House File 2673 - Reprinted HOUSE FILE 2673 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO HF 2509) (SUCCESSOR TO HSB 653) (As Amended and Passed by the House April 2, 2024 ) A BILL FOR An Act related to state behavioral health, disability, and 1 addictive disorder services and related programs, including 2 the transition of behavioral health services from a mental 3 health and disability services system to a behavioral health 4 service system, the transfer of disability services to the 5 division of aging and disability services of the department 6 of health and human services, the elimination of the 7 commission on aging, the elimination of special intellectual 8 disability units at state mental health institutes, making 9 appropriations, and including effective date provisions. 10 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 11 HF 2673 (8) 90 dg/ko/md

H.F. 2673 DIVISION I 1 BEHAVIORAL HEALTH SERVICE SYSTEM 2 Section 1. NEW SECTION . 225A.1 Definitions. 3 As used in this chapter unless the context otherwise 4 requires: 5 1. “Administrative services organization” means an entity 6 designated by the department pursuant to section 225A.4, to 7 develop and perform planning and administrative services in 8 accordance with a district behavioral health service system 9 plan. 10 2. “Behavioral health condition” means a substantial 11 limitation in major life activities due to a mental, 12 behavioral, or addictive disorder or condition diagnosed in 13 accordance with the criteria provided in the most current 14 edition of the diagnostic and statistical manual of mental 15 disorders, published by the American psychiatric association. 16 3. “Behavioral health district” or “district” means a 17 geographic, multicounty, sub-state area as designated by the 18 department under section 225A.4. 19 4. “Behavioral health provider” or “provider” means an 20 individual, firm, corporation, association, or institution 21 that, pursuant to this chapter, is providing or has been 22 approved by the department to provide services to an individual 23 with a behavioral health condition. 24 5. “Behavioral health service system” means the behavioral 25 health service system established in section 225A.3. 26 6. “Caregiver” means an adult family member, or other 27 individual, who is providing care to a person outside of a 28 formal program. 29 7. “Community mental health center” means an entity 30 designated by the department to address the mental health needs 31 of one or more counties. 32 8. “Department” means the department of health and human 33 services. 34 9. “Director” means the director of the department of health 35 -1- HF 2673 (8) 90 dg/ko/md 1/ 95

H.F. 2673 and human services. 1 10. “District behavioral health advisory council” 2 or “advisory council” means a council established by an 3 administrative services organization under section 225A.5, to 4 identify opportunities, address challenges, and advise the 5 administrative services organization in accordance with section 6 225A.5. 7 11. “District behavioral health service system plan” or 8 “district behavioral health plan” means a plan developed by 9 an administrative services organization and approved by the 10 department to outline the services intended to be provided 11 within the administrative services organization’s behavioral 12 health district. 13 12. “Indicated prevention” means prevention activities 14 designed to prevent the onset of substance use disorders in 15 individuals who do not meet the medical criteria for addiction, 16 but who show early signs of developing a substance use disorder 17 in the future. 18 13. “Selective prevention” means prevention activities 19 designed to target subsets of the total population who are 20 considered at-risk for a substance use disorder by virtue of 21 their membership in a particular segment of the population. 22 Selective prevention targets the entire subgroup, regardless of 23 the degree of risk of any individual within the group. 24 14. “State behavioral health service system plan” or 25 “state behavioral health plan” means the plan developed by the 26 department that describes the key components of the state’s 27 behavioral health service system. 28 15. “Universal prevention” means prevention activities 29 designed to address an entire population class for the purpose 30 of preventing or delaying the use of alcohol, tobacco, and 31 other drugs. Population classes include but are not limited 32 to the national population, local populations, community 33 populations, school populations, and neighborhood populations. 34 Sec. 2. NEW SECTION . 225A.2 State mental health authority 35 -2- HF 2673 (8) 90 dg/ko/md 2/ 95

