Senate File 415 - Introduced SENATE FILE 415 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SSB 1199) A BILL FOR An Act relating to human services involving mental health 1 and disability services and children’s services, making 2 appropriations, and including effective dates. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1663SV (3) 85 jp/rj

S.F. 415 DIVISION I 1 SYSTEM REDESIGN —— IMPLEMENTATION 2 RESEARCH-BASED PRACTICE 3 Section 1. Section 331.388, Code 2013, is amended by adding 4 the following new subsection: 5 NEW SUBSECTION . 4A. “Research-based practice” means a 6 service or other support in which the efficacy of the service 7 or other support is recognized as an evidence-based practice, 8 or is deemed to be an emerging and promising practice, or which 9 is part of a demonstration and will supply evidence as to the 10 effectiveness of the service or other support. 11 Sec. 2. Section 331.393, subsection 4, paragraph g, 12 unnumbered paragraph 1, Code 2013, is amended to read as 13 follows: 14 The requirements for designation of targeted case management 15 providers and for implementation of evidence-based models 16 of case management that apply research-based practice . The 17 requirements shall be designed to provide the person receiving 18 the case management with a choice of providers, allow a 19 service provider to be the case manager but prohibit the 20 provider from referring a person receiving the case management 21 only to services administered by the provider, and include 22 other provisions to ensure compliance with but not exceed 23 federal requirements for conflict-free case management. The 24 qualifications of targeted case managers and other persons 25 providing service coordination under the management plan shall 26 be specified in the rules. The rules shall also include but 27 are not limited to all of the following relating to targeted 28 case management and service coordination services: 29 Sec. 3. Section 331.397, subsection 5, paragraph b, Code 30 2013, is amended to read as follows: 31 b. Providing evidence-based services that apply 32 research-based practice . 33 Sec. 4. Section 331.397, subsection 6, paragraph d, Code 34 2013, is amended to read as follows: 35 -1- LSB 1663SV (3) 85 jp/rj 1/ 21

S.F. 415 d. Advances in the use of evidence-based treatment applying 1 research-based practice , including but not limited to all of 2 the following: 3 (1) Positive behavior support. 4 (2) Assertive community treatment. 5 (3) Peer self-help drop-in centers. 6 Sec. 5. Section 331.397, subsection 7, paragraphs b and c, 7 Code 2013, are amended to read as follows: 8 b. The efficacy of the services or other support is are 9 recognized as an evidence-based a research-based practice , is 10 deemed to be an emerging and promising practice, or providing 11 the services is part of a demonstration and will supply 12 evidence as to the services’ effectiveness . 13 c. A determination that the services or other support 14 provides an effective alternative to existing services 15 that have been shown by the evidence research base to be 16 ineffective, to not yield the desired outcome, or to not 17 support the principles outlined in Olmstead v. L.C., 527 U.S. 18 581 (1999). 19 COMMUNITY CORRECTIONS SYSTEM ACCESS TO REGIONAL SERVICES 20 Sec. 6. Section 331.395, Code 2013, is amended by adding the 21 following new subsection: 22 NEW SUBSECTION . 5. If adequate funding is provided through 23 a state appropriation made for purposes of paying for services 24 authorized pursuant to this subsection, a person with an income 25 within the level specified in subsection 1 who is housed by or 26 supervised by a judicial district department of correctional 27 services established under chapter 905 shall be deemed to 28 have met the income and resource eligibility requirements for 29 services under the regional service system. 30 ELIGIBILITY MAINTENANCE 31 Sec. 7. Section 331.396, subsection 1, paragraph b, Code 32 2013, is amended to read as follows: 33 b. The person is at least eighteen years of age and is a 34 resident of this state. However, a person who is seventeen 35 -2- LSB 1663SV (3) 85 jp/rj 2/ 21

