House File 2456 - Introduced HOUSE FILE 2456 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HF 2327) A BILL FOR An Act relating to behavioral health, including provisions 1 relating to involuntary commitments and hospitalizations, 2 the disclosure of mental health information to law 3 enforcement professionals, and mental health and disability 4 services. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 6024HV (2) 87 hb/rh

H.F. 2456 Section 1. Section 125.80, subsection 3, Code 2018, is 1 amended to read as follows: 2 3. If the report of a court-designated licensed physician 3 or mental health professional is to the effect that the 4 respondent is not a person with a substance-related disorder, 5 the court, without taking further action, may shall terminate 6 the proceeding and dismiss the application on its own motion 7 and without notice. 8 Sec. 2. Section 125.81, Code 2018, is amended by adding the 9 following new subsection: 10 NEW SUBSECTION . 2A. A respondent shall be released from 11 detention prior to the commitment hearing if a licensed 12 physician or mental health professional examines the respondent 13 and determines the respondent no longer meets the criteria for 14 detention under subsection 1 and provides notification to the 15 court. 16 Sec. 3. Section 135G.6, Code 2018, is amended by striking 17 the section and inserting in lieu thereof the following: 18 135G.6 Inspection —— conditions for issuance. 19 The department shall issue a license to an applicant under 20 this chapter if the department has ascertained that the 21 applicant’s facilities and staff are adequate to provide the 22 care and services required of a subacute care facility. 23 Sec. 4. Section 228.1, Code 2018, is amended by adding the 24 following new subsection: 25 NEW SUBSECTION . 3A. “ Law enforcement professional” means 26 a law enforcement officer as defined in section 80B.3, county 27 attorney as defined in section 331.101, probation or parole 28 officer, or jailer. 29 Sec. 5. NEW SECTION . 228.7A Disclosures to law enforcement 30 professionals. 31 1. Mental health information relating to an individual 32 shall be disclosed by a mental health professional, at the 33 minimum consistent with applicable laws and standards of 34 ethical conduct, to a law enforcement professional if all of 35 -1- LSB 6024HV (2) 87 hb/rh 1/ 26

H.F. 2456 the following apply: 1 a. The disclosure is made in good faith. 2 b. The disclosure is necessary to prevent or lessen a 3 serious and imminent threat to the health or safety of the 4 individual or to a clearly identifiable victim or victims. 5 c. The individual has the apparent intent and ability to 6 carry out the threat. 7 2. A mental health professional shall not be held criminally 8 or civilly liable for failure to disclose mental health 9 information relating to an individual to a law enforcement 10 professional except in circumstances where the individual has 11 communicated to the mental health professional an imminent 12 threat of physical violence against the individual’s self or 13 against a clearly identifiable victim or victims. 14 3. A mental health professional discharges the 15 professional’s duty to disclose pursuant to subsection 1 by 16 making reasonable efforts to communicate the threat to a law 17 enforcement professional. 18 Sec. 6. Section 229.10, subsection 3, Code 2018, is amended 19 to read as follows: 20 3. If the report of one or more of the court-designated 21 physicians or mental health professionals is to the effect 22 that the individual is not seriously mentally impaired, the 23 court may shall without taking further action terminate the 24 proceeding and dismiss the application on its own motion and 25 without notice. 26 Sec. 7. Section 229.11, Code 2018, is amended by adding the 27 following new subsection: 28 NEW SUBSECTION . 1A. A respondent shall be released from 29 detention prior to the hospitalization hearing if a licensed 30 physician or mental health professional examines the respondent 31 and determines the respondent no longer meets the criteria for 32 detention under subsection 1 and provides notification to the 33 court. 34 Sec. 8. Section 229.12, subsection 3, paragraph a, Code 35 -2- LSB 6024HV (2) 87 hb/rh 2/ 26

