Senate File 440 - Reprinted SENATE FILE 440 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO SF 415) (SUCCESSOR TO SSB 1199) (As Amended and Passed by the Senate April 16, 2013 ) A BILL FOR An Act relating to human services involving mental health 1 and disability services and children’s services, making 2 appropriations, and including effective dates. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 SF 440 (4) 85 jp/rj/jh

S.F. 440 DIVISION I 1 SYSTEM REDESIGN —— IMPLEMENTATION 2 RESEARCH-BASED PRACTICE 3 Section 1. Section 331.388, Code 2013, is amended by adding 4 the following new subsection: 5 NEW SUBSECTION . 4A. “Research-based practice” means a 6 service or other support in which the efficacy of the service 7 or other support is recognized as an evidence-based practice, 8 or is deemed to be an emerging and promising practice, or which 9 is part of a demonstration and will supply evidence as to the 10 effectiveness of the service or other support. 11 Sec. 2. Section 331.393, subsection 4, paragraph g, 12 unnumbered paragraph 1, Code 2013, is amended to read as 13 follows: 14 The requirements for designation of targeted case management 15 providers and for implementation of evidence-based models 16 of case management that apply research-based practice . The 17 requirements shall be designed to provide the person receiving 18 the case management with a choice of providers, allow a 19 service provider to be the case manager but prohibit the 20 provider from referring a person receiving the case management 21 only to services administered by the provider, and include 22 other provisions to ensure compliance with but not exceed 23 federal requirements for conflict-free case management. The 24 qualifications of targeted case managers and other persons 25 providing service coordination under the management plan shall 26 be specified in the rules. The rules shall also include but 27 are not limited to all of the following relating to targeted 28 case management and service coordination services: 29 Sec. 3. Section 331.397, subsection 5, paragraph b, Code 30 2013, is amended to read as follows: 31 b. Providing evidence-based services that apply 32 research-based practice . 33 Sec. 4. Section 331.397, subsection 6, paragraph d, Code 34 2013, is amended to read as follows: 35 -1- SF 440 (4) 85 jp/rj/jh 1/ 20

S.F. 440 d. Advances in the use of evidence-based treatment applying 1 research-based practice , including but not limited to all of 2 the following: 3 (1) Positive behavior support. 4 (2) Assertive community treatment. 5 (3) Peer self-help drop-in centers. 6 Sec. 5. Section 331.397, subsection 7, paragraphs b and c, 7 Code 2013, are amended to read as follows: 8 b. The efficacy of the services or other support is are 9 recognized as an evidence-based a research-based practice , is 10 deemed to be an emerging and promising practice, or providing 11 the services is part of a demonstration and will supply 12 evidence as to the services’ effectiveness . 13 c. A determination that the services or other support 14 provides an effective alternative to existing services 15 that have been shown by the evidence research base to be 16 ineffective, to not yield the desired outcome, or to not 17 support the principles outlined in Olmstead v. L.C., 527 U.S. 18 581 (1999). 19 COMMUNITY CORRECTIONS SYSTEM ACCESS TO REGIONAL SERVICES 20 Sec. 6. Section 331.395, Code 2013, is amended by adding the 21 following new subsection: 22 NEW SUBSECTION . 5. If adequate funding is provided through 23 a state appropriation made for purposes of paying for services 24 authorized pursuant to this subsection, a person with an income 25 within the level specified in subsection 1 who is housed by or 26 supervised by a judicial district department of correctional 27 services established under chapter 905 shall be deemed to 28 have met the income and resource eligibility requirements for 29 services under the regional service system. 30 ELIGIBILITY MAINTENANCE 31 Sec. 7. Section 331.396, subsection 1, paragraph b, Code 32 2013, is amended to read as follows: 33 b. The person is at least eighteen years of age and is a 34 resident of this state. However, a person who is seventeen 35 -2- SF 440 (4) 85 jp/rj/jh 2/ 20

