H.F. 248 DIVISION I 1 COMMUNITY MENTAL HEALTH CENTERS —— CATCHMENT AREAS 2 Section 1. NEW SECTION . 230A.101 Services system roles. 3 1. The role of the department of human services, through 4 the division of the department designated as the state 5 mental health authority with responsibility for state policy 6 concerning mental health and disability services, is to develop 7 and maintain policies for the mental health and disability 8 services system. The policies shall address the service needs 9 of individuals of all ages with disabilities in this state, 10 regardless of the individuals’ places of residence or economic 11 circumstances, and shall be consistent with the requirements of 12 chapter 225C and other applicable law. 13 2. The role of community mental health centers in the 14 mental health and disability services system is to provide 15 an organized set of services in order to adequately meet the 16 mental health needs of this state’s citizens based on organized 17 catchment areas. 18 Sec. 2. NEW SECTION . 230A.102 Definitions. 19 As used in this chapter, unless the context otherwise 20 requires: 21 1. “Administrator” , “commission” , “department” , “disability 22 services” , and “division” mean the same as defined in section 23 225C.2. 24 2. “Catchment area” means a community mental health center 25 catchment area identified in accordance with this chapter. 26 3. “Community mental health center” or “center” means a 27 community mental health center designated in accordance with 28 this chapter. 29 Sec. 3. NEW SECTION . 230A.103 Designation of community 30 mental health centers. 31 1. The division, subject to agreement by the boards of 32 supervisors of the affected counties and any community mental 33 health center that would provide services for the catchment 34 area, shall designate at least one community mental health 35 -1- LSB 1785HH (3) 84 jp/nh 1/ 19

H.F. 248 center under this chapter to serve the mental health needs of 1 the county or counties comprising the catchment area. The 2 designation process shall provide for the input of potential 3 service providers regarding designation of the initial 4 catchment area or a change in the designation. 5 2. The division shall utilize objective criteria for 6 designating a community mental health center to serve a 7 catchment area and for withdrawing such designation. The 8 commission shall adopt rules outlining the criteria. The 9 criteria shall include but are not limited to provisions for 10 meeting all of the following requirements: 11 a. An appropriate means shall be used for determining which 12 prospective designee is best able to serve all ages of the 13 targeted population within the catchment area with minimal or 14 no service denials. 15 b. An effective means shall be used for determining the 16 relative ability of a prospective designee to appropriately 17 provide mental health services and other support to consumers 18 residing within a catchment area as well as consumers residing 19 outside the catchment area. The criteria shall address the 20 duty for a prospective designee to arrange placements outside 21 the catchment area when such placements best meet consumer 22 needs and to provide services within the catchment area to 23 consumers who reside outside the catchment area when the 24 services are necessary and appropriate. 25 3. The board of directors for a designated community mental 26 center shall enter into an agreement with the division and 27 the counties affiliated with the catchment area served by 28 the center, as applicable. The terms of the agreement shall 29 include but are not limited to all of the following: 30 a. The period of time the agreement will be in force. 31 b. The services and other support the center will offer or 32 provide for the residents of the catchment area. 33 c. The standards to be followed by the center in determining 34 whether and to what extent the persons seeking services from 35 -2- LSB 1785HH (3) 84 jp/nh 2/ 19

