House Study Bill 653 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED GOVERNOR BILL) A BILL FOR An Act relating to the transition of behavioral health services 1 from a mental health and disability services system to 2 a behavioral health service system, and the transfer of 3 disability services to the division of aging and disability 4 services of the department of health and human services, 5 making appropriations, and including effective date 6 provisions. 7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 8 TLSB 5509XL (9) 90 dg/ko
S.F. _____ H.F. _____ DIVISION I 1 BEHAVIORAL HEALTH SERVICE SYSTEM 2 Section 1. NEW SECTION . 225A.1 Definitions. 3 As used in this chapter unless the context otherwise 4 requires: 5 1. “Administrative services organization” means an entity 6 designated by the department pursuant to section 225A.4, to 7 develop and perform planning and administrative services in 8 accordance with a district behavioral health service system 9 plan. 10 2. “Behavioral health condition” means a substantial 11 limitation in major life activities due to a mental, 12 behavioral, or addictive disorder or condition diagnosed in 13 accordance with the criteria provided in the most current 14 edition of the diagnostic and statistical manual of mental 15 disorders, published by the American psychiatric association. 16 3. “Behavioral health district” or “district” means a 17 geographic, multicounty, sub-state area as designated by the 18 department under section 225A.4. 19 4. “Behavioral health provider” or “provider” means an 20 individual, firm, corporation, association, or institution 21 that, pursuant to this chapter, is providing or has been 22 approved by the department to provide services to an individual 23 with a behavioral health condition. 24 5. “Behavioral health service system” means the behavioral 25 health service system established in section 225A.3. 26 6. “Caregiver” means an adult family member, or other 27 individual, who is providing care to a person outside of a 28 formal program. 29 7. “Department” means the department of health and human 30 services. 31 8. “Director” means the director of the department of health 32 and human services. 33 9. “District behavioral health advisory council” or 34 “advisory council” means a council established by an 35 -1- LSB 5509XL (9) 90 dg/ko 1/ 80
S.F. _____ H.F. _____ administrative services organization under section 225A.5, to 1 identify opportunities, address challenges, and advise the 2 administrative services organization in accordance with section 3 225A.5. 4 10. “District behavioral health service system plan” or 5 “district behavioral health plan” means a plan developed by 6 an administrative services organization and approved by the 7 department to outline the services intended to be provided 8 within the administrative services organization’s behavioral 9 health district. 10 11. “Indicated prevention” means prevention activities 11 designed to prevent the onset of substance use disorders in 12 individuals who do not meet the medical criteria for addiction, 13 but who show early signs of developing a substance use disorder 14 in the future. 15 12. “Selective prevention” means prevention activities 16 designed to target subsets of the total population who are 17 considered at-risk for a substance use disorder by virtue of 18 their membership in a particular segment of the population. 19 Selective prevention targets the entire subgroup, regardless of 20 the degree of risk of any individual within the group. 21 13. “State behavioral health service system plan” or 22 “state behavioral health plan” means the plan developed by the 23 department that describes the key components of the state’s 24 behavioral health service system. 25 14. “Universal prevention” means prevention activities 26 designed to address an entire population class for the purpose 27 of preventing or delaying the use of alcohol, tobacco, and 28 other drugs. Population classes include but are not limited 29 to the national population, local populations, community 30 populations, school populations, and neighborhood populations. 31 Sec. 2. NEW SECTION . 225A.2 State mental health authority 32 —— state agency for substance abuse. 33 1. The department is designated as the state mental health 34 authority as defined in 42 U.S.C. §201(m) for the purpose of 35 -2- LSB 5509XL (9) 90 dg/ko 2/ 80
S.F. _____ H.F. _____ directing benefits from the federal community mental health 1 services block grant, 42 U.S.C. §300x et seq., and the state 2 authority designated for the purpose of directing benefits 3 from the federal substance abuse prevention and treatment 4 block grant, 42 U.S.C. §300x-21 et seq. This designation 5 does not preclude the state board of regents from authorizing 6 or directing any institution under the board of regents’ 7 jurisdiction to carry out educational, prevention, and research 8 activities in the areas of mental health and intellectual 9 disability. 10 2. The department is designated as the single state agency 11 for substance abuse for the purposes of 42 U.S.C. §1396a et 12 seq. 13 3. For the purposes of effectuating the department’s roles 14 designated in this section, the department shall have the 15 following powers and the authority to take all the following 16 actions: 17 a. Plan, establish, and maintain prevention, education, 18 early intervention, treatment, recovery support, and crisis 19 services programs as necessary or desirable in accordance with 20 a comprehensive behavioral health service system. 21 b. Develop and submit a state plan as required by 42 U.S.C. 22 §300x-1, in accordance with 42 C.F.R. §431.10. 23 c. Review and approve district behavioral health service 24 system plans developed in accordance with the state behavioral 25 health service system plan. 26 d. Perform all necessary acts to cooperate with any state 27 agency, political subdivision, or federal government agency to 28 apply for grants. 29 e. Solicit and accept for use any gift of money or property 30 by will or otherwise, and any grant of money, services, 31 or property from the federal government, the state, or any 32 political subdivision thereof or any private source. 33 f. Collect and maintain records, engage in studies and 34 analyses, and gather relevant statistics. 35 -3- LSB 5509XL (9) 90 dg/ko 3/ 80
S.F. _____ H.F. _____ g. Take any other actions as necessary to execute the 1 duties granted to the department in this chapter, or that 2 are otherwise required to maintain compliance with federal 3 requirements related to the department’s roles established in 4 this section. 5 Sec. 3. NEW SECTION . 225A.3 Behavioral health service 6 system —— department powers and duties. 7 1. A behavioral health service system is established 8 under the control of the department for the purposes of 9 implementing a statewide system of prevention, education, early 10 intervention, treatment, recovery support, and crisis services 11 related to mental health, substance use, tobacco use, and 12 problem gambling. 13 2. To the extent funding is available, the department 14 shall perform all of the following duties to administer the 15 behavioral health service system: 16 a. Consistent with the department’s agency strategic plan 17 adopted pursuant to section 8E.206, prepare and administer 18 the state behavioral health service system plan. The state 19 behavioral health service system plan shall identify strategies 20 and targeted outcomes for the behavioral health service system 21 to continuously improve the provision of all of the following: 22 (1) Universal prevention, selective prevention, and 23 indicated prevention. 24 (2) Evidence-based and evidence-informed early intervention 25 and treatment services. 26 (3) Comprehensive recovery support services with a focus on 27 community-based services that avoid, divert, or offset the need 28 for acute inpatient services, long-term services provided in 29 large institutional settings, law enforcement involvement, and 30 incarceration. 31 (4) Crisis services with a focus on reducing escalation 32 of crisis situations, relieving the immediate distress of 33 individuals experiencing a crisis situation, reducing the 34 risk that individuals in a crisis situation harm themselves 35 -4- LSB 5509XL (9) 90 dg/ko 4/ 80
S.F. _____ H.F. _____ or others, and promoting timely access to behavioral health 1 services for those who require ongoing treatment. 2 b. Administer and distribute state appropriations, federal 3 aid, and grants deposited into the behavioral health fund 4 established in section 225A.7. 5 c. Oversee, provide technical assistance to, and 6 monitor administrative services organizations to ensure the 7 administrative services organizations’ compliance with district 8 behavioral health plans. 9 d. Oversee behavioral health provider licensure, 10 accreditation, and certification, and issue determinations 11 to approve, deny, revoke, or suspend a behavioral health 12 provider’s licensure, accreditation, or certification status. 13 e. Establish and maintain a data collection and management 14 information system to identify, collect, and analyze service 15 outcome and performance data to address the needs of patients, 16 providers, the department, and programs operating within the 17 behavioral health service system. 18 f. Collect, monitor, and utilize information including but 19 not limited to behavioral health service system patient records 20 and syndromic surveillance data to understand emerging needs, 21 and to swiftly deploy information, resources, and technical 22 assistance in response. 23 g. Adopt rules pursuant to chapter 17A to administer this 24 chapter. Such rules shall include but not be limited to rules 25 that provide for all of the following: 26 (1) Minimum access standards to ensure equitable access to 27 services provided through the behavioral health service system 28 including but not limited to when services are available, who 29 is eligible for services, and where services are available. 30 (2) Methods to ensure each individual receives an 31 uninterrupted continuum of care for prevention, education, 32 early intervention, treatment, recovery support, and crisis 33 services. 34 (3) Standards for the implementation and maintenance 35 -5- LSB 5509XL (9) 90 dg/ko 5/ 80
S.F. _____ H.F. _____ of behavioral health programs and services offered by the 1 behavioral health service system, and by each administrative 2 services organization. 3 (4) Procedures for the management and oversight of 4 behavioral health providers to ensure provider compliance with 5 the terms of the behavioral health providers’ contracts and 6 with state and federal law and rules. 7 (5) Procedures for the termination of an administrative 8 services organization’s designation as an administrative 9 services organization. 10 (6) Procedures for the collection, utilization, and 11 maintenance of the data necessary to establish a central data 12 repository in accordance with section 225A.6. 13 (7) Any other requirements the department deems necessary 14 to ensure that an administrative services organization 15 fulfills the administrative services organization’s duties 16 as established in this chapter, and as established in the 17 administrative services organization’s district behavioral 18 health plan. 19 Sec. 4. NEW SECTION . 225A.4 Behavioral health service 20 system —— districts and administrative services organizations. 21 1. a. The department shall divide the entirety of the state 22 into designated behavioral health districts. Behavioral health 23 prevention, education, early intervention, treatment, recovery 24 support, and crisis services shall be made available through 25 each behavioral health district in a manner consistent with 26 directives each district receives from the department. 27 b. For the purpose of providing equitable access to all 28 services provided through the behavioral health service 29 system, the department shall consider all of the following when 30 designating behavioral health districts: 31 (1) City and county lines. 32 (2) The maximum population size that behavioral health 33 services available in an area are able to effectively serve. 34 (3) Areas of high need for behavioral health services. 35 -6- LSB 5509XL (9) 90 dg/ko 6/ 80