H.F. 2456 2018, is amended to read as follows: 1 a. The respondent’s welfare shall be paramount and the 2 hearing shall be conducted in as informal a manner as may be 3 consistent with orderly procedure, but consistent therewith 4 the issue shall be tried as a civil matter. The hearing may 5 be held by video conference at the discretion of the court. 6 Such discovery as is permitted under the Iowa rules of civil 7 procedure shall be available to the respondent. The court 8 shall receive all relevant and material evidence which may be 9 offered and need not be bound by the rules of evidence. There 10 shall be a presumption in favor of the respondent, and the 11 burden of evidence in support of the contentions made in the 12 application shall be upon the applicant. 13 Sec. 9. Section 229.22, subsection 2, paragraph b, Code 14 2018, is amended to read as follows: 15 b. If the magistrate orders that the person be detained, 16 the magistrate shall, by the close of business on the next 17 working day, file a written order with the clerk in the county 18 where it is anticipated that an application may be filed 19 under section 229.6 . The order may be filed by facsimile if 20 necessary. A peace officer from the law enforcement agency 21 that took the person into custody, if no request was made 22 under paragraph “a” , may inform the magistrate that an arrest 23 warrant has been issued for or charges are pending against the 24 person and request that any written order issued under this 25 paragraph require the facility or hospital to notify the law 26 enforcement agency about the discharge of the person prior to 27 discharge. The order shall state the circumstances under which 28 the person was taken into custody or otherwise brought to a 29 facility or hospital, and the grounds supporting the finding 30 of probable cause to believe that the person is seriously 31 mentally impaired and likely to injure the person’s self or 32 others if not immediately detained. The order shall also 33 include any law enforcement agency notification requirements if 34 applicable. The order shall confirm the oral order authorizing 35 -3- LSB 6024HV (2) 87 hb/rh 3/ 26

H.F. 2456 the person’s detention including any order given to transport 1 the person to an appropriate facility or hospital. A peace 2 officer from the law enforcement agency that took the person 3 into custody may also request an order, separate from the 4 written order, requiring the facility or hospital to notify the 5 law enforcement agency about the discharge of the person prior 6 to discharge. The clerk shall provide a copy of the written 7 order or any separate order to the chief medical officer of the 8 facility or hospital to which the person was originally taken, 9 to any subsequent facility to which the person was transported, 10 and to any law enforcement department , or ambulance service , 11 or transportation service under contract with a mental health 12 and disability services region that transported the person 13 pursuant to the magistrate’s order. A transportation service 14 that contracts with a mental health and disability services 15 region for purposes of this paragraph shall provide a secure 16 transportation vehicle and shall employ staff that has received 17 or is receiving mental health training. 18 Sec. 10. Section 331.397, Code 2018, is amended to read as 19 follows: 20 331.397 Regional core services. 21 1. For the purposes of this section , unless the context 22 otherwise requires, “domain” means a set of similar services 23 that can be provided depending upon a person’s service needs. 24 2. a. (1) A region shall work with service providers to 25 ensure that services in the required core service domains in 26 subsections 4 and 5 are available to residents of the region, 27 regardless of potential payment source for the services. 28 (2) Subject to the available appropriations, the director 29 of human services shall ensure the initial core service domains 30 listed in subsection subsections 4 and 5 are covered services 31 for the medical assistance program under chapter 249A to the 32 greatest extent allowable under federal regulations. The 33 medical assistance program shall reimburse Medicaid enrolled 34 providers for Medicaid covered services under subsections 4 35 -4- LSB 6024HV (2) 87 hb/rh 4/ 26

H.F. 2456 and 5 when the services are medically necessary, the Medicaid 1 enrolled provider submits an appropriate claim for such 2 services, and no other third-party payer is responsible for 3 reimbursement of such services. Within funds available, the 4 region shall pay for such services for eligible persons when 5 payment through the medical assistance program or another 6 third-party payment is not available, unless the person is on a 7 waiting list for such payment or it has been determined that 8 the person does not meet the eligibility criteria for any such 9 service. 10 b. Until funding is designated for other service 11 populations, eligibility for the service domains listed in this 12 section shall be limited to such persons who are in need of 13 mental health or intellectual disability services. However, if 14 a county in a region was providing services to an eligibility 15 class of persons with a developmental disability other than 16 intellectual disability or a brain injury prior to formation of 17 the region, the class of persons shall remain eligible for the 18 services provided when the region is was formed , provided that 19 funds are available to continue such services without limiting 20 or reducing core services . 21 c. It is the intent of the general assembly to address 22 the need for funding so that the availability of the service 23 domains listed in this section may be expanded to include such 24 persons who are in need of developmental disability or brain 25 injury services. 26 3. Pursuant to recommendations made by the director of human 27 services, the state commission shall adopt rules as required by 28 section 225C.6 to define the services included in the initial 29 and additional core service domains listed in this section . 30 The rules shall provide service definitions, service provider 31 standards, service access standards, and service implementation 32 dates, and shall provide consistency, to the extent possible, 33 with similar service definitions under the medical assistance 34 program. 35 -5- LSB 6024HV (2) 87 hb/rh 5/ 26

