House File 471 - Introduced HOUSE FILE 471 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 176) A BILL FOR An Act relating to mental health and disability services 1 provided by the state and judicial procedures relating to 2 child in need of assistance proceedings, adoptions, and the 3 confinement of persons found incompetent to stand trial. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1183HV (2) 90 dg/rh

H.F. 471 DIVISION I 1 STATE MENTAL HEALTH INSTITUTES —— SPECIALIZATION 2 Section 1. Section 226.1, subsection 2, paragraph a, 3 subparagraph (1), Code 2023, is amended to read as follows: 4 (1) Treatment, training, care, habilitation, and support 5 of persons with mental illness or a substance abuse problem 6 including: 7 (a) Specialized treatment of behaviorally complex youth at 8 a mental health institute located in Independence. 9 (b) Specialized treatment and security for adults ordered 10 by the court into the custody of the state for the purposes of 11 competency restoration, adults who have been acquitted of a 12 crime by reason of insanity, and similarly situated adults at a 13 mental health institute in Cherokee . 14 DIVISION II 15 CHILD IN NEED OF ASSISTANCE —— SAFETY PLANS —— TEMPORARY 16 REMOVAL 17 Sec. 2. Section 232.79B, subsections 1, 2, and 3, Code 2023, 18 are amended to read as follows: 19 1. For the purposes of this section , “safety plan” means 20 a short-term, time-limited agreement entered into between the 21 department and a child’s parent or guardian designed to address 22 signs of imminent or impending danger to a child identified by 23 the department. 24 2. Upon the department’s determination that potential harm 25 to a child may be mitigated by the development of a safety 26 plan, the department may enter into a safety plan with the 27 child’s parent or guardian . 28 3. A safety plan shall not be construed as a removal from 29 parental or guardian custody absent a court order placing 30 the child with a person or facility other than the parent or 31 guardian who entered into the safety plan. 32 Sec. 3. Section 232.95, subsection 4, Code 2023, is amended 33 to read as follows: 34 4. If the court orders the child removed from the home 35 -1- LSB 1183HV (2) 90 dg/rh 1/ 12

H.F. 471 pursuant to subsection 2 , paragraph “a” “b” or “c” , the court 1 shall hold a hearing to review the removal order within six 2 months unless a dispositional hearing pursuant to section 3 232.99 has been held. 4 Sec. 4. Section 232.102, subsection 10, Code 2023, is 5 amended by striking the subsection. 6 DIVISION III 7 MENTAL HEALTH AND DISABILITY SERVICES REGIONS —— GOVERNANCE —— 8 CORE SERVICES —— REPORT 9 Sec. 5. Section 331.390, subsection 2, Code 2023, is amended 10 by striking the subsection and inserting in lieu thereof the 11 following: 12 2. The governing board shall comply with all of the 13 following requirements: 14 a. Each member of the governing board shall have one vote. 15 b. The membership of the governing board shall not include 16 employees of the department of health and human services or a 17 nonelected employee of a county. 18 c. The membership of the governing board shall consist of 19 the following: 20 (1) Members representing the boards of supervisors of 21 counties comprising the region. Members representing the 22 boards of supervisors for a region’s counties shall not exceed 23 forty-nine percent of the total membership of the governing 24 board. 25 (2) One member who is an adult person who utilizes mental 26 health and disability services or is an actively involved 27 relative of such an adult person. This member shall be 28 designated by the regional advisory committee formed by the 29 governing board pursuant to paragraph “d” . 30 (3) One member representing adult service providers in 31 the region. This member shall be designated by the regional 32 advisory committee formed by the governing board pursuant to 33 paragraph “d” . 34 (4) One member representing children’s behavioral health 35 -2- LSB 1183HV (2) 90 dg/rh 2/ 12

