Senate File 474 - Introduced SENATE FILE 474 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO SSB 1120) A BILL FOR An Act relating to services and support for youth, including 1 treatment, physical assessments, and behavioral health 2 evaluations for youth involved in involuntary commitment, 3 juvenile delinquency, child in need of assistance, and 4 family in need of assistance proceedings; the licensing 5 and certification of certain residential facilities; 6 the provision of home and community-based services and 7 habilitation services to certain youth by residential 8 programs; administration and supervision of juvenile court 9 services; and the suspension of Hawki eligibility for 10 inmates of public institutions. 11 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 12 TLSB 1457SV (6) 91 dg/ko

S.F. 474 DIVISION I 1 SERVICES AND SUPPORT FOR CHILDREN AND YOUTH 2 Section 1. Section 125.13, subsection 2, Code 2025, is 3 amended by adding the following new paragraph: 4 NEW PARAGRAPH . k. A psychiatric medical institution for 5 children licensed under chapter 135H. 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 with 18 standards comparable to the entities listed in paragraphs “a” 19 through “c” that are acceptable under federal regulations. 20 e. An entity specified by rule adopted by the department in 21 consultation with the department of health and human services. 22 1. 2. “Department” means the department of inspections, 23 appeals, and licensing. 24 2. 3. “Direction” means authoritative policy or procedural 25 guidance for the accomplishment of a function or an activity. 26 3. 4. “Licensee” means the holder of a license issued to 27 operate a psychiatric medical institution for children. 28 4. 5. “Medical care plan” means a plan of care and services 29 designed to eliminate the need for inpatient care by improving 30 the condition of a child youth . Services must be based upon a 31 diagnostic evaluation, which includes an examination a physical 32 assessment and behavioral health evaluation of the medical, 33 psychological, social, behavioral, and developmental aspects 34 of the child’s youth’s situation, reflecting the need for 35 -1- LSB 1457SV (6) 91 dg/ko 1/ 39

S.F. 474 inpatient care. 1 6. “Mental health disorder” means any of the following: 2 a. A mental disorder as defined by the most recent version 3 of the diagnostic and statistical manual of mental disorders 4 published by the American psychiatric association. 5 b. A mental disorder included in the mental, behavioral, or 6 neurodevelopmental disorders chapter in the most recent version 7 of the international classification of diseases published by 8 the world health organization. 9 5. 7. “Mental health professional” means an individual who 10 has all of the following qualifications: 11 a. The individual holds at least a master’s degree in a 12 mental health field, including but not limited to, psychology, 13 counseling and guidance, nursing, and or social work, or the 14 individual is a physician. 15 b. The individual holds a current Iowa license if practicing 16 in a field covered by that requires an Iowa licensure law 17 license . 18 c. The individual has at least two years of post-degree 19 clinical experience, supervised by another mental health 20 professional, in assessing mental health needs and problems and 21 in providing appropriate mental health services. 22 6. 8. “Nursing care” means services which are provided 23 under the direction of a physician or registered nurse. 24 7. 9. “Physician” means a person licensed under chapter 25 148 . 26 10. “Protective locked environment” means a setting that 27 prevents egress from a building or grounds as a protective 28 measure to ensure safety and security. 29 8. 11. “Psychiatric medical institution for children” or 30 “psychiatric institution” means an institution providing more 31 than twenty-four hours of continuous care involving long-term 32 psychiatric services to three or more children youth in 33 residence for expected periods of fourteen or more days for an 34 assessment, evaluation, and diagnosis and evaluation or for 35 -2- LSB 1457SV (6) 91 dg/ko 2/ 39

