional assessment 1 methodology approved for this purpose by the state commission. 2 3. A person must comply with all of the following 3 requirements to be eligible for brain injury services under the 4 regional service system: 5 a. The person complies with financial eligibility 6 requirements under section 331.439B. 7 b. The person is at least eighteen years of age and is a 8 resident of this state. 9 c. The person has a diagnosis of brain injury. 10 d. The person’s eligibility for individualized services 11 shall be determined in accordance with a standardized 12 functional assessment methodology approved for this purpose by 13 the state commission. 14 Sec. 5. NEW SECTION . 331.439D Mental health core services. 15 1. For the purposes of this section, unless the context 16 otherwise requires: 17 a. “Crisis stabilization facility” means an institution, 18 place, building, or agency with restricted means of egress 19 designed to provide accommodation, board, and the services 20 of a mental health professional on a short-term basis of no 21 more than five days to three or more individuals who present 22 in the facility with acute psychiatric needs. The goal of a 23 crisis stabilization facility is to decrease the severity of an 24 individual’s condition to allow transition of the individual 25 to a less restrictive facility. 26 b. “Domain” means a range of services that can be provided 27 depending upon an individual’s service needs. 28 2. Each of the providers of the core services and services 29 provided under a required service domain shall be capable of 30 working with individuals who have co-occurring disabilities or 31 specialized needs. It is the intent of the general assembly 32 that services have adequate reimbursement to ensure the 33 financial viability necessary to achieve desired outcomes and 34 fidelity to accepted service models. 35 -8- LSB 6075HV (2) 84 jp/rj 8/ 98
H.F. 2431 3. A regional service system shall provide the following 1 core mental health service domains, subject to the availability 2 of funding: 3 a. Acute care and crisis intervention services. 4 b. Mental health treatment. 5 c. Mental health disorder prevention. 6 d. Community living. 7 e. Employment. 8 f. Recovery supports. 9 g. Family supports. 10 h. Physical health and primary care services. 11 i. Justice system-involved services. 12 4. A regional service system shall provide the following 13 specific core mental health services, subject to the 14 availability of funding: 15 a. Peer-run self-help centers. 16 b. Psychiatric emergency services to provide a range of 17 crisis intervention and diversion services. The services shall 18 include but are not limited to providing a crisis stabilization 19 facility. 20 c. Subacute residential services. 21 d. Jail diversion. 22 e. Assertive community treatment. 23 f. Community support services, supportive community living, 24 and case management. 25 g. Health homes. 26 h. Supported employment and education. 27 i. Family support services. 28 j. Transportation. 29 5. A regional service system may provide funding for other 30 appropriate services or other support. In considering whether 31 to provide such funding, a region may consider the following 32 criteria: 33 a. Applying a person-centered planning process to identify 34 the need for the services or other support. 35 -9- LSB 6075HV (2) 84 jp/rj 9/ 98
H.F. 2431 b. The efficacy of the services or other support is 1 substantiated by an evidence base. 2 c. A determination that the services or other support 3 provides an effective alternative to existing services that 4 have been shown by the evidence base to be ineffective, to not 5 yield the desired outcome, or to not support the principles 6 outlined in Olmstead v. L.C., 527 U.S. 581 (1999). 7 Sec. 6. NEW SECTION . 331.439E Intellectual disability and 8 other developmental disability core services. 9 1. A regional service system shall provide funding of 10 intellectual disability services that are not funded by the 11 medical assistance program. In addition, to the extent funding 12 is available, a regional service system shall also provide 13 funding of developmental disability services for persons with a 14 developmental disability other than an intellectual disability. 15 In selecting the services eligible for the funding, a region 16 shall consider the following criteria: 17 a. Applying a person-centered planning process to identify 18 the need for the services or other support. 19 b. The efficacy of the services or other support is 20 substantiated by an evidence base. 21 c. A determination that the services or other support 22 provides an effective alternative to existing services that 23 have been shown by the evidence base to be ineffective, to not 24 yield the desired outcome, or to not support the principles 25 outlined in Olmstead v. L.C., 527 U.S. 581 (1999). 26 2. The core services provided by a region shall include all 27 of the services for adults with an intellectual disability or a 28 developmental disability that were mandated by law and covered 29 in the service management plans of the counties comprising the 30 region under section 331.439, Code 2011, as of June 30, 2012, 31 other than those services funded by the medical assistance 32 program under chapter 249A. The provision of the core services 33 is subject to availability of funding. The core services shall 34 include all of the following, unless covered by the medical 35 -10- LSB 6075HV (2) 84 jp/rj 10/ 98
H.F. 2431 assistance program: 1 a. Case management. 2 b. Homemaker-home health aide services. 3 c. Respite care. 4 d. Home and vehicle modification. 5 e. Supported community living. 6 f. Outpatient mental health services. 7 g. Evaluation. 8 h. Sheltered workshop services. 9 i. Work activity services. 10 j. Adult day care. 11 k. Residential care facility services. 12 l. Residential care facility for persons with an 13 intellectual disability services. 14 m. Intermediate care facility for persons with an 15 intellectual disability services. 16 n. Supported community living. 17 o. Inpatient care at a state mental health institute. 18 p. Inpatient care at a state resource center. 19 q. Inpatient care at a community hospital. 20 r. Diagnostic evaluation related to a civil commitment 21 proceeding. 22 s. Transportation related to a civil commitment. 23 t. Legal representation for commitment. 24 u. Mental health advocate. 25 3. A region shall transition from and replace the services 26 under subsection 2 with services that expand and support 27 the community support and integration principles outlined 28 in Olmstead v. L.C., 527 U.S. 581 (1999) and the purposes 29 identified in section 225C.1. 30 4. The core services for persons with an intellectual 31 disability or a developmental disability shall include all of 32 the following: 33 a. Efforts to support the availability of best practice 34 health and primary care services in local communities. 35 -11- LSB 6075HV (2) 84 jp/rj 11/ 98
H.F. 2431 b. Efforts to provide best practice family support services 1 to help families to maintain a family member with a disability 2 at home. 3 Sec. 7. NEW SECTION . 331.440B Regional service system 4 financing. 5 1. a. The financing of a regional mental health and 6 disability service system is limited to a fixed budget amount. 7 The fixed budget amount shall be the amount identified in a 8 regional service system management plan and budget for the 9 fiscal year. The region shall be authorized an allowed growth 10 factor adjustment as established by statute for services 11 addressed by the regional plan. The statute establishing 12 the allowed growth factor adjustment shall establish the 13 adjustment for the fiscal year which commences two years from 14 the beginning date of the fiscal year in progress at the time 15 the statute is enacted. 16 b. Based upon information contained in regional plans and 17 budgets and proposals made by representatives of the regions, 18 the state commission shall recommend an allowed growth factor 19 adjustment to the governor by November 15 for the fiscal year 20 which commences two years from the beginning date of the fiscal 21 year in progress at the time the recommendation is made. The 22 allowed growth factor adjustment may address various costs 23 including but not limited to the costs associated with new 24 consumers of services, service cost inflation, and investments 25 for economy and efficiency. In developing the service 26 cost inflation recommendation, the state commission shall 27 consider the cost trends indicated by the regional financial 28 reports. The governor shall consider the state commission’s 29 recommendation in developing the governor’s recommendation for 30 an allowed growth factor adjustment for such fiscal year. The 31 governor’s recommendation shall be submitted to the general 32 assembly at the time the governor’s proposed budget for the 33 succeeding fiscal year is submitted in accordance with chapter 34 8. 35 -12- LSB 6075HV (2) 84 jp/rj 12/ 98
H.F. 2431 2. A region shall implement its regional service system 1 management plan in a manner so as to provide adequate funding 2 of services for the entire fiscal year by budgeting for 3 ninety-nine percent of the funding anticipated to be available 4 for the regional plan for the fiscal year. A region may expend 5 all of the funding anticipated to be available for the regional 6 plan. 7 Sec. 8. IMPLEMENTATION OF ACT. Section 25B.2, subsection 3, 8 shall not apply to this division of this Act. 9 Sec. 9. CODE EDITOR. The Code editor may codify the Code 10 provisions enacted by this division of this Act as a new part 11 of chapter 331, division III. 12 Sec. 10. APPLICABILITY. The provisions of this division of 13 this Act enacting new Code sections 331.439A through 331.439E, 14 and section 331.440B apply beginning on July 1, 2013. 15 DIVISION II 16 WORKFORCE DEVELOPMENT AND REGULATION 17 Sec. 11. NEW SECTION . 225C.6C Mental health and disability 18 services workforce development workgroup. 19 1. The department of human services shall convene and 20 provide support to a mental health and disability services 21 workforce development workgroup to address issues connected 22 with assuring that an adequate workforce is available in the 23 state to provide mental health and disability services. The 24 workgroup shall report at least annually to the governor 25 and general assembly providing findings, recommendations, 26 and financing information concerning the findings and 27 recommendations. 28 2. The membership of the workgroup shall include all of the 29 following: 30 a. The director of the department of aging or the director’s 31 designee. 32 b. The director of the department of corrections or the 33 director’s designee. 34 c. The director of the department of education or the 35 -13- LSB 6075HV (2) 84 jp/rj 13/ 98