H.F. 2673 —— state agency for substance abuse. 1 1. The department is designated as the state mental health 2 authority as defined in 42 U.S.C. §201(m) for the purpose of 3 directing benefits from the federal community mental health 4 services block grant, 42 U.S.C. §300x et seq., and the state 5 authority designated for the purpose of directing benefits 6 from the federal substance abuse prevention and treatment 7 block grant, 42 U.S.C. §300x-21 et seq. This designation 8 does not preclude the state board of regents from authorizing 9 or directing any institution under the board of regents’ 10 jurisdiction to carry out educational, prevention, and research 11 activities in the areas of mental health and intellectual 12 disability. 13 2. The department is designated as the single state agency 14 for substance abuse for the purposes of 42 U.S.C. §1396a et 15 seq. 16 3. For the purposes of effectuating the department’s roles 17 designated in this section, the department shall have the 18 following powers and the authority to take all of the following 19 actions: 20 a. Plan, establish, and maintain prevention, education, 21 early intervention, treatment, recovery support, and crisis 22 services programs as necessary or desirable for the behavioral 23 health service system established in section 225A.3. 24 b. Develop and submit a state plan as required by, and in 25 accordance with, 42 U.S.C. §300x-1. 26 c. Review and approve district behavioral health service 27 system plans developed in accordance with the state behavioral 28 health service system plan. 29 d. Perform all necessary acts to cooperate with any state 30 agency, political subdivision, or federal government agency to 31 apply for grants. 32 e. Solicit and accept for use any gift of money by will or 33 otherwise, and any grant of money or services from the federal 34 government, the state, or any political subdivision thereof, 35 -3- HF 2673 (8) 90 dg/ko/md 3/ 95

H.F. 2673 or any private source. 1 f. Collect and maintain records, engage in studies and 2 analyses, and gather relevant statistics. 3 g. Take any other actions as necessary to execute the 4 duties granted to the department in this chapter, or that 5 are otherwise required to maintain compliance with federal 6 requirements related to the department’s roles as designated in 7 this section. 8 Sec. 3. NEW SECTION . 225A.3 Behavioral health service 9 system —— department powers and duties. 10 1. a. A behavioral health service system is established 11 under the control of the department for the purposes of 12 implementing a statewide system of prevention, education, early 13 intervention, treatment, recovery support, and crisis services 14 related to mental health and addictive disorders, including but 15 not limited to alcohol use, substance use, tobacco use, and 16 problem gambling. 17 b. The behavioral health service system shall support 18 equitable statewide access to all services offered through 19 the behavioral health service system and offer specialized 20 services with a focus on at-risk populations including but not 21 limited to children, youth, young adults, individuals with 22 disabilities, pregnant and parenting women, older adults, and 23 people with limited access to financial resources. 24 c. Services offered through the behavioral health service 25 system shall, at a minimum, include all of the following: 26 (1) Prevention intervention services and education 27 programs designed to reduce and mitigate behavioral health 28 conditions and future behavioral health conditions. Prevention 29 intervention programs shall incorporate indicated prevention, 30 selective prevention, and universal prevention activities. 31 (2) Evidence-based and evidence-informed early intervention 32 and treatment services. 33 (3) Comprehensive recovery support services with a focus on 34 community-based services that avoid, divert, or offset the need 35 -4- HF 2673 (8) 90 dg/ko/md 4/ 95

H.F. 2673 for long-term inpatient services, law enforcement involvement, 1 or incarceration. 2 (4) Crisis services with a focus on reducing the escalation 3 of crisis situations, relieving the immediate distress of 4 individuals experiencing a crisis situation, and reducing the 5 risk that individuals in a crisis situation harm themselves. 6 2. To the extent funding is available, the department shall 7 perform all of the following duties to develop and administer 8 the behavioral health service system: 9 a. (1) Develop a state behavioral health service system 10 plan that accomplishes all of the following: 11 (a) Identifies the goals, objectives, and targeted outcomes 12 for the behavioral health service system. 13 (b) Identifies the strategies to meet system objectives and 14 ensure equitable access statewide to prevention, education, 15 early intervention, treatment, recovery support, and crisis 16 services. 17 (c) Is consistent with the state health improvement plan 18 developed under section 217.17. 19 (d) Is consistent with the department’s agency strategic 20 plan adopted pursuant to section 8E.206. 21 (2) The department shall do all of the following when 22 developing the state behavioral health service system plan: 23 (a) Collaborate with stakeholders including but not limited 24 to county supervisors and other local elected officials, 25 experienced behavioral health providers, and organizations that 26 represent populations, including but not limited to children, 27 served by the behavioral health service system. 28 (b) Publish the proposed state behavioral health service 29 system plan on the department’s internet site and allow the 30 public to review and comment on the proposed state behavioral 31 health system plan prior to the adoption of the proposed state 32 behavioral health plan. 33 b. Administer and distribute state appropriations, federal 34 aid, and grants that have been deposited into the behavioral 35 -5- HF 2673 (8) 90 dg/ko/md 5/ 95