S.F. 474 expected periods of ninety days or more for treatment. 1 9. 12. “Psychiatric services” means services provided under 2 the direction of a physician which address mental, emotional, 3 medical, or behavioral problems. 4 13. “Record check evaluation system” means the same as 5 defined in section 135C.1. 6 10. 14. “Rehabilitative services” means services to 7 encourage and assist restoration of a resident’s optimum mental 8 and physical capabilities. 9 11. 15. “Resident” means a person who is less than 10 twenty-one years of age and youth who has been admitted by a 11 physician to a psychiatric medical institution for children. 12 16. “Serious emotional disturbance” means a diagnosable 13 mental, behavioral, or emotional disorder of sufficient 14 duration to meet diagnostic criteria specified within the most 15 current diagnostic and statistical manual of mental disorders 16 published by the American psychiatric association that results 17 in a functional impairment. “Serious emotional disturbance” 18 does not include a substance use disorder or developmental 19 disorder unless such disorder co-occurs with such a diagnosable 20 mental, behavioral, or emotional disorder. 21 17. “Substance use disorder” means the same as defined in 22 section 125.2. 23 12. 18. “Supervision” means direct oversight and inspection 24 of the an act of accomplishing that accomplishes a function or 25 activity. 26 19. “Youth” means a person who is less than twenty-one years 27 of age. 28 Sec. 3. Section 135H.3, Code 2025, is amended to read as 29 follows: 30 135H.3 Nature of care. 31 1. a. A psychiatric medical institution for children 32 shall provide shelter, food, supervision, care, assessment, 33 evaluation, diagnosis, treatment, counseling, rehabilitative 34 services, and related professional-directed services to 35 -3- LSB 1457SV (6) 91 dg/ko 3/ 39

S.F. 474 youth who have a serious emotional disturbance, a substance 1 use disorder, or both, with the intention of reducing or 2 ameliorating the disorder, the symptoms of the disorder, or the 3 effects of the disorder. 4 b. A psychiatric medical institution for children shall 5 utilize a team of professionals to direct an organized program 6 of diagnostic services, psychiatric services, nursing care, 7 and rehabilitative services to meet the needs of residents 8 in accordance with a medical care plan developed for each 9 resident. The membership of the team of professionals 10 may include but is not limited to an advanced registered 11 nurse practitioner or a physician assistant. Social and 12 rehabilitative services shall be provided under the direction 13 of a qualified mental health professional. 14 2. If a child youth is diagnosed with a biologically 15 based mental illness as defined in section 514C.22 and meets 16 the medical assistance program criteria for admission to a 17 psychiatric medical institution for children, the child youth 18 shall be deemed to meet the acuity criteria for medically 19 necessary inpatient benefits under a group policy, contract, or 20 plan providing for third-party payment or prepayment of health, 21 medical, and surgical coverage benefits issued by a carrier, as 22 defined in section 513B.2 , that is subject to section 514C.22 . 23 Such medically necessary benefits shall not be excluded or 24 denied as care that is substantially custodial in nature under 25 section 514C.22, subsection 8 , paragraph “b” . 26 Sec. 4. Section 135H.4, Code 2025, is amended to read as 27 follows: 28 135H.4 Licensure —— scope of license . 29 1. A person shall not establish, operate, or maintain a 30 psychiatric medical institution for children unless the person 31 obtains a license for the institution under this chapter and 32 either holds a license under section 237.3, subsection 2 , 33 paragraph “a” , as a comprehensive residential facility for 34 children or holds a license under section 125.13 , if the 35 -4- LSB 1457SV (6) 91 dg/ko 4/ 39

S.F. 474 facility provides substance use disorder treatment . 1 2. A licensee shall only provide serious emotional 2 disturbance or substance use disorder services for which the 3 licensee is licensed under this chapter. 4 Sec. 5. Section 135H.5, Code 2025, is amended to read as 5 follows: 6 135H.5 Application for license —— initial application and 7 annual fees . 8 1. An application for a license under this chapter shall 9 be submitted on a form requesting information required by 10 the department , which . The application may include require 11 affirmative evidence of the applicant’s ability to comply with 12 the rules for standards adopted pursuant to this chapter . The 13 application shall require the applicant to specify whether the 14 applicant intends to provide services for serious emotional 15 disturbances, substance use disorders, or both. 16 2. An application for a license shall be accompanied by the 17 required license fee which shall be credited to the general 18 fund of the state. The initial application fee and the annual 19 license fee is twenty-five dollars. 20 Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, 21 are amended to read as follows: 22 1. The department shall issue a license to an applicant 23 under this chapter if all the following conditions exist: 24 a. The department has ascertained that the applicant’s 25 medical facilities and staff are adequate to provide the care 26 and services required of a psychiatric medical institution for 27 children . 28 b. The proposed psychiatric institution is accredited 29 by the joint commission on the accreditation of health 30 care organizations, the commission on accreditation of 31 rehabilitation facilities, the council on accreditation of 32 services for families and children, or by any other recognized 33 accrediting organization with comparable standards acceptable 34 under federal regulation an approved qualifying organization . 35 -5- LSB 1457SV (6) 91 dg/ko 5/ 39