H.F. 248 the center shall be considered to be able to pay the costs of 1 the services. 2 d. The policies regarding availability of the services 3 offered by the center to the residents of the catchment area as 4 well as consumers residing outside the catchment area. 5 e. The requirements for preparation and submission to the 6 division of annual audits, cost reports, program reports, 7 performance measures, and other financial and service 8 accountability information. 9 4. This section does not limit the authority of the board 10 or boards of supervisors of any county or group of counties to 11 continue to expend money to support operation of a center. 12 Sec. 4. NEW SECTION . 230A.104 Catchment areas. 13 1. The division shall collaborate with affected counties in 14 identifying community mental health center catchment areas in 15 accordance with the requirements of this section. 16 2. The division shall implement objective criteria for 17 identifying or revising catchment areas which shall be 18 identified in rule adopted by the commission. The criteria 19 shall provide for dividing the state into catchment areas 20 based upon consideration of city and county lines, population 21 sufficiency, geographic spread and population density, and 22 service provider viability, capacity, and availability. In 23 addition, the criteria shall include but are not limited to 24 provisions for meeting all of the following requirements: 25 a. Unless the division has determined that exceptional 26 circumstances exist, a catchment area shall be served by one 27 community mental health center. The purpose of this general 28 limitation is to clearly designate the center responsible and 29 accountable for providing core mental health services to the 30 target population in the catchment area and to protect the 31 financial viability of the centers comprising the mental health 32 services system in the state. 33 b. A formal review process shall be used in determining 34 whether exceptional circumstances exist that justify 35 -3- LSB 1785HH (3) 84 jp/nh 3/ 19

H.F. 248 designating more than one center to serve a catchment area. 1 The criteria for the review process shall include but are not 2 limited to a means of determining whether the catchment area 3 can support more than one center. 4 c. Criteria shall be provided that would allow the 5 designation of more than one center for all or a portion of a 6 catchment area if designation or approval for more than one 7 center was provided by both the division and the affected 8 counties as of October 1, 2010. The criteria shall require a 9 determination that all such centers would be financially viable 10 if designation is provided for all. 11 d. A period of time for counties to self-select the 12 initial catchment area affiliation in accordance with 13 identified criteria. In addition, the division shall identify 14 requirements for a county to change the county’s catchment area 15 affiliation or to contract for certain services with a center 16 from a different catchment area or with an individual provider. 17 e. All counties in the state shall be part of a catchment 18 area. The identification criteria shall provide a means of 19 determining that each catchment area can financially support at 20 least one center. 21 Sec. 5. NEW SECTION . 230A.105 Target population —— 22 eligibility. 23 1. The target population residing in a catchment area to be 24 served by a community mental health center shall include but is 25 not limited to all of the following: 26 a. Individuals of any age who are experiencing a mental 27 health crisis. 28 b. Individuals of any age who have a mental health disorder. 29 c. Adults who have a serious mental illness or chronic 30 mental illness. 31 d. Children and youth who are experiencing a serious 32 emotional disturbance. 33 e. Individuals described in paragraph “a” , “b” , “c” , 34 or “d” who have a co-occurring disorder, including but not 35 -4- LSB 1785HH (3) 84 jp/nh 4/ 19

H.F. 248 limited to substance abuse, mental retardation, a developmental 1 disability, brain injury, autism spectrum disorder, or another 2 disability or special health care need. 3 2. Specific eligibility criteria for members of the target 4 population shall be identified in administrative rules adopted 5 by the commission. The eligibility criteria shall address both 6 clinical and financial eligibility. 7 Sec. 6. NEW SECTION . 230A.106 Services offered. 8 1. A community mental health center designated in 9 accordance with this chapter shall offer core services and 10 support addressing the basic mental health and safety needs of 11 the target population and other residents of the catchment area 12 served by the center and may offer other services and support. 13 The core services shall be identified in administrative rules 14 adopted by the commission for this purpose. 15 2. The initial core services identified shall include all 16 of the following: 17 a. Outpatient services. Outpatient services shall consist 18 of evaluation and treatment services provided on an ambulatory 19 basis for the target population. Outpatient services include 20 psychiatric evaluations, medication management, and individual, 21 family, and group therapy. In addition, outpatient services 22 shall include specialized outpatient services directed to 23 the following segments of the target population: children, 24 elderly, individuals who have serious and persistent mental 25 illness, and residents of the service area who have been 26 discharged from inpatient treatment at a mental health 27 facility. Outpatient services shall provide elements of 28 diagnosis, treatment, and appropriate follow-up. The provision 29 of only screening and referral services does not constitute 30 outpatient services. 31 b. Twenty-four-hour emergency services. Twenty-four-hour 32 emergency services shall be provided through a system that 33 provides access to a clinician and appropriate disposition with 34 follow-up documentation of the emergency service provided. 35 -5- LSB 1785HH (3) 84 jp/nh 5/ 19

