House Study Bill 215 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED DEPARTMENT OF HEALTH AND HUMAN SERVICES BILL) A BILL FOR An Act relating to matters under the purview of the department 1 of health and human services, including administrative 2 services organizations, child foster care, child and 3 dependent adult abuse, internal audit and examination 4 information, and the region incentive fund in the mental 5 health and disability services regional service fund, 6 and making an appropriation and including effective date 7 provisions. 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 9 TLSB 1459XD (3) 91 dg/ko

S.F. _____ H.F. _____ DIVISION I 1 ADMINISTRATIVE SERVICES ORGANIZATIONS 2 Section 1. Section 97B.1A, subsection 8, paragraph b, Code 3 2025, is amended by adding the following new subparagraph: 4 NEW SUBPARAGRAPH . (10) Employees of an administrative 5 services organization as defined in section 225A.1. 6 Sec. 2. Section 229.19, subsection 1, paragraph a, Code 7 2025, is amended by striking the paragraph and inserting in 8 lieu thereof the following: 9 a. (1) The board of supervisors of each county shall 10 appoint an individual to act as an advocate representing the 11 interests of patients involuntarily hospitalized by the court 12 in matters relating to a patient’s hospitalization or treatment 13 under section 229.14 or 229.15. The individual shall have 14 prior experience advocating for or promoting the welfare and 15 rehabilitation of persons with mental illness. 16 (2) A person appointed under this section shall not be any 17 of the following: 18 (a) An officer or employee of the department. 19 (b) An officer or employee of an administrative services 20 organization. 21 (c) An officer or employee of an agency or facility 22 providing care or treatment to persons with mental illness. 23 DIVISION II 24 CHILD FOSTER CARE 25 Sec. 3. Section 232.78, subsection 8, paragraph a, 26 subparagraph (4), Code 2025, is amended to read as follows: 27 (4) An individual licensed to provide foster care pursuant 28 to licensee under chapter 237 . If the child is placed with 29 a licensed foster care provider an individual licensee , the 30 department shall assign decision-making authority to the foster 31 care provider individual licensee for the purpose of applying 32 the reasonable and prudent parent standard during the child’s 33 placement. 34 Sec. 4. Section 232.95, subsection 2, paragraph c, 35 -1- LSB 1459XD (3) 91 dg/ko 1/ 17

S.F. _____ H.F. _____ subparagraph (4), Code 2025, is amended to read as follows: 1 (4) An individual licensed to provide foster care pursuant 2 to licensee under chapter 237 . If the child is placed with 3 a licensed foster care provider an individual licensee , the 4 department shall assign decision-making authority to the foster 5 care provider individual licensee for the purpose of applying 6 the reasonable and prudent parent standard during the child’s 7 placement. 8 Sec. 5. Section 232.102, subsection 1, paragraph a, 9 subparagraph (4), Code 2025, is amended to read as follows: 10 (4) An individual licensed licensee under to provide foster 11 care pursuant to chapter 237 . If the child is placed with 12 a licensed foster care provider an individual licensee , the 13 department shall assign decision-making authority to the foster 14 care provider individual licensee for the purpose of applying 15 the reasonable and prudent parent standard during the child’s 16 placement. 17 Sec. 6. Section 234.1, subsection 1, paragraph a, 18 subparagraphs (1) and (2), Code 2025, are amended to read as 19 follows: 20 (1) After reaching eighteen years of age, the person has 21 remained continuously and voluntarily under the care of an 22 individual , as defined in section 237.1 , licensed to provide 23 foster care pursuant to licensee under chapter 237 , or in a 24 supervised apartment living arrangement, in this state. 25 (2) The person aged out of foster care after reaching 26 eighteen years of age and subsequently voluntarily applied for 27 placement with an individual , as defined in section 237.1 , 28 licensed to provide foster care pursuant to licensee under 29 chapter 237 , or for placement in a supervised apartment living 30 arrangement, in this state. 31 Sec. 7. Section 234.39, subsection 2, paragraph b, Code 32 2025, is amended to read as follows: 33 b. This subsection Paragraph “a” shall not apply when a 34 child is placed with a relative or fictive kin as those terms 35 -2- LSB 1459XD (3) 91 dg/ko 2/ 17

