HSB 215 (LSB 1459XD (3) 91)

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 of health and human services, including administrative services organizations, child foster care, child and dependent adult abuse, internal audit and examination information, and the region incentive fund in the mental health and disability services regional service fund, and making an appropriation and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
ADMINISTRATIVE SERVICES ORGANIZATIONS

    Section 1.  Section 97B.1A, subsection 8, paragraph b, Code 2025, is amended by adding the following new subparagraph:
   NEW SUBPARAGRAPH.  (10)  Employees of an administrative services organization as defined in section 225A.1.
    Sec. 2.  Section 229.19, subsection 1, paragraph a, Code 2025, is amended by striking the paragraph and inserting in lieu thereof the following:
   a.  (1)  The board of supervisors of each county shall appoint an individual to act as an advocate representing the interests of patients involuntarily hospitalized by the court in matters relating to a patient’s hospitalization or treatment under section 229.14 or 229.15. The individual shall have prior experience advocating for or promoting the welfare and rehabilitation of persons with mental illness.
   (2)  A person appointed under this section shall not be any of the following:
   (a)  An officer or employee of the department.
   (b)  An officer or employee of an administrative services organization.
   (c)  An officer or employee of an agency or facility providing care or treatment to persons with mental illness.
DIVISION II
CHILD FOSTER CARE

    Sec. 3.  Section 232.78, subsection 8, paragraph a, subparagraph (4), Code 2025, is amended to read as follows:
   (4)  An individual licensed to provide foster care pursuant to licensee under chapter 237. If the child is placed with a licensed foster care provider an individual licensee, the department shall assign decision-making authority to the foster care provider individual licensee for the purpose of applying the reasonable and prudent parent standard during the child’s placement.
    Sec. 4.  Section 232.95, subsection 2, paragraph c, subparagraph (4), Code 2025, is amended to read as follows:
   (4)  An individual licensed to provide foster care pursuant to licensee under chapter 237. If the child is placed with a licensed foster care provider an individual licensee, the department shall assign decision-making authority to the foster care provider individual licensee for the purpose of applying the reasonable and prudent parent standard during the child’s placement.
    Sec. 5.  Section 232.102, subsection 1, paragraph a, subparagraph (4), Code 2025, is amended to read as follows:
   (4)  An individual licensed licensee under to provide foster care pursuant to chapter 237. If the child is placed with a licensed foster care provider an individual licensee, the department shall assign decision-making authority to the foster care provider individual licensee for the purpose of applying the reasonable and prudent parent standard during the child’s placement.
    Sec. 6.  Section 234.1, subsection 1, paragraph a, subparagraphs (1) and (2), Code 2025, are amended to read as follows:
   (1)  After reaching eighteen years of age, the person has remained continuously and voluntarily under the care of an individual, as defined in section 237.1, licensed to provide foster care pursuant to licensee under chapter 237, or in a supervised apartment living arrangement, in this state.
   (2)  The person aged out of foster care after reaching eighteen years of age and subsequently voluntarily applied for placement with an individual, as defined in section 237.1, licensed to provide foster care pursuant to licensee under chapter 237, or for placement in a supervised apartment living arrangement, in this state.
    Sec. 7.  Section 234.39, subsection 2, paragraph b, Code 2025, is amended to read as follows:
   b.  This subsection Paragraph “a” shall not apply when a child is placed with a relative or fictive kin as those terms are defined in section 232.2, who is not licensed under chapter 237 to provide child foster care unless the relative or fictive kin is a licensee under chapter 237.
    Sec. 8.  Section 237.1, subsection 3, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   “Child foster care” means the provision of parental nurturing, including but not limited to the furnishing of food, lodging, training, education, supervision, treatment, or other care, to a child on a full-time basis by a person, including a relative or fictive kin of the child if the relative or fictive kin is licensed under this chapter, but not including a guardian of the child. “Child foster care” does not include any of the following care situations:
    Sec. 9.  Section 237.1, subsection 3, paragraph f, Code 2025, is amended to read as follows:
   f.  Care furnished by a relative or fictive kin of a child or an individual person with a meaningful relationship with the child where the child is not under the placement, care, or supervision of the department.
