House File 2220 - Introduced HOUSE FILE 2220 BY MOHR and A. MEYER A BILL FOR An Act relating to mental health care, including subacute 1 mental health care facility requirements; admission to and 2 discharge from a subacute mental health care facility; 3 employment requirements at a subacute mental health care 4 facility; insurance coverage for subacute mental health 5 care; and the establishment of a psychiatric medical 6 institution for children bed tracking system, and providing 7 penalties and including effective date provisions. 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 9 TLSB 6038YH (7) 91 dg/ko

H.F. 2220 Section 1. Section 135G.1, Code 2026, is amended by adding 1 the following new subsection: 2 NEW SUBSECTION . 3A. “Health carrier” means the same as 3 defined in section 514J.102. 4 Sec. 2. Section 135G.1, subsection 12, paragraph c, Code 5 2026, is amended by striking the paragraph. 6 Sec. 3. Section 135G.3, Code 2026, is amended to read as 7 follows: 8 135G.3 Nature of care —— seclusion room —— admissions —— 9 discharge . 10 1. a. A subacute care facility shall utilize a team of 11 professionals to direct an organized program of diagnostic 12 services, subacute mental health services, social services, 13 and rehabilitative services to meet the needs of residents 14 in accordance with a treatment care plan developed for each 15 resident under the supervision of a mental health professional. 16 b. The goal of a treatment care plan is to transition 17 residents to a less restrictive environment, including a 18 home-based community setting. Social and rehabilitative 19 services shall also be provided under the direction of a mental 20 health professional. 21 c. Within twenty-four hours of a resident’s admission to 22 a subacute care facility, the subacute care facility shall 23 develop a written treatment care plan with the resident. 24 2. a. Prior authorization shall not be required for an 25 individual’s admission to a subacute care facility or for 26 the first fifteen consecutive calendar days of a resident’s 27 treatment. 28 b. Starting from a resident’s first day of treatment, on or 29 after a resident’s forty-fifth consecutive day of treatment, 30 a managed care organization may review the medical necessity 31 of the resident’s treatment. After the initial review of a 32 resident’s treatment, a managed care organization may only 33 review the medical necessity of the resident’s treatment a 34 maximum of one time within any consecutive thirty-calendar-day 35 -1- LSB 6038YH (7) 91 dg/ko 1/ 5

H.F. 2220 period. 1 2. 3. The mental health professional providing supervision 2 of the subacute care facility’s treatment care plans shall 3 evaluate the condition of each resident as medically necessary , 4 and shall be available to residents of the facility on an 5 on-call basis at all other times. Additional evaluation and 6 treatment may be provided by a mental health professional. The 7 subacute care facility may employ a seclusion room meeting the 8 conditions described in 42 C.F.R. §483.364(b) with approval 9 of a licensed psychiatrist , or by order of the resident’s 10 physician, a physician assistant, or an advanced registered 11 nurse practitioner. 12 4. A managed care organization shall not require a resident 13 to be discharged from a subacute care facility until the mental 14 health professional providing supervision of the resident’s 15 treatment care plan has determined that there are proper 16 supports in place prior to the resident’s discharge to mitigate 17 the risk of self-harm by the resident, or harm to another 18 individual by the resident. 19 5. Pursuant to section 505.36, a health carrier shall 20 provide coverage for subacute mental health services provided 21 by a subacute care facility. 22 Sec. 4. NEW SECTION . 135H.9A Bed tracking system. 23 The department of health and human services shall establish 24 an electronic system to track the availability of beds at each 25 psychiatric medical institution for children. 26 Sec. 5. NEW SECTION . 505.36 Health carriers —— subacute 27 mental health care services. 28 1. For purposes of this section: 29 a. “Health carrier” means the same as defined in section 30 514J.102. 31 b. “Subacute care facility” means the same as defined in 32 section 135G.1. 33 c. “Subacute mental health services” means the same as 34 defined in section 135G.1. 35 -2- LSB 6038YH (7) 91 dg/ko 2/ 5

