House File 2456 - Reprinted HOUSE FILE 2456 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HF 2327) (As Amended and Passed by the House February 27, 2018 ) A BILL FOR An Act relating to behavioral health, including provisions 1 relating to involuntary commitments and hospitalizations, 2 the disclosure of mental health information to law 3 enforcement professionals, and mental health and disability 4 services. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 HF 2456 (4) 87 hb/rh/md

H.F. 2456 Section 1. Section 125.80, subsection 3, Code 2018, is 1 amended to read as follows: 2 3. If the report of a court-designated licensed physician 3 or mental health professional is to the effect that the 4 respondent is not a person with a substance-related disorder, 5 the court, without taking further action, may shall terminate 6 the proceeding and dismiss the application on its own motion 7 and without notice. 8 Sec. 2. Section 125.81, Code 2018, is amended by adding the 9 following new subsection: 10 NEW SUBSECTION . 2A. A respondent shall be released from 11 detention prior to the commitment hearing if a licensed 12 physician or mental health professional examines the respondent 13 and determines the respondent no longer meets the criteria for 14 detention under subsection 1 and provides notification to the 15 court. 16 Sec. 3. Section 125.82, subsection 4, Code 2018, is amended 17 to read as follows: 18 4. The respondent’s welfare is paramount, and the hearing 19 shall be tried as a civil matter and conducted in as informal a 20 manner as is consistent with orderly procedure. The hearing 21 may be held by video conference at the discretion of the 22 court. Discovery as permitted under the Iowa rules of civil 23 procedure is available to the respondent. The court shall 24 receive all relevant and material evidence, but the court is 25 not bound by the rules of evidence. A presumption in favor of 26 the respondent exists, and the burden of evidence and support 27 of the contentions made in the application shall be upon the 28 person who filed the application. If upon completion of the 29 hearing the court finds that the contention that the respondent 30 is a person with a substance-related disorder has not been 31 sustained by clear and convincing evidence, the court shall 32 deny the application and terminate the proceeding. 33 Sec. 4. Section 135G.6, Code 2018, is amended by striking 34 the section and inserting in lieu thereof the following: 35 -1- HF 2456 (4) 87 hb/rh/md 1/ 17

H.F. 2456 135G.6 Inspection —— conditions for issuance. 1 The department shall issue a license to an applicant under 2 this chapter if the department has ascertained that the 3 applicant’s facilities and staff are adequate to provide the 4 care and services required of a subacute care facility. 5 Sec. 5. Section 228.1, Code 2018, is amended by adding the 6 following new subsection: 7 NEW SUBSECTION . 3A. “ Law enforcement professional” means 8 a law enforcement officer as defined in section 80B.3, county 9 attorney as defined in section 331.101, probation or parole 10 officer, or jailer. 11 Sec. 6. NEW SECTION . 228.7A Disclosures to law enforcement 12 professionals. 13 1. Mental health information relating to an individual may 14 be disclosed by a mental health professional, at the minimum 15 consistent with applicable laws and standards of ethical 16 conduct, to a law enforcement professional if all of the 17 following apply: 18 a. The disclosure is made in good faith. 19 b. The disclosure is necessary to prevent or lessen a 20 serious and imminent threat to the health or safety of the 21 individual or to a clearly identifiable victim or victims. 22 c. The individual has the apparent intent and ability to 23 carry out the threat. 24 2. A mental health professional shall not be held criminally 25 or civilly liable for failure to disclose mental health 26 information relating to an individual to a law enforcement 27 professional except in circumstances where the individual has 28 communicated to the mental health professional an imminent 29 threat of physical violence against the individual’s self or 30 against a clearly identifiable victim or victims. 31 3. A mental health professional discharges the 32 professional’s duty to disclose pursuant to subsection 1 by 33 making reasonable efforts to communicate the threat to a law 34 enforcement professional. 35 -2- HF 2456 (4) 87 hb/rh/md 2/ 17

