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Senate Study Bill 1197 - IntroducedA Bill ForAn Act 1relating to mental health and disability services,
2including the establishment of a children’s behavioral
3health system and a children’s behavioral health system
4state board, and requiring certain children’s behavioral
5health core services.
6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 225C.2, Code 2019, is amended by adding
2the following new subsections:
3 new subsection. 1A. “Child” or “children” means a person or
4persons under eighteen years of age.
5 new subsection. 1B. “Children’s behavioral health
6services” means services for children with a serious emotional
7disturbance.
8 new subsection. 1C. “Children’s behavioral health system” or
9“children’s system” means the behavioral health service system
10for children implemented pursuant to this subchapter.
11 new subsection. 11. “Serious emotional disturbance” means
12a diagnosable mental, behavioral, or emotional disorder of
13sufficient duration to meet diagnostic criteria specified
14within the most current diagnostic and statistical manual
15of mental disorders published by the American psychiatric
16association that results in a functional impairment. “Serious
17emotional disturbance” does not include substance use and
18developmental disorders unless such disorders co-occur with
19such a diagnosable mental, behavioral, or emotional disorder.
20 new subsection. 12. “State board” means the children’s
21behavioral health system state board created in section
22225C.51.
23 Sec. 2. Section 225C.2, subsection 9, Code 2019, is amended
24by striking the subsection.
25 Sec. 3. Section 225C.4, subsection 1, Code 2019, is amended
26by adding the following new paragraph:
27 NEW PARAGRAPH. 0c. Assist the state board in planning for
28community-based children’s behavioral health services.
29 Sec. 4. Section 225C.4, subsection 1, paragraphs d and j,
30Code 2019, are amended to read as follows:
31d. Encourage and facilitate coordination of mental health
32and disability services with the objective of developing and
33maintaining in the state a mental health and disability service
34delivery system to provide disability services to all persons
35in this state who need the services, regardless of the place
-1-1of residence or economic circumstances of those persons. The
2administrator shall work with the commission and other state
3agencies, including but not limited to the departments of
4corrections, education, and public health and the state board
5of regents, to develop and implement a strategic plan to expand
6access to qualified mental health workers across the state.
7j. Establish and maintain a data collection and management
8information system oriented to the needs of patients,
9providers, the department, and other programs or facilities in
10accordance with section 225C.6A. The system shall be used to
11identify, collect, and analyze service outcome and performance
12measures data in order to assess the effects of the services on
13the persons utilizing the services. The administrator shall
14annually submit to the commission information collected by the
15department indicating the changes and trends in the mental
16health and disability services system. The administrator shall
17make the outcome data available to the public.
18 Sec. 5. Section 225C.4, subsection 1, Code 2019, is amended
19by adding the following new paragraphs:
20 NEW PARAGRAPH. 0k. Encourage and facilitate coordination
21of children’s behavioral health services with the objective of
22developing and maintaining in the state a children’s behavioral
23health system to provide behavioral health services to all
24children in this state who need the services, regardless of the
25place of residence or economic circumstances of those children.
26The administrator shall work with the state board and other
27state agencies including but not limited to the department of
28education and the department of public health to develop and
29implement a strategic plan to expand access to qualified mental
30health workers across the state.
31 NEW PARAGRAPH. 00k. Establish and maintain a data
32collection and management information system oriented to the
33needs of children utilizing the children’s behavioral health
34system, providers, the department, and other programs or
35facilities in accordance with section 225C.6A. The system
-2-1shall be used to identify, collect, and analyze service
2outcome and performance measures data in order to assess the
3effects of the services on the children utilizing the services.
4The administrator shall annually submit to the state board
5information collected by the department indicating the changes
6and trends in the children’s behavioral health system. The
7administrator shall make the outcome data available to the
8public.
9 Sec. 6. Section 225C.4, subsection 1, paragraph u, Code
102019, is amended by adding the following new subparagraph:
11 NEW SUBPARAGRAPH. (9) School attendance.
12 Sec. 7. Section 225C.6B, subsection 3, Code 2019, is amended
13by adding the following new paragraph:
14 NEW PARAGRAPH. c. Children’s behavioral health services
15provided to eligible children that are not covered under the
16medical assistance program or other third-party payor are the
17responsibility of the county-based regional service system.
18 Sec. 8. NEW SECTION. 225C.51 Children’s behavioral health
19system state board.
201. A children’s behavioral health system state board
21is created as the state body to provide guidance on the
22implementation and management of a children’s behavioral health
23system for the provision of services to children with a serious
24emotional disturbance. The state board’s public voting members
25shall be appointed to four-year staggered terms by the governor
26and are subject to confirmation by the senate. All other
27state board voting members shall be appointed to four-year
28staggered terms and are not subject to confirmation by the
29senate. State board members shall be appointed on the basis of
30interest and experience in the fields of children’s behavioral
31health to ensure adequate representation from persons with life
32experiences and from persons knowledgeable about children’s
33behavioral health services. The department shall provide
34support to the state board, and the board may utilize staff
35support and other assistance provided to the state board by
-3-1other persons. The state board shall meet at least four times
2per year. The membership of the state board shall consist of
3the following persons who, at the time of appointment to the
4state board, are active members of the indicated groups:
5a. The director of the department or the director’s
6designee.
7b. The director of the department of education or the
8director’s designee.
9c. The director of the department of public health or the
10director’s designee.
11d. The director of workforce development or the director’s
12designee.
13e. One member shall be selected from nominees submitted by
14the state court administrator.
15f. One member shall be selected from nominees submitted
16by the early childhood Iowa office in the department of
17management.
18g. One member shall be a member of the mental health and
19disability services commission.
20h. One member shall be a board member or an employee of a
21provider of mental health services to children.
22i. One member shall be a board member or an employee of a
23provider of child welfare services.
24j. One member shall be an administrator of an area education
25agency.
26k. One member shall be an educator, counselor, or
27administrator of a school district.
28l. One member shall be a representative of an established
29advocacy organization whose mission or purpose it is, in part,
30to further goals related to children’s mental health.
31m. One member shall be a parent or guardian of a child
32utilizing behavioral health services.
33n. One member shall be a chief executive officer of a mental
34health and disability services region.
35o. In addition to the voting members, the membership shall
-4-1include four members of the general assembly with one member
2designated by each of the following: the majority leader of
3the senate, the minority leader of the senate, the speaker of
4the house of representatives, and the minority leader of the
5house of representatives. A legislative member serves for a
6term as provided in section 69.16B in a nonvoting, ex officio
7capacity and is not eligible for per diem and expenses as
8provided in section 2.10.
