House File 833 - Introduced HOUSE FILE 833 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 153) A BILL FOR An Act relating to services and support for youth, including 1 treatment, physical assessments, and behavioral health 2 evaluations for youth involved in involuntary commitment, 3 juvenile delinquency, child in need of assistance, and 4 family in need of assistance proceedings; the licensing 5 and certification of certain residential facilities; 6 the provision of home and community-based services and 7 habilitation services to certain youth by residential 8 programs; administration and supervision of juvenile court 9 services; and the suspension of Hawki eligibility for 10 inmates of public institutions. 11 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 12 TLSB 1457HV (4) 91 dg/ko

H.F. 833 DIVISION I 1 SERVICES AND SUPPORT FOR CHILDREN AND YOUTH 2 Section 1. Section 125.13, subsection 2, Code 2025, is 3 amended by adding the following new paragraph: 4 NEW PARAGRAPH . k. A psychiatric medical institution for 5 children licensed under chapter 135H. 6 Sec. 2. Section 135H.1, Code 2025, is amended to read as 7 follows: 8 135H.1 Definitions. 9 As used in this chapter , unless the context otherwise 10 requires: 11 1. “Approved qualifying organization” means any of the 12 following: 13 a. The joint commission. 14 b. The commission on accreditation of rehabilitation 15 facilities. 16 c. The council on accreditation. 17 d. A nationally recognized accrediting organization with 18 standards comparable to the entities listed in paragraphs “a” 19 through “c” that are acceptable under federal regulations. 20 e. An entity specified by rule adopted by the department in 21 consultation with the department of health and human services. 22 1. 2. “Department” means the department of inspections, 23 appeals, and licensing. 24 2. 3. “Direction” means authoritative policy or procedural 25 guidance for the accomplishment of a function or an activity. 26 3. 4. “Licensee” means the holder of a license issued to 27 operate a psychiatric medical institution for children. 28 4. 5. “Medical care plan” means a plan of care and services 29 designed to eliminate the need for inpatient care by improving 30 the condition of a child youth . Services must be based upon a 31 diagnostic evaluation, which includes an examination a physical 32 assessment and behavioral health evaluation of the medical, 33 psychological, social, behavioral, and developmental aspects 34 of the child’s youth’s situation, reflecting the need for 35 -1- LSB 1457HV (4) 91 dg/ko 1/ 38

H.F. 833 inpatient care. 1 6. “Mental health disorder” means any of the following: 2 a. A mental disorder as defined by the most recent version 3 of the diagnostic and statistical manual of mental disorders 4 published by the American psychiatric association. 5 b. A mental disorder included in the mental, behavioral, or 6 neurodevelopmental disorders chapter in the most recent version 7 of the international classification of diseases published by 8 the world health organization. 9 5. 7. “Mental health professional” means an individual who 10 has all of the following qualifications: 11 a. The individual holds at least a master’s degree in a 12 mental health field, including but not limited to, psychology, 13 counseling and guidance, nursing, and or social work, or the 14 individual is a physician. 15 b. The individual holds a current Iowa license if practicing 16 in a field covered by that requires an Iowa licensure law 17 license . 18 c. The individual has at least two years of post-degree 19 clinical experience, supervised by another mental health 20 professional, in assessing mental health needs and problems and 21 in providing appropriate mental health services. 22 6. 8. “Nursing care” means services which are provided 23 under the direction of a physician or registered nurse. 24 7. 9. “Physician” means a person licensed under chapter 25 148 . 26 10. “Protective locked environment” means a setting that 27 prevents egress from a building or grounds as a protective 28 measure to ensure safety and security. 29 8. 11. “Psychiatric medical institution for children” or 30 “psychiatric institution” means an institution providing more 31 than twenty-four hours of continuous care involving long-term 32 psychiatric services to three or more children youth in 33 residence for expected periods of fourteen or more days for an 34 assessment, evaluation, and diagnosis and evaluation or for 35 -2- LSB 1457HV (4) 91 dg/ko 2/ 38

