HF 833 (LSB 1457HV (4) 91)

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 treatment, physical assessments, and behavioral health evaluations for youth involved in involuntary commitment, juvenile delinquency, child in need of assistance, and family in need of assistance proceedings; the licensing and certification of certain residential facilities; the provision of home and community-based services and habilitation services to certain youth by residential programs; administration and supervision of juvenile court services; and the suspension of Hawki eligibility for inmates of public institutions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
SERVICES AND SUPPORT FOR CHILDREN AND YOUTH

    Section 1.  Section 125.13, subsection 2, Code 2025, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  k.  A psychiatric medical institution for children licensed under chapter 135H.
    Sec. 2.  Section 135H.1, Code 2025, is amended to read as follows:
   135H.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Approved qualifying organization” means any of the following:
   a.  The joint commission.
   b.  The commission on accreditation of rehabilitation facilities.
   c.  The council on accreditation.
   d.  A nationally recognized accrediting organization with standards comparable to the entities listed in paragraphs “a” through “c” that are acceptable under federal regulations.
   e.  An entity specified by rule adopted by the department in consultation with the department of health and human services.
   1.  2.  “Department” means the department of inspections, appeals, and licensing.
   2.  3.  “Direction” means authoritative policy or procedural guidance for the accomplishment of a function or an activity.
   3.  4.  “Licensee” means the holder of a license issued to operate a psychiatric medical institution for children.
   4.  5.  “Medical care plan” means a plan of care and services designed to eliminate the need for inpatient care by improving the condition of a child youth. Services must be based upon a diagnostic evaluation, which includes an examination a physical assessment and behavioral health evaluation of the medical, psychological, social, behavioral, and developmental aspects of the child’s youth’s situation, reflecting the need for inpatient care.
   6.  “Mental health disorder” means any of the following:
   a.  A mental disorder as defined by the most recent version of the diagnostic and statistical manual of mental disorders published by the American psychiatric association.
   b.  A mental disorder included in the mental, behavioral, or neurodevelopmental disorders chapter in the most recent version of the international classification of diseases published by the world health organization.
   5.  7.  “Mental health professional” means an individual who has all of the following qualifications:
   a.  The individual holds at least a master’s degree in a mental health field, including but not limited to, psychology, counseling and guidance, nursing, and or social work, or the individual is a physician.
   b.  The individual holds a current Iowa license if practicing in a field covered by that requires an Iowa licensure law license.
   c.  The individual has at least two years of post-degree clinical experience, supervised by another mental health professional, in assessing mental health needs and problems and in providing appropriate mental health services.
   6.  8.  “Nursing care” means services which are provided under the direction of a physician or registered nurse.
   7.  9.  “Physician” means a person licensed under chapter 148.
   10.  “Protective locked environment” means a setting that prevents egress from a building or grounds as a protective measure to ensure safety and security.
   8.  11.  “Psychiatric medical institution for children” or “psychiatric institution” means an institution providing more than twenty-four hours of continuous care involving long-term psychiatric services to three or more children youth in residence for expected periods of fourteen or more days for an assessment, evaluation, and diagnosis and evaluation or for expected periods of ninety days or more for treatment.
   9.  12.  “Psychiatric services” means services provided under the direction of a physician which address mental, emotional, medical, or behavioral problems.
   13.  “Record check evaluation system” means the same as defined in section 135C.1.
   10.  14.  “Rehabilitative services” means services to encourage and assist restoration of a resident’s optimum mental and physical capabilities.
   11.  15.  “Resident” means a person who is less than twenty-one years of age and youth who has been admitted by a physician to a psychiatric medical institution for children.
   16.  “Serious emotional disturbance” means a diagnosable disorder of sufficient duration to meet diagnostic criteria specified within the most current diagnostic and statistical manual of mental disorders published by the American psychiatric association that results in a functional impairment. “Serious emotional disturbance” does not include a substance use or developmental disorder unless such disorder co-occurs with such a diagnosable mental, behavioral, or emotional disorder.
   17.  “Substance use disorder” means the same as defined in section 125.2.
   12.  18.  “Supervision” means direct oversight and inspection of the an act of accomplishing that accomplishes a function or activity.
   19.  “Youth” means a person who is less than twenty-one years of age.
    Sec. 3.  Section 135H.3, Code 2025, is amended to read as follows:
   135H.3  Nature of care.
   1.  a.  A psychiatric medical institution for children shall provide shelter, food, supervision, care, assessment, evaluation, diagnosis, treatment, counseling, rehabilitative services, and related professional-directed services to youth who have a serious emotional disturbance, a substance use disorder, or both, with the intention of reducing or ameliorating the disorder, the symptoms of the disorder, or the effects of the disorder.
   b.  A psychiatric medical institution for children shall utilize a team of professionals to direct an organized program of diagnostic services, psychiatric services, nursing care, and rehabilitative services to meet the needs of residents in accordance with a medical care plan developed for each resident. The membership of the team of professionals may include but is not limited to an advanced registered nurse practitioner or a physician assistant. Social and rehabilitative services shall be provided under the direction of a qualified mental health professional.
   2.  If a child youth is diagnosed with a biologically based mental illness as defined in section 514C.22 and meets the medical assistance program criteria for admission to a psychiatric medical institution for children, the child youth shall be deemed to meet the acuity criteria for medically necessary inpatient benefits under a group policy, contract, or plan providing for third-party payment or prepayment of health, medical, and surgical coverage benefits issued by a carrier, as defined in section 513B.2, that is subject to section 514C.22. Such medically necessary benefits shall not be excluded or denied as care that is substantially custodial in nature under section 514C.22, subsection 8, paragraph “b”.
    Sec. 4.  Section 135H.4, Code 2025, is amended to read as follows:
   135H.4  Licensure —— scope of license.
   1.  A person shall not establish, operate, or maintain a psychiatric medical institution for children unless the person obtains a license for the institution under this chapter and either holds a license under section 237.3, subsection 2, paragraph “a”, as a comprehensive residential facility for children or holds a license under section 125.13, if the facility provides substance use disorder treatment.
   2.  A licensee shall only provide serious emotional disturbance or substance use disorder services for which the licensee is licensed under this chapter.
    Sec. 5.  Section 135H.5, Code 2025, is amended to read as follows:
   135H.5  Application for license —— initial application and annual fees.
   1.  An application for a license under this chapter shall be submitted on a form requesting information required by the department, which. The application may include require affirmative evidence of the applicant’s ability to comply with the rules for standards adopted pursuant to this chapter.  The application shall require the applicant to specify whether the applicant intends to provide services for serious emotional disturbances, substance use disorders, or both. 
   2.  An application for a license shall be accompanied by the required license fee which shall be credited to the general fund of the state. The initial application fee and the annual license fee is twenty-five dollars.