S.F. 474 c. The applicant complies with applicable state rules 1 and standards for a psychiatric institution adopted by the 2 department in accordance with federal requirements under 42 3 C.F.R. §441.150 – 441.156. 4 d. The department of health and human services has submitted 5 written approval of the application based on the department 6 of health and human services’ determination of need. The 7 department of health and human services shall identify the 8 location and number of children youth in the state who require 9 the services of a psychiatric medical institution for children. 10 Approval of an application shall be based upon the location 11 of the proposed psychiatric institution relative to the need 12 for services identified by the department of health and human 13 services and an analysis of the applicant’s ability to provide 14 services and support consistent with requirements under chapter 15 232 , particularly regarding specifically community-based 16 treatment. If the proposed psychiatric institution is not 17 freestanding from a facility licensed under chapter 135B or 18 135C , approval under this paragraph shall not be given unless 19 the department of health and human services certifies that 20 the proposed psychiatric institution is capable of providing 21 a resident with a living environment similar to the living 22 environment provided by a licensee which is freestanding from a 23 facility licensed under chapter 135B or 135C . 24 e. The proposed psychiatric institution is under the 25 direction of an agency which has operated a facility licensed 26 under section 237.3, subsection 2 , paragraph “a” , as a 27 comprehensive residential facility for children for three years 28 or of an agency which has operated a facility for three years 29 providing psychiatric services exclusively to children or 30 adolescents and the facility meets or exceeds requirements for 31 licensure under section 237.3, subsection 2 , paragraph “a” , as a 32 comprehensive residential facility for children. 33 f. e. If a child youth has an a serious emotional , 34 behavioral, or mental health disorder disturbance , the 35 -6- LSB 1457SV (6) 91 dg/ko 6/ 39

S.F. 474 psychiatric institution does not require court any of the 1 following as a condition for the youth to obtain treatment: 2 (1) Court proceedings to be initiated or that a child’s . 3 (2) For the youth’s parent, guardian, or custodian must 4 to terminate parental rights over , or transfer legal custody 5 of , the child for the purposes of obtaining treatment from the 6 psychiatric institution for the child youth . 7 (3) Relinquishment of a child’s the youth’s custody shall 8 not be a condition of the child receiving services . 9 f. (1) If the applicant will provide serious emotional 10 disturbance services, the applicant meets or exceeds the 11 requirements for a license under section 237.3, subsection 2, 12 paragraph “a” , as a comprehensive residential facility for 13 children. 14 (2) If the applicant will provide substance use disorder 15 services, the applicant meets or exceeds the requirements for a 16 license under section 125.13. 17 4. The department of health and human services may give 18 approval to approve a conversion of beds approved under 19 subsection 2 , to if the beds which are specialized to provide 20 substance use disorder treatment. However, the total number of 21 beds approved under subsection 2 and this subsection shall not 22 exceed four hundred thirty , unless approved for good cause by 23 the director pursuant to subsection 2 . Beds The limitations 24 on the number of beds under this section shall not apply to 25 beds for children youth who do not reside in this state and 26 whose service costs are not paid by public funds in this state 27 are not subject to the limitations on the number of beds 28 requirements otherwise applicable under this section . 29 5. A psychiatric institution licensed prior to July 1, 1999, 30 may exceed the number of beds authorized under subsection 2 31 if the excess beds are used to provide services funded from 32 a source other than the medical assistance program under 33 chapter 249A . Notwithstanding subsection 1 , paragraph “d” , and 34 subsection 2 , the provision of services using those excess beds 35 -7- LSB 1457SV (6) 91 dg/ko 7/ 39