H.F. 2456 a. The rules relating to the credentialing of a person 1 directly providing services shall require all of the following: 2 a. (1) The person shall provide services and represent the 3 person as competent only within the boundaries of the person’s 4 education, training, license, certification, consultation 5 received, supervised experience, or other relevant professional 6 experience. 7 b. (2) The person shall provide services in substantive 8 areas or use intervention techniques or approaches that 9 are new only after engaging in appropriate study, training, 10 consultation, and supervision from a person who is competent in 11 those areas, techniques, or approaches. 12 c. (3) If generally recognized standards do not exist 13 with respect to an emerging area of practice, the person 14 shall exercise careful judgment and take responsible steps, 15 including obtaining appropriate education, research, training, 16 consultation, and supervision, in order to ensure competence 17 and to protect from harm the persons receiving the services in 18 the emerging area of practice. 19 b. The rules relating to the availability of services shall 20 provide for all of the following: 21 (1) Twenty-two assertive community treatment teams. 22 (2) Six access centers. 23 (3) Intensive residential service homes that provide 24 services to up to one hundred twenty persons statewide. 25 4. The initial core service domains shall include the 26 following: 27 a. Treatment designed to ameliorate a person’s condition, 28 including but not limited to all of the following: 29 (1) Assessment and evaluation. 30 (2) Mental health outpatient therapy. 31 (3) Medication prescribing and management. 32 (4) Mental health inpatient treatment. 33 b. Basic crisis response provisions, including but not 34 limited to all of the following: 35 -6- LSB 6024HV (2) 87 hb/rh 6/ 26

H.F. 2456 (1) Twenty-four-hour access to crisis response. 1 (2) Evaluation. 2 (3) Personal emergency response system. 3 c. Support for community living, including but not limited 4 to all of the following: 5 (1) Home health aide. 6 (2) Home and vehicle modifications. 7 (3) Respite. 8 (4) Supportive community living. 9 d. Support for employment or for activities leading to 10 employment providing an appropriate match with an individual’s 11 abilities based upon informed, person-centered choices made 12 from an array of options, including but not limited to all of 13 the following: 14 (1) Day habilitation. 15 (2) Job development. 16 (3) Supported employment. 17 (4) Prevocational services. 18 e. Recovery services, including but not limited to all of 19 the following: 20 (1) Family support. 21 (2) Peer support. 22 f. Service coordination including coordinating physical 23 health and primary care, including but not limited to all of 24 the following: 25 (1) Case management. 26 (2) Health homes. 27 5. a. To the extent federal matching funds are available 28 under the Iowa health and wellness plan pursuant to chapter 29 249N, the following intensive mental health services in 30 strategic locations throughout the state shall be provided 31 within the following core service domains: 32 (1) Access centers that are located in crisis residential 33 and subacute residential settings with sixteen beds or fewer 34 that provide immediate, short-term assessments for persons with 35 -7- LSB 6024HV (2) 87 hb/rh 7/ 26

H.F. 2456 serious mental illness or substance use disorders who do not 1 need inpatient psychiatric hospital treatment, but who do need 2 significant amounts of supports and services not available in 3 the persons’ homes or communities. 4 (2) Assertive community treatment services. 5 (3) Comprehensive facility and community-based crisis 6 services, including all of the following: 7 (a) Mobile response. 8 (b) Twenty-three-hour crisis observation and holding. 9 (c) Crisis stabilization community-based services. 10 (d) Crisis stabilization residential services. 11 (4) Subacute services provided in facility and 12 community-based settings. 13 (5) Intensive residential service homes for persons 14 with severe and persistent mental illness in scattered site 15 community-based residential settings that provide intensive 16 services and that operate twenty-four hours a day. 17 b. The department shall accept arrangements between multiple 18 regions sharing intensive mental health services under this 19 subsection. 20 5. 6. A region shall ensure that access is available 21 to providers of core services that demonstrate competencies 22 necessary for all of the following: 23 a. Serving persons with co-occurring conditions. 24 b. Providing evidence-based services. 25 c. Providing trauma-informed care that recognizes the 26 presence of trauma symptoms in persons receiving services. 27 6. 7. A region shall ensure that services within the 28 following additional core service domains are available 29 to persons not eligible for the medical assistance program 30 under chapter 249A or receiving other third-party payment for 31 the services, when public funds are made available for such 32 services: 33 a. Comprehensive facility and community-based crisis 34 services, including but not limited to all of the following: 35 -8- LSB 6024HV (2) 87 hb/rh 8/ 26