H.F. 2673 health fund established in section 225A.7. 1 c. Oversee, provide technical assistance to, and 2 monitor administrative services organizations to ensure the 3 administrative services organizations’ compliance with district 4 behavioral health plans. 5 d. Collaborate with the department of inspections, appeals, 6 and licensing on the accreditation, certification, and 7 licensure of behavioral health providers including but not 8 limited to the approval, denial, revocation, or suspension of 9 a behavioral health provider’s accreditation, certification, 10 or licensure. 11 e. Develop and adopt minimum accreditation standards for 12 the maintenance and operation of community mental health 13 centers to ensure that each community mental health center, 14 and each entity that provides services under contract with a 15 community mental health center, furnishes high-quality mental 16 health services to the community that the community mental 17 health center serves in accordance with rules adopted by the 18 department. 19 f. Designate community mental health centers. 20 g. Conduct formal accreditation reviews of community mental 21 health centers based on minimum accreditation standards adopted 22 by the department pursuant to paragraph “e” . 23 h. Establish and maintain a data collection and management 24 information system to identify, collect, and analyze service 25 outcome and performance data to address the needs of patients, 26 providers, the department, and programs operating within the 27 behavioral health service system. 28 i. Collect, monitor, and utilize information including but 29 not limited to behavioral health service system patient records 30 and syndromic surveillance data to understand emerging needs, 31 and to deploy information, resources, and technical assistance 32 in response. 33 j. Adopt rules pursuant to chapter 17A to administer this 34 chapter. Such rules shall include but not be limited to rules 35 -6- HF 2673 (8) 90 dg/ko/md 6/ 95

H.F. 2673 that provide for all of the following: 1 (1) Minimum access standards to ensure equitable access to 2 services provided through the behavioral health service system 3 including but not limited to when services are available, who 4 is eligible for services, and where services are available. 5 (2) Methods to ensure each individual who is eligible 6 for services receives an uninterrupted continuum of care for 7 prevention, education, early intervention, treatment, recovery 8 support, and crisis services. 9 (3) Standards for the implementation and maintenance 10 of behavioral health programs and services offered by the 11 behavioral health service system, and by each administrative 12 services organization. 13 (4) Procedures for the management and oversight of 14 behavioral health providers to ensure compliance with the terms 15 of the behavioral health providers’ contracts relating to the 16 behavioral health service system, and with state and federal 17 law and rules. 18 (5) Procedures for the suspension of an administrative 19 services organization’s services due to the administrative 20 services organization’s failure to comply with the terms and 21 conditions of its contract with the department. 22 (6) Procedures for the reallocation of funds from 23 an administrative services organization that is not in 24 compliance with the terms of its contract with the department 25 to an alternative administrative services organization or 26 a behavioral health provider to provide for services the 27 noncompliant administrative services organization failed to 28 provide. 29 (7) Procedures for the termination of an administrative 30 services organization’s designation as an administrative 31 services organization. 32 (8) Procedures for the collection, utilization, and 33 maintenance of the data necessary to establish a central data 34 repository in accordance with section 225A.6. 35 -7- HF 2673 (8) 90 dg/ko/md 7/ 95

H.F. 2673 (9) Any other requirements the department deems necessary 1 to ensure that an administrative services organization 2 fulfills the administrative services organization’s duties 3 as established in this chapter, and as established in the 4 administrative services organization’s district behavioral 5 health plan. 6 Sec. 4. NEW SECTION . 225A.4 Behavioral health service 7 system —— districts and administrative services organizations. 8 1. a. The department shall divide the entirety of the 9 state into designated behavioral health districts. Behavioral 10 health prevention, education, early intervention, treatment, 11 recovery support, and crisis services related to mental health 12 and addictive disorders, including but not limited to alcohol 13 use, substance use, tobacco use, and problem gambling, shall 14 be made available through each behavioral health district in a 15 manner consistent with directives each district receives from 16 the department. 17 b. For the purpose of providing equitable access to all 18 services provided through the behavioral health service 19 system, the department shall consider all of the following when 20 designating behavioral health districts: 21 (1) City and county lines. 22 (2) The maximum population size that behavioral health 23 services available in an area are able to effectively serve. 24 (3) Areas of high need for behavioral health services. 25 (4) Patterns various populations exhibit when accessing or 26 receiving behavioral health services. 27 c. Notwithstanding chapter 17A, the manner in which the 28 department designates behavioral health districts including but 29 not limited to the determination of the boundaries for each 30 district shall not be subject to judicial review. 31 2. a. The department shall designate an administrative 32 services organization for each behavioral health district to 33 oversee and organize each district and the behavioral health 34 services associated with the district. The department shall 35 -8- HF 2673 (8) 90 dg/ko/md 8/ 95