H.F. 2431 director’s designee. 1 d. The director of human services or the director’s 2 designee. 3 e. The director of the department of public health or the 4 director’s designee. 5 f. The director of the department of workforce development 6 or the director’s designee. 7 g. At least three staff of regional administrators 8 appointed by the community services affiliate of the Iowa state 9 association of counties. 10 h. At least three individuals receiving mental health and 11 disability services or involved relatives of such individuals. 12 i. At least three providers of mental health and disability 13 services. 14 j. A representative of the entity under contract with 15 the department to provide mental health managed care for the 16 medical assistance program. 17 k. One or more representatives of the institutions under 18 the control of the state board of regents who are knowledgeable 19 concerning the mental health and disability services workforce. 20 l. Other persons identified by the workgroup. 21 3. In addition to the members identified in subsection 22 2, the membership of the workgroup shall include four 23 members of the general assembly serving in a nonvoting, ex 24 officio capacity. One member shall be designated by each 25 of the following: the majority leader of the senate, the 26 minority leader of the senate, the speaker of the house of 27 representatives, and the minority leader of the house of 28 representatives. A legislative member serves for a term as 29 provided in section 69.16B. 30 4. Except as provided in subsection 3 for legislative 31 appointments, the workgroup shall determine its own rules of 32 procedure, membership terms, and operating provisions. 33 5. The workforce development measures considered for 34 recommendation by the workgroup shall include but are not 35 -14- LSB 6075HV (2) 84 jp/rj 14/ 98
H.F. 2431 limited to all of the following: 1 a. Provide for the college of direct support or comparable 2 internet-based training to be available at no charge to all 3 service providers. 4 b. Require every direct support professional to demonstrate 5 a level of competency in core curricula. 6 c. Provide financial incentives for those providers who 7 support direct care staff in securing a voluntary certification 8 from the national alliance for direct support professionals or 9 a comparable certification or accreditation body. 10 d. Change the rate reimbursement methodologies to allow 11 providers to bill direct care staff development costs as a 12 direct expense rather than as an indirect cost. 13 e. Implement regional service system staffing capability 14 to provide positive behavior supports training and to mount a 15 crisis intervention and prevention response that is based on a 16 model successfully tested in this state. 17 f. Make technical assistance available to service providers 18 for issues such as crisis intervention, sheltered workshop 19 conversion, and other approaches to modernize services. 20 g. Implement co-occurring disability cross training for 21 mental health professionals as well as training for primary 22 care practitioners on intellectual disability and developmental 23 disability behavioral issues. 24 Sec. 12. NEW SECTION . 225C.6D Regional service system —— 25 outcomes and performance measures committee. 26 1. The department shall establish an outcomes and 27 performance measures committee to recommend to the department 28 and the commission’s specific outcomes and performance measures 29 to be utilized by the regional mental health and disability 30 services system. The membership of the committee shall include 31 regional administrator and departmental staff, individuals 32 receiving mental health and disability services or involved 33 relatives of such individuals, providers of mental health and 34 disability services, a representative of the person under 35 -15- LSB 6075HV (2) 84 jp/rj 15/ 98
H.F. 2431 contract with the department to provide mental health managed 1 care for the medical assistance program, a representative 2 of the institutions under the control of the state board of 3 regents who is knowledgeable concerning mental health and 4 disability services, a representative of the department’s task 5 force to address the decision in Olmstead v. L.C., 527 U.S. 581 6 (1999), and other stakeholders. 7 2. To the extent possible, the committee shall seek to 8 provide outcome and performance measures recommendations 9 that are consistent across the mental health and disability 10 services populations addressed. The committee shall also 11 evaluate data collection requirements utilized in the regional 12 service system to identify the requirements that could be 13 eliminated or revised due to the administrative burden involved 14 or the low degree of relevance to outcomes or other reporting 15 requirements. 16 Sec. 13. NEW SECTION . 225C.6E Regional service system —— 17 regulatory requirements. 18 1. The departments of inspections and appeals, human 19 services, and public health shall comply with the requirements 20 of this section in their efforts to improve the regulatory 21 requirements applied to the regional service system 22 administration and service providers. 23 2. The three departments shall work together to establish 24 a process to streamline accreditation, certification, and 25 licensing standards applied to the regional service system 26 administration and service providers. 27 3. The departments of human services and inspections and 28 appeals shall jointly review the standards and inspection 29 process applicable to residential care facilities. 30 4. The three departments shall do all of the following in 31 developing regulatory requirements applicable to the regional 32 service system administration and service providers: 33 a. Consider the costs to administrators and providers in the 34 development of quality monitoring efforts. 35 -16- LSB 6075HV (2) 84 jp/rj 16/ 98
H.F. 2431 b. Develop uniform, streamlined, and statewide cost 1 reporting standards and tools. 2 c. Make quality monitoring information, including services, 3 quality, and location information, easily available and 4 understandable to all citizens. 5 d. Establish standards that are clearly understood and are 6 accompanied by interpretive guidelines to support understanding 7 by those responsible for applying the standards. 8 e. Develop a partnership with providers in order to 9 improve the quality of services and develop mechanisms for the 10 provision of technical assistance. 11 f. Develop consistent data collection efforts based on 12 statewide standards and make information available to all 13 providers. 14 g. Evaluate existing provider qualification and monitoring 15 efforts to identify duplication and gaps, and align the efforts 16 with valued outcomes. 17 h. Streamline and enhance existing standards. 18 i. Consider how accreditations can be used for the 19 certification of provider qualifications. 20 5. The three departments shall seek to increase the number 21 of staff dedicated to oversight of service providers. 22 DIVISION III 23 COMMUNITY MENTAL HEALTH CENTER AMENDMENTS 24 Sec. 14. Section 230A.106, subsection 2, paragraph c, as 25 enacted by 2011 Iowa Acts, chapter 121, section 16, is amended 26 to read as follows: 27 c. Day treatment, partial hospitalization, or psychosocial 28 rehabilitation services. Such services shall be provided as 29 structured day programs in segments of less than twenty-four 30 hours using a multidisciplinary team approach to develop 31 treatment plans that vary in intensity of services and the 32 frequency and duration of services based on the needs of the 33 patient. These services may be provided directly by the center 34 or in collaboration or affiliation with other appropriately 35 -17- LSB 6075HV (2) 84 jp/rj 17/ 98
H.F. 2431 accredited providers. In lieu of day treatment, partial 1 hospitalization, or psychosocial rehabilitation services, the 2 center may provide an assertive community treatment program. 3 Sec. 15. Section 230A.110, subsection 1, as enacted by 4 2011 Iowa Acts, chapter 121, section 20, is amended to read as 5 follows: 6 1. The division shall recommend and the commission shall 7 adopt standards for designated community mental health 8 centers and comprehensive community mental health programs, 9 with the overall objective of ensuring that each center 10 and each affiliate providing services under contract with a 11 center furnishes high-quality mental health services within 12 a framework of accountability to the community it serves. 13 The standards adopted shall conform with federal standards 14 applicable to community mental health centers and shall be 15 in substantial conformity with the applicable behavioral 16 health standards adopted by the joint commission, formerly 17 known as the joint commission on accreditation of health care 18 organizations, and or other recognized national standards for 19 evaluation of psychiatric facilities unless in the judgment of 20 the division, with approval of the commission, there are sound 21 reasons for departing from the standards. 22 DIVISION IV 23 REGIONAL SERVICE SYSTEM 24 Sec. 16. NEW SECTION . 331.438A Definitions. 25 As used in this part, unless the context otherwise requires: 26 1. “Department” means the department of human services. 27 2. “Disability services” means the same as defined in 28 section 225C.2. 29 3. “Population” means the population shown by the latest 30 preceding certified federal census or the latest applicable 31 population estimate issued by the United States census bureau, 32 whichever is most recent. 33 4. “Regional administrator” means the administrative entity 34 formed by agreement of the counties participating in a region 35 -18- LSB 6075HV (2) 84 jp/rj 18/ 98
H.F. 2431 to function on behalf of those counties in accordance with this 1 part. 2 5. “State commission” means the mental health and disability 3 services commission created in section 225C.5. 4 Sec. 17. NEW SECTION . 331.438B Mental health and disability 5 services regions —— criteria. 6 1. Local access to mental health and disability services for 7 children and adults shall be provided by counties organized in 8 a regional service system. The regional service system shall 9 be implemented in stages in accordance with this section. 10 2. Formation of a mental health and disability services 11 region is subject to approval of the director of human services 12 and the mental health and disability services commission. 13 3. Each county in the state shall participate in an approved 14 mental health and disability services region. A mental health 15 and disability services region shall comply with all of the 16 following requirements: 17 a. The counties comprising the region are contiguous. 18 b. The region has at least three counties. 19 c. The combined general population of the counties 20 comprising a region shall be at least two hundred thousand 21 persons and not more than seven hundred thousand persons. 22 However, the director of human services, with the approval 23 of the commission, may grant a waiver from this requirement 24 if there is convincing evidence that compliance with the 25 requirement is not workable. 26 d. The region has the capacity to provide required core 27 services and perform required functions. 28 e. At least one community mental health center or a 29 federally qualified health center with providers qualified 30 to provide psychiatric services, either directly or with 31 assistance from psychiatric consultants, is located within the 32 region, has the capacity to provide outpatient services for the 33 region, and is either under contract with the region or has 34 provided documentation of intent to contract with the region 35 -19- LSB 6075HV (2) 84 jp/rj 19/ 98