H.F. 2456 (1) Twenty-four-hour crisis hotline. 1 (2) Mobile response. 2 (3) Twenty-three-hour crisis observation and holding, and 3 crisis stabilization facility and community-based services. 4 (4) Crisis residential services. 5 b. Subacute services provided in facility and 6 community-based settings. 7 c. a. Justice system-involved services, including but not 8 limited to all of the following: 9 (1) Jail diversion. 10 (2) Crisis intervention training. 11 (3) Civil commitment prescreening. 12 d. b. Advances in the use of evidence-based treatment, 13 including but not limited to all of the following: 14 (1) Positive behavior support. 15 (2) Assertive community treatment. 16 (3) (2) Peer self-help drop-in centers. 17 7. 8. A regional service system may provide funding for 18 other appropriate services or other support and may implement 19 demonstration projects for an initial period of up to three 20 years to model the use of research-based practices. In 21 considering whether to provide such funding, a region may 22 consider the following criteria for research-based practices: 23 a. Applying a person-centered planning process to identify 24 the need for the services or other support. 25 b. The efficacy of the services or other support is 26 recognized as an evidence-based practice, is deemed to be an 27 emerging and promising practice, or providing the services is 28 part of a demonstration and will supply evidence as to the 29 services’ effectiveness. 30 c. A determination that the services or other support 31 provides an effective alternative to existing services that 32 have been shown by the evidence base to be ineffective, to not 33 yield the desired outcome, or to not support the principles 34 outlined in Olmstead v. L.C., 527 U.S. 581 (1999). 35 -9- LSB 6024HV (2) 87 hb/rh 9/ 26

H.F. 2456 Sec. 11. Section 331.424A, subsection 9, Code 2018, is 1 amended to read as follows: 2 9. a. For the fiscal year beginning July 1, 2017, and each 3 subsequent fiscal year, the county budgeted amount determined 4 for each county shall be the amount necessary to meet the 5 county’s financial obligations for the payment of services 6 provided under the regional service system management plan 7 approved pursuant to section 331.393 , not to exceed an amount 8 equal to the product of the regional per capita expenditure 9 target amount multiplied by the county’s population , and, for 10 fiscal years beginning on or after July 1, 2021, reduced by 11 the amount of the county’s cash flow reduction amount for the 12 fiscal year calculated under subsection 4 , if applicable . 13 b. If a county officially joins a different region, the 14 county’s budgeted amount shall be the amount necessary to meet 15 the county’s financial obligations for payment of services 16 provided under the new region’s regional service system 17 management plan approved pursuant to section 331.393, not to 18 exceed an amount equal to the product of the new region’s 19 regional per capita expenditure target amount multiplied by the 20 county’s population. 21 Sec. 12. DEPARTMENT OF HUMAN SERVICES —— CIVIL COMMITMENT 22 PRESCREENING ASSESSMENTS —— RULES. The department of human 23 services, in coordination with the mental health and disability 24 services commission, shall adopt rules pursuant to chapter 17A 25 relating to civil commitment prescreening assessments provided 26 by a mental health and disability services region or an entity 27 contracting with a mental health and disability service region. 28 The rules shall provide for all of the following: 29 1. The provision of civil commitment prescreening 30 assessments by a licensed physician or mental health 31 professional within four hours of an emergency detention of 32 an individual believed to be mentally ill to determine if 33 inpatient psychiatric hospitalization is necessary. 34 2. The coordination of appropriate levels of care 35 -10- LSB 6024HV (2) 87 hb/rh 10/ 26

