Bill Text: IA HF2456 | 2017-2018 | 87th General Assembly | Amended

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Bill Title: A bill for an act relating to behavioral health, including provisions relating to involuntary commitments and hospitalizations, the disclosure of mental health information to law enforcement professionals, and mental health and disability services. (Formerly HF 2327.) Effective 7-1-18.

Spectrum: Committee Bill

Status: (Passed) 2018-03-29 - Signed by Governor. H.J. 710. [HF2456 Detail]

Download: Iowa-2017-HF2456-Amended.html

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House File 2456 - Reprinted




                                 HOUSE FILE       
                                 BY  COMMITTEE ON HUMAN
                                     RESOURCES

                                 (SUCCESSOR TO HF 2327)
       (As Amended and Passed by the House February 27, 2018)

                                      A BILL FOR

  1 An Act relating to behavioral health, including provisions
  2    relating to involuntary commitments and hospitalizations,
  3    the disclosure of mental health information to law
  4    enforcement professionals, and mental health and disability
  5    services.
  6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    HF 2456 (4) 87
    hb/rh/md

PAG LIN



  1  1    Section 1.  Section 125.80, subsection 3, Code 2018, is
  1  2 amended to read as follows:
  1  3    3.  If the report of a court=designated licensed physician
  1  4 or mental health professional is to the effect that the
  1  5 respondent is not a person with a substance=related disorder,
  1  6 the court, without taking further action, may shall terminate
  1  7 the proceeding and dismiss the application on its own motion
  1  8 and without notice.
  1  9    Sec. 2.  Section 125.81, Code 2018, is amended by adding the
  1 10 following new subsection:
  1 11    NEW SUBSECTION.  2A.  A respondent shall be released from
  1 12 detention prior to the commitment hearing if a licensed
  1 13 physician or mental health professional examines the respondent
  1 14 and determines the respondent no longer meets the criteria for
  1 15 detention under subsection 1 and provides notification to the
  1 16 court.
  1 17    Sec. 3.  Section 125.82, subsection 4, Code 2018, is amended
  1 18 to read as follows:
  1 19    4.  The respondent's welfare is paramount, and the hearing
  1 20 shall be tried as a civil matter and conducted in as informal a
  1 21 manner as is consistent with orderly procedure.  The hearing
  1 22 may be held by video conference at the discretion of the
  1 23 court. Discovery as permitted under the Iowa rules of civil
  1 24 procedure is available to the respondent. The court shall
  1 25 receive all relevant and material evidence, but the court is
  1 26 not bound by the rules of evidence. A presumption in favor of
  1 27 the respondent exists, and the burden of evidence and support
  1 28 of the contentions made in the application shall be upon the
  1 29 person who filed the application. If upon completion of the
  1 30 hearing the court finds that the contention that the respondent
  1 31 is a person with a substance=related disorder has not been
  1 32 sustained by clear and convincing evidence, the court shall
  1 33 deny the application and terminate the proceeding.
  1 34    Sec. 4.  Section 135G.6, Code 2018, is amended by striking
  1 35 the section and inserting in lieu thereof the following:
  2  1    135G.6  Inspection ==== conditions for issuance.
  2  2    The department shall issue a license to an applicant under
  2  3 this chapter if the department has ascertained that the
  2  4 applicant's facilities and staff are adequate to provide the
  2  5 care and services required of a subacute care facility.
  2  6    Sec. 5.  Section 228.1, Code 2018, is amended by adding the
  2  7 following new subsection:
  2  8    NEW SUBSECTION.  3A.  "Law enforcement professional" means
  2  9 a law enforcement officer as defined in section 80B.3, county
  2 10 attorney as defined in section 331.101, probation or parole
  2 11 officer, or jailer.
  2 12    Sec. 6.  NEW SECTION.  228.7A  Disclosures to law enforcement
  2 13 professionals.
  2 14    1.  Mental health information relating to an individual may
  2 15 be disclosed by a mental health professional, at the minimum
  2 16 consistent with applicable laws and standards of ethical
  2 17 conduct, to a law enforcement professional if all of the
  2 18 following apply:
  2 19    a.  The disclosure is made in good faith.