92. The four-year terms shall begin and end as provided in
10section 69.19. Vacancies on the state board shall be filled as
11provided in section 2.32. A member shall not be appointed for
12more than two consecutive four-year terms.
133. The director and the director of the department of
14education, or their designees, shall serve as co-chairpersons
15of the state board. Board members shall not be entitled to a
16per diem as specified in section 7E.6 and shall not be entitled
17to actual and necessary expenses incurred while engaged in
18their official duties.
19 Sec. 9. NEW SECTION. 225C.52 Children’s behavioral health
20system state board — duties.
211. To the extent funding is available, the state board shall
22perform the following duties:
23a. Advise the administrator on the administration of the
24children’s behavioral health system.
25b. Provide consultation services to agencies regarding
26the development of administrative rules for the children’s
27behavioral health system.
28c. Identify behavioral health outcomes and indicators for
29eligible children with a serious emotional disturbance to
30promote children living with their own families and in the
31community.
32d. Submit a written report on or before December 1 of each
33year to the governor and the general assembly. At a minimum,
34the report shall include a summary of all activities undertaken
35by the state board, a summary of state board activities,
-5-1and results from identified behavioral health outcomes and
2indicators for the children’s behavioral health system.
3 Sec. 10. Section 331.388, Code 2019, is amended by adding
4the following new subsections:
5 NEW SUBSECTION. 01. “Children’s behavioral health services”
6means the same as defined in section 225C.2.
7 NEW SUBSECTION. 4A. “Serious emotional disturbance” means
8the same as defined in section 225C.2.
9 NEW SUBSECTION. 4B. “State board” means the children’s
10system state board created in section 225C.51.
11 Sec. 11. Section 331.390, subsection 2, Code 2019, is
12amended by striking the subsection and inserting in lieu
13thereof the following:
142. The governing board shall comply with all of the
15following requirements:
16a. The voting membership of the governing board shall
17consist of at least one board of supervisors member from each
18county comprising the region or their designees.
19b. The membership of the governing board shall also include
20one adult person who utilizes mental health and disability
21services or is an actively involved relative of such an adult
22person. This member shall be designated by the regional
23advisory committee formed by the governing board pursuant to
24paragraph “h”.
25c. The membership of the governing board shall not include
26employees of the department of human services or an unelected
27employee of a county.
28d. The membership of the governing board shall also consist
29of one member representing adult service providers in the
30region. This member shall be designated by the regional
31advisory committee formed by the governing board pursuant to
32paragraph “h”. The member designated in accordance with this
33paragraph shall serve in a nonvoting, ex officio capacity.
34e. The membership of the governing board shall also
35consist of one member representing children’s behavioral
-6-1health services providers in the region. This member shall be
2designated by the regional children’s advisory committee formed
3by the governing board pursuant to paragraph “i”. The member
4designated in accordance with this paragraph shall serve in a
5nonvoting, ex officio capacity.
6f. The membership of the governing board shall also consist
7of one member representing area education agency administrators
8in the region. This member shall be designated by the regional
9children’s advisory committee formed by the governing board
10pursuant to paragraph “i”.
11g. The membership of the governing board shall also
12consist of one member who is a parent of a child who utilizes
13children’s behavioral health services or actively involved
14relatives of such children. This member shall be designated
15by the regional children’s advisory committee formed by the
16governing board pursuant to paragraph “i”.
17h. The governing board shall have a regional advisory
18committee consisting of adults who utilize services or actively
19involved relatives of such adults, service providers, and
20regional governing board members.
21i. The governing board shall have a regional children’s
22advisory committee consisting of parents of children who
23utilize services or actively involved relatives of such
24children, an area education agency administrator, an early
25childhood advocate, a child welfare advocate, a children’s
26behavioral health service provider, a member of the juvenile
27court, a pediatrician, a child care provider, a local law
28enforcement representative, and regional governing board
29members.
30 Sec. 12. Section 331.390, subsection 3, paragraph b, Code
312019, is amended to read as follows:
32b. The regional administrator staff shall include one or
33more coordinators of mental health and disability services
34and one or more coordinators of children’s behavioral
35health services. A coordinator shall possess a bachelor’s
-7-1or higher level degree in a human services-related or
2administration-related field, including but not limited
3to social work, psychology, nursing, or public or business
4administration, from an accredited college or university.
5However, in lieu of a degree in public or business
6administration, a coordinator may provide documentation of
7relevant management experience. An action of a coordinator
8involving a clinical decision shall be made in conjunction with
9a professional who is trained in the delivery of the mental
10health or disability service or children’s behavioral health
11service addressed by the clinical decision. The regional
12administrator shall determine whether referral to a coordinator
13of mental health and disability services or children’s
14behavioral health services is required for a person or child
15 seeking to access a service through a local access point of the
16regional service system or the children’s behavioral health
17system.
18 Sec. 13. Section 331.393, subsection 2, Code 2019, is
19amended by adding the following new paragraphs:
20 NEW PARAGRAPH. i. The scope of children’s behavioral health
21core services. Each service included shall be described and a
22projection of need shall be included.
23 NEW PARAGRAPH. j. The eligibility requirements for
24children’s behavioral health core services under the children’s
25behavioral health system.
26 Sec. 14. Section 331.393, subsection 4, paragraph g,
27subparagraph (1), Code 2019, is amended to read as follows:
28(1) Performance and outcome measures relating to the
29health, safety, education, work performance, and community
30residency of the persons receiving the services.
31 Sec. 15. Section 331.396, subsection 1, paragraph b, Code
322019, is amended to read as follows:
33b. The person is at least eighteen years of age and is a
34resident of this state. However, a person who is seventeen
35years of age, is a resident of this state, and is receiving
-8-1publicly funded children’s services may be considered eligible
2for services through the regional service system during the
3three-month period preceding the person’s eighteenth birthday
4in order to provide a smooth transition from children’s to
5adult services.
6 Sec. 16. Section 331.396, subsection 1, paragraph d, Code
72019, is amended by striking the paragraph.
8 Sec. 17. NEW SECTION. 331.396A Eligibility requirements —
9children’s behavioral health services.
101. A child shall be eligible for behavioral health services
11under the children’s behavioral health system if all of the
12following conditions are met:
13a. The child is under eighteen years of age and is a
14resident of this state.
15b. The child has been diagnosed with a serious emotional
16disturbance.
17c. (1) The child’s family has a family income equal to or
18less than five hundred percent of the federal poverty level as
19defined by the most recently revised poverty income guidelines
20published by the United States department of health and human
21services.
