House Study Bill 153 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED DEPARTMENT OF HEALTH AND HUMAN SERVICES BILL) A BILL FOR An Act relating to services and support for youth, including 1 treatment, physical assessments, and behavioral health 2 evaluations; exemptions from children’s residential facility 3 certification; the director of juvenile court services and 4 chief juvenile court officers; and suspension of Hawki 5 eligibility for public institution inmates. 6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 7 TLSB 1457XD (16) 91 dg/ko

S.F. _____ H.F. _____ DIVISION I 1 TREATMENT, PHYSICAL ASSESSMENTS, AND BEHAVIORAL HEALTH 2 EVALUATIONS 3 Section 1. Section 125.13, subsection 2, Code 2025, is 4 amended by adding the following new paragraph: 5 NEW PARAGRAPH . k. A licensee under chapter 135H. 6 Sec. 2. Section 135H.1, Code 2025, is amended to read as 7 follows: 8 135H.1 Definitions. 9 As used in this chapter , unless the context otherwise 10 requires: 11 1. “Approved qualifying organization” means any of the 12 following: 13 a. The joint commission. 14 b. The commission on accreditation of rehabilitation 15 facilities. 16 c. The council on accreditation. 17 d. A nationally recognized accrediting organization that 18 operates in conformance with federal regulations and has 19 accreditation standards comparable to the entities under 20 paragraphs “a” through “c” . 21 e. An entity specified by rule promulgated by the department 22 in consultation with the department of health and human 23 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 1457XD (16) 91 dg/ko 1/ 38

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

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

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

S.F. _____ H.F. _____ paragraph “a” , as a comprehensive residential facility for 1 children or holds a license under section 125.13 , if the 2 facility provides substance use disorder treatment . 3 2. A licensee shall only provide serious emotional 4 disturbance disorder or substance use disorder services for 5 which the licensee is licensed under this chapter. 6 Sec. 5. Section 135H.5, Code 2025, is amended to read as 7 follows: 8 135H.5 Application for license —— initial application and 9 annual fees . 10 1. An application for a license under this chapter shall 11 be submitted on a form requesting information required by 12 the department , which . The application may include require 13 affirmative evidence of the applicant’s ability to comply with 14 the rules for standards adopted pursuant to this chapter . The 15 application shall require the applicant to specify whether the 16 applicant intends to provide services for serious emotional 17 disturbance disorders, substance use disorders, or both. 18 2. An application for a license shall be accompanied by the 19 required license fee which shall be credited to the general 20 fund of the state. The initial application fee and the annual 21 license fee is twenty-five dollars. 22 Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, 23 are amended to read as follows: 24 1. The department shall issue a license to an applicant 25 under this chapter if all the following conditions exist: 26 a. The department has ascertained that the applicant’s 27 medical facilities and staff are adequate to provide the care 28 and services required of a psychiatric medical institution for 29 children . 30 b. The proposed psychiatric institution is accredited 31 by the joint commission on the accreditation of health 32 care organizations, the commission on accreditation of 33 rehabilitation facilities, the council on accreditation of 34 services for families and children, or by any other recognized 35 -5- LSB 1457XD (16) 91 dg/ko 5/ 38

