Print
House File 690 - 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
32currently utilizing or who has utilized behavioral health
33services.
34n. One member shall be a sheriff.
35o. One member shall be a pediatrician.
-4- 1p. One member shall be a representative from the health care
2system.
3q. One member shall be a chief executive officer of a mental
4health and disability services region.
5r. In addition to the voting members, the membership shall
6include four members of the general assembly with one member
7designated by each of the following: the majority leader of
8the senate, the minority leader of the senate, the speaker of
9the house of representatives, and the minority leader of the
10house of representatives. A legislative member serves for a
11term as provided in section 69.16B in a nonvoting, ex officio
12capacity and is not eligible for per diem and expenses as
13provided in section 2.10.
142. The four-year terms shall begin and end as provided in
15section 69.19. Vacancies on the state board shall be filled as
16provided in section 2.32. A member shall not be appointed for
17more than two consecutive four-year terms.
183. The director and the director of the department of
19education, or their designees, shall serve as co-chairpersons
20of the state board. Board members shall not be entitled to a
21per diem as specified in section 7E.6 and shall not be entitled
22to actual and necessary expenses incurred while engaged in
23their official duties.
24 Sec. 9. NEW SECTION. 225C.52 Children’s behavioral health
25system state board — duties.
261. To the extent funding is available, the state board shall
27perform the following duties:
28a. Advise the administrator on the administration of the
29children’s behavioral health system.
30b. Provide consultation services to agencies regarding
31the development of administrative rules for the children’s
32behavioral health system.
33c. Identify behavioral health outcomes and indicators for
34eligible children with a serious emotional disturbance to
35promote children living with their own families and in the
-5-1community.
2d. Submit a written report on or before December 1 of each
3year to the governor and the general assembly. At a minimum,
4the report shall include a summary of all activities undertaken
5by the state board, a summary of state board activities,
6and results from identified behavioral health outcomes and
7indicators for the children’s behavioral health system.
8 Sec. 10. Section 331.388, Code 2019, is amended by adding
9the following new subsections:
10 NEW SUBSECTION. 01. “Children’s behavioral health services”
11means the same as defined in section 225C.2.
12 NEW SUBSECTION. 4A. “Serious emotional disturbance” means
13the same as defined in section 225C.2.
14 NEW SUBSECTION. 4B. “State board” means the children’s
15system state board created in section 225C.51.
16 Sec. 11. Section 331.390, subsection 2, Code 2019, is
17amended by striking the subsection and inserting in lieu
18thereof the following:
192. The governing board shall comply with all of the
20following requirements:
21a. The voting membership of the governing board shall
22consist of at least one board of supervisors member from each
23county comprising the region or their designees.
24b. The membership of the governing board shall also include
25one adult person who utilizes mental health and disability
26services or is an actively involved relative of such an adult
27person. This member shall be designated by the regional
28advisory committee formed by the governing board pursuant to
29paragraph “h”.
30c. The membership of the governing board shall not include
31employees of the department of human services or an unelected
32employee of a county.
33d. The membership of the governing board shall also consist
34of one member representing adult service providers in the
35region. This member shall be designated by the regional
-6-1advisory committee formed by the governing board pursuant to
2paragraph “h”. The member designated in accordance with this
3paragraph shall serve in a nonvoting, ex officio capacity.
4e. The membership of the governing board shall also
5consist of one member representing children’s behavioral
6health services providers in the region. This member shall be
7designated by the regional children’s advisory committee formed
8by the governing board pursuant to paragraph “i”. The member
9designated in accordance with this paragraph shall serve in a
10nonvoting, ex officio capacity.
11f. The membership of the governing board shall also consist
12of one member representing area education agency administrators
13in the region. This member shall be designated by the regional
14children’s advisory committee formed by the governing board
15pursuant to paragraph “i”.
16g. The membership of the governing board shall also
17consist of one member who is a parent of a child who utilizes
18children’s behavioral health services or actively involved
19relatives of such children. This member shall be designated
20by the regional children’s advisory committee formed by the
21governing board pursuant to paragraph “i”.
22h. The governing board shall have a regional advisory
23committee consisting of adults who utilize services or actively
24involved relatives of such adults, service providers, and
25regional governing board members.
26i. The governing board shall have a regional children’s
27advisory committee consisting of parents of children who
28utilize services or actively involved relatives of such
29children, an area education agency administrator, an early
30childhood advocate, a child welfare advocate, a children’s
31behavioral health service provider, a member of the juvenile
32court, a pediatrician, a child care provider, a local law
33enforcement representative, and regional governing board
34members.
35 Sec. 12. Section 331.390, subsection 3, paragraph b, Code
-7-12019, is amended to read as follows:
2b. The regional administrator staff shall include one or
3more coordinators of mental health and disability services
4and one or more coordinators of children’s behavioral
5health services. A coordinator shall possess a bachelor’s
6or higher level degree in a human services-related or
7administration-related field, including but not limited
8to social work, psychology, nursing, or public or business
9administration, from an accredited college or university.
10However, in lieu of a degree in public or business
11administration, a coordinator may provide documentation of
12relevant management experience. An action of a coordinator
13involving a clinical decision shall be made in conjunction with
14a professional who is trained in the delivery of the mental
15health or disability service or children’s behavioral health
16service addressed by the clinical decision. The regional
17administrator shall determine whether referral to a coordinator
18of mental health and disability services or children’s
19behavioral health services is required for a person or child
20 seeking to access a service through a local access point of the
21regional service system or the children’s behavioral health
22system.
