H.F. 2445 Section 1. NEW SECTION . 230.01 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Administrator” means the administrator of the department 4 of human services assigned, in accordance with section 5 218.1, to control the state mental health institutes, or that 6 administrator’s designee. 7 2. “Book” , “list” , “record” , or “schedule” kept by a county 8 auditor, assessor, treasurer, recorder, sheriff, or other 9 county officer means the county system as defined in section 10 445.1. 11 3. “Department” means the department of human services. 12 4. “Region” means a mental health and disability services 13 region formed in accordance with section 331.389. 14 5. “Regional administrator” means the same as defined in 15 section 331.388. 16 Sec. 2. Section 230.1, subsections 1 and 3, Code 2018, are 17 amended to read as follows: 18 1. The necessary and legal costs and expenses attending 19 the taking into custody, care, investigation, admission, 20 commitment, and support of a person with mental illness 21 admitted or committed to a state hospital shall be paid by a 22 county the regional administrator on behalf of the person’s 23 county of residence or by the state as follows: 24 a. If the person is eighteen years of age or older, as 25 follows: 26 (1) The costs attributed to mental illness shall be paid by 27 the regional administrator on behalf of the person’s county of 28 residence. 29 (2) The costs attributed to a substance-related disorder 30 shall be paid by the person’s county of residence. 31 (3) The costs attributable to a dual diagnosis of mental 32 illness and a substance-related disorder may be split as 33 provided in section 226.9C . 34 b. By the state as a state case if such person has no 35 -1- LSB 5312HV (3) 87 hb/rj 1/ 13

H.F. 2445 residence in this state, if the person’s residence is unknown, 1 or if the person is under eighteen years of age. 2 3. A mental health and disability services region or county 3 of residence is not liable for costs and expenses associated 4 with a person with mental illness unless the costs and expenses 5 are for services and other support authorized for the person 6 through the regional administrator for the county. For the 7 purposes of this chapter , “regional administrator” means the 8 same as defined in section 331.388 . 9 Sec. 3. Section 230.4, Code 2018, is amended to read as 10 follows: 11 230.4 Certification to debtor county regional administrator . 12 A determination of a person’s county of residence made 13 in accordance with section 230.2 or 230.3 shall be sent 14 by the court or the county to the county auditor regional 15 administrator of the person’s county of residence. The 16 certification shall be accompanied by a copy of the evidence 17 supporting the determination. The auditor regional 18 administrator shall provide the certification to the board of 19 supervisors of the auditor’s county region’s governing board , 20 and it shall be conclusively presumed that the person has 21 residence in a county in the notified county region unless that 22 county regional administrator disputes the finding of residence 23 as provided in section 331.394 . 24 Sec. 4. Section 230.5, Code 2018, is amended to read as 25 follows: 26 230.5 Nonresidents. 27 If a person’s residence is determined in accordance with 28 section 230.2 or 230.3 to be in a foreign state or country, 29 or is unknown, the court or the county regional administrator 30 of the person’s county of residence shall immediately certify 31 the determination to the department’s administrator. The 32 certification shall be accompanied by a copy of the evidence 33 supporting the determination. A court order issued pursuant to 34 section 229.13 shall direct that the patient be hospitalized at 35 -2- LSB 5312HV (3) 87 hb/rj 2/ 13

H.F. 2445 the appropriate state hospital for persons with mental illness. 1 Sec. 5. Section 230.9, Code 2018, is amended to read as 2 follows: 3 230.9 Subsequent discovery of residence. 4 If, after a person has been received by a state hospital 5 for persons with mental illness as a state case patient 6 whose residence is supposed to be outside this state, the 7 administrator determines that the residence of the person 8 was, at the time of admission or commitment, in a county of 9 this state, the administrator shall certify the determination 10 and charge all legal costs and expenses pertaining to the 11 admission or commitment and support of the person to the 12 regional administrator of the person’s county of residence. 13 The certification shall be sent to the regional administrator 14 of the person’s county of residence. The certification 15 shall be accompanied by a copy of the evidence supporting the 16 determination. The costs and expenses shall be collected as 17 provided by law in other cases. If the person’s residency 18 status has been determined in accordance with section 331.394 , 19 the legal costs and expenses shall be charged to the regional 20 administrator of the person’s county of residence or as a state 21 case in accordance with that determination. 22 Sec. 6. Section 230.10, Code 2018, is amended to read as 23 follows: 24 230.10 Payment of costs. 25 All legal costs and expenses attending the taking into 26 custody, care, investigation, and admission or commitment of 27 a person to a state hospital for persons with mental illness 28 under a finding that the person has residency in another 29 county of this state shall be charged against the regional 30 administrator of the person’s county of residence. 31 Sec. 7. Section 230.11, Code 2018, is amended to read as 32 follows: 33 230.11 Recovery of costs from state. 34 Costs and expenses attending the taking into custody, 35 -3- LSB 5312HV (3) 87 hb/rj 3/ 13