  2 20    b.  The disclosure is necessary to prevent or lessen a
  2 21 serious and imminent threat to the health or safety of the
  2 22 individual or to a clearly identifiable victim or victims.
  2 23    c.  The individual has the apparent intent and ability to
  2 24 carry out the threat.
  2 25    2.  A mental health professional shall not be held criminally
  2 26 or civilly liable for failure to disclose mental health
  2 27 information relating to an individual to a law enforcement
  2 28 professional except in circumstances where the individual has
  2 29 communicated to the mental health professional an imminent
  2 30 threat of physical violence against the individual's self or
  2 31 against a clearly identifiable victim or victims.
  2 32    3.  A mental health professional discharges the
  2 33 professional's duty to disclose pursuant to subsection 1 by
  2 34 making reasonable efforts to communicate the threat to a law
  2 35 enforcement professional.
  3  1    Sec. 7.  Section 229.1, subsection 20, Code 2018, is amended
  3  2 by adding the following new paragraph:
  3  3    NEW PARAGRAPH.  d.  Has a history of lack of compliance with
  3  4 treatment and any of the following apply:
  3  5    (1)  Lack of compliance has been a significant factor in the
  3  6 need for emergency hospitalization.
  3  7    (2)  Lack of compliance has resulted in one or more acts of
  3  8 serious physical injury to the person's self or others or an
  3  9 attempt to physically injure the person's self or others.
  3 10    Sec. 8.  Section 229.10, subsection 3, Code 2018, is amended
  3 11 to read as follows:
  3 12    3.  If the report of one or more of the court=designated
  3 13 physicians or mental health professionals is to the effect
  3 14 that the individual is not seriously mentally impaired, the
  3 15 court may shall without taking further action terminate the
  3 16 proceeding and dismiss the application on its own motion and
  3 17 without notice.
  3 18    Sec. 9.  Section 229.11, Code 2018, is amended by adding the
  3 19 following new subsection:
  3 20    NEW SUBSECTION.  1A.  A respondent shall be released from
  3 21 detention prior to the hospitalization hearing if a licensed
  3 22 physician or mental health professional examines the respondent
  3 23 and determines the respondent no longer meets the criteria for
  3 24 detention under subsection 1 and provides notification to the
  3 25 court.
  3 26    Sec. 10.  Section 229.12, subsection 3, paragraph a, Code
  3 27 2018, is amended to read as follows:
  3 28    a.  The respondent's welfare shall be paramount and the
  3 29 hearing shall be conducted in as informal a manner as may be
  3 30 consistent with orderly procedure, but consistent therewith
  3 31 the issue shall be tried as a civil matter.  The hearing may
  3 32 be held by video conference at the discretion of the court.
  3 33  Such discovery as is permitted under the Iowa rules of civil
  3 34 procedure shall be available to the respondent. The court
  3 35 shall receive all relevant and material evidence which may be
  4  1 offered and need not be bound by the rules of evidence. There
  4  2 shall be a presumption in favor of the respondent, and the
  4  3 burden of evidence in support of the contentions made in the
  4  4 application shall be upon the applicant.
  4  5    Sec. 11.  Section 229.13, subsection 7, paragraph a,
  4  6 subparagraphs (2) and (3), Code 2018, are amended to read as
  4  7 follows:
  4  8    (2)  Once in protective custody, the respondent shall be
  4  9 given the choice of being treated by the appropriate medication
  4 10 which may include the use of oral medicine or injectable
  4 11 antipsychotic medicine by a mental health professional acting
  4 12 within the scope of the mental health professional's practice
  4 13 at an outpatient psychiatric clinic, hospital, or other
  4 14 suitable facility or being placed for treatment under the
  4 15 care of a hospital or other suitable facility for inpatient
  4 16 treatment.