S.F. _____ H.F. _____ are defined in section 232.2 , who is not licensed under chapter 1 237 to provide child foster care unless the relative or fictive 2 kin is a licensee under chapter 237 . 3 Sec. 8. Section 237.1, subsection 3, unnumbered paragraph 4 1, Code 2025, is amended to read as follows: 5 “Child foster care” means the provision of parental 6 nurturing, including but not limited to the furnishing of food, 7 lodging, training, education, supervision, treatment, or other 8 care, to a child on a full-time basis by a person, including 9 a relative or fictive kin of the child if the relative or 10 fictive kin is licensed under this chapter , but not including a 11 guardian of the child. “Child foster care” does not include any 12 of the following care situations: 13 Sec. 9. Section 237.1, subsection 3, paragraph f, Code 2025, 14 is amended to read as follows: 15 f. Care furnished by a relative or fictive kin of a child 16 or an individual person with a meaningful relationship with 17 the child where the child is not under the placement, care, or 18 supervision of the department. 19 Sec. 10. Section 237.1, Code 2025, is amended by adding the 20 following new subsection: 21 NEW SUBSECTION . 6A. “Fictive kin” means an adult person 22 who is not a relative of a child but who has an emotionally 23 positive significant relationship with the child or the child’s 24 family. 25 Sec. 11. Section 237.1, subsections 8 and 9, Code 2025, are 26 amended to read as follows: 27 8. “Licensee” means an individual or an agency licensed 28 under this chapter , or an individual who has been approved by 29 the department to provide child foster care . 30 9. “Reasonable and prudent parent standard” means the 31 standard characterized by careful and sensible parenting 32 decisions that maintain the health, safety, and best interests 33 of a child, while at the same time encouraging the emotional 34 and developmental growth of a child, that a caregiver shall 35 -3- LSB 1459XD (3) 91 dg/ko 3/ 17

S.F. _____ H.F. _____ use when determining whether to allow a child in foster care 1 under the placement, care, or supervision of the department to 2 participate in extracurricular, enrichment, cultural, or social 3 activities. For the purposes of this subsection , “caregiver” 4 means an individual or an agency licensed under this chapter a 5 licensee with which a child in foster care has been placed or a 6 juvenile shelter care home approved under chapter 232 in which 7 a child in foster care has been placed. 8 Sec. 12. Section 237.2, Code 2025, is amended to read as 9 follows: 10 237.2 Purpose. 11 It is the policy of this state to provide appropriate 12 protection for children who are separated from the direct 13 personal care of their parents, relatives, fictive kin, or 14 guardians and, as a result, are subject to difficulty in 15 achieving appropriate physical, mental, emotional, educational, 16 or social development. This chapter shall be construed and 17 administered to further that policy by assuring that child 18 foster care is adequately provided by competently staffed and 19 well-equipped child foster care facilities, including but not 20 limited to residential treatment centers, group homes, and 21 foster family homes. 22 Sec. 13. Section 237.3, subsection 10, Code 2025, is amended 23 to read as follows: 24 10. The department shall adopt rules to administer the 25 exception to the definition of child care in section 237A.1, 26 subsection 2 , paragraph “l” , allowing a child care facility, for 27 purposes of providing respite care to a foster family home, to 28 provide care, supervision, or guidance of a child for a period 29 of twenty-four hours or more who is placed with the licensed 30 foster family home. 31 Sec. 14. Section 237.4, unnumbered paragraph 1, Code 2025, 32 is amended to read as follows: 33 An individual or an agency , as defined in section 237.1 , 34 shall not provide child foster care unless the individual 35 -4- LSB 1459XD (3) 91 dg/ko 4/ 17

