Senate File 474 - Reprinted SENATE FILE 474 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO SSB 1120) (As Amended and Passed by the Senate April 16, 2025 ) A BILL FOR An Act relating to services and support for youth, including 1 treatment, physical assessments, and behavioral health 2 evaluations for youth involved in juvenile delinquency and 3 child in need of assistance proceedings; the licensing 4 and certification of certain residential facilities; 5 the provision of home and community-based services and 6 habilitation services to certain youth by residential 7 programs; administration and supervision of juvenile court 8 services; and the suspension of Hawki eligibility for 9 inmates of public institutions. 10 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 11 SF 474 (7) 91 dg/ko/mb

S.F. 474 DIVISION I 1 SERVICES AND SUPPORT FOR CHILDREN AND YOUTH 2 Section 1. Section 125.13, subsection 2, Code 2025, is 3 amended by adding the following new paragraph: 4 NEW PARAGRAPH . k. A psychiatric medical institution for 5 children licensed under chapter 135H, unless the psychiatric 6 medical institution for children provides substance use 7 disorder services. 8 Sec. 2. Section 135H.1, Code 2025, is amended to read as 9 follows: 10 135H.1 Definitions. 11 As used in this chapter , unless the context otherwise 12 requires: 13 1. “Approved qualifying organization” means any of the 14 following: 15 a. The joint commission. 16 b. The commission on accreditation of rehabilitation 17 facilities. 18 c. The council on accreditation. 19 d. A nationally recognized accrediting organization with 20 standards comparable to the entities listed in paragraphs “a” 21 through “c” that are acceptable under federal regulations. 22 e. An entity specified by rule adopted by the department in 23 consultation with the department of health and human services. 24 1. 2. “Department” means the department of inspections, 25 appeals, and licensing. 26 2. 3. “Direction” means authoritative policy or procedural 27 guidance for the accomplishment of a function or an activity. 28 3. 4. “Licensee” means the holder of a license issued to 29 operate a psychiatric medical institution for children. 30 4. 5. “Medical care plan” means a plan of care and services 31 designed to eliminate the need for inpatient care by improving 32 the condition of a child youth . Services must be based upon a 33 diagnostic evaluation, which includes an examination a physical 34 assessment and behavioral health evaluation of the medical, 35 -1- SF 474 (7) 91 dg/ko/mb 1/ 33

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

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

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

S.F. 474 children or holds a license under section 125.13 , if the 1 facility provides substance use disorder treatment under 2 chapter 237, and holds a license under this chapter . 3 2. In addition to the requirements under subsection 1, a 4 person shall not provide substance use disorder services at a 5 psychiatric medical institution for children unless the person 6 holds a license under section 125.13. The department of health 7 and human services shall adopt rules pursuant to chapter 17A 8 to create an expedited process for a person to simultaneously 9 obtain a license under section 125.13 and a license as a 10 comprehensive residential facility for children under chapter 11 237. 12 Sec. 5. Section 135H.5, Code 2025, is amended to read as 13 follows: 14 135H.5 Application for license —— initial application and 15 annual fees . 16 1. An application for a license under this chapter shall 17 be submitted on a form requesting information required by 18 the department , which . The application may include require 19 affirmative evidence of the applicant’s ability to comply with 20 the rules for standards adopted pursuant to this chapter . The 21 application shall require the applicant to specify whether the 22 applicant intends to provide services for serious emotional 23 disturbances, substance use disorders, or both. 24 2. An application for a license shall be accompanied by the 25 required license fee which shall be credited to the general 26 fund of the state. The initial application fee and the annual 27 license fee is twenty-five dollars. 28 Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, 29 are amended to read as follows: 30 1. The department shall issue a license to an applicant 31 under this chapter if all the following conditions exist: 32 a. The department has ascertained that the applicant’s 33 medical facilities and staff are adequate to provide the care 34 and services required of a psychiatric medical institution for 35 -5- SF 474 (7) 91 dg/ko/mb 5/ 33