    Sec. 6.  Section 135H.6, subsections 1, 4, and 5, Code 2025, are amended to read as follows:
   1.  The department shall issue a license to an applicant under this chapter if all the following conditions exist:
   a.  The department has ascertained that the applicant’s medical facilities and staff are adequate to provide the care and services required of a psychiatric medical institution for children.
   b.  The proposed psychiatric institution is accredited by the joint commission on the accreditation of health care organizations, the commission on accreditation of rehabilitation facilities, the council on accreditation of services for families and children, or by any other recognized accrediting organization with comparable standards acceptable under federal regulation an approved qualifying organization.
   c.  The applicant complies with applicable state rules and standards for a psychiatric institution adopted by the department in accordance with federal requirements under 42 C.F.R. §441.150 – 441.156.
   d.  The department of health and human services has submitted written approval of the application based on the department of health and human services’ determination of need. The department of health and human services shall identify the location and number of children youth in the state who require the services of a psychiatric medical institution for children. Approval of an application shall be based upon the location of the proposed psychiatric institution relative to the need for services identified by the department of health and human services and an analysis of the applicant’s ability to provide services and support consistent with requirements under chapter 232, particularly regarding specifically community-based treatment. If the proposed psychiatric institution is not freestanding from a facility licensed under chapter 135B or 135C, approval under this paragraph shall not be given unless the department of health and human services certifies that the proposed psychiatric institution is capable of providing a resident with a living environment similar to the living environment provided by a licensee which is freestanding from a facility licensed under chapter 135B or 135C.
   e.  The proposed psychiatric institution is under the direction of an agency which has operated a facility licensed under section 237.3, subsection 2, paragraph “a”, as a comprehensive residential facility for children for three years or of an agency which has operated a facility for three years providing psychiatric services exclusively to children or adolescents and the facility meets or exceeds requirements for licensure under section 237.3, subsection 2, paragraph “a”, as a comprehensive residential facility for children.
   f.  e.  If a child youth has an a serious emotional, behavioral, or mental health disorder disturbance, the psychiatric institution does not require court any of the following as a condition for the youth to obtain treatment:
   (1)  Court proceedings to be initiated or that a child’s.
   (2)  For the youth’s parent, guardian, or custodian must to terminate parental rights over, or transfer legal custody of, the child for the purposes of obtaining treatment from the psychiatric institution for the child youth.
   (3)  Relinquishment of a child’s the youth’s custody shall not be a condition of the child receiving services.
   4.  The department of health and human services may give approval to approve a conversion of beds approved under subsection 2, to if the beds which are specialized to provide substance use disorder treatment. However, the total number of beds approved under subsection 2 and this subsection shall not exceed four hundred thirty, unless approved for good cause by the director pursuant to subsection 2. Beds The limitations on the number of beds under this section shall not apply to beds for children youth who do not reside in this state and whose service costs are not paid by public funds in this state are not subject to the limitations on the number of beds requirements otherwise applicable under this section.
   5.  A psychiatric institution licensed prior to July 1, 1999, may exceed the number of beds authorized under subsection 2 if the excess beds are used to provide services funded from a source other than the medical assistance program under chapter 249A. Notwithstanding subsection 1, paragraph “d”, and subsection 2, the provision of services using those excess beds does not require a review by the department of health and human services.
    Sec. 7.  Section 135H.7, subsection 2, paragraph a, Code 2025, is amended to read as follows:
   a.  If a person who has been convicted of a crime or has a record of founded child abuse is being considered for licensure under this chapter, or for employment with a psychiatric institution involving direct responsibility for a child youth or with access to a child youth when the child youth is alone, by a licensed psychiatric institution, or if a person will reside residence in a facility utilized by a licensee, and if the person has been convicted of a crime or has a record of founded child abuse, the record check evaluation system and the licensee for an employee of the licensee considering the person for employment shall perform an evaluation to determine whether the crime or founded child abuse warrants prohibition of licensure, employment, or residence in the facility utilized by a licensee. The record check evaluation system of the department of health and human services shall conduct criminal and child abuse record checks in this state and may conduct these checks in other states. The record check evaluation shall be performed in accordance with procedures adopted for this purpose by the department of health and human services.
    Sec. 8.  NEW SECTION.  135H.7A  Protective locked environment —— rules.
   The department, in cooperation with the department of health and human services, shall adopt rules pursuant to chapter 17A relating to the application of a protective locked environment in a psychiatric medial institution for children.
    Sec. 9.  Section 135H.10, subsection 2, Code 2025, is amended to read as follows:
   2.  This chapter shall not be construed as prohibiting the use of to prohibit funds appropriated for foster care to from being used to provide payment to a psychiatric medical institution for children for the financial participation required of a child youth whose foster care placement is in a psychiatric medical institution for children. In accordance with established policies and procedures for foster care, the department of health and human services shall act to recover any such payment for financial participation, apply to be named payee for the child’s youth’s unearned income, and recommend parental liability for the costs of a court-ordered foster care placement in a psychiatric medical institution.
    Sec. 10.  Section 135H.13, subsection 1, Code 2025, is amended to read as follows:
   1.  The department’s final findings and the survey findings of the joint commission on the accreditation of health care organizations an approved qualifying organization regarding licensure or program accreditation shall be made available to the public in a readily available form and place. Other information relating to the psychiatric institution is confidential and shall not be made available to the public except in proceedings a proceeding involving licensure, a civil suit involving a resident, or an administrative action involving a resident.
    Sec. 11.  Section 229.13, subsection 1, paragraph c, Code 2025, is amended to read as follows:
   c.  (1)  If the court orders evaluation and treatment of the respondent on an inpatient basis under this section, the court may order the respondent placed under the care of an appropriate subacute care facility licensed under chapter 135G.
   (2)  If the court orders evaluation and treatment of a minor respondent on an inpatient basis under this section, the court may order the minor respondent placed under the care of an appropriate public hospital.
    Sec. 12.  Section 229.13, subsection 5, Code 2025, is amended to read as follows:
   5.  a.  (1)  The chief medical officer of the hospital or facility at which the respondent is placed shall report to the court and make a recommendation for disposition of the matter no more than fifteen days after the date the respondent is placed, making a recommendation for disposition of the matter at the hospital or facility. An
   (2)  If the respondent is a minor and is placed under the care of a public hospital pursuant to subsection 1, paragraph “c”, subparagraph (2), the chief medical officer of the public hospital shall report to the court and make a recommendation for disposition no later than thirty calendar days after the date the minor respondent is placed under the care of the public hospital. 
   b.  A copy of the chief medical officer’s report shall be sent to the respondent’s attorney.
   c.  (1)  Upon request, the court may grant the chief medical officer an extension of time may be granted, not to exceed seven days, upon a showing of cause. A copy of the report shall be sent to the The respondent’s attorney, who may contest the need for an extension of time if one is requested. An
   (2)  The court shall grant an extension of time shall be granted upon request unless the request is contested, in which case the court shall make such inquiry as it deems appropriate and may either order the respondent’s release from the hospital or facility, or grant an extension of time for psychiatric evaluation.
   d.  If the chief medical officer fails to report to the court within fifteen days after the individual is placed under the care of the hospital or facility the time specified in paragraph “a”, and an extension of time has not been requested granted, the chief medical officer is guilty of contempt and shall be punished under chapter 665. The court shall order a rehearing on the application to determine whether the respondent should continue to be detained at or placed under the care of the hospital or facility.