S.F. 440 years of age, is a resident of this state, and is receiving 1 publicly funded children’s services may be considered eligible 2 for services through the regional service system during the 3 three-month period preceding the person’s eighteenth birthday 4 in order to provide a smooth transition from children’s 5 to adult services. In addition, a person who is less than 6 eighteen years of age and a resident of this state may be 7 eligible, as determined by the region, for those mental health 8 services made available to all or a portion of the residents 9 of the region of the same age and eligibility class under the 10 county management plan of one or more counties of the region 11 applicable prior to formation of the region. 12 Sec. 8. Section 331.396, subsection 2, paragraph b, Code 13 2013, is amended to read as follows: 14 b. The person is at least eighteen years of age and is a 15 resident of this state. However, a person who is seventeen 16 years of age, is a resident of this state, and is receiving 17 publicly funded children’s services may be considered eligible 18 for services through the regional service system during the 19 three-month period preceding the person’s eighteenth birthday 20 in order to provide a smooth transition from children’s 21 to adult services. In addition, a person who is less than 22 eighteen years of age and a resident of this state may be 23 eligible, as determined by the region, for those intellectual 24 disability services made available to all or a portion of the 25 residents of the region of the same age and eligibility class 26 under the county management plan of one or more counties of the 27 region applicable prior to formation of the region. 28 Sec. 9. Section 331.397, subsection 2, paragraph b, Code 29 2013, is amended to read as follows: 30 b. Until funding is designated for other service 31 populations, eligibility for the service domains listed in this 32 section shall be limited to such persons who are in need of 33 mental health or intellectual disability services. However, if 34 a county in a region was providing services to an individual 35 -3- SF 440 (4) 85 jp/rj/jh 3/ 20

S.F. 440 person eligibility class of persons with a developmental 1 disability other than intellectual disability or a brain injury 2 prior to formation of the region, the individual person class 3 of persons shall remain eligible for the services provided when 4 the region is formed, provided that funds are available to 5 continue such services. 6 CORE SERVICES 7 Sec. 10. Section 331.397, subsection 4, paragraphs c and d, 8 Code 2013, are amended to read as follows: 9 c. Support for community living and other living 10 arrangements , including but not limited to all of the 11 following: 12 (1) Home health aide. 13 (2) Home and vehicle modifications. 14 (3) Respite. 15 (4) Supportive community living. 16 (5) Residential care facility living arrangements. 17 d. Support for employment and work activity , including but 18 not limited to all of the following: 19 (1) Day habilitation. 20 (2) Job development. 21 (3) Supported employment. 22 (4) Prevocational services. 23 (5) Other work activity services. 24 STATE PAYMENTS TO REGION 25 Sec. 11. Section 426B.3, subsection 4, as enacted by 2012 26 Iowa Acts, chapter 1120, section 137, is amended to read as 27 follows: 28 4. a. For the fiscal years beginning July 1, 2013, and 29 July 1, 2014, a county with a county population expenditure 30 target amount that exceeds the amount of the county’s base year 31 expenditures for mental health and disabilities services shall 32 receive an equalization payment for the difference. 33 b. The equalization payments determined in accordance 34 with this subsection shall be made by the department of human 35 -4- SF 440 (4) 85 jp/rj/jh 4/ 20

S.F. 440 services for each fiscal year as provided in appropriations 1 made from the property tax relief fund for this purpose. If 2 the county is part of a region that has been approved by the 3 department in accordance with section 331.389, to commence 4 partial or full operations, the county’s equalization payment 5 shall be remitted to the region for expenditure as approved by 6 the region’s governing board. 7 STRATEGIC PLAN REQUIREMENT FOR FY 2013-2014 8 Sec. 12. 2012 Iowa Acts, chapter 1128, section 8, is amended 9 to read as follows: 10 SEC. 8. COUNTY MENTAL HEALTH, MENTAL RETARDATION 11 INTELLECTUAL DISABILITY , AND DEVELOPMENTAL DISABILITIES 12 SERVICES MANAGEMENT PLAN —— STRATEGIC PLAN. Notwithstanding 13 section 331.439, subsection 1 , paragraph “b”, subparagraph (3), 14 counties are not required to submit a three-year strategic 15 plan by April 1, 2012, to the department of human services. A 16 county’s strategic plan in effect as of the effective date of 17 this section shall remain in effect until the regional service 18 system management plan for the region to which the county 19 belongs is approved in accordance with section 331.393 , subject 20 to modification before that date as necessary to conform with 21 statutory changes affecting the plan and any amendments to the 22 plan that are adopted in accordance with law . 23 RISK POOL DISTRIBUTIONS 24 Sec. 13. 2012 Iowa Acts, chapter 1128, section 6, 25 subsections 5 and 6, as amended by 2012 Iowa Acts, chapter 26 1133, section 67, are amended to read as follows: 27 5. If moneys from a distribution made under this section are 28 not expended by a county by June 30, 2013 2015 , for services 29 provided by that date under the applicable service management 30 plan , the county shall reimburse the unexpended moneys to the 31 department by August 30, 2013 2015 , and the moneys reimbursed 32 shall be credited to the risk pool in the property tax relief 33 fund. 34 6. The risk pool board shall submit annual reports to the 35 -5- SF 440 (4) 85 jp/rj/jh 5/ 20