H.F. 2431 to provide the services. 1 f. A hospital with an inpatient psychiatric unit or a state 2 mental health institute is located in or within reasonably 3 close proximity to the region, has the capacity to provide 4 inpatient services for the region, and is either under contract 5 with the region or has provided documentation of intent to 6 contract with the region to provide the services. 7 g. The regional administrator structure proposed for or 8 utilized by the region has clear lines of accountability and 9 the regional administrator functions as a lead agency utilizing 10 shared county staff or other means of limiting administrative 11 costs. 12 4. County formation of a mental health and disability 13 services region is subject to all of the following: 14 a. On or before November 1, 2012, counties voluntarily 15 participating in a region have complied with all of the 16 following formation criteria: 17 (1) The counties forming the region have been identified 18 and the board of supervisors of the counties have approved a 19 written letter of intent to join together to form the region. 20 (2) The proposed region complies with the requirements in 21 subsection 3. 22 (3) The department provides written notice to the boards 23 of supervisors of the counties identified for the region in 24 the letter of intent that the counties have complied with the 25 requirements in subsection 3. 26 b. Upon compliance with the provisions of paragraph “a” , the 27 participating counties are eligible for technical assistance 28 provided by the department. 29 c. During the period of November 2, 2012, through January 30 1, 2013, a county that has not agreed to be part of a region 31 in accordance with paragraph “a” shall be assigned by the 32 department to a region. 33 d. On or before June 30, 2013, all counties shall be part of 34 a region that is in compliance with the provisions of paragraph 35 -20- LSB 6075HV (2) 84 jp/rj 20/ 98
H.F. 2431 “a” other than meeting the November 1, 2012, date. 1 e. On or before June 30, 2014, all counties shall be 2 in compliance with all of the following mental health and 3 disability services region implementation criteria: 4 (1) The board of supervisors of each county participating in 5 the region has voted to approve a chapter 28E agreement. 6 (2) The duly authorized representatives of all the counties 7 participating in the region have signed the chapter 28E 8 agreement that is in compliance with section 331.438C. 9 (3) The county board of supervisors’ or supervisors’ 10 designee members and other members of the region’s governing 11 board have been appointed in accordance with section 331.438C. 12 (4) Executive staff for the region’s regional administrator 13 have been identified or engaged. 14 (5) An initial draft of a regional service management 15 transition plan has been developed which identifies the steps 16 to be taken by the region to do all of the following: 17 (a) Designate access points for the disability services 18 administered by the region. 19 (b) Designate the region’s targeted case manager provider 20 funded by the medical assistance program. 21 (c) Identify the service provider network for the region. 22 (d) Define the service access and service authorization 23 process to be utilized for the region. 24 (e) Identify the information technology and data management 25 capacity to be employed to support regional functions. 26 (f) Establish business functions, funds accounting 27 procedures, and other administrative processes. 28 (g) Comply with data reporting and other information 29 technology requirements adopted by the state commission. 30 (6) The department and the state commission have approved 31 the region’s chapter 28E agreement and the initial draft of the 32 regional management transition plan. 33 f. If the department, with the concurrence of the state 34 commission, determines that a region is in substantial 35 -21- LSB 6075HV (2) 84 jp/rj 21/ 98
H.F. 2431 compliance with the implementation criteria in paragraph “e” 1 and has sufficient operating capacity to begin operations, the 2 region may commence partial or full operations prior to July 3 2014. 4 Sec. 18. NEW SECTION . 331.438C Regional governance 5 structure. 6 1. The counties comprising a mental health and disability 7 services region shall enter into an agreement under chapter 8 28E to form a regional administrator under the control of a 9 governing board to function on behalf of those counties. 10 2. The governing board shall comply with all of the 11 following requirements: 12 a. The membership of the governing board shall consist 13 of one or more board of supervisor members from each county 14 comprising the region or their designees. The decisions 15 involving the local public funding administered by the 16 governing board and the regional administrator shall be made 17 by these members. 18 b. The membership of the governing board shall also consist 19 of at least three individuals who utilize mental health and 20 disability services or actively involved relatives of such 21 individuals. These members shall be designated in a manner 22 so as to represent the geographic areas of the region and to 23 provide balanced representation for the various disability 24 groups utilizing the services provided through the region. 25 c. The membership of the governing board shall not include 26 representatives of service providers or the department. 27 d. The governing board shall have a regional advisory 28 committee consisting of individuals who utilize services or 29 actively involved relatives of such individuals, service 30 providers, and regional governing board members. 31 3. The regional administrator shall be under the control of 32 the governing board. The regional administrator shall enter 33 into performance-based contracts with the department for the 34 regional administrator to manage, on behalf of the counties 35 -22- LSB 6075HV (2) 84 jp/rj 22/ 98
H.F. 2431 comprising the region, the mental health and disability 1 services that are not funded by the medical assistance program 2 under chapter 249A and for coordinating with the department the 3 provision of mental health and disability services that are 4 funded under the medical assistance program. 5 Sec. 19. NEW SECTION . 331.438D Regional finances. 6 1. The funding under the control of the governing board 7 shall be maintained in a combined account, in separate county 8 accounts that are under the control of the governing board, or 9 pursuant to other arrangements authorized by law that limit the 10 administrative burden of such control while facilitating public 11 scrutiny of financial processes. 12 2. The administrative costs of the regional administrator 13 shall be limited to five percent of expenditures. Expenditures 14 considered to be administrative costs shall be determined in 15 accordance with law. 16 3. The funding provided pursuant to performance-based 17 contracts with the department shall be credited to the account 18 or accounts under the control of the governing board. 19 Sec. 20. NEW SECTION . 331.438E Regional governance 20 agreements. 21 1. In addition to compliance with the applicable provisions 22 of chapter 28E, the chapter 28E agreement entered into by the 23 counties comprising a mental health and disability services 24 region in forming the regional administrator to function on 25 behalf of the counties shall comply with the requirements of 26 this section. 27 2. The organizational provisions of the agreement shall 28 include all of the following: 29 a. A statement of purpose, goals, and objectives of entering 30 into the agreement. 31 b. Identification of the governing board membership and the 32 terms, methods of appointment, voting procedures, and other 33 provisions applicable to the operation of the governing board. 34 c. The identification of the executive staff of the regional 35 -23- LSB 6075HV (2) 84 jp/rj 23/ 98
H.F. 2431 administrator serving as the single point of accountability for 1 the region. 2 d. The counties participating in the agreement. 3 e. The time period of the agreement and terms for 4 termination or renewal of the agreement. 5 f. The circumstances under which additional counties may 6 join the region. 7 g. Methods for dispute resolution and mediation. 8 h. Methods for termination of a county’s participation in 9 the region. 10 i. Provisions for formation and assigned responsibilities 11 for one or more advisory committees consisting of individuals 12 who utilize services or actively involved relatives of such 13 individuals, service providers, governing board members, and 14 other interests identified in the agreement. 15 3. The administrative provisions of the agreement shall 16 include all of the following: 17 a. Responsibility of the governing board in appointing and 18 evaluating the performance of the chief executive officer of 19 the regional administrator. 20 b. A specific list of the functions and responsibilities of 21 the regional administrator’s chief executive officer and other 22 administrative staff. 23 c. Specification of the functions to be carried out by each 24 party to the agreement and by any subcontractor of a party to 25 the agreement. A contract with a provider network shall be 26 separately addressed. 27 4. The financial provisions of the agreement shall include 28 all of the following: 29 a. Methods for pooling, management, and expenditure of the 30 funding under the control of the regional administrator. If 31 the agreement does not provide for pooling of the participating 32 county moneys in a single fund, the agreement shall specify how 33 the participating county moneys will be subject to the control 34 of the regional administrator. 35 -24- LSB 6075HV (2) 84 jp/rj 24/ 98
H.F. 2431 b. Methods for allocating administrative funding and 1 resources. 2 c. Contributions and uses of initial funding or related 3 contributions made by the counties participating in the 4 region for purposes of commencing operations by the regional 5 administrator. 6 d. Methods for acquiring or disposing of real property. 7 e. A process for determining the use of savings for 8 reinvestment. 9 f. A process for performance of an annual independent audit 10 of the regional administrator. 11 Sec. 21. NEW SECTION . 331.438F County of residence —— 12 services to residents —— service authorization appeals —— 13 disputes between counties or regions and the department. 14 1. For the purposes of this section, unless the context 15 otherwise requires: 16 a. “County of residence” means the county in this state in 17 which, at the time a person applies for or receives services, 18 the person is living in the county and has established an 19 ongoing presence with the declared, good faith intention of 20 living in the county for a permanent or indefinite period of 21 time. The county of residence of a person who is a homeless 22 person is the county where the homeless person usually sleeps. 23 “County of residence” does not mean the county where a person is 24 present for the purpose of receiving services in a hospital, 25 a correctional facility, a halfway house for community-based 26 corrections or substance-related treatment, a nursing facility, 27 an intermediate care facility for persons with an intellectual 28 disability, or a residential care facility, or for the purpose 29 of attending a college or university. 30 b. “Homeless person” means the same as defined in section 31 48A.2. 32 c. “Person” means a person who is a United States citizen or 33 a qualified alien as defined in 8 U.S.C. § 1641. 34 2. If a person appeals a service authorization or 35 -25- LSB 6075HV (2) 84 jp/rj 25/ 98