    Sec. 13.  Section 229.14, subsection 2, paragraph e, Code 2025, is amended to read as follows:
   e.  (1)  If the court orders placement and treatment of the a respondent on an inpatient basis under this section, the court may order the respondent placed under the care of an appropriate subacute care facility licensed under chapter 135G.
   (2)  If the court orders placement and treatment of a minor respondent on an inpatient basis under this section, the court may order the minor respondent placed under the care of an appropriate public hospital.
    Sec. 14.  Section 232.2, Code 2025, is amended by adding the following new subsections:
   NEW SUBSECTION.  3A.  “Behavioral health condition” means a serious emotional disturbance, a mental health disorder, a substance abuse disorder, life stressors and crises, and stress-related physical symptoms.
   NEW SUBSECTION.  3B.  “Behavioral health evaluation” means a process used to assess an individual’s behavioral health status and functioning for purposes including but not limited to the diagnosis of a behavioral health condition or to determine the need for treatment or intervention.
   NEW SUBSECTION.  38A.  “Mental health disorder” means the same as defined in section 135H.1.
   NEW SUBSECTION.  48A.  “Physical assessment” means direct physical touching, viewing, and medically necessary manipulation of any area of a child’s body by a physician licensed under chapter 148.
   NEW SUBSECTION.  58A.  “Serious emotional disturbance” means the same as defined in section 135H.1.
   NEW SUBSECTION.  64A.  “Substance use disorder” means the same as defined in section 125.2.
    Sec. 15.  Section 232.2, subsections 34 and 58, Code 2025, are amended to read as follows:
   34.  “Juvenile court social records” or “social records” means all records, other than official records, made with respect to a child in connection with proceedings over which the court has jurisdiction under this chapter other than official records and includes but is not limited to the records made and compiled by intake officers, predisposition reports, and reports of physical assessments and mental examinations behavioral health evaluations.
   58.  “Secure facility” means a physically restricting facility in which children adjudicated to have committed a delinquent act a child may be placed pursuant to a dispositional order of the court.
    Sec. 16.  Section 232.8, subsection 4, Code 2025, is amended to read as follows:
   4.  In a proceeding concerning a child who is alleged to have committed a second delinquent act or a second violation excluded from the jurisdiction of the juvenile court, the court or the juvenile court shall determine whether there is reason to believe that the child regularly abuses alcohol or other controlled substance has a behavioral health condition and may be in need of treatment. If the court so determines, the court shall advise appropriate juvenile authorities and refer such offenders to the juvenile court for disposition pursuant to section 232.52A.
    Sec. 17.  Section 232.49, Code 2025, is amended to read as follows:
   232.49  Physical assessments and mental examinations behavioral health evaluations —— juvenile delinquency.
   1.  a.  Following Any time after the entry of an order of adjudication under section 232.47, the court may, after a hearing which may be simultaneous with the adjudicatory hearing, order a physical assessment or mental examination behavioral health evaluation of a child if it the court finds that an examination a physical assessment or a behavioral health evaluation is necessary to determine the child’s physical condition or mental to determine if the child has a behavioral health condition.
   b.  The court may consider chemical dependency as either a physical condition or mental behavioral health condition and may consider a chemical dependency evaluation as either a physical assessment or mental examination behavioral health evaluation. If the examination 
   c.  A hearing to order a physical assessment or behavioral health evaluation may be held at the same time as the adjudicatory hearing.
   2.  Unless otherwise ordered by the court, if a physical assessment or behavioral health evaluation indicates the child has behaved in a manner that threatened the safety of another person, has committed a violent act causing bodily injury to another person, or has been a victim or perpetrator of sexual abuse, unless otherwise ordered by the court, the child’s parent, guardian, or foster parent, or other person with custody of the child shall be provided with that information.
   2.  3.  a.  When possible an examination, a physical assessment or behavioral health evaluation shall be conducted on an outpatient basis, but. However, if deemed necessary by the court, the court may, if it deems necessary commit order the child to a suitable hospital, facility, or institution for the purpose of examination an inpatient physical assessment or an inpatient behavioral health evaluation.
   b.  Commitment for examination An inpatient physical  assessment or an inpatient behavioral health evaluation shall not exceed thirty days and the civil commitment provisions of chapter 229 shall not apply.
   3.  4.  a.  At any Any time after the filing of a delinquency petition, the court may order a physical assessment or mental examination behavioral health evaluation of the child if all of the following circumstances apply:
   (1)  The court finds such examination a physical assessment or a behavioral health evaluation to be in the best interest of the child; and.
   (2)  The parent, guardian, or custodian and the child’s counsel agree to the physical assessment or behavioral health evaluation.
   b.  (1)  An examination A physical assessment or behavioral health evaluation shall be conducted on an outpatient basis unless the court, the child’s counsel, and the child’s parent, guardian, or custodian agree that it is necessary the child should be committed ordered to a suitable hospital, facility, or institution for the purpose of examination an inpatient physical assessment or an inpatient behavioral health evaluation. Commitment for examination
    Sec. 18.  Section 232.52A, subsection 1, Code 2025, is amended to read as follows:
   1.  In addition to any other order of the juvenile court, a person under age eighteen, child who may be in need of treatment, as determined under section 232.8, may be ordered to participate in an alcohol or controlled substance education or a physical assessment or behavioral health evaluation program approved by the juvenile court. If recommended after evaluation, the The court may also order the person child to participate in a treatment program approved by the court if the treatment program is recommended after the child’s physical assessment or behavioral health evaluation. The juvenile court may also require the custodial parent or parents, or other legal guardian, to participate in an educational program with the person under age eighteen child if the court determines that such participation is in the best interests of the person under age eighteen child.
    Sec. 19.  Section 232.68, subsection 3, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   “Confidential access to a child” means access to a child, during an assessment of an alleged act of child abuse, who is alleged to be the victim of the child abuse, during a child abuse assessment. The access may be accomplished by interview, observation, or examination physical assessment of the child. As used in this subsection and this part:
    Sec. 20.  Section 232.68, subsection 3, paragraph c, Code 2025, is amended by striking the paragraph.
    Sec. 21.  Section 232.69, subsection 3, paragraph b, Code 2025, is amended to read as follows:
   b.  A person required to make a report under subsection 1, other than a physician whose professional practice does not regularly involve providing primary health care to children, shall complete the core training curriculum relating to the identification and reporting of child abuse within six months of initial employment or self-employment involving the examination physical assessments or behavioral health evaluations, or attending, counseling, or treatment of treating children on a regular basis. Within one month of initial employment or self-employment, the person shall obtain a statement of the abuse reporting requirements from the person’s employer or, if self-employed, from the department. The person shall complete the core training curriculum relating to the identification and reporting of child abuse every three years.
