Bill Text: IA SF2315 | 2011-2012 | 84th General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: A bill for an act relating to redesign of publicly funded mental health and disability services by requiring certain core services and addressing other services and providing for establishment of regions, revising related property tax levy provisions, and including effective date and applicability provisions. (Formerly SSB 3152.) Various effective dates; see sections 21, 65, 130, and 139 of bill.
Spectrum: Committee Bill
Status: (Passed) 2012-05-25 - Signed by Governor. S.J. 950. [SF2315 Detail]
Download: Iowa-2011-SF2315-Introduced.html
Bill Title: A bill for an act relating to redesign of publicly funded mental health and disability services by requiring certain core services and addressing other services and providing for establishment of regions, revising related property tax levy provisions, and including effective date and applicability provisions. (Formerly SSB 3152.) Various effective dates; see sections 21, 65, 130, and 139 of bill.
Spectrum: Committee Bill
Status: (Passed) 2012-05-25 - Signed by Governor. S.J. 950. [SF2315 Detail]
Download: Iowa-2011-SF2315-Introduced.html
Senate
File
2315
-
Introduced
SENATE
FILE
2315
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
SSB
3152)
A
BILL
FOR
An
Act
relating
to
redesign
of
publicly
funded
mental
1
health
and
disability
services
by
requiring
certain
core
2
services
and
addressing
other
services
and
providing
for
3
establishment
of
regions
and
including
effective
date
and
4
applicability
provisions.
5
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
6
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DIVISION
I
1
CORE
SERVICES
2
Section
1.
Section
225C.2,
Code
2011,
is
amended
by
adding
3
the
following
new
subsections:
4
NEW
SUBSECTION
.
7A.
“Mental
health
and
disability
services
5
region”
means
a
mental
health
and
disability
services
region
6
formed
in
accordance
with
section
331.438B.
7
NEW
SUBSECTION
.
7B.
“Mental
health
and
disability
services
8
regional
service
system”
means
the
mental
health
and
disability
9
service
system
for
a
mental
health
and
disability
services
10
region.
11
NEW
SUBSECTION
.
9.
“Regional
administrator”
means
the
same
12
as
defined
in
section
331.438A.
13
Sec.
2.
Section
225C.4,
subsection
1,
paragraphs
a,
b,
c,
f,
14
h,
j,
q,
and
s,
Code
2011,
are
amended
to
read
as
follows:
15
a.
Prepare
and
administer
the
comprehensive
mental
health
16
and
disability
services
plan
as
provided
in
section
225C.6B
,
17
including
state
mental
health
and
mental
retardation
plans
for
18
the
provision
of
disability
services
within
the
state
and
the
19
state
developmental
disabilities
plan.
The
administrator
shall
20
consult
with
the
Iowa
department
of
public
health,
the
state
21
board
of
regents
or
a
body
designated
by
the
board
for
that
22
purpose,
the
department
of
management
or
a
body
designated
by
23
the
director
of
the
department
for
that
purpose,
the
department
24
of
education,
the
department
of
workforce
development
and
any
25
other
appropriate
governmental
body,
in
order
to
facilitate
26
coordination
of
disability
services
provided
in
this
state.
27
The
state
mental
health
and
mental
retardation
plans
shall
be
28
consistent
with
the
state
health
plan,
and
shall
incorporate
29
county
disability
services
mental
health
and
disability
30
services
regional
service
system
management
plans.
31
b.
Assist
county
boards
of
supervisors
and
mental
health
32
and
developmental
disabilities
regional
planning
councils
33
mental
health
and
disability
services
region
governing
boards
34
and
regional
administrators
in
planning
for
community-based
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disability
services.
1
c.
Emphasize
the
provision
of
evidence-based
outpatient
2
and
community
support
services
by
community
mental
health
3
centers
and
local
mental
retardation
providers
as
a
preferable
4
alternative
to
inpatient
hospital
services.
5
f.
Promote
coordination
Coordinate
of
community-based
6
services
with
those
of
the
state
mental
health
institutes
and
7
state
resource
centers.
8
h.
Administer
and
distribute
state
appropriations
to
9
the
mental
health
and
developmental
disabilities
community
10
disability
regional
services
fund
established
by
section
225C.7
11
225C.7A
.
12
j.
Establish
and
maintain
a
data
collection
and
management
13
information
system
oriented
to
the
needs
of
patients,
14
providers,
the
department,
and
other
programs
or
facilities.
15
The
system
shall
be
used
to
identify,
collect,
and
analyze
16
service
outcome
data
in
order
to
assess
the
effects
of
17
the
services
on
the
persons
utilizing
the
services.
The
18
administrator
shall
annually
submit
to
the
commission
19
information
collected
by
the
department
indicating
the
20
changes
and
trends
in
the
disability
services
system.
The
21
administrator
shall
make
the
outcome
data
available
to
the
22
public.
23
q.
In
cooperation
with
the
department
of
inspections
and
24
appeals,
recommend
minimum
standards
under
section
227.4
for
25
the
care
of
and
services
to
persons
with
mental
illness
and
or
26
mental
retardation
residing
in
county
care
facilities.
The
27
administrator
shall
also
cooperate
with
the
department
of
28
inspections
and
appeals
in
recommending
minimum
standards
for
29
care
of
and
services
provided
to
persons
with
mental
illness
30
or
an
intellectual
disability
living
in
a
residential
care
31
facility
regulated
under
chapter
135C.
32
s.
Provide
technical
assistance
concerning
disability
33
services
and
funding
to
counties
and
mental
health
and
34
developmental
disabilities
regional
planning
councils
mental
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health
and
disability
services
region
governing
boards
and
1
regional
administrators
.
2
Sec.
3.
Section
225C.4,
subsection
1,
Code
2011,
is
amended
3
by
adding
the
following
new
paragraphs:
4
NEW
PARAGRAPH
.
u.
Enter
into
performance-based
contracts
5
with
regional
administrators
pursuant
to
section
331.440B.
6
NEW
PARAGRAPH
.
v.
Provide
information
through
the
internet
7
concerning
waiting
lists
for
services
implemented
by
mental
8
health
and
disability
services
regions.
9
Sec.
4.
Section
225C.6,
subsection
1,
paragraph
b,
Code
10
Supplement
2011,
is
amended
to
read
as
follows:
11
b.
Adopt
Pursuant
to
recommendations
made
for
this
purpose
12
by
the
administrator,
adopt
necessary
rules
pursuant
to
13
chapter
17A
which
relate
to
disability
programs
and
services,
14
including
but
not
limited
to
definitions
of
each
disability
15
included
within
the
term
“disability
services”
as
necessary
for
16
purposes
of
state,
county,
and
regional
planning,
programs,
and
17
services.
18
Sec.
5.
Section
225C.6,
subsection
1,
paragraph
l,
Code
19
Supplement
2011,
is
amended
by
striking
the
paragraph
and
20
inserting
in
lieu
thereof
the
following:
21
l.
Pursuant
to
a
recommendation
made
by
the
administrator,
22
identify
basic
financial
eligibility
standards
for
the
23
disability
services
provided
by
a
mental
health
and
disability
24
services
region.
The
initial
standards
shall
be
as
specified
25
in
chapter
331.
26
Sec.
6.
Section
225C.6A,
Code
2011,
is
amended
to
read
as
27
follows:
28
225C.6A
Disability
services
data
system
redesign
.
29
The
commission
department
shall
do
the
following
relating
to
30
redesign
of
the
data
concerning
the
disability
services
system
31
in
the
state:
32
1.
Identify
sources
of
revenue
to
support
statewide
33
delivery
of
core
disability
services
to
eligible
disability
34
populations.
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2.
Ensure
there
is
a
continuous
improvement
process
for
1
development
and
maintenance
of
the
disability
services
system
2
for
adults
and
children.
The
process
shall
include
but
is
not
3
limited
to
data
collection
and
reporting
provisions.
4
3.
a.
1.
Plan,
collect,
and
analyze
data
as
necessary
to
5
issue
cost
estimates
for
serving
additional
populations
and
6
providing
core
disability
services
statewide.
The
department
7
shall
maintain
compliance
with
applicable
federal
and
state
8
privacy
laws
to
ensure
the
confidentiality
and
integrity
of
9
individually
identifiable
disability
services
data.
The
10
department
shall
regularly
may
periodically
assess
the
status
11
of
the
compliance
in
order
to
assure
that
data
security
is
12
protected.
13
b.
2.
In
implementing
a
system
under
this
subsection
14
section
for
collecting
and
analyzing
state,
county,
and
private
15
contractor
data,
the
department
shall
establish
a
client
16
identifier
for
the
individuals
receiving
services.
The
client
17
identifier
shall
be
used
in
lieu
of
the
individual’s
name
or
18
social
security
number.
The
client
identifier
shall
consist
of
19
the
last
four
digits
of
an
individual’s
social
security
number,
20
the
first
three
letters
of
the
individual’s
last
name,
the
21
individual’s
date
of
birth,
and
the
individual’s
gender
in
an
22
order
determined
by
the
department.
23
c.
3.
Each
county
regional
administrator
shall
regularly
24
report
to
the
department
annually
on
or
before
December
1,
for
25
the
preceding
fiscal
year
the
following
information
for
each
26
individual
served:
demographic
information,
expenditure
data,
27
and
data
concerning
the
services
and
other
support
provided
to
28
each
individual,
as
specified
in
administrative
rule
adopted
29
by
the
commission
department
.
30
4.
Work
with
county
representatives
and
other
qualified
31
persons
to
develop
an
implementation
plan
for
replacing
the
32
county
of
legal
settlement
approach
to
determining
service
33
system
funding
responsibilities
with
an
approach
based
upon
34
residency.
The
plan
shall
address
a
statewide
standard
for
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proof
of
residency,
outline
a
plan
for
establishing
a
data
1
system
for
identifying
residency
of
eligible
individuals,
2
address
residency
issues
for
individuals
who
began
residing
in
3
a
county
due
to
a
court
order
or
criminal
sentence
or
to
obtain
4
services
in
that
county,
recommend
an
approach
for
contesting
5
a
residency
determination,
and
address
other
implementation
6
issues.
7
Sec.
7.
NEW
SECTION
.
225C.7A
Mental
health
and
disability
8
regional
services
fund.
9
1.
A
mental
health
and
disability
regional
services
fund
10
is
created
in
the
office
of
the
treasurer
of
state
under
the
11
authority
of
the
department,
which
shall
consist
of
the
amounts
12
appropriated
to
the
fund
by
the
general
assembly
for
each
13
fiscal
year.
Before
completion
of
the
department’s
budget
14
estimate
as
required
by
section
8.23,
the
department
shall
15
determine
and
include
in
the
estimate
the
amount
which
in
order
16
to
address
allowed
growth
should
be
appropriated
to
the
fund
17
for
the
succeeding
fiscal
year.
18
2.
The
department
shall
allocate
the
moneys
appropriated
19
from
the
fund
to
mental
health
and
disability
services
20
regions
for
funding
of
disability
services
in
accordance
with
21
performance-based
contracts
with
the
regions
and
in
the
manner
22
provided
in
the
appropriations.
If
the
allocation
methodology
23
includes
a
population
factor,
the
definition
of
“population”
in
24
section
331.438A
shall
be
applied.
25
Sec.
8.
Section
226.10,
Code
2011,
is
amended
to
read
as
26
follows:
27
226.10
Equal
treatment.
28
The
several
patients
of
the
state
mental
health
institutes
,
29
according
to
their
different
conditions
of
mind
and
body,
and
30
their
respective
needs,
shall
be
provided
for
and
treated
31
with
equal
care.
The
care
provided
for
patients
with
two
32
or
more
co-occurring
mental
health,
intellectual
disability,
33
brain
injury,
or
substance
abuse
disorders
shall
address
the
34
co-occurring
needs.
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Sec.
9.
Section
331.439,
subsection
1,
paragraph
a,
Code
1
Supplement
2011,
is
amended
to
read
as
follows:
2
a.
The
county
accurately
reported
by
December
1
the
3
county’s
expenditures
for
mental
health,
mental
retardation,
4
and
developmental
disabilities
services
and
the
information
5
required
under
section
225C.6A,
subsection
3
,
paragraph
“c”
,
6
for
the
previous
fiscal
year
in
accordance
with
rules
adopted
7
by
the
state
commission.
The
information
reported
shall
8
segregate
expenditures
for
administration,
purchase
of
service,
9
and
enterprise
costs.
If
the
department
determines
good
10
cause
exists,
the
department
may
extend
a
deadline
otherwise
11
imposed
under
this
chapter
,
chapter
225C
,
or
chapter
426B
12
for
a
county’s
reporting
concerning
mental
health,
mental
13
retardation,
or
developmental
disabilities
services
or
related
14
revenues
and
expenditures.
15
Sec.
10.
Section
331.439,
Code
Supplement
2011,
is
amended
16
by
adding
the
following
new
subsection:
17
NEW
SUBSECTION
.
9A.
a.
Commencing
during
the
fiscal
18
year
beginning
July
1,
2012,
the
county
management
plan
for
19
mental
health
services
shall
provide
that
an
individual’s
20
eligibility
for
individualized
services
shall
be
determined
by
21
a
standardized
functional
assessment
methodology
approved
for
22
this
purpose
by
the
director
of
human
services.
23
b.
Commencing
during
the
fiscal
year
beginning
July
1,
24
2012,
the
county
management
plan
for
intellectual
disability
25
services
shall
provide
that
an
individual’s
eligibility
for
26
individualized
services
shall
be
determined
by
a
standardized
27
functional
assessment
methodology
approved
for
this
purpose
by
28
the
director
of
human
services.
29
c.
Commencing
during
the
fiscal
year
beginning
July
1,
2012,
30
if
a
county
management
plan
provides
for
brain
injury
services
31
the
plan
shall
provide
that
an
individual’s
eligibility
for
32
individualized
services
shall
be
determined
by
a
standardized
33
functional
assessment
methodology
approved
for
this
purpose
by
34
the
director
of
human
services.
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Sec.
11.
NEW
SECTION
.
331.439A
Regional
service
system
1
management
plan.
2
1.
a.
The
mental
health
and
disability
services
provided
3
by
counties
operating
as
a
region
shall
be
delivered
in
4
accordance
with
a
regional
service
system
management
plan
5
approved
by
the
region’s
governing
board
and
implemented
by
the
6
regional
administrator
in
accordance
with
this
section.
The
7
requirements
for
a
regional
service
system
management
plan
and
8
plan
format
shall
be
specified
in
rule
adopted
by
the
state
9
commission.
A
regional
service
system
management
plan
is
10
subject
to
the
approval
of
the
regional
governing
board
and
the
11
director
of
human
services
pursuant
to
a
recommendation
made
12
by
the
state
commission.
13
b.
A
regional
service
system
management
plan
shall
address
14
a
three-year
period.
The
initial
plan
shall
be
submitted
to
15
the
department
by
April
1,
2014,
and
by
April
1
of
every
third
16
year
thereafter.
The
initial
plan
is
subject
to
approval
by
17
the
director
of
human
services.
18
c.
Each
region
shall
submit
an
annual
update
of
the
region’s
19
management
plan
to
the
department
of
human
services
each
year
20
on
or
before
December
1.
The
annual
update
shall
include
any
21
changes
to
the
elements
of
the
management
plan
as
well
as
22
actual
numbers
of
persons
served,
moneys
expended,
and
outcomes
23
achieved.
An
annual
update
is
subject
to
approval
by
the
state
24
commission
pursuant
to
a
recommendation
by
the
director
of
25
human
services.
26
d.
An
amendment
to
an
approved
management
plan
shall
27
be
submitted
to
the
department
of
human
services
at
least
28
forty-five
calendar
days
prior
to
the
amendment
implementation.
29
The
amendment
is
subject
to
approval
by
the
state
commission
30
pursuant
to
a
recommendation
by
the
director
of
human
services.
31
2.
The
provisions
of
a
regional
service
system
management
32
plan
shall
include
but
are
not
limited
to
all
of
the
following:
33
Measures
to
address
the
needs
of
individuals
who
have
two
34
or
more
co-occurring
mental
health,
intellectual
disability,
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brain
injury,
or
substance-related
disorders
and
individuals
1
with
specialized
needs.
Implementation
of
measures
to
meet
the
2
needs
of
individuals
with
brain
injury
or
substance-related
3
disorders
is
contingent
upon
identification
of
a
funding
source
4
to
meet
those
needs
and
implementation
of
provisions
to
engage
5
the
entity
under
contract
with
the
state
to
provide
services
to
6
address
substance-related
disorders
within
the
regional
service
7
system.
8
3.
The
region
may
either
directly
implement
a
system
9
of
service
management
and
contract
with
service
providers,
10
or
contract
with
a
private
entity
to
manage
the
regional
11
service
system,
provided
all
requirements
of
this
section
12
are
met
by
the
private
entity.
The
regional
service
system
13
shall
incorporate
service
management
and
clinical
assessment
14
processes
developed
in
accordance
with
applicable
requirements.
15
4.
The
regional
service
system
management
plan
for
a
region
16
shall
include
but
is
not
limited
to
all
of
the
following
17
elements,
which
shall
be
specified
in
administrative
rules
18
adopted
by
the
state
commission:
19
a.
A
description
of
the
region’s
policies
and
procedures
for
20
financing
the
services
included
in
the
plan.
The
description
21
shall
also
address
how
county,
regional,
state,
and
other
22
funding
sources
will
be
used
to
meet
the
service
needs
within
23
the
region.
24
b.
The
enrollment
and
eligibility
process.
25
c.
The
scope
of
services
included
in
addition
to
the
core
26
services
required
by
this
part
of
this
chapter.
Each
service
27
included
shall
be
described
and
projections
of
need
and
the
28
funding
necessary
to
meet
the
need
shall
be
included.
29
d.
The
method
of
plan
administration.
30
e.
The
process
for
managing
utilization
and
access
to
31
services
and
other
assistance.
The
process
shall
also
describe
32
how
coordination
between
the
services
included
in
the
plan
and
33
the
disability
services
administered
by
the
state
and
others
34
will
be
managed.
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f.
The
quality
management
and
improvement
processes.
1
g.
The
risk
management
provisions
and
fiscal
viability
of
2
the
plan,
if
the
region
contracts
with
a
private
entity.
3
h.
The
access
points
for
services.
4
i.
The
requirements
for
designation
of
targeted
case
5
management
providers
and
for
implementation
of
evidence-based
6
models
of
case
management
for
persons
with
chronic
mental
7
illness.
The
requirements
shall
be
designed
to
provide
the
8
individual
receiving
the
case
management
with
a
choice
of
9
providers,
allow
a
service
provider
to
be
the
case
manager
but
10
prohibit
the
provider
from
referring
an
individual
receiving
11
the
case
management
only
to
services
administered
by
the
12
provider,
and
include
other
provisions
to
ensure
compliance
13
with
but
not
exceed
federal
requirements
for
conflict-free
case
14
management.
15
j.
A
plan
for
a
systems
of
care
approach
in
which
multiple
16
public
and
private
agencies
partner
with
families
and
17
communities
to
address
the
multiple
needs
of
the
individuals
18
and
their
families
involved
with
the
regional
service
system.
19
k.
A
plan
to
assure
effective
crisis
prevention,
response,
20
and
resolution.
21
l.
A
plan
for
provider
network
formation
and
management.
22
m.
A
plan
for
provider
reimbursement
approaches
that
23
includes
approaches
in
addition
to
fee-for-service
and
to
24
compensate
the
providers
engaged
in
a
systems
of
care
approach
25
and
other
nontraditional
providers.
A
region
shall
be
26
encouraged
to
use,
and
the
department
shall
approve,
blended
27
funding
approaches
or
coordinated
funding
approaches
known
as
28
braided
funding,
which
incorporate
all
services
and
funding
29
streams
used
by
persons
receiving
services,
including
medical
30
assistance
program
funding.
31
n.
If
the
region
applies
any
provider
licensing,
32
certification,
or
accreditation
requirements
in
addition
to
33
those
required
by
the
state,
the
procedures
for
implementing
34
the
requirements.
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o.
Service
provider
payment
provisions.
1
p.
Financial
forecasting
measures.
2
q.
A
process
for
resolving
grievances.
3
r.
Measures
for
implementing
interagency
and
multisystem
4
collaboration
and
care
coordination.
5
5.
A
region
may
provide
assistance
to
service
populations
6
with
disabilities
to
which
the
counties
comprising
the
region
7
have
historically
provided
assistance
but
who
are
not
included
8
in
the
service
management
provisions
required
under
subsection
9
2,
subject
to
the
availability
of
funding.
10
6.
If
a
region
determines
that
the
region
cannot
provide
11
services
for
the
fiscal
year
in
accordance
with
the
regional
12
plan
and
remain
in
compliance
with
applicable
budgeting
13
requirements,
the
region
may
implement
a
waiting
list
for
14
the
services.
The
procedures
for
establishing
and
applying
15
a
waiting
list
shall
be
specified
in
the
regional
plan.
If
16
a
region
implements
a
waiting
list
for
services,
the
region
17
shall
notify
the
department
of
human
services.
The
department
18
shall
maintain
on
the
department’s
internet
site
an
up-to-date
19
listing
of
the
regions
that
have
implemented
a
waiting
list
and
20
the
services
affected
by
each
waiting
list.
21
7.
The
director’s
approval
of
a
regional
plan
shall
not
be
22
construed
to
constitute
certification
of
the
respective
county
23
budgets
or
of
the
region’s
budget.
24
Sec.
12.
NEW
SECTION
.
331.439B
Financial
eligibility
25
requirements.
26
A
person
must
comply
with
all
of
the
following
financial
27
eligibility
requirements
to
be
eligible
for
services
under
the
28
regional
service
system:
29
1.
The
person
must
have
an
income
equal
to
or
less
than
30
one
hundred
fifty
percent
of
the
federal
poverty
level,
as
31
defined
by
the
most
recently
revised
poverty
income
guidelines
32
published
by
the
United
States
department
of
health
and
33
human
services,
to
be
eligible
for
disability
services
34
public
funding.
It
is
the
intent
of
the
general
assembly
to
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consider
increasing
this
income
eligibility
provision
to
two
1
hundred
percent
of
the
federal
poverty
level,
contingent
upon
2
implementation
of
the
federal
Patient
Protection
and
Affordable
3
Care
Act
beginning
in
January
2014.
4
2.
a.
A
region
or
a
service
provider
contracting
with
the
5
region
shall
not
apply
a
copayment,
sliding
fee
scale,
or
other
6
cost
sharing
requirement
for
a
particular
service
to
a
person
7
with
an
income
equal
to
or
less
than
one
hundred
fifty
percent
8
of
the
federal
poverty
level.
9
b.
A
person
with
an
income
above
one
hundred
fifty
10
percent
of
the
federal
poverty
level
may
be
eligible
for
11
services
subject
to
a
copayment,
sliding
fee
scale,
or
other
12
cost-sharing
requirement
approved
by
the
department.
13
c.
A
provider
under
the
regional
service
system
of
a
service
14
that
is
not
funded
by
the
medical
assistance
program
under
15
chapter
249A
may
waive
the
copayment
or
other
cost-sharing
16
arrangement
if
the
provider
is
fully
able
to
absorb
the
cost.
17
3.
A
person
who
is
eligible
for
federally
funded
services
18
and
other
support
must
apply
for
such
services
and
support.
19
However,
if
a
person
is
requesting
services
or
other
support
20
that
is
expected
to
be
needed
for
less
than
two
years
in
21
duration,
the
person
shall
be
exempt
from
this
requirement.
22
4.
The
person
is
in
compliance
with
resource
limitations
23
identified
in
rule
adopted
by
the
state
commission.
The
24
limitation
shall
be
derived
from
the
federal
supplemental
25
security
income
program
resource
limitations.
A
person
with
26
resources
above
the
federal
supplemental
security
income
27
program
resource
limitations
may
be
eligible
subject
to
28
limitations
adopted
in
rule
by
the
state
commission.