22(2) Notwithstanding subparagraph (1), a child’s family
23whose household income is between one hundred fifty percent
24but not more than five hundred percent of the federal poverty
25level shall be eligible for behavioral health services subject
26to a copayment, a single statewide sliding fee scale, or other
27cost-sharing requirements approved by the department.
28 Sec. 18. NEW SECTION. 331.397A Children’s behavioral health
29core services.
301. For the purposes of this section, unless the context
31otherwise requires, “domain” means a set of similar behavioral
32health services that can be provided depending on a child’s
33service needs.
342. a. (1) A region shall work with children’s behavioral
35health service providers to ensure that services in the
-9-1required behavioral health core service domains in subsection
24 are available to children who are residents of the region,
3regardless of any potential payment source for the services.
4(2) Subject to the available appropriations, the director
5of human services shall ensure the behavioral health core
6service domains listed in subsection 4 are covered services
7for the medical assistance program under chapter 249A to the
8greatest extent allowable under federal regulations. The
9medical assistance program shall reimburse Medicaid enrolled
10providers for Medicaid covered services under subsection 4 when
11the services are medically necessary, the Medicaid enrolled
12provider submits an appropriate claim for such services, and
13no other third-party payor is responsible for reimbursement
14of such services. Within the funds available, the region
15shall pay for such services for eligible children when payment
16through the medical assistance program or another third-party
17payment is not available, unless the child is on a waiting list
18for such payment or it has been determined that the child does
19not meet the eligibility criteria for any such service.
20b. Until funding is designed for other service populations,
21eligibility for the service domains listed in this section
22shall be limited to such children who are in need of behavioral
23health services.
243. Pursuant to recommendations made by the state board, the
25department of human services shall adopt rules to define the
26services included in the core domains listed in this section.
27The rules shall provide service definitions, service provider
28standards, service access standards, and service implementation
29dates, and shall provide consistency, to the extent possible,
30with similar service definitions under the medical assistance
31program.
324. The children’s behavioral health core service domains
33shall include all of the following:
34a. Treatment designed to ameliorate a child’s serious
35emotional disturbance, including but not limited to all of the
-10-1following:
2(1) Prevention, early identification, early intervention,
3and education.
4(2) Assessment and evaluation relating to eligibility for
5services.
6(3) Medication prescribing and management.
7(4) Behavioral health outpatient therapy.
8b. Comprehensive facility and community-based crisis
9services, including all of the following:
10(1) Mobile response.
11(2) Crisis stabilization community-based services.
12(3) Crisis stabilization residential services.
13(4) Behavioral health inpatient treatment.
145. A region shall ensure that services within the following
15additional core service domains are available to children not
16eligible for the medical assistance program under chapter 249A
17or receiving other third-party payment for the services, when
18public funds are made available for such services:
19a. Treatment designed to ameliorate a child’s serious
20emotional disturbance including but not limited to behavioral
21health school-based therapy.
22b. Support for community living including but not limited
23to all of the following:
24(1) Family support.
25(2) Peer support.
26(3) Therapeutic foster care.
27(4) Respite care.
28c. Transition services for children to the adult mental
29health system providing an appropriate match with a child’s
30abilities based upon informed, person-centered choices made
31from an array of options including but not limited to all of
32the following:
33(1) Day habilitation.
34(2) Job development.
35(3) Supported employment.
-11- 1(4) Prevocational services.
2(5) Educational services.
3d. Service coordination including physical health and
4primary care that follow the principles of the system of care
5including but not limited to all of the following:
6(1) Care coordination.
7(2) Health homes.
8 Sec. 19. MENTAL HEALTH AND DISABILITY SERVICES REGION
9— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION
10PLAN. Each mental health and disability services region shall
11submit to the department of human services an implementation
12plan to implement children’s behavioral health services
13described under section 331.397A, as enacted in this Act, no
14later than April 1, 2020.
15 Sec. 20. DEPARTMENT OF HUMAN SERVICES — RULES. The
16department of human services shall adopt rules pursuant to
17chapter 17A to administer this Act.
18 Sec. 21. REPEAL. Sections 225C.51, 225C.52, 225C.53, and
19225C.54, Code 2019, are repealed.
20 Sec. 22. CODE EDITOR’S DIRECTIVES. The Code editor may
21change the current subchapter title of chapter 225C, subchapter
22VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”.
23The Code editor may change the current subchapter title of
24chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES
25— REGIONAL SERVICE SYSTEM — CHILDREN’S BEHAVIORAL HEALTH
26SYSTEM”.
27EXPLANATION
28The inclusion of this explanation does not constitute agreement with
29the explanation’s substance by the members of the general assembly.
30This bill relates to mental health and disability services
31including the establishment of a children’s behavioral health
32system and a children’s behavioral health system state board,
33and requiring certain children’s behavioral health core
34services.
35DEFINITIONS. The bill provides definitions for the
-12-1children’s behavioral health system. “Child” or “children”
2is defined as a person or persons under 18 years of age.
3“Children’s behavioral health services” is defined as services
4for children with a “serious emotional disturbance” defined
5as a diagnosable mental, behavioral, or emotional disorder
6of sufficient duration to meet diagnostic criteria specified
7within the most current diagnostic and statistical manual
8of mental disorders published by the American psychiatric
9association that results in a functional impairment, but
10does not include substance use and developmental disorders
11unless such disorders co-occur with such a diagnosable mental,
12behavioral, or emotional disorder. “Children’s system”
13or “children’s behavioral health system” is defined as the
14behavioral health services system for children created in the
15bill.
16CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD. The bill
17establishes a children’s behavioral health system state board
18(state board) as the state body to provide guidance on the
19implementation and management of the children’s behavioral
20health system and for the provision of services to children
21with a serious emotional disturbance.
22The bill specifies the membership of the board and provides
23that the state board’s public voting members shall be appointed
24to four-year staggered terms by the governor and are subject
25to confirmation by the senate. All other state board voting
26members shall be appointed to four-year terms and are not
27subject to senate confirmation. A member shall not be
28appointed for more than two consecutive four-year terms. State
29board members shall be appointed on the basis of interest
30and experience in the fields of children’s behavioral health
31to ensure representation from persons with life experiences
32and persons knowledgeable about children’s behavioral health
33services. The state board shall be co-chaired by the director
34of the department of human services (DHS) and the director of
35the department of education, or their designees. In addition
-13-1to the voting members, the membership shall include four
2members of the general assembly to serve in a nonvoting, ex
3officio capacity on the board.
4The bill requires the DHS to provide support to the state
5board and the state board may utilize staff support and other
6assistance provided to the state board by other persons. The
7state board is required to meet a minimum of four times per
8year.