S.F. 415 years of age, is a resident of this state, and is receiving 1 publicly funded children’s services may be considered eligible 2 for services through the regional service system during the 3 three-month period preceding the person’s eighteenth birthday 4 in order to provide a smooth transition from children’s 5 to adult services. In addition, a person who is less than 6 eighteen years of age and a resident of this state may be 7 eligible, as determined by the region, for those mental health 8 services made available to all or a portion of the residents 9 of the region of the same age and eligibility class under the 10 county management plan of one or more counties of the region 11 applicable prior to formation of the region. 12 Sec. 8. Section 331.396, subsection 2, paragraph b, Code 13 2013, is amended to read as follows: 14 b. The person is at least eighteen years of age and is a 15 resident of this state. However, a person who is seventeen 16 years of age, is a resident of this state, and is receiving 17 publicly funded children’s services may be considered eligible 18 for services through the regional service system during the 19 three-month period preceding the person’s eighteenth birthday 20 in order to provide a smooth transition from children’s 21 to adult services. In addition, a person who is less than 22 eighteen years of age and a resident of this state may be 23 eligible, as determined by the region, for those intellectual 24 disability services made available to all or a portion of the 25 residents of the region of the same age and eligibility class 26 under the county management plan of one or more counties of the 27 region applicable prior to formation of the region. 28 Sec. 9. Section 331.397, subsection 2, paragraph b, Code 29 2013, is amended to read as follows: 30 b. Until funding is designated for other service 31 populations, eligibility for the service domains listed in this 32 section shall be limited to such persons who are in need of 33 mental health or intellectual disability services. However, if 34 a county in a region was providing services to an individual 35 -3- LSB 1663SV (3) 85 jp/rj 3/ 21

S.F. 415 person eligibility class of persons with a developmental 1 disability other than intellectual disability or a brain injury 2 prior to formation of the region, the individual person class 3 of persons shall remain eligible for the services provided when 4 the region is formed, provided that funds are available to 5 continue such services. 6 STATE PAYMENTS TO REGION 7 Sec. 10. Section 426B.3, subsection 4, as enacted by 2012 8 Iowa Acts, chapter 1120, section 137, is amended to read as 9 follows: 10 4. a. For the fiscal years beginning July 1, 2013, and 11 July 1, 2014, a county with a county population expenditure 12 target amount that exceeds the amount of the county’s base year 13 expenditures for mental health and disabilities services shall 14 receive an equalization payment for the difference. 15 b. The equalization payments determined in accordance 16 with this subsection shall be made by the department of human 17 services for each fiscal year as provided in appropriations 18 made from the property tax relief fund for this purpose. If 19 the county is part of a region that has been approved by the 20 department in accordance with section 331.389, to commence 21 partial or full operations, the county’s equalization payment 22 shall be remitted to the region for expenditure as approved by 23 the region’s governing board. 24 STRATEGIC PLAN REQUIREMENT FOR FY 2013-2014 25 Sec. 11. 2012 Iowa Acts, chapter 1128, section 8, is amended 26 to read as follows: 27 SEC. 8. COUNTY MENTAL HEALTH, MENTAL RETARDATION 28 INTELLECTUAL DISABILITY , AND DEVELOPMENTAL DISABILITIES 29 SERVICES MANAGEMENT PLAN —— STRATEGIC PLAN. Notwithstanding 30 section 331.439, subsection 1 , paragraph “b”, subparagraph (3), 31 counties are not required to submit a three-year strategic 32 plan by April 1, 2012, to the department of human services. A 33 county’s strategic plan in effect as of the effective date of 34 this section shall remain in effect until the regional service 35 -4- LSB 1663SV (3) 85 jp/rj 4/ 21

