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House Study Bill 631 - IntroducedA Bill ForAn Act 1relating to the provision and administration of mental
2health, disability, and homemaker-home health aide services
3by the department of human services.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 230.01 Definitions.
2As used in this chapter, unless the context otherwise
3requires:
41. “Administrator” means the administrator of the department
5of human services assigned, in accordance with section
6218.1, to control the state mental health institutes, or that
7administrator’s designee.
82. “Book”, “list”, “record”, or “schedule” kept by a county
9auditor, assessor, treasurer, recorder, sheriff, or other
10county officer means the county system as defined in section
11445.1.
123. “Department” means the department of human services.
134. “Region” means a mental health and disability services
14region formed in accordance with section 331.389.
155. “Regional administrator” means the same as defined in
16section 331.388.
17 Sec. 2. Section 230.1, subsections 1 and 3, Code 2018, are
18amended to read as follows:
191. The necessary and legal costs and expenses attending
20the taking into custody, care, investigation, admission,
21commitment, and support of a person with mental illness
22admitted or committed to a state hospital shall be paid by a
23county the regional administrator on behalf of the person’s
24county of residence or by the state as follows:
25a. If the person is eighteen years of age or older, as
26follows:
27(1) The costs attributed to mental illness shall be paid by
28the regional administrator on behalf of the person’s county of
29residence.
30(2) The costs attributed to a substance-related disorder
31shall be paid by the person’s county of residence.
32(3) The costs attributable to a dual diagnosis of mental
33illness and a substance-related disorder may be split as
34provided in section 226.9C.
35b. By the state as a state case if such person has no
-1-1residence in this state, if the person’s residence is unknown,
2or if the person is under eighteen years of age.
33. A mental health and disability services region or county
4of residence is not liable for costs and expenses associated
5with a person with mental illness unless the costs and expenses
6are for services and other support authorized for the person
7through the regional administrator for the county. For the
8purposes of this chapter, “regional administrator” means the
9same as defined in section 331.388.
10 Sec. 3. Section 230.4, Code 2018, is amended to read as
11follows:
12230.4 Certification to debtor county regional administrator.
13A determination of a person’s county of residence made
14in accordance with section 230.2 or 230.3 shall be sent
15by the court or the county to the county auditor regional
16administrator of the person’s county of residence. The
17certification shall be accompanied by a copy of the evidence
18supporting the determination. The auditor regional
19administrator shall provide the certification to the board of
20supervisors of the auditor’s county region’s governing board,
21and it shall be conclusively presumed that the person has
22residence in a county in the notified county region unless that
23county regional administrator disputes the finding of residence
24as provided in section 331.394.
25 Sec. 4. Section 230.5, Code 2018, is amended to read as
26follows:
27230.5 Nonresidents.
28If a person’s residence is determined in accordance with
29section 230.2 or 230.3 to be in a foreign state or country,
30or is unknown, the court or the county regional administrator
31of the person’s county of residence shall immediately certify
32the determination to the department’s administrator. The
33certification shall be accompanied by a copy of the evidence
34supporting the determination. A court order issued pursuant to
35section 229.13 shall direct that the patient be hospitalized at
-2-1the appropriate state hospital for persons with mental illness.
2 Sec. 5. Section 230.9, Code 2018, is amended to read as
3follows:
4230.9 Subsequent discovery of residence.
5If, after a person has been received by a state hospital
6for persons with mental illness as a state case patient
7whose residence is supposed to be outside this state, the
8administrator determines that the residence of the person
9was, at the time of admission or commitment, in a county of
10this state, the administrator shall certify the determination
11and charge all legal costs and expenses pertaining to the
12admission or commitment and support of the person to the
13regional administrator of the person’s county of residence.
14The certification shall be sent to the regional administrator
15of the person’s county of residence. The certification
16shall be accompanied by a copy of the evidence supporting the
17determination. The costs and expenses shall be collected as
18provided by law in other cases. If the person’s residency
19status has been determined in accordance with section 331.394,
20the legal costs and expenses shall be charged to the regional
21administrator of the person’s county of residence or as a state
22case in accordance with that determination.
23 Sec. 6. Section 230.10, Code 2018, is amended to read as
24follows:
25230.10 Payment of costs.
26All legal costs and expenses attending the taking into
27custody, care, investigation, and admission or commitment of
28a person to a state hospital for persons with mental illness
29under a finding that the person has residency in another
30county of this state shall be charged against the regional
31administrator of the person’s county of residence.
32 Sec. 7. Section 230.11, Code 2018, is amended to read as
33follows:
34230.11 Recovery of costs from state.
35Costs and expenses attending the taking into custody,
-3-1care, and investigation of a person who has been admitted
2or committed to a state hospital, United States department
3of veterans affairs hospital, or other agency of the United
4States government, for persons with mental illness and who
5has no residence in this state or whose residence is unknown,
6including cost of commitment, if any, shall be paid as a
7state case as approved by the administrator. The amount
8of the costs and expenses approved by the administrator is
9appropriated to the department from any money in the state
10treasury not otherwise appropriated. Payment shall be made by
11the department on itemized vouchers executed by the auditor of
12the regional administrator of the person’s county which has
13paid them, and approved by the administrator.