H.F. 2456 Sec. 7. Section 229.1, subsection 20, Code 2018, is amended 1 by adding the following new paragraph: 2 NEW PARAGRAPH . d. Has a history of lack of compliance with 3 treatment and any of the following apply: 4 (1) Lack of compliance has been a significant factor in the 5 need for emergency hospitalization. 6 (2) Lack of compliance has resulted in one or more acts of 7 serious physical injury to the person’s self or others or an 8 attempt to physically injure the person’s self or others. 9 Sec. 8. Section 229.10, subsection 3, Code 2018, is amended 10 to read as follows: 11 3. If the report of one or more of the court-designated 12 physicians or mental health professionals is to the effect 13 that the individual is not seriously mentally impaired, the 14 court may shall without taking further action terminate the 15 proceeding and dismiss the application on its own motion and 16 without notice. 17 Sec. 9. Section 229.11, Code 2018, is amended by adding the 18 following new subsection: 19 NEW SUBSECTION . 1A. A respondent shall be released from 20 detention prior to the hospitalization hearing if a licensed 21 physician or mental health professional examines the respondent 22 and determines the respondent no longer meets the criteria for 23 detention under subsection 1 and provides notification to the 24 court. 25 Sec. 10. Section 229.12, subsection 3, paragraph a, Code 26 2018, is amended to read as follows: 27 a. The respondent’s welfare shall be paramount and the 28 hearing shall be conducted in as informal a manner as may be 29 consistent with orderly procedure, but consistent therewith 30 the issue shall be tried as a civil matter. The hearing may 31 be held by video conference at the discretion of the court. 32 Such discovery as is permitted under the Iowa rules of civil 33 procedure shall be available to the respondent. The court 34 shall receive all relevant and material evidence which may be 35 -3- HF 2456 (4) 87 hb/rh/md 3/ 17

H.F. 2456 offered and need not be bound by the rules of evidence. There 1 shall be a presumption in favor of the respondent, and the 2 burden of evidence in support of the contentions made in the 3 application shall be upon the applicant. 4 Sec. 11. Section 229.13, subsection 7, paragraph a, 5 subparagraphs (2) and (3), Code 2018, are amended to read as 6 follows: 7 (2) Once in protective custody, the respondent shall be 8 given the choice of being treated by the appropriate medication 9 which may include the use of oral medicine or injectable 10 antipsychotic medicine by a mental health professional acting 11 within the scope of the mental health professional’s practice 12 at an outpatient psychiatric clinic, hospital, or other 13 suitable facility or being placed for treatment under the 14 care of a hospital or other suitable facility for inpatient 15 treatment. 16 (3) If the respondent chooses to be treated by the 17 appropriate medication which may include the use of oral 18 medicine or injectable antipsychotic medicine but the mental 19 health professional acting within the scope of the mental 20 health professional’s practice at the outpatient psychiatric 21 clinic, hospital, or other suitable facility determines that 22 the respondent’s behavior continues to be likely to result in 23 physical injury to the respondent’s self or others if allowed 24 to continue, the mental health professional acting within 25 the scope of the mental health professional’s practice shall 26 comply with the provisions of subparagraph (1) and, following 27 notice and hearing held in accordance with the procedures in 28 section 229.12 , the court may order the respondent treated 29 on an inpatient basis requiring full-time custody, care, and 30 treatment in a hospital until such time as the chief medical 31 officer reports that the respondent does not require further 32 treatment for serious mental impairment or has indicated the 33 respondent is willing to submit to treatment on another basis 34 as ordered by the court. 35 -4- HF 2456 (4) 87 hb/rh/md 4/ 17

