S.F. 526 Section 1. Section 125.34, subsections 1, 2, 3, 4, 6, and 7, 1 Code 2021, are amended to read as follows: 2 1. A person with a substance-related disorder due to 3 intoxication or substance-induced incapacitation may come 4 voluntarily to a facility for emergency treatment. A person 5 who appears to be intoxicated or incapacitated by a substance 6 in a public place and in need of help may be taken to a facility 7 or an access center by a peace officer under section 125.91 . 8 If the person refuses the proffered help, the person may be 9 arrested and charged with intoxication under section 123.46 , 10 if applicable. 11 2. If no facility or access center is readily available 12 the person may be taken to an emergency medical service 13 customarily used for incapacitated persons. The peace officer 14 in detaining the person and in taking the person to a facility 15 or an access center shall make every reasonable effort to 16 protect the person’s health and safety. In detaining the 17 person the detaining officer may take reasonable steps for 18 self-protection. Detaining a person under section 125.91 is 19 not an arrest and no entry or other record shall be made to 20 indicate that the person who is detained has been arrested or 21 charged with a crime. 22 3. A person who arrives at a facility or an access center 23 and voluntarily submits to examination shall be examined by a 24 licensed physician and surgeon or osteopathic physician and 25 surgeon or mental health professional as soon as possible after 26 the person arrives at the facility or access center . The 27 person may then be admitted as a patient or referred to another 28 health facility. The referring facility or access center shall 29 arrange for transportation. 30 4. If a person is voluntarily admitted to a facility or 31 an access center , the person’s family or next of kin shall be 32 notified as promptly as possible. If an adult patient who is 33 not incapacitated requests that there be no notification, the 34 request shall be respected. 35 -1- LSB 2586SV (1) 89 dg/rh 1/ 11

S.F. 526 6. If the physician and surgeon or osteopathic physician 1 and surgeon in charge of the facility or access center 2 determines it is for the patient’s benefit, the patient shall 3 be encouraged to agree to further diagnosis and appropriate 4 voluntary treatment. 5 7. A licensed physician and surgeon or osteopathic 6 physician and surgeon, mental health professional, facility 7 administrator, access center administrator, or an employee or a 8 person acting as or on behalf of an access center administrator 9 or an employee or a person acting as or on behalf of the 10 facility administrator, is not criminally or civilly liable 11 for acts in conformity with this chapter , unless the acts 12 constitute willful malice or abuse. 13 Sec. 2. Section 125.34, Code 2021, is amended by adding the 14 following new subsection: 15 NEW SUBSECTION . 8. For the purposes of this section, 16 “access center” means the same as defined in section 331.388. 17 Sec. 3. Section 125.91, subsections 2, 3, and 4, Code 2021, 18 are amended to read as follows: 19 2. a. A peace officer who has reasonable grounds to 20 believe that the circumstances described in subsection 1 are 21 applicable may, without a warrant, take or cause that person 22 to be taken to the nearest available facility referred to in 23 section 125.81, subsection 2 , paragraph “b” or “c” , or an access 24 center . Such a person with a substance-related disorder due 25 to intoxication or substance-induced incapacitation who also 26 demonstrates a significant degree of distress or dysfunction 27 may also be delivered to a facility or an access center by 28 someone other than a peace officer upon a showing of reasonable 29 grounds. Upon delivery of the person to a facility or an 30 access center under this section , the attending physician 31 and surgeon or osteopathic physician and surgeon may order 32 treatment of the person, but only to the extent necessary 33 to preserve the person’s life or to appropriately control 34 the person’s behavior if the behavior is likely to result 35 -2- LSB 2586SV (1) 89 dg/rh 2/ 11