H.F. 2456 to include securing an inpatient psychiatric bed when 1 inpatient psychiatric hospitalization is needed and 2 utilizing community-based resources and services such as 3 crisis observation and crisis stabilization services and 4 subacute care and detoxification centers and facilitating 5 outpatient treatment appointments when inpatient psychiatric 6 hospitalization is not needed. 7 3. The provision of ongoing consultations by a licensed 8 physician or mental health professional while the individual 9 remains in the emergency room. 10 4. Requiring appropriate documentation and reports to be 11 submitted by a licensed physician or mental health professional 12 to a treating hospital and the court as necessary. 13 Sec. 13. PROGRAM IMPLEMENTATION —— ADOPTION OF 14 ADMINISTRATIVE RULES. 15 1. The core services specified in this Act shall be 16 implemented and the department of human services shall adopt 17 rules pursuant to chapter 17A relating to the administration of 18 such core services no later than October 1, 2018. 19 2. The provisions of this Act and rules adopted in 20 accordance with this Act shall not be interpreted to delay 21 or disrupt services or plans for the implementation of such 22 services in effect on July 1, 2018. 23 3. The rules adopted by the department relating to access 24 centers shall provide for all of the following: 25 a. The access centers shall meet all of the following 26 criteria: 27 (1) An access center shall serve individuals with a 28 serious mental health or substance use disorder need who are 29 otherwise medically stable, who are not in need of an inpatient 30 psychiatric level of care, and who do not have alternative, 31 safe, effective services immediately available. 32 (2) Access center services shall be provided on a no reject, 33 no eject basis. 34 (3) An access center shall accept and serve individuals who 35 -11- LSB 6024HV (2) 87 hb/rh 11/ 26

H.F. 2456 are court-ordered to participate in mental health or substance 1 use disorder treatment. 2 (4) Access center providers shall be accredited under 441 3 IAC 24 to provide crisis stabilization residential services and 4 shall be licensed to provide subacute mental health services as 5 defined in section 135G.1. 6 (5) An access center shall be licensed as a substance abuse 7 treatment program pursuant to chapter 125 or have a cooperative 8 agreement with and immediate access to licensed substance abuse 9 treatment services or medical care that incorporates withdrawal 10 management. 11 (6) An access center shall provide person-centered mental 12 health and substance use disorder assessments by appropriately 13 licensed or credentialed professionals and peer support 14 services based on a comprehensive assessment. 15 (7) An access center shall provide or arrange to provide 16 necessary physical health services. 17 (8) An access center shall ensure short stays by providing 18 individuals with care coordination that provides successful 19 navigation and warm handoffs to the next service provider 20 as well as linkages to needed services including housing, 21 employment, and shelter services. 22 b. The rules shall include access center designation 23 criteria and standards that allow and encourage multiple 24 mental health and disability services regions to strategically 25 locate and share access center services, including bill-back 26 provisions to provide for reimbursement of a region when the 27 resident of another region utilizes an access center located 28 in that region. 29 c. The rules shall direct Medicaid managed care 30 organizations, mental health and disability services regions, 31 and law enforcement to jointly select, develop, and implement 32 six access centers strategically located throughout the state 33 by December 31, 2019. Regions may enter into chapter 28E 34 agreements to provide such services. 35 -12- LSB 6024HV (2) 87 hb/rh 12/ 26

H.F. 2456 d. The rules shall require that Medicaid managed care 1 organizations reimburse Medicaid services provided at access 2 centers by Medicaid providers based on the reimbursement rate 3 floor established for the covered Medicaid service. The rules 4 shall also require mental health and disability services 5 regions to provide start-up funding for the establishment of 6 access centers jointly selected by mental health and disability 7 services regions and Medicaid managed care organizations and 8 to provide funding for non-Medicaid covered services provided 9 by the access centers. 10 4. The rules relating to assertive community treatment 11 (ACT) shall provide for all of the following: 12 a. The department shall establish uniform, statewide 13 accreditation standards for ACT based on national accreditation 14 standards, including allowances for nationally recognized small 15 team standards. The statewide standards shall require that ACT 16 teams meet fidelity to practice nationally recognized standards 17 as determined by an independent review of each team that 18 includes peer review. The rules shall provide that Medicaid 19 managed care organization utilization management requirements 20 do not exceed the accreditation standards developed by the 21 department and that Medicaid managed care organizations 22 reimburse ACT teams for each day of care provided including for 23 admissions and ongoing treatment provided on weekends. 24 b. The rules shall require mental health and disability 25 services regions and Medicaid managed care organizations to 26 jointly agree on all of the following: 27 (1) Strategically located geographic areas in which ACT 28 teams should be developed upon consideration of all of the 29 following: 30 (a) Recommendations for locations included in the complex 31 service needs workgroup report published by the department of 32 human services on December 15, 2017. 33 (b) A review of known individuals with diagnoses that would 34 benefit from ACT. 35 -13- LSB 6024HV (2) 87 hb/rh 13/ 26