H.F. 833 expected periods of ninety days or more for treatment. 1 9. 12. “Psychiatric services” means services provided under 2 the direction of a physician which address mental, emotional, 3 medical, or behavioral problems. 4 13. “Record check evaluation system” means the same as 5 defined in section 135C.1. 6 10. 14. “Rehabilitative services” means services to 7 encourage and assist restoration of a resident’s optimum mental 8 and physical capabilities. 9 11. 15. “Resident” means a person who is less than 10 twenty-one years of age and youth who has been admitted by a 11 physician to a psychiatric medical institution for children. 12 16. “Serious emotional disturbance” means a diagnosable 13 disorder of sufficient duration to meet diagnostic criteria 14 specified within the most current diagnostic and statistical 15 manual of mental disorders published by the American 16 psychiatric association that results in a functional 17 impairment. “Serious emotional disturbance” does not include a 18 substance use or developmental disorder unless such disorder 19 co-occurs with such a diagnosable mental, behavioral, or 20 emotional disorder. 21 17. “Substance use disorder” means the same as defined in 22 section 125.2. 23 12. 18. “Supervision” means direct oversight and inspection 24 of the an act of accomplishing that accomplishes a function or 25 activity. 26 19. “Youth” means a person who is less than twenty-one years 27 of age. 28 Sec. 3. Section 135H.3, Code 2025, is amended to read as 29 follows: 30 135H.3 Nature of care. 31 1. a. A psychiatric medical institution for children 32 shall provide shelter, food, supervision, care, assessment, 33 evaluation, diagnosis, treatment, counseling, rehabilitative 34 services, and related professional-directed services to 35 -3- LSB 1457HV (4) 91 dg/ko 3/ 38

H.F. 833 youth who have a serious emotional disturbance, a substance 1 use disorder, or both, with the intention of reducing or 2 ameliorating the disorder, the symptoms of the disorder, or the 3 effects of the disorder. 4 b. A psychiatric medical institution for children shall 5 utilize a team of professionals to direct an organized program 6 of diagnostic services, psychiatric services, nursing care, 7 and rehabilitative services to meet the needs of residents 8 in accordance with a medical care plan developed for each 9 resident. The membership of the team of professionals 10 may include but is not limited to an advanced registered 11 nurse practitioner or a physician assistant. Social and 12 rehabilitative services shall be provided under the direction 13 of a qualified mental health professional. 14 2. If a child youth is diagnosed with a biologically 15 based mental illness as defined in section 514C.22 and meets 16 the medical assistance program criteria for admission to a 17 psychiatric medical institution for children, the child youth 18 shall be deemed to meet the acuity criteria for medically 19 necessary inpatient benefits under a group policy, contract, or 20 plan providing for third-party payment or prepayment of health, 21 medical, and surgical coverage benefits issued by a carrier, as 22 defined in section 513B.2 , that is subject to section 514C.22 . 23 Such medically necessary benefits shall not be excluded or 24 denied as care that is substantially custodial in nature under 25 section 514C.22, subsection 8 , paragraph “b” . 26 Sec. 4. Section 135H.4, Code 2025, is amended to read as 27 follows: 28 135H.4 Licensure —— scope of license . 29 1. A person shall not establish, operate, or maintain a 30 psychiatric medical institution for children unless the person 31 obtains a license for the institution under this chapter and 32 either holds a license under section 237.3, subsection 2 , 33 paragraph “a” , as a comprehensive residential facility for 34 children or holds a license under section 125.13 , if the 35 -4- LSB 1457HV (4) 91 dg/ko 4/ 38

H.F. 833 facility provides substance use disorder treatment . 1 2. A licensee shall only provide serious emotional 2 disturbance or substance use disorder services for which the 3 licensee is licensed under this chapter. 4 Sec. 5. Section 135H.5, Code 2025, is amended to read as 5 follows: 6 135H.5 Application for license —— initial application and 7 annual fees . 8 1. An application for a license under this chapter shall 9 be submitted on a form requesting information required by 10 the department , which . The application may include require 11 affirmative evidence of the applicant’s ability to comply with 12 the rules for standards adopted pursuant to this chapter . The 13 application shall require the applicant to specify whether the 14 applicant intends to provide services for serious emotional 15 disturbances, substance use disorders, or both. 16 2. An application for a license shall be accompanied by the 17 required license fee which shall be credited to the general 18 fund of the state. The initial application fee and the annual 19 license fee is twenty-five dollars. 20 Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, 21 are amended to read as follows: 22 1. The department shall issue a license to an applicant 23 under this chapter if all the following conditions exist: 24 a. The department has ascertained that the applicant’s 25 medical facilities and staff are adequate to provide the care 26 and services required of a psychiatric medical institution for 27 children . 28 b. The proposed psychiatric institution is accredited 29 by the joint commission on the accreditation of health 30 care organizations, the commission on accreditation of 31 rehabilitation facilities, the council on accreditation of 32 services for families and children, or by any other recognized 33 accrediting organization with comparable standards acceptable 34 under federal regulation an approved qualifying organization . 35 -5- LSB 1457HV (4) 91 dg/ko 5/ 38