S.F. 526 in physical injury to the person or others if allowed to 1 continue. The peace officer or other person who delivered the 2 person to the facility or access center shall describe the 3 circumstances of the matter to the attending physician and 4 surgeon or osteopathic physician and surgeon. If the person 5 is a peace officer, the peace officer may do so either in 6 person or by written report. If the attending physician and 7 surgeon or osteopathic physician and surgeon has reasonable 8 grounds to believe that the circumstances in subsection 9 1 are applicable, the attending physician shall at once 10 communicate with the nearest available magistrate as defined 11 in section 801.4, subsection 10 . The magistrate shall, based 12 upon the circumstances described by the attending physician 13 and surgeon or osteopathic physician and surgeon, give the 14 attending physician and surgeon or osteopathic physician and 15 surgeon oral instructions either directing that the person be 16 released forthwith, or authorizing the person’s detention in an 17 appropriate facility or access center . The magistrate may also 18 give oral instructions and order that the detained person be 19 transported to an appropriate facility or access center . 20 b. If the magistrate orders that the person be detained, the 21 magistrate shall, by the close of business on the next working 22 day, file a written order with the clerk in the county where it 23 is anticipated that an application may be filed under section 24 125.75 . The order may be filed by facsimile if necessary. The 25 order shall state the circumstances under which the person 26 was taken into custody or otherwise brought to a facility or 27 an access center and the grounds supporting the finding of 28 probable cause to believe that the person is a person with 29 a substance-related disorder likely to result in physical 30 injury to the person or others if not detained. The order 31 shall confirm the oral order authorizing the person’s detention 32 including any order given to transport the person to an 33 appropriate facility or access center . The clerk shall provide 34 a copy of that order to the attending physician and surgeon or 35 -3- LSB 2586SV (1) 89 dg/rh 3/ 11

S.F. 526 osteopathic physician and surgeon at the facility or access 1 center to which the person was originally taken, any subsequent 2 facility or access center to which the person was transported, 3 and to any law enforcement department or ambulance service that 4 transported the person pursuant to the magistrate’s order. 5 3. The attending physician and surgeon or osteopathic 6 physician and surgeon shall examine and may detain the person 7 pursuant to the magistrate’s order for a period not to exceed 8 forty-eight hours from the time the order is dated, excluding 9 Saturdays, Sundays, and holidays, unless the order is dismissed 10 by a magistrate. The facility or access center may provide 11 treatment which is necessary to preserve the person’s life or 12 to appropriately control the person’s behavior if the behavior 13 is likely to result in physical injury to the person or 14 others if allowed to continue or is otherwise deemed medically 15 necessary by the attending physician and surgeon or osteopathic 16 physician and surgeon or mental health professional, but shall 17 not otherwise provide treatment to the person without the 18 person’s consent. The person shall be discharged from the 19 facility or access center and released from detention no later 20 than the expiration of the forty-eight-hour period, unless 21 an application for involuntary commitment is filed with the 22 clerk pursuant to section 125.75 . The detention of a person 23 by the procedure in this section , and not in excess of the 24 period of time prescribed by this section , shall not render the 25 peace officer, attending physician and surgeon or osteopathic 26 physician and surgeon, or facility , or access center detaining 27 the person liable in a criminal or civil action for false 28 arrest or false imprisonment if the peace officer, attending 29 physician and surgeon or osteopathic physician and surgeon, 30 mental health professional, or facility , or access center had 31 reasonable grounds to believe that the circumstances described 32 in subsection 1 were applicable. 33 4. The cost of detention in a facility or an access center 34 under the procedure prescribed in this section shall be paid 35 -4- LSB 2586SV (1) 89 dg/rh 4/ 11