H.F. 2431 other services-related determination made by a regional 1 administrator, the appeal shall be heard in a contested 2 case proceeding by a state administrative law judge. The 3 administrative law judge’s decision shall be considered a final 4 agency decision under chapter 17A. 5 3. If a county of residence is part of a mental health and 6 disability services region that has agreed to pool funding and 7 liability for services, the responsibilities of the county 8 under law regarding such services shall be performed on behalf 9 of the county by the regional administrator. The county of 10 residence or the county’s mental health and disability services 11 region, as applicable, is responsible for paying the public 12 costs of the mental health and disability services that are 13 not covered by the medical assistance program under chapter 14 249A and are provided in accordance with the region’s approved 15 service management plan to persons who are residents of the 16 county or region. 17 4. a. The dispute resolution process implemented in 18 accordance with this subsection applies to residency disputes. 19 The dispute resolution process is not applicable to disputes 20 involving persons committed to a state facility pursuant to 21 chapter 812 or rule of criminal procedure 2.22, Iowa court 22 rules, or to disputes involving service authorization decisions 23 made by a region. 24 b. If a county, region, or the department, as applicable, 25 receives a billing for services provided to a resident 26 in another county or region, or objects to a residency 27 determination certified by the department or another county’s 28 or region’s regional administrator and asserts either that the 29 person has residency in another county or region or the person 30 is not a resident of this state or the person’s residency 31 is unknown so that the person is deemed a state case, the 32 person’s residency status shall be determined as provided in 33 this section. The county or region shall notify the department 34 of the county’s or region’s assertion within one hundred 35 -26- LSB 6075HV (2) 84 jp/rj 26/ 98
H.F. 2431 twenty days of receiving the billing. If the county or region 1 asserts that the person has residency in another county or 2 region, that county or region shall be notified at the same 3 time as the department. If the department disputes a residency 4 determination certification made by a regional administrator, 5 the department shall notify the affected counties or regions 6 of the department’s assertion. 7 c. The department, county, or region that received the 8 notification, as applicable, shall respond to the party that 9 provided the notification within forty-five days of receiving 10 the notification. If the parties cannot agree to a settlement 11 as to the person’s residency status within ninety days of the 12 date of notification, on motion of any of the parties, the 13 matter shall be referred to the department of inspections and 14 appeals for a contested case hearing under chapter 17A before 15 an administrative law judge assigned in accordance with section 16 10A.801 to determine the person’s residency status. 17 d. (1) The administrative law judge’s determination 18 of the person’s residency status is a final agency action, 19 notwithstanding contrary provisions of section 17A.15. 20 The party that does not prevail in the determination or 21 subsequent judicial review is liable for costs associated with 22 the proceeding, including reimbursement of the department 23 of inspections and appeals’ actual costs associated with 24 the administrative proceeding. Judicial review of the 25 determination may be sought in accordance with section 17A.19. 26 (2) If following the determination of a person’s residency 27 status in accordance with this section, additional evidence 28 becomes available that merits a change in that determination, 29 the parties affected may change the determination by mutual 30 agreement. Otherwise, a party may move that the matter be 31 reconsidered by the department, county, or region, or by the 32 administrative law judge. 33 e. (1) Unless a petition is filed for judicial review, 34 the administrative law judge’s determination of the person’s 35 -27- LSB 6075HV (2) 84 jp/rj 27/ 98
H.F. 2431 residency status shall result in one of the following: 1 (a) If a county or region is determined to be the person’s 2 residence, the county or region shall pay the amounts due and 3 shall reimburse any other amounts paid for services provided by 4 the other county or region or the department on the person’s 5 behalf prior to the determination. 6 (b) If it is determined that the person is not a resident 7 of this state or the person’s residency is unknown so that the 8 person is deemed to be a state case, the department shall pay 9 the amounts due and shall reimburse the county or region, as 10 applicable, for any payment made on behalf of the person prior 11 to the determination. 12 (2) The payment or reimbursement shall be remitted within 13 forty-five days of the date the decision was issued. After 14 the forty-five-day period, a penalty of not greater than one 15 percent per month may be added to the amount due. 16 Sec. 22. CODE EDITOR. The Code editor shall codify the 17 provisions of this division of this Act enacting new sections 18 in chapter 331, as a new part of division IV, tentatively 19 numbered part 2A. 20 Sec. 23. APPLICABILITY. The provisions of this division 21 of this Act enacting new sections in chapter 331, except 22 as specifically provided by the provisions, are applicable 23 beginning July 1, 2013. 24 DIVISION V 25 SUBACUTE CARE FACILITIES FOR PERSONS WITH SERIOUS AND 26 PERSISTENT MENTAL ILLNESS 27 Sec. 24. NEW SECTION . 135P.1 Definitions. 28 As used in this chapter, unless the context otherwise 29 requires: 30 1. “Department” means the department of inspections and 31 appeals. 32 2. “Direction” means authoritative policy or procedural 33 guidance for the accomplishment of a function or an activity. 34 3. “Licensee” means the holder of a license issued to 35 -28- LSB 6075HV (2) 84 jp/rj 28/ 98
H.F. 2431 operate a subacute care facility for persons with serious and 1 persistent mental illness. 2 4. “Mental health professional” means the same as defined 3 in section 228.1. 4 5. “Physician” means a person licensed under chapter 148. 5 6. “Psychiatric services” means services provided under 6 the direction of a physician which address mental, emotional, 7 medical, or behavioral problems. 8 7. “Rehabilitative services” means services to encourage and 9 assist restoration of a resident’s optimum mental and physical 10 capabilities. 11 8. “Resident” means a person who is eighteen years of age 12 or older and has been admitted by a physician to a subacute 13 care facility for persons with serious and persistent mental 14 illness. 15 9. “Treatment care plan” means a plan of care and services 16 designed to eliminate the need for acute care by improving 17 the condition of a person with serious and persistent mental 18 illness. Services must be based upon a diagnostic evaluation, 19 which includes an examination of the medical, psychological, 20 social, behavioral, and developmental aspects of the person’s 21 situation, reflecting the need for inpatient care. 22 10. “Subacute care facility for persons with serious and 23 persistent mental illness” or “subacute care facility” means an 24 institution, place, building, or agency with restricted means 25 of egress designed to provide accommodation, board, and the 26 services of a licensed psychiatrist for a period exceeding 27 twenty-four consecutive hours to three or more individuals who 28 primarily have serious and persistent mental illness, diagnosis 29 of a co-occurring disorder, and are not related to the owner 30 within the third degree of consanguinity. 31 11. “Supervision” means direct oversight and inspection of 32 the act of accomplishing a function or activity. 33 Sec. 25. NEW SECTION . 135P.2 Purpose. 34 The purpose of this chapter is to provide for the 35 -29- LSB 6075HV (2) 84 jp/rj 29/ 98
H.F. 2431 development, establishment, and enforcement of basic standards 1 for the operation, construction, and maintenance of a 2 subacute care facility which will ensure the safe and adequate 3 diagnosis, evaluation, and treatment of the residents. 4 Sec. 26. NEW SECTION . 135P.3 Nature of care —— seclusion 5 room —— admissions. 6 1. A subacute care facility shall utilize a team of 7 professionals to direct an organized program of diagnostic 8 services, psychiatric services, and rehabilitative services 9 to meet the needs of residents in accordance with a treatment 10 care plan developed for each resident under the supervision of 11 a licensed psychiatrist. The goal of a treatment care plan 12 is to transition residents to a less restrictive environment, 13 including a home-based community setting. Social and 14 rehabilitative services shall be provided under the direction 15 of a mental health professional. 16 2. The licensed psychiatrist providing supervision of 17 the subacute care facility shall evaluate the condition of 18 each resident no less than two times each month and shall be 19 available to residents of the facility on an on-call basis 20 at all other times. The subacute care facility may employ a 21 seclusion room meeting the conditions described in 42 C.F.R. § 22 483.364(b) with approval of the licensed psychiatrist of the 23 facility or by order of the resident’s physician. 24 3. An admission to the subacute care facility is subject 25 to a physician’s written order certifying that the individual 26 being admitted requires regular oversight by a licensed 27 psychiatrist and requires no greater degree of care than that 28 which the facility to which the admission is made is licensed 29 to provide and is capable of providing. 30 4. A subacute care facility does not constitute an 31 “institution for mental diseases” within the meaning of 42 32 U.S.C. § 1396d(i). 33 Sec. 27. NEW SECTION . 135P.4 Licensure. 34 1. A person shall not establish, operate, or maintain a 35 -30- LSB 6075HV (2) 84 jp/rj 30/ 98
