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