    Sec. 22.  Section 232.71B, subsection 10, Code 2025, is amended to read as follows:
   10.  Physical examination assessment.  If the department refers a child to a physician or physician assistant for a physical examination assessment, the department shall contact the physician or physician assistant regarding the examination physical assessment within twenty-four hours of making the referral. If the physician or physician assistant who performs the examination upon referral by the department physical assessment reasonably believes the child has been abused, the physician or physician assistant shall report to the department within twenty-four hours of performing the examination physical assessment.
    Sec. 23.  Section 232.77, subsection 1, Code 2025, is amended to read as follows:
   1.  a.  A person who is required to report suspected child abuse may take or perform, or may cause to be taken or performed, at public expense, photographs, X rays, or other physical examinations assessments, or other tests of a child which would provide medical indication of allegations arising from an assessment.
   b.  A health practitioner may, if medically indicated, cause to be performed a radiological examination, physical examination assessment, or other medical tests test of the child.
   c.  A person who takes any photographs or X rays or performs any physical examinations assessments or other tests pursuant to this section shall notify the department that the photographs or X rays have been taken or the examinations physical assessments or other tests have been performed. The person who made notification, and shall retain the photographs, or X rays, or examination physical assessment or other test findings for a reasonable time following the notification.
   d.  Whenever the person is required to report under section 232.69, in that person’s capacity as a member of the staff of a medical or other private or public institution, agency or facility, that person shall immediately notify the person in charge of the institution, agency, or facility or that person’s designated delegate of the need for photographs, or X rays or examinations, physical assessments, or other tests.
    Sec. 24.  Section 232.78, subsection 1, paragraph a, Code 2025, is amended to read as follows:
   a.  Any of the following circumstances exist:
   (1)  The person responsible for the care of the child consents to the removal.
   (2)  The person responsible for the care of the child is absent, or.
   (3)  The person responsible for the care of the child, though present, was asked and refused to consent to the removal of the child and was informed of an intent to apply for an order under this section, or there.
   (4)  There is reasonable cause to believe that a request for consent would further endanger the child, or there.
   (5)  There is reasonable cause to believe that a request for consent will cause the parent, guardian, or legal custodian person responsible for the care of the child to take flight with the child.
    Sec. 25.  Section 232.78, subsection 1, paragraph c, subparagraph (1), Code 2025, is amended to read as follows:
   (1)  The refusal or failure of the person responsible for the care of the child to comply with the request of a peace officer, juvenile court officer, or child protection worker for such the person to obtain and provide to the requester the results of a physical assessment or mental examination behavioral health evaluation of the child. The request for a physical examination assessment of the child may specify the performance of a medically relevant test.
    Sec. 26.  Section 232.78, subsection 5, Code 2025, is amended to read as follows:
   5.  The juvenile court, before or after the filing of a petition under this chapter, may enter an ex parte order authorizing a physician or physician assistant or hospital to conduct an inpatient or outpatient physical examination or authorizing a physician or physician assistant, a psychologist certified under section 154B.7, or a community mental health center accredited pursuant to chapter 230A to conduct an outpatient mental examination assessment or an inpatient or outpatient behavioral health evaluation of a child if necessary to identify the nature, extent, and cause of injuries to the child as required by section 232.71B, provided all of the following apply:
   a.  Any of the following circumstances exist:
   (1)  The child’s parent, guardian, or custodian consents to the physical assessment or the behavioral health evaluation.
   (2)  The child’s parent, guardian, or legal custodian is absent, or.
   (3)  The child’s parent, guardian, or custodian, though present, was asked and refused to provide written consent to the examination physical assessment or the behavioral health evaluation.
   b.  The juvenile court has entered an ex parte order directing the removal of the child from the child’s home or a child care facility under this section.
   c.  There is not enough time to file a petition and to hold a hearing as provided in section 232.98.
    Sec. 27.  Section 232.79, subsection 5, Code 2025, is amended to read as follows:
   5.  When there has been an emergency removal or keeping of a child without a court order, a physical examination assessment of the child by a licensed medical practitioner shall be performed within twenty-four hours of such the emergency removal or keeping of a child, unless the child is returned to the child’s home within twenty-four hours of the emergency removal or keeping of a child.
    Sec. 28.  Section 232.83, subsection 2, Code 2025, is amended to read as follows:
   2.  Anyone authorized to conduct a preliminary investigation in response to a complaint may apply for, or the court on its own motion may enter, an ex parte order authorizing a physician or physician assistant or hospital to conduct an inpatient or outpatient physical examination or authorizing a physician or physician assistant, a psychologist certified under section 154B.7, or a community mental health center accredited pursuant to chapter 230A to conduct an outpatient mental examination of a child if necessary to identify the nature, extent, and causes of any injuries, emotional damage, or other such needs of a child as specified in section 232.96A, subsection 3, 5, or 6, assessment or an inpatient or outpatient behavioral health evaluation provided that all of the following apply:
   a.  Any of the following circumstances exist:
   (1)  The parent, guardian, or custodian consents to the physical assessment or the behavioral health evaluation.
   (2)  The parent, guardian, or legal custodian is absent, or.
   (3)  The parent, guardian, or custodian, though present, was asked and refused to authorize the examination physical assessment or the behavioral health evaluation.
   b.   There is not enough time to file a petition and hold a hearing under this chapter.
   c.  The parent, guardian, or legal custodian has not provided care and treatment related to their the child’s alleged victimization.
    Sec. 29.  Section 232.98, Code 2025, is amended to read as follows:
   232.98  Physical and mental examinations assessments and behavioral health evaluations —— child in need of assistance.
   1.  a.  Except as provided in section 232.78, subsection 5, a physical assessment or mental examination behavioral health evaluation of the a child may be ordered only after the filing of a petition pursuant to section 232.87, and after a hearing to determine whether an examination a physical assessment or behavioral health evaluation is necessary to determine the child’s physical condition or mental if the child has a behavioral health condition.
   b.  The court may consider chemical dependency as either a physical or mental behavioral health condition and may consider a chemical dependency evaluation as either a physical assessment or mental examination behavioral health evaluation.
   a.  c.  The hearing required by this section may be held simultaneously with the adjudicatory hearing.
   b.  d.  An examination A physical assessment or a behavioral health evaluation ordered prior to the adjudication shall be conducted on an outpatient basis when possible, but. However, if deemed necessary by the court, the court may commit order the child to a suitable nonsecure hospital, facility, or institution for the purpose of examination an inpatient physical assessment or an inpatient behavioral health evaluation for a period not to exceed fifteen thirty days if all of the following are found to be present circumstances exist:
   (1)  Probable cause exists to believe that the child is a child in need of assistance pursuant to section 232.96A, subsection 5 or 6.