H.F. 248 A patient shall have access to evaluation and stabilization 1 services after normal business hours. The range of emergency 2 services that shall be available to a patient may include but 3 are not limited to direct contact with a clinician, medication 4 evaluation, and hospitalization. The emergency services may 5 be provided directly by the center or in collaboration or 6 affiliation with other appropriately accredited providers. 7 c. Day treatment, partial hospitalization, or psychosocial 8 rehabilitation services. Such services shall be provided as 9 structured day programs in segments of less than twenty-four 10 hours using a multidisciplinary team approach to develop 11 treatment plans that vary in intensity of services and the 12 frequency and duration of services based on the needs of the 13 patient. These services may be provided directly by the center 14 or in collaboration or affiliation with other appropriately 15 accredited providers. 16 d. Admission screening for voluntary patients. Admission 17 screening services shall be available for patients considered 18 for voluntary admission to a state mental health institute to 19 determine the patient’s appropriateness for admission. 20 e. Community support services. Community support services 21 shall consist of support and treatment services focused 22 on enhancing independent functioning and assisting persons 23 in the target population who have a serious and persistent 24 mental illness to live and work in their community setting, by 25 reducing or managing mental illness symptoms and the associated 26 functional disabilities that negatively impact such persons’ 27 community integration and stability. 28 f. Consultation services. Consultation services may 29 include provision of professional assistance and information 30 about mental health and mental illness to individuals, service 31 providers, or groups to increase such persons’ effectiveness 32 in carrying out their responsibilities for providing services. 33 Consultations may be case-specific or program-specific. 34 g. Education services. Education services may include 35 -6- LSB 1785HH (3) 84 jp/nh 6/ 19

H.F. 248 information and referral services regarding available 1 resources and information and training concerning mental 2 health, mental illness, availability of services and other 3 support, the promotion of mental health, and the prevention 4 of mental illness. Education services may be made available 5 to individuals, groups, organizations, and the community in 6 general. 7 3. A community mental health center shall be responsible 8 for coordinating with associated services provided by other 9 unaffiliated agencies to members of the target population in 10 the catchment area and to integrate services in the community 11 with services provided to the target population in residential 12 or inpatient settings. 13 Sec. 7. NEW SECTION . 230A.107 Form of organization. 14 1. Except as authorized in subsection 2, a community mental 15 health center designated in accordance with this chapter shall 16 be organized and administered as a nonprofit corporation. 17 2. A for-profit corporation, nonprofit corporation, or 18 county hospital providing mental health services to county 19 residents pursuant to a waiver approved under section 225C.7, 20 subsection 3, Code 2011, as of October 1, 2010, may also be 21 designated as a community mental health center. 22 Sec. 8. NEW SECTION . 230A.108 Administrative, diagnostic, 23 and demographic information. 24 Release of administrative and diagnostic information, as 25 defined in section 228.1, and demographic information necessary 26 for aggregated reporting to meet the data requirements 27 established by the division, relating to an individual who 28 receives services from a community mental health center through 29 the applicable central point of coordination process, may be 30 made a condition of support of that center by any county in the 31 center’s catchment area. 32 Sec. 9. NEW SECTION . 230A.109 Funding —— legislative 33 intent. 34 1. It is the intent of the general assembly that public 35 -7- LSB 1785HH (3) 84 jp/nh 7/ 19

