Senate File 2315 - Reprinted SENATE FILE 2315 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SSB 3152) (As Amended and Passed by the Senate March 12, 2012 ) A BILL FOR An Act relating to redesign of publicly funded mental 1 health and disability services by requiring certain core 2 services and addressing other services and providing for 3 establishment of regions and including effective date and 4 applicability provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 SF 2315 (11) 84 jp/rj/jh

S.F. 2315 DIVISION I 1 CORE SERVICES 2 Section 1. Section 225C.2, Code 2011, is amended by adding 3 the following new subsections: 4 NEW SUBSECTION . 7A. “Mental health and disability services 5 region” means a mental health and disability services region 6 formed in accordance with section 331.438B. 7 NEW SUBSECTION . 7B. “Mental health and disability services 8 regional service system” means the mental health and disability 9 service system for a mental health and disability services 10 region. 11 NEW SUBSECTION . 9. “Regional administrator” means the same 12 as defined in section 331.438A. 13 Sec. 2. Section 225C.4, subsection 1, paragraphs a, b, c, f, 14 h, j, q, and s, Code 2011, are amended to read as follows: 15 a. Prepare and administer the comprehensive mental health 16 and disability services plan as provided in section 225C.6B , 17 including state mental health and mental retardation plans for 18 the provision of disability services within the state and the 19 state developmental disabilities plan. The administrator shall 20 consult with the Iowa department of public health, the state 21 board of regents or a body designated by the board for that 22 purpose, the department of management or a body designated by 23 the director of the department for that purpose, the department 24 of education, the department of workforce development and any 25 other appropriate governmental body, in order to facilitate 26 coordination of disability services provided in this state. 27 The state mental health and mental retardation plans shall be 28 consistent with the state health plan, and shall incorporate 29 county disability services mental health and disability 30 services regional service system management plans. 31 b. Assist county boards of supervisors and mental health 32 and developmental disabilities regional planning councils 33 mental health and disability services region governing boards 34 and regional administrators in planning for community-based 35 -1- SF 2315 (11) 84 jp/rj/jh 1/ 74

S.F. 2315 disability services. 1 c. Emphasize the provision of evidence-based outpatient 2 and community support services by community mental health 3 centers and local mental retardation providers as a preferable 4 alternative to acute inpatient hospital services and services 5 provided in large institutional settings . 6 f. Promote coordination Coordinate of community-based 7 services with those of the state mental health institutes and 8 state resource centers. 9 h. Administer and distribute state appropriations to 10 the mental health and developmental disabilities community 11 disability regional services fund established by section 225C.7 12 225C.7A . 13 j. Establish and maintain a data collection and management 14 information system oriented to the needs of patients, 15 providers, the department, and other programs or facilities. 16 The system shall be used to identify, collect, and analyze 17 service outcome data in order to assess the effects of 18 the services on the persons utilizing the services. The 19 administrator shall annually submit to the commission 20 information collected by the department indicating the 21 changes and trends in the disability services system. The 22 administrator shall make the outcome data available to the 23 public. 24 q. In cooperation with the department of inspections and 25 appeals, recommend minimum standards under section 227.4 for 26 the care of and services to persons with mental illness and or 27 mental retardation residing in county care facilities. The 28 administrator shall also cooperate with the department of 29 inspections and appeals in recommending minimum standards for 30 care of and services provided to persons with mental illness 31 or an intellectual disability living in a residential care 32 facility regulated under chapter 135C. 33 s. Provide technical assistance concerning disability 34 services and funding to counties and mental health and 35 -2- SF 2315 (11) 84 jp/rj/jh 2/ 74