H.F. 2456 Sec. 12. Section 229.22, subsection 2, paragraph b, Code 1 2018, is amended to read as follows: 2 b. If the magistrate orders that the person be detained, 3 the magistrate shall, by the close of business on the next 4 working day, file a written order with the clerk in the county 5 where it is anticipated that an application may be filed 6 under section 229.6 . The order may be filed by facsimile if 7 necessary. A peace officer from the law enforcement agency 8 that took the person into custody, if no request was made 9 under paragraph “a” , may inform the magistrate that an arrest 10 warrant has been issued for or charges are pending against the 11 person and request that any written order issued under this 12 paragraph require the facility or hospital to notify the law 13 enforcement agency about the discharge of the person prior to 14 discharge. The order shall state the circumstances under which 15 the person was taken into custody or otherwise brought to a 16 facility or hospital, and the grounds supporting the finding 17 of probable cause to believe that the person is seriously 18 mentally impaired and likely to injure the person’s self or 19 others if not immediately detained. The order shall also 20 include any law enforcement agency notification requirements if 21 applicable. The order shall confirm the oral order authorizing 22 the person’s detention including any order given to transport 23 the person to an appropriate facility or hospital. A peace 24 officer from the law enforcement agency that took the person 25 into custody may also request an order, separate from the 26 written order, requiring the facility or hospital to notify the 27 law enforcement agency about the discharge of the person prior 28 to discharge. The clerk shall provide a copy of the written 29 order or any separate order to the chief medical officer of the 30 facility or hospital to which the person was originally taken, 31 to any subsequent facility to which the person was transported, 32 and to any law enforcement department , or ambulance service , 33 or transportation service under contract with a mental health 34 and disability services region that transported the person 35 -5- HF 2456 (4) 87 hb/rh/md 5/ 17

H.F. 2456 pursuant to the magistrate’s order. A transportation service 1 that contracts with a mental health and disability services 2 region for purposes of this paragraph shall provide a secure 3 transportation vehicle and shall employ staff that has received 4 or is receiving mental health training. 5 Sec. 13. Section 331.397, Code 2018, is amended to read as 6 follows: 7 331.397 Regional core services. 8 1. For the purposes of this section , unless the context 9 otherwise requires, “domain” means a set of similar services 10 that can be provided depending upon a person’s service needs. 11 2. a. (1) A region shall work with service providers to 12 ensure that services in the required core service domains in 13 subsections 4 and 5 are available to residents of the region, 14 regardless of potential payment source for the services. 15 (2) Subject to the available appropriations, the director 16 of human services shall ensure the initial core service domains 17 listed in subsection subsections 4 and 5 are covered services 18 for the medical assistance program under chapter 249A to the 19 greatest extent allowable under federal regulations. The 20 medical assistance program shall reimburse Medicaid enrolled 21 providers for Medicaid covered services under subsections 4 22 and 5 when the services are medically necessary, the Medicaid 23 enrolled provider submits an appropriate claim for such 24 services, and no other third-party payer is responsible for 25 reimbursement of such services. Within funds available, the 26 region shall pay for such services for eligible persons when 27 payment through the medical assistance program or another 28 third-party payment is not available, unless the person is on a 29 waiting list for such payment or it has been determined that 30 the person does not meet the eligibility criteria for any such 31 service. 32 b. Until funding is designated for other service 33 populations, eligibility for the service domains listed in this 34 section shall be limited to such persons who are in need of 35 -6- HF 2456 (4) 87 hb/rh/md 6/ 17

H.F. 2456 mental health or intellectual disability services. However, if 1 a county in a region was providing services to an eligibility 2 class of persons with a developmental disability other than 3 intellectual disability or a brain injury prior to formation of 4 the region, the class of persons shall remain eligible for the 5 services provided when the region is was formed , provided that 6 funds are available to continue such services without limiting 7 or reducing core services . 8 c. 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 service definitions, service provider 18 standards, service access standards, and service implementation 19 dates, and shall provide consistency, to the extent possible, 20 with similar service definitions under the medical assistance 21 program. 22 a. The rules relating to the credentialing of a person 23 directly providing services shall require all of the following: 24 a. (1) The person shall provide services and represent the 25 person as competent only within the boundaries of the person’s 26 education, training, license, certification, consultation 27 received, supervised experience, or other relevant professional 28 experience. 29 b. (2) The person shall provide services in substantive 30 areas or use intervention techniques or approaches that 31 are new only after engaging in appropriate study, training, 32 consultation, and supervision from a person who is competent in 33 those areas, techniques, or approaches. 34 c. (3) If generally recognized standards do not exist 35 -7- HF 2456 (4) 87 hb/rh/md 7/ 17