If
a
29
person
does
not
qualify
for
federally
funded
services
and
other
30
support
but
meets
income,
resource,
and
functional
eligibility
31
requirements
for
regional
services,
the
following
types
of
32
resources
shall
be
disregarded:
33
a.
A
retirement
account
that
is
in
the
accumulation
stage.
34
b.
A
burial,
medical
savings,
or
assistive
technology
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account.
1
Sec.
13.
NEW
SECTION
.
331.439C
Diagnosis
——
functional
2
assessment.
3
1.
A
person
must
comply
with
all
of
the
following
4
requirements
to
be
eligible
for
mental
health
services
under
5
the
regional
service
system:
6
a.
The
person
complies
with
financial
eligibility
7
requirements
under
section
331.439B.
8
b.
The
person
is
at
least
eighteen
years
of
age
and
is
a
9
resident
of
this
state.
However,
a
person
who
is
seventeen
10
years
of
age,
is
a
resident
of
this
state,
and
is
receiving
11
publicly
funded
children’s
services
may
be
considered
eligible
12
for
services
through
the
regional
service
system
during
the
13
three-month
period
preceding
the
person’s
eighteenth
birthday
14
in
order
to
provide
a
smooth
transition
from
children’s
to
15
adult
services.
16
c.
The
person
has
had
at
any
time
during
the
preceding
17
twelve-month
period
a
diagnosable
mental
health,
behavioral,
or
18
emotional
disorder.
The
diagnosis
shall
be
made
in
accordance
19
with
the
criteria
provided
in
the
diagnostic
and
statistical
20
manual
of
mental
disorders,
fourth
edition
text
revised,
21
published
by
the
American
psychiatric
association,
and
shall
22
not
include
the
manual’s
“V”
codes
identifying
conditions
other
23
than
a
disease
or
injury.
The
diagnosis
shall
also
not
include
24
substance-related
disorders,
dementia,
antisocial
personality,
25
or
developmental
disabilities,
unless
co-occurring
with
another
26
diagnosable
mental
illness.
27
d.
The
person’s
eligibility
for
individualized
services
28
shall
be
determined
in
accordance
with
the
standardized
29
functional
assessment
methodology
approved
for
mental
health
30
services
by
the
director
of
human
services.
31
2.
A
person
must
comply
with
all
of
the
following
32
requirements
to
be
eligible
for
intellectual
disability
or
33
other
developmental
disability
services
under
the
regional
34
service
system:
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a.
The
person
complies
with
financial
eligibility
1
requirements
under
section
331.439B.
2
b.
The
person
is
at
least
eighteen
years
of
age
and
is
a
3
resident
of
this
state.
However,
a
person
who
is
seventeen
4
years
of
age,
is
a
resident
of
this
state,
and
is
receiving
5
publicly
funded
children’s
services
may
be
considered
eligible
6
for
services
through
the
regional
service
system
during
the
7
three-month
period
preceding
the
person’s
eighteenth
birthday
8
in
order
to
provide
a
smooth
transition
from
children’s
to
9
adult
services.
10
c.
The
person
has
a
diagnosis
of
intellectual
disability
or
11
a
diagnosis
of
developmental
disability
other
than
intellectual
12
disability.
13
d.
The
person’s
eligibility
for
individualized
services
14
shall
be
determined
in
accordance
with
the
standardized
15
functional
assessment
methodology
approved
for
intellectual
16
disability
and
developmental
disability
services
by
the
17
director
of
human
services.
18
3.
A
person
must
comply
with
all
of
the
following
19
requirements
to
be
eligible
for
brain
injury
services
under
the
20
regional
service
system:
21
a.
The
person
complies
with
financial
eligibility
22
requirements
under
section
331.439B.
23
b.
The
person
is
at
least
eighteen
years
of
age
and
is
a
24
resident
of
this
state.
However,
a
person
who
is
seventeen
25
years
of
age,
is
a
resident
of
this
state,
and
is
receiving
26
publicly
funded
children’s
services
may
be
considered
eligible
27
for
services
through
the
regional
service
system
during
the
28
three-month
period
preceding
the
person’s
eighteenth
birthday
29
in
order
to
provide
a
smooth
transition
from
children’s
to
30
adult
services.
31
c.
The
person
has
a
diagnosis
of
brain
injury.
32
d.
The
person’s
eligibility
for
individualized
services
33
shall
be
determined
in
accordance
with
a
standardized
34
functional
assessment
methodology
approved
for
this
purpose
by
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the
director
of
human
services.
1
Sec.
14.
NEW
SECTION
.
331.439D
Regional
core
services.
2
1.
For
the
purposes
of
this
section,
unless
the
context
3
otherwise
requires:
4
a.
“Crisis
stabilization
facility”
means
an
institution,
5
place,
building,
or
agency
with
restricted
means
of
egress
6
designed
to
provide
accommodation,
board,
and
the
services
7
of
a
mental
health
professional
on
a
short-term
basis
of
no
8
more
than
five
days
to
three
or
more
individuals
who
present
9
in
the
facility
with
acute
psychiatric
needs.
The
goal
of
a
10
crisis
stabilization
facility
is
to
decrease
the
severity
of
an
11
individual’s
condition
to
allow
transition
of
the
individual
12
to
a
less
restrictive
facility.
13
b.
“Domain”
means
a
set
of
similar,
discrete
services
that
14
can
be
provided
depending
upon
an
individual’s
service
needs.
15
2.
a.
A
region
shall
ensure
that
services
within
the
16
core
service
domains
listed
in
subsection
3
are
available
for
17
eligible
persons
who
are
not
enrolled
in
the
medical
assistance
18
program
under
chapter
249A
or
receiving
other
third-party
19
payment
for
the
services.
Until
funding
is
designated
for
20
other
service
populations,
eligibility
for
the
service
domains
21
listed
in
this
section
shall
be
limited
to
such
persons
who
are
22
in
need
of
mental
health
or
intellectual
disability
services.
23
However,
if
a
county
in
a
region
was
providing
services
to
a
24
person
with
brain
injury
prior
to
formation
of
the
region,
the
25
person
shall
remain
eligible
for
the
services
provided
when
the
26
region
is
formed.
27
b.
It
is
the
intent
of
the
general
assembly
to
address
28
the
need
for
funding
so
that
the
availability
of
the
service
29
domains
listed
in
this
section
may
be
expanded
to
include
such
30
persons
who
are
in
need
of
developmental
disability
or
brain
31
injury
services.
32
3.
Pursuant
to
recommendations
made
by
the
director
of
human
33
services,
the
state
commission
shall
adopt
rules
as
required
by
34
section
225C.6
to
define
the
services
included
in
the
initial
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and
additional
core
service
domains
listed
in
this
section.
1
The
rules
shall
provide
consistency,
to
the
extent
possible,
2
with
similar
service
definitions
under
the
medical
assistance
3
program.
4
4.
The
initial
core
service
domains
shall
include
the
5
following:
6
a.
Treatment
designed
to
ameliorate
a
person’s
condition,
7
including
but
not
limited
to
all
of
the
following:
8
(1)
Assessment
and
evaluation.
9
(2)
Mental
health
outpatient
therapy.
10
(3)
Medication
prescribing
and
management.
11
(4)
Mental
health
inpatient
treatment.
12
b.
Basic
crisis
response
provisions,
including
but
not
13
limited
to
all
of
the
following:
14
(1)
Twenty-four-hour
access
to
crisis
response.
15
(2)
Evaluation.
16
(3)
Personal
emergency
response
system.
17
c.
Support
for
community
living,
including
but
not
limited
18
to
all
of
the
following:
19
(1)
Home
health
aide.
20
(2)
Home
and
vehicle
modifications.
21
(3)
Respite.
22
(4)
Supportive
community
living.
23
d.
Support
for
employment,
including
but
not
limited
to
all
24
of
the
following:
25
(1)
Day
habilitation.
26
(2)
Job
development.
27
(3)
Supported
employment.
28
(4)
Prevocational
services.
29
e.
Recovery
services,
including
but
not
limited
to
all
of
30
the
following:
31
(1)
Family
support.
32
(2)
Peer
support.
33
f.
Service
coordination
including
coordinating
physical
34
health
and
primary
care,
including
but
not
limited
to
all
of
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the
following:
1
(1)
Case
management.
2
(2)
Health
homes.
3
5.
A
region
shall
ensure
that
providers
of
core
services
4
demonstrate
competencies
necessary
for
all
of
the
following:
5
a.
Serving
persons
with
co-occurring
conditions.
6
b.
Providing
evidence-based
services.
7
c.
Providing
trauma-informed
care
that
recognizes
the
8
presence
of
trauma
symptoms
in
persons
receiving
services.
9
6.
A
region
shall
ensure
that
services
within
the
following
10
additional
core
service
domains
are
available
to
persons
not
11
eligible
for
the
medical
assistance
program
under
chapter
249A
12
or
receiving
other
third-party
payment
for
the
services,
when
13
public
funds
are
made
available
for
such
services:
14
a.
Comprehensive
crisis
services,
including
but
not
limited
15
to
all
of
the
following:
16
(1)
Twenty-four-hour
crisis
hotline.
17
(2)
Mobile
response.
18
(3)
Twenty-three-hour
crisis
observation
and
holding,
and
19
crisis
stabilization
facility
services.
20
(4)
Crisis
residential
services.
21
b.
Subacute
services.
22
c.
Justice
system-involved
services,
including
but
not
23
limited
to
all
of
the
following:
24
(1)
Jail
diversion.
25
(2)
Crisis
intervention
training.
26
(3)
Civil
commitment
prescreening.
27
d.
Advances
in
the
use
of
evidence-based
treatment,
28
including
but
not
limited
to
all
of
the
following:
29
(1)
Positive
behavior
support.
30
(2)
Assertive
community
treatment.
31
(3)
Peer
support
services.
32
7.
A
regional
service
system
may
provide
funding
for
other
33
appropriate
services
or
other
support.
In
considering
whether
34
to
provide
such
funding,
a
region
may
consider
the
following
35
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criteria:
1
a.
Applying
a
person-centered
planning
process
to
identify
2
the
need
for
the
services
or
other
support.
3
b.
The
efficacy
of
the
services
or
other
support
is
4
substantiated
by
an
evidence
base.
5
c.
A
determination
that
the
services
or
other
support
6
provides
an
effective
alternative
to
existing
services
that
7
have
been
shown
by
the
evidence
base
to
be
ineffective,
to
not
8
yield
the
desired
outcome,
or
to
not
support
the
principles
9
outlined
in
Olmstead
v.
L.C.,
527
U.S.
581
(1999).
10
Sec.
15.
NEW
SECTION
.
331.440B
Regional
service
system
11
financing.
12
1.
a.
The
financing
of
a
regional
mental
health
and
13
disability
service
system
is
limited
to
a
fixed
budget
amount.
14
The
fixed
budget
amount
shall
be
the
amount
identified
in
15
a
regional
service
system
management
plan
and
budget
for
16
the
fiscal
year.
A
region
shall
receive
state
funding
for
17
growth
in
non-Medicaid
expenditures
through
the
mental
health
18
and
disability
regional
services
fund
created
in
section
19
225C.7A
to
address
increased
service
costs,
additional
service
20
populations,
additional
core
service
domains,
and
increased
21
numbers
of
persons
receiving
services.
22
b.
The
state
commission
shall
recommend
a
non-Medicaid
23
expenditures
growth
funding
amount
to
the
department,
the
24
council
on
human
services,
and
the
governor
annually
by
July
25
15
for
the
fiscal
year
which
commences
two
years
from
the
26
beginning
date
of
the
fiscal
year
in
progress
at
the
time
27
the
recommendation
is
made.
The
director
of
human
service
28
shall
consider
the
state
commission’s
recommendation
in
the
29
director’s
budget
recommendations
to
the
council
on
human
30
services
and
the
council
shall
consider
the
recommendation
in
31
approving
the
department’s
budget
submitted
to
the
governor
in
32
accordance
with
section
217.3.
The
governor
shall
consider
the
33
state
commission’s
recommendation
in
developing
the
governor’s
34
recommendation
for
a
non-Medicaid
expenditures
growth
funding
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amount
for
such
fiscal
year.
The
governor’s
recommendation
1
shall
be
submitted
at
the
time
the
governor’s
proposed
budget
2
for
the
succeeding
fiscal
year
is
submitted
in
accordance
with
3
chapter
8.
4
2.
A
region
shall
implement
its
regional
service
system
5
management
plan
in
a
manner
so
as
to
provide
adequate
funding
6
of
services
for
the
entire
fiscal
year
by
budgeting
for
7
ninety-nine
percent
of
the
funding
anticipated
to
be
available
8
for
the
regional
plan
for
the
fiscal
year.
A
region
may
expend
9
all
of
the
funding
anticipated
to
be
available
for
the
regional
10
plan.
11
Sec.
16.
IMPLEMENTATION
OF
ACT.
Section
25B.2,
subsection
12
3,
shall
not
apply
to
this
division
of
this
Act.
13
Sec.
17.
CODE
EDITOR.
The
Code
editor
may
codify
the
14
provisions
of
this
division
of
this
Act
and
any
other
15
provisions
of
this
Act
involving
chapter
331
as
one
or
more
new
16
parts
of
chapter
331,
division
III.
17
Sec.
18.
APPLICABILITY.
The
provisions
of
this
division
of
18
this
Act
enacting
new
Code
sections
331.439A
through
331.439E,
19
and
section
331.440B
apply
beginning
on
July
1,
2013.
20
DIVISION
II
21
WORKFORCE
DEVELOPMENT
AND
REGULATION
22
Sec.
19.
NEW
SECTION
.
225C.6C
Mental
health
and
disability
23
services
workforce
development
workgroup.
24
1.
The
department
of
human
services
shall
convene
and
25
provide
support
to
a
mental
health
and
disability
services
26
workforce
development
workgroup
to
address
issues
connected
27
with
assuring
that
an
adequate
workforce
is
available
in
the
28
state
to
provide
mental
health
and
disability
services.
The
29
workgroup
shall
report
at
least
annually
to
the
governor
30
and
general
assembly
providing
findings,
recommendations,
31
and
financing
information
concerning
the
findings
and
32
recommendations.
33
2.
The
membership
of
the
workgroup
shall
include
all
of
the
34
following:
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a.
The
director
of
the
department
of
aging
or
the
director’s
1
designee.
2
b.
The
director
of
the
department
of
corrections
or
the
3
director’s
designee.
4
c.
The
director
of
the
department
of
education
or
the
5
director’s
designee.
6
d.
The
director
of
human
services
or
the
director’s
7
designee.
8
e.
The
director
of
the
department
of
public
health
or
the
9
director’s
designee.
10
f.
The
director
of
the
department
of
workforce
development
11
or
the
director’s
designee.
12
g.
At
least
three
staff
of
regional
administrators
13
appointed
by
the
community
services
affiliate
of
the
Iowa
state
14
association
of
counties.
15
h.
At
least
three
individuals
receiving
mental
health
and
16
disability
services
or
involved
relatives
of
such
individuals.
17
i.
At
least
three
providers
of
mental
health
and
disability
18
services.
19
j.
A
representative
of
the
entity
under
contract
with
20
the
department
to
provide
mental
health
managed
care
for
the
21
medical
assistance
program.
22
k.
One
or
more
representatives
of
the
institutions
under
23
the
control
of
the
state
board
of
regents
who
are
knowledgeable
24
concerning
the
mental
health
and
disability
services
workforce.
25
1.
A
provider
representative
of
the
Iowa
collaborative
26
safety
net
provider
network
established
pursuant
to
section
27
135.153.
28
m.
Other
persons
identified
by
the
workgroup.
29
3.
In
addition
to
the
members
identified
in
subsection
30
2,
the
membership
of
the
workgroup
shall
include
four
31
members
of
the
general
assembly
serving
in
a
nonvoting,
ex
32
officio
capacity.
One
member
shall
be
designated
by
each
33
of
the
following:
the
majority
leader
of
the
senate,
the
34
minority
leader
of
the
senate,
the
speaker
of
the
house
of
35
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representatives,
and
the
minority
leader
of
the
house
of
1
representatives.
A
legislative
member
serves
for
a
term
as
2
provided
in
section
69.16B.
3
4.
Except
as
provided
in
subsection
3
for
legislative
4
appointments,
the
workgroup
shall
determine
its
own
rules
of
5
procedure,
membership
terms,
and
operating
provisions.
6
5.
The
workforce
development
measures
considered
for
7
recommendation
by
the
workgroup
shall
include
but
are
not
8
limited
to
all
of
the
following:
9
a.
Provide
for
the
college
of
direct
support
or
comparable
10
internet-based
training
to
be
available
at
no
charge
to
all
11
service
providers.
12
b.
Require
every
direct
support
professional
to
demonstrate
13
a
level
of
competency
in
core
curricula.
14
c.
Provide
financial
incentives
for
those
providers
who
15
support
direct
care
staff
in
securing
a
voluntary
certification
16
from
the
national
alliance
for
direct
support
professionals
or
17
a
comparable
certification
or
accreditation
body.
18
d.
Change
the
rate
reimbursement
methodologies
to
allow
19
providers
to
bill
direct
care
staff
development
costs
as
a
20
direct
expense
rather
than
as
an
indirect
cost.
21
e.
Implement
regional
service
system
staffing
capability
22
to
provide
positive
behavior
supports
training
and
to
23
mount
a
crisis
intervention
and
prevention
response
that
is
24
evidence-based
and
utilizes
best
practices.
25
f.
Make
technical
assistance
available
to
service
providers
26
for
issues
such
as
crisis
intervention,
sheltered
workshop
27
conversion,
and
other
approaches
to
modernize
services.
28
g.
Implement
co-occurring
disability
cross
training
29
for
mental
health
professionals
as
well
as
training
for
30
primary
care
practitioners
on
substance-related
disorders,
31
mental
health,
and
intellectual
disability
and
developmental
32
disability
behavioral
issues.
33
h.
Study
the
issues
surrounding
the
shortage
of
mental
34
health
professionals
in
the
state
and
make
recommendations
for
35
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addressing
the
issues.
1
Sec.
20.
NEW
SECTION
.
225C.6D
Regional
service
system
——
2
outcomes
and
performance
measures
committee.
3
1.
The
department
shall
establish
an
outcomes
and
4
performance
measures
committee
to
recommend
to
the
department
5
and
the
commission’s
specific
outcomes
and
performance
measures
6
to
be
utilized
by
the
regional
mental
health
and
disability
7
services
system.
The
membership
of
the
committee
shall
include
8
regional
administrator
and
departmental
staff,
individuals
9
receiving
mental
health
and
disability
services
or
involved
10
relatives
of
such
individuals,
providers
of
mental
health
and
11
disability
services,
a
representative
of
the
entity
under
12
contract
with
the
department
to
provide
mental
health
managed
13
care
for
the
medical
assistance
program,
a
representative
14
of
the
institutions
under
the
control
of
the
state
board
of
15
regents
who
is
knowledgeable
concerning
mental
health
and
16
disability
services,
a
representative
of
the
department’s
task
17
force
to
address
the
decision
in
Olmstead
v.
L.C.,
527
U.S.
581
18
(1999),
a
provider
representative
of
the
Iowa
collaborative
19
safety
net
provider
network
established
pursuant
to
section
20
135.153,
and
other
stakeholders.
21
2.
The
committee’s
recommendations
shall
incorporate
the
22
outcome
measurement
methodologies
previously
developed
by
the
23
mental
health
and
disability
services
commission.
To
the
24
extent
possible,
the
committee
shall
seek
to
provide
outcome
25
and
performance
measures
recommendations
that
are
consistent
26
across
the
mental
health
and
disability
services
populations
27
addressed.
The
committee
shall
also
evaluate
data
collection
28
requirements
utilized
in
the
mental
health
and
disability
29
regional
service
system
to
identify
the
requirements
that
30
could
be
eliminated
or
revised
due
to
the
administrative
31
burden
involved
or
the
low
degree
of
relevance
to
outcomes
or
32
other
reporting
requirements.
The
committee
recommendations
33
shall
be
submitted
to
the
governor,
general
assembly,
and
34
policymaking
bodies.
The
mental
health
and
disability
services
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commission
and
other
policymaking
bodies
shall
consider
the
1
recommendations
in
eliminating
or
otherwise
revising
data
2
collection
requirements.
3
Sec.
21.
NEW
SECTION
.
225C.6E
Regional
service
system
——
4
regulatory
requirements.
5
1.
The
departments
of
inspections
and
appeals,
human
6
services,
and
public
health
shall
comply
with
the
requirements
7
of
this
section
in
their
efforts
to
improve
the
regulatory
8
requirements
applied
to
the
mental
health
and
disability
9
regional
service
system
administration
and
service
providers.
10
2.
The
three
departments
shall
work
together
to
establish
11
a
process
to
streamline
accreditation,
certification,
and
12
licensing
standards
applied
to
the
regional
service
system
13
administration
and
service
providers.
14
3.
The
departments
of
human
services
and
inspections
and
15
appeals
shall
jointly
review
the
standards
and
inspection
16
process
applicable
to
residential
care
facilities.
17
4.
The
three
departments
shall
do
all
of
the
following
in
18
developing
regulatory
requirements
applicable
to
the
regional
19
service
system
administration
and
service
providers:
20
a.
Consider
the
costs
to
administrators
and
providers
in
the
21
development
of
quality
monitoring
efforts.
22
b.
Expand
the
use
of
uniform,
streamlined,
and
statewide
23
cost
reporting
standards
and
tools.
24
c.
Make
quality
monitoring
information,
including
services,
25
quality,
and
location
information,
easily
available
and
26
understandable
to
all
citizens.
27
d.
Establish
standards
that
are
clearly
understood
and
are
28
accompanied
by
interpretive
guidelines
to
support
understanding
29
by
those
responsible
for
applying
the
standards.
30
e.
Develop
a
partnership
with
providers
in
order
to
31
improve
the
quality
of
services
and
develop
mechanisms
for
the
32
provision
of
technical
assistance.
33
f.
Develop
consistent
data
collection
efforts
based
on
34
statewide
standards
and
make
information
available
to
all
35
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providers.
1
g.
Evaluate
existing
provider
qualification
and
monitoring
2
efforts
to
identify
duplication
and
gaps,
and
align
the
efforts
3
with
valued
outcomes.
4
h.
Streamline
and
enhance
existing
standards.
5
i.
Consider
allowing
providers
to
seek
accreditation
from
6
a
national
accrediting
body
in
lieu
of
state
accreditation
or
7
certification.
8
DIVISION
III
9
COMMUNITY
MENTAL
HEALTH
CENTER
AMENDMENTS
10
Sec.
22.
Section
230A.110,
subsection
1,
as
enacted
by
11
2011
Iowa
Acts,
chapter
121,
section
20,
is
amended
to
read
as
12
follows:
13
1.
The
division
shall
recommend
and
the
commission
shall
14
adopt
standards
for
designated
community
mental
health
15
centers
and
comprehensive
community
mental
health
programs,
16
with
the
overall
objective
of
ensuring
that
each
center
17
and
each
affiliate
providing
services
under
contract
with
a
18
center
furnishes
high-quality
mental
health
services
within
19
a
framework
of
accountability
to
the
community
it
serves.
20
The
standards
adopted
shall
conform
with
federal
standards
21
applicable
to
community
mental
health
centers
and
shall
be
22
in
substantial
conformity
with
the
applicable
behavioral
23
health
standards
adopted
by
the
joint
commission,
formerly
24
known
as
the
joint
commission
on
accreditation
of
health
care
25
organizations,
and
or
other
recognized
national
standards
for
26
evaluation
of
psychiatric
facilities
unless
in
the
judgment
of
27
the
division,
with
approval
of
the
commission,
there
are
sound
28
reasons
for
departing
from
the
standards.
29
DIVISION
IV
30
REGIONAL
SERVICE
SYSTEM
31
Sec.
23.
Section
97B.1A,
subsection
9,
Code
Supplement
32
2011,
is
amended
to
read
as
follows:
33
9.
