House File 984 - Introduced HOUSE FILE 984 BY COMMITTEE ON WAYS AND MEANS (SUCCESSOR TO HF 833) (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 juvenile delinquency and 3 child in need of assistance proceedings; the licensing 4 and certification of certain residential facilities; 5 the provision of home and community-based services and 6 habilitation services to certain youth by residential 7 programs; administration and supervision of juvenile court 8 services; and the suspension of Hawki eligibility for 9 inmates of public institutions. 10 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 11 TLSB 1457HZ (3) 91 dg/ko

H.F. 984 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, unless the psychiatric 6 medical institution for children provides substance use 7 disorder services. 8 Sec. 2. Section 135H.1, Code 2025, is amended to read as 9 follows: 10 135H.1 Definitions. 11 As used in this chapter , unless the context otherwise 12 requires: 13 1. “Approved qualifying organization” means any of the 14 following: 15 a. The joint commission. 16 b. The commission on accreditation of rehabilitation 17 facilities. 18 c. The council on accreditation. 19 d. A nationally recognized accrediting organization with 20 standards comparable to the entities listed in paragraphs “a” 21 through “c” that are acceptable under federal regulations. 22 e. An entity specified by rule adopted by the department in 23 consultation with the department of health and human services. 24 1. 2. “Department” means the department of inspections, 25 appeals, and licensing. 26 2. 3. “Direction” means authoritative policy or procedural 27 guidance for the accomplishment of a function or an activity. 28 3. 4. “Licensee” means the holder of a license issued to 29 operate a psychiatric medical institution for children. 30 4. 5. “Medical care plan” means a plan of care and services 31 designed to eliminate the need for inpatient care by improving 32 the condition of a child youth . Services must be based upon a 33 diagnostic evaluation, which includes an examination a physical 34 assessment and behavioral health evaluation of the medical, 35 -1- LSB 1457HZ (3) 91 dg/ko 1/ 36

H.F. 984 psychological, social, behavioral, and developmental aspects 1 of the child’s youth’s situation, reflecting the need for 2 inpatient care. 3 6. “Mental health disorder” means any of the following: 4 a. A mental disorder as defined by the most recent version 5 of the diagnostic and statistical manual of mental disorders 6 published by the American psychiatric association. 7 b. A mental disorder included in the mental, behavioral, or 8 neurodevelopmental disorders chapter in the most recent version 9 of the international classification of diseases published by 10 the world health organization. 11 5. 7. “Mental health professional” means an individual who 12 has all of the following qualifications: 13 a. The individual holds at least a master’s degree in a 14 mental health field, including but not limited to, psychology, 15 counseling and guidance, nursing, and or social work, or the 16 individual is a physician. 17 b. The individual holds a current Iowa license if practicing 18 in a field covered by that requires an Iowa licensure law 19 license . 20 c. The individual has at least two years of post-degree 21 clinical experience, supervised by another mental health 22 professional, in assessing mental health needs and problems and 23 in providing appropriate mental health services. 24 6. 8. “Nursing care” means services which are provided 25 under the direction of a physician or registered nurse. 26 7. 9. “Physician” means a person licensed under chapter 27 148 . 28 10. “Protective locked environment” means a setting that 29 prevents egress from a building or grounds as a protective 30 measure to ensure safety and security. 31 8. 11. “Psychiatric medical institution for children” or 32 “psychiatric institution” means an institution providing more 33 than twenty-four hours of continuous care involving long-term 34 psychiatric services to three or more children youth in 35 -2- LSB 1457HZ (3) 91 dg/ko 2/ 36

