H.F. 2402 Section 1. PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN 1 —— ENHANCED MEDICAID REIMBURSEMENT —— COMPETITIVE BIDDING 2 PROCESS. No later than January 1, 2025, the department of 3 health and human services shall utilize a competitive bidding 4 process and issue an invitation to bid to select one or 5 more currently licensed psychiatric medical institutions for 6 children (PMICs), as defined in section 135H.1, located in the 7 state, to provide access to PMIC services for children with 8 specialized needs including problematic sexualized behaviors, 9 a history of aggression, or a diagnosis of intellectual or 10 developmental disability. The invitation to bid shall offer a 11 payment structure that provides enhanced reimbursement for a 12 PMIC that meets the selection criteria and which may be used to 13 provide increased staffing ratios, ongoing training of staff in 14 specialized programs that provide evidence-based treatment, and 15 appropriate services and modalities, including but not limited 16 to telemedicine, for children and their families. 17 Sec. 2. REDUCTION OF REGULATORY BARRIERS AND RESTRICTIONS 18 —— PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN. The 19 department of health and human services shall review the 20 department’s administrative rules regarding psychiatric medical 21 institutions for children (PMICs) and shall update the rules, 22 informed by the findings of the association of children’s 23 residential centers’ most recent nationwide survey and scan 24 of psychiatric residential treatment facilities, and the 25 recommendations of the coalition for family and children’s 26 services in Iowa, to do all of the following: 27 1. Allow a physician assistant or advanced registered nurse 28 practitioner to serve as a member of the plan of care team 29 as a member who is experienced in child psychiatry or child 30 psychology pursuant to 481 IAC 41.13(2). 31 2. Allow a physician assistant or advanced registered 32 nurse practitioner to be a member of the team to complete 33 the certification of need for services for a PMIC placement 34 pursuant to 481 IAC 41.9. 35 -1- LSB 5260HV (2) 90 pf/ko 1/ 4

H.F. 2402 3. Remove the reserve bed day limitations for 1 hospitalizations and expand the number of other therapeutic 2 absences beyond thirty days to allow for skill acquisition, 3 stabilization, and continuity of care as deemed necessary by 4 the child’s medical providers and in accordance with a child’s 5 discharge plan. 6 4. Allow licensed professionals, based on competencies 7 rather than license type, to order the use of restraints 8 or seclusions and to conduct post-restraint or seclusion 9 assessments, including via telehealth, to increase response 10 times and expand access to care. 11 5. a. Require therapy and behavioral health intervention 12 services to be included as required services provided during 13 a placement at a PMIC to provide continuity of care, maintain 14 established clinical relationships, and avoid disruption in 15 services or delays in reestablishing care post discharge. 16 b. Require family therapy and family behavioral health 17 intervention services to be included in required services 18 during the placement of a child in a PMIC without requiring 19 the child’s presence for the family to work on targeted skills 20 essential for the child’s success and to prepare the family for 21 the child’s return home. 22 c. Provide reimbursement codes to cover services beyond 23 those provided outside the PMIC care team as necessary to 24 adequately treat substance use disorder, sexualized behaviors, 25 autism, and other services needed to support the child. 26 6. Standardize all of the following across all managed care 27 organizations as follows: 28 a. Require that authorization for a PMIC placement shall 29 be retroactive to the date the request for authorization is 30 submitted to the managed care organization not the date the 31 managed care organization responds; or require a managed care 32 organization to respond within two business days from receipt 33 of a request for authorization for a PMIC placement. 34 b. Prohibit a managed care organization from denying 35 -2- LSB 5260HV (2) 90 pf/ko 2/ 4

H.F. 2402 authorization for a PMIC placement based on lack of parental 1 involvement, lack of participation in behavioral health 2 intervention services on an outpatient basis, or based on other 3 perceived behavioral issues. 4 c. Require a managed care organization to authorize an 5 initial PMIC placement of ninety days upon admission with 6 concurrent stay reviews every thirty days thereafter. 7 d. Require concurrent stay reviews to be standardized 8 and limited to a brief description of progress, or lack of 9 progress, toward the child’s goals and objectives. 10 e. Require a managed care organization to offer support to 11 families, including assistance with transportation to and from 12 a PMIC to visit a child. 13 7. Notwithstanding any provision of law to the contrary, 14 including certificate of need requirements, allow a previously 15 licensed PMIC that has the capacity to provide up to an 16 additional four intermediate care facility for persons with an 17 intellectual disability beds, and which additional beds meet 18 all other licensing and state fire marshal requirements, to 19 increase their licensed capacity to include the additional 20 beds without further review including by the health facilities 21 council. 22 8. Allow for step-down PMIC placements or supervised 23 apartment living for a child to utilize programming provided 24 in a PMIC while living independently in a smaller residential 25 setting without twenty-four-hour supervision. 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 psychiatric medical institutions for 30 children (PMICs). The bill requires the department of health 31 and human services (HHS), no later than January 1, 2025, to 32 utilize a competitive bidding process and issue an invitation 33 to bid to select one or more currently licensed PMICs in the 34 state to provide access to PMIC services for children with 35 -3- LSB 5260HV (2) 90 pf/ko 3/ 4

H.F. 2402 specialized needs including problematic sexualized behaviors, 1 a history of aggression, or a diagnosis of intellectual or 2 developmental disability. The invitation to bid shall offer a 3 payment structure that provides enhanced reimbursement for a 4 PMIC that meets the selection criteria and which may be used to 5 provide increased staffing ratios, ongoing training of staff in 6 specialized programs that provide evidence-based treatment, and 7 appropriate services and modalities, including but not limited 8 to telemedicine, for children and their families. 9 The bill also requires HHS to review and update 10 administrative rules regarding PMICs to allow physician 11 assistants and advanced registered nurse practitioners to 12 serve as a member of the plan of care team and to complete the 13 certification of need for services for a PMIC placement; to 14 remove the reserve bed day limitations for hospitalizations 15 and expand the number of other therapeutic absences allowed; 16 to allow licensed professionals, based on competencies rather 17 than license type, to order the use of restraints or seclusions 18 and to conduct post-restraint or seclusion assessments, 19 including via telehealth, to increase response times and expand 20 access to care; to require therapy and behavioral health 21 intervention services as required services during a PMIC 22 placement, to require family therapy and family behavioral 23 health intervention services as required services during the 24 placement of a child in a PMIC to prepare the family for 25 the child’s return home, and to provide reimbursement codes 26 to cover certain services beyond those provided outside the 27 PMIC care team to support the child; to standardize certain 28 activities across all managed care organizations; to allow 29 for certain exceptions for PMICs to increase capacity without 30 further certificate of need review; and to allow for step-down 31 PMIC placements or supervised apartment living for a child. 32 -4- LSB 5260HV (2) 90 pf/ko 4/ 4