  4 17    (3)  If the respondent chooses to be treated by the
  4 18 appropriate medication which may include the use of oral
  4 19 medicine or injectable antipsychotic medicine but the mental
  4 20 health professional acting within the scope of the mental
  4 21 health professional's practice at the outpatient psychiatric
  4 22 clinic, hospital, or other suitable facility determines that
  4 23 the respondent's behavior continues to be likely to result in
  4 24 physical injury to the respondent's self or others if allowed
  4 25 to continue, the mental health professional acting within
  4 26 the scope of the mental health professional's practice shall
  4 27 comply with the provisions of subparagraph (1) and, following
  4 28 notice and hearing held in accordance with the procedures in
  4 29 section 229.12, the court may order the respondent treated
  4 30 on an inpatient basis requiring full=time custody, care, and
  4 31 treatment in a hospital until such time as the chief medical
  4 32 officer reports that the respondent does not require further
  4 33 treatment for serious mental impairment or has indicated the
  4 34 respondent is willing to submit to treatment on another basis
  4 35 as ordered by the court.
  5  1    Sec. 12.  Section 229.22, subsection 2, paragraph b, Code
  5  2 2018, is amended to read as follows:
  5  3    b.  If the magistrate orders that the person be detained,
  5  4 the magistrate shall, by the close of business on the next
  5  5 working day, file a written order with the clerk in the county
  5  6 where it is anticipated that an application may be filed
  5  7 under section 229.6. The order may be filed by facsimile if
  5  8 necessary. A peace officer from the law enforcement agency
  5  9 that took the person into custody, if no request was made
  5 10 under paragraph "a", may inform the magistrate that an arrest
  5 11 warrant has been issued for or charges are pending against the
  5 12 person and request that any written order issued under this
  5 13 paragraph require the facility or hospital to notify the law
  5 14 enforcement agency about the discharge of the person prior to
  5 15 discharge. The order shall state the circumstances under which
  5 16 the person was taken into custody or otherwise brought to a
  5 17 facility or hospital, and the grounds supporting the finding
  5 18 of probable cause to believe that the person is seriously
  5 19 mentally impaired and likely to injure the person's self or
  5 20 others if not immediately detained. The order shall also
  5 21 include any law enforcement agency notification requirements if
  5 22 applicable. The order shall confirm the oral order authorizing
  5 23 the person's detention including any order given to transport
  5 24 the person to an appropriate facility or hospital. A peace
  5 25 officer from the law enforcement agency that took the person
  5 26 into custody may also request an order, separate from the
  5 27 written order, requiring the facility or hospital to notify the
  5 28 law enforcement agency about the discharge of the person prior
  5 29 to discharge. The clerk shall provide a copy of the written
  5 30 order or any separate order to the chief medical officer of the
  5 31 facility or hospital to which the person was originally taken,
  5 32 to any subsequent facility to which the person was transported,
  5 33 and to any law enforcement department, or ambulance service,
  5 34 or transportation service under contract with a mental health
  5 35 and disability services region that transported the person
  6  1 pursuant to the magistrate's order.  A transportation service
  6  2 that contracts with a mental health and disability services
  6  3 region for purposes of this paragraph shall provide a secure
  6  4 transportation vehicle and shall employ staff that has received
  6  5 or is receiving mental health training.
  6  6    Sec. 13.  Section 331.397, Code 2018, is amended to read as
  6  7 follows:
  6  8    331.397  Regional core services.
  6  9    1.  For the purposes of this section, unless the context
  6 10 otherwise requires, "domain" means a set of similar services
  6 11 that can be provided depending upon a person's service needs.
  6 12    2.  a.  (1)  A region shall work with service providers to
  6 13 ensure that services in the required core service domains in
  6 14 subsections 4 and 5 are available to residents of the region,
  6 15 regardless of potential payment source for the services.