S.F. 2315 developmental disabilities regional planning councils mental 1 health and disability services region governing boards and 2 regional administrators . 3 Sec. 3. Section 225C.4, subsection 1, Code 2011, is amended 4 by adding the following new paragraphs: 5 NEW PARAGRAPH . u. Enter into performance-based contracts 6 with regional administrators pursuant to section 331.440B. 7 NEW PARAGRAPH . v. Provide information through the internet 8 concerning waiting lists for services implemented by mental 9 health and disability services regions. 10 Sec. 4. Section 225C.6, subsection 1, paragraph b, Code 11 Supplement 2011, is amended to read as follows: 12 b. Adopt Pursuant to recommendations made for this purpose 13 by the administrator, adopt necessary rules pursuant to 14 chapter 17A which relate to disability programs and services, 15 including but not limited to definitions of each disability 16 included within the term “disability services” as necessary for 17 purposes of state, county, and regional planning, programs, and 18 services. 19 Sec. 5. Section 225C.6, subsection 1, paragraph l, Code 20 Supplement 2011, is amended by striking the paragraph and 21 inserting in lieu thereof the following: 22 l. Pursuant to a recommendation made by the administrator, 23 identify basic financial eligibility standards for the 24 disability services provided by a mental health and disability 25 services region. The initial standards shall be as specified 26 in chapter 331. 27 Sec. 6. Section 225C.6A, Code 2011, is amended to read as 28 follows: 29 225C.6A Disability services data system redesign . 30 The commission department shall do the following relating to 31 redesign of the data concerning the disability services system 32 in the state: 33 1. Identify sources of revenue to support statewide 34 delivery of core disability services to eligible disability 35 -3- SF 2315 (11) 84 jp/rj/jh 3/ 74

S.F. 2315 populations. 1 2. Ensure there is a continuous improvement process for 2 development and maintenance of the disability services system 3 for adults and children. The process shall include but is not 4 limited to data collection and reporting provisions. 5 3. a. 1. Plan, collect, and analyze data as necessary to 6 issue cost estimates for serving additional populations and 7 providing core disability services statewide. The department 8 shall maintain compliance with applicable federal and state 9 privacy laws to ensure the confidentiality and integrity of 10 individually identifiable disability services data. The 11 department shall regularly may periodically assess the status 12 of the compliance in order to assure that data security is 13 protected. 14 b. 2. In implementing a system under this subsection 15 section for collecting and analyzing state, county and region , 16 and private contractor data, the department shall establish a 17 client identifier for the individuals receiving services. The 18 client identifier shall be used in lieu of the individual’s 19 name or social security number. The client identifier shall 20 consist of the last four digits of an individual’s social 21 security number, the first three letters of the individual’s 22 last name, the individual’s date of birth, and the individual’s 23 gender in an order determined by the department. 24 c. 3. Each county regional administrator shall regularly 25 report to the department annually on or before December 1, for 26 the preceding fiscal year the following information for each 27 individual served: demographic information, expenditure data, 28 and data concerning the services and other support provided to 29 each individual, as specified in administrative rule adopted 30 by the commission department . 31 4. Work with county representatives and other qualified 32 persons to develop an implementation plan for replacing the 33 county of legal settlement approach to determining service 34 system funding responsibilities with an approach based upon 35 -4- SF 2315 (11) 84 jp/rj/jh 4/ 74

S.F. 2315 residency. The plan shall address a statewide standard for 1 proof of residency, outline a plan for establishing a data 2 system for identifying residency of eligible individuals, 3 address residency issues for individuals who began residing in 4 a county due to a court order or criminal sentence or to obtain 5 services in that county, recommend an approach for contesting 6 a residency determination, and address other implementation 7 issues. 8 Sec. 7. NEW SECTION . 225C.7A Mental health and disability 9 regional services fund. 10 1. A mental health and disability regional services fund 11 is created in the office of the treasurer of state under the 12 authority of the department, which shall consist of the amounts 13 appropriated to the fund by the general assembly for each 14 fiscal year. Before completion of the department’s budget 15 estimate as required by section 8.23, the department shall 16 determine and include in the estimate the amount which in order 17 to address allowed growth should be appropriated to the fund 18 for the succeeding fiscal year. 19 2. The department shall allocate the moneys appropriated 20 from the fund to mental health and disability services 21 regions for funding of disability services in accordance with 22 performance-based contracts with the regions and in the manner 23 provided in the appropriations. If the allocation methodology 24 includes a population factor, the definition of “population” in 25 section 331.438A shall be applied. 26 Sec. 8. Section 226.10, Code 2011, is amended to read as 27 follows: 28 226.10 Equal treatment. 29 The several patients of the state mental health institutes , 30 according to their different conditions of mind and body, and 31 their respective needs, shall be provided for and treated 32 with equal care. If in addition to mental illness a patient 33 has a co-occurring intellectual disability, brain injury, 34 or substance abuse disorder or other special need, the care 35 -5- SF 2315 (11) 84 jp/rj/jh 5/ 74