“Employer”
means
the
state
of
Iowa,
the
counties,
34
municipalities,
agencies,
public
school
districts,
all
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political
subdivisions,
and
all
of
their
departments
and
1
instrumentalities,
including
area
agencies
on
aging,
other
than
2
those
employing
persons
as
specified
in
subsection
8
,
paragraph
3
“b”
,
subparagraph
(7),
regional
administrators
formed
by
a
4
chapter
28E
agreement
as
authorized
in
section
331.438C,
and
5
joint
planning
commissions
created
under
chapter
28E
or
28I
.
6
If
an
interstate
agency
is
established
under
chapter
28E
7
and
similar
enabling
legislation
in
an
adjoining
state,
and
an
8
employer
had
made
contributions
to
the
retirement
system
for
9
employees
performing
functions
which
are
transferred
to
the
10
interstate
agency,
the
employees
of
the
interstate
agency
who
11
perform
those
functions
shall
be
considered
to
be
employees
12
of
the
employer
for
the
sole
purpose
of
membership
in
the
13
retirement
system,
although
the
employer
contributions
for
14
those
employees
are
made
by
the
interstate
agency.
15
Sec.
24.
NEW
SECTION
.
331.438A
Definitions.
16
As
used
in
this
part,
unless
the
context
otherwise
requires:
17
1.
“Department”
means
the
department
of
human
services.
18
2.
“Disability
services”
means
the
same
as
defined
in
19
section
225C.2.
20
3.
“Population”
means
the
population
shown
by
the
latest
21
preceding
certified
federal
census
or
the
latest
applicable
22
population
estimate
issued
by
the
United
States
census
bureau,
23
whichever
is
most
recent.
24
4.
“Regional
administrator”
means
the
administrative
office,
25
organization,
or
entity
formed
by
agreement
of
the
counties
26
participating
in
a
region
to
function
on
behalf
of
those
27
counties
in
accordance
with
this
part.
28
5.
“State
commission”
means
the
mental
health
and
disability
29
services
commission
created
in
section
225C.5.
30
Sec.
25.
NEW
SECTION
.
331.438B
Mental
health
and
disability
31
services
regions
——
criteria.
32
1.
Local
access
to
mental
health
and
disability
services
33
for
adults
shall
be
provided
by
counties
organized
in
a
34
regional
service
system.
The
regional
service
system
shall
be
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implemented
in
stages
in
accordance
with
this
section.
1
2.
The
director
of
human
services
shall
approve
any
region
2
meeting
the
requirements
of
subsection
3.
However,
the
3
director
of
human
services,
with
the
approval
of
the
state
4
commission,
may
grant
a
waiver
from
the
requirement
relating
5
to
the
minimum
number
of
counties
or
the
requirement
providing
6
population
parameters
if
there
is
convincing
evidence
that
7
compliance
with
such
requirement
is
not
workable.
8
3.
Each
county
in
the
state
shall
participate
in
an
approved
9
mental
health
and
disability
services
region.
A
mental
health
10
and
disability
services
region
shall
comply
with
all
of
the
11
following
requirements:
12
a.
The
counties
comprising
the
region
are
contiguous.
13
b.
The
region
has
at
least
three
counties.
14
c.
The
combined
general
population
of
the
counties
15
comprising
a
region
shall
be
at
least
two
hundred
thousand
16
persons
and
not
more
than
seven
hundred
thousand
persons.
17
d.
The
region
has
the
capacity
to
provide
required
core
18
services
and
perform
required
functions.
19
e.
At
least
one
community
mental
health
center
or
a
20
federally
qualified
health
center
with
providers
qualified
21
to
provide
psychiatric
services,
either
directly
or
with
22
assistance
from
psychiatric
consultants,
is
located
within
the
23
region,
has
the
capacity
to
provide
outpatient
services
for
the
24
region,
and
is
either
under
contract
with
the
region
or
has
25
provided
documentation
of
intent
to
contract
with
the
region
26
to
provide
the
services.
27
f.
A
hospital
with
an
inpatient
psychiatric
unit
or
a
state
28
mental
health
institute
is
located
in
or
within
reasonably
29
close
proximity
to
the
region,
has
the
capability
to
provide
30
inpatient
services
for
the
region,
and
is
either
under
contract
31
with
the
region
or
has
provided
documentation
of
intent
to
32
contract
with
the
region
to
provide
the
services.
33
g.
The
regional
administrator
structure
proposed
for
or
34
utilized
by
the
region
has
clear
lines
of
accountability
and
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the
regional
administrator
functions
as
a
lead
agency
utilizing
1
shared
county
staff
or
other
means
of
limiting
administrative
2
costs.
3
4.
County
formation
of
a
mental
health
and
disability
4
services
region
is
subject
to
all
of
the
following:
5
a.
On
or
before
November
1,
2012,
counties
voluntarily
6
participating
in
a
region
have
complied
with
all
of
the
7
following
formation
criteria:
8
(1)
The
counties
forming
the
region
have
been
identified
9
and
the
board
of
supervisors
of
the
counties
have
approved
a
10
written
letter
of
intent
to
join
together
to
form
the
region.
11
(2)
The
proposed
region
complies
with
the
requirements
in
12
subsection
3.
13
(3)
The
department
provides
written
notice
to
the
boards
14
of
supervisors
of
the
counties
identified
for
the
region
in
15
the
letter
of
intent
that
the
counties
have
complied
with
the
16
requirements
in
subsection
3.
17
b.
Upon
compliance
with
the
provisions
of
paragraph
“a”
,
the
18
participating
counties
are
eligible
for
technical
assistance
19
provided
by
the
department.
20
c.
During
the
period
of
November
2,
2012,
through
January
1,
21
2013,
the
department
shall
work
with
any
county
that
has
not
22
agreed
to
voluntarily
be
part
of
a
region
in
accordance
with
23
paragraph
“a”
and
with
the
counties
adjoining
the
county
to
24
resolve
issues
preventing
the
county
from
joining
a
region.
By
25
January
1,
2013,
a
county
that
has
not
agreed
to
be
part
of
a
26
region
in
accordance
with
paragraph
“a”
shall
be
assigned
by
the
27
department
to
a
region.
28
d.
On
or
before
June
30,
2013,
all
counties
shall
be
part
of
29
a
region
that
is
in
compliance
with
the
provisions
of
paragraph
30
“a”
other
than
meeting
the
November
1,
2012,
date.
31
e.
On
or
before
June
30,
2014,
all
counties
shall
be
32
in
compliance
with
all
of
the
following
mental
health
and
33
disability
services
region
implementation
criteria:
34
(1)
The
board
of
supervisors
of
each
county
participating
in
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the
region
has
voted
to
approve
a
chapter
28E
agreement.
1
(2)
The
duly
authorized
representatives
of
all
the
counties
2
participating
in
the
region
have
signed
the
chapter
28E
3
agreement
that
is
in
compliance
with
section
331.438C.
4
(3)
The
county
board
of
supervisors’
or
supervisors’
5
designee
members
and
other
members
of
the
region’s
governing
6
board
have
been
appointed
in
accordance
with
section
331.438C.
7
(4)
Executive
staff
for
the
region’s
regional
administrator
8
have
been
identified
or
engaged.
9
(5)
An
initial
draft
of
a
regional
service
management
10
transition
plan
has
been
developed
which
identifies
the
steps
11
to
be
taken
by
the
region
to
do
all
of
the
following:
12
(a)
Designate
access
points
for
the
disability
services
13
administered
by
the
region.
14
(b)
Designate
the
region’s
targeted
case
manager
providers
15
funded
by
the
medical
assistance
program.
16
(c)
Identify
the
service
provider
network
for
the
region.
17
(d)
Define
the
service
access
and
service
authorization
18
process
to
be
utilized
for
the
region.
19
(e)
Identify
the
information
technology
and
data
management
20
capacity
to
be
employed
to
support
regional
functions.
21
(f)
Establish
business
functions,
funds
accounting
22
procedures,
and
other
administrative
processes.
23
(g)
Comply
with
data
reporting
and
other
information
24
technology
requirements
identified
by
the
department.
25
(6)
The
department
has
approved
the
region’s
chapter
28E
26
agreement
and
the
initial
draft
of
the
regional
management
27
transition
plan.
28
f.
If
the
department,
with
the
concurrence
of
the
state
29
commission,
determines
that
a
region
is
in
substantial
30
compliance
with
the
implementation
criteria
in
paragraph
“e”
31
and
has
sufficient
operating
capacity
to
begin
operations,
the
32
region
may
commence
partial
or
full
operations
prior
to
July
33
2014.
34
Sec.
26.
NEW
SECTION
.
331.438C
Regional
governance
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structure.
1
1.
The
counties
comprising
a
mental
health
and
disability
2
services
region
shall
enter
into
an
agreement
under
chapter
3
28E
to
form
a
regional
administrator
under
the
control
of
a
4
governing
board
to
function
on
behalf
of
those
counties.
5
2.
The
governing
board
shall
comply
with
all
of
the
6
following
requirements:
7
a.
The
voting
membership
of
the
governing
board
shall
8
consist
of
one
board
of
supervisors
member
from
each
county
9
comprising
the
region
or
their
designees.
On
governing
board
10
decisions
involving
finances,
collective
bargaining,
and
other
11
finance-related
matters
identified
by
these
members,
any
of
12
these
members
may
request
a
weighted
vote.
In
a
weighted
vote,
13
each
of
the
counties
comprising
the
region
is
assigned
a
number
14
of
votes
equal
to
its
population
within
the
region
and
approval
15
of
the
decision
requires
at
least
three-fourths
of
the
total
16
votes
cast.
The
population
figures
in
the
federal
census
or
17
the
latest
applicable
estimate
issued
by
the
United
States
18
bureau
of
the
census,
whichever
is
more
recent,
shall
be
used
19
for
purposes
of
determining
population.
20
b.
The
membership
of
the
governing
board
shall
also
consist
21
of
not
more
than
three
individuals
who
utilize
mental
health
22
and
disability
services
or
actively
involved
relatives
of
such
23
individuals.
These
members
shall
be
designated
by
the
advisory
24
committee
or
committees
formed
by
the
governing
board
pursuant
25
to
this
section,
in
a
manner
so
as
to
represent
the
geographic
26
areas
of
the
region
and
to
provide
balanced
representation
for
27
the
various
disability
groups
utilizing
the
services
provided
28
through
the
region.
The
members
designated
in
accordance
with
29
this
paragraph
shall
serve
in
a
nonvoting,
ex
officio
capacity.
30
c.
The
membership
of
the
governing
board
shall
not
include
31
employees
of
the
department
of
human
services.
32
d.
The
membership
of
the
governing
board
shall
also
33
consist
of
not
more
than
three
members
representing
service
34
providers
in
the
region.
These
members
shall
be
designated
by
35
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the
advisory
committee
or
committees
formed
by
the
governing
1
board
pursuant
to
this
section
in
a
manner
to
represent
the
2
various
types
of
service
providers.
The
members
designated
in
3
accordance
with
this
paragraph
shall
serve
in
a
nonvoting,
ex
4
officio
capacity.
5
e.
The
governing
board
shall
have
a
regional
advisory
6
committee
consisting
of
individuals
who
utilize
services
or
7
actively
involved
relatives
of
such
individuals,
service
8
providers,
and
regional
governing
board
members.
9
3.
The
regional
administrator
shall
be
under
the
control
of
10
the
governing
board.
The
regional
administrator
shall
enter
11
into
performance-based
contracts
with
the
department
for
the
12
regional
administrator
to
manage,
on
behalf
of
the
counties
13
comprising
the
region,
the
mental
health
and
disability
14
services
that
are
not
funded
by
the
medical
assistance
program
15
under
chapter
249A
and
for
coordinating
with
the
department
the
16
provision
of
mental
health
and
disability
services
that
are
17
funded
under
the
medical
assistance
program.
18
Sec.
27.
NEW
SECTION
.
331.438D
Regional
finances.
19
1.
The
funding
under
the
control
of
the
governing
board
20
shall
be
maintained
in
a
combined
account,
in
separate
county
21
accounts
that
are
under
the
control
of
the
governing
board,
or
22
pursuant
to
other
arrangements
authorized
by
law
that
limit
the
23
administrative
burden
of
such
control
while
facilitating
public
24
scrutiny
of
financial
processes.
25
2.
The
administrative
costs
of
the
regional
administrator
26
shall
be
limited
to
the
percentage
of
expenditures
for
27
administrative
costs
allowed
for
the
entity
under
contract
28
with
the
department
of
human
services
to
provide
mental
29
health
managed
care
for
the
medical
assistance
program.
30
This
limitation
shall
be
subject
to
regular
review
by
the
31
department.
The
department
may
submit
recommendations
to
the
32
governor
and
general
assembly
for
appropriate
changes
to
the
33
limitation.
34
3.
The
funding
provided
pursuant
to
appropriations
from
the
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mental
health
and
disability
regional
services
fund
created
in
1
section
225C.7A
and
from
performance-based
contracts
with
the
2
department
shall
be
credited
to
the
account
or
accounts
under
3
the
control
of
the
governing
board.
4
Sec.
28.
NEW
SECTION
.
331.438E
Regional
governance
5
agreements.
6
1.
In
addition
to
compliance
with
the
applicable
provisions
7
of
chapter
28E,
the
chapter
28E
agreement
entered
into
by
the
8
counties
comprising
a
mental
health
and
disability
services
9
region
in
forming
the
regional
administrator
to
function
on
10
behalf
of
the
counties
shall
comply
with
the
requirements
of
11
this
section.
12
2.
The
organizational
provisions
of
the
agreement
shall
13
include
all
of
the
following:
14
a.
A
statement
of
purpose,
goals,
and
objectives
of
entering
15
into
the
agreement.
16
b.
Identification
of
the
governing
board
membership
and
the
17
terms,
methods
of
appointment,
voting
procedures,
and
other
18
provisions
applicable
to
the
operation
of
the
governing
board.
19
c.
The
identification
of
the
executive
staff
of
the
regional
20
administrator
serving
as
the
single
point
of
accountability
for
21
the
region.
22
d.
The
counties
participating
in
the
agreement.
23
e.
The
time
period
of
the
agreement
and
terms
for
24
termination
or
renewal
of
the
agreement.
25
f.
The
circumstances
under
which
additional
counties
may
26
join
the
region.
27
g.
Methods
for
dispute
resolution
and
mediation.
28
h.
Methods
for
termination
of
a
county’s
participation
in
29
the
region.
30
i.
Provisions
for
formation
and
assigned
responsibilities
31
for
one
or
more
advisory
committees
consisting
of
individuals
32
who
utilize
services
or
actively
involved
relatives
of
such
33
individuals,
service
providers,
governing
board
members,
and
34
other
interests
identified
in
the
agreement.
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3.
The
administrative
provisions
of
the
agreement
shall
1
include
all
of
the
following:
2
a.
Responsibility
of
the
governing
board
in
appointing
and
3
evaluating
the
performance
of
the
chief
executive
officer
of
4
the
regional
administrator.
5
b.
A
specific
list
of
the
functions
and
responsibilities
of
6
the
regional
administrator’s
chief
executive
officer
and
other
7
administrative
staff.
8
c.
Specification
of
the
functions
to
be
carried
out
by
each
9
party
to
the
agreement
and
by
any
subcontractor
of
a
party
to
10
the
agreement.
A
contract
with
a
provider
network
shall
be
11
separately
addressed.
12
4.
The
financial
provisions
of
the
agreement
shall
include
13
all
of
the
following:
14
a.
Methods
for
pooling,
management,
and
expenditure
of
the
15
funding
under
the
control
of
the
regional
administrator.
If
16
the
agreement
does
not
provide
for
pooling
of
the
participating
17
county
moneys
in
a
single
fund,
the
agreement
shall
specify
how
18
the
participating
county
moneys
will
be
subject
to
the
control
19
of
the
regional
administrator.
20
b.
Methods
for
allocating
administrative
funding
and
21
resources.
22
c.
Contributions
and
uses
of
initial
funding
or
related
23
contributions
made
by
the
counties
participating
in
the
24
region
for
purposes
of
commencing
operations
by
the
regional
25
administrator.
26
d.
Methods
for
acquiring
or
disposing
of
real
property.
27
e.
A
process
for
determining
the
use
of
savings
for
28
reinvestment.
29
f.
A
process
for
performance
of
an
annual
independent
audit
30
of
the
regional
administrator.
31
5.
If
implementation
of
a
region’s
regional
administrator
32
results
in
a
change
in
the
employer
of
county
employees
33
assigned
to
the
central
point
of
coordination
administrator
34
under
section
331.440,
Code
Supplement
2011,
and
the
employees
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were
covered
under
a
collective
bargaining
agreement,
such
1
employees
shall
be
retained
and
the
agreement
shall
be
2
continued
by
the
successor
employer
as
though
there
had
not
3
been
a
change
in
employer.
4
Sec.
29.
NEW
SECTION
.
331.438F
County
of
residence
——
5
services
to
residents
——
service
authorization
appeals
——
6
disputes
between
counties
or
regions
and
the
department.
7
1.
For
the
purposes
of
this
section,
unless
the
context
8
otherwise
requires:
9
a.
“County
of
residence”
means
the
county
in
this
state
in
10
which,
at
the
time
a
person
applies
for
or
receives
services,
11
the
person
is
living
in
the
county
and
has
established
an
12
ongoing
presence
with
the
declared,
good
faith
intention
of
13
living
in
the
county
for
a
permanent
or
indefinite
period
of
14
time.
The
county
of
residence
of
a
person
who
is
a
homeless
15
person
is
the
county
where
the
homeless
person
usually
16
sleeps.
A
person
maintains
residency
in
the
county
in
which
17
the
person
last
resided
while
a
person
is
present
in
another
18
county
receiving
services
in
a
hospital,
a
correctional
19
facility,
a
halfway
house
for
community-based
corrections
20
or
substance-related
treatment,
a
nursing
facility,
an
21
intermediate
care
facility
for
persons
with
an
intellectual
22
disability,
or
a
residential
care
facility,
or
for
the
purpose
23
of
attending
a
college
or
university.
24
b.
“Homeless
person”
means
the
same
as
defined
in
section
25
48A.2.
26
c.
“Person”
means
a
person
who
is
a
United
States
citizen
or
27
a
qualified
alien
as
defined
in
8
U.S.C.
§
1641.
28
2.
If
a
person
appeals
a
service
authorization
or
29
other
services-related
determination
made
by
a
regional
30
administrator,
the
appeal
shall
be
heard
in
a
contested
31
case
proceeding
by
a
state
administrative
law
judge.
The
32
administrative
law
judge’s
decision
shall
be
considered
a
final
33
agency
decision
under
chapter
17A.
34
3.
If
a
county
of
residence
is
part
of
a
mental
health
and
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disability
services
region
that
has
agreed
to
pool
funding
and
1
liability
for
services,
the
responsibilities
of
the
county
2
under
law
regarding
such
services
shall
be
performed
on
behalf
3
of
the
county
by
the
regional
administrator.
The
county
of
4
residence
or
the
county’s
mental
health
and
disability
services
5
region,
as
applicable,
is
responsible
for
paying
the
public
6
costs
of
the
mental
health
and
disability
services
that
are
7
not
covered
by
the
medical
assistance
program
under
chapter
8
249A
and
are
provided
in
accordance
with
the
region’s
approved
9
service
management
plan
to
persons
who
are
residents
of
the
10
county
or
region.
11
4.
a.
The
dispute
resolution
process
implemented
in
12
accordance
with
this
subsection
applies
to
residency
disputes.
13
The
dispute
resolution
process
is
not
applicable
to
disputes
14
involving
persons
committed
to
a
state
facility
pursuant
to
15
chapter
812
or
rule
of
criminal
procedure
2.22,
Iowa
court
16
rules,
or
to
disputes
involving
service
authorization
decisions
17
made
by
a
region.
18
b.
If
a
county,
region,
or
the
department,
as
applicable,
19
receives
a
billing
for
services
provided
to
a
resident
20
in
another
county
or
region,
or
objects
to
a
residency
21
determination
certified
by
the
department
or
another
county’s
22
or
region’s
regional
administrator
and
asserts
either
that
the
23
person
has
residency
in
another
county
or
region
or
the
person
24
is
not
a
resident
of
this
state
or
the
person’s
residency
25
is
unknown
so
that
the
person
is
deemed
a
state
case,
the
26
person’s
residency
status
shall
be
determined
as
provided
in
27
this
section.
The
county
or
region
shall
notify
the
department
28
of
the
county’s
or
region’s
assertion
within
one
hundred
29
twenty
days
of
receiving
the
billing.
If
the
county
or
region
30
asserts
that
the
person
has
residency
in
another
county
or
31
region,
that
county
or
region
shall
be
notified
at
the
same
32
time
as
the
department.
If
the
department
disputes
a
residency
33
determination
certification
made
by
a
regional
administrator,
34
the
department
shall
notify
the
affected
counties
or
regions
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of
the
department’s
assertion.
1
c.
The
department,
county,
or
region
that
received
the
2
notification,
as
applicable,
shall
respond
to
the
party
that
3
provided
the
notification
within
forty-five
days
of
receiving
4
the
notification.
If
the
parties
cannot
agree
to
a
settlement
5
as
to
the
person’s
residency
status
within
ninety
days
of
the
6
date
of
notification,
on
motion
of
any
of
the
parties,
the
7
matter
shall
be
referred
to
the
department
of
inspections
and
8
appeals
for
a
contested
case
hearing
under
chapter
17A
before
9
an
administrative
law
judge
assigned
in
accordance
with
section
10
10A.801
to
determine
the
person’s
residency
status.
11
d.
(1)
The
administrative
law
judge’s
determination
12
of
the
person’s
residency
status
is
a
final
agency
action,
13
notwithstanding
contrary
provisions
of
section
17A.15.
14
The
party
that
does
not
prevail
in
the
determination
or
15
subsequent
judicial
review
is
liable
for
costs
associated
with
16
the
proceeding,
including
reimbursement
of
the
department
17
of
inspections
and
appeals’
actual
costs
associated
with
18
the
administrative
proceeding.
Judicial
review
of
the
19
determination
may
be
sought
in
accordance
with
section
17A.19.
20
(2)
If
following
the
determination
of
a
person’s
residency
21
status
in
accordance
with
this
section,
additional
evidence
22
becomes
available
that
merits
a
change
in
that
determination,
23
the
parties
affected
may
change
the
determination
by
mutual
24
agreement.
Otherwise,
a
party
may
move
that
the
matter
be
25
reconsidered
by
the
department,
county,
or
region,
or
by
the
26
administrative
law
judge.
27
e.
(1)
Unless
a
petition
is
filed
for
judicial
review,
28
the
administrative
law
judge’s
determination
of
the
person’s
29
residency
status
shall
result
in
one
of
the
following:
30
(a)
If
a
county
or
region
is
determined
to
be
the
person’s
31
residence,
the
county
or
region
shall
pay
the
amounts
due
and
32
shall
reimburse
any
other
amounts
paid
for
services
provided
by
33
the
other
county
or
region
or
the
department
on
the
person’s
34
behalf
prior
to
the
determination.
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(b)
If
it
is
determined
that
the
person
is
not
a
resident
1
of
this
state
or
the
person’s
residency
is
unknown
so
that
the
2
person
is
deemed
to
be
a
state
case,
the
department
shall
pay
3
the
amounts
due
and
shall
reimburse
the
county
or
region,
as
4
applicable,
for
any
payment
made
on
behalf
of
the
person
prior
5
to
the
determination.
6
(2)
The
payment
or
reimbursement
shall
be
remitted
within
7
forty-five
days
of
the
date
the
decision
was
issued.
After
8
the
forty-five-day
period,
a
penalty
of
not
greater
than
one
9
percent
per
month
may
be
added
to
the
amount
due.
10
Sec.
30.
CODE
EDITOR.
The
Code
editor
may
codify
the
11
provisions
of
this
division
of
this
Act
and
any
other
12
provisions
of
this
Act
involving
chapter
331
as
one
or
more
new
13
parts
of
chapter
331,
division
III.