H.F. 2456 (c) Hospital inpatient psychiatric readmission rates. 1 (d) The interest and readiness of a provider and community 2 partners to form ACT. 3 (e) The availability of psychiatric providers interested 4 in the model. 5 (2) How to accomplish independent review of fidelity to 6 practice established standards. 7 c. The rules shall direct Medicaid managed care 8 organizations to enter into contracts with jointly selected ACT 9 teams. Reimbursement of ACT teams shall be provided based on 10 the reimbursement rate floor established for such services to 11 Medicaid covered members who have a demonstrated need for ACT. 12 The rules shall allow mental health and disability services 13 regions to enter into chapter 28E agreements to provide ACT 14 services and shall also include bill-back provisions to allow 15 for reimbursement of a region when the resident of another 16 region utilizes an ACT team located in that region. 17 d. The rules shall require mental health and disability 18 services regions to provide start-up funding for the ACT teams 19 that are not established prior to July 1, 2018, including for 20 assistance in achieving fidelity to practice standards and 21 technical assistance. 22 e. The rules shall require that mental health and disability 23 services regions ensure the efficient and effective operation 24 of ACT teams and provide funding for general operations based 25 on guidance provided by the department. 26 5. The rules relating to intensive residential service 27 homes (IRSH) shall provide for all of the following: 28 a. That an intensive residential service home be enrolled 29 with the Iowa Medicaid enterprise as a section 1915(i) home and 30 community-based services habilitation waiver or intellectual 31 disability waiver-supported community living provider. 32 b. That an intensive residential service home have adequate 33 staffing that includes appropriate specialty training including 34 applied behavior analysis as appropriate; adequate direct 35 -14- LSB 6024HV (2) 87 hb/rh 14/ 26

H.F. 2456 care staffing rations; swift access to additional staffing 1 if serious incidents occur; and adequate pay and paid time 2 off commensurate with the increased intensity of the services 3 provided. 4 c. Coordination with the individual’s clinical 5 mental health and physical health treatment including 6 ensuring treatment plans are developed by a comprehensive 7 interdisciplinary team selected by the individual that develops 8 and implements the individual’s person-centered plan; ensuring 9 access to active medication management and outpatient therapy 10 including evidence-based therapy approaches; establishing a 11 fully coordinated care plan; accessing assertive community 12 treatment if there is a demonstrated need; and developing a 13 thorough wellness recovery action plan, as appropriate. 14 d. Be licensed as a substance abuse treatment program 15 pursuant to chapter 125 or have a cooperative agreement 16 with and timely access to licensed substance abuse treatment 17 services for those with a demonstrated need. 18 e. Accept court-ordered commitments. 19 f. Have a high tolerance for serious behavioral issues. 20 g. Have a no reject, no eject policy for an individual 21 referred to the home based on the severity of the individual’s 22 mental health or co-occurring needs. 23 h. Be smaller in size, preferably providing services to 24 four or fewer individuals and no more than sixteen individuals, 25 and be located in a neighborhood setting to maximize community 26 integration and natural supports. 27 i. Determine length of stay based on an individual basis 28 using person-centered planning and objective utilization 29 review criteria with the goal for the individual to live in 30 the most integrated setting practicable. Individuals expected 31 to have a longer stay shall be provided the protections of the 32 landlord-tenant relationship pursuant to chapter 562A. 33 j. Require Medicaid managed care organizations and mental 34 health and disability services regions to jointly select and 35 -15- LSB 6024HV (2) 87 hb/rh 15/ 26

