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House File 2431 - IntroducedA Bill ForAn Act 1relating to redesign of publicly funded mental
2health and disability services by requiring certain core
3services and addressing other services and providing
4for establishment of regions, making appropriations, and
5including effective date and applicability provisions.
6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2core services
3 Section 1. Section 331.439, Code Supplement 2011, is
4amended by adding the following new subsection:
5 NEW SUBSECTION. 9A. a. Beginning July 1, 2012, the county
6management plan for mental health services shall provide that
7an individual’s eligibility for individualized services shall
8be determined by the level of care utilization system for
9psychiatric and addiction services, developed by the American
10association of community psychiatrists, or other standardized
11functional assessment methodology approved for this purpose by
12the state commission.
13b. Beginning July 1, 2012, the county management plan
14for intellectual disability services shall provide that an
15individual’s eligibility for individualized services shall
16be determined by the supports intensity scale, developed by
17the American association on intellectual and developmental
18disabilities, or other standardized functional assessment
19methodology approved for this purpose by the state commission.
20c. Beginning July 1, 2012, the county management plan
21for brain injury services shall provide that an individual’s
22eligibility for individualized services shall be determined
23in accordance with a standardized functional assessment
24methodology approved for this purpose by the state commission.
25 Sec. 2. NEW SECTION. 331.439A Regional service system
26management plan.
271. The mental health and disability services provided
28by counties operating as a region shall be delivered in
29accordance with a regional service system management plan
30approved by the region’s governing board and implemented by
31the regional administrator in accordance with this section.
32The requirements for a regional service system management plan
33shall be specified in rule adopted by the state commission.
34A regional service system management plan is subject to
35the approval of the regional governing board and the state
-1-1commission.
22. The provisions of a regional service system management
3plan shall include but are not limited to all of the following:
4a. An approved policies and procedures manual for the use of
5county, state, and other funding administered by the region. A
6service system management plan for each county in the region
7shall be defined in the manual. Once the regional manual
8is approved, an amendment to the manual shall be submitted
9to the department of human services at least forty-five
10days prior to the date of implementation of the amendment.
11Prior to implementation of an amendment to the manual, the
12amendment must be approved by the director of human services in
13consultation with the state commission.
14b. For informational purposes, a regional service system
15management plan review submitted by the regional administrator
16to the department of human services by December 1 of each year.
17The annual review shall incorporate an analysis of the data
18associated with the regional service systems managed during
19the preceding fiscal year by the region. The annual review
20shall also identify measurable outcomes and results showing the
21region’s progress in fulfilling the purposes listed in section
22225C.1 and in achieving the disability services outcomes and
23indicators identified by the state commission pursuant to
24section 225C.6.
25c. For informational purposes, a three-year strategic plan
26submitted every three years by the regional administrator to
27the department of human services. The strategic plan shall
28describe how the region will proceed to attain the plan’s
29goals and objectives, and the measurable outcomes and results
30necessary for moving the regional services system toward an
31individualized, community-based focus in accordance with
32section 225C.1. The initial three-year strategic plan shall be
33submitted by April 1, 2015, and by April 1 of every third year
34thereafter.
35d. The regional administrator’s plans to implement the
-2-1regional service system management plan and other service
2management functions in a manner that seeks to achieve all of
3the following purposes identified in section 225C.1 for persons
4who are covered by the regional plan or are otherwise subject
5to the regional service system’s management functions. The
6regional plan shall describe how the regional service system
7will accomplish all of the following purposes:
8(1) The regional service system seeks to empower persons
9to exercise their own choices about the amounts and types of
10services and other support to receive.
11(2) The regional service system seeks to empower the persons
12to accept responsibility, exercise choices, and take risks.
13(3) The regional service system seeks to provide services
14and other support that are individualized, provided to produce
15results, flexible, and cost-effective.
16(4) The regional service system seeks to provide services
17and other support in a manner which enhances the ability of the
18persons to live, learn, work, and recreate in communities of
19their choice.
20e. Measures to address the needs of individuals who have two
21or more co-occurring mental health, intellectual disability,
22brain injury, or substance-related disorders and individuals
23with specialized needs.
243. The region may either directly implement a system
25of service management and contract with service providers,
26or contract with a private entity to manage the regional
27service system, provided all requirements of this section
28are met by the private entity. The regional service system
29shall incorporate service management and clinical assessment
30processes developed in accordance with applicable requirements.
314. The regional service system management plan for a region
32shall include but is not limited to all of the following
33elements, which shall be specified in administrative rules
34adopted by the state commission:
35a. The enrollment and eligibility process.
-3- 1b. The scope of services included in addition to the core
2services required by this part of this chapter.
3c. The method of plan administration.
4d. The process for managing utilization and access to
5services and other assistance.
6e. The quality management and improvement processes.
7f. The risk management provisions and fiscal viability of
8the plan, if the region contracts with a private entity.
9g. The access points for services.
10h. The requirements for designation of targeted case
11management providers which shall be designed to provide
12consumer choice, prohibit a provider from referring consumers
13to services administered by the provider, and include other
14provisions to ensure compliance with federal requirements for
15conflict-free case management.
16i. A plan for a systems of care approach in which multiple
17public and private agencies partner with families and
18communities to address the multiple needs of the individuals
19and their families involved with the regional service system.
20j. A plan to assure effective crisis prevention, response,
21and resolution.
22k. A plan for provider network formation and management.
23l. A plan for provider reimbursement approaches that
24includes approaches other than fee-for-service and to
25compensate the providers engaged in a systems of care approach
26and other nontraditional providers.
27m. If the region applies any provider licensing,
28certification, or accreditation requirements in addition to
29those required by the state, the procedures for implementing
30the requirements.
31n. Service provider payment provisions.
32o. Financial forecasting measures.
33p. A process for resolving grievances.
34q. Measures for implementing interagency and multisystem
35collaboration and care coordination.
-4- 15. A region may provide assistance to service populations
2with disabilities to which the counties comprising the region
3have historically provided assistance but who are not included
4in the service management provisions required under subsection
52, subject to the availability of funding.
66. If a region determines that the region cannot provide
7services for the fiscal year in accordance with the regional
8plan and remain in compliance with applicable budgeting
9requirements, the region may implement a waiting list for
10the services. The procedures for establishing and applying
11a waiting list shall be specified in the regional plan. If
12a region implements a waiting list for services, the region
13shall notify the department of human services. The department
14shall maintain on the department’s internet site an up-to-date
15listing of the regions that have implemented a waiting list and
16the services affected by each waiting list.
177. The director’s approval of a regional plan shall not be
18construed to constitute certification of the respective county
19budgets or of the region’s budget.
20 Sec. 3. NEW SECTION. 331.439B Financial eligibility
21requirements.
22A person must comply with all of the following financial
23eligibility requirements to be eligible for services under the
24regional service system:
251. The person must have an income equal to or less than
26one hundred fifty percent of the federal poverty level, as
27defined by the most recently revised poverty income guidelines
28published by the United States department of health and
29human services, to be eligible for disability services
30public funding. It is the intent of the general assembly to
31consider increasing this income eligibility provision to two
32hundred percent of the federal poverty level, contingent upon
33implementation of the federal Patient Protection and Affordable
34Care Act beginning in January 2014.
352. a. A region or a service provider contracting with
-5-1the region may apply a copayment requirement for a particular
2service to a person with an income equal to or less than one
3hundred fifty percent of the federal poverty level, provided
4the disability service, uniform copayment standards, and the
5copayment amounts comply with rules adopted by the state
6commission.
7b. A person with an income above one hundred fifty percent
8of the federal poverty level may be eligible subject to a
9copayment or other cost-sharing arrangement, in accordance with
10limitations adopted in rule by the state commission.
11c. A provider under the regional service system of a service
12that is not funded by the medical assistance program under
13chapter 249A may waive the copayment or other cost-sharing
14arrangement if the provider is fully able to absorb the cost.
153. A person who is eligible for federally funded services
16and other support must apply for such services and support.
174. The person is in compliance with resource limitations
18identified in rule adopted by the state commission. The
19limitation shall be derived from the federal supplemental
20security income program resource limitations. A person with
21resources above the federal supplemental security income
22program resource limitations may be eligible subject to
23limitations adopted in rule by the state commission. If a
24person does not qualify for federally funded services and other
25support but meets income, resource, and functional eligibility
26requirements for regional services, the following types of
27resources shall be disregarded:
28a. A retirement account that is in the accumulation stage.
29b. A burial, medical savings, or assistive technology
30account.
31 Sec. 4. NEW SECTION. 331.439C Diagnosis —— functional
32assessment.
331. A person must comply with all of the following
34requirements to be eligible for mental health services under
35the regional service system:
-6- 1a. The person complies with financial eligibility
2requirements under section 331.439B.
3b. The person is at least eighteen years of age and is a
4resident of this state.
5c. The person has had at any time during the preceding
6twelve-month period a diagnosable mental health, behavioral, or
7emotional disorder. The diagnosis shall be made in accordance
8with the criteria provided in the diagnostic and statistical
9manual of mental disorders, fourth edition text revised,
10published by the American psychiatric association, and shall
11not include the manual’s “V” codes identifying conditions other
12than a disease or injury. The diagnosis shall also not include
13substance-related disorders, dementia, antisocial personality,
14or developmental disabilities, unless co-occurring with another
15diagnosable mental illness.
16d. The person’s eligibility for individualized services
17shall be determined by the level of care utilization system for
18psychiatric and addiction services, developed by the American
19association of community psychiatrists, or other standardized
20functional assessment methodology approved for this purpose by
21the state commission.
222. A person must comply with all of the following
23requirements to be eligible for intellectual disability or
24other developmental disability services under the regional
25service system:
26a. The person complies with financial eligibility
27requirements under section 331.439B.
28b. The person is at least eighteen years of age and is a
29resident of this state.
30c. The person has a diagnosis of intellectual disability or
31an intelligence quotient of seventy or less or has a diagnosis
32of developmental disability other than intellectual disability.
33d. The person’s eligibility for individualized services
34shall be determined by the supports intensity scale, developed
35by the American association on intellectual and developmental
-7-1disabilities, or other standardized functional assessment
2methodology approved for this purpose by the state commission.
33. A person must comply with all of the following
4requirements to be eligible for brain injury services under the
5regional service system:
6a. The person complies with financial eligibility
7requirements under section 331.439B.
8b. The person is at least eighteen years of age and is a
9resident of this state.
10c. The person has a diagnosis of brain injury.
11d. The person’s eligibility for individualized services
12shall be determined in accordance with a standardized
13functional assessment methodology approved for this purpose by
14the state commission.
15 Sec. 5. NEW SECTION. 331.439D Mental health core services.
161. For the purposes of this section, unless the context
17otherwise requires:
18a. “Crisis stabilization facility” means an institution,
19place, building, or agency with restricted means of egress
20designed to provide accommodation, board, and the services
21of a mental health professional on a short-term basis of no
22more than five days to three or more individuals who present
23in the facility with acute psychiatric needs. The goal of a
24crisis stabilization facility is to decrease the severity of an
25individual’s condition to allow transition of the individual
26to a less restrictive facility.
27b. “Domain” means a range of services that can be provided
28depending upon an individual’s service needs.
292. Each of the providers of the core services and services
30provided under a required service domain shall be capable of
31working with individuals who have co-occurring disabilities or
32specialized needs. It is the intent of the general assembly
33that services have adequate reimbursement to ensure the
34financial viability necessary to achieve desired outcomes and
35fidelity to accepted service models.
-8- 13. A regional service system shall provide the following
2core mental health service domains, subject to the availability
3of funding:
4a. Acute care and crisis intervention services.
5b. Mental health treatment.
6c. Mental health disorder prevention.
7d. Community living.
8e. Employment.
9f. Recovery supports.
10g. Family supports.
11h. Physical health and primary care services.
12i. Justice system-involved services.
134. A regional service system shall provide the following
14specific core mental health services, subject to the
15availability of funding:
16a. Peer-run self-help centers.
17b. Psychiatric emergency services to provide a range of
18crisis intervention and diversion services. The services shall
19include but are not limited to providing a crisis stabilization
20facility.
21c. Subacute residential services.
22d. Jail diversion.
23e. Assertive community treatment.
24f. Community support services, supportive community living,
25and case management.
26g. Health homes.
27h. Supported employment and education.
28i. Family support services.
29j. Transportation.
305. A regional service system may provide funding for other
31appropriate services or other support. In considering whether
32to provide such funding, a region may consider the following
33criteria:
34a. Applying a person-centered planning process to identify
35the need for the services or other support.
-9- 1b. The efficacy of the services or other support is
2substantiated by an evidence base.
3c. A determination that the services or other support
4provides an effective alternative to existing services that
5have been shown by the evidence base to be ineffective, to not
6yield the desired outcome, or to not support the principles
7outlined in Olmstead v.L.C., 527 U.S. 581 (1999).
8 Sec. 6. NEW SECTION. 331.439E Intellectual disability and
9other developmental disability core services.
101. A regional service system shall provide funding of
11intellectual disability services that are not funded by the
12medical assistance program. In addition, to the extent funding
13is available, a regional service system shall also provide
14funding of developmental disability services for persons with a
15developmental disability other than an intellectual disability.
16In selecting the services eligible for the funding, a region
17shall consider the following criteria:
18a. Applying a person-centered planning process to identify
19the need for the services or other support.
20b. The efficacy of the services or other support is
21substantiated by an evidence base.
22c. A determination that the services or other support
23provides an effective alternative to existing services that
24have been shown by the evidence base to be ineffective, to not
25yield the desired outcome, or to not support the principles
26outlined in Olmstead v.L.C., 527 U.S. 581 (1999).
272. The core services provided by a region shall include all
28of the services for adults with an intellectual disability or a
29developmental disability that were mandated by law and covered
30in the service management plans of the counties comprising the
31region under section 331.439, Code 2011, as of June 30, 2012,
32other than those services funded by the medical assistance
33program under chapter 249A. The provision of the core services
34is subject to availability of funding. The core services shall
35include all of the following, unless covered by the medical
-10-1assistance program:
2a. Case management.
3b. Homemaker-home health aide services.
4c. Respite care.
5d. Home and vehicle modification.
6e. Supported community living.
7f. Outpatient mental health services.
8g. Evaluation.
9h. Sheltered workshop services.
10i. Work activity services.
11j. Adult day care.
12k. Residential care facility services.
13l. Residential care facility for persons with an
14intellectual disability services.
15m. Intermediate care facility for persons with an
16intellectual disability services.
17n. Supported community living.
18o. Inpatient care at a state mental health institute.
19p. Inpatient care at a state resource center.
20q. Inpatient care at a community hospital.
21r. Diagnostic evaluation related to a civil commitment
22proceeding.
23s. Transportation related to a civil commitment.
24t. Legal representation for commitment.
25u. Mental health advocate.
263. A region shall transition from and replace the services
27under subsection 2 with services that expand and support
28the community support and integration principles outlined
29in Olmstead v.L.C., 527 U.S. 581 (1999) and the purposes
30identified in section 225C.1.
314. The core services for persons with an intellectual
32disability or a developmental disability shall include all of
33the following:
34a. Efforts to support the availability of best practice
35health and primary care services in local communities.
-11- 1b. Efforts to provide best practice family support services
2to help families to maintain a family member with a disability
3at home.
4 Sec. 7. NEW SECTION. 331.440B Regional service system
5financing.
61. a. The financing of a regional mental health and
7disability service system is limited to a fixed budget amount.
8The fixed budget amount shall be the amount identified in a
9regional service system management plan and budget for the
10fiscal year. The region shall be authorized an allowed growth
11factor adjustment as established by statute for services
12addressed by the regional plan. The statute establishing
13the allowed growth factor adjustment shall establish the
14adjustment for the fiscal year which commences two years from
15the beginning date of the fiscal year in progress at the time
16the statute is enacted.
17b. Based upon information contained in regional plans and
18budgets and proposals made by representatives of the regions,
19the state commission shall recommend an allowed growth factor
20adjustment to the governor by November 15 for the fiscal year
21which commences two years from the beginning date of the fiscal
22year in progress at the time the recommendation is made. The
23allowed growth factor adjustment may address various costs
24including but not limited to the costs associated with new
25consumers of services, service cost inflation, and investments
26for economy and efficiency. In developing the service
27cost inflation recommendation, the state commission shall
28consider the cost trends indicated by the regional financial
29reports. The governor shall consider the state commission’s
30recommendation in developing the governor’s recommendation for
31an allowed growth factor adjustment for such fiscal year. The
32governor’s recommendation shall be submitted to the general
33assembly at the time the governor’s proposed budget for the
34succeeding fiscal year is submitted in accordance with chapter
358.
-12- 12. A region shall implement its regional service system
2management plan in a manner so as to provide adequate funding
3of services for the entire fiscal year by budgeting for
4ninety-nine percent of the funding anticipated to be available
5for the regional plan for the fiscal year. A region may expend
6all of the funding anticipated to be available for the regional
7plan.
8 Sec. 8. IMPLEMENTATION OF ACT. Section 25B.2, subsection 3,
9shall not apply to this division of this Act.
10 Sec. 9. CODE EDITOR. The Code editor may codify the Code
11provisions enacted by this division of this Act as a new part
12of chapter 331, division III.
13 Sec. 10. APPLICABILITY. The provisions of this division of
14this Act enacting new Code sections 331.439A through 331.439E,
15and section 331.440B apply beginning on July 1, 2013.
16DIVISION II
17workforce development and regulation
18 Sec. 11. NEW SECTION. 225C.6C Mental health and disability
19services workforce development workgroup.
201. The department of human services shall convene and
21provide support to a mental health and disability services
22workforce development workgroup to address issues connected
23with assuring that an adequate workforce is available in the
24state to provide mental health and disability services. The
25workgroup shall report at least annually to the governor
26and general assembly providing findings, recommendations,
27and financing information concerning the findings and
28recommendations.
292. The membership of the workgroup shall include all of the
30following:
31a. The director of the department of aging or the director’s
32designee.
33b. The director of the department of corrections or the
34director’s designee.
35c. The director of the department of education or the
-13-1director’s designee.
2d. The director of human services or the director’s
3designee.
4e. The director of the department of public health or the
5director’s designee.
6f. The director of the department of workforce development
7or the director’s designee.
8g. At least three staff of regional administrators
9appointed by the community services affiliate of the Iowa state
10association of counties.
11h. At least three individuals receiving mental health and
12disability services or involved relatives of such individuals.
13i. At least three providers of mental health and disability
14services.
15j. A representative of the entity under contract with
16the department to provide mental health managed care for the
17medical assistance program.
18k. One or more representatives of the institutions under
19the control of the state board of regents who are knowledgeable
20concerning the mental health and disability services workforce.
21l. Other persons identified by the workgroup.
223. In addition to the members identified in subsection
232, the membership of the workgroup shall include four
24members of the general assembly serving in a nonvoting, ex
25officio capacity. One member shall be designated by each
26of the following: the majority leader of the senate, the
27minority leader of the senate, the speaker of the house of
28representatives, and the minority leader of the house of
29representatives. A legislative member serves for a term as
30provided in section 69.16B.
314. Except as provided in subsection 3 for legislative
32appointments, the workgroup shall determine its own rules of
33procedure, membership terms, and operating provisions.
345. The workforce development measures considered for
35recommendation by the workgroup shall include but are not
-14-1limited to all of the following:
2a. Provide for the college of direct support or comparable
3internet-based training to be available at no charge to all
4service providers.
5b. Require every direct support professional to demonstrate
6a level of competency in core curricula.
7c. Provide financial incentives for those providers who
8support direct care staff in securing a voluntary certification
9from the national alliance for direct support professionals or
10a comparable certification or accreditation body.
11d. Change the rate reimbursement methodologies to allow
12providers to bill direct care staff development costs as a
13direct expense rather than as an indirect cost.
14e. Implement regional service system staffing capability
15to provide positive behavior supports training and to mount a
16crisis intervention and prevention response that is based on a
17model successfully tested in this state.
18f. Make technical assistance available to service providers
19for issues such as crisis intervention, sheltered workshop
20conversion, and other approaches to modernize services.
21g. Implement co-occurring disability cross training for
22mental health professionals as well as training for primary
23care practitioners on intellectual disability and developmental
24disability behavioral issues.
25 Sec. 12. NEW SECTION. 225C.6D Regional service system ——
26outcomes and performance measures committee.
271. The department shall establish an outcomes and
28performance measures committee to recommend to the department
29and the commission’s specific outcomes and performance measures
30to be utilized by the regional mental health and disability
31services system. The membership of the committee shall include
32regional administrator and departmental staff, individuals
33receiving mental health and disability services or involved
34relatives of such individuals, providers of mental health and
35disability services, a representative of the person under
-15-1contract with the department to provide mental health managed
2care for the medical assistance program, a representative
3of the institutions under the control of the state board of
4regents who is knowledgeable concerning mental health and
5disability services, a representative of the department’s task
6force to address the decision in Olmstead v.L.C., 527 U.S. 581
7(1999), and other stakeholders.
82. To the extent possible, the committee shall seek to
9provide outcome and performance measures recommendations
10that are consistent across the mental health and disability
11services populations addressed. The committee shall also
12evaluate data collection requirements utilized in the regional
13service system to identify the requirements that could be
14eliminated or revised due to the administrative burden involved
15or the low degree of relevance to outcomes or other reporting
16requirements.
17 Sec. 13. NEW SECTION. 225C.6E Regional service system ——
18regulatory requirements.
191. The departments of inspections and appeals, human
20services, and public health shall comply with the requirements
21of this section in their efforts to improve the regulatory
22requirements applied to the regional service system
23administration and service providers.
242. The three departments shall work together to establish
25a process to streamline accreditation, certification, and
26licensing standards applied to the regional service system
27administration and service providers.
283. The departments of human services and inspections and
29appeals shall jointly review the standards and inspection
30process applicable to residential care facilities.
314. The three departments shall do all of the following in
32developing regulatory requirements applicable to the regional
33service system administration and service providers:
34a. Consider the costs to administrators and providers in the
35development of quality monitoring efforts.
-16- 1b. Develop uniform, streamlined, and statewide cost
2reporting standards and tools.
3c. Make quality monitoring information, including services,
4quality, and location information, easily available and
5understandable to all citizens.
6d. Establish standards that are clearly understood and are
7accompanied by interpretive guidelines to support understanding
8by those responsible for applying the standards.
9e. Develop a partnership with providers in order to
10improve the quality of services and develop mechanisms for the
11provision of technical assistance.
12f. Develop consistent data collection efforts based on
13statewide standards and make information available to all
14providers.
15g. Evaluate existing provider qualification and monitoring
16efforts to identify duplication and gaps, and align the efforts
17with valued outcomes.
18h. Streamline and enhance existing standards.
19i. Consider how accreditations can be used for the
20certification of provider qualifications.
215. The three departments shall seek to increase the number
22of staff dedicated to oversight of service providers.
23DIVISION III
24COMMUNITY MENTAL HEALTH CENTER AMENDMENTS
25 Sec. 14. Section 230A.106, subsection 2, paragraph c, as
26enacted by 2011 Iowa Acts, chapter 121, section 16, is amended
27to read as follows:
28c. Day treatment, partial hospitalization, or psychosocial
29rehabilitation services. Such services shall be provided as
30structured day programs in segments of less than twenty-four
31hours using a multidisciplinary team approach to develop
32treatment plans that vary in intensity of services and the
33frequency and duration of services based on the needs of the
34patient. These services may be provided directly by the center
35or in collaboration or affiliation with other appropriately
-17-1accredited providers. In lieu of day treatment, partial
2hospitalization, or psychosocial rehabilitation services, the
3center may provide an assertive community treatment program.
4 Sec. 15. Section 230A.110, subsection 1, as enacted by
52011 Iowa Acts, chapter 121, section 20, is amended to read as
6follows:
71. The division shall recommend and the commission shall
8adopt standards for designated community mental health
9centers and comprehensive community mental health programs,
10with the overall objective of ensuring that each center
11and each affiliate providing services under contract with a
12center furnishes high-quality mental health services within
13a framework of accountability to the community it serves.
14The standards adopted shall conform with federal standards
15applicable to community mental health centers and shall be
16in substantial conformity with the applicable behavioral
17health standards adopted by the joint commission, formerly
18known as the joint commission on accreditation of health care
19organizations, and or other recognized national standards for
20evaluation of psychiatric facilities unless in the judgment of
21the division, with approval of the commission, there are sound
22reasons for departing from the standards.
23DIVISION IV
24regional service system
25 Sec. 16. NEW SECTION. 331.438A Definitions.
26As used in this part, unless the context otherwise requires:
271. “Department” means the department of human services.
282. “Disability services” means the same as defined in
29section 225C.2.
303. “Population” means the population shown by the latest
31preceding certified federal census or the latest applicable
32population estimate issued by the United States census bureau,
33whichever is most recent.
344. “Regional administrator” means the administrative entity
35formed by agreement of the counties participating in a region
-18-1to function on behalf of those counties in accordance with this
2part.
35. “State commission” means the mental health and disability
4services commission created in section 225C.5.
5 Sec. 17. NEW SECTION. 331.438B Mental health and disability
6services regions —— criteria.
71. Local access to mental health and disability services for
8children and adults shall be provided by counties organized in
9a regional service system. The regional service system shall
10be implemented in stages in accordance with this section.
112. Formation of a mental health and disability services
12region is subject to approval of the director of human services
13and the mental health and disability services commission.
143. Each county in the state shall participate in an approved
15mental health and disability services region. A mental health
16and disability services region shall comply with all of the
17following requirements:
18a. The counties comprising the region are contiguous.
19b. The region has at least three counties.
20c. The combined general population of the counties
21comprising a region shall be at least two hundred thousand
22persons and not more than seven hundred thousand persons.
23However, the director of human services, with the approval
24of the commission, may grant a waiver from this requirement
25if there is convincing evidence that compliance with the
26requirement is not workable.
27d. The region has the capacity to provide required core
28services and perform required functions.
29e. At least one community mental health center or a
30federally qualified health center with providers qualified
31to provide psychiatric services, either directly or with
32assistance from psychiatric consultants, is located within the
33region, has the capacity to provide outpatient services for the
34region, and is either under contract with the region or has
35provided documentation of intent to contract with the region
-19-1to provide the services.
2f. A hospital with an inpatient psychiatric unit or a state
3mental health institute is located in or within reasonably
4close proximity to the region, has the capacity to provide
5inpatient services for the region, and is either under contract
6with the region or has provided documentation of intent to
7contract with the region to provide the services.
8g. The regional administrator structure proposed for or
9utilized by the region has clear lines of accountability and
10the regional administrator functions as a lead agency utilizing
11shared county staff or other means of limiting administrative
12costs.
134. County formation of a mental health and disability
14services region is subject to all of the following:
15a. On or before November 1, 2012, counties voluntarily
16participating in a region have complied with all of the
17following formation criteria:
18(1) The counties forming the region have been identified
19and the board of supervisors of the counties have approved a
20written letter of intent to join together to form the region.
21(2) The proposed region complies with the requirements in
22subsection 3.
23(3) The department provides written notice to the boards
24of supervisors of the counties identified for the region in
25the letter of intent that the counties have complied with the
26requirements in subsection 3.
27b. Upon compliance with the provisions of paragraph “a”, the
28participating counties are eligible for technical assistance
29provided by the department.
30c. During the period of November 2, 2012, through January
311, 2013, a county that has not agreed to be part of a region
32in accordance with paragraph “a” shall be assigned by the
33department to a region.
34d. On or before June 30, 2013, all counties shall be part of
35a region that is in compliance with the provisions of paragraph
-20-1“a” other than meeting the November 1, 2012, date.
2e. On or before June 30, 2014, all counties shall be
3in compliance with all of the following mental health and
4disability services region implementation criteria:
5(1) The board of supervisors of each county participating in
6the region has voted to approve a chapter 28E agreement.
7(2) The duly authorized representatives of all the counties
8participating in the region have signed the chapter 28E
9agreement that is in compliance with section 331.438C.
10(3) The county board of supervisors’ or supervisors’
11designee members and other members of the region’s governing
12board have been appointed in accordance with section 331.438C.
13(4) Executive staff for the region’s regional administrator
14have been identified or engaged.
15(5) An initial draft of a regional service management
16transition plan has been developed which identifies the steps
17to be taken by the region to do all of the following:
18(a) Designate access points for the disability services
19administered by the region.
20(b) Designate the region’s targeted case manager provider
21funded by the medical assistance program.
22(c) Identify the service provider network for the region.
23(d) Define the service access and service authorization
24process to be utilized for the region.
25(e) Identify the information technology and data management
26capacity to be employed to support regional functions.
27(f) Establish business functions, funds accounting
28procedures, and other administrative processes.
29(g) Comply with data reporting and other information
30technology requirements adopted by the state commission.
31(6) The department and the state commission have approved
32the region’s chapter 28E agreement and the initial draft of the
33regional management transition plan.
34f. If the department, with the concurrence of the state
35commission, determines that a region is in substantial
-21-1compliance with the implementation criteria in paragraph “e”
2and has sufficient operating capacity to begin operations, the
3region may commence partial or full operations prior to July
42014.
5 Sec. 18. NEW SECTION. 331.438C Regional governance
6structure.
71. The counties comprising a mental health and disability
8services region shall enter into an agreement under chapter
928E to form a regional administrator under the control of a
10governing board to function on behalf of those counties.
112. The governing board shall comply with all of the
12following requirements:
13a. The membership of the governing board shall consist
14of one or more board of supervisor members from each county
15comprising the region or their designees. The decisions
16involving the local public funding administered by the
17governing board and the regional administrator shall be made
18by these members.
19b. The membership of the governing board shall also consist
20of at least three individuals who utilize mental health and
21disability services or actively involved relatives of such
22individuals. These members shall be designated in a manner
23so as to represent the geographic areas of the region and to
24provide balanced representation for the various disability
25groups utilizing the services provided through the region.
26c. The membership of the governing board shall not include
27representatives of service providers or the department.
28d. The governing board shall have a regional advisory
29committee consisting of individuals who utilize services or
30actively involved relatives of such individuals, service
31providers, and regional governing board members.
323. The regional administrator shall be under the control of
33the governing board. The regional administrator shall enter
34into performance-based contracts with the department for the
35regional administrator to manage, on behalf of the counties
-22-1comprising the region, the mental health and disability
2services that are not funded by the medical assistance program
3under chapter 249A and for coordinating with the department the
4provision of mental health and disability services that are
5funded under the medical assistance program.
6 Sec. 19. NEW SECTION. 331.438D Regional finances.
71. The funding under the control of the governing board
8shall be maintained in a combined account, in separate county
9accounts that are under the control of the governing board, or
10pursuant to other arrangements authorized by law that limit the
11administrative burden of such control while facilitating public
12scrutiny of financial processes.
132. The administrative costs of the regional administrator
14shall be limited to five percent of expenditures. Expenditures
15considered to be administrative costs shall be determined in
16accordance with law.
173. The funding provided pursuant to performance-based
18contracts with the department shall be credited to the account
19or accounts under the control of the governing board.
20 Sec. 20. NEW SECTION. 331.438E Regional governance
21agreements.
221. In addition to compliance with the applicable provisions
23of chapter 28E, the chapter 28E agreement entered into by the
24counties comprising a mental health and disability services
25region in forming the regional administrator to function on
26behalf of the counties shall comply with the requirements of
27this section.
282. The organizational provisions of the agreement shall
29include all of the following:
30a. A statement of purpose, goals, and objectives of entering
31into the agreement.
32b. Identification of the governing board membership and the
33terms, methods of appointment, voting procedures, and other
34provisions applicable to the operation of the governing board.
35c. The identification of the executive staff of the regional
-23-1administrator serving as the single point of accountability for
2the region.
3d. The counties participating in the agreement.
4e. The time period of the agreement and terms for
5termination or renewal of the agreement.
6f. The circumstances under which additional counties may
7join the region.
8g. Methods for dispute resolution and mediation.
9h. Methods for termination of a county’s participation in
10the region.
11i. Provisions for formation and assigned responsibilities
12for one or more advisory committees consisting of individuals
13who utilize services or actively involved relatives of such
14individuals, service providers, governing board members, and
15other interests identified in the agreement.
163. The administrative provisions of the agreement shall
17include all of the following:
18a. Responsibility of the governing board in appointing and
19evaluating the performance of the chief executive officer of
20the regional administrator.
21b. A specific list of the functions and responsibilities of
22the regional administrator’s chief executive officer and other
23administrative staff.
24c. Specification of the functions to be carried out by each
25party to the agreement and by any subcontractor of a party to
26the agreement. A contract with a provider network shall be
27separately addressed.
284. The financial provisions of the agreement shall include
29all of the following:
30a. Methods for pooling, management, and expenditure of the
31funding under the control of the regional administrator. If
32the agreement does not provide for pooling of the participating
33county moneys in a single fund, the agreement shall specify how
34the participating county moneys will be subject to the control
35of the regional administrator.
-24- 1b. Methods for allocating administrative funding and
2resources.
3c. Contributions and uses of initial funding or related
4contributions made by the counties participating in the
5region for purposes of commencing operations by the regional
6administrator.
7d. Methods for acquiring or disposing of real property.
8e. A process for determining the use of savings for
9reinvestment.
10f. A process for performance of an annual independent audit
11of the regional administrator.
12 Sec. 21. NEW SECTION. 331.438F County of residence ——
13services to residents —— service authorization appeals ——
14disputes between counties or regions and the department.
151. For the purposes of this section, unless the context
16otherwise requires:
17a. “County of residence” means the county in this state in
18which, at the time a person applies for or receives services,
19the person is living in the county and has established an
20ongoing presence with the declared, good faith intention of
21living in the county for a permanent or indefinite period of
22time. The county of residence of a person who is a homeless
23person is the county where the homeless person usually sleeps.
24“County of residence” does not mean the county where a person is
25present for the purpose of receiving services in a hospital,
26a correctional facility, a halfway house for community-based
27corrections or substance-related treatment, a nursing facility,
28an intermediate care facility for persons with an intellectual
29disability, or a residential care facility, or for the purpose
30of attending a college or university.
31b. “Homeless person” means the same as defined in section
3248A.2.
33c. “Person” means a person who is a United States citizen or
34a qualified alien as defined in 8 U.S.C. § 1641.
352. If a person appeals a service authorization or
-25-1other services-related determination made by a regional
2administrator, the appeal shall be heard in a contested
3case proceeding by a state administrative law judge. The
4administrative law judge’s decision shall be considered a final
5agency decision under chapter 17A.
63. If a county of residence is part of a mental health and
7disability services region that has agreed to pool funding and
8liability for services, the responsibilities of the county
9under law regarding such services shall be performed on behalf
10of the county by the regional administrator. The county of
11residence or the county’s mental health and disability services
12region, as applicable, is responsible for paying the public
13costs of the mental health and disability services that are
14not covered by the medical assistance program under chapter
15249A and are provided in accordance with the region’s approved
16service management plan to persons who are residents of the
17county or region.
184. a. The dispute resolution process implemented in
19accordance with this subsection applies to residency disputes.
20The dispute resolution process is not applicable to disputes
21involving persons committed to a state facility pursuant to
22chapter 812 or rule of criminal procedure 2.22, Iowa court
23rules, or to disputes involving service authorization decisions
24made by a region.
25b. If a county, region, or the department, as applicable,
26receives a billing for services provided to a resident
27in another county or region, or objects to a residency
28determination certified by the department or another county’s
29or region’s regional administrator and asserts either that the
30person has residency in another county or region or the person
31is not a resident of this state or the person’s residency
32is unknown so that the person is deemed a state case, the
33person’s residency status shall be determined as provided in
34this section. The county or region shall notify the department
35of the county’s or region’s assertion within one hundred
-26-1twenty days of receiving the billing. If the county or region
2asserts that the person has residency in another county or
3region, that county or region shall be notified at the same
4time as the department. If the department disputes a residency
5determination certification made by a regional administrator,
6the department shall notify the affected counties or regions
7of the department’s assertion.
8c. The department, county, or region that received the
9notification, as applicable, shall respond to the party that
10provided the notification within forty-five days of receiving
11the notification. If the parties cannot agree to a settlement
12as to the person’s residency status within ninety days of the
13date of notification, on motion of any of the parties, the
14matter shall be referred to the department of inspections and
15appeals for a contested case hearing under chapter 17A before
16an administrative law judge assigned in accordance with section
1710A.801 to determine the person’s residency status.