H.F. 984 residence for expected periods of fourteen or more days for an 1 assessment, evaluation, and diagnosis and evaluation or for 2 expected periods of ninety days or more for treatment. 3 9. 12. “Psychiatric services” means services provided under 4 the direction of a physician which address mental, emotional, 5 medical, or behavioral problems. 6 13. “Record check evaluation system” means the same as 7 defined in section 135C.1. 8 10. 14. “Rehabilitative services” means services to 9 encourage and assist restoration of a resident’s optimum mental 10 and physical capabilities. 11 11. 15. “Resident” means a person who is less than 12 twenty-one years of age and youth who has been admitted by a 13 physician to a psychiatric medical institution for children. 14 16. “Serious emotional disturbance” means a diagnosable 15 mental, behavioral, or emotional disorder that meets the 16 diagnostic criteria specified in the most current diagnostic 17 and statistical manual of mental disorders published by 18 the American psychiatric association. “Serious emotional 19 disturbance” does not include a substance use disorder or 20 developmental disorder unless such disorder co-occurs with a 21 diagnosable mental, behavioral, or emotional disorder. 22 17. “Substance use disorder” means the same as defined in 23 section 125.2. 24 12. 18. “Supervision” means direct oversight and inspection 25 of the an act of accomplishing that accomplishes a function or 26 activity. 27 19. “Youth” means a person who is less than twenty-one years 28 of age. 29 Sec. 3. Section 135H.3, Code 2025, is amended to read as 30 follows: 31 135H.3 Nature of care. 32 1. a. A psychiatric medical institution for children 33 shall provide shelter, food, supervision, care, assessment, 34 evaluation, diagnosis, treatment, counseling, rehabilitative 35 -3- LSB 1457HZ (3) 91 dg/ko 3/ 36

H.F. 984 services, and related professional-directed services to 1 youth who have a serious emotional disturbance, a substance 2 use disorder, or both, with the intention of reducing or 3 ameliorating the disorder, the symptoms of the disorder, or the 4 effects of the disorder. 5 b. A psychiatric medical institution for children shall 6 utilize a team of professionals to direct an organized program 7 of diagnostic services, psychiatric services, nursing care, 8 and rehabilitative services to meet the needs of residents 9 in accordance with a medical care plan developed for each 10 resident. The membership of the team of professionals 11 may include but is not limited to an advanced registered 12 nurse practitioner or a physician assistant. Social and 13 rehabilitative services shall be provided under the direction 14 of a qualified mental health professional. 15 2. If a child youth is diagnosed with a biologically 16 based mental illness as defined in section 514C.22 and meets 17 the medical assistance program criteria for admission to a 18 psychiatric medical institution for children, the child youth 19 shall be deemed to meet the acuity criteria for medically 20 necessary inpatient benefits under a group policy, contract, or 21 plan providing for third-party payment or prepayment of health, 22 medical, and surgical coverage benefits issued by a carrier, as 23 defined in section 513B.2 , that is subject to section 514C.22 . 24 Such medically necessary benefits shall not be excluded or 25 denied as care that is substantially custodial in nature under 26 section 514C.22, subsection 8 , paragraph “b” . 27 Sec. 4. Section 135H.4, Code 2025, is amended to read as 28 follows: 29 135H.4 Licensure. 30 1. A person shall not establish, operate, or maintain a 31 psychiatric medical institution for children unless the person 32 obtains a license for the institution under this chapter and 33 either holds a license under section 237.3, subsection 2 , 34 paragraph “a” , as a comprehensive residential facility for 35 -4- LSB 1457HZ (3) 91 dg/ko 4/ 36

H.F. 984 children or holds a license under section 125.13 , if the 1 facility provides substance use disorder treatment under 2 chapter 237, and holds a license under this chapter . 3 2. In addition to the requirements under subsection 1, 4 a person shall not provide substance use disorder services 5 at a psychiatric medical institution for children unless the 6 person holds a license under section 125.13. The department 7 of health and human services shall adopt rules pursuant to 8 chapter 17A to create an expedited process for a person to 9 simultaneously obtain a license under section 125.13, a license 10 as a comprehensive residential facility for children under 11 chapter 237, and a license under this chapter. 12 Sec. 5. Section 135H.5, Code 2025, is amended to read as 13 follows: 14 135H.5 Application for license —— initial application and 15 annual fees . 16 1. An application for a license under this chapter shall 17 be submitted on a form requesting information required by 18 the department , which . The application may include require 19 affirmative evidence of the applicant’s ability to comply with 20 the rules for standards adopted pursuant to this chapter . The 21 application shall require the applicant to specify whether the 22 applicant intends to provide services for serious emotional 23 disturbances, substance use disorders, or both. 24 2. An application for a license shall be accompanied by the 25 required license fee which shall be credited to the general 26 fund of the state. The initial application fee and the annual 27 license fee is twenty-five dollars. 28 Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, 29 are amended to read as follows: 30 1. The department shall issue a license to an applicant 31 under this chapter if all the following conditions exist: 32 a. The department has ascertained that the applicant’s 33 medical facilities and staff are adequate to provide the care 34 and services required of a psychiatric medical institution for 35 -5- LSB 1457HZ (3) 91 dg/ko 5/ 36