14 Sec. 8. Section 230.12, Code 2018, is amended to read as
15follows:
16230.12 Residency disputes.
17If a dispute arises between different counties or between
18the administrator and a regional administrator for a county as
19to the residence of a person admitted or committed to a state
20hospital for persons with mental illness, the dispute shall be
21resolved as provided in section 331.394.
22 Sec. 9. Section 230.15, subsection 1, Code 2018, is amended
23to read as follows:
241. A person with mental illness and a person legally liable
25for the person’s support remain liable for the support of
26the person with mental illness as provided in this section.
27Persons legally liable for the support of a person with
28mental illness include the spouse of the person, and any
29person bound by contract for support of the person, and,
30with respect to persons with mental illness under eighteen
31years of age only, the father and mother of the person.
32The county auditor regional administrator of the person’s
33county of residence, subject to the direction of the region’s
34governing board of supervisors, shall enforce the obligation
35created in this section as to all sums advanced by the county
-4-1 regional administrator. The liability to the county regional
2administrator incurred by a person with mental illness or a
3person legally liable for the person’s support under this
4section is limited to an amount equal to one hundred percent
5of the cost of care and treatment of the person with mental
6illness at a state mental health institute for one hundred
7twenty days of hospitalization. This limit of liability may
8be reached by payment of the cost of care and treatment of the
9person with mental illness subsequent to a single admission
10or multiple admissions to a state mental health institute
11or, if the person is not discharged as cured, subsequent to
12a single transfer or multiple transfers to a county care
13facility pursuant to section 227.11. After reaching this
14limit of liability, a person with mental illness or a person
15legally liable for the person’s support is liable to the county
16 regional administrator for the care and treatment of the person
17with mental illness at a state mental health institute or,
18if transferred but not discharged as cured, at a county care
19facility in an amount not in excess of the average minimum
20cost of the maintenance of an individual who is physically and
21mentally healthy residing in the individual’s own home, which
22standard shall be established and may from time to time be
23revised by the department of human services. A lien imposed
24by section 230.25 shall not exceed the amount of the liability
25which may be incurred under this section on account of a person
26with mental illness.
27 Sec. 10. Section 230.16, Code 2018, is amended to read as
28follows:
29230.16 Presumption.
30In actions to enforce the liability imposed by section
31230.15, the certificate from the superintendent to the county
32auditor regional administrator of the person’s county of
33residence stating the sums charged in such cases, shall be
34presumptively correct.
35 Sec. 11. Section 230.17, Code 2018, is amended to read as
-5-1follows:
2230.17 Board may compromise lien.
3The board of supervisors of the person’s county of residence
4 is hereby empowered to compromise any and all liabilities to
5the county, created by this chapter, when such compromise is
6deemed to be for the best interests of the county.
7 Sec. 12. Section 230.18, Code 2018, is amended to read as
8follows:
9230.18 Expense in county or private hospitals.
10The estates of persons with mental illness who may be treated
11or confined in any county hospital or home, or in any private
12hospital or sanatorium, and the estates of persons legally
13bound for their support, shall be liable to the county regional
14administrator of the person’s county of residence for the
15reasonable cost of such support.
16 Sec. 13. Section 230.20, Code 2018, is amended to read as
17follows:
18230.20 Billing of patient charges — computation of actual
19costs — cost settlement.
201. The superintendent of each mental health institute
21shall compute by February 1 the average daily patient charges
22and other service charges for which each county regional
23administrator of a person’s county of residence will be billed
24for services provided to patients the person and chargeable to
25the county of residence during the fiscal year beginning the
26following July 1. The department shall certify the amount of
27the charges and notify the counties regional administrator of
28the person’s county of residence of the billing charges.
29a. The superintendent shall separately compute by program
30the average daily patient charge for a mental health institute
31for services provided in the following fiscal year, in
32accordance with generally accepted accounting procedures, by
33totaling the expenditures of the program for the immediately
34preceding calendar year, by adjusting the expenditures
35by a percentage not to exceed the percentage increase in
-6-1the consumer price index for all urban consumers for the
2immediately preceding calendar year, and by dividing the
3adjusted expenditures by the total inpatient days of service
4provided in the program during the immediately preceding
5calendar year. However, the superintendent shall not include
6the following in the computation of the average daily patient
7charge:
8(1) The costs of food, lodging, and other maintenance
9provided to persons not patients of the hospital.
10(2) The costs of certain direct medical services identified
11in administrative rule, which may include but need not be
12limited to X-ray, laboratory, and dental services.