S.F. _____ H.F. _____ (4) Patterns various populations exhibit when accessing or 1 receiving behavioral health services. 2 c. Notwithstanding chapter 17A, the manner in which the 3 department designates behavioral health districts including but 4 not limited to the determination of the boundaries for each 5 district shall not be subject to judicial review. 6 2. a. The department shall designate an administrative 7 services organization for each behavioral health district to 8 oversee and organize each district and the behavioral health 9 services associated with the district. The department shall 10 issue requests for proposals for administrative services 11 organization candidates. 12 b. At the department’s discretion, the department may 13 designate any of the following as an administrative services 14 organization: 15 (1) A mental health and disability services regional 16 administrator formed prior to July 1, 2025. 17 (2) A public or private agency in a behavioral health 18 district, or any separate organizational unit within the 19 public or private agency, that has the capabilities to engage 20 in the planning or provision of a broad range of behavioral 21 health prevention, education, early intervention, treatment, 22 recovery support, and crisis services only as directed by the 23 department. 24 c. The department shall consider all of the following 25 factors in determining whether to designate an entity as an 26 administrative services organization: 27 (1) Whether the entity has demonstrated the capacity to 28 manage and utilize available resources in a manner required of 29 an administrative services organization. 30 (2) Whether the entity has demonstrated the ability to 31 ensure the delivery of behavioral health services within the 32 district as required by the department by rule. 33 (3) Whether the entity has demonstrated the ability to 34 fulfill the monitoring, oversight, and provider compliance 35 -7- LSB 5509XL (9) 90 dg/ko 7/ 80
S.F. _____ H.F. _____ responsibilities as required by the department by rule. 1 3. a. Upon designation by the department, an administrative 2 services organization shall be considered an instrumentality of 3 the state and shall adhere to all state and federal mandates 4 and prohibitions applicable to an instrumentality of the state. 5 b. The designation as an administrative services 6 organization shall continue until the designation is removed 7 by the department, the administrative services organization 8 withdraws, or a change in state or federal law necessitates the 9 removal of the designation. 10 4. Each administrative services organization shall function 11 as a subrecipient for the purposes of the federal community 12 mental health services block grant, 42 U.S.C. §300x et seq., 13 and the federal substance abuse prevention and treatment block 14 grant, 42 U.S.C. §300x-21 et seq., and shall comply with all 15 federal requirements applicable to subrecipients under the 16 block grants. 17 5. Each administrative services organization shall perform 18 all of the following duties: 19 a. Develop and administer a district behavioral health 20 plan as approved by the department, and in accordance with the 21 standards adopted by the department by rule. 22 b. Coordinate the administration of the district behavioral 23 health plan with federal, state, and local resources in order 24 to develop a comprehensive and coordinated local behavioral 25 health service system. 26 c. Enter into contracts necessary to provide services under 27 the district behavioral health plan. 28 d. Oversee, provide technical assistance to, and monitor 29 the compliance of providers contracted by the administrative 30 services organization to provide behavioral health services in 31 accordance with the district behavioral health plan. 32 e. Establish a district behavioral health advisory council 33 pursuant to section 225A.5. 34 Sec. 5. NEW SECTION . 225A.5 District behavioral health 35 -8- LSB 5509XL (9) 90 dg/ko 8/ 80
S.F. _____ H.F. _____ advisory councils. 1 1. Each administrative services organization shall 2 establish a district behavioral health advisory council that 3 shall do all of the following: 4 a. Identify opportunities and address challenges based on 5 updates received from the administrative services organization 6 regarding the implementation of the district behavioral health 7 plan. 8 b. Advise the administrative services organization while 9 the administrative services organization is developing a 10 comprehensive behavioral health policy. 11 c. Advise the administrative services organization on how to 12 best provide access to behavioral health prevention, education, 13 early intervention, treatment, recovery support, and crisis 14 services throughout the district as directed by the department. 15 2. An advisory council shall consist of nine members. 16 Members shall be appointed by the administrative services 17 organization subject to the following requirements: 18 a. Three members shall be elected public officials 19 currently holding office, or the public official’s designated 20 representative. However, if the number of elected public 21 officials available and willing to serve is less than three 22 members, this requirement shall be waived until an elected 23 public official currently holding office is willing to serve. 24 b. Three members shall be chosen in accordance with 25 procedures established by the administrative services 26 organization to ensure representation of the populations served 27 within the behavioral health district. 28 c. Three members shall be chosen who have experience 29 or education related to core behavioral health functions, 30 essential behavioral health services, behavioral health 31 prevention, behavioral health treatment, population-based 32 behavioral health services, or community-based behavioral 33 health initiatives. 34 Sec. 6. NEW SECTION . 225A.6 Behavioral health service 35 -9- LSB 5509XL (9) 90 dg/ko 9/ 80
S.F. _____ H.F. _____ system —— data collection and use. 1 1. The department shall take all of the following actions 2 for data related to the behavioral health service system: 3 a. Collect and analyze the data, including but not 4 limited to Medicaid and community services network data, as 5 necessary to issue cost estimates for serving populations, 6 providing treatment, making and receiving payments, conducting 7 operations, and performing duties related to the behavioral 8 health service system. In doing so, the department shall 9 maintain compliance with applicable federal and state 10 privacy laws to ensure the confidentiality and integrity 11 of individually identifiable data. The department may 12 periodically assess the status of the department’s compliance 13 to ensure that data collected by and stored with the department 14 is protected. 15 b. Establish and administer a central data repository for 16 collecting and analyzing state, behavioral health district, and 17 contracted behavioral health provider data. 18 c. Establish a record for each individual receiving publicly 19 funded services from an administrative services organization. 20 Each record shall include a unique client identifier for the 21 purposes of identifying and tracking the individual’s record. 22 d. Consult with administrative services organizations, 23 behavioral health service providers, and other behavioral 24 health service system stakeholders on an ongoing basis to 25 implement and maintain the central data repository. 26 e. Engage with all entities that maintain information the 27 department is required to collect pursuant to this section in 28 order to integrate all data concerning individuals receiving 29 services within the behavioral health service system. 30 f. Engage with all entities that maintain general population 31 data relating to behavioral health in order to develop action 32 plans, create projections relating to a population’s behavioral 33 health needs, develop policies concerning behavioral health, 34 and otherwise perform acts as necessary to enhance the state’s 35 -10- LSB 5509XL (9) 90 dg/ko 10/ 80
S.F. _____ H.F. _____ overall behavioral health. 1 2. Administrative services organizations shall report all 2 data required to be maintained in the central data repository 3 to the department in a manner as established by the department 4 by rule. For the purpose of making such data reports, an 5 administrative services organization shall do one of the 6 following: 7 a. Utilize a data system that integrates with the data 8 systems used by the department. 9 b. Utilize a data system that has the capacity to securely 10 exchange information with the department, other behavioral 11 health districts, contractors, and other entities involved with 12 the behavioral health service system who are authorized to 13 access the central data repository. 14 3. Data and information maintained by and exchanged between 15 an administrative services organization and the department 16 shall be labeled consistently, share the same definitions, 17 utilize the same common coding and nomenclature, and be in a 18 form and format as required by the department by rule. 19 4. Administrative services organizations shall report, 20 to the department in a manner specified by the department, 21 information including but not limited to demographic 22 information, expenditure data, and data concerning the 23 behavioral health services and other support provided to 24 individuals in the administrative service organization’s 25 district. 26 5. The department shall ensure that administrative services 27 organizations, behavioral health providers, and contracting 28 entities operating within the behavioral health service system 29 maintain uniform methods for keeping statistical information 30 relating to behavioral health service system outcomes and 31 performance. 32 6. The department shall develop and implement a means to 33 provide key outcome and performance data to the public and to 34 persons involved with the behavioral health service system. 35 -11- LSB 5509XL (9) 90 dg/ko 11/ 80
S.F. _____ H.F. _____ Sec. 7. NEW SECTION . 225A.7 Behavioral health fund. 1 1. For purposes of this section: 2 a. “Population” means, as of July 1 of the fiscal year 3 preceding the fiscal year in which the population figure is 4 applied, the population shown by the latest preceding certified 5 federal census or the latest applicable population estimate 6 issued by the United States census bureau, whichever is most 7 recent. 8 b. “State growth factor” for a fiscal year means an amount 9 equal to the dollar amount used to calculate the appropriation 10 under this section for the immediately preceding fiscal year 11 multiplied by the percent increase, if any, in the amount of 12 sales tax revenue deposited into the general fund of the state 13 under section 423.2A, subsection 1, paragraph “a” , less the 14 transfers required under section 423.2A, subsection 2, between 15 the fiscal year beginning three years prior to the applicable 16 fiscal year and the fiscal year beginning two years prior 17 to the applicable year, but not to exceed one and one-half 18 percent. 19 2. A behavioral health fund is established in the state 20 treasury under the control of the department. The fund shall 21 consist of moneys deposited into the fund pursuant to this 22 section and section 426B.1, gifts of money or property accepted 23 by the state or the department to support any services under 24 this chapter or chapter 231, and moneys otherwise appropriated 25 by the general assembly. Moneys in the fund are appropriated 26 to the department to implement and administer the behavioral 27 health service system and related programs including but not 28 limited to all of the following: 29 a. Distributions to administrative services organizations 30 to provide services as outlined in the organizations’ district 31 behavioral health plan. 32 b. Distributions to providers of tobacco use services, 33 substance use disorder services, and problem gambling services. 34 c. Funding of disability services pursuant to chapter 231. 35 -12- LSB 5509XL (9) 90 dg/ko 12/ 80
S.F. _____ H.F. _____ d. Payment of administrative costs associated with services 1 described under paragraphs “a” , “b” , and “c” . 2 3. For the fiscal year beginning July 1, 2025, there 3 is transferred from the general fund of the state to the 4 behavioral health fund an amount equal to forty-two dollars 5 multiplied by the state’s population for the fiscal year. 6 4. For the fiscal year beginning July 1, 2026, and each 7 succeeding fiscal year, there is transferred from the general 8 fund of the state to the behavioral health fund an amount equal 9 to the state’s population for the fiscal year multiplied by 10 the sum of the dollar amount used to calculate the transfer 11 from the general fund to the behavioral health fund for the 12 immediately preceding fiscal year, plus the state growth factor 13 for the fiscal year for which the transfer is being made. 14 5. For each fiscal year, an administrative services 15 organization shall not spend on administrative costs an amount 16 more than seven percent of the total amount distributed to the 17 administrative services organization through this section and 18 other appropriations for that fiscal year. 19 6. Moneys in the behavioral health fund may be used by the 20 department for cash flow purposes, provided that any moneys so 21 allocated are returned to the behavioral health fund by the end 22 of each fiscal year. 23 7. Notwithstanding section 12C.7, subsection 2, interest 24 or earnings on moneys deposited in the behavioral health fund 25 shall be credited to the behavioral health fund. 26 8. Notwithstanding section 8.33, moneys appropriated in 27 this section that remain unencumbered or unobligated at the 28 close of the fiscal year shall not revert but shall remain 29 available for expenditure for the purposes designated until the 30 close of the succeeding fiscal year. 31 Sec. 8. CODE EDITOR DIRECTIVE. The Code editor is directed 32 to do all of the following: 33 1. Designate sections 225A.1 through 225A.7, as enacted 34 in this division of this Act, as Code chapter 225A entitled 35 -13- LSB 5509XL (9) 90 dg/ko 13/ 80