H.F. 471 services providers in the region. This member shall be 1 designated by the regional children’s advisory committee formed 2 by the governing board pursuant to paragraph “e” . 3 (5) One member representing the education system in the 4 region. This member shall be designated by the regional 5 children’s advisory committee formed by the governing board 6 pursuant to paragraph “e” . 7 (6) One member who is a parent of a child who utilizes 8 children’s behavioral health services or who is an actively 9 involved relative of such a child. This member shall be 10 designated by the regional children’s advisory committee formed 11 by the governing board pursuant to paragraph “e” . 12 (7) One member representing law enforcement in the region. 13 (8) One member representing the judicial system in the 14 region. 15 d. The governing board shall have a regional advisory 16 committee consisting of adults who utilize services or actively 17 involved relatives of such adults, service providers, and 18 regional governing board members. 19 e. The governing board shall have a regional children’s 20 advisory committee consisting of parents of children who 21 utilize services or actively involved relatives of such 22 children, a member of the education system, an early childhood 23 advocate, a child welfare advocate, a children’s behavioral 24 health service provider, a member of the juvenile court, a 25 pediatrician, a child care provider, a local law enforcement 26 representative, and regional governing board members. 27 Sec. 6. Section 331.397, subsection 4, Code 2023, is amended 28 by adding the following new paragraph: 29 NEW PARAGRAPH . g. Outpatient competency restoration. 30 Sec. 7. Section 331.397A, subsection 4, Code 2023, is 31 amended by adding the following new paragraph: 32 NEW PARAGRAPH . c. Outpatient competency restoration. 33 Sec. 8. Section 331.400, Code 2023, is amended to read as 34 follows: 35 -3- LSB 1183HV (2) 90 dg/rh 3/ 12

H.F. 471 331.400 Quarterly Annual reports. 1 Beginning with the fiscal year beginning July 1, 2022 2023 , 2 the department shall deliver on a quarterly an annual basis 3 a report to the general assembly that provides a summary of 4 the status of implementing core services in each region, 5 the accessibility of core services in each region, how each 6 region is using the funding provided under section 225C.7A , 7 and recommendations for improvements to the mental health and 8 disability services system in order to attain the outcome 9 improvement goals set by the department consistent with the 10 goals specified in the performance-based contracts under 11 section 225C.7A, subsection 2 , paragraph “c” , subparagraph (5). 12 DIVISION IV 13 ADOPTION NOTICES —— HEARINGS 14 Sec. 9. Section 600.11, subsection 2, paragraph a, 15 subparagraph (7), Code 2023, is amended by striking the 16 subparagraph. 17 Sec. 10. Section 600.11, subsection 2, Code 2023, is amended 18 by adding the following new paragraph: 19 NEW PARAGRAPH . 0b. (1) At least twenty days prior to the 20 adoption hearing, a copy of the order setting the adoption 21 hearing shall be provided to siblings of the person to be 22 adopted when either of the following applies: 23 (a) The sibling and the person to be adopted have an 24 existing relationship. 25 (b) There is a court finding that ongoing contact with 26 the person to be adopted is in the best interest of each 27 sibling and the person to be adopted was a minor child when the 28 parents of the person to be adopted had their parental rights 29 terminated subsequent to the person to be adopted having been 30 adjudicated a child in need of assistance. 31 (2) Notwithstanding subsection 3, a copy of the order 32 setting the adoption hearing may be provided to a sibling via 33 ordinary mail if the sibling’s address is known. A copy of an 34 order setting an adoption hearing sent to a sibling under ten 35 -4- LSB 1183HV (2) 90 dg/rh 4/ 12

H.F. 471 years of age shall be addressed to the sibling’s custodian or 1 guardian. 2 (3) This paragraph does not require a copy of the order 3 setting the adoption hearing to be provided to any of the 4 following: 5 (a) A person whose parental rights have been terminated with 6 regard to the person to be adopted. 7 (b) Siblings who are placed with the sibling to be adopted 8 at the time the court issued the order setting the adoption 9 hearing. 10 (c) A previously adopted sibling, unless the siblings were 11 the subjects of child in need of assistance or termination of 12 parental rights proceedings that occurred at the same time. 13 DIVISION V 14 CONFINEMENT OF PERSONS FOUND INCOMPETENT TO STAND TRIAL 15 Sec. 11. Section 812.6, subsection 1, Code 2023, is amended 16 to read as follows: 17 1. If the court finds the defendant does not pose a danger 18 to the public peace and safety, is otherwise qualified for 19 pretrial release, and is willing to cooperate with treatment, 20 the court shall order, as a condition of pretrial release, 21 that the defendant obtain mental health treatment designed to 22 restore the defendant to competency. The costs of treatment 23 pursuant to this subsection shall be paid by the mental 24 health and disability services region for the county of the 25 defendant’s residency pursuant to chapter 225C regardless of 26 whether the defendant meets financial eligibility requirements 27 under section 225C.62 or 225C.66. 28 Sec. 12. Section 812.7, Code 2023, is amended to read as 29 follows: 30 812.7 Mental status reports. 31 The psychiatrist or licensed doctorate-level psychologist 32 providing evaluating the progress of the outpatient competency 33 restoration treatment to of the defendant, or the director of 34 the facility where the defendant is being held and treated 35 -5- LSB 1183HV (2) 90 dg/rh 5/ 12