S.F. 2315 provided shall also address the co-occurring needs. 1 Sec. 9. Section 331.439, subsection 1, paragraph a, Code 2 Supplement 2011, is amended to read as follows: 3 a. The county accurately reported by December 1 the 4 county’s expenditures for mental health, mental retardation, 5 and developmental disabilities services and the information 6 required under section 225C.6A, subsection 3 , paragraph “c” , 7 for the previous fiscal year in accordance with rules adopted 8 by the state commission. The information reported shall 9 conform with the cost principles for state, local, and Indian 10 tribal governments issued by the United States office of 11 management and budget. The information shall also segregate 12 expenditures for administration, purchase of service, and 13 enterprise costs in which the county is a service provider 14 or is directly billing and collecting payments and shall be 15 submitted on forms prescribed by the department of management. 16 If the department of human services determines good cause 17 exists, the department may extend a deadline otherwise 18 imposed under this chapter , chapter 225C , or chapter 426B 19 for a county’s reporting concerning mental health, mental 20 retardation, or developmental disabilities services or related 21 revenues and expenditures. 22 Sec. 10. Section 331.439, Code Supplement 2011, is amended 23 by adding the following new subsection: 24 NEW SUBSECTION . 9A. a. Commencing during the fiscal 25 year beginning July 1, 2012, the county management plan for 26 mental health services shall provide that an individual’s 27 eligibility for individualized services shall be determined by 28 a standardized functional assessment methodology approved for 29 this purpose by the director of human services. 30 b. Commencing during the fiscal year beginning July 1, 31 2012, the county management plan for intellectual disability 32 services shall provide that an individual’s eligibility for 33 individualized services shall be determined by a standardized 34 functional assessment methodology approved for this purpose by 35 -6- SF 2315 (11) 84 jp/rj/jh 6/ 74

S.F. 2315 the director of human services. 1 c. Commencing during the fiscal year beginning July 1, 2012, 2 if a county management plan provides for brain injury services 3 the plan shall provide that an individual’s eligibility for 4 individualized services shall be determined by a standardized 5 functional assessment methodology approved for this purpose by 6 the director of human services. 7 Sec. 11. NEW SECTION . 331.439A Regional service system 8 management plan. 9 1. a. The mental health and disability services provided 10 by counties operating as a region shall be delivered in 11 accordance with a regional service system management plan 12 approved by the region’s governing board and implemented by 13 the regional administrator in accordance with this section. 14 The requirements for a regional service system management plan 15 and plan format shall be specified in rule adopted by the 16 state commission. A regional service system management plan 17 is subject to the approval of the director of human services 18 pursuant to a recommendation made by the state commission. 19 b. A regional service system management plan shall address 20 a three-year period. The initial plan shall be submitted to 21 the department by April 1, 2014, and by April 1 of every third 22 year thereafter. The initial plan is subject to approval by 23 the director of human services. 24 c. Each region shall submit an annual update of the region’s 25 management plan to the department of human services each year 26 on or before December 1. The annual update shall include any 27 changes to the elements of the management plan as well as 28 actual numbers of persons served, moneys expended, and outcomes 29 achieved. An annual update is subject to approval by the state 30 commission pursuant to a recommendation by the director of 31 human services. 32 d. An amendment to an approved management plan shall 33 be submitted to the department of human services at least 34 forty-five calendar days prior to the amendment implementation. 35 -7- SF 2315 (11) 84 jp/rj/jh 7/ 74