    Sec. 10.  Section 237.1, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  6A.  “Fictive kin” means an adult person who is not a relative of a child but who has an emotionally positive significant relationship with the child or the child’s family.
    Sec. 11.  Section 237.1, subsections 8 and 9, Code 2025, are amended to read as follows:
   8.  “Licensee” means an individual or an agency licensed under this chapter, or an individual who has been approved by the department to provide child foster care.
   9.  “Reasonable and prudent parent standard” means the standard characterized by careful and sensible parenting decisions that maintain the health, safety, and best interests of a child, while at the same time encouraging the emotional and developmental growth of a child, that a caregiver shall use when determining whether to allow a child in foster care under the placement, care, or supervision of the department to participate in extracurricular, enrichment, cultural, or social activities. For the purposes of this subsection, “caregiver” means an individual or an agency licensed under this chapter a licensee with which a child in foster care has been placed or a juvenile shelter care home approved under chapter 232 in which a child in foster care has been placed.
    Sec. 12.  Section 237.2, Code 2025, is amended to read as follows:
   237.2  Purpose.
   It is the policy of this state to provide appropriate protection for children who are separated from the direct personal care of their parents, relatives, fictive kin, or guardians and, as a result, are subject to difficulty in achieving appropriate physical, mental, emotional, educational, or social development. This chapter shall be construed and administered to further that policy by assuring that child foster care is adequately provided by competently staffed and well-equipped child foster care facilities, including but not limited to residential treatment centers, group homes, and foster family homes.
    Sec. 13.  Section 237.3, subsection 10, Code 2025, is amended to read as follows:
   10.  The department shall adopt rules to administer the exception to the definition of child care in section 237A.1, subsection 2, paragraph “l”, allowing a child care facility, for purposes of providing respite care to a foster family home, to provide care, supervision, or guidance of a child for a period of twenty-four hours or more who is placed with the licensed foster family home.
    Sec. 14.  Section 237.4, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   An individual or an agency, as defined in section 237.1, shall not provide child foster care unless the individual or agency obtains a license issued under this chapter is a licensee. However, a license is not required of the following are not required to be a licensee:
    Sec. 15.  Section 237.4, subsection 8, Code 2025, is amended to read as follows:
   8.  An individual providing child care as a babysitter at the request of a parent, guardian, fictive kin, or relative having lawful custody of the child.
    Sec. 16.  Section 237.6, Code 2025, is amended to read as follows:
   237.6  Restricted use of facility.
   A An agency licensee shall not furnish child foster care in a building or on premises not designated in the license. A licensee shall not furnish child foster care to a greater number of children than is designated in the license, unless authorized by the department. Multiple licenses authorizing separate and distinct parts of a facility to provide different categories of child foster care may be issued.
    Sec. 17.  Section 237.9, Code 2025, is amended to read as follows:
   237.9  Confidential information.
   A person who receives information from or through the department concerning a child who has received or is receiving child foster care, a relative or guardian of the child, a single-family, home licensee, or an individual employee of a licensee, shall not disclose that information directly or indirectly, except as authorized by section 217.30, or as authorized or required by section 232.69. if the information concerns any of the following:
   1.  A child who has received or is receiving child foster care.
   2.  A relative of a child who has received or is receiving child foster care.
   3.  A guardian of a child who has received or is receiving child foster care.
   4.  A fictive kin of a child who has received or is receiving child foster care.
   5.  An individual licensee.
   6.  An employee of a licensee.
    Sec. 18.  Section 237.11, Code 2025, is amended to read as follows:
   237.11  Penalty.
   An individual or an agency who provides child foster care without obtaining a license under this chapter, or approval from the department to provide child foster care, or who knowingly violates this chapter or the rules promulgated pursuant to this chapter is guilty of a serious misdemeanor.
    Sec. 19.  Section 237.12, Code 2025, is amended to read as follows:
   237.12  Injunctive relief.
   An individual or an agency who provides child foster care without obtaining a license under this chapter, or approval from the department to provide child foster care, or who knowingly violates this chapter or the rules promulgated pursuant to this chapter may be temporarily or permanently enjoined by a court in an action brought by the state, a political subdivision of the state or an interested person.