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

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

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

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

S.F. _____ H.F. _____ care of a public hospital pursuant to subsection 1, paragraph 1 “c” , subparagraph (2), the chief medical officer of the public 2 hospital shall report to the court and make a recommendation 3 for disposition no later than thirty calendar days after the 4 date the minor respondent is placed under the care of the 5 public hospital. 6 b. A copy of the chief medical officer’s report shall be 7 sent to the respondent’s attorney. 8 c. (1) Upon request, the court may grant the chief medical 9 officer an extension of time may be granted , not to exceed 10 seven days , upon a showing of cause. A copy of the report shall 11 be sent to the The respondent’s attorney , who may contest the 12 need for an extension of time if one is requested . An 13 (2) The court shall grant an extension of time shall be 14 granted upon request unless the request is contested, in which 15 case the court shall make such inquiry as it deems appropriate 16 and may either order the respondent’s release from the hospital 17 or facility , or grant an extension of time for psychiatric 18 evaluation. 19 d. If the chief medical officer fails to report to the 20 court within fifteen days after the individual is placed under 21 the care of the hospital or facility the time specified in 22 paragraph “a” , and an extension of time has not been requested 23 granted , the chief medical officer is guilty of contempt 24 and shall be punished under chapter 665 . The court shall 25 order a rehearing on the application to determine whether the 26 respondent should continue to be detained at or placed under 27 the care of the hospital or facility. 28 Sec. 13. Section 229.14, subsection 2, paragraph e, Code 29 2025, is amended to read as follows: 30 e. (1) If the court orders placement and treatment of the 31 a respondent on an inpatient basis under this section , the 32 court may order the respondent placed under the care of an 33 appropriate subacute care facility licensed under chapter 135G . 34 (2) If the court orders placement and treatment of a minor 35 -10- LSB 1457XD (16) 91 dg/ko 10/ 38

S.F. _____ H.F. _____ respondent on an inpatient basis under this section, the court 1 may order the minor respondent placed under the care of a 2 public hospital. 3 Sec. 14. Section 232.2, Code 2025, is amended by adding the 4 following new subsections: 5 NEW SUBSECTION . 3A. “Behavioral health condition” means 6 a substantial limitation in a major life activity due to 7 a mental, behavioral, or addictive disorder or condition 8 diagnosed in accordance with the criteria in the most current 9 edition of the diagnostic and statistical manual of mental 10 disorders published by the American psychiatric association. 11 NEW SUBSECTION . 3B. “Behavioral health evaluation” means a 12 process used to assess an individual’s behavioral health status 13 and functioning for purposes including but not limited to the 14 diagnosis of a behavioral health condition or to determine the 15 need for treatment or intervention. 16 NEW SUBSECTION . 38A. “Mental health disorder” means the 17 same as defined in section 135H.1. 18 NEW SUBSECTION . 48A. “Physical assessment” means 19 direct physical touching, viewing, and medically necessary 20 manipulation of any area of a child’s body by a physician 21 licensed under chapter 148. 22 NEW SUBSECTION . 58A. “Serious emotional disturbance 23 disorder” means the same as defined in section 135H.1. 24 NEW SUBSECTION . 64A. “Substance use disorder” means the 25 same as defined in section 125.2. 26 Sec. 15. Section 232.2, subsections 34 and 58, Code 2025, 27 are amended to read as follows: 28 34. “Juvenile court social records” or “social records” means 29 all records , other than official records, made with respect to 30 a child in connection with proceedings over which the court has 31 jurisdiction under this chapter other than official records and 32 includes but is not limited to the records made and compiled 33 by intake officers, predisposition reports, and reports of 34 physical assessments and mental examinations behavioral health 35 -11- LSB 1457XD (16) 91 dg/ko 11/ 38

S.F. _____ H.F. _____ evaluations . 1 58. “Secure facility” means a physically restricting 2 facility in which children adjudicated to have committed 3 a delinquent act a child may be placed pursuant to a 4 dispositional order of the court. 5 Sec. 16. Section 232.8, subsection 4, Code 2025, is amended 6 to read as follows: 7 4. In a proceeding concerning a child who is alleged to 8 have committed a second delinquent act or a second violation 9 excluded from the jurisdiction of the juvenile court, the court 10 or the juvenile court shall determine whether there is reason 11 to believe that the child regularly abuses alcohol or other 12 controlled substance has a behavioral health condition and may 13 be in need of treatment. If the court so determines, the court 14 shall advise appropriate juvenile authorities and refer such 15 offenders to the juvenile court for disposition pursuant to 16 section 232.52A . 17 Sec. 17. Section 232.49, Code 2025, is amended to read as 18 follows: 19 232.49 Physical assessments and mental examinations 20 behavioral health evaluations —— juvenile delinquency . 21 1. a. Following the Any time after entry of an order of 22 adjudication under section 232.47 , the court may , after hold 23 a hearing which may be simultaneous with the adjudicatory 24 hearing, to order a physical assessment or mental examination 25 behavioral health evaluation of the child if it the court finds 26 that an examination a physical assessment or behavioral health 27 evaluation is necessary to determine the child’s physical or 28 mental condition or to determine if the child has a behavioral 29 health condition . 30 b. The court may consider chemical dependency as either 31 a physical condition or mental behavioral health condition 32 and may consider a chemical dependency evaluation as either a 33 physical assessment or mental examination behavioral health 34 evaluation . If the examination 35 -12- LSB 1457XD (16) 91 dg/ko 12/ 38