S.F. _____ H.F. _____ or agency obtains a license issued under this chapter is a 1 licensee . However, a license is not required of the following 2 are not required to be a licensee : 3 Sec. 15. Section 237.4, subsection 8, Code 2025, is amended 4 to read as follows: 5 8. An individual providing child care as a babysitter at the 6 request of a parent, guardian , fictive kin, or relative having 7 lawful custody of the child. 8 Sec. 16. Section 237.6, Code 2025, is amended to read as 9 follows: 10 237.6 Restricted use of facility. 11 A An agency licensee shall not furnish child foster care 12 in a building or on premises not designated in the license. 13 A licensee shall not furnish child foster care to a greater 14 number of children than is designated in the license, unless 15 authorized by the department. Multiple licenses authorizing 16 separate and distinct parts of a facility to provide different 17 categories of child foster care may be issued. 18 Sec. 17. Section 237.9, Code 2025, is amended to read as 19 follows: 20 237.9 Confidential information. 21 A person who receives information from or through the 22 department concerning a child who has received or is receiving 23 child foster care, a relative or guardian of the child, a 24 single-family, home licensee, or an individual employee of 25 a licensee, shall not disclose that information directly or 26 indirectly, except as authorized by section 217.30 , or as 27 authorized or required by section 232.69 . if the information 28 concerns any of the following: 29 1. A child who has received or is receiving child foster 30 care. 31 2. A relative of a child who has received or is receiving 32 child foster care. 33 3. A guardian of a child who has received or is receiving 34 child foster care. 35 -5- LSB 1459XD (3) 91 dg/ko 5/ 17

S.F. _____ H.F. _____ 4. A fictive kin of a child who has received or is receiving 1 child foster care. 2 5. An individual licensee. 3 6. An employee of a licensee. 4 Sec. 18. Section 237.11, Code 2025, is amended to read as 5 follows: 6 237.11 Penalty. 7 An individual or an agency who provides child foster care 8 without obtaining a license under this chapter , or approval 9 from the department to provide child foster care, or who 10 knowingly violates this chapter or the rules promulgated 11 pursuant to this chapter is guilty of a serious misdemeanor. 12 Sec. 19. Section 237.12, Code 2025, is amended to read as 13 follows: 14 237.12 Injunctive relief. 15 An individual or an agency who provides child foster care 16 without obtaining a license under this chapter , or approval 17 from the department to provide child foster care, or who 18 knowingly violates this chapter or the rules promulgated 19 pursuant to this chapter may be temporarily or permanently 20 enjoined by a court in an action brought by the state, a 21 political subdivision of the state or an interested person. 22 Sec. 20. Section 237.13, subsection 1, Code 2025, is amended 23 to read as follows: 24 1. For the purposes of this section , “foster home” means an 25 individual , as defined in section 237.1, subsection 7 , who is 26 licensed to provide child foster care and shall also be known 27 as a “licensed foster home” licensee . 28 Sec. 21. Section 237.15, subsection 1, paragraph a, Code 29 2025, is amended to read as follows: 30 a. The efforts to place the child with a relative or fictive 31 kin . 32 Sec. 22. Section 237.15, subsection 5, Code 2025, is amended 33 by striking the subsection. 34 Sec. 23. Section 237A.3A, subsection 1, paragraph d, Code 35 -6- LSB 1459XD (3) 91 dg/ko 6/ 17

S.F. _____ H.F. _____ 2025, is amended to read as follows: 1 d. A person who holds a child foster care license licensee 2 under chapter 237 shall register as a child development home 3 provider in order to provide child care. 4 Sec. 24. Section 423.3, subsection 18, paragraph b, Code 5 2025, is amended to read as follows: 6 b. Residential facilities licensed by the department of 7 health and human services pursuant to chapter 237 , other than 8 those maintained by individuals as defined in section 237.1 , 9 subsection 7 . 10 DIVISION III 11 CHILD AND DEPENDENT ADULT ABUSE 12 Sec. 25. Section 22.7, Code 2025, is amended by adding the 13 following new subsections: 14 NEW SUBSECTION . 76. Child abuse information as defined in 15 section 235A.13. 16 NEW SUBSECTION . 77. Information obtained in the course 17 of an assessment or evaluation of a report of dependent adult 18 abuse under chapter 235B. 19 Sec. 26. Section 235A.1, subsection 1, paragraph b, Code 20 2025, is amended to read as follows: 21 b. Funds for the programs or projects shall be applied 22 for and received by a community-based volunteer coalition or 23 council entity . 24 Sec. 27. Section 235A.15, subsection 1, Code 2025, is 25 amended to read as follows: 26 1. Notwithstanding Subject to chapter 22 , the 27 confidentiality of all child abuse information shall be 28 maintained, except as specifically provided by this section . 29 Sec. 28. Section 235B.2, subsection 5, paragraph a, 30 subparagraph (1), subparagraph division (c), Code 2025, is 31 amended to read as follows: 32 (c) Exploitation of a dependent adult which means the act 33 or process of taking unfair advantage of a dependent adult 34 or the adult’s physical or financial resources, without the 35 -7- LSB 1459XD (3) 91 dg/ko 7/ 17