9The state board is required to advise the administrator
10of the division of mental health and disability services of
11DHS on the administration of the children’s behavioral health
12system, provide consultation services to agencies regarding
13the development of administrative rules for the children’s
14behavioral health system, identify behavioral health outcomes
15and indicators for eligible children with a serious emotional
16disturbance to promote children living with their own families
17and in the community; and submit a written report on or
18before December 1 of each year to the governor and the general
19assembly.
20ELIGIBILITY REQUIREMENTS — CHILDREN’S BEHAVIORAL HEALTH
21SERVICES. Under current law, a person who is 17 years of
22age, is a resident of Iowa, and is receiving publicly funded
23children’s mental health services may be considered eligible
24for mental health services through the adult mental health
25and disability services regional service system during the
26three-month period preceding the person’s 18th birthday in
27order to provide a smooth transition from children’s services
28to adult services. The bill strikes this provision and
29provides that a child shall be eligible for behavioral health
30services under the children’s behavioral health system if the
31child is under 18 years of age, a resident of Iowa, has been
32diagnosed with a serious emotional disturbance, and the child’s
33family has a household income equal to or less than 500 percent
34of the federal poverty level, except that a child’s family
35whose household income is between 150 percent but not more than
-14-1500 percent of the federal poverty level shall be eligible for
2behavioral health services subject to a copayment, a single
3statewide sliding fee scale, or other cost-sharing requirements
4approved by DHS. The bill does not apply to intellectual
5disability services or brain injury services for children under
6the children’s behavioral health system.
7CHILDREN’S BEHAVIORAL HEALTH SYSTEM — CORE SERVICES. The
8bill provides that, subject to available appropriations, the
9director of DHS shall ensure that the children’s behavioral
10health core service domains, as specified in the bill, are
11covered services for the medical assistance program under Code
12chapter 249A to the greatest extent allowable under federal
13regulations. The bill provides the medical assistance program
14shall reimburse Medicaid enrolled providers for Medicaid
15covered services when the services are medically necessary, the
16Medicaid enrolled provider submits an appropriate claim for
17such services, and no other third-party payor is responsible
18for reimbursement of such services. Within the funds
19available, each mental health and disability services region
20is required to pay for such services for eligible children
21when payment through the medical assistance program or another
22third-party payment is not available, unless a child is on a
23waiting list for such payment or it has been determined that
24the child does not meet the eligibility criteria for any such
25service.
26The bill provides that until funding is designed for other
27service populations, eligibility for the core services shall be
28limited to such children who are in need of behavioral health
29services.
30The bill requires DHS to adopt rules pursuant to
31recommendations made by the state board to define the services
32included in the core domains. The rules shall provide service
33definitions, service provider standards, service access
34standards, and service implementation dates, and shall also
35provide consistency, to the extent possible, with similar
-15-1service definitions under the medical assistance program.
2The bill requires each mental health and disability
3services region to submit to DHS plans to implement children’s
4behavioral health services no later than April 1, 2020.
5MENTAL HEALTH AND DISABILITY SERVICES — ADMINISTRATOR’S
6DUTIES. The bill requires the administrator of the division
7of mental health and disability services of DHS to assist
8the state board in planning for community-based children’s
9behavioral health services and to encourage and facilitate
10coordination of children’s behavioral health services with
11the objective of developing and maintaining in the state a
12children’s behavioral health system to provide behavioral
13health services to all children in this state who need the
14services, regardless of the place of residence or economic
15circumstances of those children. The administrator shall work
16with the state board and other state agencies, including but
17not limited to the departments of education and public health,
18to develop and implement a strategic plan to expand access to
19qualified mental health workers across the state.
20The bill requires the administrator to establish and
21maintain a data collection and management information system
22oriented to the needs of children utilizing the children’s
23behavioral health system, providers, DHS, and other programs or
24facilities in accordance with the disability services system
25data repository established in Code section 225C.6A. The
26system shall be used to identify, collect, and analyze service
27outcome and performance measures data in order to assess the
28effects of the services on the children utilizing the services.
29The administrator shall annually submit to the state board
30information collected by DHS indicating the changes and trends
31in the children’s behavioral health system. The administrator
32shall make the outcome data available to the public.
33Current law requires the administrator to enter into
34performance-based contracts with mental health and disability
35services regional administrators which may include requirements
-16-1for the regional service system to attain outcomes within
2a specified range of acceptable performance in certain
3categories. The bill expands the categories to include a
4school attendance category.
5STATE AND REGIONAL DISABILITY SERVICE SYSTEMS. Current law
6provides that the publicly financed disability services for
7persons with mental illness, intellectual disability or other
8developmental disability, or brain injury in Iowa shall be
9provided by DHS and the counties operating together as regions
10and provides for financial and administrative responsibility
11for such services. The bill provides that children’s
12behavioral health services provided to eligible children that
13are not covered under the medical assistance program or other
14third-party payor are the responsibility of the mental health
15and disabilities regional service system.
16MENTAL HEALTH AND DISABILITY SERVICES REGIONS. The bill
17makes changes to the mental health and disability services
18regional governing board (governing board). The governing
19board membership shall consist of at least one board of
20supervisors member from each county comprising the region
21who shall be a voting member; one adult person who utilizes
22mental health and disability services or is an actively
23involved relative of such an adult person designated by the
24regional advisory committee formed by the governing board;
25one member representing adult service providers in the region
26designated by the regional advisory committee formed by the
27governing board, who shall serve in a nonvoting, ex officio
28capacity; one member representing children’s behavioral health
29service providers in the region designated by the regional
30children’s advisory committee formed by the governing board,
31who shall serve in a nonvoting, ex officio capacity; one member
32representing area education agency administrators in the region
33designated by the regional children’s advisory committee formed
34by the governing board; and one member who is a parent of a
35child who utilizes children’s behavioral health services or
-17-1actively involved relatives of such children designated by the
2regional children’s advisory committee. The membership of
3the governing board shall not include employees of DHS or an
4unelected employee of a county.
5The bill adds to the regional administrator staff one or more
6coordinators of children’s behavioral health services.
7The bill requires a mental health and disability region to
8include provisions relating to eligibility requirements for
9children’s behavioral health core services under the children’s
10behavioral health system and performance and outcome measures
11relating to education in a region’s annual service and budget
12plan.
13The bill makes technical changes to Code section 225C.2(9)
14by striking the term “person with a disability” as that term
15is not used in Code chapter 225C (mental health and disability
16services) and to Code section 225C.4 to include mental health
17services in references to disability services in that Code
18section.
19The bill repeals 2019 Code sections 225C.51, 225C.52,
20225C.53, and 225C.54. The bill replaces 2019 Code sections
21225C.51 and 225C.52 with new content in the bill.