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

S.F. _____ H.F. _____ guardian, or custodian agree that it is necessary the child 1 should be committed to a suitable hospital, facility, or 2 institution for the purpose of examination ordered to receive 3 a physical assessment or behavioral health evaluation on an 4 inpatient basis . Commitment for examination 5 (2) An inpatient physical assessment or inpatient 6 behavioral health evaluation shall not exceed thirty days and 7 the civil commitment provisions of chapter 229 shall not apply . 8 Sec. 18. Section 232.52A, subsection 1, Code 2025, is 9 amended to read as follows: 10 1. In addition to any other order of the juvenile court, 11 a person under age eighteen, child who may be in need of 12 treatment , as determined under section 232.8 , may be ordered 13 to participate in an alcohol or controlled substance education 14 or a physical assessment or behavioral health evaluation 15 program approved by the juvenile court. If recommended after 16 evaluation, the The court may also order the person child to 17 participate in a treatment program approved by the court if the 18 treatment program is recommended after the child’s physical 19 assessment or behavioral health evaluation . The juvenile court 20 may also require the custodial parent or parents , or other 21 legal guardian , to participate in an educational program with 22 the person under age eighteen child if the court determines 23 that such participation is in the best interests of the person 24 under age eighteen child . 25 Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 26 1, Code 2025, is amended to read as follows: 27 “Confidential access to a child” means access to a child, 28 during an assessment of an alleged act of child abuse, who is 29 alleged to be the victim of the child abuse , during a child 30 abuse assessment . The access may be accomplished by interview, 31 observation, or examination physical assessment of the child. 32 As used in this subsection and this part: 33 Sec. 20. Section 232.68, subsection 3, paragraph c, Code 34 2025, is amended by striking the paragraph. 35 -14- LSB 1457XD (16) 91 dg/ko 14/ 38

S.F. _____ H.F. _____ Sec. 21. Section 232.69, subsection 3, paragraph b, Code 1 2025, is amended to read as follows: 2 b. (1) A person required to make a report under subsection 3 1 , other than a physician whose professional practice does not 4 regularly involve providing primary health care to children, 5 shall complete the core training curriculum relating to 6 the identification and reporting of child abuse within six 7 months of initial employment or self-employment involving 8 the examination physical assessments or behavioral health 9 evaluations , or attending, counseling, or treatment of treating 10 children on a regular basis. 11 (2) Within one month of initial employment or 12 self-employment, the person shall obtain a statement of the 13 abuse reporting requirements from the person’s employer or, if 14 self-employed, from the department. 15 (3) The person shall complete the at least one hour of 16 core training curriculum relating to the identification and 17 reporting of child abuse every three years. 18 Sec. 22. Section 232.71B, subsection 10, Code 2025, is 19 amended to read as follows: 20 10. Physical examination assessment . If the department 21 refers a child to a physician or physician assistant for a 22 physical examination assessment , the department shall contact 23 the physician or physician assistant regarding the examination 24 physical assessment within twenty-four hours of making the 25 referral. If the physician or physician assistant who performs 26 the examination upon referral by the department physical 27 assessment reasonably believes the child has been abused, the 28 physician or physician assistant shall report to the department 29 within twenty-four hours of performing the examination physical 30 assessment . 31 Sec. 23. Section 232.77, subsection 1, Code 2025, is amended 32 to read as follows: 33 1. a. A person who is required to report suspected child 34 abuse may take or perform, or cause to be taken or performed , 35 -15- LSB 1457XD (16) 91 dg/ko 15/ 38

