H.F. 217 DIVISION I 1 DEPARTMENTAL RESPONSIBILITY FOR MENTAL HEALTH ADVOCATES 2 Section 1. NEW SECTION . 10A.901 Definitions. 3 As used in this article, unless the context otherwise 4 requires: 5 1. “Administrator” means the person coordinating the 6 administration of this division. 7 2. “Division” means the mental health advocate division of 8 the department of inspections and appeals. 9 Sec. 2. NEW SECTION . 10A.902 Duties of administrator. 10 The administrator shall coordinate the division’s conduct 11 of the mental health advocate program as provided by section 12 229.19 and other applicable law. The administrator’s duties 13 may include but are not limited to all of the following: 14 1. Recommending the hiring of persons to serve as mental 15 health advocates and other division staff and identifying 16 qualifications. The minimum qualifications for a mental health 17 advocate whose initial appointment commences on or after July 18 1, 2013, shall be a bachelor’s degree from an accredited 19 school, college, or university or related postsecondary 20 education coursework in social science, education, nursing, or 21 other related field and at least one year of work experience in 22 mental health treatment. 23 2. Training and supervising division staff. 24 3. Providing and regularly updating a list of those persons 25 qualified to serve as a mental health advocate for the service 26 areas utilized by the mental health advocate program. If 27 deemed to be prudent by the administrator in order to improve 28 or maintain the quality of services, the administrator or the 29 administrator’s designee may petition the court to change the 30 advocate appointed by the court or to transfer the venue of the 31 appointment or the hospitalization proceeding as provided in 32 section 229.44. 33 4. Administering program additions and expansions, 34 including providing advocate services for persons with a 35 -1- LSB 1478YH (7) 85 jp/rj 1/ 13

H.F. 217 substance-related disorder and persons found not guilty 1 by reason of insanity, if such additions or expansions are 2 authorized and funded. 3 5. Developing and implementing a case weight system for use 4 in appointing and compensating advocates. 5 6. Administering case reviews and audits. 6 Sec. 3. TRANSITION. 7 1. The department of inspections and appeals shall commence 8 organizational activities during the fiscal year beginning July 9 1, 2013, as necessary to fully implement this division and 10 assume responsibility for mental health advocates as provided 11 in this division and division II of this Act on July 1, 2014. 12 2. If necessary for the purposes of subsection 1, the 13 department of inspections and appeals may adopt emergency 14 rules under section 17A.4, subsection 3, and section 17A.5, 15 subsection 2, paragraph “b”, to implement the provisions of 16 division II of this Act on July 1, 2014, and the rules shall 17 be effective immediately upon filing unless a later date is 18 specified in the rules. Any rules adopted in accordance with 19 this section shall also be published as a notice of intended 20 action as provided in section 17A.4. 21 DIVISION II 22 IMPLEMENTATION 23 Sec. 4. Section 225C.4, subsection 1, paragraph m, Code 24 2013, is amended to read as follows: 25 m. Provide consultation and technical assistance to 26 patients’ mental health advocates appointed pursuant to 27 section 229.19 , in cooperation with the judicial branch and 28 the department of inspections and appeals, and to the resident 29 advocate committees appointed for health care facilities 30 pursuant to section 135C.25 . 31 Sec. 5. Section 226.31, Code 2013, is amended to read as 32 follows: 33 226.31 Examination by court —— notice. 34 Before granting the order authorized in section 226.30 35 -2- LSB 1478YH (7) 85 jp/rj 2/ 13

H.F. 217 the court or judge shall investigate the allegations of the 1 petition and before proceeding to a hearing on the allegations 2 shall require notice to be served on the attorney who 3 represented the patient in any prior proceedings under sections 4 229.6 to 229.15 or the and to any mental health advocate 5 appointed for the patient under section 229.19 , or in the case 6 of a patient who entered the hospital voluntarily, on any 7 relative, friend, or guardian of the person in question of the 8 filing of the application. At the hearing the court or judge 9 shall appoint a guardian ad litem for the person, if the court 10 or judge deems such action necessary to protect the rights 11 of the person. The guardian ad litem shall be a practicing 12 attorney. 13 Sec. 6. Section 229.2, subsection 1, paragraph b, 14 subparagraph (6), Code 2013, is amended to read as follows: 15 (6) Upon approval of the admission of a minor over the 16 minor’s objections, the juvenile court shall appoint an 17 individual to act as an the mental health advocate representing 18 the interests of for the minor in the same manner as an 19 advocate representing the interests of patients involuntarily 20 hospitalized pursuant to in accordance with section 229.19 . 21 Sec. 7. Section 229.9A, Code 2013, is amended to read as 22 follows: 23 229.9A Advocate Mental health advocate informed —— hearings . 24 The court shall direct the clerk to furnish the office 25 of the mental health advocate of the respondent’s county of 26 legal settlement designated for the court by the department 27 of inspections and appeals with a copy of application and any 28 order issued pursuant to section 229.8, subsection 3 . The 29 mental health advocate designated for the court may attend 30 the hospitalization any court hearing of any involving the 31 respondent for whom the advocate has received notice of a 32 hospitalization hearing . 33 Sec. 8. Section 229.12, subsection 2, Code 2013, is amended 34 to read as follows: 35 -3- LSB 1478YH (7) 85 jp/rj 3/ 13