23 Sec. 13. Section 331.393, subsection 2, Code 2019, is
24amended by adding the following new paragraphs:
25 NEW PARAGRAPH. i. The scope of children’s behavioral health
26core services. Each service included shall be described and a
27projection of need shall be included.
28 NEW PARAGRAPH. j. The eligibility requirements for
29children’s behavioral health core services under the children’s
30behavioral health system.
31 Sec. 14. Section 331.393, subsection 4, paragraph g,
32subparagraph (1), Code 2019, is amended to read as follows:
33(1) Performance and outcome measures relating to the
34health, safety, education, work performance, and community
35residency of the persons receiving the services.
-8-1 Sec. 15. Section 331.396, subsection 1, paragraph b, Code
22019, is amended to read as follows:
3b. The person is at least eighteen years of age and is a
4resident of this state. However, a person who is seventeen
5years of age, is a resident of this state, and is receiving
6publicly funded children’s services may be considered eligible
7for services through the regional service system during the
8three-month period preceding the person’s eighteenth birthday
9in order to provide a smooth transition from children’s to
10adult services.
11 Sec. 16. Section 331.396, subsection 1, paragraph d, Code
122019, is amended by striking the paragraph.
13 Sec. 17. NEW SECTION. 331.396A Eligibility requirements —
14children’s behavioral health services.
15A child shall be eligible for behavioral health services
16under the children’s behavioral health system if all of the
17following conditions are met:
181. The child is under eighteen years of age and is a
19resident of this state.
202. The child has been diagnosed with a serious emotional
21disturbance.
223. a. The child’s family has a family income equal to or
23less than five hundred percent of the federal poverty level as
24defined by the most recently revised poverty income guidelines
25published by the United States department of health and human
26services.
27b. Notwithstanding subparagraph (1), a child’s family whose
28household income is between one hundred fifty percent but not
29more than five hundred percent of the federal poverty level
30shall be eligible for behavioral health services subject to
31a copayment, a single statewide sliding fee scale, or other
32cost-sharing requirements approved by the department.
33 Sec. 18. NEW SECTION. 331.397A Children’s behavioral health
34core services.
351. For the purposes of this section, unless the context
-9-1otherwise requires, “domain” means a set of similar behavioral
2health services that can be provided depending on a child’s
3service needs.
42. a. (1) A region shall work with children’s behavioral
5health service providers to ensure that services in the
6required behavioral health core service domains in subsection
74 are available to children who are residents of the region,
8regardless of any potential payment source for the services.
9(2) Subject to the available appropriations, the director
10of human services shall ensure the behavioral health core
11service domains listed in subsection 4 are covered services
12for the medical assistance program under chapter 249A to the
13greatest extent allowable under federal regulations. The
14medical assistance program shall reimburse Medicaid enrolled
15providers for Medicaid covered services under subsection 4 when
16the services are medically necessary, the Medicaid enrolled
17provider submits an appropriate claim for such services, and
18no other third-party payor is responsible for reimbursement
19of such services. Within the funds available, the region
20shall pay for such services for eligible children when payment
21through the medical assistance program or another third-party
22payment is not available, unless the child is on a waiting list
23for such payment or it has been determined that the child does
24not meet the eligibility criteria for any such service.
25b. Until funding is designed for other service populations,
26eligibility for the service domains listed in this section
27shall be limited to such children who are in need of behavioral
28health services.
293. Pursuant to recommendations made by the state board, the
30department of human services shall adopt rules to define the
31services included in the core domains listed in this section.
32The rules shall provide service definitions, service provider
33standards, service access standards, and service implementation
34dates, and shall provide consistency, to the extent possible,
35with similar service definitions under the medical assistance
-10-1program.
24. The children’s behavioral health core service domains
3shall include all of the following:
4a. Treatment designed to ameliorate a child’s serious
5emotional disturbance, including but not limited to all of the
6following:
7(1) Prevention, early identification, early intervention,
8and education.
9(2) Assessment and evaluation relating to eligibility for
10services.
11(3) Medication prescribing and management.
12(4) Behavioral health outpatient therapy.
13b. Comprehensive facility and community-based crisis
14services regardless of a diagnosis of a serious emotional
15disturbance, including all of the following:
16(1) Mobile response.
17(2) Crisis stabilization community-based services.
18(3) Crisis stabilization residential services.
19(4) Behavioral health inpatient treatment.
20(5) A statewide twenty-four-hour crisis hotline.
215. A region shall ensure that services within the following
22additional core service domains are available to children not
23eligible for the medical assistance program under chapter 249A
24or receiving other third-party payment for the services, when
25public funds are made available for such services:
26a. Treatment designed to ameliorate a child’s serious
27emotional disturbance including but not limited to behavioral
28health school-based therapy.
29b. Support for community living including but not limited
30to all of the following:
31(1) Family support.
32(2) Peer support.
33(3) Therapeutic foster care.
34(4) Respite care.
35c. Transition services for children to the adult mental
-11-1health system providing an appropriate match with a child’s
2abilities based upon informed, person-centered choices made
3from an array of options including but not limited to all of
4the following:
5(1) Day habilitation.