18d. (1) The administrative law judge’s determination
19of the person’s residency status is a final agency action,
20notwithstanding contrary provisions of section 17A.15.
21The party that does not prevail in the determination or
22subsequent judicial review is liable for costs associated with
23the proceeding, including reimbursement of the department
24of inspections and appeals’ actual costs associated with
25the administrative proceeding. Judicial review of the
26determination may be sought in accordance with section 17A.19.
27(2) If following the determination of a person’s residency
28status in accordance with this section, additional evidence
29becomes available that merits a change in that determination,
30the parties affected may change the determination by mutual
31agreement. Otherwise, a party may move that the matter be
32reconsidered by the department, county, or region, or by the
33administrative law judge.
34e. (1) Unless a petition is filed for judicial review,
35the administrative law judge’s determination of the person’s
-27-1residency status shall result in one of the following:
2(a) If a county or region is determined to be the person’s
3residence, the county or region shall pay the amounts due and
4shall reimburse any other amounts paid for services provided by
5the other county or region or the department on the person’s
6behalf prior to the determination.
7(b) If it is determined that the person is not a resident
8of this state or the person’s residency is unknown so that the
9person is deemed to be a state case, the department shall pay
10the amounts due and shall reimburse the county or region, as
11applicable, for any payment made on behalf of the person prior
12to the determination.
13(2) The payment or reimbursement shall be remitted within
14forty-five days of the date the decision was issued. After
15the forty-five-day period, a penalty of not greater than one
16percent per month may be added to the amount due.
17 Sec. 22. CODE EDITOR. The Code editor shall codify the
18provisions of this division of this Act enacting new sections
19in chapter 331, as a new part of division IV, tentatively
20numbered part 2A.
21 Sec. 23. APPLICABILITY. The provisions of this division
22of this Act enacting new sections in chapter 331, except
23as specifically provided by the provisions, are applicable
24beginning July 1, 2013.
25DIVISION V
26subacute care facilities for persons with serious and
27persistent mental illness
28 Sec. 24. NEW SECTION. 135P.1 Definitions.
29As used in this chapter, unless the context otherwise
30requires:
311. “Department” means the department of inspections and
32appeals.
332. “Direction” means authoritative policy or procedural
34guidance for the accomplishment of a function or an activity.
353. “Licensee” means the holder of a license issued to
-28-1operate a subacute care facility for persons with serious and
2persistent mental illness.
34. “Mental health professional” means the same as defined
4in section 228.1.
55. “Physician” means a person licensed under chapter 148.
66. “Psychiatric services” means services provided under
7the direction of a physician which address mental, emotional,
8medical, or behavioral problems.
97. “Rehabilitative services” means services to encourage and
10assist restoration of a resident’s optimum mental and physical
11capabilities.
128. “Resident” means a person who is eighteen years of age
13or older and has been admitted by a physician to a subacute
14care facility for persons with serious and persistent mental
15illness.
169. “Treatment care plan” means a plan of care and services
17designed to eliminate the need for acute care by improving
18the condition of a person with serious and persistent mental
19illness. Services must be based upon a diagnostic evaluation,
20which includes an examination of the medical, psychological,
21social, behavioral, and developmental aspects of the person’s
22situation, reflecting the need for inpatient care.
2310. “Subacute care facility for persons with serious and
24persistent mental illness” or “subacute care facility” means an
25institution, place, building, or agency with restricted means
26of egress designed to provide accommodation, board, and the
27services of a licensed psychiatrist for a period exceeding
28twenty-four consecutive hours to three or more individuals who
29primarily have serious and persistent mental illness, diagnosis
30of a co-occurring disorder, and are not related to the owner
31within the third degree of consanguinity.
3211. “Supervision” means direct oversight and inspection of
33the act of accomplishing a function or activity.
34 Sec. 25. NEW SECTION. 135P.2 Purpose.
35The purpose of this chapter is to provide for the
-29-1development, establishment, and enforcement of basic standards
2for the operation, construction, and maintenance of a
3subacute care facility which will ensure the safe and adequate
4diagnosis, evaluation, and treatment of the residents.
5 Sec. 26. NEW SECTION. 135P.3 Nature of care —— seclusion
6room —— admissions.
71. A subacute care facility shall utilize a team of
8professionals to direct an organized program of diagnostic
9services, psychiatric services, and rehabilitative services
10to meet the needs of residents in accordance with a treatment
11care plan developed for each resident under the supervision of
12a licensed psychiatrist. The goal of a treatment care plan
13is to transition residents to a less restrictive environment,
14including a home-based community setting. Social and
15rehabilitative services shall be provided under the direction
16of a mental health professional.
172. The licensed psychiatrist providing supervision of
18the subacute care facility shall evaluate the condition of
19each resident no less than two times each month and shall be
20available to residents of the facility on an on-call basis
21at all other times. The subacute care facility may employ a
22seclusion room meeting the conditions described in 42 C.F.R. §
23483.364(b) with approval of the licensed psychiatrist of the
24facility or by order of the resident’s physician.
253. An admission to the subacute care facility is subject
26to a physician’s written order certifying that the individual
27being admitted requires regular oversight by a licensed
28psychiatrist and requires no greater degree of care than that
29which the facility to which the admission is made is licensed
30to provide and is capable of providing.
314. A subacute care facility does not constitute an
32“institution for mental diseases” within the meaning of 42
33U.S.C. § 1396d(i).
34 Sec. 27. NEW SECTION. 135P.4 Licensure.
351. A person shall not establish, operate, or maintain a
-30-1subacute care facility unless the person obtains a license for
2the subacute care facility under this chapter.
32. An intermediate care facility for persons with mental
4illness licensed under chapter 135C may convert to a subacute
5care facility by providing written notice to the department
6that the facility has employed a full-time psychiatrist and
7desires to make the conversion.
8 Sec. 28. NEW SECTION. 135P.5 Application for license.
9An application for a license under this chapter shall be
10submitted on a form requesting information required by the
11department, which may include affirmative evidence of the
12applicant’s ability to comply with the rules for standards
13adopted pursuant to this chapter. An application for a license
14shall be accompanied by the required license fee which shall
15be credited to the general fund of the state. The initial and
16annual license fee is twenty-five dollars.
17 Sec. 29. NEW SECTION. 135P.6 Inspection —— conditions for
18issuance.
19The department shall issue a license to an applicant under
20this chapter if the department has ascertained that the
21applicant’s facilities and staff are adequate to provide the
22care and services required of a subacute care facility and if
23the applicant has been awarded a certificate of need pursuant
24to chapter 135.
25 Sec. 30. NEW SECTION. 135P.7 Denial, suspension, or
26revocation of license.
27The department may deny an application or suspend or revoke
28a license if the department finds that an applicant or licensee
29has failed or is unable to comply with this chapter or the
30rules establishing minimum standards pursuant to this chapter
31or if any of the following conditions apply:
321. It is shown that a resident is a victim of cruelty or
33neglect due to the acts or omissions of the licensee.
342. The licensee has permitted, aided, or abetted in the
35commission of an illegal act in the subacute care facility.
-31- 13. An applicant or licensee acted to obtain or to retain a
2license by fraudulent means, misrepresentation, or submitting
3false information.
44. The licensee has willfully failed or neglected to
5maintain a continuing in-service education and training program
6for persons employed by the subacute care facility.
75. The application involves a person who has failed to
8operate a subacute care facility in compliance with the
9provisions of this chapter.
10 Sec. 31. NEW SECTION. 135P.8 Provisional license.
11The department may issue a provisional license, effective
12for not more than one year, to a licensee whose subacute care
13facility does not meet the requirements of this chapter if,
14prior to issuance of the license, the applicant submits written
15plans to achieve compliance with the applicable requirements
16and the plans are approved by the department. The plans shall
17specify the deadline for achieving compliance.
18 Sec. 32. NEW SECTION. 135P.9 Notice and hearings.
19The procedure governing notice and hearing to deny an
20application or suspend or revoke a license shall be in
21accordance with rules adopted by the department pursuant to
22chapter 17A. A full and complete record shall be kept of the
23proceedings and of any testimony. The record need not be
24transcribed unless judicial review is sought. A copy or copies
25of a transcript may be obtained by an interested party upon
26payment of the cost of preparing the transcript or copies.
27 Sec. 33. NEW SECTION. 135P.10 Rules.
28The department of inspections and appeals, in consultation
29with the department of human services and affected professional
30groups, shall adopt and enforce rules setting out the standards
31for a subacute care facility and the rights of the residents
32admitted to a subacute care facility. The department of
33inspections and appeals and the department of human services
34shall coordinate the adoption of rules and the enforcement of
35the rules in order to prevent duplication of effort by the
-32-1departments and of requirements of the licensee.
2 Sec. 34. NEW SECTION. 135P.11 Complaints alleging
3violations —— confidentiality.
41. A person may request an inspection of a subacute care
5facility by filing with the department a complaint of an
6alleged violation of an applicable requirement of this chapter
7or a rule adopted pursuant to this chapter. The complaint
8shall state in a reasonably specific manner the basis of the
9complaint. A statement of the nature of the complaint shall be
10delivered to the subacute care facility involved at the time of
11or prior to the inspection. The name of the person who files a
12complaint with the department shall be kept confidential and
13shall not be subject to discovery, subpoena, or other means
14of legal compulsion for its release to a person other than
15department employees involved in the investigation of the
16complaint.
172. Upon receipt of a complaint made in accordance with
18subsection 1, the department shall make a preliminary review
19of the complaint. Unless the department concludes that the
20complaint is intended to harass a subacute care facility or a
21licensee or is without reasonable basis, it shall within twenty
22working days of receipt of the complaint make or cause to be
23made an on-site inspection of the subacute care facility which
24is the subject of the complaint. The department of inspections
25and appeals may refer to the department of human services
26any complaint received by the department of inspections and
27appeals if the complaint applies to rules adopted by the
28department of human services. The complainant shall also
29be notified of the name, address, and telephone number of
30the designated protection and advocacy agency if the alleged
31violation involves a facility with one or more residents with a
32developmental disability or mental illness. In any case, the
33complainant shall be promptly informed of the result of any
34action taken by the department in the matter.
353. An inspection made pursuant to a complaint filed under
-33-1subsection 1 need not be limited to the matter or matters
2referred to in the complaint; however, the inspection shall
3not be a general inspection unless the complaint inspection
4coincides with a scheduled general inspection. Upon arrival
5at the subacute care facility to be inspected, the inspector
6shall show identification to the person in charge of the
7subacute care facility and state that an inspection is to
8be made, before beginning the inspection. Upon request of
9either the complainant or the department, the complainant or
10the complainant’s representative or both may be allowed the
11privilege of accompanying the inspector during any on-site
12inspection made pursuant to this section. The inspector may
13cancel the privilege at any time if the inspector determines
14that the privacy of a resident of the subacute care facility to
15be inspected would be violated. The dignity of the resident
16shall be given first priority by the inspector and others.
17 Sec. 35. NEW SECTION. 135P.12 Information confidential.
181. The department’s final findings regarding licensure
19shall be made available to the public in a readily available
20form and place. Other information relating to the subacute
21care facility is confidential and shall not be made available
22to the public except in proceedings involving licensure, a
23civil suit involving a resident, or an administrative action
24involving a resident.
252. The name of a person who files a complaint with the
26department shall remain confidential and is not subject to
27discovery, subpoena, or any other means of legal compulsion for
28release to a person other than an employee of the department or
29an agent involved in the investigation of the complaint.
303. Information regarding a resident who has received or is
31receiving care shall not be disclosed directly or indirectly
32except as authorized under section 217.30.
33 Sec. 36. NEW SECTION. 135P.13 Judicial review.
34Judicial review of the action of the department may be sought
35pursuant to the Iowa administrative procedure Act, chapter 17A.
-34-1 Notwithstanding chapter 17A, a petition for judicial review of
2the department’s actions under this chapter may be filed in the
3district court of the county in which the related subacute care
4facility is located or is proposed to be located. The status
5of the petitioner or the licensee shall be preserved pending
6final disposition of the judicial review.
7 Sec. 37. NEW SECTION. 135P.14 Penalty.
8A person who establishes, operates, or manages a subacute
9care facility without obtaining a license under this chapter
10commits a serious misdemeanor. Each day of continuing
11violation following conviction shall be considered a separate
12offense.
13 Sec. 38. NEW SECTION. 135P.15 Injunction.
14Notwithstanding the existence or pursuit of another remedy,
15the department may maintain an action for injunction or other
16process to restrain or prevent the establishment, operation, or
17management of a subacute care facility without a license.
18 Sec. 39. Section 249A.26, subsection 2, Code 2011, is
19amended by adding the following new paragraph:
20 NEW PARAGRAPH. d. Notwithstanding any provision of
21this chapter to the contrary, for services provided to
22eligible persons in a subacute care facility for persons
23with serious and persistent mental illness licensed under
24chapter 135P, the daily rate shall be equal to the sum of
25the direct care Medicare-certified hospital-based nursing
26facility patient-day-weighted median and the nondirect
27care Medicare-certified hospital-based nursing facility
28patient-day-weighted median.
29 Sec. 40. IMPLEMENTATION OF ACT. Section 25B.2, subsection
303, shall not apply to this division of this Act.
31DIVISION VI
32conforming amendments —— central point of coordination, legal
33settlement, and dispute resolution processes
34 Sec. 41. Section 218.99, Code 2011, is amended to read as
35follows:
-35- 1218.99 Counties to be notified of patients’ personal
2accounts.
3The administrator in control of a state institution shall
4direct the business manager of each institution under the
5administrator’s jurisdiction which is mentioned in section
6331.424, subsection 1, paragraph “a”, subparagraphs (1) and
7(2), and for which services are paid under section 331.424A, to
8quarterly inform the regional administrator of the county of
9legal settlement’s entity designated to perform the county’s
10central point of coordination process residence of any patient
11or resident who has an amount in excess of two hundred dollars
12on account in the patients’ personal deposit fund and the
13amount on deposit. The administrators shall direct the
14business manager to further notify the entity designated to
15perform the county’s central point of coordination process
16 regional administrator of the county of residence at least
17fifteen days before the release of funds in excess of two
18hundred dollars or upon the death of the patient or resident.
19If the patient or resident has no county of legal settlement,
20notice shall be made to the director of human services and the
21administrator in control of the institution involved.
22 Sec. 42. Section 222.2, subsection 3, Code 2011, is amended
23by striking the subsection.
24 Sec. 43. Section 222.2, Code 2011, is amended by adding the
25following new subsection:
26 NEW SUBSECTION. 5A. “Regional administrator” means the same
27as defined in section 331.438A.
28 Sec. 44. Section 222.10, Code 2011, is amended to read as
29follows:
30222.10 Duty of peace officer.
31When any person with mental retardation departs without
32proper authority from an institution in another state and
33is found in this state, any peace officer in any county in
34which such patient is found may take and detain the patient
35without warrant or order and shall report such detention to the
-36-1administrator. The administrator shall provide for the return
2of the patient to the authorities in the state from which the
3unauthorized departure was made. Pending return, such patient
4may be detained temporarily at one of the institutions of this
5state governed by the administrator or by the administrator of
6the division of child and family services of the department
7of human services. The provisions of this section relating
8to the administrator shall also apply to the return of other
9nonresident persons with mental retardation having legal
10settlement residency outside the state of Iowa.
11 Sec. 45. Section 222.13, Code 2011, is amended to read as
12follows:
13222.13 Voluntary admissions.
141. If an adult person is believed to be a person with mental
15retardation, the adult person or the adult person’s guardian
16may submit a request through the central point of coordination
17process for the county board of supervisors regional
18administrator of the adult person’s county of residence in
19writing to apply to the superintendent of any state resource
20center for the voluntary admission of the adult person either
21as an inpatient or an outpatient of the resource center.
22After determining the legal settlement of the adult person as
23provided by this chapter, the board of supervisors The regional
24administrator, on behalf of the board of supervisors shall, on
25forms prescribed by the department’s administrator, apply to
26the superintendent of the resource center in the district for
27the admission of the adult person to the resource center. An
28application for admission to a special unit of any adult person
29believed to be in need of any of the services provided by the
30special unit under section 222.88 may be made in the same
31manner, upon request of the adult person or the adult person’s
32guardian. The superintendent shall accept the application
33providing if a preadmission diagnostic evaluation, performed
34through the central point of coordination process through the
35regional administrator, confirms or establishes the need for
-37-1admission, except that an application may shall not be accepted
2if the institution does not have adequate facilities available
3or if the acceptance will result in an overcrowded condition.
42. If the resource center has no does not have an
5 appropriate program for the treatment of an adult or minor
6person with mental retardation applying under this section
7or section 222.13A, the board of supervisors regional
8administrator on behalf of the board of supervisors shall
9arrange for the placement of the person in any public or
10private facility within or without the state, approved by the
11director of the department of human services, which offers
12appropriate services for the person, as determined through
13the central point of coordination process by the regional
14administrator.
153. Upon applying for admission of an adult or minor person
16to a resource center, or a special unit, or upon arranging for
17the placement of the person in a public or private facility,
18if the county would be liable to pay the expenses in full
19or in part, the regional administrator, on behalf of the
20 board of supervisors shall make a full investigation into
21the financial circumstances of that person and those liable
22for that person’s support under section 222.78 to determine
23whether or not any of them are able to pay the expenses arising
24out of the admission of the person to a resource center,
25special treatment unit, or public or private facility. If
26the board regional administrator finds that the person or
27those legally responsible for the person are presently unable
28to pay the expenses, the board regional administrator shall
29direct that the expenses be paid by the county. The board
30 regional administrator may review its finding at any subsequent
31time while the person remains at the resource center, or
32is otherwise receiving care or treatment for which this
33chapter obligates the county to pay. If the board regional
34administrator finds upon review that the person or those
35legally responsible for the person are presently able to pay
-38-1the expenses, the finding shall apply only to the charges
2incurred during the period beginning on the date of the
3review and continuing thereafter, unless and until the board
4 regional administrator again changes its finding. If the board
5 regional administrator finds that the person or those legally
6responsible for the person are able to pay the expenses, the
7board regional administrator shall direct that the charges
8be so paid to the extent required by section 222.78, and the
9county auditor shall be responsible for the collection of the
10charges.
11 Sec. 46. Section 222.13A, subsections 1, 2, and 4, Code
122011, are amended to read as follows:
131. If a minor is believed to be a person with mental
14retardation, the minor’s parent, guardian, or custodian
15may request the county board of supervisors in writing to
16apply for admission of the minor as a voluntary patient in
17a state resource center. If the resource center does not
18have appropriate services for the minor’s treatment, the
19board of supervisors may arrange for the admission of the
20minor in a public or private facility within or without the
21state, approved by the director of human services, which
22offers appropriate services for the minor’s treatment. If
23half or more of the nonfederal share of the costs of services
24provided to a minor in accordance with this section is the
25responsibility of the state, the costs of the preadmission
26diagnostic evaluation, court appointed attorney, and court
27costs, relating to the services shall be paid by the state.
28If more than half of the nonfederal share of the costs of
29such services is the responsibility of the minor’s county of
30residence, the costs of the preadmission diagnostic evaluation,
31court appointed attorney, and court costs, relating to the
32services shall be paid by the county of residence.
332. Upon receipt of an application for voluntary admission
34of a minor, the board of supervisors shall provide for a
35preadmission diagnostic evaluation of the minor to confirm
-39-1or establish the need for the admission. The preadmission
2diagnostic evaluation shall be performed by a person who
3meets the qualifications of a qualified mental retardation
4professional who is designated through the central point of
5coordination process regional administrator. Any portion of
6the cost of the evaluation not paid by the minor or those
7liable for the minor’s support under section 222.78 is the
8responsibility of the state.
94. As soon as practicable after the filing of a petition for
10approval of the voluntary admission, the court shall determine
11whether the minor has an attorney to represent the minor in the
12proceeding. If the minor does not have an attorney, the court
13shall assign to the minor an attorney. If the minor is unable
14to pay for an attorney, the attorney shall be compensated by
15the county or state, as applicable, at an hourly rate to be
16established by the county board of supervisors in substantially
17the same manner as provided in section 815.7.
18 Sec. 47. Section 222.22, Code 2011, is amended to read as
19follows:
20222.22 Time of appearance.
21The time of appearance shall not be less than five days
22after completed service unless the court orders otherwise.
23Appearance on behalf of the person who is alleged to have
24mental retardation may be made by any citizen of the county
25or by any relative. The district court shall assign counsel
26for the person who is alleged to have mental retardation.
27Counsel shall prior to proceedings personally consult with the
28person who is alleged to have mental retardation unless the
29judge appointing counsel certifies that in the judge’s opinion,
30consultation shall serve no useful purpose. The certification
31shall be made a part of the record. An attorney assigned by
32the court shall be compensated by the county state at an hourly
33rate to be established by the county board of supervisors in
34substantially the same manner as provided in section 815.7.
35 Sec. 48. Section 222.28, Code 2011, is amended to read as
-40-1follows:
2222.28 Commission to examine.
3The court may, at or prior to the final hearing, appoint
4a commission of one qualified physician and one qualified
5psychologist, designated through the central point of
6coordination process, regional administrator who shall make
7a personal examination of the person alleged to be mentally
8retarded for the purpose of determining the mental condition
9of the person.
10 Sec. 49. Section 222.31, subsection 1, paragraph b, Code
112011, is amended to read as follows:
12b. (1) Commit the person to the state resource center
13designated by the administrator to serve the county in which
14the hearing is being held, or to a special unit. The court
15shall, prior to issuing an order of commitment, request
16that a diagnostic evaluation of the person be made by the
17superintendent of the resource center or the special unit, or
18the superintendent’s qualified designee a person qualified
19to perform the diagnostic evaluation. The evaluation shall
20be conducted at a place as the superintendent may direct.
21The cost of the evaluation shall be defrayed by the county
22of legal settlement unless otherwise ordered by the court.
23 The cost of the evaluation to be charged may be equal to but
24shall not exceed the actual cost of the evaluation. Persons
25referred by a court to a resource center or the special unit
26for diagnostic evaluation shall be considered as outpatients of
27the institution. No order of commitment shall be issued unless
28the superintendent of the institution recommends that the order
29be issued, and advises the court that adequate facilities for
30the care of the person are available.
31(2) The court shall examine the report of the county
32attorney filed pursuant to section 222.13, and if the report
33shows that neither the person nor those liable for the person’s
34support under section 222.78 are presently able to pay the
35charges rising out of the person’s care in a resource center,
-41-1or special treatment unit, shall enter an order stating that
2finding and directing that the charges be paid by the person’s
3county of residence or the state, as determined in accordance
4with section 222.60. The court may, upon request of the board
5of supervisors payer of the charges, may review its finding at
6any subsequent time while the person remains at the resource
7center, or is otherwise receiving care or treatment for which
8this chapter obligates the county payer to pay. If the court
9finds upon review that the person or those legally responsible
10for the person are presently able to pay the expenses, that
11finding shall apply only to the charges incurred during the
12period beginning on the date of the board’s payer’s request
13for the review and continuing thereafter after that date,
14unless and until the court again changes its finding. If the
15court finds that the person, or those liable for the person’s
16support, are able to pay the charges, the court shall enter
17an order directing that the charges be so paid to the extent
18required by section 222.78.
19 Sec. 50. Section 222.49, Code 2011, is amended to read as
20follows:
21222.49 Costs paid.
22The costs of proceedings shall be defrayed from the county
23treasury paid by the county or the state, as determined in
24accordance with section 222.60, unless otherwise ordered by
25the court. When the person alleged to be mentally retarded
26is found not to be mentally retarded, the court shall render
27judgment for such costs against the person filing the petition
28except when the petition is filed by order of court.
29 Sec. 51. Section 222.50, Code 2011, is amended to read as
30follows:
31222.50 County of legal settlement residence or state to pay.
32When the proceedings are instituted in a county in which
33the person who is alleged to have mental retardation was found
34but which is not the county of legal settlement residence of
35the person, and the costs are not taxed to the petitioner, the
-42- 1person’s county which is the legal settlement of the person
2 of residence or the state, as determined in accordance with
3section 222.60, shall, on presentation of a properly itemized
4bill for such costs, repay the costs to the former county.
5When the person’s legal settlement is outside the state or is
6unknown, the costs shall be paid out of money in the state
7treasury not otherwise appropriated, itemized on vouchers
8executed by the auditor of the county which paid the costs, and
9approved by the administrator.
10 Sec. 52. Section 222.59, subsection 1, unnumbered paragraph
111, Code 2011, is amended to read as follows:
12Upon receiving a request from an authorized requester, the
13superintendent of a state resource center shall coordinate
14with the central point of coordination process regional
15administrator in assisting the requester in identifying
16available community-based services as an alternative to
17continued placement of a patient in the state resource center.
18For the purposes of this section, “authorized requester” means
19the parent, guardian, or custodian of a minor patient, the
20guardian of an adult patient, or an adult patient who does not
21have a guardian. The assistance shall identify alternatives
22to continued placement which are appropriate to the patient’s
23needs and shall include but are not limited to any of the
24following:
25 Sec. 53. Section 222.60, subsection 1, Code 2011, is amended
26to read as follows:
271. All necessary and legal expenses for the cost of
28admission or commitment or for the treatment, training,
29instruction, care, habilitation, support and transportation of
30persons with mental retardation, as provided for in the county
31 regional mental health and disability services management plan
32provisions implemented pursuant to section 331.439, subsection
331 chapter 331, in a state resource center, or in a special
34unit, or any public or private facility within or without the
35state, approved by the director of the department of human
-43-1services, shall be paid by either:
2a. The person’s county in which such person has legal
3settlement as defined in section 252.16 of residence unless the
4expenses are covered by the medical assistance program under
5chapter 249A.
6b. The state when such the person has no legal settlement
7or when such settlement is unknown is a resident in another
8state or in a foreign country, the residence is unknown, or the
9expenses are covered by the medical assistance program under
10chapter 249A. The payment responsibility shall be deemed to be
11a state case.
12 Sec. 54. Section 222.60, subsection 2, Code 2011, is amended
13to read as follows:
142. a. Prior to a county of legal settlement residence
15 approving the payment of expenses for a person under this
16section, the county may require that the person be diagnosed
17to determine if the person has mental retardation or that
18the person be evaluated to determine the appropriate level
19of services required to meet the person’s needs relating to
20mental retardation. The diagnosis and the evaluation may be
21performed concurrently and shall be performed by an individual
22or individuals approved by the county who are qualified
23to perform the diagnosis or the evaluation. Following the
24initial approval for payment of expenses, the county of legal
25settlement may require that an evaluation be performed at
26reasonable time periods.
27b. The cost of a county-required diagnosis and an evaluation
28is at the county’s expense. In the case of a person without
29legal settlement or whose legal settlement is unknown service
30covered under the medical assistance program, the state
31may apply the diagnosis and evaluation provisions of this
32subsection at the state’s expense.
33c. A diagnosis or an evaluation under this section may be
34part of a county’s central point of coordination process under
35section 331.440, regional service management plan provided that
-44-1a diagnosis is performed only by an individual qualified as
2provided in this section.
3 Sec. 55. Section 222.61, Code 2011, is amended to read as
4follows:
5222.61 Legal settlement Residency determined.
6When a county receives an application on behalf of any
7person for admission to a resource center or a special unit
8or when a court issues an order committing any person to a
9resource center or a special unit, the board of supervisors
10shall utilize refer the determination of residency to the
11central point of coordination process regional administrator to
12determine and certify that the legal settlement residence of
13the person is in one of the following:
141. In the county in which the application is received or in
15which the court is located.
162. In some other county of the state.
173. In another state or in a foreign country.
184. Unknown.
19 Sec. 56. Section 222.62, Code 2011, is amended to read as
20follows:
21222.62 Settlement Residency in another county.
22When the board of supervisors determines through the central
23point of coordination process regional administrator determines
24 that the legal settlement residency of the person is other
25than in the county in which the application is received, the
26determination shall be certified to the superintendent of the
27resource center or the special unit where the person is a
28patient. The certification shall be accompanied by a copy of
29the evidence supporting the determination. The superintendent
30shall charge the expenses already incurred and unadjusted, and
31all future expenses of the patient, to the county certified to
32be the county of legal settlement residency.
33 Sec. 57. Section 222.63, Code 2011, is amended to read as
34follows:
35222.63 Finding of settlement residency —— objection.
-45- 1A board of supervisors’ certification utilizing of the
2central point of coordination process county’s regional
3administrator that a person’s legal settlement residency is in
4another county shall be sent by the board of supervisors to
5the auditor of the county of legal settlement residence. The
6certification shall be accompanied by a copy of the evidence
7supporting the determination. The auditor of the county of
8legal settlement residence shall submit the certification
9to the board of supervisors regional administrator of the
10auditor’s county and it shall be conclusively presumed that the
11patient has a legal settlement residency in that county unless
12that county disputes the determination of legal settlement
13 residency as provided in section 225C.8 331.438F.
14 Sec. 58. Section 222.64, Code 2011, is amended to read as
15follows:
16222.64 Foreign state or country or unknown legal settlement
17 residency.
18If the legal settlement residency of the person is
19determined by the board of supervisors through the central
20point of coordination process a county or the state to be in
21a foreign state or country or is determined to be unknown,
22the board of supervisors county or the state shall certify
23the determination to the administrator. The certification
24shall be accompanied by a copy of the evidence supporting the
25determination. The care of the person shall be as arranged
26by the board of supervisors county or the state or by an
27order as the court may enter. Application for admission or
28order of commitment may be made pending investigation by the
29administrator.
30 Sec. 59. Section 222.65, Code 2011, is amended to read as
31follows:
32222.65 Investigation.
33If an application is made for placement of a person in
34a state resource center or special unit, the department’s
35 administrator shall immediately investigate the legal
-46-1settlement residency of the person and proceed as follows:
21. If the administrator concurs with a certified
3determination as to legal settlement residency of the person
4so that the person is deemed a state case under section
5222.60, the administrator shall cause the person either to be
6transferred to a resource center or a special unit or to be
7transferred to the place of foreign settlement residency.
82. If the administrator disputes a certified determination
9of legal settlement residency, the administrator shall order
10the person transferred to a state resource center or a special
11unit until the dispute is resolved.
123. If the administrator disputes a certified determination
13of legal settlement residency, the administrator shall utilize
14the procedure provided in section 225C.8 331.438F to resolve
15the dispute. A determination of the person’s legal settlement
16 residency status made pursuant to section 225C.8 331.438F is
17conclusive.
18 Sec. 60. Section 222.66, Code 2011, is amended to read as
19follows:
20222.66 Transfers —— state cases ——expenses.
211. The transfer to a resource center or a special unit or
22to the place of legal settlement residency of a person with
23mental retardation who has no legal settlement residence in
24this state or whose legal settlement residency is unknown,
25shall be made in accordance with such directions as shall
26be prescribed by the administrator and when practicable by
27employees of the state resource center or the special unit.
28The actual and necessary expenses of such transfers shall be
29paid by the department on itemized vouchers sworn to by the
30claimants and approved by the administrator and the approved
31amount is appropriated to the department from any funds in the
32state treasury not otherwise appropriated.
332. The case of a person with mental retardation who
34is determined to have no residence in this state or whose
35residence is unknown shall be considered a state case.
-47-1 Sec. 61. Section 222.67, Code 2011, is amended to read as
2follows:
3222.67 Charge on finding of settlement residency.
4If a person has been received into a resource center or a
5special unit as a patient whose legal settlement is supposedly
6outside the state or residency is unknown and the administrator
7determines that the legal settlement residency of the patient
8was at the time of admission or commitment in a county of
9this state, the administrator shall certify the determination
10and charge all legal costs and expenses pertaining to the
11admission or commitment and support of the patient to the
12county of legal settlement residence. The certification shall
13be sent to the county of legal settlement residence. The
14certification shall be accompanied by a copy of the evidence
15supporting the determination. If the person’s legal settlement
16 residency status has been determined in accordance with section
17225C.8 331.438F, the legal costs and expenses shall be charged
18to the county or as a state case in accordance with that
19determination. The costs and expenses shall be collected as
20provided by law in other cases.
21 Sec. 62. Section 222.68, Code 2011, is amended to read as
22follows:
23222.68 Costs paid in first instance.
24All necessary and legal expenses for the cost of admission
25or commitment of a person to a resource center or a special
26unit when the person’s legal settlement residency is found to
27be in another county of this state shall in the first instance
28be paid by the county from which the person was admitted or
29committed. The county of legal settlement residence shall
30reimburse the county which pays for all such expenses. Where
31any If a county fails to make such reimbursement within
32forty-five days following submission of a properly itemized
33bill to the county of legal settlement residence, a penalty of
34not greater than one percent per month on and after forty-five
35days from submission of the bill may be added to the amount
-48-1due.
2 Sec. 63. Section 222.69, Code 2011, is amended to read as
3follows:
4222.69 Payment by state.
5All The amount necessary to pay the necessary and legal
6expenses for the cost of admission or commitment of a person
7to a resource center or a special unit when the person’s legal
8settlement residence is outside this state or is unknown shall
9be paid out of is appropriated to the department from any
10money in the state treasury not otherwise appropriated. Such
11payments shall be made by the department on itemized vouchers
12executed by the auditor of the county from which the expenses
13have been paid and approved by the administrator.
14 Sec. 64. Section 222.70, Code 2011, is amended to read as
15follows:
16222.70 Legal settlement Residency disputes.
17If a dispute arises between counties or between the
18department and a county as to the legal settlement residency
19 of a person admitted or committed to a resource center, a
20special unit, or a community-based service, the dispute shall
21be resolved as provided in section 225C.8 331.438F.
22 Sec. 65. Section 222.77, Code 2011, is amended to read as
23follows:
24222.77 Patients on leave.
25The cost of support of patients placed on convalescent leave
26or removed as a habilitation measure from a resource center,
27or a special unit, except when living in the home of a person
28legally bound for the support of the patient, shall be paid
29by the county of legal settlement residence or the state as
30provided in section 222.60. If the patient has no county of
31legal settlement, the cost shall be paid from the support fund
32of the resource center or special unit and charged on abstract
33in the same manner as other state inpatients until the patient
34becomes self-supporting or qualifies for support under other
35statutes.
-49-1 Sec. 66. Section 222.78, Code 2011, is amended to read as
2follows:
3222.78 Parents and others liable for support.
41. The father and mother of any patient admitted or
5committed to a resource center or to a special unit, as
6either an inpatient or an outpatient, and any person, firm, or
7corporation bound by contract made for support of the patient
8are liable for the support of the patient. The patient and
9those legally bound for the support of the patient shall be
10liable to the county or state, as applicable, for all sums
11advanced by the county to the state under in accordance with
12 the provisions of sections 222.60 and 222.77.
132. The liability of any person, other than the patient,
14who is legally bound for the support of a patient who is under
15eighteen years of age in a resource center or a special unit
16shall not exceed the average minimum cost of the care of a
17normally intelligent minor without a disability of the same
18age and sex as the minor patient. The administrator shall
19establish the scale for this purpose but the scale shall not
20exceed the standards for personal allowances established by
21the state division under the family investment program. The
22father or mother shall incur liability only during any period
23when the father or mother either individually or jointly
24receive a net income from whatever source, commensurate with
25that upon which they would be liable to make an income tax
26payment to this state. The father or mother of a patient shall
27not be liable for the support of the patient upon the patient
28attaining eighteen years of age. Nothing in this section
29shall be construed to prevent a relative or other person
30from voluntarily paying the full actual cost as established
31by the administrator for caring for the patient with mental
32retardation.
33 Sec. 67. Section 222.79, Code 2011, is amended to read as
34follows:
35222.79 Certification statement presumed correct.
-50- 1In actions to enforce the liability imposed by section
2222.78, the certification statement sent from the
3superintendent to the county auditor pursuant to section
4222.74 or the county of residence, as applicable, shall submit
5a certification statement stating the sums charged in such
6cases and the certification statement shall be considered
7 presumptively correct.
8 Sec. 68. Section 222.80, Code 2011, is amended to read as
9follows:
10222.80 Liability to county or state.
11A person admitted or committed to a county institution or
12home or admitted or committed at county or state expense to a
13private hospital, sanitarium, or other facility for treatment,
14training, instruction, care, habilitation, and support as a
15patient with mental retardation shall be liable to the county
16or state, as applicable, for the reasonable cost of the support
17as provided in section 222.78.