H.F. 217 2. All persons not necessary for the conduct of the 1 proceeding shall be excluded, except that the court may admit 2 persons having a legitimate interest in the proceeding and 3 shall permit the mental health advocate from the respondent’s 4 county of legal settlement designated for the court by the 5 department of inspections and appeals to attend the hearing. 6 Upon motion of the county attorney, the judge may exclude 7 the respondent from the hearing during the testimony of any 8 particular witness if the judge determines that witness’s 9 testimony is likely to cause the respondent severe emotional 10 trauma. 11 Sec. 9. Section 229.14A, subsection 1, Code 2013, is amended 12 to read as follows: 13 1. With respect to a chief medical officer’s report made 14 pursuant to section 229.14, subsection 1 , paragraph “b” , “c” , 15 or “d” , or any other provision of this chapter related to 16 involuntary commitment for which the court issues a placement 17 order or a transfer of placement is authorized, the court shall 18 provide notice to the respondent , and the respondent’s attorney 19 or , and any mental health advocate appointed for the respondent 20 pursuant to section 229.19 concerning the placement order 21 and the respondent’s right to request a placement hearing to 22 determine if the order for placement or transfer of placement 23 is appropriate. 24 Sec. 10. Section 229.14A, subsection 5, paragraph c, Code 25 2013, is amended to read as follows: 26 c. If the respondent’s attorney has withdrawn pursuant to 27 section 229.19 , the court shall appoint an attorney for the 28 respondent in the manner described in section 229.8, subsection 29 1 . 30 Sec. 11. Section 229.15, subsection 6, Code 2013, is amended 31 to read as follows: 32 6. Upon receipt of any report required or authorized by 33 this section the court shall furnish a copy to the patient’s 34 attorney , or alternatively and to the mental health advocate 35 -4- LSB 1478YH (7) 85 jp/rj 4/ 13

H.F. 217 appointed as required by section 229.19 for the patient . The 1 court shall examine the report and take the action thereon 2 which it deems appropriate. Should the court fail to receive 3 any report required by this section or section 229.14 at the 4 time the report is due, the court shall investigate the reason 5 for the failure to report and take whatever action may be 6 necessary in the matter. 7 Sec. 12. Section 229.19, Code 2013, is amended to read as 8 follows: 9 229.19 Advocates Mental health advocates —— duties —— 10 compensation —— state and county liability . 11 1. a. In each county with a population of three hundred 12 thousand or more inhabitants the board of supervisors shall 13 appoint an individual who has demonstrated by prior activities 14 an informed concern for the welfare and rehabilitation of 15 persons with mental illness, and who is not an officer or 16 employee of the department of human services nor of any agency 17 or facility providing care or treatment to persons with mental 18 illness, to act as an advocate representing the interests of 19 patients involuntarily hospitalized by the court, in any matter 20 relating to the patients’ hospitalization or treatment under 21 section 229.14 or 229.15 . In each county with a population of 22 under three hundred thousand inhabitants, the chief judge of 23 the judicial district encompassing the county shall appoint 24 the advocate. For the purposes of this section, “division” 25 means the mental health advocate division of the department of 26 inspections and appeals. 27 b. The court or, if the advocate is appointed by the county 28 board of supervisors, the board shall assign the advocate 29 appointed from a patient’s county of legal settlement to 30 represent the interests of the patient. If a patient has 31 no county of legal settlement, the court or, if the advocate 32 is appointed by the county board of supervisors, the board 33 shall assign the advocate appointed from the county where the 34 hospital or facility is located to represent the interests of 35 -5- LSB 1478YH (7) 85 jp/rj 5/ 13