6(2) Job development.
7(3) Supported employment.
8(4) Prevocational services.
9(5) Educational services.
10d. Service coordination including physical health and
11primary care that follow the principles of the system of care
12including but not limited to all of the following:
13(1) Care coordination.
14(2) Health homes.
15 Sec. 19. MENTAL HEALTH AND DISABILITY SERVICES REGION
16— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION
17PLAN. Each mental health and disability services region shall
18submit to the department of human services an implementation
19plan to implement children’s behavioral health services
20described under section 331.397A, as enacted in this Act, no
21later than April 1, 2020.
22 Sec. 20. DEPARTMENT OF HUMAN SERVICES — RULES. The
23department of human services shall submit a notice of intended
24action to the administrative rules coordinator and the
25Iowa administrative code editor pursuant to section 17A.4,
26subsection 1, paragraph “a”, not later than January 1, 2020,
27for the adoption of rules to implement this Act.
28 Sec. 21. REPEAL. Sections 225C.51, 225C.52, 225C.53, and
29225C.54, Code 2019, are repealed.
30 Sec. 22. CODE EDITOR’S DIRECTIVES. The Code editor may
31change the current subchapter title of chapter 225C, subchapter
32VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”.
33The Code editor may change the current subchapter title of
34chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES
35— REGIONAL SERVICE SYSTEM — CHILDREN’S BEHAVIORAL HEALTH
-12-1SYSTEM”.
2EXPLANATION
3The inclusion of this explanation does not constitute agreement with
4the explanation’s substance by the members of the general assembly.
5This bill relates to mental health and disability services
6including the establishment of a children’s behavioral health
7system and a children’s behavioral health system state board,
8and requiring certain children’s behavioral health core
9services.
10DEFINITIONS. The bill provides definitions for the
11children’s behavioral health system. “Child” or “children”
12is defined as a person or persons under 18 years of age.
13“Children’s behavioral health services” is defined as services
14for children with a “serious emotional disturbance” defined
15as a diagnosable mental, behavioral, or emotional disorder
16of sufficient duration to meet diagnostic criteria specified
17within the most current diagnostic and statistical manual
18of mental disorders published by the American psychiatric
19association that results in a functional impairment, but
20does not include substance use and developmental disorders
21unless such disorders co-occur with such a diagnosable mental,
22behavioral, or emotional disorder. “Children’s system”
23or “children’s behavioral health system” is defined as the
24behavioral health services system for children created in the
25bill.
26CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD. The bill
27establishes a children’s behavioral health system state board
28(state board) as the state body to provide guidance on the
29implementation and management of the children’s behavioral
30health system and for the provision of services to children
31with a serious emotional disturbance.
32The bill specifies the membership of the board and provides
33that the state board’s public voting members shall be appointed
34to four-year staggered terms by the governor and are subject
35to confirmation by the senate. All other state board voting
-13-1members shall be appointed to four-year terms and are not
2subject to senate confirmation. A member shall not be
3appointed for more than two consecutive four-year terms. State
4board members shall be appointed on the basis of interest
5and experience in the fields of children’s behavioral health
6to ensure representation from persons with life experiences
7and persons knowledgeable about children’s behavioral health
8services. The state board shall be co-chaired by the director
9of the department of human services (DHS) and the director of
10the department of education, or their designees. In addition
11to the voting members, the membership shall include four
12members of the general assembly to serve in a nonvoting, ex
13officio capacity on the board.
14The bill requires the DHS to provide support to the state
15board and the state board may utilize staff support and other
16assistance provided to the state board by other persons. The
17state board is required to meet a minimum of four times per
18year.
19The state board is required to advise the administrator
20of the division of mental health and disability services of
21DHS on the administration of the children’s behavioral health
22system, provide consultation services to agencies regarding
23the development of administrative rules for the children’s
24behavioral health system, identify behavioral health outcomes
25and indicators for eligible children with a serious emotional
26disturbance to promote children living with their own families
27and in the community; and submit a written report on or
28before December 1 of each year to the governor and the general
29assembly.
30ELIGIBILITY REQUIREMENTS — CHILDREN’S BEHAVIORAL HEALTH
31SERVICES. Under current law, a person who is 17 years of
32age, is a resident of Iowa, and is receiving publicly funded
33children’s mental health services may be considered eligible
34for mental health services through the adult mental health
35and disability services regional service system during the
-14-1three-month period preceding the person’s 18th birthday in
2order to provide a smooth transition from children’s services
3to adult services. The bill strikes this provision and
4provides that a child shall be eligible for behavioral health
5services under the children’s behavioral health system if the
6child is under 18 years of age, a resident of Iowa, has been
7diagnosed with a serious emotional disturbance, and the child’s
8family has a household income equal to or less than 500 percent
9of the federal poverty level, except that a child’s family
10whose household income is between 150 percent but not more than
11500 percent of the federal poverty level shall be eligible for
12behavioral health services subject to a copayment, a single
13statewide sliding fee scale, or other cost-sharing requirements
14approved by DHS. The bill does not apply to intellectual
15disability services or brain injury services for children under
16the children’s behavioral health system.