H.F. 2456 with respect to an emerging area of practice, the person 1 shall exercise careful judgment and take responsible steps, 2 including obtaining appropriate education, research, training, 3 consultation, and supervision, in order to ensure competence 4 and to protect from harm the persons receiving the services in 5 the emerging area of practice. 6 b. The rules relating to the availability of intensive 7 mental health services specified in subsection 5 shall specify 8 that the minimum amount of services provided statewide shall 9 be as follows: 10 (1) Twenty-two assertive community treatment teams. 11 (2) Six access centers. 12 (3) Intensive residential service homes that provide 13 services to up to one hundred twenty persons. 14 4. The initial core service domains shall include the 15 following: 16 a. Treatment designed to ameliorate a person’s condition, 17 including but not limited to all of the following: 18 (1) Assessment and evaluation. 19 (2) Mental health outpatient therapy. 20 (3) Medication prescribing and management. 21 (4) Mental health inpatient treatment. 22 b. Basic crisis response provisions, including but not 23 limited to all of the following: 24 (1) Twenty-four-hour access to crisis response. 25 (2) Evaluation. 26 (3) Personal emergency response system. 27 c. Support for community living, including but not limited 28 to all of the following: 29 (1) Home health aide. 30 (2) Home and vehicle modifications. 31 (3) Respite. 32 (4) Supportive community living. 33 d. Support for employment or for activities leading to 34 employment providing an appropriate match with an individual’s 35 -8- HF 2456 (4) 87 hb/rh/md 8/ 17

H.F. 2456 abilities based upon informed, person-centered choices made 1 from an array of options, including but not limited to all of 2 the following: 3 (1) Day habilitation. 4 (2) Job development. 5 (3) Supported employment. 6 (4) Prevocational services. 7 e. Recovery services, including but not limited to all of 8 the following: 9 (1) Family support. 10 (2) Peer support. 11 f. Service coordination including coordinating physical 12 health and primary care, including but not limited to all of 13 the following: 14 (1) Case management. 15 (2) Health homes. 16 5. a. Provided that federal matching funds are available 17 under the Iowa health and wellness plan pursuant to chapter 18 249N, the following intensive mental health services in 19 strategic locations throughout the state shall be provided 20 within the following core service domains: 21 (1) Access centers that are located in crisis residential 22 and subacute residential settings with sixteen beds or fewer 23 that provide immediate, short-term assessments for persons with 24 serious mental illness or substance use disorders who do not 25 need inpatient psychiatric hospital treatment, but who do need 26 significant amounts of supports and services not available in 27 the persons’ homes or communities. 28 (2) Assertive community treatment services. 29 (3) Comprehensive facility and community-based crisis 30 services, including all of the following: 31 (a) Mobile response. 32 (b) Twenty-three-hour crisis observation and holding. 33 (c) Crisis stabilization community-based services. 34 (d) Crisis stabilization residential services. 35 -9- HF 2456 (4) 87 hb/rh/md 9/ 17

H.F. 2456 (4) Subacute services provided in facility and 1 community-based settings. 2 (5) Intensive residential service homes for persons 3 with severe and persistent mental illness in scattered site 4 community-based residential settings that provide intensive 5 services and that operate twenty-four hours a day. 6 b. The department shall accept arrangements between multiple 7 regions sharing intensive mental health services under this 8 subsection. 9 5. 6. A region shall ensure that access is available 10 to providers of core services that demonstrate competencies 11 necessary for all of the following: 12 a. Serving persons with co-occurring conditions. 13 b. Providing evidence-based services. 14 c. Providing trauma-informed care that recognizes the 15 presence of trauma symptoms in persons receiving services. 16 6. 7. A region shall ensure that services within the 17 following additional core service domains are available 18 to persons not eligible for the medical assistance program 19 under chapter 249A or receiving other third-party payment for 20 the services, when public funds are made available for such 21 services: 22 a. Comprehensive facility and community-based crisis 23 services, including but not limited to all of the following: 24 (1) Twenty-four-hour crisis hotline. 25 (2) Mobile response. 26 (3) Twenty-three-hour crisis observation and holding, and 27 crisis stabilization facility and community-based services. 28 (4) Crisis residential services. 29 b. Subacute services provided in facility and 30 community-based settings. 31 c. a. Justice system-involved services, including but not 32 limited to all of the following: 33 (1) Jail diversion. 34 (2) Crisis intervention training. 35 -10- HF 2456 (4) 87 hb/rh/md 10/ 17