H.F. 217 the patient. 1 c. The advocate’s responsibility with respect to any patient 2 shall begin at whatever time the attorney employed or appointed 3 to represent that patient as respondent in hospitalization 4 proceedings, conducted under sections 229.6 to 229.13 , reports 5 to the court that the attorney’s services are no longer 6 required and requests the court’s approval to withdraw as 7 counsel for that patient. However, if 8 b. If the patient is found to be seriously mentally impaired 9 at the hospitalization hearing, the attorney representing the 10 patient shall automatically be relieved of responsibility in 11 the case and an a mental health advocate shall be assigned to 12 appointed for the patient at the conclusion of the hearing 13 unless the attorney indicates an intent to continue the 14 attorney’s services and . The court shall appoint the advocate 15 from a list of qualified persons provided to the court by the 16 administrator of the division of mental health advocates of 17 the department of inspections and appeals in accordance with 18 section 10A.902. The advocate’s responsibility with respect 19 to a patient shall begin when the advocate is appointed for 20 the patient. The attorney representing the patient shall 21 automatically be relieved of responsibility at the conclusion 22 of the hearing unless the attorney requests to continue 23 representation and the court so directs authorizes the attorney 24 to remain on the case . If the court directs the attorney to 25 remain on the case, the attorney shall assume all the duties 26 of an advocate cooperate with the advocate appointed for the 27 patient . The clerk shall furnish the advocate with a copy of 28 the court’s order approving the withdrawal or continuation of 29 the attorney and shall inform the patient of the name of the 30 patient’s advocate. 31 d. c. With regard to each patient whose interests the 32 for whom a mental health advocate is required to represent 33 appointed pursuant to this section , the advocate’s duties shall 34 include all of the following: 35 -6- LSB 1478YH (7) 85 jp/rj 6/ 13

H.F. 217 (1) To review each report submitted pursuant to sections 1 229.14 and 229.15 . 2 (2) If the advocate is not an attorney, to To advise the 3 court at any time it appears that the services of an attorney 4 are required to properly safeguard the patient’s interests. 5 (3) To be readily accessible to communications from the 6 patient and to originate communications with the patient within 7 five days of the patient’s commitment. 8 (4) To visit the patient within fifteen days of the 9 patient’s commitment and periodically thereafter. 10 (5) To communicate with medical personnel treating the 11 patient and to review the patient’s medical records pursuant 12 to section 229.25 . 13 (6) To file with the court and the division quarterly 14 reports, and additional reports as the advocate feels necessary 15 or as required by the court or the division , in a form 16 prescribed by the court or the division, as applicable . The 17 reports shall state what actions the advocate has taken with 18 respect to each patient and the amount of time spent. 19 (7) To utilize the related best practices for the duties 20 identified in this paragraph “d” “c” developed and promulgated 21 by the judicial council. 22 e. d. An Subject to the availability of funding 23 appropriated for this purpose, a mental health advocate may 24 also be appointed pursuant to this section for an individual 25 who has been diagnosed with a co-occurring mental illness and 26 substance-related substance-related disorder. 27 2. The hospital or facility to which a patient is committed 28 shall grant all reasonable requests of the patient’s mental 29 health advocate to visit the patient, to communicate with 30 medical personnel treating the patient, and to review the 31 patient’s medical records pursuant to section 229.25 . An 32 advocate shall not disseminate information from a patient’s 33 medical records to any other person unless done for official 34 purposes in connection with the advocate’s duties pursuant to 35 -7- LSB 1478YH (7) 85 jp/rj 7/ 13