H.F. 2673 issue requests for proposals for administrative services 1 organization candidates. 2 b. At the department’s discretion, the department may 3 designate any of the following entities as an administrative 4 services organization: 5 (1) An organization that coordinated administrative 6 services or mental health and disability services for a mental 7 health and disability services region formed on or before June 8 30, 2024. 9 (2) A public or private agency located in a behavioral 10 health district, or any separate organizational unit within the 11 public or private agency, that has the capabilities to engage 12 in the planning or provision of a broad range of behavioral 13 health prevention, education, early intervention, treatment, 14 recovery support, and crisis services related to mental health 15 and addictive disorders, including but not limited to alcohol 16 use, substance use, tobacco use, and problem gambling, only as 17 directed by the department. 18 c. The department shall consider all of the following 19 factors in determining whether to designate an entity as an 20 administrative services organization: 21 (1) Whether the entity has demonstrated the capacity to 22 manage and utilize available resources in a manner required of 23 an administrative services organization. 24 (2) Whether the entity has demonstrated the ability to 25 ensure the delivery of behavioral health services within the 26 district as required by the department by rule. 27 (3) Whether the entity has demonstrated the ability to 28 fulfill the monitoring, oversight, and provider compliance 29 responsibilities as required by the department by rule. 30 (4) Whether the entity has demonstrated the capacity to 31 function as a subrecipient for the purposes of the federal 32 community mental health services block grant, 42 U.S.C. 33 §300x et seq., and the federal substance abuse prevention and 34 treatment block grant, 42 U.S.C. §300x-21 et seq., and the 35 -9- HF 2673 (8) 90 dg/ko/md 9/ 95

H.F. 2673 ability to comply with all federal requirements applicable to 1 subrecipients under the block grants. 2 3. a. Upon designation by the department, an administrative 3 services organization shall be considered an instrumentality of 4 the state and shall adhere to all state and federal mandates 5 and prohibitions applicable to an instrumentality of the state. 6 b. An entity’s designation as an administrative services 7 organization shall continue until the designation is removed 8 by the department, the administrative services organization 9 withdraws, or a change in state or federal law necessitates the 10 removal of the designation. 11 4. Each administrative services organization shall function 12 as a subrecipient for the purposes of the federal community 13 mental health services block grant, 42 U.S.C. §300x et seq., 14 and the federal substance abuse prevention and treatment block 15 grant, 42 U.S.C. §300x-21 et seq., and shall comply with all 16 federal requirements applicable to subrecipients under the 17 block grants. 18 5. Each administrative services organization shall perform 19 all of the following duties: 20 a. Develop and administer a district behavioral health plan 21 in accordance with the standards adopted by the department by 22 rule. 23 b. Coordinate the administration of the district behavioral 24 health plan with federal, state, and local resources in order 25 to develop a comprehensive and coordinated local behavioral 26 health service system. 27 c. Enter into contracts necessary to provide services under 28 the district behavioral health plan. 29 d. Oversee, provide technical assistance to, and monitor 30 the compliance of providers contracted by the administrative 31 services organization to provide behavioral health services in 32 accordance with the district behavioral health plan. 33 e. Establish a district behavioral health advisory council 34 pursuant to section 225A.5. 35 -10- HF 2673 (8) 90 dg/ko/md 10/ 95