-18-hb/rh
2including the establishment of a children’s behavioral
3health system and a children’s behavioral health system
4state board, and requiring certain children’s behavioral
5health core services.
6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 225C.2, Code 2019, is amended by adding
2the following new subsections:
3 new subsection. 1A. “Child” or “children” means a person or
4persons under eighteen years of age.
5 new subsection. 1B. “Children’s behavioral health
6services” means services for children with a serious emotional
7disturbance.
8 new subsection. 1C. “Children’s behavioral health system” or
9“children’s system” means the behavioral health service system
10for children implemented pursuant to this subchapter.
11 new subsection. 11. “Serious emotional disturbance” means
12a diagnosable mental, behavioral, or emotional disorder of
13sufficient duration to meet diagnostic criteria specified
14within the most current diagnostic and statistical manual
15of mental disorders published by the American psychiatric
16association that results in a functional impairment. “Serious
17emotional disturbance” does not include substance use and
18developmental disorders unless such disorders co-occur with
19such a diagnosable mental, behavioral, or emotional disorder.
20 new subsection. 12. “State board” means the children’s
21behavioral health system state board created in section
22225C.51.
23 Sec. 2. Section 225C.2, subsection 9, Code 2019, is amended
24by striking the subsection.
25 Sec. 3. Section 225C.4, subsection 1, Code 2019, is amended
26by adding the following new paragraph:
27 NEW PARAGRAPH. 0c. Assist the state board in planning for
28community-based children’s behavioral health services.
29 Sec. 4. Section 225C.4, subsection 1, paragraphs d and j,
30Code 2019, are amended to read as follows:
31d. Encourage and facilitate coordination of mental health
32and disability services with the objective of developing and
33maintaining in the state a mental health and disability service
34delivery system to provide disability services to all persons
35in this state who need the services, regardless of the place
-1-1of residence or economic circumstances of those persons. The
2administrator shall work with the commission and other state
3agencies, including but not limited to the departments of
4corrections, education, and public health and the state board
5of regents, to develop and implement a strategic plan to expand
6access to qualified mental health workers across the state.
7j. Establish and maintain a data collection and management
8information system oriented to the needs of patients,
9providers, the department, and other programs or facilities in
10accordance with section 225C.6A. The system shall be used to
11identify, collect, and analyze service outcome and performance
12measures data in order to assess the effects of the services on
13the persons utilizing the services. The administrator shall
14annually submit to the commission information collected by the
15department indicating the changes and trends in the mental
16health and disability services system. The administrator shall
17make the outcome data available to the public.
18 Sec. 5. Section 225C.4, subsection 1, Code 2019, is amended
19by adding the following new paragraphs:
20 NEW PARAGRAPH. 0k. Encourage and facilitate coordination
21of children’s behavioral health services with the objective of
22developing and maintaining in the state a children’s behavioral
23health system to provide behavioral health services to all
24children in this state who need the services, regardless of the
25place of residence or economic circumstances of those children.
26The administrator shall work with the state board and other
27state agencies including but not limited to the department of
28education and the department of public health to develop and
29implement a strategic plan to expand access to qualified mental
30health workers across the state.
31 NEW PARAGRAPH. 00k. Establish and maintain a data
32collection and management information system oriented to the
33needs of children utilizing the children’s behavioral health
34system, providers, the department, and other programs or
35facilities in accordance with section 225C.6A. The system
-2-1shall be used to identify, collect, and analyze service
2outcome and performance measures data in order to assess the
3effects of the services on the children utilizing the services.
4The administrator shall annually submit to the state board
5information collected by the department indicating the changes
6and trends in the children’s behavioral health system. The
7administrator shall make the outcome data available to the
8public.
9 Sec. 6. Section 225C.4, subsection 1, paragraph u, Code
102019, is amended by adding the following new subparagraph:
11 NEW SUBPARAGRAPH. (9) School attendance.
12 Sec. 7. Section 225C.6B, subsection 3, Code 2019, is amended
13by adding the following new paragraph:
14 NEW PARAGRAPH. c. Children’s behavioral health services
15provided to eligible children that are not covered under the
16medical assistance program or other third-party payor are the
17responsibility of the county-based regional service system.
18 Sec. 8. NEW SECTION. 225C.51 Children’s behavioral health
19system state board.
201. A children’s behavioral health system state board
21is created as the state body to provide guidance on the
22implementation and management of a children’s behavioral health
23system for the provision of services to children with a serious
24emotional disturbance. The state board’s public voting members
25shall be appointed to four-year staggered terms by the governor
26and are subject to confirmation by the senate. All other
27state board voting members shall be appointed to four-year
28staggered terms and are not subject to confirmation by the
29senate. State board members shall be appointed on the basis of
30interest and experience in the fields of children’s behavioral
31health to ensure adequate representation from persons with life
32experiences and from persons knowledgeable about children’s
33behavioral health services. The department shall provide
34support to the state board, and the board may utilize staff
35support and other assistance provided to the state board by
-3-1other persons. The state board shall meet at least four times
2per year. The membership of the state board shall consist of
3the following persons who, at the time of appointment to the
4state board, are active members of the indicated groups:
5a. The director of the department or the director’s
6designee.
7b. The director of the department of education or the
8director’s designee.
9c. The director of the department of public health or the
10director’s designee.
11d. The director of workforce development or the director’s
12designee.
13e. One member shall be selected from nominees submitted by
14the state court administrator.
15f. One member shall be selected from nominees submitted
16by the early childhood Iowa office in the department of
17management.
18g. One member shall be a member of the mental health and
19disability services commission.
20h. One member shall be a board member or an employee of a
21provider of mental health services to children.
22i. One member shall be a board member or an employee of a
23provider of child welfare services.
24j. One member shall be an administrator of an area education
25agency.
26k. One member shall be an educator, counselor, or
27administrator of a school district.
28l. One member shall be a representative of an established
29advocacy organization whose mission or purpose it is, in part,
30to further goals related to children’s mental health.
31m. One member shall be a parent or guardian of a child
32utilizing behavioral health services.
33n. One member shall be a chief executive officer of a mental
34health and disability services region.
35o. In addition to the voting members, the membership shall
-4-1include four members of the general assembly with one member
2designated by each of the following: the majority leader of
3the senate, the minority leader of the senate, the speaker of
4the house of representatives, and the minority leader of the
5house of representatives. A legislative member serves for a
6term as provided in section 69.16B in a nonvoting, ex officio
7capacity and is not eligible for per diem and expenses as
8provided in section 2.10.