17CHILDREN’S BEHAVIORAL HEALTH SYSTEM — CORE SERVICES. The
18bill provides that, subject to available appropriations, the
19director of DHS shall ensure that the children’s behavioral
20health core service domains, as specified in the bill, are
21covered services for the medical assistance program under Code
22chapter 249A to the greatest extent allowable under federal
23regulations. The bill provides the medical assistance program
24shall reimburse Medicaid enrolled providers for Medicaid
25covered services when the services are medically necessary, the
26Medicaid enrolled provider submits an appropriate claim for
27such services, and no other third-party payor is responsible
28for reimbursement of such services. Within the funds
29available, each mental health and disability services region
30is required to pay for such services for eligible children
31when payment through the medical assistance program or another
32third-party payment is not available, unless a child is on a
33waiting list for such payment or it has been determined that
34the child does not meet the eligibility criteria for any such
35service.
-15- 1The bill provides that until funding is designed for other
2service populations, eligibility for the core services shall be
3limited to such children who are in need of behavioral health
4services.
5The bill requires DHS to adopt rules pursuant to
6recommendations made by the state board to define the services
7included in the core domains. The rules shall provide service
8definitions, service provider standards, service access
9standards, and service implementation dates, and shall also
10provide consistency, to the extent possible, with similar
11service definitions under the medical assistance program.
12The bill requires each mental health and disability
13services region to submit to DHS plans to implement children’s
14behavioral health services no later than April 1, 2020.
15MENTAL HEALTH AND DISABILITY SERVICES — ADMINISTRATOR’S
16DUTIES. The bill requires the administrator of the division
17of mental health and disability services of DHS to assist
18the state board in planning for community-based children’s
19behavioral health services and to encourage and facilitate
20coordination of children’s behavioral health services with
21the objective of developing and maintaining in the state a
22children’s behavioral health system to provide behavioral
23health services to all children in this state who need the
24services, regardless of the place of residence or economic
25circumstances of those children. The administrator shall work
26with the state board and other state agencies, including but
27not limited to the departments of education and public health,
28to develop and implement a strategic plan to expand access to
29qualified mental health workers across the state.
30The bill requires the administrator to establish and
31maintain a data collection and management information system
32oriented to the needs of children utilizing the children’s
33behavioral health system, providers, DHS, and other programs or
34facilities in accordance with the disability services system
35data repository established in Code section 225C.6A. The
-16-1system shall 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 DHS indicating the changes and trends
6in the children’s behavioral health system. The administrator
7shall make the outcome data available to the public.
8Current law requires the administrator to enter into
9performance-based contracts with mental health and disability
10services regional administrators which may include requirements
11for the regional service system to attain outcomes within
12a specified range of acceptable performance in certain
13categories. The bill expands the categories to include a
14school attendance category.
15STATE AND REGIONAL DISABILITY SERVICE SYSTEMS. Current law
16provides that the publicly financed disability services for
17persons with mental illness, intellectual disability or other
18developmental disability, or brain injury in Iowa shall be
19provided by DHS and the counties operating together as regions
20and provides for financial and administrative responsibility
21for such services. The bill provides that children’s
22behavioral health services provided to eligible children that
23are not covered under the medical assistance program or other
24third-party payor are the responsibility of the mental health
25and disabilities regional service system.
26MENTAL HEALTH AND DISABILITY SERVICES REGIONS. The bill
27makes changes to the mental health and disability services
28regional governing board (governing board). The governing
29board membership shall consist of at least one board of
30supervisors member from each county comprising the region
31who shall be a voting member; one adult person who utilizes
32mental health and disability services or is an actively
33involved relative of such an adult person designated by the
34regional advisory committee formed by the governing board;
35one member representing adult service providers in the region
-17-1designated by the regional advisory committee formed by the
2governing board, who shall serve in a nonvoting, ex officio
3capacity; one member representing children’s behavioral health
4service providers in the region designated by the regional
5children’s advisory committee formed by the governing board,
6who shall serve in a nonvoting, ex officio capacity; one member
7representing area education agency administrators in the region
8designated by the regional children’s advisory committee formed
9by the governing board; and one member who is a parent of a
10child who utilizes children’s behavioral health services or
11actively involved relatives of such children designated by the
12regional children’s advisory committee. The membership of
13the governing board shall not include employees of DHS or an
14unelected employee of a county.
15The bill adds to the regional administrator staff one or more
16coordinators of children’s behavioral health services.
17The bill requires a mental health and disability region to
18include provisions relating to eligibility requirements for
19children’s behavioral health core services under the children’s
20behavioral health system and performance and outcome measures
21relating to education in a region’s annual service and budget
22plan.
23RULES. The bill requires DHS to submit a notice of intended
24action to the administrative rules coordinator and the Iowa
25administrative code editor not later than January 1, 2020, for
26the adoption of rules to implement the bill.
27MISCELLANEOUS CODE CHANGES. The bill makes technical
28changes to Code section 225C.2(9) by striking the term “person
29with a disability” as that term is not used in Code chapter
30225C (mental health and disability services) and to Code
31section 225C.4 to include mental health services in references
32to disability services in that Code section.
33REPEALS. The bill repeals 2019 Code sections 225C.51,
34225C.52, 225C.53, and 225C.54. The bill replaces 2019 Code
35sections 225C.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
32currently utilizing or who has utilized behavioral health
33services.