14
Sec.
31.
APPLICABILITY.
The
provisions
of
this
division
15
of
this
Act
enacting
new
sections
in
chapter
331,
except
16
as
specifically
provided
by
the
provisions,
are
applicable
17
beginning
July
1,
2013.
18
DIVISION
V
19
SUBACUTE
CARE
FACILITIES
FOR
PERSONS
WITH
SERIOUS
AND
20
PERSISTENT
MENTAL
ILLNESS
21
Sec.
32.
NEW
SECTION
.
135P.1
Definitions.
22
As
used
in
this
chapter,
unless
the
context
otherwise
23
requires:
24
1.
“Advanced
registered
nurse
practitioner”
means
a
person
25
currently
licensed
as
a
registered
nurse
under
chapter
152
or
26
152E
who
is
registered
with
the
board
of
nursing
as
an
advanced
27
registered
nurse
practitioner.
28
2.
“Department”
means
the
department
of
inspections
and
29
appeals.
30
3.
“Direction”
means
authoritative
policy
or
procedural
31
guidance
for
the
accomplishment
of
a
function
or
an
activity.
32
4.
“Licensee”
means
the
holder
of
a
license
issued
to
33
operate
a
subacute
care
facility
for
persons
with
serious
and
34
persistent
mental
illness.
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5.
“Mental
health
professional”
means
the
same
as
defined
1
in
section
228.1.
2
6.
“Physician”
means
a
person
licensed
under
chapter
148.
3
7.
“Physician
assistant”
means
a
person
licensed
to
practice
4
under
the
supervision
of
a
physician
as
authorized
in
chapters
5
147
and
148C.
6
8.
“Psychiatric
services”
means
services
provided
under
7
the
direction
of
a
physician
which
address
mental,
emotional,
8
medical,
or
behavioral
problems.
“Psychiatric
services”
also
9
includes
such
services
provided
by
a
physician
assistant
or
an
10
advanced
registered
nurse
practitioner.
11
9.
“Rehabilitative
services”
means
services
to
encourage
and
12
assist
restoration
of
a
resident’s
optimum
mental
and
physical
13
capabilities.
14
10.
“Resident”
means
a
person
who
is
eighteen
years
of
age
15
or
older
and
has
been
admitted
by
a
physician
to
a
subacute
16
care
facility
for
persons
with
serious
and
persistent
mental
17
illness.
18
11.
“Subacute
care
facility
for
persons
with
serious
and
19
persistent
mental
illness”
or
“subacute
care
facility”
means
an
20
institution,
place,
building,
or
agency
with
restricted
means
21
of
egress
designed
to
provide
accommodation,
board,
and
the
22
services
of
a
licensed
psychiatrist
for
a
period
exceeding
23
twenty-four
consecutive
hours
to
three
or
more
individuals
who
24
primarily
have
serious
and
persistent
mental
illness,
diagnosis
25
of
a
co-occurring
disorder,
and
are
not
related
to
the
owner
26
within
the
third
degree
of
consanguinity.
27
12.
“Supervision”
means
direct
oversight
and
inspection
of
28
the
act
of
accomplishing
a
function
or
activity.
29
13.
“Treatment
care
plan”
means
a
plan
of
care
and
services
30
designed
to
eliminate
the
need
for
acute
care
by
improving
31
the
condition
of
a
person
with
serious
and
persistent
mental
32
illness.
Services
must
be
based
upon
a
diagnostic
evaluation,
33
which
includes
an
examination
of
the
medical,
psychological,
34
social,
behavioral,
and
developmental
aspects
of
the
person’s
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situation,
reflecting
the
need
for
inpatient
care.
1
Sec.
33.
NEW
SECTION
.
135P.2
Purpose.
2
The
purpose
of
this
chapter
is
to
provide
for
the
3
development,
establishment,
and
enforcement
of
basic
standards
4
for
the
operation,
construction,
and
maintenance
of
a
5
subacute
care
facility
which
will
ensure
the
safe
and
adequate
6
diagnosis,
evaluation,
and
treatment
of
the
residents.
7
Sec.
34.
NEW
SECTION
.
135P.3
Nature
of
care
——
seclusion
8
room
——
admissions.
9
1.
A
subacute
care
facility
shall
utilize
a
team
of
10
professionals
to
direct
an
organized
program
of
diagnostic
11
services,
psychiatric
services,
and
rehabilitative
services
12
to
meet
the
needs
of
residents
in
accordance
with
a
treatment
13
care
plan
developed
for
each
resident
under
the
supervision
of
14
a
licensed
psychiatrist.
The
goal
of
a
treatment
care
plan
15
is
to
transition
residents
to
a
less
restrictive
environment,
16
including
a
home-based
community
setting.
Social
and
17
rehabilitative
services
shall
be
provided
under
the
direction
18
of
a
mental
health
professional.
19
2.
The
licensed
psychiatrist
providing
supervision
of
20
the
subacute
care
facility
shall
evaluate
the
condition
of
21
each
resident
no
less
than
two
times
each
month
and
shall
be
22
available
to
residents
of
the
facility
on
an
on-call
basis
23
at
all
other
times.
Additional
evaluation
and
treatment
may
24
be
provided
by
or
the
licensed
psychiatrist
may
delegate
25
evaluation
and
treatment
responsibilities
to
a
physician
26
assistant
or
advanced
registered
nurse
practitioner.
The
27
subacute
care
facility
may
employ
a
seclusion
room
meeting
the
28
conditions
described
in
42
C.F.R.
§
483.364(b)
with
approval
of
29
the
licensed
psychiatrist
of
the
facility
or
by
order
of
the
30
resident’s
physician,
a
physician
assistant,
or
an
advanced
31
registered
nurse
practitioner.
32
3.
An
admission
to
the
subacute
care
facility
is
subject
33
to
a
physician’s
written
order
certifying
that
the
individual
34
being
admitted
requires
regular
oversight
by
a
licensed
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psychiatrist
and
requires
no
greater
degree
of
care
than
that
1
which
the
facility
to
which
the
admission
is
made
is
licensed
2
to
provide
and
is
capable
of
providing.
3
4.
A
subacute
care
facility
does
not
constitute
an
4
“institution
for
mental
diseases”
within
the
meaning
of
42
5
U.S.C.
§
1396d(i).
6
Sec.
35.
NEW
SECTION
.
135P.4
Licensure.
7
1.
A
person
shall
not
establish,
operate,
or
maintain
a
8
subacute
care
facility
unless
the
person
obtains
a
license
for
9
the
subacute
care
facility
under
this
chapter.
10
2.
An
intermediate
care
facility
for
persons
with
mental
11
illness
licensed
under
chapter
135C
may
convert
to
a
subacute
12
care
facility
by
providing
written
notice
to
the
department
13
that
the
facility
has
employed
a
full-time
psychiatrist
and
14
desires
to
make
the
conversion.
15
Sec.
36.
NEW
SECTION
.
135P.5
Application
for
license.
16
An
application
for
a
license
under
this
chapter
shall
be
17
submitted
on
a
form
requesting
information
required
by
the
18
department,
which
may
include
affirmative
evidence
of
the
19
applicant’s
ability
to
comply
with
the
rules
for
standards
20
adopted
pursuant
to
this
chapter.
An
application
for
a
license
21
shall
be
accompanied
by
the
required
license
fee
which
shall
22
be
credited
to
the
general
fund
of
the
state.
The
initial
and
23
annual
license
fee
is
twenty-five
dollars.
24
Sec.
37.
NEW
SECTION
.
135P.6
Inspection
——
conditions
for
25
issuance.
26
The
department
shall
issue
a
license
to
an
applicant
under
27
this
chapter
if
the
department
has
ascertained
that
the
28
applicant’s
facilities
and
staff
are
adequate
to
provide
the
29
care
and
services
required
of
a
subacute
care
facility
and
if
30
the
applicant
has
been
awarded
a
certificate
of
need
pursuant
31
to
chapter
135.
32
Sec.
38.
NEW
SECTION
.
135P.7
Denial,
suspension,
or
33
revocation
of
license.
34
The
department
may
deny
an
application
or
suspend
or
revoke
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a
license
if
the
department
finds
that
an
applicant
or
licensee
1
has
failed
or
is
unable
to
comply
with
this
chapter
or
the
2
rules
establishing
minimum
standards
pursuant
to
this
chapter
3
or
if
any
of
the
following
conditions
apply:
4
1.
It
is
shown
that
a
resident
is
a
victim
of
cruelty
or
5
neglect
due
to
the
acts
or
omissions
of
the
licensee.
6
2.
The
licensee
has
permitted,
aided,
or
abetted
in
the
7
commission
of
an
illegal
act
in
the
subacute
care
facility.
8
3.
An
applicant
or
licensee
acted
to
obtain
or
to
retain
a
9
license
by
fraudulent
means,
misrepresentation,
or
submitting
10
false
information.
11
4.
The
licensee
has
willfully
failed
or
neglected
to
12
maintain
a
continuing
in-service
education
and
training
program
13
for
persons
employed
by
the
subacute
care
facility.
14
5.
The
application
involves
a
person
who
has
failed
to
15
operate
a
subacute
care
facility
in
compliance
with
the
16
provisions
of
this
chapter.
17
Sec.
39.
NEW
SECTION
.
135P.8
Provisional
license.
18
The
department
may
issue
a
provisional
license,
effective
19
for
not
more
than
one
year,
to
a
licensee
whose
subacute
care
20
facility
does
not
meet
the
requirements
of
this
chapter
if,
21
prior
to
issuance
of
the
license,
the
applicant
submits
written
22
plans
to
achieve
compliance
with
the
applicable
requirements
23
and
the
plans
are
approved
by
the
department.
The
plans
shall
24
specify
the
deadline
for
achieving
compliance.
25
Sec.
40.
NEW
SECTION
.
135P.9
Notice
and
hearings.
26
The
procedure
governing
notice
and
hearing
to
deny
an
27
application
or
suspend
or
revoke
a
license
shall
be
in
28
accordance
with
rules
adopted
by
the
department
pursuant
to
29
chapter
17A.
A
full
and
complete
record
shall
be
kept
of
the
30
proceedings
and
of
any
testimony.
The
record
need
not
be
31
transcribed
unless
judicial
review
is
sought.
A
copy
or
copies
32
of
a
transcript
may
be
obtained
by
an
interested
party
upon
33
payment
of
the
cost
of
preparing
the
transcript
or
copies.
34
Sec.
41.
NEW
SECTION
.
135P.10
Rules.
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The
department
of
inspections
and
appeals,
in
consultation
1
with
the
department
of
human
services
and
affected
professional
2
groups,
shall
adopt
and
enforce
rules
setting
out
the
standards
3
for
a
subacute
care
facility
and
the
rights
of
the
residents
4
admitted
to
a
subacute
care
facility.
The
department
of
5
inspections
and
appeals
and
the
department
of
human
services
6
shall
coordinate
the
adoption
of
rules
and
the
enforcement
of
7
the
rules
in
order
to
prevent
duplication
of
effort
by
the
8
departments
and
of
requirements
of
the
licensee.
9
Sec.
42.
NEW
SECTION
.
135P.11
Complaints
alleging
10
violations
——
confidentiality.
11
1.
A
person
may
request
an
inspection
of
a
subacute
care
12
facility
by
filing
with
the
department
a
complaint
of
an
13
alleged
violation
of
an
applicable
requirement
of
this
chapter
14
or
a
rule
adopted
pursuant
to
this
chapter.
The
complaint
15
shall
state
in
a
reasonably
specific
manner
the
basis
of
the
16
complaint.
A
statement
of
the
nature
of
the
complaint
shall
be
17
delivered
to
the
subacute
care
facility
involved
at
the
time
of
18
or
prior
to
the
inspection.
The
name
of
the
person
who
files
a
19
complaint
with
the
department
shall
be
kept
confidential
and
20
shall
not
be
subject
to
discovery,
subpoena,
or
other
means
21
of
legal
compulsion
for
its
release
to
a
person
other
than
22
department
employees
involved
in
the
investigation
of
the
23
complaint.
24
2.
Upon
receipt
of
a
complaint
made
in
accordance
with
25
subsection
1,
the
department
shall
make
a
preliminary
review
26
of
the
complaint.
Unless
the
department
concludes
that
the
27
complaint
is
intended
to
harass
a
subacute
care
facility
or
a
28
licensee
or
is
without
reasonable
basis,
it
shall
within
twenty
29
working
days
of
receipt
of
the
complaint
make
or
cause
to
be
30
made
an
on-site
inspection
of
the
subacute
care
facility
which
31
is
the
subject
of
the
complaint.
The
department
of
inspections
32
and
appeals
may
refer
to
the
department
of
human
services
33
any
complaint
received
by
the
department
of
inspections
and
34
appeals
if
the
complaint
applies
to
rules
adopted
by
the
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department
of
human
services.
The
complainant
shall
also
1
be
notified
of
the
name,
address,
and
telephone
number
of
2
the
designated
protection
and
advocacy
agency
if
the
alleged
3
violation
involves
a
facility
with
one
or
more
residents
with
a
4
developmental
disability
or
mental
illness.
In
any
case,
the
5
complainant
shall
be
promptly
informed
of
the
result
of
any
6
action
taken
by
the
department
in
the
matter.
7
3.
An
inspection
made
pursuant
to
a
complaint
filed
under
8
subsection
1
need
not
be
limited
to
the
matter
or
matters
9
referred
to
in
the
complaint;
however,
the
inspection
shall
10
not
be
a
general
inspection
unless
the
complaint
inspection
11
coincides
with
a
scheduled
general
inspection.
Upon
arrival
12
at
the
subacute
care
facility
to
be
inspected,
the
inspector
13
shall
show
identification
to
the
person
in
charge
of
the
14
subacute
care
facility
and
state
that
an
inspection
is
to
15
be
made,
before
beginning
the
inspection.
Upon
request
of
16
either
the
complainant
or
the
department,
the
complainant
or
17
the
complainant’s
representative
or
both
may
be
allowed
the
18
privilege
of
accompanying
the
inspector
during
any
on-site
19
inspection
made
pursuant
to
this
section.
The
inspector
may
20
cancel
the
privilege
at
any
time
if
the
inspector
determines
21
that
the
privacy
of
a
resident
of
the
subacute
care
facility
to
22
be
inspected
would
be
violated.
The
dignity
of
the
resident
23
shall
be
given
first
priority
by
the
inspector
and
others.
24
Sec.
43.
NEW
SECTION
.
135P.12
Information
confidential.
25
1.
The
department’s
final
findings
regarding
licensure
26
shall
be
made
available
to
the
public
in
a
readily
available
27
form
and
place.
Other
information
relating
to
the
subacute
28
care
facility
is
confidential
and
shall
not
be
made
available
29
to
the
public
except
in
proceedings
involving
licensure,
a
30
civil
suit
involving
a
resident,
or
an
administrative
action
31
involving
a
resident.
32
2.
The
name
of
a
person
who
files
a
complaint
with
the
33
department
shall
remain
confidential
and
is
not
subject
to
34
discovery,
subpoena,
or
any
other
means
of
legal
compulsion
for
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release
to
a
person
other
than
an
employee
of
the
department
or
1
an
agent
involved
in
the
investigation
of
the
complaint.
2
3.
Information
regarding
a
resident
who
has
received
or
is
3
receiving
care
shall
not
be
disclosed
directly
or
indirectly
4
except
as
authorized
under
section
217.30.
5
Sec.
44.
NEW
SECTION
.
135P.13
Judicial
review.
6
Judicial
review
of
the
action
of
the
department
may
be
sought
7
pursuant
to
the
Iowa
administrative
procedure
Act,
chapter
17A.
8
Notwithstanding
chapter
17A,
a
petition
for
judicial
review
of
9
the
department’s
actions
under
this
chapter
may
be
filed
in
the
10
district
court
of
the
county
in
which
the
related
subacute
care
11
facility
is
located
or
is
proposed
to
be
located.
The
status
12
of
the
petitioner
or
the
licensee
shall
be
preserved
pending
13
final
disposition
of
the
judicial
review.
14
Sec.
45.
NEW
SECTION
.
135P.14
Penalty.
15
A
person
who
establishes,
operates,
or
manages
a
subacute
16
care
facility
without
obtaining
a
license
under
this
chapter
17
commits
a
serious
misdemeanor.
Each
day
of
continuing
18
violation
following
conviction
shall
be
considered
a
separate
19
offense.
20
Sec.
46.
NEW
SECTION
.
135P.15
Injunction.
21
Notwithstanding
the
existence
or
pursuit
of
another
remedy,
22
the
department
may
maintain
an
action
for
injunction
or
other
23
process
to
restrain
or
prevent
the
establishment,
operation,
or
24
management
of
a
subacute
care
facility
without
a
license.
25
Sec.
47.
Section
225.15,
unnumbered
paragraph
1,
Code
2011,
26
is
amended
to
read
as
follows:
27
When
a
respondent
arrives
at
the
state
psychiatric
hospital,
28
the
admitting
physician
shall
examine
the
respondent
and
29
determine
whether
or
not,
in
the
physician’s
judgment,
the
30
respondent
is
a
fit
subject
for
observation,
treatment,
and
31
hospital
care.
If,
upon
examination,
the
physician
decides
32
that
the
respondent
should
be
admitted
to
the
hospital,
the
33
respondent
shall
be
provided
a
proper
bed
in
the
hospital
;
34
and
the
.
The
physician
who
has
charge
of
the
respondent
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shall
proceed
with
observation,
medical
treatment,
and
1
hospital
care
as
in
the
physician’s
judgment
are
proper
and
2
necessary,
in
compliance
with
sections
229.13
to
229.16
.
3
After
the
respondent’s
admission,
the
physician
may
delegate
4
the
observation,
medical
treatment,
and
hospital
care
of
the
5
respondent
to
a
physician
assistant
licensed
to
practice
under
6
the
supervision
of
a
physician
as
authorized
in
chapters
147
7
and
148C
or
to
an
advanced
registered
nurse
practitioner
8
licensed
under
chapter
152
or
152E
and
registered
with
the
9
board
of
nursing.
10
Sec.
48.
Section
249A.26,
subsection
2,
Code
2011,
is
11
amended
by
adding
the
following
new
paragraph:
12
NEW
PARAGRAPH
.
d.
Notwithstanding
any
provision
of
13
this
chapter
to
the
contrary,
for
services
provided
to
14
eligible
persons
in
a
subacute
care
facility
for
persons
15
with
serious
and
persistent
mental
illness
licensed
under
16
chapter
135P,
the
daily
rate
shall
be
equal
to
the
sum
of
17
the
direct
care
Medicare-certified
hospital-based
nursing
18
facility
patient-day-weighted
median
and
the
nondirect
19
care
Medicare-certified
hospital-based
nursing
facility
20
patient-day-weighted
median.
21
Sec.
49.
STUDY
OF
SUBACUTE
FACILITIES.
The
department
22
of
human
services
shall
conduct
a
feasibility
study
and
cost
23
analysis
of
providing
institutional
subacute
services
utilizing
24
facilities
available
at
one
or
more
of
the
state
mental
health
25
institutes
or
the
Iowa
veterans
home,
and
shall
submit
a
report
26
of
the
study
containing
findings
and
recommendations
to
the
27
governor
and
general
assembly
on
or
before
December
1,
2012.
28
Sec.
50.
IMPLEMENTATION
OF
ACT.
Section
25B.2,
subsection
29
3,
shall
not
apply
to
this
division
of
this
Act.
30
DIVISION
VI
31
BRAIN
INJURY
DEFINITION
——
CONFORMING
AMENDMENTS
——
LEGAL
32
SETTLEMENT
AND
DISPUTE
RESOLUTION
PROCESSES
33
Sec.
51.
Section
135.22,
subsection
1,
paragraph
a,
Code
34
2011,
is
amended
to
read
as
follows:
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a.
“Brain
injury”
means
the
occurrence
of
injury
clinically
1
evident
damage
to
the
head
brain
resulting
directly
or
2
indirectly
from
trauma,
infection,
anoxia,
vascular
lesions,
3
or
tumor
of
the
brain,
not
primarily
related
to
a
degenerative
4
disease
or
aging
process
that
is
documented
in
a
medical
record
5
with
one
or
more
of
the
following
conditions
attributed
to
the
6
head
injury:
7
(1)
An
observed
or
self-reported
decreased
level
of
8
consciousness.
9
(2)
Amnesia.
10
(3)
A
skull
fracture.
11
(4)
An
objective
neurological
or
neuropsychological
12
abnormality.
13
(5)
A
diagnosed
intracranial
lesion
,
which
temporarily
14
or
permanently
impairs
a
person’s
physical,
cognitive,
15
or
behavioral
functions,
and
is
diagnosed
by
a
physician.
16
Pursuant
to
recommendations
made
by
the
advisory
council
on
17
brain
injuries,
the
mental
health
and
disability
services
18
commission
shall
adopt
rules
specifying
the
diagnoses
of
19
clinically
evident
damage
to
the
brain
used
for
a
diagnosis
of
20
brain
injury
.
21
Sec.
52.
Section
218.99,
Code
2011,
is
amended
to
read
as
22
follows:
23
218.99
Counties
to
be
notified
of
patients’
personal
24
accounts.
25
The
administrator
in
control
of
a
state
institution
shall
26
direct
the
business
manager
of
each
institution
under
the
27
administrator’s
jurisdiction
which
is
mentioned
in
section
28
331.424,
subsection
1
,
paragraph
“a”
,
subparagraphs
(1)
29
and
(2),
and
for
which
services
are
paid
under
section
30
331.424A
,
to
quarterly
inform
the
county
of
legal
settlement’s
31
entity
designated
to
perform
the
county’s
central
point
of
32
coordination
process
residence
of
any
patient
or
resident
who
33
has
an
amount
in
excess
of
two
hundred
dollars
on
account
in
34
the
patients’
personal
deposit
fund
and
the
amount
on
deposit.
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The
administrators
shall
direct
the
business
manager
to
further
1
notify
the
entity
designated
to
perform
the
county’s
central
2
point
of
coordination
process
county
of
residence
at
least
3
fifteen
days
before
the
release
of
funds
in
excess
of
two
4
hundred
dollars
or
upon
the
death
of
the
patient
or
resident.
5
If
the
patient
or
resident
has
no
county
of
legal
settlement
6
residency
in
this
state
or
the
person’s
residency
is
unknown
so
7
that
the
person
is
deemed
to
be
a
state
case
,
notice
shall
be
8
made
to
the
director
of
human
services
and
the
administrator
in
9
control
of
the
institution
involved.
10
Sec.
53.
Section
222.10,
Code
2011,
is
amended
to
read
as
11
follows:
12
222.10
Duty
of
peace
officer.
13
When
any
person
with
mental
retardation
departs
without
14
proper
authority
from
an
institution
in
another
state
and
15
is
found
in
this
state,
any
peace
officer
in
any
county
in
16
which
such
patient
is
found
may
take
and
detain
the
patient
17
without
warrant
or
order
and
shall
report
such
detention
to
the
18
administrator.
The
administrator
shall
provide
for
the
return
19
of
the
patient
to
the
authorities
in
the
state
from
which
the
20
unauthorized
departure
was
made.
Pending
return,
such
patient
21
may
be
detained
temporarily
at
one
of
the
institutions
of
this
22
state
governed
by
the
administrator
or
by
the
administrator
of
23
the
division
of
child
and
family
services
of
the
department
24
of
human
services.
The
provisions
of
this
section
relating
25
to
the
administrator
shall
also
apply
to
the
return
of
other
26
nonresident
persons
with
mental
retardation
having
legal
27
settlement
residency
outside
the
state
of
Iowa.
28
Sec.
54.
Section
222.13,
subsection
1,
Code
2011,
is
amended
29
to
read
as
follows:
30
1.