S.F. 415 system management plan for the region to which the county 1 belongs is approved in accordance with section 331.393 , subject 2 to modification before that date as necessary to conform with 3 statutory changes affecting the plan and any amendments to the 4 plan that are adopted in accordance with law . 5 TRANSITION FUND —— SERVICES MAINTENANCE 6 Sec. 12. TRANSITION FUND —— SERVICES MAINTENANCE. A county 7 receiving an allocation of funding from the mental health and 8 disability services redesign transition fund created in 2012 9 Iowa Acts, chapter 1120, section 23, shall utilize the funding 10 received by the county as necessary for the services covered 11 in accordance with the county’s approved management plan in 12 effect as of June 30, 2012, for the fiscal year beginning July 13 1, 2012, and ending June 30, 2013. 14 REDESIGN EQUALIZATION PAYMENT APPROPRIATION 15 Sec. 13. MENTAL HEALTH AND DISABILITY SERVICES —— 16 EQUALIZATION PAYMENTS TRANSFER AND APPROPRIATION. 17 1. There is transferred from the general fund of the 18 state to the department of human services for the fiscal year 19 beginning July 1, 2013, and ending June 30, 2014, the following 20 amount, or so much thereof as is necessary, to be used for the 21 purposes designated: 22 For deposit in the property tax relief fund created in 23 section 426B.1, for distribution as provided in this section: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 29,820,478 25 2. The moneys credited to the property tax relief fund in 26 accordance with this section are appropriated to the department 27 of human services for distribution of equalization payments for 28 counties in the amounts specified in section 426B.3, subsection 29 4, as enacted by 2012 Iowa Acts, chapter 1120, section 137, 30 for the fiscal year beginning July 1, 2013. If the county is 31 part of a region that has been approved by the department in 32 accordance with section 331.389, to commence partial or full 33 operations, the county’s equalization payment shall be remitted 34 to the region for expenditure as approved by the region’s 35 -5- LSB 1663SV (3) 85 jp/rj 5/ 21

S.F. 415 governing board. The payments shall be remitted on or before 1 July 15, 2013. 2 SUBSTANCE-RELATED DISORDER DETOXIFICATION 3 Sec. 14. MENTAL HEALTH AND DISABILITY SERVICES POLICY 4 REVIEWS. The mental health and disability services commission 5 shall review options for the mental health and disability 6 services regions to coordinate substance-related disorder 7 funding provided by counties and other such disorder funding 8 provided by counties in place of county coordination. The 9 commission shall report to the governor and general assembly 10 its findings, options, and recommendations on or before October 11 15, 2013. 12 MEDICAID OBLIGATION COST SETTLEMENT 13 Sec. 15. COUNTY MEDICAL ASSISTANCE NONFEDERAL SHARE —— 14 COST SETTLEMENT. Any county obligation for payment to the 15 department of human services of the nonfederal share of the 16 cost of services provided under the medical assistance program 17 prior to July 1, 2012, pursuant to sections 249A.12 and 18 249A.26, shall remain at the amount agreed upon as of June 30, 19 2013. Beginning July 1, 2013, other than a county payment on 20 the obligation, the department shall be responsible for any 21 adjustment that would otherwise be applied to the amount of the 22 county obligation after that date due to cost settlement of 23 charges or other reasons. 24 CONTINUATION OF STATE PAYMENT PROGRAM FUNDING 25 Sec. 16. STATE PAYMENT PROGRAM —— FY 2013-2014. Unless 26 otherwise provided by law, state payment program moneys 27 appropriated for the fiscal year beginning July 1, 2013, to pay 28 the costs of non-Medicaid mental health and disability services 29 provided by counties to persons without a county of legal 30 settlement considered in the previous fiscal year to be a state 31 case shall continue to be remitted to the county of residence 32 paying for the services. If the county of residence is part of 33 a region that has been approved by the department in accordance 34 with section 331.389, to commence partial or full operations, 35 -6- LSB 1663SV (3) 85 jp/rj 6/ 21

S.F. 415 the state payment program moneys shall be remitted to the 1 region for expenditure as approved by the region’s governing 2 board. 3 Sec. 17. EFFECTIVE UPON ENACTMENT. This division of this 4 Act, being deemed of immediate importance, takes effect upon 5 enactment. 6 DIVISION II 7 DATA AND STATISTICAL INFORMATION AND OUTCOME AND PERFORMANCE 8 MEASURES 9 Sec. 18. Section 225C.4, subsection 1, paragraph j, Code 10 2013, is amended to read as follows: 11 j. Establish and maintain a data collection and management 12 information system oriented to the needs of patients, 13 providers, the department, and other programs or facilities in 14 accordance with section 225C.6A . The system shall be used to 15 identify, collect, and analyze service outcome and performance 16 measures data in order to assess the effects of the services on 17 the persons utilizing the services. The administrator shall 18 annually submit to the commission information collected by the 19 department indicating the changes and trends in the disability 20 services system. The administrator shall make the outcome data 21 available to the public. 22 Sec. 19. Section 225C.6A, Code 2013, is amended to read as 23 follows: 24 225C.6A Disability services system redesign central data 25 repository . 26 1. The commission department shall do the following 27 relating to redesign of data concerning the disability services 28 system in the state: 29 1. Identify sources of revenue to support statewide 30 delivery of core disability services to eligible disability 31 populations. 32 2. Ensure there is a continuous improvement process for 33 development and maintenance of the disability services system 34 for adults and children. The process shall include but is not 35 -7- LSB 1663SV (3) 85 jp/rj 7/ 21