S.F. 440 governor and general assembly on or before December 31 , 2012 1 and 2013, regarding the expenditure of funds distributed under 2 this section. The final annual report shall be submitted on or 3 before December 31, 2015. 4 TRANSITION FUND —— SERVICES MAINTENANCE 5 Sec. 14. TRANSITION FUND —— SERVICES MAINTENANCE. A county 6 receiving an allocation of funding from the mental health and 7 disability services redesign transition fund created in 2012 8 Iowa Acts, chapter 1120, section 23, shall utilize the funding 9 received by the county as necessary for the services covered 10 in accordance with the county’s approved management plan in 11 effect as of June 30, 2012, for the fiscal year beginning July 12 1, 2012, and ending June 30, 2013. 13 REDESIGN EQUALIZATION PAYMENTS AND RISK POOL 14 Sec. 15. EQUALIZATION PAYMENTS AND RISK POOL. 15 1. There is transferred from the general fund of the state 16 to the property tax relief fund created in section 426B.1 17 for the fiscal year beginning July 1, 2012, and ending June 18 30, 2013, the following amount to be used for the purposes 19 designated: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 42,826,316 21 2. a. The moneys credited to the property tax relief 22 fund in accordance with this section are appropriated to the 23 department of human services for the fiscal year beginning July 24 1, 2013, and ending June 30, 2014, for distribution to counties 25 and regions in accordance with this section. If a county is 26 part of a region that has been approved by the department to 27 commence partial or full operations in accordance with section 28 331.389 for the fiscal year, the county’s payment made pursuant 29 to this section shall be remitted to the region for expenditure 30 as approved by the region’s governing board. The payments made 31 under this section are in lieu of equalization payments for the 32 fiscal year beginning July 1, 2013, otherwise required under 33 section 426B.3, as amended by 2012 Iowa Acts, section 137. 34 b. For the purposes of this section, unless the context 35 -6- SF 440 (4) 85 jp/rj/jh 6/ 20

S.F. 440 otherwise requires: 1 (1) “Net expenditures from the county’s services fund” 2 means a county’s payments for non-Medicaid services, as 3 reported to the department of management pursuant to section 4 331.403, plus any reimbursement of moneys distributed to the 5 county pursuant to 2012 Iowa Acts, chapter 1128, section 6, as 6 amended by 2012 Iowa Acts, chapter 1133, section 67, and less 7 any moneys expended by the county as a provider of services 8 that were reimbursed to the county. 9 (2) “Population” means the same as defined in section 10 331.388. 11 (3) “Services fund” means a county’s mental health and 12 disabilities services fund created in accordance with section 13 331.424A. 14 3. Of the amount appropriated in this section, $31,388,667 15 shall be distributed to counties as per capita growth payments 16 in accordance with this section. 17 4. A per capita growth amount shall be distributed to each 18 county in two payments. The provisional per capita growth 19 amount for the fiscal year is $10.25, with the final amount 20 determined in accordance with subsection 5. A county’s first 21 per capita growth payment shall be the product of $8.25 of the 22 provisional per capita growth amount times the county’s general 23 population for the fiscal year. 24 5. The moneys transferred to the property tax relief fund 25 for the fiscal year beginning July 1, 2013, from the federal 26 social services block grant pursuant to 2013 Iowa Acts, House 27 File 614, or any other 2013 Iowa Acts, if enacted and from 28 the federal temporary assistance for needy families block 29 grant, totaling at least $11,774,275, are appropriated to the 30 department of human services for the fiscal year beginning July 31 1, 2013, to be used for distribution of state payment program 32 remittances to counties for the fiscal year in accordance 33 with this subsection. The state payment program remittance 34 shall be an amount equal to the amount paid to a county of 35 -7- SF 440 (4) 85 jp/rj/jh 7/ 20

