H.F. 661 DIVISION I 1 MENTAL HEALTH AND DISABILITY SERVICES —— FUNDING 2 Section 1. Section 331.391, subsection 4, paragraph c, Code 3 2021, is amended by striking the paragraph. 4 Sec. 2. Section 331.424A, subsection 1, paragraph b, Code 5 2021, is amended by striking the paragraph. 6 Sec. 3. Section 331.424A, subsection 4, Code 2021, is 7 amended by striking the subsection. 8 Sec. 4. Section 331.424A, subsection 9, Code 2021, is 9 amended to read as follows: 10 9. a. For the fiscal year beginning July 1, 2017, and each 11 subsequent fiscal year, the county budgeted amount determined 12 for each county shall be the amount necessary to meet the 13 county’s financial obligations for the payment of services 14 provided under the regional service system management plan 15 approved pursuant to section 331.393 , not to exceed an amount 16 equal to the product of the regional per capita expenditure 17 target amount multiplied by the county’s population , and, for 18 fiscal years beginning on or after July 1, 2023, reduced by 19 the amount of the county’s cash flow reduction amount for the 20 fiscal year calculated under subsection 4 , if applicable . 21 b. If a county officially joins a different region, the 22 county’s budgeted amount shall be the amount necessary to meet 23 the county’s financial obligations for payment of services 24 provided under the new region’s regional service system 25 management plan approved pursuant to section 331.393 , not to 26 exceed an amount equal to the product of the new region’s 27 regional per capita expenditure target amount multiplied by 28 the county’s population , and, for fiscal years beginning on 29 or after July 1, 2023, reduced by the amount of the county’s 30 cash flow reduction amount for the fiscal year calculated under 31 subsection 4 , if applicable . 32 Sec. 5. COUNTY BUDGET AMENDMENT AND RECERTIFICATION —— 33 REGIONAL SERVICE SYSTEM MANAGEMENT PLAN AMENDMENT. 34 1. To the extent necessary to implement the provisions 35 -1- LSB 2208YH (4) 89 dg/rh 1/ 5

H.F. 661 this division of this Act, a county may amend that portion of 1 the county’s budget related to cash flow amounts in the county 2 mental health and disability services fund for the fiscal year 3 beginning July 1, 2021. 4 2. If this division of this Act takes effect on or after 5 March 15, 2021, notwithstanding section 24.17, for the fiscal 6 year beginning July 1, 2021, a county may recertify the 7 county’s budget as necessary to implement the provisions of 8 this division of this Act. A budget recertified pursuant to 9 this section must be recertified in duplicate to the county 10 auditor not later than thirty days after the effective date of 11 this Act, and protests to the budget shall be filed not later 12 than ten days after the county’s budget is recertified. 13 3. To the extent necessary to implement the provisions 14 of this division of this Act, a mental health and disability 15 services region may amend the region’s regional service system 16 management plan or annual service and budget plan approved 17 under section 331.393 for the fiscal year beginning July 1, 18 2020, or for the fiscal year beginning July 1, 2021. 19 Sec. 6. RETROACTIVE APPLICABILITY. This division of this 20 Act applies retroactively to July 1, 2020, for fiscal years 21 beginning on or after that date. 22 DIVISION II 23 MENTAL HEALTH AND DISABILITY SERVICES REGIONS —— CORE SERVICES 24 Sec. 7. DEPARTMENT OF HUMAN SERVICES —— INTENSIVE MENTAL 25 HEALTH CORE SERVICES IMPLEMENTATION DATE. The department of 26 human services shall amend its administrative rules pursuant 27 to chapter 17A to provide that mental health and disability 28 services regions shall implement the following intensive mental 29 health core services for eligible persons on or before July 1, 30 2023, provided that federal matching funds are available under 31 the Iowa health and wellness plan pursuant to chapter 249N: 32 1. Access centers. 33 2. Assertive community treatment. 34 3. Crisis stabilization community-based services. 35 -2- LSB 2208YH (4) 89 dg/rh 2/ 5