    Sec. 20.  Section 237.13, subsection 1, Code 2025, is amended to read as follows:
   1.  For the purposes of this section, “foster home” means an individual, as defined in section 237.1, subsection 7, who is licensed to provide child foster care and shall also be known as a “licensed foster home” licensee.
    Sec. 21.  Section 237.15, subsection 1, paragraph a, Code 2025, is amended to read as follows:
   a.  The efforts to place the child with a relative or fictive kin.
    Sec. 22.  Section 237.15, subsection 5, Code 2025, is amended by striking the subsection.
    Sec. 23.  Section 237A.3A, subsection 1, paragraph d, Code 2025, is amended to read as follows:
   d.  A person who holds a child foster care license licensee under chapter 237 shall register as a child development home provider in order to provide child care.
    Sec. 24.  Section 423.3, subsection 18, paragraph b, Code 2025, is amended to read as follows:
   b.  Residential facilities licensed by the department of health and human services pursuant to chapter 237, other than those maintained by individuals as defined in section 237.1, subsection 7.
DIVISION III
CHILD AND DEPENDENT ADULT ABUSE

    Sec. 25.  Section 22.7, Code 2025, is amended by adding the following new subsections:
   NEW SUBSECTION.  76.  Child abuse information as defined in section 235A.13.
   NEW SUBSECTION.  77.  Information obtained in the course of an assessment or evaluation of a report of dependent adult abuse under chapter 235B.
    Sec. 26.  Section 235A.1, subsection 1, paragraph b, Code 2025, is amended to read as follows:
   b.  Funds for the programs or projects shall be applied for and received by a community-based volunteer coalition or council entity.
    Sec. 27.  Section 235A.15, subsection 1, Code 2025, is amended to read as follows:
   1.  Notwithstanding Subject to chapter 22, the confidentiality of all child abuse information shall be maintained, except as specifically provided by this section.
    Sec. 28.  Section 235B.2, subsection 5, paragraph a, subparagraph (1), subparagraph division (c), Code 2025, is amended to read as follows:
   (c)  Exploitation of a dependent adult which means the act or process of taking unfair advantage of a dependent adult or the adult’s physical or financial resources, without the informed consent of the dependent adult, including theft, by the use of undue influence, harassment, duress, deception, false representation, or false pretenses.
    Sec. 29.  Section 235B.2, subsection 5, paragraph a, subparagraphs (3) and (4), Code 2025, are amended to read as follows:
   (3)  (a)  Sexual exploitation of a dependent adult by a caretaker.
   (b)  “Sexual exploitation” means any consensual or nonconsensual sexual conduct with a dependent adult which includes but is not limited to kissing; touching of the clothed or unclothed inner thigh, breast, groin, buttock, anus, pubes, or genitals; or a sex act, as defined in section 702.17. “Sexual exploitation” includes the transmission, display, taking of electronic images of the unclothed breast, groin, buttock, anus, pubes, or genitals of a dependent adult by a caretaker for a purpose not related to treatment or diagnosis or as part of an ongoing assessment, evaluation, or investigation. Sexual exploitation does not include touching which is part of a necessary examination, treatment, or care by a caretaker acting within the scope of the practice or employment of the caretaker; the exchange of a brief touch or hug between the dependent adult and a caretaker for the purpose of reassurance, comfort, or casual friendship; or touching between spouses.
   (4)  (a)  Personal degradation of a dependent adult by a caretaker.
   (b)  (i)  “Personal degradation” means a willful act or statement by a caretaker intended to shame, degrade, humiliate, or otherwise harm the personal dignity of a dependent adult, or where the caretaker knew or reasonably should have known the act or statement would cause shame, degradation, humiliation, or harm to the personal dignity of a reasonable person. “Personal degradation” includes the taking, transmission, or display of an electronic image of a dependent adult by a caretaker, where the caretaker’s actions constitute a willful act or statement intended to shame, degrade, humiliate, or otherwise harm the personal dignity of the dependent adult, or where the caretaker knew or reasonably should have known the act would cause shame, degradation, humiliation, or harm to the personal dignity of a reasonable person. 