H.F. 471 pursuant to a court order, shall provide a written status 1 report to the court regarding the defendant’s mental disorder 2 within , methods used to restore competency to the defendant, 3 the defendant’s current abilities related to competency, 4 and whether it appears the defendant’s competency can be 5 restored within a reasonable amount of time. The psychiatrist, 6 psychologist, or director shall submit an initial report to 7 the court no later than thirty days of after the defendant’s 8 placement pursuant to section 812.6 . The report shall also 9 state whether it appears that the defendant can be restored to 10 competency in a reasonable amount of time. Progress reports 11 shall be provided to the court , and subsequent reports every 12 sixty days or less thereafter after the submission of the 13 initial report until the defendant’s competency is restored or 14 the placement of the defendant is terminated. 15 Sec. 13. Section 812.8, subsections 1 and 3, Code 2023, are 16 amended to read as follows: 17 1. At any time, upon a finding by a psychiatrist or licensed 18 doctorate-level psychologist that there is a substantial 19 probability that the defendant has acquired the ability 20 to appreciate the charge, understand the proceedings, and 21 effectively assist in the defendant’s defense, the psychiatrist 22 or licensed doctorate-level psychologist providing evaluating 23 the progress of the defendant’s outpatient treatment to the 24 defendant or the director of the inpatient facility shall 25 immediately notify the court. After receiving notice the court 26 shall proceed as provided in subsection 4 . 27 3. At any time upon a finding by a treating an evaluating 28 psychiatrist or licensed doctorate-level psychologist that 29 there is no substantial probability that the defendant will 30 be restored to competency in a reasonable amount of time, 31 the psychiatrist or licensed doctorate-level psychologist 32 providing evaluating the defendant’s outpatient treatment to 33 the defendant or the director of the inpatient facility shall 34 immediately notify the court. Upon receiving notification, the 35 -6- LSB 1183HV (2) 90 dg/rh 6/ 12

H.F. 471 court shall proceed as provided under subsection 4 . 1 DIVISION VI 2 CONFORMING CODE CHANGES 3 Sec. 14. Section 256.25, subsections 2 and 3, Code 2023, are 4 amended to read as follows: 5 2. A school district, which may collaborate and partner 6 with one or more school districts, area education agencies, 7 accredited nonpublic schools, nonprofit agencies, and 8 institutions that provide children’s mental health services, 9 located in mental health and disability services regions 10 providing children’s behavioral health services in accordance 11 with chapter 331 225C , subchapter III VII , part 6, may apply 12 for a grant under this program to establish a therapeutic 13 classroom in the school district in accordance with this 14 section . 15 3. The department shall develop a grant application 16 and selection and evaluation criteria. Selection criteria 17 shall include a method for prioritizing grant applications 18 submitted by school districts. First priority shall be given 19 to applications submitted by school districts that submitted an 20 application pursuant to this section for the previous fiscal 21 year. Second priority shall be given to applications submitted 22 by school districts that, pursuant to subsection 2 , are 23 collaborating and partnering with one or more school districts, 24 area education agencies, accredited nonpublic schools, 25 nonprofit agencies, or institutions that provide mental health 26 services for children. Third priority shall be given to 27 applications submitted by school districts located in mental 28 health and disability services regions providing behavioral 29 health services for children in accordance with chapter 331 30 225C , subchapter III, part 6 VII . Grant awards shall be 31 distributed as equitably as possible among small, medium, and 32 large school districts. For purposes of this subsection , a 33 small school district is a district with an actual enrollment 34 of fewer than six hundred pupils; a medium school district is a 35 -7- LSB 1183HV (2) 90 dg/rh 7/ 12