S.F. 474 does not require a review by the department of health and human 1 services. 2 Sec. 7. Section 135H.7, subsection 2, paragraph a, Code 3 2025, is amended to read as follows: 4 a. If a person who has been convicted of a crime or has a 5 record of founded child abuse is being considered for licensure 6 under this chapter , or for employment with a psychiatric 7 institution involving direct responsibility for a child youth 8 or with access to a child youth when the child youth is alone, 9 by a licensed psychiatric institution, or if a person will 10 reside residence in a facility utilized by a licensee, and if 11 the person has been convicted of a crime or has a record of 12 founded child abuse, the record check evaluation system and 13 the licensee for an employee of the licensee considering the 14 person for employment shall perform an evaluation to determine 15 whether the crime or founded child abuse warrants prohibition 16 of licensure, employment, or residence in the facility utilized 17 by a licensee . The record check evaluation system of the 18 department of health and human services shall conduct criminal 19 and child abuse record checks in this state and may conduct 20 these checks in other states. The record check evaluation 21 shall be performed in accordance with procedures adopted for 22 this purpose by the department of health and human services. 23 Sec. 8. NEW SECTION . 135H.7A Protective locked environment 24 —— rules. 25 The department, in cooperation with the department of health 26 and human services, shall adopt rules pursuant to chapter 17A 27 relating to the application of a protective locked environment 28 in a psychiatric medical institution for children. 29 Sec. 9. Section 135H.10, subsection 2, Code 2025, is amended 30 to read as follows: 31 2. This chapter shall not be construed as prohibiting 32 the use of to prohibit funds appropriated for foster care to 33 from being used to provide payment to a psychiatric medical 34 institution for children for the financial participation 35 -8- LSB 1457SV (6) 91 dg/ko 8/ 39

S.F. 474 required of a child youth whose foster care placement is in a 1 psychiatric medical institution for children. In accordance 2 with established policies and procedures for foster care, the 3 department of health and human services shall act to recover 4 any such payment for financial participation, apply to be named 5 payee for the child’s youth’s unearned income, and recommend 6 parental liability for the costs of a court-ordered foster care 7 placement in a psychiatric medical institution. 8 Sec. 10. Section 135H.13, subsection 1, Code 2025, is 9 amended to read as follows: 10 1. The department’s final findings and the survey findings 11 of the joint commission on the accreditation of health care 12 organizations an approved qualifying organization regarding 13 licensure or program accreditation shall be made available 14 to the public in a readily available form and place. Other 15 information relating to the psychiatric institution is 16 confidential and shall not be made available to the public 17 except in proceedings a proceeding involving licensure, a 18 civil suit involving a resident, or an administrative action 19 involving a resident. 20 Sec. 11. Section 229.13, subsection 1, paragraph c, Code 21 2025, is amended to read as follows: 22 c. (1) If the court orders evaluation and treatment of 23 the respondent on an inpatient basis under this section , the 24 court may order the respondent placed under the care of an 25 appropriate subacute care facility licensed under chapter 135G . 26 (2) If the court orders evaluation and treatment of a minor 27 respondent on an inpatient basis under this section, the court 28 may order the minor respondent placed under the care of an 29 appropriate public hospital. 30 Sec. 12. Section 229.13, subsection 5, Code 2025, is amended 31 to read as follows: 32 5. a. (1) The chief medical officer of the hospital or 33 facility at which the respondent is placed shall report to the 34 court and make a recommendation for disposition of the matter 35 -9- LSB 1457SV (6) 91 dg/ko 9/ 39