S.F. 2315 The amendment is subject to approval by the state commission 1 pursuant to a recommendation by the director of human services. 2 2. The provisions of a regional service system management 3 plan shall include but are not limited to all of the following: 4 Measures to address the needs of individuals who have two 5 or more co-occurring mental health, intellectual or other 6 developmental disability, brain injury, or substance-related 7 disorders and individuals with specialized needs. 8 Implementation of measures to meet the needs of individuals 9 with a developmental disability other than intellectual 10 disability, brain injury, or substance-related disorders is 11 contingent upon identification of a funding source to meet 12 those needs and implementation of provisions to engage the 13 entity under contract with the state to provide services to 14 address substance-related disorders within the regional service 15 system. 16 3. The region may either directly implement a system of 17 service management and contract with service providers, or 18 contract with a private entity to manage the regional service 19 system, provided all requirements of this section are met 20 by the private entity. The regional service system shall 21 incorporate service management and functional assessment 22 processes developed in accordance with applicable requirements. 23 4. The regional service system management plan for a region 24 shall include but is not limited to all of the following 25 elements, which shall be specified in administrative rules 26 adopted by the state commission: 27 a. A description of the region’s policies and procedures for 28 financing the services included in the plan. The description 29 shall also address how county, regional, state, and other 30 funding sources will be used to meet the service needs within 31 the region. 32 b. The enrollment and eligibility process. 33 c. The scope of services included in addition to the core 34 services required by this part of this chapter. Each service 35 -8- SF 2315 (11) 84 jp/rj/jh 8/ 74

S.F. 2315 included shall be described and projections of need and the 1 funding necessary to meet the need shall be included. 2 d. The method of plan administration. 3 e. The process for managing utilization and access to 4 services and other assistance. The process shall also describe 5 how coordination between the services included in the plan and 6 the disability services administered by the state and others 7 will be managed. 8 f. The quality management and improvement processes. 9 g. The risk management provisions and fiscal viability of 10 the plan, if the region contracts with a private entity. 11 h. The access points for services. 12 i. The requirements for designation of targeted case 13 management providers and for implementation of evidence-based 14 models of case management for persons with chronic mental 15 illness. The requirements shall be designed to provide the 16 individual receiving the case management with a choice of 17 providers, allow a service provider to be the case manager but 18 prohibit the provider from referring an individual receiving 19 the case management only to services administered by the 20 provider, and include other provisions to ensure compliance 21 with but not exceed federal requirements for conflict-free case 22 management. 23 j. A plan for a systems of care approach in which multiple 24 public and private agencies partner with families and 25 communities to address the multiple needs of the individuals 26 and their families involved with the regional service system. 27 k. A plan to assure effective crisis prevention, response, 28 and resolution. 29 l. A plan for provider network formation and management. 30 m. A plan for provider reimbursement approaches that 31 includes approaches in addition to fee-for-service and to 32 compensate the providers engaged in a systems of care approach 33 and other nontraditional providers. A region shall be 34 encouraged to use, and the department shall approve, blended 35 -9- SF 2315 (11) 84 jp/rj/jh 9/ 74

S.F. 2315 funding approaches or coordinated funding approaches known as 1 braided funding, which incorporate all services and funding 2 streams used by persons receiving services, including medical 3 assistance program funding. 4 n. If the region applies any provider licensing, 5 certification, or accreditation requirements in addition to 6 those required by the state, the procedures for implementing 7 the requirements. 8 o. Service provider payment provisions. 9 p. Financial forecasting measures. 10 q. A process for resolving grievances. 11 r. Measures for implementing interagency and multisystem 12 collaboration and care coordination. 13 5. A region may provide assistance to service populations 14 with disabilities to which the counties comprising the region 15 have historically provided assistance but who are not included 16 in the service management provisions required under subsection 17 2, subject to the availability of funding. 18 6. If a region determines that the region cannot provide 19 services for the fiscal year in accordance with the regional 20 plan and remain in compliance with applicable budgeting 21 requirements, the region may implement a waiting list for 22 the services. The procedures for establishing and applying 23 a waiting list shall be specified in the regional plan. If 24 a region implements a waiting list for services, the region 25 shall notify the department of human services. The department 26 shall maintain on the department’s internet site an up-to-date 27 listing of the regions that have implemented a waiting list and 28 the services affected by each waiting list. 29 7. The director’s approval of a regional plan shall not be 30 construed to constitute certification of the respective county 31 budgets or of the region’s budget. 32 Sec. 12. NEW SECTION . 331.439B Financial eligibility 33 requirements. 34 A person must comply with all of the following financial 35 -10- SF 2315 (11) 84 jp/rj/jh 10/ 74