S.F. 415 limited to data collection and reporting provisions. 1 3. a. Plan, collect, and analyze data as necessary to 2 issue cost estimates for serving additional populations and 3 providing core disability services statewide. The department 4 shall maintain compliance with applicable federal and state 5 privacy laws to ensure the confidentiality and integrity of 6 individually identifiable disability services data. The 7 department shall regularly may periodically assess the status 8 of the compliance in order to assure that data security is 9 protected. 10 b. In implementing Implement a system central data 11 repository under this subsection section for collecting and 12 analyzing state, county and region , and private contractor 13 data , the . The department shall establish a client identifier 14 for the individuals receiving services. The client identifier 15 shall be used in lieu of the individual’s name or social 16 security number. The client identifier shall consist of the 17 last four digits of an individual’s social security number, 18 the first three letters of the individual’s last name, the 19 individual’s date of birth, and the individual’s gender in an 20 order determined by the department. 21 c. Consult on an ongoing basis with regional administrators, 22 service providers, and other stakeholders in implementing the 23 central data repository and operations of the repository. The 24 consultation shall focus on minimizing the state and local 25 costs associated with operating the repository. 26 d. Engage with other state and local government and 27 nongovernmental entities operating the Iowa health information 28 network under chapter 135 and other data systems that maintain 29 information relating to individuals with information in the 30 central data repository in order to integrate data concerning 31 individuals. 32 c. 2. A county or region shall not be required to utilize a 33 uniform data operational or transactional system. However, the 34 system utilized shall have the capacity to exchange information 35 -8- LSB 1663SV (3) 85 jp/rj 8/ 21

S.F. 415 with the department, counties and regions, contractors, and 1 others involved with services to persons with a disability 2 who have authorized access to the central data repository. 3 The information exchanged shall be labeled consistently 4 and share the same definitions. Each county regional 5 administrator shall regularly report to the department annually 6 on or before December 1, for the preceding fiscal year the 7 following information for each individual served: demographic 8 information, expenditure data, and data concerning the services 9 and other support provided to each individual, as specified 10 in administrative rule adopted by the commission by the 11 department . 12 4. Work with county representatives and other qualified 13 persons to develop an implementation plan for replacing the 14 county of legal settlement approach to determining service 15 system funding responsibilities with an approach based upon 16 residency. The plan shall address a statewide standard for 17 proof of residency, outline a plan for establishing a data 18 system for identifying residency of eligible individuals, 19 address residency issues for individuals who began residing in 20 a county due to a court order or criminal sentence or to obtain 21 services in that county, recommend an approach for contesting 22 a residency determination, and address other implementation 23 issues. 24 3. The outcome and performance measures applied to the 25 regional disability services system shall utilize measurement 26 domains. The department may identify other measurement domains 27 in consultation with system stakeholders to be utilized in 28 addition to the following initial set of measurement domains: 29 a. Access to services. 30 b. Life in the community. 31 c. Person-centeredness. 32 d. Health and wellness. 33 e. Quality of life and safety. 34 f. Family and natural supports. 35 -9- LSB 1663SV (3) 85 jp/rj 9/ 21