18 Sec. 69. Section 222.82, Code 2011, is amended to read as
19follows:
20222.82 Collection of liabilities and claims.
21The If liabilities and claims exist as provided in section
22222.78 or other provision of this chapter, the county of
23residence or the state, as applicable, may proceed as provided
24in this section. If the liabilities and claims are owed to
25a county of residence, the county’s board of supervisors of
26each county may direct the county attorney to proceed with the
27collection of said the liabilities and claims as a part of
28the duties of the county attorney’s office when the board of
29supervisors deems such action advisable. If the liabilities
30and claims are owed to the state, the state shall proceed
31with the collection. The board of supervisors or the state,
32as applicable, may and is hereby empowered to compromise any
33and all liabilities to the county or state arising under this
34chapter when such compromise is deemed to be in the best
35interests of the county or state. Any collections and liens
-51-1shall be limited in conformance to section 614.1, subsection 4.
2 Sec. 70. Section 222.86, Code 2011, is amended to read as
3follows:
4222.86 Payment for care from fund.
5If a patient is not receiving medical assistance under
6chapter 249A and the amount in the account of any patient
7in the patients’ personal deposit fund exceeds two hundred
8dollars, the business manager of the resource center or special
9unit may apply any amount of the excess to reimburse the
10county of legal settlement or the state in a case where no
11legal settlement exists residence for liability incurred by
12the county or the state for the payment of care, support, and
13maintenance of the patient, when billed by the county of legal
14settlement or by the administrator for a patient having no
15legal settlement or state, as applicable.
16 Sec. 71. Section 222.92, subsection 3, paragraph a, Code
172011, is amended to read as follows:
18a. Moneys received by the state from billings to counties
19under section 222.73.
20 Sec. 72. Section 225.11, Code 2011, is amended to read as
21follows:
22225.11 Initiating commitment procedures.
23When a court finds upon completion of a hearing held pursuant
24to section 229.12 that the contention that a respondent is
25seriously mentally impaired has been sustained by clear and
26convincing evidence, and the application filed under section
27229.6 also contends or the court otherwise concludes that it
28would be appropriate to refer the respondent to the state
29psychiatric hospital for a complete psychiatric evaluation and
30appropriate treatment pursuant to section 229.13, the judge
31may order that a financial investigation be made in the manner
32prescribed by section 225.13. If the costs of a respondent’s
33evaluation or treatment are payable in whole or in part by
34a county, an order under this section shall be for referral
35of the respondent through the central point of coordination
-52-1process regional administrator for an evaluation and referral
2of the respondent to an appropriate placement or service, which
3may include the state psychiatric hospital for additional
4evaluation or treatment. For purposes of this chapter, “central
5point of coordination process” “regional administrator” means the
6same as defined in section 331.440 331.438A.
7 Sec. 73. Section 225.15, Code 2011, is amended to read as
8follows:
9225.15 Examination and treatment.
101. When a respondent arrives at the state psychiatric
11hospital, the admitting physician shall examine the respondent
12and determine whether or not, in the physician’s judgment, the
13respondent is a fit subject for observation, treatment, and
14hospital care. If, upon examination, the physician decides
15that the respondent should be admitted to the hospital, the
16respondent shall be provided a proper bed in the hospital;
17and the physician who has charge of the respondent shall
18proceed with observation, medical treatment, and hospital care
19as in the physician’s judgment are proper and necessary, in
20compliance with sections 229.13 to 229.16.
212. A proper and competent nurse shall also be assigned to
22look after and care for the respondent during observation,
23treatment, and care. Observation, treatment, and hospital care
24under this section which are payable in whole or in part by a
25county shall only be provided as determined through the central
26point of coordination process county’s regional administrator.
27 Sec. 74. Section 225.17, subsection 2, Code 2011, is amended
28to read as follows:
292. When the respondent arrives at the hospital, the
30respondent shall receive the same treatment as is provided for
31committed public patients in section 225.15, in compliance with
32sections 229.13 to 229.16. However, observation, treatment,
33and hospital care under this section of a respondent whose
34expenses are payable in whole or in part by a county shall
35only be provided as determined through the central point of
-53-1coordination process county’s regional administrator.
2 Sec. 75. Section 225.23, Code 2011, is amended to read as
3follows:
4225.23 Collection for treatment.
5If the bills for a committed or voluntary private patient are
6paid by the state, the state psychiatric hospital shall file a
7certified copy of the claim for the bills with the auditor of
8the patient’s county of residence department of administrative
9services. The county of residence department shall proceed to
10collect the claim in the name of the state psychiatric hospital
11and, when collected, pay the amount collected to the director
12of the department of administrative services. The hospital
13shall also, at the same time, forward a duplicate of the claim
14to the director of the department of administrative services.
15 Sec. 76. Section 225C.2, subsection 2, Code 2011, is amended
16by striking the subsection.
17 Sec. 77. Section 225C.2, Code 2011, is amended by adding the
18following new subsection:
19 NEW SUBSECTION. 9. “Regional administrator” means the same
20as defined in section 331.438A.
21 Sec. 78. Section 225C.5, subsection 1, paragraph f, Code
22Supplement 2011, is amended to read as follows:
23f. Two members shall be administrators of the central point
24of coordination process established in accordance with section
25331.440 regional administrator staff selected from nominees
26submitted by the community services affiliate of the Iowa state
27association of counties.
28 Sec. 79. Section 225C.6, subsection 1, paragraph b, Code
29Supplement 2011, is amended to read as follows:
30b. Adopt necessary rules pursuant to chapter 17A which
31relate to disability programs, core disability services, and
32other services, including but not limited to definitions of
33each disability included within the term “disability services”
34as necessary for purposes of state, county, and regional
35planning, programs, and services.
-54-1 Sec. 80. Section 225C.6, subsection 1, paragraph l, Code
2Supplement 2011, is amended by striking the paragraph and
3inserting in lieu thereof the following:
4l. Identify basic financial eligibility standards for the
5disability services provided by a mental health and disability
6services region. The initial standards shall be as specified
7in chapter 331.
8 Sec. 81. Section 225C.6A, Code 2011, is amended to read as
9follows:
10225C.6A Disability services data system redesign.
11The commission shall do the following relating to redesign
12of the data concerning the disability services system in the
13state:
141. Identify sources of revenue to support statewide
15delivery of core disability services to eligible disability
16populations.
172. Ensure there is a continuous improvement process for
18development and maintenance of the disability services system
19for adults and children. The process shall include but is not
20limited to data collection and reporting provisions.
213. a. 1. Plan, collect, and analyze data as necessary to
22issue cost estimates for serving additional populations and
23providing core disability services statewide. The department
24shall maintain compliance with applicable federal and state
25privacy laws to ensure the confidentiality and integrity of
26individually identifiable disability services data. The
27department shall regularly assess the status of the compliance
28in order to assure that data security is protected.
29b. 2. In implementing a system under this subsection
30 section for collecting and analyzing state, county, and private
31contractor data, the department shall establish a client
32identifier for the individuals receiving services. The client
33identifier shall be used in lieu of the individual’s name or
34social security number. The client identifier shall consist of
35the last four digits of an individual’s social security number,
-55-1the first three letters of the individual’s last name, the
2individual’s date of birth, and the individual’s gender in an
3order determined by the department.
4c. 3. Each county regional administrator shall regularly
5 report to the department annually on or before December 1, for
6the preceding fiscal year the following information for each
7individual served: demographic information, expenditure data,
8and data concerning the services and other support provided to
9each individual, as specified in administrative rule adopted
10by the commission.
114. Work with county representatives and other qualified
12persons to develop an implementation plan for replacing the
13county of legal settlement approach to determining service
14system funding responsibilities with an approach based upon
15residency. The plan shall address a statewide standard for
16proof of residency, outline a plan for establishing a data
17system for identifying residency of eligible individuals,
18address residency issues for individuals who began residing in
19a county due to a court order or criminal sentence or to obtain
20services in that county, recommend an approach for contesting
21a residency determination, and address other implementation
22issues.
23 Sec. 82. Section 225C.14, subsection 1, Code 2011, is
24amended to read as follows:
251. Except in cases of medical emergency, a person shall be
26admitted to a state mental health institute as an inpatient
27only after a preliminary diagnostic evaluation performed
28through the central point of coordination process regional
29administrator of the person’s county of residence has confirmed
30that the admission is appropriate to the person’s mental health
31needs, and that no suitable alternative method of providing the
32needed services in a less restrictive setting or in or nearer
33to the person’s home community is currently available. If
34provided for through the central point of coordination process
35 regional administrator, the evaluation may be performed by a
-56-1community mental health center or by an alternative diagnostic
2facility. The policy established by this section shall be
3implemented in the manner and to the extent prescribed by
4sections 225C.15, 225C.16 and 225C.17.
5 Sec. 83. Section 225C.16, subsections 2 through 4, Code
62011, are amended to read as follows:
72. The clerk of the district court in that county shall
8refer a person applying for authorization for voluntary
9admission, or for authorization for voluntary admission of
10another person, in accordance with section 229.42, to the
11appropriate entity designated through the central point of
12coordination process regional administrator of the person’s
13county of residence under section 225C.14 for the preliminary
14diagnostic evaluation unless the applicant furnishes a written
15statement from the appropriate entity which indicates that the
16evaluation has been performed and that the person’s admission
17to a state mental health institute is appropriate. This
18subsection does not apply when authorization for voluntary
19admission is sought under circumstances which, in the opinion
20of the chief medical officer or that officer’s physician
21designee, constitute a medical emergency.
223. Judges of the district court in that county or the
23judicial hospitalization referee appointed for that county
24shall so far as possible arrange for the entity designated
25through the central point of coordination process regional
26administrator under section 225C.14 to perform a prehearing
27examination of a respondent required under section 229.8,
28subsection 3, paragraph “b”.
294. The chief medical officer of a state mental health
30institute shall promptly submit to the appropriate entity
31designated through the central point of coordination process
32 regional administrator under section 225C.14 a report of the
33voluntary admission of a patient under the medical emergency
34clauses of subsections 1 and 2. The report shall explain the
35nature of the emergency which necessitated the admission of
-57-1the patient without a preliminary diagnostic evaluation by the
2designated entity.
3 Sec. 84. Section 225C.19, subsection 3, paragraph c,
4subparagraph (4), Code 2011, is amended to read as follows:
5(4) County central point of coordination processes regional
6administrators.
7 Sec. 85. Section 226.9C, subsection 1, unnumbered paragraph
81, Code Supplement 2011, is amended to read as follows:
9The state mental health institute at Mount Pleasant shall
10operate the dual diagnosis mental health and substance
11abuse substance-related disorder treatment program on a net
12budgeting basis in which fifty percent of the actual per diem
13and ancillary services costs are chargeable to the patient’s
14county of legal settlement or as a state case, as appropriate
15 residence. Subject to the approval of the department, revenues
16attributable to the dual diagnosis program for each fiscal year
17shall be deposited in the mental health institute’s account
18and are appropriated to the department for the dual diagnosis
19program, including but not limited to all of the following
20revenues:
21 Sec. 86. Section 226.9C, subsection 2, Code Supplement
222011, is amended to read as follows:
232. The following additional provisions are applicable in
24regard to the dual diagnosis program:
25a. A county may split the charges between the county’s
26mental health, mental retardation, and developmental
27disabilities services fund created pursuant to section 331.424A
28and the county’s budget for substance abuse substance-related
29disorder expenditures.
30b. If an individual is committed to the custody of the
31department of corrections at the time the individual is
32referred for dual diagnosis treatment, the department of
33corrections shall be charged for the costs of treatment.
34c. Prior to an individual’s admission for dual diagnosis
35treatment, the individual shall have been screened through a
-58-1county’s central point of coordination process implemented
2pursuant to section 331.440 regional administrator to determine
3the appropriateness of the treatment.
4d. A county shall not be chargeable for the costs of
5treatment for an individual enrolled in and authorized by or
6decertified by a managed behavioral care plan under the medical
7assistance program.
8e. Notwithstanding section 8.33, state mental health
9institute revenues related to the dual diagnosis program that
10remain unencumbered or unobligated at the close of the fiscal
11year shall not revert but shall remain available up to the
12amount which would allow the state mental health institute
13to meet credit obligations owed to counties as a result of
14year-end per diem adjustments for the dual diagnosis program.
15 Sec. 87. Section 226.45, Code 2011, is amended to read as
16follows:
17226.45 Reimbursement to county or state.
18If a patient is not receiving medical assistance under
19chapter 249A and the amount to the account of any patient
20in the patients’ personal deposit fund exceeds two hundred
21dollars, the business manager of the hospital may apply any of
22the excess to reimburse the county of legal settlement or the
23state in a case where no legal settlement exists residence for
24liability incurred by the county or the state for the payment
25of care, support and maintenance of the patient, when billed by
26the county of legal settlement or by the administrator for a
27patient having no legal settlement residence.
28 Sec. 88. Section 227.10, Code 2011, is amended to read as
29follows:
30227.10 Transfers from county or private institutions.
31Patients who have been admitted at public expense to
32any institution to which this chapter is applicable may be
33involuntarily transferred to the proper state hospital for
34persons with mental illness in the manner prescribed by
35sections 229.6 to 229.13. The application required by section
-59-1229.6 may be filed by the administrator of the division or
2the administrator’s designee, or by the administrator of the
3institution where the patient is then being maintained or
4treated. If the patient was admitted to that institution
5involuntarily, the administrator of the division may arrange
6and complete the transfer, and shall report it as required of
7a chief medical officer under section 229.15, subsection 5.
8The transfer shall be made at county expense, and the expense
9recovered, as provided in section 227.7. However, transfer
10under this section of a patient whose expenses are payable in
11whole or in part by a county is subject to an authorization for
12the transfer through the central point of coordination process
13 county’s regional administrator as defined in chapter 331.
14 Sec. 89. Section 229.1, subsection 3, Code Supplement 2011,
15is amended by striking the subsection.
16 Sec. 90. Section 229.1, Code Supplement 2011, is amended by
17adding the following new subsection:
18 NEW SUBSECTION. 14A. “Regional administrator” means the
19same as defined in section 331.438A.
20 Sec. 91. Section 229.1B, Code 2011, is amended to read as
21follows:
22229.1B Central point of coordination process Regional
23administrator authorization.
24Notwithstanding any provision of this chapter to the
25contrary, any person whose hospitalization expenses are
26payable in whole or in part by a county shall be subject to
27all requirements of the central point of coordination process
28 county’s regional administrator.
29 Sec. 92. Section 229.9A, Code 2011, is amended to read as
30follows:
31229.9A Advocate informed.
32The court shall direct the clerk to furnish the advocate
33of the respondent’s county of legal settlement residence
34 with a copy of application and any order issued pursuant to
35section 229.8, subsection 3. The advocate may attend the
-60-1hospitalization hearing of any respondent for whom the advocate
2has received notice of a hospitalization hearing.
3 Sec. 93. Section 229.11, subsection 1, unnumbered paragraph
41, Code 2011, is amended to read as follows:
5If the applicant requests that the respondent be taken into
6immediate custody and the judge, upon reviewing the application
7and accompanying documentation, finds probable cause to believe
8that the respondent has a serious mental impairment and is
9likely to injure the respondent or other persons if allowed
10to remain at liberty, the judge may enter a written order
11directing that the respondent be taken into immediate custody
12by the sheriff or the sheriff’s deputy and be detained until
13the hospitalization hearing. The hospitalization hearing shall
14be held no more than five days after the date of the order,
15except that if the fifth day after the date of the order is
16a Saturday, Sunday, or a holiday, the hearing may be held
17on the next succeeding business day. If the expenses of a
18respondent are payable in whole or in part by a county, for a
19placement in accordance with paragraph “a”, the judge shall give
20notice of the placement to the central point of coordination
21process county’s regional administrator, and for a placement
22in accordance with paragraph “b” or “c”, the judge shall order
23the placement in a hospital or facility designated through
24the central point of coordination process county’s regional
25administrator. The judge may order the respondent detained for
26the period of time until the hearing is held, and no longer,
27in accordance with paragraph “a”, if possible, and if not then
28in accordance with paragraph “b”, or, only if neither of these
29alternatives is available, in accordance with paragraph “c”.
30Detention may be:
31 Sec. 94. Section 229.12, subsection 2, Code 2011, is amended
32to read as follows:
332. All persons not necessary for the conduct of the
34proceeding shall be excluded, except that the court may admit
35persons having a legitimate interest in the proceeding and
-61-1shall permit the advocate from the respondent’s county of legal
2settlement residence to attend the hearing. Upon motion of the
3county attorney, the judge may exclude the respondent from the
4hearing during the testimony of any particular witness if the
5judge determines that witness’s testimony is likely to cause
6the respondent severe emotional trauma.
7 Sec. 95. Section 229.13, subsection 1, paragraph a, Code
82011, is amended to read as follows:
9a. The court shall order a respondent whose expenses are
10payable in whole or in part by a county placed under the care
11of an appropriate hospital or facility designated through the
12central point of coordination process regional administrator
13of the respondent’s county of residence on an inpatient or
14outpatient basis.
15 Sec. 96. Section 229.14, subsection 2, paragraph a, Code
162011, is amended to read as follows:
17a. For a respondent whose expenses are payable in whole
18or in part by a county, placement as designated through the
19central point of coordination process regional administrator
20of the respondent’s county of residence in the care of an
21appropriate hospital or facility on an inpatient or outpatient
22basis, or other appropriate treatment, or in an appropriate
23alternative placement.
24 Sec. 97. Section 229.14A, subsections 7 and 9, Code 2011,
25are amended to read as follows:
267. If a respondent’s expenses are payable in whole or in
27part by a county through the central point of coordination
28process regional administrator of the respondent’s county of
29residence, notice of a placement hearing shall be provided
30to the county attorney and the county’s central point of
31coordination process regional administrator. At the hearing,
32the county may present evidence regarding appropriate
33placement.
349. A placement made pursuant to an order entered under
35section 229.13 or 229.14 or this section shall be considered to
-62-1be authorized through the central point of coordination process
2 regional administrator.
3 Sec. 98. Section 229.19, subsection 1, paragraph b, Code
42011, is amended to read as follows:
5b. The court or, if the advocate is appointed by the county
6board of supervisors, the board shall assign the advocate
7appointed from a patient’s county of legal settlement residence
8 to represent the interests of the patient. If a patient has no
9county of legal settlement residence or the patient’s residence
10is unknown, the court or, if the advocate is appointed by
11the county board of supervisors, the board shall assign the
12advocate appointed from the county where the hospital or
13facility is located to represent the interests of the patient.
14 Sec. 99. Section 229.24, subsection 3, unnumbered paragraph
151, Code 2011, is amended to read as follows:
16If all or part of the costs associated with hospitalization
17of an individual under this chapter are chargeable to a county
18of legal settlement residence, the clerk of the district court
19shall provide to the county of legal settlement regional
20administrator of the respondent’s county of residence and
21to the regional administrator of the county in which the
22hospitalization order is entered the following information
23pertaining to the individual which would be confidential under
24subsection 1:
25 Sec. 100. Section 229.31, Code 2011, is amended to read as
26follows:
27229.31 Commission of inquiry.
28A sworn complaint, alleging that a named person is not
29seriously mentally impaired and is unjustly deprived of liberty
30in any hospital in the state, may be filed by any person with
31the clerk of the district court of the county in which such
32named person is so confined, or of the county in which such
33named person has a legal settlement, and thereupon a is a
34resident. Upon receiving the complaint, a judge of said that
35 court shall appoint a commission of not more than three persons
-63-1to inquire into the truth of said the allegations. One of
2said the commissioners shall be a physician and if additional
3commissioners are appointed, one of such the additional
4 commissioners shall be a lawyer.
5 Sec. 101. Section 229.42, Code 2011, is amended to read as
6follows:
7229.42 Costs paid by county.
81. If a person wishing to make application for voluntary
9admission to a mental hospital established by chapter 226 is
10unable to pay the costs of hospitalization or those responsible
11for the person are unable to pay the costs, application for
12authorization of voluntary admission must be made through a
13central point of coordination process regional administrator
14 before application for admission is made to the hospital.
15The person’s county of legal settlement residence shall be
16determined through the central point of coordination process
17 county’s regional administrator and if the admission is
18approved through the central point of coordination process
19 regional administrator, the person’s admission to a mental
20health hospital shall be authorized as a voluntary case.
21The authorization shall be issued on forms provided by the
22administrator. The costs of the hospitalization shall be paid
23by the county of legal settlement residence to the department
24of human services and credited to the general fund of the
25state, provided that the mental health hospital rendering the
26services has certified to the county auditor of the county
27of legal settlement residence the amount chargeable to the
28county and has sent a duplicate statement of the charges to the
29department of human services. A county shall not be billed
30for the cost of a patient unless the patient’s admission is
31authorized through the central point of coordination process
32 county’s regional administrator. The mental health institute
33and the county shall work together to locate appropriate
34alternative placements and services, and to educate patients
35and family members of patients regarding such alternatives.
-64- 12. All the provisions of chapter 230 shall apply to such
2voluntary patients so far as is applicable.
33. The provisions of this section and of section 229.41
4shall apply to all voluntary inpatients or outpatients
5receiving mental health services either away from or at the
6institution.
74. If a county fails to pay the billed charges within
8forty-five days from the date the county auditor received the
9certification statement from the superintendent, the department
10of human services shall charge the delinquent county the
11penalty of one percent per month on and after forty-five days
12from the date the county received the certification statement
13until paid. The penalties received shall be credited to the
14general fund of the state.
15 Sec. 102. Section 229.43, Code 2011, is amended to read as
16follows:
17229.43 Nonresidents or no-settlement Nonresident patients.
18The administrator may place patients of mental health
19institutes who have no county of legal settlement, who
20are nonresidents, or whose legal settlement is unknown on
21convalescent leave to a private sponsor or in a health care
22facility licensed under chapter 135C, when in the opinion
23of the administrator the placement is in the best interests
24of the patient and the state of Iowa. If the patient was
25involuntarily hospitalized, the district court which ordered
26hospitalization of the patient must be informed when the
27patient is placed on convalescent leave, as required by section
28229.15, subsection 5.
29 Sec. 103. Section 230.1, Code 2011, is amended to read as
30follows:
31230.1 Liability of county and state.
321. The necessary and legal costs and expenses attending
33the taking into custody, care, investigation, admission,
34commitment, and support of a person with mental illness
35admitted or committed to a state hospital shall be paid by a
-65-1county or by the state as follows:
2a. By the county in which such person has a legal
3settlement, if If the person is eighteen years of age or older,
4by the person’s county of residence unless the costs and
5expenses are covered by the medical assistance program under
6chapter 249A or the person is described by paragraph “b”.
7b. By the state when if such person has no legal settlement
8 residence in this state, when if the person’s legal settlement
9 residence is unknown, or if the costs and expenses are covered
10by the medical assistance program under chapter 249A, or if the
11person is under eighteen years of age.
122. The legal settlement county of residence of any person
13found mentally ill with mental illness who is a patient of
14any state institution shall be that the person’s county of
15residence existing at the time of admission thereto to the
16institution.
173. A county of legal settlement residence is not liable
18for costs and expenses associated with a person with mental
19illness unless the costs and expenses are for services and
20other support authorized for the person through the central
21point of coordination process county’s regional administrator.
22For the purposes of this chapter, “central point of coordination
23process” “regional administrator” means the same as defined in
24section 331.440 331.438A.
25 Sec. 104. Section 230.2, Code 2011, is amended to read as
26follows:
27230.2 Finding of legal settlement residence.
28If a person’s legal settlement residency status is
29disputed, legal settlement the residency shall be determined
30in accordance with section 225C.8 331.438F. Otherwise, the
31district court may, when the person is ordered placed in a
32hospital for psychiatric examination and appropriate treatment,
33or as soon thereafter as the court obtains the proper
34information, determine and enter of record whether the legal
35settlement residence of the person is one of the following:
-66- 11. In the county from which the person was placed in the
2hospital;.
32. In some other another county of the state;.
43. In some a foreign state or country; or.
54. Unknown.
6 Sec. 105. Section 230.3, Code 2011, is amended to read as
7follows:
8230.3 Certification of settlement.
9If a person’s legal settlement county of residence
10 is determined through by the county’s central point of
11coordination process regional administrator to be in another
12county of this state, the county making the determination
13 regional administrator shall certify the determination to the
14superintendent of the hospital to which the person is admitted
15or committed. The certification shall be accompanied by a copy
16of the evidence supporting the determination. Upon receiving
17the certification, the superintendent shall charge the expenses
18already incurred and unadjusted, and all future expenses of
19the person, to the county determined to be the county of legal
20settlement residence.
21 Sec. 106. Section 230.4, Code 2011, is amended to read as
22follows:
23230.4 Certification to debtor county.
24A determination of a person’s legal settlement county of
25residence made in accordance with section 230.2 or 230.3 shall
26be sent by the court or the county to the county auditor of
27the county of legal settlement residence. The certification
28shall be accompanied by a copy of the evidence supporting the
29determination. The auditor shall provide the certification
30to the board of supervisors of the auditor’s county, and it
31shall be conclusively presumed that the person has a legal
32settlement residence in the notified county unless that county
33disputes the finding of legal settlement residence as provided
34in section 225C.8 331.438F.
35 Sec. 107. Section 230.5, Code 2011, is amended to read as
-67-1follows:
2230.5 Nonresidents.
3If a person’s legal settlement residence is determined in
4accordance with section 230.2 or 230.3 to be in a foreign state
5or country, or is unknown, the court or the county regional
6administrator shall immediately certify the determination
7to the department’s administrator. The certification shall
8be accompanied by a copy of the evidence supporting the
9determination. A court order issued pursuant to section
10229.13 shall direct that the patient be hospitalized at the
11appropriate state hospital for persons with mental illness.
12 Sec. 108. Section 230.8, Code 2011, is amended to read as
13follows:
14230.8 Transfers of persons with mental illness —— expenses.
15The transfer to any state hospitals or to the places of
16their legal settlement residence of persons with mental illness
17who have no legal settlement residence in this state or whose
18legal settlement residence is unknown, shall be made according
19to the directions of the administrator, and when practicable
20by employees of the state hospitals, and the. The actual
21and necessary expenses of such transfers shall be paid on
22itemized vouchers sworn to by the claimants and approved by the
23administrator, and the amount of the expenses is appropriated
24to the department from any funds in the state treasury not
25otherwise appropriated.
26 Sec. 109. Section 230.9, Code 2011, is amended to read as
27follows:
28230.9 Subsequent discovery of residence.
29If, after a person has been received by a state hospital for
30persons with mental illness as a state case patient whose legal
31settlement residence is supposed to be outside this state or
32unknown, the administrator determines that the legal settlement
33 residence of the person was, at the time of admission or
34commitment, in a county of this state, the administrator shall
35certify the determination and charge all legal costs and
-68-1expenses pertaining to the admission or commitment and support
2of the person to the county of legal settlement residence. The
3certification shall be sent to the county of legal settlement
4 residence. The certification shall be accompanied by a copy
5of the evidence supporting the determination. The costs and
6expenses shall be collected as provided by law in other cases.
7If the person’s legal settlement residency status has been
8determined in accordance with section 225C.8 331.438F, the
9legal costs and expenses shall be charged to the county or as a
10state case of residence in accordance with that determination.
11 Sec. 110. Section 230.10, Code 2011, is amended to read as
12follows:
13230.10 Payment of costs.
14All legal costs and expenses attending the taking into
15custody, care, investigation, and admission or commitment of
16a person to a state hospital for persons with mental illness
17under a finding that such the person has a legal settlement
18 residency in another county of this state shall be charged
19against the county of legal settlement residence.
20 Sec. 111. Section 230.11, Code 2011, is amended to read as
21follows:
22230.11 Recovery of costs from state.
23Costs and expenses attending the taking into custody,
24care, and investigation of a person who has been admitted
25or committed to a state hospital, United States department
26of veterans affairs hospital, or other agency of the United
27States government, for persons with mental illness and who
28has no legal settlement residence in this state or whose
29legal settlement residence is unknown, including cost of
30commitment, if any, shall be paid out of as approved by the
31administrator. The amount of the costs and expenses approved
32by the administrator is appropriated to the department from
33 any money in the state treasury not otherwise appropriated, on
34itemized vouchers executed by the auditor of the county which
35has paid them, and approved by the administrator.
-69-1 Sec. 112. Section 230.12, Code 2011, is amended to read as
2follows:
3230.12 Legal settlement Residency disputes.
4If a dispute arises between different counties or between
5the administrator and a county as to the legal settlement
6 residence of a person admitted or committed to a state hospital
7for persons with mental illness, the dispute shall be resolved
8as provided in section 225C.8 331.438F.
9 Sec. 113. Section 230.20, subsection 2, paragraph b, Code
102011, is amended to read as follows:
11b. The per diem costs billed to each county shall not exceed
12the per diem costs billed to the county in the fiscal year
13beginning July 1, 1996. However, the per diem costs billed
14to a county may be adjusted annually to reflect increased
15costs to the extent of the percentage increase in the total
16of county fixed budgets pursuant to the allowed growth factor
17adjustment authorized by the general assembly for the fiscal
18year in accordance with section 331.439, Code 2011, and annual
19percentage increases in state support provided to the regional
20mental health and disability service system under chapter 331.
21 Sec. 114. Section 230.32, Code 2011, is amended to read as
22follows:
23230.32 Support of nonresident patients on leave.
24The cost of support of patients without legal settlement
25 residence in this state, who are placed on convalescent
26leave or removed from a state mental institute to any health
27care facility licensed under chapter 135C for rehabilitation
28purposes, shall be paid from the hospital support fund
29and shall be charged on abstract in the same manner as
30state inpatients, until such time as the patient becomes
31self-supporting or qualifies for support under existing
32statutes.
33 Sec. 115. Section 231.56A, subsection 2, Code 2011, is
34amended to read as follows:
352. The target population of the projects shall be any
-70-1older individual residing in Iowa who is at risk of or who is
2experiencing abuse, neglect, or exploitation which may include
3but is not limited to an older individual who is the subject of
4a report of suspected dependent adult abuse pursuant to chapter
5235B. This subsection shall not apply to an older individual
6who is receiving assistance under a county management plan
7approved pursuant to section 331.439 regional mental health and
8disability services system under chapter 331.
9 Sec. 116. Section 232.2, subsection 4, paragraph f,
10subparagraph (3), Code 2011, is amended to read as follows:
11(3) The transition plan shall be developed and reviewed
12by the department in collaboration with a child-centered
13transition team. The transition team shall be comprised of
14the child’s caseworker and persons selected by the child,
15persons who have knowledge of services available to the child,
16and any person who may reasonably be expected to be a service
17provider for the child when the child becomes an adult or to
18become responsible for the costs of services at that time.
19If the child is reasonably likely to need or be eligible for
20adult services, the transition team membership shall include
21representatives from the adult services system. The adult
22services system representatives may include but are not
23limited to the administrator of county general relief under
24chapter 251 or 252 or of the central point of coordination
25process implemented under section 331.440 county’s regional
26administrator under chapter 331. The membership of the
27transition team and the meeting dates for the team shall be
28documented in the transition plan.
29 Sec. 117. Section 235.7, subsection 2, Code 2011, is amended
30to read as follows:
312. Membership. The department may authorize the governance
32boards of decategorization of child welfare and juvenile
33justice funding projects established under section 232.188 to
34appoint the transition committee membership and may utilize
35the boundaries of decategorization projects to establish
-71-1the service areas for transition committees. The committee
2membership may include but is not limited to department of
3human services staff involved with foster care, child welfare,
4and adult services, juvenile court services staff, staff
5involved with county general relief under chapter 251 or 252,
6or of the central point of coordination process regional
7mental health and disability services implemented under
8section 331.440 chapter 331, school district and area education
9agency staff involved with special education, and a child’s
10court appointed special advocate, guardian ad litem, service
11providers, and other persons knowledgeable about the child.
12 Sec. 118. Section 235A.15, subsection 2, paragraph c,
13subparagraph (9), Code Supplement 2011, is amended to read as
14follows:
15(9) To the administrator of an agency providing mental
16health, mental retardation, or developmental disability
17services under a county regional mental health and disability
18services management plan developed pursuant to section 331.439
19chapter 331, if the data concerns a person employed by or being
20considered by the agency for employment.
21 Sec. 119. Section 235B.6, subsection 2, paragraph c,
22subparagraph (6), Code Supplement 2011, is amended to read as
23follows:
24(6) To the administrator of an agency providing mental
25health, mental retardation, or developmental disability
26services under a county regional mental health and disability
27services management plan developed pursuant to section 331.439
28chapter 331, if the information concerns a person employed by
29or being considered by the agency for employment.
30 Sec. 120. Section 249A.12, Code 2011, is amended to read as
31follows:
32249A.12 Assistance to persons with mental retardation ——
33state cases.
341. Assistance may be furnished under this chapter to an
35otherwise eligible recipient who is a resident of a health
-72-1care facility licensed under chapter 135C and certified as an
2intermediate care facility for persons with mental retardation.
32. A county shall reimburse the department on a monthly
4basis for that portion of the cost of assistance provided
5under this section to a recipient with legal settlement in
6the county, which is not paid from federal funds, if the
7recipient’s placement has been approved by the appropriate
8review organization as medically necessary and appropriate.
9The department’s goal for the maximum time period for
10submission of a claim to a county is not more than sixty
11days following the submission of the claim by the provider
12of the service to the department. The department’s goal for
13completion and crediting of a county for cost settlement for
14the actual costs of a service under a home and community-based
15services waiver is within two hundred seventy days of the close
16of a fiscal year for which cost reports are due from providers.
17The department shall place all reimbursements from counties
18in the appropriation for medical assistance, and may use the
19reimbursed funds in the same manner and for any purpose for
20which the appropriation for medical assistance may be used.
213. 2. If a county reimburses reimbursed the department for
22medical assistance provided under this section, Code 2011, and
23the amount of medical assistance is subsequently repaid through
24a medical assistance income trust or a medical assistance
25special needs trust as defined in section 633C.1, the
26department shall reimburse the county on a proportionate basis.
27The department shall adopt rules to implement this subsection.
284. 3. a. Effective July 1, 1995, the state shall be
29responsible for all of the nonfederal share of the costs of
30intermediate care facility for persons with mental retardation
31services provided under medical assistance to minors.
32Notwithstanding subsection 2 and contrary provisions of section
33222.73, Code 2011, effective July 1, 1995, a county is not
34required to reimburse the department and shall not be billed
35for the nonfederal share of the costs of such services provided
-73-1to minors.
2b. The state shall be responsible for all of the nonfederal
3share of medical assistance home and community-based services
4waivers for persons with intellectual disabilities services
5provided to minors, and a county is not required to reimburse
6the department and shall not be billed for the nonfederal share
7of the costs of the services.
8c. Effective February 1, 2002, the state shall be
9responsible for all of the nonfederal share of the costs of
10intermediate care facility for persons with mental retardation
11services provided under medical assistance attributable to the
12assessment fee for intermediate care facilities for individuals
13with mental retardation imposed pursuant to section 249A.21.
14Notwithstanding subsection 2, effective Effective February 1,
152003, a county is not required to reimburse the department and
16shall not be billed for the nonfederal share of the costs of
17such services attributable to the assessment fee.
185. 4. a. The mental health and disability services
19commission shall recommend to the department the actions
20necessary to assist in the transition of individuals being
21served in an intermediate care facility for persons with
22mental retardation, who are appropriate for the transition,
23to services funded under a medical assistance home and
24community-based services waiver for persons with intellectual
25disabilities in a manner which maximizes the use of existing
26public and private facilities. The actions may include but are
27not limited to submitting any of the following or a combination
28of any of the following as a request for a revision of the
29medical assistance home and community-based services waiver for
30persons with intellectual disabilities:
31(1) Allow for the transition of intermediate care
32facilities for persons with mental retardation licensed under
33chapter 135C, to services funded under the medical assistance
34home and community-based services waiver for persons with
35intellectual disabilities. The request shall be for inclusion
-74-1of additional persons under the waiver associated with the
2transition.