S.F. 2315 eligibility requirements to be eligible for services under the 1 regional service system: 2 1. The person must have an income equal to or less than 3 one hundred fifty percent of the federal poverty level, as 4 defined by the most recently revised poverty income guidelines 5 published by the United States department of health and 6 human services, to be eligible for disability services 7 public funding. It is the intent of the general assembly to 8 consider increasing this income eligibility provision to two 9 hundred percent of the federal poverty level, contingent upon 10 implementation of the federal Patient Protection and Affordable 11 Care Act beginning in January 2014. 12 2. a. A region or a service provider contracting with the 13 region shall not apply a copayment, sliding fee scale, or other 14 cost sharing requirement for a particular service to a person 15 with an income equal to or less than one hundred fifty percent 16 of the federal poverty level. 17 b. A person with an income above one hundred fifty 18 percent of the federal poverty level may be eligible for 19 services subject to a copayment, sliding fee scale, or other 20 cost-sharing requirement approved by the department. 21 c. A provider under the regional service system of a service 22 that is not funded by the medical assistance program under 23 chapter 249A may waive the copayment or other cost-sharing 24 arrangement if the provider is fully able to absorb the cost. 25 3. A person who is eligible for federally funded services 26 and other support must apply for such services and support. 27 4. The person is in compliance with resource limitations 28 identified in rule adopted by the state commission. The 29 limitation shall be derived from the federal supplemental 30 security income program resource limitations. A person with 31 resources above the federal supplemental security income 32 program resource limitations may be eligible subject to 33 limitations adopted in rule by the state commission. If a 34 person does not qualify for federally funded services and other 35 -11- SF 2315 (11) 84 jp/rj/jh 11/ 74

S.F. 2315 support but meets income, resource, and functional eligibility 1 requirements for regional services, the following types of 2 resources shall be disregarded: 3 a. A retirement account that is in the accumulation stage. 4 b. A burial, medical savings, or assistive technology 5 account. 6 Sec. 13. NEW SECTION . 331.439C Diagnosis —— functional 7 assessment. 8 1. A person must comply with all of the following 9 requirements to be eligible for mental health services under 10 the regional service system: 11 a. The person complies with financial eligibility 12 requirements under section 331.439B. 13 b. The person is at least eighteen years of age and is a 14 resident of this state. However, a person who is seventeen 15 years of age, is a resident of this state, and is receiving 16 publicly funded children’s services may be considered eligible 17 for services through the regional service system during the 18 three-month period preceding the person’s eighteenth birthday 19 in order to provide a smooth transition from children’s to 20 adult services. 21 c. The person has had at any time during the preceding 22 twelve-month period a diagnosable mental health, behavioral, or 23 emotional disorder. The diagnosis shall be made in accordance 24 with the criteria provided in the diagnostic and statistical 25 manual of mental disorders, fourth edition text revised, 26 published by the American psychiatric association, and shall 27 not include the manual’s “V” codes identifying conditions other 28 than a disease or injury. The diagnosis shall also not include 29 substance-related disorders, dementia, antisocial personality, 30 or developmental disabilities, unless co-occurring with another 31 diagnosable mental illness. 32 d. The person’s eligibility for individualized services 33 shall be determined in accordance with the standardized 34 functional assessment methodology approved for mental health 35 -12- SF 2315 (11) 84 jp/rj/jh 12/ 74