S.F. 440 residence under the program for state case services known as 1 the state payment program, implemented pursuant to section 2 331.440, subsection 5, during the most recently available 3 twelve-month period. The department shall draw upon the 4 appropriation made from the general fund of the state for the 5 medical assistance program for the fiscal year as necessary for 6 cash flow purposes in order to comply with the date specified 7 for remitting payments to counties in subsection 6, and to 8 distribute at least the amount specified in this subsection. 9 If the procedure for reduced federal funds specified in 2013 10 Iowa Acts, House File 614, or any other 2013 Iowa Acts, if 11 enacted, reduces the amount of block grant funding available 12 for the purposes of this subsection, the amount drawn from the 13 medical assistance appropriation shall be increased to replace 14 the amount of the reduction. 15 6. The first per capita growth payment due a county under 16 subsection 4 and any state payment program remittance due a 17 county under subsection 5, shall be combined and remitted to 18 the counties on or before July 15, 2013. 19 7. a. Of the amount appropriated in this section, 20 $11,437,649 shall be distributed to counties as stabilization 21 payments in accordance with this subsection. A stabilization 22 payment shall be distributed to each county for which the 23 amount of net expenditures from the county’s services fund 24 under section 331.424A for the fiscal year beginning July 1, 25 2012, exceeds the sum of the county’s state payment program 26 remittance under subsection 5 plus the dollar amount of the 27 county’s services fund levies for the fiscal year beginning 28 July 1, 2013. A county’s stabilization payment amount shall 29 be equal to the excess net expenditures amount. To receive 30 a stabilization payment, on or before December 1, 2013, the 31 county shall submit a statement of net expenditures from 32 the county’s services fund for the fiscal year beginning 33 July 1, 2012. The statement shall be accompanied by the 34 annual financial report for that fiscal year submitted to the 35 -8- SF 440 (4) 85 jp/rj/jh 8/ 20

S.F. 440 department of management pursuant to section 331.403. The 1 department shall determine the county’s stabilization payment 2 amount by subtracting the sum of the county’s state payment 3 program remittance and the dollar amount of the county’s 4 certified levy amount for the services fund for the fiscal year 5 from the county’s statement of total net expenditures. 6 b. If the sum of the total of all eligible counties’ 7 stabilization payments plus the product of $2.00 of the 8 provisional per capita growth payment amount under subsection 9 4 times the state’s general population for the fiscal year is 10 greater or less than the amount of moneys remaining after the 11 first per capita growth payments made pursuant to subsection 12 4 and the amount allocated in this subsection, the department 13 shall identify a final per capita growth amount by adjusting 14 the provisional per capita growth amount as necessary to 15 distribute all of the moneys remaining. If the total of the 16 stabilization payments exceeds the amount allocated in this 17 subsection, the provisional per capita growth amount shall be 18 reduced to provide sufficient funding to address the excess. 19 If the total of the stabilization payments is less than the 20 amount allocated in this subsection, the provisional per 21 capita growth amount shall be increased to address the reduced 22 amount. A county’s second per capita growth payment shall be 23 the product of the remainder of the final per capita growth 24 amount as adjusted by the department times the county’s general 25 population for the fiscal year. 26 c. Each county’s second per capita growth payment shall be 27 combined with any stabilization payment due the county. The 28 payments shall be remitted to the counties on or before January 29 2, 2014. 30 SUBSTANCE-RELATED DISORDER DETOXIFICATION 31 Sec. 16. COORDINATION OF DETOXIFICATION SERVICES. The 32 department of human services shall review options for the 33 mental health and disability services regions to coordinate 34 detoxification funding provided by counties and other such 35 -9- SF 440 (4) 85 jp/rj/jh 9/ 20