3(2) Allow for reimbursement under the waiver for day program
4or other service costs.
5(3) Allow for exception provisions in which an intermediate
6care facility for persons with mental retardation which does
7not meet size and other facility-related requirements under
8the waiver in effect on June 30, 1996, may convert to a waiver
9service for a set period of time such as five years. Following
10the set period of time, the facility would be subject to the
11waiver requirements applicable to services which were not
12operating under the exception provisions.
13b. In implementing the provisions of this subsection, the
14mental health and disability services commission shall consult
15with other states. The waiver revision request or other action
16necessary to assist in the transition of service provision
17from intermediate care facilities for persons with mental
18retardation to alternative programs shall be implemented by
19the department in a manner that can appropriately meet the
20needs of individuals at an overall lower cost to counties, the
21federal government, and the state. In addition, the department
22shall take into consideration significant federal changes to
23the medical assistance program in formulating the department’s
24actions under this subsection. The department shall consult
25with the mental health and disability services commission in
26adopting rules for oversight of facilities converted pursuant
27to this subsection. A transition approach described in
28paragraph “a” may be modified as necessary to obtain federal
29waiver approval.
306. 5. a. The provisions of the home and community-based
31services waiver for persons with intellectual disabilities
32shall include adult day care, prevocational, and transportation
33services. Transportation shall be included as a separately
34payable service.
35b. The department of human services shall seek federal
-75-1approval to amend the home and community-based services waiver
2for persons with intellectual disabilities to include day
3habilitation services. Inclusion of day habilitation services
4in the waiver shall take effect upon receipt of federal
5approval.
6c. The person’s county of legal settlement shall pay for
7the nonfederal share of the cost of services provided under
8the waiver, and the state shall pay for the nonfederal share
9of such costs if the person has no legal settlement or the
10legal settlement is unknown so that the person is deemed to be
11a state case.
12d. The county of legal settlement shall pay for one hundred
13percent of the nonfederal share of the costs of care provided
14for adults which is reimbursed under a home and community-based
15services waiver that would otherwise be approved for provision
16in an intermediate care facility for persons with mental
17retardation provided under the medical assistance program.
187. 6. When paying the necessary and legal expenses for
19intermediate care facility for persons with mental retardation
20services, the cost requirements of section 222.60 shall
21be considered fulfilled when payment is made in accordance
22with the medical assistance payment rates established by
23the department for intermediate care facilities for persons
24with mental retardation, and the state or a county of legal
25settlement shall not be obligated for any amount in excess of
26the rates.
278. 7. If a person with mental retardation has no legal
28settlement or the legal settlement is unknown so that the
29person is deemed to be a state case and services associated
30with the mental retardation can be covered under a medical
31assistance home and community-based services waiver or other
32medical assistance program provision, the nonfederal share of
33the medical assistance program costs for such coverage shall
34be paid from the appropriation made for the medical assistance
35program.
-76-1 Sec. 121. Section 249A.26, subsection 2, Code 2011, is
2amended to read as follows:
32. a. Except as provided for disallowed costs in section
4249A.27, the county of legal settlement shall pay for fifty
5percent of the nonfederal share of the cost and the state shall
6have responsibility for the remaining fifty pay one hundred
7 percent of the nonfederal share of the cost of case management
8provided to adults, day treatment, and partial hospitalization
9provided under the medical assistance program for persons
10with mental retardation, a developmental disability, or
11chronic mental illness. For purposes of this section, persons
12with mental disorders resulting from Alzheimer’s disease
13or substance abuse a substance-related disorder shall not
14be considered chronically mentally ill to be persons with
15chronic mental illness. To the maximum extent allowed under
16federal law and regulations, the department shall consult with
17and inform a county of legal settlement’s central point of
18coordination process, as defined in section 331.440, regarding
19the necessity for and the provision of any service for which
20the county is required to provide reimbursement under this
21subsection.
22b. The state shall pay for one hundred percent of the
23nonfederal share of the costs of case management provided for
24adults, day treatment, partial hospitalization, and the home
25and community-based services waiver services for persons who
26have no legal settlement residence in this state or the legal
27settlement whose residence is unknown so that the persons are
28deemed to be state cases.
29c. The case management services specified in this subsection
30shall be paid for by a county only if the services are provided
31outside of a managed care contract.
32 Sec. 122. Section 249A.26, subsections 3, 4, 7, and 8, Code
332011, are amended to read as follows:
343. To the maximum extent allowed under federal law and
35regulations, a person with mental illness or mental retardation
-77-1shall not be eligible for any service which is funded in
2whole or in part by a county share of the nonfederal portion
3of medical assistance funds unless the person is referred
4through the central point of coordination process, as defined
5in section 331.440. However, to the extent federal law allows
6referral of a medical assistance recipient to a service without
7approval of the central point of coordination process, the
8county of legal settlement shall be billed for the nonfederal
9share of costs for any adult person for whom the county would
10otherwise be responsible.
114. The county of legal settlement state shall pay for one
12hundred percent of the nonfederal share of the cost of services
13provided to adult persons with chronic mental illness who
14qualify for habilitation services in accordance with the rules
15adopted for the services. The state shall pay for one hundred
16percent of the nonfederal share of the cost of such services
17provided to such persons who have no legal settlement or the
18legal settlement is unknown so that the persons are deemed to
19be state cases.
207. Unless a county has paid or is paying for the nonfederal
21share of the costs of a person’s home and community-based
22waiver services or placement in an intermediate care facility
23for persons with mental retardation under the county’s mental
24health, mental retardation, and developmental disabilities
25services fund, or unless a county of legal settlement would
26become liable for the costs of services for a person at the
27level of care provided in an intermediate care facility for
28persons with mental retardation due to the person reaching the
29age of majority, the The state shall pay for the nonfederal
30share of the costs of an eligible person’s services under the
31home and community-based services waiver for persons with brain
32injury.
338. If a dispute arises between different counties or between
34the department and a county as to the legal settlement of a
35person who receives received medical assistance for which the
-78-1nonfederal share is was payable in whole or in part by a county
2of legal settlement in accordance with Code 2011, and cannot
3be resolved by the parties, the dispute shall be resolved as
4provided in section 225C.8, Code 2011.
5 Sec. 123. Section 252.6, Code 2011, is amended to read as
6follows:
7252.6 Enforcement of liability.
81. Upon the failure of such relatives to assist or maintain
9a poor person who has made application for assistance, the
10county board of supervisors, service area advisory board
11created under section 217.43, or state division of child and
12family services of the department of human services may apply
13to the district court of the county where the poor person
14resides or may be found for an order to compel the assistance
15or maintenance.
162. If the assistance or maintenance needed is provided by
17a county through the regional mental health and disability
18services system implemented under chapter 331, application
19for the assistance and maintenance shall be made through the
20regional administrator of the person’s county of residence.
21For the purposes of this subsection, “regional administrator”
22 means the same as defined in section 331.438A.
23 Sec. 124. Section 252.23, Code 2011, is amended to read as
24follows:
25252.23 Legal settlement disputes.
26If the alleged settlement is disputed, then, within thirty
27days after notice as provided in section 252.22, a copy of
28the notices sent and received shall be filed in the office of
29the clerk of the district court of the county against which
30claim is made, and a cause docketed without other pleadings,
31and tried as an ordinary action, in which the county granting
32the assistance shall be plaintiff, and the other defendant,
33and the burden of proof shall be upon the county granting the
34assistance. However, a legal settlement dispute concerning
35the liability of a person’s county of residence for assistance
-79-1provided through the regional mental health and disability
2services system implemented under chapter 331 in connection
3with services initiated under chapter 222, 230, or 249A shall
4be resolved as provided in section 225C.8 331.438F.
5 Sec. 125. Section 252.24, Code 2011, is amended to read as
6follows:
7252.24 County of settlement liable.
81. The county where the settlement is shall be liable to
9the county granting assistance for all reasonable charges and
10expenses incurred in the assistance and care of a poor person.
112. When assistance is furnished by any governmental agency
12of the county, township, or city, the assistance shall be
13deemed to have been furnished by the county in which the
14agency is located and the agency furnishing the assistance
15shall certify the correctness of the costs of the assistance
16to the board of supervisors of that county and that county
17shall collect from the county of the person’s settlement. The
18amounts collected by the county where the agency is located
19shall be paid to the agency furnishing the assistance. This
20statute applies to services and supplies furnished as provided
21in section 139A.18.
223. Notwithstanding subsection 2, if assistance or
23maintenance is provided by a county through the regional mental
24health and disability services system implemented under chapter
25331, liability for the assistance and maintenance is the
26responsibility of the person’s county of residence.
27 Sec. 126. Section 331.502, subsection 11, Code 2011, is
28amended to read as follows:
2911. Carry out duties relating to the determination of legal
30settlement, collection of funds due the county, and support
31of persons with mental retardation as provided in sections
32222.13, 222.50, 222.61 to 222.66, 222.63, 222.64, and 222.69,
33and 222.74.
34 Sec. 127. Section 347.16, subsection 3, Code 2011, is
35amended to read as follows:
-80- 13. Care and treatment may be furnished in a county public
2hospital to any sick or injured person who has legal settlement
3outside the county which maintains the hospital, subject to
4such policies and rules as the board of hospital trustees may
5adopt. If care and treatment is provided under this subsection
6to a person who is indigent, the county in which that person
7has legal settlement shall pay to the board of hospital
8trustees the fair and reasonable cost of the care and treatment
9provided by the county public hospital unless the cost of the
10indigent person’s care and treatment is otherwise provided for.
11If care and treatment is provided to an indigent person under
12this subsection, the county public hospital furnishing the
13care and treatment shall immediately notify, by regular mail,
14the auditor of the county of legal settlement of the indigent
15person of the provision of care and treatment to the indigent
16person. However, if the care and treatment is provided by
17a county through the regional mental health and disability
18services system implemented under chapter 331, liability for
19the assistance and maintenance is the responsibility of the
20person’s county of residence.
21 Sec. 128. REPEAL. Sections 222.73, 222.74, 222.75, and
22225C.8, Code 2011, are repealed.
23 Sec. 129. EFFECTIVE DATE. This division of this Act takes
24effect July 1, 2013.
25DIVISION VII
26funding provisions
27 Sec. 130. Section 331.424A, subsection 6, Code Supplement
282011, is amended to read as follows:
296. This section is repealed July 1, 2013 2017.
30 Sec. 131. Section 426B.1, Code 2011, is amended by adding
31the following new subsection:
32 NEW SUBSECTION. 3. In addition to the appropriation made
33pursuant to subsection 2, there is appropriated from the
34general fund of the state to the property tax relief fund for
35the indicated fiscal years the following amounts:
-81- 1a. For the fiscal year beginning July 1, 2013, thirty-one
2million five hundred thousand dollars.
3b. For the fiscal year beginning July 1, 2014, sixty-three
4million dollars.
5c. For the fiscal year beginning July 1, 2015, ninety-four
6million five hundred thousand dollars.
7d. For the fiscal year beginning July 1, 2016, one hundred
8twenty-six million dollars.
9 Sec. 132. Section 426B.2, subsection 2, Code 2011, is
10amended by striking the subsection.
11 Sec. 133. Section 426B.3, subsection 1, Code 2011, is
12amended to read as follows:
131. The county auditor shall reduce the certified budget
14amount received from the board of supervisors for the
15succeeding fiscal year for the county mental health, mental
16retardation, and developmental disabilities services fund
17created in section 331.424A by an amount equal to the amount
18the county will receive from the property tax relief fund
19pursuant to section 426B.2, for the succeeding fiscal year and
20the auditor shall determine the rate of taxation necessary to
21raise the reduced amount. On the tax list, the county auditor
22shall compute the amount of taxes due and payable on each
23parcel before and after the amount received from the property
24tax relief fund is used to reduce the county budget. The
25director of human services shall notify the county auditor of
26each county of the amount of moneys the county will receive
27from the property tax relief fund pursuant to section 426B.2,
28for the succeeding fiscal year. If the amount the county will
29receive is changed after the county has certified its budget,
30the county board of supervisors shall amend the certified
31budget to reflect the change and the county auditor shall
32revise the levy rate and amount of taxes due and payable on
33each parcel accordingly. Such an amendment to the budget shall
34be made without public hearing and without being subject to
35protest.
-82-1 Sec. 134. Section 426B.6, Code Supplement 2011, is amended
2to read as follows:
3426B.6 Future repeal.
4This chapter is repealed July 1, 2013 2017.
5 Sec. 135. EFFECTIVE DATE. The following provision of this
6division of this Act takes effect July 1, 2014:
71. The section of this Act amending section 426B.2.
8EXPLANATION
9This bill relates to redesign of publicly funded mental
10health and disability services by requiring certain core
11services and addressing other services and providing for
12establishment of regions. The bill is organized into
13divisions.
14CORE SERVICES. This division specifies core services and
15service management requirements applicable to the regional
16service system required by the bill.
17Code section 331.439, relating to the requirements under
18existing law for a county to receive state payments for mental
19health and disability services and specifying inclusion of
20various provisions in service system management plans, is
21amended to require the use of certain functional assessments or
22other standardized functional assessment methodologies approved
23by the mental health and disability services commission. For
24mental health services, the level of care utilization system
25(LOCUS) is specified; for intellectual disabilities services,
26the supports intensity scale (SIS) is specified; and for brain
27injury services, the commission is required to approve a
28methodology. The use of the methodologies is required to begin
29July 1, 2012. This Code section is repealed on July 1, 2013.
30New Code section 331.439A requires MH/DS provided by
31counties to be delivered in accordance with a regional service
32system management plan approved by the region’s governing board
33and implemented by the regional administrator. The plans are
34required to include a policies and procedures manual for the
35funding administered by the region, submission of an annual
-83-1management plan review, submission of three-year strategic
2plans addressing the effort to achieve various purposes
3identified in Code section 225C.1, and authorizing a region to
4either directly implement a system of service management or to
5contract with a private entity for service management. The
6plan is required to include various elements and the commission
7is directed to specify the elements in administrative rules.
8New Code section 331.439A also authorizes a region to
9provide assistance to other disability service populations
10subject to availability of funding and to implement waiting
11lists for services as a financial management tool.
12New Code section 331.439B provides financial eligibility
13requirements to be used in the regional system. Income
14eligibility is set at 150 percent of the federal poverty
15level and a region or service provider may apply a copayment
16requirement to persons who meet this requirement. Persons with
17higher incomes may also be eligible subject to a copayment or
18other cost-sharing arrangement; however, a service provider may
19waive copayments or cost-sharing if able to fully absorb the
20cost. A person who is eligible for federally funded services
21must apply for the services. The commission is required to
22adopt rules for resource limitations eligibility derived from
23the federal supplemental security income program resource
24limitations. If a person does not qualify for federally funded
25support, but meets income, resource, and functional eligibility
26requirements, retirement accounts in the accumulation stage and
27burial, medical savings, or assistive technology accounts are
28to be disregarded.
29New Code section 331.439C specifies requirements for
30diagnoses, functional assessments, and other requirements for
31eligibility in the regional system. Other requirements include
32an age of at least 18 years and compliance with financial
33eligibility provisions and determination of eligibility for
34individualized services to be made by the functional assessment
35provisions specified in the bill’s amendment to Code section
-84-1331.439. For mental health services, a person must have had a
2diagnosable mental health, behavioral, or emotional disorder
3during the preceding 12-month period. For intellectual
4disability services, an intellectual disability diagnosis or
5an intelligence quotient of 70 or less is required. For brain
6injury services, a diagnosis of brain injury is required.
7New Code section 331.439D addresses mental health core
8services and core service domains to be provided in the
9regional system, subject to the availability of funding. The
10domains are defined to mean a range of services that can be
11provided depending upon an individual’s service needs. A
12region may also provide funding for other services or support
13not listed based on optional criteria that may be considered.
14New Code section 331.439E addresses core services for
15persons with an intellectual disability or other developmental
16disability, provides a list of core services, and requires
17inclusion of all services covered by all of the service system
18management plans of the counties comprising a region as of June
1930, 2012, other than services funded by the Medicaid program.
20The provision of core services is subject to availability of
21funding. The region is required to transition from and replace
22the current services with services that expand and support the
23community support and integration principles outlined in the
24federal Olmstead v.L.C. ruling and the purposes identified in
25Code section 225C.1. Certain best practice efforts must also
26be included.
27New Code section 331.440B addresses regional service system
28financing. The financing of each regional service system is
29limited to a fixed budget amount subject to an allowed growth
30adjustment to be recommended by the commission and the governor
31two years prior to application. The region is required to
32implement the region’s service system management plan by
33budgeting for 99 percent of the funding anticipated to be
34available for the plan for a fiscal year.
35The bill may include a state mandate as defined in Code
-85-1section 25B.3. The bill makes inapplicable Code section 25B.2,
2subsection 3, which would relieve a political subdivision from
3complying with a state mandate if funding for the cost of
4the state mandate is not provided or specified. Therefore,
5political subdivisions are required to comply with any state
6mandate included in the bill.
7The Code editor is authorized to codify the division as a new
8part of Code chapter 331, division III.
9The new Code provisions of the Code chapter are applicable
10beginning July 1, 2013.
11WORKFORCE DEVELOPMENT AND REGULATION. This division relates
12to workforce development and regulation applicable to the
13administration and service providers for the regional service
14system.
15New Code section 225C.6C establishes a mental health and
16disability services workforce development workgroup to be
17convened and staffed by the department of human services to
18address issues connected with assuring there is an adequate
19workforce to provide mental health and disability services in
20the state. Various stakeholders and legislator members are
21specified.
22New Code section 225C.6D requires the department of
23human services to establish an outcomes and performance
24measures committee for the regional service system. Various
25stakeholders are specified for the committee membership.
26New Code section 225C.6E requires the departments of
27human services, inspections and appeals, and public health
28to comply with various provisions in efforts to improve the
29regulatory requirements applied to the regional service system
30administration and service providers.
31COMMUNITY MENTAL HEALTH CENTER AMENDMENTS. This division
32amends Acts provisions relating to community mental health
33centers that were enacted in 2011 Iowa Acts, chapter 121 (SF
34525) that have a delayed effective date of July 1, 2012.
35Provisionally numbered Code section 230A.106, specifying the
-86-1core service required to be offered by a center, is amended
2to allow a center to provide an assertive community treatment
3program in lieu of day treatment, partial hospitalization, or
4psychosocial rehabilitation services.
5Provisionally numbered Code section 230A.110, relating to
6the standards adopted for centers by the commission, is amended
7to allow the standards to be in substantial conformity with
8either applicable behavioral health standards adopted by the
9joint commission or other recognized national standards for
10evaluation of psychiatric facilities rather than requiring
11conformity with both sets of standards.
12REGIONAL SERVICE SYSTEM. This division provides the
13requirements for counties to form mental health and disability
14services (MH/DS) regions.
15New Code section 331.438A defines terms utilized, including
16“department” for the department of human services, “disability
17services” as defined in Code section 225C.2 (services and
18other support available to a person with mental illness,
19mental retardation or other developmental disability, or brain
20injury), “population” to mean the latest federal census or the
21latest applicable population estimate issued by the U.S. census
22bureau, “regional administrator” as provided by the bill, and
23“state commission” as the mental health and disability services
24commission.
25New Code section 331.438B requires counties to form regions
26to provide local access to MH/DS for children and adults.
27Minimum criteria for formation of a group of counties are
28included along with a schedule for voluntary formation until
29the period of November 2, 2012, through January 1, 2013,
30during which the department is required to assign unaffiliated
31counties to a region.
32New Code section 331.438C requires the counties comprising
33a region to enter into a Code chapter 28E agreement for the
34joint exercise of governmental powers to form a regional
35administrator entity to function on behalf of the counties.
-87-1The regional administrator is required to enter into
2performance-based contracts with the department to manage for
3the counties the MH/DS not funded by the medical assistance
4(Medicaid) program and for coordinating with the department
5such services that are funded by the Medicaid program. The
6regional administrator is under the control of a governing
7board. Elected county supervisors of the participating
8counties and at least three individuals who utilize MH/DS or
9actively involved relatives of such individuals are required
10slots for each governing board. The membership cannot include
11representatives of the department or service providers. A
12regional advisory committee for each board is required to
13include individuals who utilize services or actively involved
14relatives, service providers, governing board members, and
15others.
16New Code section 331.438D addresses regional finances.
17The funding administered under the authority of a governing
18board is required to be in a combined account, separate
19county accounts that are administered under the authority of
20the governing board, or pursuant to other arrangement. The
21regional administrator’s administrative costs, as this term
22is determined in accordance with law, is limited to 5 percent
23of expenditures. The funding received from performance-based
24contracts with the department is required to be credited to the
25account or accounts administered by the regional administrator.
26New Code section 331.438E requires the counties comprising
27a MH/DS region to enter into a Code chapter 28E agreement.
28The agreement is required to address various specific
29organizational provisions, administrative provisions, and
30financial provisions.
31New Code section 331.438F requires a county to pay for the
32public costs of the MH/DS for the county’s residents that
33are not covered by the Medicaid program and are provided
34in accordance with the county’s approved regional services
35management plan. If the county is part of a region that has
-88-1agreed to pool funding and liability for services, the regional
2administrator performs the county’s responsibilities on behalf
3of the county. A dispute resolution process is provided to
4address disputes between counties or regions or the department,
5as applicable.
6The provisions of this division enacting new Code sections
7in Code chapter 331, except as specifically provided by the
8provisions, are applicable beginning July 1, 2013.
9SUBACUTE CARE FACILITIES FOR PERSONS WITH SERIOUS AND
10PERSISTENT MENTAL ILLNESS. This division creates a new health
11care facility licensure chapter in Code chapter 135P to be
12regulated by the department of inspections and appeals. The
13new type of facility is called a “subacute care facility
14for persons with serious and persistent mental illness”
15and provides physical facilities with restricted egress to
16provide accommodation, board, and the services of a licensed
17psychiatrist for periods exceeding 24 consecutive hours to
18three or more individuals with serious and persistent mental
19illness and who may have a diagnosis of another disorder. The
20facility cannot be used by individuals related to the owner
21within the third degree of consanguinity.
22New Code sections 135P.1 and 135P.2 define the terms
23utilized and state the purpose of the new Code chapter.
24New Code section 135P.3 describes the nature of care
25to be utilized and the duties of the facility’s licensed
26psychiatrist, authorizes the use of a seclusion room that meets
27the conditions specified under federal regulations for the use
28of seclusion in psychiatric residential treatment facilities
29providing inpatient psychiatric services for individuals under
30age 21, and specifies requirements for admission.
31New Code section 135P.4 prohibits establishing, operating,
32or maintaining a subacute care facility without a license and
33allows a licensed intermediate care facility for persons with
34mental illness to convert to a licensed subacute care facility.
35New Code section 135P.5 requires an application for a
-89-1license and sets the annual licensure fee at $25.
2New Code section 135P.6 requires the department of
3inspections and appeals to ascertain the adequacy of the
4facility before issuing a license and requires the applicant
5to have been awarded a certificate of need for the facility
6through the department of public health under Code chapter 135.
7New Code section 135P.7 authorizes the department to deny
8an application or suspend or revoke a license for failure or
9inability to comply with requirements under the Code chapter
10and provides a list of specific infractions.
11New Code section 135P.8 authorizes the department to issue a
12provisional license and addresses compliance plans.
13New Code section 135P.9 requires the notice and hearing
14process for licensure issues to be performed in compliance with
15the Iowa administrative procedure Act, Code chapter 17A.
16New Code section 135P.10 requires the department of
17inspections and appeals to adopt rules for the facilities in
18consultation with the department of human services and for the
19department to coordinate its rules adoption and enforcement
20efforts.
21New Code section 135P.11 addresses complaints alleging
22violations. Any person may file a complaint and the person’s
23name is required to be kept confidential. The department is
24required to make a preliminary review of the complaint and
25under most circumstances an on-site inspection is required
26within 20 working days. The complainant may accompany the
27inspector upon request of the complainant or the department.
28New Code section 135P.12 requires the department’s
29findings regarding licensure to be made public but other
30information relating to a facility is to be kept confidential.
31Disclosure of information regarding residents is prohibited
32except as provided in Code section 217.30, relating to the
33confidentiality of records pertaining to individuals receiving
34services or assistance from the department of human services.
35New Code section 135P.13 provides for judicial review of
-90-1departmental action in accordance with Code chapter 17A and for
2a petition for the review to be filed in the court of the county
3in which the subacute care facility is located or proposed to
4be located.
5New Code section 135P.14 provides that establishing,
6operating, or managing a subacute care facility without a
7license is a serious misdemeanor offense.
8New Code section 135P.15 authorizes the department to
9maintain an action for an injunction to prevent establishing,
10operating, or managing a subacute care facility without a
11license.
12Code section 249A.26, relating to state and county
13participation in funding for services to persons with
14disabilities in the medical assistance (Medicaid) program
15chapter, is amended to provide that the daily reimbursement
16rate for subacute care facilities is the sum of the
17direct care Medicare-certified hospital-based nursing
18facility patient-day-weighted median and the nondirect
19care Medicare-certified hospital-based nursing facility
20patient-day-weighted median.
21The division may include a state mandate as defined in
22Code section 25B.3. The division makes inapplicable Code
23section 25B.2, subsection 3, which would relieve a political
24subdivision from complying with a state mandate if funding for
25the cost of the state mandate is not provided or specified.
26Therefore, political subdivisions are required to comply with
27any state mandate included in the division.
28CONFORMING AMENDMENTS —— CENTRAL POINT OF COORDINATION AND
29LEGAL SETTLEMENT. This division provides conforming amendments
30to change references to county central point of coordination
31administrators to regional administrators, county of legal
32settlement to county of residence, and county mental health,
33mental retardation, and developmental disabilities services
34funds under Code section 331.424A to generally apply to the
35provisions for MH/DS regions. The Code provisions for the
-91-1affected Code sections are repealed on July 1, 2013, pursuant
2to 2011 Iowa Acts, chapter 123 (SF 209).
3References to the “central point of coordination process”
4(CPC process) are amended to instead refer to the “regional
5administrator” of the county of residence in the following Code
6sections: section 218.99, requiring counties to be notified of
7patient personal accounts in DHS state institutions; section
8222.2, providing a definition of CPC process; section 222.13,
9relating to voluntary admissions to a state resource center;
10section 222.13A, relating to voluntary admission of a minor
11to a state resource center; section 222.28, authorizing the
12court to appoint a commission of inquiry to examine a person
13to determine the person’s mental condition; section 222.59,
14requiring the superintendent of a state resource center
15to coordinate in assisting location of a community-based
16placement instead of a state resource center; section 222.60,
17relating to the costs paid by county and state and requiring a
18diagnosis; section 222.61, relating to determination of legal
19settlement; section 222.62, relating to legal settlement in
20another county; section 222.63, relating to an objection to
21a finding of legal settlement; section 222.64, relating to
22state financial responsibility when a person is in a foreign
23state or is unknown; section 225.11, relating to initiation
24of commitment proceedings for the state psychiatric hospital
25connected to the state university of Iowa; section 225.15,
26relating to examination and treatment of a respondent at
27the state psychiatric hospital; section 225.17, relating to
28payment for the cost of treatment at the state psychiatric
29hospital; section 225C.2, relating to definitions, is amended
30to strike the CPC definition; section 225C.5, relating to
31the MH-DS commission membership; section 225C.6A, relating
32to data requirements addressed in the disability services
33system redesign enacted in 2004; section 225C.14, providing
34requirements for a preliminary diagnostic evaluation for
35admission to a state mental health institute; section 225C.16,
-92-1providing for referrals for evaluations for persons applying
2for voluntary admission to a state mental health institute;
3section 225C.19, relating to an emergency mental health
4crisis system; section 226.9C, authorizing a net general
5fund appropriation for the dual diagnosis program at the
6Mount Pleasant state mental health institute; section 227.10,
7relating to transfers from a county or private institution
8to a state hospital for persons with mental illness; section
9229.1, relating to definitions; section 229.1B, specifying that
10a person is subject to the CPC process, notwithstanding any
11provision of Code chapter 229 to the contrary; section 229.11,
12authorizing a judge to order immediate custody of a person
13alleged to have a serious mental impairment; section 229.13,
14relating to evaluation orders for psychiatric treatment;
15section 229.14, relating to the report of a psychiatric
16evaluation; section 229.14A, relating to the notice and hearing
17for a placement order; section 229.42, relating to costs
18paid by a county for a voluntary admission to a state mental
19health institute; section 230.1, relating to the liability of
20counties and the state for costs associated with admission of a
21person with mental illness to a state hospital; section 230.3,
22providing for certification of legal settlement of a person
23with mental illness admitted to a hospital; section 232.2,
24relating to involvement of the CPC process in the transition
25team of a specific child aging to adulthood while in foster
26care; section 235.7, relating to appointment of transition
27committees for children in an area who are aging to adulthood
28while in child welfare services; and section 249A.26, relating
29to state and county participation in funding for services to
30persons with disabilities.
31Code chapter 252 provisions regarding determinations of
32county of legal settlement (Code sections 252.6, 252.23, and
33252.24) are amended to provide that in provisions involving the
34MH/DS administered through the regional system, the county of
35residence is responsible and any disputes are to be settled in
-93-1accordance with new Code section 331.438F.
2References to “county of legal settlement” are amended to
3be “county of residence” or the state in the following Code
4sections: section 218.99, requiring counties to be notified of
5patient personal accounts in DHS state institutions; section
6222.10, relating to the duty of a peace officer to detain a
7person with mental retardation who departs from an institution
8in another state without proper authority; section 222.13,
9relating to voluntary admissions to a state resource center;
10section 222.13A, relating to voluntary admission of a minor to
11a state resource center; section 222.31, relating to liability
12for charges at a state resource center; section 222.49,
13relating to payment for costs of proceedings; section 222.50,
14requiring the county of legal settlement to pay charges;
15section 222.60, relating to the costs paid by county and
16state and requiring a diagnosis; section 222.61, relating to
17determination of legal settlement; section 222.62, relating to
18legal settlement in another county; section 222.63, relating to
19an objection to a finding of legal settlement; section 222.64,
20providing for state financial responsibility when a person is
21in a foreign state or is unknown; section 222.65, requiring the
22state administrator to investigate a person’s residency when
23placed in a state resource center; section 222.66, providing
24a standing appropriation for the transfer expenses of state
25cases to a state resource center; section 222.67, relating to
26charges when legal settlement was initially unknown; section
27222.68, requiring the county of legal settlement to reimburse
28the county that initially paid the charges; section 222.69,
29providing a standing appropriation for the admission or
30commitment expenses of state cases; section 222.70, requiring
31a dispute resolution process to be used for legal settlement
32disputes; section 222.77, providing for the county of legal
33settlement to pay the costs of support of patients placed on
34leave from a state resources center; section 222.78, relating
35to parents and other persons liable for the support of a
-94-1patient in a state resource center; section 222.79, relating
2to the certification of statements of charges for purposes of
3Code section 222.78; section 222.80, providing for liability
4for the costs of persons admitted or committed to a private
5facility; section 222.82, relating to collection of claims
6under Code section 222.78 or other provisions of Code chapter
7222; section 222.86, relating to payment of excess amounts from
8resource center patient personal deposit funds to the county
9of legal settlement; section 222.92, relating to operation of
10the state resource center on the basis of a net general fund
11appropriation; section 226.9C, relating to the net general
12fund appropriations provisions for the dual diagnosis program
13at the Mount Pleasant state mental health institute; section
14226.45, relating to payment of excess amounts from state mental
15health institute patient personal deposit funds to the county
16of legal settlement; section 229.9A, relating to the mental
17health advocate of the county of legal settlement; section
18229.12, relating to the presence of the mental health advocate
19at civil commitment hearings; section 229.19, relating to the
20duties of the patient advocate; section 229.24, relating to
21the provision of civil commitment court records to the county
22of legal settlement; section 229.31, relating to a commission
23of inquiry; section 229.42, relating to hospitalization costs
24paid on voluntary cases by the county of legal settlement;
25section 229.43, relating to nonresidents on convalescent leave;
26section 230.1, relating to the liability of counties and the
27state for costs associated with admission of a person with
28mental illness to a state hospital; section 230.2, relating to
29finding of legal settlement for persons with mental illness;
30section 230.3, providing for certification of legal settlement
31of a person with mental illness admitted to a hospital; section
32230.4, providing for evidence to accompany the certification
33of legal settlement for a person with mental illness; section
34230.5, relating to legal settlement of nonresidents; section
35230.8, relating to transfer expenses of persons with mental
-95-1illness with no legal settlement; section 230.9, relating to
2charges when legal settlement was initially unknown; section
3230.10, requiring all costs attending the taking into custody,
4care, investigation, and admission or commitment of a person
5to a state hospital for persons with mental illness to be paid
6by the county of legal settlement; section 230.11, relating
7to recovery of costs from the state for state cases; section
8230.12, relating to settlement of legal settlement disputes
9for support of persons with mental illness; section 230.32,
10relating to support of persons who are nonresidents of this
11state; section 249A.12, relating to assistance to persons with
12mental retardation paid under the Medicaid program; section
13249A.26, addressing state and county participation in funding
14for services to persons with disabilities, including case
15management; section 331.502, relating to the duties of the
16county auditor; and section 347.16, relating to the cost of
17care provided in county hospitals.
18Miscellaneous provisions are also amended. Code section
19222.22, relating to representation for a person with mental
20retardation in commitment proceedings, is amended to shift
21the responsibility to pay for counsel from the county to the
22state. Code section 225.23, requiring counties to collect
23claims paid by the state on behalf of committed or voluntary
24private patients at the state psychiatric hospital, is
25amended to shift this responsibility to the department of
26administrative services. Code section 225C.6, relating to the
27duties of the mental health and disability services commission,
28is amended to include a requirement to adopt rules for core
29disability services. Code section 230.20, relating to the
30billing to counties for patient charges at the state mental
31health institutes, is amended to change the cap on inflation
32increases from current law’s percentage increase in the allowed
33growth factor adjustment to the annual percentage increase
34in the state support provided to the regional service system
35under Code chapter 331. Code section 231.56A, relating to
-96-1the elder abuse initiative, emergency shelter, and support
2services projects involving the department on aging, is amended
3to eliminate a reference to county MH/MR/DD management plans.
4Code sections 235A.15 and 235B.6, relating to the child abuse
5and elder abuse registries and allowing employment record
6checks for the administrator of an MH/MR/DD agency providing
7services under a county management plan is amended to refer
8instead to regional management plans.
9Code section 222.49, relating to the costs of proceedings
10for involuntary commitment of persons with mental retardation,
11is amended to provide that the responsibility to pay costs is
12with either the county or the state.
13The bill repeals these Code sections: section 222.73,
14relating to billing of charges to counties for services
15provided at the state resource centers; section 222.74,
16relating to sending of duplicate statements to counties of the
17billing statements under Code section 222.73; section 222.75,
18relating to penalties for failure to pay the charges billed
19under Code section 222.73; and section 225C.8, relating to the
20legal settlement dispute resolution process replaced by the
21bill.
22FUNDING PROVISIONS. This division relates to state property
23tax relief funding and county property taxes for mental health
24and disability services.
25Under current law enacted by 2011 Iowa Acts, chapter 123
26(SF 209), the provisions for property tax relief under Code
27chapter 426B and for county mental health, mental retardation,
28and developmental disabilities services funds and the county
29property tax levies for the services in Code section 331.424A
30are repealed on July 1, 2013. The bill extends the repeal
31dates in those Code provisions to July 1, 2017.
32Under current law, each county’s property tax levies for
33the services are limited to a dollar amount established in the
34mid-1990s that the county expended for the services at that
35time. The state provides property tax relief funding from a
-97-1standing appropriation in Code chapter 426B and the county
2property taxes for the services are reduced dollar-for-dollar
3by the amount received under that Code chapter. The bill
4provides additional standing appropriations, increasing over
5the four-year period so that in FY 2016-2017 the appropriation
6is equal to the maximum county property tax levies for the
7services authorized for FY 2011-2012.
8The bill also provides that during the four-year period if
9the amount that a county will receive under Code chapter 426B
10is changed after the county has certified its levy, the board
11of supervisors is required to amend the certified budget to
12reflect the change and the county auditor must revise the levy
13rate and amount of taxes due on each parcel accordingly. The
14amendment is not subject to public hearing and without being
15subject to protest.