S.F. _____ H.F. _____ “Department of Health and Human Services —— Behavioral Health 1 Service System”. 2 2. Correct internal references in the Code and in any 3 enacted legislation as necessary due to the enactment of this 4 division of this Act. 5 Sec. 9. EFFECTIVE DATE. This division of this Act takes 6 effect July 1, 2025. 7 DIVISION II 8 BEHAVIORAL HEALTH SERVICE SYSTEM —— CONFORMING CHANGES 9 Sec. 10. Section 11.6, subsection 1, paragraph b, Code 2024, 10 is amended to read as follows: 11 b. The financial condition and transactions of community 12 mental health centers organized under chapter 230A , substance 13 use disorder programs organized licensed under chapter 125 , and 14 community action agencies organized under chapter 216A , shall 15 be audited at least once each year. 16 Sec. 11. Section 35D.9, Code 2024, is amended to read as 17 follows: 18 35D.9 County of residence upon discharge. 19 1. A member of the home does not acquire residency in 20 the county in which the home is located unless the member is 21 voluntarily or involuntarily discharged from the home and the 22 member meets county of residence requirements. 23 2. For purposes of this section , “county of residence” 24 means the same as defined in section 225C.61 the county in 25 this state in which, at the time a person applies for or 26 receives services, the person is living and has established 27 an ongoing presence with the declared, good faith intention 28 of living for a permanent or indefinite period of time . The 29 county of residence of a homeless person is the county in 30 which the homeless person usually sleeps. A person maintains 31 residency in the county or state in which the person last 32 resided during the time period that the person is present in 33 a different county or state receiving services in a hospital, 34 a correctional facility, a halfway house for community-based 35 -14- LSB 5509XL (9) 90 dg/ko 14/ 80
S.F. _____ H.F. _____ corrections or substance use disorder treatment, a nursing 1 facility, an intermediate care facility for persons with an 2 intellectual disability, a residential care facility, or for 3 the purpose of attending a college or university. 4 3. a. The dispute resolution process in this subsection 5 shall apply to county of residence disputes. The dispute 6 resolution process shall not be applicable to any of the 7 following: 8 (1) Disputes involving persons committed to a state 9 facility pursuant to chapter 812. 10 (2) Disputes involving Iowa rule of criminal procedure 11 2.22(8)(b), commitment for evaluation. 12 (3) Disputes involving chapter 12 of Iowa court rules, rules 13 for involuntary hospitalization of mentally ill persons. 14 b. If a county objects to a billing for services or a 15 residency determination and asserts that either the person 16 has residency in a different county or the person is not a 17 resident of this state, the person’s county of residence 18 shall be determined as provided in this subsection. If the 19 county asserts that the person has residency in a different 20 county in this state, the county shall notify that county in 21 writing within one hundred twenty calendar days of receiving 22 the billing for services or of the county of residence 23 determination. 24 c. The county that receives the notification under paragraph 25 “b” shall respond in writing to the county that provided the 26 notification within forty-five calendar days of receiving the 27 notification. If the parties cannot agree as to the person’s 28 county of residence within ninety calendar days of the date of 29 notification, on motion of either of the parties, the matter 30 shall be referred to the administrative hearings division of 31 the department of inspections, appeals, and licensing for 32 a contested case proceeding under chapter 17A, before an 33 administrative law judge assigned in accordance with section 34 10A.801, to determine the person’s county of residence. 35 -15- LSB 5509XL (9) 90 dg/ko 15/ 80
S.F. _____ H.F. _____ d. (1) Notwithstanding section 17A.15, the administrative 1 law judge’s determination of a person’s county of residence 2 shall be considered final agency action. Judicial review of 3 the determination may be sought in accordance with section 4 17A.19. 5 (2) If following the determination of a person’s county of 6 residence under this subsection additional evidence becomes 7 available that merits a change in the determination of the 8 person’s county of residence, the affected parties may change 9 the determination of county of residence by mutual agreement. 10 Otherwise, a party may move that the matter be reconsidered 11 by the county, or by an administrative law judge assigned in 12 accordance with section 10A.801. 13 e. Unless a petition is filed for judicial review, the 14 administrative law judge’s determination of the person’s county 15 of residence shall result in one of the following: 16 (1) If a county is determined to be the person’s county 17 of residence, that county shall pay any amounts due and shall 18 reimburse the other county for any amounts paid for services 19 provided to the person by the other county prior to the county 20 of residence determination. 21 (2) If it is determined that the person is not a resident of 22 this state, neither the state nor either county shall be liable 23 for payment of amounts due for services provided to the person 24 prior to the determination of the person’s county of residence. 25 f. (1) The party that does not prevail in a contested 26 case proceeding or a subsequent judicial review pursuant to 27 this subsection shall be liable for costs associated with 28 the proceeding or judicial review, including reimbursement 29 of the administrative hearings division of the department of 30 inspections, appeals, and licensing’s actual costs associated 31 with the administrative proceeding, court costs, and reasonable 32 attorney fees. 33 (2) A payment or reimbursement pursuant to this subsection 34 shall be remitted within forty-five calendar days of the 35 -16- LSB 5509XL (9) 90 dg/ko 16/ 80
S.F. _____ H.F. _____ date the county of residence determination is issued by the 1 administrative law judge or the date the court files an order 2 determining the person’s county of residence, whichever is 3 later. After forty-five calendar days, the prevailing party 4 may add a penalty of up to one percent per month to any amounts 5 due. 6 Sec. 12. Section 97B.1A, subsection 8, paragraph a, 7 subparagraph (13), Code 2024, is amended by striking the 8 subparagraph. 9 Sec. 13. Section 123.17, subsections 5 and 8, Code 2024, are 10 amended to read as follows: 11 5. After any transfer provided for in subsection 3 is 12 made, the department shall transfer into a special revenue 13 account in the general fund of the state, a sum of money at 14 least equal to seven percent of the gross amount of sales 15 made by the department from the beer and liquor control fund 16 on a monthly basis but not less than nine million dollars 17 annually. Of the amounts transferred, two million dollars, 18 plus an additional amount determined by the general assembly, 19 shall be appropriated to the department of health and human 20 services for use by the staff who administer the comprehensive 21 substance use disorder program under chapter 125 for substance 22 use disorder treatment and prevention programs the purposes of 23 planning, establishing, and maintaining prevention, education, 24 early intervention, treatment, and recovery support services 25 programs for substance use . Any amounts received in excess of 26 the amounts appropriated to the department of health and human 27 services for use by the staff who administer the comprehensive 28 substance use disorder program under chapter 125 the purposes 29 of planning, establishing, and maintaining prevention, 30 education, early intervention, treatment, and recovery support 31 services programs for substance use shall be considered part of 32 the general fund balance. 33 8. After any transfers provided for in subsections 3, 5, 34 6, and 7 , and before any other transfer to the general fund, 35 -17- LSB 5509XL (9) 90 dg/ko 17/ 80
S.F. _____ H.F. _____ the department shall transfer from the beer and liquor control 1 fund one million dollars to the department of health and human 2 services for distribution pursuant to section 125.59 behavioral 3 health fund established under section 225A.7 . 4 Sec. 14. Section 124.409, subsection 2, Code 2024, is 5 amended by striking the subsection. 6 Sec. 15. Section 125.2, subsections 4, 5, and 10, Code 2024, 7 are amended by striking the subsections. 8 Sec. 16. Section 125.91, subsection 1, Code 2024, is amended 9 to read as follows: 10 1. The procedure prescribed by this section shall only 11 be used for a person with a substance use disorder due to 12 intoxication or substance-induced incapacitation who has 13 threatened, attempted, or inflicted physical self-harm or harm 14 on another, and is likely to inflict physical self-harm or harm 15 on another unless immediately detained, or who is incapacitated 16 by a chemical substance, if an application has not been filed 17 naming the person as the respondent pursuant to section 125.75 18 and the person cannot be ordered into immediate custody and 19 detained pursuant to section 125.81 . 20 Sec. 17. Section 125.93, Code 2024, is amended to read as 21 follows: 22 125.93 Commitment records —— confidentiality. 23 Records of the identity, diagnosis, prognosis, or treatment 24 of a person which are maintained in connection with the 25 provision of substance use disorder treatment services are 26 confidential, consistent with the requirements of section 27 125.37 , and with the federal confidentiality regulations 28 authorized by the federal Drug Abuse Office and Treatment Act , 29 42 U.S.C. §290ee and the federal Comprehensive Alcohol Abuse 30 and Alcoholism Prevention, Treatment and Rehabilitation Act, 42 31 U.S.C. §290dd-2. However, such records may be disclosed to an 32 employee of the department of corrections, if authorized by the 33 director of the department of corrections, or to an employee 34 of a judicial district department of correctional services, if 35 -18- LSB 5509XL (9) 90 dg/ko 18/ 80
S.F. _____ H.F. _____ authorized by the director of the judicial district department 1 of correctional services. 2 Sec. 18. Section 135.11, subsection 11, Code 2024, is 3 amended to read as follows: 4 11. Administer chapters 125, 136A , 136C , 139A , 142 , 142A , 5 144 , and 147A . 6 Sec. 19. Section 135C.2, subsection 5, unnumbered paragraph 7 1, Code 2024, is amended to read as follows: 8 The department shall establish a special classification 9 within the residential care facility category in order to 10 foster the development of residential care facilities which 11 serve persons with an intellectual disability, chronic mental 12 illness, a developmental disability, or brain injury, as 13 described under section 225C.26 , and which contain five or 14 fewer residents. A facility within the special classification 15 established pursuant to this subsection is exempt from the 16 requirements of section 10A.713 . The department shall adopt 17 rules which are consistent with rules previously developed for 18 the waiver demonstration waiver project pursuant to 1986 Iowa 19 Acts, ch. 1246, §206 , and which include all of the following 20 provisions: 21 Sec. 20. Section 135C.6, subsection 1, Code 2024, is amended 22 to read as follows: 23 1. A person or governmental unit acting severally or 24 jointly with any other person or governmental unit shall not 25 establish or operate a health care facility in this state 26 without a license for the facility. A supported community 27 living service, as defined in section 225C.21 249A.38A , is not 28 required to be licensed under this chapter , but is subject to 29 approval under section 225C.21 249A.38A in order to receive 30 public funding. 31 Sec. 21. Section 135C.23, subsection 1, unnumbered 32 paragraph 1, Code 2024, is amended to read as follows: 33 Each resident shall be covered by a contract executed at 34 the time of admission or prior thereto by the resident, or the 35 -19- LSB 5509XL (9) 90 dg/ko 19/ 80