S.F. 440 disorder funding provided by counties in place of county 1 coordination. The department shall report to the governor and 2 general assembly its findings, options, and recommendations on 3 or before October 15, 2013. 4 MEDICAID OBLIGATION COST SETTLEMENT 5 Sec. 17. COUNTY MEDICAL ASSISTANCE NONFEDERAL SHARE —— 6 COST SETTLEMENT. Any county obligation for payment to the 7 department of human services of the nonfederal share of the 8 cost of services provided under the medical assistance program 9 prior to July 1, 2012, pursuant to sections 249A.12 and 10 249A.26, shall remain at the amount agreed upon as of June 30, 11 2013. Beginning July 1, 2013, other than a county payment on 12 the obligation or for a charge when the county is the provider 13 of the service, the department shall be responsible for any 14 adjustment that would otherwise be applied to the amount of the 15 county obligation after that date due to cost settlement of 16 charges or other reasons. 17 COUNTY MENTAL HEALTH AND DISABILITY 18 SERVICES FUND —— FY 2013-2014 19 Sec. 18. SERVICES FUND —— MANAGEMENT PLAN. For the fiscal 20 year beginning July 1, 2013, and ending June 30, 2014, the 21 appropriations made by the county board of supervisors for 22 payment for mental health and disability services pursuant 23 to section 331.424A, subsection 3, as enacted by 2012 Iowa 24 Acts, chapter 1120, section 132, shall be made in accordance 25 with the county’s service management plan approved under 26 section 331.439, Code 2013, until the county management plan is 27 replaced by a regional service system management plan approved 28 under section 331.393. 29 Sec. 19. CONTINUATION OF MENTAL HEALTH AND DISABILITY 30 SERVICES REDESIGN FISCAL VIABILITY STUDY COMMITTEE. The 31 legislative council is requested to continue for the 2013 32 legislative interim the mental health and disability services 33 redesign fiscal viability study committee initially created by 34 the legislative council in 2012. The legislative council is 35 -10- SF 440 (4) 85 jp/rj/jh 10/ 20

S.F. 440 requested to add at least four citizen members to the study 1 committee to provide representation for service consumers, 2 service providers, county supervisors, and the community 3 services affiliate of the Iowa state association of counties. 4 In addition to monitoring implementation of the mental health 5 and disability services redesign and receiving reports from 6 stakeholder groups engaged in implementation of the redesign, 7 the study committee shall be directed to propose a permanent 8 approach for state, county, and regional financing of the 9 redesign. 10 Sec. 20. EFFECTIVE UPON ENACTMENT. This division of this 11 Act, being deemed of immediate importance, takes effect upon 12 enactment. 13 DIVISION II 14 DATA AND STATISTICAL INFORMATION AND OUTCOME AND PERFORMANCE 15 MEASURES 16 Sec. 21. Section 225C.4, subsection 1, paragraph j, Code 17 2013, is amended to read as follows: 18 j. Establish and maintain a data collection and management 19 information system oriented to the needs of patients, 20 providers, the department, and other programs or facilities in 21 accordance with section 225C.6A . The system shall be used to 22 identify, collect, and analyze service outcome and performance 23 measures data in order to assess the effects of the services on 24 the persons utilizing the services. The administrator shall 25 annually submit to the commission information collected by the 26 department indicating the changes and trends in the disability 27 services system. The administrator shall make the outcome data 28 available to the public. 29 Sec. 22. Section 225C.6A, Code 2013, is amended to read as 30 follows: 31 225C.6A Disability services system redesign central data 32 repository . 33 1. The commission department shall do the following 34 relating to redesign of data concerning the disability services 35 -11- SF 440 (4) 85 jp/rj/jh 11/ 20