13(3) The costs of outpatient and state placement services.
14(4) The costs of the psychiatric residency program.
15(5) The costs of the chaplain intern program.
16b. The department shall compute the direct medical
17services, outpatient, and state placement services charges, in
18accordance with generally accepted accounting procedures, on
19the basis of the actual cost of the services provided during
20the immediately preceding calendar year. The direct medical
21services, outpatient, and state placement services shall be
22billed directly against the patient who received the services.
232. a. The superintendent shall certify to the department
24the billings to each county the regional administrator of the
25person’s county of residence for services provided to patients
26 the person and chargeable to the county of residence during
27the preceding calendar quarter. The county of residence
28 billings shall be based on the average daily patient charge
29and other service charges computed pursuant to subsection
301, and the number of inpatient days and other service units
31chargeable to the regional administrator of the person’s county
32of residence. However, a county of residence billing shall
33be decreased by an amount equal to reimbursement by a third
34party payor or estimation of such reimbursement from a claim
35submitted by the superintendent to the third party payor for
-7-1the preceding calendar quarter. When the actual third party
2payor reimbursement is greater or less than estimated, the
3difference shall be reflected in the county billing in the
4calendar quarter the actual third party payor reimbursement is
5determined.
6b. The per diem costs billed to each mental health and
7disability services region shall not exceed the per diem costs
8billed to the region in the fiscal year beginning July 1, 2016.
93. The superintendent shall compute in January the actual
10per-patient-per-day cost for each mental health institute for
11the immediately preceding calendar year, in accordance with
12generally accepted accounting procedures, by totaling the
13actual expenditures of the mental health institute for the
14calendar year and by dividing the total actual expenditures
15by the total inpatient days of service provided during the
16calendar year.
174. The department shall certify to the counties regional
18administrator by February 1 the actual per-patient-per-day
19costs, as computed pursuant to subsection 3, and the actual
20costs owed by each county regional administrator itemized
21for each county in the region for the immediately preceding
22calendar year for patients chargeable to the county regional
23administrator. If the actual costs owed by the county regional
24administrator are greater than the charges billed to the county
25 regional administrator pursuant to subsection 2, the department
26shall bill the county regional administrator for the difference
27itemized for each county in the region with the billing for the
28quarter ending June 30. If the actual costs owed by the county
29 regional administrator are less than the charges billed to the
30county regional administrator pursuant to subsection 2, the
31department shall credit the county regional administrator for
32the difference itemized for each county in the region starting
33with the billing for the quarter ending June 30.
345. An individual statement shall be prepared for a patient
35on or before the fifteenth day of the month following the month
-8-1in which the patient leaves the mental health institute, and
2a general statement shall be prepared at least quarterly for
3each county regional administrator itemized for each county
4in the region to which charges are made under this section.
5Except as otherwise required by sections 125.33 and 125.34,
6the general statement shall list the name of each patient
7chargeable to that a county in the region who was served by the
8mental health institute during the preceding month or calendar
9quarter, the amount due on account of each patient, and the
10specific dates for which any third party payor reimbursement
11received by the state is applied to the statement and billing,
12and the county regional administrator shall be billed for
13eighty percent of the stated charge for each patient specified
14in this subsection. The statement prepared for each county
15 regional administrator shall be certified by the department and
16a duplicate statement shall be mailed to the auditor of that
17county.
186. All or any reasonable portion of the charges incurred
19for services provided to a patient, to the most recent date for
20which the charges have been computed, may be paid at any time
21by the patient or by any other person on the patient’s behalf.
22Any payment made by the patient or other person, and any
23federal financial assistance received pursuant to Tit.XVIII
24or XIX of the federal Social Security Act for services rendered
25to a patient, shall be credited against the patient’s account
26and, if the charges paid as described in this subsection have
27previously been billed to a county regional administrator on
28behalf of the person’s county of residence, reflected in the
29mental health institute’s next general statement to that county
30 regional administrator.
317. A superintendent of a mental health institute may request
32that the director of human services enter into a contract
33with a person for the mental health institute to provide
34consultation or treatment services or for fulfilling other
35purposes which are consistent with the purposes stated in
-9-1section 226.1. The contract provisions shall include charges
2which reflect the actual cost of providing the services or
3fulfilling the other purposes. Any income from a contract
4authorized under this subsection may be retained by the
5mental health institute to defray the costs of providing the
6services. Except for a contract voluntarily entered into by a
7county under this subsection, the costs or income associated
8with a contract authorized under this subsection shall not
9be considered in computing charges and per diem costs in
10accordance with the provisions of subsections 1 through 6 of
11this section.
128. The department shall provide a county regional
13administrator with information, which is not otherwise
14confidential under law, in the department’s possession
15concerning a patient whose cost of care is chargeable to the
16county regional administrator, including but not limited to the
17information specified in section 229.24, subsection 3.