If
an
adult
person
is
believed
to
be
a
person
with
31
mental
retardation,
the
adult
person
or
the
adult
person’s
32
guardian
may
submit
a
request
through
the
central
point
of
33
coordination
process
for
the
county
board
of
supervisors
of
the
34
adult
person’s
county
of
residence
in
writing
to
apply
to
the
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superintendent
of
any
state
resource
center
for
the
voluntary
1
admission
of
the
adult
person
either
as
an
inpatient
or
an
2
outpatient
of
the
resource
center.
After
determining
the
legal
3
settlement
of
the
adult
person
as
provided
by
this
chapter
,
4
the
The
board
of
supervisors
shall,
on
forms
prescribed
by
5
the
department’s
administrator,
apply
to
the
superintendent
6
of
the
resource
center
in
the
district
for
the
admission
of
7
the
adult
person
to
the
resource
center.
An
application
for
8
admission
to
a
special
unit
of
any
adult
person
believed
to
be
9
in
need
of
any
of
the
services
provided
by
the
special
unit
10
under
section
222.88
may
be
made
in
the
same
manner,
upon
11
request
of
the
adult
person
or
the
adult
person’s
guardian.
12
The
superintendent
shall
accept
the
application
providing
if
13
a
preadmission
diagnostic
evaluation,
performed
through
the
14
central
point
of
coordination
process,
confirms
or
establishes
15
the
need
for
admission,
except
that
an
application
may
shall
16
not
be
accepted
if
the
institution
does
not
have
adequate
17
facilities
available
or
if
the
acceptance
will
result
in
an
18
overcrowded
condition.
19
Sec.
55.
Section
222.31,
subsection
1,
paragraph
b,
20
subparagraph
(1),
Code
2011,
is
amended
to
read
as
follows:
21
(1)
Commit
the
person
to
the
state
resource
center
22
designated
by
the
administrator
to
serve
the
county
in
which
23
the
hearing
is
being
held,
or
to
a
special
unit.
The
court
24
shall,
prior
to
issuing
an
order
of
commitment,
request
25
that
a
diagnostic
evaluation
of
the
person
be
made
by
the
26
superintendent
of
the
resource
center
or
the
special
unit,
or
27
the
superintendent’s
qualified
designee
a
person
qualified
to
28
perform
the
diagnostic
evaluation
.
The
evaluation
shall
be
29
conducted
at
a
place
as
the
superintendent
may
direct.
The
30
cost
of
the
evaluation
shall
be
defrayed
by
the
committed
31
person’s
county
of
legal
settlement
residence
unless
otherwise
32
ordered
by
the
court.
The
cost
of
the
evaluation
to
be
33
charged
may
be
equal
to
but
shall
not
exceed
the
actual
cost
34
of
the
evaluation.
Persons
referred
by
a
court
to
a
resource
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center
or
the
special
unit
for
diagnostic
evaluation
shall
be
1
considered
as
outpatients
of
the
institution.
No
order
of
2
commitment
shall
be
issued
unless
the
superintendent
of
the
3
institution
recommends
that
the
order
be
issued,
and
advises
4
the
court
that
adequate
facilities
for
the
care
of
the
person
5
are
available.
6
Sec.
56.
Section
222.49,
Code
2011,
is
amended
to
read
as
7
follows:
8
222.49
Costs
paid.
9
The
costs
of
proceedings
shall
be
defrayed
from
the
county
10
treasury
paid
by
the
county
or
the
state,
as
determined
in
11
accordance
with
section
222.60,
unless
otherwise
ordered
by
12
the
court.
When
the
person
alleged
to
be
mentally
retarded
13
is
found
not
to
be
mentally
retarded,
the
court
shall
render
14
judgment
for
such
costs
against
the
person
filing
the
petition
15
except
when
the
petition
is
filed
by
order
of
court.
16
Sec.
57.
Section
222.50,
Code
2011,
is
amended
to
read
as
17
follows:
18
222.50
County
of
legal
settlement
residence
or
state
to
pay.
19
When
the
proceedings
are
instituted
in
a
county
in
which
20
the
person
who
is
alleged
to
have
mental
retardation
was
found
21
but
which
is
not
the
county
of
legal
settlement
residence
of
22
the
person,
and
the
costs
are
not
taxed
to
the
petitioner,
the
23
person’s
county
which
is
the
legal
settlement
of
the
person
24
of
residence
or
the
state,
as
determined
in
accordance
with
25
section
222.60,
shall,
on
presentation
of
a
properly
itemized
26
bill
for
such
costs,
repay
the
costs
to
the
former
county.
27
When
the
person’s
legal
settlement
is
outside
the
state
or
is
28
unknown,
the
costs
shall
be
paid
out
of
money
in
the
state
29
treasury
not
otherwise
appropriated,
itemized
on
vouchers
30
executed
by
the
auditor
of
the
county
which
paid
the
costs,
and
31
approved
by
the
administrator.
32
Sec.
58.
Section
222.60,
subsection
1,
Code
2011,
is
amended
33
to
read
as
follows:
34
1.
All
necessary
and
legal
expenses
for
the
cost
of
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admission
or
commitment
or
for
the
treatment,
training,
1
instruction,
care,
habilitation,
support
and
transportation
2
of
persons
with
mental
retardation,
as
provided
for
in
the
3
county
management
plan
provisions
implemented
pursuant
to
4
section
331.439,
subsection
1
,
in
a
state
resource
center,
or
5
in
a
special
unit,
or
any
public
or
private
facility
within
or
6
without
the
state,
approved
by
the
director
of
the
department
7
of
human
services,
shall
be
paid
by
either:
8
a.
The
person’s
county
in
which
such
person
has
legal
9
settlement
as
defined
in
section
252.16
of
residence
.
10
b.
The
state
when
such
the
person
has
no
legal
settlement
11
or
when
such
settlement
is
unknown
is
a
resident
in
another
12
state
or
in
a
foreign
country
or
the
residence
is
unknown
.
The
13
payment
responsibility
shall
be
deemed
to
be
a
state
case.
14
Sec.
59.
Section
222.60,
subsection
2,
Code
2011,
is
amended
15
to
read
as
follows:
16
2.
a.
Prior
to
a
county
of
legal
settlement
residence
17
approving
the
payment
of
expenses
for
a
person
under
this
18
section
,
the
county
may
require
that
the
person
be
diagnosed
19
to
determine
if
the
person
has
mental
retardation
or
that
20
the
person
be
evaluated
to
determine
the
appropriate
level
21
of
services
required
to
meet
the
person’s
needs
relating
to
22
mental
retardation.
The
diagnosis
and
the
evaluation
may
be
23
performed
concurrently
and
shall
be
performed
by
an
individual
24
or
individuals
approved
by
the
county
who
are
qualified
25
to
perform
the
diagnosis
or
the
evaluation.
Following
the
26
initial
approval
for
payment
of
expenses,
the
county
of
legal
27
settlement
may
require
that
an
evaluation
be
performed
at
28
reasonable
time
periods.
29
b.
The
cost
of
a
county-required
diagnosis
and
an
evaluation
30
is
at
the
county’s
expense.
In
the
For
a
state
case
of
a
person
31
without
legal
settlement
or
whose
legal
settlement
is
unknown
,
32
the
state
may
apply
the
diagnosis
and
evaluation
provisions
of
33
this
subsection
at
the
state’s
expense.
34
c.
A
diagnosis
or
an
evaluation
under
this
section
may
be
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part
of
a
county’s
central
point
of
coordination
process
under
1
section
331.440
,
provided
that
a
diagnosis
is
performed
only
by
2
an
individual
qualified
as
provided
in
this
section
.
3
Sec.
60.
Section
222.61,
Code
2011,
is
amended
to
read
as
4
follows:
5
222.61
Legal
settlement
Residency
determined.
6
When
a
county
receives
an
application
on
behalf
of
any
person
7
for
admission
to
a
resource
center
or
a
special
unit
or
when
8
a
court
issues
an
order
committing
any
person
to
a
resource
9
center
or
a
special
unit,
the
board
of
supervisors
shall
10
utilize
refer
the
determination
of
residency
to
the
central
11
point
of
coordination
process
to
determine
and
certify
that
12
the
legal
settlement
residence
of
the
person
is
in
one
of
the
13
following:
14
1.
In
the
county
in
which
the
application
is
received
or
in
15
which
the
court
is
located.
16
2.
In
some
other
county
of
the
state.
17
3.
In
another
state
or
in
a
foreign
country.
18
4.
Unknown.
19
Sec.
61.
Section
222.62,
Code
2011,
is
amended
to
read
as
20
follows:
21
222.62
Settlement
Residency
in
another
county.
22
When
the
board
of
supervisors
determines
through
the
23
central
point
of
coordination
process
that
the
legal
settlement
24
residency
of
the
person
is
other
than
in
the
county
in
which
25
the
application
is
received,
the
determination
shall
be
26
certified
to
the
superintendent
of
the
resource
center
or
the
27
special
unit
where
the
person
is
a
patient.
The
certification
28
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
29
determination.
The
superintendent
shall
charge
the
expenses
30
already
incurred
and
unadjusted,
and
all
future
expenses
of
31
the
patient,
to
the
county
certified
to
be
the
county
of
legal
32
settlement
residency
.
33
Sec.
62.
Section
222.63,
Code
2011,
is
amended
to
read
as
34
follows:
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222.63
Finding
of
settlement
residency
——
objection.
1
A
board
of
supervisors’
certification
utilizing
the
central
2
point
of
coordination
process
that
a
person’s
legal
settlement
3
residency
is
in
another
county
shall
be
sent
by
the
board
of
4
supervisors
to
the
auditor
of
the
county
of
legal
settlement
5
residence
.
The
certification
shall
be
accompanied
by
a
copy
6
of
the
evidence
supporting
the
determination.
The
auditor
7
of
the
county
of
legal
settlement
residence
shall
submit
the
8
certification
to
the
board
of
supervisors
of
the
auditor’s
9
county
and
it
shall
be
conclusively
presumed
that
the
patient
10
has
a
legal
settlement
residency
in
that
county
unless
that
11
county
disputes
the
determination
of
legal
settlement
residency
12
as
provided
in
section
225C.8
.
13
Sec.
63.
Section
222.64,
Code
2011,
is
amended
to
read
as
14
follows:
15
222.64
Foreign
state
or
country
or
unknown
legal
settlement
16
residency
.
17
If
the
legal
settlement
residency
of
the
person
is
18
determined
by
the
board
of
supervisors
through
the
central
19
point
of
coordination
process
a
county
or
the
state
to
be
in
20
a
foreign
state
or
country
or
is
determined
to
be
unknown,
21
the
board
of
supervisors
county
or
the
state
shall
certify
22
the
determination
to
the
administrator.
The
certification
23
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
24
determination.
The
care
of
the
person
shall
be
as
arranged
25
by
the
board
of
supervisors
county
or
the
state
or
by
an
26
order
as
the
court
may
enter.
Application
for
admission
or
27
order
of
commitment
may
be
made
pending
investigation
by
the
28
administrator.
29
Sec.
64.
Section
222.65,
Code
2011,
is
amended
to
read
as
30
follows:
31
222.65
Investigation.
32
If
an
application
is
made
for
placement
of
a
person
in
33
a
state
resource
center
or
special
unit,
the
department’s
34
administrator
shall
immediately
investigate
the
legal
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settlement
residency
of
the
person
and
proceed
as
follows:
1
1.
If
the
administrator
concurs
with
a
certified
2
determination
as
to
legal
settlement
residency
of
the
person
3
so
that
the
person
is
deemed
a
state
case
under
section
4
222.60
,
the
administrator
shall
cause
the
person
either
to
be
5
transferred
to
a
resource
center
or
a
special
unit
or
to
be
6
transferred
to
the
place
of
foreign
settlement
residency
.
7
2.
If
the
administrator
disputes
a
certified
determination
8
of
legal
settlement
residency
,
the
administrator
shall
order
9
the
person
transferred
to
a
state
resource
center
or
a
special
10
unit
until
the
dispute
is
resolved.
11
3.
If
the
administrator
disputes
a
certified
determination
12
of
legal
settlement
residency
,
the
administrator
shall
utilize
13
the
procedure
provided
in
section
225C.8
to
resolve
the
14
dispute.
A
determination
of
the
person’s
legal
settlement
15
residency
status
made
pursuant
to
section
225C.8
is
conclusive.
16
Sec.
65.
Section
222.66,
Code
2011,
is
amended
to
read
as
17
follows:
18
222.66
Transfers
——
state
cases
——
expenses.
19
1.
The
transfer
to
a
resource
center
or
a
special
unit
or
20
to
the
place
of
legal
settlement
residency
of
a
person
with
21
mental
retardation
who
has
no
legal
settlement
residence
in
22
this
state
or
whose
legal
settlement
residency
is
unknown,
23
shall
be
made
in
accordance
with
such
directions
as
shall
24
be
prescribed
by
the
administrator
and
when
practicable
by
25
employees
of
the
state
resource
center
or
the
special
unit.
26
The
actual
and
necessary
expenses
of
such
transfers
shall
be
27
paid
by
the
department
on
itemized
vouchers
sworn
to
by
the
28
claimants
and
approved
by
the
administrator
and
the
approved
29
amount
is
appropriated
to
the
department
from
any
funds
in
the
30
state
treasury
not
otherwise
appropriated.
31
2.
The
case
of
a
person
with
an
intellectual
disability
32
who
is
determined
to
have
no
residence
in
this
state
or
whose
33
residence
is
unknown
shall
be
considered
a
state
case.
34
Sec.
66.
Section
222.67,
Code
2011,
is
amended
to
read
as
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follows:
1
222.67
Charge
on
finding
of
settlement
residency
.
2
If
a
person
has
been
received
into
a
resource
center
or
a
3
special
unit
as
a
patient
whose
legal
settlement
is
supposedly
4
outside
the
state
or
residency
is
unknown
and
the
administrator
5
determines
that
the
legal
settlement
residency
of
the
patient
6
was
at
the
time
of
admission
or
commitment
in
a
county
of
this
7
state,
the
administrator
shall
certify
the
determination
and
8
charge
all
legal
costs
and
expenses
pertaining
to
the
admission
9
or
commitment
and
support
of
the
patient
to
the
county
of
legal
10
settlement
residence
.
The
certification
shall
be
sent
to
11
the
county
of
legal
settlement
residence
.
The
certification
12
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
13
determination.
If
the
person’s
legal
settlement
residency
14
status
has
been
determined
in
accordance
with
section
225C.8
,
15
the
legal
costs
and
expenses
shall
be
charged
to
the
county
or
16
as
a
state
case
in
accordance
with
that
determination.
The
17
costs
and
expenses
shall
be
collected
as
provided
by
law
in
18
other
cases.
19
Sec.
67.
Section
222.68,
Code
2011,
is
amended
to
read
as
20
follows:
21
222.68
Costs
paid
in
first
instance.
22
All
necessary
and
legal
expenses
for
the
cost
of
admission
23
or
commitment
of
a
person
to
a
resource
center
or
a
special
24
unit
when
the
person’s
legal
settlement
residency
is
found
to
25
be
in
another
county
of
this
state
shall
in
the
first
instance
26
be
paid
by
the
county
from
which
the
person
was
admitted
or
27
committed.
The
county
of
legal
settlement
residence
shall
28
reimburse
the
county
which
pays
for
all
such
expenses.
Where
29
any
If
a
county
fails
to
make
such
reimbursement
within
30
forty-five
days
following
submission
of
a
properly
itemized
31
bill
to
the
county
of
legal
settlement
residence
,
a
penalty
of
32
not
greater
than
one
percent
per
month
on
and
after
forty-five
33
days
from
submission
of
the
bill
may
be
added
to
the
amount
34
due.
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Sec.
68.
Section
222.69,
Code
2011,
is
amended
to
read
as
1
follows:
2
222.69
Payment
by
state.
3
All
The
amount
necessary
to
pay
the
necessary
and
legal
4
expenses
for
the
cost
of
admission
or
commitment
of
a
person
5
to
a
resource
center
or
a
special
unit
when
the
person’s
legal
6
settlement
residence
is
outside
this
state
or
is
unknown
shall
7
be
paid
out
of
is
appropriated
to
the
department
from
any
8
money
in
the
state
treasury
not
otherwise
appropriated.
Such
9
payments
shall
be
made
by
the
department
on
itemized
vouchers
10
executed
by
the
auditor
of
the
county
from
which
the
expenses
11
have
been
paid
and
approved
by
the
administrator.
12
Sec.
69.
Section
222.70,
Code
2011,
is
amended
to
read
as
13
follows:
14
222.70
Legal
settlement
Residency
disputes.
15
If
a
dispute
arises
between
counties
or
between
the
16
department
and
a
county
as
to
the
legal
settlement
residency
17
of
a
person
admitted
or
committed
to
a
resource
center,
a
18
special
unit,
or
a
community-based
service,
the
dispute
shall
19
be
resolved
as
provided
in
section
225C.8
.
20
Sec.
70.
Section
222.73,
subsection
2,
paragraph
a,
21
unnumbered
paragraph
1,
Code
2011,
is
amended
to
read
as
22
follows:
23
The
superintendent
shall
certify
to
the
department
the
24
billings
to
each
county
for
services
provided
to
patients
25
chargeable
to
the
county
during
the
preceding
calendar
quarter.
26
The
county
billings
shall
be
based
on
the
average
daily
patient
27
charge
and
outpatient
treatment
charges
computed
pursuant
to
28
subsection
1
,
and
the
number
of
inpatient
days
and
outpatient
29
treatment
service
units
chargeable
to
the
county.
The
billings
30
to
a
county
of
legal
settlement
residence
are
subject
to
31
adjustment
for
all
of
the
following
circumstances:
32
Sec.
71.
Section
222.77,
Code
2011,
is
amended
to
read
as
33
follows:
34
222.77
Patients
on
leave.
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The
cost
of
support
of
patients
placed
on
convalescent
leave
1
or
removed
as
a
habilitation
measure
from
a
resource
center,
2
or
a
special
unit,
except
when
living
in
the
home
of
a
person
3
legally
bound
for
the
support
of
the
patient,
shall
be
paid
4
by
the
county
of
legal
settlement
residence
or
the
state
as
5
provided
in
section
222.60
.
If
the
patient
has
no
county
of
6
legal
settlement,
the
cost
shall
be
paid
from
the
support
fund
7
of
the
resource
center
or
special
unit
and
charged
on
abstract
8
in
the
same
manner
as
other
state
inpatients
until
the
patient
9
becomes
self-supporting
or
qualifies
for
support
under
other
10
statutes.
11
Sec.
72.
Section
222.78,
Code
2011,
is
amended
to
read
as
12
follows:
13
222.78
Parents
and
others
liable
for
support.
14
1.
The
father
and
mother
of
any
patient
admitted
or
15
committed
to
a
resource
center
or
to
a
special
unit,
as
16
either
an
inpatient
or
an
outpatient,
and
any
person,
firm,
or
17
corporation
bound
by
contract
made
for
support
of
the
patient
18
are
liable
for
the
support
of
the
patient.
The
patient
and
19
those
legally
bound
for
the
support
of
the
patient
shall
be
20
liable
to
the
county
or
state,
as
applicable,
for
all
sums
21
advanced
by
the
county
to
the
state
under
in
accordance
with
22
the
provisions
of
sections
222.60
and
222.77
.
23
2.
The
liability
of
any
person,
other
than
the
patient,
24
who
is
legally
bound
for
the
support
of
a
patient
who
is
under
25
eighteen
years
of
age
in
a
resource
center
or
a
special
unit
26
shall
not
exceed
the
average
minimum
cost
of
the
care
of
a
27
normally
intelligent
minor
without
a
disability
of
the
same
28
age
and
sex
as
the
minor
patient.
The
administrator
shall
29
establish
the
scale
for
this
purpose
but
the
scale
shall
not
30
exceed
the
standards
for
personal
allowances
established
by
31
the
state
division
under
the
family
investment
program.
The
32
father
or
mother
shall
incur
liability
only
during
any
period
33
when
the
father
or
mother
either
individually
or
jointly
34
receive
a
net
income
from
whatever
source,
commensurate
with
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that
upon
which
they
would
be
liable
to
make
an
income
tax
1
payment
to
this
state.
The
father
or
mother
of
a
patient
shall
2
not
be
liable
for
the
support
of
the
patient
upon
the
patient
3
attaining
eighteen
years
of
age.
Nothing
in
this
section
4
shall
be
construed
to
prevent
a
relative
or
other
person
5
from
voluntarily
paying
the
full
actual
cost
as
established
6
by
the
administrator
for
caring
for
the
patient
with
mental
7
retardation.
8
Sec.
73.
Section
222.79,
Code
2011,
is
amended
to
read
as
9
follows:
10
222.79
Certification
statement
presumed
correct.
11
In
actions
to
enforce
the
liability
imposed
by
section
12
222.78
,
the
certification
statement
sent
from
the
13
superintendent
to
the
county
auditor
pursuant
to
section
14
222.74
or
the
county
of
residence,
as
applicable,
shall
submit
15
a
certification
statement
stating
the
sums
charged
in
such
16
cases
and
the
certification
statement
shall
be
considered
17
presumptively
correct.
18
Sec.
74.
Section
222.80,
Code
2011,
is
amended
to
read
as
19
follows:
20
222.80
Liability
to
county
or
state
.
21
A
person
admitted
or
committed
to
a
county
institution
or
22
home
or
admitted
or
committed
at
county
or
state
expense
to
a
23
private
hospital,
sanitarium,
or
other
facility
for
treatment,
24
training,
instruction,
care,
habilitation,
and
support
as
a
25
patient
with
mental
retardation
shall
be
liable
to
the
county
26
or
state,
as
applicable,
for
the
reasonable
cost
of
the
support
27
as
provided
in
section
222.78
.
28
Sec.
75.
Section
222.82,
Code
2011,
is
amended
to
read
as
29
follows:
30
222.82
Collection
of
liabilities
and
claims.
31
The
If
liabilities
and
claims
exist
as
provided
in
section
32
222.78
or
other
provision
of
this
chapter,
the
county
of
33
residence
or
the
state,
as
applicable,
may
proceed
as
provided
34
in
this
section.
If
the
liabilities
and
claims
are
owed
to
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a
county
of
residence,
the
county’s
board
of
supervisors
of
1
each
county
may
direct
the
county
attorney
to
proceed
with
the
2
collection
of
said
the
liabilities
and
claims
as
a
part
of
3
the
duties
of
the
county
attorney’s
office
when
the
board
of
4
supervisors
deems
such
action
advisable.
If
the
liabilities
5
and
claims
are
owed
to
the
state,
the
state
shall
proceed
6
with
the
collection.
The
board
of
supervisors
or
the
state,
7
as
applicable,
may
and
is
hereby
empowered
to
compromise
any
8
and
all
liabilities
to
the
county
or
state
arising
under
this
9
chapter
when
such
compromise
is
deemed
to
be
in
the
best
10
interests
of
the
county
or
state
.
Any
collections
and
liens
11
shall
be
limited
in
conformance
to
section
614.1,
subsection
4
.
12
Sec.
76.
Section
222.86,
Code
2011,
is
amended
to
read
as
13
follows:
14
222.86
Payment
for
care
from
fund.
15
If
a
patient
is
not
receiving
medical
assistance
under
16
chapter
249A
and
the
amount
in
the
account
of
any
patient
17
in
the
patients’
personal
deposit
fund
exceeds
two
hundred
18
dollars,
the
business
manager
of
the
resource
center
or
special
19
unit
may
apply
any
amount
of
the
excess
to
reimburse
the
county
20
of
legal
settlement
or
the
state
in
a
case
where
no
legal
21
settlement
exists
residence
or
the
state
for
liability
incurred
22
by
the
county
or
the
state
for
the
payment
of
care,
support,
23
and
maintenance
of
the
patient,
when
billed
by
the
county
of
24
legal
settlement
or
by
the
administrator
for
a
patient
having
25
no
legal
settlement
or
state,
as
applicable
.
26
Sec.
77.