H.F. 984 children . 1 b. The proposed psychiatric institution is accredited 2 by the joint commission on the accreditation of health 3 care organizations, the commission on accreditation of 4 rehabilitation facilities, the council on accreditation of 5 services for families and children, or by any other recognized 6 accrediting organization with comparable standards acceptable 7 under federal regulation an approved qualifying organization . 8 c. The applicant complies with applicable state rules 9 and standards for a psychiatric institution adopted by the 10 department in accordance with federal requirements under 42 11 C.F.R. §441.150 – 441.156. 12 d. The department of health and human services has submitted 13 written approval of the application based on the department 14 of health and human services’ determination of need. The 15 department of health and human services shall identify the 16 location and number of children youth in the state who require 17 the services of a psychiatric medical institution for children. 18 Approval of an application shall be based upon the location 19 of the proposed psychiatric institution relative to the need 20 for services identified by the department of health and human 21 services and an analysis of the applicant’s ability to provide 22 services and support consistent with requirements under chapter 23 232 , particularly regarding specifically community-based 24 treatment. If the proposed psychiatric institution is not 25 freestanding from a facility licensed under chapter 135B or 26 135C , approval under this paragraph shall not be given unless 27 the department of health and human services certifies that 28 the proposed psychiatric institution is capable of providing 29 a resident with a living environment similar to the living 30 environment provided by a licensee which is freestanding from a 31 facility licensed under chapter 135B or 135C . 32 e. The proposed psychiatric institution is under the 33 direction of an agency which has operated a facility licensed 34 under section 237.3, subsection 2 , paragraph “a” , as a 35 -6- LSB 1457HZ (3) 91 dg/ko 6/ 36

H.F. 984 comprehensive residential facility for children for three years 1 or of an agency which has operated a facility for three years 2 providing psychiatric services exclusively to children or 3 adolescents and the facility meets or exceeds requirements for 4 licensure under section 237.3, subsection 2 , paragraph “a” , as a 5 comprehensive residential facility for children. 6 f. e. If a child youth has an a serious emotional , 7 behavioral, or mental health disorder disturbance , the 8 psychiatric institution does not require court any of the 9 following as a condition for the youth to obtain treatment: 10 (1) Court proceedings to be initiated or that a child’s . 11 (2) For the youth’s parent, guardian, or custodian must 12 to terminate parental rights over , or transfer legal custody 13 of , the child for the purposes of obtaining treatment from the 14 psychiatric institution for the child youth . 15 (3) Relinquishment of a child’s the youth’s custody shall 16 not be a condition of the child receiving services . 17 4. The department of health and human services may give 18 approval to approve a conversion of beds approved under 19 subsection 2 , to if the beds which are specialized to provide 20 substance use disorder treatment. However, the total number of 21 beds approved under subsection 2 and this subsection shall not 22 exceed four hundred thirty , unless approved for good cause by 23 the director pursuant to subsection 2 . Beds The limitations 24 on the number of beds under this section shall not apply to 25 beds for children youth who do not reside in this state and 26 whose service costs are not paid by public funds in this state 27 are not subject to the limitations on the number of beds 28 requirements otherwise applicable under this section . 29 5. A psychiatric institution licensed prior to July 1, 1999, 30 may exceed the number of beds authorized under subsection 2 31 if the excess beds are used to provide services funded from 32 a source other than the medical assistance program under 33 chapter 249A . Notwithstanding subsection 1 , paragraph “d” , and 34 subsection 2 , the provision of services using those excess beds 35 -7- LSB 1457HZ (3) 91 dg/ko 7/ 36

