House File 243 - Introduced HOUSE FILE 243 BY ISENHART A BILL FOR An Act relating to county funding of services for persons 1 with substance-related disorders and co-occurring mental 2 health and substance-related disorders, including intensive 3 mental health services provided through access centers and 4 intensive residential service homes, and including effective 5 date provisions. 6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 7 TLSB 1334YH (5) 88 hb/rh

H.F. 243 Section 1. Section 331.391, subsection 4, paragraph b, Code 1 2019, is amended to read as follows: 2 b. For fiscal years beginning July 1, 2017, July 1, 2018, 3 and July 1, 2019, that portion of each region’s cash flow 4 amount either reserved in the combined account or reserved 5 among all separate county accounts under the control of the 6 governing board that exceeds twenty-five percent of the gross 7 expenditures from the combined account or from all separate 8 county accounts under control of the governing board in the 9 fiscal year preceding the fiscal year in progress shall be used 10 in whole or in part to fund the payment of services provided 11 under the regional service system management plan under section 12 331.393 , which for fiscal years beginning July 1, 2018, and 13 July 1, 2019, may include expenses associated with increasing 14 capacity to provide services to persons with substance-related 15 disorders and persons with co-occurring mental health and 16 substance-related disorders including intensive mental 17 health services provided through access centers and intensive 18 residential service homes . 19 Sec. 2. Section 331.393, subsection 2, Code 2019, is amended 20 to read as follows: 21 2. Each region shall submit to the department an annual 22 service and budget plan approved by the region’s governing 23 board and subject to approval by the director of human 24 services. Provisions for the director of human services’ 25 approval of the annual service and budget plan, and any 26 amendments to the plan, and other requirements shall be 27 specified in rule adopted by the state commission. 28 a. The provisions addressed in the annual plan shall include 29 but are not limited to all of the following: 30 a. (1) The region’s budget and financing provisions for 31 the next fiscal year. The provisions shall address how county, 32 regional, state, and other funding sources will be used to meet 33 the service needs within the region. 34 b. (2) The scope of services included in addition to 35 -1- LSB 1334YH (5) 88 hb/rh 1/ 4

H.F. 243 the required core services. Each service included shall be 1 described and projection of need and the funding necessary to 2 meet the need shall be included. 3 c. (3) The location of the local access points for 4 services. 5 d. (4) The plan for assuring effective crisis prevention, 6 response, and resolution. 7 e. (5) The provider reimbursement provisions. A region’s 8 use of provider reimbursement approaches in addition to 9 fee-for-service reimbursement and for compensating the 10 providers engaged in a systems of care approach and other 11 nontraditional providers shall be encouraged. A region also 12 shall be encouraged to use and the department shall approve 13 funding approaches that identify and incorporate all services 14 and sources of funding used by persons receiving services, 15 including medical assistance program funding. 16 f. (6) Financial forecasting measures. 17 g. (7) The targeted case managers designated for the 18 region. 19 h. (8) The financial eligibility requirements for service 20 under the regional service system. A plan that otherwise 21 incorporates the financial eligibility requirements of section 22 331.395 but allows eligibility for persons with resources above 23 the minimum resource limitations adopted pursuant to section 24 331.395, subsection 1 , paragraph “c” , who were eligible under 25 resource limitations in effect prior to July 1, 2014, or are 26 authorized by the region as an exception to policy, shall be 27 deemed by the department to be in compliance with financial 28 eligibility requirements of section 331.395 . 29 b. The provisions addressed in the annual plan may include 30 a plan for the use of anticipated residual funding in excess 31 of twenty-five percent of the gross expenditures as provided 32 in section 331.391, subsection 4, paragraph “b” , to increase 33 capacity to provide services to persons with substance-related 34 disorders and co-occurring mental health and substance-related 35 -2- LSB 1334YH (5) 88 hb/rh 2/ 4

H.F. 243 disorders including intensive mental health services provided 1 through access centers and intensive residential service homes. 2 Sec. 3. Section 331.393, Code 2019, is amended by adding the 3 following new subsection: 4 NEW SUBSECTION . 8A. The region’s budget and financing 5 provisions for the next fiscal year may include expenses 6 associated with providing services to persons with 7 substance-related disorders and persons with co-occurring 8 mental health and substance-related disorders including 9 intensive mental health services provided through access 10 centers and intensive residential service homes. 11 Sec. 4. Section 331.397, Code 2019, is amended by adding the 12 following new subsection: 13 NEW SUBSECTION . 7A. Notwithstanding any other provision 14 of this section to the contrary, a regional service system 15 may provide funding to increase capacity to provide services 16 to persons with substance-related disorders and persons with 17 co-occurring mental health and substance-related disorders 18 pursuant to section 331.391, subsection 4, paragraph “b” . 19 Sec. 5. EFFECTIVE DATE. This Act, being deemed of immediate 20 importance, takes effect upon enactment. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 Under current law, if a mental health and disability 25 services region is meeting the financial obligations for 26 implementation of its regional service system management plan 27 for a fiscal year and residual funding is anticipated, the 28 regional administrator shall reserve an adequate amount of 29 unobligated and unencumbered funds for cash flow of expenditure 30 obligations in the next fiscal year. For fiscal years 31 beginning July 1, 2017, July 1, 2018, and July 1, 2019, that 32 portion of each region’s cash flow amount either reserved in 33 the combined account or reserved among all separate county 34 accounts under the control of the governing board that exceeds 35 -3- LSB 1334YH (5) 88 hb/rh 3/ 4

H.F. 243 25 percent of the gross expenditures from the combined account 1 or from all separate county accounts under the control of 2 the governing board in the fiscal year preceding the fiscal 3 year in progress are required to be used in whole or in part 4 to fund the payment of services provided under the regional 5 service system management plan. The bill provides that for 6 fiscal years beginning July 1, 2018, and July 1, 2019, such 7 funds may be used for expenses associated with increasing 8 capacity to provide services to persons with substance-related 9 disorders and persons with co-occurring mental health and 10 substance-related disorders including intensive mental 11 health services provided through access centers and intensive 12 residential service homes. 13 Current law requires each region to submit to the department 14 of human services an annual service and budget plan approved 15 by the region’s governing board and subject to the approval of 16 the director of human services. The bill provides the annual 17 service and budget plan may include a plan to provide services 18 to persons with substance-related disorders and co-occurring 19 mental health and substance-related disorders, including 20 intensive mental health services provided through access 21 centers and intensive residential service homes, and that a 22 regional service system may provide funding for such services 23 including any anticipated residual funding. 24 The bill takes effect upon enactment. 25 -4- LSB 1334YH (5) 88 hb/rh 4/ 4