-98-
2health and disability services by requiring certain core
3services and addressing other services and providing
4for establishment of regions, making appropriations, and
5including effective date and applicability provisions.
6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2core services
3 Section 1. Section 331.439, Code Supplement 2011, is
4amended by adding the following new subsection:
5 NEW SUBSECTION. 9A. a. Beginning July 1, 2012, the county
6management plan for mental health services shall provide that
7an individual’s eligibility for individualized services shall
8be determined by the level of care utilization system for
9psychiatric and addiction services, developed by the American
10association of community psychiatrists, or other standardized
11functional assessment methodology approved for this purpose by
12the state commission.
13b. Beginning July 1, 2012, the county management plan
14for intellectual disability services shall provide that an
15individual’s eligibility for individualized services shall
16be determined by the supports intensity scale, developed by
17the American association on intellectual and developmental
18disabilities, or other standardized functional assessment
19methodology approved for this purpose by the state commission.
20c. Beginning July 1, 2012, the county management plan
21for brain injury services shall provide that an individual’s
22eligibility for individualized services shall be determined
23in accordance with a standardized functional assessment
24methodology approved for this purpose by the state commission.
25 Sec. 2. NEW SECTION. 331.439A Regional service system
26management plan.
271. The mental health and disability services provided
28by counties operating as a region shall be delivered in
29accordance with a regional service system management plan
30approved by the region’s governing board and implemented by
31the regional administrator in accordance with this section.
32The requirements for a regional service system management plan
33shall be specified in rule adopted by the state commission.
34A regional service system management plan is subject to
35the approval of the regional governing board and the state
-1-1commission.
22. The provisions of a regional service system management
3plan shall include but are not limited to all of the following:
4a. An approved policies and procedures manual for the use of
5county, state, and other funding administered by the region. A
6service system management plan for each county in the region
7shall be defined in the manual. Once the regional manual
8is approved, an amendment to the manual shall be submitted
9to the department of human services at least forty-five
10days prior to the date of implementation of the amendment.
11Prior to implementation of an amendment to the manual, the
12amendment must be approved by the director of human services in
13consultation with the state commission.
14b. For informational purposes, a regional service system
15management plan review submitted by the regional administrator
16to the department of human services by December 1 of each year.
17The annual review shall incorporate an analysis of the data
18associated with the regional service systems managed during
19the preceding fiscal year by the region. The annual review
20shall also identify measurable outcomes and results showing the
21region’s progress in fulfilling the purposes listed in section
22225C.1 and in achieving the disability services outcomes and
23indicators identified by the state commission pursuant to
24section 225C.6.
25c. For informational purposes, a three-year strategic plan
26submitted every three years by the regional administrator to
27the department of human services. The strategic plan shall
28describe how the region will proceed to attain the plan’s
29goals and objectives, and the measurable outcomes and results
30necessary for moving the regional services system toward an
31individualized, community-based focus in accordance with
32section 225C.1. The initial three-year strategic plan shall be
33submitted by April 1, 2015, and by April 1 of every third year
34thereafter.
35d. The regional administrator’s plans to implement the
-2-1regional service system management plan and other service
2management functions in a manner that seeks to achieve all of
3the following purposes identified in section 225C.1 for persons
4who are covered by the regional plan or are otherwise subject
5to the regional service system’s management functions. The
6regional plan shall describe how the regional service system
7will accomplish all of the following purposes:
8(1) The regional service system seeks to empower persons
9to exercise their own choices about the amounts and types of
10services and other support to receive.
11(2) The regional service system seeks to empower the persons
12to accept responsibility, exercise choices, and take risks.
13(3) The regional service system seeks to provide services
14and other support that are individualized, provided to produce
15results, flexible, and cost-effective.
16(4) The regional service system seeks to provide services
17and other support in a manner which enhances the ability of the
18persons to live, learn, work, and recreate in communities of
19their choice.
20e. Measures to address the needs of individuals who have two
21or more co-occurring mental health, intellectual disability,
22brain injury, or substance-related disorders and individuals
23with specialized needs.
243. The region may either directly implement a system
25of service management and contract with service providers,
26or contract with a private entity to manage the regional
27service system, provided all requirements of this section
28are met by the private entity. The regional service system
29shall incorporate service management and clinical assessment
30processes developed in accordance with applicable requirements.
314. The regional service system management plan for a region
32shall include but is not limited to all of the following
33elements, which shall be specified in administrative rules
34adopted by the state commission:
35a. The enrollment and eligibility process.
-3- 1b. The scope of services included in addition to the core
2services required by this part of this chapter.
3c. The method of plan administration.
4d. The process for managing utilization and access to
5services and other assistance.
6e. The quality management and improvement processes.
7f. The risk management provisions and fiscal viability of
8the plan, if the region contracts with a private entity.
9g. The access points for services.
10h. The requirements for designation of targeted case
11management providers which shall be designed to provide
12consumer choice, prohibit a provider from referring consumers
13to services administered by the provider, and include other
14provisions to ensure compliance with federal requirements for
15conflict-free case management.
16i. A plan for a systems of care approach in which multiple
17public and private agencies partner with families and
18communities to address the multiple needs of the individuals
19and their families involved with the regional service system.
20j. A plan to assure effective crisis prevention, response,
21and resolution.
22k. A plan for provider network formation and management.
23l. A plan for provider reimbursement approaches that
24includes approaches other than fee-for-service and to
25compensate the providers engaged in a systems of care approach
26and other nontraditional providers.
27m. If the region applies any provider licensing,
28certification, or accreditation requirements in addition to
29those required by the state, the procedures for implementing
30the requirements.
31n. Service provider payment provisions.
32o. Financial forecasting measures.
33p. A process for resolving grievances.
34q. Measures for implementing interagency and multisystem
35collaboration and care coordination.
-4- 15. A region may provide assistance to service populations
2with disabilities to which the counties comprising the region
3have historically provided assistance but who are not included
4in the service management provisions required under subsection
52, subject to the availability of funding.
66. If a region determines that the region cannot provide
7services for the fiscal year in accordance with the regional
8plan and remain in compliance with applicable budgeting
9requirements, the region may implement a waiting list for
10the services. The procedures for establishing and applying
11a waiting list shall be specified in the regional plan. If
12a region implements a waiting list for services, the region
13shall notify the department of human services. The department
14shall maintain on the department’s internet site an up-to-date
15listing of the regions that have implemented a waiting list and
16the services affected by each waiting list.
177. The director’s approval of a regional plan shall not be
18construed to constitute certification of the respective county
19budgets or of the region’s budget.
20 Sec. 3. NEW SECTION. 331.439B Financial eligibility
21requirements.
22A person must comply with all of the following financial
23eligibility requirements to be eligible for services under the
24regional service system:
251. The person must have an income equal to or less than
26one hundred fifty percent of the federal poverty level, as
27defined by the most recently revised poverty income guidelines
28published by the United States department of health and
29human services, to be eligible for disability services
30public funding. It is the intent of the general assembly to
31consider increasing this income eligibility provision to two
32hundred percent of the federal poverty level, contingent upon
33implementation of the federal Patient Protection and Affordable
34Care Act beginning in January 2014.
352. a. A region or a service provider contracting with
-5-1the region may apply a copayment requirement for a particular
2service to a person with an income equal to or less than one
3hundred fifty percent of the federal poverty level, provided
4the disability service, uniform copayment standards, and the
5copayment amounts comply with rules adopted by the state
6commission.
7b. A person with an income above one hundred fifty percent
8of the federal poverty level may be eligible subject to a
9copayment or other cost-sharing arrangement, in accordance with
10limitations adopted in rule by the state commission.
11c. A provider under the regional service system of a service
12that is not funded by the medical assistance program under
13chapter 249A may waive the copayment or other cost-sharing
14arrangement if the provider is fully able to absorb the cost.
153. A person who is eligible for federally funded services
16and other support must apply for such services and support.
174. The person is in compliance with resource limitations
18identified in rule adopted by the state commission. The
19limitation shall be derived from the federal supplemental
20security income program resource limitations. A person with
21resources above the federal supplemental security income
22program resource limitations may be eligible subject to
23limitations adopted in rule by the state commission. If a
24person does not qualify for federally funded services and other
25support but meets income, resource, and functional eligibility
26requirements for regional services, the following types of
27resources shall be disregarded:
28a. A retirement account that is in the accumulation stage.
29b. A burial, medical savings, or assistive technology
30account.
31 Sec. 4. NEW SECTION. 331.439C Diagnosis —— functional
32assessment.
331. A person must comply with all of the following
34requirements to be eligible for mental health services under
35the regional service system:
-6- 1a. The person complies with financial eligibility
2requirements under section 331.439B.
3b. The person is at least eighteen years of age and is a
4resident of this state.
5c. The person has had at any time during the preceding
6twelve-month period a diagnosable mental health, behavioral, or
7emotional disorder. The diagnosis shall be made in accordance
8with the criteria provided in the diagnostic and statistical
9manual of mental disorders, fourth edition text revised,
10published by the American psychiatric association, and shall
11not include the manual’s “V” codes identifying conditions other
12than a disease or injury. The diagnosis shall also not include
13substance-related disorders, dementia, antisocial personality,
14or developmental disabilities, unless co-occurring with another
15diagnosable mental illness.
16d. The person’s eligibility for individualized services
17shall be determined by the level of care utilization system for
18psychiatric and addiction services, developed by the American
19association of community psychiatrists, or other standardized
20functional assessment methodology approved for this purpose by
21the state commission.
222. A person must comply with all of the following
23requirements to be eligible for intellectual disability or
24other developmental disability services under the regional
25service system:
26a. The person complies with financial eligibility
27requirements under section 331.439B.
28b. The person is at least eighteen years of age and is a
29resident of this state.
30c. The person has a diagnosis of intellectual disability or
31an intelligence quotient of seventy or less or has a diagnosis
32of developmental disability other than intellectual disability.
33d. The person’s eligibility for individualized services
34shall be determined by the supports intensity scale, developed
35by the American association on intellectual and developmental
-7-1disabilities, or other standardized functional assessment
2methodology approved for this purpose by the state commission.
33. A person must comply with all of the following
4requirements to be eligible for brain injury services under the
5regional service system:
6a. The person complies with financial eligibility
7requirements under section 331.439B.
8b. The person is at least eighteen years of age and is a
9resident of this state.
10c. The person has a diagnosis of brain injury.
11d. The person’s eligibility for individualized services
12shall be determined in accordance with a standardized
13functional assessment methodology approved for this purpose by
14the state commission.
15 Sec. 5. NEW SECTION. 331.439D Mental health core services.
161. For the purposes of this section, unless the context
17otherwise requires:
18a. “Crisis stabilization facility” means an institution,
19place, building, or agency with restricted means of egress
20designed to provide accommodation, board, and the services
21of a mental health professional on a short-term basis of no
22more than five days to three or more individuals who present
23in the facility with acute psychiatric needs. The goal of a
24crisis stabilization facility is to decrease the severity of an
25individual’s condition to allow transition of the individual
26to a less restrictive facility.
27b. “Domain” means a range of services that can be provided
28depending upon an individual’s service needs.
292. Each of the providers of the core services and services
30provided under a required service domain shall be capable of
31working with individuals who have co-occurring disabilities or
32specialized needs. It is the intent of the general assembly
33that services have adequate reimbursement to ensure the
34financial viability necessary to achieve desired outcomes and
35fidelity to accepted service models.
-8- 13. A regional service system shall provide the following
2core mental health service domains, subject to the availability
3of funding:
4a. Acute care and crisis intervention services.
5b. Mental health treatment.
6c. Mental health disorder prevention.
7d. Community living.
8e. Employment.
9f. Recovery supports.
10g. Family supports.
11h. Physical health and primary care services.
12i. Justice system-involved services.
134. A regional service system shall provide the following
14specific core mental health services, subject to the
15availability of funding:
16a. Peer-run self-help centers.
17b. Psychiatric emergency services to provide a range of
18crisis intervention and diversion services. The services shall
19include but are not limited to providing a crisis stabilization
20facility.
21c. Subacute residential services.
22d. Jail diversion.
23e. Assertive community treatment.
24f. Community support services, supportive community living,
25and case management.
26g. Health homes.
27h. Supported employment and education.
28i. Family support services.
29j. Transportation.
305. A regional service system may provide funding for other
31appropriate services or other support. In considering whether
32to provide such funding, a region may consider the following
33criteria:
34a. Applying a person-centered planning process to identify
35the need for the services or other support.
-9- 1b. The efficacy of the services or other support is
2substantiated by an evidence base.
3c. A determination that the services or other support
4provides an effective alternative to existing services that
5have been shown by the evidence base to be ineffective, to not
6yield the desired outcome, or to not support the principles
7outlined in Olmstead v.L.C., 527 U.S. 581 (1999).
8 Sec. 6. NEW SECTION. 331.439E Intellectual disability and
9other developmental disability core services.
101. A regional service system shall provide funding of
11intellectual disability services that are not funded by the
12medical assistance program. In addition, to the extent funding
13is available, a regional service system shall also provide
14funding of developmental disability services for persons with a
15developmental disability other than an intellectual disability.
16In selecting the services eligible for the funding, a region
17shall consider the following criteria:
18a. Applying a person-centered planning process to identify
19the need for the services or other support.
20b. The efficacy of the services or other support is
21substantiated by an evidence base.
22c. A determination that the services or other support
23provides an effective alternative to existing services that
24have been shown by the evidence base to be ineffective, to not
25yield the desired outcome, or to not support the principles
26outlined in Olmstead v.L.C., 527 U.S. 581 (1999).
272. The core services provided by a region shall include all
28of the services for adults with an intellectual disability or a
29developmental disability that were mandated by law and covered
30in the service management plans of the counties comprising the
31region under section 331.439, Code 2011, as of June 30, 2012,
32other than those services funded by the medical assistance
33program under chapter 249A. The provision of the core services
34is subject to availability of funding. The core services shall
35include all of the following, unless covered by the medical
-10-1assistance program:
2a. Case management.
3b. Homemaker-home health aide services.
4c. Respite care.
5d. Home and vehicle modification.
6e. Supported community living.
7f. Outpatient mental health services.
8g. Evaluation.
9h. Sheltered workshop services.
10i. Work activity services.
11j. Adult day care.
12k. Residential care facility services.
13l. Residential care facility for persons with an
14intellectual disability services.
15m. Intermediate care facility for persons with an
16intellectual disability services.
17n. Supported community living.
18o. Inpatient care at a state mental health institute.
19p. Inpatient care at a state resource center.
20q. Inpatient care at a community hospital.
21r. Diagnostic evaluation related to a civil commitment
22proceeding.
23s. Transportation related to a civil commitment.
24t. Legal representation for commitment.
25u. Mental health advocate.
263. A region shall transition from and replace the services
27under subsection 2 with services that expand and support
28the community support and integration principles outlined
29in Olmstead v.L.C., 527 U.S. 581 (1999) and the purposes
30identified in section 225C.1.
314. The core services for persons with an intellectual
32disability or a developmental disability shall include all of
33the following:
34a. Efforts to support the availability of best practice
35health and primary care services in local communities.
-11- 1b. Efforts to provide best practice family support services
2to help families to maintain a family member with a disability
3at home.
4 Sec. 7. NEW SECTION. 331.440B Regional service system
5financing.
61. a. The financing of a regional mental health and
7disability service system is limited to a fixed budget amount.
8The fixed budget amount shall be the amount identified in a
9regional service system management plan and budget for the
10fiscal year. The region shall be authorized an allowed growth
11factor adjustment as established by statute for services
12addressed by the regional plan. The statute establishing
13the allowed growth factor adjustment shall establish the
14adjustment for the fiscal year which commences two years from
15the beginning date of the fiscal year in progress at the time
16the statute is enacted.
17b. Based upon information contained in regional plans and
18budgets and proposals made by representatives of the regions,
19the state commission shall recommend an allowed growth factor
20adjustment to the governor by November 15 for the fiscal year
21which commences two years from the beginning date of the fiscal
22year in progress at the time the recommendation is made. The
23allowed growth factor adjustment may address various costs
24including but not limited to the costs associated with new
25consumers of services, service cost inflation, and investments
26for economy and efficiency. In developing the service
27cost inflation recommendation, the state commission shall
28consider the cost trends indicated by the regional financial
29reports. The governor shall consider the state commission’s
30recommendation in developing the governor’s recommendation for
31an allowed growth factor adjustment for such fiscal year. The
32governor’s recommendation shall be submitted to the general
33assembly at the time the governor’s proposed budget for the
34succeeding fiscal year is submitted in accordance with chapter
358.
-12- 12. A region shall implement its regional service system
2management plan in a manner so as to provide adequate funding
3of services for the entire fiscal year by budgeting for
4ninety-nine percent of the funding anticipated to be available
5for the regional plan for the fiscal year. A region may expend
6all of the funding anticipated to be available for the regional
7plan.
8 Sec. 8. IMPLEMENTATION OF ACT. Section 25B.2, subsection 3,
9shall not apply to this division of this Act.
10 Sec. 9. CODE EDITOR. The Code editor may codify the Code
11provisions enacted by this division of this Act as a new part
12of chapter 331, division III.
13 Sec. 10. APPLICABILITY. The provisions of this division of
14this Act enacting new Code sections 331.439A through 331.439E,
15and section 331.440B apply beginning on July 1, 2013.
16DIVISION II
17workforce development and regulation
18 Sec. 11. NEW SECTION. 225C.6C Mental health and disability
19services workforce development workgroup.
201. The department of human services shall convene and
21provide support to a mental health and disability services
22workforce development workgroup to address issues connected
23with assuring that an adequate workforce is available in the
24state to provide mental health and disability services. The
25workgroup shall report at least annually to the governor
26and general assembly providing findings, recommendations,
27and financing information concerning the findings and
28recommendations.
292. The membership of the workgroup shall include all of the
30following:
31a. The director of the department of aging or the director’s
32designee.
33b. The director of the department of corrections or the
34director’s designee.
35c. The director of the department of education or the
-13-1director’s designee.
2d. The director of human services or the director’s
3designee.
4e. The director of the department of public health or the
5director’s designee.
6f. The director of the department of workforce development
7or the director’s designee.
8g. At least three staff of regional administrators
9appointed by the community services affiliate of the Iowa state
10association of counties.
11h. At least three individuals receiving mental health and
12disability services or involved relatives of such individuals.
13i. At least three providers of mental health and disability
14services.
15j. A representative of the entity under contract with
16the department to provide mental health managed care for the
17medical assistance program.
18k. One or more representatives of the institutions under
19the control of the state board of regents who are knowledgeable
20concerning the mental health and disability services workforce.
21l. Other persons identified by the workgroup.
223. In addition to the members identified in subsection
232, the membership of the workgroup shall include four
24members of the general assembly serving in a nonvoting, ex
25officio capacity. One member shall be designated by each
26of the following: the majority leader of the senate, the
27minority leader of the senate, the speaker of the house of
28representatives, and the minority leader of the house of
29representatives. A legislative member serves for a term as
30provided in section 69.16B.
314. Except as provided in subsection 3 for legislative
32appointments, the workgroup shall determine its own rules of
33procedure, membership terms, and operating provisions.
345. The workforce development measures considered for
35recommendation by the workgroup shall include but are not
-14-1limited to all of the following:
2a. Provide for the college of direct support or comparable
3internet-based training to be available at no charge to all
4service providers.
5b. Require every direct support professional to demonstrate
6a level of competency in core curricula.
7c. Provide financial incentives for those providers who
8support direct care staff in securing a voluntary certification
9from the national alliance for direct support professionals or
10a comparable certification or accreditation body.
11d. Change the rate reimbursement methodologies to allow
12providers to bill direct care staff development costs as a
13direct expense rather than as an indirect cost.
14e. Implement regional service system staffing capability
15to provide positive behavior supports training and to mount a
16crisis intervention and prevention response that is based on a
17model successfully tested in this state.
18f. Make technical assistance available to service providers
19for issues such as crisis intervention, sheltered workshop
20conversion, and other approaches to modernize services.
21g. Implement co-occurring disability cross training for
22mental health professionals as well as training for primary
23care practitioners on intellectual disability and developmental
24disability behavioral issues.
25 Sec. 12. NEW SECTION. 225C.6D Regional service system ——
26outcomes and performance measures committee.
271. The department shall establish an outcomes and
28performance measures committee to recommend to the department
29and the commission’s specific outcomes and performance measures
30to be utilized by the regional mental health and disability
31services system. The membership of the committee shall include
32regional administrator and departmental staff, individuals
33receiving mental health and disability services or involved
34relatives of such individuals, providers of mental health and
35disability services, a representative of the person under
-15-1contract with the department to provide mental health managed
2care for the medical assistance program, a representative
3of the institutions under the control of the state board of
4regents who is knowledgeable concerning mental health and
5disability services, a representative of the department’s task
6force to address the decision in Olmstead v.L.C., 527 U.S. 581
7(1999), and other stakeholders.
82. To the extent possible, the committee shall seek to
9provide outcome and performance measures recommendations
10that are consistent across the mental health and disability
11services populations addressed. The committee shall also
12evaluate data collection requirements utilized in the regional
13service system to identify the requirements that could be
14eliminated or revised due to the administrative burden involved
15or the low degree of relevance to outcomes or other reporting
16requirements.
17 Sec. 13. NEW SECTION. 225C.6E Regional service system ——
18regulatory requirements.
191. The departments of inspections and appeals, human
20services, and public health shall comply with the requirements
21of this section in their efforts to improve the regulatory
22requirements applied to the regional service system
23administration and service providers.
242. The three departments shall work together to establish
25a process to streamline accreditation, certification, and
26licensing standards applied to the regional service system
27administration and service providers.
283. The departments of human services and inspections and
29appeals shall jointly review the standards and inspection
30process applicable to residential care facilities.
314. The three departments shall do all of the following in
32developing regulatory requirements applicable to the regional
33service system administration and service providers:
34a. Consider the costs to administrators and providers in the
35development of quality monitoring efforts.
-16- 1b. Develop uniform, streamlined, and statewide cost
2reporting standards and tools.
3c. Make quality monitoring information, including services,
4quality, and location information, easily available and
5understandable to all citizens.
6d. Establish standards that are clearly understood and are
7accompanied by interpretive guidelines to support understanding
8by those responsible for applying the standards.
9e. Develop a partnership with providers in order to
10improve the quality of services and develop mechanisms for the
11provision of technical assistance.
12f. Develop consistent data collection efforts based on
13statewide standards and make information available to all
14providers.
15g. Evaluate existing provider qualification and monitoring
16efforts to identify duplication and gaps, and align the efforts
17with valued outcomes.
18h. Streamline and enhance existing standards.
19i. Consider how accreditations can be used for the
20certification of provider qualifications.
215. The three departments shall seek to increase the number
22of staff dedicated to oversight of service providers.
23DIVISION III
24COMMUNITY MENTAL HEALTH CENTER AMENDMENTS
25 Sec. 14. Section 230A.106, subsection 2, paragraph c, as
26enacted by 2011 Iowa Acts, chapter 121, section 16, is amended
27to read as follows:
28c. Day treatment, partial hospitalization, or psychosocial
29rehabilitation services. Such services shall be provided as
30structured day programs in segments of less than twenty-four
31hours using a multidisciplinary team approach to develop
32treatment plans that vary in intensity of services and the
33frequency and duration of services based on the needs of the
34patient. These services may be provided directly by the center
35or in collaboration or affiliation with other appropriately
-17-1accredited providers. In lieu of day treatment, partial
2hospitalization, or psychosocial rehabilitation services, the
3center may provide an assertive community treatment program.
4 Sec. 15. Section 230A.110, subsection 1, as enacted by
52011 Iowa Acts, chapter 121, section 20, is amended to read as
6follows:
71. The division shall recommend and the commission shall
8adopt standards for designated community mental health
9centers and comprehensive community mental health programs,
10with the overall objective of ensuring that each center
11and each affiliate providing services under contract with a
12center furnishes high-quality mental health services within
13a framework of accountability to the community it serves.
14The standards adopted shall conform with federal standards
15applicable to community mental health centers and shall be
16in substantial conformity with the applicable behavioral
17health standards adopted by the joint commission, formerly
18known as the joint commission on accreditation of health care
19organizations, and or other recognized national standards for
20evaluation of psychiatric facilities unless in the judgment of
21the division, with approval of the commission, there are sound
22reasons for departing from the standards.
23DIVISION IV
24regional service system
25 Sec. 16. NEW SECTION. 331.438A Definitions.
26As used in this part, unless the context otherwise requires:
271. “Department” means the department of human services.
282. “Disability services” means the same as defined in
29section 225C.2.
303. “Population” means the population shown by the latest
31preceding certified federal census or the latest applicable
32population estimate issued by the United States census bureau,
33whichever is most recent.
344. “Regional administrator” means the administrative entity
35formed by agreement of the counties participating in a region
-18-1to function on behalf of those counties in accordance with this
2part.
35. “State commission” means the mental health and disability
4services commission created in section 225C.5.
5 Sec. 17. NEW SECTION. 331.438B Mental health and disability
6services regions —— criteria.
71. Local access to mental health and disability services for
8children and adults shall be provided by counties organized in
9a regional service system. The regional service system shall
10be implemented in stages in accordance with this section.
112. Formation of a mental health and disability services
12region is subject to approval of the director of human services
13and the mental health and disability services commission.
143. Each county in the state shall participate in an approved
15mental health and disability services region. A mental health
16and disability services region shall comply with all of the
17following requirements:
18a. The counties comprising the region are contiguous.
19b. The region has at least three counties.
20c. The combined general population of the counties
21comprising a region shall be at least two hundred thousand
22persons and not more than seven hundred thousand persons.
23However, the director of human services, with the approval
24of the commission, may grant a waiver from this requirement
25if there is convincing evidence that compliance with the
26requirement is not workable.
27d. The region has the capacity to provide required core
28services and perform required functions.
29e. At least one community mental health center or a
30federally qualified health center with providers qualified
31to provide psychiatric services, either directly or with
32assistance from psychiatric consultants, is located within the
33region, has the capacity to provide outpatient services for the
34region, and is either under contract with the region or has
35provided documentation of intent to contract with the region
-19-1to provide the services.
2f. A hospital with an inpatient psychiatric unit or a state
3mental health institute is located in or within reasonably
4close proximity to the region, has the capacity to provide
5inpatient services for the region, and is either under contract
6with the region or has provided documentation of intent to
7contract with the region to provide the services.
8g. The regional administrator structure proposed for or
9utilized by the region has clear lines of accountability and
10the regional administrator functions as a lead agency utilizing
11shared county staff or other means of limiting administrative
12costs.
134. County formation of a mental health and disability
14services region is subject to all of the following:
15a. On or before November 1, 2012, counties voluntarily
16participating in a region have complied with all of the
17following formation criteria:
18(1) The counties forming the region have been identified
19and the board of supervisors of the counties have approved a
20written letter of intent to join together to form the region.
21(2) The proposed region complies with the requirements in
22subsection 3.
23(3) The department provides written notice to the boards
24of supervisors of the counties identified for the region in
25the letter of intent that the counties have complied with the
26requirements in subsection 3.
27b. Upon compliance with the provisions of paragraph “a”, the
28participating counties are eligible for technical assistance
29provided by the department.
30c. During the period of November 2, 2012, through January
311, 2013, a county that has not agreed to be part of a region
32in accordance with paragraph “a” shall be assigned by the
33department to a region.
34d. On or before June 30, 2013, all counties shall be part of
35a region that is in compliance with the provisions of paragraph
-20-1“a” other than meeting the November 1, 2012, date.
2e. On or before June 30, 2014, all counties shall be
3in compliance with all of the following mental health and
4disability services region implementation criteria:
5(1) The board of supervisors of each county participating in
6the region has voted to approve a chapter 28E agreement.
7(2) The duly authorized representatives of all the counties
8participating in the region have signed the chapter 28E
9agreement that is in compliance with section 331.438C.
10(3) The county board of supervisors’ or supervisors’
11designee members and other members of the region’s governing
12board have been appointed in accordance with section 331.438C.
13(4) Executive staff for the region’s regional administrator
14have been identified or engaged.
15(5) An initial draft of a regional service management
16transition plan has been developed which identifies the steps
17to be taken by the region to do all of the following:
18(a) Designate access points for the disability services
19administered by the region.
20(b) Designate the region’s targeted case manager provider
21funded by the medical assistance program.
22(c) Identify the service provider network for the region.
23(d) Define the service access and service authorization
24process to be utilized for the region.
25(e) Identify the information technology and data management
26capacity to be employed to support regional functions.
27(f) Establish business functions, funds accounting
28procedures, and other administrative processes.
29(g) Comply with data reporting and other information
30technology requirements adopted by the state commission.
31(6) The department and the state commission have approved
32the region’s chapter 28E agreement and the initial draft of the
33regional management transition plan.
34f. If the department, with the concurrence of the state
35commission, determines that a region is in substantial
-21-1compliance with the implementation criteria in paragraph “e”
2and has sufficient operating capacity to begin operations, the
3region may commence partial or full operations prior to July
42014.
5 Sec. 18. NEW SECTION. 331.438C Regional governance
6structure.
71. The counties comprising a mental health and disability
8services region shall enter into an agreement under chapter
928E to form a regional administrator under the control of a
10governing board to function on behalf of those counties.
112. The governing board shall comply with all of the
12following requirements:
13a. The membership of the governing board shall consist
14of one or more board of supervisor members from each county
15comprising the region or their designees. The decisions
16involving the local public funding administered by the
17governing board and the regional administrator shall be made
18by these members.
19b. The membership of the governing board shall also consist
20of at least three individuals who utilize mental health and
21disability services or actively involved relatives of such
22individuals. These members shall be designated in a manner
23so as to represent the geographic areas of the region and to
24provide balanced representation for the various disability
25groups utilizing the services provided through the region.
26c. The membership of the governing board shall not include
27representatives of service providers or the department.
28d. The governing board shall have a regional advisory
29committee consisting of individuals who utilize services or
30actively involved relatives of such individuals, service
31providers, and regional governing board members.
323. The regional administrator shall be under the control of
33the governing board. The regional administrator shall enter
34into performance-based contracts with the department for the
35regional administrator to manage, on behalf of the counties
-22-1comprising the region, the mental health and disability
2services that are not funded by the medical assistance program
3under chapter 249A and for coordinating with the department the
4provision of mental health and disability services that are
5funded under the medical assistance program.
6 Sec. 19. NEW SECTION. 331.438D Regional finances.
71. The funding under the control of the governing board
8shall be maintained in a combined account, in separate county
9accounts that are under the control of the governing board, or
10pursuant to other arrangements authorized by law that limit the
11administrative burden of such control while facilitating public
12scrutiny of financial processes.
132. The administrative costs of the regional administrator
14shall be limited to five percent of expenditures. Expenditures
15considered to be administrative costs shall be determined in
16accordance with law.
173. The funding provided pursuant to performance-based
18contracts with the department shall be credited to the account
19or accounts under the control of the governing board.
20 Sec. 20. NEW SECTION. 331.438E Regional governance
21agreements.
221. In addition to compliance with the applicable provisions
23of chapter 28E, the chapter 28E agreement entered into by the
24counties comprising a mental health and disability services
25region in forming the regional administrator to function on
26behalf of the counties shall comply with the requirements of
27this section.
282. The organizational provisions of the agreement shall
29include all of the following:
30a. A statement of purpose, goals, and objectives of entering
31into the agreement.
32b. Identification of the governing board membership and the
33terms, methods of appointment, voting procedures, and other
34provisions applicable to the operation of the governing board.
35c. The identification of the executive staff of the regional
-23-1administrator serving as the single point of accountability for
2the region.
3d. The counties participating in the agreement.
4e. The time period of the agreement and terms for
5termination or renewal of the agreement.
6f. The circumstances under which additional counties may
7join the region.
8g. Methods for dispute resolution and mediation.
9h. Methods for termination of a county’s participation in
10the region.
11i. Provisions for formation and assigned responsibilities
12for one or more advisory committees consisting of individuals
13who utilize services or actively involved relatives of such
14individuals, service providers, governing board members, and
15other interests identified in the agreement.
163. The administrative provisions of the agreement shall
17include all of the following:
18a. Responsibility of the governing board in appointing and
19evaluating the performance of the chief executive officer of
20the regional administrator.
21b. A specific list of the functions and responsibilities of
22the regional administrator’s chief executive officer and other
23administrative staff.
24c. Specification of the functions to be carried out by each
25party to the agreement and by any subcontractor of a party to
26the agreement. A contract with a provider network shall be
27separately addressed.
284. The financial provisions of the agreement shall include
29all of the following:
30a. Methods for pooling, management, and expenditure of the
31funding under the control of the regional administrator. If
32the agreement does not provide for pooling of the participating
33county moneys in a single fund, the agreement shall specify how
34the participating county moneys will be subject to the control
35of the regional administrator.
-24- 1b. Methods for allocating administrative funding and
2resources.
3c. Contributions and uses of initial funding or related
4contributions made by the counties participating in the
5region for purposes of commencing operations by the regional
6administrator.
7d. Methods for acquiring or disposing of real property.
8e. A process for determining the use of savings for
9reinvestment.
10f. A process for performance of an annual independent audit
11of the regional administrator.
12 Sec. 21. NEW SECTION. 331.438F County of residence ——
13services to residents —— service authorization appeals ——
14disputes between counties or regions and the department.
151. For the purposes of this section, unless the context
16otherwise requires:
17a. “County of residence” means the county in this state in
18which, at the time a person applies for or receives services,
19the person is living in the county and has established an
20ongoing presence with the declared, good faith intention of
21living in the county for a permanent or indefinite period of
22time. The county of residence of a person who is a homeless
23person is the county where the homeless person usually sleeps.
24“County of residence” does not mean the county where a person is
25present for the purpose of receiving services in a hospital,
26a correctional facility, a halfway house for community-based
27corrections or substance-related treatment, a nursing facility,
28an intermediate care facility for persons with an intellectual
29disability, or a residential care facility, or for the purpose
30of attending a college or university.
31b. “Homeless person” means the same as defined in section
3248A.2.
33c. “Person” means a person who is a United States citizen or
34a qualified alien as defined in 8 U.S.C. § 1641.
352. If a person appeals a service authorization or
-25-1other services-related determination made by a regional
2administrator, the appeal shall be heard in a contested
3case proceeding by a state administrative law judge. The
4administrative law judge’s decision shall be considered a final
5agency decision under chapter 17A.
63. If a county of residence is part of a mental health and
7disability services region that has agreed to pool funding and
8liability for services, the responsibilities of the county
9under law regarding such services shall be performed on behalf
10of the county by the regional administrator. The county of
11residence or the county’s mental health and disability services
12region, as applicable, is responsible for paying the public
13costs of the mental health and disability services that are
14not covered by the medical assistance program under chapter
15249A and are provided in accordance with the region’s approved
16service management plan to persons who are residents of the
17county or region.
184. a. The dispute resolution process implemented in
19accordance with this subsection applies to residency disputes.
20The dispute resolution process is not applicable to disputes
21involving persons committed to a state facility pursuant to
22chapter 812 or rule of criminal procedure 2.22, Iowa court
23rules, or to disputes involving service authorization decisions
24made by a region.
25b. If a county, region, or the department, as applicable,
26receives a billing for services provided to a resident
27in another county or region, or objects to a residency
28determination certified by the department or another county’s
29or region’s regional administrator and asserts either that the
30person has residency in another county or region or the person
31is not a resident of this state or the person’s residency
32is unknown so that the person is deemed a state case, the
33person’s residency status shall be determined as provided in
34this section. The county or region shall notify the department
35of the county’s or region’s assertion within one hundred
-26-1twenty days of receiving the billing. If the county or region
2asserts that the person has residency in another county or
3region, that county or region shall be notified at the same
4time as the department. If the department disputes a residency
5determination certification made by a regional administrator,
6the department shall notify the affected counties or regions
7of the department’s assertion.
8c. The department, county, or region that received the
9notification, as applicable, shall respond to the party that
10provided the notification within forty-five days of receiving
11the notification. If the parties cannot agree to a settlement
12as to the person’s residency status within ninety days of the
13date of notification, on motion of any of the parties, the
14matter shall be referred to the department of inspections and
15appeals for a contested case hearing under chapter 17A before
16an administrative law judge assigned in accordance with section
1710A.801 to determine the person’s residency status.