S.F. 474 children . 1 b. The proposed psychiatric institution is accredited 2 by the joint commission on the accreditation of health 3 care organizations, the commission on accreditation of 4 rehabilitation facilities, the council on accreditation of 5 services for families and children, or by any other recognized 6 accrediting organization with comparable standards acceptable 7 under federal regulation an approved qualifying organization . 8 c. The applicant complies with applicable state rules 9 and standards for a psychiatric institution adopted by the 10 department in accordance with federal requirements under 42 11 C.F.R. §441.150 – 441.156. 12 d. The department of health and human services has submitted 13 written approval of the application based on the department 14 of health and human services’ determination of need. The 15 department of health and human services shall identify the 16 location and number of children youth in the state who require 17 the services of a psychiatric medical institution for children. 18 Approval of an application shall be based upon the location 19 of the proposed psychiatric institution relative to the need 20 for services identified by the department of health and human 21 services and an analysis of the applicant’s ability to provide 22 services and support consistent with requirements under chapter 23 232 , particularly regarding specifically community-based 24 treatment. If the proposed psychiatric institution is not 25 freestanding from a facility licensed under chapter 135B or 26 135C , approval under this paragraph shall not be given unless 27 the department of health and human services certifies that 28 the proposed psychiatric institution is capable of providing 29 a resident with a living environment similar to the living 30 environment provided by a licensee which is freestanding from a 31 facility licensed under chapter 135B or 135C . 32 e. The proposed psychiatric institution is under the 33 direction of an agency which has operated a facility licensed 34 under section 237.3, subsection 2 , paragraph “a” , as a 35 -6- SF 474 (7) 91 dg/ko/mb 6/ 33

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

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

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

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

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

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

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

S.F. 474 facility, or institution for the purpose of examination an 1 inpatient physical assessment or an inpatient behavioral health 2 evaluation . Commitment for examination 3 (2) An inpatient physical assessment or inpatient 4 behavioral health evaluation shall not exceed thirty days and 5 the civil commitment provisions of chapter 229 shall not apply . 6 Sec. 18. Section 232.52A, subsection 1, Code 2025, is 7 amended to read as follows: 8 1. In addition to any other order of the juvenile court, 9 a person under age eighteen, child who may be in need of 10 treatment , as determined under section 232.8 , may be ordered 11 to participate in an alcohol or controlled substance education 12 or a physical assessment or behavioral health evaluation 13 program approved by the juvenile court. If recommended after 14 evaluation, the The court may also order the person child to 15 participate in a treatment program approved by the court if the 16 treatment program is recommended after the child’s physical 17 assessment or behavioral health evaluation . The juvenile court 18 may also require the custodial parent or parents , or other 19 legal guardian , to participate in an educational program with 20 the person under age eighteen child if the court determines 21 that such participation is in the best interests of the person 22 under age eighteen child . 23 Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 24 1, Code 2025, is amended to read as follows: 25 “Confidential access to a child” means access to a child, 26 during an assessment of an alleged act of child abuse, who is 27 alleged to be the victim of the child abuse , during a child 28 abuse assessment . The access may be accomplished by interview, 29 observation, or examination physical assessment of the child. 30 As used in this subsection and this part: 31 Sec. 20. Section 232.68, subsection 3, paragraph c, Code 32 2025, is amended by striking the paragraph. 33 Sec. 21. Section 232.69, subsection 3, paragraph b, Code 34 2025, is amended to read as follows: 35 -14- SF 474 (7) 91 dg/ko/mb 14/ 33

S.F. 474 b. A person required to make a report under subsection 1, 1 other than a physician whose professional practice does not 2 regularly involve providing primary health care to children, 3 shall complete the core training curriculum relating to 4 the identification and reporting of child abuse within six 5 months of initial employment or self-employment involving 6 the examination physical assessments or behavioral health 7 evaluations , or attending, counseling, or treatment of treating 8 children on a regular basis. Within one month of initial 9 employment or self-employment, the person shall obtain a 10 statement of the abuse reporting requirements from the person’s 11 employer or, if self-employed, from the department. The person 12 shall complete the core training curriculum relating to the 13 identification and reporting of child abuse every three years. 14 Sec. 22. Section 232.71B, subsection 10, Code 2025, is 15 amended to read as follows: 16 10. Physical examination assessment . If the department 17 refers a child to a physician or physician assistant for a 18 physical examination assessment , the department shall contact 19 the physician or physician assistant regarding the examination 20 physical assessment within twenty-four hours of making the 21 referral. If the physician or physician assistant who performs 22 the examination upon referral by the department physical 23 assessment reasonably believes the child has been abused, the 24 physician or physician assistant shall report to the department 25 within twenty-four hours of performing the examination physical 26 assessment . 27 Sec. 23. Section 232.77, subsection 1, Code 2025, is amended 28 to read as follows: 29 1. a. A person who is required to report suspected 30 child abuse may take or perform, or may cause to be taken or 31 performed , at public expense, photographs, X rays, or other 32 physical examinations assessments, or other tests of a child 33 which would provide medical indication of allegations arising 34 from an assessment. 35 -15- SF 474 (7) 91 dg/ko/mb 15/ 33

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

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