34n. One member shall be a sheriff.
35o. One member shall be a pediatrician.
-4- 1p. One member shall be a representative from the health care
2system.
3q. One member shall be a chief executive officer of a mental
4health and disability services region.
5r. In addition to the voting members, the membership shall
6include four members of the general assembly with one member
7designated by each of the following: the majority leader of
8the senate, the minority leader of the senate, the speaker of
9the house of representatives, and the minority leader of the
10house of representatives. A legislative member serves for a
11term as provided in section 69.16B in a nonvoting, ex officio
12capacity and is not eligible for per diem and expenses as
13provided in section 2.10.
142. The four-year terms shall begin and end as provided in
15section 69.19. Vacancies on the state board shall be filled as
16provided in section 2.32. A member shall not be appointed for
17more than two consecutive four-year terms.
183. The director and the director of the department of
19education, or their designees, shall serve as co-chairpersons
20of the state board. Board members shall not be entitled to a
21per diem as specified in section 7E.6 and shall not be entitled
22to actual and necessary expenses incurred while engaged in
23their official duties.
24 Sec. 9. NEW SECTION. 225C.52 Children’s behavioral health
25system state board — duties.
261. To the extent funding is available, the state board shall
27perform the following duties:
28a. Advise the administrator on the administration of the
29children’s behavioral health system.
30b. Provide consultation services to agencies regarding
31the development of administrative rules for the children’s
32behavioral health system.
33c. Identify behavioral health outcomes and indicators for
34eligible children with a serious emotional disturbance to
35promote children living with their own families and in the
-5-1community.
2d. Submit a written report on or before December 1 of each
3year to the governor and the general assembly. At a minimum,
4the report shall include a summary of all activities undertaken
5by the state board, a summary of state board activities,
6and results from identified behavioral health outcomes and
7indicators for the children’s behavioral health system.
8 Sec. 10. Section 331.388, Code 2019, is amended by adding
9the following new subsections:
10 NEW SUBSECTION. 01. “Children’s behavioral health services”
11means the same as defined in section 225C.2.
12 NEW SUBSECTION. 4A. “Serious emotional disturbance” means
13the same as defined in section 225C.2.
14 NEW SUBSECTION. 4B. “State board” means the children’s
15system state board created in section 225C.51.
16 Sec. 11. Section 331.390, subsection 2, Code 2019, is
17amended by striking the subsection and inserting in lieu
18thereof the following:
192. The governing board shall comply with all of the
20following requirements:
21a. The voting membership of the governing board shall
22consist of at least one board of supervisors member from each
23county comprising the region or their designees.
24b. The membership of the governing board shall also include
25one adult person who utilizes mental health and disability
26services or is an actively involved relative of such an adult
27person. This member shall be designated by the regional
28advisory committee formed by the governing board pursuant to
29paragraph “h”.
30c. The membership of the governing board shall not include
31employees of the department of human services or an unelected
32employee of a county.
33d. The membership of the governing board shall also consist
34of one member representing adult service providers in the
35region. This member shall be designated by the regional
-6-1advisory committee formed by the governing board pursuant to
2paragraph “h”. The member designated in accordance with this
3paragraph shall serve in a nonvoting, ex officio capacity.
4e. The membership of the governing board shall also
5consist of one member representing children’s behavioral
6health services providers in the region. This member shall be
7designated by the regional children’s advisory committee formed
8by the governing board pursuant to paragraph “i”. The member
9designated in accordance with this paragraph shall serve in a
10nonvoting, ex officio capacity.
11f. The membership of the governing board shall also consist
12of one member representing area education agency administrators
13in the region. This member shall be designated by the regional
14children’s advisory committee formed by the governing board
15pursuant to paragraph “i”.
16g. The membership of the governing board shall also
17consist of one member who is a parent of a child who utilizes
18children’s behavioral health services or actively involved
19relatives of such children. This member shall be designated
20by the regional children’s advisory committee formed by the
21governing board pursuant to paragraph “i”.
22h. The governing board shall have a regional advisory
23committee consisting of adults who utilize services or actively
24involved relatives of such adults, service providers, and
25regional governing board members.
26i. The governing board shall have a regional children’s
27advisory committee consisting of parents of children who
28utilize services or actively involved relatives of such
29children, an area education agency administrator, an early
30childhood advocate, a child welfare advocate, a children’s
31behavioral health service provider, a member of the juvenile
32court, a pediatrician, a child care provider, a local law
33enforcement representative, and regional governing board
34members.
35 Sec. 12. Section 331.390, subsection 3, paragraph b, Code
-7-12019, is amended to read as follows:
2b. The regional administrator staff shall include one or
3more coordinators of mental health and disability services
4and one or more coordinators of children’s behavioral
5health services. A coordinator shall possess a bachelor’s
6or higher level degree in a human services-related or
7administration-related field, including but not limited
8to social work, psychology, nursing, or public or business
9administration, from an accredited college or university.
10However, in lieu of a degree in public or business
11administration, a coordinator may provide documentation of
12relevant management experience. An action of a coordinator
13involving a clinical decision shall be made in conjunction with
14a professional who is trained in the delivery of the mental
15health or disability service or children’s behavioral health
16service addressed by the clinical decision. The regional
17administrator shall determine whether referral to a coordinator
18of mental health and disability services or children’s
19behavioral health services is required for a person or child
20 seeking to access a service through a local access point of the
21regional service system or the children’s behavioral health
22system.