   (2)  Commitment An inpatient physical assessment or inpatient behavioral health evaluation is necessary to determine whether there is clear and convincing evidence that the child is a child in need of assistance.
   (3)  The child’s attorney agrees to the commitment an inpatient physical assessment or inpatient behavioral health evaluation.
   c.  e.  An examination A physical assessment or a behavioral health evaluation ordered after the adjudication shall be conducted on an outpatient basis when possible, but. However, if deemed necessary by the court, the court may commit order the child to a suitable nonsecure hospital, facility, or institution for the purpose of examination an inpatient physical assessment or an inpatient behavioral health evaluation for a period not to exceed thirty days.
   d.  f.  The child’s parent, guardian, or custodian shall be included in counseling sessions offered during the child’s stay in a hospital, facility, or institution when feasible, and when in the best interests of the child and the child’s parent, guardian, or custodian. If separate counseling sessions are conducted for the child and the child’s parent, guardian, or custodian, a joint counseling session shall be offered prior to the release of the child from the hospital, facility, or institution. The court shall require that notice be provided to the child’s guardian ad litem of the counseling sessions, and of the counseling session participants, and results the outcomes of the counseling sessions.
   2.  Following an adjudication that a child is a child in need of assistance, the court may, after a hearing, order the a physical assessment or mental examination behavioral health evaluation of the child’s parent, guardian, or custodian if that person’s ability to care for the child is at issue.
    Sec. 30.  Section 232.102, subsection 5, Code 2025, is amended to read as follows:
   5.  a.  The child shall not be placed in the state training school.
   b.  (1)  Paragraph “a” shall not preclude the department’s use of the facilities of the state training school for the purposes of conducting a physical assessment, a behavioral health evaluation, or both, as described in section 232.98, of a male child for a period not to exceed thirty days. Such use of the facilities of the state training school shall be subject to the director’s authorization and approval for any request to obtain a court order for these purposes. Following review of the authorized and approved departmental request, the court may order such use of the facilities of the state training school.
   (2)  A male child temporarily located at the state training school pursuant to subparagraph (1) shall at all times be separated from children adjudicated to have committed a delinquent act who are placed at the state training school.
   (3)  The department shall adopt rules pursuant to chapter 17A to administer this paragraph.
    Sec. 31.  Section 232.127, subsection 7, Code 2025, is amended to read as follows:
   7.  a.  The court may not order the child placed on probation, in a foster home or in a nonsecure facility unless the child requests and agrees to such supervision or placement. In no event shall the
   b.  The court shall not order the child placed in a secure facility or in the state training school or other secure facility.
   c.  (1)  Paragraph “b” shall not preclude the department’s use of the facilities of the state training school for the purposes of conducting a physical assessment, a behavioral health evaluation, or both, as described in section 232.98, of a male child for a period not to exceed thirty days. Such use of the facilities of the state training school shall be subject to the director’s authorization and approval for any request to obtain a court order for these purposes. Following review of the authorized and approved departmental request, the court may order such use of the facilities of the state training school.
   (2)  A male child temporarily located at the state training school pursuant to subparagraph (1) shall at all times be separated from children adjudicated to have committed a delinquent act who are placed at the state training school.
   (3)  The department shall adopt rules pursuant to chapter 17A to administer this paragraph.
    Sec. 32.  Section 232.141, subsection 1, Code 2025, is amended to read as follows:
   1.  Except as otherwise provided by law, the court shall inquire into the ability of the child or the child’s parent to pay expenses incurred pursuant to subsections 2, 4, and 8. After giving the parent a reasonable opportunity to be heard, the court may order the parent to pay all or part of the costs of the child’s care, examination physical assessment, behavioral health evaluation, treatment, legal expenses, or other expenses. An order entered under this section does not obligate a parent paying child support under a custody decree, except that part of the monthly support payment may be used to satisfy the obligations imposed by the order entered pursuant to this section. If a parent fails to pay as ordered, without good reason, the court may proceed against the parent for contempt and may inform the county attorney who shall proceed against the parent to collect the unpaid amount. Any payment ordered by the court shall be a judgment against each of the child’s parents and a lien as provided in section 624.23. If all or part of the amount that the parents are ordered to pay is subsequently paid by the county or state, the judgment and lien shall thereafter be against each of the parents in favor of the county to the extent of the county’s payments and in favor of the state to the extent of the state’s payments.
    Sec. 33.  Section 232.141, subsection 4, paragraph b, Code 2025, is amended to read as follows:
   b.  Expenses for mental or physical examinations assessments or behavioral health evaluations of a child if ordered by the court.
    Sec. 34.  Section 232.141, subsection 6, Code 2025, is amended to read as follows:
   6.  If a child is given A physical or mental examinations assessment, behavioral health evaluation, or any treatment relating to an assessment performed pursuant to section 232.71B, shall be paid by the state if physical assessment, behavioral health evaluation, or other treatment was performed with the consent of the child’s parent, guardian, or legal custodian and no other provision of law otherwise requires payment for the costs of the examination and treatment, the costs shall be paid by the state. Reimbursement for The department shall reimburse costs of services described in under this subsection is subject to in accordance with subsection 5.
    Sec. 35.  Section 237.1, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  8A.  “Protective locked environment” means a setting that prevents egress from a building or grounds as a protective measure to ensure safety and security.
    Sec. 36.  Section 237.3, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  13.  The department shall adopt rules pursuant to chapter 17A relating to the application of a protective locked environment to child foster care licensees.
    Sec. 37.  Section 237.4, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  9.  A psychiatric medical institution for children licensed under chapter 135H.
    Sec. 38.  Section 237C.1, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  5.  “Protective locked environment” means a setting that prevents egress from a building or grounds as a protective measure to ensure safety and security.
    Sec. 39.  Section 237C.4, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  6A.  Rules governing the application of a protective locked environment to a children’s residential facility shall be adopted by the department.
    Sec. 40.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING —— ADMINISTRATIVE RULES.
   1.  The department of health and human services and the department of inspections, appeals, and licensing shall each adopt rules pursuant to chapter 17A to administer this division of this Act. The departments shall coordinate in developing their respective rules to provide continuity for, and maximize utilization of the array of behavioral health services available by, affected individuals.
   2.  a.  The department of health and human services and the department of inspections, appeals, and licensing shall review applicable existing rules and shall each adopt rules pursuant to chapter 17A to provide for the following relative to facilities licensed or certified under chapters 135H, 237, and 237C:
   (1)  Consistency to the greatest extent possible regarding the use of restraints and seclusion across these facilities.
   (2)  Adaptation in application of licensing and certification requirements to provide for the unmet residential care needs of affected individuals.
   b.  In reviewing and adopting the rules, the departments shall consider the nature of the services and programming provided by the specific type of facility and applicable federal requirements, including those for psychiatric residential treatment facilities as described in 42 C.F.R. §483.352.
