S.F. _____ H.F. _____ DIVISION I 1 HEALTH AND HUMAN SERVICES DISTRICTS 2 Section 1. Section 12.51, subsection 1, Code 2026, is 3 amended to read as follows: 4 1. As used in this section unless the context otherwise 5 requires: 6 a. “Administrative services organization” means the same as 7 defined in section 225A.1 . 8 b. “Behavioral health district” means the same as defined 9 in section 225A.1 . 10 c. “Behavioral health district advisory council” means the 11 same as defined in section 225A.1. 12 c. d. “Department” means the department of health and human 13 services. 14 d. “District behavioral health advisory council” means the 15 same as defined in section 225A.1 . 16 Sec. 2. Section 12.51, subsection 2, paragraph b, 17 subparagraph (3), subparagraph division (d), subparagraph 18 subdivision (ii), Code 2026, is amended to read as follows: 19 (ii) Input from each district behavioral health district 20 advisory council regarding disbursements from the fund, 21 intended outcomes, and recommendations for future disbursements 22 from the fund. 23 Sec. 3. Section 217.1, Code 2026, is amended by adding the 24 following new subsection: 25 NEW SUBSECTION . 4. “Health and human services district” or 26 “HHS district” means a geographic, multicounty area designated 27 by the department under section 217.1B for statewide program 28 and service delivery. 29 Sec. 4. NEW SECTION . 217.1B Health and human services 30 districts. 31 1. The department shall divide the entirety of the state 32 into designated health and human services districts. The 33 initial HHS districts shall be the same as the behavioral 34 health districts designated pursuant to section 225A.4, Code 35 -1- LSB 5558XD (10) 91 dg/ko 1/ 14

S.F. _____ H.F. _____ 2026, and that exist on the effective date of this division 1 of this Act. The department shall review the designated HHS 2 districts at least once every seven consecutive fiscal years. 3 2. a. The department may modify a designated HHS district. 4 When modifying a designated HHS district, the department shall 5 consider all of the following: 6 (1) City and county boundaries. 7 (2) The population size that can be effectively served in a 8 specific area. 9 (3) Areas of high need for services. 10 (4) Patterns various populations exhibit when accessing or 11 receiving services. 12 b. Notwithstanding chapter 17A, the manner in which 13 the modification of an HHS district is made, including the 14 determination of boundaries for a modified HHS district, shall 15 not be subject to judicial review. 16 3. The department shall adopt rules pursuant to chapter 17A 17 to administer this section. 18 Sec. 5. Section 225A.1, Code 2026, is amended to read as 19 follows: 20 225A.1 Definitions. 21 As used in this chapter unless the context otherwise 22 requires: 23 1. “Administrative services organization” means an entity 24 designated by the department pursuant to section 225A.4 , to 25 develop and perform planning and administrative services in 26 accordance with a district behavioral health service system 27 district plan. 28 2. “Behavioral health condition” means a substantial 29 limitation in major life activities due to a mental, 30 behavioral, or addictive disorder or condition diagnosed in 31 accordance with the criteria provided in the most current 32 edition of the diagnostic and statistical manual of mental 33 disorders, published by the American psychiatric association. 34 3. “Behavioral health district” or “district” means a 35 -2- LSB 5558XD (10) 91 dg/ko 2/ 14

S.F. _____ H.F. _____ geographic, multicounty, sub-state area as designated by the 1 department under section 225A.4 health and human services 2 district through which the behavioral health service system is 3 administered or will be administered . 4 4. “Behavioral health district advisory council” means an 5 advisory council established pursuant to section 225A.5. 6 4. 5. “Behavioral health provider” or “provider” means an 7 individual, firm, corporation, association, or institution 8 that, pursuant to this chapter , is providing or has been 9 approved by the department to provide services to an individual 10 with a behavioral health condition. 11 5. 6. “Behavioral health service system” means the 12 behavioral health service system established in section 225A.3 . 13 7. “Behavioral health service system district plan” or 14 “behavioral health district plan” means a plan developed by 15 an administrative services organization and approved by the 16 department that outlines the services intended to be provided 17 within the administrative services organization’s behavioral 18 health district. 19 8. “Behavioral health service system state plan” means 20 the plan developed by the department that describes the key 21 components of the behavioral health service system. 22 6. 9. “Caregiver” means an adult family member, or other 23 individual, who is providing care to a person outside of a 24 formal program. 25 7. 10. “Community mental health center” means an entity 26 designated by the department to address the mental health needs 27 of one or more counties. 28 8. 11. “Department” means the department of health and 29 human services. 30 9. 12. “Director” means the director of the department of 31 health and human services. 32 10. “District behavioral health advisory council” 33 or “advisory council” means a council established by an 34 administrative services organization under section 225A.5 , to 35 -3- LSB 5558XD (10) 91 dg/ko 3/ 14