S.F. 415 4. a. The processes used for collecting outcome and 1 performance measures data shall include but are not limited 2 to direct surveys of the individuals and families receiving 3 services and the providers of the services. The department 4 shall involve a workgroup of persons who are knowledgeable 5 about both the regional service system and survey techniques 6 to implement and maintain the processes. The workgroup shall 7 conduct an ongoing evaluation for the purpose of eliminating 8 the collection of information that is not utilized. The 9 surveys shall be conducted with a conflict-free approach in 10 which someone other than a provider of services surveys an 11 individual receiving the services. 12 b. The outcome and performance measures data shall encompass 13 and provide a means to evaluate both the regional services and 14 the services funded by the medical assistance program provided 15 to the same service populations. 16 c. The department shall develop and implement an 17 internet-based approach with graphical display of information 18 to provide outcome and performance measures data to the public 19 and those engaged with the regional service system. 20 d. The department shall include any significant costs for 21 collecting and interpreting outcome and performance measures 22 and other data in the department’s operating budget. 23 Sec. 20. REPEAL. The amendment to section 225C.4, 24 subsection 1, paragraph j, in 2012 Iowa Acts, chapter 1120, 25 section 2, is repealed. 26 Sec. 21. REPEAL. The amendments to section 225C.6A, in 2012 27 Iowa Acts, chapter 1120, sections 6, 7, and 95, are repealed. 28 DIVISION III 29 CHILDREN’S CABINET 30 Sec. 22. NEW SECTION . 242.1 Findings. 31 The general assembly finds there is a need for a 32 state-level children’s cabinet to provide guidance, oversight, 33 problem-solving, and long-term strategy development, and to 34 foster collaboration among state and local efforts to build a 35 -10- LSB 1663SV (3) 85 jp/rj 10/ 21

S.F. 415 comprehensive, coordinated system of care in order to promote 1 the well-being of the children in this state. The system of 2 care should address all domains of child physical, mental, 3 intellectual, developmental, and social health and meet the 4 particular needs of children for family-centered mental health 5 and disability services and for other appropriate specialized 6 services. 7 Sec. 23. NEW SECTION . 242.2 Children’s cabinet established. 8 There is established within the department of human services 9 a children’s cabinet. 10 1. The voting members of the children’s cabinet shall 11 consist of the following: 12 a. The director of the department of education or the 13 director’s designee. 14 b. The director of the department of human services or the 15 director’s designee. This member shall be chairperson of the 16 cabinet. 17 c. The director of the department of inspections and appeals 18 or the director’s designee. 19 d. The director of the department of public health or the 20 director’s designee. 21 e. A parent of a child with a severe emotional disturbance 22 or a disability who is the primary caregiver for that child, 23 appointed by the governor. 24 f. A juvenile court judge or juvenile court officer 25 appointed by the chief justice of the supreme court. 26 g. A community-based provider of child welfare, health, 27 or juvenile justice services to children, appointed by the 28 director of human services. 29 h. A member of the early childhood Iowa state board or the 30 early childhood stakeholders alliance, appointed by the state 31 board. 32 i. A community stakeholder who is not affiliated with a 33 provider of services, appointed by the governor. 34 j. A member of a child advocacy organization approved by the 35 -11- LSB 1663SV (3) 85 jp/rj 11/ 21

S.F. 415 members of the children’s cabinet. 1 k. A member of the Iowa chapter of the American academy 2 of pediatrics who has expertise in pediatric health care and 3 addressing the needs of children with special needs, designated 4 by the Iowa chapter. 5 l. Not more than three other members designated by 6 the cabinet chairperson to ensure adequate representation 7 of the persons and interests who may be affected by the 8 recommendations made by the cabinet. 9 2. In addition to the voting members, there shall be four ex 10 officio, nonvoting members of the children’s cabinet. These 11 members shall be two state representatives, one appointed by 12 the speaker of the house of representatives and one by the 13 minority leader of the house of representatives, and two state 14 senators, one appointed by the majority leader of the senate 15 and one by the minority leader of the senate. 16 3. a. The voting members, other than department directors 17 and their designees, shall be appointed for four-year terms. 18 The terms of such members begin on May 1 in the year of 19 appointment and expire on April 30 in the year of expiration. 20 b. Vacancies shall be filled in the same manner as original 21 appointments. A vacancy shall be filled for the unexpired 22 term. 23 c. The voting members shall receive actual and necessary 24 expenses incurred in the performance of their duties and 25 legislative members shall be compensated as provided in section 26 2.32A. 27 4. Staffing services for the children’s cabinet shall be 28 provided by the department of human services. 29 Sec. 24. NEW SECTION . 242.3 Duties. 30 The children’s cabinet shall perform the following duties 31 in making recommendations to the agencies and organizations 32 represented on the cabinet, the governor, the general assembly, 33 and the judicial branch to address the needs of children and 34 families in this state: 35 -12- LSB 1663SV (3) 85 jp/rj 12/ 21