S.F. 2315 services by the director of human services in consultation with 1 the state commission. 2 2. A person must comply with all of the following 3 requirements to be eligible for intellectual disability or 4 other developmental disability services under the regional 5 service system: 6 a. The person complies with financial eligibility 7 requirements under section 331.439B. 8 b. The person is at least eighteen years of age and is a 9 resident of this state. However, a person who is seventeen 10 years of age, is a resident of this state, and is receiving 11 publicly funded children’s services may be considered eligible 12 for services through the regional service system during the 13 three-month period preceding the person’s eighteenth birthday 14 in order to provide a smooth transition from children’s to 15 adult services. 16 c. The person has a diagnosis of intellectual disability. 17 d. The person’s eligibility for individualized services 18 shall be determined in accordance with the standardized 19 functional assessment methodology approved for intellectual 20 disability and developmental disability services by the 21 director of human services. 22 3. A person must comply with all of the following 23 requirements to be eligible for brain injury services under the 24 regional service system: 25 a. The person complies with financial eligibility 26 requirements under section 331.439B. 27 b. The person is at least eighteen years of age and is a 28 resident of this state. However, a person who is seventeen 29 years of age, is a resident of this state, and is receiving 30 publicly funded children’s services may be considered eligible 31 for services through the regional service system during the 32 three-month period preceding the person’s eighteenth birthday 33 in order to provide a smooth transition from children’s to 34 adult services. 35 -13- SF 2315 (11) 84 jp/rj/jh 13/ 74

S.F. 2315 c. The person has a diagnosis of brain injury. 1 d. The person’s eligibility for individualized services 2 shall be determined in accordance with a standardized 3 functional assessment methodology approved for this purpose by 4 the director of human services. 5 Sec. 14. NEW SECTION . 331.439D Regional core services. 6 1. For the purposes of this section, unless the context 7 otherwise requires: 8 a. “Crisis stabilization facility” means an institution, 9 place, building, or agency with restricted means of egress 10 designed to provide accommodation, board, and the services 11 of a mental health professional on a short-term basis of no 12 more than five days to three or more individuals who present 13 in the facility with acute psychiatric needs. The goal of a 14 crisis stabilization facility is to decrease the severity of an 15 individual’s condition to allow transition of the individual to 16 a less restrictive facility or to the individual’s home. 17 b. “Domain” means a set of similar, discrete services that 18 can be provided depending upon an individual’s service needs. 19 2. a. (1) A region shall work with service providers to 20 ensure that services are available to residents of the region, 21 regardless of potential payment source for the services. 22 (2) Subject to available appropriations, the director of 23 human services shall ensure the initial core service domains 24 listed in subsection 4 are covered services for the medical 25 assistance program under chapter 249A to the greatest extent 26 allowable under federal regulations. Within funds available, 27 the region shall pay for such services for eligible individuals 28 when payment through the medical assistance program or another 29 third-party payment is not available, unless the individual is 30 on a waiting list for such payment or it has been determined 31 that the individual does not meet the eligibility criteria for 32 any such service. 33 (3) Until funding is designated for other service 34 populations, eligibility for the service domains listed in this 35 -14- SF 2315 (11) 84 jp/rj/jh 14/ 74

S.F. 2315 section shall be limited to such persons who are in need of 1 mental health or intellectual disability services. However, if 2 a county in a region was providing services to an individual 3 with a developmental disability other than intellectual 4 disability or a brain injury prior to formation of the region, 5 the individual shall remain eligible for the services provided 6 when the region is formed, provided that funds are available to 7 continue such services. 8 b. It is the intent of the general assembly to address 9 the need for funding so that the availability of the service 10 domains listed in this section may be expanded to include such 11 persons who are in need of developmental disability or brain 12 injury services. 13 3. Pursuant to recommendations made by the director of human 14 services, the state commission shall adopt rules as required by 15 section 225C.6 to define the services included in the initial 16 and additional core service domains listed in this section. 17 The rules shall provide consistency, to the extent possible, 18 with similar service definitions under the medical assistance 19 program. 20 4. The initial core service domains shall include the 21 following: 22 a. Treatment designed to ameliorate a person’s condition, 23 including but not limited to all of the following: 24 (1) Assessment and evaluation. 25 (2) Mental health outpatient therapy. 26 (3) Medication prescribing and management. 27 (4) Mental health inpatient treatment. 28 b. Basic crisis response provisions, including but not 29 limited to all of the following: 30 (1) Twenty-four-hour access to crisis response. 31 (2) Evaluation. 32 (3) Personal emergency response system. 33 c. Support for community living, including but not limited 34 to all of the following: 35 -15- SF 2315 (11) 84 jp/rj/jh 15/ 74