   (ii)  “Personal degradation” does not include any of the following:
   (A)  The taking, transmission, or display of an electronic image of a dependent adult for the purpose of reporting dependent adult abuse to law enforcement, the department, or any other regulatory agency that oversees caretakers or enforces abuse or neglect provisions, or for the purpose of treatment or diagnosis or as part of an ongoing investigation.
   (B)  The taking, transmission, or display of an electronic image by a caretaker who takes, transmits, or displays the electronic image in accordance with the confidentiality policy and release of information or consent policies of a contractor, employer, or facility or program not covered under section 235E.1, subsection 5, paragraph “a”, subparagraph (3).
   (C)  A statement by a caretaker who is the spouse of a dependent adult that is not intended to shame, degrade, humiliate, or otherwise harm the personal dignity of the dependent adult spouse.
    Sec. 30.  Section 235B.2, Code 2025, is amended by adding the following new subsections:
   NEW SUBSECTION.  7A.  “Exploitation of a dependent adult” means a fraudulent, illegal, unauthorized, or otherwise improper act or process of an individual, including a caregiver or a fiduciary, that results in any of the following:
   a.  Use of a dependent adult’s resources for the financial or personal benefit, profit, or gain of a person other than the dependent adult.
   b.  Deprivation of a dependent adult’s rightful access to or use of the dependent adult’s benefits, resources, belongings, or assets.
   NEW SUBSECTION.  12A.  “Personal degradation” means a willful act or statement by a caretaker intended to shame, degrade, humiliate, or otherwise harm the personal dignity of a dependent adult, or where the caretaker knew or reasonably should have known the act or statement would cause shame, degradation, humiliation, or harm to the personal dignity of a reasonable person.
   a.  “Personal degradation” includes the taking, transmission, or display of an electronic image of a dependent adult by a caretaker, where the caretaker’s actions constitute a willful act or statement intended to shame, degrade, humiliate, or otherwise harm the personal dignity of the dependent adult, or where the caretaker knew or reasonably should have known the act would cause shame, degradation, humiliation, or harm to the personal dignity of a reasonable person.
   b.  “Personal degradation” does not include any of the following:
   (1)  The taking, transmission, or display of an electronic image of a dependent adult for the purpose of reporting dependent adult abuse to law enforcement, the department, or any other regulatory agency that oversees caretakers or enforces abuse or neglect provisions, or for the purpose of treatment or diagnosis or as part of an ongoing investigation.
   (2)  The taking, transmission, or display of an electronic image by a caretaker who takes, transmits, or displays the electronic image in accordance with the confidentiality policy and release of information or consent policies of a facility as defined in section 235E.1.
   (3)  A statement by a caretaker who is the spouse of a dependent adult that is not intended to shame, degrade, humiliate, or otherwise harm the personal dignity of the dependent adult spouse.
   NEW SUBSECTION.  14A.  a.  “Sexual exploitation” means any consensual or nonconsensual sexual conduct with a dependent adult which includes but is not limited to any of the following:
   (1)  Kissing.
   (2)  Touching of the clothed or unclothed inner thigh, breast, groin, buttock, anus, pubes, or genitals.
   (3)  A sex act, as defined in section 702.17.
   b.  “Sexual exploitation” includes but is not limited to the transmission, display, taking of electronic images of the unclothed breast, groin, buttock, anus, pubes, or genitals of a dependent adult by a caretaker for a purpose not related to treatment or diagnosis or as part of an ongoing assessment, evaluation, or investigation.
   c.  “Sexual exploitation” does not include any of the following:
   (1)  Touching which is part of a necessary examination, treatment, or care by a caretaker acting within the scope of the practice or employment of the caretaker.
   (2)  The exchange of a brief touch or hug between the dependent adult and a caretaker for the purpose of reassurance, comfort, or casual friendship.
   (3)  Touching between spouses.