H.F. 471 district with an actual enrollment that is at least six hundred 1 pupils, but less than two thousand five hundred pupils; and a 2 large school district is a district with an actual enrollment 3 of two thousand five hundred or more pupils. 4 DIVISION VII 5 CODE EDITOR DIRECTIVE —— MENTAL HEALTH AND DISABILITY SERVICES 6 CODE TRANSFERS 7 Sec. 15. CODE EDITOR DIRECTIVE. 8 1. The Code editor is directed to make the following 9 transfers: 10 a. Section 331.388 to section 225C.55. 11 b. Section 331.389 to section 225C.56. 12 c. Section 331.390, as amended in this Act, to section 13 225C.57. 14 d. Section 331.391, as amended in this Act, to section 15 225C.58. 16 e. Section 331.392 to section 225C.59. 17 f. Section 331.393 to section 225C.60. 18 g. Section 331.394 to section 225C.61. 19 h. Section 331.395 to section 225C.62. 20 i. Section 331.396 to section 225C.63. 21 j. Section 331.396A to section 225C.64. 22 k. Section 331.397, as amended in this Act, to section 23 225C.65. 24 l. Section 331.397A, as amended in this Act, to section 25 225C.66. 26 m. Section 331.398 to section 225C.67. 27 n. Section 331.399 to section 225C.68. 28 o. Section 331.400, as amended in this Act, to section 29 225C.69. 30 2. The Code editor shall correct internal references in the 31 Code and in any enacted legislation as necessary due to the 32 enactment of this section. 33 3. The Code editor may add a new subchapter to chapter 34 225C preceding section 225C.55 entitled “MENTAL HEALTH AND 35 -8- LSB 1183HV (2) 90 dg/rh 8/ 12

H.F. 471 DISABILITY SERVICES —— REGIONAL SERVICE SYSTEM —— CHILDREN’S 1 BEHAVIORAL HEALTH SYSTEM”. 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 mental health and disability services 6 provided by the state and judicial procedures relating to 7 child in need of assistance proceedings, adoptions, and the 8 confinement of persons found incompetent to stand trial. The 9 bill is organized into divisions. 10 DIVISION I —— STATE MENTAL HEALTH INSTITUTES —— 11 SPECIALIZATION. The bill removes persons who solely have a 12 substance abuse problem as a population eligible to receive 13 treatment, training, care, habilitation, and support at a state 14 mental health institute. 15 The bill designates the state mental health institute 16 located in Independence, Iowa, for specialized treatment of 17 behaviorally complex youth, and designates the state mental 18 health institute located in Cherokee, Iowa, for specialized 19 treatment and security of adults ordered by the court into 20 the custody of the state for the purposes of competency 21 restoration, adults who have been acquitted of a crime by 22 reason of insanity, and similarly situated adults. 23 DIVISION II —— CHILD IN NEED OF ASSISTANCE —— SAFETY PLANS 24 —— TEMPORARY REMOVAL. The bill allows, in a child in need 25 of assistance proceeding, a child’s guardian to enter into a 26 safety plan, and prohibits a safety plan from being construed 27 as a child’s removal from a guardian absent a court order 28 placing the child with a person or facility other than the 29 guardian who entered into the safety plan. 30 The bill makes a corrective change to Code section 31 232.95(2)(a) relating to hearings concerning the temporary 32 removal of a child in child in need of assistance cases. 33 The bill strikes Code section 232.102(10) relating to 34 transfer of legal custody of a child in a child in need of 35 -9- LSB 1183HV (2) 90 dg/rh 9/ 12

H.F. 471 assistance case for placement and visitation of the child by 1 the child’s grandparents, great-grandparents, and certain other 2 adult relatives. 3 DIVISION III —— MENTAL HEALTH AND DISABILITY SERVICES 4 REGIONS —— GOVERNANCE —— CORE SERVICES —— REPORT. The bill 5 makes changes to the regional governance of mental health and 6 disability services (MHDS) governing boards. The bill allows 7 each member of an MHDS governing board to have a vote, limits 8 the number of representatives county boards of supervisors 9 may have on an MHDS regional governing board to 49 percent 10 of the total governing board membership, and adds a member 11 representing law enforcement and a member representing the 12 judicial system in an MHDS region as representatives on an MHDS 13 governing board. 14 The bill adds outpatient competency restoration as a core 15 service for both adult and children’s MHDS regions. 16 The bill requires the department of health and human 17 services (HHS) to deliver a report on an annual basis to the 18 general assembly that provides a summary of the status of 19 implementing core services in each region, the accessibility 20 of core services in each region, how each region is using the 21 funding provided to MHDS regions, and recommendations for 22 improvements to the MHDS system in order to attain the outcome 23 improvement goals set by HHS. Under current law, HHS is 24 required to give such a report on a quarterly basis. 25 DIVISION IV —— ADOPTION NOTICES —— HEARINGS. The bill 26 requires an adoption petitioner to provide a copy of the order 27 setting the adoption hearing to siblings of a person to be 28 adopted at least 20 days prior to the adoption hearing when 29 there is either an existing relationship or a court finding 30 that ongoing contact with the person to be adopted is in the 31 best interests of each sibling and the person to be adopted was 32 a minor child when the parents of the person to be adopted had 33 their parental rights terminated subsequent to the person to be 34 adopted having been adjudicated a child in need of assistance. 35 -10- LSB 1183HV (2) 90 dg/rh 10/ 12