S.F. 526 in the same way as if the person had been committed to the 1 facility or access center pursuant to an application filed 2 under section 125.75 . 3 Sec. 4. Section 125.91, Code 2021, is amended by adding the 4 following new subsection: 5 NEW SUBSECTION . 5. For the purposes of this section, 6 “access center” means the same as defined in section 331.388. 7 Sec. 5. Section 229.22, subsections 2, 3, 5, and 6, Code 8 2021, are amended to read as follows: 9 2. a. (1) In the circumstances described in subsection 10 1 , any peace officer who has reasonable grounds to believe 11 that a person is mentally ill, and because of that illness is 12 likely to physically injure the person’s self or others if 13 not immediately detained, may without a warrant take or cause 14 that person to be taken to the nearest available facility or 15 hospital as defined referred to in section 229.11, subsection 16 1 , paragraphs “b” and “c” , or an access center . A person 17 believed mentally ill, and likely to injure the person’s self 18 or others if not immediately detained, may be delivered to a 19 facility or hospital or an access center by someone other than 20 a peace officer. 21 (2) Upon delivery of the person believed mentally ill to 22 the facility , or hospital , or access center , the examining 23 physician, examining physician assistant, examining mental 24 health professional, or examining psychiatric advanced 25 registered nurse practitioner may order treatment of that 26 person, including chemotherapy, but only to the extent 27 necessary to preserve the person’s life or to appropriately 28 control behavior by the person which is likely to result 29 in physical injury to that person or others if allowed to 30 continue. 31 (3) The peace officer who took the person into custody, 32 or other party who brought the person to the facility , or 33 hospital , or access center , shall describe the circumstances 34 of the matter to the examining physician, examining physician 35 -5- LSB 2586SV (1) 89 dg/rh 5/ 11

S.F. 526 assistant, examining mental health professional, or examining 1 psychiatric advanced registered nurse practitioner. If the 2 person is a peace officer, the peace officer may do so either 3 in person or by written report. 4 (4) If the examining physician, examining physician 5 assistant, examining mental health professional, or examining 6 psychiatric advanced registered nurse practitioner finds 7 that there is reason to believe that the person is seriously 8 mentally impaired, and because of that impairment is likely 9 to physically injure the person’s self or others if not 10 immediately detained, the examining physician, examining 11 physician assistant, examining mental health professional, or 12 examining psychiatric advanced registered nurse practitioner 13 shall at once communicate with the nearest available magistrate 14 as defined in section 801.4, subsection 10 . 15 (5) The magistrate shall, based upon the circumstances 16 described by the examining physician, examining physician 17 assistant, examining mental health professional, or examining 18 psychiatric advanced registered nurse practitioner, give the 19 examining physician, examining physician assistant, examining 20 mental health professional, or examining psychiatric advanced 21 registered nurse practitioner oral instructions either 22 directing that the person be released forthwith or authorizing 23 the person’s detention in an appropriate facility or access 24 center . A peace officer from the law enforcement agency 25 that took the person into custody, if available, during the 26 communication with the magistrate, may inform the magistrate 27 that an arrest warrant has been issued for or charges are 28 pending against the person and request that any oral or written 29 order issued under this subsection require the facility , or 30 hospital , or access center to notify the law enforcement agency 31 about the discharge of the person prior to discharge. The 32 magistrate may also give oral instructions and order that the 33 detained person be transported to an appropriate facility. 34 b. If the magistrate orders that the person be detained, 35 -6- LSB 2586SV (1) 89 dg/rh 6/ 11