    Sec. 31.  Section 235B.3, subsection 7, Code 2025, is amended to read as follows:
   7.  a.  Upon a showing of probable cause that a dependent adult has been abused, a court may authorize a person, also authorized by the department, to make an evaluation, to enter the residence of, and to examine the dependent adult.
   b.  Upon a showing of probable cause that a dependent adult there has been financially exploited financial exploitation of a dependent adult, a court may authorize a person, also authorized by the department, to make an evaluation, and to gain access to the financial records that the department reasonably believes are related to the financial resources of the dependent adult.
    Sec. 32.  Section 235B.6, subsection 1, Code 2025, is amended to read as follows:
   1.  Notwithstanding Subject to chapter 22, the confidentiality of all dependent adult abuse information shall be maintained, except as specifically provided by subsections 2 and 3.
    Sec. 33.  Section 235B.6, subsection 2, paragraph e, subparagraph (2), Code 2025, is amended to read as follows:
   (2)  Registry or department personnel when necessary to the performance of their official duties, or a person, an instrumentality of the state, or an agency under contract with the department to carry out official duties and functions of the registry.
    Sec. 34.  Section 249A.4, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  16.  Require providers to share information with the department as necessary to identify, prevent, or respond to child abuse as defined in section 232.68, and dependent adult abuse as defined in section 235B.2.
DIVISION IV
DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CONFIDENTIALITY OF INTERNAL AUDIT AND EXAMINATION INFORMATION

    Sec. 35.  Section 11.41, subsection 4, paragraph a, Code 2025, is amended by adding the following new subparagraph:
   NEW SUBPARAGRAPH.  (10)  Information, including workpapers, created or received by the department of health and human services while conducting an internal audit or examination relating to an allegation of misconduct or noncompliance.
    Sec. 36.  Section 22.7, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  24.  a.  Information, including workpapers, created or received by the department of health and human services while conducting an internal audit or examination relating to an allegation of misconduct or noncompliance.
   b.  The department of health and human services may disclose the information kept confidential under paragraph “a” as necessary to complete an audit or examination, to comply with a state or federal law, or to allow a representative of the department of health and human services to testify in court.
   c.  Information kept confidential under paragraph “a” shall become a public record upon completion of the internal audit or examination to which the information and workpapers pertain.
DIVISION V
REGION INCENTIVE FUND —— DISTRIBUTIONS AND TRANSFERS

    Sec. 37.  DEPARTMENT OF HEALTH AND HUMAN SERVICES —— BEHAVIORAL HEALTH SERVICES SYSTEM —— REGION INCENTIVE FUND.
   1.  For purposes of this section:
   a.  “Administrative services organization” means the same as defined in 2024 Iowa Acts, chapter 1161, section 1.
   b.  “Behavioral health fund” means the behavioral health fund established in 2024 Iowa Acts, chapter 1161, section 7, subsection 2.
   c.  “Behavioral health services system” means the behavioral health services system established in 2024 Iowa Acts, chapter 1161, section 3, subsection 1.
   d.  “Mental health and disability services system” means the mental health and disability services system described in section 225C.6B.
   2.  Notwithstanding any provision of law to the contrary, there is appropriated from the region incentive fund created in section 225C.7A, subsection 8, to the department of health and human services for the fiscal year beginning July 1, 2024, and ending June 30, 2025, an amount necessary to ensure the continuity of care for persons transferring services from the mental health and disability services system to the behavioral health services system, and to establish the behavioral health services system. The department of health and human services may distribute moneys appropriated under this subsection to administrative services organizations to be used for expenses related to the purposes described in this subsection.
   3.  Notwithstanding 2024 Iowa Acts, chapter 1161, section 7, subsection 5, moneys distributed to, and used by, administrative services organizations under subsection 2 shall not count toward an administrative services organization’s seven percent limit on administrative costs.
   4.  Moneys in the mental health and disability services regional service fund established in section 225C.7A, subsection 1, that remain unencumbered or unobligated on June 30, 2025, shall be transferred to the behavioral health fund.
    Sec. 38.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to matters under the purview of the department of health and human services (HHS).
   DIVISION I —— ADMINISTRATIVE SERVICES ORGANIZATIONS. The bill excludes persons employed by an administrative services organization (ASO) from the definition of an employee for the purposes of the Iowa public employees’ retirement system.