H.F. 2673 Sec. 5. NEW SECTION . 225A.5 District behavioral health 1 advisory councils. 2 1. Each administrative services organization shall 3 establish a district behavioral health advisory council that 4 shall do all of the following: 5 a. Identify opportunities and address challenges based on 6 updates received from the administrative services organization 7 regarding the implementation of the district behavioral health 8 plan. 9 b. Advise the administrative services organization while the 10 administrative services organization is developing behavioral 11 health policies. 12 c. Advise the administrative services organization on 13 how to best provide access to behavioral health prevention, 14 education, early intervention, treatment, recovery support, 15 and crisis services related to mental health and addictive 16 disorders, including but not limited to alcohol use, substance 17 use, tobacco use, and problem gambling, throughout the district 18 as directed by the department. 19 2. An advisory council shall consist of ten members. 20 Members shall be appointed by the administrative services 21 organization subject to the following requirements: 22 a. Three members shall be local elected public officials 23 currently holding office within the behavioral health district, 24 or the public official’s designated representative. 25 b. Three members shall be chosen in accordance with 26 procedures established by the administrative services 27 organization to ensure representation of the populations 28 served within the behavioral health district. At least one 29 member chosen under this paragraph shall represent child and 30 adolescent persons. 31 c. Three members shall be chosen who have experience 32 or education related to core behavioral health functions, 33 essential behavioral health services, behavioral health 34 prevention, behavioral health treatment, population-based 35 -11- HF 2673 (8) 90 dg/ko/md 11/ 95

H.F. 2673 behavioral health services, or community-based behavioral 1 health initiatives. 2 d. One member shall be a law enforcement representative from 3 within the behavioral health district. 4 3. An advisory council shall perform the duties required 5 under this section regardless of whether any seat on the 6 advisory council is vacant. 7 Sec. 6. NEW SECTION . 225A.6 Behavioral health service 8 system —— data collection and use. 9 1. The department shall take all of the following actions 10 for data related to the behavioral health service system: 11 a. Collect and analyze the data, including but not 12 limited to Medicaid and community services network data, as 13 necessary to issue cost estimates for serving populations, 14 providing treatment, making and receiving payments, conducting 15 operations, and performing prevention and health promotion 16 activities. In doing so, the department shall maintain 17 compliance with applicable federal and state privacy laws 18 to ensure the confidentiality and integrity of individually 19 identifiable data. The department shall periodically assess 20 the status of the department’s compliance to ensure that data 21 collected by and stored with the department is protected. 22 b. Establish and administer a central data repository for 23 collecting and analyzing state, behavioral health district, and 24 contracted behavioral health provider data. 25 c. Establish a record for each individual receiving publicly 26 funded services from an administrative services organization. 27 Each record shall include a unique client identifier for the 28 purposes of identifying and tracking the individual’s record. 29 d. Consult with administrative services organizations, 30 behavioral health service providers, and other behavioral 31 health service system stakeholders on an ongoing basis to 32 implement and maintain the central data repository. 33 e. Engage with all entities that maintain information the 34 department is required to collect pursuant to this section in 35 -12- HF 2673 (8) 90 dg/ko/md 12/ 95

H.F. 2673 order to integrate all data concerning individuals receiving 1 services within the behavioral health service system. 2 f. Engage with all entities that maintain general population 3 data relating to behavioral health in order to develop action 4 plans, create projections relating to a population’s behavioral 5 health needs, develop policies concerning behavioral health, 6 and otherwise perform acts as necessary to enhance the state’s 7 overall behavioral health. 8 2. Administrative services organizations shall report all 9 data required to be maintained in the central data repository 10 to the department in a manner as established by the department 11 by rule. For the purpose of making such data reports, an 12 administrative services organization shall do one of the 13 following: 14 a. Utilize a data system that integrates with the data 15 systems used by the department. 16 b. Utilize a data system that has the capacity to securely 17 exchange information with the department, other behavioral 18 health districts, contractors, and other entities involved with 19 the behavioral health service system who are authorized to 20 access the central data repository. 21 3. Data and information maintained by and exchanged between 22 an administrative services organization and the department 23 shall be labeled consistently, share the same definitions, 24 utilize the same common coding and nomenclature, and be in a 25 form and format as required by the department by rule. 26 4. Administrative services organizations shall report 27 to the department, in a manner specified by the department, 28 information including but not limited to demographic 29 information, expenditure data, and data concerning the 30 behavioral health services and other support provided to 31 individuals in the administrative service organization’s 32 district. 33 5. The department shall ensure that public and private 34 agencies, organizations, and individuals that operate within 35 -13- HF 2673 (8) 90 dg/ko/md 13/ 95