   3.  The department of health and human services shall adopt rules pursuant to chapter 17A relating to the application of a protective locked environment to detention and shelter care as defined in section 232.2. For purposes of this subsection, “protective locked environment” means a setting that prevents egress from a building or grounds as a protective measure to ensure safety and security.
    Sec. 41.  REPEAL.  2024 Iowa Acts, chapter 1161, sections 97 and 98, are repealed.
DIVISION II
HOME AND COMMUNITY-BASED SERVICES —— HABILITATION SERVICES PROVIDED BY A RESIDENTIAL PROGRAM —— EXCLUSION FROM CHILDREN’S RESIDENTIAL FACILITY DEFINITION

    Sec. 42.  Section 237C.1, subsection 2, Code 2025, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  j.  Care furnished to persons sixteen years of age and older by a residential program to which the department applies accreditation, certification, or standards of review under the provisions of a federally approved medical assistance home and community-based services waiver, or other provision of the medical assistance program.
DIVISION III
DIRECTOR OF JUVENILE COURT SERVICES —— CHIEF JUVENILE COURT OFFICERS

    Sec. 43.  Section 602.1101, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  5A.  “Director of juvenile court services” means the same as defined in the Iowa court rules of juvenile court services directed programs and includes the deputy director of juvenile court services.
    Sec. 44.  Section 602.1217, Code 2025, is amended to read as follows:
   602.1217  Chief juvenile court officer.
   1.  The chief judge of director of juvenile court services shall appoint a chief juvenile court officer for each judicial district, after consultation with the judges of the judicial district, shall appoint a chief juvenile court officer and may remove the a chief juvenile court officer for cause.
   2.  The chief juvenile court officer is subject to the immediate supervision and direction of the chief judge of the judicial district director of juvenile court services.
   3.  The chief juvenile court officer, in addition to performing the duties of a juvenile court officer, shall supervise juvenile court officers and administer juvenile court services within the judicial district in a uniform manner, under the supervision and direction of the director of juvenile court services, in accordance with law and with the rules, directives, and procedures of the judicial branch and the judicial district.
   4.  The chief juvenile court officer shall assist the state court administrator and the district court administrator director of juvenile court services in implementing the rules, directives, and procedures of the judicial branch and the judicial district.
   5.  A chief juvenile court officer shall have other duties as prescribed by the supreme court or by the chief judge of the judicial district director of juvenile court services.
    Sec. 45.  Section 602.7201, subsections 2 and 3, Code 2025, are amended to read as follows:
   2.  The juvenile court officers and other personnel employed in juvenile court service offices are subject to the supervision of the chief juvenile court officer.  The chief juvenile court officer is subject to the supervision and direction of the director of juvenile court services.
   3.  The chief juvenile court officer may employ, shall supervise, and may remove for cause with due process secretarial, clerical, and other staff within juvenile court service offices as authorized by the chief judge director of juvenile court services.
    Sec. 46.  Section 602.7202, subsections 1 and 3, Code 2025, are amended to read as follows:
   1.  Subject to the approval of the chief judge of the judicial district director of juvenile court services, the chief juvenile court officer shall appoint juvenile court officers to serve the juvenile court. Juvenile court officers may be required to serve in two or more counties within the judicial district.
   3.  Juvenile court officers shall have the duties prescribed in chapter 232, subject to the direction of the judges of the juvenile court director of juvenile court services. A judge of the juvenile court shall not attempt to direct or influence a juvenile court officer in the performance of the officer’s duties.
DIVISION IV
HAWKI ELIGIBILITY —— PUBLIC INSTITUTION INMATES

    Sec. 47.  Section 514I.8, subsection 2, paragraph g, Code 2025, is amended to read as follows:
   g.  Is not an inmate of a public institution or a patient in an institution for mental diseases.
    Sec. 48.  NEW SECTION.  514I.8B  Inmates of public institutions —— suspension of medical assistance.
   1.  Following the first thirty days of commitment, the department shall suspend, but not terminate, the eligibility of an eligible child who is an inmate of a public institution as defined in 42 C.F.R. §435.1010, who is enrolled in the medical assistance program under this chapter at the time of commitment to the public institution, and who remains eligible for medical assistance under this chapter except for the eligible child’s institutional status, during the entire period of the eligible child’s commitment to the public institution.
   2.  To the extent applicable, the public institution and the department shall comply with the reporting requirements and the expediting of the restoration of an eligible child’s medical assistance benefits under this chapter upon the eligible child’s discharge, consistent with section 249A.38.
   3.  The department shall adopt rules pursuant to chapter 17A to administer this section.
DIVISION V
CORRECTIVE CHANGES

    Sec. 49.  Section 125.13, subsection 2, paragraphs a, i, and j, Code 2025, are amended to read as follows:
   a.  A hospital providing care or treatment to persons with a substance use disorder licensed under chapter 135B which is accredited by the joint commission on the accreditation of health care organizations, the commission on accreditation of rehabilitation facilities, the American osteopathic association, or another recognized organization approved by the department. All survey reports from the accrediting or licensing body must be sent to the department.
   i.  A substance use disorder treatment program not funded by the department which is accredited or licensed by the joint commission on the accreditation of health care organizations, the commission on the accreditation of rehabilitation facilities, the American osteopathic association, or another recognized organization approved by the department. All survey reports from the accrediting or licensing body must be sent to the department.
   j.  A hospital substance use disorder treatment program that is accredited or licensed by the joint commission on the accreditation of health care organizations, the commission on the accreditation of rehabilitation facilities, the American osteopathic association, or another recognized organization approved by the department. All survey reports for the hospital substance use disorder treatment program from the accrediting or licensing body shall be sent to the department.
    Sec. 50.  Section 125.43A, Code 2025, is amended to read as follows:
   125.43A  Prescreening —— exception.
   Except in cases of medical emergency or court-ordered admissions, a person shall be admitted to a state mental health institute for treatment of a substance use disorder only after a preliminary intake and assessment by a department-licensed treatment facility or a hospital providing care or treatment for persons with a substance use disorder licensed under chapter 135B and accredited by the joint commission on the accreditation of health care organizations, the commission on accreditation of rehabilitation facilities, the American osteopathic association, or another recognized organization approved by the department, or by a designee of a department-licensed treatment facility or a hospital other than a state mental health institute, which confirms that the admission is appropriate to the person’s substance use disorder service needs. A county board of supervisors may seek an admission of a patient to a state mental health institute who has not been confirmed for appropriate admission and the county shall be responsible for one hundred percent of the cost of treatment and services of the patient.
    Sec. 51.  Section 135B.12, Code 2025, is amended to read as follows:
   135B.12  Confidentiality.