H.F. 984 does not require a review by the department of health and human 1 services. 2 Sec. 7. Section 135H.7, subsection 2, paragraph a, Code 3 2025, is amended to read as follows: 4 a. If a person who has been convicted of a crime or has a 5 record of founded child abuse is being considered for licensure 6 under this chapter , or for employment with a psychiatric 7 institution involving direct responsibility for a child youth 8 or with access to a child youth when the child youth is alone, 9 by a licensed psychiatric institution, or if a person will 10 reside residence in a facility utilized by a licensee, and if 11 the person has been convicted of a crime or has a record of 12 founded child abuse, the record check evaluation system and 13 the licensee for an employee of the licensee considering the 14 person for employment shall perform an evaluation to determine 15 whether the crime or founded child abuse warrants prohibition 16 of licensure, employment, or residence in the facility utilized 17 by a licensee . The record check evaluation system of the 18 department of health and human services shall conduct criminal 19 and child abuse record checks in this state and may conduct 20 these checks in other states. The record check evaluation 21 shall be performed in accordance with procedures adopted for 22 this purpose by the department of health and human services. 23 Sec. 8. NEW SECTION . 135H.7A Protective locked environment 24 —— rules. 25 The department, in cooperation with the department of health 26 and human services, shall adopt rules pursuant to chapter 17A 27 relating to the application of a protective locked environment 28 in a psychiatric medical institution for children. 29 Sec. 9. Section 135H.10, subsection 2, Code 2025, is amended 30 to read as follows: 31 2. This chapter shall not be construed as prohibiting 32 the use of to prohibit funds appropriated for foster care to 33 from being used to provide payment to a psychiatric medical 34 institution for children for the financial participation 35 -8- LSB 1457HZ (3) 91 dg/ko 8/ 36

H.F. 984 required of a child youth whose foster care placement is in a 1 psychiatric medical institution for children. In accordance 2 with established policies and procedures for foster care, the 3 department of health and human services shall act to recover 4 any such payment for financial participation, apply to be named 5 payee for the child’s youth’s unearned income, and recommend 6 parental liability for the costs of a court-ordered foster care 7 placement in a psychiatric medical institution. 8 Sec. 10. Section 135H.13, subsection 1, Code 2025, is 9 amended to read as follows: 10 1. The department’s final findings and the survey findings 11 of the joint commission on the accreditation of health care 12 organizations an approved qualifying organization regarding 13 licensure or program accreditation shall be made available 14 to the public in a readily available form and place. Other 15 information relating to the psychiatric institution is 16 confidential and shall not be made available to the public 17 except in proceedings a proceeding involving licensure, a 18 civil suit involving a resident, or an administrative action 19 involving a resident. 20 Sec. 11. Section 232.2, Code 2025, is amended by adding the 21 following new subsections: 22 NEW SUBSECTION . 3A. “Behavioral health condition” means 23 a serious emotional disturbance, a mental health disorder, 24 a substance abuse disorder, life stressors and crises, and 25 stress-related physical symptoms. 26 NEW SUBSECTION . 3B. “Behavioral health evaluation” means a 27 process used to assess an individual’s behavioral health status 28 and functioning for purposes including but not limited to the 29 diagnosis of a behavioral health condition or to determine the 30 need for treatment or intervention. 31 NEW SUBSECTION . 38A. “Mental health disorder” means the 32 same as defined in section 135H.1. 33 NEW SUBSECTION . 48A. “Physical assessment” means 34 direct physical touching, viewing, and medically necessary 35 -9- LSB 1457HZ (3) 91 dg/ko 9/ 36

H.F. 984 manipulation of any area of a child’s body by a physician 1 licensed under chapter 148. 2 NEW SUBSECTION . 58A. “Serious emotional disturbance” means 3 the same as defined in section 135H.1. 4 NEW SUBSECTION . 64A. “Substance use disorder” means the 5 same as defined in section 125.2. 6 Sec. 12. Section 232.2, subsection 34, Code 2025, is amended 7 to read as follows: 8 34. “Juvenile court social records” or “social records” means 9 all records , other than official records, made with respect to 10 a child in connection with proceedings over which the court has 11 jurisdiction under this chapter other than official records and 12 includes but is not limited to the records made and compiled 13 by intake officers, predisposition reports, and reports of 14 physical assessments and mental examinations behavioral health 15 evaluations . 16 Sec. 13. Section 232.8, subsection 4, Code 2025, is amended 17 to read as follows: 18 4. In a proceeding concerning a child who is alleged to 19 have committed a second delinquent act or a second violation 20 excluded from the jurisdiction of the juvenile court, the court 21 or the juvenile court shall determine whether there is reason 22 to believe that the child regularly abuses alcohol or other 23 controlled substance has a behavioral health condition and may 24 be in need of treatment. If the court so determines, the court 25 shall advise appropriate juvenile authorities and refer such 26 offenders to the juvenile court for disposition pursuant to 27 section 232.52A . 28 Sec. 14. Section 232.49, Code 2025, is amended to read as 29 follows: 30 232.49 Physical assessments and mental examinations 31 behavioral health evaluations —— juvenile delinquency . 32 1. a. Following Any time after the entry of an order 33 of adjudication under section 232.47 , the court may, after 34 a hearing which may be simultaneous with the adjudicatory 35 -10- LSB 1457HZ (3) 91 dg/ko 10/ 36