H.F. 248 funding for community mental health centers designated in 1 accordance with this chapter shall continue to be provided as a 2 combination of federal, state, and county funding. The funding 3 sources may include but are not limited to federal supplemental 4 security income, block grants and other grants, and medical 5 assistance program funding, state allowed growth and property 6 tax relief funding, and county property tax funding. 7 2. It is the intent of the general assembly that the shared 8 state and county funding provided to centers be a sufficient 9 amount for the core services and support addressing the 10 basic mental health and safety needs of the residents of the 11 catchment area served by each center to be provided regardless 12 of individual ability to pay for the services and support. 13 3. While a community mental health center must comply with 14 the core services requirements and other standards associated 15 with designation, provision of services is subject to the 16 availability of a payment source for the services. 17 Sec. 10. NEW SECTION . 230A.110 Standards. 18 1. The division shall recommend and the commission shall 19 adopt standards for designated community mental health centers 20 and comprehensive community mental health programs, with 21 the overall objective of ensuring that each center and each 22 affiliate providing services under contract with a center 23 furnishes high-quality mental health services within a 24 framework of accountability to the community it serves. The 25 standards adopted shall be in substantial conformity with 26 the applicable behavioral health standards adopted by the 27 joint commission, formerly known as the joint commission 28 on accreditation of health care organizations, and other 29 recognized national standards for evaluation of psychiatric 30 facilities unless in the judgment of the division, with 31 approval of the commission, there are sound reasons for 32 departing from the standards. 33 2. When recommending standards under this section, the 34 division shall designate an advisory committee representing 35 -8- LSB 1785HH (3) 84 jp/nh 8/ 19

H.F. 248 boards of directors and professional staff of designated 1 community mental health centers to assist in the formulation 2 or revision of standards. The membership of the advisory 3 committee shall include representatives of professional and 4 nonprofessional staff, at least one representative of county 5 boards of supervisors and central point of coordination 6 administrators, and other appropriate individuals. 7 3. The standards recommended under this section shall 8 include requirements that each community mental health center 9 designated under this chapter do all of the following: 10 a. Maintain and make available to the public a written 11 statement of the services the center offers to residents of 12 the catchment area being served. The center shall employ or 13 contract for services with affiliates to employ staff who are 14 appropriately credentialed or meet other qualifications in 15 order to provide services. 16 b. If organized as a nonprofit corporation, be governed by 17 a board of directors which adequately represents interested 18 professions, consumers of the center’s services, socioeconomic, 19 cultural, and age groups, and various geographical areas in 20 the catchment area served by the center. If organized as a 21 for-profit corporation, the corporation’s policy structure 22 shall incorporate such representation. 23 c. Arrange for the financial condition and transactions of 24 the community mental health center to be audited once each year 25 by the auditor of state. However, in lieu of an audit by state 26 accountants, the local governing body of a community mental 27 health center organized under this chapter may contract with 28 or employ certified public accountants to conduct the audit, 29 pursuant to the applicable terms and conditions prescribed by 30 sections 11.6 and 11.19 and audit format prescribed by the 31 auditor of state. Copies of each audit shall be furnished by 32 the accountant to the administrator of the division of mental 33 health and disability services and the board or boards of 34 supervisors supporting the audited community mental health 35 -9- LSB 1785HH (3) 84 jp/nh 9/ 19