S.F. 2315 (1) Home health aide. 1 (2) Home and vehicle modifications. 2 (3) Respite. 3 (4) Supportive community living. 4 d. Support for employment, including but not limited to all 5 of the following: 6 (1) Day habilitation. 7 (2) Job development. 8 (3) Supported employment. 9 (4) Prevocational services. 10 e. Recovery services, including but not limited to all of 11 the following: 12 (1) Family support. 13 (2) Peer support. 14 f. Service coordination including coordinating physical 15 health and primary care, including but not limited to all of 16 the following: 17 (1) Case management. 18 (2) Health homes. 19 5. A region shall ensure that access is available to 20 providers of core services that demonstrate competencies 21 necessary for all of the following: 22 a. Serving persons with co-occurring conditions. 23 b. Providing evidence-based services. 24 c. Providing trauma-informed care that recognizes the 25 presence of trauma symptoms in persons receiving services. 26 6. A region shall ensure that services within the following 27 additional core service domains are available to persons not 28 eligible for the medical assistance program under chapter 249A 29 or receiving other third-party payment for the services, when 30 public funds are made available for such services: 31 a. Comprehensive crisis services, including but not limited 32 to all of the following: 33 (1) Twenty-four-hour crisis hotline. 34 (2) Mobile response. 35 -16- SF 2315 (11) 84 jp/rj/jh 16/ 74

S.F. 2315 (3) Twenty-three-hour crisis observation and holding, and 1 crisis stabilization facility and community-based services. 2 (4) Crisis residential services. 3 b. Subacute services provided in facility and 4 community-based settings. 5 c. Justice system-involved services, including but not 6 limited to all of the following: 7 (1) Jail diversion. 8 (2) Crisis intervention training. 9 (3) Civil commitment prescreening. 10 d. Advances in the use of evidence-based treatment, 11 including but not limited to all of the following: 12 (1) Positive behavior support. 13 (2) Assertive community treatment. 14 (3) Peer support services. 15 7. A regional service system may provide funding for other 16 appropriate services or other support. In considering whether 17 to provide such funding, a region may consider the following 18 criteria: 19 a. Applying a person-centered planning process to identify 20 the need for the services or other support. 21 b. The efficacy of the services or other support is 22 recognized as an evidence-based practice, is deemed to be an 23 emerging and promising practice, or providing the services is 24 part of a demonstration and will supply evidence as to the 25 services’ effectiveness. 26 c. A determination that the services or other support 27 provides an effective alternative to existing services that 28 have been shown by the evidence base to be ineffective, to not 29 yield the desired outcome, or to not support the principles 30 outlined in Olmstead v. L.C., 527 U.S. 581 (1999). 31 Sec. 15. NEW SECTION . 331.440B Regional service system 32 financing. 33 1. a. The financing of a regional mental health and 34 disability service system is limited to a fixed budget amount. 35 -17- SF 2315 (11) 84 jp/rj/jh 17/ 74

S.F. 2315 The fixed budget amount shall be the amount identified in 1 a regional service system management plan and budget for 2 the fiscal year. A region shall receive state funding for 3 growth in non-Medicaid expenditures through the mental health 4 and disability regional services fund created in section 5 225C.7A to address increased service costs, additional service 6 populations, additional core service domains, and increased 7 numbers of persons receiving services. 8 b. The state commission shall recommend a non-Medicaid 9 expenditures growth funding amount to the department, the 10 council on human services, and the governor annually by July 11 15 for the fiscal year which commences two years from the 12 beginning date of the fiscal year in progress at the time 13 the recommendation is made. The director of human service 14 shall consider the state commission’s recommendation in the 15 director’s budget recommendations to the council on human 16 services and the council shall consider the recommendation in 17 approving the department’s budget submitted to the governor in 18 accordance with section 217.3. The governor shall consider the 19 state commission’s recommendation in developing the governor’s 20 recommendation for a non-Medicaid expenditures growth funding 21 amount for such fiscal year. The governor’s recommendation 22 shall be submitted at the time the governor’s proposed budget 23 for the succeeding fiscal year is submitted in accordance with 24 chapter 8. 25 2. A region shall implement its regional service system 26 management plan in a manner so as to provide adequate funding 27 of services for the entire fiscal year by budgeting for 28 ninety-nine percent of the funding anticipated to be available 29 for the regional plan for the fiscal year. A region may expend 30 all of the funding anticipated to be available for the regional 31 plan. 32 Sec. 16. IMPLEMENTATION OF ACT. Section 25B.2, subsection 33 3, shall not apply to this division of this Act. 34 Sec. 17. CODE EDITOR. The Code editor may codify the 35 -18- SF 2315 (11) 84 jp/rj/jh 18/ 74