23 Sec. 13. Section 331.393, subsection 2, Code 2019, is
24amended by adding the following new paragraphs:
25 NEW PARAGRAPH. i. The scope of children’s behavioral health
26core services. Each service included shall be described and a
27projection of need shall be included.
28 NEW PARAGRAPH. j. The eligibility requirements for
29children’s behavioral health core services under the children’s
30behavioral health system.
31 Sec. 14. Section 331.393, subsection 4, paragraph g,
32subparagraph (1), Code 2019, is amended to read as follows:
33(1) Performance and outcome measures relating to the
34health, safety, education, work performance, and community
35residency of the persons receiving the services.
-8-1 Sec. 15. Section 331.396, subsection 1, paragraph b, Code
22019, is amended to read as follows:
3b. The person is at least eighteen years of age and is a
4resident of this state. However, a person who is seventeen
5years of age, is a resident of this state, and is receiving
6publicly funded children’s services may be considered eligible
7for services through the regional service system during the
8three-month period preceding the person’s eighteenth birthday
9in order to provide a smooth transition from children’s to
10adult services.
11 Sec. 16. Section 331.396, subsection 1, paragraph d, Code
122019, is amended by striking the paragraph.
13 Sec. 17. NEW SECTION. 331.396A Eligibility requirements —
14children’s behavioral health services.
15A child shall be eligible for behavioral health services
16under the children’s behavioral health system if all of the
17following conditions are met:
181. The child is under eighteen years of age and is a
19resident of this state.
202. The child has been diagnosed with a serious emotional
21disturbance.
223. a. The child’s family has a family income equal to or
23less than five hundred percent of the federal poverty level as
24defined by the most recently revised poverty income guidelines
25published by the United States department of health and human
26services.
27b. Notwithstanding subparagraph (1), a child’s family whose
28household income is between one hundred fifty percent but not
29more than five hundred percent of the federal poverty level
30shall be eligible for behavioral health services subject to
31a copayment, a single statewide sliding fee scale, or other
32cost-sharing requirements approved by the department.
33 Sec. 18. NEW SECTION. 331.397A Children’s behavioral health
34core services.
351. For the purposes of this section, unless the context
-9-1otherwise requires, “domain” means a set of similar behavioral
2health services that can be provided depending on a child’s
3service needs.
42. a. (1) A region shall work with children’s behavioral
5health service providers to ensure that services in the
6required behavioral health core service domains in subsection
74 are available to children who are residents of the region,
8regardless of any potential payment source for the services.
9(2) Subject to the available appropriations, the director
10of human services shall ensure the behavioral health core
11service domains listed in subsection 4 are covered services
12for the medical assistance program under chapter 249A to the
13greatest extent allowable under federal regulations. The
14medical assistance program shall reimburse Medicaid enrolled
15providers for Medicaid covered services under subsection 4 when
16the services are medically necessary, the Medicaid enrolled
17provider submits an appropriate claim for such services, and
18no other third-party payor is responsible for reimbursement
19of such services. Within the funds available, the region
20shall pay for such services for eligible children when payment
21through the medical assistance program or another third-party
22payment is not available, unless the child is on a waiting list
23for such payment or it has been determined that the child does
24not meet the eligibility criteria for any such service.
25b. Until funding is designed for other service populations,
26eligibility for the service domains listed in this section
27shall be limited to such children who are in need of behavioral
28health services.
293. Pursuant to recommendations made by the state board, the
30department of human services shall adopt rules to define the
31services included in the core domains listed in this section.
32The rules shall provide service definitions, service provider
33standards, service access standards, and service implementation
34dates, and shall provide consistency, to the extent possible,
35with similar service definitions under the medical assistance
-10-1program.
24. The children’s behavioral health core service domains
3shall include all of the following:
4a. Treatment designed to ameliorate a child’s serious
5emotional disturbance, including but not limited to all of the
6following:
7(1) Prevention, early identification, early intervention,
8and education.
9(2) Assessment and evaluation relating to eligibility for
10services.
11(3) Medication prescribing and management.
12(4) Behavioral health outpatient therapy.
13b. Comprehensive facility and community-based crisis
14services regardless of a diagnosis of a serious emotional
15disturbance, including all of the following:
16(1) Mobile response.
17(2) Crisis stabilization community-based services.
18(3) Crisis stabilization residential services.
19(4) Behavioral health inpatient treatment.
20(5) A statewide twenty-four-hour crisis hotline.
215. A region shall ensure that services within the following
22additional core service domains are available to children not
23eligible for the medical assistance program under chapter 249A
24or receiving other third-party payment for the services, when
25public funds are made available for such services:
26a. Treatment designed to ameliorate a child’s serious
27emotional disturbance including but not limited to behavioral
28health school-based therapy.
29b. Support for community living including but not limited
30to all of the following:
31(1) Family support.
32(2) Peer support.
33(3) Therapeutic foster care.
34(4) Respite care.
35c. Transition services for children to the adult mental
-11-1health system providing an appropriate match with a child’s
2abilities based upon informed, person-centered choices made
3from an array of options including but not limited to all of
4the following:
5(1) Day habilitation.