H.F. 2456 (3) Civil commitment prescreening. 1 d. b. Advances in the use of evidence-based treatment, 2 including but not limited to all of the following: 3 (1) Positive behavior support. 4 (2) Assertive community treatment. 5 (3) (2) Peer self-help drop-in centers. 6 7. 8. A regional service system may provide funding for 7 other appropriate services or other support and may implement 8 demonstration projects for an initial period of up to three 9 years to model the use of research-based practices. In 10 considering whether to provide such funding, a region may 11 consider the following criteria for research-based practices: 12 a. Applying a person-centered planning process to identify 13 the need for the services or other support. 14 b. The efficacy of the services or other support is 15 recognized as an evidence-based practice, is deemed to be an 16 emerging and promising practice, or providing the services is 17 part of a demonstration and will supply evidence as to the 18 services’ effectiveness. 19 c. A determination that the services or other support 20 provides an effective alternative to existing services that 21 have been shown by the evidence base to be ineffective, to not 22 yield the desired outcome, or to not support the principles 23 outlined in Olmstead v. L.C., 527 U.S. 581 (1999). 24 Sec. 14. Section 331.424A, subsection 9, Code 2018, is 25 amended to read as follows: 26 9. a. For the fiscal year beginning July 1, 2017, and each 27 subsequent fiscal year, the county budgeted amount determined 28 for each county shall be the amount necessary to meet the 29 county’s financial obligations for the payment of services 30 provided under the regional service system management plan 31 approved pursuant to section 331.393 , not to exceed an amount 32 equal to the product of the regional per capita expenditure 33 target amount multiplied by the county’s population , and, for 34 fiscal years beginning on or after July 1, 2021, reduced by 35 -11- HF 2456 (4) 87 hb/rh/md 11/ 17

H.F. 2456 the amount of the county’s cash flow reduction amount for the 1 fiscal year calculated under subsection 4 , if applicable . 2 b. If a county officially joins a different region, the 3 county’s budgeted amount shall be the amount necessary to meet 4 the county’s financial obligations for payment of services 5 provided under the new region’s regional service system 6 management plan approved pursuant to section 331.393, not to 7 exceed an amount equal to the product of the new region’s 8 regional per capita expenditure target amount multiplied by the 9 county’s population. 10 Sec. 15. DEPARTMENT OF HUMAN SERVICES —— CIVIL COMMITMENT 11 PRESCREENING ASSESSMENTS —— RULES. The department of human 12 services, in coordination with the mental health and disability 13 services commission, shall adopt rules pursuant to chapter 17A 14 relating to civil commitment prescreening assessments provided 15 by a mental health and disability services region or an entity 16 contracting with a mental health and disability service region. 17 The rules shall provide for all of the following: 18 1. The provision of civil commitment prescreening 19 assessments by a licensed physician or mental health 20 professional within four hours of an emergency detention of 21 an individual believed to be mentally ill to determine if 22 inpatient psychiatric hospitalization is necessary. 23 2. The coordination of appropriate levels of care 24 to include securing an inpatient psychiatric bed when 25 inpatient psychiatric hospitalization is needed and 26 utilizing community-based resources and services such as 27 crisis observation and crisis stabilization services and 28 subacute care and detoxification centers and facilitating 29 outpatient treatment appointments when inpatient psychiatric 30 hospitalization is not needed. 31 3. The provision of ongoing consultations by a licensed 32 physician or mental health professional while the individual 33 remains in the emergency room. 34 4. Requiring appropriate documentation and reports to be 35 -12- HF 2456 (4) 87 hb/rh/md 12/ 17