H.F. 217 this chapter or when required by law. 1 3. The court or, if the advocate is appointed by the county 2 board of supervisors, the board division shall prescribe 3 provide reasonable compensation for the services of the 4 advocate in accordance with section 10A.902 . The compensation 5 shall be based upon the reports filed by the advocate with 6 the court. The advocate’s compensation shall be paid by the 7 county in which the court is located, either on order of the 8 court or, if the advocate is appointed by the county board of 9 supervisors, on the direction of the board. If the advocate 10 is appointed by the court, the advocate is an employee of 11 the state for purposes of chapter 669 . If the advocate is 12 appointed by the county board of supervisors, the advocate is 13 an employee of the county for purposes of chapter 670 . If the 14 patient or the person who is legally liable for the patient’s 15 support is not indigent, the board division shall recover 16 the costs of compensating the advocate from that person. If 17 that person has an income level as determined pursuant to 18 section 815.9 greater than one hundred percent but not more 19 than one hundred fifty percent of the poverty guidelines, 20 at least one hundred dollars of the advocate’s compensation 21 shall be recovered in the manner prescribed by the county 22 board of supervisors. If that person has an income level as 23 determined pursuant to section 815.9 greater than one hundred 24 fifty percent of the poverty guidelines, at least two hundred 25 dollars of the advocate’s compensation shall be recovered in 26 substantially the same manner prescribed by the county board of 27 supervisors as provided in section 815.9 . 28 Sec. 13. Section 229.25, subsection 1, paragraph a, 29 subparagraph (1), Code 2013, is amended to read as follows: 30 (1) The information is requested by a licensed physician, 31 attorney , or the mental health advocate who provides appointed 32 for the person. The requester must provide the chief medical 33 officer with a written waiver signed by the person about whom 34 the information is sought. 35 -8- LSB 1478YH (7) 85 jp/rj 8/ 13

H.F. 217 Sec. 14. TRANSITION OF EMPLOYEE RIGHTS OF FORMER COUNTY 1 EMPLOYEES. 2 1. If appointed by the director of the department of 3 inspections and appeals as a mental health advocate pursuant 4 to section 10A.902, county employees paid for mental health 5 advocate services under section 229.19 shall become employees 6 of the department of inspections and appeals effective July 7 1, 2014, and the department shall assume all costs associated 8 with the functions of the employees on that date. Employees 9 who were paid salaries by the counties immediately prior to 10 becoming state employees as a result of this Act shall not 11 forfeit accrued vacation, accrued sick leave, or benefits 12 related to longevity of service, except as provided in this 13 section. 14 2. The department of inspections and appeals, after 15 consulting with the department of administrative services, 16 shall adopt rules to provide for the following: 17 a. A person referred to in subsection 1 shall have to the 18 person’s credit as a state employee commencing on the date of 19 becoming a state employee the number of accrued vacation days 20 that was credited to the person as a county employee as of the 21 end of the day prior to becoming a state employee. 22 b. Each person referred to in subsection 1 shall have to 23 the person’s credit as a state employee commencing on the 24 date of becoming a state employee the number of accrued days 25 of sick leave that was credited to the person as a county 26 employee as of the end of the day prior to becoming a state 27 employee. However, the number of days of sick leave credited 28 to a person under this subsection and eligible to be taken 29 when sick or eligible to be received upon retirement shall not 30 respectively exceed the maximum number of days, if any, or the 31 maximum dollar amount as provided in section 70A.23 that state 32 employees generally are entitled to accrue or receive according 33 to rules in effect as of the date the person becomes a state 34 employee. 35 -9- LSB 1478YH (7) 85 jp/rj 9/ 13

H.F. 217 c. Commencing on the date of becoming a state employee, each 1 person referred to in subsection 1 is entitled to claim the 2 person’s most recent continuous period of service in full-time 3 county employment as full-time state employment for purposes 4 of determining the number of days of vacation which the person 5 is entitled to earn each year. The actual vacation benefit, 6 including the limitation on the maximum accumulated vacation 7 leave, shall be determined as provided in section 70A.1 8 according to rules in effect for state employees of comparable 9 longevity, irrespective of any greater or lesser benefit as a 10 county employee. 11 3. Persons referred to in subsection 1 who were covered 12 by county employee life insurance and accident and health 13 insurance plans prior to becoming state employees in accordance 14 with this section shall be permitted to apply prior to becoming 15 state employees for life insurance and health and accident 16 insurance plans that are available to state employees so that 17 those persons do not suffer a lapse of insurance coverage as 18 a result of this section. The department of inspections and 19 appeals, after consulting with the department of administrative 20 services, shall prescribe rules and distribute application 21 forms and take other actions as necessary to enable those 22 persons to elect to have insurance coverage that is in effect 23 on the date of becoming state employees. The actual insurance 24 coverage available to a person shall be determined by the plans 25 that are available to state employees, irrespective of any 26 greater or lesser benefits that may have been available to the 27 person as a county employee. 28 4. Commencing on the date of becoming a state employee, each 29 person referred to in subsection 1 is entitled to claim the 30 person’s most recent continuous period of service in full-time 31 county employment as full-time state employment for purposes of 32 determining disability benefits as provided in section 70A.20 33 according to rules in effect for state employees of comparable 34 longevity, irrespective of any greater or lesser benefit that 35 -10- LSB 1478YH (7) 85 jp/rj 10/ 13