S.F. _____ H.F. _____ informed consent of the dependent adult, including theft, by 1 the use of undue influence, harassment, duress, deception, 2 false representation, or false pretenses . 3 Sec. 29. Section 235B.2, subsection 5, paragraph a, 4 subparagraphs (3) and (4), Code 2025, are amended to read as 5 follows: 6 (3) (a) Sexual exploitation of a dependent adult by a 7 caretaker. 8 (b) “Sexual exploitation” means any consensual or 9 nonconsensual sexual conduct with a dependent adult which 10 includes but is not limited to kissing; touching of the clothed 11 or unclothed inner thigh, breast, groin, buttock, anus, pubes, 12 or genitals; or a sex act, as defined in section 702.17 . 13 “Sexual exploitation” includes the transmission, display, taking 14 of electronic images of the unclothed breast, groin, buttock, 15 anus, pubes, or genitals of a dependent adult by a caretaker 16 for a purpose not related to treatment or diagnosis or as 17 part of an ongoing assessment, evaluation, or investigation. 18 Sexual exploitation does not include touching which is part 19 of a necessary examination, treatment, or care by a caretaker 20 acting within the scope of the practice or employment of the 21 caretaker; the exchange of a brief touch or hug between the 22 dependent adult and a caretaker for the purpose of reassurance, 23 comfort, or casual friendship; or touching between spouses. 24 (4) (a) Personal degradation of a dependent adult by a 25 caretaker. 26 (b) (i) “Personal degradation” means a willful act or 27 statement by a caretaker intended to shame, degrade, humiliate, 28 or otherwise harm the personal dignity of a dependent adult, or 29 where the caretaker knew or reasonably should have known the 30 act or statement would cause shame, degradation, humiliation, 31 or harm to the personal dignity of a reasonable person. 32 “Personal degradation” includes the taking, transmission, 33 or display of an electronic image of a dependent adult by a 34 caretaker, where the caretaker’s actions constitute a willful 35 -8- LSB 1459XD (3) 91 dg/ko 8/ 17

S.F. _____ H.F. _____ act or statement intended to shame, degrade, humiliate, or 1 otherwise harm the personal dignity of the dependent adult, or 2 where the caretaker knew or reasonably should have known the 3 act would cause shame, degradation, humiliation, or harm to the 4 personal dignity of a reasonable person. 5 (ii) “Personal degradation” does not include any of the 6 following: 7 (A) The taking, transmission, or display of an electronic 8 image of a dependent adult for the purpose of reporting 9 dependent adult abuse to law enforcement, the department, 10 or any other regulatory agency that oversees caretakers or 11 enforces abuse or neglect provisions, or for the purpose of 12 treatment or diagnosis or as part of an ongoing investigation. 13 (B) The taking, transmission, or display of an electronic 14 image by a caretaker who takes, transmits, or displays the 15 electronic image in accordance with the confidentiality policy 16 and release of information or consent policies of a contractor, 17 employer, or facility or program not covered under section 18 235E.1, subsection 5 , paragraph “a” , subparagraph (3). 19 (C) A statement by a caretaker who is the spouse of a 20 dependent adult that is not intended to shame, degrade, 21 humiliate, or otherwise harm the personal dignity of the 22 dependent adult spouse. 23 Sec. 30. Section 235B.2, Code 2025, is amended by adding the 24 following new subsections: 25 NEW SUBSECTION . 7A. “Exploitation of a dependent adult” 26 means a fraudulent, illegal, unauthorized, or otherwise 27 improper act or process of an individual, including a caregiver 28 or a fiduciary, that results in any of the following: 29 a. Use of a dependent adult’s resources for the financial or 30 personal benefit, profit, or gain of a person other than the 31 dependent adult. 32 b. Deprivation of a dependent adult’s rightful access to or 33 use of the dependent adult’s benefits, resources, belongings, 34 or assets. 35 -9- LSB 1459XD (3) 91 dg/ko 9/ 17