H.F. 2456 submitted by a licensed physician or mental health professional 1 to a treating hospital and the court as necessary. 2 Sec. 16. PROGRAM IMPLEMENTATION —— ADOPTION OF 3 ADMINISTRATIVE RULES. 4 1. The department of human services shall submit a notice 5 of intended action to the administrative rules coordinator and 6 the Iowa administrative code editor pursuant to section 17A.4, 7 subsection 1, paragraph “a”, not later than August 15, 2018, 8 for the adoption of rules to implement the standards of core 9 services specified in this Act. 10 2. The provisions of this Act and rules adopted in 11 accordance with this Act shall minimize any delay or disruption 12 of services or plans for the implementation of such services in 13 effect on July 1, 2018. 14 3. The rules adopted by the department relating to access 15 centers shall provide for all of the following: 16 a. The access centers shall meet all of the following 17 criteria: 18 (1) An access center shall serve individuals with a 19 serious mental health or substance use disorder need who are 20 otherwise medically stable, who are not in need of an inpatient 21 psychiatric level of care, and who do not have alternative, 22 safe, effective services immediately available. 23 (2) Access center services shall be provided on a no reject, 24 no eject basis. 25 (3) An access center shall accept and serve individuals who 26 are court-ordered to participate in mental health or substance 27 use disorder treatment. 28 (4) Access center providers shall be accredited under 441 29 IAC 24 to provide crisis stabilization residential services and 30 shall be licensed to provide subacute mental health services 31 as defined in section 135G.1. 32 (5) An access center shall be licensed as a substance abuse 33 treatment program pursuant to chapter 125 or have a cooperative 34 agreement with and immediate access to licensed substance abuse 35 -13- HF 2456 (4) 87 hb/rh/md 13/ 17

H.F. 2456 treatment services or medical care that incorporates withdrawal 1 management. 2 (6) An access center shall provide or arrange for the 3 provision of necessary physical health services. 4 (7) An access center shall provide navigation and warm 5 handoffs to the next service provider as well as linkages to 6 needed services including housing, employment, and shelter 7 services. 8 b. The rules shall include access center designation 9 criteria and standards that allow and encourage multiple mental 10 health and disability services regions to strategically locate 11 and share access center services including bill-back provisions 12 to provide for reimbursement of a region when the resident of 13 another region utilizes an access center or other non-Medicaid 14 covered services located in that region. 15 4. The department shall establish uniform, statewide 16 standards for assertive community treatment based on national 17 accreditation standards, including allowances for nationally 18 recognized small team standards. The statewide standards 19 shall require that assertive teams meet fidelity to nationally 20 recognized practice standards as determined by an independent 21 review of each team that includes peer review. The department 22 shall ensure that Medicaid managed care organization 23 utilization management requirements do not exceed the standards 24 developed by the department. 25 5. The rules relating to intensive residential service 26 homes shall provide for all of the following: 27 a. That an intensive residential service home be enrolled 28 with the Iowa Medicaid enterprise as a section 1915(i) home and 29 community-based services habilitation waiver or intellectual 30 disability waiver-supported community living provider. 31 b. That an intensive residential service home have adequate 32 staffing that includes appropriate specialty training including 33 applied behavior analysis as appropriate. 34 c. Coordination with the individual’s clinical mental 35 -14- HF 2456 (4) 87 hb/rh/md 14/ 17

