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