18d. (1) The administrative law judge’s determination
19of the person’s residency status is a final agency action,
20notwithstanding contrary provisions of section 17A.15.
21The party that does not prevail in the determination or
22subsequent judicial review is liable for costs associated with
23the proceeding, including reimbursement of the department
24of inspections and appeals’ actual costs associated with
25the administrative proceeding. Judicial review of the
26determination may be sought in accordance with section 17A.19.
27(2) If following the determination of a person’s residency
28status in accordance with this section, additional evidence
29becomes available that merits a change in that determination,
30the parties affected may change the determination by mutual
31agreement. Otherwise, a party may move that the matter be
32reconsidered by the department, county, or region, or by the
33administrative law judge.
34e. (1) Unless a petition is filed for judicial review,
35the administrative law judge’s determination of the person’s
-27-1residency status shall result in one of the following:
2(a) If a county or region is determined to be the person’s
3residence, the county or region shall pay the amounts due and
4shall reimburse any other amounts paid for services provided by
5the other county or region or the department on the person’s
6behalf prior to the determination.
7(b) If it is determined that the person is not a resident
8of this state or the person’s residency is unknown so that the
9person is deemed to be a state case, the department shall pay
10the amounts due and shall reimburse the county or region, as
11applicable, for any payment made on behalf of the person prior
12to the determination.
13(2) The payment or reimbursement shall be remitted within
14forty-five days of the date the decision was issued. After
15the forty-five-day period, a penalty of not greater than one
16percent per month may be added to the amount due.
17 Sec. 22. CODE EDITOR. The Code editor shall codify the
18provisions of this division of this Act enacting new sections
19in chapter 331, as a new part of division IV, tentatively
20numbered part 2A.
21 Sec. 23. APPLICABILITY. The provisions of this division
22of this Act enacting new sections in chapter 331, except
23as specifically provided by the provisions, are applicable
24beginning July 1, 2013.
25DIVISION V
26subacute care facilities for persons with serious and
27persistent mental illness
28 Sec. 24. NEW SECTION. 135P.1 Definitions.
29As used in this chapter, unless the context otherwise
30requires:
311. “Department” means the department of inspections and
32appeals.
332. “Direction” means authoritative policy or procedural
34guidance for the accomplishment of a function or an activity.
353. “Licensee” means the holder of a license issued to
-28-1operate a subacute care facility for persons with serious and
2persistent mental illness.
34. “Mental health professional” means the same as defined
4in section 228.1.
55. “Physician” means a person licensed under chapter 148.
66. “Psychiatric services” means services provided under
7the direction of a physician which address mental, emotional,
8medical, or behavioral problems.
97. “Rehabilitative services” means services to encourage and
10assist restoration of a resident’s optimum mental and physical
11capabilities.
128. “Resident” means a person who is eighteen years of age
13or older and has been admitted by a physician to a subacute
14care facility for persons with serious and persistent mental
15illness.
169. “Treatment care plan” means a plan of care and services
17designed to eliminate the need for acute care by improving
18the condition of a person with serious and persistent mental
19illness. Services must be based upon a diagnostic evaluation,
20which includes an examination of the medical, psychological,
21social, behavioral, and developmental aspects of the person’s
22situation, reflecting the need for inpatient care.
2310. “Subacute care facility for persons with serious and
24persistent mental illness” or “subacute care facility” means an
25institution, place, building, or agency with restricted means
26of egress designed to provide accommodation, board, and the
27services of a licensed psychiatrist for a period exceeding
28twenty-four consecutive hours to three or more individuals who
29primarily have serious and persistent mental illness, diagnosis
30of a co-occurring disorder, and are not related to the owner
31within the third degree of consanguinity.
3211. “Supervision” means direct oversight and inspection of
33the act of accomplishing a function or activity.
34 Sec. 25. NEW SECTION. 135P.2 Purpose.
35The purpose of this chapter is to provide for the
-29-1development, establishment, and enforcement of basic standards
2for the operation, construction, and maintenance of a
3subacute care facility which will ensure the safe and adequate
4diagnosis, evaluation, and treatment of the residents.
5 Sec. 26. NEW SECTION. 135P.3 Nature of care —— seclusion
6room —— admissions.
71. A subacute care facility shall utilize a team of
8professionals to direct an organized program of diagnostic
9services, psychiatric services, and rehabilitative services
10to meet the needs of residents in accordance with a treatment
11care plan developed for each resident under the supervision of
12a licensed psychiatrist. The goal of a treatment care plan
13is to transition residents to a less restrictive environment,
14including a home-based community setting. Social and
15rehabilitative services shall be provided under the direction
16of a mental health professional.
172. The licensed psychiatrist providing supervision of
18the subacute care facility shall evaluate the condition of
19each resident no less than two times each month and shall be
20available to residents of the facility on an on-call basis
21at all other times. The subacute care facility may employ a
22seclusion room meeting the conditions described in 42 C.F.R. §
23483.364(b) with approval of the licensed psychiatrist of the
24facility or by order of the resident’s physician.
253. An admission to the subacute care facility is subject
26to a physician’s written order certifying that the individual
27being admitted requires regular oversight by a licensed
28psychiatrist and requires no greater degree of care than that
29which the facility to which the admission is made is licensed
30to provide and is capable of providing.
314. A subacute care facility does not constitute an
32“institution for mental diseases” within the meaning of 42
33U.S.C. § 1396d(i).
34 Sec. 27. NEW SECTION. 135P.4 Licensure.
351. A person shall not establish, operate, or maintain a
-30-1subacute care facility unless the person obtains a license for
2the subacute care facility under this chapter.
32. An intermediate care facility for persons with mental
4illness licensed under chapter 135C may convert to a subacute
5care facility by providing written notice to the department
6that the facility has employed a full-time psychiatrist and
7desires to make the conversion.
8 Sec. 28. NEW SECTION. 135P.5 Application for license.
9An application for a license under this chapter shall be
10submitted on a form requesting information required by the
11department, which may include affirmative evidence of the
12applicant’s ability to comply with the rules for standards
13adopted pursuant to this chapter. An application for a license
14shall be accompanied by the required license fee which shall
15be credited to the general fund of the state. The initial and
16annual license fee is twenty-five dollars.
17 Sec. 29. NEW SECTION. 135P.6 Inspection —— conditions for
18issuance.
19The department shall issue a license to an applicant under
20this chapter if the department has ascertained that the
21applicant’s facilities and staff are adequate to provide the
22care and services required of a subacute care facility and if
23the applicant has been awarded a certificate of need pursuant
24to chapter 135.
25 Sec. 30. NEW SECTION. 135P.7 Denial, suspension, or
26revocation of license.
27The department may deny an application or suspend or revoke
28a license if the department finds that an applicant or licensee
29has failed or is unable to comply with this chapter or the
30rules establishing minimum standards pursuant to this chapter
31or if any of the following conditions apply:
321. It is shown that a resident is a victim of cruelty or
33neglect due to the acts or omissions of the licensee.
342. The licensee has permitted, aided, or abetted in the
35commission of an illegal act in the subacute care facility.
-31- 13. An applicant or licensee acted to obtain or to retain a
2license by fraudulent means, misrepresentation, or submitting
3false information.
44. The licensee has willfully failed or neglected to
5maintain a continuing in-service education and training program
6for persons employed by the subacute care facility.
75. The application involves a person who has failed to
8operate a subacute care facility in compliance with the
9provisions of this chapter.
10 Sec. 31. NEW SECTION. 135P.8 Provisional license.
11The department may issue a provisional license, effective
12for not more than one year, to a licensee whose subacute care
13facility does not meet the requirements of this chapter if,
14prior to issuance of the license, the applicant submits written
15plans to achieve compliance with the applicable requirements
16and the plans are approved by the department. The plans shall
17specify the deadline for achieving compliance.
18 Sec. 32. NEW SECTION. 135P.9 Notice and hearings.
19The procedure governing notice and hearing to deny an
20application or suspend or revoke a license shall be in
21accordance with rules adopted by the department pursuant to
22chapter 17A. A full and complete record shall be kept of the
23proceedings and of any testimony. The record need not be
24transcribed unless judicial review is sought. A copy or copies
25of a transcript may be obtained by an interested party upon
26payment of the cost of preparing the transcript or copies.
27 Sec. 33. NEW SECTION. 135P.10 Rules.
28The department of inspections and appeals, in consultation
29with the department of human services and affected professional
30groups, shall adopt and enforce rules setting out the standards
31for a subacute care facility and the rights of the residents
32admitted to a subacute care facility. The department of
33inspections and appeals and the department of human services
34shall coordinate the adoption of rules and the enforcement of
35the rules in order to prevent duplication of effort by the
-32-1departments and of requirements of the licensee.
2 Sec. 34. NEW SECTION. 135P.11 Complaints alleging
3violations —— confidentiality.
41. A person may request an inspection of a subacute care
5facility by filing with the department a complaint of an
6alleged violation of an applicable requirement of this chapter
7or a rule adopted pursuant to this chapter. The complaint
8shall state in a reasonably specific manner the basis of the
9complaint. A statement of the nature of the complaint shall be
10delivered to the subacute care facility involved at the time of
11or prior to the inspection. The name of the person who files a
12complaint with the department shall be kept confidential and
13shall not be subject to discovery, subpoena, or other means
14of legal compulsion for its release to a person other than
15department employees involved in the investigation of the
16complaint.
172. Upon receipt of a complaint made in accordance with
18subsection 1, the department shall make a preliminary review
19of the complaint. Unless the department concludes that the
20complaint is intended to harass a subacute care facility or a
21licensee or is without reasonable basis, it shall within twenty
22working days of receipt of the complaint make or cause to be
23made an on-site inspection of the subacute care facility which
24is the subject of the complaint. The department of inspections
25and appeals may refer to the department of human services
26any complaint received by the department of inspections and
27appeals if the complaint applies to rules adopted by the
28department of human services. The complainant shall also
29be notified of the name, address, and telephone number of
30the designated protection and advocacy agency if the alleged
31violation involves a facility with one or more residents with a
32developmental disability or mental illness. In any case, the
33complainant shall be promptly informed of the result of any
34action taken by the department in the matter.
353. An inspection made pursuant to a complaint filed under
-33-1subsection 1 need not be limited to the matter or matters
2referred to in the complaint; however, the inspection shall
3not be a general inspection unless the complaint inspection
4coincides with a scheduled general inspection. Upon arrival
5at the subacute care facility to be inspected, the inspector
6shall show identification to the person in charge of the
7subacute care facility and state that an inspection is to
8be made, before beginning the inspection. Upon request of
9either the complainant or the department, the complainant or
10the complainant’s representative or both may be allowed the
11privilege of accompanying the inspector during any on-site
12inspection made pursuant to this section. The inspector may
13cancel the privilege at any time if the inspector determines
14that the privacy of a resident of the subacute care facility to
15be inspected would be violated. The dignity of the resident
16shall be given first priority by the inspector and others.
17 Sec. 35. NEW SECTION. 135P.12 Information confidential.
181. The department’s final findings regarding licensure
19shall be made available to the public in a readily available
20form and place. Other information relating to the subacute
21care facility is confidential and shall not be made available
22to the public except in proceedings involving licensure, a
23civil suit involving a resident, or an administrative action
24involving a resident.
252. The name of a person who files a complaint with the
26department shall remain confidential and is not subject to
27discovery, subpoena, or any other means of legal compulsion for
28release to a person other than an employee of the department or
29an agent involved in the investigation of the complaint.
303. Information regarding a resident who has received or is
31receiving care shall not be disclosed directly or indirectly
32except as authorized under section 217.30.
33 Sec. 36. NEW SECTION. 135P.13 Judicial review.
34Judicial review of the action of the department may be sought
35pursuant to the Iowa administrative procedure Act, chapter 17A.
-34-1 Notwithstanding chapter 17A, a petition for judicial review of
2the department’s actions under this chapter may be filed in the
3district court of the county in which the related subacute care
4facility is located or is proposed to be located. The status
5of the petitioner or the licensee shall be preserved pending
6final disposition of the judicial review.
7 Sec. 37. NEW SECTION. 135P.14 Penalty.
8A person who establishes, operates, or manages a subacute
9care facility without obtaining a license under this chapter
10commits a serious misdemeanor. Each day of continuing
11violation following conviction shall be considered a separate
12offense.
13 Sec. 38. NEW SECTION. 135P.15 Injunction.
14Notwithstanding the existence or pursuit of another remedy,
15the department may maintain an action for injunction or other
16process to restrain or prevent the establishment, operation, or
17management of a subacute care facility without a license.
18 Sec. 39. Section 249A.26, subsection 2, Code 2011, is
19amended by adding the following new paragraph:
20 NEW PARAGRAPH. d. Notwithstanding any provision of
21this chapter to the contrary, for services provided to
22eligible persons in a subacute care facility for persons
23with serious and persistent mental illness licensed under
24chapter 135P, the daily rate shall be equal to the sum of
25the direct care Medicare-certified hospital-based nursing
26facility patient-day-weighted median and the nondirect
27care Medicare-certified hospital-based nursing facility
28patient-day-weighted median.
29 Sec. 40. IMPLEMENTATION OF ACT. Section 25B.2, subsection
303, shall not apply to this division of this Act.
31DIVISION VI
32conforming amendments —— central point of coordination, legal
33settlement, and dispute resolution processes
34 Sec. 41. Section 218.99, Code 2011, is amended to read as
35follows:
-35- 1218.99 Counties to be notified of patients’ personal
2accounts.
3The administrator in control of a state institution shall
4direct the business manager of each institution under the
5administrator’s jurisdiction which is mentioned in section
6331.424, subsection 1, paragraph “a”, subparagraphs (1) and
7(2), and for which services are paid under section 331.424A, to
8quarterly inform the regional administrator of the county of
9legal settlement’s entity designated to perform the county’s
10central point of coordination process residence of any patient
11or resident who has an amount in excess of two hundred dollars
12on account in the patients’ personal deposit fund and the
13amount on deposit. The administrators shall direct the
14business manager to further notify the entity designated to
15perform the county’s central point of coordination process
16 regional administrator of the county of residence at least
17fifteen days before the release of funds in excess of two
18hundred dollars or upon the death of the patient or resident.
19If the patient or resident has no county of legal settlement,
20notice shall be made to the director of human services and the
21administrator in control of the institution involved.
22 Sec. 42. Section 222.2, subsection 3, Code 2011, is amended
23by striking the subsection.
24 Sec. 43. Section 222.2, Code 2011, is amended by adding the
25following new subsection:
26 NEW SUBSECTION. 5A. “Regional administrator” means the same
27as defined in section 331.438A.
28 Sec. 44. Section 222.10, Code 2011, is amended to read as
29follows:
30222.10 Duty of peace officer.
31When any person with mental retardation departs without
32proper authority from an institution in another state and
33is found in this state, any peace officer in any county in
34which such patient is found may take and detain the patient
35without warrant or order and shall report such detention to the
-36-1administrator. The administrator shall provide for the return
2of the patient to the authorities in the state from which the
3unauthorized departure was made. Pending return, such patient
4may be detained temporarily at one of the institutions of this
5state governed by the administrator or by the administrator of
6the division of child and family services of the department
7of human services. The provisions of this section relating
8to the administrator shall also apply to the return of other
9nonresident persons with mental retardation having legal
10settlement residency outside the state of Iowa.
11 Sec. 45. Section 222.13, Code 2011, is amended to read as
12follows:
13222.13 Voluntary admissions.
141. If an adult person is believed to be a person with mental
15retardation, the adult person or the adult person’s guardian
16may submit a request through the central point of coordination
17process for the county board of supervisors regional
18administrator of the adult person’s county of residence in
19writing to apply to the superintendent of any state resource
20center for the voluntary admission of the adult person either
21as an inpatient or an outpatient of the resource center.
22After determining the legal settlement of the adult person as
23provided by this chapter, the board of supervisors The regional
24administrator, on behalf of the board of supervisors shall, on
25forms prescribed by the department’s administrator, apply to
26the superintendent of the resource center in the district for
27the admission of the adult person to the resource center. An
28application for admission to a special unit of any adult person
29believed to be in need of any of the services provided by the
30special unit under section 222.88 may be made in the same
31manner, upon request of the adult person or the adult person’s
32guardian. The superintendent shall accept the application
33providing if a preadmission diagnostic evaluation, performed
34through the central point of coordination process through the
35regional administrator, confirms or establishes the need for
-37-1admission, except that an application may shall not be accepted
2if the institution does not have adequate facilities available
3or if the acceptance will result in an overcrowded condition.
42. If the resource center has no does not have an
5 appropriate program for the treatment of an adult or minor
6person with mental retardation applying under this section
7or section 222.13A, the board of supervisors regional
8administrator on behalf of the board of supervisors shall
9arrange for the placement of the person in any public or
10private facility within or without the state, approved by the
11director of the department of human services, which offers
12appropriate services for the person, as determined through
13the central point of coordination process by the regional
14administrator.
153. Upon applying for admission of an adult or minor person
16to a resource center, or a special unit, or upon arranging for
17the placement of the person in a public or private facility,
18if the county would be liable to pay the expenses in full
19or in part, the regional administrator, on behalf of the
20 board of supervisors shall make a full investigation into
21the financial circumstances of that person and those liable
22for that person’s support under section 222.78 to determine
23whether or not any of them are able to pay the expenses arising
24out of the admission of the person to a resource center,
25special treatment unit, or public or private facility. If
26the board regional administrator finds that the person or
27those legally responsible for the person are presently unable
28to pay the expenses, the board regional administrator shall
29direct that the expenses be paid by the county. The board
30 regional administrator may review its finding at any subsequent
31time while the person remains at the resource center, or
32is otherwise receiving care or treatment for which this
33chapter obligates the county to pay. If the board regional
34administrator finds upon review that the person or those
35legally responsible for the person are presently able to pay
-38-1the expenses, the finding shall apply only to the charges
2incurred during the period beginning on the date of the
3review and continuing thereafter, unless and until the board
4 regional administrator again changes its finding. If the board
5 regional administrator finds that the person or those legally
6responsible for the person are able to pay the expenses, the
7board regional administrator shall direct that the charges
8be so paid to the extent required by section 222.78, and the
9county auditor shall be responsible for the collection of the
10charges.
11 Sec. 46. Section 222.13A, subsections 1, 2, and 4, Code
122011, are amended to read as follows:
131. If a minor is believed to be a person with mental
14retardation, the minor’s parent, guardian, or custodian
15may request the county board of supervisors in writing to
16apply for admission of the minor as a voluntary patient in
17a state resource center. If the resource center does not
18have appropriate services for the minor’s treatment, the
19board of supervisors may arrange for the admission of the
20minor in a public or private facility within or without the
21state, approved by the director of human services, which
22offers appropriate services for the minor’s treatment. If
23half or more of the nonfederal share of the costs of services
24provided to a minor in accordance with this section is the
25responsibility of the state, the costs of the preadmission
26diagnostic evaluation, court appointed attorney, and court
27costs, relating to the services shall be paid by the state.
28If more than half of the nonfederal share of the costs of
29such services is the responsibility of the minor’s county of
30residence, the costs of the preadmission diagnostic evaluation,
31court appointed attorney, and court costs, relating to the
32services shall be paid by the county of residence.
332. Upon receipt of an application for voluntary admission
34of a minor, the board of supervisors shall provide for a
35preadmission diagnostic evaluation of the minor to confirm
-39-1or establish the need for the admission. The preadmission
2diagnostic evaluation shall be performed by a person who
3meets the qualifications of a qualified mental retardation
4professional who is designated through the central point of
5coordination process regional administrator. Any portion of
6the cost of the evaluation not paid by the minor or those
7liable for the minor’s support under section 222.78 is the
8responsibility of the state.
94. As soon as practicable after the filing of a petition for
10approval of the voluntary admission, the court shall determine
11whether the minor has an attorney to represent the minor in the
12proceeding. If the minor does not have an attorney, the court
13shall assign to the minor an attorney. If the minor is unable
14to pay for an attorney, the attorney shall be compensated by
15the county or state, as applicable, at an hourly rate to be
16established by the county board of supervisors in substantially
17the same manner as provided in section 815.7.
18 Sec. 47. Section 222.22, Code 2011, is amended to read as
19follows:
20222.22 Time of appearance.
21The time of appearance shall not be less than five days
22after completed service unless the court orders otherwise.
23Appearance on behalf of the person who is alleged to have
24mental retardation may be made by any citizen of the county
25or by any relative. The district court shall assign counsel
26for the person who is alleged to have mental retardation.
27Counsel shall prior to proceedings personally consult with the
28person who is alleged to have mental retardation unless the
29judge appointing counsel certifies that in the judge’s opinion,
30consultation shall serve no useful purpose. The certification
31shall be made a part of the record. An attorney assigned by
32the court shall be compensated by the county state at an hourly
33rate to be established by the county board of supervisors in
34substantially the same manner as provided in section 815.7.
35 Sec. 48. Section 222.28, Code 2011, is amended to read as
-40-1follows:
2222.28 Commission to examine.
3The court may, at or prior to the final hearing, appoint
4a commission of one qualified physician and one qualified
5psychologist, designated through the central point of
6coordination process, regional administrator who shall make
7a personal examination of the person alleged to be mentally
8retarded for the purpose of determining the mental condition
9of the person.
10 Sec. 49. Section 222.31, subsection 1, paragraph b, Code
112011, is amended to read as follows:
12b. (1) Commit the person to the state resource center
13designated by the administrator to serve the county in which
14the hearing is being held, or to a special unit. The court
15shall, prior to issuing an order of commitment, request
16that a diagnostic evaluation of the person be made by the
17superintendent of the resource center or the special unit, or
18the superintendent’s qualified designee a person qualified
19to perform the diagnostic evaluation. The evaluation shall
20be conducted at a place as the superintendent may direct.
21The cost of the evaluation shall be defrayed by the county
22of legal settlement unless otherwise ordered by the court.
23 The cost of the evaluation to be charged may be equal to but
24shall not exceed the actual cost of the evaluation. Persons
25referred by a court to a resource center or the special unit
26for diagnostic evaluation shall be considered as outpatients of
27the institution. No order of commitment shall be issued unless
28the superintendent of the institution recommends that the order
29be issued, and advises the court that adequate facilities for
30the care of the person are available.
31(2) The court shall examine the report of the county
32attorney filed pursuant to section 222.13, and if the report
33shows that neither the person nor those liable for the person’s
34support under section 222.78 are presently able to pay the
35charges rising out of the person’s care in a resource center,
-41-1or special treatment unit, shall enter an order stating that
2finding and directing that the charges be paid by the person’s
3county of residence or the state, as determined in accordance
4with section 222.60. The court may, upon request of the board
5of supervisors payer of the charges, may review its finding at
6any subsequent time while the person remains at the resource
7center, or is otherwise receiving care or treatment for which
8this chapter obligates the county payer to pay. If the court
9finds upon review that the person or those legally responsible
10for the person are presently able to pay the expenses, that
11finding shall apply only to the charges incurred during the
12period beginning on the date of the board’s payer’s request
13for the review and continuing thereafter after that date,
14unless and until the court again changes its finding. If the
15court finds that the person, or those liable for the person’s
16support, are able to pay the charges, the court shall enter
17an order directing that the charges be so paid to the extent
18required by section 222.78.
19 Sec. 50. Section 222.49, Code 2011, is amended to read as
20follows:
21222.49 Costs paid.
22The costs of proceedings shall be defrayed from the county
23treasury paid by the county or the state, as determined in
24accordance with section 222.60, unless otherwise ordered by
25the court. When the person alleged to be mentally retarded
26is found not to be mentally retarded, the court shall render
27judgment for such costs against the person filing the petition
28except when the petition is filed by order of court.
29 Sec. 51. Section 222.50, Code 2011, is amended to read as
30follows:
31222.50 County of legal settlement residence or state to pay.
32When the proceedings are instituted in a county in which
33the person who is alleged to have mental retardation was found
34but which is not the county of legal settlement residence of
35the person, and the costs are not taxed to the petitioner, the
-42- 1person’s county which is the legal settlement of the person
2 of residence or the state, as determined in accordance with
3section 222.60, shall, on presentation of a properly itemized
4bill for such costs, repay the costs to the former county.
5When the person’s legal settlement is outside the state or is
6unknown, the costs shall be paid out of money in the state
7treasury not otherwise appropriated, itemized on vouchers
8executed by the auditor of the county which paid the costs, and
9approved by the administrator.
10 Sec. 52. Section 222.59, subsection 1, unnumbered paragraph
111, Code 2011, is amended to read as follows:
12Upon receiving a request from an authorized requester, the
13superintendent of a state resource center shall coordinate
14with the central point of coordination process regional
15administrator in assisting the requester in identifying
16available community-based services as an alternative to
17continued placement of a patient in the state resource center.
18For the purposes of this section, “authorized requester” means
19the parent, guardian, or custodian of a minor patient, the
20guardian of an adult patient, or an adult patient who does not
21have a guardian. The assistance shall identify alternatives
22to continued placement which are appropriate to the patient’s
23needs and shall include but are not limited to any of the
24following:
25 Sec. 53. Section 222.60, subsection 1, Code 2011, is amended
26to read as follows:
271. All necessary and legal expenses for the cost of
28admission or commitment or for the treatment, training,
29instruction, care, habilitation, support and transportation of
30persons with mental retardation, as provided for in the county
31 regional mental health and disability services management plan
32provisions implemented pursuant to section 331.439, subsection
331 chapter 331, in a state resource center, or in a special
34unit, or any public or private facility within or without the
35state, approved by the director of the department of human
-43-1services, shall be paid by either:
2a. The person’s county in which such person has legal
3settlement as defined in section 252.16 of residence unless the
4expenses are covered by the medical assistance program under
5chapter 249A.
6b. The state when such the person has no legal settlement
7or when such settlement is unknown is a resident in another
8state or in a foreign country, the residence is unknown, or the
9expenses are covered by the medical assistance program under
10chapter 249A. The payment responsibility shall be deemed to be
11a state case.
12 Sec. 54. Section 222.60, subsection 2, Code 2011, is amended
13to read as follows:
142. a. Prior to a county of legal settlement residence
15 approving the payment of expenses for a person under this
16section, the county may require that the person be diagnosed
17to determine if the person has mental retardation or that
18the person be evaluated to determine the appropriate level
19of services required to meet the person’s needs relating to
20mental retardation. The diagnosis and the evaluation may be
21performed concurrently and shall be performed by an individual
22or individuals approved by the county who are qualified
23to perform the diagnosis or the evaluation. Following the
24initial approval for payment of expenses, the county of legal
25settlement may require that an evaluation be performed at
26reasonable time periods.
27b. The cost of a county-required diagnosis and an evaluation
28is at the county’s expense. In the case of a person without
29legal settlement or whose legal settlement is unknown service
30covered under the medical assistance program, the state
31may apply the diagnosis and evaluation provisions of this
32subsection at the state’s expense.
33c. A diagnosis or an evaluation under this section may be
34part of a county’s central point of coordination process under
35section 331.440, regional service management plan provided that
-44-1a diagnosis is performed only by an individual qualified as
2provided in this section.
3 Sec. 55. Section 222.61, Code 2011, is amended to read as
4follows:
5222.61 Legal settlement Residency determined.
6When a county receives an application on behalf of any
7person for admission to a resource center or a special unit
8or when a court issues an order committing any person to a
9resource center or a special unit, the board of supervisors
10shall utilize refer the determination of residency to the
11central point of coordination process regional administrator to
12determine and certify that the legal settlement residence of
13the person is in one of the following:
141. In the county in which the application is received or in
15which the court is located.
162. In some other county of the state.
173. In another state or in a foreign country.
184. Unknown.
19 Sec. 56. Section 222.62, Code 2011, is amended to read as
20follows:
21222.62 Settlement Residency in another county.
22When the board of supervisors determines through the central
23point of coordination process regional administrator determines
24 that the legal settlement residency of the person is other
25than in the county in which the application is received, the
26determination shall be certified to the superintendent of the
27resource center or the special unit where the person is a
28patient. The certification shall be accompanied by a copy of
29the evidence supporting the determination. The superintendent
30shall charge the expenses already incurred and unadjusted, and
31all future expenses of the patient, to the county certified to
32be the county of legal settlement residency.
33 Sec. 57. Section 222.63, Code 2011, is amended to read as
34follows:
35222.63 Finding of settlement residency —— objection.
-45- 1A board of supervisors’ certification utilizing of the
2central point of coordination process county’s regional
3administrator that a person’s legal settlement residency is in
4another county shall be sent by the board of supervisors to
5the auditor of the county of legal settlement residence. The
6certification shall be accompanied by a copy of the evidence
7supporting the determination. The auditor of the county of
8legal settlement residence shall submit the certification
9to the board of supervisors regional administrator of the
10auditor’s county and it shall be conclusively presumed that the
11patient has a legal settlement residency in that county unless
12that county disputes the determination of legal settlement
13 residency as provided in section 225C.8 331.438F.
14 Sec. 58. Section 222.64, Code 2011, is amended to read as
15follows:
16222.64 Foreign state or country or unknown legal settlement
17 residency.
18If the legal settlement residency of the person is
19determined by the board of supervisors through the central
20point of coordination process a county or the state to be in
21a foreign state or country or is determined to be unknown,
22the board of supervisors county or the state shall certify
23the determination to the administrator. The certification
24shall be accompanied by a copy of the evidence supporting the
25determination. The care of the person shall be as arranged
26by the board of supervisors county or the state or by an
27order as the court may enter. Application for admission or
28order of commitment may be made pending investigation by the
29administrator.
30 Sec. 59. Section 222.65, Code 2011, is amended to read as
31follows:
32222.65 Investigation.
33If an application is made for placement of a person in
34a state resource center or special unit, the department’s
35 administrator shall immediately investigate the legal
-46-1settlement residency of the person and proceed as follows:
21. If the administrator concurs with a certified
3determination as to legal settlement residency of the person
4so that the person is deemed a state case under section
5222.60, the administrator shall cause the person either to be
6transferred to a resource center or a special unit or to be
7transferred to the place of foreign settlement residency.
82. If the administrator disputes a certified determination
9of legal settlement residency, the administrator shall order
10the person transferred to a state resource center or a special
11unit until the dispute is resolved.
123. If the administrator disputes a certified determination
13of legal settlement residency, the administrator shall utilize
14the procedure provided in section 225C.8 331.438F to resolve
15the dispute. A determination of the person’s legal settlement
16 residency status made pursuant to section 225C.8 331.438F is
17conclusive.
18 Sec. 60. Section 222.66, Code 2011, is amended to read as
19follows:
20222.66 Transfers —— state cases ——expenses.
211. The transfer to a resource center or a special unit or
22to the place of legal settlement residency of a person with
23mental retardation who has no legal settlement residence in
24this state or whose legal settlement residency is unknown,
25shall be made in accordance with such directions as shall
26be prescribed by the administrator and when practicable by
27employees of the state resource center or the special unit.
28The actual and necessary expenses of such transfers shall be
29paid by the department on itemized vouchers sworn to by the
30claimants and approved by the administrator and the approved
31amount is appropriated to the department from any funds in the
32state treasury not otherwise appropriated.
332. The case of a person with mental retardation who
34is determined to have no residence in this state or whose
35residence is unknown shall be considered a state case.
-47-1 Sec. 61. Section 222.67, Code 2011, is amended to read as
2follows:
3222.67 Charge on finding of settlement residency.
4If a person has been received into a resource center or a
5special unit as a patient whose legal settlement is supposedly
6outside the state or residency is unknown and the administrator
7determines that the legal settlement residency of the patient
8was at the time of admission or commitment in a county of
9this state, the administrator shall certify the determination
10and charge all legal costs and expenses pertaining to the
11admission or commitment and support of the patient to the
12county of legal settlement residence. The certification shall
13be sent to the county of legal settlement residence. The
14certification shall be accompanied by a copy of the evidence
15supporting the determination. If the person’s legal settlement
16 residency status has been determined in accordance with section
17225C.8 331.438F, the legal costs and expenses shall be charged
18to the county or as a state case in accordance with that
19determination. The costs and expenses shall be collected as
20provided by law in other cases.
21 Sec. 62. Section 222.68, Code 2011, is amended to read as
22follows:
23222.68 Costs paid in first instance.
24All necessary and legal expenses for the cost of admission
25or commitment of a person to a resource center or a special
26unit when the person’s legal settlement residency is found to
27be in another county of this state shall in the first instance
28be paid by the county from which the person was admitted or
29committed. The county of legal settlement residence shall
30reimburse the county which pays for all such expenses. Where
31any If a county fails to make such reimbursement within
32forty-five days following submission of a properly itemized
33bill to the county of legal settlement residence, a penalty of
34not greater than one percent per month on and after forty-five
35days from submission of the bill may be added to the amount
-48-1due.
2 Sec. 63. Section 222.69, Code 2011, is amended to read as
3follows:
4222.69 Payment by state.
5All The amount necessary to pay the necessary and legal
6expenses for the cost of admission or commitment of a person
7to a resource center or a special unit when the person’s legal
8settlement residence is outside this state or is unknown shall
9be paid out of is appropriated to the department from any
10money in the state treasury not otherwise appropriated. Such
11payments shall be made by the department on itemized vouchers
12executed by the auditor of the county from which the expenses
13have been paid and approved by the administrator.
14 Sec. 64. Section 222.70, Code 2011, is amended to read as
15follows:
16222.70 Legal settlement Residency disputes.
17If a dispute arises between counties or between the
18department and a county as to the legal settlement residency
19 of a person admitted or committed to a resource center, a
20special unit, or a community-based service, the dispute shall
21be resolved as provided in section 225C.8 331.438F.
22 Sec. 65. Section 222.77, Code 2011, is amended to read as
23follows:
24222.77 Patients on leave.
25The cost of support of patients placed on convalescent leave
26or removed as a habilitation measure from a resource center,
27or a special unit, except when living in the home of a person
28legally bound for the support of the patient, shall be paid
29by the county of legal settlement residence or the state as
30provided in section 222.60. If the patient has no county of
31legal settlement, the cost shall be paid from the support fund
32of the resource center or special unit and charged on abstract
33in the same manner as other state inpatients until the patient
34becomes self-supporting or qualifies for support under other
35statutes.
-49-1 Sec. 66. Section 222.78, Code 2011, is amended to read as
2follows:
3222.78 Parents and others liable for support.
41. The father and mother of any patient admitted or
5committed to a resource center or to a special unit, as
6either an inpatient or an outpatient, and any person, firm, or
7corporation bound by contract made for support of the patient
8are liable for the support of the patient. The patient and
9those legally bound for the support of the patient shall be
10liable to the county or state, as applicable, for all sums
11advanced by the county to the state under in accordance with
12 the provisions of sections 222.60 and 222.77.
132. The liability of any person, other than the patient,
14who is legally bound for the support of a patient who is under
15eighteen years of age in a resource center or a special unit
16shall not exceed the average minimum cost of the care of a
17normally intelligent minor without a disability of the same
18age and sex as the minor patient. The administrator shall
19establish the scale for this purpose but the scale shall not
20exceed the standards for personal allowances established by
21the state division under the family investment program. The
22father or mother shall incur liability only during any period
23when the father or mother either individually or jointly
24receive a net income from whatever source, commensurate with
25that upon which they would be liable to make an income tax
26payment to this state. The father or mother of a patient shall
27not be liable for the support of the patient upon the patient
28attaining eighteen years of age. Nothing in this section
29shall be construed to prevent a relative or other person
30from voluntarily paying the full actual cost as established
31by the administrator for caring for the patient with mental
32retardation.
33 Sec. 67. Section 222.79, Code 2011, is amended to read as
34follows:
35222.79 Certification statement presumed correct.
-50- 1In actions to enforce the liability imposed by section
2222.78, the certification statement sent from the
3superintendent to the county auditor pursuant to section
4222.74 or the county of residence, as applicable, shall submit
5a certification statement stating the sums charged in such
6cases and the certification statement shall be considered
7 presumptively correct.
8 Sec. 68. Section 222.80, Code 2011, is amended to read as
9follows:
10222.80 Liability to county or state.
11A person admitted or committed to a county institution or
12home or admitted or committed at county or state expense to a
13private hospital, sanitarium, or other facility for treatment,
14training, instruction, care, habilitation, and support as a
15patient with mental retardation shall be liable to the county
16or state, as applicable, for the reasonable cost of the support
17as provided in section 222.78.