Section
222.92,
subsection
3,
paragraph
a,
Code
27
2011,
is
amended
to
read
as
follows:
28
a.
Moneys
received
by
the
state
from
billings
to
counties
29
under
section
222.73
.
30
Sec.
78.
Section
225.23,
Code
2011,
is
amended
to
read
as
31
follows:
32
225.23
Collection
for
treatment.
33
If
the
bills
for
a
committed
or
voluntary
private
patient
are
34
paid
by
the
state,
the
state
psychiatric
hospital
shall
file
a
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certified
copy
of
the
claim
for
the
bills
with
the
auditor
of
1
the
patient’s
county
of
residence
department
of
administrative
2
services
.
The
county
of
residence
department
shall
proceed
to
3
collect
the
claim
in
the
name
of
the
state
psychiatric
hospital
4
and,
when
collected,
pay
the
amount
collected
to
the
director
5
of
the
department
of
administrative
services
.
The
hospital
6
shall
also,
at
the
same
time,
forward
a
duplicate
of
the
claim
7
to
the
director
of
the
department
of
administrative
services.
8
Sec.
79.
Section
225C.6A,
subsection
4,
Code
2011,
is
9
amended
by
striking
the
subsection.
10
Sec.
80.
Section
225C.8,
Code
2011,
is
amended
to
read
as
11
follows:
12
225C.8
Legal
settlement
Residency
dispute
resolution.
13
1.
a.
The
dispute
resolution
process
implemented
in
14
accordance
with
this
section
applies
to
legal
settlement
15
residency
disputes
and
is
not
applicable
to
disputes
involving
16
persons
committed
to
a
state
facility
pursuant
to
chapter
812
17
or
rule
of
criminal
procedure
2.22,
Iowa
court
rules,
or
to
18
disputes
of
service
authorization
decisions
made
through
the
19
county
central
point
of
coordination
process.
20
b.
If
a
county
receives
a
billing
for
services
provided
to
21
a
person
under
chapter
222
,
230
,
or
249A
,
or
objects
to
a
legal
22
settlement
residency
determination
certified
by
the
department
23
or
another
county
and
asserts
either
that
the
person
has
legal
24
settlement
residency
in
another
county
or
that
the
person
has
25
no
legal
settlement
residency
or
the
legal
settlement
person’s
26
residency
is
unknown
so
that
the
person
is
deemed
to
be
a
27
state
case,
the
person’s
legal
settlement
residency
status
28
shall
be
determined
as
provided
in
this
section
.
The
county
29
shall
notify
the
department
of
the
county’s
assertion
within
30
one
hundred
twenty
days
of
receiving
the
billing.
If
the
31
county
asserts
that
the
person
has
legal
settlement
residency
32
in
another
county,
that
county
shall
be
notified
at
the
same
33
time
as
the
department.
If
the
department
disputes
a
legal
34
settlement
residency
determination
certification
made
by
a
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county,
the
department
shall
notify
the
affected
counties
of
1
the
department’s
assertion.
2
2.
The
department
or
the
county
that
received
the
3
notification,
as
applicable,
shall
respond
to
the
party
that
4
provided
the
notification
within
forty-five
days
of
receiving
5
the
notification.
If
the
parties
cannot
agree
to
a
settlement
6
resolution
as
to
the
person’s
legal
settlement
residency
status
7
within
ninety
days
of
the
date
of
notification,
on
motion
8
of
any
of
the
parties,
the
matter
shall
be
referred
to
the
9
department
of
inspections
and
appeals
for
a
contested
case
10
hearing
under
chapter
17A
before
an
administrative
law
judge
11
assigned
in
accordance
with
section
10A.801
to
determine
the
12
person’s
legal
settlement
residency
status.
13
3.
a.
The
administrative
law
judge’s
determination
of
14
the
person’s
legal
settlement
residency
status
is
a
final
15
agency
action,
notwithstanding
contrary
provisions
of
section
16
17A.15
.
The
party
that
does
not
prevail
in
the
determination
17
or
subsequent
judicial
review
is
liable
for
costs
associated
18
with
the
proceeding,
including
reimbursement
of
the
department
19
of
inspections
and
appeals’
actual
costs
associated
with
20
the
administrative
proceeding.
Judicial
review
of
the
21
determination
may
be
sought
in
accordance
with
section
17A.19
.
22
b.
If
following
the
determination
of
a
person’s
legal
23
settlement
residency
status
in
accordance
with
this
section
,
24
additional
evidence
becomes
available
that
merits
a
change
25
in
that
determination,
the
parties
affected
may
change
the
26
determination
by
mutual
agreement.
Otherwise,
a
party
may
move
27
that
the
matter
be
reconsidered.
28
4.
Unless
a
petition
is
filed
for
judicial
review,
the
29
administrative
law
judge’s
determination
of
the
person’s
30
legal
settlement
residency
status
shall
result
in
one
of
the
31
following:
32
a.
If
a
county
is
determined
to
be
the
person’s
county
of
33
legal
settlement
residence
,
the
county
shall
pay
the
amounts
34
due
and
shall
reimburse
any
other
amounts
paid
for
services
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provided
under
chapter
222
,
230
,
or
249A
by
the
county
or
the
1
department
on
the
person’s
behalf
prior
to
issuance
of
the
2
decision.
The
payment
or
reimbursement
shall
be
remitted
3
within
forty-five
days
of
the
date
the
decision
was
issued.
4
After
the
forty-five-day
period,
a
penalty
may
be
applied
as
5
authorized
under
section
222.68
,
222.75
,
or
230.22
.
6
b.
If
it
is
determined
that
the
person
has
no
legal
7
settlement
residency
in
the
state
or
the
legal
settlement
8
person’s
residency
is
unknown
so
that
the
person
is
deemed
to
9
be
a
state
case,
the
department
shall
credit
the
county
for
10
any
payment
made
on
behalf
of
the
person
by
the
county
prior
11
to
issuance
of
the
decision.
The
credit
shall
be
applied
by
12
the
department
on
a
county
billing
no
later
than
the
end
of
13
the
quarter
immediately
following
the
date
of
the
decision’s
14
issuance.
15
5.
This
section
is
repealed
July
1,
2013.
16
Sec.
81.
Section
225C.16,
subsection
2,
Code
2011,
is
17
amended
to
read
as
follows:
18
2.
The
clerk
of
the
district
court
in
that
county
shall
19
refer
a
person
applying
for
authorization
for
voluntary
20
admission,
or
for
authorization
for
voluntary
admission
of
21
another
person,
in
accordance
with
section
229.42
,
to
the
22
appropriate
entity
designated
through
the
central
point
of
23
coordination
process
of
the
person’s
county
of
residence
under
24
section
225C.14
for
the
preliminary
diagnostic
evaluation
25
unless
the
applicant
furnishes
a
written
statement
from
the
26
appropriate
entity
which
indicates
that
the
evaluation
has
been
27
performed
and
that
the
person’s
admission
to
a
state
mental
28
health
institute
is
appropriate.
This
subsection
does
not
29
apply
when
authorization
for
voluntary
admission
is
sought
30
under
circumstances
which,
in
the
opinion
of
the
chief
medical
31
officer
or
that
officer’s
physician
designee,
constitute
a
32
medical
emergency.
33
Sec.
82.
Section
225C.23,
subsection
2,
Code
2011,
is
34
amended
to
read
as
follows:
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2.
For
the
purposes
of
this
section
and
section
135.22A
,
1
“brain
injury”
means
the
occurrence
of
injury
to
the
head
not
2
primarily
related
to
a
degenerative
disease
or
aging
process
3
that
is
documented
in
a
medical
record
with
one
or
more
of
the
4
following
conditions
attributed
to
the
head
injury:
5
a.
An
observed
or
self-reported
decreased
level
of
6
consciousness.
7
b.
Amnesia.
8
c.
A
skull
fracture.
9
d.
An
objective
neurological
or
neuropsychological
10
abnormality.
11
e.
A
diagnosed
intracranial
lesion
same
as
defined
in
12
section
135.22
.
13
Sec.
83.
Section
226.9C,
subsection
1,
unnumbered
paragraph
14
1,
Code
Supplement
2011,
is
amended
to
read
as
follows:
15
The
state
mental
health
institute
at
Mount
Pleasant
shall
16
operate
the
dual
diagnosis
mental
health
and
substance
17
abuse
substance-related
disorder
treatment
program
on
a
net
18
budgeting
basis
in
which
fifty
percent
of
the
actual
per
diem
19
and
ancillary
services
costs
are
chargeable
to
the
patient’s
20
county
of
legal
settlement
residence
or
as
a
state
case,
as
21
appropriate.
Subject
to
the
approval
of
the
department,
22
revenues
attributable
to
the
dual
diagnosis
program
for
each
23
fiscal
year
shall
be
deposited
in
the
mental
health
institute’s
24
account
and
are
appropriated
to
the
department
for
the
dual
25
diagnosis
program,
including
but
not
limited
to
all
of
the
26
following
revenues:
27
Sec.
84.
Section
226.45,
Code
2011,
is
amended
to
read
as
28
follows:
29
226.45
Reimbursement
to
county
or
state.
30
If
a
patient
is
not
receiving
medical
assistance
under
31
chapter
249A
and
the
amount
to
the
account
of
any
patient
32
in
the
patients’
personal
deposit
fund
exceeds
two
hundred
33
dollars,
the
business
manager
of
the
hospital
may
apply
any
34
of
the
excess
to
reimburse
the
county
of
legal
settlement
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residence
or
the
state
in
a
case
where
no
legal
settlement
1
exists
for
a
state
case
for
liability
incurred
by
the
county
2
or
the
state
for
the
payment
of
care,
support
and
maintenance
3
of
the
patient,
when
billed
by
the
county
of
legal
settlement
4
residence
or
by
the
administrator
for
a
patient
having
no
legal
5
settlement
state
case
.
6
Sec.
85.
Section
229.9A,
Code
2011,
is
amended
to
read
as
7
follows:
8
229.9A
Advocate
informed.
9
The
court
shall
direct
the
clerk
to
furnish
the
advocate
10
of
the
respondent’s
county
of
legal
settlement
residence
11
with
a
copy
of
application
and
any
order
issued
pursuant
to
12
section
229.8,
subsection
3
.
The
advocate
may
attend
the
13
hospitalization
hearing
of
any
respondent
for
whom
the
advocate
14
has
received
notice
of
a
hospitalization
hearing.
15
Sec.
86.
Section
229.12,
subsection
2,
Code
2011,
is
amended
16
to
read
as
follows:
17
2.
All
persons
not
necessary
for
the
conduct
of
the
18
proceeding
shall
be
excluded,
except
that
the
court
may
admit
19
persons
having
a
legitimate
interest
in
the
proceeding
and
20
shall
permit
the
advocate
from
the
respondent’s
county
of
legal
21
settlement
residence
to
attend
the
hearing.
Upon
motion
of
the
22
county
attorney,
the
judge
may
exclude
the
respondent
from
the
23
hearing
during
the
testimony
of
any
particular
witness
if
the
24
judge
determines
that
witness’s
testimony
is
likely
to
cause
25
the
respondent
severe
emotional
trauma.
26
Sec.
87.
Section
229.19,
subsection
1,
paragraph
b,
Code
27
2011,
is
amended
to
read
as
follows:
28
b.
The
court
or,
if
the
advocate
is
appointed
by
the
county
29
board
of
supervisors,
the
board
shall
assign
the
advocate
30
appointed
from
a
patient’s
county
of
legal
settlement
residence
31
to
represent
the
interests
of
the
patient.
If
a
patient
has
no
32
county
of
legal
settlement
residence
or
the
patient
is
a
state
33
case
,
the
court
or,
if
the
advocate
is
appointed
by
the
county
34
board
of
supervisors,
the
board
shall
assign
the
advocate
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appointed
from
the
county
where
the
hospital
or
facility
is
1
located
to
represent
the
interests
of
the
patient.
2
Sec.
88.
Section
229.24,
subsection
3,
unnumbered
paragraph
3
1,
Code
2011,
is
amended
to
read
as
follows:
4
If
all
or
part
of
the
costs
associated
with
hospitalization
5
of
an
individual
under
this
chapter
are
chargeable
to
a
county
6
of
legal
settlement
residence
,
the
clerk
of
the
district
7
court
shall
provide
to
the
county
of
legal
settlement
county
8
of
residence
and
to
the
county
in
which
the
hospitalization
9
order
is
entered
the
following
information
pertaining
to
the
10
individual
which
would
be
confidential
under
subsection
1
:
11
Sec.
89.
Section
229.31,
Code
2011,
is
amended
to
read
as
12
follows:
13
229.31
Commission
of
inquiry.
14
A
sworn
complaint,
alleging
that
a
named
person
is
not
15
seriously
mentally
impaired
and
is
unjustly
deprived
of
liberty
16
in
any
hospital
in
the
state,
may
be
filed
by
any
person
with
17
the
clerk
of
the
district
court
of
the
county
in
which
such
18
named
person
is
so
confined,
or
of
the
county
in
which
such
19
named
person
has
a
legal
settlement,
and
thereupon
a
is
a
20
resident.
Upon
receiving
the
complaint,
a
judge
of
said
that
21
court
shall
appoint
a
commission
of
not
more
than
three
persons
22
to
inquire
into
the
truth
of
said
the
allegations.
One
of
23
said
the
commissioners
shall
be
a
physician
and
if
additional
24
commissioners
are
appointed,
one
of
such
the
additional
25
commissioners
shall
be
a
lawyer.
26
Sec.
90.
Section
229.42,
Code
2011,
is
amended
to
read
as
27
follows:
28
229.42
Costs
paid
by
county.
29
1.
If
a
person
wishing
to
make
application
for
voluntary
30
admission
to
a
mental
hospital
established
by
chapter
226
is
31
unable
to
pay
the
costs
of
hospitalization
or
those
responsible
32
for
the
person
are
unable
to
pay
the
costs,
application
for
33
authorization
of
voluntary
admission
must
be
made
through
a
34
central
point
of
coordination
process
before
application
for
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admission
is
made
to
the
hospital.
The
person’s
county
of
1
legal
settlement
residence
shall
be
determined
through
the
2
central
point
of
coordination
process
and
if
the
admission
is
3
approved
through
the
central
point
of
coordination
process,
4
the
person’s
admission
to
a
mental
health
hospital
shall
be
5
authorized
as
a
voluntary
case.
The
authorization
shall
be
6
issued
on
forms
provided
by
the
administrator.
The
costs
7
of
the
hospitalization
shall
be
paid
by
the
county
of
legal
8
settlement
residence
to
the
department
of
human
services
and
9
credited
to
the
general
fund
of
the
state,
provided
that
the
10
mental
health
hospital
rendering
the
services
has
certified
to
11
the
county
auditor
of
the
county
of
legal
settlement
residence
12
the
amount
chargeable
to
the
county
and
has
sent
a
duplicate
13
statement
of
the
charges
to
the
department
of
human
services.
14
A
county
shall
not
be
billed
for
the
cost
of
a
patient
unless
15
the
patient’s
admission
is
authorized
through
the
central
point
16
of
coordination
process.
The
mental
health
institute
and
the
17
county
shall
work
together
to
locate
appropriate
alternative
18
placements
and
services,
and
to
educate
patients
and
family
19
members
of
patients
regarding
such
alternatives.
20
2.
All
the
provisions
of
chapter
230
shall
apply
to
such
21
voluntary
patients
so
far
as
is
applicable.
22
3.
The
provisions
of
this
section
and
of
section
229.41
23
shall
apply
to
all
voluntary
inpatients
or
outpatients
24
receiving
mental
health
services
either
away
from
or
at
the
25
institution.
26
4.
If
a
county
fails
to
pay
the
billed
charges
within
27
forty-five
days
from
the
date
the
county
auditor
received
the
28
certification
statement
from
the
superintendent,
the
department
29
of
human
services
shall
charge
the
delinquent
county
the
30
penalty
of
one
percent
per
month
on
and
after
forty-five
days
31
from
the
date
the
county
received
the
certification
statement
32
until
paid.
The
penalties
received
shall
be
credited
to
the
33
general
fund
of
the
state.
34
Sec.
91.
Section
229.43,
Code
2011,
is
amended
to
read
as
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follows:
1
229.43
Nonresidents
or
no-settlement
Nonresident
patients.
2
The
administrator
may
place
patients
of
mental
health
3
institutes
who
have
no
county
of
legal
settlement,
who
4
are
nonresidents
,
or
whose
legal
settlement
is
unknown
on
5
convalescent
leave
to
a
private
sponsor
or
in
a
health
care
6
facility
licensed
under
chapter
135C
,
when
in
the
opinion
7
of
the
administrator
the
placement
is
in
the
best
interests
8
of
the
patient
and
the
state
of
Iowa.
If
the
patient
was
9
involuntarily
hospitalized,
the
district
court
which
ordered
10
hospitalization
of
the
patient
must
be
informed
when
the
11
patient
is
placed
on
convalescent
leave,
as
required
by
section
12
229.15,
subsection
5
.
13
Sec.
92.
Section
230.1,
Code
2011,
is
amended
to
read
as
14
follows:
15
230.1
Liability
of
county
and
state.
16
1.
The
necessary
and
legal
costs
and
expenses
attending
17
the
taking
into
custody,
care,
investigation,
admission,
18
commitment,
and
support
of
a
person
with
mental
illness
19
admitted
or
committed
to
a
state
hospital
shall
be
paid
by
a
20
county
or
by
the
state
as
follows:
21
a.
By
the
county
in
which
such
person
has
a
legal
22
settlement,
if
If
the
person
is
eighteen
years
of
age
or
older
,
23
by
the
person’s
county
of
residence
.
24
b.
By
the
state
when
as
a
state
case
if
such
person
has
no
25
legal
settlement
residence
in
this
state,
when
if
the
person’s
26
legal
settlement
residence
is
unknown,
or
if
the
person
is
27
under
eighteen
years
of
age.
28
2.
The
legal
settlement
county
of
residence
of
any
person
29
found
mentally
ill
with
mental
illness
who
is
a
patient
of
30
any
state
institution
shall
be
that
the
person’s
county
of
31
residence
existing
at
the
time
of
admission
thereto
to
the
32
institution
.
33
3.
A
county
of
legal
settlement
residence
is
not
liable
34
for
costs
and
expenses
associated
with
a
person
with
mental
35
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illness
unless
the
costs
and
expenses
are
for
services
and
1
other
support
authorized
for
the
person
through
the
central
2
point
of
coordination
process.
For
the
purposes
of
this
3
chapter
,
“central
point
of
coordination
process”
means
the
same
4
as
defined
in
section
331.440
.
5
Sec.
93.
Section
230.2,
Code
2011,
is
amended
to
read
as
6
follows:
7
230.2
Finding
of
legal
settlement
residence
.
8
If
a
person’s
legal
settlement
residency
status
is
9
disputed,
legal
settlement
the
residency
shall
be
determined
10
in
accordance
with
section
225C.8
.
Otherwise,
the
district
11
court
may,
when
the
person
is
ordered
placed
in
a
hospital
12
for
psychiatric
examination
and
appropriate
treatment,
or
as
13
soon
thereafter
as
the
court
obtains
the
proper
information,
14
determine
and
enter
of
record
whether
the
legal
settlement
15
residence
of
the
person
is
one
of
the
following
in
a
county
or
16
the
person
is
deemed
to
be
a
state
case,
as
follows
:
17
1.
In
the
county
from
which
the
person
was
placed
in
the
18
hospital
;
.
19
2.
In
some
other
another
county
of
the
state
;
.
20
3.
In
some
a
foreign
state
or
country
;
or
and
deemed
to
be
21
a
state
case.
22
4.
Unknown
and
deemed
to
be
a
state
case
.
23
Sec.
94.
Section
230.3,
Code
2011,
is
amended
to
read
as
24
follows:
25
230.3
Certification
of
settlement
residence
.
26
If
a
person’s
legal
settlement
county
of
residence
27
is
determined
through
by
the
county’s
central
point
of
28
coordination
process
to
be
in
another
county
of
this
state,
the
29
county
making
the
determination
shall
certify
the
determination
30
to
the
superintendent
of
the
hospital
to
which
the
person
is
31
admitted
or
committed.
The
certification
shall
be
accompanied
32
by
a
copy
of
the
evidence
supporting
the
determination.
Upon
33
receiving
the
certification,
the
superintendent
shall
charge
34
the
expenses
already
incurred
and
unadjusted,
and
all
future
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expenses
of
the
person
,
to
the
county
determined
to
be
the
1
county
of
legal
settlement
residence
.
2
Sec.
95.
Section
230.4,
Code
2011,
is
amended
to
read
as
3
follows:
4
230.4
Certification
to
debtor
county.
5
A
determination
of
a
person’s
legal
settlement
county
of
6
residence
made
in
accordance
with
section
230.2
or
230.3
shall
7
be
sent
by
the
court
or
the
county
to
the
county
auditor
of
8
the
county
of
legal
settlement
residence
.
The
certification
9
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
10
determination.
The
auditor
shall
provide
the
certification
11
to
the
board
of
supervisors
of
the
auditor’s
county,
and
it
12
shall
be
conclusively
presumed
that
the
person
has
a
legal
13
settlement
residence
in
the
notified
county
unless
that
county
14
disputes
the
finding
of
legal
settlement
residence
as
provided
15
in
section
225C.8
.
16
Sec.
96.
Section
230.5,
Code
2011,
is
amended
to
read
as
17
follows:
18
230.5
Nonresidents.
19
If
a
person’s
legal
settlement
residence
is
determined
in
20
accordance
with
section
230.2
or
230.3
to
be
in
a
foreign
21
state
or
country,
or
is
unknown,
the
court
or
the
county
shall
22
immediately
certify
the
determination
to
the
department’s
23
administrator.
The
certification
shall
be
accompanied
by
a
24
copy
of
the
evidence
supporting
the
determination.
A
court
25
order
issued
pursuant
to
section
229.13
shall
direct
that
the
26
patient
be
hospitalized
at
the
appropriate
state
hospital
for
27
persons
with
mental
illness.
28
Sec.
97.
Section
230.8,
Code
2011,
is
amended
to
read
as
29
follows:
30
230.8
Transfers
of
persons
with
mental
illness
——
expenses.
31
The
transfer
to
any
state
hospitals
or
to
the
places
of
their
32
legal
settlement
residence
of
persons
with
mental
illness
who
33
have
no
legal
settlement
residence
in
this
state
or
whose
legal
34
settlement
residence
is
unknown
and
deemed
to
be
a
state
case
,
35
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shall
be
made
according
to
the
directions
of
the
administrator,
1
and
when
practicable
by
employees
of
the
state
hospitals
,
and
2
the
.
The
actual
and
necessary
expenses
of
such
transfers
shall
3
be
paid
on
itemized
vouchers
sworn
to
by
the
claimants
and
4
approved
by
the
administrator,
and
the
amount
of
the
expenses
5
is
appropriated
to
the
department
from
any
funds
in
the
state
6
treasury
not
otherwise
appropriated.
7
Sec.
98.
Section
230.9,
Code
2011,
is
amended
to
read
as
8
follows:
9
230.9
Subsequent
discovery
of
residence.
10
If,
after
a
person
has
been
received
by
a
state
hospital
for
11
persons
with
mental
illness
as
a
state
case
patient
whose
legal
12
settlement
residence
is
supposed
to
be
outside
this
state
or
13
unknown
,
the
administrator
determines
that
the
legal
settlement
14
residence
of
the
person
was,
at
the
time
of
admission
or
15
commitment,
in
a
county
of
this
state,
the
administrator
shall
16
certify
the
determination
and
charge
all
legal
costs
and
17
expenses
pertaining
to
the
admission
or
commitment
and
support
18
of
the
person
to
the
county
of
legal
settlement
residence
.
The
19
certification
shall
be
sent
to
the
county
of
legal
settlement
20
residence
.
The
certification
shall
be
accompanied
by
a
copy
21
of
the
evidence
supporting
the
determination.
The
costs
and
22
expenses
shall
be
collected
as
provided
by
law
in
other
cases.