H.F. 2673 the behavioral health service system, or that make formal 1 requests for the release of data collected by the department, 2 maintain uniform methods for keeping statistical information 3 relating to behavioral health service system outcomes and 4 performance. 5 6. The department shall develop and implement a 6 communication plan that details how outcome and performance 7 data will be shared with stakeholders including but not limited 8 to the public, persons involved with the behavioral health 9 service system, and the general assembly. 10 Sec. 7. NEW SECTION . 225A.7 Behavioral health fund. 11 1. For purposes of this section: 12 a. “Population” means, as of July 1 of the fiscal year 13 preceding the fiscal year in which the population figure is 14 applied, the population shown by the latest preceding certified 15 federal census or the latest applicable population estimate 16 issued by the United States census bureau, whichever is most 17 recent. 18 b. “State growth factor” for a fiscal year means an amount 19 equal to the dollar amount used to calculate the appropriation 20 under this section for the immediately preceding fiscal year 21 multiplied by the percent increase, if any, in the amount of 22 sales tax revenue deposited into the general fund of the state 23 under section 423.2A, subsection 1, paragraph “a” , less the 24 transfers required under section 423.2A, subsection 2, between 25 the fiscal year beginning three years prior to the applicable 26 fiscal year and the fiscal year beginning two years prior 27 to the applicable year, but not to exceed one and one-half 28 percent. 29 2. A behavioral health fund is established in the state 30 treasury under the control of the department. The fund shall 31 consist of moneys deposited into the fund pursuant to this 32 section and section 426B.1, gifts of money or property accepted 33 by the state or the department to support any services under 34 this chapter or chapter 231, and moneys otherwise appropriated 35 -14- HF 2673 (8) 90 dg/ko/md 14/ 95

H.F. 2673 by the general assembly. Moneys in the fund are appropriated 1 to the department to implement and administer the behavioral 2 health service system and related programs including but not 3 limited to all of the following: 4 a. Distributions to administrative services organizations 5 to provide services as outlined in the organizations’ district 6 behavioral health plan. 7 b. Distributions to providers of mental health services 8 and addictive disorder services, including but not limited to 9 tobacco use services, substance use disorder services, and 10 problem gambling services. 11 c. Funding of disability services pursuant to chapter 231. 12 This paragraph is repealed July 1, 2028. 13 d. Administrative costs associated with services described 14 under this subsection. 15 3. For the fiscal year beginning July 1, 2025, there 16 is transferred from the general fund of the state to the 17 behavioral health fund an amount equal to forty-two dollars 18 multiplied by the state’s population for the fiscal year. 19 4. For the fiscal year beginning July 1, 2026, and each 20 succeeding fiscal year, there is transferred from the general 21 fund of the state to the behavioral health fund an amount equal 22 to the state’s population for the fiscal year multiplied by 23 the sum of the dollar amount used to calculate the transfer 24 from the general fund to the behavioral health fund for the 25 immediately preceding fiscal year, plus the state growth factor 26 for the fiscal year for which the transfer is being made. 27 5. For each fiscal year, an administrative services 28 organization shall not spend on administrative costs an amount 29 more than seven percent of the total amount distributed to the 30 administrative services organization through this section and 31 all other appropriations for the same fiscal year. 32 6. Moneys in the behavioral health fund may be used by the 33 department for cash flow purposes, provided that any moneys so 34 allocated are returned to the behavioral health fund by the end 35 -15- HF 2673 (8) 90 dg/ko/md 15/ 95