18 Sec. 14. Section 230.21, Code 2018, is amended to read as
19follows:
20230.21 Duty of county auditor and treasurer Notice to county
21of residence.
22The county auditor, upon receipt of the duplicate statement
23required by section 230.20, shall enter it to the credit of the
24state in the ledger of state accounts, regional administrator
25 shall furnish to the board of supervisors of the county of
26residence a list of the names of the persons so certified, and
27at once issue a notice authorizing the county treasurer to
28transfer the amount billed to the county by the statement, from
29the county to the general state revenue, which notice shall be
30filed by the treasurer as authority for making the transfer who
31are residents of that county and eligible for mental health
32and disability services funding. The auditor shall promptly
33remit the amount so transferred to the treasurer of state,
34designating the fund to which it belongs.
35 Sec. 15. Section 230.22, Code 2018, is amended to read as
-10-1follows:
2230.22 Penalty.
3Should any county fail If a regional administrator fails
4 to pay the amount billed by a statement submitted pursuant
5to section 230.20 within forty-five days from the date the
6statement is received by the county regional administrator,
7the department shall charge the delinquent county regional
8administrator the penalty of one percent per month on and
9after forty-five days from the date the statement is received
10by the county regional administrator until paid. Provided,
11however, that the penalty shall not be imposed if the county
12 regional administrator has notified the department of error
13or questionable items in the billing, in which event, the
14department shall suspend the penalty only during the period of
15negotiation.
16 Sec. 16. Section 230.25, subsection 1, Code 2018, is amended
17to read as follows:
181. Upon receipt from the county auditor for substance use
19services or the regional administrator for mental health and
20disability services of the list of names furnished pursuant
21to section 230.21, the board of supervisors of the county
22of residence shall make an investigation to determine the
23ability of each person whose name appears on the list, and
24also the ability of any person liable under section 230.15
25for the support of that person, to pay the expenses of that
26person’s hospitalization. If the board finds that neither
27the hospitalized person nor any person legally liable for the
28person’s support is able to pay those expenses, they the board
29 shall direct the county auditor or regional administrator not
30to index the names of any of those persons as would otherwise
31be required by section 230.26. However the board may review
32its finding with respect to any person at any subsequent time
33at which another list is furnished by the auditor county
34auditor or regional administrator upon which that person’s name
35appears. If the board finds upon review that that person or
-11-1those legally liable for the person’s support are presently
2able to pay the expenses of that person’s hospitalization, that
3finding shall apply only to charges stated upon the certificate
4from which the list was drawn up and any subsequent charges
5similarly certified, unless and until the board again changes
6its finding.
7 Sec. 17. Section 230.26, Code 2018, is amended to read as
8follows:
9230.26 Auditor Regional administrator to keep record.
10The auditor of each county regional administrator shall
11keep an accurate account of the cost of the maintenance of
12any patient kept in any institution as provided for in this
13chapter and keep an index of the names of the persons admitted
14or committed from such each county in the region. The name of
15the husband or the wife of such person designating such party
16as the spouse of the person admitted or committed shall also be
17indexed in the same manner as the names of the persons admitted
18or committed are indexed. The book shall be designated as an
19account book or index, and shall have no reference in any place
20to a lien.
21 Sec. 18. Section 230.33, Code 2018, is amended to read as
22follows:
23230.33 Reciprocal agreements.
24The administrator may enter into agreements with other
25states, through their duly constituted authorities, to effect
26the reciprocal return of persons with mental illness and
27persons with an intellectual disability to the contracting
28states, and to effect the reciprocal supervision of persons on
29convalescent leave.
30However, in the case of a proposed transfer of a person with
31mental illness or an intellectual disability from this state,
32final action shall not be taken without the approval either of
33the commission of hospitalization, or of the district court, of
34the county of admission or commitment.
35 Sec. 19. REPEAL. Sections 230.34 and 232.80, Code 2018,
-12-1are repealed.
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 administrative procedures and services
6provided by the department of human services.
7Under current law, expenses and legal costs relating to
8the taking into custody, care, investigation, admission,
9commitment, and support of a person with mental illness
10admitted or committed to a state hospital are sent to the
11county auditor of the person’s county of residence. The county
12auditor submits the bills to the regional administrator of
13the person’s county of residence. The regional administrator
14pays the state hospital for the expenses. The bill amends
15current law to provide such expenses are billed to the regional
16administrator of the person’s county of residence. References
17to the county auditor are amended to refer to the regional
18administrator. The bill removes the definition of auditor from
19the Code, makes technical changes to the location of other
20definitions, and defines region.
21The bill provides that county auditors maintain lists of
22persons receiving substance use services for determination of
23ability to pay hospitalization expenses.
24Code section 232.80 relating to services by a homemaker-home
25health aide providing care to a child in the child’s place of
26residence in preference to removal of the child from the home
27is repealed by the bill.