23
If
the
person’s
legal
settlement
residency
status
has
been
24
determined
in
accordance
with
section
225C.8
,
the
legal
costs
25
and
expenses
shall
be
charged
to
the
county
of
residence
or
as
26
a
state
case
in
accordance
with
that
determination.
27
Sec.
99.
Section
230.10,
Code
2011,
is
amended
to
read
as
28
follows:
29
230.10
Payment
of
costs.
30
All
legal
costs
and
expenses
attending
the
taking
into
31
custody,
care,
investigation,
and
admission
or
commitment
of
32
a
person
to
a
state
hospital
for
persons
with
mental
illness
33
under
a
finding
that
such
the
person
has
a
legal
settlement
34
residency
in
another
county
of
this
state
shall
be
charged
35
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against
the
county
of
legal
settlement
residence
.
1
Sec.
100.
Section
230.11,
Code
2011,
is
amended
to
read
as
2
follows:
3
230.11
Recovery
of
costs
from
state.
4
Costs
and
expenses
attending
the
taking
into
custody,
5
care,
and
investigation
of
a
person
who
has
been
admitted
6
or
committed
to
a
state
hospital,
United
States
department
7
of
veterans
affairs
hospital,
or
other
agency
of
the
United
8
States
government,
for
persons
with
mental
illness
and
who
has
9
no
legal
settlement
residence
in
this
state
or
whose
legal
10
settlement
residence
is
unknown,
including
cost
of
commitment,
11
if
any,
shall
be
paid
out
of
as
a
state
case
as
approved
by
the
12
administrator.
The
amount
of
the
costs
and
expenses
approved
13
by
the
administrator
is
appropriated
to
the
department
from
14
any
money
in
the
state
treasury
not
otherwise
appropriated,
on
15
itemized
vouchers
executed
by
the
auditor
of
the
county
which
16
has
paid
them,
and
approved
by
the
administrator.
17
Sec.
101.
Section
230.12,
Code
2011,
is
amended
to
read
as
18
follows:
19
230.12
Legal
settlement
Residency
disputes.
20
If
a
dispute
arises
between
different
counties
or
between
21
the
administrator
and
a
county
as
to
the
legal
settlement
22
residence
of
a
person
admitted
or
committed
to
a
state
hospital
23
for
persons
with
mental
illness,
the
dispute
shall
be
resolved
24
as
provided
in
section
225C.8
.
25
Sec.
102.
Section
230.32,
Code
2011,
is
amended
to
read
as
26
follows:
27
230.32
Support
of
nonresident
patients
on
leave.
28
The
cost
of
support
of
patients
without
legal
settlement
29
residence
in
this
state,
who
are
placed
on
convalescent
30
leave
or
removed
from
a
state
mental
institute
to
any
health
31
care
facility
licensed
under
chapter
135C
for
rehabilitation
32
purposes,
shall
be
paid
from
the
hospital
support
fund
33
and
shall
be
charged
on
abstract
in
the
same
manner
as
34
state
inpatients,
until
such
time
as
the
patient
becomes
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self-supporting
or
qualifies
for
support
under
existing
1
statutes.
2
Sec.
103.
Section
249A.12,
subsection
2,
Code
2011,
is
3
amended
to
read
as
follows:
4
2.
A
county
shall
reimburse
the
department
on
a
monthly
5
basis
for
that
portion
of
the
cost
of
assistance
provided
6
under
this
section
to
a
recipient
with
legal
settlement
in
who
7
is
a
resident
of
the
county,
which
is
not
paid
from
federal
8
funds,
if
the
recipient’s
placement
has
been
approved
by
the
9
appropriate
review
organization
as
medically
necessary
and
10
appropriate.
The
department’s
goal
for
the
maximum
time
period
11
for
submission
of
a
claim
to
a
county
is
not
more
than
sixty
12
days
following
the
submission
of
the
claim
by
the
provider
13
of
the
service
to
the
department.
The
department’s
goal
for
14
completion
and
crediting
of
a
county
for
cost
settlement
for
15
the
actual
costs
of
a
service
under
a
home
and
community-based
16
services
waiver
is
within
two
hundred
seventy
days
of
the
close
17
of
a
fiscal
year
for
which
cost
reports
are
due
from
providers.
18
The
department
shall
place
all
reimbursements
from
counties
19
in
the
appropriation
for
medical
assistance,
and
may
use
the
20
reimbursed
funds
in
the
same
manner
and
for
any
purpose
for
21
which
the
appropriation
for
medical
assistance
may
be
used.
22
Sec.
104.
Section
249A.12,
subsection
6,
paragraphs
c
and
d,
23
Code
2011,
are
amended
to
read
as
follows:
24
c.
The
person’s
county
of
legal
settlement
residence
shall
25
pay
for
the
nonfederal
share
of
the
cost
of
services
provided
26
under
the
waiver,
and
the
state
shall
pay
for
the
nonfederal
27
share
of
such
costs
if
the
person
has
no
legal
settlement
is
28
not
a
resident
of
this
state
or
the
legal
settlement
person’s
29
residency
is
unknown
so
that
the
person
is
deemed
to
be
a
state
30
case.
31
d.
The
county
of
legal
settlement
residence
shall
pay
32
for
one
hundred
percent
of
the
nonfederal
share
of
the
costs
33
of
care
provided
for
adults
which
is
reimbursed
under
a
home
34
and
community-based
services
waiver
that
would
otherwise
be
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approved
for
provision
in
an
intermediate
care
facility
for
1
persons
with
mental
retardation
provided
under
the
medical
2
assistance
program.
3
Sec.
105.
Section
249A.12,
subsections
7
and
8,
Code
2011,
4
are
amended
to
read
as
follows:
5
7.
When
paying
the
necessary
and
legal
expenses
for
6
intermediate
care
facility
for
persons
with
mental
retardation
7
services,
the
cost
requirements
of
section
222.60
shall
8
be
considered
fulfilled
when
payment
is
made
in
accordance
9
with
the
medical
assistance
payment
rates
established
by
10
the
department
for
intermediate
care
facilities
for
persons
11
with
mental
retardation,
and
the
state
or
a
county
of
legal
12
settlement
residence
shall
not
be
obligated
for
any
amount
in
13
excess
of
the
rates.
14
8.
If
a
person
with
mental
retardation
has
no
legal
15
settlement
residence
in
this
state
or
the
legal
settlement
16
whose
residency
is
unknown
so
that
the
person
is
deemed
17
to
be
a
state
case
and
services
associated
with
the
mental
18
retardation
can
be
covered
under
a
medical
assistance
home
and
19
community-based
services
waiver
or
other
medical
assistance
20
program
provision,
the
nonfederal
share
of
the
medical
21
assistance
program
costs
for
such
coverage
shall
be
paid
from
22
the
appropriation
made
for
the
medical
assistance
program.
23
Sec.
106.
Section
249A.26,
subsection
2,
Code
2011,
is
24
amended
to
read
as
follows:
25
2.
a.
Except
as
provided
for
disallowed
costs
in
section
26
249A.27
,
the
county
of
legal
settlement
residence
shall
pay
for
27
fifty
percent
of
the
nonfederal
share
of
the
cost
and
the
state
28
shall
have
responsibility
for
the
remaining
fifty
percent
of
29
the
nonfederal
share
of
the
cost
of
case
management
provided
30
to
adults,
day
treatment,
and
partial
hospitalization
provided
31
under
the
medical
assistance
program
for
persons
with
mental
32
retardation,
a
developmental
disability,
or
chronic
mental
33
illness.
For
purposes
of
this
section
,
persons
with
mental
34
disorders
resulting
from
Alzheimer’s
disease
or
substance
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abuse
a
substance-related
disorder
shall
not
be
considered
1
chronically
mentally
ill
to
be
persons
with
chronic
mental
2
illness
.
To
the
maximum
extent
allowed
under
federal
law
and
3
regulations,
the
department
shall
consult
with
and
inform
a
4
person’s
county
of
legal
settlement’s
residence’s
central
5
point
of
coordination
process,
as
defined
in
section
331.440
,
6
regarding
the
necessity
for
and
the
provision
of
any
service
7
for
which
the
county
is
required
to
provide
reimbursement
under
8
this
subsection
.
9
b.
The
state
shall
pay
for
one
hundred
percent
of
the
10
nonfederal
share
of
the
costs
of
case
management
provided
for
11
adults,
day
treatment,
partial
hospitalization,
and
the
home
12
and
community-based
services
waiver
services
for
persons
who
13
have
no
legal
settlement
residence
in
this
state
or
the
legal
14
settlement
whose
residence
is
unknown
so
that
the
persons
are
15
deemed
to
be
state
cases.
16
c.
The
case
management
services
specified
in
this
subsection
17
shall
be
paid
for
by
a
county
only
if
the
services
are
provided
18
outside
of
a
managed
care
contract.
19
Sec.
107.
Section
249A.26,
subsections
3,
4,
and
7,
Code
20
2011,
are
amended
to
read
as
follows:
21
3.
To
the
maximum
extent
allowed
under
federal
law
and
22
regulations,
a
person
with
mental
illness
or
mental
retardation
23
shall
not
be
eligible
for
any
service
which
is
funded
in
24
whole
or
in
part
by
a
county
share
of
the
nonfederal
portion
25
of
medical
assistance
funds
unless
the
person
is
referred
26
through
the
central
point
of
coordination
process,
as
defined
27
in
section
331.440
.
However,
to
the
extent
federal
law
allows
28
referral
of
a
medical
assistance
recipient
to
a
service
without
29
approval
of
the
central
point
of
coordination
process,
the
30
county
of
legal
settlement
residence
shall
be
billed
for
the
31
nonfederal
share
of
costs
for
any
adult
person
for
whom
the
32
county
would
otherwise
be
responsible.
33
4.
The
county
of
legal
settlement
residence
shall
pay
for
34
one
hundred
percent
of
the
nonfederal
share
of
the
cost
of
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services
provided
to
adult
persons
with
chronic
mental
illness
1
who
qualify
for
habilitation
services
in
accordance
with
the
2
rules
adopted
for
the
services.
The
state
shall
pay
for
one
3
hundred
percent
of
the
nonfederal
share
of
the
cost
of
such
4
services
provided
to
such
persons
who
have
no
legal
settlement
5
residency
in
this
state
or
the
legal
settlement
whose
residency
6
is
unknown
so
that
the
persons
are
deemed
to
be
state
cases.
7
7.
Unless
a
county
has
paid
or
is
paying
for
the
nonfederal
8
share
of
the
costs
of
a
person’s
home
and
community-based
9
waiver
services
or
placement
in
an
intermediate
care
facility
10
for
persons
with
mental
retardation
under
the
county’s
mental
11
health,
mental
retardation,
and
developmental
disabilities
12
services
fund
created
in
section
331.424A
,
or
unless
a
county
13
of
legal
settlement
residence
would
become
liable
for
the
costs
14
of
services
for
a
person
at
the
level
of
care
provided
in
an
15
intermediate
care
facility
for
persons
with
mental
retardation
16
due
to
the
person
reaching
the
age
of
majority,
the
state
17
shall
pay
for
the
nonfederal
share
of
the
costs
of
an
eligible
18
person’s
services
under
the
home
and
community-based
services
19
waiver
for
persons
with
brain
injury.
20
Sec.
108.
Section
252.23,
Code
2011,
is
amended
to
read
as
21
follows:
22
252.23
Legal
settlement
disputes.
23
If
the
alleged
settlement
is
disputed,
then,
within
thirty
24
days
after
notice
as
provided
in
section
252.22
,
a
copy
of
25
the
notices
sent
and
received
shall
be
filed
in
the
office
of
26
the
clerk
of
the
district
court
of
the
county
against
which
27
claim
is
made,
and
a
cause
docketed
without
other
pleadings,
28
and
tried
as
an
ordinary
action,
in
which
the
county
granting
29
the
assistance
shall
be
plaintiff,
and
the
other
defendant,
30
and
the
burden
of
proof
shall
be
upon
the
county
granting
the
31
assistance.
However,
a
legal
settlement
dispute
concerning
32
the
liability
of
a
person’s
county
of
residence
for
assistance
33
provided
through
the
county’s
mental
health
and
disability
34
services
system
implemented
under
chapter
331
in
connection
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with
services
initiated
under
chapter
222
,
230
,
or
249A
shall
1
be
resolved
as
provided
in
section
225C.8
.
2
Sec.
109.
Section
252.24,
Code
2011,
is
amended
to
read
as
3
follows:
4
252.24
County
of
settlement
liable.
5
1.
The
county
where
the
settlement
is
shall
be
liable
to
6
the
county
granting
assistance
for
all
reasonable
charges
and
7
expenses
incurred
in
the
assistance
and
care
of
a
poor
person.
8
2.
When
assistance
is
furnished
by
any
governmental
agency
9
of
the
county,
township,
or
city,
the
assistance
shall
be
10
deemed
to
have
been
furnished
by
the
county
in
which
the
11
agency
is
located
and
the
agency
furnishing
the
assistance
12
shall
certify
the
correctness
of
the
costs
of
the
assistance
13
to
the
board
of
supervisors
of
that
county
and
that
county
14
shall
collect
from
the
county
of
the
person’s
settlement.
The
15
amounts
collected
by
the
county
where
the
agency
is
located
16
shall
be
paid
to
the
agency
furnishing
the
assistance.
This
17
statute
applies
to
services
and
supplies
furnished
as
provided
18
in
section
139A.18
.
19
3.
Notwithstanding
subsection
2,
if
assistance
or
20
maintenance
is
provided
by
a
county
through
the
county’s
mental
21
health
and
disability
services
system
implemented
under
chapter
22
331,
liability
for
the
assistance
and
maintenance
is
the
23
responsibility
of
the
person’s
county
of
residence.
24
Sec.
110.
Section
331.424A,
subsection
6,
Code
Supplement
25
2011,
is
amended
by
striking
the
subsection.
26
Sec.
111.
Section
331.440,
subsection
2,
paragraph
b,
Code
27
Supplement
2011,
is
amended
to
read
as
follows:
28
b.
“County
of
residence”
means
the
county
in
this
state
in
29
which,
at
the
time
an
adult
person
applies
for
or
receives
30
services,
the
adult
person
is
living
and
has
established
an
31
ongoing
presence
with
the
declared,
good
faith
intention
of
32
living
for
a
permanent
or
indefinite
period
of
time.
The
33
county
of
residence
of
an
adult
person
who
is
a
homeless
34
person
is
the
county
where
the
homeless
person
usually
sleeps.
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A
person
maintains
residency
in
the
county
in
which
the
1
person
last
resided
while
the
person
is
present
in
another
2
county
receiving
services
in
a
hospital,
a
correctional
3
facility,
a
halfway
house
for
community-based
corrections
4
or
substance-related
treatment,
a
nursing
facility,
an
5
intermediate
care
facility
for
persons
with
an
intellectual
6
disability,
or
a
residential
care
facility,
or
for
the
purpose
7
of
attending
a
college
or
university.
8
Sec.
112.
Section
331.502,
subsection
11,
Code
2011,
is
9
amended
to
read
as
follows:
10
11.
Carry
out
duties
relating
to
the
determination
of
legal
11
settlement
residency
,
collection
of
funds
due
the
county
,
and
12
support
of
persons
with
mental
retardation
as
provided
in
13
sections
222.13
,
222.50
,
222.61
to
222.66
,
222.69
,
and
222.74
.
14
Sec.
113.
Section
347.16,
subsection
3,
Code
2011,
is
15
amended
to
read
as
follows:
16
3.
Care
and
treatment
may
be
furnished
in
a
county
public
17
hospital
to
any
sick
or
injured
person
who
has
legal
settlement
18
outside
the
county
which
maintains
the
hospital,
subject
to
19
such
policies
and
rules
as
the
board
of
hospital
trustees
may
20
adopt.
If
care
and
treatment
is
provided
under
this
subsection
21
to
a
person
who
is
indigent,
the
county
in
which
that
person
22
has
legal
settlement
shall
pay
to
the
board
of
hospital
23
trustees
the
fair
and
reasonable
cost
of
the
care
and
treatment
24
provided
by
the
county
public
hospital
unless
the
cost
of
the
25
indigent
person’s
care
and
treatment
is
otherwise
provided
for.
26
If
care
and
treatment
is
provided
to
an
indigent
person
under
27
this
subsection
,
the
county
public
hospital
furnishing
the
28
care
and
treatment
shall
immediately
notify,
by
regular
mail,
29
the
auditor
of
the
county
of
legal
settlement
of
the
indigent
30
person
of
the
provision
of
care
and
treatment
to
the
indigent
31
person.
However,
if
the
care
and
treatment
is
provided
by
32
a
county
through
the
county’s
mental
health
and
disability
33
services
system
implemented
under
chapter
331,
liability
for
34
the
assistance
and
maintenance
is
the
responsibility
of
the
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person’s
county
of
residence.
1
EXPLANATION
2
This
bill
relates
to
redesign
of
publicly
funded
mental
3
health
and
disability
services
by
requiring
certain
core
4
services
and
addressing
other
services
and
providing
for
5
establishment
of
regions.
The
bill
is
organized
into
6
divisions.
7
CORE
SERVICES.
This
division
specifies
core
services
and
8
service
management
requirements
applicable
to
the
regional
9
service
system
required
by
the
bill
and
addresses
the
10
responsibilities
of
the
department
of
human
services
(DHS)
11
relating
to
core
services.
12
Code
section
225C.2,
providing
definitions
for
Code
13
chapter
225C
pertaining
to
mental
health
and
disability
14
services,
is
amended
to
add
definitions
for
the
terms
“mental
15
health
and
disability
services
region”,
“mental
health
and
16
disability
services
regional
service
system”,
and
“regional
17
administrator”.
18
Code
section
225C.4,
specifying
the
duties
of
the
19
administrator
of
the
department’s
division
of
mental
health
and
20
disability
services,
is
amended
to
change
county
references
21
to
regions,
address
data
and
outcomes,
and
add
responsibility
22
for
entering
into
performance-based
contracts
with
regions
and
23
providing
internet-based
information
concerning
waiting
lists
24
implemented
by
regions.
25
Code
section
225C.6,
relating
to
the
duties
of
the
mental
26
health
and
disability
services
(MH/DS)
commission,
is
27
amended
to
provide
that
certain
responsibilities
to
adopt
28
rules
defining
“disability
services”
are
performed
after
29
recommendations
are
made
by
the
administrator.
In
addition,
a
30
listing
of
the
basic
financial
eligibility
standards
for
county
31
MH/DS
services
in
the
current
commission
responsibilities
is
32
replaced
with
a
reference
to
similar
standards
in
the
new
33
regional
system
provisions
in
Code
chapter
331.
34
Code
section
225C.6A,
addressing
a
previous
MH/DS
system
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redesign,
is
amended
to
only
apply
to
data
systems.
1
New
Code
section
225C.7A
creates
a
new
mental
health
and
2
disability
regional
services
fund
for
distribution
of
moneys
3
through
performance-based
contracts
with
regions.
4
Code
section
226.10,
requiring
equal
treatment
of
the
5
patients
in
the
state
mental
health
institutes,
is
amended
to
6
require
the
institutes
to
address
the
needs
of
persons
with
two
7
or
more
co-occurring
conditions.
8
Code
section
331.439,
relating
to
current
county
service
9
system
management
plans,
is
amended
to
require
the
financial
10
information
submitted
to
the
state
to
segregate
expenditures
11
for
administration,
purchase
of
service,
and
enterprise
costs.
12
In
addition,
beginning
during
FY
2012-2013,
the
management
13
plans
are
to
begin
requiring
that
a
person’s
need
for
14
individualized
services
is
to
be
determined
by
a
standardized
15
functional
assessment
methodology
approved
by
the
director
16
of
human
services.
Under
current
law,
this
Code
section
is
17
repealed
on
July
1,
2013.
18
New
Code
section
331.439A
requires
MH/DS
provided
by
19
counties
to
be
delivered
in
accordance
with
a
regional
service
20
system
management
plan
approved
by
the
region’s
governing
board
21
and
implemented
by
the
regional
administrator.
The
plans
apply
22
to
three-year
periods
with
the
initial
plan
to
be
submitted
to
23
DHS
by
April
1,
2014.
The
plan
is
required
to
include
various
24
elements
and
the
commission
is
directed
to
specify
the
elements
25
in
administrative
rules.
26
New
Code
section
331.439A
also
authorizes
a
region
to
27
provide
assistance
to
other
disability
service
populations
28
subject
to
availability
of
funding
and
to
implement
waiting
29
lists
for
services
as
a
financial
management
tool.
30
New
Code
section
331.439B
provides
financial
eligibility
31
requirements
to
be
used
in
the
regional
system.
Income
32
eligibility
is
set
at
150
percent
of
the
federal
poverty
33
level
and
requirements
for
cost
sharing
are
prohibited
at
34
this
income
level.
Persons
with
higher
incomes
may
also
be
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eligible
subject
to
a
copayment,
sliding
fee
scale,
or
other
1
cost-sharing
arrangement;
however,
a
service
provider
may
waive
2
copayments
or
cost-sharing
if
able
to
fully
absorb
the
cost.
A
3
person
who
is
eligible
for
federally
funded
services
must
apply
4
for
the
services
but
if
regional
services
are
expected
to
be
5
needed
for
less
than
two
years,
the
person
may
be
exempted.
6
The
commission
is
required
to
adopt
rules
for
resource
7
limitations
eligibility
derived
from
the
federal
supplemental
8
security
income
program
resource
limitations.
If
a
person
does
9
not
qualify
for
federally
funded
support,
but
meets
income,
10
resource,
and
functional
eligibility
requirements,
retirement
11
accounts
in
the
accumulation
stage
and
burial,
medical
savings,
12
or
assistive
technology
accounts
are
to
be
disregarded.
13
New
Code
section
331.439C
specifies
requirements
for
14
diagnoses,
functional
assessments,
and
other
requirements
for
15
eligibility
in
the
regional
system.
Other
requirements
include
16
an
age
of
at
least
18
years
and
compliance
with
financial
17
eligibility
provisions
and
determination
of
eligibility
for
18
individualized
services
to
be
made
by
the
functional
assessment
19
provisions
specified
in
the
bill’s
amendment
to
Code
section
20
331.439.
A
person
who
is
age
17
and
receiving
publicly
21
funded
services
may
begin
eligibility
for
services
through
the
22
regional
system
during
the
three-month
period
preceding
the
23
person’s
18th
birthday.
For
mental
health
services,
a
person
24
must
have
had
a
diagnosable
mental
health,
behavioral,
or
25
emotional
disorder
during
the
preceding
12-month
period.
For
26
intellectual
disability
services,
an
intellectual
disability
27
(ID)
diagnosis
is
required.
For
brain
injury
services,
a
28
diagnosis
of
brain
injury
(BI)
is
required.
29
New
Code
section
331.439D
addresses
core
service
domains
to
30
be
provided
in
the
regional
system,
subject
to
the
availability
31
of
funding.
The
domains
are
defined
to
mean
a
set
of
similar,
32
discrete
services
that
can
be
provided
depending
upon
an
33
individual’s
service
needs.
The
services
included
in
the
34
core
services
domains
are
to
be
adopted
in
rule
by
the
MH/DS
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commission
pursuant
to
recommendations
by
the
DHS
director.
1
An
initial
set
of
core
service
domains
applies
to
MH
and
ID
2
services
not
covered
under
the
Medicaid
program
and
legislative
3
intent
is
stated
to
address
funding
in
order
to
include
persons
4
in
need
of
BI
or
developmental
disability
(DD)
services.
The
5
region
is
required
to
ensure
services
providers
have
the
6
competencies
to
serve
persons
with
co-occurring
conditions,
7
provide
evidence-based
services,
and
provide
trauma-informed
8
care.
A
set
of
additional
core
services
is
listed
when
public
9
funds
are
made
available
for
the
services.
A
region
may
also
10
provide
funding
for
other
services
or
support
not
listed
based
11
on
optional
criteria
that
may
be
considered.