S.F. 474 no more than fifteen days after the date the respondent is 1 placed , making a recommendation for disposition of the matter 2 at the hospital or facility . An 3 (2) If the respondent is a minor and is placed under the 4 care of a public hospital pursuant to subsection 1, paragraph 5 “c” , subparagraph (2), the chief medical officer of the public 6 hospital shall report to the court and make a recommendation 7 for disposition no later than thirty calendar days after the 8 date the minor respondent is placed under the care of the 9 public hospital. 10 b. A copy of the chief medical officer’s report shall be 11 sent to the respondent’s attorney. 12 c. (1) Upon request, the court may grant the chief medical 13 officer an extension of time may be granted , not to exceed 14 seven days , upon a showing of cause. A copy of the report shall 15 be sent to the The respondent’s attorney , who may contest the 16 need for an extension of time if one is requested . An 17 (2) The court shall grant an extension of time shall be 18 granted upon request unless the request is contested, in which 19 case the court shall make such inquiry as it deems appropriate 20 and may either order the respondent’s release from the hospital 21 or facility , or grant an extension of time for psychiatric 22 evaluation. 23 d. If the chief medical officer fails to report to the 24 court within fifteen days after the individual is placed under 25 the care of the hospital or facility the time specified in 26 paragraph “a” , and an extension of time has not been requested 27 granted , the chief medical officer is guilty of contempt 28 and shall be punished under chapter 665. The court shall 29 order a rehearing on the application to determine whether the 30 respondent should continue to be detained at or placed under 31 the care of the hospital or facility. 32 Sec. 13. Section 229.14, subsection 2, paragraph e, Code 33 2025, is amended to read as follows: 34 e. (1) If the court orders placement and treatment of the 35 -10- LSB 1457SV (6) 91 dg/ko 10/ 39

S.F. 474 a respondent on an inpatient basis under this section , the 1 court may order the respondent placed under the care of an 2 appropriate subacute care facility licensed under chapter 135G . 3 (2) If the court orders placement and treatment of a minor 4 respondent on an inpatient basis under this section, the court 5 may order the minor respondent placed under the care of an 6 appropriate public hospital. 7 Sec. 14. Section 232.2, Code 2025, is amended by adding the 8 following new subsections: 9 NEW SUBSECTION . 3A. “Behavioral health condition” means 10 a serious emotional disturbance, a mental health disorder, 11 a substance abuse disorder, life stressors and crises, and 12 stress-related physical symptoms. 13 NEW SUBSECTION . 3B. “Behavioral health evaluation” means a 14 process used to assess an individual’s behavioral health status 15 and functioning for purposes including but not limited to the 16 diagnosis of a behavioral health condition or to determine the 17 need for treatment or intervention. 18 NEW SUBSECTION . 38A. “Mental health disorder” means the 19 same as defined in section 135H.1. 20 NEW SUBSECTION . 48A. “Physical assessment” means 21 direct physical touching, viewing, and medically necessary 22 manipulation of any area of a child’s body by a physician 23 licensed under chapter 148. 24 NEW SUBSECTION . 58A. “Serious emotional disturbance” means 25 the same as defined in section 135H.1. 26 NEW SUBSECTION . 64A. “Substance use disorder” means the 27 same as defined in section 125.2. 28 Sec. 15. Section 232.2, subsections 34 and 58, Code 2025, 29 are amended to read as follows: 30 34. “Juvenile court social records” or “social records” means 31 all records , other than official records, made with respect to 32 a child in connection with proceedings over which the court has 33 jurisdiction under this chapter other than official records and 34 includes but is not limited to the records made and compiled 35 -11- LSB 1457SV (6) 91 dg/ko 11/ 39

S.F. 474 by intake officers, predisposition reports, and reports of 1 physical assessments and mental examinations behavioral health 2 evaluations . 3 58. “Secure facility” means a physically restricting 4 facility in which children adjudicated to have committed 5 a delinquent act a child may be placed pursuant to a 6 dispositional order of the court. 7 Sec. 16. Section 232.8, subsection 4, Code 2025, is amended 8 to read as follows: 9 4. In a proceeding concerning a child who is alleged to 10 have committed a second delinquent act or a second violation 11 excluded from the jurisdiction of the juvenile court, the court 12 or the juvenile court shall determine whether there is reason 13 to believe that the child regularly abuses alcohol or other 14 controlled substance has a behavioral health condition and may 15 be in need of treatment. If the court so determines, the court 16 shall advise appropriate juvenile authorities and refer such 17 offenders to the juvenile court for disposition pursuant to 18 section 232.52A . 19 Sec. 17. Section 232.49, Code 2025, is amended to read as 20 follows: 21 232.49 Physical assessments and mental examinations 22 behavioral health evaluations —— juvenile delinquency . 23 1. a. Following Any time after the entry of an order 24 of adjudication under section 232.47 , the court may, after 25 a hearing which may be simultaneous with the adjudicatory 26 hearing , order a physical assessment or mental examination 27 behavioral health evaluation of a child if it the court finds 28 that an examination a physical assessment or a behavioral 29 health evaluation is necessary to determine the child’s 30 physical condition or mental to determine if the child has a 31 behavioral health condition. 32 b. The court may consider chemical dependency as either 33 a physical condition or mental behavioral health condition 34 and may consider a chemical dependency evaluation as either a 35 -12- LSB 1457SV (6) 91 dg/ko 12/ 39