S.F. 415 1. Develop operating provisions for health homes for 1 children implemented by the department of human services. The 2 provisions shall include but are not limited to all of the 3 following: 4 a. Identification of quality metrics. 5 b. Identification of performance criteria. 6 c. Provisions for monitoring the implementation of 7 specialized health homes. 8 d. Identification of system of care principles and values 9 based on the recommendations of the workgroup for redesign of 10 publicly funded children’s disability services implemented by 11 the department of human services in accordance with 2011 Iowa 12 Acts, chapter 121, section 1, subsection 4, paragraph “i” . 13 2. Gather information and improve the understanding of 14 policymakers and the public of how the various service systems 15 intended to meet the needs of children and families operate at 16 the local level. 17 3. Address areas of overlap, gaps, and conflict between 18 service systems. 19 4. Support the evolution of service systems in implementing 20 new services and enhancing existing services to address the 21 needs of children and families through process improvement 22 methodologies. 23 5. Assist policymakers and service system users in 24 understanding and effectively managing system costs. 25 6. Ensure services offered are evidence-based. 26 7. Issue guidelines to enable the services and other support 27 which is provided by or under the control of state entities and 28 delivered at the local level to have sufficient flexibility to 29 engage local resources and meet unique needs of children and 30 families. 31 8. Integrate efforts of policymakers and service providers 32 to improve the well-being of community members in addition to 33 children and families. 34 9. Implement strategies so that the children and families 35 -13- LSB 1663SV (3) 85 jp/rj 13/ 21

S.F. 415 engaged with the service systems avoid the need for higher 1 level services and other support. 2 10. Oversee the practices utilized by accountable care 3 organizations and other care management entities operating on 4 behalf of the state in the provision of government supported 5 children’s services and systems of care. 6 11. Identify and promote evidence-based practices that may 7 be creatively applied in appropriate settings for prevention 8 and early identification of social, emotional, behavioral, and 9 developmental risk factors for children from birth through age 10 eight. 11 12. Making periodic recommendations to the agencies 12 and organizations represented on the cabinet. An agency or 13 organization receiving such a recommendation shall respond 14 in writing to the children’s cabinet detailing how the 15 recommendation was addressed. The response shall be submitted 16 not later than sixty business days following the date of the 17 receipt of the recommendation. 18 13. Submit a report annually by December 15 to the governor, 19 general assembly, and supreme court providing findings and 20 recommendations and issue other reports as deemed necessary by 21 the cabinet. 22 Sec. 25. INITIAL TERMS. Notwithstanding section 242.2, 23 subsection 3, paragraph “a”, as enacted by this division of 24 this Act, the appointing authorities for the members of the 25 children’s cabinet created by this division of this Act who are 26 subject to terms of service shall be coordinated so that the 27 initial terms of approximately half of such members are two 28 years and the remainder are for four years and remain staggered 29 thereafter. 30 DIVISION IV 31 CENTER FOR CHILD HEALTH INNOVATION AND EXCELLENCE 32 Sec. 26. Section 135.11, Code 2013, is amended by adding the 33 following new subsection: 34 NEW SUBSECTION . 32. Create and operate, subject to 35 -14- LSB 1663SV (3) 85 jp/rj 14/ 21