S.F. _____ H.F. _____ NEW SUBSECTION . 12A. “Personal degradation” means a 1 willful act or statement by a caretaker intended to shame, 2 degrade, humiliate, or otherwise harm the personal dignity of 3 a dependent adult, or where the caretaker knew or reasonably 4 should have known the act or statement would cause shame, 5 degradation, humiliation, or harm to the personal dignity of a 6 reasonable person. 7 a. “Personal degradation” includes the taking, transmission, 8 or display of an electronic image of a dependent adult by a 9 caretaker, where the caretaker’s actions constitute a willful 10 act or statement intended to shame, degrade, humiliate, or 11 otherwise harm the personal dignity of the dependent adult, or 12 where the caretaker knew or reasonably should have known the 13 act would cause shame, degradation, humiliation, or harm to the 14 personal dignity of a reasonable person. 15 b. “Personal degradation” does not include any of the 16 following: 17 (1) The taking, transmission, or display of an electronic 18 image of a dependent adult for the purpose of reporting 19 dependent adult abuse to law enforcement, the department, 20 or any other regulatory agency that oversees caretakers or 21 enforces abuse or neglect provisions, or for the purpose of 22 treatment or diagnosis or as part of an ongoing investigation. 23 (2) The taking, transmission, or display of an electronic 24 image by a caretaker who takes, transmits, or displays the 25 electronic image in accordance with the confidentiality policy 26 and release of information or consent policies of a facility 27 as defined in section 235E.1. 28 (3) A statement by a caretaker who is the spouse of a 29 dependent adult that is not intended to shame, degrade, 30 humiliate, or otherwise harm the personal dignity of the 31 dependent adult spouse. 32 NEW SUBSECTION . 14A. a. “Sexual exploitation” means any 33 consensual or nonconsensual sexual conduct with a dependent 34 adult which includes but is not limited to any of the 35 -10- LSB 1459XD (3) 91 dg/ko 10/ 17

S.F. _____ H.F. _____ following: 1 (1) Kissing. 2 (2) Touching of the clothed or unclothed inner thigh, 3 breast, groin, buttock, anus, pubes, or genitals. 4 (3) A sex act, as defined in section 702.17. 5 b. “Sexual exploitation” includes but is not limited to 6 the transmission, display, taking of electronic images of the 7 unclothed breast, groin, buttock, anus, pubes, or genitals of 8 a dependent adult by a caretaker for a purpose not related to 9 treatment or diagnosis or as part of an ongoing assessment, 10 evaluation, or investigation. 11 c. “Sexual exploitation” does not include any of the 12 following: 13 (1) Touching which is part of a necessary examination, 14 treatment, or care by a caretaker acting within the scope of 15 the practice or employment of the caretaker. 16 (2) The exchange of a brief touch or hug between the 17 dependent adult and a caretaker for the purpose of reassurance, 18 comfort, or casual friendship. 19 (3) Touching between spouses. 20 Sec. 31. Section 235B.3, subsection 7, Code 2025, is amended 21 to read as follows: 22 7. a. Upon a showing of probable cause that a dependent 23 adult has been abused, a court may authorize a person, also 24 authorized by the department, to make an evaluation, to enter 25 the residence of, and to examine the dependent adult. 26 b. Upon a showing of probable cause that a dependent adult 27 there has been financially exploited financial exploitation 28 of a dependent adult , a court may authorize a person, also 29 authorized by the department, to make an evaluation, and to 30 gain access to the financial records that the department 31 reasonably believes are related to the financial resources of 32 the dependent adult. 33 Sec. 32. Section 235B.6, subsection 1, Code 2025, is amended 34 to read as follows: 35 -11- LSB 1459XD (3) 91 dg/ko 11/ 17