H.F. 2445 care, and investigation of a person who has been admitted 1 or committed to a state hospital, United States department 2 of veterans affairs hospital, or other agency of the United 3 States government, for persons with mental illness and who 4 has no residence in this state or whose residence is unknown, 5 including cost of commitment, if any, shall be paid as a 6 state case as approved by the administrator. The amount 7 of the costs and expenses approved by the administrator is 8 appropriated to the department from any money in the state 9 treasury not otherwise appropriated. Payment shall be made by 10 the department on itemized vouchers executed by the auditor of 11 the regional administrator of the person’s county which has 12 paid them, and approved by the administrator. 13 Sec. 8. Section 230.12, Code 2018, is amended to read as 14 follows: 15 230.12 Residency disputes. 16 If a dispute arises between different counties or between 17 the administrator and a regional administrator for a county as 18 to the residence of a person admitted or committed to a state 19 hospital for persons with mental illness, the dispute shall be 20 resolved as provided in section 331.394 . 21 Sec. 9. Section 230.15, subsection 1, Code 2018, is amended 22 to read as follows: 23 1. A person with mental illness and a person legally liable 24 for the person’s support remain liable for the support of 25 the person with mental illness as provided in this section . 26 Persons legally liable for the support of a person with 27 mental illness include the spouse of the person, and any 28 person bound by contract for support of the person , and, 29 with respect to persons with mental illness under eighteen 30 years of age only, the father and mother of the person . 31 The county auditor regional administrator of the person’s 32 county of residence , subject to the direction of the region’s 33 governing board of supervisors , shall enforce the obligation 34 created in this section as to all sums advanced by the county 35 -4- LSB 5312HV (3) 87 hb/rj 4/ 13

H.F. 2445 regional administrator . The liability to the county regional 1 administrator incurred by a person with mental illness or a 2 person legally liable for the person’s support under this 3 section is limited to an amount equal to one hundred percent 4 of the cost of care and treatment of the person with mental 5 illness at a state mental health institute for one hundred 6 twenty days of hospitalization. This limit of liability may 7 be reached by payment of the cost of care and treatment of the 8 person with mental illness subsequent to a single admission 9 or multiple admissions to a state mental health institute 10 or, if the person is not discharged as cured, subsequent to 11 a single transfer or multiple transfers to a county care 12 facility pursuant to section 227.11 . After reaching this 13 limit of liability, a person with mental illness or a person 14 legally liable for the person’s support is liable to the county 15 regional administrator for the care and treatment of the person 16 with mental illness at a state mental health institute or, 17 if transferred but not discharged as cured, at a county care 18 facility in an amount not in excess of the average minimum 19 cost of the maintenance of an individual who is physically and 20 mentally healthy residing in the individual’s own home, which 21 standard shall be established and may from time to time be 22 revised by the department of human services. A lien imposed 23 by section 230.25 shall not exceed the amount of the liability 24 which may be incurred under this section on account of a person 25 with mental illness. 26 Sec. 10. Section 230.16, Code 2018, is amended to read as 27 follows: 28 230.16 Presumption. 29 In actions to enforce the liability imposed by section 30 230.15 , the certificate from the superintendent to the county 31 auditor regional administrator of the person’s county of 32 residence stating the sums charged in such cases, shall be 33 presumptively correct. 34 Sec. 11. Section 230.17, Code 2018, is amended to read as 35 -5- LSB 5312HV (3) 87 hb/rj 5/ 13