H.F. 2431 subacute care facility unless the person obtains a license for 1 the subacute care facility under this chapter. 2 2. An intermediate care facility for persons with mental 3 illness licensed under chapter 135C may convert to a subacute 4 care facility by providing written notice to the department 5 that the facility has employed a full-time psychiatrist and 6 desires to make the conversion. 7 Sec. 28. NEW SECTION . 135P.5 Application for license. 8 An application for a license under this chapter shall be 9 submitted on a form requesting information required by the 10 department, which may include affirmative evidence of the 11 applicant’s ability to comply with the rules for standards 12 adopted pursuant to this chapter. An application for a license 13 shall be accompanied by the required license fee which shall 14 be credited to the general fund of the state. The initial and 15 annual license fee is twenty-five dollars. 16 Sec. 29. NEW SECTION . 135P.6 Inspection —— conditions for 17 issuance. 18 The department shall issue a license to an applicant under 19 this chapter if the department has ascertained that the 20 applicant’s facilities and staff are adequate to provide the 21 care and services required of a subacute care facility and if 22 the applicant has been awarded a certificate of need pursuant 23 to chapter 135. 24 Sec. 30. NEW SECTION . 135P.7 Denial, suspension, or 25 revocation of license. 26 The department may deny an application or suspend or revoke 27 a license if the department finds that an applicant or licensee 28 has failed or is unable to comply with this chapter or the 29 rules establishing minimum standards pursuant to this chapter 30 or if any of the following conditions apply: 31 1. It is shown that a resident is a victim of cruelty or 32 neglect due to the acts or omissions of the licensee. 33 2. The licensee has permitted, aided, or abetted in the 34 commission of an illegal act in the subacute care facility. 35 -31- LSB 6075HV (2) 84 jp/rj 31/ 98
H.F. 2431 3. An applicant or licensee acted to obtain or to retain a 1 license by fraudulent means, misrepresentation, or submitting 2 false information. 3 4. The licensee has willfully failed or neglected to 4 maintain a continuing in-service education and training program 5 for persons employed by the subacute care facility. 6 5. The application involves a person who has failed to 7 operate a subacute care facility in compliance with the 8 provisions of this chapter. 9 Sec. 31. NEW SECTION . 135P.8 Provisional license. 10 The department may issue a provisional license, effective 11 for not more than one year, to a licensee whose subacute care 12 facility does not meet the requirements of this chapter if, 13 prior to issuance of the license, the applicant submits written 14 plans to achieve compliance with the applicable requirements 15 and the plans are approved by the department. The plans shall 16 specify the deadline for achieving compliance. 17 Sec. 32. NEW SECTION . 135P.9 Notice and hearings. 18 The procedure governing notice and hearing to deny an 19 application or suspend or revoke a license shall be in 20 accordance with rules adopted by the department pursuant to 21 chapter 17A. A full and complete record shall be kept of the 22 proceedings and of any testimony. The record need not be 23 transcribed unless judicial review is sought. A copy or copies 24 of a transcript may be obtained by an interested party upon 25 payment of the cost of preparing the transcript or copies. 26 Sec. 33. NEW SECTION . 135P.10 Rules. 27 The department of inspections and appeals, in consultation 28 with the department of human services and affected professional 29 groups, shall adopt and enforce rules setting out the standards 30 for a subacute care facility and the rights of the residents 31 admitted to a subacute care facility. The department of 32 inspections and appeals and the department of human services 33 shall coordinate the adoption of rules and the enforcement of 34 the rules in order to prevent duplication of effort by the 35 -32- LSB 6075HV (2) 84 jp/rj 32/ 98
H.F. 2431 departments and of requirements of the licensee. 1 Sec. 34. NEW SECTION . 135P.11 Complaints alleging 2 violations —— confidentiality. 3 1. A person may request an inspection of a subacute care 4 facility by filing with the department a complaint of an 5 alleged violation of an applicable requirement of this chapter 6 or a rule adopted pursuant to this chapter. The complaint 7 shall state in a reasonably specific manner the basis of the 8 complaint. A statement of the nature of the complaint shall be 9 delivered to the subacute care facility involved at the time of 10 or prior to the inspection. The name of the person who files a 11 complaint with the department shall be kept confidential and 12 shall not be subject to discovery, subpoena, or other means 13 of legal compulsion for its release to a person other than 14 department employees involved in the investigation of the 15 complaint. 16 2. Upon receipt of a complaint made in accordance with 17 subsection 1, the department shall make a preliminary review 18 of the complaint. Unless the department concludes that the 19 complaint is intended to harass a subacute care facility or a 20 licensee or is without reasonable basis, it shall within twenty 21 working days of receipt of the complaint make or cause to be 22 made an on-site inspection of the subacute care facility which 23 is the subject of the complaint. The department of inspections 24 and appeals may refer to the department of human services 25 any complaint received by the department of inspections and 26 appeals if the complaint applies to rules adopted by the 27 department of human services. The complainant shall also 28 be notified of the name, address, and telephone number of 29 the designated protection and advocacy agency if the alleged 30 violation involves a facility with one or more residents with a 31 developmental disability or mental illness. In any case, the 32 complainant shall be promptly informed of the result of any 33 action taken by the department in the matter. 34 3. An inspection made pursuant to a complaint filed under 35 -33- LSB 6075HV (2) 84 jp/rj 33/ 98
H.F. 2431 subsection 1 need not be limited to the matter or matters 1 referred to in the complaint; however, the inspection shall 2 not be a general inspection unless the complaint inspection 3 coincides with a scheduled general inspection. Upon arrival 4 at the subacute care facility to be inspected, the inspector 5 shall show identification to the person in charge of the 6 subacute care facility and state that an inspection is to 7 be made, before beginning the inspection. Upon request of 8 either the complainant or the department, the complainant or 9 the complainant’s representative or both may be allowed the 10 privilege of accompanying the inspector during any on-site 11 inspection made pursuant to this section. The inspector may 12 cancel the privilege at any time if the inspector determines 13 that the privacy of a resident of the subacute care facility to 14 be inspected would be violated. The dignity of the resident 15 shall be given first priority by the inspector and others. 16 Sec. 35. NEW SECTION . 135P.12 Information confidential. 17 1. The department’s final findings regarding licensure 18 shall be made available to the public in a readily available 19 form and place. Other information relating to the subacute 20 care facility is confidential and shall not be made available 21 to the public except in proceedings involving licensure, a 22 civil suit involving a resident, or an administrative action 23 involving a resident. 24 2. The name of a person who files a complaint with the 25 department shall remain confidential and is not subject to 26 discovery, subpoena, or any other means of legal compulsion for 27 release to a person other than an employee of the department or 28 an agent involved in the investigation of the complaint. 29 3. Information regarding a resident who has received or is 30 receiving care shall not be disclosed directly or indirectly 31 except as authorized under section 217.30. 32 Sec. 36. NEW SECTION . 135P.13 Judicial review. 33 Judicial review of the action of the department may be sought 34 pursuant to the Iowa administrative procedure Act, chapter 17A. 35 -34- LSB 6075HV (2) 84 jp/rj 34/ 98
H.F. 2431 Notwithstanding chapter 17A, a petition for judicial review of 1 the department’s actions under this chapter may be filed in the 2 district court of the county in which the related subacute care 3 facility is located or is proposed to be located. The status 4 of the petitioner or the licensee shall be preserved pending 5 final disposition of the judicial review. 6 Sec. 37. NEW SECTION . 135P.14 Penalty. 7 A person who establishes, operates, or manages a subacute 8 care facility without obtaining a license under this chapter 9 commits a serious misdemeanor. Each day of continuing 10 violation following conviction shall be considered a separate 11 offense. 12 Sec. 38. NEW SECTION . 135P.15 Injunction. 13 Notwithstanding the existence or pursuit of another remedy, 14 the department may maintain an action for injunction or other 15 process to restrain or prevent the establishment, operation, or 16 management of a subacute care facility without a license. 17 Sec. 39. Section 249A.26, subsection 2, Code 2011, is 18 amended by adding the following new paragraph: 19 NEW PARAGRAPH . d. Notwithstanding any provision of 20 this chapter to the contrary, for services provided to 21 eligible persons in a subacute care facility for persons 22 with serious and persistent mental illness licensed under 23 chapter 135P, the daily rate shall be equal to the sum of 24 the direct care Medicare-certified hospital-based nursing 25 facility patient-day-weighted median and the nondirect 26 care Medicare-certified hospital-based nursing facility 27 patient-day-weighted median. 28 Sec. 40. IMPLEMENTATION OF ACT. Section 25B.2, subsection 29 3, shall not apply to this division of this Act. 30 DIVISION VI 31 CONFORMING AMENDMENTS —— CENTRAL POINT OF COORDINATION, LEGAL 32 SETTLEMENT, AND DISPUTE RESOLUTION PROCESSES 33 Sec. 41. Section 218.99, Code 2011, is amended to read as 34 follows: 35 -35- LSB 6075HV (2) 84 jp/rj 35/ 98
H.F. 2431 218.99 Counties to be notified of patients’ personal 1 accounts. 2 The administrator in control of a state institution shall 3 direct the business manager of each institution under the 4 administrator’s jurisdiction which is mentioned in section 5 331.424, subsection 1 , paragraph “a” , subparagraphs (1) and 6 (2), and for which services are paid under section 331.424A , to 7 quarterly inform the regional administrator of the county of 8 legal settlement’s entity designated to perform the county’s 9 central point of coordination process residence of any patient 10 or resident who has an amount in excess of two hundred dollars 11 on account in the patients’ personal deposit fund and the 12 amount on deposit. The administrators shall direct the 13 business manager to further notify the entity designated to 14 perform the county’s central point of coordination process 15 regional administrator of the county of residence at least 16 fifteen days before the release of funds in excess of two 17 hundred dollars or upon the death of the patient or resident. 18 If the patient or resident has no county of legal settlement, 19 notice shall be made to the director of human services and the 20 administrator in control of the institution involved. 21 Sec. 42. Section 222.2, subsection 3, Code 2011, is amended 22 by striking the subsection. 23 Sec. 43. Section 222.2, Code 2011, is amended by adding the 24 following new subsection: 25 NEW SUBSECTION . 5A. “Regional administrator” means the same 26 as defined in section 331.438A. 27 Sec. 44. Section 222.10, Code 2011, is amended to read as 28 follows: 29 222.10 Duty of peace officer. 30 When any person with mental retardation departs without 31 proper authority from an institution in another state and 32 is found in this state, any peace officer in any county in 33 which such patient is found may take and detain the patient 34 without warrant or order and shall report such detention to the 35 -36- LSB 6075HV (2) 84 jp/rj 36/ 98