H.F. 2673 of each fiscal year. 1 7. Notwithstanding section 12C.7, subsection 2, interest 2 or earnings on moneys deposited in the behavioral health fund 3 shall be credited to the behavioral health fund. 4 8. Notwithstanding section 8.33, moneys appropriated in 5 this section that remain unencumbered or unobligated at the 6 close of the fiscal year shall not revert but shall remain 7 available for expenditure for the purposes designated. 8 Sec. 8. NEW SECTION . 225A.8 Addictive disorders prevention 9 —— prohibitions. 10 1. For purposes of this section, “entity” means a 11 manufacturer, distributor, wholesaler, retailer, or 12 distributing agent, or an agent of a manufacturer, distributor, 13 wholesaler, retailer, or distributing agent as those terms are 14 defined in section 453A.1. 15 2. To promote comprehensive tobacco use prevention and 16 control initiatives outlined in the state behavioral health 17 service system plan, an entity shall not perform any of the 18 following acts: 19 a. Give away cigarettes or tobacco products. 20 b. Provide free articles, products, commodities, gifts, or 21 concessions in any exchange for the purchase of cigarettes or 22 tobacco products. 23 3. The prohibitions in this section shall not apply to 24 transactions between manufacturers, distributors, wholesalers, 25 or retailers as those terms are defined in section 453A.1. 26 Sec. 9. NEW SECTION . 225A.9 Application for services —— 27 minors. 28 A minor who is twelve years of age or older shall have 29 the legal capacity to act and give consent to the provision 30 of tobacco cessation coaching services pursuant to a tobacco 31 cessation telephone and internet-based program approved by 32 the department through the behavioral health service system 33 established in section 225A.3. Consent shall not be subject to 34 later disaffirmance by reason of such minority. The consent of 35 -16- HF 2673 (8) 90 dg/ko/md 16/ 95

H.F. 2673 another person, including but not limited to the consent of a 1 spouse, parent, custodian, or guardian, shall not be necessary. 2 Sec. 10. CODE EDITOR DIRECTIVE. The Code editor is directed 3 to do all of the following: 4 1. Designate sections 225A.1 through 225A.9, as enacted 5 in this division of this Act, as Code chapter 225A entitled 6 “Department of Health and Human Services —— Behavioral Health 7 Service System”. 8 2. Correct internal references in the Code and in any 9 enacted legislation as necessary due to the enactment of this 10 division of this Act. 11 Sec. 11. EFFECTIVE DATE. This division of this Act takes 12 effect July 1, 2025. 13 DIVISION II 14 BEHAVIORAL HEALTH SERVICE SYSTEM —— CONFORMING CHANGES 15 Sec. 12. Section 11.6, subsection 1, paragraph b, Code 2024, 16 is amended to read as follows: 17 b. The financial condition and transactions of community 18 mental health centers organized under chapter 230A , substance 19 use disorder programs organized licensed under chapter 125 , and 20 community action agencies organized under chapter 216A , shall 21 be audited at least once each year. 22 Sec. 13. Section 97B.1A, subsection 8, paragraph a, 23 subparagraph (13), Code 2024, is amended by striking the 24 subparagraph. 25 Sec. 14. Section 123.17, subsection 5, Code 2024, is amended 26 to read as follows: 27 5. After any transfer provided for in subsection 3 is made, 28 the department shall transfer into a special revenue account 29 in the general fund of the state, a sum of money at least equal 30 to seven percent of the gross amount of sales made by the 31 department from the beer and liquor control fund on a monthly 32 basis but not less than nine million dollars annually. Of 33 the amounts transferred, two three million dollars, plus an 34 additional amount determined by the general assembly, shall be 35 -17- HF 2673 (8) 90 dg/ko/md 17/ 95

H.F. 2673 appropriated to the department of health and human services for 1 use by the staff who administer the comprehensive substance use 2 disorder program under chapter 125 for substance use disorder 3 treatment and prevention programs shall be transferred to the 4 behavioral health fund established under section 225A.7 . Any 5 amounts received in excess of the amounts appropriated to the 6 department of health and human services for use by the staff 7 who administer the comprehensive substance use disorder program 8 under chapter 125 transferred to the behavioral health fund 9 shall be considered part of the general fund balance. 10 Sec. 15. Section 123.17, subsection 8, Code 2024, is amended 11 by striking the subsection. 12 Sec. 16. Section 123.17, subsection 9, Code 2024, is amended 13 to read as follows: 14 9. After any transfers provided for in subsections 3, 5, 15 6, and 7 , and 8 are made, and before any other transfer to the 16 general fund, the department shall transfer to the economic 17 development authority from the beer and liquor control fund the 18 lesser of two hundred fifty thousand dollars or one percent of 19 the gross sales of native distilled spirits by all class “A” 20 native distilled spirits license holders made by the department 21 for the purposes of promoting Iowa wine, beer, and spirits. 22 Sec. 17. Section 124.409, subsection 2, Code 2024, is 23 amended by striking the subsection. 24 Sec. 18. Section 125.2, subsections 4, 5, and 10, Code 2024, 25 are amended by striking the subsections. 26 Sec. 19. Section 125.91, subsection 1, Code 2024, is amended 27 to read as follows: 28 1. The procedure prescribed by this section shall only 29 be used for a person with a substance use disorder due to 30 intoxication or substance-induced incapacitation who has 31 threatened, attempted, or inflicted physical self-harm or harm 32 on another, and is likely to inflict physical self-harm or harm 33 on another unless immediately detained, or who is incapacitated 34 by a chemical substance, if an application has not been filed 35 -18- HF 2673 (8) 90 dg/ko/md 18/ 95