S.F. _____ H.F. _____ identify opportunities, address challenges, and advise the 1 administrative services organization in accordance with section 2 225A.5 . 3 11. “District behavioral health service system plan” or 4 “district behavioral health plan” means a plan developed by 5 an administrative services organization and approved by the 6 department to outline the services intended to be provided 7 within the administrative services organization’s behavioral 8 health district. 9 13. “Health and human services district” or “HHS district” 10 means the same as defined in section 217.1. 11 12. 14. “Indicated prevention” means prevention activities 12 designed to prevent the onset of substance use disorders in 13 individuals who do not meet the medical criteria for addiction, 14 but who show early signs of developing a substance use disorder 15 in the future. 16 13. 15. “Selective prevention” means prevention activities 17 designed to target subsets of the total population who are 18 considered at-risk for a substance use disorder by virtue of 19 their membership in a particular segment of the population. 20 Selective prevention targets the entire subgroup, regardless of 21 the degree of risk of any individual within the group. 22 14. “State behavioral health service system plan” or 23 “state behavioral health plan” means the plan developed by the 24 department that describes the key components of the state’s 25 behavioral health service system. 26 15. 16. “Universal prevention” means prevention activities 27 designed to address an entire population class for the purpose 28 of preventing or delaying the use of alcohol, tobacco, and 29 other drugs. Population classes include but are not limited 30 to the national population, local populations, community 31 populations, school populations, and neighborhood populations. 32 Sec. 6. Section 225A.2, subsection 3, paragraph c, Code 33 2026, is amended to read as follows: 34 c. Review and approve district behavioral health service 35 -4- LSB 5558XD (10) 91 dg/ko 4/ 14

S.F. _____ H.F. _____ system district plans developed in accordance with the state 1 behavioral health service system state plan. 2 Sec. 7. Section 225A.3, subsection 2, paragraph a, 3 subparagraph (1), unnumbered paragraph 1, Code 2026, is amended 4 to read as follows: 5 Develop a state behavioral health service system state plan 6 that accomplishes all of the following: 7 Sec. 8. Section 225A.3, subsection 2, paragraph a, 8 subparagraph (1), subparagraph division (d), Code 2026, is 9 amended to read as follows: 10 (d) Is consistent with the department’s agency strategic 11 plan adopted pursuant to section 8E.206 8E.204 . 12 Sec. 9. Section 225A.3, subsection 2, paragraph a, 13 subparagraph (2), unnumbered paragraph 1, Code 2026, is amended 14 to read as follows: 15 The department shall do all of the following when developing 16 the state behavioral health service system state plan: 17 Sec. 10. Section 225A.3, subsection 2, paragraph a, 18 subparagraph (2), subparagraph division (b), Code 2026, is 19 amended to read as follows: 20 (b) Publish the proposed state behavioral health service 21 system state plan on the department’s internet site and 22 allow the public to review and comment on the proposed state 23 behavioral health service system state plan prior to the 24 adoption of the proposed state behavioral health service system 25 state plan. 26 Sec. 11. Section 225A.3, subsection 2, paragraph c, Code 27 2026, is amended to read as follows: 28 c. Oversee, provide technical assistance to, and 29 monitor administrative services organizations to ensure the 30 administrative services organizations’ compliance with district 31 behavioral health district plans. 32 Sec. 12. Section 225A.3, subsection 2, paragraph k, 33 subparagraph (9), Code 2026, is amended to read as follows: 34 (9) Any other requirements the department deems necessary 35 -5- LSB 5558XD (10) 91 dg/ko 5/ 14