S.F. _____ H.F. _____ resident’s legal representative, and the health care facility , 1 except as otherwise provided by subsection 5 with respect to 2 residents admitted at public expense to a county care facility 3 operated under chapter 347B . Each party to the contract shall 4 be entitled to a duplicate original thereof, and the health 5 care facility shall keep on file all contracts which it has 6 with residents and shall not destroy or otherwise dispose of 7 any such contract for at least one year after its expiration. 8 Each such contract shall expressly set forth: 9 Sec. 22. Section 135C.23, subsection 2, paragraph b, Code 10 2024, is amended to read as follows: 11 b. This section does not prohibit the admission of a 12 patient with a history of dangerous or disturbing behavior to 13 an intermediate care facility for persons with mental illness, 14 intermediate care facility for persons with an intellectual 15 disability, or nursing facility , or county care facility when 16 the intermediate care facility for persons with mental illness, 17 intermediate care facility for persons with an intellectual 18 disability, or nursing facility , or county care facility has a 19 program which has received prior approval from the department 20 to properly care for and manage the patient. An intermediate 21 care facility for persons with mental illness, intermediate 22 care facility for persons with an intellectual disability, 23 or nursing facility , or county care facility is required to 24 transfer or discharge a resident with dangerous or disturbing 25 behavior when the intermediate care facility for persons with 26 mental illness, intermediate care facility for persons with an 27 intellectual disability, or nursing facility , or county care 28 facility cannot control the resident’s dangerous or disturbing 29 behavior. The department , in coordination with the state 30 mental health and disability services commission created in 31 section 225C.5 , shall adopt rules pursuant to chapter 17A for 32 programs to be required in intermediate care facilities for 33 persons with mental illness, intermediate care facilities 34 for persons with an intellectual disability, and nursing 35 -20- LSB 5509XL (9) 90 dg/ko 20/ 80
S.F. _____ H.F. _____ facilities , and county care facilities that admit patients 1 or have residents with histories of dangerous or disturbing 2 behavior. 3 Sec. 23. Section 135C.23, subsection 5, Code 2024, is 4 amended by striking the subsection. 5 Sec. 24. Section 135C.24, subsection 5, Code 2024, is 6 amended by striking the subsection. 7 Sec. 25. Section 135G.1, subsection 12, Code 2024, is 8 amended to read as follows: 9 12. a. “Subacute mental health services” means the same 10 as defined in section 225C.6 services that provide all of the 11 following: 12 (1) A comprehensive set of wraparound services for a 13 person who has had, or is at imminent risk of having, acute or 14 crisis mental health symptoms that do not permit the person to 15 remain in or threatens removal of the person from the person’s 16 home and community, but who has been determined by a mental 17 health professional and a licensed health care professional, 18 subject to the professional’s scope of practice, not to need 19 inpatient acute hospital services. For the purposes of this 20 subparagraph, “licensed health care professional” means a person 21 licensed under chapter 148, an advanced registered nurse 22 practitioner, or a physician assistant. 23 (2) Intensive, recovery-oriented treatment and monitoring 24 of a person. Treatment may be provided directly or remotely 25 by a licensed psychiatrist or an advanced registered nurse 26 practitioner. 27 (3) An outcome-focused, interdisciplinary approach designed 28 to return a person to living successfully in the community. 29 b. Subacute mental health services may include services 30 provided in a wide array of settings ranging from a person’s 31 home to a specialized facility with restricted means of egress. 32 c. Subacute mental health services shall be limited to a 33 period not to exceed ten calendar days or another time period 34 determined in accordance with rules adopted by the department 35 -21- LSB 5509XL (9) 90 dg/ko 21/ 80
S.F. _____ H.F. _____ for this purpose, whichever is longer . 1 Sec. 26. Section 142.1, Code 2024, is amended to read as 2 follows: 3 142.1 Delivery of bodies. 4 The body of every person dying who died in a public asylum, 5 hospital, county care facility, penitentiary, or reformatory 6 in this state, or found dead within the state, or which who 7 is to be buried at public expense in this state, except those 8 buried under the provisions of chapter 144C or 249 , and which 9 is suitable for scientific purposes, shall be delivered to the 10 medical college of the state university, or some osteopathic 11 or chiropractic college or school located in this state, which 12 has been approved under the law regulating the practice of 13 osteopathic medicine or chiropractic; but no such body shall 14 be delivered to any such college or school if the deceased 15 person expressed a desire during the person’s last illness 16 that the person’s body should be buried or cremated, nor if 17 such is the desire of the person’s relatives. Such bodies 18 shall be equitably distributed among said colleges and schools 19 according to their needs for teaching anatomy in accordance 20 with such rules as may be adopted by the department of health 21 and human services. The expense of transporting said bodies to 22 such college or school shall be paid by the college or school 23 receiving the same. If the deceased person has not expressed 24 a desire during the person’s last illness that the person’s 25 body should be buried or cremated and no person authorized to 26 control the deceased person’s remains under section 144C.5 27 requests the person’s body for burial or cremation, and if a 28 friend objects to the use of the deceased person’s body for 29 scientific purposes, said deceased person’s body shall be 30 forthwith delivered to such friend for burial or cremation at 31 no expense to the state or county. Unless such friend provides 32 for burial and burial expenses within five days, the body shall 33 be used for scientific purposes under this chapter . 34 Sec. 27. Section 142.3, Code 2024, is amended to read as 35 -22- LSB 5509XL (9) 90 dg/ko 22/ 80
S.F. _____ H.F. _____ follows: 1 142.3 Notification of department. 2 Every county medical examiner, funeral director or embalmer, 3 and the managing officer of every public asylum, hospital, 4 county care facility, penitentiary, or reformatory, as soon as 5 any dead body shall come into the person’s custody which may be 6 used for scientific purposes as provided in sections 142.1 and 7 142.2 , shall at once notify the nearest relative or friend of 8 the deceased, if known, and the department of health and human 9 services, and hold such body unburied for forty-eight hours. 10 Upon receipt of notification, the department shall issue verbal 11 or written instructions relative to the disposition to be made 12 of said body. Complete jurisdiction over said bodies is vested 13 exclusively in the department of health and human services. No 14 autopsy or post mortem, except as are legally ordered by county 15 medical examiners, shall be performed on any of said bodies 16 prior to their delivery to the medical schools. 17 Sec. 28. Section 218.30, Code 2024, is amended to read as 18 follows: 19 218.30 Investigation of other facilities. 20 The director may investigate or cause the investigation of 21 charges of abuse, neglect, or mismanagement on the part of an 22 officer or employee of a private facility which is subject to 23 the director’s supervision or control. The director shall also 24 investigate or cause the investigation of charges concerning 25 county care facilities in which persons with mental illness are 26 served. 27 Sec. 29. Section 218.78, subsection 1, Code 2024, is amended 28 to read as follows: 29 1. All institutional receipts of the department, including 30 funds received from client participation at the state resource 31 centers under section 222.78 and at the state mental health 32 institutes under section 230.20 , shall be deposited in the 33 general fund except for reimbursements for services provided 34 to another institution or state agency, for receipts deposited 35 -23- LSB 5509XL (9) 90 dg/ko 23/ 80
S.F. _____ H.F. _____ in the revolving farm fund under section 904.706 , for deposits 1 into the medical assistance fund under section 249A.11 , and for 2 rentals charged to employees or others for room, apartment, or 3 house and meals, which shall be available to the institutions. 4 Sec. 30. Section 222.1, subsection 1, Code 2024, is amended 5 to read as follows: 6 1. This chapter addresses the public and private services 7 available in this state to meet the needs of persons with an 8 intellectual disability. The responsibility of the mental 9 health and disability services regions formed by counties and 10 of the state for the costs and administration of publicly 11 funded services shall be as set out in section 222.60 and other 12 pertinent sections of this chapter . 13 Sec. 31. Section 222.2, Code 2024, is amended by adding the 14 following new subsection: 15 NEW SUBSECTION . 01. “Administrative services organization” 16 means the same as defined in section 225A.1. 17 Sec. 32. Section 222.2, subsections 6 and 7, Code 2024, are 18 amended by striking the subsections. 19 Sec. 33. Section 222.12, subsection 2, Code 2024, is amended 20 by striking the subsection. 21 Sec. 34. Section 222.13, Code 2024, is amended to read as 22 follows: 23 222.13 Voluntary admissions. 24 1. If an adult person is believed to be a person with an 25 intellectual disability, the adult person or the adult person’s 26 guardian may apply to the department and the superintendent of 27 any state resource center for the voluntary admission of the 28 adult person either as an inpatient or an outpatient of the 29 resource center. If the expenses of the person’s admission 30 or placement are payable in whole or in part by the person’s 31 county of residence, application for the admission shall be 32 made through the regional administrator. An application for 33 admission to a special unit of any adult person believed to be 34 in need of any of the services provided by the special unit 35 -24- LSB 5509XL (9) 90 dg/ko 24/ 80
S.F. _____ H.F. _____ under section 222.88 may be made in the same manner. The 1 superintendent shall accept the application if a preadmission 2 diagnostic evaluation confirms or establishes the need for 3 admission, except that an application shall not be accepted if 4 the institution does not have adequate facilities available or 5 if the acceptance will result in an overcrowded condition. 6 2. If the resource center does not have an appropriate 7 program for the treatment of an adult or minor person with an 8 intellectual disability applying under this section or section 9 222.13A , the regional administrator for the person’s county 10 of residence or the department , as applicable, shall arrange 11 for the placement of the person in any public or private 12 facility within or without outside of the state, approved by 13 the director, which offers appropriate services for the person. 14 If the expenses of the placement are payable in whole or in 15 part by a county, the placement shall be made by the regional 16 administrator for the county. 17 3. If the expenses of an admission of an adult to a resource 18 center or a special unit, or of the placement of the person 19 in a public or private facility are payable in whole or in 20 part by a mental health and disability services region, the 21 regional administrator shall make a full investigation into 22 the financial circumstances of the person and those liable for 23 the person’s support under section 222.78 to determine whether 24 or not any of them are able to pay the expenses arising out of 25 the admission of the person to a resource center, special unit, 26 or public or private facility. If the regional administrator 27 finds that the person or those legally responsible for 28 the person are presently unable to pay the expenses, the 29 regional administrator shall pay the expenses. The regional 30 administrator may review such a finding at any subsequent 31 time while the person remains at the resource center, or is 32 otherwise receiving care or treatment for which this chapter 33 obligates the region to pay. If the regional administrator 34 finds upon review that the person or those legally responsible 35 -25- LSB 5509XL (9) 90 dg/ko 25/ 80