   The bill prohibits an ASO, or an officer or an employee of an ASO, from acting as a county’s advocate to represent the interests of patients involuntarily hospitalized by the court in matters relating to a patient’s hospitalization or treatment.
   DIVISION II —— CHILD FOSTER CARE. Under current law, a person’s periodic support payments pursuant to an order or judgment are deemed assigned to HHS if the person is or has a child receiving foster care services. The assignment does not apply when a child is placed with a relative or fictive kin of the child who is not licensed to provide child foster care. The bill permits the assignment unless the relative or fictive kin is not licensed to provide child foster care and not approved by HHS to provide services as specified by HHS.
   The bill includes within the Code chapter 237 (child foster care facilities) definition of “licensee”, an individual who has been approved by HHS to provide child foster care.
   The bill makes several changes to Code chapter 237 and to Code sections 232.78 (temporary custody of a child pursuant to ex parte court order), 232.98 (hearing concerning temporary removal), 232.102 (transfer of legal custody of child and placement), 234.1 (child and family services —— definitions), 234.39 (child and family services —— responsibility for costs of services), 237A.3A (child development homes), and 423.3 (streamlined sales and use tax Act —— exemptions).
   DIVISION III —— CHILD AND DEPENDENT ADULT ABUSE. The bill makes child abuse information and information obtained in the course of an assessment or evaluation of a report of dependent adult abuse confidential records.
   The bill allows a community-based entity to apply for and receive funds appropriated to HHS by the general assembly for child abuse prevention. Under current law, only a community-based volunteer coalition or council can apply for and receive such funds.
   The bill defines “exploitation of a dependent adult” as a fraudulent, illegal, unauthorized, or otherwise improper act or process of an individual, including a caregiver or a fiduciary, that results in the use of a dependent adult’s resources for the financial or personal benefit, profit, or gain of a person other than the dependent adult, or the deprivation of a dependent adult’s rightful access to or use of the dependent adult’s benefits, resources, belongings, or assets.
   Under current law, upon a showing of probable cause that a dependent adult has been financially exploited a court may authorize a person, who is also authorized by HHS, to gain access to the financial records of the dependent adult. The bill amends the statute so the person authorized by the court and HHS can gain access to financial records that HHS has a reasonable belief are related to the financial resources of the dependent adult.
   The bill authorizes an instrumentality of the state to access dependent adult abuse records if the instrumentality is under contract with HHS to carry out official duties and functions of the dependent adult abuse registry.
   The bill requires the director of HHS to require providers under the medical assistance program to share information with HHS as necessary to identify, prevent, or respond to child or dependent adult abuse.
   The bill makes conforming changes to Code section 235B.6 (dependent adult abuse services —— authorized access).
   DIVISION IV —— DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CONFIDENTIALITY OF INTERNAL AUDIT AND EXAMINATION INFORMATION.  The bill makes information, including workpapers, created or received by HHS during an internal audit or examination (information) confidential. HHS may disclose the information as necessary to complete an audit or examination, to comply with a state or federal law, or to allow an HHS representative to testify in court. The information becomes public record upon completion of the internal audit or examination to which the information pertains. The bill also prevents the state auditor from accessing the information except as required to comply with the standards for engagement described in Code section 11.3 (when audits and examinations begin), to comply with state or federal regulations, or in case of alleged or suspected embezzlement or theft.
   DIVISION V —— REGION INCENTIVE FUND —— DISTRIBUTIONS AND TRANSFERS. The bill appropriates from the region incentive fund of the mental health and disability services regional service fund to HHS for FY 2024-2025, an amount as necessary to ensure the continuity of care for persons transferring services from the mental health and disability services system to the behavioral health services system (BHSS) and establish the BHSS. The moneys may be distributed to and used by an ASO for expenses related to the purposes described in the bill. The moneys used by an ASO do not count toward the ASO’s 7 percent limit on administrative costs.
   The bill requires any unobligated and unencumbered moneys remaining in the mental health and disability services regional service fund on June 30, 2025, to be transferred to the behavioral health fund.
   This division of the bill is effective upon enactment.