   The department’s final findings or the final survey findings of the joint commission on the accreditation of health care organizations or the American osteopathic association with respect to compliance by a hospital or rural emergency hospital with requirements for licensing or accreditation shall be made available to the public in a readily available form and place. Other information relating to a hospital or rural emergency hospital obtained by the department which does not constitute the department’s findings from an inspection of the hospital or rural emergency hospital or the final survey findings of the joint commission on the accreditation of health care organizations or the American osteopathic association shall not be made available to the public, except in proceedings involving the denial, suspension, or revocation of a license under this chapter. The name of a person who files a complaint with the department shall remain confidential and shall not be subject to discovery, subpoena, or other means of legal compulsion for its release to a person other than department employees or agents involved in the investigation of the complaint.
    Sec. 52.  Section 135B.20, subsection 4, Code 2025, is amended to read as follows:
   4.  “Joint conference committee” shall mean the joint conference committee as required by the joint commission on accreditation of health care organizations or, in a hospital having no such committee, a similar committee, an equal number of which shall be members of the medical staff selected by the staff and an equal number of which shall be selected by the governing board of the hospital.
    Sec. 53.  Section 135C.2, subsection 7, Code 2025, is amended to read as follows:
   7.  The rules adopted by the department regarding nursing facilities shall provide that a nursing facility may choose to be inspected either by the department or by the joint commission on accreditation of health care organizations. The rules regarding acceptance of inspection by the joint commission on accreditation of health care organizations shall include recognition, in lieu of inspection by the department, of comparable inspections and inspection findings of the joint commission on accreditation of health care organizations, if the department is provided with copies of all requested materials relating to the inspection process.
    Sec. 54.  Section 135C.6, subsection 10, Code 2025, is amended to read as follows:
   10.  Notwithstanding section 135C.9, nursing facilities which are accredited by the joint commission on accreditation of health care organizations shall be licensed without inspection by the department, if the nursing facility has chosen to be inspected by the joint commission on accreditation of health care organizations in lieu of inspection by the department.
    Sec. 55.  Section 135J.2, subsection 2, Code 2025, is amended to read as follows:
   2.  The hospice program shall meet the criteria pursuant to section 135J.3 before a license is issued. The department is responsible to provide the necessary personnel to inspect the hospice program, the home care and inpatient care provided and the hospital or facility used by the hospice to determine if the hospice complies with necessary standards before a license is issued. Hospices that are certified as Medicare hospice providers by the department, or are accredited as hospices by the joint commission on the accreditation of health care organizations, shall be licensed without inspection by the department.
    Sec. 56.  Section 144F.5, subsection 1, Code 2025, is amended to read as follows:
   1.  The standards for accreditation adopted by the joint commission on the accreditation of health care organizations or any other nationally recognized hospital accreditation organization.
    Sec. 57.  Section 155A.13, subsection 4, paragraph a, subparagraph (4), Code 2025, is amended to read as follows:
   (4)  Give recognition to the standards of the joint commission on the accreditation of health care organizations and the American osteopathic association, and to the conditions of participation under Medicare.
    Sec. 58.  Section 232.2, subsection 4, paragraph i, Code 2025, is amended to read as follows:
   i.  If reasonable efforts to place a child for adoption or with a guardian are made concurrently with reasonable efforts as defined in section 232.102 232.102A, the concurrent goals and timelines may be identified. Concurrent case permanency plan goals for reunification, and for adoption or for other permanent out-of-home placement of a child shall not be considered inconsistent in that the goals reflect divergent possible outcomes for a child in an out-of-home placement.
    Sec. 59.  Section 232.36, subsection 3, paragraph b, subparagraph (3), Code 2025, is amended to read as follows:
   (3)  Legal custodian Custodian of the child.
    Sec. 60.  Section 232.37, subsection 2, Code 2025, is amended to read as follows:
   2.  Notice of the pendency of the case shall be served upon the known parents, guardians, or legal custodians of a child if these persons are not summoned to appear as provided in subsection 1. Notice shall also be served upon the child and upon the child’s guardian ad litem, if any. The notice shall attach a copy of the petition and shall give notification of the right to counsel provided for in section 232.11.
    Sec. 61.  Section 232.101A, subsection 1, paragraph c, Code 2025, is amended to read as follows:
   c.  The parent of the child does not appear at the dispositional hearing, or the parent appears at the dispositional hearing, does not object to the transfer of guardianship, and agrees to waive the requirement for making reasonable efforts as defined in section 232.102 232.102A.
    Sec. 62.  Section 232.102A, subsection 3, Code 2025, is amended to read as follows:
   3.  The performance of reasonable efforts to place a child for adoption or with a guardian may be made concurrently with making reasonable efforts as defined in this section.
    Sec. 63.  Section 232B.5, subsection 19, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   A party seeking an involuntary foster care placement of or termination of parental rights over an Indian child shall provide evidence to the court that active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the breakup of the Indian family and that these efforts have proved unsuccessful. The court shall not order the placement or termination, unless the evidence of active efforts shows there has been a vigorous and concerted level of casework beyond the level that typically constitutes reasonable efforts as defined in sections 232.57 and 232.102 232.102A. Reasonable efforts shall not be construed to be active efforts. The active efforts must be made in a manner that takes into account the prevailing social and cultural values, conditions, and way of life of the Indian child’s tribe. Active efforts shall utilize the available resources of the Indian child’s extended family, tribe, tribal and other Indian social service agencies, and individual Indian caregivers. Active efforts shall include but are not limited to all of the following:
    Sec. 64.  Section 233.2, subsection 5, Code 2025, is amended to read as follows:
   5.  Reasonable efforts, as defined in section 232.102 232.102A, that are made in regard to the newborn infant shall be limited to the efforts made in a timely manner to finalize a permanency plan for the newborn infant.
    Sec. 65.  Section 237.3, subsection 7, Code 2025, is amended to read as follows:
   7.  If an agency is accredited by the joint commission on the accreditation of health care organizations under the joint commission’s consolidated standards for residential settings or by the council on accreditation of services for families and children, the department shall modify facility licensure standards applied to the agency in order to avoid duplicating standards applied through accreditation.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to services and support for youth and is organized by divisions.
   DIVISION I —— TREATMENT, PHYSICAL ASSESSMENTS, AND BEHAVIORAL HEALTH EVALUATIONS. Under current law, a psychiatric medical institution for children (PMIC) is an institution providing more than 24 hours of continuous care involving long-term psychiatric services to 3 or more children in residence for expected periods of 14 days or more for diagnosis and evaluation, or for expected periods of 90 days or more for treatment.
   The bill exempts PMICs from licensing requirements for maintaining or conducting programs with the primary purpose of treating and rehabilitating persons with a substance use disorder.
   The bill defines “approved qualifying organization” as the joint commission, the commission on the accreditation of rehabilitation facilities, the council on accreditation, or a nationally recognized accrediting organization with standards comparable to the joint commission and commission on the accreditation of rehabilitation facilities that are acceptable under federal regulations.
   The bill defines “mental health disorder” as a mental disorder as defined in the most recent version of the diagnostic and statistical manual of mental disorders published by the American psychiatric association, or a mental disorder as defined in the most recent version of the international classification of diseases published by the world health organization.