-13-hb/rj
2health, disability, and homemaker-home health aide services
3by the department of human services.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 230.01 Definitions.
2As used in this chapter, unless the context otherwise
3requires:
41. “Administrator” means the administrator of the department
5of human services assigned, in accordance with section
6218.1, to control the state mental health institutes, or that
7administrator’s designee.
82. “Book”, “list”, “record”, or “schedule” kept by a county
9auditor, assessor, treasurer, recorder, sheriff, or other
10county officer means the county system as defined in section
11445.1.
123. “Department” means the department of human services.
134. “Region” means a mental health and disability services
14region formed in accordance with section 331.389.
155. “Regional administrator” means the same as defined in
16section 331.388.
17 Sec. 2. Section 230.1, subsections 1 and 3, Code 2018, are
18amended to read as follows:
191. The necessary and legal costs and expenses attending
20the taking into custody, care, investigation, admission,
21commitment, and support of a person with mental illness
22admitted or committed to a state hospital shall be paid by a
23county the regional administrator on behalf of the person’s
24county of residence or by the state as follows:
25a. If the person is eighteen years of age or older, as
26follows:
27(1) The costs attributed to mental illness shall be paid by
28the regional administrator on behalf of the person’s county of
29residence.
30(2) The costs attributed to a substance-related disorder
31shall be paid by the person’s county of residence.
32(3) The costs attributable to a dual diagnosis of mental
33illness and a substance-related disorder may be split as
34provided in section 226.9C.
35b. By the state as a state case if such person has no
-1-1residence in this state, if the person’s residence is unknown,
2or if the person is under eighteen years of age.
33. A mental health and disability services region or county
4of residence is not liable for costs and expenses associated
5with a person with mental illness unless the costs and expenses
6are for services and other support authorized for the person
7through the regional administrator for the county. For the
8purposes of this chapter, “regional administrator” means the
9same as defined in section 331.388.
10 Sec. 3. Section 230.4, Code 2018, is amended to read as
11follows:
12230.4 Certification to debtor county regional administrator.
13A determination of a person’s county of residence made
14in accordance with section 230.2 or 230.3 shall be sent
15by the court or the county to the county auditor regional
16administrator of the person’s county of residence. The
17certification shall be accompanied by a copy of the evidence
18supporting the determination. The auditor regional
19administrator shall provide the certification to the board of
20supervisors of the auditor’s county region’s governing board,
21and it shall be conclusively presumed that the person has
22residence in a county in the notified county region unless that
23county regional administrator disputes the finding of residence
24as provided in section 331.394.
25 Sec. 4. Section 230.5, Code 2018, is amended to read as
26follows:
27230.5 Nonresidents.
28If a person’s residence is determined in accordance with
29section 230.2 or 230.3 to be in a foreign state or country,
30or is unknown, the court or the county regional administrator
31of the person’s county of residence shall immediately certify
32the determination to the department’s administrator. The
33certification shall be accompanied by a copy of the evidence
34supporting the determination. A court order issued pursuant to
35section 229.13 shall direct that the patient be hospitalized at
-2-1the appropriate state hospital for persons with mental illness.
2 Sec. 5. Section 230.9, Code 2018, is amended to read as
3follows:
4230.9 Subsequent discovery of residence.
5If, after a person has been received by a state hospital
6for persons with mental illness as a state case patient
7whose residence is supposed to be outside this state, the
8administrator determines that the residence of the person
9was, at the time of admission or commitment, in a county of
10this state, the administrator shall certify the determination
11and charge all legal costs and expenses pertaining to the
12admission or commitment and support of the person to the
13regional administrator of the person’s county of residence.
14The certification shall be sent to the regional administrator
15of the person’s county of residence. The certification
16shall be accompanied by a copy of the evidence supporting the
17determination. The costs and expenses shall be collected as
18provided by law in other cases. If the person’s residency
19status has been determined in accordance with section 331.394,
20the legal costs and expenses shall be charged to the regional
21administrator of the person’s county of residence or as a state
22case in accordance with that determination.
23 Sec. 6. Section 230.10, Code 2018, is amended to read as
24follows:
25230.10 Payment of costs.
26All legal costs and expenses attending the taking into
27custody, care, investigation, and admission or commitment of
28a person to a state hospital for persons with mental illness
29under a finding that the person has residency in another
30county of this state shall be charged against the regional
31administrator of the person’s county of residence.
32 Sec. 7. Section 230.11, Code 2018, is amended to read as
33follows:
34230.11 Recovery of costs from state.
35Costs and expenses attending the taking into custody,
-3-1care, and investigation of a person who has been admitted
2or committed to a state hospital, United States department
3of veterans affairs hospital, or other agency of the United
4States government, for persons with mental illness and who
5has no residence in this state or whose residence is unknown,
6including cost of commitment, if any, shall be paid as a
7state case as approved by the administrator. The amount
8of the costs and expenses approved by the administrator is
9appropriated to the department from any money in the state
10treasury not otherwise appropriated. Payment shall be made by
11the department on itemized vouchers executed by the auditor of
12the regional administrator of the person’s county which has
13paid them, and approved by the administrator.