H.F. 248 center. 1 d. Comply with the accreditation standards applicable to the 2 center. 3 Sec. 11. NEW SECTION . 230A.111 Review and evaluation. 4 1. The review and evaluation of designated centers shall 5 be performed through a formal accreditation review process as 6 recommended by the division and approved by the commission. 7 The accreditation process shall include all of the following: 8 a. Specific time intervals for full accreditation reviews 9 based upon levels of accreditation. 10 b. Use of random or complaint-specific, on-site limited 11 accreditation reviews in the interim between full accreditation 12 reviews, as a quality review approach. The results of such 13 reviews shall be presented to the commission. 14 c. Use of center accreditation self-assessment tools to 15 gather data regarding quality of care and outcomes, whether 16 used during full or limited reviews or at other times. 17 2. The accreditation process shall include but is not 18 limited to addressing all of the following: 19 a. Measures to address centers that do not meet standards, 20 including authority to revoke accreditation. 21 b. Measures to address noncompliant centers that do not 22 develop a corrective action plan or fail to implement steps 23 included in a corrective action plan accepted by the division. 24 c. Measures to appropriately recognize centers that 25 successfully complete a corrective action plan. 26 d. Criteria to determine when a center’s accreditation 27 should be denied, revoked, suspended, or made provisional. 28 Sec. 12. IMPLEMENTATION. 29 1. Community mental health centers operating under 30 the provisions of chapter 230A, Code 2011, and associated 31 standards, rules, and other requirements as of June 30, 2011, 32 may continue to operate under such requirements until the 33 department of human services, division of mental health and 34 disability services, and the mental health and disability 35 -10- LSB 1785HH (3) 84 jp/nh 10/ 19

H.F. 248 services commission have completed the rules adoption process 1 to implement the amendments to chapter 230A enacted by this 2 Act, identified catchment areas, and completed designations of 3 centers. 4 2. The division and the commission shall complete the rules 5 adoption process and other requirements addressed in subsection 6 1 on or before June 30, 2012. 7 Sec. 13. REPEAL. Sections 230A.1 through 230A.18, Code 8 2011, are repealed. 9 DIVISION II 10 CONFORMING AMENDMENTS 11 Sec. 14. Section 135.80, subsection 3, Code 2011, is amended 12 to read as follows: 13 3. The program shall provide stipends to support 14 psychiatrist positions with an emphasis on securing and 15 retaining medical directors at community mental health centers, 16 providers of mental health services to county residents 17 pursuant to a waiver approved under section 225C.7, subsection 18 3 , and hospital psychiatric units that are located in mental 19 health professional shortage areas. 20 Sec. 15. Section 225C.4, subsection 1, paragraph o, Code 21 2011, is amended to read as follows: 22 o. Recommend to the commission minimum accreditation 23 standards for the maintenance and operation of community 24 mental health centers, services, and programs designated under 25 section 230A.16 chapter 230A . The administrator’s review 26 and evaluation of the centers, services, and programs for 27 compliance with the adopted standards shall be as provided in 28 section 230A.17 chapter 230A . 29 Sec. 16. Section 225C.6, subsection 1, paragraph c, Code 30 2011, is amended to read as follows: 31 c. Adopt standards for community mental health centers, 32 services, and programs as recommended under section 230A.16 by 33 the administrator . The administrator shall determine whether 34 to grant, deny, or revoke the accreditation of the centers, 35 -11- LSB 1785HH (3) 84 jp/nh 11/ 19

H.F. 248 services, and programs. 1 Sec. 17. Section 225C.7, subsection 3, Code 2011, is amended 2 to read as follows: 3 3. If a county has not established or is not affiliated 4 with a community mental health center under chapter 230A , 5 the county shall expend a portion of the money received 6 under this appropriation to contract with a community mental 7 health center to provide mental health services to the 8 county’s residents. If such a contractual relationship 9 is unworkable or undesirable, the commission may waive the 10 expenditure requirement. However, if the commission waives the 11 requirement, the commission shall address the specific concerns 12 of the county and shall attempt to facilitate the provision 13 of mental health services to the county’s residents through 14 an affiliation agreement or other means. A county must be 15 affiliated with the community mental health center designated 16 in accordance with chapter 230A in order to receive moneys from 17 the fund. 18 Sec. 18. Section 225C.15, Code 2011, is amended to read as 19 follows: 20 225C.15 County implementation of evaluations. 21 The board of supervisors of a county shall , no later 22 than July 1, 1982, require that the preadmission diagnostic 23 evaluation policy stated in section 225C.14 be followed with 24 respect to admission of persons from that county to a state 25 mental health institute. A community mental health center 26 which is supported, directly or in affiliation with other 27 counties, by that county designated for the county’s catchment 28 area may perform the preliminary diagnostic evaluations for 29 that county, unless the performance of the evaluations is 30 not covered by the agreement entered into by the county and 31 the center under section 230A.12 , and the center’s director 32 certifies to the board of supervisors that the center does not 33 have the capacity to perform the evaluations, in which case 34 the board of supervisors shall proceed with an alternative 35 -12- LSB 1785HH (3) 84 jp/nh 12/ 19