18 Sec. 69. Section 222.82, Code 2011, is amended to read as
19follows:
20222.82 Collection of liabilities and claims.
21The If liabilities and claims exist as provided in section
22222.78 or other provision of this chapter, the county of
23residence or the state, as applicable, may proceed as provided
24in this section. If the liabilities and claims are owed to
25a county of residence, the county’s board of supervisors of
26each county may direct the county attorney to proceed with the
27collection of said the liabilities and claims as a part of
28the duties of the county attorney’s office when the board of
29supervisors deems such action advisable. If the liabilities
30and claims are owed to the state, the state shall proceed
31with the collection. The board of supervisors or the state,
32as applicable, may and is hereby empowered to compromise any
33and all liabilities to the county or state arising under this
34chapter when such compromise is deemed to be in the best
35interests of the county or state. Any collections and liens
-51-1shall be limited in conformance to section 614.1, subsection 4.
2 Sec. 70. Section 222.86, Code 2011, is amended to read as
3follows:
4222.86 Payment for care from fund.
5If a patient is not receiving medical assistance under
6chapter 249A and the amount in the account of any patient
7in the patients’ personal deposit fund exceeds two hundred
8dollars, the business manager of the resource center or special
9unit may apply any amount of the excess to reimburse the
10county of legal settlement or the state in a case where no
11legal settlement exists residence for liability incurred by
12the county or the state for the payment of care, support, and
13maintenance of the patient, when billed by the county of legal
14settlement or by the administrator for a patient having no
15legal settlement or state, as applicable.
16 Sec. 71. Section 222.92, subsection 3, paragraph a, Code
172011, is amended to read as follows:
18a. Moneys received by the state from billings to counties
19under section 222.73.
20 Sec. 72. Section 225.11, Code 2011, is amended to read as
21follows:
22225.11 Initiating commitment procedures.
23When a court finds upon completion of a hearing held pursuant
24to section 229.12 that the contention that a respondent is
25seriously mentally impaired has been sustained by clear and
26convincing evidence, and the application filed under section
27229.6 also contends or the court otherwise concludes that it
28would be appropriate to refer the respondent to the state
29psychiatric hospital for a complete psychiatric evaluation and
30appropriate treatment pursuant to section 229.13, the judge
31may order that a financial investigation be made in the manner
32prescribed by section 225.13. If the costs of a respondent’s
33evaluation or treatment are payable in whole or in part by
34a county, an order under this section shall be for referral
35of the respondent through the central point of coordination
-52-1process regional administrator for an evaluation and referral
2of the respondent to an appropriate placement or service, which
3may include the state psychiatric hospital for additional
4evaluation or treatment. For purposes of this chapter, “central
5point of coordination process” “regional administrator” means the
6same as defined in section 331.440 331.438A.
7 Sec. 73. Section 225.15, Code 2011, is amended to read as
8follows:
9225.15 Examination and treatment.
101. When a respondent arrives at the state psychiatric
11hospital, the admitting physician shall examine the respondent
12and determine whether or not, in the physician’s judgment, the
13respondent is a fit subject for observation, treatment, and
14hospital care. If, upon examination, the physician decides
15that the respondent should be admitted to the hospital, the
16respondent shall be provided a proper bed in the hospital;
17and the physician who has charge of the respondent shall
18proceed with observation, medical treatment, and hospital care
19as in the physician’s judgment are proper and necessary, in
20compliance with sections 229.13 to 229.16.
212. A proper and competent nurse shall also be assigned to
22look after and care for the respondent during observation,
23treatment, and care. Observation, treatment, and hospital care
24under this section which are payable in whole or in part by a
25county shall only be provided as determined through the central
26point of coordination process county’s regional administrator.
27 Sec. 74. Section 225.17, subsection 2, Code 2011, is amended
28to read as follows:
292. When the respondent arrives at the hospital, the
30respondent shall receive the same treatment as is provided for
31committed public patients in section 225.15, in compliance with
32sections 229.13 to 229.16. However, observation, treatment,
33and hospital care under this section of a respondent whose
34expenses are payable in whole or in part by a county shall
35only be provided as determined through the central point of
-53-1coordination process county’s regional administrator.
2 Sec. 75. Section 225.23, Code 2011, is amended to read as
3follows:
4225.23 Collection for treatment.
5If the bills for a committed or voluntary private patient are
6paid by the state, the state psychiatric hospital shall file a
7certified copy of the claim for the bills with the auditor of
8the patient’s county of residence department of administrative
9services. The county of residence department shall proceed to
10collect the claim in the name of the state psychiatric hospital
11and, when collected, pay the amount collected to the director
12of the department of administrative services. The hospital
13shall also, at the same time, forward a duplicate of the claim
14to the director of the department of administrative services.
15 Sec. 76. Section 225C.2, subsection 2, Code 2011, is amended
16by striking the subsection.
17 Sec. 77. Section 225C.2, Code 2011, is amended by adding the
18following new subsection:
19 NEW SUBSECTION. 9. “Regional administrator” means the same
20as defined in section 331.438A.
21 Sec. 78. Section 225C.5, subsection 1, paragraph f, Code
22Supplement 2011, is amended to read as follows:
23f. Two members shall be administrators of the central point
24of coordination process established in accordance with section
25331.440 regional administrator staff selected from nominees
26submitted by the community services affiliate of the Iowa state
27association of counties.
28 Sec. 79. Section 225C.6, subsection 1, paragraph b, Code
29Supplement 2011, is amended to read as follows:
30b. Adopt necessary rules pursuant to chapter 17A which
31relate to disability programs, core disability services, and
32other services, including but not limited to definitions of
33each disability included within the term “disability services”
34as necessary for purposes of state, county, and regional
35planning, programs, and services.
-54-1 Sec. 80. Section 225C.6, subsection 1, paragraph l, Code
2Supplement 2011, is amended by striking the paragraph and
3inserting in lieu thereof the following:
4l. Identify basic financial eligibility standards for the
5disability services provided by a mental health and disability
6services region. The initial standards shall be as specified
7in chapter 331.
8 Sec. 81. Section 225C.6A, Code 2011, is amended to read as
9follows:
10225C.6A Disability services data system redesign.
11The commission shall do the following relating to redesign
12of the data concerning the disability services system in the
13state:
141. Identify sources of revenue to support statewide
15delivery of core disability services to eligible disability
16populations.
172. Ensure there is a continuous improvement process for
18development and maintenance of the disability services system
19for adults and children. The process shall include but is not
20limited to data collection and reporting provisions.
213. a. 1. Plan, collect, and analyze data as necessary to
22issue cost estimates for serving additional populations and
23providing core disability services statewide. The department
24shall maintain compliance with applicable federal and state
25privacy laws to ensure the confidentiality and integrity of
26individually identifiable disability services data. The
27department shall regularly assess the status of the compliance
28in order to assure that data security is protected.
29b. 2. In implementing a system under this subsection
30 section for collecting and analyzing state, county, and private
31contractor data, the department shall establish a client
32identifier for the individuals receiving services. The client
33identifier shall be used in lieu of the individual’s name or
34social security number. The client identifier shall consist of
35the last four digits of an individual’s social security number,
-55-1the first three letters of the individual’s last name, the
2individual’s date of birth, and the individual’s gender in an
3order determined by the department.
4c. 3. Each county regional administrator shall regularly
5 report to the department annually on or before December 1, for
6the preceding fiscal year the following information for each
7individual served: demographic information, expenditure data,
8and data concerning the services and other support provided to
9each individual, as specified in administrative rule adopted
10by the commission.
114. Work with county representatives and other qualified
12persons to develop an implementation plan for replacing the
13county of legal settlement approach to determining service
14system funding responsibilities with an approach based upon
15residency. The plan shall address a statewide standard for
16proof of residency, outline a plan for establishing a data
17system for identifying residency of eligible individuals,
18address residency issues for individuals who began residing in
19a county due to a court order or criminal sentence or to obtain
20services in that county, recommend an approach for contesting
21a residency determination, and address other implementation
22issues.
23 Sec. 82. Section 225C.14, subsection 1, Code 2011, is
24amended to read as follows:
251. Except in cases of medical emergency, a person shall be
26admitted to a state mental health institute as an inpatient
27only after a preliminary diagnostic evaluation performed
28through the central point of coordination process regional
29administrator of the person’s county of residence has confirmed
30that the admission is appropriate to the person’s mental health
31needs, and that no suitable alternative method of providing the
32needed services in a less restrictive setting or in or nearer
33to the person’s home community is currently available. If
34provided for through the central point of coordination process
35 regional administrator, the evaluation may be performed by a
-56-1community mental health center or by an alternative diagnostic
2facility. The policy established by this section shall be
3implemented in the manner and to the extent prescribed by
4sections 225C.15, 225C.16 and 225C.17.
5 Sec. 83. Section 225C.16, subsections 2 through 4, Code
62011, are amended to read as follows:
72. The clerk of the district court in that county shall
8refer a person applying for authorization for voluntary
9admission, or for authorization for voluntary admission of
10another person, in accordance with section 229.42, to the
11appropriate entity designated through the central point of
12coordination process regional administrator of the person’s
13county of residence under section 225C.14 for the preliminary
14diagnostic evaluation unless the applicant furnishes a written
15statement from the appropriate entity which indicates that the
16evaluation has been performed and that the person’s admission
17to a state mental health institute is appropriate. This
18subsection does not apply when authorization for voluntary
19admission is sought under circumstances which, in the opinion
20of the chief medical officer or that officer’s physician
21designee, constitute a medical emergency.
223. Judges of the district court in that county or the
23judicial hospitalization referee appointed for that county
24shall so far as possible arrange for the entity designated
25through the central point of coordination process regional
26administrator under section 225C.14 to perform a prehearing
27examination of a respondent required under section 229.8,
28subsection 3, paragraph “b”.
294. The chief medical officer of a state mental health
30institute shall promptly submit to the appropriate entity
31designated through the central point of coordination process
32 regional administrator under section 225C.14 a report of the
33voluntary admission of a patient under the medical emergency
34clauses of subsections 1 and 2. The report shall explain the
35nature of the emergency which necessitated the admission of
-57-1the patient without a preliminary diagnostic evaluation by the
2designated entity.
3 Sec. 84. Section 225C.19, subsection 3, paragraph c,
4subparagraph (4), Code 2011, is amended to read as follows:
5(4) County central point of coordination processes regional
6administrators.
7 Sec. 85. Section 226.9C, subsection 1, unnumbered paragraph
81, Code Supplement 2011, is amended to read as follows:
9The state mental health institute at Mount Pleasant shall
10operate the dual diagnosis mental health and substance
11abuse substance-related disorder treatment program on a net
12budgeting basis in which fifty percent of the actual per diem
13and ancillary services costs are chargeable to the patient’s
14county of legal settlement or as a state case, as appropriate
15 residence. Subject to the approval of the department, revenues
16attributable to the dual diagnosis program for each fiscal year
17shall be deposited in the mental health institute’s account
18and are appropriated to the department for the dual diagnosis
19program, including but not limited to all of the following
20revenues:
21 Sec. 86. Section 226.9C, subsection 2, Code Supplement
222011, is amended to read as follows:
232. The following additional provisions are applicable in
24regard to the dual diagnosis program:
25a. A county may split the charges between the county’s
26mental health, mental retardation, and developmental
27disabilities services fund created pursuant to section 331.424A
28and the county’s budget for substance abuse substance-related
29disorder expenditures.
30b. If an individual is committed to the custody of the
31department of corrections at the time the individual is
32referred for dual diagnosis treatment, the department of
33corrections shall be charged for the costs of treatment.
34c. Prior to an individual’s admission for dual diagnosis
35treatment, the individual shall have been screened through a
-58-1county’s central point of coordination process implemented
2pursuant to section 331.440 regional administrator to determine
3the appropriateness of the treatment.
4d. A county shall not be chargeable for the costs of
5treatment for an individual enrolled in and authorized by or
6decertified by a managed behavioral care plan under the medical
7assistance program.
8e. Notwithstanding section 8.33, state mental health
9institute revenues related to the dual diagnosis program that
10remain unencumbered or unobligated at the close of the fiscal
11year shall not revert but shall remain available up to the
12amount which would allow the state mental health institute
13to meet credit obligations owed to counties as a result of
14year-end per diem adjustments for the dual diagnosis program.
15 Sec. 87. Section 226.45, Code 2011, is amended to read as
16follows:
17226.45 Reimbursement to county or state.
18If a patient is not receiving medical assistance under
19chapter 249A and the amount to the account of any patient
20in the patients’ personal deposit fund exceeds two hundred
21dollars, the business manager of the hospital may apply any of
22the excess to reimburse the county of legal settlement or the
23state in a case where no legal settlement exists residence for
24liability incurred by the county or the state for the payment
25of care, support and maintenance of the patient, when billed by
26the county of legal settlement or by the administrator for a
27patient having no legal settlement residence.
28 Sec. 88. Section 227.10, Code 2011, is amended to read as
29follows:
30227.10 Transfers from county or private institutions.
31Patients who have been admitted at public expense to
32any institution to which this chapter is applicable may be
33involuntarily transferred to the proper state hospital for
34persons with mental illness in the manner prescribed by
35sections 229.6 to 229.13. The application required by section
-59-1229.6 may be filed by the administrator of the division or
2the administrator’s designee, or by the administrator of the
3institution where the patient is then being maintained or
4treated. If the patient was admitted to that institution
5involuntarily, the administrator of the division may arrange
6and complete the transfer, and shall report it as required of
7a chief medical officer under section 229.15, subsection 5.
8The transfer shall be made at county expense, and the expense
9recovered, as provided in section 227.7. However, transfer
10under this section of a patient whose expenses are payable in
11whole or in part by a county is subject to an authorization for
12the transfer through the central point of coordination process
13 county’s regional administrator as defined in chapter 331.
14 Sec. 89. Section 229.1, subsection 3, Code Supplement 2011,
15is amended by striking the subsection.
16 Sec. 90. Section 229.1, Code Supplement 2011, is amended by
17adding the following new subsection:
18 NEW SUBSECTION. 14A. “Regional administrator” means the
19same as defined in section 331.438A.
20 Sec. 91. Section 229.1B, Code 2011, is amended to read as
21follows:
22229.1B Central point of coordination process Regional
23administrator authorization.
24Notwithstanding any provision of this chapter to the
25contrary, any person whose hospitalization expenses are
26payable in whole or in part by a county shall be subject to
27all requirements of the central point of coordination process
28 county’s regional administrator.
29 Sec. 92. Section 229.9A, Code 2011, is amended to read as
30follows:
31229.9A Advocate informed.
32The court shall direct the clerk to furnish the advocate
33of the respondent’s county of legal settlement residence
34 with a copy of application and any order issued pursuant to
35section 229.8, subsection 3. The advocate may attend the
-60-1hospitalization hearing of any respondent for whom the advocate
2has received notice of a hospitalization hearing.
3 Sec. 93. Section 229.11, subsection 1, unnumbered paragraph
41, Code 2011, is amended to read as follows:
5If the applicant requests that the respondent be taken into
6immediate custody and the judge, upon reviewing the application
7and accompanying documentation, finds probable cause to believe
8that the respondent has a serious mental impairment and is
9likely to injure the respondent or other persons if allowed
10to remain at liberty, the judge may enter a written order
11directing that the respondent be taken into immediate custody
12by the sheriff or the sheriff’s deputy and be detained until
13the hospitalization hearing. The hospitalization hearing shall
14be held no more than five days after the date of the order,
15except that if the fifth day after the date of the order is
16a Saturday, Sunday, or a holiday, the hearing may be held
17on the next succeeding business day. If the expenses of a
18respondent are payable in whole or in part by a county, for a
19placement in accordance with paragraph “a”, the judge shall give
20notice of the placement to the central point of coordination
21process county’s regional administrator, and for a placement
22in accordance with paragraph “b” or “c”, the judge shall order
23the placement in a hospital or facility designated through
24the central point of coordination process county’s regional
25administrator. The judge may order the respondent detained for
26the period of time until the hearing is held, and no longer,
27in accordance with paragraph “a”, if possible, and if not then
28in accordance with paragraph “b”, or, only if neither of these
29alternatives is available, in accordance with paragraph “c”.
30Detention may be:
31 Sec. 94. Section 229.12, subsection 2, Code 2011, is amended
32to read as follows:
332. All persons not necessary for the conduct of the
34proceeding shall be excluded, except that the court may admit
35persons having a legitimate interest in the proceeding and
-61-1shall permit the advocate from the respondent’s county of legal
2settlement residence to attend the hearing. Upon motion of the
3county attorney, the judge may exclude the respondent from the
4hearing during the testimony of any particular witness if the
5judge determines that witness’s testimony is likely to cause
6the respondent severe emotional trauma.
7 Sec. 95. Section 229.13, subsection 1, paragraph a, Code
82011, is amended to read as follows:
9a. The court shall order a respondent whose expenses are
10payable in whole or in part by a county placed under the care
11of an appropriate hospital or facility designated through the
12central point of coordination process regional administrator
13of the respondent’s county of residence on an inpatient or
14outpatient basis.
15 Sec. 96. Section 229.14, subsection 2, paragraph a, Code
162011, is amended to read as follows:
17a. For a respondent whose expenses are payable in whole
18or in part by a county, placement as designated through the
19central point of coordination process regional administrator
20of the respondent’s county of residence in the care of an
21appropriate hospital or facility on an inpatient or outpatient
22basis, or other appropriate treatment, or in an appropriate
23alternative placement.
24 Sec. 97. Section 229.14A, subsections 7 and 9, Code 2011,
25are amended to read as follows:
267. If a respondent’s expenses are payable in whole or in
27part by a county through the central point of coordination
28process regional administrator of the respondent’s county of
29residence, notice of a placement hearing shall be provided
30to the county attorney and the county’s central point of
31coordination process regional administrator. At the hearing,
32the county may present evidence regarding appropriate
33placement.
349. A placement made pursuant to an order entered under
35section 229.13 or 229.14 or this section shall be considered to
-62-1be authorized through the central point of coordination process
2 regional administrator.
3 Sec. 98. Section 229.19, subsection 1, paragraph b, Code
42011, is amended to read as follows:
5b. The court or, if the advocate is appointed by the county
6board of supervisors, the board shall assign the advocate
7appointed from a patient’s county of legal settlement residence
8 to represent the interests of the patient. If a patient has no
9county of legal settlement residence or the patient’s residence
10is unknown, the court or, if the advocate is appointed by
11the county board of supervisors, the board shall assign the
12advocate appointed from the county where the hospital or
13facility is located to represent the interests of the patient.
14 Sec. 99. Section 229.24, subsection 3, unnumbered paragraph
151, Code 2011, is amended to read as follows:
16If all or part of the costs associated with hospitalization
17of an individual under this chapter are chargeable to a county
18of legal settlement residence, the clerk of the district court
19shall provide to the county of legal settlement regional
20administrator of the respondent’s county of residence and
21to the regional administrator of the county in which the
22hospitalization order is entered the following information
23pertaining to the individual which would be confidential under
24subsection 1:
25 Sec. 100. Section 229.31, Code 2011, is amended to read as
26follows:
27229.31 Commission of inquiry.
28A sworn complaint, alleging that a named person is not
29seriously mentally impaired and is unjustly deprived of liberty
30in any hospital in the state, may be filed by any person with
31the clerk of the district court of the county in which such
32named person is so confined, or of the county in which such
33named person has a legal settlement, and thereupon a is a
34resident. Upon receiving the complaint, a judge of said that
35 court shall appoint a commission of not more than three persons
-63-1to inquire into the truth of said the allegations. One of
2said the commissioners shall be a physician and if additional
3commissioners are appointed, one of such the additional
4 commissioners shall be a lawyer.
5 Sec. 101. Section 229.42, Code 2011, is amended to read as
6follows:
7229.42 Costs paid by county.
81. If a person wishing to make application for voluntary
9admission to a mental hospital established by chapter 226 is
10unable to pay the costs of hospitalization or those responsible
11for the person are unable to pay the costs, application for
12authorization of voluntary admission must be made through a
13central point of coordination process regional administrator
14 before application for admission is made to the hospital.
15The person’s county of legal settlement residence shall be
16determined through the central point of coordination process
17 county’s regional administrator and if the admission is
18approved through the central point of coordination process
19 regional administrator, the person’s admission to a mental
20health hospital shall be authorized as a voluntary case.
21The authorization shall be issued on forms provided by the
22administrator. The costs of the hospitalization shall be paid
23by the county of legal settlement residence to the department
24of human services and credited to the general fund of the
25state, provided that the mental health hospital rendering the
26services has certified to the county auditor of the county
27of legal settlement residence the amount chargeable to the
28county and has sent a duplicate statement of the charges to the
29department of human services. A county shall not be billed
30for the cost of a patient unless the patient’s admission is
31authorized through the central point of coordination process
32 county’s regional administrator. The mental health institute
33and the county shall work together to locate appropriate
34alternative placements and services, and to educate patients
35and family members of patients regarding such alternatives.
-64- 12. All the provisions of chapter 230 shall apply to such
2voluntary patients so far as is applicable.
33. The provisions of this section and of section 229.41
4shall apply to all voluntary inpatients or outpatients
5receiving mental health services either away from or at the
6institution.
74. If a county fails to pay the billed charges within
8forty-five days from the date the county auditor received the
9certification statement from the superintendent, the department
10of human services shall charge the delinquent county the
11penalty of one percent per month on and after forty-five days
12from the date the county received the certification statement
13until paid. The penalties received shall be credited to the
14general fund of the state.
15 Sec. 102. Section 229.43, Code 2011, is amended to read as
16follows:
17229.43 Nonresidents or no-settlement Nonresident patients.
18The administrator may place patients of mental health
19institutes who have no county of legal settlement, who
20are nonresidents, or whose legal settlement is unknown on
21convalescent leave to a private sponsor or in a health care
22facility licensed under chapter 135C, when in the opinion
23of the administrator the placement is in the best interests
24of the patient and the state of Iowa. If the patient was
25involuntarily hospitalized, the district court which ordered
26hospitalization of the patient must be informed when the
27patient is placed on convalescent leave, as required by section
28229.15, subsection 5.
29 Sec. 103. Section 230.1, Code 2011, is amended to read as
30follows:
31230.1 Liability of county and state.
321. The necessary and legal costs and expenses attending
33the taking into custody, care, investigation, admission,
34commitment, and support of a person with mental illness
35admitted or committed to a state hospital shall be paid by a
-65-1county or by the state as follows:
2a. By the county in which such person has a legal
3settlement, if If the person is eighteen years of age or older,
4by the person’s county of residence unless the costs and
5expenses are covered by the medical assistance program under
6chapter 249A or the person is described by paragraph “b”.
7b. By the state when if such person has no legal settlement
8 residence in this state, when if the person’s legal settlement
9 residence is unknown, or if the costs and expenses are covered
10by the medical assistance program under chapter 249A, or if the
11person is under eighteen years of age.
122. The legal settlement county of residence of any person
13found mentally ill with mental illness who is a patient of
14any state institution shall be that the person’s county of
15residence existing at the time of admission thereto to the
16institution.
173. A county of legal settlement residence is not liable
18for costs and expenses associated with a person with mental
19illness unless the costs and expenses are for services and
20other support authorized for the person through the central
21point of coordination process county’s regional administrator.
22For the purposes of this chapter, “central point of coordination
23process” “regional administrator” means the same as defined in
24section 331.440 331.438A.
25 Sec. 104. Section 230.2, Code 2011, is amended to read as
26follows:
27230.2 Finding of legal settlement residence.
28If a person’s legal settlement residency status is
29disputed, legal settlement the residency shall be determined
30in accordance with section 225C.8 331.438F. Otherwise, the
31district court may, when the person is ordered placed in a
32hospital for psychiatric examination and appropriate treatment,
33or as soon thereafter as the court obtains the proper
34information, determine and enter of record whether the legal
35settlement residence of the person is one of the following:
-66- 11. In the county from which the person was placed in the
2hospital;.
32. In some other another county of the state;.
43. In some a foreign state or country; or.
54. Unknown.
6 Sec. 105. Section 230.3, Code 2011, is amended to read as
7follows:
8230.3 Certification of settlement.
9If a person’s legal settlement county of residence
10 is determined through by the county’s central point of
11coordination process regional administrator to be in another
12county of this state, the county making the determination
13 regional administrator shall certify the determination to the
14superintendent of the hospital to which the person is admitted
15or committed. The certification shall be accompanied by a copy
16of the evidence supporting the determination. Upon receiving
17the certification, the superintendent shall charge the expenses
18already incurred and unadjusted, and all future expenses of
19the person, to the county determined to be the county of legal
20settlement residence.
21 Sec. 106. Section 230.4, Code 2011, is amended to read as
22follows:
23230.4 Certification to debtor county.
24A determination of a person’s legal settlement county of
25residence made in accordance with section 230.2 or 230.3 shall
26be sent by the court or the county to the county auditor of
27the county of legal settlement residence. The certification
28shall be accompanied by a copy of the evidence supporting the
29determination. The auditor shall provide the certification
30to the board of supervisors of the auditor’s county, and it
31shall be conclusively presumed that the person has a legal
32settlement residence in the notified county unless that county
33disputes the finding of legal settlement residence as provided
34in section 225C.8 331.438F.
35 Sec. 107. Section 230.5, Code 2011, is amended to read as
-67-1follows:
2230.5 Nonresidents.
3If a person’s legal settlement residence is determined in
4accordance with section 230.2 or 230.3 to be in a foreign state
5or country, or is unknown, the court or the county regional
6administrator shall immediately certify the determination
7to the department’s administrator. The certification shall
8be accompanied by a copy of the evidence supporting the
9determination. A court order issued pursuant to section
10229.13 shall direct that the patient be hospitalized at the
11appropriate state hospital for persons with mental illness.
12 Sec. 108. Section 230.8, Code 2011, is amended to read as
13follows:
14230.8 Transfers of persons with mental illness —— expenses.
15The transfer to any state hospitals or to the places of
16their legal settlement residence of persons with mental illness
17who have no legal settlement residence in this state or whose
18legal settlement residence is unknown, shall be made according
19to the directions of the administrator, and when practicable
20by employees of the state hospitals, and the. The actual
21and necessary expenses of such transfers shall be paid on
22itemized vouchers sworn to by the claimants and approved by the
23administrator, and the amount of the expenses is appropriated
24to the department from any funds in the state treasury not
25otherwise appropriated.
26 Sec. 109. Section 230.9, Code 2011, is amended to read as
27follows:
28230.9 Subsequent discovery of residence.
29If, after a person has been received by a state hospital for
30persons with mental illness as a state case patient whose legal
31settlement residence is supposed to be outside this state or
32unknown, the administrator determines that the legal settlement
33 residence of the person was, at the time of admission or
34commitment, in a county of this state, the administrator shall
35certify the determination and charge all legal costs and
-68-1expenses pertaining to the admission or commitment and support
2of the person to the county of legal settlement residence. The
3certification shall be sent to the county of legal settlement
4 residence. The certification shall be accompanied by a copy
5of the evidence supporting the determination. The costs and
6expenses shall be collected as provided by law in other cases.
7If the person’s legal settlement residency status has been
8determined in accordance with section 225C.8 331.438F, the
9legal costs and expenses shall be charged to the county or as a
10state case of residence in accordance with that determination.
11 Sec. 110. Section 230.10, Code 2011, is amended to read as
12follows:
13230.10 Payment of costs.
14All legal costs and expenses attending the taking into
15custody, care, investigation, and admission or commitment of
16a person to a state hospital for persons with mental illness
17under a finding that such the person has a legal settlement
18 residency in another county of this state shall be charged
19against the county of legal settlement residence.
20 Sec. 111. Section 230.11, Code 2011, is amended to read as
21follows:
22230.11 Recovery of costs from state.
23Costs and expenses attending the taking into custody,
24care, and investigation of a person who has been admitted
25or committed to a state hospital, United States department
26of veterans affairs hospital, or other agency of the United
27States government, for persons with mental illness and who
28has no legal settlement residence in this state or whose
29legal settlement residence is unknown, including cost of
30commitment, if any, shall be paid out of as approved by the
31administrator. The amount of the costs and expenses approved
32by the administrator is appropriated to the department from
33 any money in the state treasury not otherwise appropriated, on
34itemized vouchers executed by the auditor of the county which
35has paid them, and approved by the administrator.
-69-1 Sec. 112. Section 230.12, Code 2011, is amended to read as
2follows:
3230.12 Legal settlement Residency disputes.
4If a dispute arises between different counties or between
5the administrator and a county as to the legal settlement
6 residence of a person admitted or committed to a state hospital
7for persons with mental illness, the dispute shall be resolved
8as provided in section 225C.8 331.438F.
9 Sec. 113. Section 230.20, subsection 2, paragraph b, Code
102011, is amended to read as follows:
11b. The per diem costs billed to each county shall not exceed
12the per diem costs billed to the county in the fiscal year
13beginning July 1, 1996. However, the per diem costs billed
14to a county may be adjusted annually to reflect increased
15costs to the extent of the percentage increase in the total
16of county fixed budgets pursuant to the allowed growth factor
17adjustment authorized by the general assembly for the fiscal
18year in accordance with section 331.439, Code 2011, and annual
19percentage increases in state support provided to the regional
20mental health and disability service system under chapter 331.
21 Sec. 114. Section 230.32, Code 2011, is amended to read as
22follows:
23230.32 Support of nonresident patients on leave.
24The cost of support of patients without legal settlement
25 residence in this state, who are placed on convalescent
26leave or removed from a state mental institute to any health
27care facility licensed under chapter 135C for rehabilitation
28purposes, shall be paid from the hospital support fund
29and shall be charged on abstract in the same manner as
30state inpatients, until such time as the patient becomes
31self-supporting or qualifies for support under existing
32statutes.
33 Sec. 115. Section 231.56A, subsection 2, Code 2011, is
34amended to read as follows:
352. The target population of the projects shall be any
-70-1older individual residing in Iowa who is at risk of or who is
2experiencing abuse, neglect, or exploitation which may include
3but is not limited to an older individual who is the subject of
4a report of suspected dependent adult abuse pursuant to chapter
5235B. This subsection shall not apply to an older individual
6who is receiving assistance under a county management plan
7approved pursuant to section 331.439 regional mental health and
8disability services system under chapter 331.
9 Sec. 116. Section 232.2, subsection 4, paragraph f,
10subparagraph (3), Code 2011, is amended to read as follows:
11(3) The transition plan shall be developed and reviewed
12by the department in collaboration with a child-centered
13transition team. The transition team shall be comprised of
14the child’s caseworker and persons selected by the child,
15persons who have knowledge of services available to the child,
16and any person who may reasonably be expected to be a service
17provider for the child when the child becomes an adult or to
18become responsible for the costs of services at that time.
19If the child is reasonably likely to need or be eligible for
20adult services, the transition team membership shall include
21representatives from the adult services system. The adult
22services system representatives may include but are not
23limited to the administrator of county general relief under
24chapter 251 or 252 or of the central point of coordination
25process implemented under section 331.440 county’s regional
26administrator under chapter 331. The membership of the
27transition team and the meeting dates for the team shall be
28documented in the transition plan.
29 Sec. 117. Section 235.7, subsection 2, Code 2011, is amended
30to read as follows:
312. Membership. The department may authorize the governance
32boards of decategorization of child welfare and juvenile
33justice funding projects established under section 232.188 to
34appoint the transition committee membership and may utilize
35the boundaries of decategorization projects to establish
-71-1the service areas for transition committees. The committee
2membership may include but is not limited to department of
3human services staff involved with foster care, child welfare,
4and adult services, juvenile court services staff, staff
5involved with county general relief under chapter 251 or 252,
6or of the central point of coordination process regional
7mental health and disability services implemented under
8section 331.440 chapter 331, school district and area education
9agency staff involved with special education, and a child’s
10court appointed special advocate, guardian ad litem, service
11providers, and other persons knowledgeable about the child.
12 Sec. 118. Section 235A.15, subsection 2, paragraph c,
13subparagraph (9), Code Supplement 2011, is amended to read as
14follows:
15(9) To the administrator of an agency providing mental
16health, mental retardation, or developmental disability
17services under a county regional mental health and disability
18services management plan developed pursuant to section 331.439
19chapter 331, if the data concerns a person employed by or being
20considered by the agency for employment.
21 Sec. 119. Section 235B.6, subsection 2, paragraph c,
22subparagraph (6), Code Supplement 2011, is amended to read as
23follows:
24(6) To the administrator of an agency providing mental
25health, mental retardation, or developmental disability
26services under a county regional mental health and disability
27services management plan developed pursuant to section 331.439
28chapter 331, if the information concerns a person employed by
29or being considered by the agency for employment.
30 Sec. 120. Section 249A.12, Code 2011, is amended to read as
31follows:
32249A.12 Assistance to persons with mental retardation ——
33state cases.
341. Assistance may be furnished under this chapter to an
35otherwise eligible recipient who is a resident of a health
-72-1care facility licensed under chapter 135C and certified as an
2intermediate care facility for persons with mental retardation.
32. A county shall reimburse the department on a monthly
4basis for that portion of the cost of assistance provided
5under this section to a recipient with legal settlement in
6the county, which is not paid from federal funds, if the
7recipient’s placement has been approved by the appropriate
8review organization as medically necessary and appropriate.
9The department’s goal for the maximum time period for
10submission of a claim to a county is not more than sixty
11days following the submission of the claim by the provider
12of the service to the department. The department’s goal for
13completion and crediting of a county for cost settlement for
14the actual costs of a service under a home and community-based
15services waiver is within two hundred seventy days of the close
16of a fiscal year for which cost reports are due from providers.
17The department shall place all reimbursements from counties
18in the appropriation for medical assistance, and may use the
19reimbursed funds in the same manner and for any purpose for
20which the appropriation for medical assistance may be used.
213. 2. If a county reimburses reimbursed the department for
22medical assistance provided under this section, Code 2011, and
23the amount of medical assistance is subsequently repaid through
24a medical assistance income trust or a medical assistance
25special needs trust as defined in section 633C.1, the
26department shall reimburse the county on a proportionate basis.
27The department shall adopt rules to implement this subsection.
284. 3. a. Effective July 1, 1995, the state shall be
29responsible for all of the nonfederal share of the costs of
30intermediate care facility for persons with mental retardation
31services provided under medical assistance to minors.
32Notwithstanding subsection 2 and contrary provisions of section
33222.73, Code 2011, effective July 1, 1995, a county is not
34required to reimburse the department and shall not be billed
35for the nonfederal share of the costs of such services provided
-73-1to minors.
2b. The state shall be responsible for all of the nonfederal
3share of medical assistance home and community-based services
4waivers for persons with intellectual disabilities services
5provided to minors, and a county is not required to reimburse
6the department and shall not be billed for the nonfederal share
7of the costs of the services.
8c. Effective February 1, 2002, the state shall be
9responsible for all of the nonfederal share of the costs of
10intermediate care facility for persons with mental retardation
11services provided under medical assistance attributable to the
12assessment fee for intermediate care facilities for individuals
13with mental retardation imposed pursuant to section 249A.21.
14Notwithstanding subsection 2, effective Effective February 1,
152003, a county is not required to reimburse the department and
16shall not be billed for the nonfederal share of the costs of
17such services attributable to the assessment fee.
185. 4. a. The mental health and disability services
19commission shall recommend to the department the actions
20necessary to assist in the transition of individuals being
21served in an intermediate care facility for persons with
22mental retardation, who are appropriate for the transition,
23to services funded under a medical assistance home and
24community-based services waiver for persons with intellectual
25disabilities in a manner which maximizes the use of existing
26public and private facilities. The actions may include but are
27not limited to submitting any of the following or a combination
28of any of the following as a request for a revision of the
29medical assistance home and community-based services waiver for
30persons with intellectual disabilities:
31(1) Allow for the transition of intermediate care
32facilities for persons with mental retardation licensed under
33chapter 135C, to services funded under the medical assistance
34home and community-based services waiver for persons with
35intellectual disabilities. The request shall be for inclusion
-74-1of additional persons under the waiver associated with the
2transition.
3(2) Allow for reimbursement under the waiver for day program
4or other service costs.