H.F. 833 c. The applicant complies with applicable state rules 1 and standards for a psychiatric institution adopted by the 2 department in accordance with federal requirements under 42 3 C.F.R. §441.150 – 441.156. 4 d. The department of health and human services has submitted 5 written approval of the application based on the department 6 of health and human services’ determination of need. The 7 department of health and human services shall identify the 8 location and number of children youth in the state who require 9 the services of a psychiatric medical institution for children. 10 Approval of an application shall be based upon the location 11 of the proposed psychiatric institution relative to the need 12 for services identified by the department of health and human 13 services and an analysis of the applicant’s ability to provide 14 services and support consistent with requirements under chapter 15 232 , particularly regarding specifically community-based 16 treatment. If the proposed psychiatric institution is not 17 freestanding from a facility licensed under chapter 135B or 18 135C , approval under this paragraph shall not be given unless 19 the department of health and human services certifies that 20 the proposed psychiatric institution is capable of providing 21 a resident with a living environment similar to the living 22 environment provided by a licensee which is freestanding from a 23 facility licensed under chapter 135B or 135C . 24 e. The proposed psychiatric institution is under the 25 direction of an agency which has operated a facility licensed 26 under section 237.3, subsection 2 , paragraph “a” , as a 27 comprehensive residential facility for children for three years 28 or of an agency which has operated a facility for three years 29 providing psychiatric services exclusively to children or 30 adolescents and the facility meets or exceeds requirements for 31 licensure under section 237.3, subsection 2 , paragraph “a” , as a 32 comprehensive residential facility for children. 33 f. e. If a child youth has an a serious emotional , 34 behavioral, or mental health disorder disturbance , the 35 -6- LSB 1457HV (4) 91 dg/ko 6/ 38

H.F. 833 psychiatric institution does not require court any of the 1 following as a condition for the youth to obtain treatment: 2 (1) Court proceedings to be initiated or that a child’s . 3 (2) For the youth’s parent, guardian, or custodian must 4 to terminate parental rights over , or transfer legal custody 5 of , the child for the purposes of obtaining treatment from the 6 psychiatric institution for the child youth . 7 (3) Relinquishment of a child’s the youth’s custody shall 8 not be a condition of the child receiving services . 9 4. The department of health and human services may give 10 approval to approve a conversion of beds approved under 11 subsection 2 , to if the beds which are specialized to provide 12 substance use disorder treatment. However, the total number of 13 beds approved under subsection 2 and this subsection shall not 14 exceed four hundred thirty , unless approved for good cause by 15 the director pursuant to subsection 2 . Beds The limitations 16 on the number of beds under this section shall not apply to 17 beds for children youth who do not reside in this state and 18 whose service costs are not paid by public funds in this state 19 are not subject to the limitations on the number of beds 20 requirements otherwise applicable under this section . 21 5. A psychiatric institution licensed prior to July 1, 1999, 22 may exceed the number of beds authorized under subsection 2 23 if the excess beds are used to provide services funded from 24 a source other than the medical assistance program under 25 chapter 249A . Notwithstanding subsection 1 , paragraph “d” , and 26 subsection 2 , the provision of services using those excess beds 27 does not require a review by the department of health and human 28 services. 29 Sec. 7. Section 135H.7, subsection 2, paragraph a, Code 30 2025, is amended to read as follows: 31 a. If a person who has been convicted of a crime or has a 32 record of founded child abuse is being considered for licensure 33 under this chapter , or for employment with a psychiatric 34 institution involving direct responsibility for a child youth 35 -7- LSB 1457HV (4) 91 dg/ko 7/ 38