92. The four-year terms shall begin and end as provided in
10section 69.19. Vacancies on the state board shall be filled as
11provided in section 2.32. A member shall not be appointed for
12more than two consecutive four-year terms.
133. The director and the director of the department of
14education, or their designees, shall serve as co-chairpersons
15of the state board. Board members shall not be entitled to a
16per diem as specified in section 7E.6 and shall not be entitled
17to actual and necessary expenses incurred while engaged in
18their official duties.
19 Sec. 9. NEW SECTION. 225C.52 Children’s behavioral health
20system state board — duties.
211. To the extent funding is available, the state board shall
22perform the following duties:
23a. Advise the administrator on the administration of the
24children’s behavioral health system.
25b. Provide consultation services to agencies regarding
26the development of administrative rules for the children’s
27behavioral health system.
28c. Identify behavioral health outcomes and indicators for
29eligible children with a serious emotional disturbance to
30promote children living with their own families and in the
31community.
32d. Submit a written report on or before December 1 of each
33year to the governor and the general assembly. At a minimum,
34the report shall include a summary of all activities undertaken
35by the state board, a summary of state board activities,
-5-1and results from identified behavioral health outcomes and
2indicators for the children’s behavioral health system.
3 Sec. 10. Section 331.388, Code 2019, is amended by adding
4the following new subsections:
5 NEW SUBSECTION. 01. “Children’s behavioral health services”
6means the same as defined in section 225C.2.
7 NEW SUBSECTION. 4A. “Serious emotional disturbance” means
8the same as defined in section 225C.2.
9 NEW SUBSECTION. 4B. “State board” means the children’s
10system state board created in section 225C.51.
11 Sec. 11. Section 331.390, subsection 2, Code 2019, is
12amended by striking the subsection and inserting in lieu
13thereof the following:
142. The governing board shall comply with all of the
15following requirements:
16a. The voting membership of the governing board shall
17consist of at least one board of supervisors member from each
18county comprising the region or their designees.
19b. The membership of the governing board shall also include
20one adult person who utilizes mental health and disability
21services or is an actively involved relative of such an adult
22person. This member shall be designated by the regional
23advisory committee formed by the governing board pursuant to
24paragraph “h”.
25c. The membership of the governing board shall not include
26employees of the department of human services or an unelected
27employee of a county.
28d. The membership of the governing board shall also consist
29of one member representing adult service providers in the
30region. This member shall be designated by the regional
31advisory committee formed by the governing board pursuant to
32paragraph “h”. The member designated in accordance with this
33paragraph shall serve in a nonvoting, ex officio capacity.
34e. The membership of the governing board shall also
35consist of one member representing children’s behavioral
-6-1health services providers in the region. This member shall be
2designated by the regional children’s advisory committee formed
3by the governing board pursuant to paragraph “i”. The member
4designated in accordance with this paragraph shall serve in a
5nonvoting, ex officio capacity.
6f. The membership of the governing board shall also consist
7of one member representing area education agency administrators
8in the region. This member shall be designated by the regional
9children’s advisory committee formed by the governing board
10pursuant to paragraph “i”.
11g. The membership of the governing board shall also
12consist of one member who is a parent of a child who utilizes
13children’s behavioral health services or actively involved
14relatives of such children. This member shall be designated
15by the regional children’s advisory committee formed by the
16governing board pursuant to paragraph “i”.
17h. The governing board shall have a regional advisory
18committee consisting of adults who utilize services or actively
19involved relatives of such adults, service providers, and
20regional governing board members.
21i. The governing board shall have a regional children’s
22advisory committee consisting of parents of children who
23utilize services or actively involved relatives of such
24children, an area education agency administrator, an early
25childhood advocate, a child welfare advocate, a children’s
26behavioral health service provider, a member of the juvenile
27court, a pediatrician, a child care provider, a local law
28enforcement representative, and regional governing board
29members.
30 Sec. 12. Section 331.390, subsection 3, paragraph b, Code
312019, is amended to read as follows:
32b. The regional administrator staff shall include one or
33more coordinators of mental health and disability services
34and one or more coordinators of children’s behavioral
35health services. A coordinator shall possess a bachelor’s
-7-1or higher level degree in a human services-related or
2administration-related field, including but not limited
3to social work, psychology, nursing, or public or business
4administration, from an accredited college or university.
5However, in lieu of a degree in public or business
6administration, a coordinator may provide documentation of
7relevant management experience. An action of a coordinator
8involving a clinical decision shall be made in conjunction with
9a professional who is trained in the delivery of the mental
10health or disability service or children’s behavioral health
11service addressed by the clinical decision. The regional
12administrator shall determine whether referral to a coordinator
13of mental health and disability services or children’s
14behavioral health services is required for a person or child
15 seeking to access a service through a local access point of the
16regional service system or the children’s behavioral health
17system.
18 Sec. 13. Section 331.393, subsection 2, Code 2019, is
19amended by adding the following new paragraphs:
20 NEW PARAGRAPH. i. The scope of children’s behavioral health
21core services. Each service included shall be described and a
22projection of need shall be included.
23 NEW PARAGRAPH. j. The eligibility requirements for
24children’s behavioral health core services under the children’s
25behavioral health system.
26 Sec. 14. Section 331.393, subsection 4, paragraph g,
27subparagraph (1), Code 2019, is amended to read as follows:
28(1) Performance and outcome measures relating to the
29health, safety, education, work performance, and community
30residency of the persons receiving the services.
31 Sec. 15. Section 331.396, subsection 1, paragraph b, Code
322019, is amended to read as follows:
33b. The person is at least eighteen years of age and is a
34resident of this state. However, a person who is seventeen
35years of age, is a resident of this state, and is receiving
-8-1publicly funded children’s services may be considered eligible
2for services through the regional service system during the
3three-month period preceding the person’s eighteenth birthday
4in order to provide a smooth transition from children’s to
5adult services.
6 Sec. 16. Section 331.396, subsection 1, paragraph d, Code
72019, is amended by striking the paragraph.
8 Sec. 17. NEW SECTION. 331.396A Eligibility requirements —
9children’s behavioral health services.
101. A child shall be eligible for behavioral health services
11under the children’s behavioral health system if all of the
12following conditions are met:
13a. The child is under eighteen years of age and is a
14resident of this state.
15b. The child has been diagnosed with a serious emotional
16disturbance.
17c. (1) The child’s family has a family income equal to or
18less than five hundred percent of the federal poverty level as
19defined by the most recently revised poverty income guidelines
20published by the United States department of health and human
21services.
22(2) Notwithstanding subparagraph (1), a child’s family
23whose household income is between one hundred fifty percent
24but not more than five hundred percent of the federal poverty
25level shall be eligible for behavioral health services subject
26to a copayment, a single statewide sliding fee scale, or other
27cost-sharing requirements approved by the department.