H.F. 2456 health and physical health treatment. 1 d. Be licensed as a substance abuse treatment program 2 pursuant to chapter 125 or have a cooperative agreement 3 with and timely access to licensed substance abuse treatment 4 services for those with a demonstrated need. 5 e. Accept court-ordered commitments. 6 f. Have a no reject, no eject policy for an individual 7 referred to the home based on the severity of the individual’s 8 mental health or co-occurring needs. 9 g. Be smaller in size, preferably providing services to 10 four or fewer individuals and no more than sixteen individuals, 11 and be located in a neighborhood setting to maximize community 12 integration and natural supports. 13 h. The department of human services shall provide guidance 14 for objective utilization review criteria. 15 6. The department of human services and the department of 16 public health shall provide a single statewide twenty-four-hour 17 crisis hotline that incorporates warmline services which may be 18 provided through expansion of the YourLifeIowa platform. 19 Sec. 17. COMMITMENT PROCESS REVIEW. The department of 20 human services, in cooperation with the department of public 21 health, representative members of the judicial branch, the Iowa 22 hospital association, the Iowa medical society, the national 23 alliance on mental illness, the Iowa state sheriffs’ and 24 deputies’ association, Iowa behavioral health association, 25 and other affected or interested stakeholders shall review 26 the commitment processes under chapters 125 and 229 and shall 27 report recommendations for improvements in the processes 28 and any amendments to law to increase efficiencies and more 29 appropriately utilize the array of mental health and disability 30 services available based upon an individual’s needs to the 31 governor and the general assembly by December 31, 2018. 32 Sec. 18. TERTIARY CARE PSYCHIATRIC HOSPITALS. The 33 departments of human services and inspections and appeals, 34 representative members of the Iowa hospital association, 35 -15- HF 2456 (4) 87 hb/rh/md 15/ 17

H.F. 2456 managed care organizations, the national alliance on mental 1 illness, the mental health institutes, and other affected or 2 interested stakeholders shall review the role of tertiary care 3 psychiatric hospitals in the array of mental health services 4 and shall report recommendations for providing tertiary 5 psychiatric services to the governor and the general assembly 6 by November 30, 2018. The recommendations shall address 7 the role and responsibilities of tertiary care psychiatric 8 hospitals in the mental health array of services in the state, 9 the viability of utilizing the mental health institutes as 10 tertiary care psychiatric hospitals, any potential sustainable 11 funding, and admissions criteria. 12 Sec. 19. MENTAL HEALTH AND DISABILITY SERVICES FUNDING —— 13 FISCAL VIABILITY REVIEW DURING 2018 LEGISLATIVE INTERIM. The 14 legislative council is requested to authorize a study committee 15 to analyze the viability of the mental health and disability 16 services funding including the methodology used to calculate 17 and determine the base expenditure amount, the county budgeted 18 amount, the regional per capita expenditure amount, the 19 statewide per capita expenditure target amount, and the cash 20 flow reduction amount. The study committee shall consist of 21 five members of the senate, three of whom shall be appointed 22 by the majority leader of the senate and two of whom shall 23 be appointed by the minority leader of the senate, and five 24 members of the house of representatives, three of whom shall 25 be appointed by the speaker of the house of representatives 26 and two of whom shall be appointed by the minority leader 27 of the house of representatives. The study committee shall 28 meet during the 2018 legislative interim to make appropriate 29 recommendations for consideration during the 2019 legislative 30 session in a report submitted to the general assembly by 31 January 15, 2019. 32 Sec. 20. DIRECTIVE TO DEPARTMENT OF HUMAN SERVICES —— 33 PSYCHIATRIC BED TRACKING SYSTEM. The department of human 34 services shall amend its administrative rules pursuant to 35 -16- HF 2456 (4) 87 hb/rh/md 16/ 17

H.F. 2456 chapter 17A to require subacute mental health care facilities 1 to participate in the psychiatric bed tracking system and 2 to report the number of beds available for children and 3 adults with a co-occurring mental illness and substance abuse 4 disorder. 5 Sec. 21. ASSERTIVE COMMUNITY TREATMENT —— REIMBURSEMENT 6 RATES. The department of human services shall review the 7 reimbursement rates for assertive community treatment and 8 shall report recommendations for reimbursement rates to the 9 governor and the general assembly by December 15, 2018. The 10 recommendations shall address any potential sustainable 11 funding. 12 Sec. 22. DEPARTMENT OF HUMAN SERVICES. The department of 13 human services shall adopt rules pursuant to chapter 17A to 14 administer this Act. 15 -17- HF 2456 (4) 87 hb/rh/md 17/ 17