S.F. 415 appropriation of funding by the general assembly, a center for 1 child health excellence and innovation. The purpose of the 2 center is to provide a policy forum for efforts to improve 3 child health, including but not limited to improving health 4 quality, demonstrating better health outcomes, and reducing 5 long-term health care costs. 6 a. The center shall engage major providers of child health 7 services and associated groups, including but not limited to 8 representatives of the department, the medical assistance 9 program administrator, child health specialty clinics, the 10 association representing community health centers, the state 11 council created by the department for the department’s project 12 LAUNCH initiative, staff of institutions of higher education 13 with expertise in pediatric health and child health care, and 14 others. 15 b. The center shall lead the review and analysis of public 16 policy efforts that are directed toward the purpose of the 17 center. 18 c. The center shall develop community-based initiatives 19 to promote healthy child development, leveraging medical 20 assistance program funding where possible. The initiatives 21 of Iowa shall include but are not limited to the promotion of 22 demonstration programs within the behavioral health managed 23 care contract and the development of a grant application for 24 federal and foundation funding opportunities that focus upon 25 improving child health through innovation and the diffusion of 26 innovation. 27 d. The center shall develop an early childhood mental health 28 certification for professionals and others engaged in working 29 with young children. 30 e. The center shall draw upon national and state 31 expertise in the field of child health, including experts 32 from Iowa’s institutions of higher education, health provider 33 organizations, and health policy and advocacy organizations. 34 The center shall seek support from the Iowa research 35 -15- LSB 1663SV (3) 85 jp/rj 15/ 21

S.F. 415 community in data report development and analysis of available 1 information from Iowa child health data sources. 2 f. The center shall work with the departments of human 3 services and public health and with the governor and members 4 of the general assembly in child health public policy efforts 5 such as providing medical assistance funding as necessary to 6 expand the department’s initiative to provide for adequate 7 developmental surveillance and screening during a child’s first 8 five years to be available statewide and enabling child care 9 resource and referral service agencies to facilitate provision 10 of child mental health consultation for child care providers. 11 g. The center shall submit a report of its activities and 12 policy recommendations to the general assembly by December 15 13 annually. 14 EXPLANATION 15 This bill relates to mental health and disability services 16 (MH/DS) administered by counties and the regions being formed 17 by counties to provide adult MH/DS that are not covered by the 18 medical assistance (Medicaid) program, children’s services, and 19 makes appropriations. The bill addresses recommendations made 20 to the mental health and disability services redesign fiscal 21 viability study committee by various committees and workgroups 22 created or continued by the MH/DS redesign legislation enacted 23 in 2012 Iowa Acts, chapter 1120 (SF 2315) and chapter 1133 (SF 24 2336). The bill also includes other provisions. The bill is 25 organized into divisions. 26 Under current law, certain MH/DS redesign requirements 27 for regions specify the use of evidence-based practices 28 or approaches. The bill defines the term, “research-based 29 practice” in Code section 331.388, relating to definitions for 30 the redesign, to mean a service or other support in which the 31 efficacy of the service or other support is recognized as an 32 evidence-based practice, or is deemed to be an emerging or 33 promising practice, or which is part of a demonstration and 34 will supply evidence as to effectiveness. The redesign-related 35 -16- LSB 1663SV (3) 85 jp/rj 16/ 21

S.F. 415 Code requirements for evidence-based practice are changed by 1 the bill to research-based practice in Code section 331.393, 2 relating to the service management plans that must be adopted 3 by regions and requirements for designating targeted case 4 managers, and in Code section 331.397, relating to the core 5 services that must be provided by regions. 6 Code section 331.395, relating to financial eligibility 7 requirements for the regional service system, is amended to 8 provide eligibility for the regional service system for persons 9 who meet income requirements and are housed by or supervised by 10 community-based correctional services, if a state appropriation 11 is made to cover the service costs. 12 Code section 331.396, relating to diagnosis and functional 13 assessment requirements for eligibility for the regional 14 service system, is amended to allow a child to be eligible, 15 as determined by the region, for those mental health or 16 intellectual disability services provided to residents of 17 the same age and eligibility class under an approved county 18 management plan of one or more counties of the region prior 19 to formation of the region. The person’s eligibility for 20 individualized services is subject to determination in 21 accordance with a functional assessment. 22 Code section 331.397, relating to the requirements 23 for regional core services, is amended to provide that an 24 eligibility class of persons with a developmental disability or 25 a brain injury who was receiving services prior to formation of 26 a region remains eligible for the services after formation of 27 the region, subject to the availability of funding. 28 Code section 426B.3, as amended by SF 2315, relates to 29 eligibility for equalization payments from the state in fiscal 30 years 2013-2014 and 2014-2015 for those counties with a base 31 year levy which is less than a target amount computed by 32 multiplying the county’s general population times a statewide 33 per capita expenditure target amount of $47.28. The bill 34 provides that if the county is part of a region approved by 35 -17- LSB 1663SV (3) 85 jp/rj 17/ 21