H.F. 2456 mutually agree upon the strategic geographic locations of 1 IRSHs. Any existing section 1915(i) home and community-based 2 services habilitation waiver or intellectual disability 3 waiver-supported community living providers that meet IRSH 4 criteria shall be considered in the selection process. 5 Medicaid managed care organizations and mental health and 6 disability services regions shall also work with the state 7 mental health institutes, Broadlawns, the university of Iowa 8 hospitals and clinics, and other interested hospitals with 9 inpatient psychiatric programs to operate or affiliate with 10 one IRSH each as an integral part of the mental health and 11 disability services provided by a region. 12 k. Direct Medicaid managed care organizations to enter 13 into contracts with jointly selected IRSHs. Reimbursement of 14 IRSH shall be provided based on the reimbursement rate floor 15 established for such services provided to Medicaid covered 16 members who have a demonstrated need for IRSH. The rules shall 17 allow mental health and disability services regions to enter 18 into chapter 28E agreements to provide IRSH services. The 19 rules shall also include bill-back provisions to allow for 20 reimbursement of a region when the resident of another region 21 utilizes an IRSH located in that region. 22 l. Require mental health and disability services regions to 23 provide start-up funding for an IRSH that is not established 24 prior to July 1, 2018. Regions shall also provide funding as 25 necessary for non-Medicaid covered services provided by the 26 IRSH. 27 m. Require contracts entered into between the regions and 28 the Medicaid managed care organizations to include objective 29 utilization review criteria. 30 6. The department of human services and the department of 31 public health shall provide a single statewide twenty-four-hour 32 crisis hotline that incorporates warmline services which may be 33 provided through expansion of the YourLifeIowa platform. 34 Sec. 14. COMMITMENT PROCESS REVIEW. The department of 35 -16- LSB 6024HV (2) 87 hb/rh 16/ 26

H.F. 2456 human services, in cooperation with the department of public 1 health, representatives of the mental health institutes, Iowa 2 hospital association, Iowa health care association, managed 3 care organizations, the national alliance on mental illness, 4 and other affected or interested stakeholders shall review 5 the commitment processes under chapters 125 and 229 and shall 6 report recommendations for improvements in the processes 7 and any amendments to law to increase efficiencies and more 8 appropriately utilize the array of mental health and disability 9 services available based upon an individual’s needs to the 10 governor and the general assembly by December 31, 2018. 11 Sec. 15. TERTIARY CARE PSYCHIATRIC HOSPITALS. The 12 departments of human services and public health and other 13 affected or interested stakeholders shall review the role of 14 tertiary care psychiatric hospitals in the array of mental 15 health services and shall report recommendations for providing 16 tertiary psychiatric services to the governor and the general 17 assembly by November 30, 2018. The recommendations shall 18 address the role and responsibilities of tertiary care 19 psychiatric hospitals in the mental health array of services 20 in the state, the viability of utilizing the mental health 21 institutes as tertiary care psychiatric hospitals, any 22 potential sustainable funding, and admissions criteria. 23 Sec. 16. DEPARTMENT OF HUMAN SERVICES. The department of 24 human services shall adopt rules pursuant to chapter 17A to 25 administer this Act. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill relates to behavioral health, including provisions 30 relating to involuntary commitments and hospitalizations, the 31 disclosure of mental health information to law enforcement 32 professionals, and mental health and disability services. 33 Under current law, if the report of a court-designated 34 licensed physician or mental health professional indicates 35 -17- LSB 6024HV (2) 87 hb/rh 17/ 26

H.F. 2456 that a respondent who is the subject of an application 1 for involuntary commitment or treatment due to the 2 respondent’s substance-related disorder is not a person 3 with a substance-related disorder, the court, without taking 4 further action, may terminate the proceeding and dismiss 5 the application on its own motion and without notice. The 6 bill amends current law to provide that the court, under the 7 same circumstances and without taking further action, shall 8 terminate such a proceeding and dismiss the application on its 9 own motion and without notice. 10 The bill provides that a respondent who is the subject of an 11 application for involuntary commitment for a substance-related 12 disorder and who is taken into immediate custody shall be 13 released from custody prior to a commitment hearing if a 14 licensed physician or mental health professional examines the 15 respondent and determines that the respondent no longer meets 16 the criteria for custody and provides notification to the 17 court. 18 Under current law, the department of inspections and appeals 19 is required to issue a license to an applicant for a subacute 20 mental health care facility if the department of inspections 21 and appeals has ascertained that the applicant’s facilities and 22 staff are adequate to provide the care and services required 23 of a subacute care facility. The bill strikes additional 24 conditions for licensure requiring the department of human 25 services to submit written approval of the application based 26 upon the process used by the department of human services 27 to identify the best qualified providers, prohibiting the 28 department of human services from approving an application 29 which would cause the number of publicly funded subacute 30 care facility beds to exceed 75 beds, and requiring that the 31 subacute care facility beds identified be new beds located in 32 hospitals and facilities licensed as a subacute care facility 33 under Code chapter 135G. 34 Under Code chapter 228, a mental health professional, data 35 -18- LSB 6024HV (2) 87 hb/rh 18/ 26