H.F. 984 hearing , order a physical assessment or mental examination 1 behavioral health evaluation of a child if it the court finds 2 that an examination a physical assessment or a behavioral 3 health evaluation is necessary to determine the child’s 4 physical condition or mental to determine if the child has a 5 behavioral health condition. 6 b. The court may consider chemical dependency as either 7 a physical condition or mental behavioral health condition 8 and may consider a chemical dependency evaluation as either a 9 physical assessment or mental examination behavioral health 10 evaluation . If the examination 11 c. A hearing to order a physical assessment or behavioral 12 health evaluation may be held at the same time as the 13 adjudicatory hearing. 14 2. Unless otherwise ordered by the court, if a physical 15 assessment or behavioral health evaluation indicates the child 16 has behaved in a manner that threatened the safety of another 17 person, has committed a violent act causing bodily injury to 18 another person, or has been a victim or perpetrator of sexual 19 abuse, unless otherwise ordered by the court, the child’s 20 parent, guardian, or foster parent , or other person with 21 custody of the child shall be provided with that information. 22 2. 3. a. When possible an examination , a physical 23 assessment or behavioral health evaluation shall be conducted 24 on an outpatient basis , but . However, if deemed necessary by 25 the court, the court may , if it deems necessary commit order 26 the child to a suitable hospital, facility , or institution for 27 the purpose of examination an inpatient physical assessment or 28 an inpatient behavioral health evaluation . 29 b. Commitment for examination An inpatient physical 30 assessment or an inpatient behavioral health evaluation shall 31 not exceed thirty days and the civil commitment provisions of 32 chapter 229 shall not apply . 33 3. 4. a. At any Any time after the filing of a delinquency 34 petition , the court may order a physical assessment or mental 35 -11- LSB 1457HZ (3) 91 dg/ko 11/ 36

H.F. 984 examination behavioral health evaluation of the child if all of 1 the following circumstances apply: 2 (1) The court finds such examination a physical assessment 3 or a behavioral health evaluation to be in the best interest 4 of the child ; and . 5 (2) The parent, guardian, or custodian and the child’s 6 counsel agree to the physical assessment or behavioral health 7 evaluation . 8 b. (1) An examination A physical assessment or behavioral 9 health evaluation shall be conducted on an outpatient basis 10 unless the court, the child’s counsel, and the child’s 11 parent, guardian, or custodian agree that it is necessary the 12 child should be committed ordered to a suitable hospital, 13 facility, or institution for the purpose of examination an 14 inpatient physical assessment or an inpatient behavioral health 15 evaluation . Commitment for examination 16 (2) An inpatient physical assessment or inpatient 17 behavioral health evaluation shall not exceed thirty days and 18 the civil commitment provisions of chapter 229 shall not apply . 19 Sec. 15. Section 232.52A, subsection 1, Code 2025, is 20 amended to read as follows: 21 1. In addition to any other order of the juvenile court, 22 a person under age eighteen, child who may be in need of 23 treatment , as determined under section 232.8 , may be ordered 24 to participate in an alcohol or controlled substance education 25 or a physical assessment or behavioral health evaluation 26 program approved by the juvenile court. If recommended after 27 evaluation, the The court may also order the person child to 28 participate in a treatment program approved by the court if the 29 treatment program is recommended after the child’s physical 30 assessment or behavioral health evaluation . The juvenile court 31 may also require the custodial parent or parents , or other 32 legal guardian , to participate in an educational program with 33 the person under age eighteen child if the court determines 34 that such participation is in the best interests of the person 35 -12- LSB 1457HZ (3) 91 dg/ko 12/ 36