28 Sec. 18. NEW SECTION. 331.397A Children’s behavioral health
29core services.
301. For the purposes of this section, unless the context
31otherwise requires, “domain” means a set of similar behavioral
32health services that can be provided depending on a child’s
33service needs.
342. a. (1) A region shall work with children’s behavioral
35health service providers to ensure that services in the
-9-1required behavioral health core service domains in subsection
24 are available to children who are residents of the region,
3regardless of any potential payment source for the services.
4(2) Subject to the available appropriations, the director
5of human services shall ensure the behavioral health core
6service domains listed in subsection 4 are covered services
7for the medical assistance program under chapter 249A to the
8greatest extent allowable under federal regulations. The
9medical assistance program shall reimburse Medicaid enrolled
10providers for Medicaid covered services under subsection 4 when
11the services are medically necessary, the Medicaid enrolled
12provider submits an appropriate claim for such services, and
13no other third-party payor is responsible for reimbursement
14of such services. Within the funds available, the region
15shall pay for such services for eligible children when payment
16through the medical assistance program or another third-party
17payment is not available, unless the child is on a waiting list
18for such payment or it has been determined that the child does
19not meet the eligibility criteria for any such service.
20b. Until funding is designed for other service populations,
21eligibility for the service domains listed in this section
22shall be limited to such children who are in need of behavioral
23health services.
243. Pursuant to recommendations made by the state board, the
25department of human services shall adopt rules to define the
26services included in the core domains listed in this section.
27The rules shall provide service definitions, service provider
28standards, service access standards, and service implementation
29dates, and shall provide consistency, to the extent possible,
30with similar service definitions under the medical assistance
31program.
324. The children’s behavioral health core service domains
33shall include all of the following:
34a. Treatment designed to ameliorate a child’s serious
35emotional disturbance, including but not limited to all of the
-10-1following:
2(1) Prevention, early identification, early intervention,
3and education.
4(2) Assessment and evaluation relating to eligibility for
5services.
6(3) Medication prescribing and management.
7(4) Behavioral health outpatient therapy.
8b. Comprehensive facility and community-based crisis
9services, including all of the following:
10(1) Mobile response.
11(2) Crisis stabilization community-based services.
12(3) Crisis stabilization residential services.
13(4) Behavioral health inpatient treatment.
145. A region shall ensure that services within the following
15additional core service domains are available to children not
16eligible for the medical assistance program under chapter 249A
17or receiving other third-party payment for the services, when
18public funds are made available for such services:
19a. Treatment designed to ameliorate a child’s serious
20emotional disturbance including but not limited to behavioral
21health school-based therapy.
22b. Support for community living including but not limited
23to all of the following:
24(1) Family support.
25(2) Peer support.
26(3) Therapeutic foster care.
27(4) Respite care.
28c. Transition services for children to the adult mental
29health system providing an appropriate match with a child’s
30abilities based upon informed, person-centered choices made
31from an array of options including but not limited to all of
32the following:
33(1) Day habilitation.
34(2) Job development.
35(3) Supported employment.
-11- 1(4) Prevocational services.
2(5) Educational services.
3d. Service coordination including physical health and
4primary care that follow the principles of the system of care
5including but not limited to all of the following:
6(1) Care coordination.
7(2) Health homes.
8 Sec. 19. MENTAL HEALTH AND DISABILITY SERVICES REGION
9— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION
10PLAN. Each mental health and disability services region shall
11submit to the department of human services an implementation
12plan to implement children’s behavioral health services
13described under section 331.397A, as enacted in this Act, no
14later than April 1, 2020.
15 Sec. 20. DEPARTMENT OF HUMAN SERVICES — RULES. The
16department of human services shall adopt rules pursuant to
17chapter 17A to administer this Act.
18 Sec. 21. REPEAL. Sections 225C.51, 225C.52, 225C.53, and
19225C.54, Code 2019, are repealed.
20 Sec. 22. CODE EDITOR’S DIRECTIVES. The Code editor may
21change the current subchapter title of chapter 225C, subchapter
22VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”.
23The Code editor may change the current subchapter title of
24chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES
25— REGIONAL SERVICE SYSTEM — CHILDREN’S BEHAVIORAL HEALTH
26SYSTEM”.
27EXPLANATION
28The inclusion of this explanation does not constitute agreement with
29the explanation’s substance by the members of the general assembly.
30This bill relates to mental health and disability services
31including the establishment of a children’s behavioral health
32system and a children’s behavioral health system state board,
33and requiring certain children’s behavioral health core
34services.
35DEFINITIONS. The bill provides definitions for the
-12-1children’s behavioral health system. “Child” or “children”
2is defined as a person or persons under 18 years of age.
3“Children’s behavioral health services” is defined as services
4for children with a “serious emotional disturbance” defined
5as a diagnosable mental, behavioral, or emotional disorder
6of sufficient duration to meet diagnostic criteria specified
7within the most current diagnostic and statistical manual
8of mental disorders published by the American psychiatric
9association that results in a functional impairment, but
10does not include substance use and developmental disorders
11unless such disorders co-occur with such a diagnosable mental,
12behavioral, or emotional disorder. “Children’s system”
13or “children’s behavioral health system” is defined as the
14behavioral health services system for children created in the
15bill.
16CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD. The bill
17establishes a children’s behavioral health system state board
18(state board) as the state body to provide guidance on the
19implementation and management of the children’s behavioral
20health system and for the provision of services to children
21with a serious emotional disturbance.
22The bill specifies the membership of the board and provides
23that the state board’s public voting members shall be appointed
24to four-year staggered terms by the governor and are subject
25to confirmation by the senate. All other state board voting
26members shall be appointed to four-year terms and are not
27subject to senate confirmation. A member shall not be
28appointed for more than two consecutive four-year terms. State
29board members shall be appointed on the basis of interest
30and experience in the fields of children’s behavioral health
31to ensure representation from persons with life experiences
32and persons knowledgeable about children’s behavioral health
33services. The state board shall be co-chaired by the director
34of the department of human services (DHS) and the director of
35the department of education, or their designees. In addition
-13-1to the voting members, the membership shall include four
2members of the general assembly to serve in a nonvoting, ex
3officio capacity on the board.
4The bill requires the DHS to provide support to the state
5board and the state board may utilize staff support and other
6assistance provided to the state board by other persons. The
7state board is required to meet a minimum of four times per
8year.