S.F. _____ H.F. _____ for the person are presently able to pay the expenses, the 1 finding shall apply only to the charges incurred during the 2 period beginning on the date of the review and continuing 3 thereafter, unless and until the regional administrator again 4 changes such a finding. If the regional administrator finds 5 that the person or those legally responsible for the person 6 are able to pay the expenses, the regional administrator shall 7 collect the charges to the extent required by section 222.78 , 8 and the regional administrator shall be responsible for the 9 payment of the remaining charges. 10 Sec. 35. Section 222.13A, subsections 3 and 4, Code 2024, 11 are amended to read as follows: 12 3. During the preadmission diagnostic evaluation, the 13 minor shall be informed both orally and in writing that the 14 minor has the right to object to the voluntary admission. If 15 Notwithstanding section 222.33, if the preadmission diagnostic 16 evaluation determines that the voluntary admission is 17 appropriate but the minor objects to the admission, the minor 18 shall not be admitted to the state resource center unless the 19 court approves of the admission. A petition for approval of 20 the minor’s admission may be submitted to the juvenile court by 21 the minor’s parent, guardian, or custodian. 22 4. As soon as practicable after the filing of a petition for 23 approval of the voluntary admission, the court shall determine 24 whether the minor has an attorney to represent the minor in the 25 proceeding. If the minor does not have an attorney, the court 26 shall assign to the minor an attorney. If the minor is unable 27 to pay for an attorney, the attorney shall be compensated by 28 the mental health and disability services region applicable 29 administrative services organization at an hourly rate to be 30 established by the regional administrator in substantially the 31 same manner as provided in section 815.7 . 32 Sec. 36. Section 222.14, Code 2024, is amended to read as 33 follows: 34 222.14 Care by region pending admission. 35 -26- LSB 5509XL (9) 90 dg/ko 26/ 80
S.F. _____ H.F. _____ If the institution is unable to receive a patient, the 1 superintendent shall notify the regional administrator for 2 the county of residence of the prospective patient applicable 3 administrative services organization . Until such time as the 4 patient is able to be received by the institution, or when 5 application has been made for admission to a public or private 6 facility as provided in section 222.13 and the application 7 is pending, the care of the patient shall be provided as 8 arranged by the regional administrator administrative services 9 organization . 10 Sec. 37. NEW SECTION . 222.33 State resource center and 11 special units —— admissions and discharge. 12 1. The department shall make all final determinations 13 concerning whether a person may be admitted to a state resource 14 center or to a special unit. 15 2. If a patient is admitted to a state resource center or a 16 special unit pursuant to section 222.13, or a state resource 17 center pursuant to section 222.13A, and the patient wishes to 18 be placed outside of the state resource center or the special 19 unit, the discharge of the patient shall be made in accordance 20 with section 222.15. 21 Sec. 38. NEW SECTION . 222.35 State —— payor of last resort. 22 The department shall implement services and adopt rules 23 pursuant to this chapter in a manner that ensures that the 24 state is the payor of last resort, and that the department 25 shall not make any payments for services that have been 26 provided until the department has determined that the services 27 provided are not payable by a third-party source. 28 Sec. 39. Section 222.73, subsections 2 and 4, Code 2024, are 29 amended by striking the subsections. 30 Sec. 40. Section 222.77, Code 2024, is amended to read as 31 follows: 32 222.77 Patients on leave. 33 The cost of support of patients placed on convalescent leave 34 or removed as a habilitation measure from a resource center, 35 -27- LSB 5509XL (9) 90 dg/ko 27/ 80
S.F. _____ H.F. _____ or a special unit, except when living in the home of a person 1 legally bound for the support of the patient, shall be paid by 2 the county of residence or the state as provided in section 3 222.60 . 4 Sec. 41. Section 222.78, subsection 1, Code 2024, is amended 5 to read as follows: 6 1. The father and mother of any patient admitted to a 7 resource center or to a special unit, as either an inpatient 8 or an outpatient, and any person, firm, or corporation bound 9 by contract made for support of the patient are liable for the 10 support of the patient. The patient and those legally bound 11 for the support of the patient shall be liable to the county 12 or state , as applicable, for all sums advanced in accordance 13 with the provisions of sections 222.60 and 222.77 relating to 14 reasonable attorney fees and court costs for the patient’s 15 admission to the resource center or special unit, and for the 16 treatment, training, instruction, care, habilitation, support, 17 transportation, or other expenditures made on behalf of the 18 patient pursuant to this chapter . 19 Sec. 42. Section 222.79, Code 2024, is amended to read as 20 follows: 21 222.79 Certification statement presumed correct. 22 In actions to enforce the liability imposed by section 23 222.78 , the superintendent or the county of residence, as 24 applicable, shall submit a certification statement stating 25 the sums charged, and the certification statement shall be 26 considered presumptively correct. 27 Sec. 43. Section 222.80, Code 2024, is amended to read as 28 follows: 29 222.80 Liability to county or state. 30 A person admitted to a county institution or home or admitted 31 at county or state expense to a private hospital, sanitarium, 32 or other facility for treatment, training, instruction, care, 33 habilitation, and support as a patient with an intellectual 34 disability shall be liable to the county or state , as 35 -28- LSB 5509XL (9) 90 dg/ko 28/ 80
S.F. _____ H.F. _____ applicable, for the reasonable cost of the support as provided 1 in section 222.78 . 2 Sec. 44. Section 222.82, Code 2024, is amended to read as 3 follows: 4 222.82 Collection of liabilities and claims. 5 If liabilities and claims exist as provided in section 6 222.78 or any other provision of this chapter , the county of 7 residence or the state , as applicable, may proceed as provided 8 in this section . If the liabilities and claims are owed to 9 a county of residence, the county’s board of supervisors may 10 direct the county attorney to proceed with the collection of 11 the liabilities and claims as a part of the duties of the 12 county attorney’s office when the board of supervisors deems 13 such action advisable. If the liabilities and claims are owed 14 to the state, the state shall proceed with the collection. 15 The board of supervisors or the state , as applicable, may 16 compromise any and all liabilities to the county or state 17 arising under this chapter when such compromise is deemed to be 18 in the best interests of the county or state. Any collections 19 and liens shall be limited in conformance to section 614.1, 20 subsection 4 . 21 Sec. 45. Section 222.85, subsection 2, Code 2024, is amended 22 to read as follows: 23 2. Moneys paid to a resource center from any source other 24 than state appropriated funds and intended to pay all or a 25 portion of the cost of care of a patient, which cost would 26 otherwise be paid from state or county funds or from the 27 patient’s own funds, shall not be deemed “funds belonging to a 28 patient” for the purposes of this section . 29 Sec. 46. Section 222.86, Code 2024, is amended to read as 30 follows: 31 222.86 Payment for care from fund. 32 If a patient is not receiving medical assistance under 33 chapter 249A and the amount in the account of any patient 34 in the patients’ personal deposit fund exceeds two hundred 35 -29- LSB 5509XL (9) 90 dg/ko 29/ 80
S.F. _____ H.F. _____ dollars, the department may apply any amount of the excess to 1 reimburse the county of residence or the state for liability 2 incurred by the county or the state for the payment of care, 3 support, and maintenance of the patient, when billed by the 4 county or state , as applicable . 5 Sec. 47. Section 222.92, subsection 1, Code 2024, is amended 6 to read as follows: 7 1. The department shall operate the state resource centers 8 on the basis of net appropriations from the general fund of 9 the state. The appropriation amounts shall be the net amounts 10 of state moneys projected to be needed for the state resource 11 centers for the fiscal year of the appropriations. The purpose 12 of utilizing net appropriations is to encourage the state 13 resource centers to operate with increased self-sufficiency, to 14 improve quality and efficiency, and to support collaborative 15 efforts between the state resource centers and counties and 16 other providers of funding for the services available from 17 the state resource centers. The state resource centers shall 18 not be operated under the net appropriations in a manner that 19 results in a cost increase to the state or in cost shifting 20 between the state, the medical assistance program, counties, or 21 other sources of funding for the state resource centers. 22 Sec. 48. Section 222.92, subsection 3, paragraph a, Code 23 2024, is amended by striking the paragraph. 24 Sec. 49. Section 225.1, subsection 2, Code 2024, is amended 25 to read as follows: 26 2. For the purposes of this chapter , unless the context 27 otherwise requires: 28 a. “Mental health and disability services region” means 29 a mental health and disability services region approved in 30 accordance with section 225C.56 . “Administrative services 31 organization” means the same as defined in section 225A.1. 32 b. “Regional administrator” means the administrator of a 33 mental health and disability services region, as defined in 34 section 225C.55 . “Department” means the department of health 35 -30- LSB 5509XL (9) 90 dg/ko 30/ 80
S.F. _____ H.F. _____ and human services. 1 c. “Respondent” means the same as defined in section 229.1 . 2 Sec. 50. NEW SECTION . 225.4 State psychiatric hospital —— 3 admissions. 4 The department shall make all final determinations 5 concerning whether a person may be admitted to the state 6 psychiatric hospital. 7 Sec. 51. Section 225.11, Code 2024, is amended to read as 8 follows: 9 225.11 Initiating commitment procedures. 10 When a court finds upon completion of a hearing held pursuant 11 to section 229.12 that the contention that a respondent is 12 seriously mentally impaired has been sustained by clear and 13 convincing evidence, and the application filed under section 14 229.6 also contends or the court otherwise concludes that it 15 would be appropriate to refer the respondent to the state 16 psychiatric hospital for a complete psychiatric evaluation and 17 appropriate treatment pursuant to section 229.13 , the judge 18 may order that a financial investigation be made in the manner 19 prescribed by section 225.13 . If the costs of a respondent’s 20 evaluation or treatment are payable in whole or in part by 21 a county an administrative services organization , an order 22 under this section shall be for referral of the respondent 23 through the regional administrator for the respondent’s county 24 of residence administrative services organization for an 25 evaluation and referral of the respondent to an appropriate 26 placement or service, which may include the state psychiatric 27 hospital for additional evaluation or treatment. 28 Sec. 52. Section 225.12, Code 2024, is amended to read as 29 follows: 30 225.12 Voluntary public patient —— physician’s or physician 31 assistant’s report. 32 A physician or a physician assistant who meets the 33 qualifications set forth in the definition of a mental health 34 professional in section 228.1 filing information under 35 -31- LSB 5509XL (9) 90 dg/ko 31/ 80