H.F. 2445 follows: 1 230.17 Board may compromise lien. 2 The board of supervisors of the person’s county of residence 3 is hereby empowered to compromise any and all liabilities to 4 the county, created by this chapter , when such compromise is 5 deemed to be for the best interests of the county. 6 Sec. 12. Section 230.18, Code 2018, is amended to read as 7 follows: 8 230.18 Expense in county or private hospitals. 9 The estates of persons with mental illness who may be treated 10 or confined in any county hospital or home, or in any private 11 hospital or sanatorium, and the estates of persons legally 12 bound for their support, shall be liable to the county regional 13 administrator of the person’s county of residence for the 14 reasonable cost of such support. 15 Sec. 13. Section 230.20, Code 2018, is amended to read as 16 follows: 17 230.20 Billing of patient charges —— computation of actual 18 costs —— cost settlement. 19 1. The superintendent of each mental health institute 20 shall compute by February 1 the average daily patient charges 21 and other service charges for which each county regional 22 administrator of a person’s county of residence will be billed 23 for services provided to patients the person and chargeable to 24 the county of residence during the fiscal year beginning the 25 following July 1. The department shall certify the amount of 26 the charges and notify the counties regional administrator of 27 the person’s county of residence of the billing charges. 28 a. The superintendent shall separately compute by program 29 the average daily patient charge for a mental health institute 30 for services provided in the following fiscal year, in 31 accordance with generally accepted accounting procedures, by 32 totaling the expenditures of the program for the immediately 33 preceding calendar year, by adjusting the expenditures 34 by a percentage not to exceed the percentage increase in 35 -6- LSB 5312HV (3) 87 hb/rj 6/ 13

H.F. 2445 the consumer price index for all urban consumers for the 1 immediately preceding calendar year, and by dividing the 2 adjusted expenditures by the total inpatient days of service 3 provided in the program during the immediately preceding 4 calendar year. However, the superintendent shall not include 5 the following in the computation of the average daily patient 6 charge: 7 (1) The costs of food, lodging, and other maintenance 8 provided to persons not patients of the hospital. 9 (2) The costs of certain direct medical services identified 10 in administrative rule, which may include but need not be 11 limited to X-ray, laboratory, and dental services. 12 (3) The costs of outpatient and state placement services. 13 (4) The costs of the psychiatric residency program. 14 (5) The costs of the chaplain intern program. 15 b. The department shall compute the direct medical 16 services, outpatient, and state placement services charges, in 17 accordance with generally accepted accounting procedures, on 18 the basis of the actual cost of the services provided during 19 the immediately preceding calendar year. The direct medical 20 services, outpatient, and state placement services shall be 21 billed directly against the patient who received the services. 22 2. a. The superintendent shall certify to the department 23 the billings to each county the regional administrator of the 24 person’s county of residence for services provided to patients 25 the person and chargeable to the county of residence during 26 the preceding calendar quarter. The county of residence 27 billings shall be based on the average daily patient charge 28 and other service charges computed pursuant to subsection 29 1 , and the number of inpatient days and other service units 30 chargeable to the regional administrator of the person’s county 31 of residence . However, a county of residence billing shall 32 be decreased by an amount equal to reimbursement by a third 33 party payor or estimation of such reimbursement from a claim 34 submitted by the superintendent to the third party payor for 35 -7- LSB 5312HV (3) 87 hb/rj 7/ 13

H.F. 2445 the preceding calendar quarter. When the actual third party 1 payor reimbursement is greater or less than estimated, the 2 difference shall be reflected in the county billing in the 3 calendar quarter the actual third party payor reimbursement is 4 determined. 5 b. The per diem costs billed to each mental health and 6 disability services region shall not exceed the per diem costs 7 billed to the region in the fiscal year beginning July 1, 2016. 8 3. The superintendent shall compute in January the actual 9 per-patient-per-day cost for each mental health institute for 10 the immediately preceding calendar year, in accordance with 11 generally accepted accounting procedures, by totaling the 12 actual expenditures of the mental health institute for the 13 calendar year and by dividing the total actual expenditures 14 by the total inpatient days of service provided during the 15 calendar year. 16 4. The department shall certify to the counties regional 17 administrator by February 1 the actual per-patient-per-day 18 costs, as computed pursuant to subsection 3 , and the actual 19 costs owed by each county regional administrator itemized 20 for each county in the region for the immediately preceding 21 calendar year for patients chargeable to the county regional 22 administrator . If the actual costs owed by the county regional 23 administrator are greater than the charges billed to the county 24 regional administrator pursuant to subsection 2 , the department 25 shall bill the county regional administrator for the difference 26 itemized for each county in the region with the billing for the 27 quarter ending June 30. If the actual costs owed by the county 28 regional administrator are less than the charges billed to the 29 county regional administrator pursuant to subsection 2 , the 30 department shall credit the county regional administrator for 31 the difference itemized for each county in the region starting 32 with the billing for the quarter ending June 30. 33 5. An individual statement shall be prepared for a patient 34 on or before the fifteenth day of the month following the month 35 -8- LSB 5312HV (3) 87 hb/rj 8/ 13