S.F. 474 physical assessment or mental examination behavioral health 1 evaluation . If the examination 2 c. A hearing to order a physical assessment or behavioral 3 health evaluation may be held at the same time as the 4 adjudicatory hearing. 5 2. Unless otherwise ordered by the court, if a physical 6 assessment or behavioral health evaluation indicates the child 7 has behaved in a manner that threatened the safety of another 8 person, has committed a violent act causing bodily injury to 9 another person, or has been a victim or perpetrator of sexual 10 abuse, unless otherwise ordered by the court, the child’s 11 parent, guardian, or foster parent , or other person with 12 custody of the child shall be provided with that information. 13 2. 3. a. When possible an examination , a physical 14 assessment or behavioral health evaluation shall be conducted 15 on an outpatient basis , but . However, if deemed necessary by 16 the court, the court may , if it deems necessary commit order 17 the child to a suitable hospital, facility , or institution for 18 the purpose of examination an inpatient physical assessment or 19 an inpatient behavioral health evaluation . 20 b. Commitment for examination An inpatient physical 21 assessment or an inpatient behavioral health evaluation shall 22 not exceed thirty days and the civil commitment provisions of 23 chapter 229 shall not apply . 24 3. 4. a. At any Any time after the filing of a delinquency 25 petition , the court may order a physical assessment or mental 26 examination behavioral health evaluation of the child if all of 27 the following circumstances apply: 28 (1) The court finds such examination a physical assessment 29 or a behavioral health evaluation to be in the best interest 30 of the child ; and . 31 (2) The parent, guardian, or custodian and the child’s 32 counsel agree to the physical assessment or behavioral health 33 evaluation . 34 b. (1) An examination A physical assessment or behavioral 35 -13- LSB 1457SV (6) 91 dg/ko 13/ 39

S.F. 474 health evaluation shall be conducted on an outpatient basis 1 unless the court, the child’s counsel, and the child’s 2 parent, guardian, or custodian agree that it is necessary the 3 child should be committed ordered to a suitable hospital, 4 facility, or institution for the purpose of examination an 5 inpatient physical assessment or an inpatient behavioral health 6 evaluation . Commitment for examination 7 (2) An inpatient physical assessment or inpatient 8 behavioral health evaluation shall not exceed thirty days and 9 the civil commitment provisions of chapter 229 shall not apply . 10 Sec. 18. Section 232.52A, subsection 1, Code 2025, is 11 amended to read as follows: 12 1. In addition to any other order of the juvenile court, 13 a person under age eighteen, child who may be in need of 14 treatment , as determined under section 232.8 , may be ordered 15 to participate in an alcohol or controlled substance education 16 or a physical assessment or behavioral health evaluation 17 program approved by the juvenile court. If recommended after 18 evaluation, the The court may also order the person child to 19 participate in a treatment program approved by the court if the 20 treatment program is recommended after the child’s physical 21 assessment or behavioral health evaluation . The juvenile court 22 may also require the custodial parent or parents , or other 23 legal guardian , to participate in an educational program with 24 the person under age eighteen child if the court determines 25 that such participation is in the best interests of the person 26 under age eighteen child . 27 Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 28 1, Code 2025, is amended to read as follows: 29 “Confidential access to a child” means access to a child, 30 during an assessment of an alleged act of child abuse, who is 31 alleged to be the victim of the child abuse , during a child 32 abuse assessment . The access may be accomplished by interview, 33 observation, or examination physical assessment of the child. 34 As used in this subsection and this part: 35 -14- LSB 1457SV (6) 91 dg/ko 14/ 39