S.F. _____ H.F. _____ section 225.10 shall include a written report to the regional 1 administrator for the county of residence of the person named 2 in the information, giving shall submit a detailed history of 3 the case to the applicable administrative services organization 4 as will be likely to aid in the observation, treatment, and 5 hospital care of the person and describing the history in 6 detail . 7 Sec. 53. Section 225.13, Code 2024, is amended to read as 8 follows: 9 225.13 Financial condition. 10 The regional administrator for the county of residence 11 applicable administrative services organization of a person 12 being admitted to the state psychiatric hospital is responsible 13 for investigating the financial condition of the person and of 14 those legally responsible for the person’s support. 15 Sec. 54. Section 225.15, Code 2024, is amended to read as 16 follows: 17 225.15 Examination and treatment. 18 1. When a respondent arrives at the state psychiatric 19 hospital, the admitting physician, or a physician assistant 20 who meets the qualifications set forth in the definition of a 21 mental health professional in section 228.1 , shall examine the 22 respondent and determine whether or not, in the physician’s 23 or physician assistant’s judgment, the respondent is a fit 24 subject for observation, treatment, and hospital care. If, 25 upon examination, the physician or physician assistant who 26 meets the qualifications set forth in the definition of a 27 mental health professional in section 228.1 decides that the 28 respondent should be admitted to the hospital, the respondent 29 shall be provided a proper bed in the hospital. The physician 30 or physician assistant who meets the qualifications set forth 31 in the definition of a mental health professional in section 32 228.1 who has charge of the respondent shall proceed with 33 observation, medical treatment, and hospital care as in the 34 physician’s or physician assistant’s judgment are proper and 35 -32- LSB 5509XL (9) 90 dg/ko 32/ 80
S.F. _____ H.F. _____ necessary, in compliance with sections 229.13 , 229.14 , this 1 section , and section 229.16 . After the respondent’s admission, 2 the observation, medical treatment, and hospital care of the 3 respondent may be provided by a mental health professional, 4 as defined in section 228.1 , who is licensed as a physician, 5 advanced registered nurse practitioner, or physician assistant. 6 2. A proper and competent nurse shall also be assigned to 7 look after and care for the respondent during observation, 8 treatment, and care. Observation, treatment, and hospital 9 care under this section which are payable in whole or in part 10 by a county shall only be provided as determined through 11 the regional administrator for the respondent’s county of 12 residence. 13 Sec. 55. Section 225.16, subsection 1, Code 2024, is amended 14 to read as follows: 15 1. If the regional administrator for a person’s county of 16 residence department finds from the physician’s information 17 or from the information of a physician assistant who 18 meets the qualifications set forth in the definition of 19 a mental health professional in section 228.1 which was 20 filed under the provisions of section 225.10 225.12 that it 21 would be appropriate for the person to be admitted to the 22 state psychiatric hospital, and the report of the regional 23 administrator made pursuant to section 225.13 shows the 24 department finds that the person and those who are legally 25 responsible for the person are not able to pay the expenses 26 incurred at the hospital, or are able to pay only a part of 27 the expenses, the person shall be considered to be a voluntary 28 public patient and the regional administrator shall direct that 29 the person shall be sent to the state psychiatric hospital at 30 the state university of Iowa for observation, treatment, and 31 hospital care. 32 Sec. 56. Section 225.17, subsection 2, Code 2024, is amended 33 to read as follows: 34 2. When the respondent arrives at the hospital, the 35 -33- LSB 5509XL (9) 90 dg/ko 33/ 80
S.F. _____ H.F. _____ respondent shall receive the same treatment as is provided for 1 committed public patients in section 225.15 , in compliance 2 with sections 229.13 through 229.16 . However, observation, 3 treatment, and hospital care under this section of a respondent 4 whose expenses are payable in whole or in part by a county 5 shall only be provided as determined through the regional 6 administrator for the respondent’s county of residence. 7 Sec. 57. Section 225.18, Code 2024, is amended to read as 8 follows: 9 225.18 Attendants. 10 The regional administrator An administrative services 11 organization may appoint an attendant to accompany the 12 committed public patient or the voluntary public patient 13 or the committed private patient from the place where the 14 patient may be to the state psychiatric hospital, or to 15 accompany the patient from the hospital to a place as may 16 be designated by the regional administrator administrative 17 services organization . If a patient is moved pursuant to this 18 section , at least one attendant shall be of the same gender as 19 the patient. 20 Sec. 58. Section 225.22, Code 2024, is amended to read as 21 follows: 22 225.22 Liability of private patients —— payment. 23 Every committed private patient, if the patient has an 24 estate sufficient for that purpose, or if those legally 25 responsible for the patient’s support are financially able, 26 shall be liable to the county and state for all expenses paid 27 by them in the state on behalf of such patient. All bills 28 for the care, nursing, observation, treatment, medicine, and 29 maintenance of such patients shall be paid by the director of 30 the department of administrative services in the same manner as 31 those of committed and voluntary public patients as provided in 32 this chapter , unless the patient or those legally responsible 33 for the patient make such settlement with the state psychiatric 34 hospital. 35 -34- LSB 5509XL (9) 90 dg/ko 34/ 80
S.F. _____ H.F. _____ Sec. 59. Section 225.24, Code 2024, is amended to read as 1 follows: 2 225.24 Collection of preliminary expense. 3 Unless a committed private patient or those legally 4 responsible for the patient’s support offer to settle the 5 amount of the claims, the regional administrator for the 6 person’s county of residence department shall collect, by 7 action if necessary, the amount of all claims for per diem and 8 expenses that have been approved by the regional administrator 9 for the county an administrative services organization and 10 paid by the regional administrator as provided under section 11 225.21 administrative services organization . Any amount 12 collected shall be credited to the mental health and disability 13 services region combined account created behavioral health fund 14 established in accordance with section 225C.58 225A.7 . 15 Sec. 60. Section 225.27, Code 2024, is amended to read as 16 follows: 17 225.27 Discharge —— transfer. 18 The state psychiatric hospital may, at any time, discharge 19 any patient as recovered, as improved, or as not likely to 20 be benefited by further treatment. If the patient being so 21 discharged was involuntarily hospitalized, the hospital shall 22 notify the committing judge or court of the discharge as 23 required by section 229.14 or section 229.16 , whichever is as 24 applicable , and the applicable regional administrator . Upon 25 receiving the notification, the court shall issue an order 26 confirming the patient’s discharge from the hospital or from 27 care and custody, as the case may be, and shall terminate the 28 proceedings pursuant to which the order was issued. The court 29 or judge shall, if necessary, appoint a person to accompany the 30 discharged patient from the state psychiatric hospital to such 31 place as the hospital or the court may designate, or authorize 32 the hospital to appoint such attendant. 33 Sec. 61. Section 226.1, subsection 4, Code 2024, is amended 34 by adding the following new paragraph: 35 -35- LSB 5509XL (9) 90 dg/ko 35/ 80
S.F. _____ H.F. _____ NEW PARAGRAPH . 0a. “Administrative services organization” 1 means the same as defined in section 225A.1. 2 Sec. 62. Section 226.1, subsection 4, paragraphs d and f, 3 Code 2024, are amended by striking the paragraphs. 4 Sec. 63. Section 226.8, subsection 2, Code 2024, is amended 5 to read as follows: 6 2. Charges for the care of any person with a diagnosis of 7 an intellectual disability admitted to a state mental health 8 institute shall be made by the institute in the manner provided 9 by chapter 230 , but the liability of any other person to any 10 mental health and disability services region the state for the 11 cost of care of such person with a diagnosis of an intellectual 12 disability shall be as prescribed by section 222.78 . 13 Sec. 64. Section 226.32, Code 2024, is amended to read as 14 follows: 15 226.32 Overcrowded conditions. 16 The director shall order the discharge or removal from the 17 mental health institute of incurable and harmless patients 18 whenever it is necessary to make room for recent cases. If 19 a patient who is to be discharged entered the mental health 20 institute voluntarily, the director shall notify the regional 21 administrator for the county interested at least ten days in 22 advance of the day of actual discharge. 23 Sec. 65. Section 226.34, subsection 2, paragraph d, Code 24 2024, is amended to read as follows: 25 d. The regional administrator for the county from which 26 the patient was committed applicable administrative services 27 organization . 28 Sec. 66. Section 228.6, subsection 1, Code 2024, is amended 29 to read as follows: 30 1. A mental health professional or an employee of or 31 agent for a mental health facility may disclose mental health 32 information if and to the extent necessary, to meet the 33 requirements of section 229.24 , 229.25 , 230.20 , 230.21 , 230.25 , 34 230.26 , 230A.108 , 232.74 , or 232.147 , or to meet the compulsory 35 -36- LSB 5509XL (9) 90 dg/ko 36/ 80
S.F. _____ H.F. _____ reporting or disclosure requirements of other state or federal 1 law relating to the protection of human health and safety. 2 Sec. 67. Section 229.1, Code 2024, is amended by adding the 3 following new subsection: 4 NEW SUBSECTION . 01. “Administrative services organization” 5 means the same as defined in section 225A.1. 6 Sec. 68. Section 229.1, subsections 11, 18, and 19, Code 7 2024, are amended by striking the subsections. 8 Sec. 69. Section 229.1B, Code 2024, is amended to read as 9 follows: 10 229.1B Regional administrator Administrative services 11 organization . 12 Notwithstanding any provision of this chapter to the 13 contrary, any person whose hospitalization expenses are 14 payable in whole or in part by a mental health and disability 15 services region an administrative services organization 16 shall be subject to all administrative requirements of the 17 regional administrator for the county administrative services 18 organization . 19 Sec. 70. Section 229.2, subsection 1, paragraph b, 20 subparagraph (3), Code 2024, is amended to read as follows: 21 (3) As soon as is practicable after the filing of a 22 petition for juvenile court approval of the admission of the 23 minor, the juvenile court shall determine whether the minor 24 has an attorney to represent the minor in the hospitalization 25 proceeding, and if not, the court shall assign to the minor 26 an attorney. If the minor is financially unable to pay for 27 an attorney, the attorney shall be compensated by the mental 28 health and disability services region administrative services 29 organization responsible for the minor’s behavioral health 30 care at an hourly rate to be established by the regional 31 administrator for the county in which the proceeding is held 32 administrative services organization in substantially the same 33 manner as provided in section 815.7 . 34 Sec. 71. Section 229.2, subsection 2, paragraph a, Code 35 -37- LSB 5509XL (9) 90 dg/ko 37/ 80
S.F. _____ H.F. _____ 2024, is amended to read as follows: 1 a. The chief medical officer of a public hospital shall 2 receive and may admit the person whose admission is sought, 3 subject in cases other than medical emergencies to availability 4 of suitable accommodations and to the provisions of sections 5 section 229.41 and 229.42 . 6 Sec. 72. Section 229.8, subsection 1, Code 2024, is amended 7 to read as follows: 8 1. Determine whether the respondent has an attorney 9 who is able and willing to represent the respondent in the 10 hospitalization proceeding, and if not, whether the respondent 11 is financially able to employ an attorney and capable of 12 meaningfully assisting in selecting one. In accordance with 13 those determinations, the court shall if necessary allow the 14 respondent to select, or shall assign to the respondent, an 15 attorney. If the respondent is financially unable to pay an 16 attorney, the attorney shall be compensated by the mental 17 health and disability services region administrative services 18 organization responsible for the respondent’s behavioral health 19 care at an hourly rate to be established by the regional 20 administrator for the county in which the proceeding is held 21 administrative services organization in substantially the same 22 manner as provided in section 815.7 . 23 Sec. 73. Section 229.10, subsection 1, paragraph a, Code 24 2024, is amended to read as follows: 25 a. An examination of the respondent shall be conducted by 26 one or more licensed physicians or mental health professionals, 27 as required by the court’s order, within a reasonable time. 28 If the respondent is detained pursuant to section 229.11, 29 subsection 1 , paragraph “b” , the examination shall be conducted 30 within twenty-four hours. If the respondent is detained 31 pursuant to section 229.11, subsection 1 , paragraph “a” or 32 “c” , the examination shall be conducted within forty-eight 33 hours. If the respondent so desires, the respondent shall be 34 entitled to a separate examination by a licensed physician or 35 -38- LSB 5509XL (9) 90 dg/ko 38/ 80