  6 16    (2)  Subject to the available appropriations, the director
  6 17 of human services shall ensure the initial core service domains
  6 18 listed in subsection subsections 4 and 5 are covered services
  6 19 for the medical assistance program under chapter 249A to the
  6 20 greatest extent allowable under federal regulations.  The
  6 21 medical assistance program shall reimburse Medicaid enrolled
  6 22 providers for Medicaid covered services under subsections 4
  6 23 and 5 when the services are medically necessary, the Medicaid
  6 24 enrolled provider submits an appropriate claim for such
  6 25 services, and no other third=party payer is responsible for
  6 26 reimbursement of such services. Within funds available, the
  6 27 region shall pay for such services for eligible persons when
  6 28 payment through the medical assistance program or another
  6 29 third=party payment is not available, unless the person is on a
  6 30 waiting list for such payment or it has been determined that
  6 31 the person does not meet the eligibility criteria for any such
  6 32 service.
  6 33    b.  Until funding is designated for other service
  6 34 populations, eligibility for the service domains listed in this
  6 35 section shall be limited to such persons who are in need of
  7  1 mental health or intellectual disability services. However, if
  7  2 a county in a region was providing services to an eligibility
  7  3 class of persons with a developmental disability other than
  7  4 intellectual disability or a brain injury prior to formation of
  7  5 the region, the class of persons shall remain eligible for the
  7  6 services provided when the region is was formed, provided that
  7  7 funds are available to continue such services without limiting
  7  8 or reducing core services.
  7  9    c.  It is the intent of the general assembly to address
  7 10 the need for funding so that the availability of the service
  7 11 domains listed in this section may be expanded to include such
  7 12 persons who are in need of developmental disability or brain
  7 13 injury services.
  7 14    3.  Pursuant to recommendations made by the director of human
  7 15 services, the state commission shall adopt rules as required by
  7 16 section 225C.6 to define the services included in the initial
  7 17 and additional core service domains listed in this section.
  7 18 The rules shall provide service definitions, service provider
  7 19 standards, service access standards, and service implementation
  7 20 dates, and shall provide consistency, to the extent possible,
  7 21 with similar service definitions under the medical assistance
  7 22 program.
  7 23    a.  The rules relating to the credentialing of a person
  7 24 directly providing services shall require all of the following:
  7 25    a.  (1)  The person shall provide services and represent the
  7 26 person as competent only within the boundaries of the person's
  7 27 education, training, license, certification, consultation
  7 28 received, supervised experience, or other relevant professional
  7 29 experience.
  7 30    b.  (2)  The person shall provide services in substantive
  7 31 areas or use intervention techniques or approaches that
  7 32 are new only after engaging in appropriate study, training,
  7 33 consultation, and supervision from a person who is competent in
  7 34 those areas, techniques, or approaches.
  7 35    c.  (3)  If generally recognized standards do not exist
  8  1 with respect to an emerging area of practice, the person
  8  2 shall exercise careful judgment and take responsible steps,
  8  3 including obtaining appropriate education, research, training,
  8  4 consultation, and supervision, in order to ensure competence
  8  5 and to protect from harm the persons receiving the services in
  8  6 the emerging area of practice.
  8  7    b.  The rules relating to the availability of intensive
  8  8 mental health services specified in subsection 5 shall specify
  8  9 that the minimum amount of services provided statewide shall
  8 10 be as follows: 
  8 11    (1)  Twenty=two assertive community treatment teams.
  8 12    (2)  Six access centers.
  8 13    (3)  Intensive residential service homes that provide
  8 14 services to up to one hundred twenty persons.
  8 15    4.  The initial core service domains shall include the
  8 16 following:
  8 17    a.  Treatment designed to ameliorate a person's condition,
  8 18 including but not limited to all of the following:
  8 19    (1)  Assessment and evaluation.
  8 20    (2)  Mental health outpatient therapy.
  8 21    (3)  Medication prescribing and management.
  8 22    (4)  Mental health inpatient treatment.
  8 23    b.  Basic crisis response provisions, including but not
  8 24 limited to all of the following:
  8 25    (1)  Twenty=four=hour access to crisis response.
  8 26    (2)  Evaluation.
  8 27    (3)  Personal emergency response system.
  8 28    c.  Support for community living, including but not limited
  8 29 to all of the following:
  8 30    (1)  Home health aide.
  8 31    (2)  Home and vehicle modifications.
  8 32    (3)  Respite.
  8 33    (4)  Supportive community living.