H.F. 833 or with access to a child youth when the child youth is alone, 1 by a licensed psychiatric institution, or if a person will 2 reside residence in a facility utilized by a licensee, and if 3 the person has been convicted of a crime or has a record of 4 founded child abuse, the record check evaluation system and 5 the licensee for an employee of the licensee considering the 6 person for employment shall perform an evaluation to determine 7 whether the crime or founded child abuse warrants prohibition 8 of licensure, employment, or residence in the facility utilized 9 by a licensee . The record check evaluation system of the 10 department of health and human services shall conduct criminal 11 and child abuse record checks in this state and may conduct 12 these checks in other states. The record check evaluation 13 shall be performed in accordance with procedures adopted for 14 this purpose by the department of health and human services. 15 Sec. 8. NEW SECTION . 135H.7A Protective locked environment 16 —— rules. 17 The department, in cooperation with the department of health 18 and human services, shall adopt rules pursuant to chapter 17A 19 relating to the application of a protective locked environment 20 in a psychiatric medial institution for children. 21 Sec. 9. Section 135H.10, subsection 2, Code 2025, is amended 22 to read as follows: 23 2. This chapter shall not be construed as prohibiting 24 the use of to prohibit funds appropriated for foster care to 25 from being used to provide payment to a psychiatric medical 26 institution for children for the financial participation 27 required of a child youth whose foster care placement is in a 28 psychiatric medical institution for children. In accordance 29 with established policies and procedures for foster care, the 30 department of health and human services shall act to recover 31 any such payment for financial participation, apply to be named 32 payee for the child’s youth’s unearned income, and recommend 33 parental liability for the costs of a court-ordered foster care 34 placement in a psychiatric medical institution. 35 -8- LSB 1457HV (4) 91 dg/ko 8/ 38

H.F. 833 Sec. 10. Section 135H.13, subsection 1, Code 2025, is 1 amended to read as follows: 2 1. The department’s final findings and the survey findings 3 of the joint commission on the accreditation of health care 4 organizations an approved qualifying organization regarding 5 licensure or program accreditation shall be made available 6 to the public in a readily available form and place. Other 7 information relating to the psychiatric institution is 8 confidential and shall not be made available to the public 9 except in proceedings a proceeding involving licensure, a 10 civil suit involving a resident, or an administrative action 11 involving a resident. 12 Sec. 11. Section 229.13, subsection 1, paragraph c, Code 13 2025, is amended to read as follows: 14 c. (1) If the court orders evaluation and treatment of 15 the respondent on an inpatient basis under this section , the 16 court may order the respondent placed under the care of an 17 appropriate subacute care facility licensed under chapter 135G . 18 (2) If the court orders evaluation and treatment of a minor 19 respondent on an inpatient basis under this section, the court 20 may order the minor respondent placed under the care of an 21 appropriate public hospital. 22 Sec. 12. Section 229.13, subsection 5, Code 2025, is amended 23 to read as follows: 24 5. a. (1) The chief medical officer of the hospital or 25 facility at which the respondent is placed shall report to the 26 court and make a recommendation for disposition of the matter 27 no more than fifteen days after the date the respondent is 28 placed , making a recommendation for disposition of the matter 29 at the hospital or facility . An 30 (2) If the respondent is a minor and is placed under the 31 care of a public hospital pursuant to subsection 1, paragraph 32 “c” , subparagraph (2), the chief medical officer of the public 33 hospital shall report to the court and make a recommendation 34 for disposition no later than thirty calendar days after the 35 -9- LSB 1457HV (4) 91 dg/ko 9/ 38

H.F. 833 date the minor respondent is placed under the care of the 1 public hospital. 2 b. A copy of the chief medical officer’s report shall be 3 sent to the respondent’s attorney. 4 c. (1) Upon request, the court may grant the chief medical 5 officer an extension of time may be granted , not to exceed 6 seven days , upon a showing of cause. A copy of the report shall 7 be sent to the The respondent’s attorney , who may contest the 8 need for an extension of time if one is requested . An 9 (2) The court shall grant an extension of time shall be 10 granted upon request unless the request is contested, in which 11 case the court shall make such inquiry as it deems appropriate 12 and may either order the respondent’s release from the hospital 13 or facility , or grant an extension of time for psychiatric 14 evaluation. 15 d. If the chief medical officer fails to report to the 16 court within fifteen days after the individual is placed under 17 the care of the hospital or facility the time specified in 18 paragraph “a” , and an extension of time has not been requested 19 granted , the chief medical officer is guilty of contempt 20 and shall be punished under chapter 665. The court shall 21 order a rehearing on the application to determine whether the 22 respondent should continue to be detained at or placed under 23 the care of the hospital or facility. 24 Sec. 13. Section 229.14, subsection 2, paragraph e, Code 25 2025, is amended to read as follows: 26 e. (1) If the court orders placement and treatment of the 27 a respondent on an inpatient basis under this section , the 28 court may order the respondent placed under the care of an 29 appropriate subacute care facility licensed under chapter 135G . 30 (2) If the court orders placement and treatment of a minor 31 respondent on an inpatient basis under this section, the court 32 may order the minor respondent placed under the care of an 33 appropriate public hospital. 34 Sec. 14. Section 232.2, Code 2025, is amended by adding the 35 -10- LSB 1457HV (4) 91 dg/ko 10/ 38