H.F. 984 under age eighteen child . 1 Sec. 16. Section 232.68, subsection 3, unnumbered paragraph 2 1, Code 2025, is amended to read as follows: 3 “Confidential access to a child” means access to a child, 4 during an assessment of an alleged act of child abuse, who is 5 alleged to be the victim of the child abuse , during a child 6 abuse assessment . The access may be accomplished by interview, 7 observation, or examination physical assessment of the child. 8 As used in this subsection and this part: 9 Sec. 17. Section 232.68, subsection 3, paragraph c, Code 10 2025, is amended by striking the paragraph. 11 Sec. 18. Section 232.69, subsection 3, paragraph b, Code 12 2025, is amended to read as follows: 13 b. A person required to make a report under subsection 1, 14 other than a physician whose professional practice does not 15 regularly involve providing primary health care to children, 16 shall complete the core training curriculum relating to 17 the identification and reporting of child abuse within six 18 months of initial employment or self-employment involving 19 the examination physical assessments or behavioral health 20 evaluations , or attending, counseling, or treatment of treating 21 children on a regular basis. Within one month of initial 22 employment or self-employment, the person shall obtain a 23 statement of the abuse reporting requirements from the person’s 24 employer or, if self-employed, from the department. The person 25 shall complete the core training curriculum relating to the 26 identification and reporting of child abuse every three years. 27 Sec. 19. Section 232.71B, subsection 10, Code 2025, is 28 amended to read as follows: 29 10. Physical examination assessment . If the department 30 refers a child to a physician or physician assistant for a 31 physical examination assessment , the department shall contact 32 the physician or physician assistant regarding the examination 33 physical assessment within twenty-four hours of making the 34 referral. If the physician or physician assistant who performs 35 -13- LSB 1457HZ (3) 91 dg/ko 13/ 36

H.F. 984 the examination upon referral by the department physical 1 assessment reasonably believes the child has been abused, the 2 physician or physician assistant shall report to the department 3 within twenty-four hours of performing the examination physical 4 assessment . 5 Sec. 20. Section 232.77, subsection 1, Code 2025, is amended 6 to read as follows: 7 1. a. A person who is required to report suspected 8 child abuse may take or perform, or may cause to be taken or 9 performed , at public expense, photographs, X rays, or other 10 physical examinations assessments, or other tests of a child 11 which would provide medical indication of allegations arising 12 from an assessment. 13 b. A health practitioner may, if medically indicated, 14 cause to be performed a radiological examination, physical 15 examination assessment , or other medical tests test of the 16 child. 17 c. A person who takes any photographs or X rays or 18 performs any physical examinations assessments or other tests 19 pursuant to this section shall notify the department that the 20 photographs or X rays have been taken or the examinations 21 physical assessments or other tests have been performed . The 22 person who made notification , and shall retain the photographs , 23 or X rays , or examination physical assessment or other test 24 findings for a reasonable time following the notification. 25 d. Whenever the person is required to report under section 26 232.69 , in that person’s capacity as a member of the staff of 27 a medical or other private or public institution, agency or 28 facility, that person shall immediately notify the person in 29 charge of the institution, agency, or facility or that person’s 30 designated delegate of the need for photographs , or X rays or 31 examinations , physical assessments, or other tests. 32 Sec. 21. Section 232.78, subsection 1, paragraph a, Code 33 2025, is amended to read as follows: 34 a. Any of the following circumstances exist: 35 -14- LSB 1457HZ (3) 91 dg/ko 14/ 36

H.F. 984 (1) The person responsible for the care of the child 1 consents to the removal. 2 (2) The person responsible for the care of the child is 3 absent , or . 4 (3) The person responsible for the care of the child, though 5 present, was asked and refused to consent to the removal of the 6 child and was informed of an intent to apply for an order under 7 this section , or there . 8 (4) There is reasonable cause to believe that a request for 9 consent would further endanger the child , or there . 10 (5) There is reasonable cause to believe that a request for 11 consent will cause the parent, guardian, or legal custodian 12 person responsible for the care of the child to take flight 13 with the child. 14 Sec. 22. Section 232.78, subsection 1, paragraph c, 15 subparagraph (1), Code 2025, is amended to read as follows: 16 (1) The refusal or failure of the person responsible for 17 the care of the child to comply with the request of a peace 18 officer, juvenile court officer, or child protection worker 19 for such the person to obtain and provide to the requester 20 the results of a physical assessment or mental examination 21 behavioral health evaluation of the child. The request for a 22 physical examination assessment of the child may specify the 23 performance of a medically relevant test. 24 Sec. 23. Section 232.78, subsection 5, Code 2025, is amended 25 to read as follows: 26 5. The juvenile court, before or after the filing of a 27 petition under this chapter , may enter an ex parte order 28 authorizing a physician or physician assistant or hospital to 29 conduct an inpatient or outpatient physical examination or 30 authorizing a physician or physician assistant, a psychologist 31 certified under section 154B.7 , or a community mental health 32 center accredited pursuant to chapter 230A to conduct an 33 outpatient mental examination assessment or an inpatient or 34 outpatient behavioral health evaluation of a child if necessary 35 -15- LSB 1457HZ (3) 91 dg/ko 15/ 36