  8 34    d.  Support for employment or for activities leading to
  8 35 employment providing an appropriate match with an individual's
  9  1 abilities based upon informed, person=centered choices made
  9  2 from an array of options, including but not limited to all of
  9  3 the following:
  9  4    (1)  Day habilitation.
  9  5    (2)  Job development.
  9  6    (3)  Supported employment.
  9  7    (4)  Prevocational services.
  9  8    e.  Recovery services, including but not limited to all of
  9  9 the following:
  9 10    (1)  Family support.
  9 11    (2)  Peer support.
  9 12    f.  Service coordination including coordinating physical
  9 13 health and primary care, including but not limited to all of
  9 14 the following:
  9 15    (1)  Case management.
  9 16    (2)  Health homes.
  9 17    5.  a.  Provided that federal matching funds are available
  9 18 under the Iowa health and wellness plan pursuant to chapter
  9 19 249N, the following intensive mental health services in
  9 20 strategic locations throughout the state shall be provided
  9 21 within the following core service domains:
  9 22    (1)  Access centers that are located in crisis residential
  9 23 and subacute residential settings with sixteen beds or fewer
  9 24 that provide immediate, short=term assessments for persons with
  9 25 serious mental illness or substance use disorders who do not
  9 26 need inpatient psychiatric hospital treatment, but who do need
  9 27 significant amounts of supports and services not available in
  9 28 the persons' homes or communities.
  9 29    (2)  Assertive community treatment services.
  9 30    (3)  Comprehensive facility and community=based crisis
  9 31 services, including all of the following:
  9 32    (a)  Mobile response.
  9 33    (b)  Twenty=three=hour crisis observation and holding.
  9 34    (c)  Crisis stabilization community=based services.
  9 35    (d)  Crisis stabilization residential services.
 10  1    (4)  Subacute services provided in facility and
 10  2 community=based settings.
 10  3    (5)  Intensive residential service homes for persons
 10  4 with severe and persistent mental illness in scattered site
 10  5 community=based residential settings that provide intensive
 10  6 services and that operate twenty=four hours a day.
 10  7    b.  The department shall accept arrangements between multiple
 10  8 regions sharing intensive mental health services under this
 10  9 subsection. 
 10 10    5.  6.  A region shall ensure that access is available
 10 11 to providers of core services that demonstrate competencies
 10 12 necessary for all of the following:
 10 13    a.  Serving persons with co=occurring conditions.
 10 14    b.  Providing evidence=based services.
 10 15    c.  Providing trauma=informed care that recognizes the
 10 16 presence of trauma symptoms in persons receiving services.
 10 17    6.  7.  A region shall ensure that services within the
 10 18 following additional core service domains are available
 10 19 to persons not eligible for the medical assistance program
 10 20 under chapter 249A or receiving other third=party payment for
 10 21 the services, when public funds are made available for such
 10 22 services:
 10 23    a.  Comprehensive facility and community=based crisis
 10 24 services, including but not limited to all of the following:
 10 25    (1)  Twenty=four=hour crisis hotline.
 10 26    (2)  Mobile response.
 10 27    (3)  Twenty=three=hour crisis observation and holding, and
 10 28 crisis stabilization facility and community=based services.
 10 29    (4)  Crisis residential services.
 10 30    b.  Subacute services provided in facility and
 10 31 community=based settings. 
 10 32    c.  a.  Justice system=involved services, including but not
 10 33 limited to all of the following:
 10 34    (1)  Jail diversion.
 10 35    (2)  Crisis intervention training.
 11  1    (3)  Civil commitment prescreening.
 11  2    d.  b.  Advances in the use of evidence=based treatment,
 11  3 including but not limited to all of the following:
 11  4    (1)  Positive behavior support.
 11  5    (2)  Assertive community treatment. 
 11  6    (3)  (2)  Peer self=help drop=in centers.
 11  7    7.  8.  A regional service system may provide funding for
 11  8 other appropriate services or other support and may implement
 11  9 demonstration projects for an initial period of up to three
 11 10 years to model the use of research=based practices. In
 11 11 considering whether to provide such funding, a region may
 11 12 consider the following criteria for research=based practices:
 11 13    a.  Applying a person=centered planning process to identify
 11 14 the need for the services or other support.