H.F. 217 may have been available to the person as a county employee. 1 Sec. 15. EFFECTIVE DATE. This division of this Act takes 2 effect July 1, 2014. 3 EXPLANATION 4 This bill creates a mental health advocate division in 5 the department of inspections and appeals in order for the 6 department to become the administrative agency for mental 7 health advocates. Under current law, except for one county 8 with a population of 300,000 or more inhabitants where the 9 advocate is appointed by the county, mental health advocates 10 are appointed by the chief judge of a judicial district and all 11 advocate positions are funded by the counties. The bill is 12 organized into divisions. 13 DEPARTMENTAL RESPONSIBILITY FOR MENTAL HEALTH ADVOCATES. 14 This division establishes a mental health advocate division in 15 the department of inspections and appeals and specifies duties 16 for the division administrator. A transition provision directs 17 the department to commence organizational activities during FY 18 2013-2014 as necessary to fully implement the new departmental 19 division and all of the bill’s division II provisions on July 20 1, 2014. The department is granted emergency rulemaking 21 authority if necessary to achieve the implementation date. 22 This division takes effect July 1, 2013. 23 IMPLEMENTATION. This division provides for implementation 24 of the change in administration of the mental health advocates 25 on July 1, 2014, including conforming changes to various Code 26 sections. 27 Code section 225C.4, relating to the duties of the 28 administrator of the mental health and disability services 29 division of the department of human services, is amended to 30 correct a reference to mental health advocates and to include 31 the department of inspections and appeals in a duty for 32 providing consultation and technical assistance to advocates. 33 Code section 226.31, relating to an application for a court 34 order for transfer of a dangerous patient from a state mental 35 -11- LSB 1478YH (7) 85 jp/rj 11/ 13

H.F. 217 health institute, is amended to correct a reference to the 1 advocate to be included in a notice of a hearing. 2 Code section 229.2, relating to admissions of juvenile 3 mental health patients, is amended to correct a reference to 4 the appointment of a mental health advocate for juveniles 5 involuntarily committed. 6 Code section 229.9A, relating to requirements for the clerk 7 of court to notify a mental health advocate of application 8 and order information, is amended to correct a reference to 9 the advocate, to eliminate a reference to county of legal 10 settlement, and to authorize the advocate to attend any court 11 hearing involving the respondent. 12 Code section 229.12, relating to the procedure for 13 hospitalization hearings, is amended to correct a reference to 14 the advocate and to eliminate a reference to county of legal 15 settlement. 16 Code section 229.14A, relating to notice requirements 17 for involuntary commitment placement orders and transfers, 18 is amended to require notice to correct a reference to the 19 advocate and to eliminate a reference to a procedure for 20 withdrawal of an attorney that is revised by the bill. 21 Code section 229.15, relating to the periodic reports 22 required when hospitalization of a patient is continued by 23 court order, is amended to require the report to be provided to 24 the advocate. 25 Code section 229.19, the primary Code provision for 26 mental health advocates, is extensively revised to insert 27 the new department of inspections and appeals division in 28 place of the counties. The advocate is to be appointed by 29 the court from a list of qualified persons provided by the 30 division administrator. A procedure for continuation of the 31 respondent’s attorney when a patient is found to be seriously 32 mentally impaired is revised to require the attorney to 33 cooperate with the patient’s advocate instead of assuming the 34 duties of an advocate. Responsibility for compensation of 35 -12- LSB 1478YH (7) 85 jp/rj 12/ 13

H.F. 217 the mental health advocate is shifted to the division and the 1 division is required to recover the costs of the mental health 2 advocate if the person is not indigent. 3 Code section 229.25, relating to exceptions for release of 4 medical records maintained by a hospital or other treatment 5 facility, is amended to correct a reference to the advocate 6 regarding the release of the records to the advocate when the 7 patient has signed a waiver. 8 The bill includes a transition section outlining sick time, 9 vacation leave, and health, life, and disability insurance 10 rights of county employees who become employees of the 11 department of inspections and appeals in accordance with the 12 bill. 13 This division takes effect July 1, 2014. 14 -13- LSB 1478YH (7) 85 jp/rj 13/ 13