H.F. 661 4. Crisis stabilization residential services. 1 5. Intensive residential service homes. 2 6. Mobile response. 3 7. Subacute mental health services provided in facility and 4 community-based settings. 5 8. Twenty-three-hour crisis observation and holding. 6 Sec. 8. DEPARTMENT OF HUMAN SERVICES —— CHILDREN’S 7 BEHAVIORAL HEALTH CORE SERVICES IMPLEMENTATION DATE. The 8 department of human services shall amend its administrative 9 rules pursuant to chapter 17A to provide that mental health 10 and disability services regions shall implement the following 11 children’s behavioral health core services for eligible 12 children on or before July 1, 2023, and meet applicable access 13 standards on or before July 1, 2023: 14 1. Assessment and evaluation relating to eligibility for 15 services. 16 2. Behavioral health outpatient therapy. 17 3. Education services. 18 4. Medication prescribing and management. 19 5. Prevention. 20 6. Behavioral health inpatient treatment. 21 7. Crisis stabilization community-based services. 22 8. Crisis stabilization residential services. 23 9. Early identification. 24 10. Early intervention. 25 11. Mobile response. 26 DIVISION III 27 EFFECTIVE DATE 28 Sec. 9. EFFECTIVE DATE. This Act, being deemed of immediate 29 importance, takes effect upon enactment. 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill relates to mental health and disability services 34 (MH/DS) regions and funding, and provides effective date and 35 -3- LSB 2208YH (4) 89 dg/rh 3/ 5

H.F. 661 retroactive applicability provisions. 1 MENTAL HEALTH AND DISABILITY SERVICES —— FUNDING. The bill 2 removes the cash flow reduction amount that requires MH/DS 3 regions to spend down reserve cash deposits to 40 percent 4 of the region’s annual budget. Code section 331.424A(6) 5 establishes the amount certified for levy by the county each 6 fiscal year to raise funds for MH/DS under the MH/DS regional 7 system. Revenues from taxes imposed by the county credited to 8 the county mental health and disability services fund shall not 9 exceed an amount equal to the county budgeted amount, which is 10 the amount necessary to meet the county’s financial obligations 11 for the payment of services provided under the regional service 12 system management plan, not to exceed an amount equal to the 13 product of the regional per capita expenditure target amount 14 multiplied by the county’s population, and, for fiscal years 15 beginning on or after July 1, 2023, reduced by the amount of 16 the county’s cash flow reduction amount. 17 The bill allows a county to recertify the county’s FY 18 2021-2022 budget if the bill takes effect after March 15, 2021. 19 A budget recertified pursuant to the bill must be recertified 20 in duplicate to the county auditor not later than 30 days after 21 the effective date of the bill, and protests to the budget 22 shall be filed not later than 10 days after the county’s budget 23 is recertified. 24 The bill allows a MH/DS region to amend the region’s 25 previously approved regional service system management plan or 26 annual service and budget plan for the fiscal year beginning 27 July 1, 2020, or for the fiscal year beginning July 1, 2021. 28 MENTAL HEALTH AND DISABILITY SERVICES REGIONS —— CORE 29 SERVICES. The bill provides that the department of human 30 services shall amend its administrative rules to provide that 31 MH/DS regions shall implement the following intensive mental 32 health core services for eligible persons on or before July 33 1, 2023, provided that federal matching funds are available 34 under the Iowa health and wellness plan under Code chapter 35 -4- LSB 2208YH (4) 89 dg/rh 4/ 5

H.F. 661 249N: access centers; assertive community treatment; crisis 1 stabilization community-based services; crisis stabilization 2 residential services; intensive residential service homes; 3 mobile response; subacute mental health services provided in 4 facility and community-based settings; and 23-hour crisis 5 observation and holding. 6 The bill provides that the department of human services 7 shall amend its administrative rules to provide that MH/DS 8 regions shall implement the following children’s behavioral 9 health core services for eligible children on or before July 1, 10 2023, and meet applicable access standards on or before July 11 1, 2023: assessment and evaluation relating to eligibility 12 for services; behavioral health outpatient therapy; education 13 services; medication prescribing and management; prevention; 14 behavioral health inpatient treatment; crisis stabilization 15 community-based services; crisis stabilization residential 16 services; early identification; early intervention; and mobile 17 response. 18 The bill takes effect upon enactment. 19 -5- LSB 2208YH (4) 89 dg/rh 5/ 5