 11 15    b.  The efficacy of the services or other support is
 11 16 recognized as an evidence=based practice, is deemed to be an
 11 17 emerging and promising practice, or providing the services is
 11 18 part of a demonstration and will supply evidence as to the
 11 19 services' effectiveness.
 11 20    c.  A determination that the services or other support
 11 21 provides an effective alternative to existing services that
 11 22 have been shown by the evidence base to be ineffective, to not
 11 23 yield the desired outcome, or to not support the principles
 11 24 outlined in Olmstead v. L.C., 527 U.S. 581 (1999).
 11 25    Sec. 14.  Section 331.424A, subsection 9, Code 2018, is
 11 26 amended to read as follows:
 11 27    9.  a.  For the fiscal year beginning July 1, 2017, and each
 11 28 subsequent fiscal year, the county budgeted amount determined
 11 29 for each county shall be the amount necessary to meet the
 11 30 county's financial obligations for the payment of services
 11 31 provided under the regional service system management plan
 11 32 approved pursuant to section 331.393, not to exceed an amount
 11 33 equal to the product of the regional per capita expenditure
 11 34 target amount multiplied by the county's population, and, for
 11 35 fiscal years beginning on or after July 1, 2021, reduced by
 12  1 the amount of the county's cash flow reduction amount for the
 12  2 fiscal year calculated under subsection 4, if applicable.
 12  3    b.  If a county officially joins a different region, the
 12  4 county's budgeted amount shall be the amount necessary to meet
 12  5 the county's financial obligations for payment of services
 12  6 provided under the new region's regional service system
 12  7 management plan approved pursuant to section 331.393, not to
 12  8 exceed an amount equal to the product of the new region's
 12  9 regional per capita expenditure target amount multiplied by the
 12 10 county's population.
 12 11    Sec. 15.  DEPARTMENT OF HUMAN SERVICES ==== CIVIL COMMITMENT
 12 12 PRESCREENING ASSESSMENTS ==== RULES.  The department of human
 12 13 services, in coordination with the mental health and disability
 12 14 services commission, shall adopt rules pursuant to chapter 17A
 12 15 relating to civil commitment prescreening assessments provided
 12 16 by a mental health and disability services region or an entity
 12 17 contracting with a mental health and disability service region.
 12 18 The rules shall provide for all of the following:
 12 19    1.  The provision of civil commitment prescreening
 12 20 assessments by a licensed physician or mental health
 12 21 professional within four hours of an emergency detention of
 12 22 an individual believed to be mentally ill to determine if
 12 23 inpatient psychiatric hospitalization is necessary.
 12 24    2.  The coordination of appropriate levels of care
 12 25 to include securing an inpatient psychiatric bed when
 12 26 inpatient psychiatric hospitalization is needed and
 12 27 utilizing community=based resources and services such as
 12 28 crisis observation and crisis stabilization services and
 12 29 subacute care and detoxification centers and facilitating
 12 30 outpatient treatment appointments when inpatient psychiatric
 12 31 hospitalization is not needed.
 12 32    3.  The provision of ongoing consultations by a licensed
 12 33 physician or mental health professional while the individual
 12 34 remains in the emergency room.
 12 35    4.  Requiring appropriate documentation and reports to be
 13  1 submitted by a licensed physician or mental health professional
 13  2 to a treating hospital and the court as necessary.
 13  3    Sec. 16.  PROGRAM IMPLEMENTATION ==== ADOPTION OF
 13  4 ADMINISTRATIVE RULES.
 13  5    1.  The department of human services shall submit a notice
 13  6 of intended action to the administrative rules coordinator and
 13  7 the Iowa administrative code editor pursuant to section 17A.4,
 13  8 subsection 1, paragraph "a", not later than August 15, 2018,
 13  9 for the adoption of rules to implement the standards of core
 13 10 services specified in this Act.