H.F. 248 diagnostic facility as provided under section 225C.17 . 1 Sec. 19. Section 225C.19, subsection 3, paragraph a, Code 2 2011, is amended to read as follows: 3 a. Standards for accrediting or approving emergency mental 4 health crisis services providers. Such providers may include 5 but are not limited to a community mental health center, a 6 provider approved in a waiver adopted by the commission to 7 provide services to a county in lieu of a community mental 8 health center, a unit of the department or other state agency, 9 a county, or any other public or private provider who meets the 10 accreditation or approval standards for an emergency mental 11 health crisis services provider. 12 Sec. 20. Section 225C.54, subsection 1, Code 2011, is 13 amended to read as follows: 14 1. The mental health services system for children and youth 15 shall be initially implemented by the division commencing with 16 the fiscal year beginning July 1, 2008. The division shall 17 begin implementation by utilizing a competitive bidding process 18 to allocate state block grants to develop services through 19 existing community mental health centers , providers approved 20 in a waiver adopted by the commission to provide services to a 21 county in lieu of a community mental health center, designated 22 in accordance with chapter 230A and other local service 23 partners. The implementation shall be limited to the extent of 24 the appropriations provided for the children’s system. 25 Sec. 21. Section 228.6, subsection 1, Code 2011, is amended 26 to read as follows: 27 1. A mental health professional or an employee of or 28 agent for a mental health facility may disclose mental health 29 information if and to the extent necessary, to meet the 30 requirements of section 229.24 , 229.25 , 230.20 , 230.21 , 230.25 , 31 230.26 , 230A.13 230A.108 , 232.74 , or 232.147 , or to meet the 32 compulsory reporting or disclosure requirements of other state 33 or federal law relating to the protection of human health and 34 safety. 35 -13- LSB 1785HH (3) 84 jp/nh 13/ 19

H.F. 248 Sec. 22. Section 232.78, subsection 5, unnumbered paragraph 1 1, Code 2011, is amended to read as follows: 2 The juvenile court, before or after the filing of a petition 3 under this chapter , may enter an ex parte order authorizing 4 a physician or hospital to conduct an outpatient physical 5 examination or authorizing a physician, a psychologist 6 certified under section 154B.7 , or a community mental health 7 center accredited pursuant to designated under chapter 230A 8 to conduct an outpatient mental examination of a child if 9 necessary to identify the nature, extent, and cause of injuries 10 to the child as required by section 232.71B , provided all of 11 the following apply: 12 Sec. 23. Section 232.83, subsection 2, unnumbered paragraph 13 1, Code 2011, is amended to read as follows: 14 Anyone authorized to conduct a preliminary investigation 15 in response to a complaint may apply for, or the court on its 16 own motion may enter an ex parte order authorizing a physician 17 or hospital to conduct an outpatient physical examination or 18 authorizing a physician, a psychologist certified under section 19 154B.7 , or a community mental health center accredited pursuant 20 to designated under chapter 230A to conduct an outpatient 21 mental examination of a child if necessary to identify the 22 nature, extent, and causes of any injuries, emotional damage, 23 or other such needs of a child as specified in section 232.2, 24 subsection 6 , paragraph “c” , “e” , or “f” , provided that all of 25 the following apply: 26 Sec. 24. Section 235A.15, subsection 2, paragraph c, 27 subparagraph (6), Code 2011, is amended to read as follows: 28 (6) To an administrator of a community mental health center 29 accredited under designated in accordance with chapter 230A if 30 the data concerns a person employed or being considered for 31 employment by the center. 32 Sec. 25. Section 331.321, subsection 1, paragraph e, Code 33 2011, is amended by striking the paragraph. 34 Sec. 26. Section 331.382, subsection 1, paragraph f, Code 35 -14- LSB 1785HH (3) 84 jp/nh 14/ 19