H.F. 833 following new subsections: 1 NEW SUBSECTION . 3A. “Behavioral health condition” means 2 a serious emotional disturbance, a mental health disorder, 3 a substance abuse disorder, life stressors and crises, and 4 stress-related physical symptoms. 5 NEW SUBSECTION . 3B. “Behavioral health evaluation” means a 6 process used to assess an individual’s behavioral health status 7 and functioning for purposes including but not limited to the 8 diagnosis of a behavioral health condition or to determine the 9 need for treatment or intervention. 10 NEW SUBSECTION . 38A. “Mental health disorder” means the 11 same as defined in section 135H.1. 12 NEW SUBSECTION . 48A. “Physical assessment” means 13 direct physical touching, viewing, and medically necessary 14 manipulation of any area of a child’s body by a physician 15 licensed under chapter 148. 16 NEW SUBSECTION . 58A. “Serious emotional disturbance” means 17 the same as defined in section 135H.1. 18 NEW SUBSECTION . 64A. “Substance use disorder” means the 19 same as defined in section 125.2. 20 Sec. 15. Section 232.2, subsections 34 and 58, Code 2025, 21 are amended to read as follows: 22 34. “Juvenile court social records” or “social records” means 23 all records , other than official records, made with respect to 24 a child in connection with proceedings over which the court has 25 jurisdiction under this chapter other than official records and 26 includes but is not limited to the records made and compiled 27 by intake officers, predisposition reports, and reports of 28 physical assessments and mental examinations behavioral health 29 evaluations . 30 58. “Secure facility” means a physically restricting 31 facility in which children adjudicated to have committed 32 a delinquent act a child may be placed pursuant to a 33 dispositional order of the court. 34 Sec. 16. Section 232.8, subsection 4, Code 2025, is amended 35 -11- LSB 1457HV (4) 91 dg/ko 11/ 38

H.F. 833 to read as follows: 1 4. In a proceeding concerning a child who is alleged to 2 have committed a second delinquent act or a second violation 3 excluded from the jurisdiction of the juvenile court, the court 4 or the juvenile court shall determine whether there is reason 5 to believe that the child regularly abuses alcohol or other 6 controlled substance has a behavioral health condition and may 7 be in need of treatment. If the court so determines, the court 8 shall advise appropriate juvenile authorities and refer such 9 offenders to the juvenile court for disposition pursuant to 10 section 232.52A . 11 Sec. 17. Section 232.49, Code 2025, is amended to read as 12 follows: 13 232.49 Physical assessments and mental examinations 14 behavioral health evaluations —— juvenile delinquency . 15 1. a. Following Any time after the entry of an order 16 of adjudication under section 232.47 , the court may, after 17 a hearing which may be simultaneous with the adjudicatory 18 hearing , order a physical assessment or mental examination 19 behavioral health evaluation of a child if it the court finds 20 that an examination a physical assessment or a behavioral 21 health evaluation is necessary to determine the child’s 22 physical condition or mental to determine if the child has a 23 behavioral health condition. 24 b. The court may consider chemical dependency as either 25 a physical condition or mental behavioral health condition 26 and may consider a chemical dependency evaluation as either a 27 physical assessment or mental examination behavioral health 28 evaluation . If the examination 29 c. A hearing to order a physical assessment or behavioral 30 health evaluation may be held at the same time as the 31 adjudicatory hearing. 32 2. Unless otherwise ordered by the court, if a physical 33 assessment or behavioral health evaluation indicates the child 34 has behaved in a manner that threatened the safety of another 35 -12- LSB 1457HV (4) 91 dg/ko 12/ 38