6(2) Job development.
7(3) Supported employment.
8(4) Prevocational services.
9(5) Educational services.
10d. Service coordination including physical health and
11primary care that follow the principles of the system of care
12including but not limited to all of the following:
13(1) Care coordination.
14(2) Health homes.
15 Sec. 19. MENTAL HEALTH AND DISABILITY SERVICES REGION
16— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION
17PLAN. Each mental health and disability services region shall
18submit to the department of human services an implementation
19plan to implement children’s behavioral health services
20described under section 331.397A, as enacted in this Act, no
21later than April 1, 2020.
22 Sec. 20. DEPARTMENT OF HUMAN SERVICES — RULES. The
23department of human services shall submit a notice of intended
24action to the administrative rules coordinator and the
25Iowa administrative code editor pursuant to section 17A.4,
26subsection 1, paragraph “a”, not later than January 1, 2020,
27for the adoption of rules to implement this Act.
28 Sec. 21. REPEAL. Sections 225C.51, 225C.52, 225C.53, and
29225C.54, Code 2019, are repealed.
30 Sec. 22. CODE EDITOR’S DIRECTIVES. The Code editor may
31change the current subchapter title of chapter 225C, subchapter
32VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”.
33The Code editor may change the current subchapter title of
34chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES
35— REGIONAL SERVICE SYSTEM — CHILDREN’S BEHAVIORAL HEALTH
-12-1SYSTEM”.
2EXPLANATION
3The inclusion of this explanation does not constitute agreement with
4the explanation’s substance by the members of the general assembly.
5This bill relates to mental health and disability services
6including the establishment of a children’s behavioral health
7system and a children’s behavioral health system state board,
8and requiring certain children’s behavioral health core
9services.
10DEFINITIONS. The bill provides definitions for the
11children’s behavioral health system. “Child” or “children”
12is defined as a person or persons under 18 years of age.
13“Children’s behavioral health services” is defined as services
14for children with a “serious emotional disturbance” defined
15as a diagnosable mental, behavioral, or emotional disorder
16of sufficient duration to meet diagnostic criteria specified
17within the most current diagnostic and statistical manual
18of mental disorders published by the American psychiatric
19association that results in a functional impairment, but
20does not include substance use and developmental disorders
21unless such disorders co-occur with such a diagnosable mental,
22behavioral, or emotional disorder. “Children’s system”
23or “children’s behavioral health system” is defined as the
24behavioral health services system for children created in the
25bill.
26CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD. The bill
27establishes a children’s behavioral health system state board
28(state board) as the state body to provide guidance on the
29implementation and management of the children’s behavioral
30health system and for the provision of services to children
31with a serious emotional disturbance.
32The bill specifies the membership of the board and provides
33that the state board’s public voting members shall be appointed
34to four-year staggered terms by the governor and are subject
35to confirmation by the senate. All other state board voting
-13-1members shall be appointed to four-year terms and are not
2subject to senate confirmation. A member shall not be
3appointed for more than two consecutive four-year terms. State
4board members shall be appointed on the basis of interest
5and experience in the fields of children’s behavioral health
6to ensure representation from persons with life experiences
7and persons knowledgeable about children’s behavioral health
8services. The state board shall be co-chaired by the director
9of the department of human services (DHS) and the director of
10the department of education, or their designees. In addition
11to the voting members, the membership shall include four
12members of the general assembly to serve in a nonvoting, ex
13officio capacity on the board.
14The bill requires the DHS to provide support to the state
15board and the state board may utilize staff support and other
16assistance provided to the state board by other persons. The
17state board is required to meet a minimum of four times per
18year.
19The state board is required to advise the administrator
20of the division of mental health and disability services of
21DHS on the administration of the children’s behavioral health
22system, provide consultation services to agencies regarding
23the development of administrative rules for the children’s
24behavioral health system, identify behavioral health outcomes
25and indicators for eligible children with a serious emotional
26disturbance to promote children living with their own families
27and in the community; and submit a written report on or
28before December 1 of each year to the governor and the general
29assembly.
30ELIGIBILITY REQUIREMENTS — CHILDREN’S BEHAVIORAL HEALTH
31SERVICES. Under current law, a person who is 17 years of
32age, is a resident of Iowa, and is receiving publicly funded
33children’s mental health services may be considered eligible
34for mental health services through the adult mental health
35and disability services regional service system during the
-14-1three-month period preceding the person’s 18th birthday in
2order to provide a smooth transition from children’s services
3to adult services. The bill strikes this provision and
4provides that a child shall be eligible for behavioral health
5services under the children’s behavioral health system if the
6child is under 18 years of age, a resident of Iowa, has been
7diagnosed with a serious emotional disturbance, and the child’s
8family has a household income equal to or less than 500 percent
9of the federal poverty level, except that a child’s family
10whose household income is between 150 percent but not more than
11500 percent of the federal poverty level shall be eligible for
12behavioral health services subject to a copayment, a single
13statewide sliding fee scale, or other cost-sharing requirements
14approved by DHS. The bill does not apply to intellectual
15disability services or brain injury services for children under
16the children’s behavioral health system.