S.F. _____ H.F. _____ mental health professional of the respondent’s own choice. The 1 reasonable cost of the examinations shall, if the respondent 2 lacks sufficient funds to pay the cost, be paid by the regional 3 administrator from mental health and disability services region 4 funds an administrative services organization upon order of the 5 court. 6 Sec. 74. Section 229.11, subsection 1, unnumbered paragraph 7 1, Code 2024, is amended to read as follows: 8 If the applicant requests that the respondent be taken into 9 immediate custody and the judge, upon reviewing the application 10 and accompanying documentation, finds probable cause to believe 11 that the respondent has a serious mental impairment and is 12 likely to injure the respondent or other persons if allowed 13 to remain at liberty, the judge may enter a written order 14 directing that the respondent be taken into immediate custody 15 by the sheriff or the sheriff’s deputy and be detained until 16 the hospitalization hearing. The hospitalization hearing shall 17 be held no more than five days after the date of the order, 18 except that if the fifth day after the date of the order is 19 a Saturday, Sunday, or a holiday, the hearing may be held 20 on the next succeeding business day. If the expenses of a 21 respondent are payable in whole or in part by a mental health 22 and disability services region an administrative services 23 organization , for a placement in accordance with paragraph “a” , 24 the judge shall give notice of the placement to the regional 25 administrator for the county in which the court is located 26 applicable administrative services organization , and for a 27 placement in accordance with paragraph “b” or “c” , the judge 28 shall order the placement in a hospital or facility designated 29 through by the regional administrator applicable administrative 30 services organization . The judge may order the respondent 31 detained for the period of time until the hearing is held, 32 and no longer, in accordance with paragraph “a” , if possible, 33 and if not then in accordance with paragraph “b” , or, only if 34 neither of these alternatives is available, in accordance with 35 -39- LSB 5509XL (9) 90 dg/ko 39/ 80
S.F. _____ H.F. _____ paragraph “c” . Detention may be in any of the following: 1 Sec. 75. Section 229.13, subsection 1, paragraph a, Code 2 2024, is amended to read as follows: 3 a. The court shall order a respondent whose expenses are 4 payable in whole or in part by a mental health and disability 5 services region an administrative services organization 6 placed under the care of an appropriate hospital or facility 7 designated through by the regional administrator for the 8 county administrative services organization on an inpatient or 9 outpatient basis. 10 Sec. 76. Section 229.13, subsection 7, paragraph b, Code 11 2024, is amended to read as follows: 12 b. A region An administrative services organization shall 13 contract with mental health professionals to provide the 14 appropriate treatment including treatment by the use of oral 15 medicine or injectable antipsychotic medicine pursuant to this 16 section . 17 Sec. 77. Section 229.14, subsection 2, paragraph a, Code 18 2024, is amended to read as follows: 19 a. For a respondent whose expenses are payable in whole 20 or in part by a mental health and disability services 21 region an administrative services organization , placement 22 as designated through the regional administrator for the 23 county administrative services organization in the care of an 24 appropriate hospital or facility on an inpatient or outpatient 25 basis, or other appropriate treatment, or in an appropriate 26 alternative placement. 27 Sec. 78. Section 229.14A, subsections 7 and 9, Code 2024, 28 are amended to read as follows: 29 7. If a respondent’s expenses are payable in whole or in 30 part by a mental health and disability services region through 31 the regional administrator for the county an administrative 32 services organization , notice of a placement hearing shall be 33 provided to the county attorney and the regional administrator 34 administrative services organization . At the hearing, the 35 -40- LSB 5509XL (9) 90 dg/ko 40/ 80
S.F. _____ H.F. _____ county may present evidence regarding appropriate placement. 1 9. A placement made pursuant to an order entered under 2 section 229.13 or 229.14 or this section shall be considered to 3 be authorized through the regional administrator for the county 4 applicable administrative services organization . 5 Sec. 79. Section 229.15, subsection 4, Code 2024, is amended 6 to read as follows: 7 4. When a patient has been placed in an alternative facility 8 other than a hospital pursuant to a report issued under section 9 229.14, subsection 1 , paragraph “d” , a report on the patient’s 10 condition and prognosis shall be made to the court which placed 11 the patient, at least once every six months, unless the court 12 authorizes annual reports. If an evaluation of the patient is 13 performed pursuant to section 227.2, subsection 4 , a copy of 14 the evaluation report shall be submitted to the court within 15 fifteen days of the evaluation’s completion. The court may in 16 its discretion waive the requirement of an additional report 17 between the annual evaluations. If the department exercises 18 the authority to remove residents or patients from a county 19 care facility or other county or private facility under section 20 227.6 , the department shall promptly notify each court which 21 placed in that facility any resident or patient removed. 22 Sec. 80. Section 229.19, subsection 1, paragraphs a and b, 23 Code 2024, are amended to read as follows: 24 a. In each county the board of supervisors shall appoint 25 an individual who has demonstrated by prior activities an 26 informed concern for the welfare and rehabilitation of persons 27 with mental illness, and who is not an officer or employee of 28 the department , an officer or employee of a region, an officer 29 or employee of a county performing duties for a region, or 30 an officer or employee of any agency or facility providing 31 care or treatment to persons with mental illness, to act as an 32 advocate representing the interests of patients involuntarily 33 hospitalized by the court, in any matter relating to the 34 patients’ hospitalization or treatment under section 229.14 or 35 -41- LSB 5509XL (9) 90 dg/ko 41/ 80
S.F. _____ H.F. _____ 229.15 . 1 b. The committing court shall assign the advocate for the 2 county where the patient is located. A county or region may 3 seek reimbursement from the patient’s county of residence or 4 from the region in which the patient’s county of residence is 5 located applicable administrative services organization . 6 Sec. 81. Section 229.19, subsection 4, unnumbered paragraph 7 1, Code 2024, is amended to read as follows: 8 The state mental health and disability services commission 9 council on health and human services created in section 225C.5 10 217.2 , in consultation with advocates and county and judicial 11 branch representatives, shall adopt rules pursuant to chapter 12 17A relating to advocates that include but are not limited to 13 all of the following topics: 14 Sec. 82. Section 229.22, subsection 2, paragraph b, Code 15 2024, is amended to read as follows: 16 b. If the magistrate orders that the person be detained, 17 the magistrate shall, by the close of business on the next 18 working day, file a written order with the clerk in the county 19 where it is anticipated that an application may be filed 20 under section 229.6 . The order may be filed by facsimile if 21 necessary. A peace officer from the law enforcement agency 22 that took the person into custody, if no request was made 23 under paragraph “a” , may inform the magistrate that an arrest 24 warrant has been issued for or charges are pending against the 25 person and request that any written order issued under this 26 paragraph require the facility or hospital to notify the law 27 enforcement agency about the discharge of the person prior to 28 discharge. The order shall state the circumstances under which 29 the person was taken into custody or otherwise brought to a 30 facility or hospital, and the grounds supporting the finding 31 of probable cause to believe that the person is seriously 32 mentally impaired and likely to injure the person’s self or 33 others if not immediately detained. The order shall also 34 include any law enforcement agency notification requirements if 35 -42- LSB 5509XL (9) 90 dg/ko 42/ 80
S.F. _____ H.F. _____ applicable. The order shall confirm the oral order authorizing 1 the person’s detention including any order given to transport 2 the person to an appropriate facility or hospital. A peace 3 officer from the law enforcement agency that took the person 4 into custody may also request an order, separate from the 5 written order, requiring the facility or hospital to notify the 6 law enforcement agency about the discharge of the person prior 7 to discharge. The clerk shall provide a copy of the written 8 order or any separate order to the chief medical officer of 9 the facility or hospital to which the person was originally 10 taken, to any subsequent facility to which the person was 11 transported, and to any law enforcement department, ambulance 12 service, or transportation service under contract with a 13 mental health and disability services region an administrative 14 services organization that transported the person pursuant 15 to the magistrate’s order. A transportation service that 16 contracts with a mental health and disability services region 17 an administrative services organization for purposes of this 18 paragraph shall provide a secure transportation vehicle and 19 shall employ staff that has received or is receiving mental 20 health training. 21 Sec. 83. Section 229.24, subsection 3, unnumbered paragraph 22 1, Code 2024, is amended to read as follows: 23 If all or part of the costs associated with hospitalization 24 of an individual under this chapter are chargeable to a county 25 of residence an administrative services organization , the 26 clerk of the district court shall provide to the regional 27 administrator for the county of residence and to the regional 28 administrator for the county in which the hospitalization 29 order is entered administrative services organization the 30 following information pertaining to the individual which would 31 be confidential under subsection 1 : 32 Sec. 84. Section 229.38, Code 2024, is amended to read as 33 follows: 34 229.38 Cruelty or official misconduct. 35 -43- LSB 5509XL (9) 90 dg/ko 43/ 80
S.F. _____ H.F. _____ If any person having the care of a person with mental illness 1 who has voluntarily entered a hospital or other facility for 2 treatment or care, or who is responsible for psychiatric 3 examination care, treatment, and maintenance of any person 4 involuntarily hospitalized under sections 229.6 through 229.15 , 5 whether in a hospital or elsewhere, with or without proper 6 authority, shall treat such patient with unnecessary severity, 7 harshness, or cruelty, or in any way abuse the patient or if 8 any person unlawfully detains or deprives of liberty any person 9 with mental illness or any person who is alleged to have mental 10 illness, or if any officer required by the provisions of this 11 chapter and chapters chapter 226 and 227 , to perform any act 12 shall willfully refuse or neglect to perform the same, the 13 offending person shall, unless otherwise provided, be guilty of 14 a serious misdemeanor. 15 Sec. 85. Section 230.1, Code 2024, is amended by adding the 16 following new subsection: 17 NEW SUBSECTION . 01. “Administrative service organization” 18 means the same as defined in section 225A.1. 19 Sec. 86. Section 230.1, subsections 4 and 5, Code 2024, are 20 amended by striking the subsections. 21 Sec. 87. Section 230.10, Code 2024, is amended to read as 22 follows: 23 230.10 Payment of costs. 24 All legal costs and expenses for the taking into custody, 25 care, investigation, and admission or commitment of a person to 26 a state mental health institute under a finding that the person 27 has residency in another county of this state shall be charged 28 against to the regional administrator of the person’s county of 29 residence applicable administrative services organization . 30 Sec. 88. Section 230.11, Code 2024, is amended to read as 31 follows: 32 230.11 Recovery of costs from state. 33 Costs and expenses for the taking into custody, care, and 34 investigation of a person who has been admitted or committed 35 -44- LSB 5509XL (9) 90 dg/ko 44/ 80