H.F. 2431 administrator. The administrator shall provide for the return 1 of the patient to the authorities in the state from which the 2 unauthorized departure was made. Pending return, such patient 3 may be detained temporarily at one of the institutions of this 4 state governed by the administrator or by the administrator of 5 the division of child and family services of the department 6 of human services. The provisions of this section relating 7 to the administrator shall also apply to the return of other 8 nonresident persons with mental retardation having legal 9 settlement residency outside the state of Iowa. 10 Sec. 45. Section 222.13, Code 2011, is amended to read as 11 follows: 12 222.13 Voluntary admissions. 13 1. If an adult person is believed to be a person with mental 14 retardation, the adult person or the adult person’s guardian 15 may submit a request through the central point of coordination 16 process for the county board of supervisors regional 17 administrator of the adult person’s county of residence in 18 writing to apply to the superintendent of any state resource 19 center for the voluntary admission of the adult person either 20 as an inpatient or an outpatient of the resource center. 21 After determining the legal settlement of the adult person as 22 provided by this chapter , the board of supervisors The regional 23 administrator, on behalf of the board of supervisors shall, on 24 forms prescribed by the department’s administrator, apply to 25 the superintendent of the resource center in the district for 26 the admission of the adult person to the resource center. An 27 application for admission to a special unit of any adult person 28 believed to be in need of any of the services provided by the 29 special unit under section 222.88 may be made in the same 30 manner, upon request of the adult person or the adult person’s 31 guardian. The superintendent shall accept the application 32 providing if a preadmission diagnostic evaluation, performed 33 through the central point of coordination process through the 34 regional administrator , confirms or establishes the need for 35 -37- LSB 6075HV (2) 84 jp/rj 37/ 98
H.F. 2431 admission, except that an application may shall not be accepted 1 if the institution does not have adequate facilities available 2 or if the acceptance will result in an overcrowded condition. 3 2. If the resource center has no does not have an 4 appropriate program for the treatment of an adult or minor 5 person with mental retardation applying under this section 6 or section 222.13A , the board of supervisors regional 7 administrator on behalf of the board of supervisors shall 8 arrange for the placement of the person in any public or 9 private facility within or without the state, approved by the 10 director of the department of human services, which offers 11 appropriate services for the person, as determined through 12 the central point of coordination process by the regional 13 administrator . 14 3. Upon applying for admission of an adult or minor person 15 to a resource center, or a special unit, or upon arranging for 16 the placement of the person in a public or private facility, 17 if the county would be liable to pay the expenses in full 18 or in part, the regional administrator, on behalf of the 19 board of supervisors shall make a full investigation into 20 the financial circumstances of that person and those liable 21 for that person’s support under section 222.78 to determine 22 whether or not any of them are able to pay the expenses arising 23 out of the admission of the person to a resource center, 24 special treatment unit, or public or private facility. If 25 the board regional administrator finds that the person or 26 those legally responsible for the person are presently unable 27 to pay the expenses, the board regional administrator shall 28 direct that the expenses be paid by the county. The board 29 regional administrator may review its finding at any subsequent 30 time while the person remains at the resource center, or 31 is otherwise receiving care or treatment for which this 32 chapter obligates the county to pay. If the board regional 33 administrator finds upon review that the person or those 34 legally responsible for the person are presently able to pay 35 -38- LSB 6075HV (2) 84 jp/rj 38/ 98
H.F. 2431 the expenses, the finding shall apply only to the charges 1 incurred during the period beginning on the date of the 2 review and continuing thereafter, unless and until the board 3 regional administrator again changes its finding. If the board 4 regional administrator finds that the person or those legally 5 responsible for the person are able to pay the expenses, the 6 board regional administrator shall direct that the charges 7 be so paid to the extent required by section 222.78 , and the 8 county auditor shall be responsible for the collection of the 9 charges. 10 Sec. 46. Section 222.13A, subsections 1, 2, and 4, Code 11 2011, are amended to read as follows: 12 1. If a minor is believed to be a person with mental 13 retardation, the minor’s parent, guardian, or custodian 14 may request the county board of supervisors in writing to 15 apply for admission of the minor as a voluntary patient in 16 a state resource center. If the resource center does not 17 have appropriate services for the minor’s treatment, the 18 board of supervisors may arrange for the admission of the 19 minor in a public or private facility within or without the 20 state, approved by the director of human services, which 21 offers appropriate services for the minor’s treatment. If 22 half or more of the nonfederal share of the costs of services 23 provided to a minor in accordance with this section is the 24 responsibility of the state, the costs of the preadmission 25 diagnostic evaluation, court appointed attorney, and court 26 costs, relating to the services shall be paid by the state. 27 If more than half of the nonfederal share of the costs of 28 such services is the responsibility of the minor’s county of 29 residence, the costs of the preadmission diagnostic evaluation, 30 court appointed attorney, and court costs, relating to the 31 services shall be paid by the county of residence. 32 2. Upon receipt of an application for voluntary admission 33 of a minor, the board of supervisors shall provide for a 34 preadmission diagnostic evaluation of the minor to confirm 35 -39- LSB 6075HV (2) 84 jp/rj 39/ 98
H.F. 2431 or establish the need for the admission. The preadmission 1 diagnostic evaluation shall be performed by a person who 2 meets the qualifications of a qualified mental retardation 3 professional who is designated through the central point of 4 coordination process regional administrator . Any portion of 5 the cost of the evaluation not paid by the minor or those 6 liable for the minor’s support under section 222.78 is the 7 responsibility of the state. 8 4. As soon as practicable after the filing of a petition for 9 approval of the voluntary admission, the court shall determine 10 whether the minor has an attorney to represent the minor in the 11 proceeding. If the minor does not have an attorney, the court 12 shall assign to the minor an attorney. If the minor is unable 13 to pay for an attorney, the attorney shall be compensated by 14 the county or state, as applicable, at an hourly rate to be 15 established by the county board of supervisors in substantially 16 the same manner as provided in section 815.7 . 17 Sec. 47. Section 222.22, Code 2011, is amended to read as 18 follows: 19 222.22 Time of appearance. 20 The time of appearance shall not be less than five days 21 after completed service unless the court orders otherwise. 22 Appearance on behalf of the person who is alleged to have 23 mental retardation may be made by any citizen of the county 24 or by any relative. The district court shall assign counsel 25 for the person who is alleged to have mental retardation. 26 Counsel shall prior to proceedings personally consult with the 27 person who is alleged to have mental retardation unless the 28 judge appointing counsel certifies that in the judge’s opinion, 29 consultation shall serve no useful purpose. The certification 30 shall be made a part of the record. An attorney assigned by 31 the court shall be compensated by the county state at an hourly 32 rate to be established by the county board of supervisors in 33 substantially the same manner as provided in section 815.7 . 34 Sec. 48. Section 222.28, Code 2011, is amended to read as 35 -40- LSB 6075HV (2) 84 jp/rj 40/ 98
H.F. 2431 follows: 1 222.28 Commission to examine. 2 The court may, at or prior to the final hearing, appoint 3 a commission of one qualified physician and one qualified 4 psychologist, designated through the central point of 5 coordination process, regional administrator who shall make 6 a personal examination of the person alleged to be mentally 7 retarded for the purpose of determining the mental condition 8 of the person. 9 Sec. 49. Section 222.31, subsection 1, paragraph b, Code 10 2011, is amended to read as follows: 11 b. (1) Commit the person to the state resource center 12 designated by the administrator to serve the county in which 13 the hearing is being held, or to a special unit. The court 14 shall, prior to issuing an order of commitment, request 15 that a diagnostic evaluation of the person be made by the 16 superintendent of the resource center or the special unit, or 17 the superintendent’s qualified designee a person qualified 18 to perform the diagnostic evaluation . The evaluation shall 19 be conducted at a place as the superintendent may direct. 20 The cost of the evaluation shall be defrayed by the county 21 of legal settlement unless otherwise ordered by the court. 22 The cost of the evaluation to be charged may be equal to but 23 shall not exceed the actual cost of the evaluation. Persons 24 referred by a court to a resource center or the special unit 25 for diagnostic evaluation shall be considered as outpatients of 26 the institution. No order of commitment shall be issued unless 27 the superintendent of the institution recommends that the order 28 be issued, and advises the court that adequate facilities for 29 the care of the person are available. 30 (2) The court shall examine the report of the county 31 attorney filed pursuant to section 222.13 , and if the report 32 shows that neither the person nor those liable for the person’s 33 support under section 222.78 are presently able to pay the 34 charges rising out of the person’s care in a resource center, 35 -41- LSB 6075HV (2) 84 jp/rj 41/ 98