H.F. 2220 2. A health carrier shall provide coverage for subacute 1 mental health services provided by a subacute care facility. A 2 health carrier that violates this section shall be subject to 3 penalties pursuant to section 505.7A. 4 Sec. 6. DEPARTMENTS OF HEALTH AND HUMAN SERVICES AND 5 INSPECTIONS, APPEALS, AND LICENSING —— ADMINISTRATIVE RULE 6 REVIEW. The department of health and human services and 7 the department of inspections, appeals, and licensing shall 8 collaborate to review each department’s administrative rules 9 adopted pursuant to section 135G.10 and eliminate any rule 10 the departments determine impedes any of the following goals 11 without providing an equal or greater benefit: 12 1. Establishment of new subacute mental health care 13 facilities and services. 14 2. Expansion of existing subacute mental health care 15 facilities and services. 16 3. Ease of access to subacute mental health care facilities 17 and services. 18 Sec. 7. DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING 19 —— SUBACUTE MENTAL HEALTH CARE FACILITIES —— BED CAPACITY 20 —— FACILITY AND EMPLOYEE REQUIREMENTS. The department of 21 inspections, appeals, and licensing shall adopt rules pursuant 22 to chapter 17A to do the following: 23 1. Increase the maximum number of beds a subacute care 24 facility may have without the subacute care facility being 25 defined as a state mental health institute. 26 2. Provide that requirements applicable to a subacute 27 mental health care facility, and subacute mental health 28 care facility employees, are less stringent than comparable 29 requirements that apply to a state mental health institute or a 30 state mental health institute’s employees. 31 Sec. 8. EMERGENCY RULES. The department of health and 32 human services and the department of inspections, appeals, 33 and licensing may adopt emergency rules under section 17A.4, 34 subsection 3, and section 17A.5, subsection 2, paragraph “b”, 35 -3- LSB 6038YH (7) 91 dg/ko 3/ 5

H.F. 2220 to implement the provisions of this Act and shall submit 1 such rules to the administrative rules coordinator and 2 the administrative code editor pursuant to section 17A.5, 3 subsection 1, within the same period. The rules shall be 4 effective immediately upon filing unless a later date is 5 specified in the rules. Any rules adopted in accordance with 6 this section shall also be published as a notice of intended 7 action as provided in section 17A.4. 8 Sec. 9. EFFECTIVE DATE. This Act, being deemed of immediate 9 importance, takes effect upon enactment. 10 EXPLANATION 11 The inclusion of this explanation does not constitute agreement with 12 the explanation’s substance by the members of the general assembly. 13 This bill relates to mental health care. 14 The bill eliminates the requirement that subacute mental 15 health care (SMHC) must be limited to a period of 10 calendar 16 days unless a longer period of time is adopted by the 17 department of health and human services (HHS). 18 The bill requires an SMHC facility to develop a written 19 treatment care plan with a resident within 24 hours of the 20 resident’s admission to the SMHC facility. 21 The bill prohibits a preauthorization requirement for an 22 individual’s admission to an SMHC facility or for the first 15 23 consecutive calendar days of a resident’s treatment. Starting 24 from the date of a resident’s first day of treatment, on or 25 after a resident’s 45th consecutive day of treatment, a managed 26 care organization (MCO) may review the medical necessity of the 27 resident’s treatment. After the initial review of a resident’s 28 treatment, an MCO may only review the medical necessity of 29 the resident’s treatment a maximum of one time within any 30 consecutive 30-calendar-day period. 31 The bill prohibits an MCO from requiring a resident’s 32 discharge until the mental health professional providing 33 supervision of the resident’s treatment care plan has 34 determined that there are proper supports in place prior to 35 -4- LSB 6038YH (7) 91 dg/ko 4/ 5

H.F. 2220 the resident’s discharge to mitigate the risk of the patient 1 committing self-harm or the patient harming other individuals. 2 The bill defines “health carrier” and requires a health 3 carrier to provide coverage for SMHC services provided by an 4 SMHC facility. A health carrier that violates the bill is 5 subject to a civil penalty of up to $1,000 for each violation 6 of the bill, up to an aggregate of $10,000, unless the 7 person knew or reasonably should have known the person was 8 in violation of the bill, in which case the penalty is up to 9 $5,000 for each violation, up to an aggregate of $50,000 in any 10 one six-month period. 11 The bill requires HHS to establish an electronic system to 12 track the availability of beds at each psychiatric medical 13 institution for children. 14 The bill directs HHS and the department of inspections, 15 appeals, and licensing (DIAL) to collaborate to review each 16 department’s rules and eliminate any rule the departments 17 determine impedes the establishment of new SMHC facilities and 18 services; expansion of existing SMHC facilities and services; 19 or ease of access to SMHC facilities and services. 20 The bill directs DIAL to adopt rules to increase the maximum 21 number of beds an SMHC facility may have without the SMHC 22 facility being defined as a state mental health institute, and 23 provide that requirements applicable to an SMHC facility, and 24 SMHC facility employees, are less stringent than comparable 25 requirements that apply to a state mental health institute or a 26 state mental health institute’s employees. 27 The bill allows HHS and DIAL to adopt emergency rules to 28 implement the bill. 29 The bill takes effect upon enactment. 30 -5- LSB 6038YH (7) 91 dg/ko 5/ 5