14 Sec. 8. Section 230.12, Code 2018, is amended to read as
15follows:
16230.12 Residency disputes.
17If a dispute arises between different counties or between
18the administrator and a regional administrator for a county as
19to the residence of a person admitted or committed to a state
20hospital for persons with mental illness, the dispute shall be
21resolved as provided in section 331.394.
22 Sec. 9. Section 230.15, subsection 1, Code 2018, is amended
23to read as follows:
241. A person with mental illness and a person legally liable
25for the person’s support remain liable for the support of
26the person with mental illness as provided in this section.
27Persons legally liable for the support of a person with
28mental illness include the spouse of the person, and any
29person bound by contract for support of the person, and,
30with respect to persons with mental illness under eighteen
31years of age only, the father and mother of the person.
32The county auditor regional administrator of the person’s
33county of residence, subject to the direction of the region’s
34governing board of supervisors, shall enforce the obligation
35created in this section as to all sums advanced by the county
-4-1 regional administrator. The liability to the county regional
2administrator incurred by a person with mental illness or a
3person legally liable for the person’s support under this
4section is limited to an amount equal to one hundred percent
5of the cost of care and treatment of the person with mental
6illness at a state mental health institute for one hundred
7twenty days of hospitalization. This limit of liability may
8be reached by payment of the cost of care and treatment of the
9person with mental illness subsequent to a single admission
10or multiple admissions to a state mental health institute
11or, if the person is not discharged as cured, subsequent to
12a single transfer or multiple transfers to a county care
13facility pursuant to section 227.11. After reaching this
14limit of liability, a person with mental illness or a person
15legally liable for the person’s support is liable to the county
16 regional administrator for the care and treatment of the person
17with mental illness at a state mental health institute or,
18if transferred but not discharged as cured, at a county care
19facility in an amount not in excess of the average minimum
20cost of the maintenance of an individual who is physically and
21mentally healthy residing in the individual’s own home, which
22standard shall be established and may from time to time be
23revised by the department of human services. A lien imposed
24by section 230.25 shall not exceed the amount of the liability
25which may be incurred under this section on account of a person
26with mental illness.
27 Sec. 10. Section 230.16, Code 2018, is amended to read as
28follows:
29230.16 Presumption.
30In actions to enforce the liability imposed by section
31230.15, the certificate from the superintendent to the county
32auditor regional administrator of the person’s county of
33residence stating the sums charged in such cases, shall be
34presumptively correct.
35 Sec. 11. Section 230.17, Code 2018, is amended to read as
-5-1follows:
2230.17 Board may compromise lien.
3The board of supervisors of the person’s county of residence
4 is hereby empowered to compromise any and all liabilities to
5the county, created by this chapter, when such compromise is
6deemed to be for the best interests of the county.
7 Sec. 12. Section 230.18, Code 2018, is amended to read as
8follows:
9230.18 Expense in county or private hospitals.
10The estates of persons with mental illness who may be treated
11or confined in any county hospital or home, or in any private
12hospital or sanatorium, and the estates of persons legally
13bound for their support, shall be liable to the county regional
14administrator of the person’s county of residence for the
15reasonable cost of such support.
16 Sec. 13. Section 230.20, Code 2018, is amended to read as
17follows:
18230.20 Billing of patient charges — computation of actual
19costs — cost settlement.
201. The superintendent of each mental health institute
21shall compute by February 1 the average daily patient charges
22and other service charges for which each county regional
23administrator of a person’s county of residence will be billed
24for services provided to patients the person and chargeable to
25the county of residence during the fiscal year beginning the
26following July 1. The department shall certify the amount of
27the charges and notify the counties regional administrator of
28the person’s county of residence of the billing charges.
29a. The superintendent shall separately compute by program
30the average daily patient charge for a mental health institute
31for services provided in the following fiscal year, in
32accordance with generally accepted accounting procedures, by
33totaling the expenditures of the program for the immediately
34preceding calendar year, by adjusting the expenditures
35by a percentage not to exceed the percentage increase in
-6-1the consumer price index for all urban consumers for the
2immediately preceding calendar year, and by dividing the
3adjusted expenditures by the total inpatient days of service
4provided in the program during the immediately preceding
5calendar year. However, the superintendent shall not include
6the following in the computation of the average daily patient
7charge:
8(1) The costs of food, lodging, and other maintenance
9provided to persons not patients of the hospital.
10(2) The costs of certain direct medical services identified
11in administrative rule, which may include but need not be
12limited to X-ray, laboratory, and dental services.
13(3) The costs of outpatient and state placement services.