H.F. 2431 or special treatment unit, shall enter an order stating that 1 finding and directing that the charges be paid by the person’s 2 county of residence or the state, as determined in accordance 3 with section 222.60 . The court may , upon request of the board 4 of supervisors payer of the charges , may review its finding at 5 any subsequent time while the person remains at the resource 6 center, or is otherwise receiving care or treatment for which 7 this chapter obligates the county payer to pay. If the court 8 finds upon review that the person or those legally responsible 9 for the person are presently able to pay the expenses, that 10 finding shall apply only to the charges incurred during the 11 period beginning on the date of the board’s payer’s request 12 for the review and continuing thereafter after that date , 13 unless and until the court again changes its finding. If the 14 court finds that the person, or those liable for the person’s 15 support, are able to pay the charges, the court shall enter 16 an order directing that the charges be so paid to the extent 17 required by section 222.78 . 18 Sec. 50. Section 222.49, Code 2011, is amended to read as 19 follows: 20 222.49 Costs paid. 21 The costs of proceedings shall be defrayed from the county 22 treasury paid by the county or the state, as determined in 23 accordance with section 222.60, unless otherwise ordered by 24 the court. When the person alleged to be mentally retarded 25 is found not to be mentally retarded, the court shall render 26 judgment for such costs against the person filing the petition 27 except when the petition is filed by order of court. 28 Sec. 51. Section 222.50, Code 2011, is amended to read as 29 follows: 30 222.50 County of legal settlement residence or state to pay. 31 When the proceedings are instituted in a county in which 32 the person who is alleged to have mental retardation was found 33 but which is not the county of legal settlement residence of 34 the person, and the costs are not taxed to the petitioner, the 35 -42- LSB 6075HV (2) 84 jp/rj 42/ 98
H.F. 2431 person’s county which is the legal settlement of the person 1 of residence or the state, as determined in accordance with 2 section 222.60, shall, on presentation of a properly itemized 3 bill for such costs, repay the costs to the former county. 4 When the person’s legal settlement is outside the state or is 5 unknown, the costs shall be paid out of money in the state 6 treasury not otherwise appropriated, itemized on vouchers 7 executed by the auditor of the county which paid the costs, and 8 approved by the administrator. 9 Sec. 52. Section 222.59, subsection 1, unnumbered paragraph 10 1, Code 2011, is amended to read as follows: 11 Upon receiving a request from an authorized requester, the 12 superintendent of a state resource center shall coordinate 13 with the central point of coordination process regional 14 administrator in assisting the requester in identifying 15 available community-based services as an alternative to 16 continued placement of a patient in the state resource center. 17 For the purposes of this section , “authorized requester” means 18 the parent, guardian, or custodian of a minor patient, the 19 guardian of an adult patient, or an adult patient who does not 20 have a guardian. The assistance shall identify alternatives 21 to continued placement which are appropriate to the patient’s 22 needs and shall include but are not limited to any of the 23 following: 24 Sec. 53. Section 222.60, subsection 1, Code 2011, is amended 25 to read as follows: 26 1. All necessary and legal expenses for the cost of 27 admission or commitment or for the treatment, training, 28 instruction, care, habilitation, support and transportation of 29 persons with mental retardation, as provided for in the county 30 regional mental health and disability services management plan 31 provisions implemented pursuant to section 331.439, subsection 32 1 chapter 331 , in a state resource center, or in a special 33 unit, or any public or private facility within or without the 34 state, approved by the director of the department of human 35 -43- LSB 6075HV (2) 84 jp/rj 43/ 98
H.F. 2431 services, shall be paid by either: 1 a. The person’s county in which such person has legal 2 settlement as defined in section 252.16 of residence unless the 3 expenses are covered by the medical assistance program under 4 chapter 249A . 5 b. The state when such the person has no legal settlement 6 or when such settlement is unknown is a resident in another 7 state or in a foreign country, the residence is unknown, or the 8 expenses are covered by the medical assistance program under 9 chapter 249A . The payment responsibility shall be deemed to be 10 a state case. 11 Sec. 54. Section 222.60, subsection 2, Code 2011, is amended 12 to read as follows: 13 2. a. Prior to a county of legal settlement residence 14 approving the payment of expenses for a person under this 15 section , the county may require that the person be diagnosed 16 to determine if the person has mental retardation or that 17 the person be evaluated to determine the appropriate level 18 of services required to meet the person’s needs relating to 19 mental retardation. The diagnosis and the evaluation may be 20 performed concurrently and shall be performed by an individual 21 or individuals approved by the county who are qualified 22 to perform the diagnosis or the evaluation. Following the 23 initial approval for payment of expenses, the county of legal 24 settlement may require that an evaluation be performed at 25 reasonable time periods. 26 b. The cost of a county-required diagnosis and an evaluation 27 is at the county’s expense. In the case of a person without 28 legal settlement or whose legal settlement is unknown service 29 covered under the medical assistance program , the state 30 may apply the diagnosis and evaluation provisions of this 31 subsection at the state’s expense. 32 c. A diagnosis or an evaluation under this section may be 33 part of a county’s central point of coordination process under 34 section 331.440 , regional service management plan provided that 35 -44- LSB 6075HV (2) 84 jp/rj 44/ 98
H.F. 2431 a diagnosis is performed only by an individual qualified as 1 provided in this section . 2 Sec. 55. Section 222.61, Code 2011, is amended to read as 3 follows: 4 222.61 Legal settlement Residency determined. 5 When a county receives an application on behalf of any 6 person for admission to a resource center or a special unit 7 or when a court issues an order committing any person to a 8 resource center or a special unit, the board of supervisors 9 shall utilize refer the determination of residency to the 10 central point of coordination process regional administrator to 11 determine and certify that the legal settlement residence of 12 the person is in one of the following: 13 1. In the county in which the application is received or in 14 which the court is located. 15 2. In some other county of the state. 16 3. In another state or in a foreign country. 17 4. Unknown. 18 Sec. 56. Section 222.62, Code 2011, is amended to read as 19 follows: 20 222.62 Settlement Residency in another county. 21 When the board of supervisors determines through the central 22 point of coordination process regional administrator determines 23 that the legal settlement residency of the person is other 24 than in the county in which the application is received, the 25 determination shall be certified to the superintendent of the 26 resource center or the special unit where the person is a 27 patient. The certification shall be accompanied by a copy of 28 the evidence supporting the determination. The superintendent 29 shall charge the expenses already incurred and unadjusted, and 30 all future expenses of the patient, to the county certified to 31 be the county of legal settlement residency . 32 Sec. 57. Section 222.63, Code 2011, is amended to read as 33 follows: 34 222.63 Finding of settlement residency —— objection. 35 -45- LSB 6075HV (2) 84 jp/rj 45/ 98
H.F. 2431 A board of supervisors’ certification utilizing of the 1 central point of coordination process county’s regional 2 administrator that a person’s legal settlement residency is in 3 another county shall be sent by the board of supervisors to 4 the auditor of the county of legal settlement residence . The 5 certification shall be accompanied by a copy of the evidence 6 supporting the determination. The auditor of the county of 7 legal settlement residence shall submit the certification 8 to the board of supervisors regional administrator of the 9 auditor’s county and it shall be conclusively presumed that the 10 patient has a legal settlement residency in that county unless 11 that county disputes the determination of legal settlement 12 residency as provided in section 225C.8 331.438F . 13 Sec. 58. Section 222.64, Code 2011, is amended to read as 14 follows: 15 222.64 Foreign state or country or unknown legal settlement 16 residency . 17 If the legal settlement residency of the person is 18 determined by the board of supervisors through the central 19 point of coordination process a county or the state to be in 20 a foreign state or country or is determined to be unknown, 21 the board of supervisors county or the state shall certify 22 the determination to the administrator. The certification 23 shall be accompanied by a copy of the evidence supporting the 24 determination. The care of the person shall be as arranged 25 by the board of supervisors county or the state or by an 26 order as the court may enter. Application for admission or 27 order of commitment may be made pending investigation by the 28 administrator. 29 Sec. 59. Section 222.65, Code 2011, is amended to read as 30 follows: 31 222.65 Investigation. 32 If an application is made for placement of a person in 33 a state resource center or special unit, the department’s 34 administrator shall immediately investigate the legal 35 -46- LSB 6075HV (2) 84 jp/rj 46/ 98
H.F. 2431 settlement residency of the person and proceed as follows: 1 1. If the administrator concurs with a certified 2 determination as to legal settlement residency of the person 3 so that the person is deemed a state case under section 4 222.60 , the administrator shall cause the person either to be 5 transferred to a resource center or a special unit or to be 6 transferred to the place of foreign settlement residency . 7 2. If the administrator disputes a certified determination 8 of legal settlement residency , the administrator shall order 9 the person transferred to a state resource center or a special 10 unit until the dispute is resolved. 11 3. If the administrator disputes a certified determination 12 of legal settlement residency , the administrator shall utilize 13 the procedure provided in section 225C.8 331.438F to resolve 14 the dispute. A determination of the person’s legal settlement 15 residency status made pursuant to section 225C.8 331.438F is 16 conclusive. 17 Sec. 60. Section 222.66, Code 2011, is amended to read as 18 follows: 19 222.66 Transfers —— state cases —— expenses. 20 1. The transfer to a resource center or a special unit or 21 to the place of legal settlement residency of a person with 22 mental retardation who has no legal settlement residence in 23 this state or whose legal settlement residency is unknown, 24 shall be made in accordance with such directions as shall 25 be prescribed by the administrator and when practicable by 26 employees of the state resource center or the special unit. 27 The actual and necessary expenses of such transfers shall be 28 paid by the department on itemized vouchers sworn to by the 29 claimants and approved by the administrator and the approved 30 amount is appropriated to the department from any funds in the 31 state treasury not otherwise appropriated. 32 2. The case of a person with mental retardation who 33 is determined to have no residence in this state or whose 34 residence is unknown shall be considered a state case. 35 -47- LSB 6075HV (2) 84 jp/rj 47/ 98