S.F. 415 DHS to commence partial or full operations, the county’s 1 equalization payment is remitted to the region for expenditure 2 as approved by the region’s governing board. 3 Under Code section 331.439, counties are required to submit 4 a three-year strategic plan for MH/DS and the latest plan was 5 due by April 1, 2012. In accordance with 2012 Iowa Acts, 6 chapter 1128, the strategic plan submission was not required 7 and the existing strategic plan remained in effect. The bill 8 provides that a county’s strategic plan remains in effect, 9 unless modified pursuant to statute or amended by the county, 10 until it is replaced by approval of the regional service system 11 management plan for the region to which the county belongs. 12 If a county receives an allocation of funding from the 13 mental health and disability services redesign transition fund 14 created in SF 2315, the county is required to utilize the 15 funding provided as necessary for the services provided to an 16 individual child or other individual person receiving services 17 in accordance with the county’s approved service management 18 plan in effect as of June 30, 2012. 19 A transfer of approximately $30 million is made from 20 the general fund of the state to DHS to be credited to the 21 property tax relief fund and is appropriated for DHS to make 22 equalization payments to eligible counties for FY 2013-2014. 23 The MH/DS commission is required to review options for 24 the MH/DS regions to coordinate the county substance-related 25 disorder funding for detoxification and other such 26 county-provided disorder funding in place of county 27 coordination. The commission is required to report to the 28 governor and general assembly its findings, options, and 29 recommendations on or before October 15, 2013. 30 Any county obligation for payment to DHS of the nonfederal 31 share of the cost of services provided under the Medicaid 32 program prior to July 1, 2012, is required to remain at the 33 amount agreed upon as of June 30, 2013. Beginning July 1, 34 2013, other than a county payment on the obligation, DHS is 35 -18- LSB 1663SV (3) 85 jp/rj 18/ 21

S.F. 415 responsible for any adjustment that would otherwise be applied 1 to the amount of the county obligation after that date due to 2 cost settlement of charges or other reasons. 3 Unless otherwise provided by law, state payment program 4 moneys appropriated to DHS for FY 2013-2014, to pay the costs 5 of non-Medicaid mental health and disability services provided 6 by counties to persons without a county of legal settlement 7 considered in the previous fiscal year to be a state case, 8 shall continue to be remitted to the county of residence paying 9 for the services. If the county of residence is part of a 10 region that has been approved by DHS to commence partial or 11 full operations, the state payment program moneys shall be 12 remitted to the region for expenditure as approved by the 13 region’s governing board. 14 This division takes effect upon enactment. 15 DATA AND STATISTICAL INFORMATION AND OUTCOME AND PERFORMANCE 16 MEASURES. This division addresses recommendations submitted by 17 the data and statistical information integration workgroup and 18 the outcomes and performance measures committee. 19 Current law is amended in Code section 225C.4, relating 20 to the duties of the DHS MH/DS division administrator, and 21 in Code section 225C.6A, relating to disability services 22 system redesign, to delineate requirements pertaining to 23 MH/DS state collection and management information systems 24 and outcome and performance data. These Code provisions 25 were previously amended by SF 2315. The bill incorporates 26 the SF 2315 amendments and adds new language and repeals 27 the SF 2315 amendments that would otherwise take effect on 28 July 1, 2013. For Code section 225C.4, the bill references 29 in the administrator’s duties the specific new requirements 30 established by the bill in Code section 225C.6A. The new 31 requirements pertain to DHS implementation of a central data 32 repository, information exchange capacity, regular reporting 33 of individual information, data security, consultation with 34 regional staff, providers, and other stakeholders, engaging 35 -19- LSB 1663SV (3) 85 jp/rj 19/ 21