S.F. _____ H.F. _____ to a state mental health institute, United States department 1 of veterans affairs hospital, or other agency of the United 2 States government, for persons with mental illness and 3 who has no residence in this state or whose residence is 4 unknown, including cost of commitment, if any, shall be paid 5 as approved by the department. The amount of the costs and 6 expenses approved by the department is appropriated to the 7 department from any moneys in the state treasury not otherwise 8 appropriated. Payment shall be made by the department on 9 itemized vouchers executed by the regional administrator of 10 the person’s county which has paid them, and approved by the 11 department. 12 Sec. 89. Section 230.15, subsections 1 and 2, Code 2024, are 13 amended to read as follows: 14 1. A person with mental illness and a person legally liable 15 for the person’s support remain liable for the support of 16 the person with mental illness as provided in this section . 17 Persons legally liable for the support of a person with mental 18 illness include the spouse of the person, and any person 19 bound by contract for support of the person. The regional 20 administrator of the person’s county of residence, subject to 21 the direction of the region’s governing board, shall enforce 22 the obligation created in this section as to all sums advanced 23 by the regional administrator. The liability to the regional 24 administrator incurred by a person with mental illness or a 25 person legally liable for the person’s support under this 26 section is limited to an amount equal to one hundred percent 27 of the cost of care and treatment of the person with mental 28 illness at a state mental health institute for one hundred 29 twenty days of hospitalization. This limit of liability may 30 be reached by payment of the cost of care and treatment of the 31 person with mental illness subsequent to a single admission 32 or multiple admissions to a state mental health institute or, 33 if the person is not discharged as cured, subsequent to a 34 single transfer or multiple transfers to a county care facility 35 -45- LSB 5509XL (9) 90 dg/ko 45/ 80
S.F. _____ H.F. _____ pursuant to section 227.11 . After reaching this limit of 1 liability, a person with mental illness or a person legally 2 liable for the person’s support is liable to the regional 3 administrator state for the care and treatment of the person 4 with mental illness at a state mental health institute or, 5 if transferred but not discharged as cured, at a county care 6 facility in an amount not in excess of to exceed the average 7 minimum cost of the maintenance of an individual who is 8 physically and mentally healthy residing in the individual’s 9 own home , which standard shall be as established and may be 10 revised by the department by rule . A lien imposed by section 11 230.25 shall not exceed the amount of the liability which may 12 be incurred under this section on account of a person with 13 mental illness. 14 2. A person with a substance use disorder is legally 15 liable for the total amount of the cost of providing care, 16 maintenance, and treatment for the person with a substance 17 use disorder while a voluntary or committed patient. When 18 a portion of the cost is paid by a county an administrative 19 services organization , the person with a substance use disorder 20 is legally liable to the county administrative services 21 organization for the amount paid. The person with a substance 22 use disorder shall assign any claim for reimbursement under any 23 contract of indemnity, by insurance or otherwise, providing 24 for the person’s care, maintenance, and treatment in a state 25 mental health institute to the state. Any payments received 26 by the state from or on behalf of a person with a substance use 27 disorder shall be in part credited to the county in proportion 28 to the share of the costs paid by the county. 29 Sec. 90. NEW SECTION . 230.23 State —— payor of last resort. 30 The department shall implement services and adopt rules 31 pursuant to this chapter in a manner that ensures that the 32 state is the payor of last resort, and that the department 33 shall not make any payments for services that have been 34 provided until the department has determined that the services 35 -46- LSB 5509XL (9) 90 dg/ko 46/ 80
S.F. _____ H.F. _____ provided are not payable by a third-party source. 1 Sec. 91. Section 230.30, Code 2024, is amended to read as 2 follows: 3 230.30 Claim against estate. 4 On the death of a person receiving or who has received 5 assistance under the provisions of this chapter , and whom the 6 board department has previously found , under section 230.25 , 7 is able to pay , there shall be allowed against the estate of 8 such decedent a claim of the sixth class for that portion of 9 the total amount paid for that person’s care which exceeds 10 the total amount of all claims of the first through the fifth 11 classes, inclusive, as defined in section 633.425 , which are 12 allowed against that estate. 13 Sec. 92. Section 232.78, subsection 5, unnumbered paragraph 14 1, Code 2024, is amended to read as follows: 15 The juvenile court, before or after the filing of a petition 16 under this chapter , may enter an ex parte order authorizing 17 a physician or physician assistant or hospital to conduct an 18 outpatient physical examination or authorizing a physician or 19 physician assistant, or a psychologist certified under section 20 154B.7 , or a community mental health center accredited pursuant 21 to chapter 230A to conduct an outpatient mental examination 22 of a child if necessary to identify the nature, extent, and 23 cause of injuries to the child as required by section 232.71B , 24 provided all of the following apply: 25 Sec. 93. Section 232.83, subsection 2, unnumbered paragraph 26 1, Code 2024, is amended to read as follows: 27 Anyone authorized to conduct a preliminary investigation in 28 response to a complaint may apply for, or the court on its own 29 motion may enter, an ex parte order authorizing a physician 30 or physician assistant or hospital to conduct an outpatient 31 physical examination or authorizing a physician or physician 32 assistant, or a psychologist certified under section 154B.7 , or 33 a community mental health center accredited pursuant to chapter 34 230A to conduct an outpatient mental examination of a child if 35 -47- LSB 5509XL (9) 90 dg/ko 47/ 80
S.F. _____ H.F. _____ necessary to identify the nature, extent, and causes of any 1 injuries, emotional damage, or other such needs of a child as 2 specified in section 232.96A, subsection 3, 5, or 6 , provided 3 that all of the following apply: 4 Sec. 94. Section 232.141, subsections 7 and 8, Code 2024, 5 are amended to read as follows: 6 7. A county charged with the costs and expenses under 7 subsections 2 and 3 may recover the costs and expenses from 8 the child’s custodial parent’s county of residence, as defined 9 in section 225C.61 35D.9 , by filing verified claims which are 10 payable as are other claims against the county. A detailed 11 statement of the facts upon which a claim is based shall 12 accompany the claim. 13 8. This subsection applies only to placements in a juvenile 14 shelter care home which is publicly owned, operated as a county 15 or multicounty shelter care home, organized under a chapter 16 28E agreement, or operated by a private juvenile shelter care 17 home. If the actual and allowable costs of a child’s shelter 18 care placement exceed the amount the department is authorized 19 to pay, the unpaid costs may be recovered from the child’s 20 custodial parent’s county of residence. However, the maximum 21 amount of the unpaid costs which may be recovered under this 22 subsection is limited to the difference between the amount 23 the department is authorized to pay and the statewide average 24 of the actual and allowable rates as reasonably determined 25 by the department annually. A home may only be reimbursed 26 for the lesser of the home’s actual and allowable costs or 27 the statewide average of the actual and allowable rates as 28 determined by the department in effect on the date the costs 29 were paid. The unpaid costs are payable pursuant to filing of 30 verified claims against the child’s custodial parent’s county 31 of residence. A detailed statement of the facts upon which a 32 claim is based shall accompany the claim. Any dispute between 33 counties arising from filings of claims filed pursuant to this 34 subsection shall be settled in the manner provided to determine 35 -48- LSB 5509XL (9) 90 dg/ko 48/ 80
S.F. _____ H.F. _____ residency county of residence in section 225C.61 35D.9 . 1 Sec. 95. Section 235.7, subsection 2, Code 2024, is amended 2 to read as follows: 3 2. Membership. The department may authorize the governance 4 boards of decategorization of child welfare and juvenile 5 justice funding projects established under section 232.188 to 6 appoint the transition committee membership and may utilize 7 the boundaries of decategorization projects to establish 8 the service areas for transition committees. The committee 9 membership may include but is not limited to department staff 10 involved with foster care, child welfare, and adult services, 11 juvenile court services staff, staff involved with county 12 general assistance or emergency relief under chapter 251 or 13 252 , or a regional administrator of the county mental health 14 and disability services region, as defined in section 225C.55 , 15 in the area, school district and area education agency staff 16 involved with special education, and a child’s court appointed 17 special advocate, guardian ad litem, service providers, and 18 other persons knowledgeable about the child . 19 Sec. 96. Section 235A.15, subsection 2, paragraph c, 20 subparagraphs (5) and (8), Code 2024, are amended by striking 21 the subparagraphs. 22 Sec. 97. Section 235B.6, subsection 2, paragraph d, 23 subparagraph (6), Code 2024, is amended by striking the 24 subparagraph. 25 Sec. 98. Section 249A.4, subsection 15, Code 2024, is 26 amended by striking the subsection. 27 Sec. 99. Section 249A.12, subsection 4, paragraph a, 28 unnumbered paragraph 1, Code 2024, is amended to read as 29 follows: 30 The mental health and disability services commission council 31 on health and human services created pursuant to section 217.2, 32 shall recommend to the department the actions necessary to 33 assist in the transition of individuals being served in an 34 intermediate care facility for persons with an intellectual 35 -49- LSB 5509XL (9) 90 dg/ko 49/ 80
S.F. _____ H.F. _____ disability, who are appropriate for the transition, to services 1 funded under a medical assistance home and community-based 2 services waiver for persons with an intellectual disability in 3 a manner which maximizes the use of existing public and private 4 facilities. The actions may include but are not limited to 5 submitting any of the following or a combination of any of the 6 following as a request for a revision of the medical assistance 7 home and community-based services waiver for persons with an 8 intellectual disability: 9 Sec. 100. Section 249A.12, subsection 4, paragraph b, Code 10 2024, is amended to read as follows: 11 b. In implementing the provisions of this subsection , the 12 mental health and disability services commission council on 13 health and human services shall consult with other states. The 14 waiver revision request or other action necessary to assist 15 in the transition of service provision from intermediate care 16 facilities for persons with an intellectual disability to 17 alternative programs shall be implemented by the department in 18 a manner that can appropriately meet the needs of individuals 19 at an overall lower cost to counties, the federal government, 20 and the state. In addition, the department shall take into 21 consideration significant federal changes to the medical 22 assistance program in formulating the department’s actions 23 under this subsection . The department shall consult with the 24 mental health and disability services commission council on 25 health and human services in adopting rules for oversight of 26 facilities converted pursuant to this subsection . A transition 27 approach described in paragraph “a” may be modified as necessary 28 to obtain federal waiver approval. 29 Sec. 101. NEW SECTION . 249A.38A Supported community living 30 services. 31 1.