H.F. 2456 collector, or employee or agent thereof, is prohibited from 1 disclosing or allowing the disclosure of an individual’s 2 mental health information without the individual’s consent or 3 written authorization. However, disclosure of such mental 4 health information without the individual’s consent or written 5 authorization is allowed under certain circumstances, including 6 for certain administrative disclosures to other mental health 7 providers for administrative and professional services to 8 the individual and to meet certain compulsory disclosure 9 requirements pursuant to state or federal law. In addition, 10 the disclosure of certain limited mental health information is 11 allowed to authorized family members without the individual’s 12 consent or written authorization in some circumstances. 13 The bill provides that a mental health professional shall 14 disclose mental health information, at the minimum consistent 15 with applicable laws and standards of ethical conduct, relating 16 to an individual without the individual’s consent or written 17 permission to a law enforcement professional if the disclosure 18 is made in good faith, is necessary to prevent or lessen a 19 serious and imminent threat to the health or safety of the 20 individual or to a clearly identifiable victim or victims, 21 and the individual has the apparent intent and ability to 22 carry out the threat. The bill provides that a mental health 23 professional shall not be held criminally or civilly liable 24 for failure to disclose mental health information relating 25 to an individual to a law enforcement professional except in 26 circumstances where the individual has communicated to the 27 mental health professional an imminent threat of physical 28 violence against the individual’s self or against a clearly 29 identifiable victim or victims. The bill provides that a 30 mental health professional discharges the professional’s duty 31 to disclose under the bill by making reasonable efforts to 32 communicate the threat to a law enforcement professional. 33 The bill defines “law enforcement professional” to mean 34 a law enforcement officer as defined in Code section 80B.3 35 -19- LSB 6024HV (2) 87 hb/rh 19/ 26

H.F. 2456 (an officer appointed by the director of the department of 1 natural resources, a member of the police force or other 2 agency or department of the state, county, city, or tribal 3 government regularly employed as such and who is responsible 4 for the prevention and detection of crime and the enforcement 5 of the criminal laws of this state and all individuals, as 6 determined by the council, who by the nature of their duties 7 may be required to perform the duties of a peace officer), 8 county attorney as defined in Code section 331.101 (the 9 county attorney, a deputy county attorney or an assistant 10 county attorney designated by the county attorney), probation 11 or parole officer, or jailer. “Mental health information” 12 is defined in Code section 228.1 to mean oral, written, 13 or recorded information which indicates the identity of an 14 individual receiving professional services and which relates to 15 the diagnosis, course, or treatment of the individual’s mental 16 or emotional condition. 17 Under current law, a respondent who is the subject of 18 a petition for involuntary hospitalization due to the 19 respondent’s serious mental impairment shall be examined by 20 one or more licensed physician or mental health professionals 21 within a reasonable time and a report shall be submitted to the 22 court. If the report of one or more of the court-designated 23 physicians or mental health professionals indicates that the 24 person is not seriously mentally impaired, the court, without 25 taking further action, may terminate the proceeding and dismiss 26 the application on its own motion and without notice. The 27 bill amends current law to provide that the court, under the 28 same circumstances and without taking further action, shall 29 terminate the proceeding and dismiss the application on its own 30 motion and without notice. 31 The bill provides that a respondent who is the subject of 32 an application for involuntary hospitalization for a serious 33 mental impairment and who is taken into immediate custody shall 34 be released from custody prior to the hospitalization hearing 35 -20- LSB 6024HV (2) 87 hb/rh 20/ 26