S.F. 440 system in the state: 1 1. Identify sources of revenue to support statewide 2 delivery of core disability services to eligible disability 3 populations. 4 2. Ensure there is a continuous improvement process for 5 development and maintenance of the disability services system 6 for adults and children. The process shall include but is not 7 limited to data collection and reporting provisions. 8 3. a. Plan, collect, and analyze data as necessary to 9 issue cost estimates for serving additional populations and 10 providing core disability services statewide. The department 11 shall maintain compliance with applicable federal and state 12 privacy laws to ensure the confidentiality and integrity of 13 individually identifiable disability services data. The 14 department shall regularly may periodically assess the status 15 of the compliance in order to assure that data security is 16 protected. 17 b. In implementing Implement a system central data 18 repository under this subsection section for collecting and 19 analyzing state, county and region , and private contractor 20 data , the . The department shall establish a client identifier 21 for the individuals receiving services. The client identifier 22 shall be used in lieu of the individual’s name or social 23 security number. The client identifier shall consist of the 24 last four digits of an individual’s social security number, 25 the first three letters of the individual’s last name, the 26 individual’s date of birth, and the individual’s gender in an 27 order determined by the department. 28 c. Consult on an ongoing basis with regional administrators, 29 service providers, and other stakeholders in implementing the 30 central data repository and operations of the repository. The 31 consultation shall focus on minimizing the state and local 32 costs associated with operating the repository. 33 d. Engage with other state and local government and 34 nongovernmental entities operating the Iowa health information 35 -12- SF 440 (4) 85 jp/rj/jh 12/ 20

S.F. 440 network under chapter 135 and other data systems that maintain 1 information relating to individuals with information in the 2 central data repository in order to integrate data concerning 3 individuals. 4 c. 2. A county or region shall not be required to utilize a 5 uniform data operational or transactional system. However, the 6 system utilized shall have the capacity to exchange information 7 with the department, counties and regions, contractors, and 8 others involved with services to persons with a disability 9 who have authorized access to the central data repository. 10 The information exchanged shall be labeled consistently 11 and share the same definitions. Each county regional 12 administrator shall regularly report to the department annually 13 on or before December 1, for the preceding fiscal year the 14 following information for each individual served: demographic 15 information, expenditure data, and data concerning the services 16 and other support provided to each individual, as specified 17 in administrative rule adopted by the commission by the 18 department . 19 4. Work with county representatives and other qualified 20 persons to develop an implementation plan for replacing the 21 county of legal settlement approach to determining service 22 system funding responsibilities with an approach based upon 23 residency. The plan shall address a statewide standard for 24 proof of residency, outline a plan for establishing a data 25 system for identifying residency of eligible individuals, 26 address residency issues for individuals who began residing in 27 a county due to a court order or criminal sentence or to obtain 28 services in that county, recommend an approach for contesting 29 a residency determination, and address other implementation 30 issues. 31 3. The outcome and performance measures applied to the 32 regional disability services system shall utilize measurement 33 domains. The department may identify other measurement domains 34 in consultation with system stakeholders to be utilized in 35 -13- SF 440 (4) 85 jp/rj/jh 13/ 20

S.F. 440 addition to the following initial set of measurement domains: 1 a. Access to services. 2 b. Life in the community. 3 c. Person-centeredness. 4 d. Health and wellness. 5 e. Quality of life and safety. 6 f. Family and natural supports. 7 4. a. The processes used for collecting outcome and 8 performance measures data shall include but are not limited 9 to direct surveys of the individuals and families receiving 10 services and the providers of the services. The department 11 shall involve a workgroup of persons who are knowledgeable 12 about both the regional service system and survey techniques 13 to implement and maintain the processes. The workgroup shall 14 conduct an ongoing evaluation for the purpose of eliminating 15 the collection of information that is not utilized. The 16 surveys shall be conducted with a conflict-free approach in 17 which someone other than a provider of services surveys an 18 individual receiving the services. 19 b. The outcome and performance measures data shall encompass 20 and provide a means to evaluate both the regional services and 21 the services funded by the medical assistance program provided 22 to the same service populations. 23 c. The department shall develop and implement an 24 internet-based approach with graphical display of information 25 to provide outcome and performance measures data to the public 26 and those engaged with the regional service system. 27 d. The department shall include any significant costs for 28 collecting and interpreting outcome and performance measures 29 and other data in the department’s operating budget. 30 Sec. 23. REPEAL. The amendment to section 225C.4, 31 subsection 1, paragraph j, in 2012 Iowa Acts, chapter 1120, 32 section 2, is repealed. 33 Sec. 24. REPEAL. The amendments to section 225C.6A, in 2012 34 Iowa Acts, chapter 1120, sections 6, 7, and 95, are repealed. 35 -14- SF 440 (4) 85 jp/rj/jh 14/ 20