S.F. 474 Sec. 20. Section 232.68, subsection 3, paragraph c, Code 1 2025, is amended by striking the paragraph. 2 Sec. 21. Section 232.69, subsection 3, paragraph b, Code 3 2025, is amended to read as follows: 4 b. A person required to make a report under subsection 1, 5 other than a physician whose professional practice does not 6 regularly involve providing primary health care to children, 7 shall complete the core training curriculum relating to 8 the identification and reporting of child abuse within six 9 months of initial employment or self-employment involving 10 the examination physical assessments or behavioral health 11 evaluations , or attending, counseling, or treatment of treating 12 children on a regular basis. Within one month of initial 13 employment or self-employment, the person shall obtain a 14 statement of the abuse reporting requirements from the person’s 15 employer or, if self-employed, from the department. The person 16 shall complete the core training curriculum relating to the 17 identification and 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 34 child abuse may take or perform, or may cause to be taken or 35 -15- LSB 1457SV (6) 91 dg/ko 15/ 39

S.F. 474 performed , at public expense, photographs, X rays, or other 1 physical examinations assessments, or other tests of a child 2 which would provide medical indication of allegations arising 3 from an assessment. 4 b. A health practitioner may, if medically indicated, 5 cause to be performed a radiological examination, physical 6 examination assessment , or other medical tests test of the 7 child. 8 c. A person who takes any photographs or X rays or 9 performs any physical examinations assessments or other tests 10 pursuant to this section shall notify the department that the 11 photographs or X rays have been taken or the examinations 12 physical assessments or other tests have been performed . The 13 person who made notification , and shall retain the photographs , 14 or X rays , or examination physical assessment or other test 15 findings for a reasonable time following the notification. 16 d. Whenever the person is required to report under section 17 232.69 , in that person’s capacity as a member of the staff of 18 a medical or other private or public institution, agency or 19 facility, that person shall immediately notify the person in 20 charge of the institution, agency, or facility or that person’s 21 designated delegate of the need for photographs , or X rays or 22 examinations , physical assessments, or other tests. 23 Sec. 24. Section 232.78, subsection 1, paragraph a, Code 24 2025, is amended to read as follows: 25 a. Any of the following circumstances exist: 26 (1) The person responsible for the care of the child 27 consents to the removal. 28 (2) The person responsible for the care of the child is 29 absent , or . 30 (3) The person responsible for the care of the child, though 31 present, was asked and refused to consent to the removal of the 32 child and was informed of an intent to apply for an order under 33 this section , or there . 34 (4) There is reasonable cause to believe that a request for 35 -16- LSB 1457SV (6) 91 dg/ko 16/ 39

S.F. 474 consent would further endanger the child , or there . 1 (5) There is reasonable cause to believe that a request for 2 consent will cause the parent, guardian, or legal custodian 3 person responsible for the care of the child to take flight 4 with the child. 5 Sec. 25. Section 232.78, subsection 1, paragraph c, 6 subparagraph (1), Code 2025, is amended to read as follows: 7 (1) The refusal or failure of the person responsible for 8 the care of the child to comply with the request of a peace 9 officer, juvenile court officer, or child protection worker 10 for such the person to obtain and provide to the requester 11 the results of a physical assessment or mental examination 12 behavioral health evaluation of the child. The request for a 13 physical examination assessment of the child may specify the 14 performance of a medically relevant test. 15 Sec. 26. Section 232.78, subsection 5, Code 2025, is amended 16 to read as follows: 17 5. The juvenile court, before or after the filing of a 18 petition under this chapter , may enter an ex parte order 19 authorizing a physician or physician assistant or hospital to 20 conduct an inpatient or outpatient physical examination or 21 authorizing a physician or physician assistant, a psychologist 22 certified under section 154B.7 , or a community mental health 23 center accredited pursuant to chapter 230A to conduct an 24 outpatient mental examination assessment or an inpatient or 25 outpatient behavioral health evaluation of a child if necessary 26 to identify the nature, extent, and cause of injuries to the 27 child as required by section 232.71B , provided all of the 28 following apply: 29 a. Any of the following circumstances exist: 30 (1) The child’s parent, guardian, or custodian consents to 31 the physical assessment or the behavioral health evaluation. 32 (2) The child’s parent, guardian, or legal custodian is 33 absent , or . 34 (3) The child’s parent, guardian, or custodian, though 35 -17- LSB 1457SV (6) 91 dg/ko 17/ 39