 13 11    2.  The provisions of this Act and rules adopted in
 13 12 accordance with this Act shall minimize any delay or disruption
 13 13 of services or plans for the implementation of such services in
 13 14 effect on July 1, 2018.
 13 15    3.  The rules adopted by the department relating to access
 13 16 centers shall provide for all of the following:
 13 17    a.  The access centers shall meet all of the following
 13 18 criteria:
 13 19    (1)  An access center shall serve individuals with a
 13 20 serious mental health or substance use disorder need who are
 13 21 otherwise medically stable, who are not in need of an inpatient
 13 22 psychiatric level of care, and who do not have alternative,
 13 23 safe, effective services immediately available.
 13 24    (2)  Access center services shall be provided on a no reject,
 13 25 no eject basis.
 13 26    (3)  An access center shall accept and serve individuals who
 13 27 are court=ordered to participate in mental health or substance
 13 28 use disorder treatment.
 13 29    (4)  Access center providers shall be accredited under 441
 13 30 IAC 24 to provide crisis stabilization residential services and
 13 31 shall be licensed to provide subacute mental health services
 13 32 as defined in section 135G.1.
 13 33    (5)  An access center shall be licensed as a substance abuse
 13 34 treatment program pursuant to chapter 125 or have a cooperative
 13 35 agreement with and immediate access to licensed substance abuse
 14  1 treatment services or medical care that incorporates withdrawal
 14  2 management.
 14  3    (6)  An access center shall provide or arrange for the
 14  4 provision of necessary physical health services.
 14  5    (7)  An access center shall provide navigation and warm
 14  6 handoffs to the next service provider as well as linkages to
 14  7 needed services including housing, employment, and shelter
 14  8 services.
 14  9    b.  The rules shall include access center designation
 14 10 criteria and standards that allow and encourage multiple mental
 14 11 health and disability services regions to strategically locate
 14 12 and share access center services including bill=back provisions
 14 13 to provide for reimbursement of a region when the resident of
 14 14 another region utilizes an access center or other non=Medicaid
 14 15 covered services located in that region.
 14 16    4.  The department shall establish uniform, statewide
 14 17 standards for assertive community treatment based on national
 14 18 accreditation standards, including allowances for nationally
 14 19 recognized small team standards. The statewide standards
 14 20 shall require that assertive teams meet fidelity to nationally
 14 21 recognized practice standards as determined by an independent
 14 22 review of each team that includes peer review. The department
 14 23 shall ensure that Medicaid managed care organization
 14 24 utilization management requirements do not exceed the standards
 14 25 developed by the department.
 14 26    5.  The rules relating to intensive residential service
 14 27 homes shall provide for all of the following:
 14 28    a.  That an intensive residential service home be enrolled
 14 29 with the Iowa Medicaid enterprise as a section 1915(i) home and
 14 30 community=based services habilitation waiver or intellectual
 14 31 disability waiver=supported community living provider.
 14 32    b.  That an intensive residential service home have adequate
 14 33 staffing that includes appropriate specialty training including
 14 34 applied behavior analysis as appropriate.
 14 35    c.  Coordination with the individual's clinical mental
 15  1 health and physical health treatment.
 15  2    d.  Be licensed as a substance abuse treatment program
 15  3 pursuant to chapter 125 or have a cooperative agreement
 15  4 with and timely access to licensed substance abuse treatment
 15  5 services for those with a demonstrated need.
 15  6    e.  Accept court=ordered commitments.
 15  7    f.  Have a no reject, no eject policy for an individual
 15  8 referred to the home based on the severity of the individual's
 15  9 mental health or co=occurring needs.
 15 10    g.  Be smaller in size, preferably providing services to
 15 11 four or fewer individuals and no more than sixteen individuals,
 15 12 and be located in a neighborhood setting to maximize community
 15 13 integration and natural supports.
 15 14    h.  The department of human services shall provide guidance
 15 15 for objective utilization review criteria.
 15 16    6.  The department of human services and the department of
 15 17 public health shall provide a single statewide twenty=four=hour
 15 18 crisis hotline that incorporates warmline services which may be
 15 19 provided through expansion of the YourLifeIowa platform.