9The state board is required to advise the administrator
10of the division of mental health and disability services of
11DHS on the administration of the children’s behavioral health
12system, provide consultation services to agencies regarding
13the development of administrative rules for the children’s
14behavioral health system, identify behavioral health outcomes
15and indicators for eligible children with a serious emotional
16disturbance to promote children living with their own families
17and in the community; and submit a written report on or
18before December 1 of each year to the governor and the general
19assembly.
20ELIGIBILITY REQUIREMENTS — CHILDREN’S BEHAVIORAL HEALTH
21SERVICES. Under current law, a person who is 17 years of
22age, is a resident of Iowa, and is receiving publicly funded
23children’s mental health services may be considered eligible
24for mental health services through the adult mental health
25and disability services regional service system during the
26three-month period preceding the person’s 18th birthday in
27order to provide a smooth transition from children’s services
28to adult services. The bill strikes this provision and
29provides that a child shall be eligible for behavioral health
30services under the children’s behavioral health system if the
31child is under 18 years of age, a resident of Iowa, has been
32diagnosed with a serious emotional disturbance, and the child’s
33family has a household income equal to or less than 500 percent
34of the federal poverty level, except that a child’s family
35whose household income is between 150 percent but not more than
-14-1500 percent of the federal poverty level shall be eligible for
2behavioral health services subject to a copayment, a single
3statewide sliding fee scale, or other cost-sharing requirements
4approved by DHS. The bill does not apply to intellectual
5disability services or brain injury services for children under
6the children’s behavioral health system.
7CHILDREN’S BEHAVIORAL HEALTH SYSTEM — CORE SERVICES. The
8bill provides that, subject to available appropriations, the
9director of DHS shall ensure that the children’s behavioral
10health core service domains, as specified in the bill, are
11covered services for the medical assistance program under Code
12chapter 249A to the greatest extent allowable under federal
13regulations. The bill provides the medical assistance program
14shall reimburse Medicaid enrolled providers for Medicaid
15covered services when the services are medically necessary, the
16Medicaid enrolled provider submits an appropriate claim for
17such services, and no other third-party payor is responsible
18for reimbursement of such services. Within the funds
19available, each mental health and disability services region
20is required to pay for such services for eligible children
21when payment through the medical assistance program or another
22third-party payment is not available, unless a child is on a
23waiting list for such payment or it has been determined that
24the child does not meet the eligibility criteria for any such
25service.
26The bill provides that until funding is designed for other
27service populations, eligibility for the core services shall be
28limited to such children who are in need of behavioral health
29services.
30The bill requires DHS to adopt rules pursuant to
31recommendations made by the state board to define the services
32included in the core domains. The rules shall provide service
33definitions, service provider standards, service access
34standards, and service implementation dates, and shall also
35provide consistency, to the extent possible, with similar
-15-1service definitions under the medical assistance program.
2The bill requires each mental health and disability
3services region to submit to DHS plans to implement children’s
4behavioral health services no later than April 1, 2020.
5MENTAL HEALTH AND DISABILITY SERVICES — ADMINISTRATOR’S
6DUTIES. The bill requires the administrator of the division
7of mental health and disability services of DHS to assist
8the state board in planning for community-based children’s
9behavioral health services and to encourage and facilitate
10coordination of children’s behavioral health services with
11the objective of developing and maintaining in the state a
12children’s behavioral health system to provide behavioral
13health services to all children in this state who need the
14services, regardless of the place of residence or economic
15circumstances of those children. The administrator shall work
16with the state board and other state agencies, including but
17not limited to the departments of education and public health,
18to develop and implement a strategic plan to expand access to
19qualified mental health workers across the state.
20The bill requires the administrator to establish and
21maintain a data collection and management information system
22oriented to the needs of children utilizing the children’s
23behavioral health system, providers, DHS, and other programs or
24facilities in accordance with the disability services system
25data repository established in Code section 225C.6A. The
26system shall be used to identify, collect, and analyze service
27outcome and performance measures data in order to assess the
28effects of the services on the children utilizing the services.
29The administrator shall annually submit to the state board
30information collected by DHS indicating the changes and trends
31in the children’s behavioral health system. The administrator
32shall make the outcome data available to the public.
33Current law requires the administrator to enter into
34performance-based contracts with mental health and disability
35services regional administrators which may include requirements
-16-1for the regional service system to attain outcomes within
2a specified range of acceptable performance in certain
3categories. The bill expands the categories to include a
4school attendance category.
5STATE AND REGIONAL DISABILITY SERVICE SYSTEMS. Current law
6provides that the publicly financed disability services for
7persons with mental illness, intellectual disability or other
8developmental disability, or brain injury in Iowa shall be
9provided by DHS and the counties operating together as regions
10and provides for financial and administrative responsibility
11for such services. The bill provides that children’s
12behavioral health services provided to eligible children that
13are not covered under the medical assistance program or other
14third-party payor are the responsibility of the mental health
15and disabilities regional service system.
16MENTAL HEALTH AND DISABILITY SERVICES REGIONS. The bill
17makes changes to the mental health and disability services
18regional governing board (governing board). The governing
19board membership shall consist of at least one board of
20supervisors member from each county comprising the region
21who shall be a voting member; one adult person who utilizes
22mental health and disability services or is an actively
23involved relative of such an adult person designated by the
24regional advisory committee formed by the governing board;
25one member representing adult service providers in the region
26designated by the regional advisory committee formed by the
27governing board, who shall serve in a nonvoting, ex officio
28capacity; one member representing children’s behavioral health
29service providers in the region designated by the regional
30children’s advisory committee formed by the governing board,
31who shall serve in a nonvoting, ex officio capacity; one member
32representing area education agency administrators in the region
33designated by the regional children’s advisory committee formed
34by the governing board; and one member who is a parent of a
35child who utilizes children’s behavioral health services or
-17-1actively involved relatives of such children designated by the
2regional children’s advisory committee. The membership of
3the governing board shall not include employees of DHS or an
4unelected employee of a county.
5The bill adds to the regional administrator staff one or more
6coordinators of children’s behavioral health services.
7The bill requires a mental health and disability region to
8include provisions relating to eligibility requirements for
9children’s behavioral health core services under the children’s
10behavioral health system and performance and outcome measures
11relating to education in a region’s annual service and budget
12plan.
13The bill makes technical changes to Code section 225C.2(9)
14by striking the term “person with a disability” as that term
15is not used in Code chapter 225C (mental health and disability
16services) and to Code section 225C.4 to include mental health
17services in references to disability services in that Code
18section.
19The bill repeals 2019 Code sections 225C.51, 225C.52,
20225C.53, and 225C.54. The bill replaces 2019 Code sections
21225C.51 and 225C.52 with new content in the bill.
-18-hb/rh