S.F. 526 the magistrate shall, by the close of business on the next 1 working day, file a written order with the clerk in the county 2 where it is anticipated that an application may be filed 3 under section 229.6 . The order may be filed by facsimile if 4 necessary. A peace officer from the law enforcement agency 5 that took the person into custody, if no request was made 6 under paragraph “a” , may inform the magistrate that an arrest 7 warrant has been issued for or charges are pending against 8 the person and request that any written order issued under 9 this paragraph require the facility , or hospital , or access 10 center to notify the law enforcement agency about the discharge 11 of the person prior to discharge. The order shall state the 12 circumstances under which the person was taken into custody 13 or otherwise brought to a facility or hospital or an access 14 center , and the grounds supporting the finding of probable 15 cause to believe that the person is seriously mentally impaired 16 and likely to injure the person’s self or others if not 17 immediately detained. The order shall also include any law 18 enforcement agency notification requirements if applicable. 19 The order shall confirm the oral order authorizing the person’s 20 detention including any order given to transport the person 21 to an appropriate facility , or hospital , or access center . A 22 peace officer from the law enforcement agency that took the 23 person into custody may also request an order, separate from 24 the written order, requiring the facility , or hospital , or 25 access center to notify the law enforcement agency about the 26 discharge of the person prior to discharge. The clerk shall 27 provide a copy of the written order or any separate order to 28 the chief medical officer of the facility , or hospital , or 29 access center to which the person was originally taken, to 30 any subsequent facility to which the person was transported, 31 and to any law enforcement department, ambulance service, or 32 transportation service under contract with a mental health 33 and disability services region that transported the person 34 pursuant to the magistrate’s order. A transportation service 35 -7- LSB 2586SV (1) 89 dg/rh 7/ 11

S.F. 526 that contracts with a mental health and disability services 1 region for purposes of this paragraph shall provide a secure 2 transportation vehicle and shall employ staff that has received 3 or is receiving mental health training. 4 c. If an arrest warrant has been issued for or charges are 5 pending against the person, but no court order exists requiring 6 notification to a law enforcement agency under paragraph “a ” 7 or “b” , and if the peace officer delivers the person to a 8 facility or hospital or an access center and the peace officer 9 notifies the facility , or hospital , or access center in writing 10 on a form prescribed by the department of public safety that 11 the facility , or hospital , or access center notify the law 12 enforcement agency about the discharge of the person prior to 13 discharge, the facility , or hospital , or access center shall 14 do all of the following: 15 (1) Notify the dispatch of the law enforcement agency that 16 employs the peace officer by telephone prior to the discharge 17 of the person from the facility , or hospital , or access center . 18 (2) Notify the law enforcement agency that employs the peace 19 officer by electronic mail prior to the discharge of the person 20 from the facility , or hospital , or access center . 21 3. The chief medical officer of the facility , or hospital , 22 or access center shall examine and may detain and care for the 23 person taken into custody under the magistrate’s order for a 24 period not to exceed forty-eight hours from the time such order 25 is dated, excluding Saturdays, Sundays and holidays, unless 26 the order is sooner dismissed by a magistrate. The facility , 27 or hospital , or access center may provide treatment which is 28 necessary to preserve the person’s life, or to appropriately 29 control behavior by the person which is likely to result in 30 physical injury to the person’s self or others if allowed to 31 continue, but may not otherwise provide treatment to the person 32 without the person’s consent. The person shall be discharged 33 from the facility , or hospital , or access center and released 34 from custody not later than the expiration of that period, 35 -8- LSB 2586SV (1) 89 dg/rh 8/ 11

S.F. 526 unless an application is sooner filed with the clerk pursuant 1 to section 229.6 . Prior to such discharge , the facility , or 2 hospital , or access center shall, if required by this section , 3 notify the law enforcement agency requesting such notification 4 about the discharge of the person. The law enforcement 5 agency shall retrieve the person no later than six hours after 6 notification from the facility , or hospital , or access center 7 but in no circumstances shall the detention of the person 8 exceed the period of time prescribed for detention by this 9 subsection . The detention of any person by the procedure 10 and not in excess of the period of time prescribed by this 11 section shall not render the peace officer, physician, mental 12 health professional, facility, or hospital , or access center 13 so detaining that person liable in a criminal or civil action 14 for false arrest or false imprisonment if the peace officer, 15 physician, mental health professional, facility, or hospital , 16 or access center had reasonable grounds to believe the person 17 so detained was mentally ill and likely to physically injure 18 the person’s self or others if not immediately detained, or 19 if the facility , or hospital , or access center was required 20 to notify a law enforcement agency by this section , and 21 the law enforcement agency requesting notification prior to 22 discharge retrieved the person no later than six hours after 23 the notification, and the detention prior to the retrieval of 24 the person did not exceed the period of time prescribed for 25 detention by this subsection . 26 5. The department of public safety shall prescribe the form 27 to be used when a law enforcement agency desires notification 28 under this section from a facility or hospital or an access 29 center prior to discharge of a person admitted to the facility , 30 or hospital , or access center and for whom an arrest warrant 31 has been issued or against whom charges are pending. The 32 form shall be consistent with all laws, regulations, and 33 rules relating to the confidentiality or privacy of personal 34 information or medical records, including but not limited to 35 -9- LSB 2586SV (1) 89 dg/rh 9/ 11