S.F. 440 DIVISION III 1 CHILDREN’S CABINET 2 Sec. 25. NEW SECTION . 242.1 Findings. 3 The general assembly finds there is a need for a 4 state-level children’s cabinet to provide guidance, oversight, 5 problem-solving, and long-term strategy development, and to 6 foster collaboration among state and local efforts to build a 7 comprehensive, coordinated system of care in order to promote 8 the well-being of the children in this state. The system of 9 care should address all domains of child physical, mental, 10 intellectual, developmental, and social health and meet the 11 particular needs of children for family-centered mental health 12 and disability services and for other appropriate specialized 13 services. 14 Sec. 26. NEW SECTION . 242.2 Children’s cabinet established. 15 There is established within the department of human services 16 a children’s cabinet. 17 1. The voting members of the children’s cabinet shall 18 consist of the following: 19 a. The director of the department of education or the 20 director’s designee. 21 b. The director of the department of human services or the 22 director’s designee. This member shall be chairperson of the 23 cabinet. 24 c. The director of the department of inspections and appeals 25 or the director’s designee. 26 d. The director of the department of public health or the 27 director’s designee. 28 e. A parent of a child with a severe emotional disturbance 29 or a disability who is the primary caregiver for that child, 30 appointed by the governor. 31 f. A juvenile court judge or juvenile court officer 32 appointed by the chief justice of the supreme court. 33 g. A community-based provider of child welfare, health, 34 or juvenile justice services to children, appointed by the 35 -15- SF 440 (4) 85 jp/rj/jh 15/ 20

S.F. 440 director of human services. 1 h. A member of the early childhood Iowa state board or the 2 early childhood stakeholders alliance, appointed by the state 3 board. 4 i. A community stakeholder who is not affiliated with a 5 provider of services, appointed by the governor. 6 j. A member of a child advocacy organization approved by the 7 members of the children’s cabinet. 8 k. A member of the Iowa chapter of the American academy 9 of pediatrics who has expertise in pediatric health care and 10 addressing the needs of children with special needs, designated 11 by the Iowa chapter. 12 l. An area education agency staff member who works with 13 early childhood services, appointed by the state’s area 14 education agency directors. 15 m. An area education agency staff member who works with 16 children’s mental health services, appointed by the state’s 17 area education agency directors. 18 n. Not more than three other members designated by 19 the cabinet chairperson to ensure adequate representation 20 of the persons and interests who may be affected by the 21 recommendations made by the cabinet. 22 2. In addition to the voting members, there shall be four ex 23 officio, nonvoting members of the children’s cabinet. These 24 members shall be two state representatives, one appointed by 25 the speaker of the house of representatives and one by the 26 minority leader of the house of representatives, and two state 27 senators, one appointed by the majority leader of the senate 28 and one by the minority leader of the senate. 29 3. a. The voting members, other than department directors 30 and their designees, shall be appointed for four-year terms. 31 The terms of such members begin on May 1 in the year of 32 appointment and expire on April 30 in the year of expiration. 33 b. Vacancies shall be filled in the same manner as original 34 appointments. A vacancy shall be filled for the unexpired 35 -16- SF 440 (4) 85 jp/rj/jh 16/ 20