12
New
Code
section
331.440B
addresses
regional
service
system
13
financing.
The
financing
of
each
regional
service
system
is
14
limited
to
a
fixed
budget
amount.
The
region
is
required
15
to
implement
the
region’s
service
system
management
plan
by
16
budgeting
for
99
percent
of
the
funding
anticipated
to
be
17
available
for
the
plan
for
a
fiscal
year.
The
MH/DS
commission
18
is
required
to
annually
by
July
15
submit
to
DHS,
council
19
on
human
services,
and
the
governor
a
recommendation
for
a
20
non-Medicaid
expenditures
growth
funding
amount
for
the
fiscal
21
year
which
commences
two
years
from
the
start
date
of
the
22
fiscal
year
in
progress
at
the
time
the
recommendation
is
made.
23
The
division
may
include
a
state
mandate
as
defined
in
Code
24
section
25B.3.
The
bill
makes
inapplicable
Code
section
25B.2,
25
subsection
3,
which
would
relieve
a
political
subdivision
from
26
complying
with
a
state
mandate
if
funding
for
the
cost
of
27
the
state
mandate
is
not
provided
or
specified.
Therefore,
28
political
subdivisions
are
required
to
comply
with
any
state
29
mandate
included
in
the
bill.
30
The
Code
editor
is
authorized
to
codify
the
division
and
31
other
provisions
involving
Code
chapter
331
as
a
new
part
of
32
Code
chapter
331,
division
III.
33
The
new
Code
provisions
of
the
Code
chapter
are
applicable
34
beginning
July
1,
2013.
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WORKFORCE
DEVELOPMENT
AND
REGULATION.
This
division
relates
1
to
workforce
development
and
regulation
applicable
to
the
2
administration
and
service
providers
for
the
regional
service
3
system.
4
New
Code
section
225C.6C
establishes
a
mental
health
and
5
disability
services
workforce
development
workgroup
to
be
6
convened
and
staffed
by
DHS
to
address
issues
connected
with
7
assuring
there
is
an
adequate
workforce
to
provide
MH/DS
in
8
the
state.
Various
stakeholders
and
legislator
members
are
9
specified.
10
New
Code
section
225C.6D
requires
DHS
to
establish
an
11
outcomes
and
performance
measures
committee
for
the
regional
12
service
system.
Various
stakeholders
are
specified
for
the
13
committee
membership.
14
New
Code
section
225C.6E
requires
the
departments
of
15
human
services,
inspections
and
appeals,
and
public
health
16
to
comply
with
various
provisions
in
efforts
to
improve
the
17
regulatory
requirements
applied
to
the
regional
service
system
18
administration
and
service
providers.
19
COMMUNITY
MENTAL
HEALTH
CENTER
AMENDMENTS.
This
division
20
amends
Acts
provisions
relating
to
community
mental
health
21
centers
that
were
enacted
in
2011
Iowa
Acts,
chapter
121
(SF
22
525)
that
have
a
delayed
effective
date
of
July
1,
2012.
23
Provisionally
numbered
Code
section
230A.110,
relating
to
24
the
standards
adopted
for
centers
by
the
MH/DS
commission,
is
25
amended
to
allow
the
standards
to
be
in
substantial
conformity
26
with
either
applicable
behavioral
health
standards
adopted
by
27
the
joint
commission
or
other
recognized
national
standards
28
for
evaluation
of
psychiatric
facilities
rather
than
requiring
29
conformity
with
both
sets
of
standards.
30
REGIONAL
SERVICE
SYSTEM.
This
division
provides
the
31
requirements
for
counties
to
form
mental
health
and
disability
32
services
(MH/DS)
regions.
33
The
Code
section
97B.1A
definition
of
the
term
“employer”
34
used
for
the
Iowa
public
employees’
retirement
system
(IPERS)
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is
amended
to
include
the
regional
administrator
entities
1
created
pursuant
to
the
bill.
2
New
Code
section
331.438A
defines
terms
utilized,
including
3
“department”
for
the
department
of
human
services,
“disability
4
services”
as
defined
in
Code
section
225C.2
(services
and
other
5
support
available
to
a
person
with
mental
illness,
intellectual
6
disability
or
other
developmental
disability,
or
brain
injury),
7
“population”
to
mean
the
latest
federal
census
or
the
latest
8
applicable
population
estimate
issued
by
the
U.S.
census
9
bureau,
“regional
administrator”
as
provided
by
the
bill,
and
10
“state
commission”
as
the
MH/DS
commission.
11
New
Code
section
331.438B
requires
counties
to
form
regions
12
to
provide
local
access
to
MH/DS
for
adults.
Minimum
criteria
13
for
formation
of
a
group
of
counties
are
included
along
with
a
14
schedule
for
voluntary
formation
until
the
period
of
November
15
2,
2012,
through
January
1,
2013,
during
which
the
department
16
is
required
to
assign
unaffiliated
counties
to
a
region.
17
The
director
of
human
services,
with
approval
of
the
MH/DS
18
commission,
is
authorized
to
waive
the
population
range
and
19
minimum
number
of
counties
criteria.
20
New
Code
section
331.438C
requires
the
counties
comprising
21
a
region
to
enter
into
a
Code
chapter
28E
agreement
for
the
22
joint
exercise
of
governmental
powers
to
form
a
regional
23
administrator
entity
to
function
on
behalf
of
the
counties.
24
The
regional
administrator
is
required
to
enter
into
25
performance-based
contracts
with
the
department
to
manage
for
26
the
counties
the
MH/DS
not
funded
by
the
medical
assistance
27
(Medicaid)
program
and
for
coordinating
with
the
department
28
such
services
that
are
funded
by
the
Medicaid
program.
The
29
regional
administrator
is
under
the
control
of
a
governing
30
board.
An
elected
county
supervisor
or
designee
of
each
of
31
the
participating
counties
make
up
the
voting
membership
of
32
the
governing
board.
Any
of
the
voting
members
may
call
33
for
a
weighted
voting
on
certain
decisions.
The
weighted
34
vote
is
based
upon
the
relative
population
of
the
respective
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counties
and
requires
a
three-fourths
majority
for
approval.
1
In
addition,
not
more
than
three
individuals
who
utilize
MH/DS
2
or
actively
involved
relatives
of
such
individuals
and
not
more
3
than
three
service
providers
are
specified
for
ex
officio,
4
nonvoting
slots.
A
regional
advisory
committee
for
each
board
5
is
required
to
include
individuals
who
utilize
services
or
6
actively
involved
relatives,
service
providers,
governing
board
7
members,
and
others.
8
New
Code
section
331.438D
addresses
regional
finances.
9
The
funding
administered
under
the
authority
of
a
governing
10
board
is
required
to
be
in
a
combined
account,
separate
11
county
accounts
that
are
administered
under
the
authority
of
12
the
governing
board,
or
pursuant
to
other
arrangement.
The
13
administrative
costs
of
the
regional
administrator
is
limited
14
to
the
same
percentage
of
expenditures
allowed
for
the
entity
15
under
contract
with
DHS
to
provide
mental
health
managed
16
care
for
the
Medicaid
program.
The
funding
received
from
17
performance-based
contracts
with
the
department
is
required
18
to
be
credited
to
the
account
or
accounts
administered
by
the
19
regional
administrator.
20
New
Code
section
331.438E
requires
the
counties
comprising
21
a
MH/DS
region
to
enter
into
a
Code
chapter
28E
agreement.
22
The
agreement
is
required
to
address
various
specific
23
organizational
provisions,
administrative
provisions,
and
24
financial
provisions.
25
If
the
county
is
part
of
a
region
that
has
agreed
to
pool
26
funding
and
liability
for
services,
the
regional
administrator
27
performs
the
county’s
responsibilities
on
behalf
of
the
county.
28
If
implementation
of
a
region’s
regional
administrator
entity
29
results
in
a
change
in
the
employer
of
the
county
employees
30
assigned
to
the
county
central
point
of
coordination
entity
31
administering
services
under
current
law
and
the
employees
were
32
covered
under
a
collective
bargaining
agreement,
the
employees
33
are
to
be
retained
and
the
agreement
continued.
34
New
Code
section
331.438F
defines
terms
relating
to
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residency,
requires
appeals
of
service
authorizations
and
1
other
services-related
determinations
to
be
heard
in
a
2
contested
case
proceeding
by
an
administrative
law
judge,
and
3
also
provides
for
resolution
of
residency-related
disputes
4
by
an
administrative
law
judge.
The
administrative
law
5
judge’s
decision
is
considered
a
final
agency
action
so
that
6
further
appeals
go
to
the
district
court
rather
than
a
state
7
department.
8
The
provisions
of
this
division
enacting
new
Code
sections
9
in
Code
chapter
331,
except
as
specifically
provided
by
the
10
provisions,
are
applicable
beginning
July
1,
2013.
11
SUBACUTE
CARE
FACILITIES
FOR
PERSONS
WITH
SERIOUS
AND
12
PERSISTENT
MENTAL
ILLNESS.
This
division
creates
a
new
health
13
care
facility
licensure
chapter
numbered
Code
chapter
135P
to
14
be
regulated
by
the
department
of
inspections
and
appeals.
15
The
new
type
of
facility
is
called
a
“subacute
care
facility
16
for
persons
with
serious
and
persistent
mental
illness”
17
and
provides
physical
facilities
with
restricted
egress
to
18
provide
accommodation,
board,
and
the
services
of
a
licensed
19
psychiatrist
for
periods
exceeding
24
consecutive
hours
to
20
three
or
more
individuals
with
serious
and
persistent
mental
21
illness
and
who
may
have
a
diagnosis
of
another
disorder.
The
22
facility
cannot
be
used
by
individuals
related
to
the
owner
23
within
the
third
degree
of
consanguinity.
24
New
Code
sections
135P.1
and
135P.2
define
the
terms
25
utilized
and
state
the
purpose
of
the
new
Code
chapter.
26
New
Code
section
135P.3
describes
the
nature
of
care
27
to
be
utilized
and
the
duties
of
the
facility’s
licensed
28
psychiatrist,
authorizes
the
use
of
a
seclusion
room
that
meets
29
the
conditions
specified
under
federal
regulations
for
the
use
30
of
seclusion
in
psychiatric
residential
treatment
facilities
31
providing
inpatient
psychiatric
services
for
individuals
under
32
age
21,
and
specifies
requirements
for
admission.
Various
33
services
may
be
performed
by
or
delegated
to
a
physician
34
assistant
or
advanced
registered
nurse
practitioner.
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New
Code
section
135P.4
prohibits
establishing,
operating,
1
or
maintaining
a
subacute
care
facility
without
a
license
and
2
allows
a
licensed
intermediate
care
facility
for
persons
with
3
mental
illness
to
convert
to
a
licensed
subacute
care
facility.
4
New
Code
section
135P.5
requires
an
application
for
a
5
license
and
sets
the
annual
licensure
fee
at
$25.
6
New
Code
section
135P.6
requires
the
department
of
7
inspections
and
appeals
to
ascertain
the
adequacy
of
the
8
facility
before
issuing
a
license
and
requires
the
applicant
9
to
have
been
awarded
a
certificate
of
need
for
the
facility
10
through
the
department
of
public
health
under
Code
chapter
135.
11
New
Code
section
135P.7
authorizes
the
department
to
deny
12
an
application
or
suspend
or
revoke
a
license
for
failure
or
13
inability
to
comply
with
requirements
under
the
Code
chapter
14
and
provides
a
list
of
specific
infractions.
15
New
Code
section
135P.8
authorizes
the
department
to
issue
a
16
provisional
license
and
addresses
compliance
plans.
17
New
Code
section
135P.9
requires
the
notice
and
hearing
18
process
for
licensure
issues
to
be
performed
in
compliance
with
19
the
Iowa
administrative
procedure
Act,
Code
chapter
17A.
20
New
Code
section
135P.10
requires
the
department
of
21
inspections
and
appeals
to
adopt
rules
for
the
facilities
in
22
consultation
with
the
department
of
human
services
and
for
the
23
department
to
coordinate
its
rules
adoption
and
enforcement
24
efforts.
25
New
Code
section
135P.11
addresses
complaints
alleging
26
violations.
Any
person
may
file
a
complaint
and
the
person’s
27
name
is
required
to
be
kept
confidential.
The
department
is
28
required
to
make
a
preliminary
review
of
the
complaint
and
29
under
most
circumstances
an
on-site
inspection
is
required
30
within
20
working
days.
The
complainant
may
accompany
the
31
inspector
upon
request
of
the
complainant
or
the
department.
32
New
Code
section
135P.12
requires
the
department’s
33
findings
regarding
licensure
to
be
made
public
but
other
34
information
relating
to
a
facility
is
to
be
kept
confidential.
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Disclosure
of
information
regarding
residents
is
prohibited
1
except
as
provided
in
Code
section
217.30,
relating
to
the
2
confidentiality
of
records
pertaining
to
individuals
receiving
3
services
or
assistance
from
the
department
of
human
services.
4
New
Code
section
135P.13
provides
for
judicial
review
of
5
departmental
action
in
accordance
with
Code
chapter
17A
and
for
6
a
petition
for
the
review
to
be
filed
in
the
court
of
the
county
7
in
which
the
subacute
care
facility
is
located
or
proposed
to
8
be
located.
9
New
Code
section
135P.14
provides
that
establishing,
10
operating,
or
managing
a
subacute
care
facility
without
a
11
license
is
a
serious
misdemeanor
offense.
12
New
Code
section
135P.15
authorizes
the
department
to
13
maintain
an
action
for
an
injunction
to
prevent
establishing,
14
operating,
or
managing
a
subacute
care
facility
without
a
15
license.
16
Code
section
225.15
is
amended
to
allow
state
psychiatric
17
hospital
physicians
to
delegate
the
performance
of
certain
18
services
to
physician
assistants
and
advanced
registered
nurse
19
practitioners.
20
Code
section
249A.26,
relating
to
state
and
county
21
participation
in
funding
for
services
to
persons
with
22
disabilities
in
the
medical
assistance
(Medicaid)
program
23
chapter,
is
amended
to
provide
that
the
daily
reimbursement
24
rate
for
subacute
care
facilities
is
the
sum
of
the
25
direct
care
Medicare-certified
hospital-based
nursing
26
facility
patient-day-weighted
median
and
the
nondirect
27
care
Medicare-certified
hospital-based
nursing
facility
28
patient-day-weighted
median.
29
In
addition,
DHS
is
required
to
conduct
a
feasibility
30
study
and
cost
analysis
of
providing
institutional
subacute
31
services
using
available
facilities
at
the
state
mental
health
32
institutes
or
the
Iowa
veterans
home.
33
The
division
may
include
a
state
mandate
as
defined
in
34
Code
section
25B.3.
The
division
makes
inapplicable
Code
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section
25B.2,
subsection
3,
which
would
relieve
a
political
1
subdivision
from
complying
with
a
state
mandate
if
funding
for
2
the
cost
of
the
state
mandate
is
not
provided
or
specified.
3
Therefore,
political
subdivisions
are
required
to
comply
with
4
any
state
mandate
included
in
the
division.
5
BRAIN
INJURY
DEFINITION
——
CONFORMING
AMENDMENTS
——
LEGAL
6
SETTLEMENT
AND
DISPUTE
RESOLUTION
PROCESSES.
This
division
7
provides
conforming
amendments
to
change
references
to
county
8
of
legal
settlement
to
county
of
residence,
effective
on
July
9
1,
2012,
amends
brain
injury
definitions,
and
strikes
the
10
future
repeal
on
July
1,
2013,
of
the
county
mental
health,
11
mental
retardation,
and
developmental
disabilities
services
12
funds
and
property
tax
levies
under
Code
section
331.424A.
13
Code
definitions
for
the
term
“brain
injury”
are
revised
14
in
Code
sections
135.22
and
225C.23
to
be
similar
to
the
15
definition
used
for
the
Medicaid
home
and
community-based
16
services
waiver
for
brain
injury.
The
Code
section
135.22
17
definition
applies
to
provisions
administered
by
the
department
18
of
public
health,
including
the
central
registry
for
persons
19
with
brain
or
spinal
cord
injuries,
the
advisory
council
on
20
brain
injuries,
the
department’s
responsibilities
as
the
21
state’s
lead
agency
for
brain
injury,
and
resource
facilitation
22
for
persons
with
brain
injury
and
other
services
under
the
23
brain
injury
services
program.
24
The
Code
section
225C.23
definition
applies
to
recognition
25
of
brain
injury
as
a
distinct
disability.
The
Code
chapter
26
includes
a
number
of
references
to
the
term
brain
injury
but
27
this
provision
provides
the
only
definition
of
the
term.
28
Code
chapter
252
provisions
regarding
determinations
of
29
county
of
legal
settlement
(Code
sections
252.23,
and
252.24)
30
are
amended
to
provide
that
in
provisions
involving
the
MH/DS
31
administered
through
the
counties,
the
county
of
residence
is
32
responsible
and
any
disputes
are
to
be
settled
in
accordance
33
with
Code
section
225C.8,
which
is
also
amended
accordingly.
34
References
to
“county
of
legal
settlement”
are
amended
to
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be
“county
of
residence”
or
the
state
in
the
following
Code
1
sections:
section
218.99,
requiring
counties
to
be
notified
2
of
patient
personal
accounts
in
DHS
state
institutions;
3
section
222.10,
relating
to
the
duty
of
a
peace
officer
to
4
detain
a
person
with
mental
retardation
who
departs
from
an
5
institution
in
another
state
without
proper
authority;
section
6
222.13,
relating
to
voluntary
admissions
to
a
state
resource
7
center;
section
222.31,
relating
to
liability
for
charges
at
8
a
state
resource
center;
section
222.49,
relating
to
payment
9
for
costs
of
proceedings;
section
222.50,
requiring
the
10
county
of
legal
settlement
to
pay
charges;
section
222.60,
11
relating
to
the
costs
paid
by
county
and
state
and
requiring
12
a
diagnosis;
section
222.61,
relating
to
determination
of
13
legal
settlement;
section
222.62,
relating
to
legal
settlement
14
in
another
county;
section
222.63,
relating
to
an
objection
15
to
a
finding
of
legal
settlement;
section
222.64,
providing
16
for
state
financial
responsibility
when
a
person
is
in
a
17
foreign
state
or
is
unknown;
section
222.65,
requiring
the
18
state
administrator
to
investigate
a
person’s
residency
when
19
placed
in
a
state
resource
center;
section
222.66,
providing
20
a
standing
appropriation
for
the
transfer
expenses
of
state
21
cases
to
a
state
resource
center;
section
222.67,
relating
to
22
charges
when
legal
settlement
was
initially
unknown;
section
23
222.68,
requiring
the
county
of
legal
settlement
to
reimburse
24
the
county
that
initially
paid
the
charges;
section
222.69,
25
providing
a
standing
appropriation
for
the
admission
or
26
commitment
expenses
of
state
cases;
section
222.70,
requiring
27
a
dispute
resolution
process
to
be
used
for
legal
settlement
28
disputes;
section
222.77,
providing
for
the
county
of
legal
29
settlement
to
pay
the
costs
of
support
of
patients
placed
on
30
leave
from
a
state
resources
center;
section
222.78,
relating
31
to
parents
and
other
persons
liable
for
the
support
of
a
32
patient
in
a
state
resource
center;
section
222.79,
relating
33
to
the
certification
of
statements
of
charges
for
purposes
of
34
Code
section
222.78;
section
222.80,
providing
for
liability
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for
the
costs
of
persons
admitted
or
committed
to
a
private
1
facility;
section
222.82,
relating
to
collection
of
claims
2
under
Code
section
222.78
or
other
provisions
of
Code
chapter
3
222;
section
222.86,
relating
to
payment
of
excess
amounts
from
4
resource
center
patient
personal
deposit
funds
to
the
county
5
of
legal
settlement;
section
222.92,
relating
to
operation
6
of
the
state
resource
center
on
the
basis
of
a
net
general
7
fund
appropriation;
section
225C.16,
relating
to
referrals
of
8
persons
applying
for
voluntary
admission
to
a
state
mental
9
health
institute
for
diagnostic
evaluations;
section
226.9C,
10
relating
to
the
net
general
fund
appropriations
provisions
11
for
the
dual
diagnosis
program
at
the
Mount
Pleasant
state
12
mental
health
institute;
section
226.45,
relating
to
payment
13
of
excess
amounts
from
state
mental
health
institute
patient
14
personal
deposit
funds
to
the
county
of
legal
settlement;
15
section
229.9A,
relating
to
the
mental
health
advocate
of
the
16
county
of
legal
settlement;
section
229.12,
relating
to
the
17
presence
of
the
mental
health
advocate
at
civil
commitment
18
hearings;
section
229.19,
relating
to
the
duties
of
the
patient
19
advocate;
section
229.24,
relating
to
the
provision
of
civil
20
commitment
court
records
to
the
county
of
legal
settlement;
21
section
229.31,
relating
to
a
commission
of
inquiry;
section
22
229.42,
relating
to
hospitalization
costs
paid
on
voluntary
23
cases
by
the
county
of
legal
settlement;
section
229.43,
24
relating
to
nonresidents
on
convalescent
leave;
section
230.1,
25
relating
to
the
liability
of
counties
and
the
state
for
costs
26
associated
with
admission
of
a
person
with
mental
illness
to
27
a
state
hospital;
section
230.2,
relating
to
finding
of
legal
28
settlement
for
persons
with
mental
illness;
section
230.3,
29
providing
for
certification
of
legal
settlement
of
a
person
30
with
mental
illness
admitted
to
a
hospital;
section
230.4,
31
providing
for
evidence
to
accompany
the
certification
of
legal
32
settlement
for
a
person
with
mental
illness;
section
230.5,
33
relating
to
legal
settlement
of
nonresidents;
section
230.8,
34
relating
to
transfer
expenses
of
persons
with
mental
illness
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with
no
legal
settlement;
section
230.9,
relating
to
charges
1
when
legal
settlement
was
initially
unknown;
section
230.10,
2
requiring
all
costs
attending
the
taking
into
custody,
care,
3
investigation,
and
admission
or
commitment
of
a
person
to
a
4
state
hospital
for
persons
with
mental
illness
to
be
paid
by
5
the
county
of
legal
settlement;
section
230.11,
relating
to
6
recovery
of
costs
from
the
state
for
state
cases;
section
7
230.12,
relating
to
settlement
of
legal
settlement
disputes
8
for
support
of
persons
with
mental
illness;
section
230.32,
9
relating
to
support
of
persons
who
are
nonresidents
of
this
10
state;
section
249A.12,
relating
to
assistance
to
persons
with
11
mental
retardation
paid
under
the
Medicaid
program;
section
12
249A.26,
addressing
state
and
county
participation
in
funding
13
for
services
to
persons
with
disabilities,
including
case
14
management;
section
331.502,
relating
to
the
duties
of
the
15
county
auditor;
and
section
347.16,
relating
to
the
cost
of
16
care
provided
in
county
hospitals.
17
Miscellaneous
provisions
are
also
amended.
Code
section
18
225.23,
requiring
counties
to
collect
claims
paid
by
the
19
state
on
behalf
of
committed
or
voluntary
private
patients
20
at
the
state
psychiatric
hospital,
is
amended
to
shift
this
21
responsibility
to
the
department
of
administrative
services.
22
Code
section
225C.8,
relating
to
legal
settlement
dispute
23
resolution,
is
amended
to
instead
refer
to
residency
dispute
24
resolution.
This
provision
is
repealed
on
July
1,
2013,
25
when
it
is
replaced
by
the
bill’s
new
Code
section
331.438F.
26
The
county
of
residence
definition
in
Code
section
331.440,
27
relating
to
the
county
MH/MR/DD
central
point
of
coordination
28
process
and
state
case
services,
is
amended
to
match
the
29
corresponding
definition
in
new
Code
section
331.439F.
Under
30
the
terms
of
current
law,
Code
section
331.440
is
repealed
on
31
July
1,
2013.
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