 15 20    Sec. 17.  COMMITMENT PROCESS REVIEW.  The department of
 15 21 human services, in cooperation with the department of public
 15 22 health, representative members of the judicial branch, the Iowa
 15 23 hospital association, the Iowa medical society, the national
 15 24 alliance on mental illness, the Iowa state sheriffs' and
 15 25 deputies' association, Iowa behavioral health association,
 15 26 and other affected or interested stakeholders shall review
 15 27 the  commitment processes under chapters 125 and 229 and shall
 15 28 report recommendations for improvements in the processes
 15 29 and any amendments to law to increase efficiencies and more
 15 30 appropriately utilize the array of mental health and disability
 15 31 services available based upon an individual's needs to the
 15 32 governor and the general assembly by December 31, 2018.
 15 33    Sec. 18.  TERTIARY CARE PSYCHIATRIC HOSPITALS.  The
 15 34 departments of human services and inspections and appeals,
 15 35 representative members of the Iowa hospital association,
 16  1 managed care organizations, the national alliance on mental
 16  2 illness, the mental health institutes, and other affected or
 16  3 interested stakeholders shall review the role of tertiary care
 16  4 psychiatric hospitals in the array of mental health services
 16  5 and shall report recommendations for providing tertiary
 16  6 psychiatric services to the governor and the general assembly
 16  7 by November 30, 2018.  The recommendations shall address
 16  8 the role and responsibilities of tertiary care psychiatric
 16  9 hospitals in the mental health array of services in the state,
 16 10 the viability of utilizing the mental health institutes as
 16 11 tertiary care psychiatric hospitals, any potential sustainable
 16 12 funding, and admissions criteria.
 16 13    Sec. 19.  MENTAL HEALTH AND DISABILITY SERVICES FUNDING ====
 16 14 FISCAL VIABILITY REVIEW DURING 2018 LEGISLATIVE INTERIM.  The
 16 15 legislative council is requested to authorize a study committee
 16 16 to analyze the viability of the mental health and disability
 16 17 services funding including the methodology used to calculate
 16 18 and determine the base expenditure amount, the county budgeted
 16 19 amount, the regional per capita expenditure amount, the
 16 20 statewide per capita expenditure target amount, and the cash
 16 21 flow reduction amount. The study committee shall consist of
 16 22 five members of the senate, three of  whom shall be appointed
 16 23 by the majority leader of the senate and two of whom shall
 16 24 be appointed by the minority leader of the senate, and five
 16 25 members  of the house of representatives, three of whom shall
 16 26 be appointed by the speaker of the house of representatives
 16 27 and two of whom shall be appointed by the minority leader
 16 28 of the house of representatives.  The study committee shall
 16 29 meet during the 2018 legislative interim to make appropriate
 16 30 recommendations for consideration during the 2019 legislative
 16 31 session in a report submitted to the general assembly by
 16 32 January 15, 2019.
 16 33    Sec. 20.  DIRECTIVE TO DEPARTMENT OF HUMAN SERVICES ====
 16 34 PSYCHIATRIC BED TRACKING SYSTEM.  The department of human
 16 35 services shall amend its administrative rules pursuant to
 17  1 chapter 17A to require subacute mental health care facilities
 17  2 to participate in the psychiatric bed tracking system and
 17  3 to report the number of beds available for children and
 17  4 adults with a co=occurring mental illness and substance abuse
 17  5 disorder.
 17  6    Sec. 21.  ASSERTIVE COMMUNITY TREATMENT ==== REIMBURSEMENT
 17  7 RATES.  The department of human services shall review the
 17  8 reimbursement rates for assertive community treatment and
 17  9 shall report recommendations for reimbursement rates to the
 17 10 governor and the general assembly by December 15, 2018.  The
 17 11 recommendations shall address any potential sustainable
 17 12 funding.
 17 13    Sec. 22.  DEPARTMENT OF HUMAN SERVICES.  The department of
 17 14 human services shall adopt rules pursuant to chapter 17A to
 17 15 administer this Act.
       HF 2456 (4) 87
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