H.F. 2445 in which the patient leaves the mental health institute, and 1 a general statement shall be prepared at least quarterly for 2 each county regional administrator itemized for each county 3 in the region to which charges are made under this section . 4 Except as otherwise required by sections 125.33 and 125.34 , 5 the general statement shall list the name of each patient 6 chargeable to that a county in the region who was served by the 7 mental health institute during the preceding month or calendar 8 quarter, the amount due on account of each patient, and the 9 specific dates for which any third party payor reimbursement 10 received by the state is applied to the statement and billing, 11 and the county regional administrator shall be billed for 12 eighty percent of the stated charge for each patient specified 13 in this subsection . The statement prepared for each county 14 regional administrator shall be certified by the department and 15 a duplicate statement shall be mailed to the auditor of that 16 county . 17 6. All or any reasonable portion of the charges incurred 18 for services provided to a patient, to the most recent date for 19 which the charges have been computed, may be paid at any time 20 by the patient or by any other person on the patient’s behalf. 21 Any payment made by the patient or other person, and any 22 federal financial assistance received pursuant to Tit. XVIII or 23 XIX of the federal Social Security Act for services rendered 24 to a patient, shall be credited against the patient’s account 25 and, if the charges paid as described in this subsection have 26 previously been billed to a county regional administrator on 27 behalf of the person’s county of residence , reflected in the 28 mental health institute’s next general statement to that county 29 regional administrator . 30 7. A superintendent of a mental health institute may request 31 that the director of human services enter into a contract 32 with a person for the mental health institute to provide 33 consultation or treatment services or for fulfilling other 34 purposes which are consistent with the purposes stated in 35 -9- LSB 5312HV (3) 87 hb/rj 9/ 13

H.F. 2445 section 226.1 . The contract provisions shall include charges 1 which reflect the actual cost of providing the services or 2 fulfilling the other purposes. Any income from a contract 3 authorized under this subsection may be retained by the 4 mental health institute to defray the costs of providing the 5 services. Except for a contract voluntarily entered into by a 6 county under this subsection , the costs or income associated 7 with a contract authorized under this subsection shall not 8 be considered in computing charges and per diem costs in 9 accordance with the provisions of subsections 1 through 6 of 10 this section . 11 8. The department shall provide a county regional 12 administrator with information, which is not otherwise 13 confidential under law, in the department’s possession 14 concerning a patient whose cost of care is chargeable to the 15 county regional administrator , including but not limited to the 16 information specified in section 229.24, subsection 3 . 17 Sec. 14. Section 230.21, Code 2018, is amended to read as 18 follows: 19 230.21 Duty of county auditor and treasurer Notice to county 20 of residence . 21 The county auditor, upon receipt of the duplicate statement 22 required by section 230.20 , shall enter it to the credit of the 23 state in the ledger of state accounts, regional administrator 24 shall furnish to the board of supervisors of the county of 25 residence a list of the names of the persons so certified, and 26 at once issue a notice authorizing the county treasurer to 27 transfer the amount billed to the county by the statement, from 28 the county to the general state revenue, which notice shall be 29 filed by the treasurer as authority for making the transfer who 30 are residents of that county and eligible for mental health 31 and disability services funding . The auditor shall promptly 32 remit the amount so transferred to the treasurer of state, 33 designating the fund to which it belongs. 34 Sec. 15. Section 230.22, Code 2018, is amended to read as 35 -10- LSB 5312HV (3) 87 hb/rj 10/ 13