H.F. 984 to identify the nature, extent, and cause of injuries to the 1 child as required by section 232.71B , provided all of the 2 following apply: 3 a. Any of the following circumstances exist: 4 (1) The child’s parent, guardian, or custodian consents to 5 the physical assessment or the behavioral health evaluation. 6 (2) The child’s parent, guardian, or legal custodian is 7 absent , or . 8 (3) The child’s parent, guardian, or custodian, though 9 present, was asked and refused to provide written consent to 10 the examination physical assessment or the behavioral health 11 evaluation . 12 b. The juvenile court has entered an ex parte order 13 directing the removal of the child from the child’s home or a 14 child care facility under this section. 15 c. There is not enough time to file a petition and to hold 16 a hearing as provided in section 232.98. 17 Sec. 24. Section 232.79, subsection 5, Code 2025, is amended 18 to read as follows: 19 5. When there has been an emergency removal or keeping of a 20 child without a court order, a physical examination assessment 21 of the child by a licensed medical practitioner shall be 22 performed within twenty-four hours of such the emergency 23 removal or keeping of a child , unless the child is returned 24 to the child’s home within twenty-four hours of the emergency 25 removal or keeping of a child . 26 Sec. 25. Section 232.83, subsection 2, Code 2025, is amended 27 to read as follows: 28 2. Anyone authorized to conduct a preliminary investigation 29 in response to a complaint may apply for, or the court on its 30 own motion may enter, an ex parte order authorizing a physician 31 or physician assistant or hospital to conduct an inpatient or 32 outpatient physical examination or authorizing a physician or 33 physician assistant, a psychologist certified under section 34 154B.7 , or a community mental health center accredited pursuant 35 -16- LSB 1457HZ (3) 91 dg/ko 16/ 36

H.F. 984 to chapter 230A to conduct an outpatient mental examination 1 of a child if necessary to identify the nature, extent, and 2 causes of any injuries, emotional damage, or other such needs 3 of a child as specified in section 232.96A, subsection 3, 5, or 4 6 , assessment or an inpatient or outpatient behavioral health 5 evaluation provided that all of the following apply: 6 a. Any of the following circumstances exist: 7 (1) The parent, guardian, or custodian consents to the 8 physical assessment or the behavioral health evaluation. 9 (2) The parent, guardian, or legal custodian is absent , or . 10 (3) The parent, guardian, or custodian, though present, 11 was asked and refused to authorize the examination physical 12 assessment or the behavioral health evaluation . 13 b. There is not enough time to file a petition and hold a 14 hearing under this chapter. 15 c. The parent, guardian, or legal custodian has not provided 16 care and treatment related to their the child’s alleged 17 victimization. 18 Sec. 26. Section 232.98, Code 2025, is amended to read as 19 follows: 20 232.98 Physical and mental examinations assessments and 21 behavioral health evaluations —— child in need of assistance . 22 1. a. Except as provided in section 232.78, subsection 5 , 23 a physical assessment or mental examination behavioral health 24 evaluation of the a child may be ordered only after the filing 25 of a petition pursuant to section 232.87 , and after a hearing 26 to determine whether an examination a physical assessment 27 or behavioral health evaluation is necessary to determine 28 the child’s physical condition or mental if the child has a 29 behavioral health condition. 30 b. The court may consider chemical dependency as either 31 a physical or mental behavioral health condition and may 32 consider a chemical dependency evaluation as either a physical 33 assessment or mental examination behavioral health evaluation . 34 a. c. The hearing required by this section may be held 35 -17- LSB 1457HZ (3) 91 dg/ko 17/ 36