17CHILDREN’S BEHAVIORAL HEALTH SYSTEM — CORE SERVICES. The
18bill provides that, subject to available appropriations, the
19director of DHS shall ensure that the children’s behavioral
20health core service domains, as specified in the bill, are
21covered services for the medical assistance program under Code
22chapter 249A to the greatest extent allowable under federal
23regulations. The bill provides the medical assistance program
24shall reimburse Medicaid enrolled providers for Medicaid
25covered services when the services are medically necessary, the
26Medicaid enrolled provider submits an appropriate claim for
27such services, and no other third-party payor is responsible
28for reimbursement of such services. Within the funds
29available, each mental health and disability services region
30is required to pay for such services for eligible children
31when payment through the medical assistance program or another
32third-party payment is not available, unless a child is on a
33waiting list for such payment or it has been determined that
34the child does not meet the eligibility criteria for any such
35service.
-15- 1The bill provides that until funding is designed for other
2service populations, eligibility for the core services shall be
3limited to such children who are in need of behavioral health
4services.
5The bill requires DHS to adopt rules pursuant to
6recommendations made by the state board to define the services
7included in the core domains. The rules shall provide service
8definitions, service provider standards, service access
9standards, and service implementation dates, and shall also
10provide consistency, to the extent possible, with similar
11service definitions under the medical assistance program.
12The bill requires each mental health and disability
13services region to submit to DHS plans to implement children’s
14behavioral health services no later than April 1, 2020.
15MENTAL HEALTH AND DISABILITY SERVICES — ADMINISTRATOR’S
16DUTIES. The bill requires the administrator of the division
17of mental health and disability services of DHS to assist
18the state board in planning for community-based children’s
19behavioral health services and to encourage and facilitate
20coordination of children’s behavioral health services with
21the objective of developing and maintaining in the state a
22children’s behavioral health system to provide behavioral
23health services to all children in this state who need the
24services, regardless of the place of residence or economic
25circumstances of those children. The administrator shall work
26with the state board and other state agencies, including but
27not limited to the departments of education and public health,
28to develop and implement a strategic plan to expand access to
29qualified mental health workers across the state.
30The bill requires the administrator to establish and
31maintain a data collection and management information system
32oriented to the needs of children utilizing the children’s
33behavioral health system, providers, DHS, and other programs or
34facilities in accordance with the disability services system
35data repository established in Code section 225C.6A. The
-16-1system shall 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 DHS indicating the changes and trends
6in the children’s behavioral health system. The administrator
7shall make the outcome data available to the public.
8Current law requires the administrator to enter into
9performance-based contracts with mental health and disability
10services regional administrators which may include requirements
11for the regional service system to attain outcomes within
12a specified range of acceptable performance in certain
13categories. The bill expands the categories to include a
14school attendance category.
15STATE AND REGIONAL DISABILITY SERVICE SYSTEMS. Current law
16provides that the publicly financed disability services for
17persons with mental illness, intellectual disability or other
18developmental disability, or brain injury in Iowa shall be
19provided by DHS and the counties operating together as regions
20and provides for financial and administrative responsibility
21for such services. The bill provides that children’s
22behavioral health services provided to eligible children that
23are not covered under the medical assistance program or other
24third-party payor are the responsibility of the mental health
25and disabilities regional service system.
26MENTAL HEALTH AND DISABILITY SERVICES REGIONS. The bill
27makes changes to the mental health and disability services
28regional governing board (governing board). The governing
29board membership shall consist of at least one board of
30supervisors member from each county comprising the region
31who shall be a voting member; one adult person who utilizes
32mental health and disability services or is an actively
33involved relative of such an adult person designated by the
34regional advisory committee formed by the governing board;
35one member representing adult service providers in the region
-17-1designated by the regional advisory committee formed by the
2governing board, who shall serve in a nonvoting, ex officio
3capacity; one member representing children’s behavioral health
4service providers in the region designated by the regional
5children’s advisory committee formed by the governing board,
6who shall serve in a nonvoting, ex officio capacity; one member
7representing area education agency administrators in the region
8designated by the regional children’s advisory committee formed
9by the governing board; and one member who is a parent of a
10child who utilizes children’s behavioral health services or
11actively involved relatives of such children designated by the
12regional children’s advisory committee. The membership of
13the governing board shall not include employees of DHS or an
14unelected employee of a county.
15The bill adds to the regional administrator staff one or more
16coordinators of children’s behavioral health services.
17The bill requires a mental health and disability region to
18include provisions relating to eligibility requirements for
19children’s behavioral health core services under the children’s
20behavioral health system and performance and outcome measures
21relating to education in a region’s annual service and budget
22plan.
23RULES. The bill requires DHS to submit a notice of intended
24action to the administrative rules coordinator and the Iowa
25administrative code editor not later than January 1, 2020, for
26the adoption of rules to implement the bill.
27MISCELLANEOUS CODE CHANGES. The bill makes technical
28changes to Code section 225C.2(9) by striking the term “person
29with a disability” as that term is not used in Code chapter
30225C (mental health and disability services) and to Code
31section 225C.4 to include mental health services in references
32to disability services in that Code section.
33REPEALS. The bill repeals 2019 Code sections 225C.51,
34225C.52, 225C.53, and 225C.54. The bill replaces 2019 Code
35sections 225C.51 and 225C.52 with new content in the bill.
-18-hb/rh