H.F. 248 2011, is amended by striking the paragraph. 1 EXPLANATION 2 This bill relates to the requirements of community mental 3 health centers under Code chapter 230A. The bill is organized 4 into divisions. 5 CODE CHAPTER 230A AMENDMENTS. This division repeals and 6 replaces Code chapter 230A which was originally enacted by 1974 7 Iowa Acts, chapter 1160. 8 The bill maintains the requirements under current law 9 for accreditation of community mental health centers to be 10 performed by the department of human services (DHS), division 11 of mental health and disability services, in accordance 12 with standards adopted by the mental health and disability 13 services commission. 2008 Iowa Acts, chapter 1187, required 14 the division to utilize an advisory group to develop a 15 proposal for revising Code chapter 230A and for revising the 16 accreditation process for centers. Until the proposal has been 17 considered and acted upon by the general assembly, the division 18 administrator is authorized to defer consideration of requests 19 for accreditation of a new community mental health center or 20 for approval of a provider to fill the role of a center. The 21 proposal was submitted to the governor and general assembly 22 April 17, 2009. The bill provides for implementation of the 23 proposal. 24 The current Code chapter provides for community mental 25 health centers to either be directly established by a county 26 or counties and administered by a board of trustees or by 27 establishment of a nonprofit corporation operating on the basis 28 of an agreement with a county or counties. Code section 225C.7 29 allows the department of human services to authorize the center 30 services to be provided by an alternative provider. 31 The bill replaces this approach by requiring the division 32 and commission to consult with affected counties in identifying 33 catchment areas of counties to be served by a center. The 34 general requirement is for one center to be designated to 35 -15- LSB 1785HH (3) 84 jp/nh 15/ 19

H.F. 248 serve a catchment area but more than one can be designated if 1 exceptional circumstances outlined in the bill are determined 2 to exist. 3 New Code section 230A.101 describes the regulatory and 4 policy role to be filled by the department and the service 5 provider role of the community mental health centers. 6 New Code section 230A.102 provides definitions. These 7 terms, defined in Code chapter 225C, are adopted by reference: 8 “administrator” (administrator of MH and disability services 9 division), “commission” (mental health and disability services 10 commission), “department” (DHS), “disability services” 11 (services and other support available to a person with mental 12 illness, MR or other developmental disability or brain injury), 13 and “division” (MH and disability services division). In 14 addition, the terms “community mental health center” and 15 “catchment area” are defined to reflect the contents of the 16 bill. 17 New Code section 230A.103 provides criteria to be 18 implemented by the division for designation of at least one 19 community mental health center to serve a catchment area 20 consisting of a county or counties. Various operating and 21 services requirements are to be addressed in the terms of an 22 agreement between the designated center, the division, and the 23 counties comprising the catchment area. 24 New Code section 230A.104 provides for the division to 25 implement objective criteria for identifying catchment areas 26 for centers. A general limitation of one center per catchment 27 area is stated, however, the criteria are to include a formal 28 review process for use in determining whether exceptional 29 circumstances exist for designating more than one center 30 for a catchment area. The other stated criteria involve 31 determinations of financial viability for a center to operate. 32 New Code section 230A.105 lists the attributes of the 33 target population required to be served by a center. The 34 list includes individuals of any age experiencing a mental 35 -16- LSB 1785HH (3) 84 jp/nh 16/ 19