S.F. _____ H.F. _____ to ensure that an administrative services organization 1 fulfills the administrative services organization’s duties 2 as established in this chapter , and as established in the 3 administrative services organization’s district behavioral 4 health district plan. 5 Sec. 13. Section 225A.4, subsection 1, Code 2026, is amended 6 to read as follows: 7 1. a. The department shall divide the entirety of the 8 state into designated behavioral health districts. Behavioral 9 provide for behavioral health prevention, education, early 10 intervention, treatment, recovery support, and crisis services 11 related to mental health and addictive disorders, including 12 but not limited to alcohol use, substance use, tobacco use, 13 and problem gambling , shall be made available through in a 14 consistent manner in each behavioral health district in a 15 manner consistent with directives each district receives from 16 the department . 17 b. For the purpose of providing equitable access to all 18 services provided through the behavioral health service 19 system, the department shall consider all of the following when 20 designating behavioral health districts: 21 (1) City and county lines. 22 (2) The maximum population size that behavioral health 23 services available in an area are able to effectively serve. 24 (3) Areas of high need for behavioral health services. 25 (4) Patterns various populations exhibit when accessing or 26 receiving behavioral health services. 27 c. Notwithstanding chapter 17A , the manner in which the 28 department designates behavioral health districts including but 29 not limited to the determination of the boundaries for each 30 district shall not be subject to judicial review. 31 Sec. 14. Section 225A.4, subsection 2, paragraph a, Code 32 2026, is amended to read as follows: 33 a. The department shall designate an administrative services 34 organization for each behavioral health district to oversee and 35 -6- LSB 5558XD (10) 91 dg/ko 6/ 14

S.F. _____ H.F. _____ organize each behavioral health district and the behavioral 1 health services associated with the behavioral health district. 2 The department shall may issue requests for proposals for 3 administrative services organization candidates. 4 Sec. 15. Section 225A.4, subsection 2, paragraph b, 5 subparagraph (2), Code 2026, is amended to read as follows: 6 (2) A public or private nonprofit agency located in a 7 the behavioral health district for which the agency is being 8 designated an administrative services organization , or any 9 separate organizational unit within the that public or private 10 nonprofit agency, that has the capabilities to engage in the 11 planning or provision of a broad range of behavioral health 12 prevention, education, early intervention, treatment, recovery 13 support, and crisis services related to mental health and 14 addictive disorders, including but not limited to alcohol use, 15 substance use, tobacco use, and problem gambling, only as 16 directed by the department. 17 Sec. 16. Section 225A.4, subsection 2, paragraph c, 18 subparagraph (2), Code 2026, is amended to read as follows: 19 (2) Whether the entity has demonstrated the ability to 20 ensure the delivery of behavioral health services within the 21 behavioral health district as required by the department by 22 rule. 23 Sec. 17. Section 225A.4, subsection 5, Code 2026, is amended 24 to read as follows: 25 5. Each administrative services organization shall perform 26 all of the following duties: 27 a. Develop and administer a district behavioral health 28 district plan in accordance with the standards adopted by the 29 department by rule. 30 b. Coordinate the administration of the district behavioral 31 health district plan with federal, state, and local resources 32 in order to develop a comprehensive and coordinated local 33 behavioral health service system. 34 c. Enter into contracts necessary to provide services under 35 -7- LSB 5558XD (10) 91 dg/ko 7/ 14

S.F. _____ H.F. _____ the district behavioral health district plan. 1 d. Oversee, provide technical assistance to, and monitor 2 the compliance of providers contracted by the administrative 3 services organization to provide behavioral health services in 4 accordance with the district behavioral health district plan. 5 e. Establish a district behavioral health district advisory 6 council pursuant to section 225A.5 . 7 Sec. 18. Section 225A.5, Code 2026, is amended to read as 8 follows: 9 225A.5 District behavioral Behavioral health district 10 advisory councils. 11 1. Each administrative services organization shall 12 establish a district behavioral health district advisory 13 council that shall do all of the following: 14 a. Identify opportunities and address challenges based on 15 updates received from the administrative services organization 16 regarding the implementation of the district behavioral health 17 district plan. 18 b. Advise the administrative services organization while the 19 administrative services organization is developing behavioral 20 health policies. 21 c. Advise the administrative services organization on how to 22 best provide access to behavioral health prevention, education, 23 early intervention, treatment, recovery support, and crisis 24 services related to mental health and addictive disorders, 25 including but not limited to alcohol use, substance use, 26 tobacco use, and problem gambling, throughout the behavioral 27 health district as directed by the department. 28 2. An A behavioral health district advisory council shall 29 consist of ten members. Members shall be appointed by the 30 administrative services organization subject to the following 31 requirements: 32 a. Three members shall be local elected public officials 33 currently holding office within the behavioral health district, 34 or the public official’s designated representative. 35 -8- LSB 5558XD (10) 91 dg/ko 8/ 14