S.F. _____ H.F. _____ at public expense, photographs, X rays, or other a physical 1 examinations assessment, or tests other test of a child which 2 would provide medical indication of allegations arising from 3 an assessment. 4 b. A health practitioner may, if medically indicated, 5 cause to be performed a radiological examination, a physical 6 examination assessment , or other medical tests of test to be 7 performed on the child. 8 c. A person who takes any photographs or , takes X rays , or 9 performs a physical examinations assessment, or other tests 10 performs another test pursuant to this section shall notify 11 the department that the photographs or X rays have been taken , 12 or the examinations physical assessment or other tests have 13 test has been performed . The person who made notification , 14 and shall retain the photographs , or X rays or examination , 15 physical assessment findings, or other test findings for a 16 reasonable time following the notification. 17 d. Whenever the a person is required to report under section 18 232.69 , in that person’s capacity as a member of the staff 19 of a medical or other private or public institution, agency , 20 or facility, that person shall immediately notify the person 21 in charge of the institution, agency, or facility , or that 22 person’s designated delegate , of the need for photographs , or X 23 rays or examinations , physical assessments, or other tests. 24 Sec. 24. Section 232.78, subsection 1, paragraph a, Code 25 2025, is amended to read as follows: 26 a. Any of the following circumstances exist: 27 (1) The person responsible for the care of the child 28 consents to the removal. 29 (2) The person responsible for the care of the child is 30 absent , or though present, . 31 (3) The person responsible for the care of the child was 32 asked and refused to consent to the removal of the child and 33 was informed of an intent to apply for an order under this 34 section , or there . 35 -16- LSB 1457XD (16) 91 dg/ko 16/ 38

S.F. _____ H.F. _____ (4) There is reasonable cause to believe that a request for 1 consent would further endanger the child , or there . 2 (5) There is reasonable cause to believe that a request for 3 consent will cause the parent, guardian, or legal custodian 4 person responsible for the care of the child to take flight 5 with the child. 6 Sec. 25. Section 232.78, subsection 1, paragraph c, 7 subparagraph (1), Code 2025, is amended to read as follows: 8 (1) The refusal or failure of the person responsible for 9 the care of the child to comply with the request of a peace 10 officer, juvenile court officer, or child protection worker 11 for such the person to obtain and provide to the requester 12 the results of a physical assessment or mental examination 13 behavioral health evaluation of the child. The request for a 14 physical examination assessment of the child may specify the 15 performance of a medically relevant test. 16 Sec. 26. Section 232.78, subsection 5, Code 2025, is amended 17 to read as follows: 18 5. The juvenile court, before or after the filing of a 19 petition under this chapter , may enter an ex parte order 20 authorizing a physician or physician assistant or hospital to 21 conduct an inpatient or outpatient physical examination or 22 authorizing a physician or physician assistant, a psychologist 23 certified under section 154B.7 , or a community mental health 24 center accredited pursuant to chapter 230A to conduct an 25 outpatient mental examination assessment or an inpatient or 26 outpatient behavioral health evaluation of a child if necessary 27 to identify the nature, extent, and cause of injuries to the 28 child as required by section 232.71B , provided all of the 29 following apply: 30 a. Any of the following circumstances exist: 31 (1) The child’s parent, guardian, or custodian consents to 32 the physical assessment or behavioral health evaluation. 33 (2) The child’s parent, guardian, or legal custodian is 34 absent , or though present, . 35 -17- LSB 1457XD (16) 91 dg/ko 17/ 38