H.F. 471 The bill allows a copy of the order setting the adoption 1 hearing to be provided to a sibling via ordinary mail if the 2 sibling’s address is known. A copy of an order setting an 3 adoption hearing sent to a sibling under 10 years of age shall 4 be addressed to the sibling’s custodian or guardian. 5 The bill does not require a copy of the order setting the 6 adoption hearing to be provided to a person whose parental 7 rights have been terminated with regard to the person to be 8 adopted; siblings who are placed with the sibling to be adopted 9 at the time the court issued the order setting the adoption 10 hearing; or a previously adopted sibling, unless the siblings 11 were the subjects of child in need of assistance or termination 12 of parental rights proceedings that occurred at the same time. 13 DIVISION V —— CONFINEMENT OF PERSONS FOUND INCOMPETENT TO 14 STAND TRIAL. The bill requires the MHDS region for the county 15 of a defendant’s residency to pay for the costs of mental 16 health treatment the defendant receives as a condition of 17 pretrial release. 18 The bill allows a psychiatrist or licensed doctorate-level 19 psychologist evaluating the progress of a defendant’s 20 outpatient competency restoration treatment, or the director 21 of the facility where the defendant is being held and treated 22 pursuant to a court order, to provide a written status report 23 to the court regarding the defendant’s mental disorder. Under 24 current law, only the psychiatrist or licensed doctorate 25 level psychologist providing the defendant’s treatment or the 26 director of the facility where the defendant is being held and 27 treated can provide the written status report. 28 The bill requires a written status report prepared for an 29 incompetent defendant to include the methods used to restore 30 competency to the defendant, the defendant’s current abilities 31 related to competency, and whether it appears the defendant’s 32 competency can be restored within a reasonable amount of time. 33 The bill requires a psychiatrist, psychologist, or director to 34 submit an initial report to the court no later than 30 days 35 -11- LSB 1183HV (2) 90 dg/rh 11/ 12

H.F. 471 after the defendant’s placement by the court for treatment, and 1 subsequent reports every 60 days or less after submission of 2 the initial report until the defendant’s competency is restored 3 or the placement of the defendant is terminated. 4 The bill requires a psychiatrist or licensed doctorate-level 5 psychologist evaluating the progress of a defendant’s 6 outpatient competency restoration treatment, or the director 7 of the facility where the defendant is being held and treated 8 pursuant to a court order, to notify a court if there is a 9 substantial probability or is no substantial probability that 10 a defendant formerly deemed incompetent either has acquired 11 the ability to appreciate the charge against the defendant, 12 understand the proceedings, and effectively assist in the 13 defendant’s defense or will be restored to competency in 14 a reasonable amount of time. Under current law, only the 15 psychiatrist or licensed doctorate-level psychologist providing 16 the defendant’s treatment or the director of the facility where 17 the defendant is being held and treated could provide such 18 notice to a court. 19 DIVISION VI —— CONFORMING CODE CHANGE. The bill makes a 20 conforming change to Code section 256.25 (therapeutic classroom 21 incentive grant program —— fund). 22 DIVISION VII —— CODE TRANSFERS. The bill transfers Code 23 sections 331.388 through 331.400 (mental health and disability 24 services —— regional service system —— children’s behavioral 25 health system) to Code sections 225C.55 through 225C.69 and 26 directs the Code editor to make conforming changes. 27 -12- LSB 1183HV (2) 90 dg/rh 12/ 12