H.F. 248 health crisis or disorder, adults who have a serious or chronic 1 mental illness, children and youth experiencing a serious 2 emotional disturbance, and listed individuals who also have a 3 co-occurring disorder. The specific clinical and financial 4 eligibility criteria are required to be identified in rules 5 adopted by the commission. 6 New Code section 230A.106 requires each designated center 7 to offer core services and support addressing the basic mental 8 health and safety needs of the target population and other 9 residents of the catchment area. The core services are to be 10 identified in rules adopted by the commission. 11 An initial list of core services is specified to include the 12 following: outpatient services; 24-hour emergency services; 13 day treatment, partial hospitalization, or psychological 14 rehabilitation services; admission screening for voluntary 15 patients; community support services; consultation services; 16 and education services. 17 In addition, a center is responsible for coordinating 18 associated services provided by other unaffiliated agencies to 19 members of the target population and for integrating services 20 provided to the target population in residential or inpatient 21 settings. 22 New Code section 230A.107 requires a designated center to be 23 organized as a nonprofit corporation. However, a for-profit 24 corporation, nonprofit corporation, or county hospital 25 providing services under a waiver approved as of October 1, 26 2010, may also be designated. 27 New Code section 230A.108 requires release of 28 administrative, diagnostic, and demographic information as a 29 condition of support by any of the counties in the catchment 30 area served by a center. Language with a similar requirement 31 is part of current law in Code section 230A.13, relating to 32 annual budgets of centers. 33 New Code section 230A.109 states legislative intent 34 regarding continuation of the current combination of federal, 35 -17- LSB 1785HH (3) 84 jp/nh 17/ 19

H.F. 248 state, and county funding supporting centers and for the amount 1 of funding to be sufficient for core services to be provided 2 regardless of an individual’s ability to pay for the services. 3 This section also states that provision of services is subject 4 to the availability of payment sources for the services. 5 New Code section 230A.110 provides for accreditation 6 standards for centers to be recommended by the division 7 and adopted by the commission. The standards are to be in 8 substantial conformity with certain national standards. The 9 division is directed to use an advisory committee to assist in 10 standards development. In addition, the standards recommended 11 are required to include various organizational requirements. 12 New Code section 230A.111 addresses how the review and 13 evaluation components of the accreditation process are to be 14 performed. 15 An implementation section authorizes centers operating under 16 current law as of June 30, 2011, to continue operating until 17 the rules are adopted, catchment areas are identified, and 18 centers are designated, as required by the bill. The division 19 and commission are required to complete those requirements on 20 or before June 30, 2012. 21 CONFORMING AMENDMENTS. This division amends internal 22 references and provides other conforming amendments in the 23 following Code provisions: Code section 135.80, relating to 24 the mental health professional shortage area program; Code 25 section 225C.4, relating to the duties of the MH and disability 26 services administrator; Code section 225C.6, relating to 27 the duties of the commission, Code section 225C.7, relating 28 to the requirements for the MH/DD community services fund; 29 Code section 225C.15, relating to county implementation 30 of evaluations relating to admissions of persons from the 31 counties to a state mental health institute; Code section 32 225C.19, relating to implementation of an emergency mental 33 health services system; Code section 225C.54, relating to 34 implementation of a mental health services system for children 35 -18- LSB 1785HH (3) 84 jp/nh 18/ 19

H.F. 248 and youth; Code section 228.6, relating to disclosure of 1 confidential mental health information; Code section 232.78, 2 relating to temporary custody of a child pursuant to an ex 3 parte court order; Code section 232.83, relating to child 4 sexual abuse involving a person not responsible for the care 5 of a child; Code section 331.321, by striking the requirement 6 for county appointments to an initial community mental health 7 center board of trustees; and Code section 331.382, by striking 8 the authority of a county board of supervisors to establish a 9 community mental health center. 10 -19- LSB 1785HH (3) 84 jp/nh 19/ 19