S.F. 2315 provisions of this division of this Act and any other 1 provisions of this Act involving chapter 331 as one or more new 2 parts of chapter 331, division III. 3 Sec. 18. APPLICABILITY. The provisions of this division of 4 this Act enacting new Code sections 331.439A through 331.439E, 5 and section 331.440B apply beginning on July 1, 2013. 6 Sec. 19. APPLICABILITY. The provisions of this division 7 of this Act amending chapter 225C are applicable prior to July 8 1, 2013, for purposes of adopting rules to be effective on or 9 after July 1, 2013. 10 Sec. 20. EFFECTIVE DATE. The following provisions of this 11 Act take effect July 1, 2013: 12 1. The sections of this division of this Act amending 13 chapter 225C. 14 DIVISION II 15 REDESIGN PLANNING, SUPPORT, AND IMPLEMENTATION 16 Sec. 21. REDESIGN SUPPORT. 17 1. The department of human services shall work with the Iowa 18 state association of counties in providing training, support, 19 and technical assistance to counties in developing the mental 20 health and disability services regional services system as 21 provided in this Act and in evaluating whether any barriers 22 exist that would prevent or restrict the community services 23 network developed by the association from being used as the 24 data system for the service system. 25 2. The department shall identify third-party coverage 26 sources and develop estimates and financing options for 27 maximizing the use of the third-party coverage sources in 28 adding eligibility for core services under the mental health 29 and disability services regional service system for adults with 30 a developmental disability other than intellectual disability 31 and for adults with brain injury. The estimates and financing 32 options shall be submitted to the governor and general assembly 33 on or before December 14, 2012. 34 Sec. 22. MENTAL HEALTH AND DISABILITY SERVICES WORKFORCE 35 -19- SF 2315 (11) 84 jp/rj/jh 19/ 74

S.F. 2315 DEVELOPMENT WORKGROUP. 1 1. The department of human services shall create and 2 provide support to a mental health and disability services 3 workforce development workgroup to address issues in connection 4 with assuring that an adequate workforce is available in the 5 state to provide mental health and disability services. The 6 membership of the workgroup shall include the other state 7 agencies involved with the services and other appropriate 8 stakeholders designated by the director of human services in 9 consultation with the chairpersons and ranking members of 10 the committees on human resources of the senate and house of 11 representatives. In addition, the membership shall include 12 four members of the general assembly with one each appointed 13 by the majority and minority leader of the senate and the 14 speaker and minority leader of the house of representatives. 15 The workgroup shall report to the governor and general 16 assembly providing findings and recommendations and financing 17 information concerning the findings and recommendations. A 18 preliminary report shall be submitted on or before December 14, 19 2012, and a final report on or before December 16, 2013. 20 2. The workgroup shall consider the recommendations of 21 the direct care worker task force created pursuant to 2005 22 Iowa Acts, chapter 88, and the direct care worker advisory 23 council created pursuant to 2008 Iowa Acts, chapter 69, 24 regarding training, level of competency, core curricula, and 25 certification, including but not limited to those provisions 26 relating to the use of the college of direct support and other 27 internet-based training. 28 Sec. 23. REGIONAL SERVICE SYSTEM —— OUTCOMES AND 29 PERFORMANCE MEASURES COMMITTEE. 30 1. The department of human services shall establish 31 an outcomes and performance measures committee to make 32 recommendations for specific outcomes and performance measures 33 to be utilized by the mental health and disability services 34 regional service system. The membership of the committee shall 35 -20- SF 2315 (11) 84 jp/rj/jh 20/ 74