H.F. 833 person, has committed a violent act causing bodily injury to 1 another person, or has been a victim or perpetrator of sexual 2 abuse, unless otherwise ordered by the court, the child’s 3 parent, guardian, or foster parent , or other person with 4 custody of the child shall be provided with that information. 5 2. 3. a. When possible an examination , a physical 6 assessment or behavioral health evaluation shall be conducted 7 on an outpatient basis , but . However, if deemed necessary by 8 the court, the court may , if it deems necessary commit order 9 the child to a suitable hospital, facility , or institution for 10 the purpose of examination an inpatient physical assessment or 11 an inpatient behavioral health evaluation . 12 b. Commitment for examination An inpatient physical 13 assessment or an inpatient behavioral health evaluation shall 14 not exceed thirty days and the civil commitment provisions of 15 chapter 229 shall not apply . 16 3. 4. a. At any Any time after the filing of a delinquency 17 petition , the court may order a physical assessment or mental 18 examination behavioral health evaluation of the child if all of 19 the following circumstances apply: 20 (1) The court finds such examination a physical assessment 21 or a behavioral health evaluation to be in the best interest 22 of the child ; and . 23 (2) The parent, guardian, or custodian and the child’s 24 counsel agree to the physical assessment or behavioral health 25 evaluation . 26 b. (1) An examination A physical assessment or behavioral 27 health evaluation shall be conducted on an outpatient basis 28 unless the court, the child’s counsel, and the child’s 29 parent, guardian, or custodian agree that it is necessary the 30 child should be committed ordered to a suitable hospital, 31 facility, or institution for the purpose of examination an 32 inpatient physical assessment or an inpatient behavioral health 33 evaluation . Commitment for examination 34 Sec. 18. Section 232.52A, subsection 1, Code 2025, is 35 -13- LSB 1457HV (4) 91 dg/ko 13/ 38

H.F. 833 amended to read as follows: 1 1. In addition to any other order of the juvenile court, 2 a person under age eighteen, child who may be in need of 3 treatment , as determined under section 232.8 , may be ordered 4 to participate in an alcohol or controlled substance education 5 or a physical assessment or behavioral health evaluation 6 program approved by the juvenile court. If recommended after 7 evaluation, the The court may also order the person child to 8 participate in a treatment program approved by the court if the 9 treatment program is recommended after the child’s physical 10 assessment or behavioral health evaluation . The juvenile court 11 may also require the custodial parent or parents , or other 12 legal guardian , to participate in an educational program with 13 the person under age eighteen child if the court determines 14 that such participation is in the best interests of the person 15 under age eighteen child . 16 Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 17 1, Code 2025, is amended to read as follows: 18 “Confidential access to a child” means access to a child, 19 during an assessment of an alleged act of child abuse, who is 20 alleged to be the victim of the child abuse , during a child 21 abuse assessment . The access may be accomplished by interview, 22 observation, or examination physical assessment of the child. 23 As used in this subsection and this part: 24 Sec. 20. Section 232.68, subsection 3, paragraph c, Code 25 2025, is amended by striking the paragraph. 26 Sec. 21. Section 232.69, subsection 3, paragraph b, Code 27 2025, is amended to read as follows: 28 b. A person required to make a report under subsection 1, 29 other than a physician whose professional practice does not 30 regularly involve providing primary health care to children, 31 shall complete the core training curriculum relating to 32 the identification and reporting of child abuse within six 33 months of initial employment or self-employment involving 34 the examination physical assessments or behavioral health 35 -14- LSB 1457HV (4) 91 dg/ko 14/ 38