H.F. 2445 follows: 1 230.22 Penalty. 2 Should any county fail If a regional administrator fails 3 to pay the amount billed by a statement submitted pursuant 4 to section 230.20 within forty-five days from the date the 5 statement is received by the county regional administrator , 6 the department shall charge the delinquent county regional 7 administrator the penalty of one percent per month on and 8 after forty-five days from the date the statement is received 9 by the county regional administrator until paid. Provided, 10 however, that the penalty shall not be imposed if the county 11 regional administrator has notified the department of error 12 or questionable items in the billing, in which event, the 13 department shall suspend the penalty only during the period of 14 negotiation. 15 Sec. 16. Section 230.25, subsection 1, Code 2018, is amended 16 to read as follows: 17 1. Upon receipt from the county auditor or the regional 18 administrator for mental health and disability services of 19 the list of names furnished pursuant to section 230.21 , the 20 board of supervisors of the county of residence shall make an 21 investigation to determine the ability of each person whose 22 name appears on the list, and also the ability of any person 23 liable under section 230.15 for the support of that person, 24 to pay the expenses of that person’s hospitalization. If 25 the board finds that neither the hospitalized person nor any 26 person legally liable for the person’s support is able to 27 pay those expenses, they the board shall direct the county 28 auditor or regional administrator not to index the names 29 of any of those persons as would otherwise be required by 30 section 230.26 . However the board may review its finding with 31 respect to any person at any subsequent time at which another 32 list is furnished by the auditor county auditor or regional 33 administrator upon which that person’s name appears. If the 34 board finds upon review that that person or those legally 35 -11- LSB 5312HV (3) 87 hb/rj 11/ 13

H.F. 2445 liable for the person’s support are presently able to pay the 1 expenses of that person’s hospitalization, that finding shall 2 apply only to charges stated upon the certificate from which 3 the list was drawn up and any subsequent charges similarly 4 certified, unless and until the board again changes its 5 finding. 6 Sec. 17. Section 230.26, Code 2018, is amended to read as 7 follows: 8 230.26 Auditor Regional administrator to keep record. 9 The auditor of each county regional administrator shall 10 keep an accurate account of the cost of the maintenance of 11 any patient kept in any institution as provided for in this 12 chapter and keep an index of the names of the persons admitted 13 or committed from such each county in the region . The name of 14 the husband or the wife of such person designating such party 15 as the spouse of the person admitted or committed shall also be 16 indexed in the same manner as the names of the persons admitted 17 or committed are indexed. The book shall be designated as an 18 account book or index, and shall have no reference in any place 19 to a lien. 20 Sec. 18. Section 230.33, Code 2018, is amended to read as 21 follows: 22 230.33 Reciprocal agreements. 23 The administrator may enter into agreements with other 24 states, through their duly constituted authorities, to effect 25 the reciprocal return of persons with mental illness and 26 persons with an intellectual disability to the contracting 27 states, and to effect the reciprocal supervision of persons on 28 convalescent leave. 29 However, in the case of a proposed transfer of a person with 30 mental illness or an intellectual disability from this state, 31 final action shall not be taken without the approval either of 32 the commission of hospitalization, or of the district court, of 33 the county of admission or commitment. 34 Sec. 19. REPEAL. Sections 230.34 and 232.80, Code 2018, 35 -12- LSB 5312HV (3) 87 hb/rj 12/ 13

H.F. 2445 are repealed. 1 EXPLANATION 2 The inclusion of this explanation does not constitute agreement with 3 the explanation’s substance by the members of the general assembly. 4 This bill relates to administrative procedures and services 5 provided by the department of human services. 6 Under current law, expenses and legal costs relating to 7 the taking into custody, care, investigation, admission, 8 commitment, and support of a person with mental illness 9 admitted or committed to a state hospital are sent to the 10 county auditor of the person’s county of residence. The county 11 auditor submits the bills to the regional administrator of 12 the person’s county of residence. The regional administrator 13 pays the state hospital for the expenses. The bill amends 14 current law to provide such expenses are billed to the regional 15 administrator of the person’s county of residence. References 16 to the county auditor are amended to refer to the regional 17 administrator. The bill removes the definition of auditor from 18 the Code, makes technical changes to the location of other 19 definitions, and defines region. 20 Code section 232.80 relating to services by a homemaker-home 21 health aide providing care to a child in the child’s place of 22 residence in preference to removal of the child from the home 23 is repealed by the bill. 24 -13- LSB 5312HV (3) 87 hb/rj 13/ 13