H.F. 2431 Sec. 61. Section 222.67, Code 2011, is amended to read as 1 follows: 2 222.67 Charge on finding of settlement residency . 3 If a person has been received into a resource center or a 4 special unit as a patient whose legal settlement is supposedly 5 outside the state or residency is unknown and the administrator 6 determines that the legal settlement residency of the patient 7 was at the time of admission or commitment in a county of 8 this state, the administrator shall certify the determination 9 and charge all legal costs and expenses pertaining to the 10 admission or commitment and support of the patient to the 11 county of legal settlement residence . The certification shall 12 be sent to the county of legal settlement residence . The 13 certification shall be accompanied by a copy of the evidence 14 supporting the determination. If the person’s legal settlement 15 residency status has been determined in accordance with section 16 225C.8 331.438F , the legal costs and expenses shall be charged 17 to the county or as a state case in accordance with that 18 determination. The costs and expenses shall be collected as 19 provided by law in other cases. 20 Sec. 62. Section 222.68, Code 2011, is amended to read as 21 follows: 22 222.68 Costs paid in first instance. 23 All necessary and legal expenses for the cost of admission 24 or commitment of a person to a resource center or a special 25 unit when the person’s legal settlement residency is found to 26 be in another county of this state shall in the first instance 27 be paid by the county from which the person was admitted or 28 committed. The county of legal settlement residence shall 29 reimburse the county which pays for all such expenses. Where 30 any If a county fails to make such reimbursement within 31 forty-five days following submission of a properly itemized 32 bill to the county of legal settlement residence , a penalty of 33 not greater than one percent per month on and after forty-five 34 days from submission of the bill may be added to the amount 35 -48- LSB 6075HV (2) 84 jp/rj 48/ 98
H.F. 2431 due. 1 Sec. 63. Section 222.69, Code 2011, is amended to read as 2 follows: 3 222.69 Payment by state. 4 All The amount necessary to pay the necessary and legal 5 expenses for the cost of admission or commitment of a person 6 to a resource center or a special unit when the person’s legal 7 settlement residence is outside this state or is unknown shall 8 be paid out of is appropriated to the department from any 9 money in the state treasury not otherwise appropriated. Such 10 payments shall be made by the department on itemized vouchers 11 executed by the auditor of the county from which the expenses 12 have been paid and approved by the administrator. 13 Sec. 64. Section 222.70, Code 2011, is amended to read as 14 follows: 15 222.70 Legal settlement Residency disputes. 16 If a dispute arises between counties or between the 17 department and a county as to the legal settlement residency 18 of a person admitted or committed to a resource center, a 19 special unit, or a community-based service, the dispute shall 20 be resolved as provided in section 225C.8 331.438F . 21 Sec. 65. Section 222.77, Code 2011, is amended to read as 22 follows: 23 222.77 Patients on leave. 24 The cost of support of patients placed on convalescent leave 25 or removed as a habilitation measure from a resource center, 26 or a special unit, except when living in the home of a person 27 legally bound for the support of the patient, shall be paid 28 by the county of legal settlement residence or the state as 29 provided in section 222.60 . If the patient has no county of 30 legal settlement, the cost shall be paid from the support fund 31 of the resource center or special unit and charged on abstract 32 in the same manner as other state inpatients until the patient 33 becomes self-supporting or qualifies for support under other 34 statutes. 35 -49- LSB 6075HV (2) 84 jp/rj 49/ 98
H.F. 2431 Sec. 66. Section 222.78, Code 2011, is amended to read as 1 follows: 2 222.78 Parents and others liable for support. 3 1. The father and mother of any patient admitted or 4 committed to a resource center or to a special unit, as 5 either an inpatient or an outpatient, and any person, firm, or 6 corporation bound by contract made for support of the patient 7 are liable for the support of the patient. The patient and 8 those legally bound for the support of the patient shall be 9 liable to the county or state, as applicable, for all sums 10 advanced by the county to the state under in accordance with 11 the provisions of sections 222.60 and 222.77 . 12 2. The liability of any person, other than the patient, 13 who is legally bound for the support of a patient who is under 14 eighteen years of age in a resource center or a special unit 15 shall not exceed the average minimum cost of the care of a 16 normally intelligent minor without a disability of the same 17 age and sex as the minor patient. The administrator shall 18 establish the scale for this purpose but the scale shall not 19 exceed the standards for personal allowances established by 20 the state division under the family investment program. The 21 father or mother shall incur liability only during any period 22 when the father or mother either individually or jointly 23 receive a net income from whatever source, commensurate with 24 that upon which they would be liable to make an income tax 25 payment to this state. The father or mother of a patient shall 26 not be liable for the support of the patient upon the patient 27 attaining eighteen years of age. Nothing in this section 28 shall be construed to prevent a relative or other person 29 from voluntarily paying the full actual cost as established 30 by the administrator for caring for the patient with mental 31 retardation. 32 Sec. 67. Section 222.79, Code 2011, is amended to read as 33 follows: 34 222.79 Certification statement presumed correct. 35 -50- LSB 6075HV (2) 84 jp/rj 50/ 98
H.F. 2431 In actions to enforce the liability imposed by section 1 222.78 , the certification statement sent from the 2 superintendent to the county auditor pursuant to section 3 222.74 or the county of residence, as applicable, shall submit 4 a certification statement stating the sums charged in such 5 cases and the certification statement shall be considered 6 presumptively correct. 7 Sec. 68. Section 222.80, Code 2011, is amended to read as 8 follows: 9 222.80 Liability to county or state . 10 A person admitted or committed to a county institution or 11 home or admitted or committed at county or state expense to a 12 private hospital, sanitarium, or other facility for treatment, 13 training, instruction, care, habilitation, and support as a 14 patient with mental retardation shall be liable to the county 15 or state, as applicable, for the reasonable cost of the support 16 as provided in section 222.78 . 17 Sec. 69. Section 222.82, Code 2011, is amended to read as 18 follows: 19 222.82 Collection of liabilities and claims. 20 The If liabilities and claims exist as provided in section 21 222.78 or other provision of this chapter, the county of 22 residence or the state, as applicable, may proceed as provided 23 in this section. If the liabilities and claims are owed to 24 a county of residence, the county’s board of supervisors of 25 each county may direct the county attorney to proceed with the 26 collection of said the liabilities and claims as a part of 27 the duties of the county attorney’s office when the board of 28 supervisors deems such action advisable. If the liabilities 29 and claims are owed to the state, the state shall proceed 30 with the collection. The board of supervisors or the state, 31 as applicable, may and is hereby empowered to compromise any 32 and all liabilities to the county or state arising under this 33 chapter when such compromise is deemed to be in the best 34 interests of the county or state . Any collections and liens 35 -51- LSB 6075HV (2) 84 jp/rj 51/ 98
H.F. 2431 shall be limited in conformance to section 614.1, subsection 4 . 1 Sec. 70. Section 222.86, Code 2011, is amended to read as 2 follows: 3 222.86 Payment for care from fund. 4 If a patient is not receiving medical assistance under 5 chapter 249A and the amount in the account of any patient 6 in the patients’ personal deposit fund exceeds two hundred 7 dollars, the business manager of the resource center or special 8 unit may apply any amount of the excess to reimburse the 9 county of legal settlement or the state in a case where no 10 legal settlement exists residence for liability incurred by 11 the county or the state for the payment of care, support, and 12 maintenance of the patient, when billed by the county of legal 13 settlement or by the administrator for a patient having no 14 legal settlement or state, as applicable . 15 Sec. 71. Section 222.92, subsection 3, paragraph a, Code 16 2011, is amended to read as follows: 17 a. Moneys received by the state from billings to counties 18 under section 222.73 . 19 Sec. 72. Section 225.11, Code 2011, is amended to read as 20 follows: 21 225.11 Initiating commitment procedures. 22 When a court finds upon completion of a hearing held pursuant 23 to section 229.12 that the contention that a respondent is 24 seriously mentally impaired has been sustained by clear and 25 convincing evidence, and the application filed under section 26 229.6 also contends or the court otherwise concludes that it 27 would be appropriate to refer the respondent to the state 28 psychiatric hospital for a complete psychiatric evaluation and 29 appropriate treatment pursuant to section 229.13 , the judge 30 may order that a financial investigation be made in the manner 31 prescribed by section 225.13 . If the costs of a respondent’s 32 evaluation or treatment are payable in whole or in part by 33 a county, an order under this section shall be for referral 34 of the respondent through the central point of coordination 35 -52- LSB 6075HV (2) 84 jp/rj 52/ 98
H.F. 2431 process regional administrator for an evaluation and referral 1 of the respondent to an appropriate placement or service, which 2 may include the state psychiatric hospital for additional 3 evaluation or treatment. For purposes of this chapter , “central 4 point of coordination process” “regional administrator” means the 5 same as defined in section 331.440 331.438A . 6 Sec. 73. Section 225.15, Code 2011, is amended to read as 7 follows: 8 225.15 Examination and treatment. 9 1. When a respondent arrives at the state psychiatric 10 hospital, the admitting physician shall examine the respondent 11