14(4) The costs of the psychiatric residency program.
15(5) The costs of the chaplain intern program.
16b. The department shall compute the direct medical
17services, outpatient, and state placement services charges, in
18accordance with generally accepted accounting procedures, on
19the basis of the actual cost of the services provided during
20the immediately preceding calendar year. The direct medical
21services, outpatient, and state placement services shall be
22billed directly against the patient who received the services.
232. a. The superintendent shall certify to the department
24the billings to each county the regional administrator of the
25person’s county of residence for services provided to patients
26 the person and chargeable to the county of residence during
27the preceding calendar quarter. The county of residence
28 billings shall be based on the average daily patient charge
29and other service charges computed pursuant to subsection
301, and the number of inpatient days and other service units
31chargeable to the regional administrator of the person’s county
32of residence. However, a county of residence billing shall
33be decreased by an amount equal to reimbursement by a third
34party payor or estimation of such reimbursement from a claim
35submitted by the superintendent to the third party payor for
-7-1the preceding calendar quarter. When the actual third party
2payor reimbursement is greater or less than estimated, the
3difference shall be reflected in the county billing in the
4calendar quarter the actual third party payor reimbursement is
5determined.
6b. The per diem costs billed to each mental health and
7disability services region shall not exceed the per diem costs
8billed to the region in the fiscal year beginning July 1, 2016.
93. The superintendent shall compute in January the actual
10per-patient-per-day cost for each mental health institute for
11the immediately preceding calendar year, in accordance with
12generally accepted accounting procedures, by totaling the
13actual expenditures of the mental health institute for the
14calendar year and by dividing the total actual expenditures
15by the total inpatient days of service provided during the
16calendar year.
174. The department shall certify to the counties regional
18administrator by February 1 the actual per-patient-per-day
19costs, as computed pursuant to subsection 3, and the actual
20costs owed by each county regional administrator itemized
21for each county in the region for the immediately preceding
22calendar year for patients chargeable to the county regional
23administrator. If the actual costs owed by the county regional
24administrator are greater than the charges billed to the county
25 regional administrator pursuant to subsection 2, the department
26shall bill the county regional administrator for the difference
27itemized for each county in the region with the billing for the
28quarter ending June 30. If the actual costs owed by the county
29 regional administrator are less than the charges billed to the
30county regional administrator pursuant to subsection 2, the
31department shall credit the county regional administrator for
32the difference itemized for each county in the region starting
33with the billing for the quarter ending June 30.
345. An individual statement shall be prepared for a patient
35on or before the fifteenth day of the month following the month
-8-1in which the patient leaves the mental health institute, and
2a general statement shall be prepared at least quarterly for
3each county regional administrator itemized for each county
4in the region to which charges are made under this section.
5Except as otherwise required by sections 125.33 and 125.34,
6the general statement shall list the name of each patient
7chargeable to that a county in the region who was served by the
8mental health institute during the preceding month or calendar
9quarter, the amount due on account of each patient, and the
10specific dates for which any third party payor reimbursement
11received by the state is applied to the statement and billing,
12and the county regional administrator shall be billed for
13eighty percent of the stated charge for each patient specified
14in this subsection. The statement prepared for each county
15 regional administrator shall be certified by the department and
16a duplicate statement shall be mailed to the auditor of that
17county.
186. All or any reasonable portion of the charges incurred
19for services provided to a patient, to the most recent date for
20which the charges have been computed, may be paid at any time
21by the patient or by any other person on the patient’s behalf.
22Any payment made by the patient or other person, and any
23federal financial assistance received pursuant to Tit.XVIII
24or XIX of the federal Social Security Act for services rendered
25to a patient, shall be credited against the patient’s account
26and, if the charges paid as described in this subsection have
27previously been billed to a county regional administrator on
28behalf of the person’s county of residence, reflected in the
29mental health institute’s next general statement to that county
30 regional administrator.
317. A superintendent of a mental health institute may request
32that the director of human services enter into a contract
33with a person for the mental health institute to provide
34consultation or treatment services or for fulfilling other
35purposes which are consistent with the purposes stated in
-9-1section 226.1. The contract provisions shall include charges
2which reflect the actual cost of providing the services or
3fulfilling the other purposes. Any income from a contract
4authorized under this subsection may be retained by the
5mental health institute to defray the costs of providing the
6services. Except for a contract voluntarily entered into by a
7county under this subsection, the costs or income associated
8with a contract authorized under this subsection shall not
9be considered in computing charges and per diem costs in
10accordance with the provisions of subsections 1 through 6 of
11this section.
128. The department shall provide a county regional
13administrator with information, which is not otherwise
14confidential under law, in the department’s possession
15concerning a patient whose cost of care is chargeable to the
16county regional administrator, including but not limited to the
17information specified in section 229.24, subsection 3.