S.F. _____ H.F. _____ 1. Notwithstanding Subject to chapter 22 , the 1 confidentiality of all dependent adult abuse information shall 2 be maintained, except as specifically provided by subsections 2 3 and 3 . 4 Sec. 33. Section 235B.6, subsection 2, paragraph e, 5 subparagraph (2), Code 2025, is amended to read as follows: 6 (2) Registry or department personnel when necessary to 7 the performance of their official duties , or a person , an 8 instrumentality of the state, or an agency under contract with 9 the department to carry out official duties and functions of 10 the registry. 11 Sec. 34. Section 249A.4, Code 2025, is amended by adding the 12 following new subsection: 13 NEW SUBSECTION . 16. Require providers to share information 14 with the department as necessary to identify, prevent, or 15 respond to child abuse as defined in section 232.68, and 16 dependent adult abuse as defined in section 235B.2. 17 DIVISION IV 18 DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CONFIDENTIALITY OF 19 INTERNAL AUDIT AND EXAMINATION INFORMATION 20 Sec. 35. Section 11.41, subsection 4, paragraph a, Code 21 2025, is amended by adding the following new subparagraph: 22 NEW SUBPARAGRAPH . (10) Information, including workpapers, 23 created or received by the department of health and human 24 services while conducting an internal audit or examination 25 relating to an allegation of misconduct or noncompliance. 26 Sec. 36. Section 22.7, Code 2025, is amended by adding the 27 following new subsection: 28 NEW SUBSECTION . 24. a. Information, including workpapers, 29 created or received by the department of health and human 30 services while conducting an internal audit or examination 31 relating to an allegation of misconduct or noncompliance. 32 b. The department of health and human services may disclose 33 the information kept confidential under paragraph “a” as 34 necessary to complete an audit or examination, to comply with 35 -12- LSB 1459XD (3) 91 dg/ko 12/ 17

S.F. _____ H.F. _____ a state or federal law, or to allow a representative of the 1 department of health and human services to testify in court. 2 c. Information kept confidential under paragraph “a” shall 3 become a public record upon completion of the internal audit or 4 examination to which the information and workpapers pertain. 5 DIVISION V 6 REGION INCENTIVE FUND —— DISTRIBUTIONS AND TRANSFERS 7 Sec. 37. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 8 BEHAVIORAL HEALTH SERVICES SYSTEM —— REGION INCENTIVE FUND. 9 1. For purposes of this section: 10 a. “Administrative services organization” means the same as 11 defined in 2024 Iowa Acts, chapter 1161, section 1. 12 b. “Behavioral health fund” means the behavioral health 13 fund established in 2024 Iowa Acts, chapter 1161, section 7, 14 subsection 2. 15 c. “Behavioral health services system” means the behavioral 16 health services system established in 2024 Iowa Acts, chapter 17 1161, section 3, subsection 1. 18 d. “Mental health and disability services system” means 19 the mental health and disability services system described in 20 section 225C.6B. 21 2. Notwithstanding any provision of law to the contrary, 22 there is appropriated from the region incentive fund created 23 in section 225C.7A, subsection 8, to the department of health 24 and human services for the fiscal year beginning July 1, 2024, 25 and ending June 30, 2025, an amount necessary to ensure the 26 continuity of care for persons transferring services from the 27 mental health and disability services system to the behavioral 28 health services system, and to establish the behavioral health 29 services system. The department of health and human services 30 may distribute moneys appropriated under this subsection to 31 administrative services organizations to be used for expenses 32 related to the purposes described in this subsection. 33 3. Notwithstanding 2024 Iowa Acts, chapter 1161, section 34 7, subsection 5, moneys distributed to, and used by, 35 -13- LSB 1459XD (3) 91 dg/ko 13/ 17

S.F. _____ H.F. _____ administrative services organizations under subsection 2 shall 1 not count toward an administrative services organization’s 2 seven percent limit on administrative costs. 3 4. Moneys in the mental health and disability services 4 regional service fund established in section 225C.7A, 5 subsection 1, that remain unencumbered or unobligated on June 6 30, 2025, shall be transferred to the behavioral health fund. 7 Sec. 38. EFFECTIVE DATE. This division of this Act, being 8 deemed of immediate importance, takes effect upon enactment. 9 EXPLANATION 10 The inclusion of this explanation does not constitute agreement with 11 the explanation’s substance by the members of the general assembly. 12 This bill relates to matters under the purview of the 13 department of health and human services (HHS). 14 DIVISION I —— ADMINISTRATIVE SERVICES ORGANIZATIONS. The 15 bill excludes persons employed by an administrative services 16 organization (ASO) from the definition of an employee for the 17 purposes of the Iowa public employees’ retirement system. 18 The bill prohibits an ASO, or an officer or an employee 19 of an ASO, from acting as a county’s advocate to represent 20 the interests of patients involuntarily hospitalized by the 21 court in matters relating to a patient’s hospitalization or 22 treatment. 23 DIVISION II —— CHILD FOSTER CARE. Under current law, a 24 person’s periodic support payments pursuant to an order or 25 judgment are deemed assigned to HHS if the person is or has 26 a child receiving foster care services. The assignment does 27 not apply when a child is placed with a relative or fictive 28 kin of the child who is not licensed to provide child foster 29 care. The bill permits the assignment unless the relative or 30 fictive kin is not licensed to provide child foster care and 31 not approved by HHS to provide services as specified by HHS. 32 The bill includes within the Code chapter 237 (child foster 33 care facilities) definition of “licensee”, an individual who 34 has been approved by HHS to provide child foster care. 35 -14- LSB 1459XD (3) 91 dg/ko 14/ 17