S.F. 526 the federal Health Insurance Portability and Accountability Act 1 of 1996, Pub. L. No. 104-191, and regulations promulgated in 2 accordance with that Act and published in 45 C.F.R. pts. 160 3 – 164. 4 6. A facility or hospital or an access center , which has 5 been notified by a peace officer or a law enforcement agency by 6 delivery of a form as prescribed by the department of public 7 safety indicating that an arrest warrant has been issued 8 for or charges are pending against a person admitted to the 9 facility , or hospital, or access center that does not notify 10 the law enforcement agency about the discharge of the person 11 as required by subsection 2 , paragraph “c” , shall pay a civil 12 penalty as provided in section 805.8C, subsection 9 . 13 Sec. 6. Section 229.22, Code 2021, is amended by adding the 14 following new subsection: 15 NEW SUBSECTION . 7. For the purposes of this section, 16 “access center” means the same as defined in section 331.388. 17 Sec. 7. Section 331.388, Code 2021, is amended by adding the 18 following new subsection: 19 NEW SUBSECTION . 01. “Access center” means the coordinated 20 provision of intake assessment, screening for co-occurring 21 conditions, care coordination, crisis stabilization residential 22 services, subacute mental health services, and substance abuse 23 treatment for persons experiencing a mental health or substance 24 use crisis who do not need inpatient psychiatric hospital 25 treatment, but who do need significant amounts of supports 26 and services not available in other home and community-based 27 settings. 28 Sec. 8. Section 331.397, subsection 5, paragraph a, 29 subparagraph (1), Code 2021, is amended to read as follows: 30 (1) Access centers that are located in crisis residential 31 and subacute residential settings with sixteen beds or fewer 32 that provide immediate, short-term assessments for persons with 33 serious mental illness or substance use disorders who do not 34 need inpatient psychiatric hospital treatment, but who do need 35 -10- LSB 2586SV (1) 89 dg/rh 10/ 11

S.F. 526 significant amounts of supports and services not available in 1 the persons’ homes or communities . 2 EXPLANATION 3 The inclusion of this explanation does not constitute agreement with 4 the explanation’s substance by the members of the general assembly. 5 This bill relates to the emergency detention of a person 6 experiencing a mental health or substance use crisis and access 7 centers. 8 The bill amends Code sections 124.34 (treatment and 9 services for persons with substance-related disorders due to 10 intoxication and substance-induced incapacitation), 125.91 11 (emergency detention for persons with substance-related 12 disorders), and 229.22 (emergency hospitalization for persons 13 with a serious mental impairment) to allow emergency detention 14 and treatment services in an access center for persons 15 experiencing a mental health or substance use crisis. 16 The bill defines an “access center” as the coordinated 17 provision of intake assessment, screening for co-occurring 18 conditions, care coordination, crisis stabilization residential 19 services, subacute mental health services, and substance abuse 20 treatment for persons experiencing a mental health or substance 21 use crisis who do not need inpatient psychiatric hospital 22 treatment, but who do need significant amounts of supports 23 and services not available in other home and community-based 24 settings. 25 The bill makes a conforming change to Code section 331.397 26 relating to intensive mental health services provided in mental 27 health and disability services regions. 28 -11- LSB 2586SV (1) 89 dg/rh 11/ 11