18 Sec. 14. Section 230.21, Code 2018, is amended to read as
19follows:
20230.21 Duty of county auditor and treasurer Notice to county
21of residence.
22The county auditor, upon receipt of the duplicate statement
23required by section 230.20, shall enter it to the credit of the
24state in the ledger of state accounts, regional administrator
25 shall furnish to the board of supervisors of the county of
26residence a list of the names of the persons so certified, and
27at once issue a notice authorizing the county treasurer to
28transfer the amount billed to the county by the statement, from
29the county to the general state revenue, which notice shall be
30filed by the treasurer as authority for making the transfer who
31are residents of that county and eligible for mental health
32and disability services funding. The auditor shall promptly
33remit the amount so transferred to the treasurer of state,
34designating the fund to which it belongs.
35 Sec. 15. Section 230.22, Code 2018, is amended to read as
-10-1follows:
2230.22 Penalty.
3Should any county fail If a regional administrator fails
4 to pay the amount billed by a statement submitted pursuant
5to section 230.20 within forty-five days from the date the
6statement is received by the county regional administrator,
7the department shall charge the delinquent county regional
8administrator the penalty of one percent per month on and
9after forty-five days from the date the statement is received
10by the county regional administrator until paid. Provided,
11however, that the penalty shall not be imposed if the county
12 regional administrator has notified the department of error
13or questionable items in the billing, in which event, the
14department shall suspend the penalty only during the period of
15negotiation.
16 Sec. 16. Section 230.25, subsection 1, Code 2018, is amended
17to read as follows:
181. Upon receipt from the county auditor for substance use
19services or the regional administrator for mental health and
20disability services of the list of names furnished pursuant
21to section 230.21, the board of supervisors of the county
22of residence shall make an investigation to determine the
23ability of each person whose name appears on the list, and
24also the ability of any person liable under section 230.15
25for the support of that person, to pay the expenses of that
26person’s hospitalization. If the board finds that neither
27the hospitalized person nor any person legally liable for the
28person’s support is able to pay those expenses, they the board
29 shall direct the county auditor or regional administrator not
30to index the names of any of those persons as would otherwise
31be required by section 230.26. However the board may review
32its finding with respect to any person at any subsequent time
33at which another list is furnished by the auditor county
34auditor or regional administrator upon which that person’s name
35appears. If the board finds upon review that that person or
-11-1those legally liable for the person’s support are presently
2able to pay the expenses of that person’s hospitalization, that
3finding shall apply only to charges stated upon the certificate
4from which the list was drawn up and any subsequent charges
5similarly certified, unless and until the board again changes
6its finding.
7 Sec. 17. Section 230.26, Code 2018, is amended to read as
8follows:
9230.26 Auditor Regional administrator to keep record.
10The auditor of each county regional administrator shall
11keep an accurate account of the cost of the maintenance of
12any patient kept in any institution as provided for in this
13chapter and keep an index of the names of the persons admitted
14or committed from such each county in the region. The name of
15the husband or the wife of such person designating such party
16as the spouse of the person admitted or committed shall also be
17indexed in the same manner as the names of the persons admitted
18or committed are indexed. The book shall be designated as an
19account book or index, and shall have no reference in any place
20to a lien.
21 Sec. 18. Section 230.33, Code 2018, is amended to read as
22follows:
23230.33 Reciprocal agreements.
24The administrator may enter into agreements with other
25states, through their duly constituted authorities, to effect
26the reciprocal return of persons with mental illness and
27persons with an intellectual disability to the contracting
28states, and to effect the reciprocal supervision of persons on
29convalescent leave.
30However, in the case of a proposed transfer of a person with
31mental illness or an intellectual disability from this state,
32final action shall not be taken without the approval either of
33the commission of hospitalization, or of the district court, of
34the county of admission or commitment.
35 Sec. 19. REPEAL. Sections 230.34 and 232.80, Code 2018,
-12-1are repealed.
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 administrative procedures and services
6provided by the department of human services.
7Under current law, expenses and legal costs relating to
8the taking into custody, care, investigation, admission,
9commitment, and support of a person with mental illness
10admitted or committed to a state hospital are sent to the
11county auditor of the person’s county of residence. The county
12auditor submits the bills to the regional administrator of
13the person’s county of residence. The regional administrator
14pays the state hospital for the expenses. The bill amends
15current law to provide such expenses are billed to the regional
16administrator of the person’s county of residence. References
17to the county auditor are amended to refer to the regional
18administrator. The bill removes the definition of auditor from
19the Code, makes technical changes to the location of other
20definitions, and defines region.
21The bill provides that county auditors maintain lists of
22persons receiving substance use services for determination of
23ability to pay hospitalization expenses.
24Code section 232.80 relating to services by a homemaker-home
25health aide providing care to a child in the child’s place of
26residence in preference to removal of the child from the home
27is repealed by the bill.
-13-hb/rj