S.F. _____ H.F. _____ The bill makes several changes to Code chapter 237 and to 1 Code sections 232.78 (temporary custody of a child pursuant to 2 ex parte court order), 232.98 (hearing concerning temporary 3 removal), 232.102 (transfer of legal custody of child and 4 placement), 234.1 (child and family services —— definitions), 5 234.39 (child and family services —— responsibility for costs 6 of services), 237A.3A (child development homes), and 423.3 7 (streamlined sales and use tax Act —— exemptions). 8 DIVISION III —— CHILD AND DEPENDENT ADULT ABUSE. The bill 9 makes child abuse information and information obtained in the 10 course of an assessment or evaluation of a report of dependent 11 adult abuse confidential records. 12 The bill allows a community-based entity to apply for and 13 receive funds appropriated to HHS by the general assembly 14 for child abuse prevention. Under current law, only a 15 community-based volunteer coalition or council can apply for 16 and receive such funds. 17 The bill defines “exploitation of a dependent adult” as a 18 fraudulent, illegal, unauthorized, or otherwise improper act or 19 process of an individual, including a caregiver or a fiduciary, 20 that results in the use of a dependent adult’s resources 21 for the financial or personal benefit, profit, or gain of a 22 person other than the dependent adult, or the deprivation of a 23 dependent adult’s rightful access to or use of the dependent 24 adult’s benefits, resources, belongings, or assets. 25 Under current law, upon a showing of probable cause that 26 a dependent adult has been financially exploited a court may 27 authorize a person, who is also authorized by HHS, to gain 28 access to the financial records of the dependent adult. The 29 bill amends the statute so the person authorized by the court 30 and HHS can gain access to financial records that HHS has a 31 reasonable belief are related to the financial resources of the 32 dependent adult. 33 The bill authorizes an instrumentality of the state to 34 access dependent adult abuse records if the instrumentality 35 -15- LSB 1459XD (3) 91 dg/ko 15/ 17

S.F. _____ H.F. _____ is under contract with HHS to carry out official duties and 1 functions of the dependent adult abuse registry. 2 The bill requires the director of HHS to require providers 3 under the medical assistance program to share information with 4 HHS as necessary to identify, prevent, or respond to child or 5 dependent adult abuse. 6 The bill makes conforming changes to Code section 235B.6 7 (dependent adult abuse services —— authorized access). 8 DIVISION IV —— DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 9 CONFIDENTIALITY OF INTERNAL AUDIT AND EXAMINATION INFORMATION. 10 The bill makes information, including workpapers, created 11 or received by HHS during an internal audit or examination 12 (information) confidential. HHS may disclose the information 13 as necessary to complete an audit or examination, to comply 14 with a state or federal law, or to allow an HHS representative 15 to testify in court. The information becomes public record 16 upon completion of the internal audit or examination to which 17 the information pertains. The bill also prevents the state 18 auditor from accessing the information except as required to 19 comply with the standards for engagement described in Code 20 section 11.3 (when audits and examinations begin), to comply 21 with state or federal regulations, or in case of alleged or 22 suspected embezzlement or theft. 23 DIVISION V —— REGION INCENTIVE FUND —— DISTRIBUTIONS AND 24 TRANSFERS. The bill appropriates from the region incentive 25 fund of the mental health and disability services regional 26 service fund to HHS for FY 2024-2025, an amount as necessary to 27 ensure the continuity of care for persons transferring services 28 from the mental health and disability services system to the 29 behavioral health services system (BHSS) and establish the 30 BHSS. The moneys may be distributed to and used by an ASO for 31 expenses related to the purposes described in the bill. The 32 moneys used by an ASO do not count toward the ASO’s 7 percent 33 limit on administrative costs. 34 The bill requires any unobligated and unencumbered moneys 35 -16- LSB 1459XD (3) 91 dg/ko 16/ 17