H.F. 2673 naming the person as the respondent pursuant to section 125.75 1 and the person cannot be ordered into immediate custody and 2 detained pursuant to section 125.81 . 3 Sec. 20. Section 125.93, Code 2024, is amended to read as 4 follows: 5 125.93 Commitment records —— confidentiality. 6 Records of the identity, diagnosis, prognosis, or treatment 7 of a person which are maintained in connection with the 8 provision of substance use disorder treatment services are 9 confidential, consistent with the requirements of section 10 125.37 , and with the federal confidentiality regulations 11 authorized by the federal Drug Abuse Office and Treatment Act , 12 42 U.S.C. §290ee and the federal Comprehensive Alcohol Abuse 13 and Alcoholism Prevention, Treatment and Rehabilitation Act, 42 14 U.S.C. §290dd-2. However, such records may be disclosed to an 15 employee of the department of corrections, if authorized by the 16 director of the department of corrections, or to an employee 17 of a judicial district department of correctional services, if 18 authorized by the director of the judicial district department 19 of correctional services. 20 Sec. 21. Section 135.11, subsection 11, Code 2024, is 21 amended to read as follows: 22 11. Administer chapters 125, 136A , 136C , 139A , 142 , 142A , 23 144 , and 147A . 24 Sec. 22. Section 135C.2, subsection 5, unnumbered paragraph 25 1, Code 2024, is amended to read as follows: 26 The department shall establish a special classification 27 within the residential care facility category in order to 28 foster the development of residential care facilities which 29 serve persons with an intellectual disability, chronic mental 30 illness, a developmental disability, or brain injury, as 31 described under section 225C.26 , and which contain five or 32 fewer residents. A facility within the special classification 33 established pursuant to this subsection is exempt from the 34 requirements of section 10A.713 . The department shall adopt 35 -19- HF 2673 (8) 90 dg/ko/md 19/ 95

H.F. 2673 rules which are consistent with rules previously developed for 1 the waiver demonstration waiver project pursuant to 1986 Iowa 2 Acts, ch. 1246, §206 , and which include all of the following 3 provisions: 4 Sec. 23. Section 135C.6, subsection 1, Code 2024, is amended 5 to read as follows: 6 1. A person or governmental unit acting severally or 7 jointly with any other person or governmental unit shall not 8 establish or operate a health care facility in this state 9 without a license for the facility. A supported community 10 living service, as defined in section 225C.21 249A.38A , is not 11 required to be licensed under this chapter , but is subject to 12 approval under section 225C.21 249A.38A in order to receive 13 public funding. 14 Sec. 24. Section 135C.23, subsection 1, unnumbered 15 paragraph 1, Code 2024, is amended to read as follows: 16 Each resident shall be covered by a contract executed 17 by the resident, or the resident’s legal representative, 18 and the health care facility at or prior to the time of the 19 resident’s admission or prior thereto by the resident, or the 20 legal representative, and the health care facility, except as 21 otherwise provided by subsection 5 with respect to residents 22 admitted at public expense to a county care facility operated 23 under chapter 347B . Each party to the contract shall be 24 entitled to a duplicate of the original thereof contract , and 25 the health care facility shall keep on file all contracts 26 which it has with residents and shall not destroy or otherwise 27 dispose of any such contract for at least one year after its 28 expiration. Each such contract shall expressly set forth: 29 Sec. 25. Section 135C.23, subsection 2, paragraph b, Code 30 2024, is amended to read as follows: 31 b. This section does not prohibit the admission of a 32 patient with a history of dangerous or disturbing behavior to 33 an intermediate care facility for persons with mental illness, 34 intermediate care facility for persons with an intellectual 35 -20- HF 2673 (8) 90 dg/ko/md 20/ 95