S.F. 440 term. 1 c. The voting members shall receive actual and necessary 2 expenses incurred in the performance of their duties and 3 legislative members shall be compensated as provided in section 4 2.32A. 5 4. Staffing services for the children’s cabinet shall be 6 provided by the department of human services. 7 Sec. 27. NEW SECTION . 242.3 Duties. 8 The children’s cabinet shall perform the following duties 9 in making recommendations to the agencies and organizations 10 represented on the cabinet, the governor, the general assembly, 11 and the judicial branch to address the needs of children and 12 families in this state: 13 1. Recommend operating provisions for health homes for 14 children implemented by the department of human services. The 15 provisions shall include but are not limited to all of the 16 following: 17 a. Identification of quality metrics. 18 b. Identification of performance criteria. 19 c. Provisions for monitoring the implementation of 20 specialized health homes. 21 d. Identification of system of care principles and values 22 based on the recommendations of the workgroup for redesign of 23 publicly funded children’s disability services implemented by 24 the department of human services in accordance with 2011 Iowa 25 Acts, chapter 121, section 1, subsection 4, paragraph “i” . 26 2. Gather information and improve the understanding of 27 policymakers and the public of how the various service systems 28 intended to meet the needs of children and families operate at 29 the local level. 30 3. Address areas of overlap, gaps, and conflict between 31 service systems. 32 4. Support the evolution of service systems in implementing 33 new services and enhancing existing services to address the 34 needs of children and families through process improvement 35 -17- SF 440 (4) 85 jp/rj/jh 17/ 20

S.F. 440 methodologies. 1 5. Assist policymakers and service system users in 2 understanding and effectively managing system costs. 3 6. Ensure services offered are evidence-based. 4 7. Issue guidelines to enable the services and other support 5 which is provided by or under the control of state entities and 6 delivered at the local level to have sufficient flexibility to 7 engage local resources and meet unique needs of children and 8 families. 9 8. Integrate efforts of policymakers and service providers 10 to improve the well-being of community members in addition to 11 children and families. 12 9. Implement strategies so that the children and families 13 engaged with the service systems avoid the need for higher 14 level services and other support. 15 10. Oversee the practices utilized by accountable care 16 organizations and other care management entities operating on 17 behalf of the state in the provision of government supported 18 children’s services and systems of care. 19 11. Identify and promote evidence-based practices that may 20 be creatively applied in appropriate settings for prevention 21 and early identification of social, emotional, behavioral, and 22 developmental risk factors for children from birth through age 23 eight. 24 12. Making periodic recommendations to the agencies 25 and organizations represented on the cabinet. An agency or 26 organization receiving such a recommendation shall respond 27 in writing to the children’s cabinet detailing how the 28 recommendation was addressed. The response shall be submitted 29 not later than sixty business days following the date of the 30 receipt of the recommendation. 31 13. Submit a report annually by December 15 to the governor, 32 general assembly, and supreme court providing findings and 33 recommendations and issue other reports as deemed necessary by 34 the cabinet. 35 -18- SF 440 (4) 85 jp/rj/jh 18/ 20

S.F. 440 Sec. 28. INITIAL TERMS. Notwithstanding section 242.2, 1 subsection 3, paragraph “a”, as enacted by this division of 2 this Act, the appointing authorities for the members of the 3 children’s cabinet created by this division of this Act who are 4 subject to terms of service shall be coordinated so that the 5 initial terms of approximately half of such members are two 6 years and the remainder are for four years and remain staggered 7 thereafter. 8 DIVISION IV 9 CENTER FOR CHILD HEALTH INNOVATION AND EXCELLENCE 10 Sec. 29. Section 135.11, Code 2013, is amended by adding the 11 following new subsection: 12 NEW SUBSECTION . 32. Create and operate, subject to 13 appropriation of funding by the general assembly, a center for 14 child health excellence and innovation. The purpose of the 15 center is to provide a policy forum for efforts to improve 16 child health, including but not limited to improving health 17 quality, demonstrating better health outcomes, and reducing 18 long-term health care costs. 19 a. The center shall engage major providers of child health 20 services and associated groups, including but not limited to 21 representatives of the department, the medical assistance 22 program administrator, child health specialty clinics, the 23 association representing community health centers, the state 24 council created by the department for the department’s project 25 LAUNCH initiative, staff of institutions of higher education 26 with expertise in pediatric health and child health care, the 27 prevention of disabilities policy council in conjunction with 28 the center for disabilities and development of the university 29 of Iowa’s children’s hospital, and others. 30 b. The center shall lead the review and analysis of public 31 policy efforts that are directed toward the purpose of the 32 center. 33 c. The center shall develop community-based initiatives 34 to promote healthy child development, leveraging medical 35 -19- SF 440 (4) 85 jp/rj/jh 19/ 20