   The bill defines “protective locked environment” as a setting that prevents egress from a building or grounds as a protective measure to ensure safety and security.
   The bill defines “record check evaluation system” as the record check evaluation system of HHS used to perform child and dependent adult abuse record checks and to evaluate criminal history and abuse records.
   The bill defines “serious emotional disturbance” as a diagnosable disorder of sufficient duration to meet diagnostic criteria specified within the most current diagnostic and statistical manual of mental disorders published by the American psychiatric association that results in a functional impairment. “Serious emotional disturbance” does not include a substance use disorder or developmental disorder unless such disorder co-occurs with such diagnosable mental, behavioral, or emotional disorder.
   The bill defines “substance use disorder” as a diagnosable substance use disorder of sufficient duration to meet diagnostic criteria specified within the most current diagnostic and statistical manual of mental disorders published by the American psychiatric association that results in a functional impairment.
   The bill defines “youth” as a person who is less than 21 years of age.
   The bill describes the nature of care a PMIC must offer youth with a serious emotional disturbance (SED), a substance use disorder (SUD), or both.
   Under current law, a person who establishes a PMIC must also hold a license under Code chapter 237 (child foster care facilities) as a comprehensive residential facility for children, or hold a license under Code chapter 125 (substance use disorders) if the facility provides SUD treatment. The bill eliminates the requirement that a PMIC holds either of these additional licenses, and instead requires that an applicant for a PMIC license specify whether the applicant will provide SED services, SUD services, or both. A PMIC may only provide services for which it is licensed.
   The bill eliminates the requirement that a proposed PMIC be under the direction of an agency which has previously operated a facility for children or adolescents and meets or exceeds requirements for licensure as a comprehensive residential facility for children.
   The bill requires the department of inspections, appeals and licensing (DIAL), in cooperation with the department of health and human services (HHS), to adopt rules relating to the application of a protective locked environment in a PMIC.
   Under current law, following the hospitalization hearing on an involuntary commitment petition, if the court finds by clear and convincing evidence that the respondent has a serious mental impairment, the court shall order the respondent committed for a complete psychiatric evaluation and appropriate treatment. The chief medical officer (CMO) of the hospital or facility at which a respondent is committed must report to the court no more than 15 days after the date the respondent is placed, making a recommendation for disposition of the matter. The bill allows a court to place a minor respondent in a public hospital and allows a CMO of the hospital no more than 30 days after the date the minor respondent is placed to make a recommendation for disposition of the matter.
   The bill defines “behavioral health evaluation” as a comprehensive evaluation of a person’s mental and behavioral health by a person licensed under Code chapter 154B (psychology), 154C (social work), or 154D (behavioral science) for purposes including but not limited to identifying a possible behavioral health condition.
   The bill defines “physical assessment” as direct physical touching, viewing, and medically necessary manipulation of any area of a child’s body by a licensed physician.
   The bill replaces several references to a physical or mental examination with references to a physical assessment (PA) or behavioral health evaluation (BHE) and replaces references to a person’s abuse of alcohol or other controlled substances with references to the person having a behavioral health condition.
   Under current law, one of several specific circumstances must exist before a juvenile court has the authority to enter an ex parte order to direct a peace officer or a juvenile court officer to take custody of a child before or after the filing of a petition under Code chapter 232 (juvenile justice). The bill adds the circumstance when the child’s parent, guardian, or legal custodian consents to the removal as a condition that would permit a juvenile court to enter such an ex parte order. The bill creates similar provisions for when a juvenile court may enter an ex parte order for a child to undergo an inpatient PA or an inpatient BHE and when a person authorized to conduct a preliminary investigation in response to a complaint may motion to ask the court to order a child to undergo an inpatient PA or an inpatient BHE.
   The bill authorizes a court, after a dispositional hearing, to order a male child in a child in need of assistance (CINA) proceeding or a family in need of assistance (FINA) proceeding to receive an inpatient PA, an inpatient BHE, or both, at the state training school (STS). A request for the use of the STS for purposes of a PA or BHE must be approved by the director of HHS. A child ordered to the STS pursuant to a CINA proceeding or a FINA proceeding must be separated at all times from children placed in the STS pursuant to a juvenile delinquency proceeding. Under current law, the court in a CINA or FINA proceeding is prohibited from placing a child in the STS for any reason.
   The bill exempts a PMIC from licensing requirements for child foster care.
   The bill defines “protective locked environment” as a setting that prevents egress from a building or grounds as a protective measure to ensure safety and security. The bill directs HHS and DIAL to adopt rules relating to the application of a protective locked environment to child foster care licensees.
   The bill directs HHS and DIAL to coordinate in developing rules related to this division of the bill. The bill outlines goals and considerations each department must take into account while adopting such rules.
   The bill makes conforming changes to Code chapters 135H (psychiatric medical institutions for children) and 232 (juvenile justice). The bill repeals 2024 Iowa Acts, chapter 1161, sections 97 and 98.
   DIVISION II —— HOME AND COMMUNITY-BASED SERVICES —— HABILITATION SERVICES PROVIDED BY A RESIDENTIAL PROGRAM —— EXCLUSION FROM CHILDREN’S RESIDENTIAL FACILITY DEFINITION. The bill excludes care furnished to persons 16 years of age or older by certain residential programs detailed in the bill from the definition of a children’s residential facility.
   DIVISION III —— DIRECTOR OF JUVENILE COURT SERVICES —— CHIEF JUVENILE COURT OFFICERS. Under current law, the chief juvenile court officers are appointed, terminated for cause, and otherwise act under the direction and supervision of the chief judge for the judicial district in which the chief juvenile court officer was appointed. The bill transfers the chief judges’ authority over chief juvenile court officers to the director of juvenile court services.
   DIVISION IV —— HAWKI ELIGIBILITY —— PUBLIC INSTITUTION INMATES. The bill defines “public institution” to mean the same as defined in 42 C.F.R. §435.1010.
   Current law does not permit a child who is an inmate in a public institution to be eligible for the Hawki program. The bill requires HHS to suspend, but not terminate, Hawki program eligibility for a child in a public institution if the child is otherwise eligible for the Hawki program except for the child’s status as an inmate, the child was enrolled in the Hawki program at the time the child was committed to the public institution, and 30 calendar days have elapsed since the date the child was committed to the public institution. A child’s suspension of Hawki benefits must continue for the duration of the child’s commitment to a public institution.
   The bill requires the public institution to which a child is committed and HHS to provide monthly reports and expedite the restoration of the child’s Hawki benefits upon the child’s discharge from the public institution. The bill requires HHS to adopt rules to administer the bill’s provisions related to Hawki benefits for children committed to a public institution.
   DIVISION V —— CORRECTIVE CHANGES. The bill updates references to certain accrediting organizations through the Code, corrects a reference throughout the Code related to the citation for the definition of “reasonable efforts”, and changes the term “legal custodian” to the defined term “custodian”.