5(3) Allow for exception provisions in which an intermediate
6care facility for persons with mental retardation which does
7not meet size and other facility-related requirements under
8the waiver in effect on June 30, 1996, may convert to a waiver
9service for a set period of time such as five years. Following
10the set period of time, the facility would be subject to the
11waiver requirements applicable to services which were not
12operating under the exception provisions.
13b. In implementing the provisions of this subsection, the
14mental health and disability services commission shall consult
15with other states. The waiver revision request or other action
16necessary to assist in the transition of service provision
17from intermediate care facilities for persons with mental
18retardation to alternative programs shall be implemented by
19the department in a manner that can appropriately meet the
20needs of individuals at an overall lower cost to counties, the
21federal government, and the state. In addition, the department
22shall take into consideration significant federal changes to
23the medical assistance program in formulating the department’s
24actions under this subsection. The department shall consult
25with the mental health and disability services commission in
26adopting rules for oversight of facilities converted pursuant
27to this subsection. A transition approach described in
28paragraph “a” may be modified as necessary to obtain federal
29waiver approval.
306. 5. a. The provisions of the home and community-based
31services waiver for persons with intellectual disabilities
32shall include adult day care, prevocational, and transportation
33services. Transportation shall be included as a separately
34payable service.
35b. The department of human services shall seek federal
-75-1approval to amend the home and community-based services waiver
2for persons with intellectual disabilities to include day
3habilitation services. Inclusion of day habilitation services
4in the waiver shall take effect upon receipt of federal
5approval.
6c. The person’s county of legal settlement shall pay for
7the nonfederal share of the cost of services provided under
8the waiver, and the state shall pay for the nonfederal share
9of such costs if the person has no legal settlement or the
10legal settlement is unknown so that the person is deemed to be
11a state case.
12d. The county of legal settlement shall pay for one hundred
13percent of the nonfederal share of the costs of care provided
14for adults which is reimbursed under a home and community-based
15services waiver that would otherwise be approved for provision
16in an intermediate care facility for persons with mental
17retardation provided under the medical assistance program.
187. 6. When paying the necessary and legal expenses for
19intermediate care facility for persons with mental retardation
20services, the cost requirements of section 222.60 shall
21be considered fulfilled when payment is made in accordance
22with the medical assistance payment rates established by
23the department for intermediate care facilities for persons
24with mental retardation, and the state or a county of legal
25settlement shall not be obligated for any amount in excess of
26the rates.
278. 7. If a person with mental retardation has no legal
28settlement or the legal settlement is unknown so that the
29person is deemed to be a state case and services associated
30with the mental retardation can be covered under a medical
31assistance home and community-based services waiver or other
32medical assistance program provision, the nonfederal share of
33the medical assistance program costs for such coverage shall
34be paid from the appropriation made for the medical assistance
35program.
-76-1 Sec. 121. Section 249A.26, subsection 2, Code 2011, is
2amended to read as follows:
32. a. Except as provided for disallowed costs in section
4249A.27, the county of legal settlement shall pay for fifty
5percent of the nonfederal share of the cost and the state shall
6have responsibility for the remaining fifty pay one hundred
7 percent of the nonfederal share of the cost of case management
8provided to adults, day treatment, and partial hospitalization
9provided under the medical assistance program for persons
10with mental retardation, a developmental disability, or
11chronic mental illness. For purposes of this section, persons
12with mental disorders resulting from Alzheimer’s disease
13or substance abuse a substance-related disorder shall not
14be considered chronically mentally ill to be persons with
15chronic mental illness. To the maximum extent allowed under
16federal law and regulations, the department shall consult with
17and inform a county of legal settlement’s central point of
18coordination process, as defined in section 331.440, regarding
19the necessity for and the provision of any service for which
20the county is required to provide reimbursement under this
21subsection.
22b. The state shall pay for one hundred percent of the
23nonfederal share of the costs of case management provided for
24adults, day treatment, partial hospitalization, and the home
25and community-based services waiver services for persons who
26have no legal settlement residence in this state or the legal
27settlement whose residence is unknown so that the persons are
28deemed to be state cases.
29c. The case management services specified in this subsection
30shall be paid for by a county only if the services are provided
31outside of a managed care contract.
32 Sec. 122. Section 249A.26, subsections 3, 4, 7, and 8, Code
332011, are amended to read as follows:
343. To the maximum extent allowed under federal law and
35regulations, a person with mental illness or mental retardation
-77-1shall not be eligible for any service which is funded in
2whole or in part by a county share of the nonfederal portion
3of medical assistance funds unless the person is referred
4through the central point of coordination process, as defined
5in section 331.440. However, to the extent federal law allows
6referral of a medical assistance recipient to a service without
7approval of the central point of coordination process, the
8county of legal settlement shall be billed for the nonfederal
9share of costs for any adult person for whom the county would
10otherwise be responsible.
114. The county of legal settlement state shall pay for one
12hundred percent of the nonfederal share of the cost of services
13provided to adult persons with chronic mental illness who
14qualify for habilitation services in accordance with the rules
15adopted for the services. The state shall pay for one hundred
16percent of the nonfederal share of the cost of such services
17provided to such persons who have no legal settlement or the
18legal settlement is unknown so that the persons are deemed to
19be state cases.
207. Unless a county has paid or is paying for the nonfederal
21share of the costs of a person’s home and community-based
22waiver services or placement in an intermediate care facility
23for persons with mental retardation under the county’s mental
24health, mental retardation, and developmental disabilities
25services fund, or unless a county of legal settlement would
26become liable for the costs of services for a person at the
27level of care provided in an intermediate care facility for
28persons with mental retardation due to the person reaching the
29age of majority, the The state shall pay for the nonfederal
30share of the costs of an eligible person’s services under the
31home and community-based services waiver for persons with brain
32injury.
338. If a dispute arises between different counties or between
34the department and a county as to the legal settlement of a
35person who receives received medical assistance for which the
-78-1nonfederal share is was payable in whole or in part by a county
2of legal settlement in accordance with Code 2011, and cannot
3be resolved by the parties, the dispute shall be resolved as
4provided in section 225C.8, Code 2011.
5 Sec. 123. Section 252.6, Code 2011, is amended to read as
6follows:
7252.6 Enforcement of liability.
81. Upon the failure of such relatives to assist or maintain
9a poor person who has made application for assistance, the
10county board of supervisors, service area advisory board
11created under section 217.43, or state division of child and
12family services of the department of human services may apply
13to the district court of the county where the poor person
14resides or may be found for an order to compel the assistance
15or maintenance.
162. If the assistance or maintenance needed is provided by
17a county through the regional mental health and disability
18services system implemented under chapter 331, application
19for the assistance and maintenance shall be made through the
20regional administrator of the person’s county of residence.
21For the purposes of this subsection, “regional administrator”
22 means the same as defined in section 331.438A.
23 Sec. 124. Section 252.23, Code 2011, is amended to read as
24follows:
25252.23 Legal settlement disputes.
26If the alleged settlement is disputed, then, within thirty
27days after notice as provided in section 252.22, a copy of
28the notices sent and received shall be filed in the office of
29the clerk of the district court of the county against which
30claim is made, and a cause docketed without other pleadings,
31and tried as an ordinary action, in which the county granting
32the assistance shall be plaintiff, and the other defendant,
33and the burden of proof shall be upon the county granting the
34assistance. However, a legal settlement dispute concerning
35the liability of a person’s county of residence for assistance
-79-1provided through the regional mental health and disability
2services system implemented under chapter 331 in connection
3with services initiated under chapter 222, 230, or 249A shall
4be resolved as provided in section 225C.8 331.438F.
5 Sec. 125. Section 252.24, Code 2011, is amended to read as
6follows:
7252.24 County of settlement liable.
81. The county where the settlement is shall be liable to
9the county granting assistance for all reasonable charges and
10expenses incurred in the assistance and care of a poor person.
112. When assistance is furnished by any governmental agency
12of the county, township, or city, the assistance shall be
13deemed to have been furnished by the county in which the
14agency is located and the agency furnishing the assistance
15shall certify the correctness of the costs of the assistance
16to the board of supervisors of that county and that county
17shall collect from the county of the person’s settlement. The
18amounts collected by the county where the agency is located
19shall be paid to the agency furnishing the assistance. This
20statute applies to services and supplies furnished as provided
21in section 139A.18.
223. Notwithstanding subsection 2, if assistance or
23maintenance is provided by a county through the regional mental
24health and disability services system implemented under chapter
25331, liability for the assistance and maintenance is the
26responsibility of the person’s county of residence.
27 Sec. 126. Section 331.502, subsection 11, Code 2011, is
28amended to read as follows:
2911. Carry out duties relating to the determination of legal
30settlement, collection of funds due the county, and support
31of persons with mental retardation as provided in sections
32222.13, 222.50, 222.61 to 222.66, 222.63, 222.64, and 222.69,
33and 222.74.
34 Sec. 127. Section 347.16, subsection 3, Code 2011, is
35amended to read as follows:
-80- 13. Care and treatment may be furnished in a county public
2hospital to any sick or injured person who has legal settlement
3outside the county which maintains the hospital, subject to
4such policies and rules as the board of hospital trustees may
5adopt. If care and treatment is provided under this subsection
6to a person who is indigent, the county in which that person
7has legal settlement shall pay to the board of hospital
8trustees the fair and reasonable cost of the care and treatment
9provided by the county public hospital unless the cost of the
10indigent person’s care and treatment is otherwise provided for.
11If care and treatment is provided to an indigent person under
12this subsection, the county public hospital furnishing the
13care and treatment shall immediately notify, by regular mail,
14the auditor of the county of legal settlement of the indigent
15person of the provision of care and treatment to the indigent
16person. However, if the care and treatment is provided by
17a county through the regional mental health and disability
18services system implemented under chapter 331, liability for
19the assistance and maintenance is the responsibility of the
20person’s county of residence.
21 Sec. 128. REPEAL. Sections 222.73, 222.74, 222.75, and
22225C.8, Code 2011, are repealed.
23 Sec. 129. EFFECTIVE DATE. This division of this Act takes
24effect July 1, 2013.
25DIVISION VII
26funding provisions
27 Sec. 130. Section 331.424A, subsection 6, Code Supplement
282011, is amended to read as follows:
296. This section is repealed July 1, 2013 2017.
30 Sec. 131. Section 426B.1, Code 2011, is amended by adding
31the following new subsection:
32 NEW SUBSECTION. 3. In addition to the appropriation made
33pursuant to subsection 2, there is appropriated from the
34general fund of the state to the property tax relief fund for
35the indicated fiscal years the following amounts:
-81- 1a. For the fiscal year beginning July 1, 2013, thirty-one
2million five hundred thousand dollars.
3b. For the fiscal year beginning July 1, 2014, sixty-three
4million dollars.
5c. For the fiscal year beginning July 1, 2015, ninety-four
6million five hundred thousand dollars.
7d. For the fiscal year beginning July 1, 2016, one hundred
8twenty-six million dollars.
9 Sec. 132. Section 426B.2, subsection 2, Code 2011, is
10amended by striking the subsection.
11 Sec. 133. Section 426B.3, subsection 1, Code 2011, is
12amended to read as follows:
131. The county auditor shall reduce the certified budget
14amount received from the board of supervisors for the
15succeeding fiscal year for the county mental health, mental
16retardation, and developmental disabilities services fund
17created in section 331.424A by an amount equal to the amount
18the county will receive from the property tax relief fund
19pursuant to section 426B.2, for the succeeding fiscal year and
20the auditor shall determine the rate of taxation necessary to
21raise the reduced amount. On the tax list, the county auditor
22shall compute the amount of taxes due and payable on each
23parcel before and after the amount received from the property
24tax relief fund is used to reduce the county budget. The
25director of human services shall notify the county auditor of
26each county of the amount of moneys the county will receive
27from the property tax relief fund pursuant to section 426B.2,
28for the succeeding fiscal year. If the amount the county will
29receive is changed after the county has certified its budget,
30the county board of supervisors shall amend the certified
31budget to reflect the change and the county auditor shall
32revise the levy rate and amount of taxes due and payable on
33each parcel accordingly. Such an amendment to the budget shall
34be made without public hearing and without being subject to
35protest.
-82-1 Sec. 134. Section 426B.6, Code Supplement 2011, is amended
2to read as follows:
3426B.6 Future repeal.
4This chapter is repealed July 1, 2013 2017.
5 Sec. 135. EFFECTIVE DATE. The following provision of this
6division of this Act takes effect July 1, 2014:
71. The section of this Act amending section 426B.2.
8EXPLANATION
9This bill relates to redesign of publicly funded mental
10health and disability services by requiring certain core
11services and addressing other services and providing for
12establishment of regions. The bill is organized into
13divisions.
14CORE SERVICES. This division specifies core services and
15service management requirements applicable to the regional
16service system required by the bill.
17Code section 331.439, relating to the requirements under
18existing law for a county to receive state payments for mental
19health and disability services and specifying inclusion of
20various provisions in service system management plans, is
21amended to require the use of certain functional assessments or
22other standardized functional assessment methodologies approved
23by the mental health and disability services commission. For
24mental health services, the level of care utilization system
25(LOCUS) is specified; for intellectual disabilities services,
26the supports intensity scale (SIS) is specified; and for brain
27injury services, the commission is required to approve a
28methodology. The use of the methodologies is required to begin
29July 1, 2012. This Code section is repealed on July 1, 2013.
30New Code section 331.439A requires MH/DS provided by
31counties to be delivered in accordance with a regional service
32system management plan approved by the region’s governing board
33and implemented by the regional administrator. The plans are
34required to include a policies and procedures manual for the
35funding administered by the region, submission of an annual
-83-1management plan review, submission of three-year strategic
2plans addressing the effort to achieve various purposes
3identified in Code section 225C.1, and authorizing a region to
4either directly implement a system of service management or to
5contract with a private entity for service management. The
6plan is required to include various elements and the commission
7is directed to specify the elements in administrative rules.
8New Code section 331.439A also authorizes a region to
9provide assistance to other disability service populations
10subject to availability of funding and to implement waiting
11lists for services as a financial management tool.
12New Code section 331.439B provides financial eligibility
13requirements to be used in the regional system. Income
14eligibility is set at 150 percent of the federal poverty
15level and a region or service provider may apply a copayment
16requirement to persons who meet this requirement. Persons with
17higher incomes may also be eligible subject to a copayment or
18other cost-sharing arrangement; however, a service provider may
19waive copayments or cost-sharing if able to fully absorb the
20cost. A person who is eligible for federally funded services
21must apply for the services. The commission is required to
22adopt rules for resource limitations eligibility derived from
23the federal supplemental security income program resource
24limitations. If a person does not qualify for federally funded
25support, but meets income, resource, and functional eligibility
26requirements, retirement accounts in the accumulation stage and
27burial, medical savings, or assistive technology accounts are
28to be disregarded.
29New Code section 331.439C specifies requirements for
30diagnoses, functional assessments, and other requirements for
31eligibility in the regional system. Other requirements include
32an age of at least 18 years and compliance with financial
33eligibility provisions and determination of eligibility for
34individualized services to be made by the functional assessment
35provisions specified in the bill’s amendment to Code section
-84-1331.439. For mental health services, a person must have had a
2diagnosable mental health, behavioral, or emotional disorder
3during the preceding 12-month period. For intellectual
4disability services, an intellectual disability diagnosis or
5an intelligence quotient of 70 or less is required. For brain
6injury services, a diagnosis of brain injury is required.
7New Code section 331.439D addresses mental health core
8services and core service domains to be provided in the
9regional system, subject to the availability of funding. The
10domains are defined to mean a range of services that can be
11provided depending upon an individual’s service needs. A
12region may also provide funding for other services or support
13not listed based on optional criteria that may be considered.
14New Code section 331.439E addresses core services for
15persons with an intellectual disability or other developmental
16disability, provides a list of core services, and requires
17inclusion of all services covered by all of the service system
18management plans of the counties comprising a region as of June
1930, 2012, other than services funded by the Medicaid program.
20The provision of core services is subject to availability of
21funding. The region is required to transition from and replace
22the current services with services that expand and support the
23community support and integration principles outlined in the
24federal Olmstead v.L.C. ruling and the purposes identified in
25Code section 225C.1. Certain best practice efforts must also
26be included.
27New Code section 331.440B addresses regional service system
28financing. The financing of each regional service system is
29limited to a fixed budget amount subject to an allowed growth
30adjustment to be recommended by the commission and the governor
31two years prior to application. The region is required to
32implement the region’s service system management plan by
33budgeting for 99 percent of the funding anticipated to be
34available for the plan for a fiscal year.
35The bill may include a state mandate as defined in Code
-85-1section 25B.3. The bill makes inapplicable Code section 25B.2,
2subsection 3, which would relieve a political subdivision from
3complying with a state mandate if funding for the cost of
4the state mandate is not provided or specified. Therefore,
5political subdivisions are required to comply with any state
6mandate included in the bill.
7The Code editor is authorized to codify the division as a new
8part of Code chapter 331, division III.
9The new Code provisions of the Code chapter are applicable
10beginning July 1, 2013.
11WORKFORCE DEVELOPMENT AND REGULATION. This division relates
12to workforce development and regulation applicable to the
13administration and service providers for the regional service
14system.
15New Code section 225C.6C establishes a mental health and
16disability services workforce development workgroup to be
17convened and staffed by the department of human services to
18address issues connected with assuring there is an adequate
19workforce to provide mental health and disability services in
20the state. Various stakeholders and legislator members are
21specified.
22New Code section 225C.6D requires the department of
23human services to establish an outcomes and performance
24measures committee for the regional service system. Various
25stakeholders are specified for the committee membership.
26New Code section 225C.6E requires the departments of
27human services, inspections and appeals, and public health
28to comply with various provisions in efforts to improve the
29regulatory requirements applied to the regional service system
30administration and service providers.
31COMMUNITY MENTAL HEALTH CENTER AMENDMENTS. This division
32amends Acts provisions relating to community mental health
33centers that were enacted in 2011 Iowa Acts, chapter 121 (SF
34525) that have a delayed effective date of July 1, 2012.
35Provisionally numbered Code section 230A.106, specifying the
-86-1core service required to be offered by a center, is amended
2to allow a center to provide an assertive community treatment
3program in lieu of day treatment, partial hospitalization, or
4psychosocial rehabilitation services.
5Provisionally numbered Code section 230A.110, relating to
6the standards adopted for centers by the commission, is amended
7to allow the standards to be in substantial conformity with
8either applicable behavioral health standards adopted by the
9joint commission or other recognized national standards for
10evaluation of psychiatric facilities rather than requiring
11conformity with both sets of standards.
12REGIONAL SERVICE SYSTEM. This division provides the
13requirements for counties to form mental health and disability
14services (MH/DS) regions.
15New Code section 331.438A defines terms utilized, including
16“department” for the department of human services, “disability
17services” as defined in Code section 225C.2 (services and
18other support available to a person with mental illness,
19mental retardation or other developmental disability, or brain
20injury), “population” to mean the latest federal census or the
21latest applicable population estimate issued by the U.S. census
22bureau, “regional administrator” as provided by the bill, and
23“state commission” as the mental health and disability services
24commission.
25New Code section 331.438B requires counties to form regions
26to provide local access to MH/DS for children and adults.
27Minimum criteria for formation of a group of counties are
28included along with a schedule for voluntary formation until
29the period of November 2, 2012, through January 1, 2013,
30during which the department is required to assign unaffiliated
31counties to a region.
32New Code section 331.438C requires the counties comprising
33a region to enter into a Code chapter 28E agreement for the
34joint exercise of governmental powers to form a regional
35administrator entity to function on behalf of the counties.
-87-1The regional administrator is required to enter into
2performance-based contracts with the department to manage for
3the counties the MH/DS not funded by the medical assistance
4(Medicaid) program and for coordinating with the department
5such services that are funded by the Medicaid program. The
6regional administrator is under the control of a governing
7board. Elected county supervisors of the participating
8counties and at least three individuals who utilize MH/DS or
9actively involved relatives of such individuals are required
10slots for each governing board. The membership cannot include
11representatives of the department or service providers. A
12regional advisory committee for each board is required to
13include individuals who utilize services or actively involved
14relatives, service providers, governing board members, and
15others.
16New Code section 331.438D addresses regional finances.
17The funding administered under the authority of a governing
18board is required to be in a combined account, separate
19county accounts that are administered under the authority of
20the governing board, or pursuant to other arrangement. The
21regional administrator’s administrative costs, as this term
22is determined in accordance with law, is limited to 5 percent
23of expenditures. The funding received from performance-based
24contracts with the department is required to be credited to the
25account or accounts administered by the regional administrator.
26New Code section 331.438E requires the counties comprising
27a MH/DS region to enter into a Code chapter 28E agreement.
28The agreement is required to address various specific
29organizational provisions, administrative provisions, and
30financial provisions.
31New Code section 331.438F requires a county to pay for the
32public costs of the MH/DS for the county’s residents that
33are not covered by the Medicaid program and are provided
34in accordance with the county’s approved regional services
35management plan. If the county is part of a region that has
-88-1agreed to pool funding and liability for services, the regional
2administrator performs the county’s responsibilities on behalf
3of the county. A dispute resolution process is provided to
4address disputes between counties or regions or the department,
5as applicable.
6The provisions of this division enacting new Code sections
7in Code chapter 331, except as specifically provided by the
8provisions, are applicable beginning July 1, 2013.
9SUBACUTE CARE FACILITIES FOR PERSONS WITH SERIOUS AND
10PERSISTENT MENTAL ILLNESS. This division creates a new health
11care facility licensure chapter in Code chapter 135P to be
12regulated by the department of inspections and appeals. The
13new type of facility is called a “subacute care facility
14for persons with serious and persistent mental illness”
15and provides physical facilities with restricted egress to
16provide accommodation, board, and the services of a licensed
17psychiatrist for periods exceeding 24 consecutive hours to
18three or more individuals with serious and persistent mental
19illness and who may have a diagnosis of another disorder. The
20facility cannot be used by individuals related to the owner
21within the third degree of consanguinity.
22New Code sections 135P.1 and 135P.2 define the terms
23utilized and state the purpose of the new Code chapter.
24New Code section 135P.3 describes the nature of care
25to be utilized and the duties of the facility’s licensed
26psychiatrist, authorizes the use of a seclusion room that meets
27the conditions specified under federal regulations for the use
28of seclusion in psychiatric residential treatment facilities
29providing inpatient psychiatric services for individuals under
30age 21, and specifies requirements for admission.
31New Code section 135P.4 prohibits establishing, operating,
32or maintaining a subacute care facility without a license and
33allows a licensed intermediate care facility for persons with
34mental illness to convert to a licensed subacute care facility.
35New Code section 135P.5 requires an application for a
-89-1license and sets the annual licensure fee at $25.
2New Code section 135P.6 requires the department of
3inspections and appeals to ascertain the adequacy of the
4facility before issuing a license and requires the applicant
5to have been awarded a certificate of need for the facility
6through the department of public health under Code chapter 135.
7New Code section 135P.7 authorizes the department to deny
8an application or suspend or revoke a license for failure or
9inability to comply with requirements under the Code chapter
10and provides a list of specific infractions.
11New Code section 135P.8 authorizes the department to issue a
12provisional license and addresses compliance plans.
13New Code section 135P.9 requires the notice and hearing
14process for licensure issues to be performed in compliance with
15the Iowa administrative procedure Act, Code chapter 17A.
16New Code section 135P.10 requires the department of
17inspections and appeals to adopt rules for the facilities in
18consultation with the department of human services and for the
19department to coordinate its rules adoption and enforcement
20efforts.
21New Code section 135P.11 addresses complaints alleging
22violations. Any person may file a complaint and the person’s
23name is required to be kept confidential. The department is
24required to make a preliminary review of the complaint and
25under most circumstances an on-site inspection is required
26within 20 working days. The complainant may accompany the
27inspector upon request of the complainant or the department.
28New Code section 135P.12 requires the department’s
29findings regarding licensure to be made public but other
30information relating to a facility is to be kept confidential.
31Disclosure of information regarding residents is prohibited
32except as provided in Code section 217.30, relating to the
33confidentiality of records pertaining to individuals receiving
34services or assistance from the department of human services.
35New Code section 135P.13 provides for judicial review of
-90-1departmental action in accordance with Code chapter 17A and for
2a petition for the review to be filed in the court of the county
3in which the subacute care facility is located or proposed to
4be located.
5New Code section 135P.14 provides that establishing,
6operating, or managing a subacute care facility without a
7license is a serious misdemeanor offense.
8New Code section 135P.15 authorizes the department to
9maintain an action for an injunction to prevent establishing,
10operating, or managing a subacute care facility without a
11license.
12Code section 249A.26, relating to state and county
13participation in funding for services to persons with
14disabilities in the medical assistance (Medicaid) program
15chapter, is amended to provide that the daily reimbursement
16rate for subacute care facilities is the sum of the
17direct care Medicare-certified hospital-based nursing
18facility patient-day-weighted median and the nondirect
19care Medicare-certified hospital-based nursing facility
20patient-day-weighted median.
21The division may include a state mandate as defined in
22Code section 25B.3. The division makes inapplicable Code
23section 25B.2, subsection 3, which would relieve a political
24subdivision from complying with a state mandate if funding for
25the cost of the state mandate is not provided or specified.
26Therefore, political subdivisions are required to comply with
27any state mandate included in the division.
28CONFORMING AMENDMENTS —— CENTRAL POINT OF COORDINATION AND
29LEGAL SETTLEMENT. This division provides conforming amendments
30to change references to county central point of coordination
31administrators to regional administrators, county of legal
32settlement to county of residence, and county mental health,
33mental retardation, and developmental disabilities services
34funds under Code section 331.424A to generally apply to the
35provisions for MH/DS regions. The Code provisions for the
-91-1affected Code sections are repealed on July 1, 2013, pursuant
2to 2011 Iowa Acts, chapter 123 (SF 209).
3References to the “central point of coordination process”
4(CPC process) are amended to instead refer to the “regional
5administrator” of the county of residence in the following Code
6sections: section 218.99, requiring counties to be notified of
7patient personal accounts in DHS state institutions; section
8222.2, providing a definition of CPC process; section 222.13,
9relating to voluntary admissions to a state resource center;
10section 222.13A, relating to voluntary admission of a minor
11to a state resource center; section 222.28, authorizing the
12court to appoint a commission of inquiry to examine a person
13to determine the person’s mental condition; section 222.59,
14requiring the superintendent of a state resource center
15to coordinate in assisting location of a community-based
16placement instead of a state resource center; section 222.60,
17relating to the costs paid by county and state and requiring a
18diagnosis; section 222.61, relating to determination of legal
19settlement; section 222.62, relating to legal settlement in
20another county; section 222.63, relating to an objection to
21a finding of legal settlement; section 222.64, relating to
22state financial responsibility when a person is in a foreign
23state or is unknown; section 225.11, relating to initiation
24of commitment proceedings for the state psychiatric hospital
25connected to the state university of Iowa; section 225.15,
26relating to examination and treatment of a respondent at
27the state psychiatric hospital; section 225.17, relating to
28payment for the cost of treatment at the state psychiatric
29hospital; section 225C.2, relating to definitions, is amended
30to strike the CPC definition; section 225C.5, relating to
31the MH-DS commission membership; section 225C.6A, relating
32to data requirements addressed in the disability services
33system redesign enacted in 2004; section 225C.14, providing
34requirements for a preliminary diagnostic evaluation for
35admission to a state mental health institute; section 225C.16,
-92-1providing for referrals for evaluations for persons applying
2for voluntary admission to a state mental health institute;
3section 225C.19, relating to an emergency mental health
4crisis system; section 226.9C, authorizing a net general
5fund appropriation for the dual diagnosis program at the
6Mount Pleasant state mental health institute; section 227.10,
7relating to transfers from a county or private institution
8to a state hospital for persons with mental illness; section
9229.1, relating to definitions; section 229.1B, specifying that
10a person is subject to the CPC process, notwithstanding any
11provision of Code chapter 229 to the contrary; section 229.11,
12authorizing a judge to order immediate custody of a person
13alleged to have a serious mental impairment; section 229.13,
14relating to evaluation orders for psychiatric treatment;
15section 229.14, relating to the report of a psychiatric
16evaluation; section 229.14A, relating to the notice and hearing
17for a placement order; section 229.42, relating to costs
18paid by a county for a voluntary admission to a state mental
19health institute; section 230.1, relating to the liability of
20counties and the state for costs associated with admission of a
21person with mental illness to a state hospital; section 230.3,
22providing for certification of legal settlement of a person
23with mental illness admitted to a hospital; section 232.2,
24relating to involvement of the CPC process in the transition
25team of a specific child aging to adulthood while in foster
26care; section 235.7, relating to appointment of transition
27committees for children in an area who are aging to adulthood
28while in child welfare services; and section 249A.26, relating
29to state and county participation in funding for services to
30persons with disabilities.
31Code chapter 252 provisions regarding determinations of
32county of legal settlement (Code sections 252.6, 252.23, and
33252.24) are amended to provide that in provisions involving the
34MH/DS administered through the regional system, the county of
35residence is responsible and any disputes are to be settled in
-93-1accordance with new Code section 331.438F.
2References to “county of legal settlement” are amended to
3be “county of residence” or the state in the following Code
4sections: section 218.99, requiring counties to be notified of
5patient personal accounts in DHS state institutions; section
6222.10, relating to the duty of a peace officer to detain a
7person with mental retardation who departs from an institution
8in another state without proper authority; section 222.13,
9relating to voluntary admissions to a state resource center;
10section 222.13A, relating to voluntary admission of a minor to
11a state resource center; section 222.31, relating to liability
12for charges at a state resource center; section 222.49,
13relating to payment for costs of proceedings; section 222.50,
14requiring the county of legal settlement to pay charges;
15section 222.60, relating to the costs paid by county and
16state and requiring a diagnosis; section 222.61, relating to
17determination of legal settlement; section 222.62, relating to
18legal settlement in another county; section 222.63, relating to
19an objection to a finding of legal settlement; section 222.64,
20providing for state financial responsibility when a person is
21in a foreign state or is unknown; section 222.65, requiring the
22state administrator to investigate a person’s residency when
23placed in a state resource center; section 222.66, providing
24a standing appropriation for the transfer expenses of state
25cases to a state resource center; section 222.67, relating to
26charges when legal settlement was initially unknown; section
27222.68, requiring the county of legal settlement to reimburse
28the county that initially paid the charges; section 222.69,
29providing a standing appropriation for the admission or
30commitment expenses of state cases; section 222.70, requiring
31a dispute resolution process to be used for legal settlement
32disputes; section 222.77, providing for the county of legal
33settlement to pay the costs of support of patients placed on
34leave from a state resources center; section 222.78, relating
35to parents and other persons liable for the support of a
-94-1patient in a state resource center; section 222.79, relating
2to the certification of statements of charges for purposes of
3Code section 222.78; section 222.80, providing for liability
4for the costs of persons admitted or committed to a private
5facility; section 222.82, relating to collection of claims
6under Code section 222.78 or other provisions of Code chapter
7222; section 222.86, relating to payment of excess amounts from
8resource center patient personal deposit funds to the county
9of legal settlement; section 222.92, relating to operation of
10the state resource center on the basis of a net general fund
11appropriation; section 226.9C, relating to the net general
12fund appropriations provisions for the dual diagnosis program
13at the Mount Pleasant state mental health institute; section
14226.45, relating to payment of excess amounts from state mental
15health institute patient personal deposit funds to the county
16of legal settlement; section 229.9A, relating to the mental
17health advocate of the county of legal settlement; section
18229.12, relating to the presence of the mental health advocate
19at civil commitment hearings; section 229.19, relating to the
20duties of the patient advocate; section 229.24, relating to
21the provision of civil commitment court records to the county
22of legal settlement; section 229.31, relating to a commission
23of inquiry; section 229.42, relating to hospitalization costs
24paid on voluntary cases by the county of legal settlement;
25section 229.43, relating to nonresidents on convalescent leave;
26section 230.1, relating to the liability of counties and the
27state for costs associated with admission of a person with
28mental illness to a state hospital; section 230.2, relating to
29finding of legal settlement for persons with mental illness;
30section 230.3, providing for certification of legal settlement
31of a person with mental illness admitted to a hospital; section
32230.4, providing for evidence to accompany the certification
33of legal settlement for a person with mental illness; section
34230.5, relating to legal settlement of nonresidents; section
35230.8, relating to transfer expenses of persons with mental
-95-1illness with no legal settlement; section 230.9, relating to
2charges when legal settlement was initially unknown; section
3230.10, requiring all costs attending the taking into custody,
4care, investigation, and admission or commitment of a person
5to a state hospital for persons with mental illness to be paid
6by the county of legal settlement; section 230.11, relating
7to recovery of costs from the state for state cases; section
8230.12, relating to settlement of legal settlement disputes
9for support of persons with mental illness; section 230.32,
10relating to support of persons who are nonresidents of this
11state; section 249A.12, relating to assistance to persons with
12mental retardation paid under the Medicaid program; section
13249A.26, addressing state and county participation in funding
14for services to persons with disabilities, including case
15management; section 331.502, relating to the duties of the
16county auditor; and section 347.16, relating to the cost of
17care provided in county hospitals.
18Miscellaneous provisions are also amended. Code section
19222.22, relating to representation for a person with mental
20retardation in commitment proceedings, is amended to shift
21the responsibility to pay for counsel from the county to the
22state. Code section 225.23, requiring counties to collect
23claims paid by the state on behalf of committed or voluntary
24private patients at the state psychiatric hospital, is
25amended to shift this responsibility to the department of
26administrative services. Code section 225C.6, relating to the
27duties of the mental health and disability services commission,
28is amended to include a requirement to adopt rules for core
29disability services. Code section 230.20, relating to the
30billing to counties for patient charges at the state mental
31health institutes, is amended to change the cap on inflation
32increases from current law’s percentage increase in the allowed
33growth factor adjustment to the annual percentage increase
34in the state support provided to the regional service system
35under Code chapter 331. Code section 231.56A, relating to
-96-1the elder abuse initiative, emergency shelter, and support
2services projects involving the department on aging, is amended
3to eliminate a reference to county MH/MR/DD management plans.
4Code sections 235A.15 and 235B.6, relating to the child abuse
5and elder abuse registries and allowing employment record
6checks for the administrator of an MH/MR/DD agency providing
7services under a county management plan is amended to refer
8instead to regional management plans.
9Code section 222.49, relating to the costs of proceedings
10for involuntary commitment of persons with mental retardation,
11is amended to provide that the responsibility to pay costs is
12with either the county or the state.
13The bill repeals these Code sections: section 222.73,
14relating to billing of charges to counties for services
15provided at the state resource centers; section 222.74,
16relating to sending of duplicate statements to counties of the
17billing statements under Code section 222.73; section 222.75,
18relating to penalties for failure to pay the charges billed
19under Code section 222.73; and section 225C.8, relating to the
20legal settlement dispute resolution process replaced by the
21bill.
22FUNDING PROVISIONS. This division relates to state property
23tax relief funding and county property taxes for mental health
24and disability services.
25Under current law enacted by 2011 Iowa Acts, chapter 123
26(SF 209), the provisions for property tax relief under Code
27chapter 426B and for county mental health, mental retardation,
28and developmental disabilities services funds and the county
29property tax levies for the services in Code section 331.424A
30are repealed on July 1, 2013. The bill extends the repeal
31dates in those Code provisions to July 1, 2017.
32Under current law, each county’s property tax levies for
33the services are limited to a dollar amount established in the
34mid-1990s that the county expended for the services at that
35time. The state provides property tax relief funding from a
-97-1standing appropriation in Code chapter 426B and the county
2property taxes for the services are reduced dollar-for-dollar
3by the amount received under that Code chapter. The bill
4provides additional standing appropriations, increasing over
5the four-year period so that in FY 2016-2017 the appropriation
6is equal to the maximum county property tax levies for the
7services authorized for FY 2011-2012.
8The bill also provides that during the four-year period if
9the amount that a county will receive under Code chapter 426B
10is changed after the county has certified its levy, the board
11of supervisors is required to amend the certified budget to
12reflect the change and the county auditor must revise the levy
13rate and amount of taxes due on each parcel accordingly. The
14amendment is not subject to public hearing and without being
15subject to protest.
-98-