S.F. _____ H.F. _____ b. Three members shall be chosen in accordance with 1 procedures established by the administrative services 2 organization to ensure representation of the populations 3 served within the behavioral health district. At least one 4 member chosen under this paragraph shall represent child and 5 adolescent persons. 6 c. Three members shall be chosen who have experience 7 or education related to core behavioral health functions, 8 essential behavioral health services, behavioral health 9 prevention, behavioral health treatment, population-based 10 behavioral health services, or community-based behavioral 11 health initiatives. 12 d. One member shall be a law enforcement representative from 13 within the behavioral health district. 14 3. An A behavioral health district advisory council shall 15 perform the duties required under this section regardless of 16 whether any seat on the behavioral health district advisory 17 council is vacant. 18 Sec. 19. Section 225A.6, subsection 4, Code 2026, is amended 19 to read as follows: 20 4. Administrative services organizations shall report 21 to the department, in a manner specified by the department, 22 information including but not limited to demographic 23 information, expenditure data, and data concerning the 24 behavioral health services and other support provided to 25 individuals in the administrative service organization’s 26 behavioral health district. 27 Sec. 20. Section 225A.7, subsection 2, paragraph a, Code 28 2026, is amended to read as follows: 29 a. Distributions to administrative services organizations 30 to provide services as outlined in the organizations’ district 31 behavioral health district plan. 32 Sec. 21. Section 225A.8, subsection 2, unnumbered paragraph 33 1, Code 2026, is amended to read as follows: 34 To promote comprehensive tobacco use prevention and control 35 -9- LSB 5558XD (10) 91 dg/ko 9/ 14

S.F. _____ H.F. _____ initiatives outlined in the state behavioral health service 1 system state plan, an entity shall not perform any of the 2 following acts: 3 Sec. 22. EFFECTIVE DATE. This division of this Act, being 4 deemed of immediate importance, takes effect upon enactment. 5 DIVISION II 6 AGING AND DISABILITY SERVICES 7 Sec. 23. Section 231.4, subsection 1, Code 2026, is amended 8 by adding the following new paragraph: 9 NEW PARAGRAPH . 0k. “Health and human services district” 10 means the same as defined in section 217.1. 11 Sec. 24. Section 231.23, subsection 5, Code 2026, is amended 12 by striking the subsection and inserting in lieu thereof the 13 following: 14 5. Designate planning and service areas throughout the 15 state in accordance with the Older Americans Act of 1965, Pub. 16 L. No. 89-73, as amended. The boundaries of a planning and 17 service area shall match the boundaries of a health and human 18 services district. 19 Sec. 25. EFFECTIVE DATE. This division of this Act, being 20 deemed of immediate importance, takes effect upon enactment. 21 Sec. 26. CONTINGENT APPLICABILITY. Section 231.23, 22 subsection 5, as amended by this division of this Act, shall 23 apply upon the department of health and human services’ 24 receipt, from the administration for community living of 25 the United States department of health and human services, 26 of approval of the planning and service areas under section 27 231.23, subsection 5, as amended by this division of this Act. 28 DIVISION III 29 VOLUNTEER SERVICES 30 Sec. 27. Section 15H.2, subsection 1, Code 2026, is amended 31 to read as follows: 32 1. The Iowa commission on volunteer service is created 33 within the department. The governor shall appoint the 34 commission’s members. The director may employ personnel as 35 -10- LSB 5558XD (10) 91 dg/ko 10/ 14