H.F. 833 evaluations , or attending, counseling, or treatment of treating 1 children on a regular basis. Within one month of initial 2 employment or self-employment, the person shall obtain a 3 statement of the abuse reporting requirements from the person’s 4 employer or, if self-employed, from the department. The person 5 shall complete the core training curriculum relating to the 6 identification and reporting of child abuse every three years. 7 Sec. 22. Section 232.71B, subsection 10, Code 2025, is 8 amended to read as follows: 9 10. Physical examination assessment . If the department 10 refers a child to a physician or physician assistant for a 11 physical examination assessment , the department shall contact 12 the physician or physician assistant regarding the examination 13 physical assessment within twenty-four hours of making the 14 referral. If the physician or physician assistant who performs 15 the examination upon referral by the department physical 16 assessment reasonably believes the child has been abused, the 17 physician or physician assistant shall report to the department 18 within twenty-four hours of performing the examination physical 19 assessment . 20 Sec. 23. Section 232.77, subsection 1, Code 2025, is amended 21 to read as follows: 22 1. a. A person who is required to report suspected 23 child abuse may take or perform, or may cause to be taken or 24 performed , at public expense, photographs, X rays, or other 25 physical examinations assessments, or other tests of a child 26 which would provide medical indication of allegations arising 27 from an assessment. 28 b. A health practitioner may, if medically indicated, 29 cause to be performed a radiological examination, physical 30 examination assessment , or other medical tests test of the 31 child. 32 c. A person who takes any photographs or X rays or 33 performs any physical examinations assessments or other tests 34 pursuant to this section shall notify the department that the 35 -15- LSB 1457HV (4) 91 dg/ko 15/ 38

H.F. 833 photographs or X rays have been taken or the examinations 1 physical assessments or other tests have been performed . The 2 person who made notification , and shall retain the photographs , 3 or X rays , or examination physical assessment or other test 4 findings for a reasonable time following the notification. 5 d. Whenever the person is required to report under section 6 232.69 , in that person’s capacity as a member of the staff of 7 a medical or other private or public institution, agency or 8 facility, that person shall immediately notify the person in 9 charge of the institution, agency, or facility or that person’s 10 designated delegate of the need for photographs , or X rays or 11 examinations , physical assessments, or other tests. 12 Sec. 24. Section 232.78, subsection 1, paragraph a, Code 13 2025, is amended to read as follows: 14 a. Any of the following circumstances exist: 15 (1) The person responsible for the care of the child 16 consents to the removal. 17 (2) The person responsible for the care of the child is 18 absent , or . 19 (3) The person responsible for the care of the child, though 20 present, was asked and refused to consent to the removal of the 21 child and was informed of an intent to apply for an order under 22 this section , or there . 23 (4) There is reasonable cause to believe that a request for 24 consent would further endanger the child , or there . 25 (5) There is reasonable cause to believe that a request for 26 consent will cause the parent, guardian, or legal custodian 27 person responsible for the care of the child to take flight 28 with the child. 29 Sec. 25. Section 232.78, subsection 1, paragraph c, 30 subparagraph (1), Code 2025, is amended to read as follows: 31 (1) The refusal or failure of the person responsible for 32 the care of the child to comply with the request of a peace 33 officer, juvenile court officer, or child protection worker 34 for such the person to obtain and provide to the requester 35 -16- LSB 1457HV (4) 91 dg/ko 16/ 38

H.F. 833 the results of a physical assessment or mental examination 1 behavioral health evaluation of the child. The request for a 2 physical examination assessment of the child may specify the 3 performance of a medically relevant test. 4 Sec. 26. Section 232.78, subsection 5, Code 2025, is amended 5 to read as follows: 6 5. The juvenile court, before or after the filing of a 7 petition under this chapter , may enter an ex parte order 8 authorizing a physician or physician assistant or hospital to 9 conduct an inpatient or outpatient physical examination or 10 authorizing a physician or physician assistant, a psychologist 11 certified under section 154B.7 , or a community mental health 12 center accredited pursuant to chapter 230A to conduct an 13 outpatient mental examination assessment or an inpatient or 14 outpatient behavioral health evaluation of a child if necessary 15 to identify the nature, extent, and cause of injuries to the 16 child as required by section 232.71B , provided all of the 17 following apply: 18 a. Any of the following circumstances exist: 19 (1) The child’s parent, guardian, or custodian consents to 20 the physical assessment or the behavioral health evaluation. 21 (2) The child’s parent, guardian, or legal custodian is 22 absent , or . 23 (3) The child’s parent, guardian, or custodian, though 24 present, was asked and refused to provide written consent to 25 the examination physical assessment or the behavioral health 26 evaluation . 27 b. The juvenile court has entered an ex parte order 28 directing the removal of the child from the child’s home or a 29 child care facility under this section. 30 c. There is not enough time to file a petition and to hold 31 a hearing as provided in section 232.98. 32 Sec. 27. Section 232.79, subsection 5, Code 2025, is amended 33 to read as follows: 34 5. When there has been an emergency removal or keeping of a 35 -17- LSB 1457HV (4) 91 dg/ko 17/ 38