S.F. _____ H.F. _____ necessary to carry out the duties and responsibilities of the 1 commission. 2 Sec. 28. Section 15H.4, Code 2026, is amended to read as 3 follows: 4 15H.4 Administration —— funding. 5 1. a. The department shall serve as the lead agency for 6 administration of the commission. 7 b. The department may consult with the department of 8 education, the state board of regents, and the department of 9 workforce development for any additional administrative support 10 as necessary to fulfill the duties of the commission. 11 c. All other state agencies, at the request of the 12 department, shall provide assistance to the commission to 13 ensure a fully coordinated state effort for promoting national 14 and community service. 15 d. The commission may delegate the administration of 16 nonpolicymaking duties, in compliance with 42 U.S.C. §12638, to 17 the subunit for volunteerism created in section 217.13. 18 2. The commission may accept funds and in-kind services from 19 other state, federal, and private entities. 20 Sec. 29. Section 217.13, Code 2026, is amended by striking 21 the section and inserting in lieu thereof the following: 22 217.13 Department subunit for volunteerism —— volunteer 23 liability. 24 1. A subunit for volunteerism is created within the 25 department. The subunit for volunteerism shall establish 26 volunteer programs designed to enhance the services provided 27 by the department and provide administrative support for the 28 nonpolicymaking duties of the Iowa commission on volunteer 29 service. 30 2. a. The director shall appoint an executive director 31 to oversee the administration of the department subunit for 32 volunteerism and to carry out nonpolicymaking duties delegated 33 to the subunit for volunteerism by the Iowa commission on 34 volunteer service pursuant to section 15H.4. 35 -11- LSB 5558XD (10) 91 dg/ko 11/ 14

S.F. _____ H.F. _____ b. The department may employ personnel for the subunit 1 for volunteerism as necessary to carry out the duties of the 2 subunit for volunteerism and the duties delegated to the 3 subunit for volunteerism by the Iowa commission on volunteer 4 service pursuant to section 15H.4. 5 3. All volunteers registered with programs administered 6 by the subunit for volunteerism and in compliance with rules 7 adopted by the department pursuant to chapter 17A shall be 8 considered employees of the state for purposes of chapter 669. 9 However, this section does not exempt a volunteer guardian 10 from an action brought under section 658.1A, or a volunteer 11 guardian or volunteer conservator from an action brought under 12 section 658.3. This section shall not be construed to relieve 13 a volunteer guardian or conservator from duties under chapter 14 633. 15 4. The department shall adopt rules pursuant to chapter 17A 16 to administer this section. 17 Sec. 30. EFFECTIVE DATE. This division of this Act, being 18 deemed of immediate importance, takes effect upon enactment. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill relates to activities, programs, and services 23 under the purview of the department of health and human 24 services (HHS). 25 DIVISION I —— HEALTH AND HUMAN SERVICES DISTRICTS. The bill 26 directs HHS to divide the state into health and human services 27 districts (districts), as defined in the bill, to be used by 28 HHS in the delivery of programs and services. The initial 29 districts shall be the same as the behavioral health districts 30 designated in Code section 225A.4, Code 2026, as the behavioral 31 health districts exist on the effective date of this division 32 of the bill. The bill provides factors HHS must consider when 33 modifying the districts. The manner in which HHS modifies a 34 district is not subject to judicial review. 35 -12- LSB 5558XD (10) 91 dg/ko 12/ 14

S.F. _____ H.F. _____ The bill changes Code chapter 225A (HHS —— behavioral health 1 service system) so that behavioral health services are provided 2 through the health and human services districts instead of 3 behavioral health districts. 4 The bill makes conforming changes to Code section 12.51. 5 This division of the bill takes effect upon enactment. 6 DIVISION II —— AGING AND DISABILITY SERVICES. Under current 7 law, HHS is required to divide the state into distinct planning 8 and service areas based on various factors for the purpose of 9 providing aging and disability services. The bill requires 10 HHS to designate each planning and service area (service area) 11 throughout the state in accordance with federal requirements. 12 The boundaries of service areas shall match the boundaries of 13 districts. 14 This division of the bill takes effect upon enactment 15 and applies upon HHS’s receipt, from the administration for 16 community living of the United States department of health and 17 human services, of approval of the planning and service areas 18 as amended in the bill. 19 DIVISION III —— VOLUNTEER SERVICES. The bill creates a 20 subunit for volunteerism (subunit) within HHS. The subunit 21 shall establish volunteer programs designed to enhance the 22 services provided by HHS and provide administrative support 23 for the nonpolicymaking duties of the Iowa commission on 24 volunteer service (commission). The director of HHS shall 25 appoint an executive director to oversee the administration of 26 the subunit and to carry out nonpolicymaking duties delegated 27 to the subunit by the commission. HHS may employ personnel 28 for the subunit to carry out the duties of the subunit and 29 the duties delegated to the subunit by the commission. All 30 volunteers registered with programs administered by the 31 subunit are considered employees of the state; however, this 32 does not exempt a volunteer conservator or guardian from the 33 conservator’s or guardian’s duties and does not limit the 34 conservator’s or guardian’s civil liability for performing the 35 -13- LSB 5558XD (10) 91 dg/ko 13/ 14